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Gaskin CJ, Cooper K, Stephens LD, Peeters A, Salmon J, Porter J. Clinical practice guidelines for the management of overweight and obesity published internationally: A scoping review. Obes Rev 2024; 25:e13700. [PMID: 38296655 DOI: 10.1111/obr.13700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 10/17/2023] [Accepted: 12/20/2023] [Indexed: 02/02/2024]
Abstract
With the increasing prevalence of obesity placing additional demands on healthcare systems, many jurisdictions and professional bodies have developed clinical practice guidelines to support practitioners in the management of people with overweight and obesity. This scoping review aimed to identify key features of contemporary guidelines for the clinical management of overweight and obesity. Searches of MEDLINE, Guidelines International Network's international guidelines library, and other grey literature sources identified 38 guidelines of 18 countries and one region published since 2010. Guidelines were developed by committees (n = 36, 95%) that comprised knowledgeable experts (n = 36, 95%) and were multidisciplinary (n = 33, 87%), with limited consumer representation (n = 11, 29%). Guideline documentation incorporated review questions (n = 23, 61%), systematic reviews (n = 25, 66%), evidence grading systems (n = 33, 87%), processes for reaching consensus (n = 19, 50%), and guideline review details (n = 28, 74%). Treatment approaches included in most guidelines were nutrition and physical activity (n = 38, 100%), psychology (n = 37, 97%), pharmacotherapy (n = 32, 84%), and bariatric surgery (n = 31, 82%). Most guidelines targeted populations based on age (n = 30, 79%). Guidelines contained recommendations for pregnancy (n = 12, 32%), older adults (n = 9, 24%), and people with eating disorders (n = 8, 21%). Future guidelines would benefit from involvement of consumers including groups known to be at increased risk of overweight and obesity, targeted guidance for at risk groups, and consideration of weight bias and stigma.
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Affiliation(s)
- Cadeyrn J Gaskin
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
- Institute for Health Transformation (IHT), School of Health and Social Development, Deakin University, Geelong, Australia
| | - Kelly Cooper
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Lena D Stephens
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
- Institute for Health Transformation (IHT), School of Health and Social Development, Deakin University, Geelong, Australia
| | - Anna Peeters
- Institute for Health Transformation (IHT), School of Health and Social Development, Deakin University, Geelong, Australia
| | - Jo Salmon
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Judi Porter
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
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Kim K, Au-Yeung A, Dagher D, Jacobs N, Martin-Hill D, Wekerle C. Exploring the relevance of a psychology-based resilience app (JoyPop™) for Indigenous youth. CHILD ABUSE & NEGLECT 2024; 148:106343. [PMID: 37451896 DOI: 10.1016/j.chiabu.2023.106343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 04/15/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Despite facing challenges to mental wellness from ongoing multifold trauma, Indigenous youth continue to galvanize their resilience. One pathway undertaken is embracing technology. The JoyPop™ youth resilience mobile application (app) was invited by Six Nations of the Grand River (SN) leadership to consider its use with their reserve youth. OBJECTIVE This study explored the feasibility of JoyPop™ research from the SN community adult perspective for appropriateness and relevance to SN youth, as a precursor to a user-experience study with community youth. METHODS Semi-structured, online interviews with 19 adult community members (26 % male) about JoyPop™ were conducted with nominated stakeholders from SN. Based on a standard presentation of the app, comments were solicited about app features, design, and relevance to Haudenosaunee culture. Interviews were transcribed, coded in a double-blind fashion, and analyzed for themes. RESULTS Most offered positive feedback, with some level of support for each feature of JoyPop™. Themes were identified (Need for Indigenous Design, Incorporation of Indigenous Culture, Appreciation of Ease, Flexibility and Personalization), stemming from comments of appraisal and suggestions for adaptations (e.g., incorporating more cultural elements, localized resources, simplification of app). CONCLUSIONS The JoyPop™ app was viewed as positive and relevant, based on feedback from adults within SN. Adaptations were identified by adults to better fit SN youth needs, and research with SN youth is pending before implementation of adaptations. Research with other communities is encouraged to expand the reach of technology interventions, to holistically support Indigenous youth mental health in a culturally relevant way.
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Affiliation(s)
- Katherine Kim
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Allison Au-Yeung
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Danielle Dagher
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Norma Jacobs
- Department of Social Work, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Dawn Martin-Hill
- Department of Anthropology, Indigenous Studies Program, McMaster University, Hamilton, Ontario, Canada
| | - Christine Wekerle
- Department of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Optentia Research Unit, North-West University, South Africa; Department of Psychiatry and Behavioral Neuroscience, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
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Hassan S, Rac VE, Hodges B, Leake P, Cobbing S, Gray CM, Bartley N, Etherington A, Abdulwasi M, Cheung HCK, Anderson M, Woods NN. Upskilling programmes for unregulated care providers to provide diabetic foot screening for systematically marginalised populations: how, why and in what contexts do they work? A realist review. BMJ Open 2024; 14:e081006. [PMID: 38262651 PMCID: PMC10806612 DOI: 10.1136/bmjopen-2023-081006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/09/2024] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVE We aimed to understand how, why and in what context upskilling programmes for unregulated care providers (UCPs) to provide foot screening for systematically marginalised groups living with diabetes were implemented. DESIGN We used realist synthesis based on Realist And Meta-narrative Evidence Syntheses: Evolving Standards guidance. DATA SOURCES We searched the Medline, Embase, PsycINFO, CINAHL, ERIC, Web of Science Core Collection, and Scopus databases and the grey literature (Google Scholar, ProQuest Dissertations and Theses) up to November 2022. ELIGIBILITY CRITERIA We included experimental and non-experimental articles in English that either described mechanisms or discussed expected outcomes for educational interventions for patients and family caregivers or healthcare providers, both regulated and unregulated. We also included articles that evaluated the impact of foot care programmes if the UCPs' training was described. DATA EXTRACTION AND SYNTHESIS The lead author extracted, annotated and coded uploaded relevant data to identify contexts, mechanisms and outcome configurations using MAXQDA (a qualitative data analysis software). We used deductive and inductive coding to structure the process. Our team members double-reviewed and appraised a random sample of 20% of articles at all stages to ensure consistency. RESULTS Our search identified 52 articles. Evidence suggested the necessity of developing upskilling foot screening programmes within the context of preventive care programmes that also provide education in diabetes, and early referrals for appropriate interventions. Multidisciplinary programmes created an ideal context facilitating coordination between UCPs and their regulated counterparts. Engaging patients and community partners, using a competency-based model, and incorporating cultural competencies were determinants of success for these programmes. CONCLUSION This review provides a realistic programme theory for the mechanisms used, the context in which these programmes were developed, and the expected outcomes to train UCPs to provide preventive foot care for systematically marginalised populations. PROSPERO REGISTRATION NUMBER CRD42022369208.
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Affiliation(s)
- Samah Hassan
- University Health Network, Toronto, Ontario, Canada
- Program for Health System and Technology Evaluation, Ted Rogers Centre for Heart Research at Peter Munk Cardiac Centre, Toronto General Hospital Research Institute (TGHRI), University Health Network (UHN), Toronto, Ontario, Canada
| | - Valeria E Rac
- University Health Network, Toronto, Ontario, Canada
- Program for Health System and Technology Evaluation, Ted Rogers Centre for Heart Research at Peter Munk Cardiac Centre, Toronto General Hospital Research Institute (TGHRI), University Health Network (UHN), Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute (TGHRI), University Health Network (UHN), Toronto, Ontario, Canada
- Diabetes Action Canada, CIHR SPOR Network, Toronto, Ontario, Canada
| | - Brian Hodges
- University Health Network, Toronto, Ontario, Canada
- The Institute of Education Research, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Patti Leake
- University Health Network, Toronto, Ontario, Canada
- The Institute of Education Research, University Health Network, Toronto, Ontario, Canada
| | - Saul Cobbing
- University Health Network, Toronto, Ontario, Canada
- The Institute of Education Research, University Health Network, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Department of Physiotherapy, University of KwaZulu-Natal, Durban, South Africa
| | - Catharine Marie Gray
- University Health Network, Toronto, Ontario, Canada
- The Michener Institute of Education, University Health Network, Toronto, Ontario, Canada
| | - Nicola Bartley
- University Health Network, Toronto, Ontario, Canada
- The Michener Institute of Education, University Health Network, Toronto, Ontario, Canada
| | - Andrea Etherington
- University Health Network, Toronto, Ontario, Canada
- The Institute of Education Research, University Health Network, Toronto, Ontario, Canada
| | - Munira Abdulwasi
- University Health Network, Toronto, Ontario, Canada
- The Institute of Education Research, University Health Network, Toronto, Ontario, Canada
- The Michener Institute of Education, University Health Network, Toronto, Ontario, Canada
| | - Hei-Ching Kristy Cheung
- University Health Network, Toronto, Ontario, Canada
- The Institute of Education Research, University Health Network, Toronto, Ontario, Canada
| | - Melanie Anderson
- University Health Network, Toronto, Ontario, Canada
- Library and Information Services, University Health Network, Toronto, Ontario, Canada
| | - Nicole N Woods
- University Health Network, Toronto, Ontario, Canada
- The Institute of Education Research, University Health Network, Toronto, Ontario, Canada
- The Michener Institute of Education, University Health Network, Toronto, Ontario, Canada
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Schafte K, Bruna S. The influence of intergenerational trauma on epigenetics and obesity in Indigenous populations - a scoping review. Epigenetics 2023; 18:2260218. [PMID: 37752750 PMCID: PMC10538456 DOI: 10.1080/15592294.2023.2260218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 09/07/2023] [Indexed: 09/28/2023] Open
Abstract
Background: Research has recently begun to examine the potential intergenerational impacts of trauma on obesity.Objective: This scoping review examines the literature on the interactions between intergenerational trauma, epigenetics, and obesity in Indigenous populations. The review was conducted to identify what is known from the literature about how intergenerational trauma may epigenetically influence obesity in Indigenous populations.Methods: Following the PRISMA-ScR guidelines for scoping reviews, online databases were used to identify studies that included discussion of the four focus topics: trauma, epigenetics, obesity, and Indigeneity. The review resulted in six studies that examined those themes. The focus and findings of the selected studies varied from cultural to biological mechanisms and from discussion regarding trauma, epigenetics, obesity, or Indigeneity, but they support three broad statements. First, they support that obesity has genetic and epigenetic factors. Second, intergenerational trauma is prevalent in Indigenous communities. Finally, intergenerational trauma has cultural and biological influences on obesity.Conclusions: Current literature illustrates that intergenerational trauma has behavioural and epigenetic influences that can lead to increased obesity. This scoping review provides a preliminary map of the current literature and understandings of these topics. This review calls for continued studies regarding the connection between trauma, obesity, and epigenetics in Indigenous communities. Future research is vital for practice and policy surrounding individual and communal healing.
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Affiliation(s)
- Krista Schafte
- Department of Anthropology, Western Washington University, Bellingham, WA, USA
| | - Sean Bruna
- Department of Anthropology, Western Washington University, Bellingham, WA, USA
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McKay CD, Gubhaju L, Gibberd AJ, McNamara BJ, Macniven R, Joshy G, Roseby R, Williams R, Yashadhana A, Fields T, Porykali B, Azzopardi P, Banks E, Eades SJ. Health behaviours associated with healthy body composition among Aboriginal adolescents in Australia in the 'Next Generation: Youth Well-being study'. Prev Med 2023; 175:107715. [PMID: 37775084 DOI: 10.1016/j.ypmed.2023.107715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/21/2023] [Accepted: 09/23/2023] [Indexed: 10/01/2023]
Abstract
This study described the distribution of healthy body composition among Aboriginal adolescents in Australia aged 10-24 years and examined associations with health behaviours and self-rated health. Data were cross-sectional from the 'Next Generation: Youth Well-being study' baseline (N = 1294). We used robust Poisson regression to quantify associations of self-reported health behaviours (physical activity, screen time, sleep, consumption of vegetables, fruit, soft drinks and fast food, and tobacco smoking and alcohol) and self-rated health to healthy body mass index (BMI) and waist/height ratio (WHtR). Overall, 48% of participants had healthy BMI and 64% healthy WHtR, with healthy body composition more common among younger adolescents. Higher physical activity was associated with healthy body composition (5-7 days last week vs none; adjusted prevalence ratio (aPR) healthy BMI 1.31 [95% CI 1.05-1.64], and healthy WHtR 1.30 [1.10-1.54]), as was recommended sleep duration (vs not; aPR healthy BMI 1.56 [1.19-2.05], and healthy WHtR 1.37 [1.13-1.67]). There was a trend for higher proportion of healthy body composition with more frequent fast food consumption. Healthy body composition was also associated with higher self-rated health ('very good/excellent' vs 'poor/fair'; aPR healthy BMI 1.87 [1.45-2.42], and healthy WHtR 1.71 [1.40-2.10]). Culturally appropriate community health interventions with a focus on physical activity and sleep may hold promise for improving body composition among Aboriginal adolescents.
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Affiliation(s)
- Christopher D McKay
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.
| | - Lina Gubhaju
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Alison J Gibberd
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Bridgette J McNamara
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Rona Macniven
- School of Population Health, UNSW, Sydney, NSW, Australia
| | - Grace Joshy
- Centre for Public Health Data and Policy, National Centre for Epidemiology and Population Health, College of Health & Medicine, Australian National University, Canberra, ACT, Australia
| | - Robert Roseby
- Department of Respiratory Medicine, Monash Children's Hospital, Melbourne, VIC, Australia; Department of Paediatrics, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
| | - Robyn Williams
- Curtin Medical School, Curtin University, Perth, WA, Australia
| | - Aryati Yashadhana
- School of Population Health, UNSW, Sydney, NSW, Australia; Centre for Primary Health Care & Equity, UNSW, Sydney, NSW, Australia
| | - Ted Fields
- School of Population Health, UNSW, Sydney, NSW, Australia; Centre for Primary Health Care & Equity, UNSW, Sydney, NSW, Australia
| | - Bobby Porykali
- Guunu-maana (Heal) Aboriginal and Torres Strait Islander Health Program, The George Institute for Global Heath, Sydney, NSW, Australia
| | - Peter Azzopardi
- Murdoch Children's Research Institute, Melbourne, VIC, Australia; Telethon Kids Institute, Perth, WA, Australia
| | - Emily Banks
- Centre for Public Health Data and Policy, National Centre for Epidemiology and Population Health, College of Health & Medicine, Australian National University, Canberra, ACT, Australia
| | - Sandra J Eades
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
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Wahi G, Kandasamy S, Bangdiwala SI, Baumann A, Crea-Arsenio M, Desai D, DiLiberto D, Georgiades K, Jackson-Best F, Kwan M, Montague P, Newbold KB, Sherifali D, Sim A, de Souza RJ, Anand SS. Strengthening Community Roots: Anchoring Newcomers in Wellness and Sustainability (SCORE!): A protocol for the co-design and evaluation of a healthy active living program among a newcomer community in Canada. PLoS One 2023; 18:e0288851. [PMID: 37768908 PMCID: PMC10538726 DOI: 10.1371/journal.pone.0288851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 07/11/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND The burden of childhood obesity and cardiometabolic risk factors affecting newcomer Canadians living in lower socioeconomic circumstances is a concerning public health issue. This paper describes Strengthening Community Roots: Anchoring Newcomers in Wellness and Sustainability (SCORE!), an academic-community research partnership to co-design interventions that nurture and optimize healthy activity living (HAL) among a community of children and families new to Canada in Hamilton, Ontario, Canada. METHODS/DESIGN Our overarching program is informed by a socio-ecological model, and will co-create HAL interventions for children and families new to Canada rooted in outdoor, nature-based physical activity. We will proceed in three phases: Phase 1) synthesis of existing evidence regarding nature based HAL interventions among children and families; Phase 2) program development through four data collection activities including: i) community engagement activities to build trustful relationships and understand barriers and facilitators, including establishing a community advisory and action board, qualitative studies including a photovoice study, and co-design workshops to develop programs; ii) characterizing the demographics of the community through a household survey; iii) characterizing the built environment and HAL programs/services available in the community by developing an accessible real-time systems map; and iv) reviewing municipal policies relevant to HAL and sustainability; leading to Phase 3) implementation and evaluation of the feasibility of co-designed HAL programs. CONCLUSION The etiology of childhood obesity and related chronic diseases is complex and multifactorial, as are intervention strategies. The SCORE! program of research brings together partners including community members, service providers, academic researchers, and organizational leaders to build a multi-component intervention that promotes the health and wellness of newcomer children and families.
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Affiliation(s)
- Gita Wahi
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Chanchlani Research Centre, McMaster University, Hamilton, Ontario, Canada
| | - Sujane Kandasamy
- Chanchlani Research Centre, McMaster University, Hamilton, Ontario, Canada
- Child and Youth Studies, Brock University, St Catherines, Ontario, Canada
| | - Shrikant I. Bangdiwala
- Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Andrea Baumann
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
- Global Health Office, McMaster University, Hamilton, Ontario, Canada
| | - Mary Crea-Arsenio
- Global Health Office, McMaster University, Hamilton, Ontario, Canada
| | - Dipika Desai
- Chanchlani Research Centre, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Deborah DiLiberto
- Global Health Office, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Katholiki Georgiades
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Offord Centre for Child Studies, Ron Joyce Children’s Health Centre, Hamilton, Ontario, Canada
| | - Fatimah Jackson-Best
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Matthew Kwan
- Child and Youth Studies, Brock University, St Catherines, Ontario, Canada
| | - Patricia Montague
- Chanchlani Research Centre, McMaster University, Hamilton, Ontario, Canada
| | - K. Bruce Newbold
- School of Earth, Environment & Society, McMaster University, Hamilton, Ontario, Canada
| | - Diana Sherifali
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Amanda Sim
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Russell J. de Souza
- Chanchlani Research Centre, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Sonia S. Anand
- Chanchlani Research Centre, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Hassan S, Rac VE, Hodges BD, Leake P, Cobbing S, Gray CM, Bartley N, Etherington A, Abdulwasi M, Cheung HCK, Anderson M, Woods NN. Understanding how and why upskilling programmes for unregulated care providers can support health equity in underserved communities: a realist review protocol. BMJ Open 2023; 13:e072570. [PMID: 37612108 PMCID: PMC10450069 DOI: 10.1136/bmjopen-2023-072570] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 07/31/2023] [Indexed: 08/25/2023] Open
Abstract
INTRODUCTION Foot ulcers are one of the most devastating complications of diabetes mellitus leading to leg amputations. In Canada, systematically marginalised and racialised populations are more prone to developing foot ulcers and at higher risk of limb amputations. Shortages of regulated healthcare have hindered efforts to provide foot care. Upskilling unregulated care providers (UCPs) to deliver foot screening seems a reasonable solution to reduce limb loss. UCPs can advocate for health equity and deliver appropriate care. There is a need, however, to understand how and why an educational intervention for UCPs providing foot screening for these high-risk groups may or may not work. METHODS AND ANALYSIS This realist review will follow the Realist And Meta-narrative Evidence Syntheses: Evolving Standards standards. First, we will develop an initial programme theory (PrT) based on exploratory searches and discussions with experts and stakeholders. Then, we will search MEDLINE, Embase, PsycINFO, ERIC, CINAHL and Scopus databases along with relevant sources of grey literature. The retrieved articles will be screened for studies focusing on planned educational interventions for UCPs related to diabetic foot assessment. Data regarding contexts, mechanisms and outcomes will be extracted and analysed using a realist analysis through an iterative process that includes data reviewing and consultation with our team. Finally, we will use these results to modify the initial PrT. ETHICS AND DISSEMINATION Ethical approval is not required for this review. The main output of this research will be an evidence-based PrT for upskilling programmes for UCPs. We will share our final PrT using text, tables and infographics to summarise our results and draw insights across papers/reports. For academic, clinical, social care and educational audiences, we will produce peer-reviewed journal articles, including those detailing the process and findings of the realist review and establishing our suggestions for effective upskilling programmes. PROSPERO REGISTRATION NUMBER CRD42022369208.
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Affiliation(s)
- Samah Hassan
- The Institute of Education Research, University Health Network, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
- The Michener Institute of Education, University Health Network, Toronto, Ontario, Canada
| | - Valeria E Rac
- University Health Network, Toronto, Ontario, Canada
- Program for Health System and Technology Evaluation, Ted Rogers Centre for Heart Research at Peter Munk Cardiac Centre, Toronto General Hospital Research Institute (TGHRI), University Health Network (UHN), Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto Health Economics and Toronto General Hospital Research Institute (TGHRI), University Health Network (UHN), Toronto, Ontario, Canada
- Diabetes Action Canada, CIHR SPOR Network, Toronto, Ontario, Canada
| | - Brian David Hodges
- University Health Network, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Patti Leake
- The Institute of Education Research, University Health Network, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
- The Michener Institute of Education, University Health Network, Toronto, Ontario, Canada
| | - Saul Cobbing
- The Institute of Education Research, University Health Network, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Department of Physiotherapy, University of KwaZulu-Natal, Durban, South Africa
| | - Catharine Marie Gray
- The Institute of Education Research, University Health Network, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
- The Michener Institute of Education, University Health Network, Toronto, Ontario, Canada
| | - Nicola Bartley
- University Health Network, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | - Andrea Etherington
- The Institute of Education Research, University Health Network, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | - Munira Abdulwasi
- The Institute of Education Research, University Health Network, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
- The Michener Institute of Education, University Health Network, Toronto, Ontario, Canada
| | - Hei-Ching Kristy Cheung
- The Institute of Education Research, University Health Network, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
- Wilson Centre, University Health Network, Toronto, Ontario, Canada
| | - Melanie Anderson
- Library and Information Services, University Health Network, Toronto, Ontario, Canada
| | - Nicole N Woods
- The Institute of Education Research, University Health Network, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
- The Michener Institute of Education, University Health Network, Toronto, Ontario, Canada
- Wilson Centre, University Health Network, Toronto, Ontario, Canada
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Satterfield D, DeBruyn L, Lofton T, Francis CD, Zoumenou V, DeCora L, Wesner C. "Make Stories That Will Always Be There": Eagle Books' Appeal, Sustainability, and Contributions to Public Health, 2006-2022. Prev Chronic Dis 2023; 20:E26. [PMID: 37055154 PMCID: PMC10109502 DOI: 10.5888/pcd20.220315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023] Open
Abstract
PURPOSE AND OBJECTIVES We aimed to determine why the Eagle Books, an illustrated series for American Indian and Alaska Native (AIAN) children to address type 2 diabetes, remain viable long after their release. We sought to answer 2 questions: Why did the books maintain popularity? What factors have sustained them? INTERVENTION APPROACH Type 2 diabetes burgeoned in the US after World War II, compounding a long legacy of injustices for AIAN peoples. By the 1980s, their rates soared above those of White people. Concerned for future generations, Tribal Leaders suggested that the Centers for Disease Control and Prevention and Indian Health Service use traditional storytelling to teach children about staying healthy. Public health interventions are most effective when culture and history are integrated into health education, particularly stories to address a relatively new disease for AIAN peoples. EVALUATION METHODS From 2008 through 2013, we conducted a case study among 8 tribal communities to evaluate the uptake of the Eagle Books across Indian Country. To understand the Eagle Books' sustained appeal, in 2022 we reanalyzed the original case study themes and analyzed for the first time themes that emerged from evaluation results in the Eagle Books' program literature. These were programs that had independently evaluated their use of the Eagle Books and published their findings. RESULTS Outcomes demonstrated continuous application of the Eagle Books in diverse community interventions, influencing children's healthy choices. Community implementers described sustainability components, such as the books' versatility, flexibility of use, and availability online and in print. IMPLICATIONS FOR PUBLIC HEALTH Historical, social, economic, and environmental health determinants intersect with biological and behavioral factors to weave a complex web of causation for type 2 diabetes, beginning early in life. Compelling, colorful stories reflecting traditional wisdom and respect for Western and Indigenous science - through the eyes of a wise eagle, a clever rabbit, a tricky coyote, and kids in T-shirts and sneakers - can positively influence community health.
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Affiliation(s)
- Dawn Satterfield
- Native Diabetes Wellness Program, Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA 30341
| | - Lemyra DeBruyn
- Native Diabetes Wellness Program, Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Virginie Zoumenou
- University of Maryland Eastern Shore Extension, Princess Anne, Maryland
| | | | - Chelsea Wesner
- Center for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Potential Determinants of Cardio-Metabolic Risk among Aboriginal and Torres Strait Islander Children and Adolescents: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159180. [PMID: 35954531 PMCID: PMC9368168 DOI: 10.3390/ijerph19159180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/23/2022] [Accepted: 07/25/2022] [Indexed: 11/30/2022]
Abstract
Prevention initiatives during childhood and adolescence have great potential to address the health inequities experienced by Aboriginal and Torres Strait Islander (Indigenous) populations in Australia by targeting modifiable risk factors for cardio-metabolic diseases. We aimed to synthesize existing evidence about potential determinants of cardio-metabolic risk markers—obesity, elevated blood pressure, elevated blood glucose, abnormal lipids, or a clustering of these factors known as the metabolic syndrome (MetS)—for Indigenous children and adolescents. We systematically searched six databases for journal articles and three websites for relevant grey literature. Included articles (n = 47) reported associations between exposures (or interventions) and one or more of the risk markers among Indigenous participants aged 0–24 years. Data from 18 distinct studies about 41 exposure–outcome associations were synthesized (by outcome: obesity [n = 18]; blood pressure [n = 9]; glucose, insulin or diabetes [n = 4]; lipids [n = 5]; and MetS [n = 5]). Obesity was associated with each of the other cardio-metabolic risk markers. Larger birth size and higher area-level socioeconomic status were associated with obesity; the latter is opposite to what is observed in the non-Indigenous population. There were major gaps in the evidence for other risk markers, as well as by age group, geography, and exposure type. Screening for risk markers among those with obesity and culturally appropriate obesity prevention initiatives could reduce the burden of cardio-metabolic disease.
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Hanemaayer R, Neufeld HT, Anderson K, Haines J, Gordon K, Lickers KRL, Xavier A, Peach L, Peeters M. Exploring the environmental determinants of food choice among Haudenosaunee female youth. BMC Public Health 2022; 22:1156. [PMID: 35681193 PMCID: PMC9185972 DOI: 10.1186/s12889-022-13434-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 05/16/2022] [Indexed: 11/25/2022] Open
Abstract
Background Research on Indigenous food literacy within Canada has been focused on northern and remote communities despite the fact there are considerable and unique barriers to food access, availability, and utilization in southern Indigenous communities. Food insecurity is also a prevalent issue among Indigenous Peoples living in these more populous regions. Study objectives included investigating the determinants of food choice among youth, along with perceived opportunities that would improve food environments individually and at the community level. Methods This community-based study used Photovoice to explore the perceptions and experiences of traditional foods and the determinants of food choice among youth in the community of Six Nations of the Grand River. Participants took photos of their local food environments, including where foods were acquired, consumed, prepared, or shared, and participated in semi-structured interviews to share the stories behind these images. Thematic analysis was used to identify patterns in participants’ photos and interview content. Results Environmental factors were found to influence participants’ traditional and everyday food choices. Built, social, economic and ecological environments were described by the youth as distinct yet inter-related determinants that converge to influence individual food choice. Built environments had a notable impact on food choice, most notably at home and in school settings. Home and family were found to be facilitators of meal consistency and healthy food choices across participants. The social environment including participants’ relationships with their peers and community friends was often a barrier to healthy food choices. Eating at fast food outlets was a common social activity. The economic environment included cost deterrents associated with food choices and regular meals. The ecological environment was less of an influence and impacted the seasonal consumption of traditional and other locally harvested foods. Conclusions Overall, the study findings have generated important knowledge regarding food environments and literacy and serves as a unique example of how to explore the traditional and everyday food experiences of Indigenous youth. Recommendations will inform the development of new as well as existing initiatives and resources to enhance the holistic wellbeing of youth and the broader community.
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Affiliation(s)
- Rebecca Hanemaayer
- Department of Family Relations and Applied Nutrition, The University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - Hannah Tait Neufeld
- Department of Family Relations and Applied Nutrition, The University of Guelph, Guelph, ON, N1G 2W1, Canada. .,School of Public Health Sciences, The University of Waterloo, Waterloo, ON, N2L 3G1, Canada.
| | - Kim Anderson
- Department of Family Relations and Applied Nutrition, The University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - Jess Haines
- Department of Family Relations and Applied Nutrition, The University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - Kelly Gordon
- Six Nations Health Services, Ohsweken, ON, N0A 1M0, Canada
| | | | - Adrianne Xavier
- Indigenous Studies Program, Department of Anthropology, McMaster University, Hamilton, ON, L8S 4L8, Canada
| | - Laura Peach
- School of Public Health Sciences, The University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - Mwalu Peeters
- Department of Family Relations and Applied Nutrition, The University of Guelph, Guelph, ON, N1G 2W1, Canada
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11
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Goins RT, Conway C, Reid M, Jiang L, Chang J, Huyser KR, Brega AG, Steiner JF, Fyfe-Johnson AL, Johnson-Jennings M, Hiratsuka V, Manson SM, O'Connell J. Social determinants of obesity in American Indian and Alaska Native peoples aged ≥ 50 years. Public Health Nutr 2022; 25:1-30. [PMID: 35451356 PMCID: PMC9991752 DOI: 10.1017/s1368980022000945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/29/2022] [Accepted: 04/01/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE American Indian and Alaska Native peoples (AI/ANs) have a disproportionately high rate of obesity, but little is known about the social determinants of obesity among older AI/ANs. Thus, our study assessed social determinants of obesity in AI/ANs aged ≥ 50 years. DESIGN We conducted a cross-sectional analysis using multivariate generalized linear mixed models to identify social determinants associated with the risk of being classified as obese (BMI ≥ 30.0 kg/m2). Analyses were conducted for the total study population and stratified by median county poverty level. SETTING Indian Health Service (IHS) data for AI/ANs who used IHS services in FY2013. PARTICIPANTS 27,696 AI/ANs aged ≥ 50 years without diabetes. RESULTS Mean BMI was 29.8 ± 6.6 with 43% classified as obese. Women were more likely to be obese than men, and younger ages were associated with higher obesity risk. While having Medicaid coverage was associated with lower odds of obesity, private health insurance was associated with higher odds. Living in areas with lower rates of educational attainment and longer drive times to primary care services were associated with higher odds of obesity. Those who lived in a county where a larger percentage of people had low access to a grocery store were significantly less likely to be obese. CONCLUSIONS Our findings contribute to the understanding of social determinants of obesity among older AI/ANs and highlight the need to investigate AI/AN obesity, including longitudinal studies with a life course perspective to further examine social determinants of obesity in older AI/ANs.
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Affiliation(s)
- R Turner Goins
- Western Carolina University, College of Health and Human Sciences,
| | | | - Margaret Reid
- Colorado School of Public Health, University of Colorado, Emails: ; ; ;
| | | | | | | | - Angela G Brega
- Colorado School of Public Health, University of Colorado, Emails: ; ; ;
| | | | | | | | | | - Spero M Manson
- Colorado School of Public Health, University of Colorado, Emails: ; ; ;
| | - Joan O'Connell
- Colorado School of Public Health, University of Colorado, Emails: ; ; ;
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12
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Wahi G, Wilson J, Burning M, George S, Hill P, Homer J, Jacobs L, Lickers A, Smoke S, Davis AD, Desai D, Jack SM, Williams N, de Souza RJ, Anand SS. Impact of Maternal Health Behaviours and Social Conditions on Infant Diet at Age 1-Year: Results from a Prospective Indigenous Birth Cohort in Ontario, Canada. Nutrients 2022; 14:nu14091736. [PMID: 35565704 PMCID: PMC9102994 DOI: 10.3390/nu14091736] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/06/2022] [Accepted: 04/14/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Understanding the impact of maternal health behaviours and social conditions on childhood nutrition is important to inform strategies to promote health during childhood. Objective: To describe how maternal health sociodemographic factors (e.g., socioeconomic status, education), health behaviours (e.g., diet), and traditional health care use during pregnancy impact infant diet at age 1-year. Methods: Data were collected from the Indigenous Birth Cohort (ABC) study, a prospective birth cohort formed in partnership with an Indigenous community-based Birthing Centre in southwestern Ontario, Canada. 110 mother-infant dyads are included in the study and were enrolled between 2012 and 2017. Multiple linear regression analyses were performed to understand factors associated with infant diet scores at age 1-year, with a higher score indicating a diet with more healthy foods. Results: The mean age of women enrolled during pregnancy was 27.3 (5.9) years. Eighty percent of mothers had low or moderate social disadvantage, 47.3% completed more than high school education, and 70% were cared for by a midwife during their pregnancy. The pre-pregnancy body mass index (BMI) was <25 in 34.5% of women, 15.5% of mothers smoked during pregnancy, and 14.5% of mothers had gestational diabetes. Being cared for by an Indigenous midwife was associated with a 0.9-point higher infant diet score (p = 0.001) at age 1-year, and lower maternal social disadvantage was associated with a 0.17-point higher infant diet quality score (p = 0.04). Conclusion: This study highlights the positive impact of health care provision by Indigenous midwives and confirms that higher maternal social advantage has a positive impact on child nutrition.
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Affiliation(s)
- Gita Wahi
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 4K1, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada; (S.M.J.); (R.J.d.S.); (S.S.A.)
- Correspondence:
| | - Julie Wilson
- Six Nations Birthing Centre, Six Nations of the Grand River, Ohsweken, ON N0A 1M0, Canada; (J.W.); (M.B.); (S.G.); (P.H.); (J.H.); (L.J.); (A.L.); (S.S.)
| | - Melanie Burning
- Six Nations Birthing Centre, Six Nations of the Grand River, Ohsweken, ON N0A 1M0, Canada; (J.W.); (M.B.); (S.G.); (P.H.); (J.H.); (L.J.); (A.L.); (S.S.)
| | - Stephanie George
- Six Nations Birthing Centre, Six Nations of the Grand River, Ohsweken, ON N0A 1M0, Canada; (J.W.); (M.B.); (S.G.); (P.H.); (J.H.); (L.J.); (A.L.); (S.S.)
| | - Phyllis Hill
- Six Nations Birthing Centre, Six Nations of the Grand River, Ohsweken, ON N0A 1M0, Canada; (J.W.); (M.B.); (S.G.); (P.H.); (J.H.); (L.J.); (A.L.); (S.S.)
| | - Janet Homer
- Six Nations Birthing Centre, Six Nations of the Grand River, Ohsweken, ON N0A 1M0, Canada; (J.W.); (M.B.); (S.G.); (P.H.); (J.H.); (L.J.); (A.L.); (S.S.)
| | - Laurie Jacobs
- Six Nations Birthing Centre, Six Nations of the Grand River, Ohsweken, ON N0A 1M0, Canada; (J.W.); (M.B.); (S.G.); (P.H.); (J.H.); (L.J.); (A.L.); (S.S.)
| | - Ashley Lickers
- Six Nations Birthing Centre, Six Nations of the Grand River, Ohsweken, ON N0A 1M0, Canada; (J.W.); (M.B.); (S.G.); (P.H.); (J.H.); (L.J.); (A.L.); (S.S.)
| | - Sharon Smoke
- Six Nations Birthing Centre, Six Nations of the Grand River, Ohsweken, ON N0A 1M0, Canada; (J.W.); (M.B.); (S.G.); (P.H.); (J.H.); (L.J.); (A.L.); (S.S.)
| | - Albertha D. Davis
- Six Nations Health Services, Six Nations of the Grant River, Ohsweken, ON N0A 1M0, Canada;
| | - Dipika Desai
- Population Health Research Institute, Hamilton, ON L8L 2X2, Canada;
| | - Susan M. Jack
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada; (S.M.J.); (R.J.d.S.); (S.S.A.)
- School of Nursing, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Natalie Williams
- Chanchlani Research Centre, Department of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada;
| | - Russell J. de Souza
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada; (S.M.J.); (R.J.d.S.); (S.S.A.)
- Population Health Research Institute, Hamilton, ON L8L 2X2, Canada;
| | - Sonia S. Anand
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada; (S.M.J.); (R.J.d.S.); (S.S.A.)
- Population Health Research Institute, Hamilton, ON L8L 2X2, Canada;
- Chanchlani Research Centre, Department of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada;
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13
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Geda NR, Feng CX, Yu Y. Examining the association between work stress, life stress and obesity among working adult population in Canada: findings from a nationally representative data. Arch Public Health 2022; 80:97. [PMID: 35351179 PMCID: PMC8966340 DOI: 10.1186/s13690-022-00865-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 03/23/2022] [Indexed: 11/29/2022] Open
Abstract
Background Obesity is a priority public health concern in Canada and other parts of the world. The study primarily aims at assessing the role of self-perceived work and life stress on obesity among working adults in Canada. Methods The study was conducted based on a total of 104,636 Canadian adults aged 18 and above, extracted from the 2017–2018 Canadian Community Health Survey (CCHS) data. We used a mixed-effect logistic regression model to determine the possible association between two stress variables and obesity, controlling for other variables in the model. The random effect term accounts for the correlation among the observations from the same health region. Results A total of 63,815 adult respondents (aged 18 and above) who were working during the 12 months prior to the survey were studied. Of those, 18.7% were obese based on their self-reported BMI > =30.0 kg/m2. More than two-thirds of the respondents reported that their stress level is a bit stressful to extremely stressful. The results of multivariable mixed-effect logistic regression showed that the odds of obesity were 1.432 times (95% CI: 1.248–1.644) among those who reported extremely work-related stress, compared to those who had no work-related stress. Perceived life stress was not significantly associated with obesity risk among working adult population, after adjusting other factors. Conclusion The study concluded that obesity among Canadian adults is 18.7% of the working adult population being obese. Given the reported high prevalence of stress and its effect on obesity, the findings suggested improving social support systems, individual/group counseling, and health education focusing on work environments to prevent and manage stressors and drivers to make significant program impacts. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-022-00865-8.
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Affiliation(s)
- Nigatu Regassa Geda
- Center for Population Studies, College of Development Studies, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Cindy Xin Feng
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Yamei Yu
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
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14
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Gillies C, Blanchet R, Gokiert R, Farmer A, Willows ND. Comprehensive Nutrition Interventions in First Nation-Operated Schools in Canada. CAN J DIET PRACT RES 2022; 83:128-132. [PMID: 35014557 DOI: 10.3148/cjdpr-2021-039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Comprehensive school-based nutrition interventions offer a promising strategy to support healthy eating for First Nations children. A targeted strategic review was performed to identify nutrition interventions in 514 First Nation-operated schools across Canada through their websites. Directed content analysis was used to describe if interventions used 1 or more of the 4 components of the Comprehensive School Health (CSH) framework. Sixty schools had interventions. Nearly all (n = 56, 93%) schools offered breakfast, snack, and (or) lunch programs (social and physical environment). About one-third provided opportunities for students to learn about traditional healthy Indigenous foods and food procurement methods (n = 18, 30%) (teaching and learning) or facilitated connections between the school and students' families or the community (n = 16, 27%) (partnerships and services). Few schools (n = 10, 17%) had a nutrition policy outlining permitted foods (school policy). Less than 1% (n = 3) of interventions included all 4 CSH components. Results suggest that most First Nation-operated schools provide children with food, but few have nutrition interventions that include multiple CSH components. First Nation-operated schools may require additional financial and (or) logistical support to implement comprehensive school-based nutrition interventions, which have greater potential to support long-term health outcomes for children than single approaches.
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Affiliation(s)
- Christina Gillies
- Department of Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, AB.,Department of Social Sciences, Wageningen University & Research, Wageningen, The Netherlands
| | - Rosanne Blanchet
- Department of Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, AB
| | - Rebecca Gokiert
- School of Public Health, University of Alberta, Edmonton, AB
| | - Anna Farmer
- Department of Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, AB
| | - Noreen D Willows
- Department of Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, AB
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15
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Walch AK, Ohle KA, Koller KR, Alexie L, Sapp F, Thomas TK, Bersamin A. Alaska Native Elders' perspectives on dietary patterns in rural, remote communities. BMC Public Health 2021; 21:1645. [PMID: 34503462 PMCID: PMC8427848 DOI: 10.1186/s12889-021-11598-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 08/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Given the increasing rates of childhood obesity in Alaska Native children and the understanding that the most effective interventions are informed by and reflect the cultural knowledge of the community in which they are implemented, this project sought to gather the wisdom of local Yup'ik and Cup'ik Elders in the Yukon-Kuskokwim region of Alaska around how to maintain a healthy diet and active lifestyle. METHODS Perspectives were sought through the use of semi-structured focus groups, which were completed in person in twelve communities. All conversations were recorded, translated, transcribed, and analyzed using a qualitative approach, where key themes were identified. RESULTS Elders provided a clear and consistent recollection of what their life looked like when they were young and expressed their perspectives related to maintaining a healthy and traditional lifestyle. The key themes the Elders discussed included an emphasis on the nutritional and cultural benefits of traditional foods; concerns around changing dietary patterns such as the consumption of processed foods and sugar sweetened beverages; and concerns on the time and use of screens. Elders also expressed a desire to help younger generations learn traditional subsistence practices. CONCLUSIONS The risk of obesity in Alaska Native children is high and intervention efforts should be grounded in local knowledge and values. The perspectives from Yup'ik and Cup'ik Elders in the Yukon-Kuskokwim Delta area of Alaska provide a better understanding on local views of how to maintain a healthy diet, physical activities, and traditional values.
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Affiliation(s)
- Amanda K. Walch
- Dietetics & Nutrition Department, University of Alaska Anchorage, 146 Professional Studies Building, 3211 Providence Drive, Anchorage, AK 99508 USA
| | - Kathryn A. Ohle
- Early Childhood Education, Grand Valley State University, 441C Richard M. DeVos Center, 401 Fulton St. W, Grand Rapids, MI 49504-6431 USA
| | - Kathryn R. Koller
- Clinical & Research Services, Alaska Native Tribal Health Consortium, 3900 Ambassador Dr., Ste. 201, Anchorage, AK 99508 USA
| | - Lucinda Alexie
- Division of YKHC Medical Director, Yukon Kuskokwim Health Corporation, Post Office Box 528, Bethel, AK USA
| | - Flora Sapp
- Center for Alaska Native Health Research, Institute of Arctic Biology, University of Alaska Fairbanks, PO BOX 757000, Fairbanks, AK 99775 USA
| | - Timothy K. Thomas
- Clinical & Research Services, Alaska Native Tribal Health Consortium, 3900 Ambassador Dr., Ste. 201, Anchorage, AK 99508 USA
| | - Andrea Bersamin
- Center for Alaska Native Health Research, Institute of Arctic Biology, University of Alaska Fairbanks, PO BOX 757000, Fairbanks, AK 99775 USA
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Lopresti S, Willows ND, Storey KE, McHugh TLF. Indigenous Youth Mentorship Program: key implementation characteristics of a school peer mentorship program in Canada. Health Promot Int 2021; 36:913-923. [PMID: 33166996 DOI: 10.1093/heapro/daaa090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The Indigenous Youth Mentorship Program (IYMP) is a peer-led health promotion program developed for elementary school students in Indigenous school communities in Canada. A local young adult health leader (YAHL) and high school mentors offer students healthy snacks, physical activity games, relationship building activities and cultural teachings. IYMP aims to improve children's health and wellbeing and empower Indigenous youth and communities. The purpose of this focused ethnography was to describe the key characteristics of successful IYMP delivery. Two focus groups were conducted with 16 participants (8 YAHLS and 8 youth mentors) from 7 schools followed by 4 individual interviews (3 YAHLs, 1 youth peer mentor). Transcripts were analyzed using content analysis. Findings were triangulated with IYMP program field observations and notes from IYMP national team meetings. The five characteristics identified as important for IYMP delivery were a sense of ownership by those delivering the program, inclusion of Indigenous Elders/knowledge keepers, establishing trusting relationships, open communication among all stakeholder groups, including community and academic partners, and adequate program supports in the form of program funding, manuals that described program activities, and local and national gatherings between academic and community partners for sharing ideas about the program and its components. This study indicates the importance of respectful partnerships between community and academic leads for program success and sustainability. As IYMP is implemented in more communities and becomes community autonomous, program sustainability may be ensured and implementation challenges mitigated by embedding the identified five essential characteristics within the fabric of IYMP.
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Affiliation(s)
- Sabrina Lopresti
- Faculty of Agricultural, Life & Environmental Sciences, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, Canada T6G 2P5
| | - Noreen D Willows
- Faculty of Agricultural, Life & Environmental Sciences, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, Canada T6G 2P5
| | - Kate E Storey
- School of Public Health, University of Alberta, 8303 - 112 Street, Edmonton, Alberta, Canada T6G 2P5
| | - Tara-Leigh F McHugh
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, 1-111 University Hall, Edmonton, Alberta, Canada T6G 2P5
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Blanchet R, Batal M, Johnson-Down L, Johnson S, Willows N. An Indigenous food sovereignty initiative is positively associated with well-being and cultural connectedness in a survey of Syilx Okanagan adults in British Columbia, Canada. BMC Public Health 2021; 21:1405. [PMID: 34271895 PMCID: PMC8283975 DOI: 10.1186/s12889-021-11229-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 06/03/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND For the Syilx Okanagan Nation in Canada, salmon has vital nutritional, cultural, and spiritual significance. Yet, the Okanagan Sockeye salmon population came to near extinction, resulting in a drastic decline in salmon consumption from high historical levels. Thus, restoring and protecting salmon is crucial to Syilx well-being and way of life. A Syilx-led food sovereignty initiative re-established the Okanagan Sockeye salmon population, which has resulted in a rise in fish harvesting. The aim of this study was to assess whether engaging with this initiative was associated with health, well-being, and cultural connectedness (i.e., degree to which one is integrated in their culture) among Syilx adults. Eating Okanagan Sockeye salmon was conceptualized as a proxy for engaging with this Indigenous food sovereignty initiative. METHODS 265 Syilx adults completed a survey including a traditional food frequency questionnaire and questions on health status (e.g., BMI, self-assessed physical health), well-being (e.g., life satisfaction, stress levels), and cultural connectedness (e.g., sense of belonging, importance of cultural practices). Participants were divided into 3 groups based on their wild salmon eating during the year prior to the survey: (1) adults who ate Okanagan Sockeye salmon, (2) adults who ate salmon but did not usually know the species of the salmon they ate, or who solely ate salmon that were not Okanagan Sockeye; and (3) adults who did not eat any salmon. RESULTS A statistically significant gradient was observed for enhanced well-being and cultural connectedness, with individuals in group 1 having better indicators than those in group 2, and adults in groups 1 and 2 having better indicators than adults in group 3. No differences were observed in physical health outcomes between the three groups. CONCLUSION Findings suggest that the initiative to re-establish Okanagan Sockeye salmon in the Okanagan River system may have led to better well-being and cultural connectedness among Syilx adults. This study highlights the importance of Indigenous food sovereignty as a way to enhance well-being and cultural connectedness among First Nations in Canada. Findings also reinforce the importance of assessing health and well-being in a wholistic way in Indigenous health research.
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Affiliation(s)
- Rosanne Blanchet
- Department of Agricultural, Food & Nutritional Science, Faculty of Agricultural, Life & Environmental Sciences, University of Alberta, Edmonton Clinic Health Academy, 11405 87 Ave, Mailbox #54, Edmonton, AB, T6G 2P5, Canada
| | - Malek Batal
- Département de nutrition, Faculté de Médecine, Université de Montréal, Pavillon Liliane de Stewart, CP 6128 succ. Centre-Ville, Montréal, QC, H3T 1A8, Canada.
- Centre de recherche en santé publique de l'Université de Montréal et du CIUSS du Centre-Sud-de-l'Île-de-Montréal [CReSP], 7101 Avenue du Parc, Montréal, QC, H3N 1X7, Canada.
| | - Louise Johnson-Down
- Département de nutrition, Faculté de Médecine, Université de Montréal, Pavillon Liliane de Stewart, CP 6128 succ. Centre-Ville, Montréal, QC, H3T 1A8, Canada
| | - Suzanne Johnson
- Okanagan Nation Alliance, 3535 Old Okanagan Hwy, West Kelowna, BC, V4T 3L7, Canada
| | - Noreen Willows
- Department of Agricultural, Food & Nutritional Science, Faculty of Agricultural, Life & Environmental Sciences, University of Alberta, Edmonton Clinic Health Academy, 11405 87 Ave, Mailbox #54, Edmonton, AB, T6G 2P5, Canada
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18
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Batal M, Chan HM, Ing A, Fediuk K, Berti P, Sadik T, Johnson-Down L. Nutrient adequacy and nutrient sources of adults among ninety-two First Nations communities across Canada. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2021; 112:29-40. [PMID: 34181222 PMCID: PMC8239085 DOI: 10.17269/s41997-021-00490-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 01/28/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To identify food sources of nutrients in First Nations adults in Canada and to establish whether these populations are meeting their nutrient requirements and whether traditional foods (TF) contribute to better nutrient intake. METHODS The First Nations Food, Nutrition and Environment Study is a cross-Canada participatory study of First Nations adults living south of the 60th parallel. Twenty-four-hour recalls were conducted in 92 First Nations communities from 2008 to 2016. Repeat recalls were attempted with 20% of participants to adjust for within-person variation and estimate the proportion of individuals below recommendations according to Institute of Medicine guidelines. Nutrients from days with and without TF were compared. The main food sources of select nutrients were identified, including TF. RESULTS Mean energy intakes among women and men ranged from 1664 to 1864 and from 1761 to 2298 kcal/day respectively. Most macronutrients were within the acceptable macronutrient diet range except for fat in most age groups and carbohydrates in men 71 years of age and older. Saturated fat was above recommendations for all ages. Only niacin was identified as above recommendations in all age and sex categories. Days where TF were eaten showed greater intakes of key nutrients. CONCLUSION It is imperative that we find culturally appropriate ways to improve the quality and nutritional value of First Nations Peoples food intake by improving TF access and use on the one hand and conversely providing better quality store-bought foods. For success in this, we must empower First Nations communities and health practitioners to collaboratively overcome these challenges.
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Affiliation(s)
- Malek Batal
- Département de nutrition, Faculté de Médecine, Université de Montréal, Pavillon Liliane de Stewart, CP 6128 succ. Centre-Ville, Montréal, QC, H3T 1A8, Canada.
- Centre de recherche en santé publique de l'Université de Montréal et du CIUSS du Centre-sud-de-l'Île-de-Montréal (CReSP), 7101 Avenue du Parc, Montréal, QC, H3N 1X7, Canada.
| | - Hing Man Chan
- Department of Biology, University of Ottawa, 30 Marie Curie, Ottawa, ON, K1N 6N5, Canada
| | - Amy Ing
- Département de nutrition, Faculté de Médecine, Université de Montréal, Pavillon Liliane de Stewart, CP 6128 succ. Centre-Ville, Montréal, QC, H3T 1A8, Canada
| | - Karen Fediuk
- First Nations Food, Nutrition and Environment Study, University of Ottawa, 30 Marie Curie, Ottawa, ON, K1N 6N5, Canada
| | - Peter Berti
- HealthBridge Foundation of Canada, 1 Nicholas Street, Suite 1004, Ottawa, ON, KIN 7B7, Canada
| | - Tonio Sadik
- Assembly of First Nations, 55 Metcalfe Street, Suite 1600, Ottawa, ON, K1P 6L5, Canada
| | - Louise Johnson-Down
- Département de nutrition, Faculté de Médecine, Université de Montréal, Pavillon Liliane de Stewart, CP 6128 succ. Centre-Ville, Montréal, QC, H3T 1A8, Canada
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Batal M, Chan HM, Fediuk K, Ing A, Berti PR, Mercille G, Sadik T, Johnson-Down L. First Nations households living on-reserve experience food insecurity: prevalence and predictors among ninety-two First Nations communities across Canada. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2021; 112:52-63. [PMID: 34181224 PMCID: PMC8239078 DOI: 10.17269/s41997-021-00491-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 01/28/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To describe the prevalence of food insecurity in First Nations households across Canada while identifying barriers and enablers to traditional food (TF) consumption. METHODS The First Nations Food, Nutrition and Environment Study is a cross-Canada participatory study of on-reserve First Nations from 2008 to 2018. The Household Food Security Survey Module was used to capture income-related challenges experienced by First Nations households. Households were classified as food secure, or marginally, moderately, or severely food insecure. Barriers and enablers to TF access and use were identified describing the Indigenous experience. RESULTS Almost half of on-reserve First Nations households were food insecure and the prevalence was higher than that for non-Indigenous households in Canada. On-reserve food insecurity prevalence was higher in western regions of Canada. First Nations households with children experienced greater food insecurity than those without children. More adults experienced severe food insecurity than children. Most adults would like to have more TF in their diet but state that factors such as financial and household constraints, industrial activities, government regulations, climate change, and fear of contamination impede greater access. Food costs were substantially higher in remote First Nations communities, but remoteness was not associated with food security in multivariable analysis. CONCLUSION Existing systems have been unsuccessful in curbing the food insecurity in First Nations households. Improving food security hinges on achieving Indigenous Food Sovereignty, the key to long-term conservation and stewardship of the land and the co-management of these by Indigenous Peoples. Studies investigating the feasibility of increasing TF from an Indigenous perspective are required.
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Affiliation(s)
- Malek Batal
- Département de nutrition, Faculté de Médecine, Université de Montréal, Pavillon Liliane de Stewart, CP 6128 succ. Centre-Ville, Montréal, QC, H3T 1A8, Canada.
- Centre de recherche en santé publique de l'Université de Montréal et du CIUSS du Centre-sud-de-l'Île-de-Montréal (CReSP), 7101 Avenue du Parc, Montréal, QC, H3N 1X7, Canada.
| | - Hing Man Chan
- Department of Biology, University of Ottawa, 30 Marie Curie, Ottawa, ON, K1N 6N5, Canada
- First Nations Food, Nutrition and Environment Study, University of Ottawa, 30 Marie Curie, Ottawa, ON, K1N 6N5, Canada
| | - Karen Fediuk
- First Nations Food, Nutrition and Environment Study, University of Ottawa, 30 Marie Curie, Ottawa, ON, K1N 6N5, Canada
| | - Amy Ing
- Département de nutrition, Faculté de Médecine, Université de Montréal, Pavillon Liliane de Stewart, CP 6128 succ. Centre-Ville, Montréal, QC, H3T 1A8, Canada
| | - Peter R Berti
- HealthBridge Foundation of Canada, 1 Nicholas Street, Suite 1004, Ottawa, ON, K1N 7B7, Canada
| | - Genevieve Mercille
- Département de nutrition, Faculté de Médecine, Université de Montréal, Pavillon Liliane de Stewart, CP 6128 succ. Centre-Ville, Montréal, QC, H3T 1A8, Canada
- Centre de recherche en santé publique de l'Université de Montréal et du CIUSS du Centre-sud-de-l'Île-de-Montréal (CReSP), 7101 Avenue du Parc, Montréal, QC, H3N 1X7, Canada
| | - Tonio Sadik
- Assembly of First Nations, 55 Metcalfe Street, Suite 1600, Ottawa, ON, K1P 6L5, Canada
| | - Louise Johnson-Down
- Département de nutrition, Faculté de Médecine, Université de Montréal, Pavillon Liliane de Stewart, CP 6128 succ. Centre-Ville, Montréal, QC, H3T 1A8, Canada
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20
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Wahi G, de Souza RJ, Hartmann K, Giglia L, Jack SM, Anand SS. Effectiveness of programs aimed at obesity prevention among Indigenous children: A systematic review. Prev Med Rep 2021; 22:101347. [PMID: 33889482 PMCID: PMC8050026 DOI: 10.1016/j.pmedr.2021.101347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/30/2020] [Accepted: 02/20/2021] [Indexed: 01/03/2023] Open
Abstract
Given the significant health burden of childhood obesity, it is imperative that effective programs be better understood. When evaluating obesity prevention efforts, one must recognize the contextual factors which drive the disproportionate risk of obesity between populations. This systematic review sought to understand if programs aimed at obesity prevention and/or the promotion of healthy lifestyle behaviours for Indigenous children are effective. We conducted a search using Medline, EMBASE, PsychINFO, ERIC, CINAHL and iPORTAL databases from inception to August 13, 2019. We included experimental and quasi-experimental studies. The main outcomes of interest were change in anthropometrics, nutrition or physical activity. Our narrative synthesis included an assessment of study quality using the Effective Public Health Practice Project Quality assessment tool. A total of 34 studies met selection criteria. Most studies used a quasi-experimental design (n = 25) and were assessed as low to moderate quality (n = 32). Three studies showed a significant change in anthropometric measures, 14 studies demonstrated at least one significant nutrition-related behaviour or dietary-pattern change, and six studies demonstrated a significant impact on physical activity. This systematic review of programs to prevent obesity among Indigenous children finds a limited impact on anthropometric measurements. Future studies must prioritize Indigenous knowledge and ways of knowing to lead all phases of development, implementation, and evaluation of programs.
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Affiliation(s)
- Gita Wahi
- Departments of Pediatrics, Faculty of Health Sciences, McMaster University, Canada
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Canada
| | - Russell J. de Souza
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Canada
| | - Katrina Hartmann
- Departments of Pediatrics, Faculty of Health Sciences, McMaster University, Canada
| | - Lucia Giglia
- Departments of Pediatrics, Faculty of Health Sciences, McMaster University, Canada
| | - Susan M. Jack
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Canada
- School of Nursing, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Canada
| | - Sonia S. Anand
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Canada
- Department of Medicine, Faculty of Health Sciences, McMaster University, Canada
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21
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Lopresti S, Willows ND, Storey KE, McHugh TLF. Indigenous Youth Mentorship Program: essential characteristics of a Canadian multi-site community-university partnership with Indigenous communities. Health Promot Int 2021; 37:6278427. [PMID: 34010391 DOI: 10.1093/heapro/daab039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The Indigenous Youth Mentorship Program (IYMP) is a peer-led health promotion program grounded in the teachings of Indigenous scholars. IYMP is delivered as a multi-sited community-university partnership (CUP) with Indigenous communities across Canada for elementary students. A local young adult health leader and high school youth mentors offer students healthy snacks, physical activity games, relationship building activities and traditional cultural teachings. IYMP aims to improve children's health and wellbeing and empower Indigenous youth and communities. The purpose of this descriptive qualitative study was to describe the essential characteristics of this multi-sited CUP as perceived by the IYMP principal investigators (PIs). Key informant interviews were conducted with 5 IYMP PIs (2 Indigenous) and analysed using content analysis. The overarching theme was forming a community of practice (CoP), where people with a common interest share best practices as they interact regularly. Four sub-themes were shared interest for Indigenous health/wellbeing and social justice, relationships, mentorship and taking a decolonizing research approach. The IYMP CoP allowed mentorship to occur across regions. The essential characteristics that made the IYMP CUPs successful could be used to inform other multi-sited CUPs with Indigenous communities. Those with mutual interests in Indigenous health and partnership with Indigenous communities could consider forming a CoP. Within a newly formed CoP, relationships and mentorship can be developed through discussion and activities. It is imperative within the CoP to take a decolonizing approach to research and acknowledge the impact that colonial policies and practices have had on generations of Indigenous peoples.
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Affiliation(s)
- Sabrina Lopresti
- Department of Agricultural, Food & Nutritional Science, Faculty of Agricultural, Life & Environmental Sciences, University of Alberta, 4-378 Edmonton Clinic Health Academy, Mailbox #54, 11405 87 Avenue, Edmonton, AB T6G 2P5, Canada
| | - Noreen D Willows
- Department of Agricultural, Food & Nutritional Science, Faculty of Agricultural, Life & Environmental Sciences, University of Alberta, 4-378 Edmonton Clinic Health Academy, Mailbox #54, 11405 87 Avenue, Edmonton, AB T6G 2P5, Canada
| | - Kate E Storey
- School of Public Health, University of Alberta, 4-378 Edmonton Clinic Health Academy, Mailbox #54, 11405 87 Avenue, Edmonton, AB T6G 2P5, Canada
| | - Tara-Leigh F McHugh
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, 4-378 Edmonton Clinic Health Academy, Mailbox #54, 11405 87 Avenue, Edmonton, AB T6G 2P5, Canada
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22
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Inuit Country Food and Health during Pregnancy and Early Childhood in the Circumpolar North: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052625. [PMID: 33807905 PMCID: PMC7967653 DOI: 10.3390/ijerph18052625] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/18/2021] [Accepted: 02/18/2021] [Indexed: 02/08/2023]
Abstract
Inuit communities in the Circumpolar North have experienced a nutrition transition characterized by the decreased intake of culturally important, nutrient-rich traditional food (country food), and an increased intake of market food, resulting in concerns over reduced diet quality and emerging chronic diseases. Nutrition in early life is critical for development, may influence health risks in later life, and is an important concern for Inuit community health. The goal of this scoping review was to characterize the nature, extent, and range of the published literature on Inuit country food and health in pregnancy and childhood. A search string was developed and applied to three databases, followed by title and abstract screening and full text review. Articles published between 1995 and 2019 were included, and data were extracted and summarized descriptively. The number of articles generally increased over time, despite the unequal geographic distribution of articles. The majority of the articles focused on environmental contaminants, and one-quarter described nutrient adequacy. Few articles described food security or food safety in pregnancy, and the most utilized quantitative methods. Gaps in understanding of country food use in pregnancy and early childhood highlight areas of future research to support public health policy for this population. Given the critical role of good nutrition in early life and the important contribution country food makes to diet quality for Inuit, further understanding of this interface is warranted.
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23
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Ayala-Marín AM, Iguacel I, Miguel-Etayo PD, Moreno LA. Consideration of Social Disadvantages for Understanding and Preventing Obesity in Children. Front Public Health 2020; 8:423. [PMID: 32984237 PMCID: PMC7485391 DOI: 10.3389/fpubh.2020.00423] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 07/13/2020] [Indexed: 01/22/2023] Open
Abstract
Addressing social disadvantages that lead to obesity should be a public health priority. Obesity prevalence among children and adolescents has reached a plateau in countries with high income but it continues rising in low-income and middle-income countries. In high-income countries, an elevated prevalence of obesity is found among racial and ethnic minority groups and individuals from disadvantaged socioeconomic backgrounds. In addition to classic socioeconomic status (SES) factors, like income, parental education, and occupation, recent publications have linked parental social disadvantages, such as minimal social network, non-traditional family structure, migrant status and unemployment, with obesogenic behaviors and obesity among children. Socio-ecological models of obesity in children can explain the influence of classic SES factors, social disadvantages, culture, and genes on behaviors that could lead to obesity, contributing to the elevated prevalence of obesity. Obesity is a multifactorial disease in which multilevel interventions seem to be the most effective approach to prevent obesity in children, but previous meta-analyses have found that multilevel interventions had poor or inconsistent results. Despite these results, some multilevel interventions addressing specific disadvantaged social groups have shown beneficial effects on children's weight and energy balance-related behaviors, while other interventions have benefited children from both disadvantaged and non-disadvantaged backgrounds. Considering obesity as a worldwide problem, the World Health Organization, the European Commission, and the National Institutes of Health recommend the implementation of obesity prevention programs, but the implementation of such programs without taking into consideration social disadvantages may be an unsuccessful approach. Therefore, the present publication consists of a review of the pertinent literature related to social disadvantage and its consequences for behaviors that could lead to childhood obesity. In addition, we will discuss the relationship between social disadvantages and the socio-ecological model of obesity in children. Finally, we will summarize the relevant aspects of multilevel intervention programs aiming to prevent obesity in children and provide recommendations for future research and intervention approaches to improve weight status in children with social disadvantages.
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Affiliation(s)
- Alelí M Ayala-Marín
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Universidad de Zaragoza, Zaragoza, España.,Instituto de Investigación Sanitaria Aragón (IIS Aragón), Universidad de Zaragoza, Zaragoza, España.,Instituto Agroalimentario de Aragón, Universidad de Zaragoza, Zaragoza, España.,Departamento de Fisiatría y Enfermería, Universidad de Zaragoza, Zaragoza, España
| | - Isabel Iguacel
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Universidad de Zaragoza, Zaragoza, España.,Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, España
| | - Pilar De Miguel-Etayo
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Universidad de Zaragoza, Zaragoza, España.,Instituto Agroalimentario de Aragón, Universidad de Zaragoza, Zaragoza, España.,Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, España
| | - Luis A Moreno
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Universidad de Zaragoza, Zaragoza, España.,Instituto de Investigación Sanitaria Aragón (IIS Aragón), Universidad de Zaragoza, Zaragoza, España.,Instituto Agroalimentario de Aragón, Universidad de Zaragoza, Zaragoza, España.,Departamento de Fisiatría y Enfermería, Universidad de Zaragoza, Zaragoza, España.,Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, España
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24
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Hayba N, Elkheir S, Hu J, Allman-Farinelli M. Effectiveness of Lifestyle Interventions for Prevention of Harmful Weight Gain among Adolescents from Ethnic Minorities: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6059. [PMID: 32825394 PMCID: PMC7503574 DOI: 10.3390/ijerph17176059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/06/2020] [Accepted: 08/10/2020] [Indexed: 01/08/2023]
Abstract
The escalating obesity among adolescents is of major concern, especially among those from an ethnic minority background. The adolescent period offers a key opportunity for the implementation of positive lifestyle behaviours as children transition to adulthood. The objective of this review was to examine the effectiveness of lifestyle interventions for adolescents and their impact in ethnic and racial minorities for the prevention of overweight and obesity. Seven electronic databases were searched from 2005 until March 2019 for randomized controlled trials of lifestyle programs conducted in this population. The main outcome was change in Body Mass Index (BMI) z-score (kg/m2) or change in BMI and secondary outcomes were changes in physical activity and diet. Thirty studies met the inclusion criteria. Seven studies reported and/or conducted subgroup analysis to determine if ethnic/racial group affected weight change. None demonstrated an overall decrease in BMI z-score. However, six of the seven demonstrated changes in secondary measures such as fruit and vegetable intake and screen time. Results did not differ by ethnic/racial group for primary and secondary outcomes. Overweight and obesity prevention among adolescents from ethnic minorities is an area that needs further research. There is a lack of interventions that include analyses of effectiveness in ethnic minorities.
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Affiliation(s)
- Nematullah Hayba
- Discipline of Nutrition and Dietetics, School of Life and Environmental Science, Charles Perkins Centre, University of Sydney, Sydney 2006, Australia; (S.E.); (J.H.); (M.A.-F.)
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25
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Jones LJ, VanWassenhove-Paetzold J, Thomas K, Bancroft C, Ziatyk EQ, Kim LSH, Shirley A, Warren AC, Hamilton L, George CV, Begay MG, Wilmot T, Tsosie M, Ellis E, Selig SM, Gall G, Shin SS. Impact of a Fruit and Vegetable Prescription Program on Health Outcomes and Behaviors in Young Navajo Children. Curr Dev Nutr 2020; 4:nzaa109. [PMID: 32734135 PMCID: PMC7377262 DOI: 10.1093/cdn/nzaa109] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/04/2020] [Accepted: 06/17/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Rates of childhood obesity are higher in American Indian and Alaska Native populations, and food insecurity plays a major role in diet-related disparities. To address this need, local healthcare providers and a local nonprofit launched the Navajo Fruit and Vegetable Prescription (FVRx) Program in 2015. Children up to 6 y of age and their caregivers are enrolled in the 6-mo program by healthcare providers. Families attend monthly health coaching sessions where they receive vouchers redeemable for fruits, vegetables, and healthy traditional foods at retailers participating in the FVRx program. OBJECTIVES We assessed the impact of a fruit and vegetable prescription program on the health outcomes and behaviors of participating children. METHODS Caregivers completed voluntary surveys to assess food security, fruit and vegetable consumption, hours of sleep, and minutes of physical activity; healthcare providers also measured children's body mass index [BMI (kg/m2)] z score at initiation and completion of the program. We calculated changes in health behaviors, BMI, and food security at the end of the program, compared with baseline values. RESULTS A total of 243 Navajo children enrolled in Navajo FVRx between May 2015 and September 2018. Fruit and vegetable consumption significantly increased from 5.2 to 6.8 servings per day between initiation and program completion (P < 0.001). The proportion of participant households reporting food insecurity significantly decreased from 82% to 65% (P < 0.001). Among children classified as overweight or obese at baseline, 38% achieved a healthy BMI z score at program completion (P < 0.001). Sixty-five percent of children were retained in the program. CONCLUSIONS The Navajo FVRx program improves fruit and vegetable consumption among young children. Children who are obese or overweight may benefit most from the program.
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Affiliation(s)
- Leandra J Jones
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
| | - Joan VanWassenhove-Paetzold
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
- Partners In Health, Boston, Massachusetts
| | - Kymie Thomas
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
| | - Carolyn Bancroft
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
| | - E Quinn Ziatyk
- Chinle Comprehensive Health Care Facility, Chinle, Arizona
| | | | - Ariel Shirley
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
| | - Abigail C Warren
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
| | - Lindsey Hamilton
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
| | - Carmen V George
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
- Partners In Health, Boston, Massachusetts
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts
| | - Mae-Gilene Begay
- Navajo Nation Community Health Representative Outreach Program, Navajo Department of Health, Window Rock, Arizona
| | - Taylor Wilmot
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
- Partners In Health, Boston, Massachusetts
| | - Memarie Tsosie
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
| | - Emilie Ellis
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
- Partners In Health, Boston, Massachusetts
| | - Sara M Selig
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
- Partners In Health, Boston, Massachusetts
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts
| | - Gail Gall
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
| | - Sonya S Shin
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
- Partners In Health, Boston, Massachusetts
- Northern Navajo Medical Center, Shiprock, New Mexico
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26
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Maple-Brown LJ, Graham S, McKee J, Wicklow B. Walking the path together: incorporating Indigenous knowledge in diabetes research. Lancet Diabetes Endocrinol 2020; 8:559-560. [PMID: 32559468 DOI: 10.1016/s2213-8587(20)30188-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Louise J Maple-Brown
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Endocrinology Department, Royal Darwin Hospital, Darwin, NT, Australia.
| | - Sian Graham
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Indigenous Reference Group, Diabetes across the Lifecourse Northern Australia Partnership, Menzies School of Health Research, NT, Australia
| | - Jackie McKee
- Participant and Family Advisory Lead, iCARE Cohort Study, Waywayseecappo First Nation, MB, Canada
| | - Brandy Wicklow
- Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada; Pediatrics and Child Health, Pediatric Endocrinology, University of Manitoba, Winnipeg, MB, Canada
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Goettke E, Reynolds J. "It's all interconnected… like a spider web": a qualitative study of the meanings of food and healthy eating in an Indigenous community. Int J Circumpolar Health 2020; 78:1648969. [PMID: 31357907 PMCID: PMC6711030 DOI: 10.1080/22423982.2019.1648969] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Canadian Indigenous populations are disproportionately affected by rising rates of diet-related chronic disease and have been experiencing rapid lifestyle changes affecting diet. In recognition of these issues, this study aimed to obtain greater understanding of attitudes and meanings around healthy eating in a semi-remote community in Eeyou Istchee. A qualitative study design used semi-structured interviews and observational field notes to explore local accounts of food and health. Two distinct versions of “healthy eating” were identified: one relating to traditional food and preparation methods; the other reflecting medicalised accounts of illness and diagnosed conditions. The latter links with “southern” modes of accessing and preparing food, demonstrating local capacity to adapt to the rapid changes in body, lifestyle and environment being experienced. New connections, associating non-native ways with traditional practices, are being formed where traditional ways of living on the land have been severed. These local accounts show how people are continually negotiating different constructs of “healthy eating.” These findings expand current understandings of the context of food and healthy eating in Eeyou Istchee, emphasising present-day and historical experiences of the land. Future research and diet-related health interventions must continue to acknowledge and incorporate local understandings of health to help address the broader socio-political factors that shape Indigenous lifestyles, environments and health.
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Affiliation(s)
- Emma Goettke
- a Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine , London , UK.,b Department of Population Health Sciences, King's College London , London , UK
| | - J Reynolds
- a Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine , London , UK
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28
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Beal T, Le TD, Trinh HT, Burra DD, Béné C, Huynh TTT, Truong MT, Nguyen SD, Tran DT, Nguyen KT, Hoang HTT, de Haan S, Jones AD. Child Overweight or Obesity Is Associated with Modifiable and Geographic Factors in Vietnam: Implications for Program Design and Targeting. Nutrients 2020; 12:nu12051286. [PMID: 32369973 PMCID: PMC7282258 DOI: 10.3390/nu12051286] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/26/2020] [Accepted: 04/28/2020] [Indexed: 01/05/2023] Open
Abstract
Child overweight or obesity is increasing in most countries, including Vietnam. We sought to elucidate the drivers of child overweight or obesity in Vietnam and understand how they vary geographically. We compiled nationally representative cross-sectional data from the Vietnam Nutrition Surveillance Survey collected annually between 2012–2015 and household income data from the General Statistics Office. We used a quasi-Poisson log link function to calculate relative risks (RRs) of under-five child overweight or obesity for 13 variables and stratified analyses by child age (<2 y and 2–5 y) and region. Additional analysis included log-log linear regression to assess the relationship between average provincial monthly per capita income and child overweight or obesity. The strongest associations with child overweight or obesity included birthweight >4000 g (RR: 1.66; 95% confidence interval (CI): 1.48, 1.86), maternal body mass index (BMI) ≥27.5 compared with BMI <23 (RR: 1.62; 95% CI: 1.47, 1.78), and living in the Southeast (RR: 2.06; 95% CI: 1.84, 2.30), Mekong River Delta (RR: 1.58; 95% CI: 1.41, 1.77), or Central South (RR: 1.54; 95% CI: 1.37, 1.74) compared with the Central Highland. A 20% higher provincial average monthly per capita income was associated with a 17.4% higher prevalence in child overweight or obesity (P <0.0001, Adjusted R2 = 0.36). High birthweight and maternal BMI were strongly associated with child overweight or obesity but are not likely primary drivers in Vietnam, given their low prevalence. C-section delivery, sedentary lifestyle, high maternal education, urbanicity, and high household income affect a large proportion of the population and are, therefore, important risk factors. Policies and programs should target these factors and regions at greatest risk of overweight or obesity, particularly the Southeast and Mekong River Delta.
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Affiliation(s)
- Ty Beal
- Knowledge Leadership, Global Alliance for Improved Nutrition (GAIN), 1701 Rhode Island Ave NW, Washington, DC 20036, USA
- Department of Environmental Science and Policy, University of California, Davis, CA 95616, USA
- Correspondence: ; Tel.: +1-602-481-5211
| | - Tuyen Danh Le
- National Institute of Nutrition (NIN), Hanoi 100000, Vietnam; (T.D.L.); (M.T.T.); (S.D.N.); (D.T.T.)
| | - Huong Thi Trinh
- International Center for Tropical Agriculture (CIAT)-Asia Office, Hanoi 100000, Vietnam; (H.T.T.); (D.D.B.); (T.T.T.H.); (K.T.N.)
- Department of Mathematics and Statistics, Thuongmai University, Hanoi 100000, Vietnam (H.T.T.H.)
| | - Dharani Dhar Burra
- International Center for Tropical Agriculture (CIAT)-Asia Office, Hanoi 100000, Vietnam; (H.T.T.); (D.D.B.); (T.T.T.H.); (K.T.N.)
| | - Christophe Béné
- International Center for Tropical Agriculture (CIAT), Cali 763537, Columbia;
| | - Tuyen Thi Thanh Huynh
- International Center for Tropical Agriculture (CIAT)-Asia Office, Hanoi 100000, Vietnam; (H.T.T.); (D.D.B.); (T.T.T.H.); (K.T.N.)
| | - Mai Tuyet Truong
- National Institute of Nutrition (NIN), Hanoi 100000, Vietnam; (T.D.L.); (M.T.T.); (S.D.N.); (D.T.T.)
| | - Son Duy Nguyen
- National Institute of Nutrition (NIN), Hanoi 100000, Vietnam; (T.D.L.); (M.T.T.); (S.D.N.); (D.T.T.)
| | - Do Thanh Tran
- National Institute of Nutrition (NIN), Hanoi 100000, Vietnam; (T.D.L.); (M.T.T.); (S.D.N.); (D.T.T.)
| | - Kien Tri Nguyen
- International Center for Tropical Agriculture (CIAT)-Asia Office, Hanoi 100000, Vietnam; (H.T.T.); (D.D.B.); (T.T.T.H.); (K.T.N.)
| | - Ha Thi Thu Hoang
- Department of Mathematics and Statistics, Thuongmai University, Hanoi 100000, Vietnam (H.T.T.H.)
| | - Stef de Haan
- International Potato Center (CIP), Lima 15023, Peru;
| | - Andrew D. Jones
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA;
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Blanchet R, Willows N, Johnson S, Salmon Reintroduction Initiatives ON, Batal M. Traditional Food, Health, and Diet Quality in Syilx Okanagan Adults in British Columbia, Canada. Nutrients 2020; 12:nu12040927. [PMID: 32230797 PMCID: PMC7230592 DOI: 10.3390/nu12040927] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/20/2020] [Accepted: 03/24/2020] [Indexed: 11/16/2022] Open
Abstract
In Canada, store-bought food constitutes the majority of First Nations (FN) people’s diets; however, their traditional foods (TF; wild fish, game, fowl, and plants) remains vital for their health. This study compares health indicators and diet quality among 265 Syilx Okanagan adults according to whether or not they reported eating TF during a 24-h dietary recall. Three methods assessed diet quality: nutrient intakes and adequacy, Healthy Eating Index (HEI-C), and contributions of ultra-processed products (UPP) to %energy using the NOVA classification. Fifty-nine participants (22%) reported eating TF during the dietary recall; TF contributed to 13% of their energy intake. There were no significant differences in weight status or prevalence of chronic disease between TF eaters and non-eaters. TF eaters had significantly higher intakes of protein; omega-3 fatty acids; dietary fibre; copper; magnesium; manganese; phosphorus; potassium; zinc; niacin; riboflavin; and vitamins B6, B12, D, and E than non-eaters. TF eaters also had significantly better diet quality based on the HEI-C and the %energy from UPP. Findings support that TF are critical contributors to the diet quality of FN individuals. Strength-based FN-led interventions, such as Indigenous food sovereignty initiatives, should be promoted to improve access to TF and to foster TF consumption.
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Affiliation(s)
- Rosanne Blanchet
- Department of Agricultural, Food & Nutritional Science, Faculty of Agricultural, Life & Environmental Sciences, University of Alberta, Edmonton, AB T6G 2P5, Canada
- Correspondence: (R.B.); (N.W.); Tel.: +1-780-492-3989 (N.W.)
| | - Noreen Willows
- Department of Agricultural, Food & Nutritional Science, Faculty of Agricultural, Life & Environmental Sciences, University of Alberta, Edmonton, AB T6G 2P5, Canada
- Correspondence: (R.B.); (N.W.); Tel.: +1-780-492-3989 (N.W.)
| | | | | | - Malek Batal
- Department of Nutrition, Faculty of Medicine, University of Montreal, P.O. Box 6128, succ. Centre-ville, Montreal, QC H3C 3J7, Canada;
- Centre de recherche en santé publique du Québec (CReSP), Montreal, QC H3C 3J7, Canada
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Neufeld HT, Richmond C. Exploring First Nation Elder Women's Relationships with Food from Social, Ecological, and Historical Perspectives. Curr Dev Nutr 2020; 4:nzaa011. [PMID: 32110768 PMCID: PMC7039853 DOI: 10.1093/cdn/nzaa011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 12/09/2019] [Accepted: 01/29/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The ongoing negative health effects of colonization have disproportionately affected Indigenous women, who are disproportionately affected by diabetes, food insecurity, and undernutrition. Indigenous women also perceive their health less positively than men do. This article draws theoretically from the socio-ecological model to explore health inequalities experienced by Indigenous women associated with the intergenerational effects of the residential school legacy, specifically related to food practices. OBJECTIVES Study objectives were to describe and compare the historical context of present-day urban and rural food environments, and explore the hypothesis that food insecurity may be associated with cultural loss resulting from the intergenerational trauma of residential schools in this region of southwestern Ontario, Canada. METHODS Framed by a larger community-based participatory study, life history interviews took place with 18 Elder women living on- and off-reserve in southwestern Ontario, Canada. RESULTS Women discussed painful circumstances of displacement from the land and social disconnection from families and communities. The 10 participants who were residential school survivors conveyed the intergenerational effects of loss, responsibility, lack of support, and an altered sense of identity as narratives of survival. Six women had moved away from their home communities, which created challenges to fully engage in local food procurement and sharing practices. These altered geographies present practical limitations, along with apparent mechanisms of social and cultural exclusion. CONCLUSIONS Research on Indigenous Peoples' food systems requires further analysis of the root causes of disparities in the context of societal and gender relations. Food sovereignty has been the domain of women, who have led movements aimed at both social and environmental justice. Unraveling the historical, social, and environmental determinants of Indigenous food knowledge will support and guide community and policy recommendations, highlighting the ongoing effects of residential schooling and other indirect examples of environmental dispossession that have disproportionately affected Indigenous women.
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Affiliation(s)
- Hannah Tait Neufeld
- School of Public Health and Health Systems, The University of Waterloo, Waterloo, Ontario, Canada
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Gillies C, Blanchet R, Gokiert R, Farmer A, Thorlakson J, Hamonic L, Willows ND. School-based nutrition interventions for Indigenous children in Canada: a scoping review. BMC Public Health 2020; 20:11. [PMID: 31906984 PMCID: PMC6945607 DOI: 10.1186/s12889-019-8120-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 12/23/2019] [Indexed: 01/13/2023] Open
Abstract
Background Indigenous children in Canada (First Nations, Inuit, and Métis) are disproportionately affected by nutrition-related chronic diseases such as obesity and diabetes. Comprehensive school-based nutrition interventions offer a promising strategy for improving children’s access to healthy foods and sustaining positive eating behaviors. However, little is known about school-based nutrition interventions for Indigenous children. The objectives of this scoping review were to identify school-based nutrition interventions for Indigenous children in Canada and describe their components. Methods The scoping review consisted of searches in seven peer-reviewed databases and a general web search for grey literature. Eligibility criteria were applied by two reviewers, and data were extracted and charted by one reviewer using components of the comprehensive school health approach (social and physical environment, teaching and learning, policy, partnerships and services) and additional components with relevance to Indigenous interventions (cultural content, Indigenous control and ownership, funding source, evaluation). Numerical and descriptive summaries were used to present findings. Results Thirty-four unique interventions met the inclusion criteria. The majority (97%) of interventions targeted the social and physical environment, most often by offering food programs. Over half of interventions also incorporated teaching and learning (56%) and partnerships and services (59%), but fewer included a policy component (38%). Many interventions included a cultural component (56%) and most (62%) were owned and controlled by Indigenous communities (62%). Finally, over half of interventions disclosed their source(s) of funding (59%), but less than half (41%) included an evaluation component. Conclusions The review suggests that school-based interventions for Indigenous children can be more comprehensive by incorporating culturally relevant nutrition education and professional development opportunities for teachers, written school nutrition policies, and activities that actively engage families and community members. The continued focus on Indigenous control and ownership and incorporation of content specific to individual communities may enhance cultural relevancy and sustainability of interventions. Furthermore, there is a need to increase intervention evaluation and the sharing of resources related to funding. These recommendations may be used by communities, as well as by researchers and professionals working with communities, in developing comprehensive school-based nutrition interventions to improve the eating behaviors of Indigenous children.
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Affiliation(s)
- Christina Gillies
- Department of Agricultural, Food & Nutritional Science, University of Alberta, 11405 87 Avenue, Edmonton, AB, T6G 2P5, Canada
| | - Rosanne Blanchet
- Department of Agricultural, Food & Nutritional Science, University of Alberta, 11405 87 Avenue, Edmonton, AB, T6G 2P5, Canada
| | - Rebecca Gokiert
- Faculty of Extension, University of Alberta, 10230 Jasper Avenue, Edmonton, AB, T5J 4P6, Canada
| | - Anna Farmer
- Department of Agricultural, Food & Nutritional Science, University of Alberta, 11405 87 Avenue, Edmonton, AB, T6G 2P5, Canada
| | - Jessica Thorlakson
- University of Alberta Library, University of Alberta, Edmonton, AB, Canada
| | - Laura Hamonic
- University of Alberta Library, University of Alberta, Edmonton, AB, Canada
| | - Noreen D Willows
- Department of Agricultural, Food & Nutritional Science, University of Alberta, 11405 87 Avenue, Edmonton, AB, T6G 2P5, Canada.
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Wahi G, Wilson J, Oster R, Rain P, Jack SM, Gittelsohn J, Kandasamy S, de Souza RJ, Martin CL, Toth E, Anand SS. Strategies for Promoting Healthy Nutrition and Physical Activity Among Young Children: Priorities of Two Indigenous Communities in Canada. Curr Dev Nutr 2020; 4:nzz137. [PMID: 31938762 PMCID: PMC6949274 DOI: 10.1093/cdn/nzz137] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/20/2019] [Accepted: 11/26/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Indigenous people in Canada carry a disproportionate burden of obesity and obesity-related diseases compared with non-Indigenous Canadians, which could be related to intergenerational trauma exposures. Implementing effective health promotion strategies to improve nutrition and physical activity behaviors during early childhood could be a strategy to mitigate the burden of intergenerational trauma exposures that have the potential to impact the trajectory to obesity and related complications throughout the lifecycle. OBJECTIVES The aim of this study was to support 2 Indigenous communities in identifying priorities and strategies for promoting healthy nutrition and physical activity for young children. METHODS Using a formative approach, we conducted a 2-phase study that started with 2 community engagement workshops (n = 37 participants), followed by a qualitative descriptive study. In this latter study, in-depth interviews were conducted with a purposeful sample of 23 community parents, health care providers, and traditional knowledge holders. Data from both study phases were analyzed and synthesized using conventional content analysis. RESULTS To promote healthy nutrition and physical activity among young children living in Indigenous communities, it was identified that the primary pathway to health and well-being must prioritize the integration of knowledge about Indigenous ways of life including traditional Indigenous foods and physical activities. Participants also identified individual/family and community/contextual factors that ultimately influence the nutrition and physical activity of children in their communities. CONCLUSIONS Informed by this formative study conducted to better understand community members' strategies for healthy eating and physical activity for young children, we argue for the continued recognition of the unique Indigenous context, incorporating the history of inequity and injustice and looking toward Indigenous-led interventions that incorporate this history and ways of life as solutions in the future.
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Affiliation(s)
- Gita Wahi
- Department of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Julie Wilson
- Six Nations Health Services, Six Nations of the Grand River, Ohsweken, Ontario, Canada
| | - Richard Oster
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Patricia Rain
- Maskwacis Health Services, Samson Cree Nation, Maskwacis, Alberta, Canada
| | - Susan M Jack
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Joel Gittelsohn
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sujane Kandasamy
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Russell J de Souza
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Cindy L Martin
- Six Nations Health Services, Six Nations of the Grand River, Ohsweken, Ontario, Canada
| | - Ellen Toth
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sonia S Anand
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Gillies C, Farmer A, Maximova K, Willows ND. Alexander First Nations Parents' Perceptions of a School Nutrition Policy. CAN J DIET PRACT RES 2019; 81:66-71. [PMID: 31512509 DOI: 10.3148/cjdpr-2019-026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Purpose: A school nutrition policy (SNP) is one promising school-based health promotion strategy to improve the food environments of First Nations children. The aim of this study was to explore First Nations parents' perceptions of a SNP. Methods: A process evaluation of policy implementation was conducted using a mixed-methods design. Parents (n = 83) completed a 19-question survey to capture their perceptions of the policy. Survey responses informed questions in an 11-question semi-structured interview guide. Transcripts from interviews with parents (n = 10) were analyzed using content analysis to identify barriers and facilitators to policy implementation. Results: Parents were supportive of the SNP and the school's food programs, which they perceived as helping to address community concerns related to nutrition. However, some parents opposed the restriction of unhealthy foods at school celebrations and fundraisers. In addition, despite being aware of the SNP, parents were unable to demonstrate an understanding of the SNP content. Finally, parents struggled to provide their children with healthy foods to bring to school due to lack of affordable and accessible food in the community. Conclusions: Although SNPs may be well-received in First Nations communities, their implementation must be supported by parent involvement and consideration of wider socioeconomic conditions.
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Affiliation(s)
- Christina Gillies
- Department of Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, AB
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- Alexander Research Committee, Morinville, AB
| | - Anna Farmer
- Department of Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, AB
| | | | - Noreen D Willows
- Department of Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, AB
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Redmond LC, Jock B, Gadhoke P, Chiu DT, Christiansen K, Pardilla M, Swartz J, Platero H, Caulfield LE, Gittelsohn J. OPREVENT (Obesity Prevention and Evaluation of InterVention Effectiveness in NaTive North Americans): Design of a Multilevel, Multicomponent Obesity Intervention for Native American Adults and Households. Curr Dev Nutr 2019; 3:81-93. [PMID: 31453430 PMCID: PMC6700458 DOI: 10.1093/cdn/nzz009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 12/10/2018] [Accepted: 01/29/2019] [Indexed: 11/25/2022] Open
Abstract
Obesity prevalence is high in Native American (NA) adults, and there is a critical need to establish and implement evidence-based social, behavioral, and policy interventions that are theoretically informed. The use of multilevel, multicomponent (MLMC) interventions has been shown to be an effective strategy for comprehensive health behavior change; however, there is little guidance available in the literature to facilitate implementation in this underserved and understudied population. To decrease obesity and related comorbidities in NA adults, an MLMC intervention called OPREVENT (Obesity Prevention and Evaluation of InterVention Effectiveness in NaTive North Americans) was implemented in 5 rural NA communities to modify the food-purchasing environment, improve diet, and increase physical activity (PA). Five NA communities across the Upper Midwest and Southwest United States were randomly assigned to Immediate (n = 3) or Delayed (n = 2) Intervention. OPREVENT was implemented in Immediate Intervention community food stores, worksites, schools, and media over 1 y. A community-randomized controlled trial was used to evaluate intervention impact in adults at the individual and institutional levels, with individual-level data being collected on diet, PA, and psychosocial variables at baseline and follow-up; and institutional-level data being collected on food stores, worksites, and schools, media, and process measures. The OPREVENT intervention was one of the first MLMC obesity interventions in this population and provides evidence-based practices for future program development. The purpose of this article is to describe the design, implementation, and evaluation of OPREVENT. This trial was registered at isrctn.com as ISRCTN76144389.
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Affiliation(s)
- Leslie C Redmond
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
- University of Alaska Anchorage, School of Allied Health, Dietetics and Nutrition Department, Anchorage, AK
| | - Brittany Jock
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Preety Gadhoke
- St. John's University, Department of Pharmacy Administration & Public Health, Fresh Meadows, NY
| | - Dorothy T Chiu
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | | | - Marla Pardilla
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Jacqueline Swartz
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Harrison Platero
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Laura E Caulfield
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Joel Gittelsohn
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
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Kumanyika SK. Unraveling common threads in obesity risk among racial/ethnic minority and migrant populations. Public Health 2019; 172:125-134. [PMID: 31227270 PMCID: PMC6698150 DOI: 10.1016/j.puhe.2019.04.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 04/22/2019] [Accepted: 04/28/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Epidemic obesity poses a major threat to global health. This phenomenon reflects the inability of the average person to cope, biologically and behaviorally, with environmental contexts that promote caloric overconsumption and inadequate caloric expenditure. There is still much to be learned about how to improve these contexts nationally and within-countries for sociodemographic groups with above-average obesity risks. METHODS Higher obesity risks relative to respective white majority populations were identified among diverse indigenous, other native-born, or migrant 'racial' or ethnic minority (hereafter, ethnic minority) populations in the United States, Canada, Australia, New Zealand, and the Netherlands, using publicly available national survey data or other sources. Cross-national comparisons were of interest for identifying common risk pathways associated with social and economic inequities. Potential explanations were explored through a narrative review of peer-reviewed literature, informed by the World Health Organization's Conceptual Framework for Action on The Social Determinants of Health. MAIN FINDINGS Identifying viable solutions to the high risk of obesity in ethnic minority populations in these high-income countries requires examination of national-level social, economic, and health system contexts, food systems, and built environments for physical activity, as well as patterns of social stratification and cultural biases related to ethnicity, migration, and other determinants of social disadvantage. These factors can be linked to mediators of exposure or vulnerability to obesity-related risks, such as poverty, being an 'outsider', stress and trauma resulting from historical and current oppression, exposure to bias and discrimination, related biological or behavioral consequences, and inadequate health and social care. CONCLUSIONS Focusing on ethnic minority populations in high-income countries is critical for public health efforts to address epidemic obesity. Mitigating intersecting risk pathways arising from stratification and bias based on ethnicity and migrant status should be prominent in these efforts.
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Affiliation(s)
- S K Kumanyika
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA.
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Crawford R, Sims ED, Wang KW, Youssef M, Nadarajah A, Rivas A, Banfield L, Thabane L, Samaan MC. Traditional knowledge-based lifestyle interventions in the prevention of obesity and type 2 diabetes in Indigenous children in Canada: a systematic review protocol. Syst Rev 2019; 8:69. [PMID: 30841917 PMCID: PMC6402164 DOI: 10.1186/s13643-019-0961-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 01/23/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Approximately 50% of all youth-onset type 2 diabetes mellitus (T2DM) in Canada occurs in Indigenous children. In adults, cardiovascular disease is one of the leading causes of mortality in First Nations communities, and diabetes is a significant contributor to the risk of developing this disorder. The early onset of diabetes may predispose these children to premature cardiovascular disease and influence their longevity and quality of life. As a result, the implementation of culturally tailored obesity and T2DM primary prevention programs is vital. This systematic review aims to assess the effectiveness of existing traditional knowledge-based lifestyle intervention programs on preventing obesity and T2DM in Indigenous children in Canada. METHODS We will conduct database searches in MEDLINE, Embase, PsycINFO, SPORTDiscus, CINAHL, Web of Science, Cochrane Database of Systematic Reviews, and the Cochrane Controlled Register of Trials. We will also conduct grey literature searches of central repository of trials ( ClinicalTrials.gov ), ProQuest Dissertations, Theses A&I, and Indigenous studies portal research tools. Reviewers will independently review titles, abstracts, and full-text articles retrieved from databases to assess potentially eligible studies, and relevant articles will be assessed for risk of bias and quality. The primary outcomes include the change in body mass index z-scores or a diagnosis of diabetes. The secondary outcomes include the change in measures of adiposity as well as lifestyle and metabolic profiles. A meta-analysis will be performed if two or more studies have used similar study designs, comparable intervention techniques , similar populations and measured similar outcomes. DISCUSSION This review will provide a summary of current interventions to prevent obesity and T2DM in Indigenous children in Canada and help determine the gaps in the literature so that interventions can be developed to control the surge in pediatric T2DM in Indigenous communities. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017072781.
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Affiliation(s)
- Rebecca Crawford
- Department of Pediatrics, McMaster University, 1280 Main Street West, HSC-3A57, Hamilton, Ontario L8S 4K1 Canada
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, Ontario Canada
- Indigenous Undergraduate Summer Research Scholars Program, Hamilton, Ontario Canada
| | - E. Danielle Sims
- Department of Pediatrics, McMaster University, 1280 Main Street West, HSC-3A57, Hamilton, Ontario L8S 4K1 Canada
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, Ontario Canada
- Medical Sciences Graduate Program, McMaster University, Hamilton, Ontario Canada
| | - Kuan-Wen Wang
- Department of Pediatrics, McMaster University, 1280 Main Street West, HSC-3A57, Hamilton, Ontario L8S 4K1 Canada
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, Ontario Canada
- Medical Sciences Graduate Program, McMaster University, Hamilton, Ontario Canada
| | - Michael Youssef
- Department of Pediatrics, McMaster University, 1280 Main Street West, HSC-3A57, Hamilton, Ontario L8S 4K1 Canada
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, Ontario Canada
| | - Ajantha Nadarajah
- Department of Pediatrics, McMaster University, 1280 Main Street West, HSC-3A57, Hamilton, Ontario L8S 4K1 Canada
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, Ontario Canada
| | - Angelica Rivas
- Department of Pediatrics, McMaster University, 1280 Main Street West, HSC-3A57, Hamilton, Ontario L8S 4K1 Canada
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, Ontario Canada
| | - Laura Banfield
- Health Sciences Library, McMaster University, Hamilton, Ontario Canada
| | - Lehana Thabane
- Department of Pediatrics, McMaster University, 1280 Main Street West, HSC-3A57, Hamilton, Ontario L8S 4K1 Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario Canada
- Department of Anesthesia, McMaster University, Hamilton, Ontario Canada
- Centre for Evaluation of Medicines, St. Joseph’s Health Care, Hamilton, Ontario Canada
- Biostatistics Unit, St. Joseph’s Healthcare, Hamilton, Ontario Canada
| | - M. Constantine Samaan
- Department of Pediatrics, McMaster University, 1280 Main Street West, HSC-3A57, Hamilton, Ontario L8S 4K1 Canada
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, Ontario Canada
- Medical Sciences Graduate Program, McMaster University, Hamilton, Ontario Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario Canada
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Propagating Change: Using RE-FRAME to Scale and Sustain A Community-Based Childhood Obesity Prevention Initiative. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050736. [PMID: 30823640 PMCID: PMC6427516 DOI: 10.3390/ijerph16050736] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 02/13/2019] [Accepted: 02/21/2019] [Indexed: 12/28/2022]
Abstract
Sustainable Childhood Obesity Prevention through Community Engagement (SCOPE) has developed Live 5-2-1-0, a multi-sectoral, multi-component community-based childhood obesity prevention initiative grounded in systems thinking and participatory research principles. Building on previous work, this study continued implementation of an innovative knowledge exchange model, RE-FRAME, in two ‘new’ and two ‘existing’ Live 5-2-1-0 communities. This mixed-methods study examined follow-up data to determine the nature and extent of the model’s ability to build and sustain community capacity and facilitate the scale-up and sustainability of systems- and community-level change. Qualitative and quantitative data were collected using stakeholder interviews, and quantitative process tracking (PTT) and capacity building tools (CCBT), and were analyzed using thematic analysis and descriptive statistics, respectively. Results from three communities with baseline and follow-up CCBT data showed capacity domain scores increased (15/27; 56%) or remained constant (10/27; 37%) over the study period. PTT data showed over 50 multi-sectoral community partnerships formed in Community D (new) and 108 actions implemented. Stakeholder interviews identified having a common cause, co-ownership, champion networks and consistency of the Live 5-2-1-0 message as essential to sustainability of the initiative. RE-FRAME supports knowledge exchange and community capacity-building that is integral to initiating and sustaining a community-based childhood obesity prevention initiative.
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Willows N, Johnson-Down L, Kenny TA, Chan HM, Batal M. Modelling optimal diets for quality and cost: examples from Inuit and First Nations communities in Canada 1. Appl Physiol Nutr Metab 2018; 44:696-703. [PMID: 30566364 DOI: 10.1139/apnm-2018-0624] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This review summarizes aspects of the 2017 Canadian Nutrition Society symposium, "Modelling diets for quality and cost: examples from Inuit and First Nations in Canada". Indigenous peoples in Canada experience a high prevalence of nutrition-related chronic disease because of the poor quality and high cost of their food supply. Since European colonization, they have transitioned from a diet of minimally processed traditional foods (game, fish, and plants) procured using pursuits such as hunting, fishing, gathering, and horticulture to a diet comprised mostly of processed market foods. This nutrition transition is the result of factors such as colonial policies and practices; climate change; environmental degradation; contaminants in traditional foods; and limited availability of, or access to, economical and healthful market foods. Presenters Malek Batal and Laurie Chan characterized the contemporary diets of First Nations and Inuit populations and demonstrated novel methods for modelling more optimal diets using 2 datasets: the First Nations Food, Nutrition, and Environment Study and the Inuit Health Survey. It was demonstrated how the NOVA classification characterized the portion of the diet consisting of processed foods. Dietary components were then manipulated to reduce ultra-processed food and drink intake to increase the Healthy Eating Index score. Linear programming was explained as a way to mathematically design theoretical diets that aim to optimize food cost, nutrition quality, and contaminant level of traditional foods. While diet-modelling methodologies have limitations, they provide a basis for engaging Indigenous peoples and governments to develop nutrition goals and policies anchored in contemporary food realities.
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Affiliation(s)
- Noreen Willows
- a Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB T6G 2P5, Canada
| | - Louise Johnson-Down
- b Département de nutrition, Faculté de Médecine, Université de Montréal, Montréal, QC H3T 1A8, Canada
| | - Tiff-Annie Kenny
- c Department of Biology, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Hing Man Chan
- c Department of Biology, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Malek Batal
- b Département de nutrition, Faculté de Médecine, Université de Montréal, Montréal, QC H3T 1A8, Canada
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Gillies C, Farmer A, Maximova K, Willows ND. First Nations students' perceptions of school nutrition policy implementation: A mixed methods study. Nutr Diet 2018; 75:533-540. [PMID: 30537052 DOI: 10.1111/1747-0080.12499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 10/15/2018] [Accepted: 10/16/2018] [Indexed: 11/28/2022]
Abstract
AIM School nutrition policies can improve healthy food access for Indigenous First Nations children in Canada. This study explored First Nations students' perceptions of a school nutrition policy. METHODS The research was a process evaluation of school nutrition policy implementation using a mixed-methods design. Students in grades 4-12 (n = 94) completed a 17-question survey to capture their perceptions of the policy. Survey data informed an 11-question semi-structured interview guide. Transcripts from interviews with students (n = 20) were analysed using content analysis to identify barriers and facilitators to policy implementation. RESULTS Key facilitating factors to policy implementation were student support for the policy and taste preferences. Most students (87%) agreed that only healthy foods should be served at school and, in interviews, expressed a preference for healthy food choices. Barriers to policy implementation included foods available at school and lack of communication between students and their teachers and parents. Half (50%) of surveyed students reported that their eating habits at school were average; interviews explained that their diets could be improved by consuming more fruit and vegetables at school. Both surveys and interviews found that communication between students and their parents and teachers about what they ate and drank at school was low. CONCLUSIONS To support children's healthy eating at school, the school nutrition policy could provide clear guidelines on foods permissible in the school, while considering social and environmental barriers to healthy eating. The involvement of First Nations children in the implementation and evaluation of school nutrition policies is recommended.
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Affiliation(s)
- Christina Gillies
- Department of Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
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- Alexander First Nation Education, Morinville, Alberta, Canada
| | - Anna Farmer
- Department of Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Katerina Maximova
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Noreen D Willows
- Department of Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
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Gadais T, Boulanger M, Trudeau F, Rivard MC. Environments favorable to healthy lifestyles: A systematic review of initiatives in Canada. JOURNAL OF SPORT AND HEALTH SCIENCE 2018; 7:7-18. [PMID: 30356494 PMCID: PMC6180562 DOI: 10.1016/j.jshs.2017.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 06/09/2017] [Accepted: 06/12/2017] [Indexed: 05/24/2023]
Abstract
BACKGROUND In recent years, a number of initiatives aimed at promoting healthy lifestyles in health-friendly environments have been implemented. The purpose of this review is to synthesize initiatives conducted in Canada and documented in publications for the period 1995-2015 in order to gain a better understanding of their objectives and impacts. METHODS A systematic review of Canadian initiatives published over the past 20 years was conducted from multiple databases (i.e., Scopus, SPORTDiscus, PubMed, Academic search complete, Reseausante.com, Cairn, and Erudit). In total, 264 publications were identified and retained for the final analysis based on 5 criteria: (1) publication between 1995 and 2015, (2) online availability, (3) research conducted in Canada, (4) main topic related to environments favorable to healthy lifestyles (EFHL), and (5) publication in French or English. RESULTS A sharp increase in the number of studies on EFHL was observed between 2010 and 2015 (57%). Two major lifestyle components-physical activity and nutrition-and 2 environmental aspects-neighborhood and built environment-were the elements most frequently examined regarding adults (48%), young people (34%), and seniors (9%), using quantitative (60%) and qualitative (18%) methods. Furthermore, the analysis reveals a greater focus on the municipal (53%) than the national or provincial levels (31%). CONCLUSION This work is a first map of Canadian studies related to EFHL. It clarifies the definition of EFHL and classifies its components. As well, it documents the issues raised, the research methods employed, and the role of stakeholders, while outlining a new research agenda that includes dimensions of EFHL formerly neglected by researchers, namely, political and sociocultural spheres of action.
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Affiliation(s)
- Tegwen Gadais
- Département des sciences de l'activité physique, Université du Québec à Montréal, Montréal, Québec H2X 1Y4, Canada
| | - Maude Boulanger
- Département de psychologie, Université du Québec à Trois Rivières, Trois-Rivières, Québec G9A 5H7, Canada
| | - François Trudeau
- Département des sciences de l'activité physique, Université du Québec à Trois Rivières, Trois-Rivières, Québec G9A 5H7, Canada
| | - Marie-Claude Rivard
- Département des sciences de l'activité physique, Université du Québec à Trois Rivières, Trois-Rivières, Québec G9A 5H7, Canada
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Bhawra J, Cooke MJ, Guo Y, Wilk P. The association of household food security, household characteristics and school environment with obesity status among off-reserve First Nations and Métis children and youth in Canada: results from the 2012 Aboriginal Peoples Survey. HEALTH PROMOTION AND CHRONIC DISEASE PREVENTION IN CANADA-RESEARCH POLICY AND PRACTICE 2017; 37:77-86. [PMID: 28273035 DOI: 10.24095/hpcdp.37.3.03] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Indigenous children are twice as likely to be classified as obese and three times as likely to experience household food insecurity when compared with non- Indigenous Canadian children. The purpose of this study was to explore the relationship between food insecurity and weight status among Métis and off-reserve First Nations children and youth across Canada. METHODS We obtained data on children and youth aged 6 to 17 years (n = 6900) from the 2012 Aboriginal Peoples Survey. We tested bivariate relationships using Pearson chi-square tests and used nested binary logistic regressions to examine the food insecurity-weight status relationship, after controlling for geography, household and school characteristics and cultural factors. RESULTS Approximately 22% of Métis and First Nations children and youth were overweight, and 15% were classified as obese. Over 80% of the sample was reported as food secure, 9% experienced low food security and 7% were severely food insecure. Off-reserve Indigenous children and youth from households with very low food security were at higher risk of overweight or obese status; however, this excess risk was not independent of household socioeconomic status, and was reduced by controlling for household income, adjusted for household size. Negative school environment was also a significant predictor of obesity risk, independent of demographic, household and geographic factors. CONCLUSION Both food insecurity and obesity were prevalent among the Indigenous groups studied, and our results suggest that a large proportion of children and youth who are food insecure are also overweight or obese. This study reinforces the importance of including social determinants of health, such as income, school environment and geography, in programs or policies targeting child obesity.
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Affiliation(s)
- Jasmin Bhawra
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Martin J Cooke
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.,Department of Sociology and Legal Studies, University of Waterloo, Waterloo, Ontario, Canada
| | - Yanling Guo
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Piotr Wilk
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Mcqueen KA, Montelpare WJ, Dennis CL. Breastfeeding and Aboriginal Women: Validation of the Breastfeeding Self-Efficacy Scale–Short Form. Can J Nurs Res 2017; 45:58-75. [DOI: 10.1177/084456211304500209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Thurber KA, Dobbins T, Neeman T, Banwell C, Banks E. Body mass index trajectories of Indigenous Australian children and relation to screen time, diet, and demographic factors. Obesity (Silver Spring) 2017; 25:747-756. [PMID: 28349661 PMCID: PMC5396259 DOI: 10.1002/oby.21783] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 12/22/2016] [Accepted: 01/03/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Limited cross-sectional data indicate elevated overweight/obesity prevalence among Indigenous versus non-Indigenous Australian children. This study aims to quantify body mass index (BMI) trajectories among Indigenous Australian children aged 3-6 and 6-9 years and to identify factors associated with the development of overweight/obesity. METHODS Three-year BMI change was examined in up to 1,157 children in the national Longitudinal Study of Indigenous Children. BMI trajectories among children with normal baseline BMI (n = 907/1,157) were quantified using growth curve models. RESULTS Baseline prevalences of overweight/obesity were 12.1% and 25.4% among children of mean age 3 and 6 years, respectively. Of children with normal baseline BMI, 31.9% had overweight/obesity 3 years later; BMI increased more rapidly for younger versus older (difference: 0.59 kg/m2 /year; 95% CI: 0.50-0.69), female versus male (difference: 0.15 kg/m2 /year; 95% CI: 0.07-0.23), and Torres Strait Islander versus Aboriginal (difference: 0.36 kg/m2 /year; 95% CI: 0.17-0.55) children. Results were consistent with less rapid rates of BMI increase for children with lower sugar-sweetened beverage (including fruit juice) and high-fat food consumption. Children's BMI was lower in more disadvantaged areas. CONCLUSIONS Overweight/obesity is common, and increases rapidly, in early childhood. Interventions are required to reduce the overweight/obesity prevalence among Indigenous Australian children in the first 3 years of life and to slow the rapid overweight/obesity onset from age 3 to 9 years.
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Affiliation(s)
- Katherine Ann Thurber
- National Centre for Epidemiology and Population Health, Research School of Population HealthThe Australian National UniversityActonAustralian Capital TerritoryAustralia
| | - Timothy Dobbins
- National Drug & Alcohol Research CentreUniversity of New South WalesSydneyNew South WalesAustralia
| | - Teresa Neeman
- Statistical Consulting UnitThe Australian National UniversityActonAustralian Capital TerritoryAustralia
| | - Cathy Banwell
- National Centre for Epidemiology and Population Health, Research School of Population HealthThe Australian National UniversityActonAustralian Capital TerritoryAustralia
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Research School of Population HealthThe Australian National UniversityActonAustralian Capital TerritoryAustralia
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Harris SB, Tompkins JW, TeHiwi B. Call to action: A new path for improving diabetes care for Indigenous peoples, a global review. Diabetes Res Clin Pract 2017; 123:120-133. [PMID: 28011411 DOI: 10.1016/j.diabres.2016.11.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 11/23/2016] [Accepted: 11/30/2016] [Indexed: 12/13/2022]
Abstract
Diabetes has reached epidemic proportions in Indigenous populations around the globe, and there is an urgent need to improve the health and health equity of Indigenous peoples with diabetes through timely and appropriate diabetes prevention and management strategies. This review describes the evolution of the diabetes epidemic in Indigenous populations and associated risk factors, highlighting gestational diabetes and intergenerational risk, lifestyle risk factors and social determinants as having particular importance and impact on Indigenous peoples. This review further describes the impact of chronic disease and diabetes on Indigenous peoples and communities, specifically diabetes-related comorbidities and complications. This review provides continued evidence that dramatic changes are necessary to reduce diabetes-related inequities in Indigenous populations, with a call to action to support programmatic primary healthcare transformation capable of empowering Indigenous peoples and communities and improving chronic disease prevention and management. Promising strategies for transforming health services and care for Indigenous peoples include quality improvement initiatives, facilitating diabetes and chronic disease registry and surveillance systems to identify care gaps, and prioritizing evaluation to build the evidence-base necessary to guide future health policy and planning locally and on a global scale.
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Affiliation(s)
- Stewart B Harris
- Centre for Studies in Family Medicine, Western Centre for Public Health and Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
| | - Jordan W Tompkins
- Centre for Studies in Family Medicine, Western Centre for Public Health and Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
| | - Braden TeHiwi
- School of Kinesiology, Lakehead University, Thunder Bay, Ontario, Canada.
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Willows N, Dyck Fehderau D, Raine KD. Analysis Grid for Environments Linked to Obesity (ANGELO) framework to develop community-driven health programmes in an Indigenous community in Canada. HEALTH & SOCIAL CARE IN THE COMMUNITY 2016; 24:567-575. [PMID: 25825319 DOI: 10.1111/hsc.12229] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/10/2015] [Indexed: 06/04/2023]
Abstract
Indigenous First Nations people in Canada have high chronic disease morbidity resulting in part from enduring social inequities and colonialism. Obesity prevention strategies developed by and for First Nations people are crucial to improving the health status of this group. The research objective was to develop community-relevant strategies to address childhood obesity in a First Nations community. Strategies were derived from an action-based workshop based on the Analysis Grid for Environments Linked to Obesity (ANGELO) framework. Thirteen community members with wide-ranging community representation took part in the workshop. They combined personal knowledge and experience with community-specific and national research to dissect the broad array of environmental factors that influenced childhood obesity in their community. They then developed community-specific action plans focusing on healthy eating and physical activity for children and their families. Actions included increasing awareness of children's health issues among the local population and community leadership, promoting nutrition and physical activity at school, and improving recreation opportunities. Strengthening children's connection to their culture was considered paramount to improving their well-being; thus, workshop participants developed programmes that included elders as teachers and reinforced families' acquaintance with First Nations foods and activities. The research demonstrated that the ANGELO framework is a participatory way to develop community-driven health programmes. It also demonstrated that First Nations people involved in the creation of solutions to health issues in their communities may focus on decolonising approaches such as strengthening their connection to indigenous culture and traditions. External funds were not available to implement programmes and there was no formal follow-up to determine if community members implemented programmes. Future research needs to examine the extent to which community members can implement programmes on their own and whether community action plans, when implemented, lead to short- and long-term benefits in health outcomes.
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Affiliation(s)
- Noreen Willows
- Department of Agricultural, Food and Nutritional Science, Faculty of Agricultural, Life & Environmental Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - David Dyck Fehderau
- Department of Agricultural, Food and Nutritional Science, Faculty of Agricultural, Life & Environmental Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Kim D Raine
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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Gates A, Hanning RM, Gates M, Tsuji LJS. The Food and Nutrient Intakes of First Nations Youth Living in Northern Ontario, Canada: Evaluation of a Harvest Sharing Program. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2016. [DOI: 10.1080/19320248.2016.1157552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Wayfinding the Live 5-2-1-0 Initiative-At the Intersection between Systems Thinking and Community-Based Childhood Obesity Prevention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13060614. [PMID: 27338432 PMCID: PMC4924071 DOI: 10.3390/ijerph13060614] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 06/07/2016] [Accepted: 06/09/2016] [Indexed: 11/21/2022]
Abstract
Childhood obesity is complex and requires a ‘systems approach’ that collectively engages across multiple community settings. Sustainable Childhood Obesity Prevention through Community Engagement (SCOPE) has implemented Live 5-2-1-0—a multi-sector, multi-component childhood obesity prevention initiative informed by systems thinking and participatory research via an innovative knowledge translation (KT) model (RE-FRAME). This paper describes the protocol for implementing and evaluating RE-FRAME in two ‘existing’ (>2 years of implementation) and two ‘new’ Live 5-2-1-0 communities to understand how to facilitate and sustain systems/community-level change. In this mixed-methods study, RE-FRAME was implemented via online resources, webinars, a backbone organization (SCOPE) coordinating the initiative, and a linking system supporting KT. Qualitative and quantitative data were collected using surveys and stakeholder interviews, analyzed using thematic analysis and descriptive statistics, respectively. Existing communities described the consistency of Live 5-2-1-0 and extensive local partnerships/champions as catalysts for synergistic community-wide action; new communities felt that the simplicity of the message combined with the transfer of experiential learning would inform their own strategies and policies/programs to broadly disseminate Live 5-2-1-0. RE-FRAME effectively guided the refinement of the initiative and provided a framework upon which evaluation results described how to implement a community-based systems approach to childhood obesity prevention.
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Majowicz SE, Meyer SB, Kirkpatrick SI, Graham JL, Shaikh A, Elliott SJ, Minaker LM, Scott S, Laird B. Food, health, and complexity: towards a conceptual understanding to guide collaborative public health action. BMC Public Health 2016; 16:487. [PMID: 27277001 PMCID: PMC4898364 DOI: 10.1186/s12889-016-3142-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 05/14/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND What we eat simultaneously impacts our exposure to pathogens, allergens, and contaminants, our nutritional status and body composition, our risks for and the progression of chronic diseases, and other outcomes. Furthermore, what we eat is influenced by a complex web of drivers, including culture, politics, economics, and our built and natural environments. To date, public health initiatives aimed at improving food-related population health outcomes have primarily been developed within 'practice silos', and the potential for complex interactions among such initiatives is not well understood. Therefore, our objective was to develop a conceptual model depicting how infectious foodborne illness, food insecurity, dietary contaminants, obesity, and food allergy can be linked via shared drivers, to illustrate potential complex interactions and support future collaboration across public health practice silos. METHODS We developed the conceptual model by first conducting a systematic literature search to identify review articles containing schematics that depicted relationships between drivers and the issues of interest. Next, we synthesized drivers into a common model using a modified thematic synthesis approach that combined an inductive thematic analysis and mapping to synthesize findings. RESULTS The literature search yielded 83 relevant references containing 101 schematics. The conceptual model contained 49 shared drivers and 227 interconnections. Each of the five issues was connected to all others. Obesity and food insecurity shared the most drivers (n = 28). Obesity shared several drivers with food allergy (n = 11), infectious foodborne illness (n = 7), and dietary contamination (n = 6). Food insecurity shared several drivers with infectious foodborne illness (n = 9) and dietary contamination (n = 9). Infectious foodborne illness shared drivers with dietary contamination (n = 8). Fewer drivers were shared between food allergy and: food insecurity (n = 4); infectious foodborne illness (n = 2); and dietary contamination (n = 1). CONCLUSIONS Our model explicates potential interrelationships between five population health issues for which public health interventions have historically been siloed, suggesting that interventions targeted towards these issues have the potential to interact and produce unexpected consequences. Public health practitioners working in infectious foodborne illness, food insecurity, dietary contaminants, obesity, and food allergy should actively consider how their seemingly targeted public health actions may produce unintended positive or negative population health impacts.
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Affiliation(s)
- Shannon E Majowicz
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave. West, Waterloo, N2L 3G1, ON, Canada.
| | - Samantha B Meyer
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave. West, Waterloo, N2L 3G1, ON, Canada
| | - Sharon I Kirkpatrick
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave. West, Waterloo, N2L 3G1, ON, Canada
| | - Julianne L Graham
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave. West, Waterloo, N2L 3G1, ON, Canada
| | - Arshi Shaikh
- Social Development Studies, Renison University College-University of Waterloo, 240 Westmount Road North, Waterloo, N2L 3G4, ON, Canada
| | - Susan J Elliott
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave. West, Waterloo, N2L 3G1, ON, Canada
- Department of Geography & Environmental Management, University of Waterloo, 200 University Ave. West, Waterloo, N2L 3G1, ON, Canada
| | - Leia M Minaker
- Propel Centre for Population Health Impact, University of Waterloo, 200 University Ave. West, Waterloo, N2L 3G1, ON, Canada
| | - Steffanie Scott
- Department of Geography & Environmental Management, University of Waterloo, 200 University Ave. West, Waterloo, N2L 3G1, ON, Canada
| | - Brian Laird
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave. West, Waterloo, N2L 3G1, ON, Canada
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Rice K, Te Hiwi B, Zwarenstein M, Lavallee B, Barre DE, Harris SB. Best Practices for the Prevention and Management of Diabetes and Obesity-Related Chronic Disease among Indigenous Peoples in Canada: A Review. Can J Diabetes 2016; 40:216-25. [PMID: 27066857 DOI: 10.1016/j.jcjd.2015.10.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 10/15/2015] [Accepted: 10/25/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To carry out a systematic review of interventions that have aimed at improving screening, treatment, prevention and management of type 2 diabetes and obesity-related chronic disease in Indigenous communities in Canada from 2008 to 2014, with the aim of identifying current best practices. METHODS A comprehensive literature review was carried out through an electronic database search using Medline, EMBASE, PubMED and Google scholar. RESULTS We identified 17 publications, comprising 13 evaluated interventions. Of them, 7 were school-based programs focused on children, 5 focused on adults, and 1 included both adults and children. Most interventions aimed at encouraging behaviour change, especially dietary change, but did little to address the underlying context of systemic marginalization and colonialism experienced in many Indigenous communities. Interventions focused on improving fitness were more effective than those aimed at dietary change. Overall, we found a range of successes among these interventions. Those that met with limited success reported that complex social issues and poverty presented challenges to effective intervention work in these communities. Participatory action research methods and community ownership of the intervention were found to be essential for project success. CONCLUSIONS Diabetes-focused intervention research in Indigenous communities appears to be a low priority for Canadian funders and policymakers. More intervention research is urgently needed in these communities. To be effective, this work must take an approach that is historically deep and sufficiently broad as to enable the ideologic, policy and institutional changes necessary in order to achieve true equity. This will involve addressing colonialism, racism and social exclusion as broader determinants of health.
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Affiliation(s)
- Kathleen Rice
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Braden Te Hiwi
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Merrick Zwarenstein
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Barry Lavallee
- Department of Medical Education, College of Medicine, Faculty of Health Sciences, University of Manitoba, Manitoba, Canada
| | - Douglas Edward Barre
- Department of Health Sciences and Emergency Management, School of Professional Studies, Cape Breton University, Sydney, Nova Scotia, Canada
| | - Stewart B Harris
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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Darroch FE, Giles AR. A postcolonial feminist discourse analysis of urban Aboriginal women's description of pregnancy-related weight gain and physical activity. Women Birth 2016; 29:e23-32. [DOI: 10.1016/j.wombi.2015.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 07/23/2015] [Accepted: 08/05/2015] [Indexed: 12/16/2022]
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