Dissertations / Theses on the topic 'Obesity Social environment'

The purpose of this study was to investigate time commitment, self-efficacy and social environment as it relates to physical activity in a selected sample of hypertensive African Americans. In addition, this study focused on identifying additional research areas in regards to hypertensive African Americans. This study utilized a quantitative method for data collection. The survey instrument utilized contained the following subtopics: (1) demographics;(2)hypertension risk factors;(3) prevention and treatment;(4)hypertension knowledge, and (5)physical activity participation. Data collected did not support the hypotheses or information contained in the review of literature. It was revealed from data collection that 69% of the respondents (n=90) disagreed with the survey statement that â exercise takes too much of my time (time commitment).â Fifty-two percent of the respondents (n=68) either disagreed or strongly disagreed with the statement â exercise tires me (self-efficacy belief).â Forty-three percent of the respondents (n=56) disagreed with the statement â my spouse (or significant other) does not encourage exercise.â There is a need for future investigation to examine how additional barriers to physical effect activity African Americans individually, and is there a culmination of specific barriers to physical activity that work in conjunction to inhibit African Americans to engage in physical activity.<br>Ph. D.

A lack of adequately built environments can negatively affect obesity rates among adolescents. The purpose of this quantitative cross-sectional study was to determine if there is a relationship between the presence of built environments and childhood obesity among the immigrant population living in Cobb County Georgia. The social ecological model was used to explain how environmental factors may influence behavior. The research questions addressed whether walkability and elements of built environments such as to healthy foods and access to parks and recreational areas of census tracts affect childhood obesity when adjusting for race/ethnicity and immigrant population in Cobb County. Data was collected from government websites. Student enrollment, school ethnicity, and free/reduced lunch data were retrieved from the website, School Digger, which gathered their information from the National Center for Education Statistics, U.S. Department of Education, the U.S. Census Bureau, and the Georgia Department of Education data sources. Average BMI data were gathered from the Georgia Department of Education 2016-2017 Georgia fitness assessment report. Data were analyzed using independent t-test, Pearson correlation and 1-way ANCOVA. Findings showed a statistical significance with the existence of farmer's markets and child obesity but no significance among the other built environment variables. The results from this study can help community leaders develop an inclusive plan to reduce the occurrence of obesity in adolescents within the target area.

Obesity is currently viewed as one of the most important health concerns in the United States. Researchers have minimally investigated perspectives surrounding obesity within the African-American female population. This lack of research presented a gap in knowledge concerning the perceived social, environmental, and cultural influences of obesity within this population. The research questions asked African-American females about their views toward these influences. This research was guided by tenets of the social cognitive theory and the transtheoretical model for behavioral change. Thirteen African-American females participated in the interviews. The data collected were reviewed and coded using word frequencies and themes. Findings included recurring themes of cultural influences, social disparities, and the lack of access to healthy food sources and health providers. Positive social change could result from this research to help enlighten public health professionals and community planners to understand the perspectives of African-American women's belief systems surrounding obesity. The information delivered by this research could possibly empower the participants to address the issues within their communities with civic leaders and policy makers to create and sustain needed change.

Data were collected from 60 parents of children 5-11 years of age to describe the parental and family factors and explore the associations of these factors with children's Body Mass Index (BMI) percentiles. Mother's made up 81.7% of the sample. Whites/Caucasians comprised 88.3% of the sample. Males comprised 51.6% of the child participants while females comprised 48.3%. Among the child participants, 38.3% had BMI equal to or greater than the 95th percentile, and 6.7% had BMI 85th to less than 95th percentile. Concerns about child weight (rs = 0.582), pressure to eat (rs = -0.433), and monitoring (rs = 0.348) were found to be significantly associated with children's BMI percentile. There are variations in influence of parenting and home environments on children's eating and physical activity, and in the eating and physical activity habits amongst families. Consideration of parental and family factors is needed in developing child obesity prevention programs.

Background: Obesity and physical inactivity rates have reached epidemic levels in Canada, but differ based on whether they are self-reported or directly measured. Canadian research examining the combined and independent effects of social and built environments on adult physical activity (PA) and body mass index (BMI) is limited. Furthermore there is a lack of Canadian studies to assess these relationships using directly measured PA and BMI. Objectives: The objectives of this thesis were to systematically compare self-reported and directly measured PA and to examine associations between neighbourhood built and social environmental factors with both self-reported and directly measured PA and overweight/obesity in adults living in Ottawa, Canada. Methods: A systematic review was conducted to identify observational and experimental studies of adult populations that used both self-report and direct measures of PA and to assess the agreement between the measures. Associations between objectively measured neighbourhood-level built recreation and social environmental factors and self-reported individual-level data including total and leisure-time PA (LTPA) and overweight/obesity were examined in the adult population of Ottawa, Canada using multilevel models. Neighbourhood differences in directly measured BMI and PA (using accelerometry) were evaluated in a convenience sample of adults from four City of Ottawa neighbourhoods with contrasting socioeconomic (SES) and built recreation (REC) environments. Results: Results from the review generally indicate a poor level of agreement between self-report and direct measures of PA, with trends differing based on the measures of PA, the level of PA examined and the sex of the participants. Results of the multilevel analyses identified that very few of the built and social environmental variables were ii significantly associated with PA or overweight/obesity. Greater park area was significantly associated with total PA in females. Greater green space was shown to be associated with lower odds of male LTPA. Factors from the social environment were generally more strongly related to male outcomes. Further to the recreation and social environment, factors in the food landscape were significantly associated with male and female PA and overweight/obesity. Results of the directly measured PA and BMI investigation showed significant neighbourhood-group effects for light intensity PA and sedentary time. Post-hoc tests identified that the low REC/high SES neighbourhood had significantly more minutes of light PA than the low REC/low SES. BMI differed between the four neighbourhoods, but the differences were not significant after controlling for age, sex and household income. Conclusions: Results of this dissertation show that the quantity of PA can differ based on its method of measurement (i.e. between self-report and direct methods) with implications for the interpretation of study findings. It also identifies that PA and BMI can differ by neighbourhood and recognizes that the relationships between neighbourhood environments and PA and body composition are complex, may be differ between males and females, and may not always follow intuitive relationships. Furthermore it suggests that other factors in the environment not examined in this dissertation may influence adult PA and BMI and that longitudinal and intervention studies are needed.

Background: Childhood excess weight and family food insecurity are food-system related public health problems that exist in Canada. Since both relate to issues of food accessibility and availability, which have elements of “place”, they may share common risk factors in the local environment that are amenable to intervention. In this area of research, the literature derives mostly from a US context, and there is a dearth of high quality evidence, specifically from longitudinal studies. Objectives: The main objectives of this thesis were to examine the adjusted associations between the place factors: material deprivation, social deprivation, social cohesion, disorder, and living location, with change in child BMI Z-score and with change in family food insecurity status in a Canadian cohort of children. Methods: The Québec Longitudinal Study of Child Development was used to meet the main objectives of this thesis. Response data from six collection cycles (4 – 10 years of age) were used in three main analyses. The first analysis examined change in child BMI Z-score as a function of the place factors using mixed models regression. The second analysis examined change in child BMI Z-score as a function of place factors using group-based trajectory modeling. The third and final analysis examined change in family food insecurity status as a function of the place factors using generalized estimating equations. Results: Social deprivation, social cohesion and disorder were strongly and positively associated with family food insecurity, increasing the odds by 45-76%. These place factors, on the other hand, were not consistently associated with child weight status. Material deprivation was not important for either outcome, except for a slight positive association in the mixed models analysis of child weight status. Living location was not important in explaining family food insecurity. On the other hand, it was associated with child weight status in both analyses, but the nature of the relationship is still unclear. Conclusions: Results do not suggest that addressing similar place factors may alleviate both child excess weight and family food insecurity. More high quality longitudinal and experimental studies are needed to clarify relationships between the local environment and child weight status and family food insecurity.

El capital social, definit com els recursos als quals es té accés gràcies a la participació en grups o xarxes, ha estat reconegut com un determinant social de la salut. No obstant, el seu efecte ha estat poc investigat en relació a l’obesitat i les conductes de salut relacionades en població adolescent. Els mecanismes a través dels quals el capital social influencia diferents aspectes de la salut no estan suficientment descrits. A més, un espai poc explorat en l’estudi del capital social és el context familiar. L’objectiu general d’aquesta tesi doctoral és, doncs, investigar l’efecte del capital social en l’estil de vida, hàbits alimentaris i estatus ponderal d’una mostra d’adolescents catalans de diferents contextos socioeconòmics, amb un focus específic en l’entorn familiar. Els resultats indiquen que els diferents constructes del capital social actuen de manera separada i ens han permès caracteritzar alguns dels diversos mecanismes a través dels quals influeixen en l’estil de vida i conductes de salut en adolescents. Així mateix, en el marc d’aquesta recerca, alts nivells de capital social familiar són el factor més protector vers als indicadors de salut estudiats, i la seva influencia preval sobre el nivell socioeconòmic com a principal predictor social de salut en el nostre estudi. Investigacions futures haurien de contribuir a redefinir el paper del capital social en diferents àmbits, especialment el familiar, com a determinant social de la salut en els adolescents i en relació a altres determinants de la salut.<br>El capital social, definido como los recursos a los cuales se tiene acceso gracias a la participación en grupos o redes, ha sido reconocido como un determinante social de la salud. Sin embargo, su efecto ha sido poco investigado en relación a la obesidad y las conductas de salud relacionadas en población adolescente. Los mecanismos a través de los cuales el capital social influencia diferentes aspectos de la salud no están suficientemente descritos. Además, un espacio poco explorado en el estudio del capital social es el contexto familiar. El objetivo general de esta tesis doctoral es, pues, investigar el efecto del capital social en el estilo de vida, hábitos alimentarios y el estado ponderal de una muestra de adolescentes catalanes de diferentes contextos socioeconómicos, con un foco específico en el entorno familiar. Los resultados indican que los diferentes constructos del capital social actúan de forma separada y nos han permitido caracterizar alguno de los diversos mecanismos a través de los cuales influyen en el estilo de vida y conductas de salud en adolescentes. Así mismo, en el marco de esta investigación. Altos niveles de capital social familiar son el factor más protector hacia los indicadores de estudiados, y su influencia prevalece sobre el nivel socioeconómico como principal predictor social de salud en nuestro estudio. Investigaciones futuras deberían contribuir a redefinir el papel del capital social en diferentes ámbitos, especialmente el familiar, como determinante social de la salud en los adolescentes y en relación a otros determinantes de la salud.<br>Social capital, described as the resources that can be accessed thanks to the membership in groups or networks, has been recognized as social determinant of health. However, its effect has been little investigated in relation to obesity and its health related behaviors and in adolescent population. The pathways through which it influences different health outcomes are not sufficiently described. Furthermore, one glaring gap in the social capital related literature is the family domain. Thus, the overall aim of this dissertation is to investigate the effect of social capital on the lifestyle, eating habits and weight status of a sample of Catalan adolescents from different socioeconomic context, with a specific focus on the family environment. Results show that the different constructs of social capital act separately and have allowed to characterize some of the several mechanisms through which they influence lifestyle and health behaviors in adolescents. In the framework of this research, higher levels of social capital in the family domain are the most protective factor for the health outcomes included in this investigation, and its influence on health outplace socioeconomic status as the main social predictor of health in our study. Further research should contribute to refine the role of social capital in different domains, especially the family context, as a social determinant of health in adolescents and in relation to other determinants of health.

Background: Sugar sweetened beverages (SSBs) comprise the largest source of added sugars in US adolescents’ diets. SSB consumption is pervasive in US culture and is a critical risk factor for weight gain and obesity in adolescents. This thesis evaluates multi-level factors that influence adolescent SSB consumption. Methods: The first two aims of this thesis utilized data from the cross sectional, internet based Family Life, Activity, Sun, Health and Eating (FLASHE) study to: 1) examine availability of SSBs in multiple settings (home, school, neighborhood) and adolescent SSB consumption, 2) examine the associations between perceptions of parenting practices and adolescent SSB consumption. The third aim used focus group discussions to understand adolescents’ perceptions about SSBs. Results: We found that SSB availability in the home was an important predictor of adolescent SSB consumption, regardless of SSB availability in other settings. Also, parenting practices that facilitate adolescent SSB consumption are associated with higher adolescent SSB consumption, but discussing/negotiating SSB behaviors is not associated with adolescent SSB consumption. Adolescents’ described their attitudes, reinforcements, knowledge, and sources of influence around SSBs which are multifactorial and complex. Conclusions: This thesis identified potential targets for addressing adolescent SSB consumption through availability of SSBs at home, parenting practices, and adolescent perceptions around SSBs. These are important modifiable factors in the adolescents’ sociocultural environment that should be targeted in future dietary interventions to influence adolescent SBB consumption.

"Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Occupational Therapy, Occupational Therapy Department, College of Allied Health and Nursing, Nova Southeastern University."Obesity is a global public health issue, yet interventions to create change have been largely ineffective. Few researchers have considered obesity from the perspective of the person experiencing it, and even fewer have explored the effects obesity has on the Mexican-American population. This dissertation explored the lived experiences of Mexican-American women with obesity living along the El Paso/Mexico border. The study used occupational therapy's Lifestyle Performance Model as the orienting framework. Theoretical concepts from psychology and sociology also clarified contexts of social construction and outcomes of negative stereotyping. Using a phenomenological, qualitative design, this study answered the following research question: What are the lived experiences of Mexican-American women with obesity living along the El Paso/Mexico border? Eight women participated in the study, ranging in age from 25-45 years. The women were recruited though posted flyers and snowball sampling methods. Individual, in-depth interviewing resulted in emergent themes and subthemes that articulated the core essence of their lived experiences. The dominant themes of the study portrayed obesity as a: (a) pervasive entity, (b) disruption to a harmonious self, (c) social negotiation, (d) disconnection from self and others, and (e) product of cultural patterning. Through the voices of the participants, results showed that obesity affects physical and emotional health, which alters lifestyle performance and overall quality of life. Cultural and environmental factors also significantly influence active engagement in meaningful occupation. The data suggest a need for clinician training, student education, and advocacy skills for individuals who live with obesity. Further topics for future research and detailed recommendations regarding treatment interventions are also discussed.

This study examined personal, social, and demographic factors related to physical activity (PA) level and body mass index (BMI) in adolescent African American (AA) females. The participants were 211 AA females from selected parochial schools in a city in the southern U.S. Participants completed the Physical Activity Determinant Scale (PADS: Mitchell & Kontos, 2002), the Three Day Physical Activity Recall (3DPAR: Weston, Petosa & Pate, 1997), the Leisure Time Exercise Questionnaire (LTEQ: Godin & Shepard, 1985), and demographic items. Height and weight measures were taken to assess BMI. Results from logistic regression indicated that the personal factor was a significant (p<.001, ExpB=4.65) predictor of PA level, and the social factor (p<.05, ExpB=1.43), age (p<.05, ExpB=.74), and age at menarche (p<.05, ExpB=.80) were significant predictors of low BMI for age. Results from ANOVA revealed that late maturers had significantly (p<.05) lower BMI scores, but were no more physically active than early and average maturers. Findings suggest that female adolescent AAs exert more control over personal PA factors, than social PA factors, such as peer pressure and sport socialization. Additionally, BMI was not related to PA for this sample, suggesting that BMI may be influenced by other factors not investigated in the current study. Based on these findings, potential interventions should focus on aspects of the personal factor for increasing PA in adolescent AA females. Future investigations are needed to further explore the relationship between personal, social, and demographic factors, and PA and BMI for adolescent AA females.

Thesis (PhD)--Stellenbosch University, 2012.<br>Includes bibliography<br>ENGLISH ABSTRACT: Background/Aims: Obesity has increased rapidly in South African children and adolescents with significant variability observed among racial groups. Genes that regulate appetite have been studied in different populations worldwide, but their role in obesity among South African adolescents is unknown. The present study aimed at investigating the role of these genes, and their combined effect with physical activity in the development of obesity among South African adolescents. Methods: A total of 1564 South African school learners of Caucasian (n= 146), Mixed Ancestry (n= 872) and Black African (n= 537) ethnic groups were recruited for a research project that aimed to elucidate diabetes and the metabolic syndrome in children and adolescents attending schools in periurban areas of the Western Cape. The present case-control study included 227 obese-overweight (115 Black Africans and 112 Mixed Ancestry), and 204 normal weight (94 Black Africans and 110 Mixed Ancestry) adolescents learners. The learners were genotyped for nine polymorphisms (LEP: 19G>A, Lys36Arg, Val94Met; LEPR: Lys109Arg; Gln223Arg, Lys656Asn; CART: c.160-33G>A, c.499delA, and c.517A>G; GHRL: Leu72Met; and MC3R: Thr6Lys, Val81Ile) using allele-specific restriction enzyme analysis and automated sequencing. Genotype and haplotype associations with anthropometric variables such as body mass index (BMI), waist, hip, and mid-upper-arm circumferences (WC, HC, MUAC), and metabolic traits (fasting blood glucose, high density lipoproteincholesterol, total cholesterol), and blood pressure were further conducted. Furthermore, the type and frequency of physical activity was assessed by means of structured questionnaires; and its effect on obesity-related variables investigated in learners that were genotyped for the MC3R Thr6Lys and Val81Ile polymorphisms. Results: In a stepwise backward logistic regression analysis (containing age, gender, and LEP, LEPR, CART and GHRL polymorphisms), CART c.517A>G was independently significantly associated with obesity (OR= 5.98; 95%CI= 2.02, 21.27). CART c.517G carriers had higher MUAC (b coefficient= 1.88; 95%CI= 0.31, 3.44) while the LEPR 109Arg allele was significantly associated with decreased BMI (b coefficient = -2.36; 95%CI= -4.24, -0.47), WC (b coefficient = -5.66; 95%CI= -9.89, -1.44) and MUAC (b coefficient = -1.61; 95%CI= -3.00, -0.22); after adjusting for age, gender, and ethnicity. The haplotype containing the three LEP polymorphisms (A-A-A compared to the reference G-A-G haplotype) increased BMI (p= 0.0155), MUAC (p= 0.0146), and HC (p= 0.0128). The minor alleles of the MC3R polymorphisms decreased BMI, HC, WC, MUAC and TC; whilst only the Thr6Lys was associated with systolic and diastolic blood pressure (p= 0.0047 and 0.0027, respectively) in Mixed Ancestry learners. Doing house chores was associated with lower total cholesterol, independently and in the presence of the 81Ile allele (b coefficient = -0.355; 95%CI= 0.148, 0.561). Conclusion: To our knowledge, this is the first study that reports CART c.517A>G polymorphism as a risk factor for obesity in adolescents. Furthermore, the present study demonstrated that the MC3R polymorphisms had a positive effect on total cholesterol, which was further enhanced in physically active individuals. Similar to other studies, LEPR Lys109Arg and LEP polymorphisms were associated with variations in obesity-related variables among Black African and Mixed Ancestry South African learners.<br>AFRIKAANSE OPSOMMING: Agtergrond/Doelwitte: Vetsug het drasties toegeneem in Suid-Afrikaanse kinders en adelossente met ‘n beduidende variasie opgemerk tussen verskillende rassegroepe. Gene verantwoordelik vir regulering van eetlus is reeds wêreldwyd in verskillende bevolkingsgroepe bestudeer, maar hul rol in oorgewig Suid-Afrikaanse adolessente is onbekend. Die huidige studie was daarop gerig om ondersoek in te stel na die rol van hierdie gene en hul gekombineerde effek met fisiese aktiwiteit in die ontwikkeling van vetsug onder Suid-Afrikaanse adolessente. Metodes: ‘n Totaal van 1564 Suid-Afrikaanse leerders van Kaukasiese Afkoms (n=146), Gemengde Afkoms (n=872) en Swart Afkoms (n= 537) was gewerf in die navorsingsprojek wat ten doel gehad het om kinders en adolosente met diabetes en die metaboliese sindroom te identifiseer wat skole bygewoon het in semi-voorstedelike gebiede van die Wes-Kaap. Die huidige gevalle studie het 227 vetsugtige-oorgewig (115 Swart Afkoms en 110 Gemengde Afkoms) en 204 normale gewig (94 Swart Afkoms en 110 Gemengde Afkoms) leerders ingesluit. Die leerders was gegenotipeer vir nege polimorfismes (LEP: 19G>A, Lys36Arg, Val94Met; LEPR: Lys109Arg; Gln223Arg, Lys656Asn; CART: c.160-33G>A, c.499delA, and c.517A>G; GHRL: Leu72Met; and MC3R: Thr6Lys, Val81Ile) met die gebruik van alleel-spesifieke restriksie ensiem analises en geoutomatiseerde DNA volgorde bepalings tegnieke. Genotipiese en haplotipiese assosiasies met antropometriese veranderlikes soos liggaamsmassa indeks (BMI), middel-, heup- en mid-boarm omtrek (WC, HC, MUAC), metaboliese tendense (vastende bloed glukose, hoë-digtheid lipoproteïen-cholesterol, totale cholesterol) en bloeddruk was ook uitgevoer. Die tipe en frekwensie fisiese aktiwiteit was geassesseer deur middel van gestruktureerde vraelyste; en die uitwerking daarvan op vetsugverwante veranderlikes ondersoek in leerders wat vir die MC3R Thr6Lys en Val81Ile polimorfismes gegenotipeer was. Resultate: Statistiese ontleding (‘‘stepwise backward logistic regression analysis”), wat ouderdom, geslag en polimorfismes (LEP, LEPR, CART GHRL) ingesluit het, het getoon dat CART c.517A>G betekenisvol onafhanklik geassosiasieer was met vetsug (OR= 5.98; 95% CI= 2.02, 21.27). CART c.517G draers het ‘n hoër MUAC waarde gehad (b koeffisient = 1.88; 95%CI= 0.31, 3.44), terwyl die LEPR 109Arg alleel betekenisvol geassosieer was met verlaagde BMI ((b koeffisient = -2.36; 95%CI= -4.24, -0.47), WC (b koeffisient = -5.66; 95%CI= -9.89, -1.44) en MUAC (b koeffisient = -1.61; 95%CI= -3.00, -0.22) na die aanpassing van ouderdom, geslag en etnisiteit. Die haplotipe met die drie LEP polimorfismes (A-A-A teenoor die G-A-G verwysingshaplotipe) het die BMI (p= 0.0155), MUAC (p= 0.0146) en HC (p= 0.0128) verhoog. Die mindere allele van die MC3R polimorfismes het die BMI, HC, WC, MUAC en TC verlaag; terwyl slegs die Thr6Lys polymorfisme met sistolies en diastolies bloeddruk (p= 0.0047 en p= 0.0027, onderskeidelik) geassosieer was in Gemengde Afkoms leerders. Die verrigting van algemene huistake was geassosieer met laer totale kolesterol vlakke, onafhanklik en in die teenwoordigheid van die 81lle alleel (b koeffisient= -0.355; 95%CI= 0.148, 0.561). Gevolgtrekking: Na ons wete is hierdie die eerste studie wat die CART c.517A>G polimorfisme as ‘n risikofaktor vir vetsug in adolessente aantoon. Die huidige studie toon ook dat die MC3R polimorfisme ‘n positiewe effek op totale kolesterol gehad het, wat ook verder versterk was in fisiese aktiewe individue. Soortgelyk aan ander studies, was die LEPR Lys109Arg en LEP polimorfismes geassosieer met variasies in vetsug-verwante veranderlikes onder Suid-Afrikaanse Swart en Gemengde Afkoms leerders.<br>This research was supported by a grant from the University Research Fund of the Cape Peninsula University of Technology, Harry Crossley, University of Stellenbosch, Faculty of Health Sciences, Medical Research Council, and the National Health Laboratory Services, South Africa.

There is often an assumption that there is a right and a wrong way for consumers to behave. For example, with regard to eating, people should make food choices based on maximizing vitamins and minerals and not consuming more calories than one expends in a day. Likewise, it is assumed that buying products to conspicuously signal a message to another is wasteful and maladaptive. The research in this thesis challenges these assumptions and argues that these behaviours can be both adaptive and maladaptive depending on one’s environmental conditions. In this thesis, I describe three experiments that examine how perception of environmental harshness affects appetite for different types of foods. The data shows that food desirability in adulthood varies depending on early childhood socio-economic status, the type of environmental stressor (harsh social, harsh economic and harsh physical safety) and the intensity of the stressors within each of these environments. It was also found that different types of environmental harshness differentially affects food desire based on energy density and food category type. In addition to the experiments on harshness and food desirability, I have examined how environmental harshness affects desire for products that are used to conspicuously signal information to others. For example, under conditions of environmental stress, products may be used to advertise that a male possesses financial or physical power which is desirable to a potential mate. Likewise, a women may buy products to display she possess financial power or she may purchase products that augment her beauty and sexual attractiveness. These studies reveal that product desire is also affected by different types of environmental harshness and the intensity of the stress generated by these environmental conditions. Through the research described in this thesis, we gain a more comprehensive understanding of the proximate variables that influence two subsets of consumer behaviour, namely food desire and product signalling, and how these behaviours may have been selected for due to their adaptive value.

November 2011. "Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Occupational Therapy Department, College of Allied Health and Nursing, Nova Southeastern University." Childhood obesity has been identified as a serious public health concern for over a decade. To date, no one has examined the complex interactions which seem to be occurring within this epidemic using an exploratory approach. The purpose of this qualitative research study was to explore the complex interaction between the decisions mothers make when attempting to promote health in their children and the environmental factors which influence these decisions. A grounded theory approach guided this exploration. Eleven mothers of children aged 7-12 participated in this study. Data collection included two semi-structured interviews, personal diary entries, a parenting style questionnaire, and a demographic data sheet. Constant comparative analysis resulted in six main themes. These include: Managing Time, Managing Chaos; Managing Health from a Distance; Cultural Infatuation with Food (food is always available); Fluctuating Challenges and Supports; Strategies; and Resulting Actions/Interactions. Additionally, this research resulted in a proposition and substantive-level theory which helps illustrate and explain the complex interactions between the mothers and the surrounding context as well as the resultant influence on performance.

Determining the level of belief one has in themselves, or their self-efficacy, can be a key factor to improve certain dietary patterns and choices in the rural youth population. Sugar sweetened food and beverage consumption continues to rise and fruit and vegetable intake remains a struggle in rural areas; addressing both the food environment and adolescents’ self-efficacy could have a lasting impact on changing the nature of a generation of rural student’s food and beverage choices. This study measured self-efficacy levels of (n=425) adolescents in rural Kentucky and North Carolina using the Youth Impact Questionnaire and dietary intake using the NHANES Dietary Screener. Multiple linear regression analysis found that higher levels of self-efficacy resulted in a statistically significant ability to consume more vegetables. Further associations found that higher levels of self-efficacy resulted in increased fruit consumption, and improved added sugar food and beverage selections. These findings suggest that it could be beneficial to target adolescents’ self-efficacy as a way to modify certain health behaviors in a sparse food environment such as these rural Appalachian areas.

Lo Wing-sze.<br>One booklet (14 p. : col. ill. ; 21 cm.) mounted on leaf 156.<br>Thesis (M.Phil.)--Chinese University of Hong Kong, 2005.<br>Includes bibliographical references (leaves 100-113).<br>Abstracts in English and Chinese; questionnaires also in Chinese.<br>Acknowledgements --- p.ii<br>Abstract --- p.iii<br>Abstract (Chinese Version) --- p.v<br>Publications<br>Table of Contents --- p.viii<br>List of Figures --- p.xiii<br>List of Tables --- p.xv<br>List of Abbreviations --- p.xviii<br>Chapter Chapter One: --- Introduction<br>Chapter 1.1 --- Childhood obesity trends and measurement in Hong Kong and Elsewhere in the recent decade --- p.1<br>Chapter 1.2 --- Health consequences of childhood obesity --- p.3<br>Chapter 1.3 --- Determinants of childhood obesity --- p.4<br>Physical inactivity --- p.4<br>High-fat diet --- p.5<br>Chapter 1.4 --- Parental eating attitudes on family food environments --- p.6<br>Home food purchasing and availability --- p.6<br>Family meal frequency and location --- p.7<br>Child feeding practices- the food and eating rules --- p.8<br>Chapter 1.5 --- The relationship of socioeconomic status and obesity --- p.8<br>The economic status of households in Hong Kong --- p.10<br>Chapter 1.6 --- Targeting children aged three and four years --- p.12<br>Chapter 1.7 --- Conceptual framework and study objectives --- p.13<br>Chapter Chapter Two: --- Survey Design<br>Chapter 2.1 --- Sample design and subject recruitment --- p.15<br>Chapter 2.2 --- Survey methods --- p.17<br>Anthropometric measurement --- p.17<br>Lifestyle questionnaire --- p.18<br>Three-day 24-hour dietary intake recall --- p.20<br>Chapter 2.3 --- Data management and analysis methods --- p.23<br>Anthropometric measurements --- p.23<br>Lifestyle questionnaire --- p.24<br>Three-day 24-hour dietary intake recall --- p.24<br>Socioeconomic status (SES) of the subjects (Households) --- p.25<br>Chapter 2.4 --- Ethics --- p.25<br>Chapter Chapter Three: --- Results<br>Chapter 3.1 --- Responses to various components of the survey --- p.26<br>Chapter 3.2 --- Socioeconomic status and related characteristics of the households --- p.28<br>Chapter 3.3 --- Characteristics of the preschooler and their carers --- p.34<br>Preschooler s weight status --- p.34<br>Preschooler s growth --- p.35<br>Other characteristicsof the preschoolers --- p.37<br>Chapter 3.4 --- Home food purchasing and its determinants --- p.40<br>Chapter 3.5 --- Family meal frequency and location --- p.43<br>Chapter 3.6 --- Preschoolers' meal preparation activities --- p.48<br>Chapter 3.7 --- Food and eating rules and mealtime activities --- p.50<br>Chapter 3.8 --- Child's sedentary activities patterns and parental perceptions --- p.53<br>Chapter 3.9 --- "Parental perceptions of preschooler's height and weight, and eating habits" --- p.57<br>Chapter 3.10 --- Nutrient intakes of the preschoolers --- p.59<br>Chapter 3.11 --- Food consumption patterns of the preschoolers --- p.63<br>Chapter 3.12 --- Meal and snack patterns of the preschoolers --- p.67<br>Chapter 3.13 --- Main contribution of food sub-groups to energy and various nutrient intakes for preschoolers --- p.69<br>Chapter 3.14 --- Intakes of energy and various nutrients from foods eaten at home and outside home --- p.72<br>Chapter 3.15 --- "Associations of parental feeding practices, preschoolers' nutrient intakes and physical activity patterns with childhood overweight and obesity" --- p.75<br>Parental feeding practices and attitudes toward healthy eating by preschoolers'weight status --- p.75<br>Activity patterns of the preschoolers by weight status --- p.76<br>Energy and various nutrient intakes of the preschoolers by weight status --- p.77<br>Chapter Chapter Four: --- Discussion<br>Chapter 4.1 --- Childhood obesity rate by SES group --- p.80<br>Chapter 4.2 --- Characteristics of the preschoolers and the households --- p.81<br>Chapter 4.3 --- High SES families dined together less frequently than their low SES counterparts --- p.84<br>Chapter 4.4 --- Preferences of family members as an influential factor in purchasing fruits and vegetables --- p.86<br>Chapter 4.5 --- Encouraging healthy food shopping practices with the preschoolers --- p.87<br>Chapter 4.6 --- Food and eating rules imposed by parents may influence preschooler's eating habits and nutrient intakes --- p.88<br>Chapter 4.7 --- Preschooler's sedentary activities patterns --- p.89<br>Chapter 4.8 --- Incorrect parental perceptions of preschooler's weight --- p.91<br>Chapter 4.9 --- Nutrient intakes of the preschoolers overall --- p.91<br>Chapter 4.10 --- Comparing the nutrient intakes of the preschoolers with another study carried out in 2000 --- p.93<br>Chapter 4.11 --- Parental/preschooler association on fruit and vegetable consumption --- p.94<br>Chapter 4.12 --- Main contributors of food sub-groups to energy and various nutrient intakes for the preschoolers by SES group --- p.95<br>Chapter 4.13 --- "Differences in family food environments, feeding practices, eating habits and nutrient intakes of preschoolers by maternal education level and mother's employment status" --- p.95<br>Chapter 4.14 --- Strengths and limitations of the study --- p.96<br>Chapter Chapter Five: --- Conclusions and Recommendations --- p.99<br>References --- p.100<br>Appendices<br>Chapter A1 --- Invitation letter to principals (English version) --- p.114<br>Chapter A2 --- Invitation letter to principals (Chinese version) --- p.117<br>Chapter B --- Summary of the background information of the participating schools --- p.120<br>Chapter C1 --- Consent form and letter to parent(s) or guardian(s) (English version) --- p.121<br>Chapter C2 --- Consent form and letter to parent(s) or guardian(s) (Chinese version) --- p.123<br>Chapter D --- Paper fans with food and physical activity pyramid pictures --- p.125<br>Chapter E --- Health report --- p.126<br>Chapter F1 --- Lifestyle questionnaire (English version) --- p.127<br>Chapter F2 --- Lifestyle questionnaire (Chinese version) --- p.136<br>Chapter G1 --- 24-hour dietary recall forms (English version) --- p.144<br>Chapter G2 --- 24-hour dietary recall forms (Chinese version) --- p.150<br>Chapter H --- Food photo booklet --- p.156<br>Chapter I1 --- Table: Households receiving social benefits by paternal occupations (p<0.001) --- p.157<br>Chapter I2 --- Table: Summaries some of the characteristics of the surveyed preschoolers by gender and altogether --- p.158<br>Chapter I3a --- Table: Preschooler's parents' age --- p.159<br>Chapter I3b --- Table: Parents age by SES --- p.159<br>Chapter I4 --- Table: Factors considered by interviewee when buying food items --- p.160<br>Chapter I5 --- Table: Cost as a factor of buying queried food items by SES income group --- p.161<br>Chapter I6 --- Table: Frequencies of eating out or having takeaway meals in/from different types of caterers by SES group --- p.162<br>Chapter I7 --- Type of utensils used to feed the preschoolers by SES group --- p.162<br>Chapter I8 --- Preschoolers' activities during dinner by SES group --- p.163<br>Chapter I9 --- "Proportion of interviewees with adequate fruit, vegetable, and both fruit and vegetable intakes per day by SES group" --- p.163

Contexte : Jusqu'à présent, les résultats de la recherche de contextes environnementaux et les comportements antécédents de l’obésité pédiatrique n'ont pas été cohérents. But : L’objectif global de cette thèse est d'étudier l'association entre les caractéristiques des parcs, des écoles et des quartiers résidentiels avec des indicateurs liés à l'adiposité : 1) De regroupés les parcs par leurs caractéristiques saillantes et déterminer si certains " types " de parcs sont associés à l'activité physique (AP) et à l'adiposité ; 2) Décrire les écoles en fonction de leurs caractéristiques d’environnement bâties (EB) et sociales prédominantes pour l'AP et d’explorer leurs associations avec l'AP; 3) Déterminer si les caractéristiques théoriquement marchable de l'EB résidentiel sont associées aux comportements de mouvement de 24 heures (sommeil, sédentarité, AP légère (APL), AP modérée à vigoureuse (APMV)) dans les analyses transversales et prospectives. Méthodes : Les données proviennent de la cohorte QUALITY, une étude québécoise portant sur 630 enfants, âgés de 8 à 10 ans lors du recrutement, et ayant une histoire d’obésité parentale. Les environnements des parcs, des résidences et des écoles de 512 participants habitant la Région métropolitaine de Montréal ont été caractérisés. Les données comprenaient des données administratives, de recensement et des observations directes y compris des questionnaires complétés par un membre du personnel de l’école. L'AP des jeunes a été auto rapporté et mesuré par accéléromètres au temps 0 et au suivi 2 ans plus tard. La sédentarité a été mesuré aux deux temps à l'aide d'accéléromètres et le sommeil a été calculé basé sur le temps pendant lequel l'accéléromètre n'était pas porté. L’adiposité a été mesuré avec un DXA au temps 0. L'indice de masse corporelle a été calculé aux deux temps. Les données ont été analysées avec l’analyse en composantes principales, l'analyse en grappes, la régression linéaire et logistique, les équations d'estimation généralisées et l'analyse des données compositionnelles. Résultats : Certaines caractéristiques particulières des parcs, des écoles et des aspects « marchables » des quartiers ont été associées aux résultats liés à l'adiposité chez les participants. Les types de parcs qui offraient des possibilités de jeux non structurés et une variété d'AP étaient associés à l'AP autodéclarée, et les parcs esthétiquement agréables étaient également associés à l’adiposité réduite. Les écoles qui offraient des possibilités de jeux non structurés et qui encourageaient l'AP étaient associées à l'AP. Les caractéristiques « marchables » des quartiers étaient associées à une augmentation de l'APMV et à une diminution du sommeil, de la sédentarité et de l'APL sur une période de 24 heures chez les filles. Conclusion : Cette thèse contribue à la littérature en examinant trois influences contextuelles importantes sur les résultats liés à l'adiposité chez les enfants. Ces environnements ont été caractérisés de façon objective, en opérationnalisant leurs principales caractéristiques et en utilisant des approches statistiques novatrices. Les résultats appuient le concept que la prévention de l'obésité et les efforts visants à accroître l'AP devraient inclure la prise en compte des EB et sociaux et devraient cibler les multiples facteurs qui favorisent des comportements sains chez les enfants.<br>Background: Paediatric obesity is a global public health concern. In order to identify potential population-based intervention and prevention strategies, environmental contexts are being investigated in relation to childhood obesity and antecedent behaviours, including physical activity (PA). However, to date, findings in the area have been inconsistent. Purpose: The overarching goal of this thesis is to investigate the association between features of parks, school and neighbourhood environments in relation to adiposity-related outcomes. Specifically: 1) To group and characterize parks by their salient features and to determine if certain park “types” are associated with PA and adiposity outcomes; 2) To characterise schools by their predominant built and social environmental features for PA and to explore associations between school features and PA in cross-sectional and prospective analyses; 3) To determine if theoretically walkable features of the neighbourhood built environment are associated with 24-hour movement behaviours (sleep, sedentary behaviour, light physical activity (LPA), moderate-to-vigorous physical activity (MVPA)) in cross-sectional and prospective analyses. Methods: Data were drawn from the QUALITY Cohort, a Quebec-based study of 630 children age 8-10 years at baseline with a parental history of obesity. Baseline park, residential and school environments of 512 participants living in the Montreal Metropolitan Area were characterised. Data included geographically linked census and administrative data and in-person observations. Questionnaires were completed by school principals or physical education teachers. PA was measured at baseline and follow up using self-reported questionnaires and by accelerometer. Sedentary time was measured at baseline and follow up using accelerometers while sleep time was calculated as the time the accelerometer was not worn. Body fat was measured using a DXA at baseline. Overweight and obesity was identified using body mass index computed from measured weight and height at baseline and follow up. Analyses included principal component analysis, cluster analysis, linear and logistic regression, generalized estimating equations and compositional data analysis. Results: Findings point to specific features of parks, schools and theoretically walkable neighbourhood features that are associated with adiposity-related outcomes in the youth participants. Notably, certain types of parks that provide opportunities for unstructured play and a variety of physical activities are associated with self-reported PA while aesthetically pleasing parks are also associated with body fat. Schools that provide opportunities for unstructured play and that promote PA are associated with accelerometer measured PA, and the associations are different between boys and girls. Lastly, theoretically walkable neighbourhood features are associated with an increase in MVPA and a slight decrease in sleep, sedentary time and LPA over a 24-hour period among girls only. Conclusion: This thesis contributes to the literature by considering three important contextual influences on children’s adiposity-related outcomes: parks, school and the residential environment. This is done by objectively characterizing these environments, by operationalising key characteristics of them, and by using innovative statistical approaches. Findings support the notion that obesity prevention and efforts to increase PA should include the consideration and modification of built and social environments and should target the multiple population-level factors that support healthy behaviours among children.

Tese de doutoramento em Antropologia, no ramo de Antropologia Biológica, apresentada à Faculdade de Ciências e Tecnologia da Universidade de Coimbra<br>Introduction: Extracurricular sport has the potential to increase total physical activity (PA) which plays an important role in the prevention of a number of health problems, including obesity. However, most children do not achieve the recommended guidelines. Sport participation may be influenced by a number of factors, but little is know how those risk factors may vary according to children’s sex and place of residence. Objectives: This study aims to: (1) estimate the prevalence of PA in girls and boys living in urban and non-urban settings and observe the factors that may predict participation in extracurricular sport and, (2) to assess the prevalence of childhood general and abdominal obesity, and identify the underlying risk factors related to the respective obesity rates, namely intrapersonal, social, and physical environment factors. Results: Majority of children practiced at least one extracurricular sport (67.8%), usually sports that are socially associated with their own gender or have a tradition in their community. Children from bigger families, with lower family income, whose parents had lower education and reported more barriers, more gender-role notions on sport, and perceived less available facilities/sports in the neighbourhood had lower odds of participating in a sport. A positive association was found between father-son and mother-daughter physical behaviours, with mothers’ participation in organised PA being a strong predictor of girls’ participation in an extracurricular sport. Both sexes reported that boys are better at sport than girls and that sport is more important for boys than it is for girls. Boys, more than girls, reported an interest in pursuing a career in sport. Children from the non-urban setting reported more places to be active during winter but urban children reported more parental role-modelling than non-urban children. Not being interest in pursuing a sport-related career was the intrapersonal factor more negatively associated with sport participation, in both sexes and settings. A great number of children were overweight (WHO: 20.7%/IOTF: 15.9%) or obese (WHO: 7.7%/IOTF: 6.1%), with girls having significantly higher prevalence of obesity than boys (IOTF). Moreover, girls had higher prevalence of abdominal obesity than boys, and it was found that a large proportion of children that were classified as having normal weight or overweight were abdominally obese. Family income, parental education, parental BMI (particularly mothers) were predictors of childhood obesity. Also, obese children were less physically active than non-obese children. Being a girl and living in the urban setting were significantly associated with higher odds of having general and abdominal obesity. Conclusion: This study shows that participation in sport is associated with both intrapersonal and social factors, and that those factors may varied according to the level of urbanization. Boys and girls participate in sport in similar rates, but efforts should be made to change the notions that parents and children have about sport. By identifying barriers in different domains, this study reinforces that actions to promote PA are most effective when they enable alterations in different factors and include multiple levels of influence, starting in the nuclear family, but including teachers, schools, and government policies.<br>Introdução: A participação em desporto extracurricular está positivamente associada com incrementos nos níveis de atividade física (AF), que por sua vez tem um papel protetor importante em vários problemas de saúde como a obesidade. Contudo, a maioria das crianças não segue as recomendações relativas à AF. A participação em desporto extracurricular pode ser influenciada por vários fatores, mas pouco de sabe como é que esses fatores variam de acordo com o sexo e a ambiente físico. Objetivos: Este trabalho tem três objetivos: (1) estimar a prevalência de AF em rapazes e raparigas que vivem em ambientes distintos (urbano e não-urbano) e observar como diferentes fatores intrapessoais, sociais, e ambientais podem influenciar a prática de desporto extracurricular e (2) avaliar a prevalência de excesso de peso e obesidade abdominal e identificar possíveis fatores de risco relacionados. Material e métodos: Um estudo transversal foi feito em 2013-2014. A amostra inclui 793 crianças (6-10 anos) e 834 pais, a viver numa área urbana (Coimbra) e numa não-urbana (Lousã), ambas situadas na zona centro de Portugal. Os dados sobre AF (incluindo desporto extracurricular), fatores socioeconómicos e familiares, e a opinião dos pais sobre desporto foram recolhidos através de um inquérito. A opinião das crianças sobre desporto foi obtida através de uma entrevista semiestruturada. O peso, a altura, e a circunferência abdominal das crianças foram medidas. O excesso de peso (O) e a obesidade (OB) foram definidos aplicando os pontos de corte da OMS e da IOTF, enquanto a obesidade abdominal (AOB) foi calculada como WHtR≥0.50. Diferentes técnicas estatísticas foram usadas para testar os objetivos supramencionados. Resultados: A maior parte das crianças pratica um desporto extracurricular (67.8%), geralmente desportos socialmente atribuídos ao seu sexo e que existem na área de residência. Mais irmãos, menor rendimento familiar, educação parental mais baixa, e pais que identificaram mais barreiras, mais estereótipos de género, e reportaram menos locais/desportos na área de residência têm menor probabilidade de ter um filho(a) a praticar desporto. Uma relação na AF entre pai-filho e mãe-filha foi registada e a prática de AF organizada por parte da mãe aumenta a hipótese de a filha praticar desporto. Ambos os sexos afirmaram que os rapazes são melhores desportistas que as raparigas e que fazer desporto é mais importante para rapazes do que para raparigas. Mais rapazes do que raparigas mostraram interesse em ter uma carreira profissional relacionada com desporto. As crianças reportaram diferentes barreiras consoante o local onde vivem. Não ter interesse numa carreira desportiva foi o fator mais negativamente associado com a participação em desporto extracurricular. A prevalência de excesso de peso (WHO: 20.7%/IOTF: 15.9%) e obesidade (WHO: 7.7%/IOTF: 6.1%) foi elevada, principalmente nas raparigas. A prevalência de obesidade abdominal também foi mais elevada nas raparigas do que nos rapazes, e um grande número de crianças que foram classificadas como tendo peso normal ou excesso de peso, tinham obesidade abdominal. O rendimento mensal, a educação dos pais, e o BMI do pai e principalmente da mãe influenciaram a obesidade infantil. Ser rapariga e viver na área urbana aumentou significativamente o risco de obesidade infantil. Conclusão: Este estudo mostra que a participação em desporto está associada com fatores intrapessoais e sociais, e que estes fatores podem variar consoante a área de residência. Tanto rapazes como raparigas participam em desporto em números semelhantes, mas é necessário alterar a forma como os pais e filhos olham para o desporto. Ao identificar diferentes barreiras, este estudo reforça a necessidade de promover a AF através de intervenções que incluem múltiplos níveis, começando na família e incluindo professores, escolas e politicas governamentais.

Tese no âmbito do Doutoramento em Geografia, ramo de Geografia Humana, apresentada à Faculdade de Letras/Departamento de Geografia e Turismo da Universidade de Coimbra.<br>Childhood obesity has reached an epidemic level worldwide over the last forty years and is considered a major public health concern once it is a well-known risk factor for numerous diseases throughout life. Therefore, a thorough understanding of the determinants of obesity is important for the development of scientific-based preventive interventions. Socioeconomic inequalities impact health in various ways and in Portugal they have increased during the period of European economic crisis. Broader social inequalities contribute to the increase observed in the rates of childhood obesity. Furthermore, it is possible to identify patterns in the geographic distribution of childhood obesity. Evidence shows that living in urbanized areas with certain features have an impact in children weight status. Hence, research in this matter benefits from using the Social Ecological Model (SEM) which categorizes obesity determinants in different levels and serves as theoretical framework in both quantitative and qualitative studies. SEM comprises five levels: (1) the individual (knowledge, attitudes, beliefs and behaviours), (2) the interpersonal (family, peers, social networks and associations), (3) the community (social networks, schools and associations), (4) the environmental (social, economic, built) and (5) the state level (local, state, federal policies and laws to regulate/support healthy actions). This study main goal was to deepen the knowledge about the processes by which the environmental level of health determinants impact childhood obesity, namely during and after the economic crisis, using diverse methodological approaches. More specifically, it aimed to disentangle the underlying mechanisms of the association between urban environments and childhood obesity, through a geographic lens. The relation between the environment features and obesity was assessed and explored at different SEM levels. Different sets of primary and secondary quantitative data were statistically (SPSS) and geographically (GIS) analysed, to explore the associations between urban environment features and childhood obesity by itself or adjusted to other level of obesity determinants. Qualitative analysis was used to assess programs at the local level regarding its concerns about childhood obesity. This works’ results show that there is a lack of studies investigating the community, environmental and state level determinants of childhood obesity, either independently or combined, and further research is needed to test new analytical multilevel approaches in this field. Results also show that the weight status of children living in densely urbanized areas vary according to the neighbourhood environmental features and, more importantly, some neighbourhoods appear to protect for overweight and obesity, even when considering mother weight status and family socioeconomic class. Moreover, results show that the economic crisis might have enhanced the social inequalities regarding childhood obesity and that it is important to identify priority areas to tackle obesity, using an accurate assessment of the urban territory, thus aiding the creation of evidence-based strategies to lessen the social inequities in health outcomes, created by the crisis. Finally, local level governments are the more suitable entities to delineate and implement interventions to tackle childhood obesity. Such interventions should, however, be evidence-based which demands a greater proximity between academic institutions, research centres and governmental organs.<br>A obesidade infantil atingiu um nível epidémico em todo o mundo nos últimos quarenta anos e é considerada uma grande preocupação de saúde pública, uma vez que é um reconhecido fator de risco para inúmeras doenças ao longo da vida. Por isso, um conhecimento aprofundado dos determinantes da obesidade é importante para o desenvolvimento de intervenções preventivas com base em evidência científica. As desigualdades socioeconómicas impactam a saúde de várias maneiras e em Portugal aumentaram durante a crise económica europeia. Maiores desigualdades sociais contribuem para o aumento observado nas taxas de obesidade infantil. Além disso, viver em áreas urbanizadas com certas características tem impacto na composição corporal das crianças. Portanto, a investigação nesse assunto beneficia do uso do Modelo Socio-Ecológico (MSE), que categoriza os determinantes da obesidade em diferentes níveis e serve como enquadramento teórico tanto em estudos quantitativos e qualitativos. O MSE integra cinco níveis: (1) o individual (conhecimentos, atitudes, crenças e comportamentos), (2) o interpessoal (família, pares, redes e associações sociais), (3) o comunitário (redes sociais, escolas e associações), (4) o ambiental (social, económico e construído) e (5) o nível estatal (políticas e leis estatais para regular/apoiar ações saudáveis). O objetivo principal deste estudo foi aprofundar o conhecimento sobre os processos pelos quais os determinantes da saúde de nível ambiental afetam a obesidade infantil, nomeadamente durante e após a crise económica, utilizando diversas abordagens metodológicas. Mais especificamente, procurou destrinçar os mecanismos subjacentes à associação entre ambientes urbanos e obesidade infantil, através de uma perspetiva geográfica. A relação entre as características do ambiente e a obesidade foi avaliada e explorada em diferentes níveis de MSE. Diferentes conjuntos de dados quantitativos, primários e secundários, foram analisados estatisticamente (SPSS) e geograficamente (SIG), para explorar as associações entre as características do ambiente urbano e a obesidade infantil, por si só ou ajustadas a outros níveis de determinantes da obesidade. A análise qualitativa foi usada para avaliar os programas no nível local em relação às preocupações com a obesidade infantil. Os resultados deste trabalho mostram que faltam estudos que investiguem os determinantes de nível comunitário, ambiental e estatal da obesidade infantil, por si só ou em conjunto, e que é necessária mais investigação para testar novas abordagens analíticas multiníveis nesta área. Os resultados mostram também que o peso das crianças que vivem em áreas densamente urbanizadas varia de acordo com as características ambientais da vizinhança e, mais importante, mostram que alguns bairros parecem proteger para o sobrepeso e obesidade, mesmo considerando o peso da mãe e a classe socioeconómica da família. Além disso, os resultados mostram que a crise económica pode ter aumentado as desigualdades sociais em relação à obesidade infantil e que é importante identificar áreas prioritárias para combater a obesidade, utilizando uma avaliação precisa do território urbano, auxiliando na criação de estratégias baseadas em evidências para diminuir as desigualdades sociais nos resultados de saúde, criadas pela crise. Finalmente, os governos locais são as entidades mais adequadas para delinear e implementar intervenções para combater a obesidade infantil. Tais intervenções devem, no entanto, ser baseadas em evidências, o que exige uma maior proximidade entre instituições académicas, centros de investigação e órgãos governamentais.

Résumé Les préoccupations et comportements alimentaires entourant le poids sont omniprésentes chez les jeunes adolescentes et femmes qui habitent dans les cultures occidentales où les formes corporelles sont orientées vers un idéal ultra-mince. L’objectif de cette étude est d’examiner si une plus grande exposition aux endroits faisant la promotion de la minceur est associée à des préoccupations pour le poids plus élevées chez les femmes. Cette étude fait partie d’un projet intitulé ¨Social, cultural, and economic disparities and disordered eating: Understanding the contribution of neighbourhood and individual level factors¨ (Gauvin, Steiger, & Brodeur, 2009). Un échantillon de 1288 femmes âgées entre 20 et 40 ans et résidant à Montréal depuis au moins 12 mois ont répondu à un sondage téléphonique. Des régressions logistiques ont comparé les femmes se situant dans le quintile le plus élevé des préoccupations de poids avec les femmes dans les autres quintiles en fonction de leur exposition 15 jours ou plus dans des endroits faisant la promotion de la minceur. De plus, une analyse de sensibilité a vérifié si l’association demeurait significative à d’autres niveaux d’exposition. Les facteurs confondants ont été contrôlés statistiquement. Les résultats démontrent qu’une fréquentation d’au moins 15 jours par mois d’endroits faisant la promotion de la minceur est associée à des préoccupations plus élevées pour le poids. Aussi, fréquenter ces lieux entre 15 et 20 jours/mois est aussi associé à des préoccupations de poids élevées. Des interventions de santé publique pourraient viser la diminution des pressions socioculturelles vers la minceur.<br>Abstract Weight and eating-related disorders and behaviours are common among adolescent girls and young women in Western societies, where thin bodies are highly valued. The goal of this study was to examine whether or not more frequent exposure to places promoting thinness is associated with greater weight concerns among women. This study was part of a larger investigation entitled ¨Social, cultural, and economic disparities and disordered eating: Understanding the contribution of neighbourhood and individual level factors¨ (Gauvin, Steiger, & Brodeur, 2009). A sample of 1288 women aged 20 to 40 years and living in Montreal for at least 12 months responded to a telephone survey. Logistic regression analyses were performed comparing women in the highest quintile of weight concerns to women in other quintiles on frequentations of thin-promoting places 15 days or more. Further, a sensitivity analysis was performed to verify whether or not an association exists between high weight concerns and different levels of exposure to places promoting socio-cultural standards for thinness. A series of confounding variables were statistically controlled. Results showed that exposure to places promoting socio-cultural standards for thinness at least 15 days per month was significantly associated with greater weight concerns among women despite controlling for confounding variables. Further, going to places promoting thinness between at least 15 through 20 days/month was also associated greater weight concerns among women. Public health interventions could aim at reducing societal pressures to thinness.

Esta dissertação é composta por seis estudos e possui como objetivos: (i) caracterizar e determinar a prevalência de obesidade, indicadores cardiovasculares, atividade física e atividades sedentárias; (ii) estudar a relação da adiposidade com indicadores cardiovasculares; (iii) identificar a influência de fatores comportamentais e ambientais, na adiposidade; (iv) elaborar uma análise preliminar dos efeitos de um programa de intervenção sócio-ecológico na adiposidade, indicadores cardiovasculares, atividade física e atividades sedentárias. Os participantes nos estudos tinham idades entre os 10 e 17,9 anos, foram avaliados na altura, peso, perímetro da cintura e pregas de adiposidade tricipital e geminal. A capacidade cardiorrespiratória foi determinada através do teste do vaivém e para a síndrome metabólica, avaliadas a pressão arterial, perímetro da cintura, HDL, triglicerídeos e glicose. A atividade física, atividades sedentárias e maturação sexual foram avaliados por autorrelato. O programa de intervenção durou 16 meses e centrouse em quatro componentes: recreios, oferta de atividades organizadas, atividades educacionais e formação docente. Como principais resultados destacam-se: (i) a elevada prevalência de obesidade e tempo em atividades sedentárias, reduzidos níveis de atividade física e capacidade cardiorrespiratória; (ii) com o aumento da idade, verifica-se que os participantes passam mais tempo em atividades sedentárias, apresentam menores níveis de atividade física e da capacidade cardiorrespiratória e uma deterioração do perfil metabólico; (iii) uma forte associação entre a adiposidade e os indicadores cardiovasculares; (iv) a alimentação, a atividade física e o envolvimento como fatores etiológicos da adiposidade; (v) o grupo de intervenção apresenta uma redução dos níveis de adiposidade, estabilização dos níveis de atividade física e da capacidade cardiorrespiratória, e um aumento do tempo gasto em atividades sedentárias. Torna-se evidente a necessidade da elaboração de programas de intervenção de promoção de hábitos de vida saudável. Programas de intervenção socio-ecológicos podem facilitar a diminuição da adiposidade.<br>This dissertation consists of six studies and its objectives are to: (i) characterize and determine the prevalence of obesity, cardiovascular indicators, physical activity and sedentary activities, (ii) study the relationship between adiposity and cardiovascular indicators, (iii) identify the influence of behavioral and environmental factors on adiposity, (iv) do a preliminary analysis of the effects of a socio-ecological intervention program on adiposity, cardiovascular indicators, physical activity and sedentary activities. Participants in the study were aged between 10 and 17.9 years, and were assessed in height, weight, waist circumference and triceps and calf skinfolds. Cardiorespiratory fitness was assessed with the shuttle run test and the metabolic syndrome diagnostic based on measures of blood pressure, waist circumference, HDL, triglycerides and glucose. Physical activity, sedentary activities and sexual maturation were assessed by self-report. The intervention program lasted 16 months and focused on four components: provision of organized activities and recreation, educational activities and teacher training. The main results are: (i) the high prevalence of obesity and time in sedentary activities, reduced levels of physical activity and cardiorespiratory fitness, (ii) with increasing age, it appears that participants spend more time on sedentary activities, have lower levels of physical activity and cardiorespiratory capacity and deterioration of the metabolic profile (v) a strong association between adiposity and cardiovascular indicators, (vi) food, physical activity and environment as risk factors for adiposity; (vi) the intervention group shows a reduction in levels of adiposity, stabilization of the levels of physical activity and cardiorespiratory capacity, and an increase in time spent in sedentary activities. It becomes evident the need for development of intervention programs to promote habits for healthy living. Socio-ecological intervention programs can facilitate the decrease of adiposity.