The spread of COVID-19 has created stress worldwide and continues to disrupt our day-to-day lives, making it very difficult to sustain healthy habits. Even as we seek to find a new normal, health care professionals and public figures continue to encourage us to “stay home” and “take time for yourself”. For those of us who find ourselves with some extra time on our hands, this can be a good opportunity to reflect on our mental and physical health. Ask yourself these questions:

• Do you exercise daily?
• Do you give your body the proper nutrients it needs? (and no mom, that doesn’t include )
• Do you average 7-9 hours of sleep every night?
• Are you able to effectively manage your day to day stress?

Our body operates as a cohesive and interconnected system.�� If we do not manage ALL of these contributors to our health (exercise, nutrition, sleep, stress management), then the system (our mental and physical health) may fail.

Why is mindfulness an important place to start?

Over the past 20 years there has been a vast body of research linking emotional intelligence to positive physical and mental health outcomes. Emotional intelligence is defined as the ability to monitor feelings and emotions (your own and the emotions of others), to provide objective judgement, and to use this information as a guide for your thinking and actions (Salovey & Mayer, 1990). Some experts believe that emotional intelligence is the key to success for personal relationships, professional relationships, and the relationship you have with yourself (Goleman, 2006; Zinn, 2003). It has also been suggested that emotional intelligence is not an innate skill, and that we can use mindfulness practices, such as meditation, to train these competencies in order to improve our quality of life (Goleman, 2006).

An eye-opening study led by Richard Davidson and Jon Kabat-Zinn (2003) examined the benefits of practicing meditation in a business setting. After eight weeks of using meditation techniques, employees reported significantly lower levels of anxiety and stress. Additionally, when electrical activity was measured in the brains of participants, the meditation group showed a significant increase in left-side anterior brain activation (i.e., parts of the brain associated with positive emotion). They also developed more antibodies to a flu vaccine than employees who did not meditate, suggesting that in addition to the positive psychological effects, those who practiced mindfulness developed stronger immune responses. In my opinion, the most exciting takeaway from this research is that it may be possible to train our minds so that our bodies become stronger!

A Buddhist monk meditating with EEG for neuroscience research

Another study demonstrated that practiced Buddhist meditators are able to voluntarily regulate their brain activity to generate high-amplitude gamma brain waves, which have been linked to more effective memory, learning and perception (Lutz et al., 2004). Electroencephalogram (EEG) recordings were used to compare the brain activity of eight Buddhists who had been practicing meditation for 15-40 years to a group of ten healthy students who had been practicing meditation for one week prior to the study. The skilful meditators were able to sustain high-amplitude gamma brain waves and phase-synchrony (a measure linked to higher-level mental processes) during meditation and also displayed higher baseline gamma-wave activity than the student group, suggesting that mental training may induce both short- and long-term changes in the brain (Lutz et al., 2004).

Other studies have demonstrated the value of mindfulness-based stress reduction practices for medical students and health care professionals, including doctors, nurses, psychologists, social workers and physiotherapists (Shapiro et al., 1998; Jain et al., 2007; Shapiro et al., 2005). By comparing individuals who engaged in mindfulness meditation to those who did not, these studies variously showed that consistent mindfulness practice led to decreased psychological distress, lower stress levels, and less burnout. Another study assessing the self-care practices and well-being of mental health professionals found that a state of mindfulness was key in linking self-care to well-being (Richards et al., 2010). , the results of these studies could inform efforts to help workers stay healthy both mentally and physically as they courageously work through these difficult times.

Together these studies demonstrate the positive effects of mindfulness training after only a few weeks of practice. If mindfulness practices can provide benefits to corporate employees, Buddhists, students, and health care workers alike, then they can certainly be helpful to all of us. Let’s learn about these practices!

The simple practice of mindfulness

Hopefully at this point you’ve started to evaluate how you can do better with self-care, regardless of where you think you currently stand on the “healthy” scale. Now I’m going to explain two easy practices that you can try.

Breathing techniques – Bringing attention to breath is a simple and effective form of meditation (Tan, 2018). Try these simple steps:

1. Position yourself for meditation: begin by sitting comfortably. Sit in a position that enables you to be both relaxed and alert at the same time, whatever that means to you.
2. Take 3 deep breaths: take three slow deep breaths to inject both energy and relaxation into our practice.
3. Bring attention to what you are doing: breathe naturally and bring very gentle attention to your breath. You can bring attention to the nostrils, the abdomen, or the entire body of breath, whatever that means to you. Become aware of the in breath, the out breath and the space in between. If at any time you feel distracted by a sensation, thought or sound, just acknowledge it, experience it and gently let it go, then bring attention very gently back to your breath.

Practice this breathing technique for one minute. If you are able to hold you attention for longer, then you may lengthen the practice. This is about quality, not quantity, so if you feel you can’t sit still and focus for more than a few minutes, then try this exercise for 1 minute and build on it from there. And, because I like science, here is some evidence that shows what simple breathing practices can do for you. Valentine and Sweet (1999) compared long-term meditators, novice meditators (who were trained to focus on breath) and non-meditating controls on the Wilkins’ counting test which measures the ability to sustain attention. As expected, the long-term meditators displayed superior performance in sustained attention, but the more interesting finding was the difference between novice meditators and the control group. With short-term training designed to focus on breathing, the novice meditators greatly outperformed the controls in sustaining attention. This suggests that although long term meditation provides the best benefits, even simple short-term practices can give you an edge.

Journaling – This exercise only requires 3 minutes of your time (set a timer)! You will give yourself a prompt and spend 3 minutes writing whatever comes to mind. Try not to think about it too much, just let the words flow onto the paper. If you run out of things to write, just write, “I have run out of things to write” until the 3 minutes is up. You can create your own prompt or use one of the following: What I am feeling now is, I am aware that, What motivates me is, I am inspired by, Today my focus is, I wish, Others are, Love is, I am grateful for…

Once again, because I like science, Spera, Buhrfeind and Pennebaker (1994) conducted a study where laid-off professionals wrote about their feelings for twenty minutes every day for five consecutive days. These individuals found new jobs at a much faster rate than the non-writing control group. Another study found that an 8-week gratitude journaling intervention for elderly patients experiencing heart failure lead to positive physiological outcomes such as reduced inflammation (Redwine et al., 2016). Although this study used a 20-minute journaling period, it’s important to tailor these practices to you and how long you can sustain your attention. Whether that means 3 minutes, 10 minutes, or 20 minutes is up to you. That is the whole idea behind these practices: becoming more in tune with what works for you so that you can take the appropriate steps to improve your health.

When working towards a healthier lifestyle, it’s important to have as many tools in your (figurative) toolkit as possible so that you can handle any situation life throws at you, and evidence shows that these techniques can work!�� But remember, knowing how to do something does not mean that you have mastered it. New skills must be practiced, and when you are training new habits, consistency is key. There’s no magic number for how many workouts to complete, how many cheat meals you’re allowed, or how many weeks you need to practice mediation for it to work. Practice, practice, practice!

To conclude, consider mindfulness as a new skill you can develop during this time of distancing and isolation. One minute of paying attention to your own needs might just turn a bad day into a good one. I wish everyone well during these challenging times. Stay healthy and stay you.

References

Davidson, R. J., Kabat-Zinn, J., Schumacher, J., Rosenkranz, M., Muller, D., Santorelli, S. F., … & Sheridan, J. F. (2003). Alterations in brain and immune function produced by mindfulness meditation.��Psychosomatic medicine,��65(4), 564-570.

Goleman, D. (2006).��Emotional intelligence. Bantam.

Jain, S., Shapiro, S. L., Swanick, S., Roesch, S. C., Mills, P. J., Bell, I., & Schwartz, G. E. (2007). A randomized controlled trial of mindfulness meditation versus relaxation training: effects on distress, positive states of mind, rumination, and distraction.��Annals of behavioral medicine,��33(1), 11-21.

Kabat‐Zinn, J. (2003). Mindfulness‐based interventions in context: past, present, and future.��Clinical psychology: Science and practice,��10(2), 144-156.

Lutz, A., Greischar, L. L., Rawlings, N. B., Ricard, M., & Davidson, R. J. (2004). Long-term meditators self-induce high-amplitude gamma synchrony during mental practice.��Proceedings of the national Academy of Sciences,��101(46), 16369-16373.

Redwine, L., Henry, B. L., Pung, M. A., Wilson, K., Chinh, K., Knight, B., … & Mills, P. J. (2016). A pilot randomized study of a gratitude journaling intervention on HRV and inflammatory biomarkers in Stage B heart failure patients.��Psychosomatic medicine,��78(6), 667.

Richards, K., Campenni, C., & Muse-Burke, J. (2010). Self-care and well-being in mental health professionals: The mediating effects of self-awareness and mindfulness.��Journal of Mental Health Counseling,��32(3), 247-264.

Salovey, P., & Mayer, J. D. (1990). Emotional intelligence.��Imagination, cognition and personality,��9(3), 185-211.

Shapiro, S. L., Astin, J. A., Bishop, S. R., & Cordova, M. (2005). Mindfulness-based stress reduction for health care professionals: results from a randomized trial.��International journal of stress management,��12(2), 164.

Shapiro, S. L., Schwartz, G. E., & Bonner, G. (1998). Effects of mindfulness-based stress reduction on medical and premedical students.��Journal of behavioral medicine,��21(6), 581-599.

Spera, S. P., Buhrfeind, E. D., & Pennebaker, J. W. (1994). Expressive writing and coping with job loss.��Academy of management journal,��37(3), 722-733.

Tan, C. M. (2018).��Search inside yourself. Bentang Pustaka.

Valentine, E. R., & Sweet, P. L. (1999). Meditation and attention: A comparison of the effects of concentrative and mindfulness meditation on sustained attention.��Mental Health, Religion & Culture,��2(1), 59-70.

Before the World Health Organization (WHO) labeled COVID-19 a pandemic, they had declared an infodemic. They defined this as “”. In the media, as of March 31, 2020, COVID-19 had some , a large jump compared to mentions of the Ebola virus at 16.2 million. While the COVID-19 virus is spreading rapidly around the globe, the information and misinformation surrounding it seems to be spreading even faster. Dr. Tedros Adhanom Ghebreyesus, Director-General of the WHO, suggested that “misinformation on the coronavirus might be the most contagious thing about it” (Depoux et al., 2020). Though pandemics and the rapid spread of information, rumors, and panic are nothing new, social media has provided them a megaphone.

There are many arguments to be made in favour of social media. Helpful information can be spread just as quickly as misinformation. The WHO set up a to provide people with accurate and up-to-date information on COVID-19, which they shared on their own social media accounts. Public health agencies around the world are relying on social media to disseminate up-to-date information to citizens. While personal information gathered by social media platforms may be controversial, these data may allow for the delivery of targeted health information based on an individual’s geographical location and the local COVID-19 situation (Dunn et al., 2018). This is particularly important in light of social distancing, as social media may be the only form of connection people have with the outside world, and accurate, relevant information is key.

Empty shelves at a store in Halifax

Potentially the biggest variable with social media is how the people using the platform respond. For example, although COVID-19 does not cause significant bowel distress, stores were selling out of toilet paper and as this was shared extensively on social media, ��ensued. This prevented adequate distribution of resources, resulting in the most vulnerable individuals being left without supplies. On the other hand, social influence is one of the biggest factors influencing individuals to adopt a new health behaviours (Centola, 2013).�� Social media has been used to promote safe measures and social distancing, increasing social pressures to act in a way that benefits the group. Social media can also be used to call attention to those who need help, and facilitate an organized response. Finally, social media can provide a much-needed sense of social connection when the world feels isolated and uncertain in times of crisis.

In many ways, the current social media landscape is as new as COVID-19. Social media is being adopted by an increasingly diverse demographic. It can serve to spread panic, helpful information, or promote positive social norms and collective health behaviours. As the pandemic continues, examining how social media is affecting people’s response to COVID-19 may be an important area of study for researchers. Is the abundance of information improving individuals’ responses to the pandemic, or is it making them less likely to take it seriously? I suspect that access to information and social pressure is helping individuals to make choices that benefit the community, such as social distancing, but it may also be . Data to answer these questions could be obtained through surveys asking individuals about their responses to COVID-19 and their social media usage, content analysis of posts on social media, and assessing people’s actual behaviour. Some researchers, like Emma Spiro and Kate Starbird at the University of Washington, . This information could be vital in helping to shape guidelines for social media use in future global health situations.

References:

World Health Organization. (2020, Feb 2). Novel coronavirus (2019-nCoV) situation report-13. Retrieved from��

Information is beautiful (2020, Mar 16) COVID-19 #Coronovirus data pack. Retrieved from

Depoux, A., Martin, S., Karafillakis, E., Preet, R., Wilder-Smith, A., & Larson, H. (2020). The pandemic of social media panic travels faster than the COVID-19 outbreak.��Journal of Travel Medicine.

Dunn, A. G., Mandl, K. D., & Coiera, E. (2018). Social media interventions for precision public health: Promises and risks.��Npj Digital Medicine,��1(1).

Centola, D. (2013). Social media and the science of health behavior.��Circulation,��127(21), 2135–2144.

Since a few catchy news articles in the popular media back in 2012 pointing to a mental health crisis at universities in Canada, the seriousness of mental health issues on our campuses has been increasingly recognized (Lunau, 2012). A in Ontario triggered attention to the issue, finding that a staggering 88.8% of students felt overwhelmed, 50.2% reported being overwhelmed with anxiety, and 34.2% felt depressed (Craggs, 2012).

How is this possible you may ask? I present to you the hypothetical case of an 18-year-old first-year undergraduate student and her transition to university. Meet Sally; she has recently left home for the first time to start her freshman year at a university that is six hours from her hometown. She’s living in a single room in an on-campus residence, and is feeling lucky to have been one of the few students to score a room by herself. Nervous but excited, the semester starts full-force and Sally is determined to maintain her admission scholarship and receive medical school calibre grades, just as she has throughout high school. Sally struggles to adjust to the large class sizes, increased workload and the lack of structure to her days. But she makes it through her first midterm, only to find out that she got a D. This is the lowest grade that she has ever received in her life! And this isn’t even her only midterm; she has four others to write this week. Feeling sick with a sense of failure and anxiety, Sally is finding it hard to cope in the absence of the supports that she was accustomed to when she was living at home. As a result, she becomes discouraged and overwhelmed.

Due to a combination of the poor quality of food offered in the cafeteria and a loss of appetite, Sally’s diet also changed considerably. Sally begins to have difficulty sleeping, and has an even harder time getting out of bed in the morning. She starts skipping classes to catch up on sleep, which is putting her even further behind in her coursework. Sally has found herself stuck in a cyclical pattern of underperformance in relation to the physical and psychological impact of the stress that she is experiencing. Sally is made aware of the counselling services on campus by her residence advisor, and she decides to set up an appointment. When she calls, she is told that there is a 4-6-week wait for an initial appointment. When she finally has her initial appointment, Sally feels a bit better and hopeful that she can turn things around. She attempts to book a follow-up appointment but is told the wait time would be another 6-8 weeks. Sally never follows up with her appointment due to the long wait, and also because she believes that she should be able to manage her stress on her own. She finishes her first year on academic probation, wondering if she should reduce her course load, change programs, or possibly even take some time off from school.

Roughly 50% of college and university students experience high levels of stress that result in symptoms of anxiety and depression, with anxiety symptoms being the most common (Bayram & Bilgel, 2008; Storrie et al., 2010). Approximately one in five students has a diagnosed mental health disorder (Auerbach, 2016). Sally’s story paints a picture of how stress-induced behavioural changes and ��mental health symptoms can impact academic achievement. Students suffering from stress-related mental health issues report having poorer relationships, lower grade point averages and lower graduation rates compared to those not presenting with mental illness (Storrie et al., 2010). In addition, Sally’s story does not take into consideration other complex issues on college and university campuses such as sexual harassment, discrimination and substance use, all of which impact mental and physical health outcomes. In addition, studies on campuses in North America have found that 10% of female students and 13% of male students have experienced thoughts of suicide (Mackenzie et al., 2011).

All of this being said, what practices have universities put in place to combat student mental health challenges? One widespread response has been to expand individual counselling services. This approach does not come without flaws: it is reported that less than a quarter of students who need such services are actually using them (Rosenthal, 2008). This is likely due to a number of barriers including the ��the perception that one can manage their own stress and the wait times associated with such services (Pin et al., 2012; Rosenthal, 2008; Talebi et al., 2016). Given this, it is hard to imagine that universities would be able to support a higher volume of students choosing to seek counselling.

Similar to other areas of medicine, preventative mental health interventions are often more economical than treatment after the fact. As assessment of the effectiveness of various interventions from 24 different studies demonstrated that cognitive, behavioural, and/or mindfulness-based techniques were the most effective in reducing symptoms of anxiety in university students. Cognitive-behavioural therapy focuses on identifying and modifying dysfunctional thoughts related to stress. incorporate a combination of focusing on and being aware of one’s body, breathing, and thoughts. Some aspects of these interventions can be carried out at home (i.e. through audio-recorded guided mindfulness coaching) (Regehr et al., 2013). To the extent that such strategies are effective, campus workshops that encourage their uptake may help reduce wait times for other services so that those who need them the most get help in a timely manner. Some other evidence-based recommendations that universities can consider to help reduce student stress and improve mental health outcomes include initiatives to , and implementing peer-support programs and (Binfet et al., 2018; Felton et al., 2019; Pin et al., 2012).

Would things have turned out differently for Sally had these initiatives been in place at her institution? It’s possible. But, in fact, there isn’t a single, one-size-fits-all answer to the prevalence of mental health challenges being experienced on college and university campuses. However, one thing is clear: colleges and universities should be making the mental health of their students a priority. They need to dedicate more funds to trying new interventions and providing better support for methods that have been shown to work. After all, high drop-out rates, fewer students pursuing additional degrees, lost productivity, etc., reflect on universities’ success. Along with the students, the schools themselves will eventually suffer the consequences if this problem persists.

If you are concerned about the mental health and safety of yourself or someone you know, below is a list of available resources that can help:

�Ӱ�ԭ�� University Health and Counseling Services: (613) 520-6674

Distress Centre Ottawa and Region: (613) 238-3311, Web Site: /

Mental Health Crisis Line: within Ottawa (613) 722-6914, Web Site:

Mental Health Helpline: within Ontario (866) 531-2600, Web Site:

Canada Suicide Prevention Service: within Canada: (833) 456-456, Web Site:

References:

Auerbach, R. P., Alonso, J., Axinn, W. G., Cuijpers, P., Ebert, D. D., Green, J. G., … & Nock, M. K. (2016). Mental disorders among college students in the World Health Organization world mental health surveys.��Psychological medicine.

Bayram, N., & Bilgel, N. (2008). The prevalence and socio-demographic correlations of depression, anxiety and stress among a group of university students. Social Psychiatry and Psychiatric Epidemiology.

Binfet, J., Passmore, H., Cebry, A., Struik, K., & McKay, C. (2018). Reducing university students’ stress through a drop-in canine-therapy program. Journal of Mental Health.

Craggs, S. (2012). One-third of McMaster students battle depression: survey.

Felton, A., Lambert, M.��(2019), “Student mental health in the healthcare professions: exploring the benefits of peer support through the Bridge Network”,��he Journal of Mental Health Training, Education and Practice.

Lunau, K. (2012). Mental health crisis on campus: Canadian students feel hopeless, depressed, even suicidal. Macleans.

Mackenzie, S., Wiegel, J. R., Mundt, M., Brown, D., Saewyc, E., Heiligenstein, E., … Fleming, M. (2011). Depression and Suicide Ideation Among Students Accessing Campus Health Care. American Journal of Orthopsychiatry.

Pin, L., Martin, C. (2012). Student Health: Bringing Healthy Change to Ontario’s Universities. Toronto: Ontario Undergraduate Student Alliance.

Regehr, C., Glancy, D., & Pitts, A. (2013). Interventions to reduce stress in university students: A review and meta-analysis. Journal of Affective Disorders.

Rosenthal, B., Wilson, C. (2008). Mental health services: Use and disparity among diverse college students. Journal of American College Health.

Storrie, K., Ahern, K., & Tuckett, A. (2010). A systematic review: Students with mental health problems-A growing problem. International Journal of Nursing Practice.

Talibi, M., Matheson, K., & Anisman, H. (2016). The stigma of seeking help for mental health Issues: Mediating roles of support and coping and the moderating role of symptom profile. Journal of Applied Social Psychology.

“I’m tired!” This phrase is well used, if not excessively among students on any university campus. Students are notorious for proclaiming their��exhaustion, their desire for sleep, and their inability to withstand an entire lecture without dozing off. It appears that a student’s view on the required amount of sleep they need to function reflects their belief that it simply is not, and never will be, enough. A 2015 survey of 20,000 undergraduate students revealed that 91% indicated feeling tired during the past seven days, while 43.4% reported problems performing activities due to daytime sleepiness. Even if a student does get a good night’s sleep, the intensity of their fatigue rarely diminishes, and if it does, only for a short period. The question then becomes: why can’t students get a handle on their sleep habits?

It is likely that students are suffering from a phenomenon dubbed , a term used to describe the mounting impacts of sleep deprivation. To incur sleep debt, a person doesn’t need to go nights on end with very little sleep. Sleep debt can even affect people who are sleeping eight hours per night (Coren, 1996). Even if a person is lacking only a few hours less sleep than is recommended, this can contribute to sleep debt. Students may be under the impression that it is the exceptional activities that contribute to sleep debt, such as binge drinking and partying until dawn, or the dreaded ritual of cramming all night before an exam. Although there is no doubt that these experiences play a role, it is often the more benign habits that are leading students to fall behind in their sleep.

One of the primary culprits is the cell phone. Regardless of students insisting that they suffer from drowsiness, this apparently does not prevent them from replying to text messages in the dead of night. ������is the need to respond immediately to text messages or phones calls, for fear that people will become upset if you fail to do so (Roger & Barber, 2019). To the outside world it may appear obvious that when one is sleeping this pressure should be alleviated; however, this is not always the case. In fact, students were quite willing to give in to telepressure at night, waking up to groggily and half-heartedly respond to texts or calls.

Conversely, some may argue that they are not the type to be a slave to their cell phone and engage in a ritual of responding at three o’clock in the morning. Even if this is the case, the presence of a cell phone or other electronic device within the sleep vicinity can prevent a student from falling asleep. In fact, the blue light emitting from a cell phone or computer screen can cause a delay of sleep onset by up to one-and-a-half hours (Wise, 2018). Over time, this delay in sleep, and the periodic awakening that may also be occurring, can contribute to sleep debt.

An additional contributor to sleep debt is the infamous energy drink, one of students’ favourite catch-22’s. Consuming energy drinks is often done in order to function and accomplish optimal work, but this occurs at the cost of almost immediate burnout when the caffeine begins to wear off. What students may not know is that the price of energy drinks extends beyond just the initial caffeine plummet. A recent study indicated that consuming energy drinks predicted lower quantity and quality of sleep as well as increased tiredness the following day for college students. This is yet another contributor to the potential sleep debt students experience. While students believe they’re drinking to achieve momentary efficiency, their caffeine binge may actually be robbing them of valuable time in the future.

Despite the evidence, is it truly reasonable to expect students to give up their cell phones, or stop drinking sugary caffeinated beverages? In reality, probably not. Students often use their cell phones as a method to wind down at the end of the night, or as a way to mindlessly relieve stress. The energy drinks could be something a student has been drinking for years. Expecting them to change their ways on the basis of a few studies is unlikely to alter ingrained habits. One would hope that students would seize the opportunity for extra sleep at any chance they get. The shocking revelation is that the majority of students may not even be willing to go that far. In fact, one study suggested that even among those students who are experiencing a significant sleep deficit, when given the option of altering their habits, the majority did not jump at the chance to obtain more sleep (Anderson & Horne, 2008). Out of the 50% who stated they had the desire for more sleep, only 20% reported experiencing a level of unreasonable sleepiness during the day and opted to take extra sleep. Perhaps these students would rather deal with exhaustion than limit their time engaging in activities they enjoy. Indeed, the statistic likely includes overachievers who would be aghast at the idea of taking time away from their studies to sleep an extra hour or two.

All of this is not to suggest that students are dramatizing the state of their exhaustion as they wait in solidarity, zombie-like in line for Starbucks. The fact of the matter is, they probably are exhausted, and it is unlikely that students as a whole will ever reach the point where they are not unanimously tired. Perhaps then, a more accurate question is: how tired does a student need to be in order to do anything about it?!

References:

Anderson, C., & Horne, J. A. (2008). Do we really want more sleep? A population-based study evaluating the strength of desire for more sleep. Sleep Medicine, 9, 184-187.

Campbell, R., Soenens, B., Beyers, W., & Vansteenkiste, M. (2018). University students’ sleep during an exam period: the role of basic psychological needs and stress. Motivation and Emotion, 42, 627-681. DOI: 10.1007/s11031-018-9699-x.

Coren, S. (1996). Sleep thieves: An eye-opening exploration into the science and mysteries of sleep. New York, NY: Free Press.

Mednick. S., & Ehrman, M. (2006). Take a nap!: Change your life. New York, NY: Workman

Patrick, M. E., Griffin, J., Huntley, E. D., & Maggs, J. L. (2018;2016;). Energy drinks and binge drinking predict college students’ sleep quantity, quality, and tiredness. Behavioral Sleep Medicine, 16(1), 92-105.

Rice, A. (2011). Blear-eyed students can’t stop texting even to sleep, a researcher finds. Chronicle of Higher Education, 58(14), A13.

Rogers, A. P., & Barber, L. K. (2019). Addressing FoMO and telepressure among university students: Could a technology intervention help with social media use and sleep disruption? Computers in Human Behaviour, 93, 192-199.

Wise, M. J. (2018). Naps and sleep deprivation: Why academic libraries should consider adding nap stations to their services for students. New Review of Academic Librarianship, 24(2), 192-210. DOI: 10.1080/13614533.2018.1431948

So who are these enterprising colleagues?

Our most recent presentation at the CHAIM Brown Bag Series featured Dr. Katie Gunnell who presented her interests in the relationship between psychological health and exercise. While originally trained in kinesiology on a path to physiotherapy, Gunnell found that, often, “people weren’t motivated to do the prescribed exercises. They wanted a cure, but weren’t willing to do the work—so why are some people motivated and others are not?” Gunnell gravitated towards motivational research, as well as further exploring the relations between physical activity and mental or psychological health.

While in a previous research position at Children’s Hospital of Eastern Ontario Research Institute (CHEO-RI), Gunnell worked alongside physiologists and public health specialists to determine psychological effects of screen-time. “Youth are exposed to screens all the time. We need to gain more knowledge to bring attention to red flags so we can learn to use screens to our advantage as opposed to having them have negative impacts on our health.” Gunnell continues to examine the relations between screen-time and physical and mental health: is there bad vs. good screen time? How can quality indicators of screen-time be developed? What are the qualitative and quantitative components in screen time? ��Having worked in interdisciplinary teams at the CHEO-RI, and throughout her educational career through Brock University, University of British Columbia, and University of Ottawa, Gunnell values the potential from collaboration of interdisciplinary teams in research, as well as in knowledge dissemination and translation. Still involved in knowledge dissemination at the CHEO-RI, Gunnell acknowledges the importance of “actively working with knowledge users” to inform, engage, and inspire healthy active living.

Similarly, Dr. Rachel Burns is interested in healthy behaviours and health outcomes. Burns came to �Ӱ�ԭ�� in July 2017 following a post-doc at McGill University, where she examined relations between mental health and diabetes. Using large observational data sets, Burns investigated how mental health influences well-being and overall health outcomes. Since starting at �Ӱ�ԭ��, Burns has been working with big data sets to examine patterns related to depression and diabetes development over time. For example, she is currently exploring the differential implications of depressive symptoms over a long period of time compared to periodic, short periods of time, in relation to diabetes outcomes. Alongside this work, she is examining whether the well-being of one’s romantic partner might be implicated in the evolution of diabetes.

Burns first blended her interests of psychology and biology during her undergraduate degree at the University of Guelph. During her PhD studies at the University of Minnesota, she started to research the psychological processes that help people to maintain healthy behaviours overtime. “A big issue is that people start to engage in healthy behaviors, but shortly afterwards, they stop… so how can we help maintain these behaviours overtime?” One promising notion, she highlights, is the idea of habits; habits are automatic impulses to perform a behavior that are triggered by a stable cue in the environment and their enactment doesn’t require attention. Burns plans to explore habits in relation to physical activity. For example, she asks “Which type of people are most likely to develop strong habits for going to the [�Ӱ�ԭ��] Athletic Centre?” Understanding habit formation and function could help people maintain healthy behaviors overtime. “If we understand these processes, we can leverage them over time… we can shape interventions for diabetes or heart disease and help people live healthier lives.”

Maintaining healthy behaviours and pursing health goals are also a primary interest of Dr. Marina Milyavskaya. Specifically, Milyavskaya considers why people are successful in pursuing certain goals, but not others, as well as how this translates to day-to-day goal pursuit. After an inspiring motivational psychology class during her undergrad at McGill, Milyavskaya knew she wanted to pursue a graduate degree that focused on goals and self-regulation. After completing a Clinical Psychology degree, she realized her stronger interests are in research, and sought a post-doc at the University of Toronto researching self-control and temptations.

In her research, Milyavskaya discovered that self-control didn’t seem to matter as much as temptation. “If the goal is to eat healthy, what matters is the frequency of exposure to temptations—so don’t have chocolate in the house!” Milyavskaya has been at �Ӱ�ԭ�� since July 2015, and uses methods from social cognition, personality psychology, ecological momentary assessment, and advanced statistical modelling to better understand the mechanisms of goal pursuit, as well as strategies and interventions that can be used to better attain personal goals. Milyavskaya embraces the translation of research to those who can use it, having previously written blog-style articles explaining her research findings to lay people. In addition, she highlights the importance for researchers within the University to know what research is happening across campus, and if there is potential for new collaborations. “The Brown Bag Series is trying to bring that community [of health researchers] together.”

The Brown Bag Series will run the second Friday of every month, and will invite health researcher speakers from across campus, their research partners, or potential partners conducting relevant research in the region. Anyone who is interested in health research across campus is invited to come.�� And anyone interested in presenting a talk to get interdisciplinary feedback should get in touch with one of the organizers to get onto the schedule. Stay tuned at the CHAIM centre website and follow us on twitter to keep informed on the Brown Bag Series!

Related Resources:

Photo by Ergotron®

Weighing the Evidence on Sit-Stand desks for Weight Loss

By Heather K. Neilson

Sit-stand desks are becoming increasingly popular in the workplace. If you don’t use one yourself, you probably know someone who does. While sit-stand desks are perceived to be healthier than sitting, office workers and their managers might be interested to know whether��there is any scientific evidence of health benefits. In theory, sit-stand desks should improve health because when workers stand more, they sit less – and sitting is the new smoking. Last summer, researchers declared a physical inactivity pandemic given a high global prevalence of sedentary behaviour (sitting or lying down) and a growing body of evidence linking such behaviour to��adverse health effects. Long durations of sedentary behaviour may be associated with higher risks of mortality, type 2 diabetes, cardiovascular disease, some cancers, and also weight gain. In Canada the prevalence of obesity is higher than ever before, contributing to disability and chronic disease. Employers are interested in minimizing absenteeism and maximizing productivity. If workplace sitting contributed to the obesity epidemic, then could sit-stand desks be the solution?

THE THEORY

The way in which sitting apparently leads to weight gain is through energy imbalance. When energy intake (‘calories in’) is greater than total energy expenditure (‘calories out’) for an extended period, people gain weight. Total energy expenditure is the sum of:

• dietary thermogenesis (~10% of total energy expenditure) from metabolizing food,
• basal metabolic rate (60%-75%) from vital body functioning, and
• activity energy expenditure (15%-30%) which includes intentional activity, such as walking, and unintentional activity, such as fidgeting.

Sitting contributes to weight gain essentially by decreasing activity energy expenditure.

Dr James Levine, an American endocrinologist, Mayo Clinic obesity researcher, author, and inventor of the treadmill desk��is a for reducing sitting time. In 2005 Levine and colleagues published one of the first studies to show that sitting might lead to obesity.¹ The researchers recruited 20 self-proclaimed ‘couch potatoes’ – 10 lean and 10 mildly obese individuals (5 females and 5 males per group) – and measured energy expenditure, posture, and movement over 10 days. Sleep times were similar between the two groups, however, the obese group was seated on average 164 min/day longer than the lean group. Also an inverse trend was found, showing that participants who spent more time standing and ambulating tended to have lower fat mass. To understand whether obesity caused the participants to sit more, the researchers induced weight loss in the obese group and weight gain in the lean group. However, even after weight change, the obese group sat more than the lean group, suggesting that the obese group preferred to sit. Levine hypothesized that if environments were somehow less chair-enticing, perhaps fewer people would be obese.

Around the same time, Hamilton and colleagues published a new ‘inactivity physiology paradigm’.² They proposed that sitting causes harm by replacing non-exercise activity (Levine called this ‘non-exercise activity thermogenesis’ or NEAT). Hamilton believed that cumulative non-exercise activity may be crucial for protecting against metabolic syndrome, type 2 diabetes, coronary artery disease and obesity. The authors explained that because some of the cellular and molecular processes from inactivity are qualitatively different from not exercising, non-exercisers who sit much of the time might experience an even higher disease risk than other non-exercisers.

THE EVIDENCE

James Levine working at his treadmill desk

A number of recent studies have examined how much energy is expended in different postures. In a relatively large study of 50 men and women, researchers measured energy expenditure over 10 minutes for sitting, standing, and once-per-minute sit-stand transitions.³ The difference in energy expenditure between standing and sitting was 0.07 kcal/min, equivalent to 33 kcal/d over an eight-hour workday. For sit-stand transitions the difference was 0.32 kcal/min. These results align with findings from other studies done previously, suggesting relatively small differences in energy expenditure (for context, a sedentary middle-aged female expends ~1,900 kcal/d).

While controlled studies like this are informative, they do not reflect real life. In an office setting, sit-stand desks might not only lead to more standing, but also potentially to more incidental movement throughout the day. Conversely, workers might compensate for standing by changing their activity levels outside of work. Acceptability is crucial – just because sit-stand desks are provided doesn’t mean workers will use them. For example, subgroups of a certain age or health status may be less accepting, or workers might stand less over time. To test the effectiveness of sit-stand desks in the real world, long-term randomized controlled trials (RCTs) are needed that include a large number of people of different ages and health statuses.

Since 2014 at least six systematic review articles have been��published, comparing the physiological or psychological effects of alternative workstations in intervention studies. Nearly all came to the same conclusions about sit-stand desks and their impact on sitting time, including the most recent review through the Cochrane Collaboration.^4,5 Two RCTs had been done comparing sit-stand desks to no intervention over three months. Together these trials showed significantly less sitting in the sit-stand group by 96 min/d. A third RCT showed an 80 min/d reduction over eight weeks. Three non-randomized studies showed, within three or six months, that sit-stand desks resulted in 30-120 min/d less sitting than no intervention. Interestingly, sit-stand desks decreased sitting time at work and outside work. None of the studies measured energy expenditure, although one small study compared three-month changes in body weight, body mass index, and waist-to-hip ratio for sit-stand desk users versus no intervention and showed no difference.⁶ However, the authors deemed the evidence overall in this review to be low quality due to weak study designs and low sample sizes.⁴

“..at present, there is not enough high quality evidence available to determine whether spending more time standing at work can repair the harms of a sedentary lifestyle.” – Jos Verbeek, co-author, Cochrane Work Review Group ⁵

A GOOD INVESTMENT?

Photo by IKEA®

For many workplaces, the greatest barrier to sit-stand workstations is cost, with units now selling for about $150-$2,000 CAD. For employers seeking an obesity-relevant intervention, the evidence is still too limited for sit-stand desks, and unfortunately the preliminary data show little benefit in terms of energy expenditure. Still other outcomes might justify the cost. For example, the effects on musculoskeletal and metabolic health, cognition, quality of life, and work performance are being researched, but more evidence is needed to support those outcomes too. Interventions that induce more NEAT than sit-stand desks would have more impact on body weight. Treadmill desks and cycling desks are intriguing��except cost is even higher than sit-stand desks and there is still limited evidence of health benefits. In 2015, Public Health England recommended that workers try to spend two to four hours per day standing and light walking rather than sitting.⁷ Therefore if you are planning a workplace intervention, you may need to consider making additional changes around the office besides only sit-stand desks – whether to the physical environment or to office policies about sitting – and the more NEAT, the better.

Reference List

1. Levine JA, Lanningham-Foster LM, McCrady SK, et al. Interindividual variation in posture allocation: possible role in human obesity. Science. 2005;307(5709):584-586.
2. Hamilton MT, Hamilton DG, Zderic TW. Role of low energy expenditure and sitting in obesity, metabolic syndrome, type 2 diabetes, and cardiovascular disease. Diabetes. 2007;56(11):2655-2667.
3. Judice PB, Hamilton MT, Sardinha LB, Zderic TW, Silva AM. What is the metabolic and energy cost of sitting, standing and sit/stand transitions? Eur J Appl Physiol. 2016;116(2):263-273.
4. Shrestha N, Kukkonen-Harjula KT, Verbeek JH, Ijaz S, Hermans V, Bhaumik S. Workplace interventions for reducing sitting at work. Cochrane Database Syst Rev. 2016;3:CD010912.
5. Torjesen I. Sit-stand desks offer little evidence of health benefits, review finds. BMJ. 2016;352:i1595.
6. Alkhajah TA, Reeves MM, Eakin EG, Winkler EA, Owen N, Healy GN. Sit-stand workstations: a pilot intervention to reduce office sitting time. Am J Prev Med. 2012;43(3):298-303.
7. Buckley JP, Hedge A, Yates T, et al. The sedentary office: an expert statement on the growing case for change towards better health and productivity. Br J Sports Med. 2015;49(21):1357-1362.

By Imran Bagha, School of Public Policy & Administration

The controversy around red meat consumption and its effects on human health is a ‘hot topic’ in today’s media discourse. Recently the debate has been stimulated by a cultural shift towards vegetarianism, which frames red meat consumption as damaging to one’s health. This has, in turn, spurred responses of meat-loving advocates who tout the benefits of red meat consumption. The back-and-forth rhetoric can make it difficult to navigate the science behind the claims of each camp.

So what does the evidence tell us?

The Good

Red meat has formed an important part of North American diet for decades and is embedded into North American culture. For example, we might share ham with the family at Christmas, barbecue steaks on Canada Day, and enjoy chili cheeseburgers on Superbowl Sunday. There are many reasons for the popularity of red meat. Not only is it tasty and convenient, it has many nutritional qualities as well.

Red meat is high in macronutrients such as proteins and fats. It contains all amino and fatty acids necessary to aid the body in regular function (Williams, 2007). Furthermore, red meat is an excellent provider of minerals such as iron and magnesium, compounds that��aid in healthy immune function and red blood cell count (Williamson et al., 2005; McAfee et al., 2010).

Red meat has also been shown to promote efficient DNA synthesis and memory retention through its concentration of vitamin B12 and zinc (Williams, 2007). It is high in compounds such as creatine and carnitine that aid in athletic and cognitive performance (McAfee et al., 2010; Williamson et al., 2005; Delanghe, et al., 1989); such compounds (as well as vitamins and minerals like iron and Vitamin B12) are difficult to obtain from other food sources, making red meat a valuable nutritional source.

The Bad

However, red meat has gotten a bad reputation largely due to its high fat composition. Of all meat products, red meat and processed red meat naturally contain the highest level of both saturated and unsaturated fats (American Heart Association, 2016). For perspective, one 50g burger patty from McDonalds or Wendy’s is composed of 20-30% fat (Keeton, 1994; McDonalds, 2016), and one lean and trimmed 100g rib-eye steak (about the size of the palm of your hand) contains about 11 grams of fat (USDA National Nutrient Database, 2016). Excessive consumption or accumulation of such fat contributes to unhealthy weight gain and poor gut fauna; other compounds present in red meat have been linked to atherosclerosis and colorectal cancer (McAfee et al., 2010; Hu, 2003).

When high-fat meals such as hamburgers are consumed, carbohydrates are first metabolized and used as energy (Gropper &��Smith, 2012). This leaves fatty acids in circulation until they begin to be taken up by adipose tissue, which accumulates over time and results in weight gain. Such unhealthy weight gain results in poor mental health and reduces productivity and energy during the day (Panel, 1998). Left unchecked, excessive weight gain leads to obesity, an affliction affecting approximately one-third of the North American population (Statistics Canada, 2017; Harvard SPH, 2017). People suffering from obesity also tend to have poor metabolic activity and often suffer from a variety of health problems such as poor circulation, compromised immune function, sleep apnea, depression, and diabetes (Panel, 1998; Garrow, 1999; Wang et al., 2011). Those of us with sedentary lifestyles, such as most people with desk jobs, are especially at risk (Gropper &��Smith, 2012).

Furthermore, consumption of fatty products cause death of bacteriodites, a type of bacteria usually associated with a healthy gut flora (Eppel et al., 2013; Cani et al., 2007). When the bacteriodites die, they release compounds into circulation that��cause the body to increase fat storage and reduce fat metabolism, resulting in even sharper weight gain and its associated problems (Eppel et al., 2013; Cani et al., 2007).

In addition to the disease risks carried by its high fat content, red meat consumption has been linked to diseases such as atherosclerosis and colorectal cancer. For example, the amino acid L-carnitine is a naturally occurring compound in cooked red meat. Once consumed, gut bacteria process this compound into trimethylamine-N-oxide, which has cancerous activity in humans and��contributes to atherosclerosis in lab animals (Bingham et al., 1996; Koeth et al., 2013).

So, can we have our meat and eat it too?

The scientific evidence may suggest to us that the only course of action for our health is to eliminate red meat from our diets. However, we know that red meat is a nutrient-dense food and has many health benefits associated with its consumption. Just as importantly, red meat is a significant part of North American culture. Giving up red meat would not only mean a change of��our diets, but a cultural change as well. Thus, eliminating red meat entirely is an impractical and rather unrealistic expectation for the meat-eating public.

So, what to do? It all boils down to several important concurrences across the scientific health and nutritional communities. Most importantly, the vast majority of scientific and nutritional literature agree that we are eating too much red meat (Lima &��Gomes-da-Silva, 2005; McAfee et al., 2010; American Heart Association, 2016). An average meat-eating North American consumes over 200% more red meat than the healthy limit of 3 servings[1] 3 times per week (American Heart Association, 2016; Canadian Cancer Society, 2016). Health issues stemming from red meat consumption occur not because we are eating red meat, but because we are eating too much of it.

Second, because red meat often forms the main course of a meal, our diets lack significantly in nutrients obtained from plant-based foods – many of which suppress diseases such as obesity and cancer, and help the body metabolize fats (Moore and Thompson, 2013; Craig, 2006; Boeing et al., 2012). A diet high in plant-based foods is recognized across the scientific community as the healthiest diet.

And third, many nutritional benefits obtained from red meat can be found in other meat sources, such as fish, eggs, and white meat products (Canadian Cancer Society, 2016).

The clearest solution is to reduce the amount of red meat we presently consume. This reduction in red meat consumption may look different to different people depending on lifestyle and habit. Following are a few suggestions based on the evidence.

Some Practical Suggestions

1. Use the 3×3 rule

Try to consume no more than 3 servings of red meat 3 times weekly. This amount is plenty of red meat for a week: eating 2 single-patty hamburgers, an 8oz steak, and 2 servings of meatloaf in a week is still within the 3×3 rule.

[1] 1 serving is equivalent to 3 ounces of lean flank steak.

2. Try out vegetarian meals

Aim for 1-2 vegetarian dinners a week. For example, replace meat lasagna with vegetarian lasagna. Not only will this help increase the amount of plant-based nutrients in your diet, it will also help cut down on red meat consumption.

3. Consume more alternatives

Alternatives can consist of white meat, fish, egg, and dairy products. For example, replace the salami in your lunchtime sandwich with turkey breast, egg salad, or tuna. These products are high in protein, and contain many of the health benefits associated with red meat (Canadian Cancer Society, 2016).

None of these suggestions should prevent us from enjoying a steak on date night, grabbing a Superbowl chili cheeseburger, or cutting into the ham on Christmas eve. By reducing and monitoring red meat consumption, we can enjoy the benefits of red meat while minimizing risk from overconsumption. We can, indeed, have our meat and eat it too!

Related Resources:��

References:

American Heart Association. (2016). “What’s my daily limit for foods with saturated fats?” Accessed from: http://www.heart.org/HEARTORG/HealthyLiving/HealthyEating/Nutrition/Saturated-Fats_UCM_301110_Article.jsp#.VwQPXyfAd5c

Bingham, S.A., Pignatelli, B., Pollock, J.R.A., Ellul, A., Malaveille, C., Gross, G., Runswick, S., Cummings, J.H. and O’Neill, I.K. (1996). Does increased endogenous formation of N-nitroso compounds in the human colon explain the association between red meat and colon cancer?.��Carcinogenesis,��17(3), 515-524.

Boeing, H., Bechthold, A., Bub, A., Ellinger, S., Haller, D., Kroke, A., Leschik-Bonnet, E., Muller, M., Oberrier, H., Schulze, M., Stehle, P. & Watzl, B. (2012). Critical review: vegetables and fruit in the prevention of chronic diseases.��European journal of nutrition,��51(6), 637-663.

Canadian Cancer Society. “Meat”. 2016. Accessed from: http://www.cancer.ca/en/cancer-information/cancer-101/what-is-a-risk-factor/diet/meat/?region=on#How_much_meat

Cani, P.D., Amar, J., Iglesias, M.A., Poggi, M., Knauf, C., Bastelica, D., Neyrinck, A.M., Fava, F., Tuohy, K.M., Chabo, C. and Waget, A. (2007). Metabolic endotoxemia initiates obesity and insulin resistance.��Diabetes,��56(7), 1761-1772.

Craig, W. J. (2009). Health effects of vegan diets.��The American journal of clinical nutrition,��89(5), 1627S-1633S.

Delanghe J., De Slypere, J. P., De Buyzere, M., Robbrecht, J., Wieme, R., & Vermeulen, A. (1989). Normal reference values for creatine, creatinine, and carnitine are lower in vegetarians.��Clinical chemistry,��35(8), 1802-1803.

Dunlop, C. (2017) Accessed from: http://zniup3zx6m0ydqfpv9y6sgtf.wpengine.netdna-cdn.com/wp-content/uploads/2015/10/151026-How-much-meat-spag.png

Eppel, C., Migdal, K., Sterlin, M., & Fagan, J. M. (2013). What you eat may affect your intestinal microbial diversity and your propensity for obesity. Ruttgers University.

Garrow, J. (1999). Health risks of obesity.��Obesity: The report of the British Nutrition Foundation Task Force., 4-16.

Gropper, S., & Smith, J. (2012).��Advanced nutrition and human metabolism. Cengage Learning.

Harvard SPH. (2017). Adult obesity: A global look at rising obesity rates. Harvard School of Public Health. Available from: https://www.hsph.harvard.edu/obesity-prevention-source/obesity-trends/obesity-rates-worldwide

Hu, F. B. (2003). Sedentary lifestyle and risk of obesity and type 2 diabetes.Lipids,��38(2), 103-108.

Keeton, J. T. (1994). Low-fat meat products—technological problems with processing.��Meat Science,��36(1-2), 261-276.

Koeth, R.A., Wang, Z., Levison, B.S., Buffa, J.A., Org, E., Sheehy, B.T., Britt, E.B., Fu, X., Wu, Y., Li, L. and Smith, J.D. (2013). Intestinal microbiota metabolism of L-carnitine, a nutrient in red meat, promotes atherosclerosis.��Nature medicine,��19(5), 576-585.

Lima, M. C., & Gomes-da-Silva, M. H. G. (2005). Colorectal cancer: lifestyle and dietary factors.��Nutricion hospitalaria,��20(4), 235.

McAfee, A. J., McSorley, E. M., Cuskelly, G. J., Moss, B. W., Wallace, J. M., Bonham, M. P., & Fearon, A. M. (2010). Red meat consumption: An overview of the risks and benefits. Meat science, 84(1), 1-13.

McDonlads Canada Nutrition Information. (2016). Accessed from: http://www.mcdonalds.ca/ca/en/menu/full_menu/sandwiches.html

Moore, L. V., Thompson, F. E. (2015). Adults meeting fruit and vegetable intake recommendations—United States, 2013.��MMWR. Morbidity and mortality weekly report,��64(26), 709-713.

Panel, N. O. (1998). Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. National Heart, Lung, and Blood Institute. 98(4083).

Statistics Canada. (2017). Overweight and Obese Adults (self-reported), 2014.��Government of Canada, Statistics Canada. Available from: http://www.statcan.gc.ca/pub/82-625-x/2015001/article/14185-eng.htm

StrengthSensei. (2017) Accessed from: http://www.strengthsensei.com/wp-content/uploads/2015/04/article-1267409-03BA69770000044D-927_468x286.jpg

USDA National Nutrient Database. (2016). “Basic Report:�� 23197, Beef, rib eye steak, boneless, lip-on, separable lean and fat, trimmed to 1/8″ fat, all grades, cooked, grilled.” “Cheese”; “meat”; “milk” “cookie”, Accessed from: https://ndb.nal.usda.gov/ndb/foods/show/7288?fgcd=&manu=&lfacet=&format=&count=&max=35&offset=&sort=&qlookup=23197

Wang, Y. C., McPherson, K., Marsh, T., Gortmaker, S. L., & Brown, M. (2011). Health and economic burden of the projected obesity trends in the USA and the UK.��The Lancet,��378(9793), 815-825.

Williamson, C. S., Foster, R. K., Stanner, S. A., & Buttriss, J. L. (2005). Red meat in the diet.��Nutrition Bulletin,��30(4), 323-355.

More than Farmland:��

By Keith Van Ryswyk & Paul Villeneuve, Department of Health Sciences

Cities internationally recognize that features of the urban built environment have dramatic impacts on a number of environmental exposures that, in turn, are linked to human health. The Public Health Agency of Canada has defined the urban built environment as “… part of our physical surroundings and includes the buildings, parks, schools, road systems, and other infrastructure that we encounter in our daily lives”. Urban built environmental exposures that affect health are varied and include air pollution, noise, heat islands, and access to parks and green spaces. As diverse as these exposures are, so too are the health outcomes they’ve been linked to. Long term exposure to air pollution has been linked to premature mortality, cardiovascular and respiratory disease, diabetes, and more recently cognitive decline. Noise has similarly been linked to many of these same health outcomes, as well as to mental health and stress. In the last few years, epidemiological studies have shown that some built environment features, parks and green spaces can help mitigate some of these harmful exposures, and on their own, offer some tangible health benefits. For these reasons, the (CEF) plays a vital role for the health of Ottawa residents.

The CEF was created in 1886. It was one of five experimental farms across Canada developed to promote agricultural development in a time when most people lived and worked on farms. Here, government scientists would modify and develop new strains of wheat that best adapt to Canadian soils, and conduct research on animal and poultry breeding, insect and identification control measures, as well as many other activities. In 2016, the CEF still maintains a large footprint in the city of Ottawa, and is an unusual feature of the city, as most North American cities do not have such an expansive green space located centrally. It captures an area, 1100 acres, that is approximately the same size of New York City’s Central Park. Nearly one quarter of Ottawa’s population lives within the 5 km buffer that stretches out from its center. For these reasons, it is a valuable piece of land, and even more so given that Ottawa is a growing city that needs to deliver services to its residents. Consideration is being given to develop parts of the CEF including the possibility that it would serve as the home to a newly constructed hospital.

Decisions on future development of the farm are influenced by a number of competing interests, and would not be straightforward at the best of times. In the case of the CEF, the possible environmental benefits that it provides the city have not been well studied. The population health impact may be considerable as green spaces have been shown to absorb air pollution, reduce noise, and mediate heat island effect. Other potential impacts include reducing obesity, increasing physical activity, and enhance social networks in the surrounding area. Canadian studies have also shown that individuals who live in greener areas have reduced rates of mortality, and have healthier babies. At this time, it is not possible to fully understand these CEF impacts as there has been no coordinated effort to assess and describe CEF impacts on environmental exposures of air pollution, noise, and temperature in surrounding neighbourhoods. There also has been little attempt to describe historically how temperature and air pollution trends have differed between the area of the CEF and more developed downtown areas of the city.

As a team of graduate students enrolled in the at �Ӱ�ԭ�� University we have begun to try and tackle this controversial topic. There are four of us (myself (Keith), Erika Brisson, Mona Ahmad, and Natasha Prince). Armed with a fleet of our own personal vehicles, including a beat-up 2003 GMC��Astro van, that have been adapted to include personal monitoring devices that measure exposures on a second-by-second basis, we’ve designed an environmental sampling campaign to measure air pollution, noise and temperature in and around the CEF. For one hour��every morning and another��at night, we have driven in and around the CEF so that we will be able map these exposures across the farm and in the surrounding neighborhoods. In the time between our 1 hour tours, we are scampering up or down ladders to maintain a network of 41 air pollution monitors that have been scattered throughout our study area. We do this because we recognize how important an issue this is to our community. We are aware but not distracted by media reports of the debates of a new hospital location that seemingly appear on a daily basis.

Our typical sampling day begins with Erika and I arriving at Natasha’s apartment. Natasha is the equipment manager while the daily mobile monitoring is performed by the rest of us. While we focus on driving the same circuit around the farm each day, Natasha is our team sparkplug and ensures that all of our monitors have the power, memory and various fluids they needed to continuously measure air pollution and temperature while we drive. Erika and I finish our morning sampling and replace the monitoring equipment in our passenger seats with Mona and Natasha, respectively. We must now tour our study area again and take down all of our passive monitors. On setup day, we strapped them to lamp poles and left them there for two weeks to fend for themselves. For fourteen days they have sat there, like eggs in inverted tin nests (rain shelters). Natasha and I are discovering that some of the noise meters have been stolen. Their small blinking LED lights must have been too much to resist for some. In these three instances, we are at least grateful that they spared our NO₂ (nitrogen dioxide – a marker of traffic exhaust) and VOC (volatile organic compounds – markers of many anthropogenic sources) samples. Arriving at one site, we learn that an entire sampling set up was confiscated by the police, tin nest and all. It was eventually returned to us, encased in an evidence bag, but too late to make use of the data it collected. While our ‘Farm Squad’ has found this work mentally and physically challenging, we have completed our fall campaign and are now recharging ourselves for another two week sampling campaign in the dead of winter.

While the use of our minivan with our sampling tube��sticking out the window has attracted attention from more than a few passer-bys, this form of mobile air monitoring has proven to be an effective way to describe how air pollution concentrations vary within city blocks. Ultimately, we will consolidate the data from the loops we take each day and describe how they change within and around the CEF. Our data will be used to describe how the green space of the CEF impacts nearby concentrations of air pollution, heat and noise. Importantly, they will also provide the opportunity for a future group of students to assess what impact redevelopment of CEF has on these environmental exposures. Such redevelopment seems unavoidable now with the announcement on December 2 by Heritage�� on the grounds of the CEF be made available for the new hospital.

With our data, the community will now be well positioned to monitor some of the environmental impacts of such a decision. While our next sampling campaign will be done in frigid winter conditions, we can’t think of a better place to conduct fieldwork than in a National Historic Site in the center of our city.

Note. This project is being conducted under the supervision of Dr. Paul Villeneuve and Dr David Miller at �Ӱ�ԭ�� University.

By Jenna Coles, Department of Health Sciences

It is estimated that by 2036 about 25% of the Canadian population will be over 65 years old. To meet the needs of these seniors, the demand for home and long-term care services is expected to grow. In response to the anticipation of such a financial burden, the Ontario government introduced market-modelled management principles within the healthcare sector in 1997 (Armstrong & Armstrong, 2008). Restructuring under market-modelled principles resulted in fundamental changes to work arrangements for employees working in the long-term and home care sectors. Task shifting is one such strategy that has been employed to reduce the costs of delivering services. Task shifting refers to the delegation of tasks from regulated healthcare professionals to home care workers. In Ontario, task shifting occurs most commonly between nurses and personal support workers (PSWs). RNs and RPNs are educated at a university or college level and regulated by The College of Nurses of Ontario, whereas PSWs are unregulated healthcare workers who provide��personal support services for patients in a variety of healthcare settings.

Influence of Task-Shifting- Quality of Care

The question is what are��the impacts of task shifting on the quality of care provided to clients? Studies such as those conducted by Denton and colleagues (2015) have demonstrated mixed opinions regarding the delegation of healthcare tasks among workers. Unregulated healthcare providers, such as PSW’s, are more likely to report that task shifting has��increased the quality of care provided to patients. Unregulated workers cost significantly less money than nurses,��which��increases their��scope of practice, and in fact, PSWs are often hired to work with patients more frequently for longer hours. These workers are able to not only spend more time with patients but also follow more consistent schedules than nurses. Consistency may make the PSW��better suited to monitor a client’s health status, and thus enhances the quality of care as they become more familiar with a patient’s health conditions. Not surprisingly, patients report enhanced satisfaction with their quality of care when they are able to develop more meaningful and trusting relationships with their care worker. And��the research confirms��that trusting relationships place healthcare workers in a better position to provide patient-centered care – care that truly accommodates the patient’s particular needs and preferences (Denton et al., 2015).

While some workers have identified benefits of task shifting, others express concerns that the transfer of tasks from nurses to PSWs might decrease quality of care. An undeniable factor affecting one’s ability to provide high quality care is appropriate knowledge, training, and skills to carry out delegated tasks. In Ontario, when a task is determined as appropriate to be transferred downward by a case manager/primary care nurse, the nurse teaches the skills deemed relevant to performing the task. The training is typically limited to a single session due to scheduling and time constraints. Many nurses stated, however, that one training session��is inadequate for the PSWs to be able to successfully carry out the care tasks (Bystedt et al., 2011). One of the major concerns for Ontario’s nurses is the ability for PSWs to be able to recognize changes in a patient’s condition status and to��provide the patient with appropriate care (Denton et al., 2015).

Impact of Task-Shifting- Care Workers Health Status

The Regulated Health Professionals Act, 1991 and The Long- Term Care Act, 1994��enable nurses to teach PSWs new tasks that they themselves deem to appropriately fit within the PSW’s scope of practice. This policy action has two implications for job satisfaction: an increase in professional autonomy for the PSW, and a simultaneous loss of control experienced by the nurses (Bystedt et al., 2011; Denton et al., 2015). Task-shifting involves PSWs learning more complex skills in order to perform the newly delegated tasks. By expanding their skill set, many PSWs expressed an increased control over their practice and sense of autonomy experienced at work (Barken et al., 2015). Unfortunately, registered nurses have expressed opposite opinions.

Although Ontario employs the largest number of nurses, there has been recent concerns regarding a��nursing labour shortage and high turnover rates. Workplace factors including employment status, job satisfaction, and work-related stress have all been credited with��influencing the workforce shortage. One reason for��the adoption of task-shifting strategies was that it would conveniently allow nurses to focus on��tasks that are more knowledge intensive and appropriate��to their profession (Bystedt et al., 2011). This policy was intended to lead to decreases in job-related stress and lower turnover rates. However, when nurses are required to give up components of their care plans to lower-skilled workers who are often inadequately trained, it is unsurprising that they report feeling a loss of control and work autonomy (Barken et al., 2015). Home care nurses declared that the relationships they developed with their patients contributed greatly to their overall job satisfaction (Barken et al., 2015). Task shifting moves many of the tasks that once provided nurses with an opportunity to build trusting relationships to PSWs. When the opportunity to perform this emotional labour decreased, the levels of stress nurses experienced increased (Barken et al., 2015).

Task-Shifting Policies – Evaluation from a Feminist Political Economy Framework

Social relations are shaped by dynamic interconnections between politics, economics, and ideology. From a political economy perspective, the regulation of home care workers can be seen as��embedded in a profit-driven��mode of production. In such a market-model system of healthcare delivery, the decrease of service costs becomes the��central focus. Thus, while the number of seniors requiring care continues to increase, there has been no parallel increase in budgets for their long-term care. Cost-savings techniques are not only reflected in care workers’ low wages, but can��have potentially major health implications for both patients and care workers. This raises��the��question of who benefits from such an approach, and at whose expense?

Home care work is predominantly done by women, and in particular by women of different intersectionalities (race, cultural ethnicity, class, etc.) (Armstrong & Armstrong, 2008). Women are increasingly expected to fill in the care gaps that have been created through restructuring in the larger global market-driven��context. The failure to regulate PSWs so that their training and credentials are��recognized means that non-white immigrant women are increasingly the��source of cheap, readily available labour in the long-term and home care sectors. Consideration needs to be given to��the ways in which cost-saving policies, such as task shifting, are not only affecting the health of clients, nurses and PSWs but the ways in which they may be exacerbating the tenuous situation��of particular��women who are already vulnerable to exploitation.

Key Considerations

With demand for home care services increasing, care organizations across Ontario have adopted task shifting as a strategy to reduce costs. These policies were initially developed as a��means to decrease nurses’ overall workload and reduce work-related stress, which was��believed to be contributing to��nurses’ high turnover rates. A review of the impact of task shifting��has revealed mixed results. On the one hand, task shifting may be advantageous as PSWs are able��to spend more time with patients and feel an increase in their autonomy. On the other hand, nurses are reporting loss of control and increases in job-related stress. Although restructuring of the healthcare system may be a priority for the Canadian government, health policies should not be implemented without a thorough understanding of the impacts of these policies on the health of the public and our caregivers, and the underlying assumptions implicit in these policies.�� �� �� �� ����

References

Armstrong, P., & Armstrong, H. (2008). �Ӱ�ԭ�� Canada: Health care. Black Point & Winnipeg, Canada: Fernwood Publishing.

Barken, R., Denton, M., Plenderleith, J., Zeytinoglu, I.U., & Brookman, C. (2015). Home care workers’ skills in the context of task shifting: Complexities in care work. Canadian Review of Sociology/Revue Canadienne de Sociologie, 52(3), 289- 309.

Bystedt, M., Eriksson, M., & Wilde- Larsson, B. (2011). Delegation within municipal health care. Journal of Nursing Management, 19(4), 534-541.

Denton, M., Brookman, C., Zeytinoglu, I., Plenderleith, J., & Barken, R. (2015). Task shifting in the provision of home and social care in Ontario, Canada: implications for quality of care. Health and Social Care in the Community, 23(5), 485- 492.

Kraft Dinner made with real cauliflower? What a great way to indulge without feeling as guilty.

Think again.

Kraft Dinner, among many other companies, is a culprit of using food marketing to create a false sense of health amongst consumers. What the packaging doesn’t tell you is that there is a slim two tablespoons of cauliflower per serving. To make matters worse, there is an additional 12% of saturated fat, 9% more sodium, 12% more sugar and 4% less protein than the original version (Freedhoff, 2010).

Despite significant efforts to address the current obesity epidemic facing our nation, experts have expressed that our food environment may be one of the primary drivers (Pomeranz, 2013). The proliferation of claims on food packaging creates a misleading and illusionary representation of a product’s healthfulness. The lack of regulations restricting questionable claims, and insufficient consequences for those who do violate the regulations, further encourage such deceptive claims and undermine public health. Food and beverage companies consistently manipulate consumers and attempt to gain economic benefit from society’s yearning desire to be healthy and fit, by marketing their products as healthy, when they are in fact not.

Harris et al. (2009) analyzed a variety of data sources to provide a rigorous and comprehensive analysis of the nutritional quality and marketing of children’s cereals (115 cereal brands examined in total). Of the 115 cereals brands examined, the most health claims were found on the least healthy cereals. Lucky Charms displayed an average of 3.8 health claims, despite being categorized as one of the most unhealthy cereal brands for children.

Similarly, a study conducted by Mozaffarian et al. (2013) found that food items presenting the “Whole Grain Stamp”, used to indicate products containing at least half a serving of whole grain, actually contained the most sugar of all other grain products assessed and were often more expensive. Upon further exploration, the authors concluded that consumers are often misled by the promised healthfulness that the symbol implies. It should also be noted that Whole Grain Stamp is the only standard that is determined by the manufacturers own assessments and willingness to pay for its use, which poses significant conflict of interest issues.

“Whether or not a product contains whole grains is just one measure of healthfulness, and others factors must be considered” (Mozzaffarian et al., 2013)

These studies highlight the deceptive nature of the food marketing industry. However, does our society readily rely on these health claims when attempting to make healthy lifestyle choices in the first place? Or do they see through the claims and refer to the ingredient list or nutrition facts label when making food selections?

Northup (2014) investigated the degree to which consumers relate marketing terms on food packaging, also known as health buzzwords, to healthy lifestyle choices. The author developed an online survey that presented two different images of the same product; one presenting health buzzwords on the packaging (“organic”, “gluten-free”, “whole grain”, etc.) and the other with the health buzzwords photo-shopped out. Participants (a total of 318) were then asked to rate which product they perceived to be the healthier option. The author of this well-controlled, novel and generalizable study found that the participants consistently rated the food products displaying the health buzzwords as healthier choices.

“Words like organic, antioxidant, natural and gluten-free imply some sort of healthy benefit. When people stop to think about it, there’s nothing healthy about Antioxidant Cherry 7-Up – it’s mostly filled with high fructose syrup or sugar. But its name is giving you this clue that there is some sort of health benefit to something that is not healthy at all” (Northup, 2014).

Participants also reviewed the nutrition facts label on a variety of food items. These items were presented two at a time and participants chose which item they perceived to be healthier. Unfortunately, this proved to be a difficult task for many. Rothman et al. (2006) found that poor label comprehension was highly correlated with low-level literacy and numeracy skills. One could argue that poor health literacy increases society’s dependence and reliance on health buzzwords (Butler, 2010).

It is evident that there is a significant need for more restrictive regulations regarding food marketing, in order to protect consumers. Consumers should become aware of the food industry’s intentions and question all health claims on food packaging. Secondly, consumers should refer to the ingredient list and nutrient facts labels in order to assess the actual healthfulness of a food product. It is essential that we become active buyers when striving to make healthy lifestyle choices. With that being said, food label regulators must make changes to the current nutrition facts label, in an effort to increase its comprehensibility for the general public.

Bibliography:

Butler, K. (2010). Making smart choices: Health claims, regulation, and food packaging (Unpublished doctoral dissertation). University of Pittsburg, Pittsburg.

Freedoff, Y. (2010). Badvertising: KD smart think you’re KD stupid. Retrieved from ���������������������� kd.html

Harris, J. L., Schwartz, M. B., Brownell, K. D., Sarda, V., Weinberg, M. E., Speers, S., ….. Byrnes-�� Enoch, H. (2009). Evaluating the nutrition quality and marketing of children’s cereals. Hartford, CT: Rudd Center for Food Policy and Obesity.

Mozaffarian, R. S., Lee, R. M., Kennedy, M. A., Ludwig, D. S., Mozaffarian, D. & Gortmaker, S. L. (2013). Identifying whole grain foods: A comparison of different approaches for selecting more healthful whole grain products. Public Health Nutrition, 16(12), 2255-2264.

Northup, T. (2014). Truth, Lies, and Packaging: How Food Marketing Creates a False Sense of Health. Food Studies: An Interdisciplinary Journal, 3(1), 9-18.

Pomeranz, J. L. (2013). A comprehensive strategy to overhaul FDA authority for misleading food labels. American Journal of Law & Medicine, 39(4), 617-647.

Rothman, R. L., Housam, R., Weiss, H., Davis, D., Gregory, R., Gebretsadik, T., Shintani, A. & Elasy, T. A. (2006). Patient understanding of food labels: The role of health literacy and numeracy. American Journal of Preventative Medicine, 31(5), 391-398.