Perceptions of Beverages With Non-nutritive Sweeteners Among Indigenous Adults Living in Manitoba and Implications for Type 2 Diabetes.

OBJECTIVES: The purpose of this study was to explore the perspectives of Indigenous adults on consuming beverages with non-nutritive sweeteners. METHODS: In this work, we used a community-based, participatory design in partnership with National Indigenous Diabetes Association, Four Arrows Regional Health Authority, and Fearless R2W. We conducted 74 qualitative interviews with Indigenous adults living in Manitoba, including Island Lake First Nations (n=39), Flin Flon (n=15), and the North End neighbourhood of Winnipeg (n=20). Data were indexed in NVivo, and transcripts were analyzed thematically. RESULTS: Participants exclusively discussed beverages with non-nutritive sweeteners (BNNSs) as an alternative to regular pop or sugary drinks, which were widely available, accessible, and consumed. Why or how BNNSs were viewed as an alternative comprised 3 subthemes: an alternative for health reasons; divergent taste preferences; and an alternative with mysterious but negative health effects. Participants who reported regular consumption of BNNSs largely described consuming them to manage type 2 diabetes. Fewer participants discussed BNNS as a means of weight management or as a preventive health behaviour. Participants who did not report regular BNNS consumption described not liking the taste of BNNSs. Finally, many participants described negative health impacts of consuming BNNSs, and specifically aspartame, although few articulated what those negative impacts were. CONCLUSIONS: Divergent perspectives among Indigenous adults regarding the health implications of consuming BNNSs may reflect ongoing scholarly debates. These findings have implications for the prevention and dietary management of type 2 diabetes in Indigenous communities.

Predictors of Tri-council Funding Among Nutrition Researchers in Canada.

Purpose: Barriers in research for women and dietitians have been documented. We sought to describe tri-council funding awarded within the nutrition discipline according to institution type, academic rank, gender, dietitian status, and primary research methods used.Methods: Using an online search methodology, faculty members with research appointments were identified from nutrition departments offering accredited dietetic programs and/or at Canada's collective of research-intensive universities known as U15. All data regarding faculty members, their institutions, and funding were collected through publicly available websites and Scopus. Tri-council funding associated with the nominated principal investigator, from a 5-year period, 2013-2014 to 2017-2018, was extracted. Binary logistic regression was used to test for predictors of receiving any tri-council operating funds within the 5-year period.Results: Faculty members (n = 237) from 21 institutions were identified for inclusion. Those from U15 institutions, at the full professor rank, nondietitians, men, and those who engaged in primarily quantitative research methods (vs. qualitative or mixed-methods) were significantly more likely to hold any tri-council funding during the eligible period. Dietitians (n = 76) were significantly less likely to hold tri-council funding, independent of institution, rank, gender, and primary research methods utilized.Conclusions: The apparent under-funding of academic dietitians from federal tri-council sources requires exploration.

Policy responses to the COVID-19 pandemic in the Manitoba grocery sector: a qualitative analysis of media, organizational communications, and key informant interviews.

OBJECTIVES: The COVID-19 pandemic has impacted all aspects of the food system, including the retail grocery sector. We sought to (objective 1) document and (objective 2) analyze the policies implemented in the grocery sector during the first wave of the pandemic in Manitoba, Canada. METHODS: Our qualitative policy analysis draws from organizational communications (websites and social media) (n = 79), news media articles (n = 95), and key informant interviews with individuals (n = 8) working within the grocery sector in urban and rural, Manitoba. Media and communications were extracted between March 9-May 8, 2020 and interviews were conducted in July-August, 2020. RESULTS: Newly implemented policies due to the pandemic fell under four inter-related themes: Employee health and wellbeing, Safety measures, Operational measures, and Community support. Employee health and wellbeing included sub-themes of financial and social support, health recommendations and protocols, and new employee guidelines. Safety measures encompassed numerous policies pertaining to sanitation, personal protection, transmission prevention, physical distancing, and limiting access. Overall, new policies were discussed as effective in making grocery shopping as safe as possible given the situation. Compliance and enforcement, employee teamwork, and support for employees were key themes related to perceptions of policy success in a challenging and inequitable context. Nevertheless, government support and communication was needed as well to ensure safety within the grocery sector. CONCLUSIONS: The grocery sector reacted to the pandemic with the swift implementation of policies to address food supply issues, prevent transmission of the virus, support their employees as essential workers, and better serve high-risk populations.

A descriptive analysis of food pantries in twelve American states: hours of operation, faith-based affiliation, and location.

BACKGROUND: Our objectives were to describe both the development, and content, of a charitable food dataset that includes geographic information for food pantries in 12 American states. METHODS: Food pantries were identified from the foodpantries.org website for 12 states, which were linked to state-, county-, and census-level demographic information. The publicly available 2015 Food Access Research Atlas and the 2010 US Census of Population and Housing were used to obtain demographic information of each study state. We conducted a descriptive analysis and chi-square tests were used to test for differences in patterns of food pantries according to various factors. RESULTS: We identified 3777 food pantries in 12 US states, providing an estimated 4.84 food pantries per 100,000 people, but ranged from 2.60 to 7.76 within individual states. The majority of counties (61.2%) had at least one food pantry. In contrast, only 15.7% of all census tracts in the study states had at least one food pantry. A higher proportion of urban census tracts had food pantries compared to rural tracts. We identified 2388 (63.2%) as being faith-based food pantries. More than a third (34.4%) of food pantries did not have information on their days of operation available. Among the food pantries displaying days of operation, 78.1% were open at least once per week. Only 13.6% of food pantries were open ≤1 day per month. CONCLUSIONS: The dataset developed in this study may be linked to food access and food environment data to further examine associations between food pantries and other aspects of the consumer food system (e.g. food deserts) and population health from a systems perspective. Additional linkage with the U.S. Religion Census Data may be useful to examine associations between church communities and the spatial distribution of food pantries.

Examining differences in diet quality between Canadian Indigenous and non-Indigenous adults: results from the 2004 and 2015 Canadian Community Health Survey Nutrition Surveys.

OBJECTIVES: The Truth and Reconciliation Commission includes a call to action to close gaps in health outcomes, including type 2 diabetes, of which diet quality must be considered an important mediator. The objectives of this study were to compare diet quality between off-reserve Indigenous and non-Indigenous adults in 2004 and 2015, and examine food security as a predictor of diet quality. METHODS: We employed a repeated cross-sectional design using the 2004 and 2015 Canadian Community Health Surveys-Nutrition. Both surveys include a representative sample of the Canadian population in the 10 provinces, excluding the northern territories and people living on-reserve. Healthy Eating Index (HEI) values were estimated, using 24-hour dietary recalls, for the Indigenous and non-Indigenous population in each time period. After matching, a generalized linear model was applied to test for differences in HEI between groups across time period, adjusting for household food security. RESULTS: Overall, HEI scores were not significantly different for Indigenous men and women in 2015 as compared with 2004, but continued to be lower compared with those of the non-Indigenous population. Indigenous adults reported significantly lower diet quality independent of food security status and other factors. Scores pertaining to percent energy from 'other' foods improved in 2015 compared with 2004. CONCLUSION: Dietary disparities persist between Indigenous and non-Indigenous populations. While addressing household food insecurity among Indigenous populations is necessary to improve diet quality, it is not sufficient. Results suggest that factors other than food insecurity and socio-economic status are impacting disparities in diet quality among Indigenous adults.

RéSUMé: OBJECTIFS: L'un des appels à l'action lancé par la Commission de vérité et réconciliation vise à combler les écarts dans les résultats cliniques, notamment pour le diabète de type 2, dont la qualité du régime doit être considérée comme un médiateur important. Nous avons cherché à comparer la qualité du régime des adultes autochtones vivant hors réserve et des adultes non autochtones en 2004 et en 2015 et à examiner la sécurité alimentaire comme variable prédictive de la qualité du régime. MéTHODE: Nous avons employé un plan transversal répété en utilisant les Enquêtes sur la santé dans les collectivités canadiennes ­ Nutrition de 2004 et de 2015. Les deux enquêtes incluent un échantillon représentatif de la population canadienne dans les 10 provinces, sans les territoires nordiques ni les populations vivant dans les réserves. Les valeurs de l'Indice d'alimentation saine (IAS) ont été estimées, à l'aide de rappels alimentaires de 24 heures, pour la population autochtone et non autochtone durant chaque intervalle. Après appariement des données, nous avons appliqué un modèle linéaire généralisé pour découvrir les différentes valeurs de l'IAS entre les groupes au fil du temps, en apportant des ajustements pour tenir compte de la sécurité alimentaire des ménages. RéSULTATS: Dans l'ensemble, les valeurs de l'IAS n'étaient pas significativement différentes chez les hommes et les femmes autochtones en 2015 comparativement à 2004, mais elles restaient inférieures aux valeurs de l'IAS pour la population non autochtone. Les adultes autochtones ont déclaré une qualité du régime significativement inférieure, indépendamment de leur statut de sécurité alimentaire et d'autres facteurs. Les valeurs afférentes au pourcentage d'énergie provenant d' « autres ¼ aliments s'étaient améliorées en 2015 par rapport à 2004. CONCLUSION: Les disparités du régime alimentaire persistent entre les populations autochtones et non autochtones. Bien qu'il soit nécessaire d'aborder l'insécurité alimentaire des ménages dans les populations autochtones pour améliorer la qualité du régime, ce n'est pas suffisant. Nos résultats indiquent que d'autres facteurs que l'insécurité alimentaire et le statut socioéconomique accentuent les disparités dans la qualité du régime chez les adultes autochtones.

Diet quality among Indigenous and non-Indigenous children and youth in Canada in 2004 and 2015: a repeated cross-sectional design.

OBJECTIVE: The objectives were to describe changes in diet quality between off-reserve Indigenous and non-Indigenous children and youth from 2004 to 2015 and examine the association between food security and diet quality. DESIGN: We utilised a repeated cross-sectional design using both the 2004 and 2015 nutrition-focused Canadian Community Health Surveys, including 24-h dietary recall. Diet quality was estimated according to the Healthy Eating Index (HEI). SETTING: The surveys were conducted off-reserve in Canada's ten provinces. PARTICIPANTS: Our analysis included children and youth 2-17 years old (n 18 189). Indigenous and non-Indigenous participants were matched, and using a general linear model, we tested time period and (non-)Indigenous identifiers, including their interaction effect, as predictors of HEI. RESULTS: Both Indigenous and non-Indigenous children and youth had significantly higher HEI scores in 2015 as compared to 2004. There was not a significant (non-)Indigenous and time period interaction effect, indicating the improvements in diet quality in 2015 were similar between both Indigenous and non-Indigenous populations. Improvements in diet quality are largely attributed to reductions in percentage energy from 'other' foods, though a disparity between Indigenous and non-Indigenous children and youth persisted in 2015. Overall, food security was lower among the Indigenous population and positively, and independently, associated with diet quality overall, though this relationship differed between boys and girls. CONCLUSIONS: School policies may have contributed to similar improvements in diet quality among Indigenous and non-Indigenous populations. However, an in-depth sex and gender-based analysis of the relationship between food security and diet quality is required.

Exploring attitudes toward taxation of sugar-sweetened beverages in rural Michigan.

BACKGROUND: While policies to address "obesity" have existed for decades, they have commonly focused on behavioral interventions. More recently, the taxation of sugar-sweetened beverages is gaining traction globally. This study sought to explore individuals' attitudes and beliefs about sugar-sweetened beverages being taxed in a rural Michigan setting. METHODS: This qualitative study was conducted using critical policy analysis. Data were collected in 25 semi-structured, audio-recorded interviews with adult Michiganders. Following data collection, transcripts were coded into themes using NVivo software. RESULTS: Four themes emerged in participants' perspectives regarding sugar-sweetened beverages being taxed: resistance, unfamiliarity, tax effects, and need for education. While some participants were unfamiliar with sugar-sweetened beverage taxes, many viewed taxation as a "slippery slope" of government intervention, which invoked feelings of mistrust. In addition, participants predicted a sugar-sweetened beverage tax would be ineffective at reducing intake, particularly among regular consumers, who were frequently perceived as mostly low income and/or of higher weight. CONCLUSIONS: Further research is needed to explore perceptions of sugar-sweetened beverage taxes in different geographic areas in the USA to examine how perceptions vary. Policymakers should be aware of the potential implications of this health policy with respect to government trust and stigma towards lower income and higher-weight individuals.

Dietary gluten avoidance in Canada: a cross-sectional study using survey data.

BACKGROUND: A gluten-free diet (GFD) is required for the management of some conditions, whereas some Canadians may follow a GFD for discretionary reasons. We sought to estimate the prevalence of Canadians who adhere to a GFD, identify factors associated with adherence to a GFD, and describe and compare the location of food preparation and consumption for those who follow a GFD, those who report no dietary avoidances and those reporting other dietary avoidances. METHODS: We used cross-sectional data from the 2015 Canadian Community Health Survey - Nutrition (n = 20 487). Demographic variables included sex, age group, ethnicity, highest level of household education and income adequacy. The relations between respondent characteristics and report of a GFD were estimated using logistic regression. Respondents were further categorized as avoiding dietary gluten, other dietary avoidances and no dietary avoidances. RESULTS: An estimated 1.9% of Canadians follow a GFD. Women had 2 times higher odds (odds ratio [OR] 2.08, 95% confidence interval [CI] 1.32 to 3.27) of reporting a GFD than men. After adjustment for income adequacy, household education, sex, age group and ethnicity, residents of Ontario and Quebec had about half the odds (OR 0.52, 95% CI 0.31 to 0.87, and OR 0.55, 95% CI 0.32 to 0.94, respectively) of reporting a GFD compared with residents of Atlantic Canada. Canadians who followed a GFD consumed significantly fewer calories from foods prepared at restaurants than both Canadians who reported no dietary avoidances and those who reported dietary avoidances other than gluten. Canadians following a GFD reported that 2.0% (95% CI 1.1% to 2.9%) of their daily kilocalories were from foods prepared at restaurants, compared with 6.7% (95% CI 5.4% to 7.9%) for Canadians reporting 1 or more dietary avoidances other than gluten, and 6.4% (95% CI 6.0% to 6.9%) for those reporting no avoidances. INTERPRETATION: The estimated 1.9% prevalence of dietary gluten avoidance likely includes individuals with celiac disease, wheat allergies and nonceliac gluten sensitivity, as well as individuals excluding gluten in the management of irritable bowel syndrome or for reasons related to dietary trends. Canadians eating GFDs consume fewer daily calories from restaurant-prepared foods than other Canadians, which may have social implications.

Nutritional implications of dietary gluten avoidance among Canadians: results from the 2015 Canadian Community Health Survey.

Adherence to a gluten-free diet (GFD) is the only available treatment for gluten-related disorders, although a GFD may also be followed for discretionary reasons. The main objectives of the present study were to (1) describe and test for differences in key nutrient intakes among Canadians who follow a GFD compared with Canadians with no dietary exclusions and (2) describe additional dietary avoidances adhered to by Canadians who avoid gluten. We conducted a secondary analysis of the cross-sectional 2015 Canadian Community Health Survey-Nutrition Survey, which included a general health survey and 24-h dietary recall (n 20 487). Participants were categorised as those who avoid dietary gluten and those who reported no avoidances. Key nutrient intakes were assessed, as a percentage of Dietary Recommended Intakes, including fibre, B vitamins, vitamin D, Ca, Fe, Na and Zn, and compared between the two groups using t tests. Canadians who avoided gluten had significantly lower intakes of folate, vitamin B12, vitamin D, Fe, Na and Ca compared with those who did not avoid any food groups. However, Canadians who reported following a GFD were significantly more likely to use vitamin or mineral supplements in the past 30 d. More than 20 % of those who avoided gluten also avoided dairy products. Findings suggest that following a GFD places Canadians at risk for nutrient inadequacies, particularly folate, Ca and vitamin D. Further research is required to further examine how multiple dietary avoidances among those who avoid gluten may contribute to dietary inadequacies.

An Evaluation of an Experiential Learning Program in Global and Indigenous Health: The University of Manitoba's Queen Elizabeth II Diamond Jubilee Scholarship Program.

We conducted a mixed-methods outcome evaluation to examine student experiences and learning in the University of Manitoba's Queen Elizabeth II Diamond Jubilee Scholarship Program in Global and Indigenous Health. Our scholarship program is a bi-directional, 3-month international experiential learning program, including both undergraduate and graduate students, with associated online course focused on community engagement. Students completed a semi-structured narrative report at the conclusion of their funding related to their experience and learning. The Likert questions were analyzed descriptively and student responses to the open-ended questions were utilized for thematic analysis. Also included in this paper is a summary of our lessons learned through program administration. A total of 38 students completed the program between 2016 and 2018, with 95% reporting that they either met or exceeded their goals in the program. Three overarching and inter-related themes emerged in our thematic-analysis of students' narrative reports, including success through relationships and new perspectives, challenges of the unfamiliar, and personal growth through strong emotions. Many students reported personal growth as their greatest success and linked this with new perspectives and awareness of how different contexts shaped their understanding of health issues. Overcoming challenges in their placements contributed to students' confidence in their ability to problem-solve. Overall, students reported value in their experiential learning, which further supports the growing trend to incorporate both experiential learning and formal education in community engagement in public health pedagogy. However, international experiential learning requires considerable financial and human resource commitments to ensure its success.

The relationships between health-related behaviours in the Canadian adult population.

BACKGROUND: Health-related behaviours such as physical inactivity, low fruit and vegetable intake, smoking, alcohol use, and inadequate sleep are significant predictors of adverse health outcomes. Health promotion strategies often focus on one behavior, though research suggests health-related behaviours tend to co-occur. The purpose of this study is to describe the relationships between health-related behaviours in the Canadian adult population. METHODS: Data from cycles 3 (2012-2013) and 4 (2014-2015) of the Canadian Health Measures Survey were pooled to describe health-related behaviours (current smoking status, high-risk alcohol use, fruit and vegetable intake, inadequate sleep, and physical activity) among adults according to sex, age group, household education, and income adequacy. Logistic regression was used to test for relationships between health-related behaviours. RESULTS: Findings indicated that adverse health-related behaviours co-occur frequently, with approximately half of Canadians reporting two or more adverse health-related behaviours. Overall, Canadian men were more likely to report adverse health-related behaviours compared to women, with the exception of inadequate sleep. Smoking status, fruit and vegetable intake, sleep and physical activity exhibited an income and education gradient. Sex-based patterns in grouping of behaviours were present such that adverse health-related behaviours were associated with current smoking among men and with high-risk alcohol use among women. CONCLUSION: Our findings suggest that health-related behaviours should be considered in both isolation and combination when designing intervention strategies. Sex-specific patterns of how these behaviours co-occur must also be taken into account.

Health-related behaviours and their relationship with self-rated health among Canadian adults.

BACKGROUND: Self-rated health (SRH) is a commonly used survey measure as a substitute for a clinical measure of health, which has demonstrated validity and reliability in a variety of populations. The referents that individuals incorporate into their self-evaluations have been shown to include health-related behaviours, though these relationships are not static. Our purpose was to describe and test for relationships between health-related behaviours and SRH among Canadian adults. METHODS: We used pooled data from the Canadian Health Measures Surveys Cycles 3 (2012-13) and 4 (2014-15). All men and non-pregnant women aged 18 years and older were included (n = 6,789). We used binary logistic regression to test for relationships between health-related behaviours and SRH, including smoking status, adequate fruit and vegetable intake, inadequate sleep, alcohol use, and adequate physical activity. RESULTS: The majority of respondents rated their health as good, very good, or excellent, though differences in SRH were found according to age group, highest level of household education, and income adequacy. Inadequate sleep was most strongly associated with poorer SRH among men and women combined, as compared to other health-related behaviours. Among women only, those who report heavy episodic drinking (OR, 2.64) or daily drinking (OR, 3.51) rated their health better, as compared to women who report low-risk alcohol use. CONCLUSIONS: Sleep quality is an important predictor of SRH for both men and women. Second, sex/gender differences must be considered in strategies to address alcohol use, as we may not be fully appreciating potentially health-affirming qualities associated with alcohol use among women.

Diversity and Equity in Dietetics and Undergraduate Nutrition Education in Manitoba.

PURPOSE: The objectives of this study were (i) to describe ethnicity, tuition funding sources, and living arrangements during degree among Registered Dietitian (RD) and non-RD alumni of the University of Manitoba's undergraduate nutrition program and (ii) to describe barriers to obtaining an internship among those who did not become an RD. METHODS: A 31-item, self-administered, online questionnaire was distributed to nutrition graduates. Binary logistic regression was used to test for predictors of RD status (vs. non-RD). RESULTS: Of the 195 participants who completed the survey (37% response rate), 68% identified as an RD and 31% did not. White students had 3.8 times higher odds of being an RD (P < 0.001) compared with students of an ethnic minority. Those who had received a student loan (P = 0.033) or lived with their parents during their degree (P = 0.004) also had significantly lower odds of being an RD. The most common barrier for not completing the dietetic internship by non-RDs was that the application process was too stressful. CONCLUSIONS: Results from this study highlight the need for the dietetics field to address systemic barriers for students of ethnic minorities and low socioeconomic backgrounds, including barriers during the degree program and in the internship selection process.

A systematic search and qualitative review of reporting bias of lifestyle interventions in randomized controlled trials of diabetes prevention and management.

BACKGROUND: Scholars have documented presumptions regarding the relationships between diet, exercise, weight, and type 2 diabetes. However, it is unclear to what extent researchers contribute to these presumptions, and how often these relationships are thoroughly delineated within the context of randomized controlled trials (RCTs). Thus, the aim was to conduct a systematic search and qualitative, thematic analysis of RCTs focusing on lifestyle interventions for diabetes prevention or management, to examine how researchers discuss body weight in 1) the rationale and design of their RCTs; and 2) their presentation and interpretation of their findings. METHODS: We completed an electronic search for records published between 2007 and November 2016. Selection criteria included: RCTs with a follow-up period of ≥12 months; adult participants with type 2 diabetes/pre-diabetes; lifestyle interventions classified as dietary, exercise, and/or behavioural; primary outcomes of incident diabetes and complications, mortality, cardiovascular disease, and quality of life; and secondary outcomes of glycemic control and blood pressure. Nineteen articles were identified for inclusion and subject to thematic content analysis. RESULTS: Obesity and weight loss figured prominently in the rationale and outcomes of the majority of the articles, despite intentional exclusion of "weight loss" and "obesity" as search terms. There was ambiguity over whether weight loss was classified as inclusive to the intervention, an outcome, or a measure of adherence. Results revealed that authors frequently engaged in "spin reporting" by pooling data from intervention and control groups to test the relationship between weight lost and outcomes and in their presentation of results. CONCLUSIONS: Researchers need to be aware of their biases and assumptions regarding body weight in designing, analyzing, and interpreting lifestyle interventions for diabetes prevention and management.

Fasting triglycerides as a predictor of incident diabetes, insulin resistance and ß-cell function in a Canadian First Nation.

BACKGROUND: Diabetes prevalence is substantially higher among Canadian First Nations populations than the non-First Nation population. Fasting serum triglycerides have been found to be an important predictor of incident diabetes among non-indigenous populations. However, there is a great need to understand diabetes progression within specific ethnic groups, particularly First Nations populations. OBJECTIVE: The purpose of this study was to test for an association between fasting serum triglycerides and incident diabetes, changes in insulin resistance and changes in ß-cell function in a Manitoba First Nation cohort. METHODS: Study data were from two diabetes screening studies in Sandy Bay First Nation in Manitoba, Canada, collected in 2002/2003 and 2011/2012. The cohort was composed of respondents to both screening studies (n=171). Fasting blood samples and anthropometric, health and demographic data were collected. A generalised linear model with Poisson distribution was used to test for an association between fasting triglycerides and incident diabetes. RESULTS: There were 35 incident cases of diabetes among 128 persons without diabetes at baseline. Participants who developed incident type 2 diabetes were significantly older and had significantly higher body mass index (BMI; p=0.012), total cholesterol (p=0.007), fasting triglycerides (p<0.001), and Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) (p<0.001). Fasting triglyceride level was found to be a statistically significant positive predictor of incident diabetes independent of age, sex and waist circumference at baseline. Participants with triglycerides in the highest tertile (≥2.11 mmol/l) had a 4.0-times higher risk of developing incident diabetes compared to those in the lowest tertile (p=0.03). Notably, neither waist circumference nor BMI were significant predictors of incident diabetes independent of age, sex and triglycerides. CONCLUSION: Fasting triglycerides may be useful as a clinical predictor of insulin resistance and diabetes development among First Nations populations. Unlike other ethnic groups, BMI and waist circumference may be less important factors in diabetes development.

Incident diabetes, hypertension and dyslipidemia in a Manitoba First Nation.

BACKGROUND: Diabetes and diabetes complications are substantially higher among Canadian First Nations populations compared with the general Canadian population. However, incidence data using detailed individual assessments from a population-based cohort have not been undertaken. OBJECTIVE: We sought to describe incident diabetes, hypertension and dyslipidemia in a population-based cohort from a Manitoba Ojibway First Nation community. DESIGN: Study data were from 2 diabetes screening studies in Sandy Bay First Nation in Manitoba, Canada, collected in 2002/2003 and 2011/2012. The cohort comprised of respondents to both screening studies (n=171). Health and demographic data were collected using a questionnaire. Fasting blood samples, blood pressure and anthropometric data were also collected objectively. Incident diabetes, hypertension and dyslipidemia were determined. Generalized linear models with Poisson distribution were used to estimate risk of incident diabetes and cardiometabolic conditions according to age and sex. RESULTS: There were 35 (95% CI: 26, 45) new cases of diabetes among 128 participants without diabetes at baseline (27 or 3.3% per year). While participants who were 50 years and older at baseline had a significantly higher risk of incident diabetes at follow-up compared with participants aged 18-29 at baseline (p=0.012), more than half of the incident cases of diabetes occurred among participants aged less than 40 at baseline. There were 28 (95% CI: 20, 37) new cases of dyslipidemia at follow-up among 112 without dyslipidemia at baseline (25%). There were 36 (95% CI: 31, 42) new cases of hypertension among 104 participants without hypertension at baseline (34.6%). Women had half the risk of developing hypertension compared with men (p=0.039). CONCLUSIONS: Diabetes incidence is very high, and the number of new cases among those younger than 40 is a concern. Additional public health and primary care efforts are needed to address the diabetes burden in this First Nation community.

Between a rock and a hard place: Smoking trends in a Manitoba First Nation.

OBJECTIVES: The purpose of this study is to estimate and compare smoking prevalence over two time periods in a Manitoba First Nation community. METHODS: Data fromtwo independent Diabetes Screening Studies in Sandy Bay First Nation, collected in 2002/2003 (n = 482) and 2011/2012 (n = 596),were used. Crude prevalence of current and ever smoking as well as current smoke exposure was estimated. Change over time was tested using a χ² statistic. RESULTS: The crude prevalence of current smoking was 74.0% (95% confidence interval [CI]: 70.1, 78.0) in 2002/2003 and 80.0% (95% CI: 76.8, 83.2) in 2011/2012. The crude prevalence of ever smoking was 83.0% in 2002/2003 and 91.4% in 2011/2012. The prevalence of both current smoking status and ever smoking were significantly higher in 2011/2012 compared to 2002/2003 (p = 0.020 and p < 0.001 respectively). Among participants who were not current smokers, 58.5% (95% CI: 49.6, 67.4) and 76.5% (95% CI: 68.9, 84.1) reported at least one person who smoked in the home in 2002/2003 and 2011/2012 respectively (p = 0.003). In 2011/2012, 96.5% (95% CI: 94.8, 98.2) of those who reported having any children under the age of 18 living in the home were either a current smoker and/or reported that someone else smoked in the home. CONCLUSION: Public health and policy initiatives are needed to address the increase in smoking prevalence in the study community.

Trends in diabetes and cardiometabolic conditions in a Canadian First Nation community, 2002-2003 to 2011-2012.

INTRODUCTION: The burden of diabetes and cardiovascular disease among the Canadian First Nation population is disproportionately high compared with the general Canadian population. Continuous monitoring of the diabetes epidemic among the Canadian First Nations population is necessary to inform public health practice. The purpose of the study was to compare the prevalence of diabetes and cardiometabolic conditions in a Manitoba First Nation between 2 periods. METHODS: Study data were from 2 diabetes screening studies in Sandy Bay Ojibway First Nation in Manitoba, collected in 2002-2003 and 2011-2012. All adults aged 18 years or older were invited to participate in both studies. Crude and sex- and age-standardized prevalence of diabetes and cardiometabolic conditions for each period were estimated and compared with each other by using χ(2) tests. RESULTS: Sex- and age-standardized prevalence of diabetes was estimated at 39.4% (95% confidence interval [CI], 35.1-43.8) in 2002-2003 and was not significantly different (P = .99) in 2011-2012. Sex- and age-standardized obesity prevalence was significantly lower in 2011-2012, at 48.7% (95% CI, 44.6-52.7), compared with 60.8% (95% CI, 56.4-65.2) in 2002-2003 (P < .001). However, this finding was accounted for by a lower prevalence of obesity among men aged 40 to 49 and aged 50 years or older in 2011-2012 compared with 2002-2003. Sex- and age-standardized prevalence of hypertension (P = .97), abdominal obesity (P = .26), dyslipidemia (P = .73), and metabolic syndrome (P = .67) were not significantly different between periods. Significantly higher crude prevalence of obesity, abdominal obesity, dyslipidemia, and metabolic syndrome among women compared with men persisted from 2002-2003 to 2011-2012. CONCLUSION: The diabetes epidemic remains a serious problem in this First Nation community. The gap in cardiometabolic burden between men and women has also persisted.

Hypothesis: smoking decreases breast feeding duration by suppressing prolactin secretion.

A number of studies, including new data summarized here, conclude that breast feeding duration is lower in smoking mothers. Although some have suggested that this merely reflects poor health motivation in those prone to smoke, several lines of evidence support the view that chronic smoking does indeed compromise breast feeding by suppressing prolactin secretion and thereby lowering breast milk volume. Moreover, a recent clinical trial shows that an effective smoking cessation program can boost breast feeding duration in smokers. An analysis of pertinent rodents studies suggests that chronic nicotine administration boosts dopaminergic activity in the tuberoinfundibular tract which functions to inhibit prolactin release; this increase in dopaminergic activity, in turn, may reflect a nicotine-mediated suppression of hypothalamic opioid activity.