Public Health Commons^™

The Impact Of Financial Incentives For Cervical Cancer Screening In Ontario's Primary Care Delivery Models, Ciara Pendrith

Electronic Thesis and Dissertation Repository

Physicians practicing in capitation-based Family Health Organizations and fee-for-service-based Family Health Groups receive bonuses for delivering preventive care, including cervical cancer screening, while those practicing in the traditional fee-for-service model do not. Financial incentives were introduced to increase Ontario’s cervical screening rate to 85%. To date, the impact of incentives for cervical screening on screening rate and cost-effectiveness have not been assessed. Patient-level data obtained from the Institute for Clinical Evaluative Sciences were used to estimate primary care model screening rates and cancer treatment costs. A microsimulation model was developed from published cervical cancer natural history models and parameterized using …

Assessing The Structural Validity Of The Measure Of Processes Of Care (Mpoc-20) In Children With Epilepsy, Kariym Christopher Joachim

Electronic Thesis and Dissertation Repository

The goal of this thesis was to determine whether the 20-item Measure of Processes of Care (MPOC-20) questionnaire remains structurally/factorially valid among children with epilepsy, and to propose adaptations if it did not. Establishing the MPOC-20’s structural validity in this population makes it possible to draw conclusions on the potential effects of parent-perceived Family-Centred Care (FCC) on health outcomes within this population. Data came from the Health-related Quality of Life for Children with Epilepsy Study (HERQULES). Confirmatory Factor Analysis (CFA) indicated that the original five factor model fit poorly in children with epilepsy. An exploratory analysis within a CFA framework …

The Lunches Study: Elementary School Children's Packed Lunch Contents And Intake In The Traditional Vs. Balanced School Day Schedule, Lisa Neilson

Electronic Thesis and Dissertation Repository

The Balanced School Day (BSD), an alternative to the Traditional Schedule (TS), provides two 20-minute eating periods during the school day, rather than a midday lunch break. Widespread implementation of the BSD schedule has occurred across Ontario with limited systematic evaluation of potential health outcomes. The purpose of this study was to compare the food and nutrient value of grade 3 and 4 students’ packed lunch contents and consumption in the BSD versus TS, by direct observation. When compared to the TS, more BSD students had a sugar-sweetened beverage packed in their lunch. Greater portions of snack items were also …

An Examination Of Psychological Variables Influencing Perceptions Of The Self Among A Sample Of Female Exercise Initiates, Lisa Cooke

Electronic Thesis and Dissertation Repository

The general purpose of this dissertation was to explore the relationship among and within cognitive variables associated with exercise initiation and maintenance in a sample of female exercise initiates.

Manuscript 1 was structured to explore the changes to exercise identity among a population of female exercise initiates (N = 78) grouped into an imagery or control condition. Previous research has found that a strong exercise identity is associated with more frequent exercise (Strachan et al., 2009) and increases over time as a person continues to exercise (Cardinal & Cardinal, 1997). Participants were assessed multiple times (weeks 0, 5, 9, …

Motivational Interviewing Via Co-Active Life Coaching Intervention For Women Seeking A More Physically Active Lifestyle, Andrea M. Goddard

Electronic Thesis and Dissertation Repository

The purpose of this 12-week pre-post design pilot study was to assess the impact of Motivational Interviewing via Co-Active Life Coaching (MI-via-CALC) on exercise-specific self-efficacy, barrier-specific self-efficacy, self-esteem, and 12-week study duration engagement in physical activity (PA) for 25 women between the ages of 30 and 55 years. Participants were assessed quantitatively using the previously validated McAuley Exercise-Specific Self-Efficacy Scale (EXSE), McAuley Barrier-Specific Self-Efficacy Scale (BARSE), Rosenberg Self-Esteem Scale (RSES), and International Physical Activity Questionnaire (IPAQ-SF) at pre-, mid-, and post-intervention. Four one-way repeated measures ANOVAs were completed for each scale, and statistically significant differences in barrier-specific self-efficacy were detected …

Environmental Health Effects Of Multiple Exposures: Systemic Risks And The Detroit River International Crossing Study, Tor H. Oiamo

Electronic Thesis and Dissertation Repository

This thesis examines cumulative exposures to traffic noise and outdoor air pollution on environmental and health related quality of life in Windsor, Ontario, and provides a critical analysis of the environmental assessment process for the Detroit River International Crossing (DRIC) Study. The research utilizes a systemic risk framework to understand environmental health and stress effects of cumulative exposures. The significance of this research is based on a relative absence of literature on the systemic health risks of cumulative exposures and the need to elucidate environmental annoyance as a health outcome for risk assessment. The objectives of the research were to …

Rural Heterosexual Female Adolescents' Decision-Making About Sexual Intercourse And Pregnancy In Ontario, Paulina Ezer

Electronic Thesis and Dissertation Repository

Rural areas in Ontario tend to have higher rates of adolescent pregnancy. A constructivist grounded theory methodology was used to gain an in-depth understanding of rural female adolescents’ decision-making process regarding sexual intercourse and their reproductive health, and how they view rural factors and circumstances influencing this process. The adolescent sexual decision-making process that emerged from the analysis involved prioritizing four influences that affect and are affected by the rural context: personal values and circumstances, family values and expectations, friends’ influences, and community influences. Findings will improve our understanding of how rural female adolescents make choices regarding their reproductive health. …

The Effectiveness Of Teleglaucoma Versus In-Patient Examination For Glaucoma Screening: A Systematic Review And Meta-Analysis, Sera-Melisa Thomas, Maya M Jeyaraman, Maya Jeyaraman, William G Hodge, Cindy Hutnik, John Costella, Monali S Malvankar-Mehta

Epidemiology and Biostatistics Publications

BACKGROUND: Glaucoma is the leading cause of irreversible visual impairment in the world affecting 60.5 million people worldwide in 2010, which is expected to increase to approximately 79.6 million by 2020. Therefore, glaucoma screening is important to detect, diagnose, and treat patients at the earlier stages to prevent disease progression and vision loss. Teleglaucoma uses stereoscopic digital imaging to take ocular images, which are transmitted electronically to an ocular specialist. The purpose is to synthesize literature to evaluate teleglaucoma, its diagnostic accuracy, healthcare system benefits, and cost-effectiveness.

METHODS: A systematic search was conducted to help locate published and unpublished studies. …

Navigating Life With Hiv: The Lived Experiences Of Youth Living With Hiv, Tamara M M Landry

Electronic Thesis and Dissertation Repository

Youth and young adults living with HIV, between the ages of 15 and 29 represent one-quarter of the new infection rates in Canada, but little is known about the safer sex practices, HIV disclosure processes and coping mechanisms used by this important but often neglected group to manage the every day realities of living with HIV. The primary objectives of this study were to gather qualitative data about the lived experiences of Canadian youth who are living with HIV and enhance our understanding of their experiences of becoming HIV-positive, navigating issues related to safer sex and HIV disclosure, and managing …

Quality Of Life And Health-Related Quality Of Life In Children With Duchenne Muscular Dystrophy, Yi Wei

Electronic Thesis and Dissertation Repository

Quality of life studies in Duchenne Muscular Dystrophy are scarce. This study explores the relationship between the broad concept of quality of life and the more focused concept of health-related quality of life and examines the relationships between patient and family characteristics and health-related quality of life. Participants were recruited from the Canadian Neuromuscular Disease Registry, 98 parents and 85 children completed the Quality of My Life and Pediatric Quality of Life Inventory questionnaires. Simple regression was used to examine the relationship between quality of life and health-related quality of life. Multivariable linear regressions were used to determine child and …

Comparison Of Housed And Homeless Patients With An Orthopedic Diagnosis, Susan M. Williams

Electronic Thesis and Dissertation Repository

Studies on homelessness have shown that people who are homeless are admitted to hospital more frequently, for longer periods of time, and at a younger age than people who are housed. Once admitted to hospital, discharge planning is difficult and resource intensive, often leading to discharge back to the streets or a shelter. This puts this population at risk for complications and readmission. Although people who are homeless are prone to orthopedic injuries, there is no research on the outcomes of patients who are homeless with orthopedic injuries. This retrospective, case control study, based on the social determinants of health, …

Body Mass Index Trajectories: The Effect Of Fetal Size And Early Life Modifiable Factors, Mathew Roy

Electronic Thesis and Dissertation Repository

Background: This study examined the relationship between small for gestational age (SGA) status at birth, a measure of fetal growth restriction, and childhood body mass index trajectories (BMI) using data from the National Longitudinal Survey of Children and Youth. Analytic Method: Using latent growth curve modeling, the growth trajectories of a cohort of small and appropriate for gestational age singletons were modeled from 2-10 years (N=1,273 at baseline). Results: SGA status had no effect on the growth trajectories of children after adjusting for prenatal and early life sociodemographic and maternal variables, and also early life modifiable factors. Moreover, the modifiable …

Move More Mommy: A Web-Based Physical Activity Intervention For Postnatal Women (Pilot Study), Sarah Gray

Electronic Thesis and Dissertation Repository

Despite the many benefits of physical activity, postnatal women are not currently meeting Health Canada Guidelines of 150 minutes per week of moderate-vigorous physical activity. This study, Move More Mommy, used a mixed methods design to test the feasibility and acceptability of a web-based intervention combined with a group mediated cognitive behavioural approach, and it’s effectiveness to increase physical activity, self-efficacy, and group cohesion among postnatal women. Participants received an 8-week intervention delivered through 8 group exercise classes and a purpose built website. From baseline to post-intervention, participants significantly increased self-reported physical activity levels and group cohesion. Objectively measured physical …

Exploring Health Care Access For Gay, Bisexual, And Other Men Who Have Sex With Men Living In Middlesex County, Ontario, Todd A. Coleman

Electronic Thesis and Dissertation Repository

Published research suggests gay, bisexual, and other men who have sex with men (GB-MSM) present in health care with additional, distinct psychosocial and sexual health concerns compared to heterosexual men, emphasizing the importance of access to health care for these groups.

This exploratory thesis used data from the online survey (n=202) of the Health in Middlesex Men Matters (HiMMM) Project – a community-based study examining health care access for GB-MSM living in Middlesex County, Ontario. For each manuscript, blockwise modified Poisson regression models were fit sequentially with predisposing, enabling, and need variables, as theorized by the Behavioral Model of Health …

Older Woman Workers: Met And Unmet Needs For Health And Wellbeing In The Workplace, Gillian Gorfine

Electronic Thesis and Dissertation Repository

Older women workers report experiencing occupational injustices however the literature focuses on barriers faced rather than understanding the needs-based strategies empowering women as they age at work. This study engaged women aged 55 and older in a participatory action research project defining and examining strategies for older women workers’ health and wellbeing. In Phase 1, a key informant advisory group (N = 4) defined the problem and guided the design of an open answer survey conducted with 72 older women in work. Three categories emerged informing the fundamental, instrumental, and contextual needs of older women workers. Meeting fundamental needs may …

The Experiences Of Black Men Living With Hypertension In Ontario, Canada: A Critical Narrative Study, Rob Haile

Electronic Thesis and Dissertation Repository

To date, most Black hypertension literature centers on the risk factors predictive of hypertension, and the treatment of this condition within this population. The purpose of this critical narrative inquiry is to better understand how Black men make sense of their hypertension diagnosis, and how they negotiate this condition into their everyday lives. Eight individual in-depth interviews were utilized to elicit stories from four Black men living in Ontario, Canada. Additionally, a critical stance was used in this study to illuminate how racism and power dynamics embedded within social, historical, and political contexts affected participants’ experiences of living with hypertension. …

Maternal Employment During Infancy And Toddlerhood: Mechanisms For Associations With Childhood Overweight/Obesity In Canada, Nathalie Victoria Metzer

Electronic Thesis and Dissertation Repository

Background: Childhood overweight and obesity is a major public health issue, with approximately 1 in 3 children classified as overweight or obese in Canada. Research suggests that maternal employment during childhood may be associated with later overweight and obesity risk, but it is not known whether employment during infancy and toddlerhood has a similar effect on weight status. Mechanisms such as reduced breastfeeding and use of informal child care have been proposed in the literature but not been formally tested among infants and toddlers. It is important to identify possible mechanisms that could explain the association with overweight and obesity …

Access To The Local Aids Service Organization Among African, Caribbean And Other Black Residents Of Middlesex-London, Ontario, Canada, Soraya Blot

Electronic Thesis and Dissertation Repository

The migration of people from HIV-endemic countries has altered the demographics of the HIV epidemic in high-income countries. In Canada, most people from HIV-endemic countries are of African descent. While they are an established priority group for HIV-related services, they can face access difficulties. This study uses quantitative data from the Black, African and Caribbean Canadian Health Study to evaluate AIDS service organization access in Middlesex-London, Ontario, using the Andersen-Gelberg model for vulnerable populations and an overarching intersectionality framework. In bivariate analysis, older age, having a primary care provider, less inappropriate fear of contagion and less time in Canada were …

A Health Promotion Perspective On Transitioning Into Retirement, Catherine P. Gelinas

Electronic Thesis and Dissertation Repository

The transitional stages towards retirement of those with chronic disorder(s) often present a diversity of additional challenges and people look at the measurement of their anticipated quality of life as a meaningful way of determining this successful adjustment. The overall objective of this research study was to understand transition into retirement considering the impact of comorbidity and associated socio-demographic factors have on the (physical and mental) health status. Quantitative data analysis of people (aged 50-65) with chronic upper extremity musculoskeletal disorders was used to inform health impacts in the group transitioning towards retirement; or who have selected or required early …

Overall Survival And Biochemical Failure-Free Survival Comparison Of Brachytherapy Treatment Options Versus External Beam Radiation Therapy For Both Low And Intermediate-Risk Prostate Cancer: A Propensity-Score Matched Analysis, Graham D. Smith

Electronic Thesis and Dissertation Repository

Purpose: This study compares overall survival (OS) and biochemical failure-free survival (bFFS) in low- and intermediate-risk prostate cancer patients that received brachytherapy [low-dose-rate brachytherapy (LDR-BT) or high-dose-rate brachytherapy with external beam radiation therapy (HDR-BT+EBRT)] versus external beam radiation therapy (EBRT) alone.

Materials/Methods: Patient data was obtained from the ProCaRS database, which contains 7974 prostate cancer patients treated at four Canadian institutions. Propensity score (PS) matching was used to generate matched cohorts with balanced baseline prognostic factors.

Results/Conclusions: Final PS matches included two 1:1 intermediate-risk patient matches, LDR-BT vs. EBRT (total n = 254) and HDR-BT+EBRT vs. EBRT (total n=388), and …

The Association Between Heavy Episodic Drinking And Alcohol-Related Unsafe Sex Among Canadian Undergraduate Student Drinkers, Shirley Solomon

Electronic Thesis and Dissertation Repository

Young adults who engage in risky sexual behaviours are placing themselves at risk for serious health problems. This study assessed the extent of alcohol-related unsafe sex among Canadian undergraduate students and examined the association between unsafe sex and heavy episodic drinking as well as drinking motives, drinking locations, age when they first drank alcohol, and illicit drug use. Data were obtained from the 2004 Canadian Campus Survey (N = 4,437). Logistic regression and modified Poisson regression was used to examine associations with unsafe sex. The proportion of students reporting having had unsafe sex was estimated to be at 7.37%. Heavy …

Primary Health Service Use By Mothers And Children From London-Middlesex, Ontario, Catherine Holtz

Electronic Thesis and Dissertation Repository

Primary health service use (P-HSU) may be influenced by predisposing and enabling factors measured at individual- and contextual-levels but is equitable when driven by need factors. Objectives: 1) Estimate the effect of residential location on maternal and child P-HSU; 2) Assess P-HSU inequity by determining whether the effects of need factors on P-HSU are dependent on predisposing and enabling factors; 3) Describe perceived unmet healthcare needs in the maternal-child population observed to have inequitable P-HSU. Methodology: The sample of 1451 mother-child pairs was from a prenatal cohort recruited from London, Ontario between 2002 and 2004, with follow-up until children were …

Through The Eyes Of Children: First Nations Children's Perceptions Of Health, Kyla Annui Ursa English

Electronic Thesis and Dissertation Repository

Few studies addressing Indigenous children’s health have incorporated the voices of children or integrated an occupational science perspective. In partnership with the Southwest Ontario Aboriginal Health Access Centre, this community-based study used artwork and sharing circles to understand First Nations children’s perceptions of health during a week-long culture camp. The objectives were: (1) to understand how First Nations children view their health, and (2) to explore how children connect health and culture. Findings demonstrated that children’s perceptions (n=20, aged 10 to 12) focused on physical aspects of health, such as diet and fitness. Children attended much less to spiritual, mental, …

Women's Navigation Of Maternal Health Services In Ghana's Upper West Region In The Context Of The National Health Insurance Scheme, Andrea C. Rishworth

Electronic Thesis and Dissertation Repository

In 2008 the sub Saharan African country of Ghana implemented a Maternal Exemption Policy (MEP) within its National Health Insurance Scheme. This policy provides coverage for free antenatal, postnatal, and facility delivery to all pregnant women for a one year period. By removing the fees associated with maternal health services, the MEP was intended to reduce maternal mortality and provide equitable health care for pregnant women. While the MEP is generally regarded as beneficial to the women of Ghana, challenges remain, especially in the poor, marginalized and rural communities of the Upper West Region. Given that access to a skilled …

Exploring Occupation As A Determinant Of Health And Its Contribution To Understanding Health Inequities, Amy Patel

Electronic Thesis and Dissertation Repository

Within health literature, occupation is understood as employment whereas in occupational science the concept of occupation encompasses all the things that people want or need to do. The objective of this pragmatic-oriented, qualitative study was to elicit the perspectives of occupational scientists on occupation as a determinant of health or concept that shapes health and well-being and secondly, to identify questions from an occupational lens to address health inequities in health assessments and interventions. Purposive sampling was used to recruit occupational science experts and data were collected through focus groups. Eight occupational scientists participated. A thematic analysis of data was …

Man Versus Food: An Analysis Of 'Dude Food' Television And Public Health, Amy R. Eisner-Levine

Electronic Thesis and Dissertation Repository

Contemporary food television has moved away from an instructional and cooking-centered model, to an entertainment and eating-focused one. However, public health researchers have not considered these shows in the wake of rising obesity rates. This thesis is concerned with the kinds of messages food television conveys about food and eating and is guided by three research questions: How are food and eating represented on the shows? How is health addressed? How do these shows work to create and promote a more acceptable popular discourse around unhealthy eating habits? Through an analysis of Diners, Drive-Ins and Dives, You Gotta Eat …

Neonatal And Developmental Outcomes Of Late Preterm And Early Term Birth, Hilary K. Brown

Electronic Thesis and Dissertation Repository

Research suggests increased risk for adverse outcomes associated with late preterm (34-36 weeks) and early term (37-38 weeks) birth versus full term (39-41 weeks). However, it remains unclear to what extent these outcomes are associated with physiological immaturity or factors leading to or associated with early birth.

The first objective was to elucidate the role of gestational age in determining risk of poor neonatal outcomes in the context of biological determinants of preterm birth. A retrospective cohort study of singletons delivered at 34-41 weeks to London-Middlesex (Canada) mothers was conducted using perinatal and discharge abstract databases (N=38,807, 2002-2011). Modified Poisson …

The Stress Process Model For Community-Dwelling Adults With Mental Disorders, Samantha Davie

Electronic Thesis and Dissertation Repository

Background: Although stress has been linked to poor mental health outcomes for various populations, less is known about the impact of stress on individuals already diagnosed with mental disorders. Objective: Explore the association between stress and general psychological distress (GPD), using the stress process model. Design: Data were collected in 2011 from community-dwelling adults who have had at least one diagnosed mental disorder for at least one year in their lifetime (n=380), and are cross-sectional in nature. Multivariable linear regression was used to assess the association between stress and GPD, with various psychological resources, such as coping, social support, and …

Economic Evaluation Of Potential Applications Of Gene Expression Profiling In Clinical Oncology, Malek Hannouf

Electronic Thesis and Dissertation Repository

Histopathological analysis of tumor is currently the main tool used to guide cancer management. Gene expression profiling may provide additional valuable information for both classification and prognostication of individual tumors. A number of gene expression profiling assays have been developed recently to inform therapy decisions in women with early stage breast cancer and help identify the primary tumor site in patients with metastatic cancer of unknown primary. The impact of these assays on health and economic outcomes, if introduced into general practice, has not been determined. I aimed to conduct an economic evaluation of regulatory-approved gene expression profiling assays for …

From Their Perspective: How Adolescents And Young Adults Experience And Conceptualize Life And Occupation Surrounding Parental Divorce Or Separation, Laura R. Hartman

Electronic Thesis and Dissertation Repository

Parental divorce affects adolescents’ emotions, routines, habits, occupations and relationships. The current body of research indicates that parental divorce leads to many unfavourable social, behavioural, and mental health outcomes for adolescents. This dissertation explores the daily lives and occupations of adolescents and young adults surrounding the transition of a parental divorce or marital separation.

This thesis contains four manuscripts in addition to the introductory and final reflection chapters. The first manuscript explores the current North American literature relating to adolescent life surrounding a parental divorce or marital separation, ranging form 1998 to 2014. The second manuscript provides an overview of …