The objectives of this thesis were to examine the relationship between the built environment and obesity-related behaviours in Canadian youth, and to address measurement issues relevant for studying these relationships. The thesis is comprised of four manuscripts. The first manuscript determined the accuracy of the food retailer locations surrounding 34 schools in Ontario as provided by two geographic information system (GIS) databases. The GIS locations of 25% of the food retailers were located within 15 m of their actual location, 50% were within 25 m, and 75% were within 50 m. These values did not differ by GIS database source. The second manuscript examined the association between the presence of food retailers surrounding schools and students’ lunchtime eating behaviours. It also determined whether a circular or road network buffer provided a better geographic boundary of the food retail environment surrounding schools. It was carried out in 6,971 9th and 10th grades students from 158 schools. The presence of food retailers near schools was strongly associated with students regularly eating their lunch at a snack-bar, fast-food restaurant or café. The road network buffers provided the better measure of the food retail environment. The third manuscript determined the optimal buffer size of the food retail environment surrounding schools. Six road network buffers were created around 158 schools. These ranged in size from 500 m to 5000 m. Results indicated that the 1000 m buffer was the optimal size. The fourth manuscript explored associations between urban sprawl and active transportation, moderate to vigorous physical activity (MVPA) and overweight/obesity in 7,017 youth aged 12 to 19 who resided in one of Canada's 33 Census Metropolitan Areas. Increasing levels of sprawl were modestly associated with increased active transportation (only among 12 to 15 year olds) and MVPA. No associations were found for overweight/obesity. Taken together, the results from this thesis provide a better understanding of the role of the built environment on obesity-related behaviours in Canadian youth. Important measurement issues in this topic area were also addressed. / Thesis (Ph.D, Community Health & Epidemiology) -- Queen's University, 2012-01-30 19:36:47.354

Drug abuse as well as risky sexual behaviours has been identified, globally as well as in South Africa, as social problems with dire consequences. Research suggests that crystal methamphetamine use leads to risky sexual behaviours such having unprotected sex, which can lead to unplanned pregnancies, and sexually transmitted infections (STI's) including HIV infection. Adolescents as well as females have been identified as risk populations for both sexual risk behaviours and drug abuse. Furthermore, the Western Cape showed high rates of crystal methamphetamine addiction, especially in the under 20 age category, and the highest increase in the incidence of HIV infections in South Africa. This may be indicative of the magnitude of the problem of risky sexual behaviours in the context of crystal methamphetamine use in the Western Cape.

The main aim of this thesis was to study children’s mental health with focus on family arrangements. The thesis was based on four studies (I-IV). Study number I, III and IV were quantitative studies with cross sectional design, using the Swedish version of Health behaviour in School- aged children (HBSC), including children aged 11, 13 and 15 years. The data was analysed with multiple linear regression analysis (I) and multivariate logistic regression analysis (III, IV). Study II was of qualitative descriptive design, based on 28 interviews with parents living in shared physical custody with their children. The qualitative study was analysed with inductive latent content analysis. Study I showed that lower levels of SHC and higher levels of SWB were associated with higher degrees of social capital in the family, school and neighbourhood. Social capital in family, school and neighbourhood had a cumulative influence on children’s SHC and SWB. In study II the participating parents described their own as well as the perceptions of their children and former partners. Parents’ perceptions changed from the beginning of shared physical custody, through the current situation, ending with perception of the future. The fifteen year old boys and girls (III) living in shared physical custody were more at risk of being a smoker or having been drunk compared with children living in two parent families. The results of sex <15 years and conduct problems showed that the risks didn’t differ significantly between these two groups. Study IV showed that children living in shared physical custody with their parents were more likely than children in two parent families to report multiple SHC, and low SWB. The variable of communication did not moderate the SHC and SWB of the children in any of these two groups. This thesis contribute with new and deeper understanding of the relatively new phenomenon: shared physical custody, and its associations to children’s mental health. The parent’s perceptions were an important complement to the children’s self reported health. In order to influence the decreasing mental health among children and adolescents, their opinions contributes to further understanding. Narratives from children, parents and practitioners are required in order to further study the association between children’s health outcomes and different family arrangements. Additional studies are needed to clarify how children’s mental health and different family arrangements are related to school, community economy, and society. / Avhandlingens huvudsyfte var att studera barns mentala hälsa med fokus på familjekonstellationer. Fyra olika studier ligger till grund för avhandlingen (I-IV). Studie I, II och IV var kvantitativa studier med tvärsnittsdesign. Datamaterialet utgjordes av den svenska versionen av Health Behaviour in School- aged Children (HBSC) (Svenska skolbarns hälsovanor). De deltagande barnen var i åldrarna 11, 13 och 15 år. Datamaterialet analyserades med hjälp av multipel linjär regressions analys (I) samt multivariat logistisk regressionsanalys (III, IV). Studie II var av kvalitativ karaktär och baserades på 28 intervjuer med föräldrar som bodde växelvis boende med sina barn. Den kvalitativa studien analyserades med hjälp av induktiv latent innehållsanalys. Studie I visade att lägre nivåer av SHC (subjektiva hälsobesvär) och högre nivåer av SWB (subjektivt välbefinnande) hade ett samband med högre nivåer av socialt kapital i familjen, skolan och närområdet. Socialt kapital i familjen, skolan och närområdet hade en kumulativ effekt på barnens självrapporterade SHC och SWB. I studie två beskrev de deltagande föräldrarna sina egna upplevelser, samt upplevelser relaterat till barnen samt och den före detta partnern. Föräldrarnas upplevelser förändrades från den första tiden av växelvis boende till nuvarande situation och avslutades med tankar om framtiden. De växelvis boende femtonåriga pojkarna och flickorna i studie III rapporterade ökad risk för att vara såväl rökare som att ha varit berusade jämfört med 15- åringarna i traditionella familjer. Resultaten avseende sex <15 år samt beteendeproblem visade inga signifikanta skillnader mellan dessa två grupper. Studie IV visade att barn som bodde i växelvis boende rapporterade fler subjektiva hälsobesvär och lägre välbefinnande jämfört med barn i traditionella familjer. Kommunikationsvariabeln hade ingen modererande effekt på någon av dessa båda grupper. Föreliggande avhandling bidrar med såväl ny som fördjupad kunskap för det relativt nya fenomenet, växelvis boende, och dess relation till barns mentala hälsa. Föräldrarnas upplevelse var ett viktigt bidrag till barnens självrapporterade hälsa. För att kunna påverka barn och ungas rapporter om allt sämre mental hälsa, är deras åsikter ett viktigt inslag för ökade kunskaper inom området. Vi behöver barns, föräldrars och yrkesverksammas åsikter för att vidare kunna studera relationen mellan barns hälsoutfall och olika familjekonstellationer. Vi behöver också veta mer om olika familjekonstellationers relation till skolan, närområdet samt det övriga samhället.

Interventional technologies such as elective percutaneous coronary interventions (PCI)are increasingly used to manage the symptoms of coronary artery disease (CAD); however, this treatment approach is associated with poor risk factor management. The purpose of this study was to understand the factors that influence the health behaviors of elective PCI patients. A qualitative approach, using Interpretive Description, was used to explore the ten participants’ healthcare experiences, their perceptions of CAD, and the rationale for their health choices. This generated a profile of these individuals and their post-PCI health behaviours. Health behaviours were influenced by multiple factors and are reflected in the themes: what a relief – I’m better; uncertainty about their future health; the importance of relations; and barriers to lifestyle change. These findings not only extend our understanding of the elective PCI patients’ health behaviour choices but also provides insight into key areas to target for improving health service delivery.

In recent years, physical activity and fitness transitions, described as declines in physical activity and aerobic fitness, coupled with increased sedentary behaviour, have been observed among school-aged children. Consequently, the prevalence of childhood overweight/obesity has also increased considerably. While there is a wealth of evidence supporting such behavioural transitions in higher income countries, there exists a paucity of data on the situation in lower income countries, such as those in Sub-Saharan Africa (SSA). The premise of this thesis was to investigate the robustness of these relationships in other global regions. The first objective was to investigate the evidence for an overweight/obesity, physical activity, and fitness transition among SSA’s school-aged children. Systematic review methodology was used to examine temporal trends and correlates of overweight/obesity, physical activity, fitness, and sedentary behaviour in apparently healthy or population based samples of children (5 - 17 years). The second objective of this thesis was to determine the prevalence and correlates of overweight/obesity and physical activity among Kenyan children aged 9 to 11 years, having contextualised Kenya within the broader situation in SSA. Further, the relationships between self-reported and directly assessed measures of physical activity and sedentary time by weight status in Kenyan children were investigated. The third objective was to examine moderate-to-vigorous physical activity (MVPA) patterns accrued by time of day among Kenyan children using the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE)-Kenya data. Activity patterns in the Kenyan setting were then compared to similar ISCOLE-Canada data from Canadian children, revealing differences and similarities in the accumulation of MVPA, light physical activity, and sedentary time. Systematic review data syntheses revealed a trend towards increasing proportions of overweight/obesity among Sub-Saharan Africa’s school-aged children. Further, urbanization and higher socioeconomic status (SES) were associated with decreased physical activity and aerobic fitness, and increased sedentary behaviours and body composition measures. ISCOLE-Kenya data analyses found a prevalence of childhood overweight/obesity of 20.8% in Nairobi, with few children meeting global physical activity guidelines (12.6%). Mean daily sedentary time was 398 minutes, time spent in light physical activity was 463 minutes, and time spent in MVPA was 36 minutes. Higher SES and parental education attainment were associated with a higher likelihood of children being overweight/obese and a lower likelihood of children meeting the physical activity recommendations. Data analyses also revealed considerable discrepancies in both self-report and direct measures of physical activity by weight status, and weak to moderate correlations between self-report and direct measures of physical activity. Under/healthy weight children had significantly higher directly measured mean daily minutes of MVPA compared to overweight/obese children (39 verses 20 minutes); had lower mean weekend-day minutes of sedentary time (346 verses 365 minutes); and had a higher proportion who met physical activity guidelines (15.5% versus 2.6%). Lastly, while MVPA patterns among urban Kenyan children were largely similar to those of urban Canadian children with regard to relationships by sex, BMI category, and weekday/weekend days; in the Kenyan sample, much unlike many higher income countries, lower SES was associated with higher MVPA.

Interventional technologies such as elective percutaneous coronary interventions (PCI)are increasingly used to manage the symptoms of coronary artery disease (CAD); however, this treatment approach is associated with poor risk factor management. The purpose of this study was to understand the factors that influence the health behaviors of elective PCI patients. A qualitative approach, using Interpretive Description, was used to explore the ten participants’ healthcare experiences, their perceptions of CAD, and the rationale for their health choices. This generated a profile of these individuals and their post-PCI health behaviours. Health behaviours were influenced by multiple factors and are reflected in the themes: what a relief – I’m better; uncertainty about their future health; the importance of relations; and barriers to lifestyle change. These findings not only extend our understanding of the elective PCI patients’ health behaviour choices but also provides insight into key areas to target for improving health service delivery.

Bakgrund: Ohälsosamma levnadsvanor är ett folkhälsoproblem och står för en femtedel av den totala sjukdomsbördan i Sverige. Var annan kvinna och var tredje man i åldrarna 16-84 år rapporterar att de inte har några ohälsosamma levnadsvanor. (Socialstyrelsen, 2011; Folkhälsomyndigheten, 2014). De flesta distriktssköterskor och sjuksköterskor i den svenska primärvården tycker att det är viktigt att arbeta med patienternas levnadsvanor, de tycker även att arbetet behöver utvecklas (Kardakis, Weinehall, Jerdén, Nyström & Johansson, 2013). Syfte: Att undersöka i vilken utsträckning distriktssköterskor och sjuksköterskor arbetar med rådgivning om levnadsvanor till patienter i primärvården. Syftet är också att undersöka hur de skulle vilja arbeta, vilken kunskap de tycker sig ha och om de anser att de behöver ytterligare kunskap om rådgivning kring levnadsvanor. Metod: En totalundersökning gjordes där samtliga distriktssköterskor och sjuksköterskor verksamma inom primärvårdens vårdcentraler i föreliggande landsting inkluderades i studien. Data samlades in med hjälp av en webbenkät. Resultat: Resultatet visade att de flesta respondenterna ansåg att arbetet med levnadsvanor var mycket eller ganska viktigt och att de flesta arbetade med rådgivning om levnadsvanor i ganska stor utsträckning. Det fanns inga signifikanta skillnader mellan specialistutbildade och grundutbildande sjuksköterskor. Slutsats: Distriktssköterskor och sjuksköterskor i primärvården i föreliggande landsting anser att arbetet med rådgivning om levnadsvanor är mycket viktigt. De arbetar också mycket med detta och anser sig ha kunskaper inom området, men de vill ändå arbeta mer med rådgivning om levnadsvanor och utveckla sin kompetens.  Det är tydligt att distriktssköterskor och sjuksköterskor i primärvården är en underutnyttjad resurs i arbetet med levnadsvanor. / Background: Unhealthy lifestyle behaviour is a public health problem, accounting for a fifth of the total burden of disease in Sweden. Every second woman and every third man aged 16-84 years report that they do not have any unhealthy lifestyle behaviours. (Socialstyrelsen, 2011; Folkhälsomyndigheten, 2014). Most district nurses and registered nurses in Swedish primary health care think it is important to work with lifestyle behaviours, they also think there is need for improvement (Kardakis, Weinehall, Jerdén, Nystrom & Johansson, 2013). Aim: To examine the extent to which district nurses and nurses are working with counseling patients on lifestyle behaviours in primary health care. The aim is also to examine how they would like to work, what knowledge they think they have and if they feel they need additional knowledge of counseling on lifestyle behaviours. Method: A comprehensive survey was made in which all district nurses and registered nurses working in primary health care centers in the present county were included in the study. Data were collected using an online survey. Results: The results showed that most respondents felt that the work with lifestyle behaviours was very or quite important. Most of the respondents were working quite widely with counseling on lifestyle behaviours. There were no significant differences between nurses with specialist education and registered nurses. Conclusion: District nurses and registered nurses in primary health care in this county believe that counseling on lifestyle behavior is very important. They also work a lot with this and claim to have knowledge about lifestyle behaviours. Still they want to work more with counseling on lifestyle behaviours and develop their skills. It is clear that district nurses and registered nurses in primary health care is an underutilized resource in the work with lifestyle behaviours.

College students and emerging adults have been found to be at risk for smoking cigarettes, drinking to excess, using illicit drugs, driving dangerously, and engaging in risky sexual and delinquent behaviour. Psychosocial correlates (Sensation Seeking, peer behaviour, parent behaviour, and peer and parent anti-substance use messages) from three domains of influence (personality, parent, and peer) were examined together to provide a greater context for the occurrence of such health-risk behaviours. The strongest predictor(s) of each behaviour were identified to better inform intervention practices. Three groups were compared— 1) those who never tried substances, 2) those who tried substances in the past, and 3) those who continue to use substances at present, in a population of emerging adults. Self-report data was gathered from 203 Collèges d'Enseignement Général Et Professionnel (CEGEP) students in the Montreal region. Measures included: Reckless Behaviour Questionnaire, Reckless Driving Measure, Health Behaviour Survey, Sensation Seeking Scale—Form V, and the Marlowe-Crowne Social Desirability Scale. Results revealed that peer behaviour was the most significant predictor of substance use in emerging adults, whereas parent behaviour was only a significant predictor of reckless driving. Sensation Seeking, specifically Disinhibition, was found to predict more global reckless behaviours, including illegal activities, such as stealing or using marijuana (p < .01). Neither peer nor parent anti-substance messages were significantly related to any of the health-risk behaviours measured in this study. It would appear that health-risk behaviours tend to be related to the same underlying factors but to varying degrees. Intervention implications are discussed.

The hazards literature has identified many factors as being influential in the decision making process during high risk, short-notice disasters. Risk perception and previous disaster experience are commonly identified as two of the more influential factors in this complex process. However, few studies adequately address the complex role(s) that these factors play in self-protective decision-making during successive high-risk events. In particular, the role of previous disaster experience during subsequent events is still a matter of considerable discussion and inconsistent findings. This thesis examines two events that occurred in August, 2011 in Goderich, Ontario: an F-3 tornado that struck the community on August 21st and a tornado warning that was posted for the region three days later on August 24th. This case study provided the opportunity to examine the roles of risk perception and previous disaster experience in the decision-making process during successive high-risk events. Semi-structured interviews (n=35) and close-ended questionnaires (n=268) were conducted to learn about the ways that individuals obtained and understood risk information, and to explore whether and how such information guided protective behaviors during the two events. The interviews were analyzed using thematic coding to identify response patterns, and the questionnaires were analyzed using IBM SPSS software. It was found that a sizable portion of the sample population took protective actions on August 24th in ways that were inconsistent with their actions on August 21st. Also, a significant portion of respondents chose not to take any form of protective action on August 24th despite having previously experienced the damaging tornado. The findings of this research suggest that the significance of previous disaster experience in the decision-making process is highly variable and context-dependent. A second significant research finding involves the impact of the tornado on the place attachments of Goderich residents. It was found that the disaster had significant impacts, both positive and negative, on participants' sense of place. These findings have implications for both short- and long-term disaster recovery.

There is some evidence about the efficacy of preferred music on agitation in elders with dementia; however, little is known about its effectiveness on agitation when implemented by nursing staff in long-term care facilities. Even less is known about use of preferred music for managing anxiety in those with dementia. This quasi-experimental study aimed to evaluate the implementation of a preferred music intervention delivered by nursing staff on agitation and anxiety of institutionalised elders with dementia. The sample comprised of 57 elders with dementia residing in two building complexes which provided similar care routines and staffing in a large Taiwanese residential care facility. These two building complexes were randomly assigned as the experimental and control group. Nursing staff in the experimental group received a facilitation program to prepare them for implementing the preferred music intervention; whereas nursing staff in the control group received no facilitation program. The music intervention based on each resident's music preferences was then provided by the trained nursing staff for 32 experimental residents twice a week for six weeks. Meanwhile, 25 residents in the control group only received the usual standard care without music. All residents were assessed by Cohen-Mansfield Agitation Inventory (CMAI) for overall and three subtypes of agitated behaviours and by Rating of Anxiety in Dementia for anxiety at baseline and week 6. Additionally, the modified CMAI measured the 30-minute occurrence of agitation at baseline, session 4, and session 12. The results indicate that institutionalised elders with dementia who received six weeks of preferred music intervention implemented by trained nursing staff had significant reductions on overall, three subtypes of agitated behaviours, anxiety, and 30-minute occurrence of agitation over time compared to those who received the usual standard care without music. Preferred music shows promise as a strategy for reducing agitation and anxiety in those with dementia when implemented by trained nursing staff. Such intervention can be incorporated into routine activities to improve the quality of care provided by nursing staff and the quality of life of those with dementia in long-term care settings. Our study results provide clinically relevant evidence which contribute to closing the gap between research and practice.