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Weight bias and discrimination are highly pervasive and harmful to Canadians with higher weights. Researchers and practitioners who deliver, evaluate, and advise on dietary and weight-related interventions may inadvertently perpetuate weight bias through their work; however, trainees in these fields rarely have access to weight bias education within their applied health programs. This study evaluated the acceptability of an online educational weight bias module developed for undergraduate students enrolled in health courses. The intervention included a pre-recorded 20-minute online module with prompts for reflection or discussion, a self-assessment quiz, as well as a separate module and range of resources for instructors. Overall, 211 students from applied health courses and 4 instructors completed an online survey querying the module’s delivery, impact, and relevance. Students agreed that the module provided useful information (82%), was easy to understand (97%), and was the right length (75%), but reported wanting more interactivity and engagement with the content. Instructors found the module engaging and useful and expressed interest in additional resources and support for weight bias education. Future research should explore the impact of weight bias education on students’ weight-related attitudes and perceptions as well as feasibility and relevance of online features such as multimedia tools.

Indigenous communities in Canada are concerned about the health of their youth and the reclamation of traditional food-related skills amongst their people. Food sovereignty has an integral role in food and nutrition security, and the path to Indigenous self-determination. Learning Circles: Local Healthy Food to School (LC:LHF2S) was a community engagement model that aimed to enhance access to local, healthy, and traditional foods for youth. In each of four First Nations communities, a Learning Circle Evaluation Facilitator worked to plan and implement activities, build on community strengths, and promote partnerships. This paper describes how the model was perceived to support food sovereignty. Data included interviews, process reporting, and school surveys, and was analyzed according to pillars effective for the development of food sovereignty in Indigenous communities. Goals set by two communities incorporated food sovereignty principles, and in each community capacity-building work furthered the development of a more autonomous food system. There were many examples of a transition to greater food sovereignty, local food production, and consumption. Indigenous governance was an important theme and was influential in a community’s success. The model appears to be an adaptable strategy to support the development of food sovereignty in First Nations communities.Novelty:LC:LHF2S was a community engagement model that aimed to enhance access to local, healthy, and traditional foods for youth. The model is an adaptable strategy to support the development of food sovereignty in First Nations communities. There were many examples of a transition to greater food sovereignty, local food production, and consumption.

Purpose: The purpose of this paper is to understand Canadian dietitians’ use of the Nutrition Care Process (NCP) and terminology (NCPT) nationally and by province/territory as well as facilitators, barriers, and attitudes regarding the NCP/NCPT. Methods: Canadian dietitians were invited to complete an online survey (SurveyMonkey) on the NCP/NCPT from February to April 2017 through multiple channels. Data were analyzed using descriptive statistics and nonparametric tests. Results: Overall, there were 500 eligible respondents; the analysis focused on dietitians working in clinical care who were familiar with the NCP (n = 420). In total, 87.9% and 77.5% of respondents reported always/frequently using aspects of the NCP and NCPT in their practice, respectively. There were variations in use by province/territory (P Conclusions: Overall, most clinical care dietitians reported some type of use of the NCP/NCPT. There were provincial/territorial variations in use, barriers, and facilitators. These findings provide information to develop strategies to enhance use of the NCP/NCPT in Canada.

Background: Collaborative approaches to knowledge translation (KT) are important for advancing community-engaged research. However, there is a need for examples of participatory approaches that have effectively supported public health research and program development with First Nations communities. To strengthen KT with communities, we proposed a set of guiding principles for participatory planning and action for local food system change. Principles emerged from a cross-community analysis of Learning Circles: Local Healthy Food to School (LC:LHF2S) a participatory program (2015-2019) for Indigenous food system action. The objective was to identify guiding principles for participatory planning from key learnings and successes on scaling-up the Learning Circle (LC) vertically in Haida Nation, British Columbia (BC) and horizontally in three distinct community contexts: Gitxsan Nation, Hazelton /Upper Skeena, BC; Ministikwan Lake. Application of these principles is discussed in the context of our ongoing partnership with Williams Treaties First Nations to support community planning to enhance food security and sovereignty. Methods: A cross-community thematic analysis was conducted and guided by an implementation science framework, Foster-Fishman and Watson’s (2012) ABLe Change Framework, to identify key learnings and successes from adapting the LC approach. Information gathered from community interviews (n=52), meeting summaries (n=44) and tracking sheets (n=39) was thematically analyzed to inform development of guiding principles. Community sense making of findings informed applicability in a new community context embarking on food systems work. Results: Emergent guiding principles for participatory food system planning and action included: (1) Create safe and ethical spaces for dialogue by establishing trust and commitment from the ground up; (2) Understand context for change through community engagement; (3) Foster relationships to strengthen and sustain impact; and (4) Reflect and embrace program flexibility to integrate learnings. Conclusions: Emergent principles offer guidance to supporting Indigenous community-led research and mobilization of knowledge into action. Principles are intended to support researchers and health system administrators with taking a collaborative approach that fosters relationships and integration of community leadership, knowledge, and action for food system change. Application of principles with implementation frameworks can strengthen KT in Indigenous contexts by incorporating community-protocols and perspectives in support of Indigenous self-determined priorities.

Youth health, long-term food sovereignty and the reclamation of traditional food-related knowledge are areas of concern within Indigenous communities in Canada. Learning Circles: Local Healthy Food to School (LC:LHF2S) built on an exemplar program in four predominantly Indigenous communities. In each, the initiative worked with interested community members to plan, implement and evaluate a range of activities aimed at enhancing access to local, healthy and traditional foods for schools and youth. This case study describes the context, process, outcomes and perceptions of implementation in one of the communities, Hazelton/Upper Skeena, located in northern British Columbia. Data were collected between 2016–2019 and included semi-directed interviews with community members and LCEF (n = 18), process reporting (e.g., LCEF reports, emails, conference calls and tracking data), photographs and video footage, and photovoice. Data were analyzed thematically. Hazelton/Upper Skeena has an active local and traditional food culture. Indigenous governance was supportive, and community members focused on partnership and leadership development, gardens, and food skills work. Findings point to strengths; traditional food, knowledge and practices are valued by youth and were prioritized. LC:LHF2S is a flexible initiative that aims to engage the broader community, and exemplifies some of the best practices recommended for community-based initiatives within Indigenous communities. Results indicate that a LC is a feasible venture in this community; one that can facilitate partnership-building and contribute to increased access to local and traditional food among school-aged youth. Recommendations based on community input may help the uptake of the model in similar communities across Canada, and globally.

Integrated knowledge translation (IKT) and community-based participatory research (CBPR) are recognized as effective approaches when Indigenous and non-Indigenous partners work together to focus on a common goal. The “Learning Circles: Local Healthy Food to School” (LC:LHF2S) study supported the development and implementation of Learning Circles (LC) in 4 Canadian Indigenous communities with the goal of improving local, community-based healthy food systems. Critical to the research process were annual gatherings (AG) where diverse stakeholders (researchers, Indigenous community members, and partners) visited each community to share knowledge, experiences, and provide support in the research process. Using a qualitative, descriptive method, this paper explores how the AG supported IKT across partners. Yearly interviews involving 19 total participants (with some participating multiple times across the 4 gatherings) elicited their AG experiences in supporting local LC:LHF2S. Three themes with multiple sub-themes were identified: (a) setting the stage for IKT (importance of in-person gatherings for building relationships across partners, learning from each other), (b) enabling meaningful engagement (aligning research with Indigenous values, addressing tensions and building trust over time, ensuring flexibility, and Indigenous involvement and leadership), and (c) supporting food system action at the local level (building local community engagement and understanding, and integrating support for implementation and scale-up of LC). This paper provides useful and practical examples of the principles of Indigenous-engaged IKT and CBPR in action in healthy, local, and traditional food initiatives. AG are a valuable IKT strategy to contribute to positive, transformative change and ethical research practice within Indigenous communities.

Introduction The teenage pregnancy rate of 25% in Uganda is worrying though it may seem low compared to 28% in Sub-Saharan countries and West and Central Africa. Young mothers in Uganda risk poor maternal and child health, being isolated, attempting unsafe abortions, failure to continue with school, and poverty. This paper describes perceptions and recommendations of young mothers, family and community members on why the high rate of teenage pregnancies in Uganda and how these can be reduced. Methods This qualitative research was conducted from March to May 2016 in six communities within Budondo sub-county (Jinja district), Eastern Uganda. In-depth oral interviews were conducted with 101 purposively sampled adolescent mothers, family members, and workers of government and non-government organizations. Thematic analysis framed around levels of influence within a social cognitive framework was conducted using Atlas-ti (version 7.5.4). Results Perceived determinants of teenage pregnancies include: lack of life and social survival skills, lack of knowledge on how to avoid pregnancy, low acceptance/use of contraceptives, neglect by parents, sexual abuse, pressure to contribute to family welfare through early marriage or sexual transactions, lack of community responsibility, media influence, peer pressure, cultural beliefs that promote early marriage/childbearing and lack of role models. Other contributing factors include drug use among boys, poverty, late work hours, long travel distances, e.g., to school, and unsupervised locations like sugarcane plantation thickets. Recommendations participants offered include: sensitization seminars and counselling for parents and girls, closing pornography outlets that accept entrance of minors, using the law to punish rapists, involvement of the President to campaign against early pregnancies, school dismissal before dark, locally accessible schools and job creation for parents to earn money to support the girls financially. Areas for capacity building are: training teachers and community members in transferring empowerment and vocational skills to girls, and construction of homes with separate rooms to support parents’ privacy. Conclusion The factors associated with adolescent pregnancy in Uganda fall under individual, economic, social and physical environmental determinants. Recommendations spanning family, community and government involvement can ultimately empower girls, their families and community members, and support collective action to reduce teenage pregnancies.

Food safety and food security are two important public health sectors within Canada, which aim to address foodborne disease and food insecurity, respectively. While these sectors are often siloed within public health organizations, the actions of the two sectors often interact and conflict at the program level despite their common goal of improving population health. The objective of the present study was to identify determinants that influenced the success of collaboration between practitioners of the two sectors in British Columbia, to inform Canadian food policy. We inductively analyzed 14 interviews with practitioners working in the two sectors who had experience with successful collaboration. Data were interpreted in consultation with an inter-professional collaboration framework. Participants identified determinants at the systemic level, including the cultural, professional, educational, legislative, and political systems, which were often considered barriers to collaboration. Participants also identified determinants at the organizational level that influenced the success of collaboration between the sectors, including: the organization’s structure and philosophy, leadership, resources, and communication mechanisms. Finally, participants identified interactional determinants as ways to overcome existing barriers, including: willingness to collaborate, trust, communication, mutual respect, and taking a solutions-oriented approach. Practitioners working in food safety and food security can apply the interactional determinants identified in this study to mitigate existing barriers to collaboration and support more synergistic food policies.

Background Weight gain and unfavorable changes in body composition are common in a growing population of breast cancer survivors, but the etiology of these changes is poorly understood. Objective The aim of this study was to investigate relationships between weight change and symptoms of physical and psychological distress in the first 12 months of completing treatment in women who had completed treatment for breast cancer. Methods Physical distress and psychological distress were assessed using the Rotterdam Symptom Checklist, the Distress Thermometer, and the Fatigue Symptom Inventory. Results Weight change in 28 women since the completion of treatment (mean, 6.4 ± 4.4 months) ranged from -6.0 kg to +5.2 kg (mean, -0.4 ± 3.2), with 6 women gaining and 7 women losing an average of 3.5 ± 1.0 and 5.1 ± 0.8 kg, respectively. Rotterdam mean scores for physical (17.5 ± 9.0) and psychological distress (27.1 ± 16.9) were similar to previous findings for patients with early-stage breast cancer in active treatment and appear to be markedly higher than distress levels previously reported in cancer-free adults. Distress levels, based on the Distress Thermometer, were moderate to severe in 35% of women. Fatigue was common and associated with interference in daily living for some women. Fatigue duration was negatively correlated with weight change (P = -0.46, P Conclusions Symptoms of physical and psychological distress persist for some women in the first year after completing treatment and may associate with weight change. Implications These findings underscore a need for ongoing assessment and supportive care across the breast cancer trajectory and may guide dietary counseling aimed at promoting healthy body weight and overall health in early survivorship.

In partnership with communities of the Williams Treaties First Nations in southern Ontario (Canada), we describe an approach to work with communities, and highlight perspectives of food security and sustainability, including priorities and opportunities to revitalize local food systems as a pathway to food security and food sovereignty. The objectives of our project were: (1) to build a shared understanding of food security and sustainability, and (2) to document community priorities, challenges and opportunities to enhance local food access. Utilizing an Indigenous methodology, the conversational method, within the framework of community-based participatory research, formative work undertaken helped to conceptualize food security and sustainability from a community perspective and solidify interests within the four participating communities to inform community-led action planning. Knowledge generated from our project will inform development of initiatives, programs or projects that promote sustainable food systems. The community-based actions identified support a path towards holistic wellbeing and, ultimately, Indigenous peoples’ right to food security and food sovereignty.

Summary As providers of community-based physical activity programs, recreation and sports facilities serve as an important resource for health promotion. Unfortunately, the food environments within these settings often do not reflect healthy eating guidelines. This study sought to describe facilitators and barriers to implementing provincial nutrition guidelines in recreation and sports facilities in three Canadian provinces with nutrition guidelines. Semi-structured interviews were analysed thematically to identify facilitators and barriers to implementing provincial nutrition guidelines. Facilitators and barriers were then categorised using a modified “inside out” socio-ecological model that places health-related and other social environments at the centre. A total of 32 semi-structured interviews were conducted at two time-points across the three guideline provinces. Interview participants included recreation staff managers, facility committee or board members and recreation volunteers. Eight facilitators and barriers were identified across five levels of the inside out socio-ecological model. Facilitators included provincial or municipal expectations of guideline implementation, clear communication to staff around guideline directives and the presence of a champion within the community or facility who supported guideline implementation. Barriers included unhealthy food culture within community, competition from other food providers and issues within food service contracts that undermined healthy food provision. Findings reinforce the importance of top down (clear expectations regarding guideline implementation at the time of approval) and bottom up (need for buy-in from multiple stakeholders) approaches to ensure successful implementation of nutrition guidelines. The application of a modified socio-ecological model allowed for a more nuanced understanding of leverage points to support successful guideline implementation. Lay summary Healthy eating is an important behaviour for preventing chronic diseases. Supporting people to access healthy foods in places where they live, learn, work or play is a public health priority. Recreation and sports facilities are a setting where people can be physically active. Unfortunately, the food environment in these settings may not reflect nutrition guidelines. In this study, we interviewed key stakeholders from recreation and sports facilities in three Canadian provinces who had put guidelines for healthy eating in place. We used a specific framework to do this called the inside out socio-ecological model. Eight facilitators and barriers were identified using this model. Facilitators included provincial or municipal expectations of guideline implementation, clear communication to staff around guideline directives and the presence of a champion within the community or facility who supported guideline implementation. Barriers included unhealthy food culture within community, competition from other food providers and issues within food service contracts that undermined healthy food provision. Our findings can help people working in recreation and sports facilities to identify issues that may help or hinder healthy food provision in these settings.

The transition from elementary to secondary school is an emotionally and socially complex time when adverse behaviors appear, such as decreased levels of physical activity (PA). Behavioral and environmental factors that influence PA during this time are poorly understood. Therefore, we aimed to identify factors that influence PA as adolescents transition to secondary school. Qualitative interviews were conducted with a sample of 27 ethnically diverse child&ndash, parent dyads within the public-school system in British Columbia, Canada (50% boys, 68% mothers, 25% White). The interviews probed for environmental and behavioral factors in school, family, and social contexts that potentially initiated changes in PA, specifically related to the adolescents&rsquo, transitions. Interviews were recorded and transcribed verbatim. Thematic analyses identified factors at the individual, social, familial, and school levels that may trigger adolescents to change their participation in PA as they transition from elementary to secondary school. Twenty-two factors emerged from the qualitative analysis including school factors (8), household factors (3), social factors (4), and intrapersonal factors (7). These findings contribute to a better understanding of adolescents&rsquo, PA behaviors and highlight the influence of changing environments as they transition from elementary school to secondary school.

Background Dietitians in countries across the world have been implementing the Nutrition Care Process (NCP) and Terminology (NCPT) during the past decade. The implementation process has been evaluated in specific countries and in smaller international studies; however, no large international study comparing implementation between countries has been completed. Objective The aim of this study was to describe and compare the level of NCP/NCPT implementation across 10 countries. Methods A previously tested web-based survey was completed in 2017 by 6,719 dietitians across 10 countries. Participants were recruited through e-mail lists, e-newsletters, and social media groups for dietitians. Nondietitians were excluded through screening questions and targeted dissemination channels. Main outcome measures and statistical analysis The main outcome of interest was the level of implementation of each of the four NCP steps. Differences in implementation between the NCP (process) and NCPT (terminology) were also measured. Differences between groups were assessed using Kruskal-Wallis test and Mann-Whitney U test. Multiple linear regression was used to assess relationships between the main outcomes and respondent demographic information. Results Australia, New Zealand, and the United States had higher implementation rates compared with other countries surveyed. Awareness of the NCP was high in most countries (>90%) but lower in Greece (50%). All countries had a higher implementation level of the NCP (process) compared with the NCPT (terminology). Dietitians working with inpatients reported the highest implementation levels while those working in public health reported the lowest. Conclusions Dietitians in countries with more experience in NCP/NCPT implementation and a clear implementation strategy had higher levels of implementation. To achieve a successful NCP/NCPT implementation among dietitians, there is a need to promote the value of a standardized dietetic language together with the more easily implemented process. There is also a need to promote NCP/NCPT for all areas of practice, and develop strategic plans for implementation of the NCP and NCPT.

Objective To identify the pathways through which external, parental, and adolescent factors influence adolescents’ motivation to adopt healthy dietary behaviors. Methods A total of 28 ethnically and socioeconomically diverse (25% White) families were interviewed in which adolescents (mean age = 12.7 years; 50% girls) and parents (mean age = 43.3 years; 68% mothers) were interviewed separately. Data were first analyzed thematically, and family summaries, supplemented with diagrams, were then used to identify the processes through which factors influenced adolescents’ dietary behaviors. Results The analyses identified 3 main motivational pathways (intrinsic motivation, extrinsic motivation, and amotivation), wherein variability and inconsistencies were observed across and within pathways. The unique combination of external factors, parenting profiles, as well as adolescents’ willingness to be socialized by family members, differentiated these pathways from each other. Conclusions and Implications Health interventions need to target the overall approaches that parents use to socialize their adolescent to make healthy food choices instead of targeting specific parenting practices.

ObjectiveUnhealthy dietary behaviours are prevalent among adolescents. This might relate, in part, to obesogenic environments, including recreation food facilities. The REFRESH Study (Recreation Environment and Food Research: Experiences from Hockey) aimed to explore, from the perspectives of adolescent ice hockey players and parents, broad social and physical environmental influences on adolescent food behaviours associated with hockey participation.DesignPlayers used photovoice to describe their food experiences in relation to ice hockey. The approach included photos, individual interviews and focus groups. Exemplar photographs were exhibited for stakeholders, including five parents who were interviewed. Interview and focus group transcripts were thematically analysed.SettingRecreational ice hockey environment, Ontario, Canada, 2015–16.SubjectsIce hockey players (n24) aged 11–15 years recruited from five leagues.ResultsDominant influences among players included: their perceived importance of nutrients (e.g. protein) or foods (e.g. chocolate milk) for performance and recovery; marketing and branding (e.g. the pro-hockey aura of Tim Horton’s®, Canada’s largest quick-service restaurant); social aspects of tournaments and team meals; and moral values around ‘right’ and ‘wrong’ food choices. Both players and parents perceived recreational facility food options as unhealthy and identified that travel and time constraints contributed to less healthy choices.ConclusionsResults indicate recreation facilities are only one of a range of environments that influence eating behaviours of adolescent ice hockey players. Players’ susceptibility to advertising/brand promotion and the value of healthy food choices for performance are findings that can inform policy and interventions to support healthy environments and behaviours.

Provincial, national and international public health agencies recognize the importance of school nutrition policies that help create healthful environments aligned with healthy eating recommendations for youth. School-wide support for healthy living within the pillars of the comprehensive school health (CSH) framework (social and physical environments; teaching and learning; healthy school policy; and partnerships and services) has been positively associated with fostering improvements to student health behaviours. This study used the CSH framework to classify, compare and describe school support for healthy eating during the implementation of the Ontario School Food and Beverage Policy (P/PM 150).We collected data from consenting elementary and secondary schools in a populous region of Ontario in Time I (2012/13) and Time II (2014). Representatives from the schools completed the Healthy School Planner survey and a food environmental scan (FES), which underwent scoring and content analyses. Each school's support for healthy eating was classified as either "initiation," "action" or "maintenance" along the Healthy School Continuum in both time periods, and as "high/increased," "moderate" or "low/decreased" within individual CSH pillars from Time I to Time II.Twenty-five school representatives (8 elementary, 17 secondary) participated. Most schools remained in the "action" category (n = 20) across both time periods, with varying levels of support in the CSH pillars. The physical environment was best supported (100% high/increased support) and the social environment was the least (68% low/decreased support). Only two schools achieved the highest rating (maintenance) in Time II. Supports aligned with P/PM 150 were reportedly influenced by administration buy-in, stakeholder support and relevancy to local context.Further assistance is required to sustain comprehensive support for healthy eating in Ontario school food environments.Les agences provinciales, nationales et internationales de santé publique reconnaissent l’importance des politiques en matière de nutrition en milieu scolaire, qui contribuent à instaurer des environnements sains respectant les recommandations en matière d’alimentation saine à l’intention des jeunes. Le soutien à l’échelle de l’école d’un mode de vie sain reposant sur les piliers de l’approche globale de la santé en milieu scolaire (milieux social et physique; enseignement et apprentissage; politique de santé en milieu scolaire; partenariats et services) a été positivement associé à des améliorations encourageantes des comportements des élèves en matière de santé. Notre étude a utilisé l’approche globale de la santé en milieu scolaire pour classifier, comparer et décrire le soutien à une alimentation saine lors de la mise en oeuvre de la Politique de l’Ontario concernant les aliments et les boissons dans les écoles (N P/P 150).Nous avons recueilli des données provenant d’écoles élémentaires et secondaires consentantes d’une zone peuplée de l’Ontario à deux reprises, en 2012-2013 (période I) et en 2014 (période II). Des représentants des écoles ont rempli l’enquête Planificateur des écoles en santé ainsi qu’un document d’analyse environnementale de l’alimentation, qui ont fait l’objet d’une attribution de scores et d’analyses de contenu. Le soutien de chaque école en faveur d’une alimentation saine a été classé comme relevant de la phase « lancement », « prise de mesures » ou « maintenance » du continuum des écoles en santé pour les deux périodes, et comme étant « élevé/en hausse », « modéré », « faible/en baisse » entre la période I et la période II par rapport aux piliers de l’approche globale de la santé en milieu scolaire.Ont pris part à l’enquête 25 représentants scolaires (8 écoles élémentaires et 17 écoles secondaires). La plupart des écoles sont demeurées dans la catégorie « prise de mesures » (n = 20) au cours des deux périodes, avec des niveaux divers de soutien aux piliers de la santé en milieu scolaire. Le milieu physique a fait l’objet du soutien le plus élevé (100% de soutien « élevé/en hausse »), le milieu social a fait l’objet du soutien le plus faible (68 % de soutien « faible/en baisse »). Seules deux écoles ont atteint la plus haute note (maintenance) au cours de la période II. Les soutiens respectant la N P/P 150 semblent avoir été influencés par l’adhésion de l’administration, le soutien des intervenants et la pertinence du contexte local.Une aide supplémentaire est nécessaire pour maintenir une alimentation saine dans les environnements alimentaires des écoles ontariennes.

Introduction Les agences provinciales, nationales et internationales de santé publique reconnaissent l’importance des politiques en matière de nutrition en milieu scolaire, qui contribuent à instaurer des environnements sains respectant les recommandations en matière d’alimentation saine à l’intention des jeunes. Le soutien à l’échelle de l’école d’un mode de vie sain reposant sur les piliers de l’approche globale de la santé en milieu scolaire (milieux social et physique; enseignement et apprentissage; politique de santé en milieu scolaire; partenariats et services) a été positivement associé à des améliorations encourageantes des comportements des élèves en matière de santé. Notre étude a utilisé l’approche globale de la santé en milieu scolaire pour classifier, comparer et décrire le soutien à une alimentation saine lors de la mise en oeuvre de la Politique de l’Ontario concernant les aliments et les boissons dans les écoles (N P/P 150). Méthodologie Nous avons recueilli des données provenant d’écoles élémentaires et secondaires consentantes d’une zone peuplée de l’Ontario à deux reprises, en 2012-2013 (période I) et en 2014 (période II). Des représentants des écoles ont rempli l’enquête Planificateur des écoles en santé ainsi qu’un document d’analyse environnementale de l’alimentation, qui ont fait l’objet d’une attribution de scores et d’analyses de contenu. Le soutien de chaque école en faveur d’une alimentation saine a été classé comme relevant de la phase « lancement », « prise de mesures » ou « maintenance » du continuum des écoles en santé pour les deux périodes, et comme étant « élevé/en hausse », « modéré », « faible/en baisse » entre la période I et la période II par rapport aux piliers de l’approche globale de la santé en milieu scolaire. Résultats Ont pris part à l’enquête 25 représentants scolaires (8 écoles élémentaires et 17 écoles secondaires). La plupart des écoles sont demeurées dans la catégorie « prise de mesures » (n = 20) au cours des deux périodes, avec des niveaux divers de soutien aux piliers de la santé en milieu scolaire. Le milieu physique a fait l’objet du soutien le plus élevé (100% de soutien « élevé/en hausse »), le milieu social a fait l’objet du soutien le plus faible (68 % de soutien « faible/en baisse »). Seules deux écoles ont atteint la plus haute note (maintenance) au cours de la période II. Les soutiens respectant la N P/P 150 semblent avoir été influencés par l’adhésion de l’administration, le soutien des intervenants et la pertinence du contexte local. Conclusion Une aide supplémentaire est nécessaire pour maintenir une alimentation saine dans les environnements alimentaires des écoles ontariennes.

Background: Canadian provincial policies, like Ontario&rsquo, s School Food and Beverage Policy (P/PM 150), increasingly mandate standards for food and beverages offered for sale at school. Given concerns regarding students leaving school to purchase less healthy foods, we examined student behaviours and competitive food retail around schools in a large urban region of Southern Ontario. Methods: Using a geographic information system (GIS), we enumerated food outlets (convenience stores, fast-food restaurants, full-service restaurants) within 500, 1000 and 1500 m of all 389 regional schools spanning years of policy implementation. Consenting grade 6&ndash, 10 students within 31 randomly selected schools completed a web-based 24-h diet recall (WEB-Q) and questionnaire. Results: Food outlet numbers increased over time (p &lt, 0.01), post-policy, within 1000 m, they averaged 27.31 outlets, with a maximum of 65 fast-food restaurants around one school. Of WEB-Q respondents (n = 2075, mean age = 13.4 &plusmn, 1.6 years), those who ate lunch at a restaurant/take-out (n = 84, 4%) consumed significantly more energy (978 vs. 760 kcal), sodium (1556 vs. 1173 mg), and sugar (44.3 vs. 40.1 g). Of elementary and secondary school respondents, 22.1% and 52.4% reported ever eating at fast food outlets during school days. Conclusions: Students have easy access to food retail in school neighbourhoods. The higher energy, sodium and sugar of these options present a health risk.

Introduction L’insécurité alimentaire et les maladies d’origine alimentaire constituent des enjeux importants au Canada, et on peut considérer les mesures de santé publique prises pour les résoudre comme des facteurs qui façonnent l’environnement alimentaire. De nouvelles données probantes allant dans le sens d'une interrelation entre ces deux domaines, l’objectif de cette étude était d'explorer comment, en Colombie-Britannique (Canada), les efforts en matière de sécurité alimentaire des collectivités et les pratiques de salubrité des aliments (ainsi que les problèmes de santé de la population associés) peuvent se recouper, puis d’interpréter ces résultats pour concevoir et construire un environnement alimentaire plus sain. Méthodologie Nous avons mené 14 entrevues auprès d’informateurs clés (praticiens des secteurs de la sécurité alimentaire des collectivités et de la salubrité des aliments en Colombie-Britannique) et procédé à une analyse descriptive qualitative pour trouver les points d’intersection entre ces deux secteurs. Résultats Les participants ont fait état de quatre modalités de convergence entre les deux secteurs. Ils ont signalé comment les pratiques quotidiennes de leur secteur visant à promouvoir des aliments sûrs ou sains pouvaient être favorisées ou entravées par les activités de l’autre secteur, en partie car les politiques passées, disparates, ne tenaient pas compte des nombreux effets sur la santé en lien avec l'alimentation et car certains types de produits alimentaires, comme les fruits et légumes frais, peuvent être considérés à la fois comme risqués et bénéfiques. Enfin, ils ont souligné que les deux secteurs travaillent à l’atteinte d’un même but, soit celui d’améliorer la santé de la population, même si leur optique se révèle légèrement différente. Conclusion La sécurité alimentaire et la salubrité des aliments sont connectées de plusieurs façons, ce qui a une incidence sur les spécificités de l'environnement alimentaire canadien et sur son amélioration. La collaboration entre les divers secteurs de la santé publique en lien avec l'alimentation est nécessaire pour concevoir de nouveaux programmes ou de nouvelles politiques visant à transformer les habitudes alimentaires des Canadiens.

ObjectiveIn 2011, Dietitians of Canada added ‘My Goals’ to its website-based nutrition/activity tracking program (eaTracker®,http://www.eaTracker.ca/); this feature allows users to choose ‘ready-made’ or ‘write-your-own’ goals and to self-report progress. The purpose of the present study was to document experiences and perceptions of goal setting and My Goals, and report users’ feedback on what is needed in future website-based goal setting/tracking tools.DesignOne-on-one semi-structured interviews were conducted with (i) My Goals users and (ii) dietitians providing a public information support service, EatRight Ontario (ERO).SettingMy Goals users from Ontario and Alberta, Canada were recruited via an eaTracker website pop-up box; ERO dietitians working in Ontario, Canada were recruited via ERO.SubjectsMy Goals users (n23; age 19–70 years; 91 % female;n5 from Alberta/n18 from Ontario) and ERO dietitians (n5).ResultsDietitians and users felt goal setting for nutrition (and activity) behaviour change was both a beneficial and a challenging process. Dietitians were concerned about users setting poor-quality goals and users felt it was difficult to stick to their goals. Both users and dietitians were enthusiastic about the My Goals concept, but felt the current feature had limitations that affected use. Dietitians and users provided suggestions to improve My Goals (e.g. more prominent presence of My Goals in eaTracker; assistance with goal setting; automated personalized feedback).ConclusionsDietitians and users shared similar perspectives on the My Goals feature and both felt goal use was challenging. Several suggestions were provided to enhance My Goals that are relevant to website-based goal setting/tracking tool design in general.

To better understand the risks and benefits of eating wild-harvested fish from the Northwest Territories, Canada, levels of total mercury (HgT) and selenium (Se) and composition of omega-3 fatty acid (n-3 FA) were measured in muscle tissue of fish harvested from lakes in the Dehcho Region, Northwest Territories, Canada. Average HgT levels ranged from 0.057 mg/kg (cisco) to 0.551 mg/kg (northern pike), while average n-3 FA concentrations ranged from 101 mg/100 g (burbot) to 1,689 mg/100 g (lake trout). In contrast to HgT and n-3 FA, mean Se concentrations were relatively similar among species. Consequently, species such as lake whitefish, cisco, and longnose sucker displayed the highest nutrient levels relative to HgT content. Levels of HgT tended to increase with fish size, while Se and n-3 FA levels were typically not associated with fork length or fish weight. Interestingly, HgT concentration was occasionally inversely related to tissue nutrient content. Significant negative correlations were observed between Hg and n-3 FA for lake trout, northern pike, and walleye. There were also significant negative correlations between Hg and Se noted for lake whitefish, cisco, and northern pike. Samples with the highest nutritional content displayed, on occasion, lower levels of HgT. This study provides valuable information for the design of probabilistic models capable of refining public health messaging related to minimizing Hg risks and maximizing nutrient levels in wild-harvested fish in the Canadian subarctic.

Locally harvested food consumption is declining among Canadian First Nations (FN) youth. The objective of this study was to investigate, among youth in 2 FN communities, the frequency of lesser snow goose (Chen caerulescens caerulescens) consumption, its contribution to nutritional intake, and the nutritional outcomes of a harvest sharing program. A cross-sectional survey and pre–posttest design was used. Food intakes were assessed via 24-hour recall and food frequency questionnaire. At baseline (n = 84, 12.38 ± 1.07 years, 49% male) 48% of participants consumed snow goose. Consumption frequency was associated with meat and alternatives (P = .019), protein (P = .004), vitamin B12 (P = .004), iron (P = .011), and zinc (P = .006). At postprogram (n = 73, 12.34 ± .99 years, 44% male), consumption prevalence increased, significantly for girls (P = .015). Harvest sharing supports snow goose consumption, which imparts nutritional benefits.

Canadian provincial governments have introduced voluntary nutrition guidelines for recreation and sport facilities to promote healthy dietary patterns in children. This paper presents baseline data from the Eat, Play, Live (EPL) randomized controlled trial to examine whether facilities in guideline provinces had greater capacity, more nutrition policies, and healthier food environments than facilities in a province without guidelines. Facility capacity, policy development, and food environment quality were measured and compared in guideline (GF; n = 32) and no guideline facilities (NoGF; n = 17) using ANOVA and Chi-square statistics. Healthfulness of vending and concession items were rated as Do Not Sell (least nutritious), Sell Sometimes or Sell Most (most nutritious). Facility capacity scores did not differ between GF and NoGF. A higher proportion of GF had facility-specific nutrition policies compared to NoGF. GF vending machines had healthier profiles than NoGF; including a lower proportion of Do Not Sell snacks and beverages, and a higher proportion of Sell Sometimes snacks and beverages and Sell Most beverages. GF concessions had healthier profiles than NoGF; with a lower proportion of Do Not Sell snacks and beverages, a higher proportion of Sell Sometimes snacks and Sell Most beverages, and higher food environment summary scores. Recreation and sport facilities in guideline provinces had more nutrition policies and healthier food environments than facilities in a province without guidelines. However, food environments were unhealthy regardless of guideline status which may promote correspondingly unhealthy dietary patterns among children. Clinical trials registration (retrospectively registered): ISRCTN14669997 Jul 3 2018.

Background Human biomonitoring represents an important tool for health risk assessment, supporting the characterization of contaminant exposure and nutrient status. In communities where country foods (locally harvested foods: land animals, fish, birds, plants) are integrated in the daily diet, as is the case in remote northern regions where food security is a challenge, such foods can potentially be a significant route of contaminant exposure. To assess this issue, a biomonitoring project was implemented among Dene/Métis communities of the Dehcho region of the Northwest Territories, Canada. Methods Participants completed dietary surveys (i.e., a food frequency questionnaire and 24-h recall) to estimate food consumption patterns as well as a Health Messages Survey to evaluate the awareness and perception of contaminants and consumption notices. Biological sampling of hair, urine and blood was conducted. Toxic metals (e.g., mercury, lead, cadmium), essential metals (e.g., copper, nickel, zinc), fatty acids, and persistent organic pollutants (POPs) were measured in samples. Results The levels of contaminants in blood, hair and urine for the majority of participants were below the available guidance values for mercury, cadmium, lead and uranium. However, from the 279 participants, approximately 2% were invited to provide follow up samples, mainly for elevated mercury level. Also, at the population level, blood lead (GM: 11 μg/L) and blood cadmium (GM: 0.53 μg/L) were slightly above the Canadian Health Measures Survey data. Therefore, although country foods occasionally contain elevated levels of particular contaminants, human exposures to these metals remained similar to those seen in the Canadian general population. In addition, dietary data showed the importance and diversity of country foods across participating communities, with the consumption of an average of 5.1% of total calories from wild-harvested country foods. Conclusion This project completed in the Mackenzie Valley of the Northwest Territories fills a data gap across other biomonitoring studies in Canada as it integrates community results, will support stakeholders in the development of public health strategies, and will inform environmental health issue prioritization. Electronic supplementary material The online version of this article (10.1186/s13690-018-0318-9) contains supplementary material, which is available to authorized users.

This study explored perceived barriers and facilitators to healthful eating in schools and communities among overweight teens who completed an E-health intervention. Twenty-two teens were recruited to a photovoice study and asked to take pictures of things that made it easier or harder to make healthful food choices at school and in their community. Digital photographs were reviewed using semi-structured interviews. Transcribed audio-recordings were analyzed using constant comparative analysis. Similar themes emerged from the school and community environments with food/beverage availability emerging most frequently, followed by peer influence, accessibility/convenience, price, classroom practices, marketing and online influences. Teens described an obesity-promoting environment and perceived very limited healthful options. Policy-driven environmental changes as well as strategies that help teens navigate food choices in their schools and communities are needed to support healthful eating.

Among a group of First Nations youth, this research aimed to obtain objective measures of anthropometry, physical activity (PA) and fitness; to identify any group-level differences by sex, body mass index, waist circumference and body fat categories; to assess the barriers and supports to PA. Youth participated in anthropometric measures (BMI, waist circumference, body fat percentage), PA assessment (3 days of accelerometry) and fitness testing (guided by the Canadian Physical Activity, Fitness and Lifestyle Approach). Barriers and supports were assessed via environmental scan and focus groups. Descriptive statistics were compared to reference data. Group differences by sex, BMI status, waist circumference and body fat categories were tested using Mann–Whitney U and Chi square tests (p ≤ 0.05). Qualitative data were assembled into one file and coded manually for categories and themes. Seventy-two youth (12.1 ± 1.1 years, 61.1 % male) participated in at least one measure; 36 completed the accelerometry. Sixty-three percent were overweight or obese, 51 % were abdominally obese and 21 % had excess body fat. Most (86.1 %) met Canada’s PA guidelines. Boys were more active than girls (p = 0.025) and had greater cardiorespiratory endurance (p = 0.003). Overweight, obese, or abdominally obese youth had lower cardiorespiratory endurance than normal weight youth (p

ObjectiveTo explore perceived factors that impede or facilitate healthful eating within the home environment among overweight/obese adolescents.DesignIn the present qualitative photovoice study, participants were instructed to take photographs of things that made it easier or harder to make healthful food choices at home. Digital photographs were reviewed and semi-structured interviews were conducted to promote discussion of the photographs. Data were analysed using constant comparative analysis.SettingVancouver, Canada, in 2012–2013.SubjectsTwenty-two overweight/obese adolescents who completed a family-based lifestyle modification intervention.ResultsThe mean age of participants was 14 (sd1·9) years, 77 % were female and their mean BMIZ-score was 2·4 (sd0·6). Adolescents talked about six aspects of the home environment that influenced their eating habits (in order of frequency): home cooking, availability and accessibility of foods/beverages, parenting practices, family modelling, celebrations and screen use/studying. In general, homes with availability of less healthful foods, where family members also liked to eat less healthful foods and where healthier foods were less abundant or inaccessible were described as barriers to healthful eating. Special occasions and time spent studying or in front of the screen were also conducive to less healthful food choices. Home cooked meals supported adolescents in making healthier food choices, while specific parenting strategies such as encouragement and restriction were helpful for some adolescents.ConclusionsAdolescents struggled to make healthful choices in their home environment, but highlighted parenting strategies that were supportive. Targeting the home food environment is important to enable healthier food choices among overweight/obese adolescents.

Background The home food environment may be an important target for addressing adolescent obesity. The aim of this study was to investigate associations between aspects of the home food environment and the diets of adolescents who present for obesity treatment. Methods Cross-sectional baseline data were collected from 167 overweight/obese adolescent-parent pairs participating in an e-health lifestyle modification intervention. Adolescent intake of specific foods (fruit and vegetables, total fat, sugar-sweetened beverages, desserts/treats, and snacking occasions) was assessed by three 24-h dietary recalls, while household factors were collected from adolescent and parent questionnaires. Structural Equation Modeling, controlling for relevant covariates, was used to examine the relationship between adolescent diet and the following household factors: parent modeling, parenting style, family meal practices, and home food/beverage availability. Results Findings reveal that few characteristics of the home food environment were associated with adolescent dietary intake. Greater home availability of high-fat foods was moderately associated with adolescent snack intake (β = 0.27, p

Purpose: To conduct a qualitative evaluation of adjunct supports (brief motivational messaging regarding goals delivered by email/website, contact centre dietitian assistance) offered by EatRight Ontario (ERO) for users of a website-based nutrition/activity goal setting/tracking feature (eaTracker “My Goals”). Methods: One-on-one semi-structured interviews were conducted with My Goals users in Ontario (n = 18) and Alberta (n = 5) recruited via the eaTracker website and ERO contact centre dietitians (n = 5). Interview transcripts were analyzed using content analysis. Results: Participants had mixed experiences and perspectives with ERO motivational messaging. Messages targeted towards specific goals (e.g., tips, recipes) were generally well-liked, and generic messages (e.g., eaTracker login reminders) were less useful. No interviewed users had contacted ERO dietitians regarding goals, and dietitians reported encountering few callers asking for assistance while using My Goals. Limited user knowledge was one explanation for this finding. Participants provided suggestions to enhance these supports. Conclusion: Electronic motivational messaging and contact centre dietitian assistance have the potential to support achievement of goals set with website-based features. When considering using electronic messaging, researchers and practitioners should consider message content and delivery tailoring. Marketing that focuses on how contact centre dietitians can assist website users with their goals is needed when services are used in naturalistic settings.

Objective To provide dietitians with practical guidance on incorporating smartphone applications (apps) in the nutrition care process (NCP) to optimize patient education and counseling. Methods The current evidence-base for mobile health (mHealth) apps was searched using PubMed and Google Scholar. Where and how apps could be implemented by dietitians across the four steps of the NCP is discussed. Results With functionality to automatically convert patient dietary records into nutrient components, nutrition assessment can be streamlined using nutrition apps, allowing more time for dietitians to deliver education and nutrition counseling. Dietitians could prescribe apps to provide patients with education on nutrition skills and in counseling for better adherence to behavior change. Improved patient-provider communication is also made possible through the opportunity for real-time monitoring and evaluation of patient progress via apps. A practical framework termed the ‘Mobile Nutrition Care Process Grid’ provides dietitians with best-practice guidance on how to use apps. Conclusions Including apps into dietetic practice could enhance the efficiency and quality of nutrition care and counseling delivered by dietitians. Practice implications Apps should be considered an adjunct to enable dietetic counseling and care, rather than to replace the expertise, social support and accountability provided by dietitians.

Few studies have compared parent-child dietary intake among adolescents who are overweight or obese. The purpose of our study was to determine the relationship between parent-teen intake of selected dietary components among this sample. Baseline data from 165 parent and adolescent (aged 11 to 16 years) pairs who presented for a lifestyle behavior modification intervention were collected between 2010 and 2012. Parent and adolescent dietary intake (servings of fruits and vegetables [F/V]; grams of sugar; and percent energy from total fat, saturated fat, dessert/treats, sugar-sweetened beverages, and snacks) was assessed using web-based 24-hour dietary recalls. Multivariable linear and negative binomial regression models identified associations between parent and child dietary intake adjusting for relevant covariates. A large proportion of adolescents and parents did not meet dietary recommendations for F/V, total fat, and saturated fat. Parent-adolescent intake of F/V, total fat, saturated fat, sugar, sugar-sweetened beverages, and snacks were positively associated (r=0.19 to 0.37). No relationship was observed for dessert/treats. In multivariate models, significant interaction effects suggest that the parent-child association in diet was weaker for fat intake among parents with higher educational attainment (b=-.31; P0.05) and for snacking among adolescent boys (b=-.30; P.05). Parent intake of several dietary components important for good health, and related to obesity, was associated with adolescent intake. Helping parents improve their diet may promote improvements in their adolescent's diet and is a potential target for interventions designed to increase healthy eating among adolescents.

Understanding dietary habits of women after breast cancer is a critical first step in developing nutrition guidelines that will support weight management and optimal health in survivorship; however, limited data are available. The objective of this study was to describe changes in diet among breast cancer survivors in the first year after treatment, and to evaluate these changes in the context of current dietary intake. Changes in diet were assessed in 28 early stage breast cancer survivors, using a self-reported survey in which women identified changes in food intake since their diagnosis. Current dietary intake was estimated from 3-day food records and described relative to current recommendations. The majority of women reported changes in diet after diagnosis, most common being an increase in vegetables/fruit and fish, lower intake of red meat, and reduced alcohol. Many women reported that these changes were initiated during active treatment. Dietary changes were largely consistent with current recommendations for cancer prevention; however, some women were still above the guidelines for total and saturated fat, and many were below recommendations for vegetables/fruit, milk/alternatives, calcium, and vitamin D. Evidence that some women are willing and able to initiate positive changes in diet early in the treatment trajectory suggests that early intervention may be effective in promoting dietary habits that will assist with weight management and overall health. Data on current dietary intake highlights several possible targets for dietary intervention in this population.

Purpose A cross-sectional web-based survey of dietitians was used to explore topics related to mobile devices and their applications (apps) in Canadian dietetic practice. Methods A survey was drafted, posted on SurveyMonkey, and pretested with dietitians and dietetic interns. Dietitians of Canada (DC), a supporter of this work, promoted the survey to members through its monthly electronic newsletters from January 2012 to April 2012. Results Of 139 dietitians who answered some survey questions, 118 finished the survey; this represents a response rate of approximately 3%. Overall, 57.3% of respondents reported app use in practice, and 54.2% had a client ask about or use a nutrition/food app. About 40.5% of respondents had recommended nutrition/food apps to clients. Respondents were enthusiastic about apps, but many described challenges with use. From the survey data, three themes emerged that can affect dietitians’ use of apps and whether they recommend apps to clients: mobile device and app factors (access to information/ tools, content quality, usability, accessibility/compatibility, and cost), personal factors (knowledge, interest, suitability, and willingness/ability to pay), and workplace factors. Conclusions Apps are now infiltrating dietetic practice. Several factors can affect dietitians’ use of apps and whether they recommend them to clients. These findings will help guide future development and use of apps in practice.

This study explored the influence of healthy vending contracts (HVC) on the nutritional quality of vending machine products in 46 Canadian publicly funded recreation and sport facilities. A quasi-experimental comparison design was used to examine the difference in nutritional quality of snack and beverage vending machine products at baseline (December 2015–May 2016) and 18-month follow-up. Staff Surveys assessed facility contract type (HVC or conventional) and vending machine audits identified product nutritional quality. Products were categorized by provincial guidelines as Do Not Sell (DNS), Sell Sometimes (SS) or Sell Most (SM). ANOVA compared categories cross-sectionally (HVC vs conventional) and repeated measures ANOVA compared them longitudinally (HVC-HVC, vs conventional-conventional and conventional-HVC). Approximately one quarter of contracts (24% beverage and 28% snack) had health stipulations at baseline or follow-up. Cross-sectionally, facilities with HVC at any time period had significantly lower percentage DNS (beverage: 56% vs 73%, p = 0.001; snack: 55% vs 85%, p, Highlights • Healthy vending contracts are associated with healthier vending product profiles. • Healthy vending contracts improved the ‘healthiness’ of the products sold in vending machines. • Healthy vending contracts appear to improve the food environment of recreational and sport facilities. • Unhealthy foods remain prevalent in recreational and sport facilities even when healthy vending contracts are in place.

BACKGROUND: Sugar-sweetened beverages (SSBs) may play a role in increased rates of obesity. This study examined patterns and frequencies of beverage consumption among youth in 3 distinct regions in Canada, and examined associations between beverage consumption and age, sex, body mass index (BMI), physical activity and dieting behavior, as well as beverage displacement. METHODS: The study included data from 10,188 youth (ages 13-18) from Hamilton and Thunder Bay, Ontario, and Prince Edward Island (PEI) in 2009 to 2010. The study used in-school self-reported surveys with 12 questions regarding beverage consumption during the previous day, along with self-reported height, weight, physical activity levels, and demographic information. Logistic regression analyses were conducted to examine variables associated with SSB intake. RESULTS: Overall, 80% of youth consumed at least 1 SSB in the previous day, with 44% consuming 3 or more SSBs. Youth in Thunder Bay consumed significantly more SSBs than Hamilton and PEI, and youth in Hamilton consumed more SSBs than PEI. Boys consumed significantly more SSBs than girls. Older and more physically active youth consumed significantly fewer SSBs. No significant association between BMI and SSB consumption was observed in any model. A modest positive correlation was identified between SSB consumption and milk (r = .06, p < .001) and 100% fruit juice (r = .10, p < .001). CONCLUSIONS: A large proportion of youth consumed SSBs, many at high levels. Research evaluating SSB policy and interventions should be considered a priority.

OBJECTIVE: Unhealthy dietary and physical inactivity patterns inspired many initiatives promoting healthy youth and healthy schools in Alberta between 2005 and 2008. The purpose of this study was to examine differences in the prevalence of lifestyle risk factors for type 2 diabetes (T2D) between two province-wide samples of Alberta adolescents (2005 and 2008). METHODS: The dietary and physical activity (PA) patterns of Alberta youth were assessed in two cross-sectional studies of grade 7-10 students, one in 2005 (n=4936) and one in 2008 (n=5091), using a validated web-survey. For each diabetes risk factor, participants were classified as either at risk or not at risk, depending on their survey results relative to cut-off values. Chi-square tests and logistic regression models were used to determine differences in risk factor prevalence between 2005 and 2008. RESULTS: Compared to 2005, mean BMI, energy intake, fat intake, glycemic index (GI) and glycemic load (GL) were lower in 2008 (p

ObjectiveTo measure and describe the prevalence and severity of household food insecurity in a remote on-reserve First Nations community using the Household Food Security Survey Module (HFSSM) and to evaluate the perceived relevance of the HFSSM for this population.DesignHousehold food security status was determined from the eighteen-item HFSSM following the classifications developed by Health Canada for the Canadian Community Health Survey, Cycle 2·2 Nutrition. One adult from each household in the community was invited to complete the HFSSM and to comment on its relevance as a tool to measure food security for First Nations communities.SettingSub-Arctic Ontario, Canada.SubjectsHouseholds (n64).ResultsSeventy per cent of households were food insecure, 17 % severely and 53 % moderately. The prevalence of food insecurity in households with children was 76 %. Among respondents from homes rated as having severe food insecurity, all (100 %) reported worrying that food would run out, times when food didn't last and there wasn't money to buy more, and times when they couldn't afford to eat balanced meals. The majority of respondents felt the HFSSM did not capture an accurate picture of food security for their situation. Aspects missing from the HFSSM included the high cost of market food and the incorporation of traditional food practices.ConclusionsA high prevalence of household food insecurity was reported in this community. On-reserve remote First Nations communities may be more susceptible to food insecurity than off-reserve Aboriginal populations. Initiatives that promote food security for this vulnerable population are needed.

Purpose: This study investigated relationships between psychosocial and treatment-related factors, diet, and weight change in women treated with chemotherapy for early-stage breast cancer. Methods: Comprehensive qualitative interviews were conducted with 28 women who were within 12 months of completing chemotherapy treatment. Results: Changes in food intake and eating patterns were universal over the course of chemotherapy, with broad variability in treatment effects and associated dietary responses linked to weight change. Increased appetite, food cravings, and intake of energy-dense comfort foods were more common among women who gained weight during treatment (n = 11). Changes in taste, nausea, and emotional distress were central in promoting these dietary responses. Women who lost weight during treatment (n = 6) tended to report more severe and persistent side effects of treatment leading to poor appetite and lower food intake, and they were more likely to live alone. Conclusions: While the etiology of weight change in this population is complex, this study suggests that changes in food intake related to treatment and psychosocial challenges may play an important role for some women. These findings may help to identify women who are most at risk of weight change during treatment and may inform the development of tailored dietary interventions.