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<p>The Canadian prevalence for all food allergies is estimated to be 7.5%. The only management strategy for an allergic individual is a strict avoidance diet, which is heavily reliant on the effectiveness of food labels used on commercial food products. This thesis explores the effects of food allergen labels on the well-being of affected Canadians, using a social constructionist framework and a mixed methods approach.</p> <p>The quantitative portion of this study drew upon primary survey data. Respondents were asked to self-report household allergic status, as well as purchasing behavior and attitudes towards precautionary statements (n=1380). Results from the quantitative analysis were used to inform and develop the qualitative interview schedule for the second phase of this thesis. Qualitative interviews in a grocery store setting were conducted with 12 anaphylactic individuals, or parents of anaphylactic children.Respondents were observed during the course of product selection and questioned about their shopping habits, perceptions of and preferences for allergen labels.</p> <p>Results indicate that current Canadian allergen labels are not as effective as expected, since affected consumers reported not heeding precautionary statements. Allergic families were found to be less diligent than indirectly affected families, and also less likely to find precautionary statements helpful. Through qualitative interviews, it was found that prior experience, not allergen information, is the primary factor guiding purchasing decisions. Even though precautionary statements were found to be easy to understand, terminology, font sizes, and contrast issues on labels were reported to be key areas of improvement. Results from the two phases reflect differences in individuals‟ social constructions of risk, which ultimately shape purchasing and consumption behaviors. This research is the first to explore the effects of allergen labels on affected Canadians, using a social constructionist approach. Ultimately, results will help effective policy change in Canada and help affected consumers make safe consumption choices.</p> <p>This research contributes to the number of health studies that utilized a mixed methods approach, which is an emerging paradigm. The use of mixed methods allowed for extension and refinement of results. Future research directions identified in this research include the need for pharmaceutical labeling in Canada, as well as the need to explore purchasing behaviors of indirectly affected families, as they also utilize allergen labels to guide consumption choices when shopping for allergy-controlled environments.</p> / Master of Arts (MA)

<p>Previous research indicates that vocal and facial masculinity and femininity influence perceptions of attractiveness. Men generally perceive women with feminine traits as more attractive than less feminine women. This may be because women who possess more feminine traits are likely to be healthier and more fertile mates than are less feminine women. Masculine male traits also influence women’s perceptions of attractiveness. Although women do not always prefer masculine male traits, preferences for masculinity are observed under circumstances where women may gain the fitness benefits of heritable health and dominance. Masculine traits in men and feminine traits in women are further associated with the potential fitness risks of infidelity and reduced investment in mates. Here I address three previously unanswered questions concerning the influence of masculinity and femininity on social perceptions. First, how do male vocal and facial masculinity influence perceptions of attractiveness when these two traits are presented simultaneously? Second, does vocal masculinity influence perceptions of the potential fitness risks of infidelity and reduced relationship investment in mates? Third, do male masculinity and female femininity influence perceptions of potential same-sex rivals? In this dissertation I demonstrate that simultaneously presented male vocal and facial masculinity influence women’s perceptions of men’s attractiveness, that perceivers are somewhat aware of the potential fitness risks associated with preferring high quality mates, and that vocal and facial masculinity influence mate choice and intrasexual competition in similar ways. Overall, these studies demonstrate the pervasive influence of masculinity and femininity on mate-choice relevant social perceptions.</p> / Doctor of Philosophy (PhD)

The purpose of this research was to investigate factors affecting choral music preferences of adolescents. The rationale for this research comes from the importance of teaching culturally diverse music in 21st-century music classrooms and the possibility that curricular content and ethnic identity may affect preferences for this music. Six research questions guided the study: (1) How are middle school students' preferences for choral arrangements of folk music grouped? (2) Is there a significant main effect of type of curriculum content instruction on middle school choral students' choral music preference scores? (3) Is there a significant main effect of time on middle school choral students' choral music preference scores? (4) Is there a significant type of curriculum content by time interaction? (5) Descriptively, within each ethnic group, does strength of identity relate differently to growth in scores in different interventions? (6) How do middle school students describe their reasons for their preference? One hundred and thirty-two sixth, seventh, and eighth grade chorus members (11 to 15 years old) participated in the study. Subjects were randomly assigned to one of three intervention groups receiving different curricular content: music concept-based, sociocultural-based, or discussion-based. At the outset of the study, all subjects took a measure of ethnic identity. Two weeks later, all subjects took a preference pretest of eight music excerpts from choral arrangements of folk songs originating from the following cultures: African, American, Asian, and Latin American/Caribbean. One week after their pretest session, subjects took a posttest while simultaneously receiving one of three interventions based on one of three approaches to curricular content. Two factors emerged from principal axis factor analysis of pretest scores. The first factor (simple texture subscale) included arrangements of folk songs with simple unison or predominantly homophonic vocal textures. The second factor (complex texture subscale) included arrangements of folk songs with complex polyphonic vocal textures. A split-plot ANOVA analysis revealed no statistically significant main effects of intervention or time, and no statistically significant interaction of intervention and time for the simple texture subscale. A second split-plot ANOVA revealed no statistically significant main effects, but a statistically significant interaction of intervention and time for the complex texture subscale. A regression analysis revealed that adding ethnic identity scores to preference pretest scores did not help predict to a significantly better extent posttest scores for any of the three intervention groups. Subjects' open-ended responses were placed into one of four categories: musical, sociocultural/linguistic, affect, or perception of performance. Subjects in the sociocultural-based group wrote more sociocultural/linguistic comments than subjects in the other two groups, and subjects in the discussion-based group wrote more affect comments than subjects in the other two groups. Subjects in all three groups seemed to lack the musical vocabulary to describe why they liked or disliked the selections. Comments about perception of performance most often referred to subjects' perceptions that singing songs with complex textures or songs in a foreign language would be too difficult for their chorus. Numerous factors interact to affect music preferences. By continuing to study their students' music preferences, general music teachers and choral directors can gain further insights into how to best approach culturally unfamiliar music. Using a combination of music concept-based, sociocultural-based, and discussion-based curricular content may be an answer to ways to foster positive preferences for culturally unfamiliar choral music. Focusing on curricular content is important; however, general music teachers and choral directors may find success by initially introducing students to culturally unfamiliar choral music with simple vocal textures before songs with complex vocal textures. / Music Education

Background and objectives: Incorporating patient values and preferences as an essential input for decision-making has its potential merits in respecting the autonomy of patients, improving adherence and clinical outcomes. The Grading of Recommendations Assessment, Development and Evaluation (short GRADE) working group conceptualizes patient values and preferences as “the relative importance patient place on the main outcomes”. The objectives of this thesis include: 1) to provide an overview of a process for systematically incorporating values and preferences in guideline development; 2) to conduct a systematic review on outcome importance studies, using chronic obstructive pulmonary disease (COPD) as an example; 3) to provide guidance on how to assess certainty of evidence describing outcome importance using the GRADE criteria. Methods: We performed systematic reviews, asked clinical experts to provide feedback according to their clinical experience, and consulted patient representatives to obtain information about relative importance of outcomes in a new national guideline program. We conducted a systematic review to summarize the COPD related relative importance of outcome studies. We used a multi-pronged approach to develop the guidance for assessing certainty of evidence about relative importance of outcome and values and preferences. We applied the developed GRADE approach to relative importance of outcome systematic review examples and consulted the stakeholders in the GRADE working group for feedback. Results and conclusion: We provided an empirical strategy to find and incorporate values and preferences in guidelines by performing systematic reviews and eliciting information from guideline panel members and patient representatives. However, we identified the need for researches on how to assess the certainty of this evidence, and best summarize and present the findings. In our comprehensive systematic review project on COPD patient values and preferences we demonstrated the utility of rating evidence in systematic reviews of outcome importance. We describe the rationale for considering GRADE domains for the evidence about the importance of outcomes. We propose the assessment of the body of evidence starts at “high certainty”, and rate down for serious problems in GRADE domains including risk of bias, indirectness, inconsistency, imprecision and publication bias. Specific to risk of bias domain, we propose a preliminary consideration for risk of bias. The sources of indirectness for relative importance of outcome evidence include indirectness from PICO (population, intervention, comparison, and outcome) elements, and methodological indirectness. As meta-analyses are uncommon when summarizing the evidence about relative importance of outcome, inconsistency and imprecision assessments are challenging. Inconsistency arises from PICO and methodological elements that should be explored. The width of the confidence interval and sample size should inform judgments about imprecision. We also provide suggestions on how to detect publication bias based on empirical information. Finally, we also discuss the applicability of domains to rate up the certainty. We develop the GRADE approach for rating risk of bias, indirectness, inconsistency, imprecision and other domains when evaluating a body of evidence describing the relative importance of outcomes. Our examples should guide users and provide a basis for discussion and further development of the GRADE system. / Thesis / Doctor of Philosophy (PhD)

Background and Objectives: Understanding patient and public values and preferences is essential to healthcare and policy decision making. Discrete choice experiments (DCEs) are a common tool used to capture and quantify these preferences. Recent technological advances allow for a variety of approaches to create and analyze DCEs. However, there is no optimal DCE design, nor analysis method. Our objectives were to (i) survey DCE simulation studies to determine what design features affect statistical efficiency, and assess their reporting, (ii) further investigate these findings with a de novo simulation study, and (iii) explore the sensitivity of individuals’ preference of attributes to several methods of analysis. Methods: We conducted a systematic survey of simulation studies within the health literature, created a DCE simulation study of 3204 designs, and performed two empirical comparison studies. In one empirical comparison study, we determined addiction agency employees’ preferences on knowledge translation attributes using four models, and in the second, we determined elementary school children’s choice of bullying prevention programs using nine models. Results and Conclusions: In our evaluation of DCE designs, we identified six design features that impact the statistical efficiency of a DCE, several of which were further investigated in our simulation study. The reporting quality of these studies requires improvement to ensure that appropriate inferences can be made, and that they are reproducible. In our empirical comparison of statistical models to explore the sensitivity of individuals preferences of attributes, we found similar rankings in the relative importance measures of attributes’ mean part-worth utility estimates, which differed when using latent class models. Understanding the impact of design features on statistical efficiency are useful for designing optimal DCEs. Incorporating heterogeneity in the analysis of DCEs may be important to make appropriate inferences about individuals’ preferences of attributes within a population. / Thesis / Doctor of Philosophy (PhD) / This thesis focuses on the design and analysis of preference surveys, which are referred to as discrete choice experiments. These surveys are used to capture and quantify individuals’ preferences on various characteristics describing a product or service. They are applied in various health settings to better understand a population. For example, clinicians may want to further understand a patient population’s preferences in regards to multiple treatment alternatives. Currently, there is no optimal approach for designing or analyzing preference surveys. We investigated what factors help improve the design of a preference survey by exploring the literature and conducting our own simulation study. We also investigated how sensitive the results of a preference survey were based on the statistical model used. Overall, we found that (i) increasing the amount of information presented and reducing the number of variables to explore will maximize the statistical optimality of the survey; and (ii) analyzing the data with different statistical models will yield similar results in the ranking of individuals’ preferences of the variables explored.