Laurene Rehman

Blame, Shame, and Lack of Support: A Multilevel Study on Obesity Management

In this research, we examined the experiences of individuals living with obesity, the perceptions of health care providers, and the role of social, institutional, and political structures in the management of obesity. We used feminist poststructuralism as the guiding methodology because it questions everyday practices that many of us take for granted. We identified three key themes across the three participant groups: blame as a devastating relation of power, tensions in obesity management and prevention, and the prevailing medical management discourse. Our findings add to a growing body of literature that challenges a number of widely held assumptions about obesity within a health care system that is currently unsupportive of individuals living with obesity. Our identification of these three themes is an important finding in obesity management given the diversity of perspectives across the three groups and the tensions arising among them.

Physical activity of children and youth in Nova Scotia from 2001/02 and 2005/06

OBJECTIVES This paper reports on physical activity of students in grades 3, 7, and 11 from two surveillance studies (from 2001 and 2005). METHODS Randomly selected students (Study1 n=1730; Study2 n=2341) from randomly selected schools in Nova Scotia participated. Physical activity was measured for seven consecutive days using Actigraph accelerometers. Descriptive statistics were calculated for moderate, hard, and very hard intensity, and total minutes of physical activity. Between study, grade, and sex differences were determined using univariate Analyses of Variance. RESULTS Students in Study2 were significantly less active (mean [SD]=531.0 [392.3] min/week) than Study1 (662.2 [495.1] min/week). Girls were significantly less active (525.4 [419.1] min/week) than boys (657.1 [460.3] min/week). Students in grade 11 were significantly less active (225.2 [171.1] min/week) than students in grade 7 (457.5 [227.2] min/week) who were significantly less active than students in grade 3 (1038.4 [387.6] min/week). A significant study-grade interaction indicated that compared to students in grades 7 and 11, the level of physical activity in students in grade 3 was considerably lower in Study2 compared to Study1. CONCLUSIONS Given the lower level of physical activity found in Study2, efforts at informing public policy and strategies that promote physical activity in children and youth should be made.

Are overweight students in Grades 3, 7, and 11 less physically active than their healthy weight counterparts?

OBJECTIVE This study compared the accumulated minutes of objectively measured physical activity in 1,790 boys and girls in Grades 3, 7, and 11 classified as healthy weight, at risk of overweight, and overweight. METHODS Height and weight were measured and body mass index calculated. Minutes of sedentary, light, moderate, hard, and very hard physical activity were obtained from a seven-day measurement of physical activity using an accelerometer (Actigraph, mode 7164; MTI). RESULTS In Grade 3, boys (p=0.000) and girls (p=0.012) classified as overweight obtained significantly fewer minutes of very hard physical activity compared with their healthy weight counterparts. Boys in Grade 7 considered overweight obtained significantly fewer minutes of hard (p=0.002) and very hard physical activity (p=0.006) compared with boys who were a healthy weight. There were no significant differences in minutes of sedentary, light, moderate, hard, or very hard intensity physical activity in the boys and girls in Grade 11, who were considered a healthy weight, at risk of overweight, or overweight. CONCLUSIONS Weak and inconsistent support was provided for the notion that boys and girls classified overweight are less physically active than their healthy weight counterparts.

Far as I get is the clothesline: the impact of leisure on women's health and unpaid caregiving experiences in Nova Scotia, Canada.

This qualitative study explored the unique ways in which caregiving and leisure are conceptualized and mediated among diverse groups of female caregivers (n = 98) in the province of Nova Scotia, Canada. Data were obtained through 17 focus group discussions between March and June of 2002. Findings reveal that the contexts within which caregivers experience the health effects of caregiving create meanings, opportunities, and challenges for leisure. This study of diverse caregiving experiences fills a significant gap in the existing literature by integrating considerations of subjectivity and the ways in which caregiving influences womens perceptions and engagement in leisure pursuits. Constructivism guides the interpretive framework upon which the data were analyzed; results inform recommendations relative to policy and program audiences associated with unpaid caregiving.

Understanding gender norms, nutrition, and physical activity in adolescent girls: a scoping review

Public health is currently focused on childhood obesity, and the associated behaviors of physical activity and nutrition. Canadian youth are insufficiently active and do not meet nutritional guidelines. This is of particular concern for adolescent girls, as they are less active than boys, become less active as they age, and engage in unhealthy weight control behaviors. The purpose of this review is to determine what is known from the existing literature about how gender norms are understood in relation to the health-related behaviors of PA and nutrition in young girls. This scoping review follows the framework of Arksey and O’Malley, involving defining a research question, study identification and selection, charting, interpretation, summarizing, and reporting. In total, 28 documents are reviewed, and characteristics are summarized quantitatively and qualitatively. Five major themes are identified: (1) Girls’ relationships with PA are complex and require negotiating gender roles, (2) the literature focuses on dieting rather than nutrition, (3) appearance and perceptions influence behaviors, (4) “body” focused discourse is significant to girls’ experiences, and (5) social influences, institutions, and environments are influential and may offer opportunity for future research and action. Gaps in the literature are identified and discussed. It is concluded that young girls’ activity and nutrition is affected by gender norms and feminine ideals through complex negotiations, perceptions, body-centered discourse, and societal influences.

Harm Reduction and Women in the Canadian National Prison System: Policy or Practice?

ABSTRACT Applying the principles of harm reduction within the context of incarcerated populations raises a number of challenges. Although some access to harm reduction strategies has been promoted in general society, a divide between what is available and what is advocated continues to exist within the prison system. This paper explores the perceptions and lived experiences of a sample of nationally incarcerated women in Canada regarding their perceptions and experiences in accessing HIV and Hepatitis C prevention, care, treatment and support. In-depth interviews were conducted with 156 women in Canadian national prisons. Q.S.R.Nud*ist© was used to assist with data management. A constant comparison method was used to derive categories, patterns, and themes. Emergent themes highlighted a gap between access to harm reduction in policy and in practice. Despite the implementation of some harm reduction techniques, women in Canadian prisons reported variable access to both education and methods of reducing HIV/HCV transmission. Concerns were also raised about pre- and post-test counseling for HIV/HCV testing. Best practices are suggested for implementing harm reduction strategies within prisons for women in Canada.

The preliminary findings of a study exploring the perceptions of a sample of young heterosexual males regarding HIV prevention education programming in Nova Scotia, Canada

Abstract Despite the increasing numbers of young Canadian females becoming infected with HIV through heterosexual transmission with an infected male sexual partner, the majority of current HIV prevention programs and services in Canada continue to ignore the needs of young heterosexual males. This research is derived from 30 indepfh interviews, 9 focus groups and 13 indepfh interviews with sexual and reproductive health educators. The preliminary results of a province-wide, qualitative study on the sexual and reproductive needs of young sexually active males (n = 50) indicate that heterosexual males remain glaringly absent from HIV prevention programming in Nova Scotia. A number of key themes illustrate the current disconnect between sexual and reproductive health messages and the HIV prevention education needs of young heterosexual males. These themes include perceptions of male sexuality, peer norms, structural and attitudinal barriers to information, and confidentiality. This paper highlights these key themes in the context of focus groups conducted with a sample of young heterosexual males from across Nova Scotia, Canada. The paper concludes with possible directions for the development of healthy sexuality programming and HIV prevention education best practices for young, heterosexual males.

Ties That Bond: Youth Sport as a Vehicle for Social Identity and Positive Youth Development

ABSTRACT An emerging area of research has focused on understanding how the group dynamics of a sport team influence positive youth development (PYD). The identities that youth form through their membership in sport teams (i.e., social identities) have been found to influence teammate behavior and team performance. Yet, minimal work exists on social identity and PYD in youth sport. Purpose: The purpose of this study was to investigate the relationship between social identity and PYD in sport. Method: Youth engaged in recreational sport (N = 219; Mage = 11.61 years, SD = 1.39 years) completed measures of social identity and PYD in sport. The social identity measure assessed 3 dimensions including ingroup ties (IGT; perceptions of similarity, bonding, belongingness), cognitive centrality (importance of being a team member), and ingroup affect (IGA; feelings associated with group membership). A regression analysis was performed separately for 4 PYD outcomes (personal and social skills, goal setting, initiative, negative experiences) with the 3 dimensions of social identity entered as predictors. Results: Regression analyses revealed that IGT and IGA were positively associated with personal and social skills (R2 Adj. = .29). Further, IGT predicted initiative (R2 Adj. = .16), whereas IGA was positively associated with goal setting (R2 Adj. = .17) and negatively associated with negative experiences (R2 Adj. = .08). Conclusion: The findings extend previous research highlighting the benefits of social identity on teammate behavior and team performance and demonstrate how social identity may contribute to PYD through sport.

“I Just Want to Have Fun, But Can I?”: Examining Leisure Constraints and Negotiation by Children and Adolescents

Abstract This study examined physically active leisure constraints of children and adolescents and empirically analyzed their ability to negotiate strategies to reduce their experience of constraints. Self-administered questionnaires and accelerometers were used to collect data on leisure constraints and physical activity from students (n=1654) in grades 3, 7, and 11. Gender and age differences were found in reported leisure constraints. Grade 3 and 7 girls more frequently reported fear of going out at night than boys. Grade 7 and 11 girls reported a lack of companions and too much schoolwork more often than boys. When examining the relationship between leisure constraints and reduction in physical activity levels, significance was found for distance in grade 3 and too much schoolwork for grade 11. However, physical activity levels were not affected indicating that participants appeared to be using negotiation strategies. Further research is needed to explore the constraints identified by these participants as they have important implications for their participation and leisure experiences. Use of an empirical measure of negotiation served as a useful tool for understanding leisure participation, as it provided a clear and accurate indication of levels of participation. When such measures are included along with opportunities to explore the context of negotiation strategies, a greater understanding of childrens and adolescents leisure will be obtained.

“It is not the diet; it is the mental part we need help with.” A multilevel analysis of psychological, emotional, and social well-being in obesity

ABSTRACT In this research, we explored the psychological, emotional, and social experiences of individuals living with obesity, and perceptions of health care providers. We conducted a theoretical thematic analysis using two theoretical frameworks applied to transcripts from a previous qualitative study. Themes from a mental well-being framework were subsequently categorized under five environmental levels of the Social-Ecological Model (SEM). Key mental well-being themes appeared across all levels of the SEM, except the policy level. For the individual environment, one main theme was food as a coping mechanism and source of emotional distress. In the interpersonal environment, two themes were (a) blame and shame by family members and friends because of their weight and (b) condemnation and lack of support from health professionals. In the organizational environment, one main theme was inadequate support for mental well-being issues in obesity management programmes. In the community environment, one major theme the negative mental well-being impact of the social stigma of obesity. An overarching theme of weight stigma and bias further shaped the predominant themes in each level of the SEM. Addressing weight stigma and bias, and promoting positive mental well-being are two important areas of focus for supportive management of individuals living with obesity.