O objeto deste trabalho é o movimento estudantil contemporâneo. O objetivo foi caracterizar os estudantes que participam do movimento estudantil contemporâneo, identificar os principais temas discutidos pelo movimento na atualidade, caracterizar as práticas e formas de organização do movimento estudantil e analisar as concepções de saúde tomadas pelo movimento. Trata-se de pesquisa descritiva em que a exposição do objeto se deu, tanto pela via qualitativa, como pela via quantitativa. A coleta dos dados quantitativos ocorreu durante o conselho nacional de entidades de base (CONEB) da União Nacional dos Estudantes (UNE) entre os dias 13 e 16 de abril de 2006; os dados qualitativos foram colhidos entre os meses de abril e novembro de 2006 em Campinas e São Paulo (SP). A população foi constituída de estudantes universitários que participam de centros acadêmicos e outras entidades estudantis. Foram distribuídos aos participantes do CONEB questionários com perguntas fechadas combinando: informações acerca do estudante; questões acerca das condições sociais de suas famílias; questões acerca da participação política e social dos estudantes. Num segundo momento, foram entrevistados apenas estudantes da área da saúde e da UNE. Esse foi o momento em que, através de questões abertas, os estudantes se manifestaram acerca dos temas, do sentido e do impacto do ME, sua relação com os partidos políticos, limites e possibilidades no encaminhamento das organizações estudantis, bem como informações sobre a concepção de saúde e prática relativa às questões de saúde. Foram entrevistados dois representantes da UNE e um representante de cada executiva da saúde: biomedicina, educação física, enfermagem, farmácia, fisioterapia, fonoaudiologia, medicina, nutrição, odontologia, psicologia, serviço social, terapia ocupacional e veterinária (1 de cada curso), totalizando 15 entrevistas. Valeu-se da técnica de entrevista semi-estruturada. Resultados: os estudantes que fazem parte do movimento estudantil são em sua maioria homens, jovens brancos, solteiros, naturais do eixo sul-sudeste; quando consideradas a situação de trabalho dos pais, renda familiar, posse de moradia familiar, fontes de renda e gastos pessoais, prevalecem condições de existência relativamente estáveis. Os estudantes consideram o movimento estudantil um espaço de organização da juventude para lutar pela transformação social, espaço de formação política em que são discutidos diversos temas, sendo prevalentes os temas da educação e universidade, é um espaço também de disputa política com inserção importante dos partidos políticos. Os estudantes avaliam que o movimento está fragmentado entre executivas de curso e União Nacional dos Estudantes, apesar da sobreposição de atividades desenvolvidas pelas entidades. A concepção de saúde mais enfatizada entre as lideranças estudantis foi a multicausal, representada notadamente por fatores relacionados à esfera do consumo. Sobressaem também concepções que se aproximam do pensamento hegemônico “pós-moderno" centradas no indivíduo, na subjetividade e de caráter idealista. Poucos estudantes consideraram nas suas formulações, de maneira organizada, a categoria da reprodução social na determinação do processo saúde-doença. Pode-se concluir que na área da saúde os estudantes tendem a reproduzir os conceitos da saúde pública, fundamentados na concepção funcionalista da saúde-doença que propõe como intervenção a responsabilização do indivíduo pela sua saúde / The subject of this paper is the student movement. The goal was defining the students who take part of the student movement, identifying themes currently discussed by them, defining the practices and organizational ways of the student movement and analyzing the perception of health they have. It’s a describing research in which the exposure of the subject was done by both qualitative and quantitative ways. The collecting of quantitative data was done during the National Concil of Student Societies (CONEB) organized by National Union of Students (UNE) from April, 13th to April 16th, 2006; qualitative data were collected from April to November 2006 in Campinas and São Paulo (SP). Population was formed by university students who take part of a student society and other student organizations. Firstly, questionnaires were given to the participants of CONEB with open questions matching: information about the student; questions about the social conditions of their families; questions about their social and political initiatives. Secondly, natural science students and students from UNE were interviewed. At this moment, through open questions, students made themselves known about the themes, about the goal and impact of student movement, their involvement with political parties, limits and possibilities in student organizations, also, information about their perception of health and practices related to health issues. Two representatives of UNE and one representative of each regional society of natural science students were interviewed: biomedicine, physical education, nursing, pharmaceutics, physiotherapy, phonoaudiology, medicine, nutrition, dentistry, psychology, social work, occupational therapy and veterinarian medicine (1 of each field), totalizing 15 interviews. The technique of semi-structured interviews was used. Results: students who take part of student movement are most men, young Caucasians, single, from the Southeast; when parents’ jobs are taken into consideration, family income, owning a family dwelling, sources of income and personal expenses, relatively stable living conditions prevail. Students consider student movement an opportunity for youth organization fight against social changes, an opportunity for political constitution by the discussion of several themes, prevailing educational and university ones, it’s also a space of political dispute and the inserting of parties. Students believe that student movement is fragmented among regional societies of each science and National Student Union, despite the overlaying of activities developed by societies. The most mentioned perception of health was the multi-causal, clearly represented by factors related to consumption. Also, perceptions centered in the individual, related to “post modern" hegemony overlay, in subjectivity and idealistically. Few students take into consideration, in an organized way, the category of social reproduction while determining health-sickness process. We can conclude that in natural science field, students tend to believe public health concepts, based on functional conception of health-sickness that suggests the responsibility of each of us for our health as an intervention

U.S. military service members who are discharged from service for misconduct are at high risk for mental health and substance use disorders, homelessness, mortality, and incarceration. The purpose of this dissertation was to investigate the pre- and post-discharge experiences and characteristics of this highly vulnerable population in order to inform improved prevention and intervention strategies. Administrative data from the Department of Defense and Veterans Health Administration for veterans of recent conflicts were used to conduct 3 related retrospective cohort studies. These included (1) an evaluation of the demographic and military service characteristics and service-connected disabilities associated with discharge for misconduct; (2) an examination of post-discharge health status and healthcare utilization among misconduct-discharged veterans; and (3) the development of predictive models for homelessness and mortality among misconduct-discharged veterans. Several demographic and military service characteristics were associated with increased risk for misconduct discharge, as were exposure to sexual trauma, and post-discharge designation of service-connected disabilities related to mental illness. Misconduct-discharged veterans were found to have significant and complex healthcare needs, and used clinical services at approximately double the rate of routinely discharged veterans. Several risk factors for homelessness and mortality among this population were identified. Risk stratification models showed good predictive accuracy for homelessness, and fair predictive accuracy for mortality. Targeted counter-attrition strategies and an increased focus on health-related determinants of misconduct, including rehabilitative approaches to behavioral problems, may help to reduce misconduct-related attrition. Efforts to transition post-discharge care from specialty settings to integrated primary care settings may be successful in mitigating adverse outcomes. Risk stratification techniques can facilitate the efficient targeting of resources.

<p>In this dissertation, I study medicalization, a wide spread phenomenon in this world but understudied in the current literature. The main theoretical focus of this dissertation is on expanding the medicalization theories. Questioning the breadth of conceptualization, the feasibility of measurement, and the depth of empirical implications in the extant medicalization theories, this dissertation proposes a new conceptual model of medicalization and further develops a quantitative measure of medicalization by disaggregating it into empirically valid dimensions that could be used to examine how degree of medicalization is related to social outcomes. Specifically, I conceptualize medicalization as an institutionalization process whereby the medical model becomes increasingly dominant in the explanation of health, illness, and other human problems and behavior. Medicalization is multidimensional and is represented by expansions in the three major components of the health care system: increasing medical investment, medical professionalization/specialization, and the relative size of the pharmaceutical industry. </p><p>Based on this new conceptual model and measurement, I probe three research questions: (1) how medicalization may impact population health in the context of recent epidemiologic transitions and how this impact may differ by the stages of epidemiologic transition and socioeconomic development; (2) what are the mechanisms that reproduce medicalization; and (3) how the lay public may respond to medicalization, the institution of medicine, and the medical profession.</p><p>This dissertation links several lines of theoretical and empirical research from medical sociology, demography, epidemiology, health economics and management, and medical science, and extensively employs OECD Health Data, World Development Indicators, the World Values Survey, the European Values Study data, the U.S. General Social Survey, and the U.S. National Health Interview Survey. It uses several advanced statistical methods, e.g., multiple imputations, latent variable analysis, mixed models, generalized estimating equations models, generalized method of moments models, difference-in-difference models, and hierarchical-age-period-cohort models.</p><p>Results for the first research question suggest that various dimensions of medicalization vary in importance on population health and these effects also differ by the stages of epidemiologic transition and socioeconomic development. I discuss the mechanisms linking various dimensions of medicalization to population health and then discuss these findings in the context of epidemiologic transition, fundamental causes of disease and death, and global health movement. </p><p>Results for the second research question suggest that medicalization at both the societal and individual levels negatively affect individual subjective health, which leads to increasing health care utilization. These social processes function together to promote and reproduce medicalization at societal level. I discuss several pathways linking medicalization to lower subjective health and other agents of medicalization.</p><p>Results for the third research question suggest that American's "confidence in the medical institution and profession" has continuously declined in the last three decades and groups with higher socioeconomic status report lower obedience to doctors' authority, but are more likely to trust doctors' ethics than their counterparts. I discuss the mechanisms for the changes in public confidence in the medical institution and profession, the status of medicine and the medical profession in the era of medicalization, the paradox of opposite trends in attitudes toward medicine and health utilization behavior, and group differences in obedience and trust.</p> / Dissertation

Background: Obesity and physical inactivity rates have reached epidemic levels in Canada, but differ based on whether they are self-reported or directly measured. Canadian research examining the combined and independent effects of social and built environments on adult physical activity (PA) and body mass index (BMI) is limited. Furthermore there is a lack of Canadian studies to assess these relationships using directly measured PA and BMI. Objectives: The objectives of this thesis were to systematically compare self-reported and directly measured PA and to examine associations between neighbourhood built and social environmental factors with both self-reported and directly measured PA and overweight/obesity in adults living in Ottawa, Canada. Methods: A systematic review was conducted to identify observational and experimental studies of adult populations that used both self-report and direct measures of PA and to assess the agreement between the measures. Associations between objectively measured neighbourhood-level built recreation and social environmental factors and self-reported individual-level data including total and leisure-time PA (LTPA) and overweight/obesity were examined in the adult population of Ottawa, Canada using multilevel models. Neighbourhood differences in directly measured BMI and PA (using accelerometry) were evaluated in a convenience sample of adults from four City of Ottawa neighbourhoods with contrasting socioeconomic (SES) and built recreation (REC) environments. Results: Results from the review generally indicate a poor level of agreement between self-report and direct measures of PA, with trends differing based on the measures of PA, the level of PA examined and the sex of the participants. Results of the multilevel analyses identified that very few of the built and social environmental variables were ii significantly associated with PA or overweight/obesity. Greater park area was significantly associated with total PA in females. Greater green space was shown to be associated with lower odds of male LTPA. Factors from the social environment were generally more strongly related to male outcomes. Further to the recreation and social environment, factors in the food landscape were significantly associated with male and female PA and overweight/obesity. Results of the directly measured PA and BMI investigation showed significant neighbourhood-group effects for light intensity PA and sedentary time. Post-hoc tests identified that the low REC/high SES neighbourhood had significantly more minutes of light PA than the low REC/low SES. BMI differed between the four neighbourhoods, but the differences were not significant after controlling for age, sex and household income. Conclusions: Results of this dissertation show that the quantity of PA can differ based on its method of measurement (i.e. between self-report and direct methods) with implications for the interpretation of study findings. It also identifies that PA and BMI can differ by neighbourhood and recognizes that the relationships between neighbourhood environments and PA and body composition are complex, may be differ between males and females, and may not always follow intuitive relationships. Furthermore it suggests that other factors in the environment not examined in this dissertation may influence adult PA and BMI and that longitudinal and intervention studies are needed.

Background: Obesity and physical inactivity rates have reached epidemic levels in Canada, but differ based on whether they are self-reported or directly measured. Canadian research examining the combined and independent effects of social and built environments on adult physical activity (PA) and body mass index (BMI) is limited. Furthermore there is a lack of Canadian studies to assess these relationships using directly measured PA and BMI. Objectives: The objectives of this thesis were to systematically compare self-reported and directly measured PA and to examine associations between neighbourhood built and social environmental factors with both self-reported and directly measured PA and overweight/obesity in adults living in Ottawa, Canada. Methods: A systematic review was conducted to identify observational and experimental studies of adult populations that used both self-report and direct measures of PA and to assess the agreement between the measures. Associations between objectively measured neighbourhood-level built recreation and social environmental factors and self-reported individual-level data including total and leisure-time PA (LTPA) and overweight/obesity were examined in the adult population of Ottawa, Canada using multilevel models. Neighbourhood differences in directly measured BMI and PA (using accelerometry) were evaluated in a convenience sample of adults from four City of Ottawa neighbourhoods with contrasting socioeconomic (SES) and built recreation (REC) environments. Results: Results from the review generally indicate a poor level of agreement between self-report and direct measures of PA, with trends differing based on the measures of PA, the level of PA examined and the sex of the participants. Results of the multilevel analyses identified that very few of the built and social environmental variables were ii significantly associated with PA or overweight/obesity. Greater park area was significantly associated with total PA in females. Greater green space was shown to be associated with lower odds of male LTPA. Factors from the social environment were generally more strongly related to male outcomes. Further to the recreation and social environment, factors in the food landscape were significantly associated with male and female PA and overweight/obesity. Results of the directly measured PA and BMI investigation showed significant neighbourhood-group effects for light intensity PA and sedentary time. Post-hoc tests identified that the low REC/high SES neighbourhood had significantly more minutes of light PA than the low REC/low SES. BMI differed between the four neighbourhoods, but the differences were not significant after controlling for age, sex and household income. Conclusions: Results of this dissertation show that the quantity of PA can differ based on its method of measurement (i.e. between self-report and direct methods) with implications for the interpretation of study findings. It also identifies that PA and BMI can differ by neighbourhood and recognizes that the relationships between neighbourhood environments and PA and body composition are complex, may be differ between males and females, and may not always follow intuitive relationships. Furthermore it suggests that other factors in the environment not examined in this dissertation may influence adult PA and BMI and that longitudinal and intervention studies are needed.

Health authority administrators were interviewed for their perspectives on what makes a good health care system; on tailored population-specific services as a way to address health inequities; and on how they perceive themselves to be making good funding decisions on the public’s behalf. The qualitative descriptive research dataset includes 24 hour-and-a-half long interviews with administrators from four BC health authorities, health region documents, memos, and field notes. Participants support the continuation of a public health care system and all participants acknowledge using tailored services as a route towards reducing health inequities. However, these identified services have not been evaluated for their overall effectiveness. When it comes to decision-making, participants describe using a series of governance and bioethical principles that help them frame what and how issues can be considered. Decision situations are framed in a way that informs them whether they need to use formal or informal processes. In both cases participants collect information that allows others to understand that they have made wise decisions. The Recognition-Primed Decision Model accurately reflects the intuitive processes that participants describe using during informal decision-making and portions of formal decision-making. However, in relation to formal decision situations, there is less alignment with existing Decision-Analysis literature. Seven practice and future research recommendations are provided: 1. Increase health authority participation in intersectoral partnerships that address non-medical determinants of health. 2. Develop new strategies for addressing health inequities. 3. Evaluate the efficacy of using tailored services beyond their ability to remove barriers to access. In addition, increase focus on testing new strategies for reducing the inequities gap. 4. Enhance existing decision-making processes by including the explicit review of decision tradeoffs, value weighting, and mechanisms for requesting revisions. 5. Focus future research on developing and evaluating the usefulness of formal decision-making tools in health authority structures and their relation to decision latitude. 6. Launch a longitudinal research study that examines how health authority expert decision-makers use judgmental heuristics and how they avoid the negative effects of bias. 7. Commission public dialogue on shifting the current illness-based system to one that is wellness based.

Rising obesity rates and low physical activity levels among children and youth are a global concern due to links to adverse health outcomes, poor quality of life, and an increased burden on the health care system. One response to the problem has been the implementation of school-based physical activity and nutrition policies. For example, the Ontario Ministry of Education’s Daily Physical Activity (DPA) Policy mandates that all elementary school students receive at least 20 minutes of physical activity per day. This exploratory research sought to understand the local-level factors shaping implementation of DPA, from the perspective of elementary school teachers and principals. Qualitative in-depth interviews were conducted with Ontario grade 1-8 teachers (n=14) and elementary school principals (n=5) regarding DPA implementation, facilitators, barriers, perceived outcomes, and suggestions for change. Interviews were audio recorded (with permission) and transcribed verbatim for subsequent thematic analysis using NVivo. Although all but two participants indicated they had implemented DPA, the majority reported that students were not meeting the requirement daily. Findings were organized using the Analysis Grid for Environments Linked to Obesity (ANGELO) framework. Implementation facilitators were focused within the microenvironment (i.e., classrooms and schools), while barriers were identified within both the micro- and macroenvironments (i.e., classrooms, schools, school boards, and the Ministry of Education). Both teachers and principals considered DPA a lower priority than other subjects, partly because of limited monitoring of implementation within schools and school boards. Participants discussed student benefits resulting from DPA; however, student fitness was not identified as a positive outcome- in fact, some questioned whether the policy is improving student physical activity levels. The results suggest the status of DPA results from a failure of implementation rather than a failure of concept. Participants believed increasing student physical activity levels was important; however, they argued that factors within the classroom, school, school board, and Ministry of Education limit the feasibility of delivering DPA. This thesis contributes to the limited literature regarding the evaluation of DPA implementation and outcomes by exploring the perspectives of teachers and principals implementing the policy. Substantive, methodological, and theoretical contributions to the school-based physical activity literature are discussed, followed by policy implications and directions for future research.

Background and Rationale: There is a well-documented practice gap in the rates at which evidence-based smoking cessation treatments are delivered to patients in primary care settings. Multi-component intervention that combine practice, provider, and patient-level supports have been shown to increase the rates at which primary care providers deliver smoking cessation treatments to patients and increase rates of smoking abstinence amongst patients. The incremental value of adjunct telephone-based smoking cessation counselling when delivered as part of a multi-component intervention has not been examined. Aim: The primary objective of this study was to determine whether adjunct telephone-based smoking cessation follow-up counselling (FC), when delivered as part of a multi-component intervention program within primary care clinics is associated with increases in (a) the delivery of evidence-based smoking cessation treatments, (b) patient quit attempts, and (c) patient smoking abstinence when compared to the provision of practice and provider supports (PS) alone. The secondary objective of this study was to determine whether the introduction of a multi-component smoking cessation program is associated with increased delivery of evidence-based smoking cessation treatments by primary care providers and patient smoking outcomes, compared to pre-intervention rates. The study also sought to examine the association between patient, provider, clinic and implementation factors, and study outcomes. Methods: A two-group, pre-post cluster randomized controlled trial was conducted. Eligible clinics were randomly assigned to the PS group or FC group. Both groups were supported with implementing a multi-component intervention program that involved outreach facilitation visits, provider training, real time provider prompts and patient tools, and performance feedback. Clinics assigned to the FC group were also able to refer patients who smoke to a telephone-based follow-up support program for supplemental counselling support. An exit survey was completed with a cross-sectional sample of patients who smoked daily at each study clinic before and after the introduction of the intervention program, and all patients were contacted 4 months later to complete a brief telephone-based interview. Outcome measures included the rate at which evidence-based smoking cessation treatments (5As: ask, advise, assess, assist, arrange) were delivered to patients, the number of patients who made a quit attempt, and patient smoking abstinence at the 4-month follow-up. All data was analyzed using multi-level hierarchical modelling. Results: Seven family medicine clinics and 115 providers were enrolled in the study. A total of 12,585 patients were screened, and 835 eligible patients (mean age 45.8 SD± 14.6, 41% male) who smoke participated in the study. Contrary to the study hypothesis, a higher and statistically significant 7-day point prevalence abstinence (OR 6.8, 95% CI 2.1-21.7; p=<0.01) and continuous abstinence (OR 13.7, 95% CI 2.1-128.3; p=<0.05) rate was observed in the PS group compared to the FC group at the post-assessment after controlling for differences in smoking cessation rates between intervention groups during the baseline period. The introduction of the multi-component intervention program was associated with higher rates of provider 5As delivery and patient quit attempts compared to baseline, with no differences between groups documented. The odds ratios (OR) and 95% confidence intervals (CI) for 5As delivery between the pre- and post-intervention assessments for both intervention groups combined were: “ask” (OR 1.5; 95% CI 1.1, 2.0); “advise” (OR 2.0; 95% CI 1.5, 2.7); “assess” (OR 2.1; 95% CI 1.6, 2.9); “assist” with cessation (OR 2.30; 95% CI 1.70, 3.12); “arrange” (OR 1.9; 95% CI 1.2, 3.0); and “patient quit attempts” (OR 1.4; 95% CI 1.04, 1.94). Differences in 7-day point prevalence abstinence were not statistically significant between the pre- and post-intervention assessments (OR 1.5; 95% CI 0.94, 2.5). The study documented intra-provider variability in the rates at which evidence-based smoking cessation treatments are delivered to patients. Patient characteristics (readiness to quit, time to first cigarette, previous quit attempt in the last year), and the purpose of the clinic visit being for an annual health exam were associated with higher rates of 5As delivery. Conclusion: This is the first study to evaluate a multi-component smoking cessation intervention within the primary health care setting in Canada. The study findings demonstrate that the introduction of a multi-component intervention program in primary care settings was associated with significant improvements in the rates at which providers deliver evidence-based smoking cessation treatments, and increase patient quit attempts. The added value of adjunct telephone counselling was not evident at the 4-month follow-up. The conclusions that can be drawn from the present study are limited by the study design and sample size. A larger trial is required to conclusively determine the impact of the program on long-term smoking abstinence and examine the importance of clinic-level variables in explaining observed differences between study clinics.

Health authority administrators were interviewed for their perspectives on what makes a good health care system; on tailored population-specific services as a way to address health inequities; and on how they perceive themselves to be making good funding decisions on the public’s behalf. The qualitative descriptive research dataset includes 24 hour-and-a-half long interviews with administrators from four BC health authorities, health region documents, memos, and field notes. Participants support the continuation of a public health care system and all participants acknowledge using tailored services as a route towards reducing health inequities. However, these identified services have not been evaluated for their overall effectiveness. When it comes to decision-making, participants describe using a series of governance and bioethical principles that help them frame what and how issues can be considered. Decision situations are framed in a way that informs them whether they need to use formal or informal processes. In both cases participants collect information that allows others to understand that they have made wise decisions. The Recognition-Primed Decision Model accurately reflects the intuitive processes that participants describe using during informal decision-making and portions of formal decision-making. However, in relation to formal decision situations, there is less alignment with existing Decision-Analysis literature. Seven practice and future research recommendations are provided: 1. Increase health authority participation in intersectoral partnerships that address non-medical determinants of health. 2. Develop new strategies for addressing health inequities. 3. Evaluate the efficacy of using tailored services beyond their ability to remove barriers to access. In addition, increase focus on testing new strategies for reducing the inequities gap. 4. Enhance existing decision-making processes by including the explicit review of decision tradeoffs, value weighting, and mechanisms for requesting revisions. 5. Focus future research on developing and evaluating the usefulness of formal decision-making tools in health authority structures and their relation to decision latitude. 6. Launch a longitudinal research study that examines how health authority expert decision-makers use judgmental heuristics and how they avoid the negative effects of bias. 7. Commission public dialogue on shifting the current illness-based system to one that is wellness based.

Rising obesity rates and low physical activity levels among children and youth are a global concern due to links to adverse health outcomes, poor quality of life, and an increased burden on the health care system. One response to the problem has been the implementation of school-based physical activity and nutrition policies. For example, the Ontario Ministry of Education’s Daily Physical Activity (DPA) Policy mandates that all elementary school students receive at least 20 minutes of physical activity per day. This exploratory research sought to understand the local-level factors shaping implementation of DPA, from the perspective of elementary school teachers and principals. Qualitative in-depth interviews were conducted with Ontario grade 1-8 teachers (n=14) and elementary school principals (n=5) regarding DPA implementation, facilitators, barriers, perceived outcomes, and suggestions for change. Interviews were audio recorded (with permission) and transcribed verbatim for subsequent thematic analysis using NVivo. Although all but two participants indicated they had implemented DPA, the majority reported that students were not meeting the requirement daily. Findings were organized using the Analysis Grid for Environments Linked to Obesity (ANGELO) framework. Implementation facilitators were focused within the microenvironment (i.e., classrooms and schools), while barriers were identified within both the micro- and macroenvironments (i.e., classrooms, schools, school boards, and the Ministry of Education). Both teachers and principals considered DPA a lower priority than other subjects, partly because of limited monitoring of implementation within schools and school boards. Participants discussed student benefits resulting from DPA; however, student fitness was not identified as a positive outcome- in fact, some questioned whether the policy is improving student physical activity levels. The results suggest the status of DPA results from a failure of implementation rather than a failure of concept. Participants believed increasing student physical activity levels was important; however, they argued that factors within the classroom, school, school board, and Ministry of Education limit the feasibility of delivering DPA. This thesis contributes to the limited literature regarding the evaluation of DPA implementation and outcomes by exploring the perspectives of teachers and principals implementing the policy. Substantive, methodological, and theoretical contributions to the school-based physical activity literature are discussed, followed by policy implications and directions for future research.