<p>A decade ago the World Health Organization declared obesity to be a ‘global epidemic’. Rapidly climbing rates of excess body weight resulted in Health Canada declaring obesity as one of three major health concerns facing children today. Accordingly, there is a growing body of research examining how 'obesogenic environments' contribute to increasing prevalence. To date, multiple studies have found rates of childhood and adolescent obesity especially high in low-socioeconomic status (SES) neighbourhoods but knowledge about the specific local-level factors that shape body weight is lacking. Thus, this research focuses on examining local environmental determinants of body weight in adolescent populations living in low-socioeconomic status neighbourhoods in two cities in Southern Ontario.</p> <p>Using a mixed-method, parallel case study design, this study examines the environments in two low-SES neighbourhoods in the cities of Hamilton and Mississauga, Ontario. This study utilizes the ANGELO Framework as an analytic tool to dissect local environments. In the first phase of the study, the political and socio-cultural environments in both cities are investigated through analysis of municipal policy documents, public health websites and key informant interviews. The findings reveal that the cities each held differing health priorities and values that reflected the way they approached obesity. This phase further highlighted the integrated nature of the political and socio-cultural environments and their role in shaping other environments.</p> <p>The second phase of the study involved qualitative data collection from adolescents living in low-SES neighbourhoods (based on 11 SES neighbourhood measures). Specifically, a community mapping exercise and in-depth interviews with 31 participants were conducted in order to better understand how participants define and use neighbourhood space. The results indicate that there are differences between how urban and suburban residents defined neighbourhoods and that personal factors such as age, mobility and migration status influenced knowledge of the neighbourhood. Additionally, findings suggest that social interaction is a primary factor that influences adolescents use of neighbourhood space.</p> <p>In the third and final phase of the study, adolescent perceptions of the determinants of body weight were collected using in-depth and go-along interviews. Results of the 31 interviews revealed that adolescents perceive obese bodies as the unhealthy product of individual-level behaviours. Further exploration of environmental determinants revealed that factors in the physical and economic environments were indeed important and were often influenced by the socio-cultural environment. Participants held the view that neighbourhood space was tempting and unhealthy, and required them to self-regulate their behaviour. This research makes significant theoretical, methodological and substantive contributions to the obesity, adolescent health, and neighbourhoods and health literatures. Policy implications and future research directions are also highlighted.</p> / Doctor of Philosophy (PhD)

Access to primary health care is an important determinant of health. Within current research there has been limited examination of neighbourhood level variations in access to care, despite knowledge that local contexts shape health. The objective of this research is to examine neighbourhood-level access to primary health care in the city of Mississauga, Ontario. Street address locations of primary care physicians were obtained from the College of Physicians and Surgeons of Ontario (CPSO) website and analyzed using geographic information systems (GIS). A 'Three Step Floating Catchment Area' (3SFCA) method was derived and used to measure multiple dimensions of access for the population as a whole, for specific linguistic groups and for recent immigrants. This research identifies significant neighbourhood-level variations in access to care for each dimension of access and population subgroup studied. The research findings contribute to a more nuanced understanding of neighbourhood-level variability in access to health care.

Access to primary health care is an important determinant of health. Within current research there has been limited examination of neighbourhood level variations in access to care, despite knowledge that local contexts shape health. The objective of this research is to examine neighbourhood-level access to primary health care in the city of Mississauga, Ontario. Street address locations of primary care physicians were obtained from the College of Physicians and Surgeons of Ontario (CPSO) website and analyzed using geographic information systems (GIS). A 'Three Step Floating Catchment Area' (3SFCA) method was derived and used to measure multiple dimensions of access for the population as a whole, for specific linguistic groups and for recent immigrants. This research identifies significant neighbourhood-level variations in access to care for each dimension of access and population subgroup studied. The research findings contribute to a more nuanced understanding of neighbourhood-level variability in access to health care.