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Abstract Background While considerable research has been conducted on household food insecurity (HFI), little research has examined the effects of food donation programs on users’ living conditions. The Pathways study was established to investigate the long-term effects of food donation programs on food insecurity as well as other critical outcomes, such as diet, health, and social support. Herein, we describe the design of the Pathways Study and the participants’ characteristics at baseline. Methods The Pathways study is a prospective cohort study of 1001 food-aid users in Quebec (Canada). We recruited newly registered users of food donation programs from 106 community-based food-aid organizations that partnered with the study. Baseline data were collected through face-to-face interviews from September 2018 to January 2020, with planned follow-up interviews at 12 and 24 months after enrollment. Household food insecurity, diet, food competencies, food shopping behaviors, perceived food environment, health status, social support and isolation, sociodemographic characteristics, housing conditions, negative life events, and the impacts of COVID-19 were assessed with validated questionnaires. Results The cohort included 1001 participants living in rural (n = 181), semi-urban (n = 250), and urban areas (n = 570). Overall, household food insecurity was reported as severe among 46.2% and moderate in 36.9% of participants. Severe household food insecurity was more prevalent in rural (51.4%) and urban (47.8%) areas compared to semi-urban (39%) areas. Overall, 76.1% of participants reported an annual income below C$20,000. Half (52%) had low education levels (high school or lower), 22.0% lived in single-parent households, and 52.1% lived alone. Most (62.9%) experienced at least one major financial crisis in the preceding year. Conclusions Results show that newly registered users of food donation programs often have low-income and severe food insecurity, with major differences across geographical locations. The Pathways study is the first study designed to follow, over a 2-year period, a cohort of newly registered users of food donation programs and to quantify their trajectories of service use. Findings from the Pathways study might help adapt the community response to the strategies used by food-insecure households to feed themselves.

Background: The traditional cultural food practices of Indigenous people and adults from racial/ethnic minority groups may be eroded in the current food system where nutrient-poor and ultra-processed foods (UPF) are the most affordable and normative options, and where experiences of racism may promote unhealthy dietary patterns. We quantified absolute and relative gaps in diet quality and UPF intake of a nationally representative sample of adults in Canada by Indigenous status and race/ethnicity, and trends between 2004 and 2015. Methods: Adults (≥18 years) in the Canadian Community Health Survey-Nutrition self-reported Indigenous status and race/ethnicity and completed a 24-h dietary recall in 2004 (n = 20,880) or 2015 (n = 13,970) to calculate Healthy Eating Index-2015 (HEI-2015) scores from 0 to 100 and proportion of energy from UPF. Absolute and relative dietary gaps were quantified for Indigenous people and six racial/ethnic minority groups relative to White adults and trends between 2004 and 2015. Results: Adults from all six racial/ethnic minority groups had higher mean HEI-2015 scores (58.7–61.9) than White (56.3) and Indigenous adults (51.9), and lower mean UPF intake (31.0%–41.0%) than White (45.9%) and Indigenous adults (51.9%) in 2015. As a result, absolute gaps in diet quality were positive and gaps in UPF intake were negative among racial/ethnic minority groups—indicating more favourable intakes—while the reverse was found among Indigenous adults. Relative dietary gaps were small. Absolute and relative dietary gaps remained largely stable. Conclusions: Adults from six racial/ethnic minority groups had higher diet quality and lower UPF intake, whereas Indigenous adults had poorer diet quality and higher UPF intake compared to White adults between 2004 and 2015. Absolute and relative dietary gaps remained largely stable. Findings suggest racial/ethnic minority groups may have retained some healthful aspects of their traditional cultural food practices while highlighting persistent dietary inequities that affect Canada's Indigenous people.

The Child Feeding Questionnaire (CFQ) is a well-established tool used to assess parental beliefs, attitudes, and child feeding practices, with a focus on childhood obesity proneness. To date, there is no French version of the CFQ, nor any Canadian studies assessing its construct validity. The aim of this study was to assess the construct validity and the reliability of a French version of the CFQ among Black mothers (n = 136) of school-aged children living in Ottawa (Canada). The final best fitting model included 7 factors, 20 items, and 1 error covariance. This model was retained as the final model as it (1) excluded two items with very low factor loadings; (2) had the lowest χ2, AIC, BIC, RMSEA, and SRMR values; and (3) had CFI and TLI values ≥ 0.95. Internal consistency ranged from poor to good; the restriction subscale had the lowest internal consistency, followed by the perceived responsibility, pressure to eat, perceive child weight, concern about child weight, and monitoring scales, respectively. Our results showed that a seven-factor model with minor modifications was best fitted to the current data. Future studies are needed to test the validity and reliability of the CFQ in other population groups and among fathers.

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.

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.

Abstract Background Falls occurring on stairs or in bathrooms are associated with a high risk of injuries among older adults. Home environmental assessments are frequently used to guide fall-prevention interventions. The aims of this review were to describe how, where, by whom, and for whom environmental hazard checklists are used, and to examine the characteristics of environmental hazard assessment checklists with specific attention to features of bathrooms and stairs/steps assessed in them. Methods Studies published before January 5, 2018, were identified using several databases. Publications reporting the use and/or evaluation of environmental hazard checklists were eligible if they assessed bathrooms or stairs/steps in homes of older adults (≥65 years). Content analysis was conducted on publications that provided a complete list of specific environmental hazards assessed. Checklist items related to bathrooms and stairs/steps were extracted and categorized as structural or non-structural and as objective or subjective. Results 1119 studies were appraised. A pool of 136 published articles and 4 checklists from the grey literature were included in this scoping review. Content analysis was conducted on 42 unique checklists. There was no widely used checklist and no obvious consensus definition of either environmental hazards overall or of single hazards listed in checklists. Checklists varied greatly with respect to what rooms were assessed, whether or not outdoor stair/steps hazards were assessed, and how responses were coded. Few checklists examined person-environment fit. The majority of checklists were not oriented towards structural hazards in bathrooms. Although the majority of checklists assessing stair/steps hazards evaluated structural hazards, most features assessed were not related to the construction geometry of stairs/steps. Objective features of bathrooms and stairs/steps that would deem them safe were rarely specified. Rather, adequacy of their characteristics was mostly subjectively determined by the evaluator with little or no guidance or training. Conclusion The lack of standard definitions and objective criteria for assessing environmental hazards for falls is limiting meaningful cross-study comparisons and slowing advances in this field. To inform population health interventions aimed at preventing falls, such as building code regulations or municipal housing by-laws, it is essential to include objectively-assessed structural hazards in environmental checklists.

Abstract Background This article is based upon data gathered during a study conducted in partnership with the World Intellectual Property Organization on the patent status of products appearing on the World Health Organization’s 2013 Model List of Essential Medicines (MLEM). It is a statistical analysis aimed at answering: in which developing countries are patents on essential medicines being filed? Methods Patent data were collected by linking those listed in the United States and Canada’s medicine patent registers to corresponding patents in developing countries using two international patent databases (INPADOC and Derwent) via a commerical-grade patent search platform (Thomson Innovation). The respective supplier companies were then contacted to correct and verify our data. We next tallied the number of MLEM patents per developing country. Spearman correlations were done to assess bivariate relationships between variables, and a multivariate regression model was developed to explain the number of MLEM patents in each country using SPSS 23.0. Results A subset of 20 of the 375 (5%) products on the 2013 MLEM fit our inclusion criteria. The patent estate reports (i.e., the global list of patents for a given drug) varied greatly in their number with a median of 48 patents (interquartile range [IQR]: 26-76 ). Their geographic reach had a median of 15% of the developing countries sampled (IQR: 8-28%). The number of developing countries covered appeared to increase with the age of the patent estate (r = .433, p = 0.028). The number of MLEM patents per country was significantly positively associated with human development index (HDI), gross domestic income (GDI) per capita, total healthcare expenditure per capita, population size, the Rule of Law Index, and average education level. Population size, GDI per capita, and healthcare expenditure (in % of national expenditure) were predictors of the number of MLEM patents in countries (p = 0.001, p = 0.001, p = 0.009, respectively). Population size was the most important predictor (β = 0.59), followed by income (GDI per capita) (β = 0.32), and healthcare expenditure (β = 0.15). Holding the other factors constant, (i) 14.3 million more people, (ii) $833.33 more per capita (GDI), or (iii) 0.88% more of national spending on healthcare resulted in 1 additional essential medicine patent. Conclusion Population was a powerful predictor of the number of patent filings in developing countries along with GDI and healthcare expenditure. The age and historical context of the patent estate may make a difference in the number of patents and countries covered. Broad surveillance and benchmarking of the global medicine patent landscape is valuable for detecting significant shifts that may occur over time. With improved international medicine patent transparency by companies and data available through third parties, such studies will be increasingly feasible.

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.

The objectives of this cross-sectional study were to: (i) determine whether there are differences in self-esteem and self-efficacy for healthy lifestyle choices between children living in food secure and food insecure households; and (ii) determine whether the association between household food insecurity (HFI), self-esteem and self-efficacy differs by gender. Survey responses of 5281 fifth-grade students (10 and 11 years of age) participating in the Canadian Children’s Lifestyle and School Performance Study II were analyzed using logistic and linear regression. HFI status was determined by the six-item short-form Household Food Security Survey Module (HFSSM). Students from food insecure households had significantly higher odds of low self-esteem, and significantly lower scores for global self-efficacy to make healthy choices, compared to students from food secure households. These associations were stronger for girls than for boys and appeared independent of parental educational attainment. Household income appeared to be the essential underlying determinant of the associations of food insecurity with self-esteem and self-efficacy. Upstream social policies such as improving the household income of low-income residents will reduce food insecurity and potentially improve self-esteem and self-efficacy for healthy choices among children. This may improve health and learning, and in the long term, job opportunities and household earnings.

The prevalence of iron depletion, iron deficient erythropoiesis (IDE), and iron deficiency anemia (IDA) was assessed in preschool Inuit children using soluble transferrin receptor (sTfR) and traditional indicators of iron status while disregarding or taking inflammation into account when defining SF cutoffs. Iron depletion was defined as follows: (1) SF < 15 μg/L regardless of the C-reactive protein (CRP) level and (2) SF < 15 or 5 mg/L, respectively. IDE corresponded to iron depletion combined with total iron binding capacity > 72 μmol/L and/or transferrin saturation < 16%. Iron depletion and IDE affected almost half of the children when accounting for inflammation, compared to one-third when the SF cutoff was defined regardless of CRP level (P

Objectives. To describe traditional food (TF) consumption and to evaluate its impact on nutrient intakes of preschool Inuit children from Nunavik. Design. A cross-sectional study. Methods. Dietary intakes of children were assessed with a single 24-hour recall (n=217). TF consumption at home and at the childcare centres was compared. Differences in children's nutrient intakes when consuming or not consuming at least 1 TF item were examined using ANCOVA. Results. A total of 245 children attending childcare centres in 10 communities of Nunavik were recruited between 2006 and 2010. The children's mean age was 25.0±9.6 months (11–54 months). Thirty-six percent of children had consumed at least 1 TF item on the day of the recall. TF contributed to 2.6% of total energy intake. Caribou and Arctic char were the most reported TF species. Land animals and fish/shellfish were the main contributors to energy intake from TF (38 and 33%, respectively). In spite of a low TF intake, children who consumed TF had significantly (p