This article presents a programme for cardiovascular health for 9 to 12 years old children, called "Healthy Heart" Saint-Louis du Parc and carried out in low socioeconomic and multiethnic part of Montreal, Quebec, Canada. These five years programme targets were more both spheres: school and community (leisure centre, ethnocultural centre, groceries and other places). We develop the objectives, the conceptual models underlying to the programme, the perspective of work, the infrastructure of the programme: its staff and financing, the partnerships and the structure organising. Then we present the various interventions carried out along the period and so a description of many evaluations. At last, we discuss about the programme continuation.
A number of studies have pointed to the pressure that housing costs can exert on the resources available for food. The objectives of the present study were to characterise the relationship between the proportion of income absorbed by housing and the adequacy of household food expenditures across the Canadian population and within income quintiles; and to elucidate the impact of receipt of a housing subsidy on adequacy of food expenditures among low-income tenant households.
The 2001 Survey of Household Spending, conducted by Statistics Canada, was a national cross-sectional survey that collected detailed information on expenditures on goods and services. The adequacy of food spending was assessed in relation to the cost of a basic nutritious diet.
The person with primary responsibility for financial maintenance from 15 535 households from all provinces and territories.
As the proportion of income allocated to housing increased, food spending adequacy declined significantly among households in the three lowest income quintiles. After accounting for household income and composition, receipt of a housing subsidy was associated with an improvement in adequacy of food spending among low-income tenant households, but still mean food spending fell below the cost of a basic nutritious diet even among subsidised households.
This study indicates that housing costs compromise the food access of some low-income households and speaks to the need to re-examine policies related to housing affordability and income adequacy.
Although the sociodemographic characteristics of food-insecure households have been well documented, there has been little examination of neighbourhood characteristics in relation to this problem. In the present study we examined the association between household food security and neighbourhood features including geographic food access and perceived neighbourhood social capital.
Cross-sectional survey and mapping of discount supermarkets and community food programmes.
Twelve high-poverty neighbourhoods in Toronto, Ontario, Canada.
Respondents from 484 low-income families who had children and who lived in rental accommodations.
Food insecurity was pervasive, affecting two-thirds of families with about a quarter categorized as severely food insecure, indicative of food deprivation. Food insecurity was associated with household factors including income and income source. However, food security did not appear to be mitigated by proximity to food retail or community food programmes, and high rates of food insecurity were observed in neighbourhoods with good geographic food access. While low perceived neighbourhood social capital was associated with higher odds of food insecurity, this effect did not persist once we accounted for household sociodemographic factors.
Our findings raise questions about the extent to which neighbourhood-level interventions to improve factors such as food access or social cohesion can mitigate problems of food insecurity that are rooted in resource constraints. In contrast, the results reinforce the importance of household-level characteristics and highlight the need for interventions to address the financial constraints that underlie problems of food insecurity.
Beverage consumption by poor, lone mother-led, "milk-friendly" families living in Atlantic Canada was characterized over a one-month income cycle.
Beverage intake and food security status were assessed weekly, using a 24-hour dietary recall and the Cornell-Radimer food insecurity questionnaire. Families were classified as "milk friendly" if total consumption of milk was 720 mL on a single day during the month. Beverage intake was assessed using t-tests, analysis of variance (ANOVA), repeated measures ANOVA with post hoc comparisons, and chi-square analysis.
Milk consumption by milk-friendly families (76; total sample, 129) was highest at the time of the month when they had the most money to spend. During all time intervals, mothers consumed the least amount of milk and children aged one to three years consumed the most. Mothers consumed carbonated beverages disproportionately, while children of all ages consumed more fruit juice/drink. Mothers' coffee consumption was profoundly increased when either they or their children were hungry.
The quality of beverage intake by members of low-income households fluctuates in accordance with financial resources available to purchase foods. Mothers' beverage intake is compromised by the degree of food insecurity the family experiences.
Since 1989 the number of Canadian children depending on food banks has increased by more than 85%. To combat perceived hunger, breakfast and lunch programs have been initiated by localized volunteer efforts. This paper attempts to show the Foucauldian concepts of power, truths, space and time in action in feeding programs in Atlantic Canada. A potential 'relation of docility-utility' is imposed upon children by providers of feeding programs and ultimately the state. The 'power over life' or 'micro-physics of power' is accomplished through procedures that use food, rules, rewards, reinforcements, space, time, and truths. Children voluntarily subject themselves to this relation while reserving the power to resist through acts of defiance or by not attending at all. This ability to exercise one's agency allows for shifting power relations in the social dynamics of feeding programs. The potentially coercive nature of these relationships is embedded in the pleasurable environment generated by the feeding process.
This research suggests that point-of-choice campaigns can be implemented in low-income communities, although store personnel began to view campaign materials and activities as a nuisance after 2 months, and their enthusiasm and commitment decreased. Employee interest might have been more sustainable if the campaign had been shorter or if it had been implemented 1 or 2 weeks at a time rather than being continually present in the store. This approach would necessitate easily removable displays and materials. Items such as the kiosk were too cumbersome for easy setup and removal. Despite widespread advertisement and 4 months in the community, awareness of the campaign was moderate and use was low. Not surprisingly, awareness and use were higher among women, older persons, and persons who lived in St-Henri, possibly because they do the shopping or have the time and interest to notice promotional messages. Awareness and use of specific campaign components appeared to be higher for easily available, highly visible materials and activities that required little or no effort by consumers. Others have suggested that consumer effort required to recognize, view, read, and internalize point-of-choice messages is important and have recommended methods such as videocassettes of nutrition messages or brand-specific shelf labels that reduce customer effort to absorb information. Both the intervention agent and retailers reported that the cholesterol screening events were very popular and that they should have been offered more frequently. Although these events are relatively complex and costly, this response suggests that they are an appropriate and effective way to increase awareness and heighten interest. By contrast, almost no interest was shown in supermarket tours. Although our publicity might have been ineffective, it is more likely that this kind of activity did not interest the target group, possibly because of lack of time or low perceived need or usefulness.
As part of a larger study on food insecurity and dietary adequacy of low-income lone mothers and their children in Atlantic Canada, we examined diet quality among household members.
Network sampling for 'difficult to sample' populations was used to identify mothers living below the poverty line and alone with at least two children under age 14. Trained dietitians administered 24-hour dietary recalls weekly for one month to mothers on the dietary intake of themselves and their children. We calculated Healthy Eating Index category scores for eligible mothers (129) and children (303) using Canada's Food Guide to Healthy Eating and the Nutrition Recommendations for Canadians.
Diet quality of low-income lone mothers was poor (35.5%) or in need of improvement (64.5%), with no mother having a good diet. The diet quality of children varied by age, with 22.7% of children aged one to three having a good diet or needing improvement (74.6%), 2.1% of children aged four to eight and no child aged nine to 14 having a good diet, while the diets of about 85% of older children in both age categories needed improvement.
Younger children seem to be protected from poor quality diets in households with limited resources to acquire food.
Women who live in disadvantaged circumstances in Canada exhibit dietary intakes below recommended levels, but their children often do not. One reason for this difference may be that mothers modify their own food intake to spare their children nutritional deprivation. The objective of our study was to document whether or not low-income lone mothers compromise their own diets to feed their children.
We studied 141 low-income lone mothers with at least 2 children under the age of 14 years who lived in Atlantic Canada. Women were identified through community organizations using a variety of recruitment strategies. The women were asked weekly for 1 month to recall their food intake over the previous 24 hours; they also reported their children's (n = 333) food intake. Mothers also completed a questionnaire about "food insecurity," that is, a lack of access to adequate, nutritious food through socially acceptable means, during each interview.
Household food insecurity was reported by 78% of mothers during the study month. Mothers' dietary intakes and the adequacy of intake were consistently poorer than their children's intake overall and over the course of a month. The difference in adequacy of intake between mothers and children widened from Time 1, when the family had the most money to purchase food, to Time 4, when the family had the least money. The children experienced some improvement in nutritional intake at Time 3, which was possibly related to food purchases for them associated with receipt of the Child Tax Benefit Credit or the Goods and Services Tax Credit.
Our study demonstrates that low-income lone mothers compromise their own nutritional intake in order to preserve the adequacy of their children's diets.
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Comment On: CMAJ. 2003 Mar 18;168(6):709-1012642427
To describe the prevalence of overweight and obesity over 5 y among inner-city elementary schoolchildren aged 10-12 y in multiethnic, low-income neighborhoods in Montreal, Canada.
Height and weight of all students in grades 4-6 in 16 control schools participating in an evaluation of the impact of a school-based heart health promotion program, were measured each May/June from 1993 to 1997 in cross-sectional classroom-based school surveys.
The prevalence of overweight (> or = 85th age- and gender-specific percentile for body mass index (BMI) from NHANES I and II) was 35.9% in 1993; it increased by approximately 1.3% per year. The prevalence of obesity (> or = 95th age- and gender-specific percentile for BMI from NHANES I and II) was 15.9% in 1993; it increased by approximately 1.0% per year. In multivariate models predicting overweight and obesity, the odds ratios for year adjusted for age, sex, and family ethnic origin were 1.08 (95% confidence interval (CI), 1.04-1.12), and 1.09 (95%CI, 1.04-1.15), respectively.
There were significant secular trends of increasing overweight and obesity among young inner-city schoolchildren from the early to late 1990s. Preventive intervention is clearly indicated because childhood obesity tracks to adulthood and because obesity is associated with substantial morbidity, mortality and health care costs.
Responses to food insecurity in Canada have been dominated by community-based food initiatives, while little attention has been paid to potential policy directions to alleviate this problem. The purpose of this paper is to examine food security circumstances, participation in community food programs, and strategies employed in response to food shortages among a sample of low-income families residing in high-poverty Toronto neighbourhoods.
Data from surveys conducted with 484 families and neighbourhood mapping were analyzed.
Two thirds of families were food insecure over the past 12 months and over one quarter were severely food insecure, indicative of food deprivation. Only one in five families used food banks in the past 12 months and the odds of use were higher among food-insecure families. One third of families participated in children's food programs but participation was not associated with household food security. One in 20 families used a community kitchen, and participation in community gardens was even lower. It was relatively common for families to delay payments of bills or rent and terminate services as a way to free up money for food and these behaviours were positively associated with food insecurity.
While documenting high rates of food insecurity, this research challenges the presumption that current community-based food initiatives are reaching those in need. Public health practitioners have a responsibility to critically examine the programs that they deliver to assess their relevance to food-insecure households and to advocate for policy reforms to ensure that low-income households have adequate resources for food.