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To improve health outcomes, home cooking has been suggested as a solution to reduce intakes of processed foods. However, little is known about how cooking skills or cooking with processed foods influence health. This cross-sectional study examined associations between diet and health outcomes with cooking skills and cooking with processed foods. The dataset included a nationally representative sample of 18 460 adults from Canadian Community Health Survey (CCHS) annual component rapid response modules on food skills. In the CCHS rapid response modules, diet and health outcomes (fruit and vegetable intake, general health, mental health, and obesity) and data related to cooking skills and cooking with processed foods were collected through self-report. Separate logistic regression models were fitted for each outcome, controlling for age, income, and education, and stratified by sex. Adults with poor cooking skills were less likely to have adequate fruit and vegetable intake (≥5 servings per day) (p < 0.001), very good general health (p < 0.001) or mental health (p < 0.001), and obesity (p = 0.02) compared to advanced cooking skills. Adults who cooked with highly processed foods were less likely to have adequate fruit and vegetable intake (p < 0.001), very good general health (p = 0.002) or mental health (p < 0.001), but more likely to have obesity (p = 0.03) compared to cooking with minimally processed foods. Cooking skills alone appear insufficient to protect against obesity. Results suggest that not only are cooking skills important, but the quality of ingredients also matter. Limiting the use of processed foods in addition to improving cooking skills are potential intervention targets to promote better health and diet outcomes. [ABSTRACT FROM AUTHOR]

Objective: This study explored programme recipients’ and deliverers’ experiences and perceived outcomes of accessing or facilitating a grocery gift card (GGC) programme from I Can for Kids (iCAN), a community-based programme that provides GGC to low-income families with children. Design: This qualitative descriptive study used Freedman et al’s framework of nutritious food access to guide data generation and analysis. Semi-structured interviews were conducted between August and November 2020. Data were analysed using directed content analysis with a deductive–inductive approach. Participants: Fifty-four participants were purposively recruited, including thirty-seven programme recipients who accessed iCAN’s GGC programme and seventeen programme deliverers who facilitated it. Setting: Calgary, Alberta, Canada. Results: Three themes were generated from the data. First, iCAN’s GGC programme promoted a sense of autonomy and dignity among programme recipients as they appreciated receiving financial support, the flexibility and convenience of using GGC, and the freedom to select foods they desired. Recipients perceived these benefits improved their social and emotional well-being. Second, recipients reported that the use of GGC improved their households’ dietary patterns and food skills. Third, both participant groups identified programmatic strengths and limitations. Conclusion: Programme recipients reported that iCAN’s GGC programme provided them with dignified access to nutritious food and improved their households’ finances, dietary patterns, and social and emotional well-being. Increasing the number of GGC provided to households on each occasion, establishing clear and consistent criteria for distributing GGC to recipients, and increasing potential donors’ awareness of iCAN’s GGC programme may augment the amount of support iCAN could provide to households. [ABSTRACT FROM AUTHOR]

Background: Comprehensive School Health (CSH) approaches to developing a healthy school community can be effective in supporting chronic disease prevention while positively impacting on student behaviour and academic performance. Although a CSH framework provides principles for action, there is a lack of evidence regarding the processes that best facilitate CSH work, and enable action. Objective: The purpose of this study was to identify and describe the elements of practice-based evidence that contribute to the success and sustainability of healthy school communities, through the identification of positive practices and lessons learned from a sample of projects in Alberta, Canada. Setting: School communities in Alberta, Canada. Design and methods: Key individuals from a list of operating CSH projects were invited for interview. An exploratory, qualitative design examined the perspectives of these "school health champions". A total of 12 one-on-one interviews and one focus group with seven participants were completed, resulting in input from 19 individuals in total. Results: Elements to develop and sustain a healthy school community fall into one of two categories: (1) stakeholder buy-in and (2) adequate resources in the form of human resources, partnerships and peer support. Participants identified successful strategies for establishing buy-in from administrators, teachers, parents and students. Conclusion: To effectively mobilise a comprehensive school health framework, practical strategies for implementation are needed. While some of these strategies are context-specific, practice-based evidence that transcends the local context does exist and can be used more widely to support the development of a healthy school community.

Greater availability of low nutritional quality foods and decreased consumption of nutrient-dense foods have negatively impacted the nutrient profile of the Canadian diet. Poor diet is now the leading risk factor for chronic disease and premature death in Canada. To help consumers choose healthful foods, nutrition labelling is one policy tool for communicating relevant nutrition information. However, there are notable shortcomings with current nutrition labelling systems, which make it difficult for Canadians to navigate the complex food environment. Government action on nutrition labelling systems, including front-of-package (FOP), shelf, and menu labelling, is required. In May 2016, we hosted a consensus conference with experts from research, policy and practice to review available evidence, share experiences and come to consensus regarding the next best steps for action on nutrition labelling in Canada. In this paper, we examine the evidence, opportunities and challenges surrounding FOP, shelf, and menu labelling. We outline recommendations, emphasizing FOP, shelf, and menu labelling as part of a standardized, coordinated and multi-pronged strategy supported by a robust, evidence-based nutrition profiling system. Recommendations for monitoring adherence to regulations and participation of stakeholders to avoid conflict of interest in policy development, implementation and evaluation are included. Within a comprehensive strategy, these recommendations can help to improve the nutrition information environment for Canadians. KEY WORDS: Food labelling; consensus; policy; obesity; chronic disease La traduction du resume se trouve a la fin de l'article. La disponibilite accrue d'aliments de faible qualite nutritionnelle et la baisse de la consommation d'aliments riches en nutriments ont des impacts negatifs sur le profil nutritionnel du regime canadien. La mauvaise alimentation est maintenant le principal facteur de risque de maladies chroniques et de deces prematures au Canada. Pour aider les consommateurs a choisir des aliments sains, l'etiquetage nutritionnel est un outil strategique de communication de l'information nutritionnelle pertinente. Les systemes d'etiquetage nutritionnel actuels comportent toutefois des lacunes notables, d'ou la difficulte pour les Canadiens de s'y retrouver dans un environnement alimentaire complexe. Une action gouvernementale est necessaire en ce qui a trait aux systemes d'etiquetage nutritionnel, notamment l'etiquetage sur le devant de l'emballage (etiquetage de face), l'etiquetage sur les tablettes et l'etiquetage des menus. En mai 201 6, nous avons tenu une conference de concertation avec des specialistes de la recherche, des politiques et des pratiques pour examiner les donnees probantes disponibles, partager les experiences de chacun et parvenir a un consensus quant aux meilleures mesures a prendre maintenant pour agir sur la question de l'etiquetage nutritionnel au Canada. Nous presentons ici les donnees probantes, les possibilites et les defis concernant l'etiquetage de face, l'etiquetage sur les tablettes et l'etiquetage des menus. Nous formulons des recommandations, qui abordent l'etiquetage de face, l'etiquetage sur les tablettes et l'etiquetage des menus dans le cadre d'une strategie standardisee et coordonnee a plusieurs volets, soutenue par un systeme de profilage nutritionnel robuste et fonde sur les preuves. Nous incluons des recommandations visant a surveiller le respect de la reglementation et la participation des acteurs pour eviter les conflits d'interets dans l'elaboration, l'application et l'evaluation de politiques. Dans le cadre d'une strategie globale, ces recommandations peuvent contribuer a ameliorer l'environnement d'information nutritionnelle des Canadiens. MOTS CLES : Etiquetage des aliments; consensus; politique (principe); obesite; maladie chronique, In recent decades, greater availability of low nutritional quality foods and decreased consumption of nutrient-dense foods have negatively impacted the nutrient profile of Canadian diets. (1,2) Canadian diets are high [...]

SETTING: Municipal buildings and corporate events in the City of Hamilton, Ontario. INTERVENTION: In 2011, the City of Hamilton adopted a healthy food and beverage policy. The intent of the policy is to demonstrate the City's commitment to healthy eating by providing food and beverages that are healthy, safe, and free of industrially produced trans fats, and promoting a sustainable, local food system. The corporate policy applies to all City facilities, meetings and events. In this article, we explore adoption and implementation of the policy, as well as key lessons for healthy public policy change. OUTCOMES: Integrating the policy into corporate culture and practice through the provision of ongoing supports and resources helped the City of Hamilton overcome barriers and achieve implementation success. IMPLICATIONS: Through exploration of the City of Hamilton's healthy food and beverage policy, we identified a number of lessons for policy change and implementation. When viewed in context, these lessons may help to support policy work in other Canadian jurisdictions. KEY WORDS: Policy; municipal; nutrition; chronic disease prevention LIEU : Les edifices municipaux et les evenements generaux de la ville de Hamilton, en Ontario. INTERVENTION : En 2011, la ville de Hamilton a adopte une politique sur les aliments et les boissons sante. En offrant des aliments et des boissons salubres, bons pour la sante et sans gras trans produits industriellement, et en favorisant un circuit alimentaire local et durable, cette politique montre l'importance que la ville accorde a l'alimentation saine. La politique s'applique a l'ensemble des installations, des reunions et des evenements de la ville. Nous explorons ici son adoption et sa mise en oeuvre, ainsi que les principales lecons a en tirer pour instaurer des changements favorables a la sante dans les politiques. RESULTATS : En offrant des ressources et des mesures de soutien pour integrer la politique en question dans la culture et les pratiques generales, la ville de Hamilton a surmonte les obstacles et opere une mise en oeuvre reussie. IMPLICATIONS : Notre exploration de la politique de la ville de Hamilton sur les aliments et les boissons sante contient des lecons sur la modification et la mise en oeuvre de politiques. Replacees dans leur contexte, ces lecons peuvent appuyer le travail de reflexion d'autres collectivites publiques canadiennes. MOTS CLES : politique (principe); municipal; nutrition; prevention des maladies chroniques, Poor diet is the leading risk factor for chronic disease and early death in Canada. (1) This trend is due, in part, to the widespread availability of processed foods in [...]

OBJECTIVES: Public health policies have been criticized for promoting a simplistic narrative that may contribute to weight bias. Weight bias can impact population health by increasing morbidity and mortality. The objectives of this study were to: 1) critically analyze Canadian obesity prevention policies and strategies to identify underlying dominant narratives; 2) deconstruct dominant narratives and consider the unintended consequences for people with obesity; and 3) make recommendations to change dominant obesity narratives that may be contributing to weight bias. METHODS: We applied Bacchi's 'what's-the-problem-represented-to-be?' (WPR) approach to 15 obesity prevention policies and strategies (1 national, 2 territorial and 12 provincial). Bacchi's WPR approach is composed of six analytical questions designed to identify conceptual assumptions as well as possible effects of policies. RESULTS: We identified five prevailing narratives that may have implications for public health approaches and unintended consequences for people with obesity: 1) childhood obesity threatens the health of future generations and must be prevented; 2) obesity can be prevented through healthy eating and physical activity; 3) obesity is an individual behaviour problem; 4) achieving a healthy body weight should be a population health target; and 5) obesity is a risk factor for other chronic diseases, not a disease in itself. CONCLUSION: The consistent way in which obesity is constructed in Canadian policies and strategies may be contributing to weight bias in our society. We provide some recommendations for changing these narratives to prevent further weight bias and obesity stigma. KEY WORDS: Obesity; policy; public health; weight bias OBJECTIFS : Les politiques de sante publique font l'objet de critiques lorsqu'elles encouragent un discours simpliste qui peut contribuer aux prejuges lies au poids. Ces prejuges peuvent influer sur la sante des populations en augmentant la morbidite et la mortalite. Les objectifs de notre etude etaient : 1) de faire une analyse critique des politiques et des strategies canadiennes de prevention de l'obesite pour en extraire les discours dominants; 2) de deconstruire les discours dominants et d'en etudier les effets pervers pour les personnes obeses; et 3) de formuler des recommandations pour changer les discours dominants sur l'obesite qui peuvent contribuer aux prejuges lies au poids. METHODE : Nous avons applique le cadre d'analyse WPR (pour << What's the problem represented to be? >>) de Bacchi a 15 politiques et strategies de prevention de l'obesite (1 nationale, 2 territoriales et 12 provinciales). Ce cadre pose six questions analytiques pour mettre au jour les hypotheses conceptuelles et les effets possibles des politiques. RESULTATS : Nous avons mis au jour cinq discours dominants qui pourraient deja avoir des consequences sur les demarches de sante publique et des effets pervers pour les personnes obeses : 1) l'obesite juvenile menace la sante des generations a venir et doit etre evitee; 2) l'obesite peut etre evitee par la saine alimentation et l'activite physique; 3) l'obesite est un probleme de comportement individuel; 4) l'atteinte d'un poids sante devrait etre une cible de sante des populations; et 5) l'obesite est un facteur de risque pour d'autres maladies chroniques et non une maladie en soi. CONCLUSION : La constance avec laquelle l'obesite est envisagee dans les politiques et les strategies canadiennes pourrait contribuer aux prejuges lies au poids dans la societe. Nous presentons des recommandations pour changer ces discours afin de prevenir l'intensification des prejuges lies au poids et de la stigmatisation de l'obesite. MOTS CLES : obesite; politique (principe); sante publique; prejuges lies au poids, Obesity is a chronic disease characterized by abnormal or excessive fat accumulation to the extent that health is impaired. (1) Obesity has been identified as a public health issue that [...]

Objective: Limitations of traditional geospatial measures, like the modified Retail Food Environment Index (mRFEI), are well documented. In response, we aimed to: (1) extend existing food environment measures by inductively developing subcategories to increase the granularity of healthy v. less healthy food retailers; (2) establish replicable coding processes and procedures; and (3) demonstrate how a food retailer codebook and database can be used in healthy public policy advocacy. Design: We expanded the mRFEI measure such that 'healthy' food retailers included grocery stores, supermarkets, hypermarkets, wholesalers, bulk food stores, produce outlets, butchers, delis, fish and seafood shops, juice/smoothie bars, and fresh and healthy quick-service retailers; and 'less healthy' food retailers included fast-food restaurants, convenience stores, coffee shops, dollar stores, pharmacies, bubble tea restaurants, candy stores, frozen dessert restaurants, bakeries, and food trucks. Based on 2021 government food premise licences, we used geographic information systems software to evaluate spatial accessibility of healthy and less healthy food retailers across census tracts and in proximity to schools, calculating differences between the traditional v. expanded mRFEI. Setting: Calgary and Edmonton, Canada. Participants: N/A. Results: Of the 10 828 food retailers geocoded, 26 % were included using traditional mRFEI measures, while 53 % were included using our expanded categorisation. Changes in mean mRFEI across census tracts were minimal, but the healthfulness of food environments surrounding schools significantly decreased. Conclusions: Overall, we show how our mRFEI adaptation, and transparent reporting on its use, can promote more nuanced and comprehensive food environment assessments to better support local research, policy and practice innovations. [ABSTRACT FROM AUTHOR]

To inform public health policy implementation in Australia, our study investigated the level of public support for six policy initiatives addressing unhealthy diet. The policy initiatives included taxing soft drinks and energy drinks, taxing less healthy food and beverage purchases, zoning to restrict the supply of junk foods near schools, prohibiting advertising and promotion of less healthy food and beverages to children under the age of 16 and restricting sugar-sweetened beverages from vending machines in schools, and public places. Data from a cross-sectional population-based study for 4040 Australians aged 15+ years, were analysed. A high overall support across all policy initiatives was observed. Nearly three-quarter of public support was observed for policy initiatives targeting children (zoning to restrict the supply of junk food near schools, prohibiting advertising and promotion of less healthy food and beverages to children under the age of 16 and restricting sugars-sweetened beverages from vending machines in schools), and half of Australians supported policy initiatives of taxing soft drinks and energy drinks and taxing less healthy food and beverage purchases. Australian women and those with tertiary level of education were more likely to support public health initiatives targeting children and all policy initiatives respectively. Interestingly, young adults expressed low level of support for all policy initiatives. The study demonstrated considerable public support for policy initiatives focussed on protecting children from unhealthy diet in Australia. Framing, designing and implementing policies targeting children is potentially a good starting point for policymakers to create a health promoting food environment. [ABSTRACT FROM AUTHOR]

Native American Indians and First Nations are predisposed to obesity and diabetes. A study was done to understand Cree schoolchildren's diabetes awareness and body size perceptions in two communities that had diabetes awareness-raising activities in the Province of Quebec, Canada. Children (N = 203) in grades 4-6 were classified into weight categories using measured heights and weights and grouped on diabetes awareness based on dichotomous responses to the question "Do you know what diabetes is?" Children selected a drawing of an American Indian child whom they felt most likely to get diabetes and described their body size perception using a closed response question. Although 64.5% of children were overweight or obese, most (60.1%) children considered their body size to be "just right", with 29.6% considering it "too big" and 10.3% considering it "too small". A minority (27.6%) of children had diabetes awareness. These children were more likely than children without diabetes awareness to consider their body size too big (42.9 versus 24.5%) and to choose an obese drawing as at risk for diabetes (85.7 versus 63.3%, odds ratio 3.48 and 95% confidence interval 1.53-7.91). Culturally appropriate health education programs to increase schoolchildren's diabetes awareness and possibility to have a healthy body weight are important.

This study describes the development and psychometric evaluation of four scales measuring leadership for health promotion at an organizational level in the baseline survey (n = 144) of the Alberta Heart Health Project. Content validity was established through a series of focus groups and expert opinion appraisals, pilot testing of a draft based on capacity assessment instruments developed by other provinces involved in the Canadian Heart Health Initiative, and the literature. Psychometric analyses provided empirical evidence of the construct validity and reliability of the organizational leadership scales. Principal component analysis verified the unidimensionality of the leadership scales of (a) Practices for Organizational Learning, (b) Wellness Planning, (c) Workplace Climate, and (d) Organization Member Development. Scale alpha coefficients ranged between 0.79 and 0.91 thus establishing good to high scale internal consistencies. These measures can be used by both researchers and practitioners for the assessment of organizational leadership for health promotion and heart health promotion. (Contains 1 figure and 2 tables.)

Objective: The purpose of this study was to validate measures of individual and organisational infrastructure for health promotion within Alberta's (Canada) 17 Regional Health Authorities (RHAs). Design: A series of phases were conducted to develop individual and organisational scales to measure health promotion infrastructure. Instruments were designed with focus groups and then pre-tested prior to the validation study. Setting: In 1993 all hospitals and Public Health Units in the province of Alberta were regionalised into 17 RHAs, with responsibility for public health, community health, and acute and long-term care. While regionalisation may offer more opportunity for community participation, reorganisation of the public health system may have fragmented and diluted resources and skills for heart health promotion in some RHAs. Infrastructure (for example, human and financial resources), amongst other items, is believed to contribute to the capacity to promote health. Method: All 17 RHAs participated in the study, yielding a total of 144 individuals (that is board members, senior/middle management, and front line staff). These representative employees completed a self-administered questionnaire on individual- and organisational-level infrastructure measures. Results: Psychometric analyses of survey data provided empirical evidence for the robustness of the measures. Principal component analyses verified the construct validity of the scales, with alpha coefficients ranging from 0.75 to 0.95. Conclusion: The scales can be used by health professionals and researchers to assess individual- and organisational-level infrastructure, and tailor interventions to increase infrastructure for health promotion in health organisations. (Contains 4 tables.)

This issue includes an illuminating paper entitled 'Variation across Canada in the economic burden attributable to excess weight, tobacco smoking, and physical inactivity'. (1) The research used innovative economic modeling [...]

OBJECTIVES: To assess what health promotion policies and practices were adopted by schools in Nova Scotia and the extent that these policies and practices affected the diet quality, physical activity (PA) and weight status of students. METHODS: We developed and administered a 'school practice assessment tool' to assess the presence of 72 different school-based health promotion policies and practices. Surveys were conducted in 2003 and 2011 to assess diet, PA and weight status in approximately 100 grade 5 students. We used multilevel regression methods to examine changes in these outcomes across schools with varying levels of health promotion policies and practices between the two time-points. RESULTS: Between 2003 and 2011 the diet quality of students improved, PA decreased and the prevalence of childhood obesity increased. Although we did not find consistent or significant favourable benefits resulting from higher implementation levels, we did observe fewer negative trends among schools at higher levels of implementation. CONCLUSION: Our results build on the current gap in knowledge on the impact of Health Promoting Schools (HPS) implementation through population health interventions, but there is a continued need for further evaluation and monitoring of school policies to understand how HPS practices are supporting healthier eating and PA for students. KEY WORDS: Public health; schools; health promotion; health behaviour; prevention Can J Public Health 2015; 106(2):e43-e51 doi: 10.17269/CJPH.106.4743 OBJECTIFS : Evaluer les politiques et les pratiques de promotion de la sante adoptees dans les ecoles de la Nouvelle-Ecosse et leur effet sur la qualite du regime, l'activite physique (AP) et le statut ponderal des eleves. METHODES : Nous avons elabore et administre un <> pour evaluer la presence de 72 politiques et pratiques distinctes de promotion de la sante a l'ecole. Des sondages ont ete menes en 2003 et en 2011 pour evaluer le regime, l'AP et le statut ponderal d'environ 10 000 eleves de 5e annee. Nous avons utilise des methodes de regression multiniveaux pour examiner les changements dans les resultats obtenus par les ecoles ayant adopte divers niveaux de politiques et de pratiques de promotion de la sante entre les deux dates. RESULTATS : Entre 2003 et 2011, la qualite du regime des eleves s'est amelioree, l'AP a diminue, et la prevalence de l'obesite juvenile a augmente. Nous n'avons pas trouve d'avantages systematiques ou significatifs resultant de niveaux de mise en reuvre superieurs, mais nous avons observe moins de tendances negatives dans les ecoles aux niveaux de mise en reuvre superieurs. CONCLUSION : Nos resultats comblent une partie des lacunes actuelles dans les connaissances sur l'effet de la mise en reuvre d'interventions en sante des populations dans les << ecoles faisant la promotion de la sante >> (EPS), mais il existe encore un besoin d'evaluer et de surveiller les politiques scolaires afin de comprendre comment les pratiques des EPS appuient l'alimentation saine et l'AP chez les eleves. MOTS CLES : sante publique; ecoles; promotion de la sante; comportement sanitaire; prevention, Establishing healthy eating and physical activity (PA) behaviours among children is important for prevention of chronic diseases later in life (1) and promotion of health and well-being throughout the lifespan. [...]