Connecting qualitative research on exercise and environment to public health agendas requires an equity lens

In this commentary, I respond to the special section in Health & Place (vol. 46) on “Exercise and environment: new qualitative work to link popular practice and public health” edited by Hitchings and Latham. I argue that if qualitative research is to effectively inform public health policy and practice it cannot ignore the fact that physical activity participation is inequitable. Without building in a critical equity lens, geographers risk perpetuating the “inequality paradox”—that is, the potential for population health interventions to inadvertently exacerbate health inequalities. Related to this, I challenge the editors’ assumption that geographers’ critiques of public health approaches to physical activity and our applied efforts to foster physical activity participation are mutually exclusive endeavours. Rather, I argue they are mutually necessary within a social justice agenda. Finally, I close this commentary by offering ways forward for qualitative research on exercise and environment to connect with public health agendas and inform interventions

“It's gym, like g-y-m not J-i-m”: Exploring the role of place in the gendering of physical activity

© 2017 Elsevier Ltd Physical activity is a highly gendered health behaviour, with women less likely than men to meet internationally accepted physical activity guidelines. In this article, we take up recent arguments on the potential of indoor spaces to illuminate processes shaping health, together with social theories of gender, to conceptualize the place of the gym as a window into understanding and intervening in wider gender disparities in physical activity. Using a triangulated strategy of qualitative methods, including semi-structured interviews, drawing, and journaling with men and women in a mid-sized Canadian city, we examine how gender influences exercise practices and mobilities in gym environments. Results of our thematic analysis reveal three socio-spatial processes implicated in the gendering of physical activity: 1) embodying gender ideals, 2) policing gender performance, and 3) spatializing gender relations. A fourth theme illustrates the situated agency some individuals enact to disrupt gendered divisions. Although women were unduly disadvantaged, both women and men experienced significant limitations on their gym participation due to the presiding gendered social context of the gym. Gender-transformative interventions that go beyond engaging women to comprehensively contend with the place-based gender relations that sustain gender hegemony are needed. While gyms are potentially sites for health promotion, they are also places where gendered inequities in health opportunities emerge

Anterior cruciate ligament injury: Towards a gendered environmental approach

Background: The anterior cruciate ligament (ACL) injury rate for girls/women has not changed in over 20 years, and they remain 3-6 times more likely to experience injury compared with boys/men. To date, ACL injury prevention and management has been approached from a sex-based biological point of view which has furthered our understanding of injury risk factors, mechanisms, and prevention and rehabilitation programmes. However, the traditional sex-based approach does not take into account the growing recognition of how sex and gender (a social construct) are 'entangled' and influence each other. Objective: This paper discusses the curious absence of gender as an influencer in the dialogue surrounding ACL injuries. We propose adding gender as a pervasive developmental environment as a new theoretical overlay to an established injury model to illustrate how gender can operate as an extrinsic determinant from the presport, training and competition environments through to ACL injury and the treatment environment. Approach: We draw on social epidemiological theories of the embodiment of gender and health to provide plausible examples of how gender may influence ACL injury, and demonstrate the opportunity for new, interdisciplinary research in the field. Conclusion: Over 20 years of research has failed to decrease the ACL injury rate disparity between girls/women and boys/men. Embedding gender in the study of ACL injury will heighten awareness of possible influences outside the traditional biological elements, challenge us to think about the inextricable 'entanglement' of sex and gender, and inform more effective approaches to ACL injury prevention and treatment

The mental well-being and coping strategies of Canadian adolescents during the COVID-19 pandemic: a qualitative, cross-sectional study

BACKGROUND: Qualitative research is lacking on the mental well-being of adolescents during the COVID-19 pandemic. The aim of this study was to explore the feelings and emotions adolescents experienced during the first wave of the COVID-19 pandemic and the coping strategies they identified and employed to manage those emotions. METHODS: Participants living in Canada aged 13-19 years were recruited through social media platforms and youth-serving organizations. Qualitative data were gathered from 2 open-ended questions included in a youth-informed cross-sectional online survey: What feelings and emotions have you experienced around the pandemic? and What coping strategies have you used during the pandemic? We collected data from June 2020 to September 2020. A summative content analysis was undertaken to analyze survey responses inductively. RESULTS: A total of 1164 open-ended responses from Canadian adolescents (n = 851; mean age 15.6, standard deviation 1.7, yr) were analyzed. We identified 3 major themes within the category of feelings and emotions associated with the pandemic: sociospatial and temporal disconnections, emotional toll of the pandemic and positives amid the pandemic. Within the category of coping strategies used during the pandemic, 2 major themes were identified: connecting online and outdoors, and leisure and health-promoting activities. INTERPRETATION: Although the emotional toll of the first wave of the COVID-19 pandemic is evident, participants in our study adopted various positive coping strategies to mitigate their distress, including physical activity, safe peer interactions and hobbies. The results have important implications for public health policy and practice during pandemic times, emphasizing the importance of accessible mental health resources for those experiencing psychological distress

Working out across Canada: Is there a gender gap?

Globally, boys and men are more physically active than girls and women. Despite geographical variation in physical activity participation and gender differences across types of physical activities, physical activity is frequently assessed at national scales using only select indicators. Using 2012 Canadian Community Health Survey data, we undertake a gender‐based analysis using cross tabulations, chi‐square tests, and binary logistic regression models to investigate whether gender differences in physical activity vary across geographical scales and physical activity types in Canada. We examine: (1) whether gender gaps in physical activity change across geographical scale (national, provincial, city); (2) if any geographical variation in gender differences varies by activity type (active leisure time, weight‐training, home exercises); (3) whether age and/or income help to explain geographical variation in gender differences in physical activity; and (4) if gender, age, marital status, education, and income level predict variation in differences in physical activity at different geographical scales. Results demonstrate that both scale and activity type matter for how gender differences in physical activity are observed. By zooming in or out, or by changing the activity lens, gender gaps emerged or disappeared. We conclude that physical activity interventions need to be gender‐sensitive in ways that are place‐specific

Children's perspectives on neighbourhood barriers and enablers to active school travel: A participatory mapping study: Children's perspectives on active school travel

Children today are spending more sedentary time indoors than time playing and being active outdoors. The daily journey to and from school represents a valuable opportunity for children to be physically active through active school travel. The majority of research on children's active school travel omits children from the research process even though children interpret their environments in fundamentally different ways than adults. Our research uses innovative participatory mapping and qualitative GIS methods to examine how children's perceptions of their environments influence their school journey experiences. Through our thematic analysis of 25 map‐based focus groups, we identified three main themes characterizing barriers and enablers to active school travel: safety‐related, material, and affective features. By positioning children as experts of their environments in our participatory methodology, our findings provide an important counterpoint to the adultist privilege characterizing the majority of research on children's active school travel. Environmental features that mattered for children's school journeys took on multiple meanings in their eyes, demonstrating that children's perspectives must be engaged to inform interventions to promote active school travel. We thus argue that identifying barriers and enablers to active school travel for children requires engaging children's views

The mental well-being and coping strategies of Canadian adolescents during the COVID-19 pandemic: a qualitative, cross-sectional study

Background: Qualitative research is lacking on the mental well-being of adolescents during the COVID-19 pandemic. The aim of this study was to explore the feelings and emotions adolescents experienced during the first wave of the COVID-19 pandemic and the coping strategies they identified and employed to manage those emotions.Methods: Participants living in Canada aged 13–19 years were recruited through social media platforms and youth-serving organizations. Qualitative data were gathered from 2 open-ended questions included in a youth-informed cross-sectional online survey: “What feelings and emotions have you experienced around the pandemic?” and “What coping strategies have you used during the pandemic?” We collected data from June 2020 to September 2020. A summative content analysis was undertaken to analyze survey responses inductively.Results: A total of 1164 open-ended responses from Canadian adolescents (n = 851; mean age 15.6, standard deviation 1.7, yr) were analyzed. We identified 3 major themes within the category of feelings and emotions associated with the pandemic: sociospatial and temporal disconnections, emotional toll of the pandemic and positives amid the pandemic. Within the category of coping strategies used during the pandemic, 2 major themes were identified: connecting online and outdoors, and leisure and health-promoting activities.Interpretation: Although the emotional toll of the first wave of the COVID-19 pandemic is evident, participants in our study adopted various positive coping strategies to mitigate their distress, including physical activity, safe peer interactions and hobbies. The results have important implications for public health policy and practice during pandemic times, emphasizing the importance of accessible mental health resources for those experiencing psychological distress

External ureteric stent versus internal double J stent in kidney transplantation:a retrospective analysis on the incidence of urological complications and urinary tract infections

INTRODUCTION: Urologic complications (UCs) and urinary tract infections (UTIs) are common after kidney transplantation. Intraoperative stent placement at the vesicoureteric anastomosis reduces UC risk, but increases UTI risk.METHODS: In 2014 our stenting protocol changed from external ureteric stent (ES) to internal double J stent (DJ). We retrospectively studied the occurrence of UCs and UTIs in relation to ES or DJ in 697 kidney recipients.METHODS: An ES was used in 403 patients (57.8%), in 294 (42.2%) a DJ. ES was removed 7-12 days and DJ 3-4 weeks post-operative. Induction immunosuppression was the same in both groups. Primary outcomes at 6 months follow-up were UC (urinary leakage/ureter stenosis) and UTI; they were related to stenting procedure and clinical and transplant characteristics. The incidence of UCs was similar for ES (8.4%) and DJ (6.8%), p=0.389. ES use was a significant risk factor for UTI (OR 1.69 (1.15-2.50), p=0.008). Post-transplant hospitalization was significantly shorter in the DJ group. Despite more acute rejection episodes with ES (ES/DJ: 16.4%/6.1%, p&lt;0.001), no clinical relevant differences in graft outcomes existed.DISCUSSION: A DJ is, compared to ES, associated with a lower incidence of UTIs and comparable occurrence of UCs and is therefore the preferred technique for stenting the vesicoureteric anastomosis.</p

Factors associated with the quality of life of family carers of people with dementia: a systematic review

Introduction: Family carers of people with dementia are their most important support in practical, personal and economic terms. Carers are vital to maintaining the quality of life (QOL) of people with dementia. This review aims to identify factors related to the QOL of family carers of people with dementia. Methods: Searches on terms including ‘carers’, ‘dementia’, ‘family’ and ‘quality of life’ in research databases. Findings were synthesised inductively, grouping factors associated with carer QOL into themes. Results: 909 abstracts were identified. Following screening, lateral searches and quality appraisal, 41 studies (n=5,539) were included for synthesis. Ten themes were identified: demographics; carer-patient relationship; dementia characteristics; demands of caring; carer health; carer emotional wellbeing; support received; carer independence; carer self-efficacy; and future. Discussion: The quality and level of evidence supporting each theme varied. We need further research on what factors predict carer QOL in dementia and how to measure it