Marianne Clark

Key Stakeholder Perspectives on the Development of Walkable Neighbourhoods

Evidence supports the link between the built environment and physical activity. This study investigated factors that influence the decisions made by key stakeholders as they relate to neighbourhood development. Seventeen stakeholders including public health and municipal employees (n=9), city councillors (n=3), and the private sector (e.g., land developers, food retailers) (n=5), participated in interviews. Private sector participants considered healthy lifestyle choices (e.g., PA) to be related more to individual choice than did other groups. All groups agreed that consumer behaviour is essential to invoking change but did not agree on who is responsible for invoking change. Common barriers included financial costs, car dependency, and social norms. Facilitators included growing awareness of health and environmental issues and increasing buy-in from governing bodies for innovative neighbourhood development. More work is needed that acknowledges the differences between while integrating the diverse perspectives of those responsible for the planning of neighbourhoods that are conducive for physical activity.

A mixed methods evaluation of televised health promotion advertisements targeted at older adults

The purpose of this research was to evaluate television advertisements targeted at 55-70-year olds that promoted physical activity and fruit and vegetable consumption. Awareness of the campaign, perceived credibility of the source, intentions to visit a promoted website, and intentions to perform the healthy behaviors were evaluated using mixed methods research. Results from a population level survey (n=1600) showed low unprompted and prompted awareness of the campaign and no differences in intentions or behaviors among those who were aware of the campaign. Unprompted recall resulted in a very wide range of responses including the citation of many commercial advertisers. Qualitative themes that emerged from the focus groups included neutral, positive, and negative comments about the advertisements, source credibility, website considerations specific to seniors, and suggestions about appropriate advertising for older adults. This research showed that the increased attention paid to the advertisements was due in a large part to negative reactions to the character used in the advertisements. Another important finding was the government was not considered to be a credible source of health information. Finally, health promoters should be cautious about websites as the primary source of information, particularly for older adults.

ParticipACTION: Awareness of the participACTION campaign among Canadian adults - Examining the knowledge gap hypothesis and a hierarchy-of-effects model

BackgroundParticipACTION was a pervasive communication campaign that promoted physical activity in the Canadian population for three decades. According to McGuires hierarchy-of-effects model (HOEM), this campaign should influence physical activity through intermediate mediators such as beliefs and intention. Also, when such media campaigns occur, knowledge gaps often develop within the population about the messages being conveyed. The purposes of this study were to (a) determine the current awareness of ParticipACTION campaigns among Canadians; (b) confirm if awareness of the ParticipACTION initiative varied as a function of levels of education and household income; and, (c) to examine whether awareness of ParticipACTION was associated with physical activity related beliefs, intentions, and leisure-time physical activity (LTPA) as suggested by the HOEM. Specifically, we tested a model including awareness of ParticipACTION (unprompted, prompted), outcome expectations, self-efficacy, intention, and physical activity status.MethodsA population-based survey was conducted on 4,650 Canadians over a period of 6 months from August, 2007 to February, 2008 (response rate = 49%). The survey consisted of a set of additional questions on the 2007 Physical Activity Monitor (PAM). Our module on the PAM included questions related to awareness and knowledge of ParticipACTION. Weighted logistic models were constructed to test the knowledge gap hypotheses and to examine whether awareness was associated with physical activity related beliefs (i.e., outcome expectations, self-efficacy), intention, and LTPA. All analyses included those respondents who were 20 years of age and older in 2007/2008 (N = 4424).ResultsApproximately 8% of Canadians were still aware of ParticipACTION unprompted and 82% were aware when prompted. Both education and income were significant correlates of awareness among Canadians. The odds of people being aware of ParticipACTION were greater if they were more educated and reported higher income. Awareness of ParticipACTION was also associated with outcome expectations, self-efficacy, intention, and LTPA status.ConclusionAwareness of ParticipACTION is associated with LTPA. Knowledge gaps in awareness are associated with level of education and household income. Thus, future promotion campaigns should include specific strategies to target different segments of the population, especially people who are living in deprived conditions with lower levels of education.

In the shoes of young adolescent girls: understanding physical activity experiences through interpretive description

The purpose of this study was to understand how adolescent girls experience and make meaning of the ways in which they are active within their daily lives. Using an interpretive description methodology, we conducted two rounds of interviews with eight 6th grade girls and asked them to share their stories, thoughts and feelings about times when they were active. Two themes best captured their stories: physical activity lets girl’s shine and taking care of myself, inside and out. Dominant societal discourses around health and appearance emerged in the construction and expression of girls’ experiences and were woven through each of these themes. Consistent with previous research, health was largely defined as a narrowly defined bodily aesthetic. However, in girls’ experiential accounts of actually being active, discourses of self-expression and creativity emerged. Unstructured play that occurred in girls’ free time and dance appeared as important forums, which allowed girls to engage in activities they enjoyed and explore their physicality.

A qualitative examination of the perceptions of parents on the Canadian Sedentary Behaviour Guidelines for the early years

BackgroundMinimizing sedentary behavior, in particular screen-based sedentary behavior, during the early years is important for healthy growth and development. Consequently, new Canadian Sedentary Behaviour Guidelines for the Early Years (aged 0–4 years) were recently released. Researchers are unclear what messages should supplement the guidelines when disseminating them to parents and when using the guidelines in behaviour-change interventions to increase adoption. The objective of this study was to qualitatively examine parents’ perceptions of the new Canadian Sedentary Behaviour Guidelines for the Early Years.MethodsParents with a child ≤4 years who attended a child care centre were purposefully recruited from child care centres. A total of 7 semi-structured focus groups with 2 to 5 parents were conducted from August to November, 2013 by a trained and experienced moderator. Participants were asked a series of open-ended questions pertaining to the Sedentary Behaviour Guidelines information sheet. Initial themes were identified followed by further review and analysis.ResultsFor the most part parents thought the guidelines were clear and did not disagree with the recommendations per se. However, some confusion arose around the value of some sedentary activities, such as reading and coloring, for social and cognitive development. Many parents described feeling guilty after reading the guidelines and perceived several barriers in meeting the daily recommendations. Common barriers included the need to balance multiple demands of family life, the prevalence and accessibility of screen technology, and the weather and built environment where families live. Parents expressed the importance of communicating the guidelines early enough for good habits to be established and the need for realistic strategies and ideas to help them meet the recommendations.ConclusionsOverall the findings indicate that gain-framed messages around the role of screen-based and non-screen-based sedentary behavior for children’s cognitive and social development might be most effective for adoption of the guidelines. Furthermore, providing parents the guidelines early with resources for minimizing sedentary behavior should also be considered. Future research is needed in other demographic groups of parents to confirm these findings.

Representations of the health value of vitamin D supplementation in newspapers: media content analysis

Objective To examine the nature of media coverage of vitamin D in relation to its role in health and the need for supplements. Design Media content analysis. Setting Print articles from elite newspapers in the UK, the USA and Canada. Participants 294 print newspaper articles appearing over 5 years (2009–2014). Results Newspaper coverage of vitamin D generally supported supplementation. The most common framing of vitamin D in print articles was “adequate vitamin D is necessary for good health.” Articles also framed vitamin D as difficult to obtain from food supply and framed vitamin D deficiency as a widespread concern. In discussions of supplementation, 80% articles suggested supplementation is or may be necessary for the general population, yet almost none of the articles discussed the potential harms of vitamin D supplementation in any detail. Print articles named 40 different health conditions in relationship to vitamin D. The most commonly cited conditions included bone health, cancer and cardiovascular health. Although print articles referred to a wide range of scholarly research on vitamin D with varying degrees of endorsement for supplementation, a general tone of support for vitamin D supplementation in media coverage persisted. Conclusions Newspaper articles conveyed overall support for vitamin D supplementation. News articles linked vitamin D to a wide range of health conditions for which there is no conclusive scientific evidence. Media coverage downplayed the limitations of existing science and overlooked any potential risks associated with supplementation.

Research ethics and stem cells Is it time to re-think current approaches to oversight?

Few areas of scientific inquiry have received the amount of attention from politicians, the media and the ethics community that research involving human stem cells has received. A large part of this attention, particularly in the early days of the field, was focused as much on the controversial nature of the research as on its scientific promise. The primary cause of controversy remains the use and destruction of human embryos to derive stem cells or create human embryonic stem cell (hESC) lines, which is considered by some constituencies to be morally problematic. A common policy response to these issues has been to subject stem cell research to heightened or additional ethics reviews and oversights. Internationally, many jurisdictions have established specific legislation, ethical guidelines and oversight bodies to govern stem cell and related embryo research (Box 1). ### Box 1: Some jurisdictions with heightened ethics review process for stem cell research CANADA UNITED STATES

Unproven stem cell-based interventions & physicians' professional obligations; a qualitative study with medical regulatory authorities in Canada.

BackgroundThe pursuit of unproven stem cell-based interventions (“stem cell tourism”) is an emerging issue that raises various concerns. Physicians play different roles in this market, many of which engage their legal, ethical and professional obligations. In Canada, physicians are members of a self-regulated profession and their professional regulatory bodies are responsible for regulating the practice of medicine and protecting the public interest. They also provide policy guidance to their members and discipline members for unprofessional conduct.MethodsWe conducted semi-structured telephone interviews with representatives from six different provincial Colleges of Physicians and Surgeons in Canada to discuss their experiences and perspectives regarding stem cell tourism. Our focus was on exploring how different types of physician involvement in this market would be viewed by physicians’ professional regulatory bodies in Canada.ResultsWhen considering physicians’ professional obligations, participants drew analogies between stem cell tourism and other areas of medical tourism as well as with some aspects of complementary alternative medicine where existing policies, codes of ethics and regulations provide some guidance. Canadian physicians are required to act in the best interests of their patients, respect patient autonomy, avoid conflicts of interest and pursue evidence-based practice in accordance with accepted standards of care. Physicians who provide unproven treatments falling outside the standard of care, not in the context of an approved research protocol, could be subject to professional discipline. Other types of problematic conduct include referrals involving financial conflict of interest and failure to provide urgent medically necessary care. Areas of ambiguity include physicians’ obligations when asked for information and advice about seeking unproven medical treatments, in terms of providing non-urgent follow-up care, and when asked to support efforts to go abroad by providing tests or procedures in advance that would not otherwise be medically indicated.ConclusionsSpecific policy guidance regarding the identified areas of tension or ambiguity may prove helpful for physicians struggling with these issues. Further consideration of the complex interplay of factors at issue in how physicians may (should) respond to patient demands related to unproven medical interventions while meeting their professional, legal and ethical obligations, is warranted.

Taking a hard look at the Heart Truth campaign in Canada: A discourse analysis:

The Canadian Heart and Stroke Foundation launched the Heart Truth campaign to increase women’s awareness of heart disease. However, little is known about how such campaigns intersect with broader understandings of gender and health. This discourse analysis examined the construction of gender, risk, and prevention within campaign material. Two primary discourses emerged: one of acceptable femininity, which outlines whose risk, survivorship, and prevention matters, and another of selfless prevention. Women of diverse ethnic, sexual, and socio-economic background were largely absent. Prevention was portrayed as a personal choice, eclipsing conversations about social determinants of health and the socio-political context of heart disease.

Is abstinence really the best option? Exploring the role of exercise in the treatment and management of eating disorders

ABSTRACT Exercise prescription is suggested to help manage exercise abuse and improve overall eating disorder (ED) prognosis. This study explored emerging perceptions of ED health professionals concerning the role of exercise as a supportive treatment for EDs. Semi-structured interviews were conducted with international health professionals (n=13) with expertise in ED treatment. Verbatim transcripts were analyzed through thematic analysis. Four themes were revealed and titled 1) understanding the current state; 2) gaining perspectives; 3) barriers and benefits; 4) one size does not fit all. Within these themes, participants described the current state of exercise in ED treatment and suggested there exists a gap in research knowledge and practice. Participants also identified the implications of incorporating exercise into treatment and how an exercise protocol may be designed. Results enhance the understanding of the role of exercise in ED treatment and how it may further benefit individuals with EDs.