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Vaccines have been described as one of the greatest achievements in combating infectious diseases and promoting human health. However, not everyone shares this view. For some, childhood vaccinations are controversial, leading to individuals choosing to not vaccinate their children. To examine issues surrounding childhood vaccination, the Discourse, Science, Publics (DSP) Lab at University of Guelph recently hosted the Ontario Vaccine Deliberation in Waterloo, Ontario on October 14, 15, 28 and 29, 2017. Twenty-five randomly selected adults from across Ontario came together to share their views on childhood vaccination in a public deliberation event. Prior to the event, participants received the Ontario Vaccine Deliberation Information Booklet. During the event, participants heard from several experts and key stakeholders with diverse views on vaccination and related issues and worked together in small and large-group formats over the 4-days to identify and discuss important issues relevant to childhood vaccinations. As a collective group, the participants developed policy recommendations that reflect the diverse views of the group.

Background: Policy decisions about childhood vaccination require consideration of multiple, sometimes conflicting, public health and ethical imperatives. Examples of these decisions are whether vaccination should be mandatory and, if so, whether to allow for non-medical exemptions. In this article we argue that these policy decisions go beyond typical public health mandates and therefore require democratic input. Methods: We report on the design, implementation, and results of a deliberative public forum convened over four days in Ontario, Canada, on the topic of childhood vaccination. Results: 25 participants completed all four days of deliberation and collectively developed 20 policy recommendations on issues relating to mandatory vaccinations and exemptions, communication about vaccines and vaccination, and AEFI (adverse events following immunization) compensation and reporting. Notable recommendations include unanimous support for mandatory childhood vaccination in Ontario, the need for broad educational communication about vaccination, and the development of a no-fault compensation scheme for AEFIs. There was persistent disagreement among deliberants about the form of exemptions from vaccination (conscience, religious beliefs) that should be permissible, as well as appropriate consequences if parents do not vaccinate their children. Conclusions: We conclude that conducting deliberative democratic processes on topics that are polarizing and controversial is viable and should be further developed and implemented to support democratically legitimate and trustworthy policy about childhood vaccination.

Post-COVID-19 environments have challenged our embodied identities with these challenges coming from a variety of domains, that is, microbiological, semiotic, and digital. We are embedded in a new complex set of relations, with other species, with cultural signs, and with technology and venturing further into an era that pushes back on our anthropocentrism to create a post-human dystopia. This does not imply that we are less human or forfeit ethics in this state of flux, but can lead to considering new ways of being alive and humanists. The aim of this project was to explore walking through our associated psychogeographies as captured in photographs and text from individual walks, as the means by which to characterize responses to the distress of the pandemic and to assess resistance to non-being. The psychogeographies were the starting points for our dialogic enquiry between authors who each represent living theory, representing their own emergent knowledge, inseparable from personal commitments and history. Walking and the associated images and reflections, provided a way to regulate our affect, reconnecting with our bodies, leading to understand and adapt to new meanings of context and ways of coping and healing in this new becoming. The interdisciplinarity of philosophy, social psychology, botany, and clinical psychology is nonetheless rejected in favour of multi-vocality; each author representing their own emergent, living theory, inseparable from personal commitments, and history.

Supplemental material, sj-pdf-1-mdm-10.1177_0272989X21998980 for Layperson Views about the Design and Evaluation of Decision Aids: A Public Deliberation by Peter H. Schwartz, Kieran C. O’Doherty, Colene Bentley, Karen K. Schmidt and Michael M. Burgess in Medical Decision Making

Supplemental material, sj-pdf-1-mdm-10.1177_0272989X21998980 for Layperson Views about the Design and Evaluation of Decision Aids: A Public Deliberation by Peter H. Schwartz, Kieran C. O’Doherty, Colene Bentley, Karen K. Schmidt and Michael M. Burgess in Medical Decision Making

First in a series of working papers on the social impacts of the Coronavirus in Canada.

The vaginal microbiome plays an important role in maternal and neonatal health. Imbalances in this microbiota (dysbiosis) during pregnancy are associated with negative reproductive outcomes, such as pregnancy loss and preterm birth, but the underlying mechanisms remain poorly understood. Consequently a comprehensive understanding of the baseline microbiome in healthy pregnancy is needed. We characterized the vaginal microbiomes of healthy pregnant women at 11–16 weeks of gestational age (n = 182) and compared them to those of non-pregnant women (n = 310). Profiles were created by pyrosequencing of the cpn60 universal target region. Microbiome profiles of pregnant women clustered into six Community State Types: I, II, III, IVC, IVD and V. Overall microbiome profiles could not be distinguished based on pregnancy status. However, the vaginal microbiomes of women with healthy ongoing pregnancies had lower richness and diversity, lower prevalence of Mycoplasma and Ureaplasma and higher bacterial load when compared to non-pregnant women. Lactobacillus abundance was also greater in the microbiomes of pregnant women with Lactobacillus-dominated CSTs in comparison with non-pregnant women. This study provides further information regarding characteristics of the vaginal microbiome of low-risk pregnant women, providing a baseline for forthcoming studies investigating the diagnostic potential of the microbiome for prediction of adverse pregnancy outcomes.

Epidemiologic studies have adapted to the genomics era by forming large international consortia to overcome issues of large data volume and small sample size. Whereas both cohort and well-conducted case-control studies can inform disease risk from genetic susceptibility, cohort studies offer the additional advantages of assessing lifestyle and environmental exposure-disease time sequences often over a life course. Consortium involvement poses several logistical and ethical issues to investigators, some of which are unique to cohort studies, including the challenge to harmonize prospectively collected lifestyle and environmental exposures validly across individual studies. An open forum to discuss the opportunities and challenges of large-scale cohorts and their consortia was held in June 2009 in Banff, Canada, and is summarized in this report. © Springer Science+Business Media B.V. 2010.

A working group from across Canada comprised of clinician and basic scientists, epidemiologists, ethicists, Health Canada regulatory authorities and representatives of major funding agencies (Canadian Institutes of Health Research and the Crohn's and Colitis Foundation of Canada) met to review the current experience with fecal microbial therapy and to identify the key areas of study required to move this field forward. The report highlights the promise of fecal microbial therapy and related synthetic stool therapy (together called 'microbial ecosystems therapeutics') for the treatment of Clostridium difficile colitis and, possibly, other disorders. It identifies pressing clinical issues that need to be addressed as well as social, ethical and regulatory barriers to the use of these important therapies.

Background: The vaginal microbiome influences quality of life and health. The composition of vaginal microbiota can be affected by various health behaviors, such as vaginal douching. The purpose of this study was to examine the types and prevalence of diverse vaginal/genital health and hygiene behaviors among participants living in Canada and to examine associations between behavioral practices and adverse gynecological health conditions. Method: An anonymous online survey, available in English and French, was distributed across Canada. The sample consisted of 1435 respondents, 18 years or older, living in Canada. Results: Respondents reported engaging in diverse vaginal/genital health and hygiene behavioral practices, including the use of commercially manufactured products and homemade and naturopathic products and practices. Over 95% of respondents reported using at least one product in or around the vaginal area. Common products and practices included vaginal/genital moisturizers, anti-itch creams, feminine wipes, washes, suppositories, sprays, powders, and waxing and shaving pubic hair. The majority of the sample (80%) reported experiencing one or more adverse vaginal/genital symptom in their lifetime. Participants who had used any vaginal/genital product(s) had approximately three times higher odds of reporting an adverse health condition. Several notable associations between specific vaginal/genital health and hygiene products and adverse health conditions were identified. Conclusions: This study is the first of its kind to identify the range and prevalence of vaginal/genital health and hygiene behaviors in Canada. Despite a lack of credible information about the impact of these behaviors on women’s health, the use of commercially manufactured and homemade products for vaginal/genital health and hygiene is common. Future research can extend the current exploratory study by identifying causal relationships between vaginal/genital health and hygiene behaviors and changes to the vaginal microbiome.

The Covid-19 pandemic and subsequent school closures have disrupted family life in Ontario since its onset in 2020. Families were required to transition to online learning from March to June 2020. For the 2020-2021 school year, parents had to choose between continuing with online learning or having their children return to school in-person in an adapted school environment. I conducted a qualitative analysis of 34 interviews with parents of school-aged children in Ontario. This thesis investigated how parents navigated making the back-to-school decision on behalf of their children. The analysis shows the various ways in which considerations like the threat of the SARS-CoV-2 virus, family specific qualities, and previous experiences with online learning featured in back-to-school decision-making.

To better understand opinions and concerns around COVID-19 vaccine development and uptake, forty Ontarians were interviewed about their perspectives on a potential COVID-19 vaccine. Participants described concerns about 1) the expedited development timeline of a COVID-19 vaccine, 2) the safety and efficacy of the vaccine itself, 3) the timing of personal vaccine uptake relative to other Canadians and 4) whom to trust for information when making personal vaccine decisions. These findings suggest that Ontarians are concerned about the shortened timeframe within which a COVID-19 vaccine was developed. Participants were particularly concerned that this shortened timeframe might result in decreased safety and efficacy standards, and perceived these decreased standards as a potential catalyst for severe detrimental side effects and/or ineffective vaccines. Participants described the timing of their personal vaccine decisions as well as the sources to whom they turned for information about the vaccine as means to mitigate potential harm. This work was supported by funding provided by the Social Sciences and Humanities Research Council (SSHRC) as well as the University of Guelph’s COVID-19 Catalyst Grant.

Intrauterine devices (IUDs) are considered the most effective form of birth control for reducing unintended pregnancies. Given this, contraceptive counselling and research focuses on how to increase IUD uptake amongst women. However, this approach assumes effectiveness is the most important consideration in women’s reproductive decision-making. This study examines how women in Ontario come to make choices about their preferred form of contraception and what factors are important to their decision-making process. I conducted a pattern-based qualitative analysis of 20 semi-structured interviews with women in Ontario. Based on this analysis, I argue that contraceptive decision-making involves the considerations of individual women’s goals, their experiences with previous forms of contraception, and the changing circumstances throughout their lives. The results suggest that the current emphasis solely on effectiveness and IUDs in women’s contraceptive counselling is inconsistent with how women make sense of contraception in the context of their day-to-day lives.

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among reproductive-aged women, with symptoms and associated conditions that often undermine both gendered and biomedical norms and cause women distress. In this study, I illustrate how PCOS has been developed in biomedical literature to represent a state of being both unfeminine and unhealthy. I provide a historical overview of PCOS as a foundation for knowledge of the syndrome while also offering a critical reading of the development of that knowledge. I then conduct a feminist poststructural discourse analysis on interviews with women with PCOS. From women’s talk, I discerned four characterizations of PCOS bodies that yield particular social and material practices for management: Monstrous, Undocile, Disruptive and Impelling Identity Negotiation. I close by considering the conceptual and applied implications of these findings.

Vaginal cleansing products such as douches, sprays, wipes, powders, washes, and deodorants are part of a 2 billion industry in North America. Within Canada, use of vaginal washes and wipes in particular is on the rise among younger generations of women. According to a Nielson Consumer Data Report, Canadian women spent almost 6.8 million dollars on vaginal wipes in 2015. However, medical literature increasingly suggests there are adverse health risks associated with some of these products, including higher risks of women being susceptible to bacterial vaginosis and cervical cancer. Given the popularity of vaginal cleansing products despite potential health concerns it is important to explore the role these products play in women’s experiences of the vagina and how these experiences are constructed in relation to broader cultural meanings of women’s bodies. Therefore, this dissertation critically examines how women who use vaginal cleansing products construct, manage, and feel about their vaginas in relation to the messages they receive around vaginal health and hygiene. Drawing on interviews with 31 women who were currently using or had previously used vaginal cleansing products, this dissertation employs a critical discourse analysis to examine the multiple and overlapping constructions of the vagina within participants’ accounts that framed their use of vaginal cleansing products in different ways. This includes an examination of three distinct constructions, the clean vagina, the dirty vagina, and the healthy vagina, and how these were connected to vaginal cleansing products being viewed as necessary or unnecessary. Of these three constructions, my analysis focuses, in particular, on how the clean vagina is idealized by many participants in such a way that vaginal cleansing product use becomes a necessary beauty practice in removing vaginal odour, discharge, and menstrual blood. I show how the clean vagina is a powerful beauty ideal to the extent that some women rationalized and justified their use of vaginal cleansing products despite being aware of or experiencing negative health consequences associated with these products. Thus, I demonstrate how use of vaginal cleansing products is a beauty practice that some women feel pressured to perform within a society where vaginas are predominantly constructed as dirty, shameful, and inadequate.

The present study was designed to investigate the social processes that influenced the creation of the recommendation statements produced during a public deliberation event on funding for cancer drugs in Canada. Twenty-four ordinary citizens were recruited to participate in this deliberative mini-public through a process of random sampling that maximized diversity. Discourse analysis was used to analyze transcripts from the two-day event. The analysis indicates that participants who made direct wording suggestions may have had greater influence than those who did not when building collective recommendation statements. This analysis also illustrates some of the processes through which facilitators and principal investigators are co- producers of the outputs of the deliberation, and how deliberative voting can effectively work as a communication tool. Following the presentation of these results, several considerations that may be helpful for those who are designing and facilitating future deliberation events are discussed.

During older age, many people experience hospitalization, and during the transition from home, family members are often depended upon to provide support. Often these family members are filial caregivers, yet limited research has examined their experiences caring for their parent during this period. Eighteen filial caregivers from Southern Ontario were interviewed about their experiences caring for their parent during their parent’s transition from hospital to home, and a thematic analysis was conducted. The analysis contextualized caregivers’ experiences by examining how caregivers described the healthcare system, and the concerns they had about their parent’s care. The analysis also examined the activities that caregivers performed to support their parent during the transition from hospital to home, and the challenges they encountered in doing so. Specifically, the analysis suggests that caregivers did not always have the capacity to support their parent because they did not have access to necessary information or resources, and in some cases, may not have had the authority to intervene in their parent’s care. In such instances, their parent’s well-being could be compromised. However, caregivers actively worked to overcome these barriers, and advocated to gain access to resources and information that would improve or maintain their parent’s well-being. Findings suggest that increased attention to the role of caregivers is needed, and examining what they can reasonably be expected to do given the structural conditions under which they provide support.

This dissertation critically analyzes the ways in which urban Jamaican women position themselves within culturally available discourses on health and beauty. Forty-One Jamaican women from the Kingston and St. Andrew area of Jamaica were interviewed about their conceptualizations of health and beauty. I examine varied meanings of health, and identify the dominant and subversive health discourses (the healthism discourse, obesity epidemic discourse and slim-thick healthy body discourse) that are available to Jamaican women. Using a feminist post-structuralist framework, I analyze how Jamaican women take up, resist and partially resist these discourses. I then describe the characteristics of a beautiful body in Jamaica. I identify a light-skinned beauty ideal and demonstrate the pervasiveness of this conceptualization of beauty. I also illustrate how Jamaican women refer to Jamaica’s history of colonialism and slavery as explanations for modern-day conceptualizations of beauty in Jamaica. I show how notions of beauty intersect with socially constructed categories of race and class and discuss the intersection of gender, race, and class in relation to the subjectivities of urban Jamaican women. I conclude by considering the need for more inclusive ways of thinking and speaking about women’s bodies in Jamaica and beyond.