Breastfeeding clinics aim to increase breastfeeding duration and diminish breastfeeding difficulties. Actual improvement in the duration and satisfaction of the breastfeeding experience for women using these clinics remains unknown. This observational study assessed the impact of a Québec City breastfeeding clinic's interventions on breastfeeding duration and satisfaction among women experiencing breastfeeding difficulties in comparison with women who did not receive clinic services. The study surveyed 86 women using telephone questionnaires and semistructured interviews. After adjusted logistic regression analysis, women who attended the clinic had a higher probability of breastfeeding for at least 6 months (odds ratio [OR] = 4.34; 95% confidence interval [CI] = 1.35-13.96) than women from the comparison group. They also had a higher probability of being satisfied with their breastfeeding experience (OR = 4.17; 95% CI = 1.31-13.22). Physical and moral support could explain this influence. Larger studies on breastfeeding clinics are needed to confirm their role in enhancing breastfeeding duration and satisfaction.
This study was undertaken to understand food insecurity from the perspective of households who experienced it. The results of group interviews and personal interviews with 98 low-income households from urban and rural areas in and around Québec City, Canada, elicited the meaning of "enough food" for the households and the range of manifestations of food insecurity. Two classes of manifestations characterized the experience of food insecurity: (1) its core characteristics: a lack of food encompassing the shortage of food, the unsuitability of both food and diet and a preoccupation with continuity in access to enough food; and a lack of control of households over their food situation; and (2) a related set of potential reactions: socio-familial perturbations, hunger and physical impairment, and psychological suffering. The results substantiate the existence of food insecurity among Québecers and confirm that the nature of this experience is consistent with many of the core components identified in upstate New York. This study underlines the monotony of the diet, describes the feeling of alienation, differentiates between a lack of food and the reactions that it engenders, and emphasizes the dynamic nature of the experience.
Overweight and obesity are major public health concerns that are neither evenly distributed among the population nor between regions. Many studies suggest that beyond individual characteristics, the place where one lives influences lifestyle choices that underpin overweight and obesity. We observed such a situation in the province of Quebec (Canada), and because data availability from surveys was limited to a local level, the observed overweight disparities between local communities could not be entirely explained. Aiming to uncover local factors not captured by national survey data sets and in order to aid local level intervention, we investigated how the overweight problem was perceived by stakeholders through a concept mapping methodology. Concept mapping is a mixed method that relies upon stakeholders' perception as well as statistical techniques to draw a synthesis of the problem in the form of a conceptual map. A total of 45 stakeholders working in four areas with contrasting overweight prevalence in the Quebec City region were involved in the process. The map enables a global understanding of stakeholders' perception. This perception is not necessarily in line with public health knowledge however. For example, key concepts on the map suggest that physical activity is perceived to be much more important than diet with regards to population overweight and that urban design elements seem to be of low concern. Concept mapping is an innovative tool for planning and evaluation and can help stakeholders to develop adapted interventions to promote healthy lifestyle. It also provides relevant information to enhance the comprehension of local health disparities with a geographical perspective where data availability is limited.
This paper reports results from a case study on household food insecurity needs and the interventions that address them. It aimed at comparing households' perceptions on food insecurity experience and vulnerability to those of other stakeholders: community workers, programme managers and representatives from donor agencies. Semi-structured interviews with 55 households and 59 other stakeholders were conducted. Content analysis was performed, using a framework encompassing food sufficiency, characterization of household food insecurity and vulnerability of households to food insecurity. Overall, the results draw attention to a gap between households and the other stakeholders, where the later do not seem always able to assess the realities of food-insecure households. Other areas of divergences include: characteristics of food insecurity, relative importance of various risk factors related to food insecurity and the effectiveness of the community assistance to enhance the households' ability to face food insecurity. These divergent perceptions may jeopardize the implementation of sustainable solutions to food insecurity. Training of stakeholders for a better assessment of households' experience and needs, and systematic evaluation of interventions, appear urgent and highly relevant for an adequate response to households' needs. Collaboration between all stakeholders should lead to knowledge sharing and advocacy for policies dedicated to poverty reduction.
The present study explores the spatial distribution and in-store availability of fresh fruits and vegetables from a socio-environmental perspective in terms of the type of food store, level of deprivation and the setting (urban/rural) where the food outlets are located.
Seven types of fresh fruit and vegetable stores (FVS) were identified then visited in six districts (urban setting) and seven communities (rural setting). The quantity and diversity of fresh fruits and vegetables (F&V) were also assessed.
Québec City, Canada.
The FVS spatial distribution showed differences between the two settings, with accessibility to supermarkets being more limited in rural settings. The quantity and diversity of fresh F&V in-store availability were associated with the type of FVS, but not with setting or its level of deprivation. Greengrocers and supermarkets offered a greater quantity and diversity of fresh F&V than the other FVS.
The results suggest that inequalities in physical access to fresh F&V across the region could have an impact on public health planning considering that supermarkets, which are one of the excellent sources of F&V, are less prevalent in rural settings.
To examine the cost of fruits and vegetables (FV) with respect to different food store types, urbanization level and material deprivation for various urban areas of greater Quebec City.
A sample of 85 food stores was selected. They represented five store types (small, conventional, and large grocery stores; greengrocers; convenience stores) in four geographic areas reflecting three different socio-economic levels. We identified three FV baskets (grocery, fresh FV, convenience) by drawing on data on household food spending and consumption, and food supply in the five store types. Four investigators were trained to conduct a survey of prices for the week of September 17-23, 2007. Analysis of variance and t tests were conducted to examine variations in food baskets with regard to the variables defined in this study. A chi-square test was used to measure the frequency distribution of stores throughout the greater Quebec City.
Only food store type had a significant influence on FV cost: cost was much lower in large grocery stores and greengrocers. Convenience stores, where prices are higher, outnumbered all others in deprived urban areas, supporting the contention that there are inequities in economic access.
Economic access to FV may differ by area in the greater Quebec City, putting rural inhabitants and less privileged urban dwellers at the greatest disadvantage; this may, in turn, contribute to health disparities. The results point to the need to improve our understanding of the way components of the food environment at the regional level affect social inequality.
The aim of our study was to investigate the moderating effect of school food programs in schools in disadvantaged neighborhoods on the association between household food insecurity and scholastic difficulties among adolescents.
We analyzed data from the Social and Health Survey of Children and Adolescents in Quebec, Canada, which was conducted in 1999 and included 2346 adolescent students 13 and 16 years of age (and 1983 of their parents). Sample-weighted regression analyses were performed to determine the association between household food insecurity and school difficulties and to explore the moderating role of food supplementation programs with respect to this association.
Household food insecurity, which was linked to the indicators of family socioeconomic status, was strongly associated with the indicators of scholastic difficulties. This association disappeared for adolescents who benefited from food supplementation programs in schools in disadvantaged neighborhoods. The risk of school activity limitation decreased from OR = 2.76 (95% confidence interval [CI]: 1.41-5.41) to OR = 1.57 (95% CI: 1.35-3.40), the risk of below-average grades in the language of instruction decreased from OR = 2.19 (95% CI: 1.28-3.74) to OR = 0.59 (95% CI: 0.21-1.63), the risk of repeating a year decreased from OR = 2.14 (95% CI: 1.35-3.40) to OR = 0.87 (95% CI: 0.42-1.81), and the risk of self-rated poor academic performance decreased from OR = 1.74 (95% CI: 1.08-2.81) to OR = 0.81(95% CI: 0.37-1.78).
School food supplementation is a moderating factor in the association between household food insecurity and scholastic difficulties for adolescents.
Producing a definition of healthful eating that expresses adequately the richness and the complexity of the eating experience is challenging. Still, the effort is crucial if one wants to promote behavioural change in the population, as well as a transformation of interventional practices, programs, and policies, and even the agri-food system. We explain that the biological, social, and environmental dimensions of healthful eating, along with the interactions among them, must be addressed. Once these dimensions are considered as a whole, the definition of healthful eating allows the identification of a wide range of strategic interventions to implement such eating. We suggest a continuum of eating quality that could be used to identify, in general, the food habits of persons or groups.
The aim of the study was (i) to describe the needs of food-insecure households and their assessment of community programmes, as expressed by households and perceived by stakeholders; and (ii) to examine the similarities and differences between households' and stakeholders' perceptions in Quebec City area.
A semi-structured interview and sociodemographic questionnaire with fifty-five households and fifty-nine stakeholders (community workers, managers, donor agencies). The transcriptions were subjected to content analysis and inter-coder reliability measurement.
The respondents' perceptions converge towards three main categories of needs: needs specific to food security, conditions necessary for achieving food security and related needs. There was agreement on the necessity of better financial resources, although the impact of financial resources alone may be uncertain in the opinion of some stakeholders. Different perceptions of needs and of their fulfilment by community programmes emerge between both groups. Despite households found positive aspects, they complained that quality of food and access were major needs neglected. Their account suggests overall a partial fit between the programmes and food security needs; even a combination of programmes (e.g. collective kitchens, purchasing groups, community gardens) was insufficient to adequately meet these needs. In contrast, most stakeholders perceived that the household's primary need was a basic amount of food and that the households were satisfied with programmes.
It is urgent to evaluate the overall effect of community programmes on specific aspects of household food insecurity. The results emphasise that community programmes alone cannot bring about social change needed to prevent food insecurity.