<p>This dissertation encompasses three essays which examine the development of obesity in black and white girls and its responses to interventions. </p><p>The first chapter asks the question, how does obesity develop in girls? Using the National Growth and Health Study (NGHS), a longitudinal study of 2400 girls from age 9 to age 18, this chapter aims to address gaps in knowledge about the development and persistence of obesity in girls. Analyses using multivariate regression and growth-mixture modeling describe trajectories of body mass change in children and their correlates. Results suggest that obesity in children begins early and persists in most cases--BMI at age 17 is, on average, 1.3 times BMI at age 9. However, change does occur; 0.8 percent of the sample move from being obese at age 9 to healthy weight at age 17, and 2.2 percent of the sample make the reverse journey from healthy weight to obese. Where change occurs, it is most commonly seen among those who socio-demographically were anomalies among their body mass cohort at age 9. These results emphasize the importance of early interventions as well as the need for more study into body mass mutability in population subsamples. </p><p>The second chapter investigates 1) what motivates children to pursue weight loss; and 2) what aspects of interventions may most effectively support healthy child motivations and program success. These questions are qualitatively studied among a sample of 45 obese girls aged 9 to 13 girls participating in a behavior modification intervention. In total, 106 interviews were conducted. All of the girls in the study were interested in losing weight, most commonly in order to fit in (n=11), reduce teasing (n=10), or express particular social identities (n=6). However, not all of the girls were able to translate this desire to lose weight into a healthy and effective lifestyle change motivation. Several factors were associated with adopting healthy motivation and behavior, including familial involvement, self-regulation skills, non-social weight desires, realistic weight loss goals, and clear messages about body ideals. Other program protocols also supported motivation during difficult periods for those who adopted healthy motivation, including nutrition information, incentives, lack of physician judgment, and patient autonomy. Finally, two other potential program protocols were mentioned by girls in the study as useful aids. More support services, particularly during the summer, and more information on the expected course of weight loss could, these girls argued, help sustain motivation. Together, these findings suggest a role for self-regulation theory in the design of lifestyle change motivation and for more directly addressing expectations in weight loss treatment.</p><p>The third chapter investigates the relationship between self-worth and obesity among girls, again using the National Growth and Health Study. Results indicate a negative relationship between self-worth and obesity across all participants. However, this relationship only has predictive power from early body mass to later self-worth and self-worth trajectories. That is, higher body mass at age 9 predicts lower self-worth at age 17 and decreases in self-worth from age 9 to age 17. The effect is larger for Caucasians and for those in young adolescence but persists across the sample. Mechanisms for this relationship are also investigated, and some support found for stigma. Analyses using self-worth components suggest most of the self-worth effects are driven by social concerns, while mediational analyses suggest social body image pressures explain the relationship between global self-worth and body mass. Overall, the findings suggest a complex interrelation between self-worth and body mass in girls, meriting further investigation as well as a more nuanced discussion in the public realm.</p> / Dissertation

Background: In Sri Lanka, motherhood within marriage is highly valued. Sex out of wedlock is socially unacceptable and can create serious public health problems such as illegal abortions, suicide and infanticide, and single motherhood as a result of premarital sex is considered shameful. The way unmarried women facing single motherhood reflect on and make use of their agency in their social environments characterised by limited social and financial support has consequences for the health and well-being of both themselves and their children. The aim of this study was to explore and describe how unmarried women facing single motherhood in Sri Lanka handle their situation. Methods: This qualitative study comprised semi-structured interviews with 28 unmarried pregnant women or single mothers. The data were analysed by qualitative content analysis and the results related to the conceptual framework of social navigation. Results: The women facing single motherhood expressed awareness of having trespassed norms of sexuality through self-blame, victimhood and obedience, and by considering or attempting suicide. They demonstrated willingness to take responsibility for becoming pregnant before marriage by giving the child up for adoption, bringing up the child themselves, claiming a father for their child, refraining from marriage in the future, permanently leave their home environment, and taking up employment. Throughout the interviews, the women expressed fear of shame, and striving for familial and societal acceptance and financial survival. Conclusions: A social environment highly condemning of unmarried motherhood hindered these women from making strategic choices on how to handle their situation. However, to achieve acceptance and survival, the women tactically navigated norms of femininity, strong family dependence, a limited work market, and different sources of support. Limited access to resources restricted the women's sexual and reproductive health and rights, including their ability to make acceptable and healthy choices for themselves and their children.

Despite widespread health promotion and nutrition education efforts, gaps between official healthy eating messages and people’s actual eating practices persist. There is increasing recognition that emphasizing individual responsibility for eating may have limited applicability in improving people’s health. Many experts advocate that future research on healthy eating should involve exploration of how food practices are shaped by social structures (or determinants) and individual agency. The purpose of this study was to explore the ways in which people engage with food structures to construct everyday notions of healthy eating. ‘Food structures’ draws on the concept of ‘structure,’ described by the social theorist Anthony Giddens, to refer to the range of food rules and resources people draw on. The research was conducted as part of a qualitative study on family food decision-making that included 144 participants from 13 African Nova Scotian, 10 European Nova Scotian, 12 Punjabi British Columbian and 11 European British Columbian families. These groups were chosen for their potential differences in perspectives based on place, ethnocultural background and histories of immigration to Canada. Data collection consisted of individual interviews with three or more family members aged 13 and older, and, with each family, observation of a grocery shopping trip and a family meal. Analysis followed common qualitative procedures including coding, memoing and thematic analysis. Together, the analyses support views that the gaps between official healthy eating messages and people’s eating practices may not be closed by further education about how to eat. Drawing on the theoretical concepts of Anthony Giddens and Michael Foucault, the findings suggest that one way to understand why people eat the way they do and how changes in eating habits occur is to think about the constant exposure to change through everyday, taken-for-granted practices. The findings also suggest that further healthy eating discourses may require more reflection with respect to the roles of nutrition educators and the social roles/autonomy of people in goals for health and well-being. Dietary goals for the population cannot be considered as isolated scientific objectives without taking into consideration how healthy eating discourses provide social standards beyond messages about healthy eating.

Jürgen Habermas’ The Structural Transformation of the Public Sphere has been described as outdated and incompatible with 21st century democracies. Among other things, Habermas’ initial formulation excluded the state from the public sphere. Recently, a revised model of the public sphere has emerged that positions the state and other law-making bodies at its centre. Although some theorists have embraced this revised model, others continue to exclude the state or oversimplify its role. While some research has examined how parliaments fit into this revised model, no research has been published on this in a Canadian context. This thesis attempts to fill this gap by answering the research question: Does the Canadian House of Commons constitute a form of the public sphere? To answer this question, the Canadian House of Commons is explored along three dimensions of the public sphere – structure, representation, and interaction. This system of classification conforms to the essential function and institutional criteria of classical theory and also accounts for revised models of the public sphere. Ultimately, this work argues that the Canadian House of Commons satisfies the structural and representational dimensions of the public sphere. Its interactional dimension, however, is found to be inconsistent with public sphere theory due to a lack of real deliberation and the pervasiveness of party politics.

Over the past few decades, research into public perceptions of crime has largely focused on how mass media consumption shapes beliefs about crime. Substantially less research has been dedicated to exploring the potential influence of alternative sources of information, and even less attention has been devoted to exploring the spatiotemporal aspect of perceptions of crime. This thesis combined Geographic Information Systems (GIS) and structured interviews in order to explore the narratives about crime constructed by three sources: (1) the Ottawa Police Service, (2) the Ottawa Citizen newspaper, and (3) residents of Ottawa. Eight participants were taken on a walking tour interview, and their responses were compared to two maps depicting the geographies of crime presented by the Ottawa Police Service and the Ottawa Citizen. It was found that the places participants believed to be criminal ones were poorly maintained and dirty, were populated by large numbers of homeless individuals, had little to no commercial space, were geographically close to other areas of the city believed to be criminal spaces, and were poorly lit. The three construction of the spatial distribution of crime in Ottawa shared many common features (such as a focus on the Byward Market area as highly criminal) while remaining distinct in their presentation of certain types of spaces (such as the newspaper’s presentation of homeless shelters as highly criminal spaces). Ultimately, this thesis explores three distinct narratives about the geography of crime in Ottawa through the use of a unique mixed methods design that provides an alternative way of interpreting data most commonly analyzed through deductive or quantitative means.

This thesis is about the effects of online game addiction on both Swedish and Chinese undergraduate students at University of Gävle, Sweden. It aims at investigating the impact that online games have on undergraduate students at University of Gävle, Sweden. As most of the previous researchers in this area conducted a quantitative research, we decided to do a qualitative research which can help us to get a deeper and better understanding of online game addiction.

The Global Fund to Fight AIDS, Tuberculosis & Malaria (GF) offers new approaches and challenges in international aid for health. Little research is available exploring the experiences of individuals and communities working within the confines of GF policies in Latin America. The study fills this gap through a qualitative exploration of local experiences with tuberculosis (TB) services and the GF in Nicaragua. <p>This study sought to examine local stakeholders (administrators, health personnel and persons affected by TB) experiences related to GF policies relevant to TB services in Nicaragua. The study drew from a population health perspective and was informed by an ethnomethodological approach. Key themes focused on TB control, health systems and health rights. Data collection involved contextual analysis, participant observation, in-depth interviews and focus groups. The study involved 6 months of fieldwork in Nicaragua from November 2005-April 2006. Fieldwork was conducted with the support, participation and assistance of the Centre for Health Research and Studies, the Damian Foundation and the National Tuberculosis Control Program. <p>Analysis of findings shows various internal and external challenges in communication/procedural and disbursement/execution aspects of the GF grant. In TB control, participants identified private sector participation, case detection & reduced abandonment as improvements resulting from the GF project, though sustainability was a key concern. In health systems, concerns of efficiency and efficacy in the use of funds were commonly expressed. The focus on human resource development via the GF was considered a strength of the project. Community participation and the reduction of stigma, two facets of health rights, were perceived to have improved through the GF grant; however, remain identified as key issues for improving the context of TB in Nicaragua. The experiences of people working to implement or receiving TB services and GF activities in Nicaragua offer valuable insight into the strengths and challenges of this country-driven approach to aid for health. The GF needs to give more attention to such experiences a resource for improving flexibility and assuring sustainability in program strengthening and human resource development.

A narrative analysis was used to explore the question, What does it mean to be an Aboriginal man with quadriplegia? Six in-depth semi-structured interviews and follow-up reviews were conducted with Dennis Sapp, a 52-year old Plains Cree man with quadriplegia who requested that his full name be used in the thesis document. <p>The results of the study appear in the form of a life story written in the first person derived through a process of narrative analysis of the interview transcripts. The narrative details Dennis early beginnings on the Little Pine Reserve near North Battleford, Saskatchewan, Canada and his memories of his maternal grandfather, Cree elder and WWII Veteran, Tom Sapp, who raised Dennis in the traditional way until he was forced to go to the St. Anthonys Residential School at Onion Lake at six years of age. The narrative includes an account of Dennis life before being taken to residential school, his experiences at residential school, and his life after leaving the school. In the narrative Dennis recounts the experience of losing his traditional culture and spirituality at residential school and the difficulties he encountered in his life as a result of the trauma of the residential school experience. He gives an account of sustaining a spinal cord injury and his experience post-injury and in rehabilitation. After reconnecting with his grandfather and returning to school to complete his education, Dennis rediscovered his traditional culture and spirituality and gained a renewed sense of meaning and purpose as a counsellor, disabilities advocate, and storyteller. Through regaining his culture and spirituality and sharing his story Dennis found balance and healing.

Over the last two decades the incidence of overweight and obesity among children and adolescents has reached epidemic proportions in both developed and developing nations. Reducing the incidence of childhood overweight and obesity is of particular importance in countries undergoing social and cultural transitions, such as Trinidad and Tobago, where chronic diseases, such as childhood obesity may have severe social and economic impacts on public health. Although there are a number of studies that have investigated the health and lifestyle behaviours of school aged children, very little information exists about health and lifestyle behaviours of school age children in Trinidad and Tobago. Also, little information exists on the development of questionnaires to address health related issues within this culture and age group. The purpose of this study was to describe the development and pre-test of a knowledge, attitude, belief and practice (KABP) questionnaire to assess healthy lifestyle outcomes of school aged children in Trinidad and Tobago. Three data sources were used for the design and pre-testing of the questionnaire: content analysis of the literature, interview of key stakeholders, and onsite observations. An in-depth review of the literature was conducted for insights about questionnaire development. Interviews (individual and focus groups) were conducted of key stakeholder groups (school staff, the national school feeding program and curriculum officers) and children to determine current policies and practices, beliefs, barriers, and attitudes towards promoting health lifestyles (nutrition and fitness) in Trinidad and Tobagos elementary schools. Site observations provided insight into the school food environment, class room practices, and food services offered at school. Observations were recorded using field notes and interviews were tape recorded and transcribed verbatim. Interview data from each participant was analyzed separately for dominant themes and recurring topics. The interviews were then compiled to establish the main issues which the questionnaire needed to address. The KABP questionnaire addressed general knowledge about healthy eating and activity, screen time, physical activity, snack and food choices, and self efficacy. The KABP questionnaire consisted of question items that were developed to fit the issues unique to Trinidad and Tobago, and items from previously validated questionnaires which were modified to fit the context of Trinidad and Tobago. The questionnaire was then pre-tested with a sample group of the target population. Pre-testing was done one-on one, in small groups and in the classroom setting. Based on pre-test results the questionnaire was then modified to form version 1.0 of the KABP questionnaire. Version 1.0 of the KABP questionnaire consisted of 30 questions divided into four categories. This culturally sensitive age appropriate questionnaire was the foundation of the KABP questionnaire which was used to collect baseline, midpoint and endpoint of the larger project.

The purpose of this study was to explore protective factors that help women resist societal pressures for thinness. The present study used a qualitative life history methodology to examine the experiences of women who identified themselves as resilient to pressures to be thin and as liking their bodies regardless of size. In-depth semi-structured interviews were conducted with 14 women, ages 18 to 25, representing diverse social and ethno-cultural backgrounds and body physiques. In the interviews, the participants were inquired about their experiences related to anything they felt was helpful for them in developing a positive body image from childhood, adolescence, and to present day. The interviews were transcribed and analyzed for themes using constructivist grounded theory methodology. Data analysis was informed by the feminist theoretical approach, with attention paid to social and contextual factors. Three core categories emerged from the analysis, which included protective factors associated with participants’ experiences of identity, ways of inhabiting their bodies, and the nature of social influences in their lives. This research highlighted the women’s active role in maintaining a resilient stance in the face of pressures for thinness as well as the importance of social factors that assist them in this process.