Developing indicators to measure the different facets of food security presents numerous conceptual and methodological challenges. This paper adopts an ecological framework to reflect on these issues through an examination of the Healthy Food Basket (HFB) tool. The HFB tool is used to measure food security conditions by determining the cost and availability of a group of foods in a shopping basket across a range of stores in different regions and neighbourhoods. The paper discusses the ability of the HFB tool to describe micro-, meso- and macro-level influences on food security and the use of the ecological model in developing complementary and alternative strategies for understanding and monitoring food security.
In this case study, we explore the intersections of neoliberal educational reform and the everyday experiences of people living in a rural region in northern British Columbia, Canada. Reflecting on the provincial Ministry of Education's Strategic Plan, we explore one region's responses to a set of provincial promises, which include providing regional school districts with more autonomy and control over the delivery of education services and a mandate for a balanced budget. The region faced declining student enrolments and funding shortfalls. As a cost-saving measure, the local school district in the region launched a four-day school week. We used ethnographic fieldwork techniques to examine a set of local practices and consequences that arose following the implementation of this measure. The findings demonstrate how provincial promises of educational reform can conflict with local educational needs and create a set of problematic everyday realities with repercussions on youth health, amplifying health inequalities that are irreconcilable with the purported goals of advancing the interests of students and society.
We undertook this qualitative study to examine young people's understandings of the physical and social landscape of the downtown drug scene in Vancouver, Canada. In-depth interviews were conducted with 38 young people ranging from 16 to 26 years of age. Using the concept of symbolic violence, we describe how one downtown neighborhood in particular powerfully symbolizes 'risk' among local youth, and how the idea of this neighborhood (and what happens when young people go there) informs experiences of marginalization in society's hierarchies. We also discuss the complex role played by social networks in transcending the geographical and conceptual boundaries between distinct downtown drug-using neighborhoods. Finally, we emphasize that young people's spatial tactics within this downtown landscape - the everyday movements they employ in order to maximize their safety - must be understood in the context of everyday violence and profound social suffering.
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The paper is based on an ethnographic study conducted in a rural community in British Columbia, Canada. The study examined the impact of community culture on youth's development as sexual beings. We describe how social and geographical forces intersect to affect youth's lives and trace the ways in which deprivation of various forms of capital as well as social practices contribute to some youth being located in undesirable social positions. Our findings illustrate how the effects of stigmatisation, self-segregation, and other forms of symbolic violence can extend beyond health impacts and into the broader social realm.
Northeastern British Columbia, Canada, is undergoing in-migration of young people attracted by jobs in the oil/gas sectors. Chlamydia rates among youth ages 15-24 are increasing and exceed the provincial average by 22%. Testing for sexually transmitted infections (STIs) reduces the disease burden, contributing to prevention. We conducted ethnographic fieldwork, including interviews with 25 youth and 14 service providers, to document their perceptions regarding youth's access to STI testing. Five key barriers to access were identified: limited opportunities for access, geographic inaccessibility, local social norms, limited information, and negative interactions with providers. To address youths' needs, we recommend active STI prevention and testing service delivery models that incorporate a locally tailored public awareness campaign, outreach to oil/gas workers, condom distribution, expanded clinic hours and drop-in STI testing, specialized training for health care providers, and inter-sectoral partnerships between public health, non-profit organizations, and industry.
Little is known about service providers' knowledge, attitudes, and experiences in relation to the assessment, diagnosis, and treatment of individuals seeking care for sexually transmitted infections (STIs), and how they influence the delivery of services. The purpose of this study was to explore the perceptions of STI care providers and the ways they approached their practice.
We used a qualitative approach drawing on methods used in thematic analysis. Individual semi-structured in-depth interviews were conducted with 21 service providers delivering STI services in youth clinics, STI clinics, reproductive health clinics, and community public health units in British Columbia (BC), Canada.
Service providers' descriptions of their activities and roles were shaped by a number of themes including specialization, scarcity, and maintaining the status quo. The analysis suggests that service providers perceive, at times, the delivery of STI care to be inefficient and inadequate.
Findings from this study identify deficits in the delivery of STI services in BC. To understand these deficits, more research is needed to examine the larger health care structure within which service providers work, and how this structure not only informs and influences the delivery of services, but also how particular structural barriers impinge on and/or restrict practice.
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Noise is probably the most ubiquitous of occupational hazards. While many jurisdictions require hearing conservation programs (HCP), the most effective intervention-engineered noise controls (ENC)-is rarely implemented. We used a qualitative study design to investigate barriers to the implementation of ENC. DESIGN & STUDY SAMPLE: Fifty-five individuals at eight food and beverage manufacturers participated. In-depth interviews were conducted and analysed using grounded theory techniques. HCP audits provided contextual information.
None of the companies had fully implemented HCP as required by regulation. Many factors emerged as possible barriers to the implementation of engineered noise control, including: poor knowledge of relevant regulations, noise reduction options and the health impacts of noise; weak technical skills and experience; low ranking of noise as a hazard by stakeholders; issues around job insecurity, weak language skills; lack of 'quiet' machine options and information from equipment manufacturers; poor employer-regulator relationships; barriers to employee-employer reporting; informal valuation of ENC costs; and feasibility issues.
Potential barriers to the implementation of ENC were identified, and classified at three levels at which they operated. Many barriers could be addressed by a more rigorous application of existing HCP regulation and improvements in education, technical support, and regulatory enforcement.
Despite advances related to the provision of emergency contraception in Canada, particularly the granting of independent prescriptive authority to pharmacists in 2000, little is known about the ways in which women perceive potential barriers to using it.
In 2004, an ethnically diverse sample of 52 women living in Greater Vancouver participated in interviews that were analyzed for an assessment of women's knowledge, attitudes and experiences related to emergency contraception, with particular attention to the ways in which ethnicity affected their stories.
Participants generally misperceived emergency contraception as an abortifacient, and often mistakenly thought that it has long-term effects on health and fertility. Knowledge gaps regarding reproductive physiology impeded clear understanding of when it is most effective. Participants also reported receiving subtle and sometimes overtly stigmatizing messages from providers when they sought emergency contraception. Asian and South Asian women were particularly concerned about negative interactions with providers; for example, they feared that female providers from their sociocultural community might recognize, chastise or gossip about them. Institutional policies (e.g., a Catholic hospital's refusal to provide the method), coupled with low awareness of pharmacists' prescriptive authority, also created barriers to use.
Women's ability to benefit from emergency contraception is hampered by lack of knowledge and conservative cultural or social mores. Serious contextual and structural shifts are required before woman-centered approaches to provision of the method become the norm.
Sexually transmitted infections (STIs) are high and rising in British Columbia, Canada, and youth ages 15-24 account for a disproportionate amount of the infections. As a result, new public health interventions have increasingly turned towards media such as the internet to reach youth populations at risk for STIs/HIV. We describe youth's perceptions about online sexual health services.
We used data from in-depth, semi-structured interviews with 38 men and 14 women between the ages of 15 and 24 who discussed: online STI/HIV testing services and online counselling and education services.
In general, youth are familiar with, receptive to and have an affinity for online sexual health services. Youth in the current study suggested that online STI/HIV risk assessment and testing as well as online counselling and education could enhance opportunities for low-threshold service provision. Online services appealed to youth's needs for convenience, privacy, as well as expedient access to testing and/or counselling; however, youth also appear to have relatively low tolerance for technologies that they perceive to be antiquated (e.g., printing lab requisition forms), revealing the challenges of designing online approaches that will not quickly become outdated.
Globally, pilot programs for Internet-based sexual health services such as online testing and partner notification have shown promising results. As Canadian interventions of this type emerge, research with youth populations can provide relevant insights to help program planners launch effective interventions.
North America's first supervised injection facility (SIF) was established in Vancouver, Canada, in 2003. Although evaluation research has documented reductions in risk behavior among SIF users, there has been limited examination of the influence of operational features on injection drug users' access to these facilities. We conducted an ethnographic study that included observational research within the SIF, 50 in-depth individual interviews with SIF users, and analysis of the regulatory frameworks governing the SIF. The government-granted exemption allowing the facility to operate legally imposes key operating regulations, as well as a cap on capacity, which results in significant wait times to enter the injecting room. Regulations that prohibit practices that are common in the local drug culture also negatively affect SIF utilization. Restructuring policies that shape the operation of the SIF could enhance access to the facility and permit SIF services to better accommodate local drug use practices.