Conceptualizing Youth Participation in Children's Health Research: Insights from a Youth-Driven Process for Developing a Youth Advisory Council.

Given the power asymmetries between adults and young people, youth involvement in research is often at risk of tokenism. While many disciplines have seen a shift from conducting research on youth to conducting research with and for youth, engaging children and teens in research remains fraught with conceptual, methodological, and practical challenges. Arnstein's foundational Ladder of Participation has been adapted in novel ways in youth research, but in this paper, we present a new rendering: a 'rope ladder.' This concept came out of our youth-driven planning process to develop a Youth Advisory Council for the Human Environments Analysis Laboratory, an interdisciplinary research laboratory focused on developing healthy communities for young people. As opposed to a traditional ladder, composed of rigid material and maintaining a static position, the key innovation of our concept is that it integrates a greater degree of flexibility and mobility by allowing dynamic movement beyond a 2D vertical plane. At the same time, the pliable nature of the rope makes it both responsive and susceptible to exogenous forces. We argue that involving youth in the design of their own participatory framework reveals dimensions of participation that are important to youth, which may not be captured by the existing participatory models.

Exploring children's seasonal play to promote active lifestyles in Auckland, New Zealand.

Studies of seasonal barriers for outdoor activities seldom view families' play practices as grounded in the everyday experience of the natural elements. This paper brings 20 families' mundane outdoor play experiences in Auckland's temperate climate to the fore. Through drawings and interviews, families residing in both suburban detached houses and central city apartments revealed locally constituted beliefs about appropriate play spaces (e.g. garden, park). While the majority of participants retreated to indoor activities during winter, some children and their parents viewed the outdoors as the only opportunity for 'real fun'. We advocate the importance of a better understanding of children's seasonal outdoor play. In particular, we argue that in order to promote year-round healthy levels of outdoor activities it is necessary to understand variations in societal, neighbourhood and family values attributed to outdoor activities. Further, to develop a more nuanced understanding of the locational complexities of outdoor play it is important to understand the meanings of, and practices associated with, seasonal and weather conditions in different international locations.

Seasonal and locational variations in children's play: implications for wellbeing.

Physical activity, through independent outdoor play, has come to the fore as a way to improve children's health through it fostering healthy mental and social as well as physiological development. However, in many high-income countries children's autonomous play opportunities have diminished due to urban intensification and declining parental license. Regardless of this trend, children's play varies across countries, cities, cultures and seasons. This paper offers new insights into the complexities of play as a vital aspect of children's wellbeing. Within the context of New Zealand - whose citizens generally regard themselves as outdoor people - this paper explores why 'play' might resonate differently across localities and seasons. We contrast the play affordances provided by Auckland's central city (dominated by apartment living) with Beach Haven, a suburban area. We employed a multi-method approach and included 20 children and their parents who were recruited through school and summer holiday programs embracing different gender and ethnicities to reflect the general cultural mix of the respective neighbourhoods. We advance two arguments. First, we suggest that the rarity of children playing outdoors unsupervised normalises supervised indoor play and reduces children's opportunities to see outdoor play as an alternative to interior or supervised pastimes. Second, we follow Bourdieu's theory of practice to argue that the regard parents and children have towards outdoor play reflects locally constituted beliefs about what is seasonally 'appropriate' children's activity. We found that extra-curricular activities and supervised excursions are undertaken in the central city all year around and only vary between social groups by the type of destination. In the suburb, independent outdoor play in summer represents children's main business after school in ways that enhance their environmental literacy and potential future health gain. For others these symbolic values were replaced by safety concerns. In contrast, it seems that even in a relatively mild climate winter is the time to relax and stay indoors unless children have an outdoor habitus. We find that the determinants of seasonal outdoor play transcend modifiable barriers such as traffic and unsuitable play spaces as well as the inevitable issue of inclement weather.

Entitlements to health care: why is there a preference for private facilities among poorer residents of Chennai, India?

This paper examines access to health care by poorer residents in Chennai, India. It reveals constraining and enabling conditions for impoverished users seeking treatment. We explore patterns of health-seeking behaviour through the reasoning of residents themselves as well as stakeholders involved in providing care for these users. Particular attention is paid to the needy residents' preference for private health care providers despite the costs involved and that free public facilities are available. We address this issue by combining Sen's entitlement approach with Penchansky and Thomas' work on access to health care. Based on data gathered in a qualitative field-based research design including interviews with 14 residents and 58 stakeholders involved in caring for poor people, we argue that the availability of health care facilities within walking distance is a necessary but not sufficient precondition for satisfactory access. Rather, we demonstrate the influence of 'entitlements to health care' which allow poor households that are endowed with resources such as income, knowledge and social networks to realise access. The narratives we present reveal not only experiences of health care, but also feelings about its utilisation. The latter, we contend, are crucial in determining choice of health care facilities. This finding suggests that analyses of affordability and physical access to health care in less developed countries should include a focus on emotional dimensions of utilisation. In other words, there is a need to consider not only effective access to health care, but also affective dimensions of treatment for poorer citizens.