Current dietary recommendations for cardiovascular disease prevention suggest dietary patterns that promote achieving healthy weight, emphasize vegetables, legumes, fruit, whole grains, fish and nuts, substituting mono-unsaturated fats for saturated fats and restricting dietary sodium to less than 2300 mg/day. However, trends in nutrient intake and food consumption patterns suggest that the need for improvement in the dietary patterns of Canadians is clear. Influencing eating behaviour requires more than addressing nutrition knowledge and perceptions of healthy eating - it requires tackling the context within which individuals make choices. A comprehensive approach to improving nutrition includes traditional downstream strategies such as counselling to improve knowledge and skills; midstream strategies such as using the media to change social norms; and upstream strategies such as creating supportive environments through public policy including regulatory measures. While the evidence base for more upstream strategies continues to grow, key examples of comprehensive approaches to population change provide a call to action.
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Recreational facilities are an important community resource for health promotion because they provide access to affordable physical activities. However, despite their health mandate, many have unhealthy food environments that may paradoxically increase the risk of childhood obesity. The Alberta Nutrition Guidelines for Children and Youth (ANGCY) are government-initiated, voluntary guidelines intended to facilitate children's access to healthy food and beverage choices in schools, childcare and recreational facilities, however few recreational facilities are using them.
We used mixed methods within an exploratory multiple case study to examine factors that influenced adoption and implementation of the ANGCY and the nature of the food environment within three cases: an adopter, a semi-adopter and a non-adopter of the ANGCY. Diffusion of Innovations theory provided the theoretical platform for the study. Qualitative data were generated through interviews, observations, and document reviews, and were analysed using directed content analysis. Set theoretic logic was used to identify factors that differentiated adopters from the non-adopter. Quantitative sales data were also collected, and the quality of the food environment was scored using four complementary tools.
The keys to adoption and implementation of nutrition guidelines in recreational facilities related to the managers' nutrition-related knowledge, beliefs and perceptions, as these shaped his decisions and actions. The manager, however, could not accomplish adoption and implementation alone. Intersectoral linkages with schools and formal, health promoting partnerships with industry were also important for adoption and implementation to occur. The food environment in facilities that had adopted the ANGCY did not appear to be superior to the food environment in facilities that had not adopted the ANGCY.
ANGCY uptake may continue to falter under the current voluntary approach, as the environmental supports for voluntary action are poor. Where ANGCY uptake does occur, changes to the food environment may be relatively minor. Stronger government measures may be needed to require recreational facilities to improve their food environments and to limit availability of unhealthy foods.
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This study examines whether exposure to supermarkets and fast food outlets varies with neighborhood-level socioeconomic status in Edmonton, Canada. Only market area and fast food proximity predicted supermarket exposure. For fast food outlets, the odds of exposure were greater in areas with more Aboriginals, renters, lone parents, low-income households, and public transportation commuters; and lower in those with higher median income and dwelling value. Low wealth, renter-occupied, and lone parent neighborhoods had greater exposure to fast food outlets, which was not offset by better supermarket access. The implications are troubling for fast food consumption among lone parent families in light of growing obesity rates among children.
The increasing prevalence of obesity among youth has elicited calls for schools to become more active in promoting healthy weight. The present study examined associations between various aspects of school food environments (specifically the availability of snack- and beverage-vending machines and the presence of snack and beverage logos) and students' weight status, as well as potential influences of indices of diet and food behaviours.
A cross-sectional, self-administered web-based survey. A series of multinomial logistic regressions with generalized estimating equations (GEE) were constructed to examine associations between school environment variables (i.e. the reported presence of beverage- and snack-vending machines and logos) and self-reported weight- and diet-related behaviours.
Secondary schools in Alberta, Canada.
A total of 4936 students from grades 7 to 10.
The presence of beverage-vending machines in schools was associated with the weight status of students. The presence of snack-vending machines and logos was associated with students' frequency of consuming vended goods. The presence of snack-vending machines and logos was associated with the frequency of salty snack consumption.
The reported presence of snack- and beverage-vending machines and logos in schools is related to some indices of weight status, diet and meal behaviours but not to others. The present study supported the general hypothesis that the presence of vending machines in schools may affect students' weight through increased consumption of vended goods, but notes that the frequency of 'junk' food consumption does not seem to be related to the presence of vending machines, perhaps reflecting the ubiquity of these foods in the daily lives of students.
This paper provides a baseline profile of organizational capacity for (heart) health promotion in Alberta's regional health authorities (RHAs); and examines differences in perceived organizational health promotion capacity specific to modifiable risk factors across three levels of staff and across capacity levels. Baseline data were collected from a purposive sample of 144 board members, senior/middle managers and service providers from 17 RHAs participating in a five-year time-series repeated survey design assessing RHA capacity for (heart) health promotion. Results indicate low levels of capacity to take health promotion action on the broader determinants of health and risk conditions like poverty and social support. In contrast, capacity for health promotion action specific to physiological and behavioural risk factors is considerably higher. Organizational "will" to do health promotion is noticeably more present than is both infrastructure and leadership. Both position held within an organization as well as overall level of organizational capacity appear to influence perceptions of organizational capacity. Overall, results suggest that organizational "will", while necessary, is inadequate on its own for health promotion implementation to occur, especially in regard to addressing the broader determinants of health. A combination of low infrastructure and limited leadership may help explain a lack of health promotion action.
To determine the dose-response relationship between body mass index (BMI) and cause-specific mortality among Canadian adults.
The sample includes 10,522 adults 18-74 years of age who participated in the Canadian Heart Health Surveys (1986-1995). Participants were divided into 5 BMI categories ( or = 35 kg/m2). Multivariate-adjusted (age, sex, exam year, smoking status, alcohol consumption and education) hazard ratios for all-cause, cardiovascular disease (CVD) and cancer mortality were estimated using Cox proportional hazards regression.
There were 1,149 deaths (402 CVD; 412 cancer) over an average of 13.9 years (range 0.5 to 19.1 years), and the analyses are based on 145,865 person-years. The hazard ratios (95% CI) across successive BMI categories for all-cause mortality were 1.25 (0.83-1.90), 1.00 (reference), 1.06 (0.92-1.22), 1.27 (1.07-1.51) and 1.65 (1.29-2.10). The corresponding hazard ratios for CVD mortality were 1.30 (0.60-2.83), 1.00 (reference), 1.57 (1.22-2.01), 1.72 (1.27-2.33) and 2.09 (1.35-3.22); and for cancer, the hazard ratios were 1.02 (0.48-2.21), 1.00 (reference), 1.14 (0.90-1.44), 1.34 (1.01-1.78) and 1.82 (1.22-2.71). There were significant linear trends across BMI categories for all-cause (p = 0.0001), CVD (p
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).
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.
Compared to 2005, mean BMI, energy intake, fat intake, glycemic index (GI) and glycemic load (GL) were lower in 2008 (p
In April 2011, a conference with invited experts from research, policy and practice was held to build consensus around policy levers to address environmental determinants of obesity. The gap between existing policy tools and what can promote health through community design is a major policy opportunity. This commentary represents a consensus of next actions towards creating built environments that support healthy active living. The policy environment and Canadian evidence are reviewed. Issues and challenges to policy change are discussed. Recommendations to create supportive built environments that encourage healthy active living in communities include the following: 1) empower planning authorities to change bylaws that impede healthy active living, protect and increase access to green space, introduce zoning to increase high density, mixed land use, and influence the location and distribution of food stores; 2) establish stable funding for infrastructure promoting active transportation and opportunities for recreation; 3)?evaluate the effectiveness of programs to improve the built environment so that successful interventions can be identified and disseminated; 4)?mandate health impact assessment of planning, development and transportation policies to ensure that legislative changes promote health and safety; 5) frame issues to dispel myths and to promote protection from obesity risk factors.
The Community Health and the Built Environment (CHBE) project investigated the role of place in interventions for chronic disease prevention in order to identify contextual factors that may foster or inhibit intervention success. This paper presents a project model comprising objective-outsider and subjective-insider perspectives in a multi-method, community-based participatory research approach with an emphasis on knowledge exchange. The collaborative process generated valuable lessons concerning effective conduct of community-based research. The CHBE project model contributes a mechanism for investigating how place influences health behaviours and the outcomes of health promotion interventions.
Few studies have assessed the construct validity of measures of neighborhood food environment, which remains a major challenge in accurately assessing food access. In this study, we adapted a psychometric tool to examine the construct validity of 4 such measures for 3 constructs. We used 4 food-environment measures to collect objective data from 422 Ontario, Canada, food stores in 2010. Residents' perceptions of their neighborhood food environment were collected from 2,397 households between 2009 and 2010. Objective and perceptual data were aggregated within buffer zones around respondents' homes (at 250 m, 500 m, 1,000 m, and 1,500 m). We constructed multitrait-multimethod matrices for each scale to examine construct validity for the constructs of food availability, food quality, and food affordability. Convergent validity between objective measures decreased with increasing geographic scale. Convergent validity between objective and subjective measures increased with increasing geographic scale. High discriminant validity coefficients existed between food availability and food quality, indicating that these two constructs may not be distinct in this setting. We conclude that the construct validity of food environment measures varies over geographic scales, which has implications for research, policy, and practice.