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Objective: To examine the associations between food security status and dietary patterns among first-time food-aid users., Methods: From September 2018 to January 2020, a sample of 1001 newly registered food-aid users from 106 community-based food donation organizations were recruited across urban, rural, and peri-urban areas in four administrative regions of the province of Quebec, Canada. The Household Food Security Survey Module (HFSSM) and the Short Diet Questionnaire (SDQ) were used to assess food security status and food intake, respectively. A posteriori dietary patterns were identified through principal component analysis. Regression analyses were performed on 987 participants with complete data to quantify the association between food security status and dietary patterns., Results: Three main dietary patterns were identified: prudent (intake of fruits and fruit juice, plant-based beverages and legumes, green salad, carrots, other vegetables, whole grains, and fish), western (intake of poultry, red meat, potatoes and fried potatoes, rice, and pasta and refined grains), and snack foods (intake of salty snacks, cheese, butter and margarine, sweets, condiments, sweet beverages, and processed meat). Food insecurity was negatively associated with the prudent dietary pattern and positively associated with the snack food dietary pattern., Conclusion: This study highlights the complexity of dietary patterns in a vulnerable population of first-time food-aid users, especially among those who are severely food insecure., (© 2024. The Author(s) under exclusive license to The Canadian Public Health Association.)

Objective: To characterize 12-month trends in the use of food donations and other food-related community-based social assistance programs (CB-SAPs) during the first year following the enrollment of new food bank (FB) users in Quebec, Canada. Methods: A cohort of 1,001 newly registered FB-users in Quebec from the Pathways Study were followed-up during 12-month following baseline assessment. Outcomes were monthly use of food donations and other food-related CB-SAPs. Main predictors were alternative food source utilization (AFSU) profiles: 1) exclusive-FB-users; 2) FB+fruit/vegetable-market-users; and 3) Multiple/diverse-AFS-users. Covariates included sociodemographic characteristics, health status, and major life events. We fit Bayesian hierarchical mixed-effect models, accounting for spatial clustering, temporal correlation, and censoring. Results: We observed an overall downward trend of food donation use among study completers ( n = 745). Each AFSU profile had a distinctive monthly trend of food donation use, but probabilities of use across the three profiles overlapped, between 44% and 55%. The use of other food-related CB-SAPs was low and not correlated with AFSU profiles. Conclusion: De novo FB-users use food donations in different ways over time according to specific contextual AFSU profiles., Competing Interests: The authors declare that they do not have any conflicts of interest., (Copyright © 2024 Pérez, Carabali, Mercille, Sylvestre, Roncarolo and Potvin.)

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., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Purpose: The healthcare sector is an important area for sustainable food initiatives, given its inherent mission to heal and its substantial impact on the food system. Foodservice managers can take part in these initiatives by using sustainable menu practices (SMPs). This study aimed to explore managerial perceptions of barriers and facilitators to adopting SMPs in Québec healthcare institutions. Methods: Seventeen foodservice managers were recruited through purposeful sampling to participate in a qualitative semi-structured interview. The Diffusion of Innovations theory was used to assess the main determinants of the diffusion of an innovation (SMPs) through a complex social system (healthcare organization). Results: Participants reported more barriers than facilitators. Lack of support at many levels was recognized as a major hindrance to SMP adoption, as were shortfalls in political directives. Increased collaboration between all food system actors and better communication in healthcare were perceived as needed for increased SMP adoption. Conclusions: This research contributes to an in-depth understanding of managerial experiences in SMP adoption in various regional and healthcare settings. Findings suggest the need for support and strategies that would remove important barriers for foodservice managers and contributed to the development of a guide to support foodservice managers in implementing SMPs.

Background: Local food environments are recognized by experts as a determinant of healthy eating. Food cooperatives (coop) can promote the accessibility to healthier foods and thus improve the health of the population, particularly in remote rural communities., Objective: To measure the effects of implementing a food coop in a disadvantaged community with poor access to food. We have two main research questions: (1). Does the establishment of a food coop in rural areas described as food deserts have an impact on accessibility, frequency of use, food consumption, food quality, and ultimately the health of individuals? (2). Does the establishment of a food coop in rural areas described as food deserts have an impact on food security and community vitality?, Design: A natural experiment with a mixed pre/post method will be used. The sample is composed of households that came from geographically isolated communities (population: 215 to 885 inhabitants) which qualified as food deserts and located in rural areas of Quebec (Canada). All communities plan to open a food coop (in the years 2022-2023), and as their opening will be staggered over time, participants from communities with a new food coop (intervention) will be compared to communities awaiting the opening of their food coop (control). Data collection was carried out at three time points: (1) before; (2) 1 to 5 months after; and (3) 13 to 17 months after the opening of the coop. Questionnaires were used to measure sociodemographic variables, dietary intake, residents' health, and community vitality. Semi-structured interviews were conducted with community stakeholders., Results: Few natural experiments have been conducted regarding the impact of implementing food coops. Gathering concrete data on the effectiveness and processes surrounding these interventions through natural experiments will help to quantify their impact and guide knowledge users and policymakers to make more informed decisions.

•Researchers must overcome multiple barriers in recruiting and retaining research participants living in conditions of vulnerability.•A comprehensive recruitment strategy that combines various elements tailored to vulnerable populations is required.•Most studies describing recruitment and retention of participants from vulnerable populations pertain to clinical settings.•This study describes strategies and challenges in recruiting participants through community organizations.•This paper provides recommendations on recruiting and retaining people living in conditions of extreme vulnerability., Competing Interests: The authors declare that they have no competing interests., (© 2022 Published by Elsevier Ltd.)

Objective: To describe the prevalence of food insecurity in First Nations households across Canada while identifying barriers and enablers to traditional food (TF) consumption., Methods: The First Nations Food, Nutrition and Environment Study is a cross-Canada participatory study of on-reserve First Nations from 2008 to 2018. The Household Food Security Survey Module was used to capture income-related challenges experienced by First Nations households. Households were classified as food secure, or marginally, moderately, or severely food insecure. Barriers and enablers to TF access and use were identified describing the Indigenous experience., Results: Almost half of on-reserve First Nations households were food insecure and the prevalence was higher than that for non-Indigenous households in Canada. On-reserve food insecurity prevalence was higher in western regions of Canada. First Nations households with children experienced greater food insecurity than those without children. More adults experienced severe food insecurity than children. Most adults would like to have more TF in their diet but state that factors such as financial and household constraints, industrial activities, government regulations, climate change, and fear of contamination impede greater access. Food costs were substantially higher in remote First Nations communities, but remoteness was not associated with food security in multivariable analysis., Conclusion: Existing systems have been unsuccessful in curbing the food insecurity in First Nations households. Improving food security hinges on achieving Indigenous Food Sovereignty, the key to long-term conservation and stewardship of the land and the co-management of these by Indigenous Peoples. Studies investigating the feasibility of increasing TF from an Indigenous perspective are required.

Background: The displacement of traditional dietary practices is associated with negative nutritional consequences for rural Indigenous people, who already face the brunt of both nutritional inadequacies and excesses. Traditional food (TF) consumption and production practices can improve nutritional security by mitigating disruptive dietary transitions, providing nutrients and improving agricultural resilience. Meanwhile, traditional agricultural practices regenerate biodiversity to support healthy ecosystems. In Ecuador, Indigenous people have inserted TF agricultural and dietary practices as central elements of the country's agroecological farming movement. This study assesses factors that may promote TF practices in rural populations and explores the role of agroecology in strengthening such factors., Methods: Mixed methods include a cross-sectional comparative survey of dietary, food acquisition, production and socioeconomic characteristics of agroecological farmers (n = 61) and neighboring reference farmers (n = 30) in Ecuador's Imbabura province. Instruments include 24-h dietary recall and a food frequency questionnaire of indicator traditional foods. We triangulate results using eight focus group discussions with farmers' associations., Results: Compared to their neighbors, agroecological farmers produce and consume more TFs, and particularly underutilized TFs. Farm production diversity, reliance on non-market foods and agroecology participation act on a pathway in which TF production diversity predicts higher TF consumption diversity and ultimately TF consumption frequency. Age, income, market distance and education are not consistently associated with TF practices. Focus group discussions corroborate survey results and also identify affective (e.g. emotional) and commercial relationships in agroecological spaces as likely drivers of stronger TF practices., Conclusions: Traditional food practices in the Ecuadorian highlands are not relics of old, poor and isolated populations but rather an established part of life for diverse rural people. However, many TFs are underutilized. Sustainable agriculture initiatives may improve TF practices by integrating TFs into production diversity increases and into consumption of own production. Agroecology may be particularly effective because it is a self-expanding global movement that not only promotes the agricultural practices that are associated with TF production, but also appears to intensify affective sentiments toward TFs and inserts TFs in commercial spaces. Understanding how to promote TFs is necessary in order to scale up their potential to strengthen nutritional health.

Objectives: Sustainable nutrition is increasingly important, as the food system contributes one third of greenhouse gas emissions. Sustainable nutrition, or sustainable diet, refers to diets with low environmental impacts that contribute to food security and health. This systematic review aimed to identify factors that influence whether professionals in health-related institutions integrate sustainable nutrition into their practice., Methods: A mixed-methods systematic review was conducted using the MEDLINE, Embase, PsycINFO, and CINAHL databases. To be included, the studies had to document perspectives on sustainable nutrition from health professionals, including dietitians, students and educators in health sciences, public health officers, and hospital food service managers. Data extraction focused on perceived barriers, facilitating factors, and top recommendations for promoting sustainable nutrition., Synthesis: Twenty studies were included, most of which focused on dietitians. Data analysis revealed that 25 factors influenced the integration of sustainable nutrition into professional practice. The factors most reported in the included studies were perceived knowledge of sustainable nutrition, self-efficacy, awareness of environmental issues, and perceiving the promotion of sustainable nutrition to be part of one's professional role. Increasing societal support through awareness campaigns and increasing institutional support through guidelines, information tools, and financial support were also frequently mentioned., Conclusion: Sustainable nutrition is a multifaceted concept; integrating it into already complex professional practices is therefore challenging. At the present time, dietitians seem to be the health professionals predominantly researched regarding their views on sustainable nutrition. Many concrete avenues to promote sustainable nutrition were identified through this review.

Background: Food shopping behaviors may help determine how local food environments influence fruit and vegetable (F/V) intake, especially among food insecure households., Objective: To examine whether household food security, food access, and food shopping behaviors are associated with F/V intake among residents of a low-income neighborhood., Design: Study design is cross-sectional., Participants/setting: A simple random sample of 451 adults from a low-income neighborhood in Montreal (Canada) were recruited through telephone interviews in 2014. Final analyses included 417 participants., Main Outcome Measures: Validated assessment tools were applied to measure F/V intake and to distinguish food secure (FS) from food insecure (FI) participants. Neighborhood food access was calculated according to number of food stores within 0.5 miles of road network buffer of participants' homes. Self-reported food shopping behaviors included trip frequency, store types, and transport used to reach the 3 most frequented stores. Participants also reported on mobility constraints, use of F/V markets, gardening, and perceived access to healthy food., Statistical Analyses: F/V intake was modeled using multivariable linear regression., Results: A sample of adults, of whom 21.3% were living in FI households, reported consuming F/V an average of 4.1 times daily. FI participants had a lower intake of F/V (b = -0.69, P = .04), independent of sociodemographics, food access, resource constraints, perceived access to healthy food, and food shopping behaviors. Participants with mobility constraints had lower F/V intake (b = -0.68, P = .02), while gardening was associated with higher F/V intake (b = 0.59, P = .01). Number of supermarkets (b = -0.06, P = .03) and specialty stores (b = 0.10, P = .04) were associated with F/V intake, although the strength of the association was weak., Conclusions: For FI households, barriers to food access linked to financial challenges are associated with lower intake of F/V. Studies on food environment should include people's experience of food access to better understand the numerous barriers to F/V consumption faced by FI households., (Copyright © 2020 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Neighbourhood community life has been widely recognized as an important determinant of population health. This systematic review of reviews provides an overview of the evidence for the ecological correlation between neighbourhood community life and population health. Nine databases were searched from 2008 to 2018 in order to identify systematic reviews of studies examining the association between neighbourhood community life and population health in urban neighbourhoods within the Organisation for Economic Co-operation and Development countries. Two reviewers completed selection and data extraction, then assessed the methodological quality of reviews using the Measurement Tool to Assess Systematic Reviews. We identified three high quality reviews and five of moderate quality. The reviews vary in quality of methodology, concepts, and measures. Most of the reviews examined the influence of social cohesion, social capital, and social interactions on health. Reviews found evidence supporting a consistently favourable correlation between social cohesion and physical activity, as well as a favourable trend in the relationship between social cohesion and healthy weight. They also found evidence of a favourable trend in the correlation between social capital and healthy weight. Reviews identified studies supporting a consistently favourable correlation between social interaction and depression. We identify evidence of a positive association between neighbourhood community life and several population health outcomes. Future research should define and conceptualize neighbourhood community life factors and health indicators to improve the comparison between studies and the process of evidence synthesis. This will also enable policy makers to take appropriate decisions., Competing Interests: Declaration of competing interest No potential conflict of interest reported by the authors., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Farmers' market implementation holds promise for increasing access to healthy foods. Although rarely measured, purchase data constitute an intermediate outcome between food environment and actual consumption. In a study conducted with two seasonal Fruits and Vegetables (FV) stands in a disadvantaged area of Montréal (Canada), we analysed how accessibility, perception, and mobility-related factors were associated with FV purchase. This analysis uses a novel measure of FV purchasing practices based on sales data obtained from a mobile application. A 2016 survey collected information on markets' physical access, perceived access to FV in the neighbourhood, usual FV consumption and purchases. Multivariate models were used to analyse three purchasing practice indicators: number of FV portions, FV variety and expenditures. Average shoppers purchased 12 FV portions of three distinct varieties and spent 5$. Shoppers stopping at the market on their usual travel route spent less ( p = 0.11), bought fewer portions ( p = 0.03) and a lesser FV variety ( p < 0.01). FV stands may complement FV dietary intake. Individuals for whom the market is on their usual travel route might make more frequent visits and, therefore, smaller purchases. The novel data collection method allowed analysis of multiple purchase variables, is precise and easy to apply at unconventional points of sales and could be transposed elsewhere.

Agroecology is increasingly recognized as a sustainable production strategy that is appropriate for the rural poor. Meanwhile, agricultural initiatives have received much attention for their role in improving farmer nutrition, and three key pathways between agriculture and nutrition include consumption of own production, income and women's empowerment. In this study based in Ecuador's Imbabura province, we used qualitative methods to explore the practices of agroecological farmers with respect to these three key pathways. Results demonstrate the heterogeneity of lived experiences through which agroecology increases agricultural diversity and builds social and human capital to improve nutrition. We further identify barter as an under-explored means to nutrition outcomes, and we discuss the role of the complex rationales that mediate farmers' performance on agriculture-for-nutrition pathways. Finally, our results illustrate agroecology's potential to spread nutrition-promoting practices through endogenous farmers' networks.

Objective: Alternative food sources (AFS) such as local markets in disadvantaged areas are promising strategies for preventing chronic disease and reducing health inequalities. The present study assessed how sociodemographic characteristics, physical access and fruit and vegetable (F&V) consumption are associated with market use in a newly opened F&V market next to a subway station in a disadvantaged neighbourhood., Design: Two cross-sectional surveys were conducted among adults: (i) on-site, among shoppers who had just bought F&V and (ii) a telephone-based population survey among residents living within 1 km distance from the market., Setting: One neighbourhood in Montreal (Canada) with previously limited F&V offerings., Subjects: Respectively, 218 shoppers and 335 residents completed the on-site and telephone-based population surveys., Results: Among shoppers, 23 % were low-income, 56 % did not consume enough F&V and 54 % did not have access to a car. Among all participants living 1 km from the market (n 472), market usage was associated (OR; 95 % CI) with adequate F&V consumption (1·86; 1·10, 3·16), living closer to the market (for distance: 0·86; 0·76, 0·97), having the market on the commute route (2·77; 1·61, 4·75) and not having access to a car (2·96; 1·67, 5·26)., Conclusions: When implemented in strategic locations such as transport hubs, AFS like F&V markets offer a promising strategy to improve F&V access among populations that may be constrained in their food acquisition practices, including low-income populations and those relying on public transportation.

Objectives: The relationships between local food environments and dietary patterns are important for older adults and could be different in men and women. We examined associations between exposure to neighbourhood food sources and food consumption and the moderating role of diet knowledge separately among older women and men living in Montreal in 2003-2005 (n = 722)., Methods: The proportion of fast-food outlets relative to all restaurants (%FFO) and the proportion of healthy food stores relative to all stores (%HFS) were estimated for 500 m buffers around participants' homes. Two dietary patterns, designated "Western" and "prudent", reflecting lower- and higher-quality diets respectively, were identified from food frequency questionnaire data. The unique and interactive effects of diet knowledge and food-source exposure on diet scores were tested with separate linear regression models for women and men., Results: For men, greater %FFO exposure was related to lower prudent diet scores (β = -0.18, p = 0.02), but no effect of %HFS exposure was observed and no interactions were statistically significant. For women, an inverse relationship between %FFO and prudent diet scores was strongest among those with low diet knowledge (β = -0.22, p < 0.01). No other associations were statistically significant., Conclusion: Older men's diet patterns may reflect unhealthy cues associated with fast-food outlets. Among women, diet knowledge potentiated both negative and positive relationships with the food environment. In the absence of consistent main effects of the food environment on diet scores, subgroup analysis is a promising avenue for research.

Studies of food environment often examine single dimensions of areas that may not account for complexity of exposure to all food sources. With respect to the deprivation amplification hypothesis, particular needs are to assess whether relative or absolute measures of the food environment are related to characteristics of social environment. The objective of this study was to compare absolute availability (AA) of fast food outlets (FFO) and stores selling fresh fruits and vegetables (FVS) with the relative availability (RA) of the same food sources in relation to area-level poverty and ethnic diversity in 248 selected census tracts (CT) in Montreal, Canada. AA of FFO and FVS were expressed as areal densities of food sources within CTs. RA indices were calculated as the proportion of FVSs relative to total food stores and the proportion of FFOs relative to all restaurants within CTs, respectively. Whereas the AA of FFO was positively associated with area-level poverty and ethnic diversity, the RA of FFO was inversely associated with area-level poverty and not associated with ethnic diversity. Both measures of FVS were positively associated with area-level poverty and ethnic diversity. These findings do not support a model of deprivation amplification. Furthermore, results of FFO suggest that the alternate measure of RA can complement information based on AA indicators of the food environment, with potential utility in predicting eating practices.

Objective: This article examined the associations between proximity to selected locations considered to be conducive to social participation, and social participation itself, in urban-dwelling seniors., Methods: A sample of 520 older adults residing in the Montreal area provided reports of social participation and information about health, sociodemographic characteristics, social networks, and perceptions about features of their residential environment. Information about the distance between their home and five locations deemed to be conducive to social participation were obtained from a geographic information system., Results: Analyses showed a significant association between proximity to selected locations and social participation while accounting for individual characteristics and perceptions of neighborhood features (β = 0.37; SE = 0.17; p < 0.05)., Discussion: Findings were consistent with contributions highlighting the impact of the built environment on seniors' health-related behavior. Future work would benefit from the use of longitudinal designs and examinations of social participation through alternate channels.

Objective: To examine associations between the availability of residential-area food sources and dietary patterns among seniors., Design: Cross-sectional analyses. Individual-level data from the NuAge study on nutrition and healthy ageing were merged with geographic information system data on food store availability and area-level social composition. Two dietary patterns reflecting lower- and higher-quality diets (respectively designated 'western' and 'prudent') were identified from FFQ data. Two food source relative availability measures were calculated for a 500 m road-network buffer around participants' homes: (i) proportion of fast-food outlets (%FFO) relative to all restaurants and (ii) proportion of stores potentially selling healthful foods (%HFS, healthful food stores) relative to all food stores. Associations between dietary patterns and food source exposure were tested in linear regression models accounting for individual (health and sociodemographic) and area-level (socio-economic and ethnicity) covariates., Setting: Montréal metropolitan area, Canada., Subjects: Urban-dwelling older adults (n 751), aged 68 to 84 years., Results: %FFO was inversely associated with prudent diet (β = -0·105; P < 0·05) and this association remained statistically significant in models accounting for %HFS. %HFS was inversely associated with lower western diet scores (β = -0·124; P < 0·01). This latter association no longer reached significance once models were adjusted for area-level covariates., Conclusions: In Montréal, the food environment is related to the diet of older adults but these links are more complex than straightforward. The absence of significant relationships between healthful food stores and prudent diets, and between fast-food outlets and western diets, deserves further investigation.

Purpose: Determinants of self-efficacy related to food preparation using store-bought food were examined in women belonging to the Atikamekw Nation. Also examined was whether self-efficacy was associated with household food insecurity., Methods: A cross-sectional survey was conducted with 107 women responsible for household food supplies. Two self-efficacy scores were calculated, one for healthy food preparation and one for food preparation in general. Household food insecurity was measured with an adapted version of the United States Food Security Core Module. The other variables were household composition, income sources, food supplies, tobacco use, participants' health status, and lifestyle and sociodemographic characteristics. Multiple linear regression was used to analyze associations between self-efficacy and household food insecurity in 99 participants., Results: Severe household food insecurity was associated with significantly lower healthy food preparation scores in Atikamekw women. Other associated variables were food supplies, marital status, alcohol consumption, weight status, and understanding of the native language., Conclusions: Application of the concept of self-efficacy contributes to a better understanding of the factors influencing food preparation in Atikamekw women. In this study, self-efficacy in healthy food preparation was linked to food insecurity and obesity, particularly in the most serious cases. Efforts to improve diet will require not only behavioural interventions, but public policies.

Objective: To understand more specifically how the quality, quantity and frequency of snack food consumption differs in different BMI categories., Design: Four hundred and forty-nine school-aged children (grade 4-6) from a Kanien'kehaka (Mohawk) community provided a 24 h recall and their height and weight in 1994, 1998 and 2002, in three independent cross-sectional samples. Food consumed between two consecutive meals was defined as a snacking occasion. ANOVA and chi2 tests were used to compare food choices between BMI categories according to food quality criteria and food groups in 2006. Logistic regression models were performed to compare results between normal-weight children and those at risk of overweight and between normal-weight and overweight children., Results: Energy intake from snacks tended to be higher for children at risk of overweight, compared with the other two BMI categories. Food groups with a higher energy density were also consumed more frequently by these children, with larger average portions of cereal bars (P < 0.05). Except for dessert consumption, which was less frequent among overweight children, no other variable distinguished risk of overweight in the two logistic regression models tested., Conclusions: Differences detected in snack food intake between normal-weight children and children at risk of overweight could explain in part the relationship between food choices and risk of overweight. Studies of dietary differences in conjunction with body weight would benefit from considering children at risk of overweight and normal-weight children, rather than children with excess weight only.