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Background: Food and beverage companies play a central role in shaping the healthfulness of food environments., Methods: The BIA-Obesity tool was used to evaluate and benchmark the specificity, comprehensiveness and transparency of the food environment-related policies and commitments of leading food and beverage manufacturing and retailing companies in Canada. Policies and commitments related to the healthfulness of food environments within 6 action areas were assessed: 1) corporate nutrition strategy; 2) product (re)formulation; 3) nutrition information and labelling; 4) product and brand promotion; 5) product accessibility; and 6) disclosure of relationships with external organizations. Data were collected from publicly available sources, and companies were invited to supplement and validate information collected by the research team. Each company was then assigned a score out of 100 for each action area, and an overall BIA-Obesity score out of 100., Results: Overall BIA-Obesity scores for manufacturers ranged from 18 to 75 out of 100 (median = 49), while scores for retailers ranged from 21 to 25 (median = 22). Scores were highest within the product (re)formulation (median = 60) followed by the corporate nutrition strategy (median = 59) domain for manufacturers, while retailers performed best within the corporate nutrition strategy (median = 53), followed by the disclosure of relationships with external organizations (median = 47) domain. Companies within both sectors performed worst within the product accessibility domain (medians = 8 and 0 for manufacturers and retailers, respectively)., Conclusions: This study highlights important limitations to self-regulatory approaches of the food and beverage industry to improve the healthfulness of food environments. Although some companies had specific, comprehensive, and transparent policies and commitments to address the healthfulness of food environments in Canada, most fell short of recommended best-practice. Additional mandatory government policies and regulations may be warranted to effectively transform Canadian food environments to promote healthier diets and prevent related non-communicable diseases., (© 2024. The Author(s).)

Despite the prevalence of digital food marketing to teenagers and its potential impact on food preferences and consumption, little is known about the specific food advertisements teenagers see in Canada and how they perceive them. Further, few studies consult teenagers directly about their perceptions of teen-specific food marketing content. To shed light on such issues, this study examines perceptions of food marketing and self-reported media use of Canadian teenagers via an online survey. Four hundred and sixty-four teenagers (ages 13-17) participated. Overall, teenagers identified Instagram and TikTok as the most popular social media platforms. The top food or beverage brands that teens felt specifically targeted them were McDonald's, Starbucks, Coca-Cola and Tim Hortons, while Instagram was deemed the most important media platform when it comes to teen-targeted food marketing. Teens deemed "celebrity" and "visual style" as the most important (food and beverage) advertising techniques when it comes to persuading teenagers to buy. Overall, the study provides insights into teen media use and brand preference, including the brands teens feel target them most directly and what they consider to be salient in terms of the food advertising they see. It also provides valuable details for researchers seeking to further identify and measure elements of teen-targeted food marketing.

Background: Children and adolescents are exposed to a high volume of unhealthy food marketing across digital media. No previous Canadian data has estimated child exposure to food marketing across digital media platforms. This study aimed to compare the frequency, healthfulness and power of food marketing viewed by children and adolescents across all digital platforms in Canada., Methods: For this cross-sectional study, a quota sample of 100 youth aged 6-17 years old (50 children, 50 adolescents distributed equally by sex) were recruited online and in-person in Canada in 2022. Each participant completed the WHO screen capture protocol where they were recorded using their smartphone or tablet for 30-min in an online Zoom session. Research assistants identified all instances of food marketing in the captured video footage. A content analysis of each marketing instance was then completed to examine the use of marketing techniques. Nutritional data were collected on each product viewed and healthfulness was determined using Health Canada's 2018 Nutrient Profile Model. Estimated daily and yearly exposure to food marketing was calculated using self-reported device usage data., Results: 51% of youth were exposed to food marketing. On average, we estimated that children are exposed to 1.96 marketing instances/child/30-min (4067 marketing instances/child/year) and adolescents are exposed to 2.56 marketing instances/adolescent/30-min (8301 marketing instances/adolescent/year). Both children and adolescents were most exposed on social media platforms (83%), followed by mobile games (13%). Both age groups were most exposed to fast food (22% of marketing instances) compared to other food categories. Nearly 90% of all marketing instances were considered less healthy according to Health Canada's proposed 2018 Nutrient Profile Model, and youth-appealing marketing techniques such as graphic effects and music were used frequently., Conclusions: Using the WHO screen capture protocol, we were able to determine that child and adolescent exposure to the marketing of unhealthy foods across digital media platforms is likely high. Government regulation to protect these vulnerable populations from the negative effects of this marketing is warranted., (© 2024. The Author(s).)

Aims: Alcohol marketing is a commercial driver of alcohol use, including among youth. This study sought to quantify and characterize alcohol advertising on broadcast television in Canada., Methods: Open-source television program logs for January to December 2018 submitted to the Canadian Radio-television and Telecommunications Commission by 147 stations with alcohol advertisements were analyzed., Results: Overall, 501 628 alcohol advertisements were broadcast. Four companies accounted for 83% of advertisements, namely, Anheuser-Busch in Bev (33.7%), Molson Coors (22.7%), Diageo (16.1%), and Arterra Wines Canada (10.8%). On conventional stations, advertising was highest on French-language stations [Median (Mdn) = 3224; interquartile range (IQR) = 2262] followed by those with programming in foreign/mixed languages (Mdn = 2679; IQR = 219) and English-language stations (Mdn = 1955; IQR = 1563). On speciality stations, advertising was most frequent on those primarily focused on sports programming (Mdn = 8036; IQR = 7393), movies and scripted shows (Mdn = 7463; IQR = 5937), and cooking (Mdn = 5498; IQR = 4032). On weekdays, 33% of alcohol ads aired from 6 to 9 a.m. and 3 to 9 p.m. and on weekends, 52% aired from 6 a.m. to 9 p.m. when children or adolescents are more likely to be watching television. On youth-oriented stations (n = 4), 7937 alcohol advertisements were broadcast with most airing from 9 p.m. to midnight (44-45%) or 12-6 a.m. (50%) on both weekdays and weekends., Conclusions: While few alcohol advertisements were broadcast on youth-oriented stations, young people in Canada are likely exposed to such advertising on programming intended for older or general audiences (e.g. sports). More research is needed to ascertain the extent to which broadcast television constitutes a source of alcohol advertising exposure among youth and to inform policies aimed at protecting them from the influence of such exposure., (© The Author(s) 2024. Medical Council on Alcohol and Oxford University Press.)

Introduction: Sex differences exist in children's obesity rates, dietary patterns and television viewing. Television continues to be a source of unhealthy food advertising exposure to children in Canada. Our objective was to examine sex differences in food advertising exposure in children aged 2 to 17 years across four Canadian English language markets., Methods: We licensed 24-hour television advertising data from the company Numerator for January through December 2019, in four cities (Vancouver, Calgary, Montréal and Toronto) across Canada. Child food advertising exposure overall, by food category, television station, Health Canada's proposed nutrient profiling model, and marketing techniques were examined on the 10 most popular television stations among children and compared by sex. Advertising exposure was estimated using gross rating points, and sex differences were described using relative and absolute differences., Results: Both male and female children were exposed to an elevated level of unhealthy food advertising and a plethora of marketing techniques across all four cities. Differences between sexes were evident between and within cities. Compared to females, males in Vancouver and Montréal viewed respectively 24.7% and 24.0% more unhealthy food ads/person/year and were exposed to 90.2 and 133.4 more calls to action, 93.3 and 97.8 more health appeals, and 88.4 and 81.0 more products that appeal to children., Conclusion: Television is a significant source of children's exposure to food advertising, with clear sex differences. Policy makers need to consider sex when developing food advertising restrictions and monitoring efforts., Competing Interests: In 2018, EP received a small honorarium from the Stop Marketing to Kids Coalition, a coalition of non-governmental health organizations, for reviewing policy recommendations and supporting evidence. In 2020, EP and JSG were employed by Health Canada, on a casual basis, to support research into food marketing in Canada. EP is supported by the Canada Graduate Scholarship to Honour Nelson Mandela awarded by CIHR. All other authors have no conflicts of interest.

Background: Front-of-package labelling regulations proposed by Health Canada in their Healthy Eating Strategy (2016) were finally passed in 2022, but remain unimplemented. This study analyzed interactions that occurred between stakeholders and government related to this policy proposal to identify key themes and policy implications., Methods: A qualitative framework analysis was conducted on publicly available documents for stakeholder correspondences related to front-of-package that occurred between 2016 and 2019 in Health Canada's Meetings and Correspondence on Healthy Eating database. Five sequential steps were applied: familiarization, identifying a thematic framework, indexing, charting, and mapping and interpretation. A complex systems (i.e., a dynamic system with multiple interconnecting components) lens was incorporated in the final step to deepen the analysis., Results: Hundred and seventy-three documents were included, the majority from industry stakeholders ( n  = 108, 62.4%). Three overarching themes were identified: industry trying to control the agenda and resist regulation; questioning the evidence supporting the policy and its impact on the agri-food industry; and dismissing the need and effectiveness of the policy. Incorporating a complex system lens found industry and non-industry stakeholders held markedly different perspectives on how cohesive the system defined by the front-of-package labelling policy was, and the policy impact on its stability. Economic and opportunity costs were the main trade-offs, and symbol misinterpretation considered an unintended consequence by industry. Finally, some stakeholders argued for wider policy scope incorporating more products, while others requested a narrower approach through exemptions., Conclusion: Interactions with industry stakeholders on health food policy proposals require careful consideration, given it may suit their interests to generate delays and policy discordance. Explicitly setting out the principles of engagement and actively encouraging non-industry stakeholder representation provides a more balanced approach to policy consultation and development., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Jawad, Mulligan, Savona and L'Abbé.)

Background: Food and beverage promotion is a contributor to children's dietary behaviours, and ultimately, downstream health consequences. Broadcast television remains an important source of such advertising. The objective of this study was to examine and compare children and adolescent's exposure to food advertising on television in Canada over an entire year in a self-regulatory environment., Methods: Television advertising data for 57 selected food and beverage categories were licensed from Numerator for 36 stations in Toronto, for 2019. The estimated average number of advertisements viewed by children aged 2-11 and adolescents aged 12-17 was determined overall, by food category, and by marketing technique. The healthfulness of advertisements was also assessed using Health Canada's Nutrient Profile Model., Results: Overall in 2019, children viewed 2234.4 food ads/person/yr while adolescents viewed 1631.7 ads, exposure for both groups stemmed primarily from stations with general appeal, and both age groups were exposed to a range of powerful marketing techniques. Exposure to advertising for restaurants, snacks, breakfast food and candy and chocolate was high among both age groups and the healthfulness of most advertised products was considered poor. Adolescents were exposed to 36.4% more food products classified as unhealthy, had higher exposure to all marketing techniques examined, and were exposed to substantially more child-related marketing techniques compared to children., Conclusion: Children and adolescents were heavily exposed to food advertisements on television in 2019. Despite current self-regulatory policies, children's exposure to unhealthy food and beverages remains high. Differences in exposure to food advertisements by food category and healthfulness may suggest that adolescents are being disproportionately targeted by food companies as a result of self-regulatory marketing restrictions., (© 2023. The Author(s).)

Background: Corporate power has been recognized as an important influence on food environments and population health more broadly. Understanding the structure of national food and beverage markets can provide important insight into the power held by leading corporations. This study aimed to descriptively analyze the structure of the Canadian food and beverage manufacturing and grocery retailing sectors as of 2020/21., Methods: Packaged food manufacturers, non-alcoholic beverage manufacturers and grocery retailers with ≥ 1% market share in 2020/21 in Canada as per Euromonitor International were identified and characterized. Proportion of market share held by public vs private, multinational vs national, and foreign multinational companies was assessed for the 3 sectors. The concentration of 14 packaged food, 8 non-alcoholic beverage and 5 grocery retailing markets was assessed using the Herfindahl-Hirschman Index (HHI) and the four firm concentration ratio (CR4) (HHI > 1800 and CR4 > 60 suggest high market concentration). Company ownership structure was also assessed, including common ownership of public companies by three of the largest global asset managers using data from Refinitiv Eikon, a financial market database., Results: The Canadian non-alcoholic beverage manufacturing sector, and, to a lesser extent, the packaged food manufacturing sector were dominated by foreign multinational companies, in contrast with the grocery retailing sector which was dominated by national companies. Market concentration varied across sectors and markets but was substantially greater within the retailing (median CR4 = 84; median HHI = 2405) and non-alcoholic beverage sectors (median CR4 = 72; median HHI = 1995) compared to the packaged food sector (median CR4 = 51; median HHI = 932). There was considerable evidence of common ownership across sectors. Overall, the Vanguard Group Inc owned at least 1% of shares in 95% of publicly listed companies, Blackrock Institutional Trust Company 71%, and State Street Global Advisors (US) 43%., Conclusions: The Canadian packaged food and non-alcoholic beverage manufacturing and grocery retailing sectors include several consolidated markets, with a high degree of common ownership by major investors. Findings suggest that a small number of large corporations, particularly in the retailing sector, have extensive power to influence Canadian food environments; their policies and practices warrant substantial attention as part of efforts to improve population diets in Canada., (© 2023. The Author(s).)

Background: The food industry advertises unhealthy foods intended for children which in turn fosters poor diets. This study characterized advertising expenditures on child-targeted products in Canada and compared these expenditures between Quebec, where commercial advertising to children under 13 is restricted, and the rest of Canada, where food advertising to children is self-regulated., Methods: Advertising expenditures data for 2016 and 2019 for 57 select food categories and five media channels were licensed from Numerator. Products and brands targeted to children were identified based on their nature and the advertising techniques used to promote them. Advertising expenditures were classified as healthy/unhealthy using Health Canada's nutrient profile model. Expenditures per child capita aged 2-12 years were calculated and expenditures from 2016 were adjusted for inflation. Advertising expenditures were described by media, food category, year, and geographic region., Results: Overall, $57.2 million CAD was spent advertising child-targeted products in Canada in 2019. Television accounted for 77% of expenditures followed by digital media (18%), and the food categories with the highest expenditures were candy/chocolate (30%) and restaurants (16%). The totality of expenditures (99.9%-100%) in both Quebec and the rest of Canada in 2016 and 2019 were considered 'unhealthy'. Across all media channels (excluding digital), advertising expenditures were 9% lower in 2019 versus 2016. Advertising expenditures per capita were 32% lower in Quebec ($9.40/capita) compared to the rest of the country ($13.91/capita)., Conclusion: In Canada, millions are spent promoting child-targeted products considered inappropriate for advertising to children. While per capita advertising expenditures for these products are lower in Quebec compared to the rest of Canada, they remain high, suggesting that Quebec's commercial advertising restrictions directed to children are likely not sufficiently protecting them from unhealthy food advertising., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: In 2018, EP received a small honorarium from the Stop Marketing to Kids Coalition, a coalition of non-governmental health organizations, for reviewing policy recommendations and supporting evidence. In 2020, EP, JS and CM were also employed by Health Canada, on a casual basis, to support research on food marketing in Canada., (Copyright: © 2023 Potvin Kent et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: Unhealthy food and beverage marketing in various media and settings contributes to children's poor dietary intake. In 2019, the Canadian federal government recommended the introduction of new restrictions on food marketing to children. This scoping review aimed to provide an up-to-date assessment of the frequency of food marketing to children and youth in Canada as well as children's exposure to this marketing in various media and settings in order to determine where gaps exist in the research., Methods: For this scoping review, detailed search strategies were used to identify relevant peer-reviewed and grey literature published between October 2016 and November 2021. Two reviewers screened all results., Results: A total of 32 relevant and unique articles were identified; 28 were peer reviewed and 4 were from the grey literature. The majority of the studies (n = 26) examined the frequency of food marketing while 6 examined actual exposure to food marketing. Most research focussed on children from Ontario and Quebec and television and digital media. There was little research exploring food marketing to children by age, geographical location, sex/gender, race/ethnicity and/or socioeconomic status., Conclusion: Our synthesis suggests that unhealthy food marketing to children and adolescents is extensive and that current self-regulatory policies are insufficient at reducing the presence of such marketing. Research assessing the frequency of food marketing and preschooler, child and adolescent exposure to this marketing is needed across a variety of media and settings to inform future government policies., Competing Interests: None.

Background: Food and beverage advertising has been identified as a powerful determinant of dietary intake and weight. Available evidence suggests that the preponderance of food and beverage advertising expenditures are devoted to the promotion of unhealthy products. The purpose of this study is to estimate food advertising expenditures in Canada in 2019 overall, by media and by food category, determine how much was spent on promoting healthier versus less healthy products and assess whether changes in these expenditures occurred between 2016 and 2019., Methods: Estimates of net advertising expenditures for 57 selected food categories promoted on television, radio, out-of-home media, print media and popular websites, were licensed from Numerator. The nutrient content of promoted products or brands were collected, and related expenditures were then categorized as "healthy" or "unhealthy" according to a Nutrient Profile Model (NPM) proposed by Health Canada. Expenditures were described using frequencies and relative frequencies and percent changes in expenditures between 2016 and 2019 were computed., Results: An estimated $628.6 million was spent on examined food and beverage advertising in Canada in 2019, with television accounting for 67.7%, followed by digital media (11.8%). In 2019, most spending (55.7%) was devoted to restaurants, followed by dairy and alternatives (11%), and $492.9 million (87.2% of classified spending) was spent advertising products and brands classified as "unhealthy". Fruit and vegetables and water accounted for only 2.1 and 0.8% of expenditures, respectively, in 2019. In 2019 compared to 2016, advertising expenditures decreased by 14.1% across all media (excluding digital media), with the largest decreases noted for print media (- 63.0%) and television (- 14.6%). Overall, expenditures increased the most in relative terms for fruit and vegetables (+ 19.5%) and miscellaneous products (+ 5%), while decreasing the most for water (- 55.6%) and beverages (- 47.5%)., Conclusions: Despite a slight drop in national food and beverage advertising spending between 2016 and 2019, examined expenditures remain high, and most products or brands being advertised are unhealthy. Expenditures across all media should continue to be monitored to assess Canada's nutrition environment and track changes in food advertising over time., (© 2022. The Author(s).)

Introduction: Introducing legislation that restricts companies from exposing children to marketing of unhealthy food and beverage products is both politically and technically difficult. To advance the literature on the technical design of food marketing legislation, and to support governments around the world with legislative development, we aimed to describe the legislative approach from three governments., Methods: A multiple case study methodology was adopted to describe how three governments approached designing comprehensive food marketing legislation (Chile, Canada and the United Kingdom). A conceptual framework outlining best practice design principles guided our methodological approach to examine how each country designed the technical aspects of their regulatory response, including the regulatory form adopted, the substantive content of the laws, and the implementation and governance mechanisms used. Data from documentary evidence and 15 semi-structured key informant interviews were collected and synthesised using a directed content analysis., Results: All three countries varied in their legislative design and were therefore considered of variable strength regarding the legislative elements used to protect children from unhealthy food marketing. When compared against the conceptual framework, some elements of best practice design were present, particularly relating to the governance of legislative design and implementation, but the scope of each law (or proposed laws) had limitations. These included: the exclusion of brand marketing; not protecting children up to age 18; focusing solely on child-directed marketing instead of all marketing that children are likely to be exposed to; and not allocating sufficient resources to effectively monitor and enforce the laws. The United Kingdom's approach to legislation is the most comprehensive and more likely to meet its regulatory objectives., Conclusions: Our synthesis and analysis of the technical elements of food marketing laws can support governments around the world as they develop their own food marketing restrictions. An analysis of the three approaches illustrates an evolution in the design of food marketing laws over time, as well as the design strengths offered by a legislative approach. Opportunities remain for strengthening legislative responses to protect children from unhealthy food marketing practices., (© 2022. The Author(s).)

Background: The political activities of industry stakeholders must be understood to safeguard the development and implementation of effective public health policies., Methods: A quantitative descriptive study was performed using data from Canada's Registry of Lobbyists to examine the frequency and governmental target of lobbying that occurred between various types of stakeholders (i.e., industry versus non-industry) and designated public office holders (DPOH) regarding Health Canada's Healthy Eating Strategy, from September/2016 to January/2021. Initiatives of interest were revisions to Canada's Food Guide, changes to the nutritional quality of the food supply, front-of-pack nutrition labelling and restrictions on food marketing to children., Results: The majority of registrants (88%), and corporations and organizations (90%) represented in lobbying registrations had industry ties. Industry-affiliated stakeholders were responsible for 86% of communications with DPOH, interacting more frequently with DPOH of all ranks, compared to non-industry stakeholders. Most organizations and corporations explicitly registered to lobby on the topic of marketing to children (60%), followed by Canada's Food Guide (48%), front-of-pack nutrition labelling (44%), and the nutritional quality of the food supply (23%). The food and beverage industry, particularly the dairy industry, was the most active, accounting for the greatest number of lobbying registrations and communications, followed by the media and communication industry., Conclusions: Results suggest a strategic advantage of industry stakeholders in influencing Canadian policymakers. While some safeguards have been put in place, increased transparency would allow for a better understanding of industry discourse and help protect public health interests during the policy development process., (© 2022. The Author(s).)

Objective: Exposure to unhealthy food advertising is a known determinant of children's poor dietary behaviours. The purpose of this study was to quantify and characterize Canadian children's exposure to food advertising on broadcast television and examine trends over time., Methods: Objectively measured advertising exposure data for 19 food categories airing on 30 stations broadcast in Toronto were licenced for May 2011 and May 2019. Using ad ratings data, the average number of food advertisements viewed by children aged 2-11 years, overall, by food category and by type of television station (child-appealing, adolescent-appealing and generalist stations), was estimated per time period., Results: In May 2019, children viewed an average of 136 food advertisements on television, 20% fewer than in May 2011. More than half of advertisements viewed in May 2019 promoted unhealthy food categories such as fast food (43% of exposure), candy (6%), chocolate (6%) and regular soft drinks (5%) and only 17% of their total exposure occurred on child-appealing stations. Between May 2011 and May 2019, children's exposure increased the most, in absolute terms, for savory snack foods (+7.2 ad exposures/child), fast food (+5.4) and regular soft drinks (+5.3) with most of these increases occurring on generalist stations., Conclusion: Canadian children are still exposed to advertisements promoting unhealthy food categories on television despite voluntary restrictions adopted by some food companies. Statutory restrictions should be adopted and designed such that children are effectively protected from unhealthy food advertising on both stations intended for general audiences and those appealing to younger audiences., (© 2021. The Author(s).)

Background: Exposure to unhealthy food and beverage content is a contributing factor to the obesity epidemic. Youth are susceptible to unhealthy digital food marketing including content shared by their peers, which can be as influential as commercial marketing. Current Canadian regulations do not consider the threat digital food marketing poses to health. No research to date has examined the prevalence of food related posts on social media surrounding family-friendly events. The aim of this study was to explore the frequency of food related content (including food marketing) and the marketing techniques employed in social media posts related to a family-friendly event in Canada., Methods: In this case study, a content analysis of social media posts related to a family-friendly event on Facebook, Twitter, and Instagram was conducted between January to February 2019. Each post containing food related content was identified and categorized by source and food category using a coding manual. Marketing techniques found in each food related post were also assessed., Results: A total of 732 food and beverage related posts were assessed. These posts were most commonly promoted through Instagram (n = 561, 76.6%) with significantly more individual users (61.5%; p < 0.05) generating food and beverage related content (n = 198, 27%) than other post sources. The top most featured food category was fast food (n = 328, 44.8%) followed by dine-in restaurants (n = 126, 17.2%). The most frequently observed marketing techniques included predominantly featuring a child in the post (n = 124, 16.9%; p < 0.0001), followed by products intended for children (n = 118, 16.1%; p < 0.05), and the presence of family (n = 57, 7.8%; p < 0.0001)., Conclusions: The present study highlights the proliferation of unhealthy food and beverage content by individuals at a family-friendly event as well as the presence of food marketing. Due to the unfettered advertising found in digital spaces, and that they are largely unregulated, it is important for future policies looking to combat childhood obesity to consider incorporating social media into their regulations to safeguard family-friendly events. General awareness on the implications of peer to peer sharing of unhealthy food and beverage posts should also be considered.

Background: Canadian federal restrictions on food marketing to children (children's marketing) were proposed in 2016 as Bill S-228, the Child Health Protection Act , which subsequently died on the parliamentary table. This study quantified the interactions (meetings, correspondence and lobbying) related to Bill S-228 and children's marketing by different stakeholders with the federal government., Methods: Interactions between all stakeholders and government related to children's marketing and Bill S-228 (Sept. 1, 2016-Sept. 30, 2019) were analyzed. These included the "Meetings and correspondence on healthy eating" database, detailing interactions between stakeholders and Health Canada related to nutrition policies; and Canada's Registry of Lobbyists, reporting activities of paid lobbyists. We categorized the interactions by stakeholder type (industry, nonindustry and mixed), and analyzed the number and type of interactions with different government offices., Results: We analyzed 139 meetings, 65 lobbying registrants, 215 lobbying registrations and 3418 communications related to children's marketing and Bill S-228. Most interactions were from industry stakeholders, including 84.2% of meetings (117/139), 81.5% of lobbying registrants (53/65), 83.3% of lobbying registrations (179/215) and 83.9% of communications (2866/3418). Most interactions (> 80%) in the highest-ranking government offices were by industry., Interpretation: Industry stakeholders interacted with government more often, more broadly and with higher ranking offices than nonindustry stakeholders on subjects related to children's marketing and Bill S-228. Although further research is needed to analyze the nature of the discourse around children's marketing, it is apparent that industry viewpoints were more prominent than those of nonindustry stakeholders., Competing Interests: Competing interests: None declared., (© 2021 Joule Inc. or its licensors.)

Food allergies are life-threatening conditions that allergic individuals can avoid by consulting the food labels before consuming. Precautionary allergen labelling (or PAL), to warn against possible allergen cross-contamination, is widely used by food industries, reducing the food choices for allergic individuals. In Canada, there is limited information on the actual occurrence of allergens in products with a PAL related to the given allergen. This study attempted to fill the data gap by evaluating the occurrence of milk and egg allergens in Canadian products with PAL. A total of 1125 samples were analysed for milk and 840 for eggs, with 23% and 7% of these samples showing positive detection of ≥2.5 mg kg -1 for milk and ≥0.245 mg kg -1 for eggs. Chocolate products gave the largest number of positive results. Although the proportion of positive results was low, the levels detected reached 6471 mg kg -1 in a chocolate sample and were indicative of possible health consequences, if PAL was ignored by allergic consumers. The occurrence data generated is destinated to be used in exposure and risk assessments, to support allergen management linked to cross-contamination, with the possible development of allergen action levels that would be used by food industries, thus improving a risk-based approach for the application of PAL.

Purpose of the Review: Describe the state of knowledge on how the retail food environment contributes to diet-related health and obesity among Indigenous populations, and assess how the literature incorporates Indigenous perspectives, methodologies and engagement throughout the research process. Outcomes included dietary behaviour (purchasing, intakes and diet quality) and diet-related health outcomes (weight-related outcomes, non-communicable diseases and holistic health or definitions of health as defined by Indigenous populations involved in the study)., Recent Findings: Of fifty included articles (1996-2019), the largest proportions described Indigenous communities in Canada (20 studies, 40%), the USA (16, 32%) and Australia (9, 18%). Among articles that specified the Indigenous population of focus (42 studies, 84%), the largest proportion (11 studies, 26%) took place in Inuit communities, followed by Aboriginal and Torres Strait Islander communities (8 studies, 19%). The included literature encompassed four main study designs: type A, dietary intakes of store foods (14 studies, 28%), and type B, store food environments (16, 32%), comprised the greatest proportion of articles; the remainder were type C, store food environments and diet (7, 14%), and type D, store food environment interventions (13, 26%). Of the studies that assessed diet or health outcomes (36, 72%), 22 (61%) assessed dietary intakes; 16 (44%) sales/purchasing; and 8 (22%) weight-related outcomes. Store foods tended to contribute the greatest amount of dietary energy to the diets of Indigenous peoples and increased non-communicable disease risk as compared to traditional foods. Multi-pronged interventions appeared to have positive impacts on dietary behaviours, food purchasing and nutrition knowledge; promotion and nutrition education alone had more mixed effects. Of the nine studies which were found to have strong engagement with Indigenous populations, eight had moderate or high methodological quality. Eighteen studies (36%) did not mention any engagement with Indigenous populations. The literature confirmed the importance of store foods to the total energy intake of the contemporary diets of Indigenous people, the gaps in accessing both retail food environments and traditional foods and the potential for both new dietary assessment research and retail food environment intervention strategies to better align with and privilege Indigenous Ways of Knowing.

Food and beverage marketing is considered a determinant of childhood obesity. Sponsorship is a marketing technique used by the food industry to target young people when they are engaged in sports. The purpose of this study was to document the frequency and nature of food company sponsorship of children's sports clubs in Ottawa, Canada. Using national data on sports participation, the five most popular sports among Canadian children aged 4-15 years were first selected for inclusion in the study and relevant sports clubs located in Ottawa (Canada) were then identified. Sports club websites were reviewed between September and December 2018 for evidence of club sponsorship. Food company sponsors were identified and classified by food category. Of the 67 sports clubs identified, 40% received some form of food company sponsorship. Overall, sports clubs had 312 commercial and noncommercial sponsors. Food companies constituted 16% of total sponsors and were the second most frequent type of sponsor after sports-related goods, services, and retailers (25%). Fast food restaurants and other restaurants accounted for 45% and 41% of food company sponsors, respectively. Food company sponsorship of children's sports clubs is frequent with some promoting companies or brands associated with unhealthy foods. Policymakers should consider restricting the sponsorship of children's sports clubs by food companies that largely sell or promote unhealthy foods., Competing Interests: Funding: This research received no external funding.

Two separate human outbreaks of Salmonella enterica serotype Reading occurred between 2017 and 2019 in the United States and Canada, and both outbreaks were linked to the consumption of raw turkey products. In this study, a comprehensive genomic investigation was conducted to reconstruct the evolutionary history of S. Reading from turkeys and to determine the genomic context of outbreaks involving this infrequently isolated Salmonella serotype. A total of 988 isolates of U.S. origin were examined using whole-genome-based approaches, including current and historical isolates from humans, meat, and live food animals. Broadly, isolates clustered into three major clades, with one apparently highly adapted turkey clade. Within the turkey clade, isolates clustered into three subclades, including an "emergent" clade that contained only isolates dated 2016 or later, with many of the isolates from these outbreaks. Genomic differences were identified between emergent and other turkey subclades, suggesting that the apparent success of currently circulating subclades is, in part, attributable to plasmid acquisitions conferring antimicrobial resistance, gain of phage-like sequences with cargo virulence factors, and mutations in systems that may be involved in beta-glucuronidase activity and resistance towards colicins. U.S. and Canadian outbreak isolates were found interspersed throughout the emergent subclade and the other circulating subclade. The emergence of a novel S Reading turkey subclade, coinciding temporally with expansion in commercial turkey production and with U.S. and Canadian human outbreaks, indicates that emergent strains with higher potential for niche success were likely vertically transferred and rapidly disseminated from a common source. IMPORTANCE Increasingly, outbreak investigations involving foodborne pathogens are difficult due to the interconnectedness of food animal production and distribution, and homogeneous nature of industry integration, necessitating high-resolution genomic investigations to determine their basis. Fortunately, surveillance and whole-genome sequencing, combined with the public availability of these data, enable comprehensive queries to determine underlying causes of such outbreaks. Utilizing this pipeline, it was determined that a novel clone of Salmonella Reading has emerged that coincided with increased abundance in raw turkey products and two outbreaks of human illness in North America. The rapid dissemination of this highly adapted and conserved clone indicates that it was likely obtained from a common source and rapidly disseminated across turkey production. Key genomic changes may have contributed to its apparent continued success in commercial turkeys and ability to cause illness in humans., (Copyright © 2020 Miller et al.)

The progressive rise in Canadian child obesity has paralleled trends in unhealthy food consumption. Industry has contributed to these trends through aggressive food and beverage marketing in various media and child settings. This study aimed to assess the extent of food and beverage advertising on television in Canada and compare the frequency of food advertising broadcasted during programs targeted to preschoolers, children, adolescents and adults. Annual advertising from 2018 was drawn from publicly available television program logs. Food and beverage advertisement rates and frequencies were compared by, target age group, television station, month and food category, using linear regression modelling and chi-square tests, in SAS version 9.4. Rates of food and beverage advertising differed significantly between the four target age groups, and varied significantly by television station and time of the year, in 2018. The proportion of advertisements for food and beverage products was significantly greater during preschooler-, child-, and adult-programming [5432 (54%), 142,451 (74%) and 2,886,628 (48%), respectively; p < 0.0001] compared to adolescent-programming [27,268 (42%)]. The proportion of advertisements promoting fast food was significantly greater among adolescent-programming [33,475 (51%), p < 0.0001] compared to other age groups. Legislation restricting food and beverage advertising is needed in Canada as current self-regulatory practices are failing to protect young people from unhealthy food advertising and its potential negative health effects.

Adolescents represent a key audience for food advertisers, however there is little evidence of adolescent exposure to food marketing in Canada. This study examined trends in Canadian adolescents' exposure to food advertising on television. To do so, data on 19 food categories were licensed from Nielsen Media Research for May 2011, 2013, and 2016 for the broadcasting market of Toronto, Canada. The average number of advertisements viewed by adolescents aged 12-17 years on 31 television stations during the month of May each year was estimated using television ratings data. Findings revealed that between May 2011 and May 2016, the total number of food advertisements aired on all television stations increased by 4%, while adolescents' average exposure to food advertising decreased by 31%, going from 221 ads in May 2011 to 154 in May 2016. In May 2016, the advertising of fast food and sugary drinks dominated, relative to other categories, accounting for 42% and 11% of all exposures, respectively. The findings demonstrate a declining trend in exposure to television food advertising among Canadian adolescents, which may be due to shifts in media consumption. These data may serve as a benchmark for monitoring and evaluating future food marketing policies in Canada., Competing Interests: In 2018, E.P. received a small honorarium from the Stop Marketing to Kids Coalition for providing expert advice.

Background: Unhealthy food environments contribute to the rising rates of obesity and diet-related diseases. To improve the Canadian nutritional landscape, Health Canada launched the Healthy Eating Strategy in October 2016 which involved several initiatives including the restriction of unhealthy food marketing to children, the reduction of sodium in the food supply and the introduction of front-of-package labelling. Subsequently, various stakeholders engaged in discussions with Health Canada. This study sought to describe the interactions between Health Canada and industry and non-industry stakeholders and to identify the strategies used by industry to influence food and nutrition policy in Canada., Methods: Documents such as correspondences and presentations exchanged in interactions between Health Canada and stakeholders regarding the Healthy Eating Strategy were obtained from Health Canada's Openness and Transparency website. The participating stakeholders of each interaction and the topics discussed were determined and described quantitatively. A directed content analysis was then conducted to identify the strategies employed by industry to influence policy. This was guided by a previously developed coding framework that was adapted during analysis., Results: A total of 208 interactions concerning the Healthy Eating Strategy occurred between October 2016 and June 2018. Of the interactions for which documents were received (n = 202), 56% involved industry stakeholders, 42% involved non-industry stakeholders and 2% involved both. Industry stakeholders were more likely to initiate interactions with Health Canada (94% of their interactions) than non-industry stakeholders (49%). Front-of-package labelling was the most frequently discussed topic by industry stakeholders (discussed in 49% interactions involving industry) while non-industry stakeholders most frequently discussed the Healthy Eating Strategy as a whole (discussed in 37% of interactions involving non-industry). A wide variety of strategies were used by industry in their attempts to influence policy. Those most frequently identified included: "framing the debate on diet- and public health-related issues", "promoting deregulation", "shaping the evidence base", "stressing the economic importance of industry", and "developing and promoting alternatives to proposed policies"., Conclusion: Industry stakeholders are highly active in their attempts to influence Canadian nutritional policies. Policymakers and public health advocates should be aware of these strategies so that balanced and effective food and nutrition policies can be developed.

Concerns about conflicts of interest in commercially funded research have generated increasing disclosure requirements, but are these enough to assess influence? Using the Coca-Cola Company as an example, we explore its research agreements to understand influence. Freedom of Information requests identified 87,013 pages of documents, including five agreements between Coca-Cola and public institutions in the United States, and Canada. We assess whether they allowed Coca-Cola to exercise control or influence. Provisions gave Coca-Cola the right to review research in advance of publication as well as control over (1) study data, (2) disclosure of results and (3) acknowledgement of Coca-Cola funding. Some agreements specified that Coca-Cola has the ultimate decision about any publication of peer-reviewed papers prior to its approval of the researchers' final report. If so desired, Coca-Cola can thus prevent publication of unfavourable research, but we found no evidence of this to date in the emails we received. The documents also reveal researchers can negotiate with funders successfully to remove restrictive clauses on their research. We recommend journals supplement funding disclosures and conflict-of-interest statements by requiring authors to attach funder agreements.

Purpose: The purpose of this study was to document the frequency and healthfulness of pop-up and banner food advertisements displayed on third-party Web sites preferred by adolescents in Canada., Methods: Syndicated Internet advertising exposure data licensed from comScore was used to identify adolescents' (ages 12-17) 10 most popular Web sites and determine the frequency of food and beverage display advertisements on these Web sites from June 2015 to May 2016. The nutrition information for all advertised products was collected, and the healthfulness of all food and beverage ads was assessed using the Pan-American Health Organization (PAHO) and the U.K. Nutrient Profile Models (NPM)., Results: In total, there were 14.4 million food advertisements on all 10 Web sites from June 2015 to May 2016. The most frequently advertised food categories were cakes, cookies, and ice cream (32.5%); cold cereal (20.5%); restaurants (18.0%); and sugar-sweetened beverages (12.0%). Most advertised products (93.3%) were categorized as excessive in either fat, sodium, or free sugars according to the PAHO NPM, and 83.5% of ads were categorized as "less healthy" according to the U.K. NPM. Specifically, 81.3% of ads were excessive in free sugars, 22.1% were excessive in sodium, 14.1% were excessive in saturated fat, and 11.8% were excessive in total fat according to the PAHO NPM., Conclusions: Canadian adolescents are potentially exposed to a high frequency of unhealthy food and beverage display advertisements on their preferred Web sites. Regulations restricting food and beverage marketing to children need to include digital media and should consider protecting adolescents up to the age of 17., (Copyright © 2018 The Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Competing Interests: Competing interests: David Jenkins has received research grants from Saskatchewan Pulse Growers; Agricultural Bioproducts Innovation Program through the Pulse Research Network; Advanced Foods and Materials Network; Loblaw Companies; Unilever; Barilla; Almond Board of California; Agriculture and Agri-Food Canada; Pulse Canada; Kellogg’s Canada; Quaker Oats Canada; Procter & Gamble Technical Centre; Bayer Consumer Care; Pepsi/Quaker; International Nut and Dried Fruit Council; Soy Foods Association of North America; The Coca-Cola Company (investigator initiated, unrestricted grant); Solae; Haine Celestial; Sanitarium Company; Orafti; International Tree Nut Council Nutrition Research and Education Foundation; The Peanut Institute; Canola Council of Canada; Flax Council of Canada; Calorie Control Council; Canadian Institutes of Health Research (CIHR); Canada Foundation for Innovation; and Ontario Research Fund. He has received in-kind supplies for trials as a research support from the Almond Board of California, Walnut Council of California, American Peanut Council, Barilla, Unilever, Unico, Primo, Loblaw Companies, Quaker (Pepsico), Pristine Gourmet, Bunge Limited, Kellogg Canada and WhiteWave Foods. He has been on the speaker’s panel, served on the scientific advisory board and/or received travel support and/or honoraria from the Almond Board of California; Canadian Agriculture Policy Institute; Loblaw Companies; Griffin Hospital (for the development of the NuVal scoring system); The Coca-Cola Company; EPICURE; Danone; Diet Quality Photo Navigation; Better Therapeutics (FareWell); Very-well; True Health Initiative; Institute of Food Technologists; Saskatchewan Pulse Growers; Sanitarium Company; Orafti; American Peanut Council; International Tree Nut Council Nutrition Research and Education Foundation; The Peanut Institute; Herbalife International; Pacific Health Laboratories; Nutritional Fundamentals for Health; Barilla; Metagenics; Bayer Consumer Care; Unilever Canada and Netherlands; Solae; Kellogg; Quaker Oats; Procter & Gamble; Abbott Laboratories; Canola Council of Canada; Flax Council of Canada; Dean Foods; California Strawberry Commission; Haine Celestial; PepsiCo; Alpro Foundation; Pioneer Hi-Bred International; Du-Pont Nutrition & Health; Spherix Consulting; WhiteWave Foods; Advanced Foods and Material Network; Agriculture and Agri-Food Canada; Canadian Agri-Food Policy Institute; Pulse Canada; Soy Foods Association of North America; Nutrition Foundation of Italy; Nutrasource Diagnostics; McDougall Program; Toronto Knowledge Translation Group, St. Michael’s Hospital; Canadian College of Naturopathic Medicine; The Hospital for Sick Children; Canadian Nutrition Society; American Society of Nutrition; Arizona State University; Paolo Sorbini Foundation; and Institute of Nutrition, Metabolism and Diabetes, CIHR. He received an honorarium from the US Department of Agriculture to present the 2013 W.O. Atwater Memorial Lecture. He received the 2013 Award for Excellence in Research from the International Nut and Dried Fruit Council. He received funding and travel support from the Canadian Society of Endocrinology and Metabolism to produce mini cases for the Canadian Diabetes Association. He is a member of the International Carbohydrate Quality Consortium. His wife (Alexandra Jenkins) is a director and partner of Glycemic Index Laboratories, and his sister (Caroline Brydson) received funding through a grant from the St. Michael’s Hospital Foundation to develop a cookbook for one of his studies. No other competing intersts were declared.

Objective: To examine exposure to energy drink marketing among youth and young adults, and test perceptions of energy drink advertisements (ads) regarding target audience age and promoting energy drink use during sports., Design: A between-group experiment randomly assigned respondents to view one of four energy drink ads (sport-themed or control) and assessed perceptions of the ad. Regression models examined marketing exposure and perceptions., Setting: Online survey (2014)., Subjects: Canadians aged 12-24 years (n 2040) from a commercial panel., Results: Overall, 83 % reported ever seeing energy drink ads through at least one channel, including on television (60 %), posters/signs in stores (49 %) and online (44 %). Across experimental conditions, most respondents (70·1 %) thought the ad they viewed targeted people their age or younger, including 42·2 % of those aged 12-14 years. Two sport-themed ads were more likely to be perceived as targeting a younger audience (adjusted OR (95 % CI): 'X Games' 36·5 %, 4·16 (3·00, 5·77); 'snowboard' 19·2 %, 1·50 (1·06, 2·13)) v. control (13·3 %). Participants were more likely to believe an ad promoted energy drink use during sports if they viewed any sport-themed ad ('X Games' 69·9 %, 8·29 (6·24, 11·02); 'snowboard' 76·7 %, 11·85 (8·82, 15·92); 'gym' 66·8 %, 7·29 (5·52, 9·64)) v. control (22·0 %). Greater reported exposure to energy drink marketing was associated with perceiving study ads as promoting energy drink use during sports., Conclusions: Energy drink marketing has a high reach among young people. Ads for energy drinks were perceived as targeting youth and promoting use during sports. Such ads may be perceived as making physical performance claims, counter to Canadian regulations.

Introduction: Food marketing impacts children's food knowledge, behaviours and health. Current regulations in Canada focus on restricting promotional aspects of food marketing with little-to-no consideration of the places where children experience food. Understanding food marketing in children's everyday settings is necessary to protect children. This scoping review describes the current literature on food marketing to children in Canada by setting., Methods: The author searched databases for Canadian research on children's exposure to food marketing, and the power and impact of food marketing to children (2-17 years) across settings, and on how current regulations may mediate the effect of food marketing on children. Peer-reviewed studies in English, published between 2000 and 2016, were included., Results: Twenty-five studies documented children's exposure to food marketing and its power and/or impact on them in homes (via television, or online) (n = 12), public schools (n = 1), grocery stores (n = 8), fast food restaurants (n = 2), and in general (n = 2). Research trends suggest that unhealthy foods are targeted at children using multiple promotional techniques that overlap across settings. Several research gaps exist in this area, leading to an incomplete, and potentially underestimated, picture of food marketing to children in Canada. Available evidence suggests that current Canadian approaches have not reduced children's exposure to or the power of food marketing in these settings, with the exception of some positive influences from Quebec's statutory regulations., Conclusion: The settings where children eat, buy or learn about food expose them to powerful, often unhealthy food marketing. The current evidence suggests that "place" may be an important marketing component to be included in public policy in order to broadly protect children from unhealthy food marketing. Organizations and communities can engage in settings-based health promotion interventions by developing their own marketing policies that address the promotion and place of unhealthy food and beverages., Competing Interests: Rachel Prowse has no financial relationships that may pose a conflict of interest.

Background: Front-of-pack (FOP) nutrition rating systems and symbols are a form of nutrition marketing used on food labels worldwide. In the absence of standardized criteria for their use, it is unclear if FOP symbols are being used to promote products more nutritious than products without symbols., Objectives: To compare the amount of calories, saturated fat, sodium, and sugar in products with FOP symbols, and different FOP symbol types, to products without symbols., Methods: The median calorie, saturated fat, sodium, and sugar content per reference amount of products with FOP symbols were compared to products without FOP symbols using data from the Food Label Information Program, a database of 10,487 Canadian packaged food labels. Ten food categories and 60 subcategories were analyzed. Nutrient content differences were compared using Wilcoxon rank-sum test; differences greater than 25% were deemed nutritionally relevant., Results: Products with FOP symbols were not uniformly lower in calories, saturated fat, sodium, and sugar per reference amount than products without these symbols in any food category and the majority of subcategories (59/60). None of the different FOP types examined were used to market products with overall better nutritional profiles than products without this type of marketing., Conclusion: FOP symbols are being used to market foods that are no more nutritious than foods without this type of marketing. Because FOP symbols may influence consumer perceptions of products and their purchases, it may be a useful public health strategy to set minimum nutritional standards for products using FOP symbol marketing., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

The transmission of pathogens is a common consequence of animal food production. Marine salmon farms and their processing facilities can serve as sources of virulent fish pathogens; our study is the first to confirm the broadcast of a live fish pathogen from a farmed salmon processing facility into the marine waters of Canada's Pacific coast. We found live salmon lice Lepeophtheirus salmonis, mucus, and fish tissue in effluent from the processing facility. Sea lice transmitted from this source may pose a threat to wild salmon populations, and the release of untreated offal, including blood water, is of considerable concern. Further research is needed to quantify the extent to which processing facilities release sea lice and to determine whether more virulent fish pathogens are present in effluent. These data underscore the need for fish farming nations to develop mandatory biosecurity programs to ensure that farmed salmon processing facilities will prevent the broadcast of infectious fish pathogens into wild fish habitat.

Objective: Increased consumption of sugar-sweetened beverages has contributed to rising obesity levels. Under Canadian law, calories for pre-packaged foods and beverages are presented by serving size; however, serving sizes differ across products and even for the same product in different containers. This study examined consumer understanding of calorie amounts for government nutrition labels and industry labelling schemes., Methods: A national sample of 687 Canadian adults completed an online survey. Participants were randomized to view images of Coke® bottles that displayed different serving sizes and calorie amounts. Participants viewed either the regulated nutrition information on the "back" of containers, or the voluntary calorie symbols displayed on the "front" of Coke® products. Participants were asked to determine how many calories the bottle contained., Results: Across all conditions, 54.2% of participants correctly identified the number of calories in the beverage. Participants who viewed government-mandated nutrition information were more likely to answer correctly (59.0%) than those who saw industry labelling (49.1%) (OR=5.3, 95% CI: 2.6-10.6). Only 11.8% who viewed the Coke® bottle with calorie amounts per serving correctly identified the calorie amount, compared to 91.8% who saw calorie amounts per container, regardless of whether information was presented in the Nutrition Facts Table or the front-of-pack symbol (OR=242.9, 95% CI: 112.1-526.2)., Conclusions: Few individuals can use nutrition labels to correctly identify calorie content when presented per serving or using industry labelling schemes. The findings highlight the importance of revising labelling standards and indicate that industry labelling initiatives warrant greater scrutiny.

Background: The Baby-Friendly Hospital Initiative (BFHI) promotes the World Health Organization International Code of Marketing of Breast-milk Substitutes (WHO Code) and the WHO/UNICEF's Ten Steps to Successful Breastfeeding (Ten Steps). The purpose of this study is to describe and compare maternity hospitals' adherence to the BFHI in 1993 and 2007 for Canada and for each province and territory., Methods: A survey of all Canadian maternity hospitals was conducted in 1993 and 2007 on routine maternity care practices and policies including infant feeding., Results: The overall response rate was 91 percent (n = 523/572 hospitals) in 1993 and 92 percent (n = 323/353 hospitals) in 2007. Eighty-two percent (415/507) of hospitals in 1993 and 68 percent (198/292) in 2007 had exclusive contracts with formula companies. Fifty-eight percent (302/517) of hospitals in 1993 and 90 percent (289/322) in 2007 never gave breastfeeding mothers sample packs containing formula. Fifty-eight percent (296/507) in 1993 and 85 percent (273/321) in 2007 had written breastfeeding policies (Step 1); 97 percent (503/518) in 1993 and 99 percent (320/322) in 2007 allowed mothers to breastfeed, on cue, whenever the babies indicated an interest 24 hours a day (Step 8); 24 percent (126/519) in 1993 and 64 percent (206/321) in 2007 reported that they did not provide soothers (Step 9); 58 percent (297/513) in 1993 and 68 percent (215/316) in 2007 always offered information on breastfeeding support groups and/or advice at time of discharge (Step 10)., Conclusions: In the 14 years separating the two surveys, Canadian maternity hospitals substantially improved their implementation of the WHO Code and their adherence to the WHO/UNICEF Ten Steps., (© 2011, Copyright the Authors. Journal compilation © 2011, Wiley Periodicals, Inc.)

Hypertension is the leading risk for premature death in the world. High dietary sodium is an important contributor to increased blood pressure and is strongly associated with other important diseases (e.g., gastric cancer, calcium containing kidney stones, osteoporosis, asthma and obesity). The average dietary sodium intake in Canada is approximately 3400 mg/day. It is estimated that 30% of hypertension, more than 10% of cardiovascular events and 1.4 billion dollars/year in health care expenses are caused by this high level of intake in Canada. Since 2006, Canada has had a focused and evolving effort to reduce dietary sodium based on actions from Non Governmental Organizations (NGO), and Federal and Provincial/Territorial Government actions. NGOs initiated Canadian sodium reduction programs by developing a policy statement outlining the health issue and calling for governmental, NGO and industry action, developing and disseminating an extensive health care professional education program including resources for patient education, developing a public awareness campaign through extensive media releases and publications in the lay press. The Federal Government responded by striking a Intersectoral Sodium Work Group to develop recommendations on how to implement Canada's dietary reference intake values for dietary sodium and by developing timelines and targets for foods to be reduced in sodium, assessing key research gaps with funding for targeted dietary sodium based research, developing plans for public education and for conducting evaluation of the program to reduce dietary sodium. While food regulation is a Federal Government responsibility Provincial and Territorial governments indicated reducing dietary sodium needed to be a priority. Federal and Provincial Ministers of Health have endorsed a target to reduce the average consumption of sodium to 2300 mg/day by 2016 and the Deputy Ministers of Health have tasked a joint committee to review the recommendations of the Sodium Work Group and report back to them.

Traceability systems are an important tool (1) for tracking, monitoring, and managing product flows through the supply chain for better efficiency and profitability of suppliers, and (2) to improve consumer confidence in the face of serious food safety incidents. After the global bovine spongiform encephalopathy (BSE) crisis affected producers, consumers, trade, and the health status of animals and humans, new systems to help confirm the status of cattle products along the supply chain from farm to fork were implemented in many countries (Trautman et al. 2008 ). In this study, people's overall food safety beliefs are explored with the main objective of measuring the link between their food safety beliefs and their attitudes toward traceability. A comparison is made among English-speaking Canadians, French-speaking Canadians, and Japanese consumers. In the study, an Internet-based survey was used to collect data from nationally representative samples of the population in Canada-English (1275), Canada-French (343), and Japanese (1940) in the summer of 2009. Respondents' interests in traceability systems are clearly linked to their sense that the industry is primarily responsible for any food safety outbreaks. Moreover, it is clear that certain segments of the population in all samples feel strongly about the importance of farm to fork traceability in beef; thus, policymakers may wish to consider extending traceability beyond the point of slaughter as a way of encouraging beef sales in Canada.

The purpose of this study was to carry out an acute aquatic toxicity assessment on select effluent samples from Atlantic Canadian seafood processing plants. Raw effluent acute aquatic toxicity for the flatfish and salmon effluents was assessed using the acute lethality test and Microtox test. The effectiveness of dissolved air flotation treatment (DAF) in removing acute toxicity from these effluents was evaluated using the Microtox test. The salmon effluent failed the acute lethality test using rainbow trout while the flatfish effluent showed acute toxicity in the Microtox test with a 50% inhibiting concentration (IC(50)) of 38.84%. Subsequent treatment by DAF of the flatfish and salmon effluents increased IC(50) values by 20% and 26% respectively. The findings of this study indicate that all of the processing effluents sampled showed characteristics that could potentially degrade effluent receiving waters and acute toxicity was demonstrated in the two raw finfish effluents. Application of DAF treatment was successful in significantly increasing Microtox IC(50) values, thereby reducing acute toxicity, but failed to entirely remove acute toxicity.

Research conducted in the mid-1990s indicated that the levels of trans fats in Canadian diets were among the highest in the world. The consumption of trans fats raises blood levels of low-density lipoprotein (LDL)-cholesterol, while reducing levels of high-density lipoprotein (HDL)-cholesterol. In June 2007, Health Canada called on the food industry to voluntarily reduce levels of trans fats in vegetable oils and soft (tub)-margarines to < 2% of total fat, and in all other foods, to < 5%. Industry must show satisfactory progress by June 2009, or Health Canada might have to introduce legislation to ensure that recommended limits are achieved. Since 2005, Health Canada has been performing a national assessment of prepackaged and restaurant foods that likely contain trans fats. From 2005 to 2009, 1120 samples were analyzed, of which 852 or approximately 76% met the recommended trans fat limits. As a result of reformulation, most of the products had decreased trans + saturated fat content. The estimated average intake of trans fatty acids (TFA) in Canada significantly dropped from the high value of 8.4 g/day in the mid-1990s to 3.4 g/day (or 1.4% food energy) in 2008. However, this TFA intake of 1.4% of energy is still above the World Health Organization recommended limit of TFA intake of < 1% of energy, which suggests that the Canadian food industry needs to put more effort into reducing the TFA content in its products, especially in tub-margarines, donuts, and bakery products.

Food advertisements on mainstream television have received less research attention than those on children's television. Little is known about how television food advertisements vary internationally or if there have been changes over recent years. We describe food-related television advertisements and the nutrient content of foods advertised during prime-time television in Ontario, Canada and the UK in 1991 and 2006. Information on what advertisements were broadcast were obtained from video recordings and audience research bureaux. Data on nutrient content of foods advertised were obtained from manufacturers and standard food tables. The proportion of advertisements that were food related decreased between 1991 and 2006 in both countries. The frequency of food-related advertisements was relatively constant in Canada but decreased between 1991 and 2006 in the UK. In 1991, advertisements for beverages and meals predominated in both countries. By 2006, food-related advertisements in Canada were dominated by meals and restaurants. In the UK advertisements for food stores and beverages predominated. The 'TV diet' in Canada in 1991 was relatively high in fat, high in alcohol and low in fibre, compared to current recommendations. By 2006, this had changed to high in fat and sodium and low in fibre. The 'TV diet' in the UK in 1991 was high in fat, sodium, sugar and alcohol and low in fibre compared to current recommendations. By 2006, the UK 'TV diet' was high in sodium, sugar and alcohol and low in fibre. Foods advertised on 'prime-time' television do not reflect a healthful diet.

The impact of recent efforts to reduce the content of industrially produced trans fatty acids (TFA) in foods has not been systematically assessed in any country. Concerns exist that food manufacturers/restaurants may replace TFA with saturated fat acids (SFA), rather than cis unsaturated fats, or increase the total fat content. We present findings from a national systematic assessment of grocery and restaurant foods likely to contain TFA in Canada in 2005-2007. Of the total of 221 assessed products, 92 (42%) contained TFA (> or = 5% of fatty acids) on initial assessment. Of an unselected sample assessed more than once, 72% were reformulated during 2005-2007: mean+/-s.d. TFA levels decreased from 26+/-13 to 2+/-4%. Following reformulation, one product had similar TFA+SFA content; all others had decreased TFA+SFA and increased cis unsaturated fat content. The total fat content was generally unaffected. The findings suggest that manufacturers/restaurants generally take advantage of costs and efforts of reformulation to not only reduce TFA but also increase the content of cis unsaturated fats.

On December 23, 2003, the U.S. Department of Agriculture (USDA) made a preliminary diagnosis of bovine spongiform encephalopathy (BSE) in a single "downer" (i.e., nonambulatory disabled) dairy cow in Washington state. On December 25, this diagnosis was confirmed by the BSE international reference laboratory in Weybridge, England. This report summarizes the findings of the initial investigation of this case and describes the public health prevention measures adopted by USDA to protect the human food supply. The occurrence of BSE in the United States reinforces the need for physicians to be aware of the clinical features of variant Creutzfeldt-Jakob disease (vCJD) and to arrange for brain autopsies in all decedents with suspected or probable CJD to assess the neuropathology of these patients.