Int. J. Environ. Res. Public Health 2009, 6, 2481-2499; doi:10.3390/ijerph6092481 OPEN ACCESS International Journal of Environmental Research and Public Health ISSN 1660-4601 www.mdpi.com/journal/ijerph Article Context and Cardiovascular Risk Modification in Two Regions of Ontario, Canada: A Photo Elicitation Study Jan E. Angus 1,*, Ellen Rukholm 2, Isabelle Michel 3, Sylvie Larocque 2, Lisa Seto 1, Jennifer Lapum 4, Katherine Timmermans 2, Renée Chevrier-Lamoureux 3 and Robert P. Nolan 5 1 Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Rm 130, Toronto, ON M5T 1P8, Canada; E-Mail: lisa.seto@utoronto.ca 2 School of Nursing, Laurentian University, 935 Ramsey Lake Road, Sudbury, ON P3E 2C6, Canada; E-Mails: erukholm@laurentian.ca (E.R.); slarocque@laurentian.ca (S.L.); ke_timmermans@laurentian.ca (K.T.) 3 Resources, Research, Evaluation and Development Division, Sudbury & District Health Unit, 1300 Paris Street, Sudbury, ON P3E 3A3, Canada; E-Mails: micheli@sdhu.com (I.M.); chevrierr@sdhu.com (R.C.L.) 4 Daphne Cockwell School of Nursing, Ryerson University, 350 Victoria Street, Toronto, ON M5B 2K3, Canada; E-Mail: jlapum@ryerson.ca 5 Behavioural Cardiology Research Unit, University Health Network, NU 6N-618, 585 University Avenue, Toronto, ON M5G 2N2, Canada; E-Mail: rnolan@uhnres.utoronto.ca * Author to whom correspondence should be addressed; E-Mail: jan.angus@utoronto.ca; Tel.: +1-416-978-0695; Fax: +1-416-978-8222. Received: 14 August 2009 / Accepted: 14 September 2009 / Published: 17 September 2009 Abstract: Cardiovascular diseases, which include coronary heart diseases (CHD), remain the leading cause of death in Canada and other industrialized countries. This qualitative study used photo-elicitation, focus groups and in-depth interviews to understand health behaviour change from the perspectives of 38 people who were aware of their high risk for CHD and had received information about cardiovascular risk modification while participating in a larger intervention study. Participants were drawn from two selected regions: Sudbury and District (northern Ontario) and the Greater Toronto Area (southern Ontario). Analysis drew on concepts of place and space to capture the complex interplay between geographic location, sociodemographic position, and people‟s efforts to understand and modify their risk