Exploring Risk Perception of an Emerging Environmental Health Risk: A case study of allergic disease in youth team sport in Ontario, Canada

Asthma is the most common chronic disease among children worldwide, and approximately 3.8 million Canadians are diagnosed. Although the relationship is complex, participation in physical activity is recommended as part of a comprehensive asthma management plan, as it can reduce symptoms and improve wellbeing for those affected. Team sport participation is a common way for children and youth to engage in physical activity. The spaces in which team sport is experienced can present unique challenges for vulnerable children, and evidence suggests that those with asthma may be less physically active than their non-asthmatic peers. While asthmatic youth may experience barriers to sport participation, effective allergic disease management that includes coach consideration of the environmental contexts of sport can help asthmatic athletes maintain long-term engagement in activity. \n \nThe research presented in this thesis therefore aims to increase understanding of how children, parents and organized youth team sport coaches in Ontario understand and manage the links between allergic disease, the environment and physical activity. The research focuses on three broad objectives: first, to explore the knowledge, attitudes, and practices of users and providers of child and youth team sport with respect to the links between the environment, allergic disease and physical activity; second, to investigate the impact of a coach education module related to coach attitudes and behaviours regarding the links between the environment, allergic disease and physical activity; and finally, to document the factors shaping the perception of asthma as an emerging environmental health risk in Ontario youth team sport. A mixed-methods case study approach was used in this research. \n \nThere is an inherent geographic component to understanding how environmental factors impact allergic disease risk in organized team sport. Understanding how elements of the environment are managed and risk is perceived amongst sport stakeholders is important for effective asthma management. In-depth interviews with coaches (n=18) and athletes with asthma (n=11) suggest that ensuring both the physical (e.g., recognizing potential triggers) and social (e.g., reducing stigmatization) needs of vulnerable athletes are recognized is important to maximize enjoyment and performance, and improve asthma management for those affected. Focus groups with coaches (n=12) indicate that while coaches perceived an education module related to the environment, physical activity and allergic disease as valuable, some content was considered less relevant, and barriers to its implementation (e.g., coach autonomy) were identified. Finally, multivariate analysis of two surveys (coaches, n=94; parents of athletes with allergic disease, n=90) suggests that various factors (e.g., exposure, education, propensity for risk, gender) contribute to how asthma risk is perceived amongst and between sport stakeholders, emphasizing the value of population-specific risk management communication. \n \nThis research makes multiple important contributions. Theoretically, a place-based conceptual framework for understanding public experience of risk was applied; this framework informed research design, and recommendations (e.g., consideration of scale) with respect to future application are offered. The use of multiple and mixed methods, and including a potentially vulnerable group in the interviews, allowed for enhanced understanding of the factors that contribute to asthma management in sport. Substantively, this research contributed to the Geographies of Asthma literature, increasing understanding of asthma risk perception outcomes, and the environmental factors (e.g., sociocultural, political) that contribute to how asthma is perceived amongst sport stakeholders in Ontario. Considering the environmental contexts of risk is therefore critical to improve environment and health management in Ontario organized team sport, and reduce the future chronic disease burden associated with physical inactivity in Canada.

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