Stone Et Al 2024 It s Not Something We Like to Think About Because It s So Devastating Understanding Eastern Canadian

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PRVXXX10.1177/26320770231204339Journal of Prevention and Health PromotionStone et al.

Article
Journal of Prevention and

“It’s Not Something


Health Promotion
2024, Vol. 5(1) 121­–152
© The Author(s) 2024
We Like to Think
About Because It’s Article reuse guidelines:
sagepub.com/journals-permissions
So Devastating”: https://doi.org/10.1177/26320770231204339
DOI: 10.1177/26320770231204339
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Understanding Eastern
Canadian Young
Women’s Mental Health
in Our Changing Climate

Kathryn Stone1 , Barbara Hamilton-Hinch1,


Megan Aston1, Daniel Rainham1 ,
and Rebecca Spencer1

Abstract
Women are disproportionately affected by climate change, yet even though
mental health and climate change is an emerging field, little research focuses
on their mental health. The purpose of this study was to explore young
women’s perceptions of climate change, gender, and mental health. A feminist
poststructural (FPS) approach guided this research. FPS and discourse
analysis were used to explore nine participants’ perceptions of their mental
health in relation to the changing climate, and how their experiences
were personally, socially, and institutionally constructed. Findings highlight
participant relationships to discourses surrounding hopelessness, anxiety,
grief and frustration, intersectionality, stereotypes, and gender-based
violence (GBV). Study findings supported by broader literature provide
recommendations for the discipline of health promotion regarding gender
appropriate climate mitigation and adaptation strategies that prioritize

1
Dalhousie University, Halifax, NS, Canada

Corresponding Author:
Kathryn Stone, Dalhousie University, 2497 Sherwood Street, Halifax, NS B3L3G9, Canada.
Email: Kathryn.stone@dal.ca
122 Journal of Prevention and Health Promotion 5(1)

and recognize mental health. We urge health promotion to recognize and


integrate the fact that climate change amplifies existing inequities into health
and climate change policies whenever possible. Climate change and health
policies should ensure women are safe and protected before climate driven
weather events to prevent instances of GBV. We recommend that health
promotion media specialists recognize the dangers and ineffectiveness of
fear mongering and attempt to promote climate solutions as opposed to
only stories of despair and ecological degradation.

Keywords: climate change, gender, mental health, hopelessness, eco-anxiety,


gender stereotypes, gender based violence, feminist poststructuralism

Introduction
Climate change is an existential threat to human health (Chiabai et al., 2018;
Comeau & Nunes, 2019; Costello et al., 2009; Haines et al., 2021; Howard
et al., 2018; Sellers, 2016; Watts et al., 2021). The changing climate has and
will continue to impact health by threatening food and water security, exacer-
bating asthma symptoms, increasing the spread of Lyme disease, and increas-
ing risks of heat stroke and death (Costello et al., 2009; Howard et al., 2018).
While the physical health implications of climate change are well docu-
mented, the social and mental health impacts are beginning to emerge as a
critical area for inquiry (Albrecht et al., 2007; Anastario et al., 2009; Borish
et al., 2021; Dodd et al., 2018; Hayes & Poland, 2018; Meyiwa et al., 2014;
Stone et al., 2022; Willox, 2012).
The mental health implications of climate change have recently been
added to the discussion in large and well-known documents, such as the
Lancet Countdown on Health and Climate Change (Romanello et al., 2022;
Watts et al., 2021). Studies and health reports are progressively including
mental health as a key issue to address when it comes to the impacts of cli-
mate change on human health, especially for those living with pre-existing
mental health conditions, challenging socioeconomic positions (SEPs), and/
or those living in geographically vulnerable areas (Bourque & Willox, 2014;
Every-Palmer et al., 2016; Howard et al., 2018; Obradovich et al., 2018; Rice
& McIver, 2016). However, this research lacks a distinct gender component,
despite overwhelming evidence and understanding that climate change
impacts women disproportionately (Government of Canada, 2018; Osman-
Elasha, 2022; United Nations, n.d.).
Stone et al. 123

This study employed a feminist poststructural (FPS) methodology to


explore young women’s mental health and climate change. We sought to
answer the research question: How do young women experience mental
health and gender in relation to the changing climate in Nova Scotia, Canada?
The study objectives were to (a) understand how young women perceive their
mental health in relation to the changing climate and (b) explore how wom-
en’s experiences with the changing climate are personally, socially, and insti-
tutionally constructed. This second objective is common in studies using
FPS, wherein the goal is often to explore how participant experiences are
personally, socially, and institutionally constructed through different subject
positions (Aston, Price, Hunter et al., 2021; Aston, Price, Paynter et al., 2021;
Joy et al., 2020; Ollivier et al., 2021).

Background
Current research on the mental health impacts of climate change focuses
largely on direct impacts including extreme weather events, such as floods,
wildfires, storms, and heat waves (Ajibade et al., 2013; Anastario et al., 2009;
Dodd et al., 2018; Mamun et al., 2019; Thompson et al., 2018; Tyler &
Fairbrother, 2013). Mental health impacts also arise from indirect impacts
such as increasing variability in weather patterns, sea-level rise, and drought
conditions (Beaumier & Ford, 2010; Cunsolo Willox et al., 2015; Dean &
Stain, 2010; Durkalec, 2015; Petrasek MacDonald et al., 2015; Willox, 2012).
Challenges to mental health are also associated with feelings of fatalism and
eco-anxiety related to the knowledge and awareness of climate change and
environmental degradation (Albrecht, 2011; Albrecht et al., 2007; Fritze
et al., 2008; Hayes & Poland, 2018). However, studies on the gendered
aspects of mental health and climate change are scarce, despite evidence that
women bear the brunt of the impact of climate change and are leaders in
shaping adaptation and mitigation efforts worldwide (Anthony, 2019; Dennis
& Bell, 2019; Johnson & Wilkinson, 2020).
The gendered implications of climate change have been well documented
over the past 10 years, where we know women experience climate change
disproportionately. For example, women are more likely to die during an
extreme weather event (Araujo & Quesada-Aguilar, 2007; Demetriades &
Esplen, 2009), experience heightened rates of gender-based violence (GBV)
after disasters (Anastario et al., 2009; Boetto & McKinnon, 2013), and face
danger while collecting resources for their families at more remote and far
away locations (Meyiwa et al., 2014). Furthermore, women report sexual
harassment while waiting in lines for food and supplies after extreme weather
events (Nahar et al., 2014), as well as an increase in domestic labor, causing
124 Journal of Prevention and Health Promotion 5(1)

some to drop out of school (Araujo & Quesada-Aguilar, 2007). Some impacts
are more nuanced, for example, women in rural Australia reported that cli-
mate change has increased the cost of living, thus making it more difficult for
women to leave domestic violence situations (Boetto & McKinnon, 2013).
Furthermore, women have limited engagement in climate-related decision-
making processes, preventing them from fully participating in climate policy,
governance, and leadership (Alston, 2013; Government of Canada, 2018;
IUCN, 2015; Sellers, 2016). While we are beginning to understand how the
effects of climate change disproportionately affect women, a dearth of knowl-
edge exists about how climate change is associated with women’s mental
health.
While one scoping review revealed how women’s mental health is dis-
tinctly impacted by climate change (Stone et al., 2022), youth were not a focus
of studies reviewed. Yet, youth are progressively active and vocal in advocat-
ing for climate action (Johnson & Wilkinson, 2020). Greta Thunberg, Autumn
Peltier, and Helena Gualinga are only a small sample of young women across
the world making change and advocating for climate and environmental jus-
tice (Greta’s Not the Only One, 2019). Many of these young women choose to
address climate change because they have been and continue to be impacted
by it. For example, Hilda Flavia Nakabuye from Kampala, Uganda was pushed
to action because climate change is impacting her grandmother’s ability to
grow food (Sommer, 2021). Youth are particularly vulnerable to climate
change, especially in terms of heat exposure and exposure to environmental
disasters associated with climate change (Majeed & Lee, 2017). The mental
health impacts associated with climate change among youth are much less
understood than those of adults (Majeed & Lee, 2017).
Although there is reported evidence on the separate topics of mental health
and climate change, women and climate change, and youth and climate
change, there has yet to be a distinct exploration of climate change, young
women, and mental health. To our knowledge, this is the first study to explore
how young women’s mental health is impacted by our changing climate.
Through using FPS to guide all phases of the research process, we were able
to develop a qualitative study that critically explored how the personal expe-
riences of young women were affected by and embedded in socially and insti-
tutionally constructed conceptualizations of climate change. The research
question was: How do young women experience mental health and gender in
relation to the changing climate in Nova Scotia, Canada? The study objec-
tives were to (a) understand how young women perceive their mental health
in relation to the changing climate and (b) explore how women’s experiences
with the changing climate are personally, socially, and institutionally con-
structed. Using FPS as the theoretical framework allowed a deep exploration
of participant experiences of gender, climate change, and mental health.
Stone et al. 125

Methods
Methodology
An FPS approach was used to guide this research. FPS is a methodology,
theory, and philosophy that centers relations of power, subjectivity and
agency, and participant experiences, values, practices, and beliefs (Aston,
2016; Butler, 2005; Scott & Butler, 1992; Weedon, 1996). FPS enabled an
exploration of how young women’s experiences with the changing climate
were socially and institutionally constructed through subject positions such
as gender, race, and age. FPS also enabled us to examine how relations of
power influenced young women’s experiences with climate change. Discourse
analysis is a method of analysis aligned with FPS and was used to analyze
participant experiences, values, beliefs, and practices in relation to social and
institutional discourses (Aston, 2016). This allowed us to deconstruct the
meaning of participant experiences and understand the relations of power
that influenced how they perceived mental health in relation to the changing
climate.
Power relations, considered by FPS as fluid and dynamic as opposed to
something one can have or not have, are relevant to this study because of the
ways they relate to the patriarchal norms that create women’s disproportion-
ately negative experiences with climate change (Boetto & McKinnon, 2013;
Jost et al., 2016; Mamun et al., 2019; Meyiwa et al., 2014). Exploring oppor-
tunities for change is fundamental to the FPS methodology and imperative to
this study, as the climate crisis begs for change to sustain human and plane-
tary health. Women’s perceptions of mental health in the changing climate
were explored knowing that the FPS approach accommodates the subjectiv-
ity of truth, and that truth and reality have been constructed in the patriarchal
western society by male domination, serving male interests (Gavey, 1989).
Women’s knowledge and experiences in this study are important to uncover
to break down what counts as truth, which is normally regulated by those
who attempt to maintain privilege (Gavey, 1989). This study explores and
challenges power relations by hearing the voices and truths of women on the
subject of climate change.
Qualitative research urges research teams to be transparent and reflexive
of who they are, consistently acknowledging their subject positions (Braun &
Clarke, 2019; Byrne, 2022; Creswell, 2014; Creswell & Poth, 2018). The
first author of this research is a young woman, providing useful insight into
the study population and potentially addressing a common power dynamic
between interviewer and interviewees, enabling participants to relate to the
first author and speak freely during data collection. This closeness to the
study population also risks interpreting the data to represent how the first
126 Journal of Prevention and Health Promotion 5(1)

author feels about the climate crisis, which could be different from the par-
ticipants’ feelings and perceptions. This potential bias was mitigated by care-
ful supervision of data analysis by supervisors and constant reflection on
personal feelings and perceptions. The two co-supervisors of this research
have extensive experience and knowledge in gender and race-related health
research; however, neither had experience working climate change.
Furthermore, one committee member had extensive experience working in
climate change and with the ecological determinants of health. This careful
balance of background and expertise helped to mitigate potential biases. The
lead researcher is White, one supervisor is White, and one supervisor is
African Nova Scotian. Both supervisors have been instrumental in develop-
ing, overseeing, and providing feedback for this work. Both committee mem-
bers are White, and all researchers are non-Indigenous. It is important to
acknowledge these different subject positions as they can influence data
analysis. For example, a majority of White researchers may have contributed
to a limited worldview. To mitigate this, we have read and cited books, arti-
cles, and stories written by Black, Indigenous, People of Color (BIPOC) in an
attempt to diversify this work and to include diverse voices as much as pos-
sible. It is our hope that by citing BIPOC authors, this article is more repre-
sentative of the actual work being done by diverse peoples.

Participant Recruitment and Data Collection


Ethical approval was obtained through Dalhousie review ethics board. This
study was open to all women who resided in Nova Scotia and who were
between the ages of 16 and 28, as the Government of Canada (2014) defines
youth as 16 to 28 years of age. A recruitment poster was uploaded to various
social media platforms and distributed to local community organizations who
may have been frequented by diverse populations. We recognize that although
not all women have all experiences and interests in common, the category can
still exist due to the overlapping oppression, exploitation, discrimination, and
exclusion that exist within the group (Garry, 2011). Nine young women were
recruited, which is appropriate for studies guided by FPS, where 6 to 10 par-
ticipants are common (Griscti et al., 2017; MacConnell et al., 2013; Mselle
et al., 2017). The concept of data saturation was not used in this study (Braun
& Clarke, 2021), but rather, data collection came to a natural conclusion,
where around the time we reached the number of intended participants, we
saw a decline in potential participants reaching out with interest. Informed
consent was obtained verbally before interviews began, where it was made
clear to all participants that the study was voluntary, their identities would
remain confidential, and that they could stop participating at any time.
Stone et al. 127

Data collection took place between September 2020 and November 2020.
Nine participants were interviewed, with two choosing a group interview for-
mat and the remainder using the one-on-one interview option. The group
interview structure was the same as the one-on-one interviews, where both
participants took turns answering the same set of questions. While this may
have impacted data collection by potentially allowing one participant to talk
over the other or feel that they should share similar things, they may have been
inspired by one another’s responses and discussed issues more deeply and
fully than if they were alone in the interview (Wilson et al., 2016). All in inter-
views were conducted by the first author. Interviews align with the FPS
approach, as their open-ended nature allows for a deep dive into the experi-
ences and knowledge of the participant (Aston, 2016). Interview questions
related to where participants receive their climate information, how they talk
about climate change with their peers, their experiences with and feelings
about climate change, and their thoughts about gender, mental health, and cli-
mate change. Interviews lasted approximately 30 to 50 min, took place over
Microsoft Teams, and were audio recorded using IOS software (Apple, Inc.).

Data Analysis
Interviews were transcribed verbatim and then analyzed using Aston (2016)’s
five-step guide for using FPS informed by discourse analysis to interpret
findings. Analysis started with step one, identifying important issues, and
step two, attributing any beliefs, values, and practices that aligned with the
quotations. For example, a quotation could contain the belief that climate
change is scary, a value of protecting earth, and a practice of discussing fear
of climate change with peers. Step three was to describe the social and insti-
tutional discourses informing the identified issues, such as the discourses of
fear and hopelessness surrounding climate change in media (Aston, 2016).
For step four, we wrote about how the discourses relate to the participant and
their experiences of power relations. This means unpacking how the dis-
courses affect the participant, if they agree or disagree with the beliefs, val-
ues, and practices, and if there are conflicts and/or tensions (Aston, 2016).
This step is exemplified in results when participants challenged, accepted, or
recognized dominant discourses. For step five, participants’ subjectivity, or
how they are positioned in the world (gender, career, student, etc.) was
applied, if this information was given in the quote. Often, we also added the
participants’ agency, looking at how they “chose” to act in each situation,
perhaps by embracing or challenging the discourse in question (Aston, 2016).
Using this method of analysis allowed close attention to the way participants
tell their stories and an exploration of relations of power.
128 Journal of Prevention and Health Promotion 5(1)

All transcripts were analyzed with this process separately, as well as


together to find common trends. After finding similar results and interpreta-
tions, results were divided into two main findings sections: (a) mental health
and (b) gender. Each findings section was reviewed iteratively by supervisors
and committee members to ensure interpretations were rigorous and grounded
in the FPS methodology.
Trustworthiness was established in this study through credibility, con-
firmability, dependability, authenticity, and transferability (Bradshaw et al.,
2017; Creswell & Poth, 2018). Credibility is the confidence in the truth and
reality of the study (Connelly, 2016). To ensure this, the lead researcher
expressed compassion and empathy during interviews and repeated points
back to participants to ensure accuracy in interpreting the meaning of their
words (Bradshaw et al., 2017). Furthermore, Aston (2016) noted that par-
ticipants are experts in their own lived experiences, which allows for cred-
ibility as well. Next, confirmability is the degree to which the findings are
consistent, for which we described participant demographics as much as
possible and used direct quotes from the participants in results (Bradshaw
et al., 2017). Dependability is the stability of the data overtime (Connelly,
2016), to which we were transparent about changes to the study and
remained consistent throughout the study process and provided a detailed
description of all methods (Bradshaw et al., 2017; Creswell & Poth, 2018).
Authenticity was maintained by conducting analysis with both supervisors
and committee members to ensure theme accuracy (Creswell & Poth, 2018).
Finally, transferability was achieved through the in-depth analysis and
descriptions of participants’ experiences and perceptions, allowing for
transferability of results to a similar context or setting (Bradshaw et al.,
2017; Creswell & Poth, 2018).

Participant Context
To provide context to findings, it should be noted that participants varied in
age, race, and profession. Specific ages, pronouns, and identities were not
asked of participants, leaving this information up to them to share should they
have felt it necessary. We did not obtain further demographic details as our
criteria for taking part in this study were specific and adding further detail
might have led to identifiability. However, we ensured that interview ques-
tions permitted discussion of the important contextual elements of subjectiv-
ity, which was relevant to feminist poststructuralism and discourse analysis
(Aston, 2016) and allowed the following brief context. Throughout inter-
views, two participants mentioned being from the Caribbean, one mentioned
Stone et al. 129

being from the United Kingdom, and one mentioned being Mohawk First
Nation. Other participants noted roots in the Atlantic provinces, but details
were not fully discussed. Most participants mentioned attending post-second-
ary education in the past or at the time of the interviews. None declared them-
selves climate activists, nor did any participants mention being part of an
activist group or attending climate-related protests, talks, sit-ins, etc.;
although, one participant did state that they worked in the field of climate
adaptation. This may have influenced results, as people more engaged in the
climate change/justice movement may have answered questions differently
and expressed different values, practices, and beliefs based on their experi-
ences as activists.

Results
Findings are reported in two interdependent but separate sections, each with
their own subheadings. The mental health section explores hopelessness,
anxiety, and grief and frustration, whereas the gender section explores inter-
sectionality, stereotypes, and GBV. All findings are linked through the main
issues in this research of gender, mental health, and climate change. A con-
cept map of the findings can be found in Figure 1. Participants were all asked
the source of their information about climate change, as this could markedly
shape beliefs on the issue. Answers varied from peers and formal education
to social media and email newsletters. No participants mentioned a specific
news source. Occasionally, participants discussed an article they had read
relating to climate change, and how it shaped their feelings and beliefs. This
is important context, as findings are dependent on the discourses that are
partly constructed by media. All participants exemplified a belief that climate
change is a reality caused by humans, of which we are now seeing
symptoms.

Findings Section 1: Mental Health


Participants discussed how the climate crisis has implications for their and
their peer’s mental health. They described the issue as overly hopeless and
anxiety inducing. Many participants also discussed their grief for the climate,
describing it as “heavy” (P2). This discourse of climate change as something
that “weighs” (P9) on participants relates to the discourse of climate change
as a burden. Climate change was also described as something that disrupts
our connection to nature. The heavy climate burden also meant frustration,
where participants felt anger related to a discourse of inaction.
130 Journal of Prevention and Health Promotion 5(1)

Figure 1

Concept Map

Hopelessness
Discourse concerning the future was hopeless and pessimistic, where partici-
pants implied that the future is potentially doomed and doubted the ability of
humans to adequately address climate change. For example, P3 noted that
“the world is definitely going to end from climate change because we’ve
gone too far now.” P1 expressed their concern for adequate action by saying
“it’s all downhill from here unless something changes,” indicating doubt that
things will change for the better. Another participant reflected on the future
and noted that “prospects don’t look good right now and so just, it’s a bit
hopeless in a way” (P5). Furthermore, the idea of climate change and the
future was so uncomfortable for participants that many discussed their con-
scious efforts not to think about it: “It’s not something we like thinking about
because it’s so devastating” (P4). Similarly, P9 equates the climate crisis to
death: “I wouldn’t seek out an article about death, it’s something I don’t want
my mind to go to.” These instances represent a discourse of hopelessness
about climate change that participants embraced.
Participants also embraced a discourse of limited agency, indicating that
they did not know what could be done or what to do themselves to help the
climate. For example, P2 admitted thinking about waste a lot but does not
Stone et al. 131

know how to solve the problem. They reflect: “that’s how I see climate
change as impacting mental health the most is because I literally don’t know
what to do,” exhibiting a challenge in uncovering even hypothetical solutions
when thinking about climate change on their own. Similarly, P6 stated that
they “don’t even know what could be done at this point,” indicating their
doubt that adequate solutions even exist to address the sheer scale of the
problem, regardless of whether humans act on it or not. These instances pro-
vide evidence of the doubt and hopelessness discussed by participants.

Anxiety
Participants displayed anxiety for the health and safety of their loved ones
during extreme weather such as storms, flooding, and hurricanes, as well as
general shifts in weather patterns such as drought, dust, hotter summers, ice
melting, and sea level rise. One participant from The Caribbean grew up
experiencing hurricanes and recalled that the year before last, they had hur-
ricanes “back-to-back to back-to-back. Where some of the islands before
they could even catch a break there was another one hitting” (P6). P6’s worry
came mostly from losing their home and for the safety of their family. Another
participant noticed that the United Kingdom summers are much warmer than
usual, and there have been more cases of extreme weather, such as “freak
snowstorms” (P7). When asked how these changes made them feel, P7
believed they induced worry and stress for the future. Another participant
noted sea levels rising and the fear that brings since most of their family lives
in Nova Scotia, which is coastal. They also mentioned hearing about ice
melting:

I heard somewhere and I haven’t even googled if this is true but there’s like all
sorts of diseases under the ice, like the Arctic and then the Arctic will melt, and
all these diseases will come out. It just kind of seems like, honestly the way I
understand, it now is impending apocalypse type thing is how it’s made out to
be. (P9)

This participant’s description of an “impending apocalypse” demonstrates


their view of climate change as an ultimate threat.
Participants discussed their fear for the future through embracing a dis-
course of uncertainty, especially for the next generation. The discourse of
uncertainty surrounding climate change is constructed by the unknown nature
of the phenomenon. For example, we do not know to what extent emissions
will be reduced, nor exactly what will happen to humanity. One participant
mentioned how anxious they are for generations ahead given this
uncertainty:
132 Journal of Prevention and Health Promotion 5(1)

So, I get anxious and scared that there’s not gonna be a good future for future
generations, like its already different for me than it was my parents or my
grandparents or those generations before. And they’re scared for me. And I am
in turn scared for the people ahead because we need to be able to keep sharing
these relationships with the natural world and the knowledge that’s embedded
within it. (P1)

P1 expressed worry for the knowledge systems held within the relationships
with the natural world that have been threatened since the first contact of
colonists. The fear for future generations is something that participants dis-
cussed with their friends: “we were just talking about how within the next
hundred years things are not going to be as liveable on earth and how that was
going to affect our kids and grandchildren and kind of how that’s pretty nerve
wracking” (P5). This conversation with P5 and their friend’s is described as
“nerve wracking,” where the discourse is uncertain, and participants are
scared for their potential children and grandchildren.
Through discussing future generations, participants also considered their
fears, negotiations, and reservations about the decision to birth children,
mostly related to the discourse of uncertainty about leaving a safe and sus-
tainable planet for their children. While no participants declared their deci-
sion to not have children because of climate change, it was one of the ways
participants discussed climate change as impacting their lives and mental
health. One participant, embracing the discourses of hopelessness and uncer-
tainty surrounding the future, mentioned how they believe that always being
surrounded by negative climate media has impacted their decision to have
kids:

Like it doesn’t really make a lot of sense with where the world is going in terms
of climate and everything. I feel like if I had children, I’m almost accepting the
fact where I’m putting them in a position where they’re not inheriting
sustainable world. (P9)

Another participant discussed the popular timeline that suggests humans


have 11 years to adequately take action to address climate change in relation
to having children now: “I don’t know what type of world it’s going to be in
11 years, that child is only going to be 11, so I feel like that’s going to be
pretty impactful on like reproduction” (P8). This quote furthers the discourse
of uncertainty for the future, where they note not knowing how the world will
look in years to come. Another participant recognized their struggle and ten-
sion with the topic: “Well it’s really shitty because I really do want to have
kids, but then when you think about it it’s like would that be just completely
Stone et al. 133

selfish?” (P3). These inner conflicts surrounding participant value in having


children revealed a complex relationship between discourses of uncertainty
and hopelessness for participants wishing to someday have a baby.

Grief and Frustration


Participants displayed grief for what is being done to the planet and frustra-
tion related to a discourse of inaction. Although most participants said that
climate change did not drastically, permanently, or consistently alter their
state of well-being, they believed it is something that can weigh on them. For
example, P2 noted: “It’s just kind of one of those things that weigh on you a
little. . .it can be hard to talk about. . .it just feels super heavy sometimes.” A
similar sentiment was discussed with P9, as they believed that although cli-
mate change may not be someone’s entire reason for being unwell, it is cer-
tainly one of the “weights” that most Generation Z or Millennials have grown
up with. This discourse of heaviness may derive from climate change’s ever-
present threat, as it is not a problem that has ever or will ever (in near future)
simply go away. Another participant told a story from their education, where
resource extraction was a “heavy” conversation:

There were a few classes we had, and some were climate change and some
were just other sort of like other marine issues, and like for example, deep sea
mining was a big one actually, and you could see that everyone was like feeling
pretty heavy. There was one of my classmates; she actually started crying. (P7)

Describing everyone as feeling “heavy” is an example of the metaphor of


climate change weighing on participants. The idea that climate change is a
heavy topic exemplifies its impact on mental health.
One participant described how important it is for them to be on the land
and take “care of the natural world so, it in turn can like take care of me and
my community” (P1), while reflecting that climate change is creating “less
connection to the land and the natural world” (P1). For example, P1 described
how not only caribou migration has changed, but the seasonal times when
deer shed their antlers is different, which has significant cultural implica-
tions: “it’s important for me to find antlers that were shed and make things
out of it to honor the spirit of the animal, but if you don’t know when the deer
shed their antlers you can’t find it.” In this instance, the climate crisis can cut
people off from important traditions, potentially leading to a grief for lost
practices.
Participants experienced frustration at the burden they carry related to a
discourse of inaction. This discourse is in the headings of news articles across
134 Journal of Prevention and Health Promotion 5(1)

the globe, constructed potentially by the impacts of climate change itself. For
example, “Leading scientists condemn politician inaction on climate change
as Australia literally burns” (Cox, 2019). One participant voiced their frustra-
tion related to the discourse of inaction, specifically, with the ultra-rich. They
note that people like Jeff Bezos (the CEO of Amazon) have the resources and
ability to address climate change but do not do enough: “Jeff Bezos could
literally pay for that [reversal of global warming] out of pocket and, you
know, make that change, but obviously he’s not doing that” (P5). Another
participant mentioned Amazon, remembering reading that, “If you return
something to Amazon, they just like throw it out. A large amount of the time
it just goes on some huge conveyor belt to a huge trash heap, which was very,
very upsetting” (P9). These concerns related to the discourse of inaction fur-
thered the feeling of frustration within participants.

Findings Section 2: Gender


Participants discussed how gender can be relevant to discussions of climate
change. They noted how race and income intersect with gender and can
impact the experience of climate change, and they spoke about how gender
stereotypes, such as women as traditional caretakers and women’s voices as
unserious, impacts the way women experience climate change. Finally, par-
ticipants discussed the ways in which GBV are related to the changing
climate.

Intersectionality
Participants reflected on the importance of using an intersectional lens when
discussing the impacts of climate change, the origins of climate change, and
climate solutions. Participants recognized that not everyone experiences cli-
mate change equally, where race, SEP, and gender all play a role in how
people are impacted. For example, P1 noted that “Indigenous people bear the
burden [of climate change]. And within that, Indigenous women bear the bur-
den.” (P1). Another participant mentioned the inequities Indigenous people
face, believing the federal government has “vastly ignored Indigenous com-
munities in Canada and they are experiencing climate change in much differ-
ent ways than the rest of us” (P8). The same participant mentioned that many
Indigenous young women climate and social justice advocates receive less
media coverage than Greta Thunberg and even backlash on Facebook for
their intersecting identities (young, Indigenous, women).
One participant described their experience visiting New Orleans, where
the tour guide described the city as a bowl, telling tourists “not to worry”
Stone et al. 135

about the nice homes flooding because “it’s all the ghettos and stuff that are
in the middle” (P9) that will be washed away. This is an example of a tour
guide using environmental racism discourse, as he perpetuated the dispropor-
tionate value of “beautiful homes” versus the “ghetto” homes, inhabited by
African Americans. The tour guide embraced the environmental racism dis-
course and by doing so potentially entrenches racist and classist norms in
clients, yet P9 challenged this narrative by labeling it as unacceptable sys-
temic racism. Another participant discussed environmental racism more gen-
erally, stating while they “haven’t had to worry about the environment” (P5),
they recognized it is different for Indigenous and Black people who have
often been pushed to the margins where housing is unstable, and risks are
larger during extreme weather.
Participants also discussed SEP and climate change. One participant noted
how people with high paying jobs will often hire people who look like them:
“let’s say we talk about a cis White man but then the more different you are
from that the more challenging employment becomes” (P3). This participant
highlighted the systematic and institutional challenges that BIPOC and those
who identify as women or outside of the gender binary face in gaining high
paying, secure employment. P3 then connects income type to climate change,
noting that people earning high income are more likely to fair better through-
out the climate crisis. Another participant believed that women-dominated
careers are often unstable, which can make climate change more difficult to
deal with: “Women tend to have more vulnerable employment and so like
when the shit hits the fan with climate change, it’s the vulnerable employ-
ment that, you know, it’s less likely to carry on” (P2). This quote demon-
strates participant recognition of women’s oppression in employment and
income, potentially exacerbated by climate change.

Stereotypes
Participants recognized various stereotypes that women face, such as caretak-
ing responsibilities, familial and birth decision responsibilities, and their
voices not being taken seriously. Participants recognized how women have
expectations to be caretakers, especially in times of climatic changes. For
example, one participant noted that in times of flooding, their community
followed strict gender roles where the mothers took care of the children and
food while the fathers did the physical labor. This participant recognized that
this norm was socially perpetuated and challenged it by saying that “both
parties would have been equally capable to do each thing, but it was kind of
the way that it was separated” (P8). The discourse of gendered tasks is chal-
lenged when their social construction is recognized. These comments led to
conversations surrounding reproductive choices.
136 Journal of Prevention and Health Promotion 5(1)

Participants noted that although all genders may experience a struggle in


deciding whether to have children, women often bear the burden of that deci-
sion-making. This finding ties in with the larger social discourse of women as
caretakers. For example:

Women are known for being so family-oriented that when it comes to like them
having to make the decision not to have kids or being faced with that decision,
it feels like a big decision that is not necessarily, well I think it’s, I think that as
women maybe we feel it more. (P2)

While P2 did not explicitly disagree or challenge the notion of women


facing disproportionate pressures related to families and reproduction, they
recognized that the social discourse of women as family-oriented exists. P3
felt similarly, noting how “it takes two people to make a baby, whatever, but
it still does feel like that’s kind of under the woman’s responsibility,” which
relates back to women as caretakers. Another participant noted that the deci-
sion to have children is increasingly challenging: “it suddenly just feels like
a pretty heavy decision to make and a pretty heavy response, you know, and
then you have the kid, they’re your kid you have to take care of them, and like
the world is going to shit. Am I going to be toting around a child with me?”
(P9). Even imagining being responsible for children was daunting for this
participant.
Participants discussed their concerns around the social discourse of wom-
en’s voices not being taken seriously, especially in the context of advocating
for climate action. Participants discussed their specific concerns with women
not being taken seriously when speaking about climate change, sometimes
mentioning the backlash that Greta Thunberg has received:

A lot of male politicians and a lot of male people look down on her [Greta]
currently because she’s young but also because she’s a girl, which I think plays
into the narrative of how women are affected by climate change. (P8)

Another participant uses Greta’s backlash as an example of what happens


“when women try to advocate or fight for something. There’s always men or
people who are going to just like say, ‘oh, they’re a woman and don’t know
what they’re talking about’” (P9). This quote exemplifies how women’s
voices are automatically discredited because of their gender, whereby no
matter what they say, they “don’t know what they’re talking about.” Another
participant notes that Greta has been “mocked for being a sad little girl, and
those types of comments relate to her gender, even though what she’s saying
should have absolutely nothing to do with her gender” (P5). This is an
Stone et al. 137

example of resistance of a dominant social discourse on women’s voices,


stating that the current model is inequitable, and women should be able to
speak without the listeners relating their speech to their gender.

Gender-Based Violence
Participants also discussed how climate change relates to GBV, a concept
well documented in the literature. One participant examined the relationship
between murdered and missing Indigenous women, girls, and Two-Spirit
people (MMIWG2S) and climate change. P1 related MMIWG2S and vio-
lence against the land, where “the land’s our mother; that’s violence against
women and as climate change has intensified so have rates of violence against
women especially Indigenous women.” Because Indigenous ways of know-
ing and understanding the land and climate have been silenced and oppressed
within settler culture, this participant is using their knowledge to challenge
climate change and settler ways of imparting harm on the Earth.
One participant detailed the situation of many women who flee other
countries to arrive in the Caribbean in hope of a better life. These women
often face significant challenges, especially in the face of climate change. P6
stated that immigrant women are largely marginalized and live in “run-down
homes, like shacks almost, and for them I would say they would probably
experience the most anxiety.” Some of these houses are in flood zones, so P6
notes that it is very challenging and stressful to experience hurricane season
each year when homes are barely able to stand as is. P6 discussed their moth-
er’s relationship with some of the immigrant women: “I know my mom has
had a couple of friends in those communities, and for them, it’s definitely
been challenging and especially for a lot of them where they’re single moth-
ers, so there’s anxiety for them.” This comment highlights the intersections
between where women live, gender, and SEP.
P9 explained how men have sexualized Greta Thunberg, which could lead
women to feel uncomfortable speaking out about climate change considering
what Greta has been through:

The one that really bothers me is that men always feel a need to sexualize it. I
see people sexualizing it. I don’t know how old she is; is she (Greta) like 15
maybe? Yah, and like there were like these badges or stickers that people made
that were like her with her braids and she was naked or something. I don’t
know it’s just icky. (P9)

This participant is referring to a sticker that depicts Greta in a violent sexual


position, for which X-Site Energy Services, an Alberta oil company, took
138 Journal of Prevention and Health Promotion 5(1)

responsibility (Messervey, 2020). This example is an act of sexualized vio-


lence that bothered the participant. The fact that Greta has spoken out about
climate change and has become known around the world but has been
assaulted in this way could be a serious deterrent for young women to speak
out about climate change or other issues, with P9 describing it as “icky.” The
sexualization of women’s bodies has led to the objectification, harassment,
exploitation, and dehumanization of women; norms that reflect rape culture
and are particularly disturbing due to the age of the survivor.

Discussion
This research set out to understand how young women experience mental
health and gender in relation to the changing climate in Nova Scotia, Canada.
Through in-depth interviews, this study was able to delve into the experi-
ences, values, and beliefs of young women during a climate crisis. With FPS
informed by discourse analysis, we were able to examine social discourses
related to climate change, mental health, and gender that participants recog-
nized, challenged, or accepted. The research objectives were addressed and
developed by deconstructing participant experiences and language, as well as
by examining how participants negotiated and discussed power. The main
study findings are as follows. First, participants embraced the discourse of
hopelessness and pessimism surrounding climate change and our future, with
the issue seeming too uncertain, grave, and anxiety-inducing to think about.
Second, participants believed that subject positions, such as gender, SEP, and
race, impact how people experience climate change.

Mental Health
Participants embraced popular discourses of doubt and doom surrounding
climate change. This discourse was constructed by the ways in which climate
change issues and solutions are framed as complicated and overwhelming,
where media captures catastrophes significantly more than solutions (Boykoff
& Boykoff, 2007). For example, the language used to describe climate change
by the public is often related to fear, using words such as catastrophe, terror,
extinction, and danger (Hulme, 2008; Stecula & Merkley, 2019), creating a
discourse wherein the problem is too big for humanity to deal with. Wall
Kimmerer (Wall Kimmerer, 2013) discussed the fear and despair narrative,
whereby we are inundated by information of ecological degradation but
know less on how we can nurture it. She noted that with this discourse, envi-
ronmentalism relates to “powerless feelings” (p. 327). Such feelings were
evident in the theme of hopelessness as participants produced discourses of
Stone et al. 139

pessimism, where they felt they could never do enough to help. The hopeless-
ness and subsequent avoidance of climate change thought/discussion
described by participants in this study can be related to “psychoterratic syn-
dromes,” such as eco-paralysis, eco-anxiety, ecological grief, and solastalgia,
which are words used to describe emotional distress related to the awareness
and experiences of the climate crisis (Albrecht, 2011; Albrecht et al., 2007;
Ellis & Albrecht, 2017).
Eco-paralysis is a symptom derived from the complex feelings that arise
when we feel we cannot take enough action to significantly address the cli-
mate crisis (Albrecht, 2011; Hayes & Poland, 2018). When climate change is
framed using sensational and alarming techniques, some authors argue that
denial, paralysis, or apathy are evoked instead of action, exemplified by par-
ticipants in this study who did not want to think about climate change at all
(Khan, 2022). Relatedly, eco-anxiety is a type of anxiety specifically related
to a changing and uncertain environment and can be brought about when we
are bombarded with threatening facts about climate change (Albrecht, 2011;
Hayes & Poland, 2018). With the internet, negative information about what is
happening to Earth has increased, sparking feelings of anxiety surrounding
the scope and complexity of the problem. For example, participants from this
study felt the problem was overwhelming and could not be solved. As climate
change continues and our ability to predict the future weakens, concern for
children and future generations is intensified (Albrecht, 2011). Finally, solas-
talgia describes a sadness caused by gradual changes to one’s environment,
through recognition that the place you love is going through ecological deg-
radation (Albrecht, 2011). For example, the deep-sea mining and changes to
animal and ecosystem patterns described in the theme of grief and frustration
are changes that could evoke solastalgia.

Gender
As many Black feminists have contended (The Combahee River Collective,
1983; Crenshaw, 1989; Davis, 1981; Hamilton-Hinch, 2015; Hill Collins &
Bilge, 2016; Lorde, 1984), gender, race, sexuality, class, and other identities
cannot be separated, as they are inextricably linked and interdependent of one
another. In other words, they intersect. Though the word “intersectionality”
was not used by all participants, they all discussed the concept, especially
when discussing the impacts of climate change. Briefly, intersectionality
refers to how multiple forms of oppression, such as racism, sexism, homopho-
bia, and classism, intersect.
Women of color and Indigenous women have long fought against environ-
mental destruction (Dennis & Bell, 2019; Waldron, 2018), yet are not always
140 Journal of Prevention and Health Promotion 5(1)

recognized as climate leaders and activists and are excluded from the White
majority led climate movement (Johnson & Wilkinson, 2020; Olson, 2015).
Those with the experience and knowledge have been overlooked despite their
appropriate position as climate leaders. Furthermore, as participants have dis-
cussed, Black and Indigenous women face climate impacts disproportion-
ately, along with people with low incomes or in low-income countries.
Climate change amplifies existing inequities, and those closest to climate
impacts need to be part of solution development (Hayes & Poland, 2018;
Johnson & Wilkinson, 2020).This narrative may have played into participant
beliefs that climate experiences are different depending on gender, race, and
SEP. Particularly, when participants discussed the ability of women to speak
up, be heard, and be taken seriously, a couple mentioned that being heard
appropriately can depend on race, where Indigenous women and women of
color can experience disproportionate difficulty being heard.
Women’s responsibility as caretakers is repeatedly discussed in the litera-
ture around gender inequality and climate change (Ajibade et al., 2013;
Alston, 2013; Beaumier & Ford, 2010; Demetriades & Esplen, 2009; Eissler,
2019; Ford et al., 2010; Kevany & Huisingh, 2013). Women have reported
skipping meals in times of climate-related food or water scarcity, putting the
needs of others before their own, and handling multiple stresses and tasks at
once (Alston, 2013; Beaumier & Ford, 2010; Demetriades & Esplen, 2009).
Although participants did not discuss experiencing these types of care bur-
dens, they were aware of them, and even hypothesized that someday they
may become a reality for them. Participants also recognized the discourse of
women as caretakers by reflecting on their stress in deciding whether or not
to birth children, a stress they felt was amplified by their positionality as
women.
Participant concerns of women’s voices not being taken seriously can be
related back to climate science in the mid-19th century. In 1856, Eunice
Newton Foote became the first woman in climate science by theorizing
changes in carbon dioxide in the atmosphere could affect Earth’s temperature
(Johnson & Wilkinson, 2020). Specifically, she found an association between
carbon dioxide and planetary warming yet was overlooked until just a few
years ago. John Tyndall, who published his article on heat trapping gases
three years after Eunice published hers, has been typically regarded and cited
as the foundation of climate science (Johnson & Wilkinson, 2020). With the
very history of women in climate science beginning with this narrative of
women not being listen to or credited, it is fitting that participants discussed
not being taken seriously.
The connection between GBV and climate change has been well docu-
mented. Both after extreme weather events and during times of
Stone et al. 141

climate-related resource scarcity, women face an increase in sexual,


domestic, and intimate partner violence (Alston, 2013; Anastario et al.,
2009; Boetto & McKinnon, 2013; Meyiwa et al., 2014; Stone et al., 2022).
However, participants did not describe GBV associated with climate-
related weather changes and events but rather in a variety of other ways.
For example, one participant discussed the relationship between climate
change and MMIWG2S. This issue demonstrates the interconnectedness
of climate change, the resource extraction industry, and GBV, where “man
camps” (often set up near resource extraction sites) have been found to
significantly increase the risk of MMIWG2S (National Inquiry into
Missing and Murdered Indigenous Women and Girls (Canada), 2019).

Implications
Participants may benefit from hearing more positive, hopeful, and empower-
ing news on climate change. For example, Stacey Abrams, Collette Pichon-
Battle, Jay Braun, Rhiana Gunn-Wright, Leah Stokes, and Melina
Laboucan-Massimo are only a handful of women successfully protecting
people and planet, yet we hear about their inspiring work too infrequently.
News that demonstrates the strength and successful action of women may
help to mitigate feelings of hopelessness, as well as feelings of women not
being taken seriously. Health promotion media specialists should understand
the dangers and ineffectiveness of fear mongering and attempt to promote
climate solutions as opposed to only stories of despair and ecological degra-
dation. Furthermore, Clayton et al. (2017) encouraged mental healthcare pro-
viders to help clients foster optimism to help protect against the mental health
impacts of climate change.
Mental healthcare providers may also benefit from understanding how
young women conceptualize the climate crisis. For example, climate change
was described by participants as a heavy subject that weighs on them. They
also described the future as hopeless and out of their control. They noted that
the topic does not cause significant mental health challenges or mental illness
but acts as an added layer of stress. This additional stress, understood with
client position, could be further unpacked by mental health providers
and integrated into practice. Furthermore, Hayes and Poland (2018) recom-
mended that mental health practitioners communicate about climate change
and mental health in a way that allows patients to understand what is relevant
and important to them, advocate for reducing greenhouse gas emissions in
healthcare facilities, and engage in adaptation measures such as preparing
and responding to extreme weather events.
142 Journal of Prevention and Health Promotion 5(1)

Conversely, Hayes and Poland (2018) discussed how mental health can be
positively impacted by climate change-related extreme weather events. If
people come together to rebuild, salvage, and heal during this time of a
changing climate, they can foster a sense of meaning and personal growth,
sometimes referred to as post-traumatic growth (Hayes & Poland, 2018).
While extreme weather can cause anxiety, depression, and psychological dis-
tress, it can also instill compassion and optimism in coming together to work
in climate adaptation and mitigation. This area of research requires further
investigation, as, to date, most research focuses on the negative impacts of
climate change on mental health (Hayes & Poland, 2018). Relatedly, engag-
ing in climate activism (in any form) has been shown to bolster mental health.
The gender, racial, and class inequality discussed in this work indicates
that society would benefit from dismantling such systems, especially in the
wake of the climate crisis. Health promotion should continue working to
reduce health disparities and to address the social determinants of health
while considering climate change implications. For example, health promot-
ers must grapple with how climate change amplifies existing inequities and
use this information to inform health and climate change policies. Climate
change is a far-reaching, global health problem that can only intensify; thus,
health promotors should also advocate for climate mitigation solutions and
just economic diversification strategies where no one is left behind (Healy &
Barry, 2017). The way we mitigate and adapt to climate change must consider
the health and well-being of all people. Health promotors must ensure that the
determinants of health, including social and ecological determinants, are
integrated into climate solutions to fulfill their goal of promoting health and
reducing health inequities (Dempsey et al., 2011; Health Promotion Canada,
2018). Furthermore, the voices of women, especially BIPOC women, must
be included in climate action.
The health, safety, and security of women should be integrated into all
emergency preparedness and response strategy plans. One participant dis-
cussed the impacts that single mothers face in their community during hurri-
cane season. This information is compounded with the abundance of literature
suggesting an increase in GBV worldwide during and after extreme weather
points to the need to protect women before, during, and after climate emergen-
cies (Anastario et al., 2009; Boetto & McKinnon, 2013; Meyiwa et al., 2014;
Stone et al., 2022). In recognizing this disparity, the discipline of health pro-
motion must make the sustainable development goals of the United Nations
Development Program a priority, especially the goal of achieving gender
equality (UNDP, 2015). This goal notes the importance of considering how
women continue to be disproportionately impacted by climate change (UNDP,
2015). Health promotion must work toward ensuring women are safe and well
Stone et al. 143

protected before climate-driven weather events. This includes safe and secure
housing built to withstand the stronger weather and social safety nets and sur-
veillance that catch and address GBV (Clayton et al., 2017).
Specifically, the NIMMIWG (National Inquiry into Missing and Murdered
Indigenous Women and Girls [Canada, 2019]) report provided 231 calls for
justice directed at governments, institutions, social service providers, and
industries, all of which reach the health promotion discipline. Calls 13.1 to
13.5 specifically target the issues relating to extractive and development
industry. Actions include the need for industry to consider the safety of
Indigenous women, girls, and people who identify as 2SLGBTQQIA, include
input from government to mandate, approve, and evaluate development plans
with GBA in mind, and the need to ensure Indigenous women benefit equally
from such development projects. Finally, the NIMMIWG (2019) report calls
for further research and investigation into the relationship between resource
extraction and violence against Indigenous women, girls, and people who
identify as 2LGBTQQIA.

Strengths and Limitations


This study was able to explore the experiences, values, practices, and beliefs
of nine participants in respect to mental health, gender, and climate change.
Through data collection and analysis, it was possible to achieve the two
research objectives of this study to: (a) understand how young women per-
ceive their mental health in relation to the changing climate and (b) explore
how women’s experiences with the changing climate are personally, socially,
and institutionally constructed. This work also provides data on youth who
have grown up with the looming threat of climate change, filling a gap in the
literature on young people’s mental health in the changing climate.
Furthermore, this study provides data on the health implications of climate
change, which is within the broader goal of researchers to monitor the impacts
of climate change on human health. Finally, this research employed a critical
methodology, allowing researchers to analyze data deeply and fully and to
provide rich descriptions and interpretations of participants’ experiences.
The lead researcher’s identity as a young woman may have impacted
interpretation of results. This bias was mitigated as much as possible by care-
ful supervision of data analysis by supervisors and constant reflection of per-
sonal values, beliefs, and practices. Furthermore, most participants in this
study presented as White. This may have contributed to results of the study
being overwhelmingly from the perspective and point of view of the White
lens, especially since the analysis and writing has mostly been done by the
lead researcher who is White. Having this limited worldview may have
144 Journal of Prevention and Health Promotion 5(1)

contributed to a skewed version of the stories told, as the environmental


movement has not only been dominated by people who identify as White but
has been intentionally exclusive of people who identify as Black, Indigenous,
and people of color. Furthermore, researchers did not collect demographic
data from participants, which limited the extent of participant context pro-
vided in this article surrounding race, age, sexual orientation, occupation, and
more. The group interview may have impacted findings due to the potential
differences in group interviews vs one-on-one interviews.

Conclusion
The current literature revealed a gap, wherein women’s mental health relating
to climate change had yet to be fully studied. This study presents a unique
contribution to the literature by exploring young women’s mental health in a
changing climate. This study also adds to the body of research surrounding
the health impacts of climate change. Participants of this study allowed for an
in-depth analysis of the ways in which gender interplays with climate change
and mental health. Using FPS informed by discourse analysis, participant
values, beliefs, practices, and discourses were carefully analyzed to address
research objectives. Mental health and gender are inescapable dimensions of
the crisis we face that must be part of our response and journey toward
sustainability.

Acknowledgments
We would like to acknowledge the instructors at Dalhousie who helped shape this
work throughout my master’s degree in health promotion.

Declaration of Conflicting Interests


The authors declared no potential conflicts of interest with respect to the research,
authorship, and/or publication of this article.

Funding
The authors disclosed receipt of the following financial support for the research,
authorship, and/or publication of this article: This work was funded by Canadian
Graduate Scholars and the School of Health and Human Performance, Dalhousie
University.

ORCID iDs
Kathryn Stone https://orcid.org/0000-0002-5884-5108
Daniel Rainham https://orcid.org/0000-0002-3932-2942
Stone et al. 145

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