The goal of this research was to consolidate and expand on current knowledge about the use of objective and subjective measures to assess the health of Canadians. Specifically, this dissertation examined the relationship between self-report and direct measures of health to determine the extent of discrepancies between the two methods. This was accomplished through a series of five research papers, including three systematic reviews that examined the relationship between self-reported and directly measured estimates of height, weight and Body Mass Index (BMI), hypertension and smoking. An in-depth examination of the discrepancies in reported obesity followed. It included two additional papers, one examining the feasibility of establishing correction factors to increase the accuracy of reported estimates of obesity and a second examining the trends in the reporting bias over time and between two different population groups (Canada and the U.S.). Results clearly documented a bias in self-reported estimates of height, weight, BMI, hypertension and smoking; reported estimates of height were consistently overestimated while reported weight, BMI, hypertension and smoking were consistently underestimated in both men and women. Statistical adjustment of reported values generated estimates of height, weight and obesity that were more accurate than those generated by self-report alone. Historical analysis with Canadian and American datasets indicated that the bias in reported obesity is increasing, implying that the generalizability of the correction equations may be limited and that in Canada, monitoring trends in obesity based solely on self-reported height and weight may produce inaccurate estimates because of the diverging discrepancy between self-reported and measured data. This work has made an important contribution to understanding the bias in current surveillance practices that are grounded in the collection of self-reported data and presents a series of recommendations to improve population health surveillance in Canada.

To study how context influences health and well-being it is first necessary to measure the boundary of a person's geographical context. Rigorous description of context is difficult and existing studies have offered weak and mixed evidence about the importance of context to health. Either the characteristics of places have been inadequately conceptualized, or the spatial definition of place relies on inflexible administrative boundaries and a limited set of corresponding attribute data. Furthermore, the influence of context on health presumably depends a great deal on the amount of time spent in each space, and the potential for misclassifying context is greater for individuals whose routine activities are spatially diffuse. However, errors in spatial classification are usually not specified in studies linking context to health. This dissertation combines theories from geomatics and population health to argue that the time geography of human activities has an important role in delineating and describing contexts relevant to health. Specifically, the contextual impact on health status reflects not only the person's immediate neighbourhood, but also locations where other activities of daily life occur. The theoretical contribution of the thesis is to conceptualize context as a healthscape---a spatial notion that captures an array of contexts defined by individuals as they navigate through the spatial patterns of daily life. The empirical goal of the dissertation is to compare these healthscapes to contexts delineated by census tract geographies typically used in health and place research. Individual healthscapes are defined by developing a wearable global positioning system and data logger that records an individual's location and velocity at one-second intervals over a seven-day period. Data from 53 people are linked to responses from a health questionnaire. Several approaches drawn from ecology and spatial statistics are used to quantify the properties of each person's spatial activity patterns, or healthscape. These objectively measured contexts are compared statistically to the traditionally used census boundaries to examine differences in morphology, compositional and contextual characteristics. The results are broadly consistent with the theoretical justification proposed for healthscapes, and signal the need for place and health research to better represent the geography of human activities.

Power, how it is defined, embodied and expressed by individuals is central to how those individuals will behave in and perceive their relationships. This dissertation is based on a study focusing on the issues of power and positive sexual health outcomes within adolescent heterosexual relationships from a Population Health perspective that attends to selected social determinants of health. Specifically, this dissertation examines how power is conceptualized, understood and measured in the context of adolescent heterosexual relationships and how power influences the outcomes of these relationships. An explicit concentration is placed on positive outcomes while maintaining a consideration of negative outcomes as key factors in the achievement of sexual health for adolescents. Both qualitative interviews and a quantitative cross-sectional survey were used to explore these issues with a convenience sample of self-defined heterosexual youth between the ages of 14 and 20 who primarily self-identified as Caucasian. Results show that power is overwhelming conceptualized as negative, with some adolescents denying that they have or exercise power. The embodiment of power is perceived to be gendered. 'Powerful girls' are critiqued in a way that 'powerful guys' are not. Young men and women described expressing power in their relationships in generally positive fashions. A minority of young men described expressing power in dominant ways while a minority of young women described using their sexuality as a means of expressing power. The quantitative measurement of relationship power as measured by a modified version of the Sexual Relationship Power scale (Pulerwitz, Gortmaker, & Delong, 2000) revealed lower scores for young men as compared to young women. Regression analyses revealed that for both males and females and experience of physical or verbal violence from a partner in the past year was negatively associated with scores on the SRPS and communication within the most recent relationship was positively associated with scores on the SRPS. High rates of positive sexual health outcomes such as, sexual self-efficacy, satisfaction, sexual assertiveness and communication were seen. Findings, as well as limitations of this study, point to the need for more research on issues of power, equity, gender and positive sexual health outcomes.

This doctoral thesis presents an exploratory case study of Kids in Shape (KIS), a community-institution initiative (CII) in which the author operated as an intermediary change agent responsible for facilitating community mobilization around the initiative. This study sought to examine the processes and dynamics underlying the mobilization of intersectoral local organizations involved in the project, as well as the role the first author played from her posture. A single case analysis was constructed based on qualitative methods and analysis of the community mobilization process and intermediary change agent's practice over a 29-month period (December 2005-April 2008). The data derived from five sources: (1) intermediary change agent participant observation and descriptive notes, (2) intermediary change agent reflective notes, (3) local partners' monthly meeting recording transcripts and notes, (4) debriefing notes from KIS research team meetings, and (5) written and electronic material. The analysis involved a two-stage process: (1) inductive, thematic coding and analysis of the raw data (Patton, 1990); and (2) theoretical, conceptual coding and interpretation of emerging themes (Braun & Clarke, 2006; Paquette, 2007) based on four concepts derived from resource dependence theory (i.e., resource interdependence, autonomy, ownership, and control over the use and contribution of resources). The results showed that the intermediary change agent's work was characterized by a set of tensions occurring along three continuums: process-product, insider-outsider, and bottom-up/top-down. Inherent to these tensions were organizational autonomy and ownership (i.e., control) over various types of processes/capacities and resources, notably between KIS's research team and local partners. This case analysis also revealed key managerial strategies (i.e., activating, synthesizing, framing, mobilizing) which strengthened relationships of interdependence between local organizations, and barriers which hindered the development of collective capacities. Finally, local organizations were found to move through different stages as they learned to work together and achieve collective goals. Results from this case study enabled the conceptualization of a theoretical construct of interdependence dynamics operating among organizations involved in KIS, and strategies used by the intermediary change agent to manage these dynamics throughout the community mobilization process. The results suggest that the notions of organizational resources (i.e., financial, in-kind, political), capacities, autonomy, and ownership need to be considered in an integrated model in order to understand the complex dynamics and relationships operating among organizations involved in CII.

Low-income Franco-Ontarian women have a higher prevalence of smoking than the general population. Smoking cessation programmes specifically designed for low-income women and in the French language are not offered in the Champlain region of Eastern Ontario. In order to redress inequities in delivery of French language services, a culturally sensitive smoking cessation programme for low income Franco-Ontarian women was designed. The following three studies were conducted: 1) a systematic review of the effects of smoking cessation interventions for low-income women; 2) an exploration study on the meaning of smoking to disadvantaged Franco-Ontarian women and their programme needs; 3) a narrative synthesis that informed the development of a logic model for a culturally sensitive smoking cessation programme for the population of interest. The first study, the systematic review, no evidence was found to support that smoking cessation interventions were effective in a population of low-income pregnant women. In addition, there was limited evidence that smoking cessation interventions were effective in low-income non-pregnant women. Overall, this systematic review was inconclusive: there were few studies included in this review, and several studies had limitations. This review has important implications for future research, suggesting that further attention should be given to the design of smoking cessation interventions by including outcome measures of cessation at 6-month and 12-month as well as biochemical validation of self-reported cessation. In addition, interventions should be tailored to meet the specific needs of low-income women and target the underlying causes of smoking. The second study provided new and important contextual information surrounding a population of low-income and Franco-Ontarian female smokers that are living in the community of Vanier. The third study involved a narrative synthesis which integrated several forms of knowledge and informed the development of a logic model. The logic model explains the pathways for a culturally sensitive smoking cessation program for low-income Franco-Ontarian women. The main levers of the intervention are to improve coping strategies/mechanisms, improve self-esteem while providing social support within a working group. Potential programme components were recommended: a gender-centered, holistic and culturally competent approach; the inclusion of empowerment, skill building and self-care; as well as community involvement.

No description available.

The problem. The AIDS Case Reporting Surveillance System (ACRSS) is a passive surveillance system that was initiated in 1982. It is used to follow the health impact of HIV in the population at large and to determine HIV prevalence through back-calculation. An assessment of the proportion of all AIDS cases reported out of all AIDS cases diagnosed (i.e., reporting completeness) was required as part of the evaluation of this surveillance system. Methods. A number of secondary data sources were considered; the use of death certificate data from the Canadian Mortality Data Base (CMDB) was chosen by a process of elimination. Reporting completeness to the AIDS Case Reporting Surveillance System is about 85% which compares well with that seen in other countries. Reporting completeness is lower for females than males. Reporting completeness varies by province with Quebec, P.E.I., and New Brunswick having the lowest rates of reporting. Alberta and Ontario have the highest rates of reporting. Reporting is less complete in those that die in smaller communities. Reporting completeness decreased slightly during the 1980s. The most important finding is the trend to increased underreporting with time. Future validations of reporting completeness will become more difficult in Quebec due to the lack of initials on their dataset. The causes of incomplete reporting will only be elucidated with qualitative investigation. (Abstract shortened by UMI.)

This present investigation is a prospective study of 123 cardiac patients who attended a community-based program of education and support, following hospital admission for acute cardiovascular disease. The objective of the study was to derive a predictive model that would maximally discriminate between participants who were vs. participants who were not successful in modifying a health-risk behaviour. The four behaviours examined were following a low-fat diet, performing regular exercise, weight reduction and smoking cessation. Readiness for change was assessed prior to the commencement of the eight-week program, at post-treatment and at five-month follow-up. Participants were grouped into two outcome groups based on their stage of change as delineated by the Transtheoretical Model. Subjects who were in the action or maintenance stages of change at seven-month follow-up were classified as Progressors, and those who were in pre-action stages were classified as Non-progressors. The variables included in the predictive model were optimism, psychological distress, social intimacy and self-efficacy. Neuroticism was also included to explore its relationship with optimism. Discriminant function analysis showed that the variables that maximally separated individuals who were successful in risk-factor modification from those who were unsuccessful were social intimacy and self-efficacy. A secondary objective of this study was to compare Progressing subjects with Non-progressing subjects on psychological distress and on two Transtheoretical Model measures, decisional balance and the processes of change. Repeated measures analysis of variance indicated a slight reduction over time in scores on the measure of psychological distress for all participants as a group. However, no differences were found in psychological distress between participants who changed their health-risk behaviour and those who did not. Because more subjects than anticipated were successful in changing their target health-risk behaviour, there were insufficient data to further compare successful changers with unsuccessful changers. Thus the data did not provide for a robust test of how individuals progress through the Transtheoretical model stages of change following a coronary event. Overall this thesis emphasizes the importance of the social context of behaviour change as evidenced by the contribution of the measure of social intimacy. In addition, this thesis offers some information on the relationship between personality constructs (e.g., neuroticism) and behaviour change, although this requires further investigation.

Le diagnostic d'hyperactivite (ou TDAH) releve de la sphere medicale, mais son application concrete est souvent amorcee et developee par des enseignants et/ou des professionnels scolaires. La prescription de medicaments, dont le plus connu est sans doute le Ritalin, pose plusieurs problemes supplementaires. Les effets a court terme peuvent s'averer plutot serieux et les effets a long terme ne sont pas entierement clairs. D'autre part, la medicalisation du probleme peut nous amener a croire qu'il s'agit d'un probleme ou d'un desordre dont souffre cet individu. Il est pertinent de tenter de comprendre les variables institutionnelles qui peuvent entrer en jeu, notamment l'importance que revet l'ordre dans le cadre scolaire. L'appui theorique qui sous-tend cette approche pour etudier la categorisation d'hyperactif est ti'e de deux theories principales: la theorie de la construction sociale de la realite et la theorie de l'etiquetage. Dans un premier temps, nous examinons la construction des categories en general, notamment les categories de deviance. Cela nous permet d'extrapoler sur la construction de la categorie d'hyperactivite. Dans un deuxieme temps, nous etudions le processus d'etiquetage tel que decrit par Schur (1971) en tentant d'appliquer ce processus au processus d'etiquetage d'un enfant comme etant hyperactif. (Abstract shortened by UMI.)

The purpose of this study was to examine whether impaired smooth pursuit tracking, which has consistently been found in studies of adult schizophrenics, also characterizes adolescents with this disorder. Volumetric brain imaging (MRI) of specific regions thought to be implicated in disordered tracking (i.e., the frontal eye fields and cerebellar vermis), Wisconsin Card Sorting performance (i.e., WCST; a test considered to index frontal lobe functioning), and a measure of the integrity of visual-vestibular interaction were also assessed to examine the possibility of co-occurrence of deficits across patients in order to provide a better understanding of the correlates of impaired smooth pursuit tracking in this disorder. Subjects included 12 adolescents with schizophrenia (6 males, 6 females; mean age = 17.7 years) who were compared to 12 gender- and age-matched normal controls (mean age = 17.1 years). A surprising absence of group differences was found on standard, computer-quantified measures of smooth pursuit tracking (i.e., root mean-square error, gain, and saccades). However, post-hoc analyses using a visual (non-automated) rating scale revealed that the lack of group differences resulted from both controls and patients displaying high rates of impaired tracking. Although analyses of brain volumetrics revealed no overall group differences, two patient sub-groups were identified based on impairments on the WCST and the visual-vestibular index, providing indirect evidence of frontal and cerebellar involvement in these sub-groups, respectively. These results question the usefulness of smooth pursuit tracking impairment in discriminating individuals with schizophrenia from normals at this young age, and are interpreted as providing indirect support for the neurodevelopmental hypothesis of schizophrenia. The need for further studies of smooth pursuit tracking in this population, using a multiparameter approach, is highlighted.