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.

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.

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.

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.

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.

A qualitative analysis of the perceived socio-cultural contexts and health concerns of sugar-sweetened beverages among adults studying or working at a post-secondary institution in Dharwad, India.

BACKGROUND: We sought to explore the perceptions of the socio-cultural contexts and health concerns of consuming sugar-sweetened beverages (SSB) among Indian adults working or studying at a post-secondary institution in Karnataka, India. METHODS: We completed a qualitative study, including 24 semi-structured interviews between 2017 and 2018 at the University of Agricultural Sciences, Dharwad, Karnataka, India. Data were analyzed using thematic content analysis. RESULTS: One over-arching theme emerged, westernization and changing perceptions of food, sugar, and health. Participants discussed SSB and associated health concerns in the broad context of westernization and overall economic development in India. Three sub-themes regarding the health perceptions of consuming SSB were: healthy drinks are clean and natural; hydration and energy; and moderation and body weight. Hygienically-prepared beverages were a consistent concern among participants. Juices and beverages, such as tea or coffee, sweetened with jaggery were viewed positively due to their naturalness and lack of processed sugar. Participants perceived SSB as providing hydration and energy, particularly in hot weather. Lastly, if consumed in moderation, SSB were thought to have no direct adverse health consequences. Though some participants noted excessive, 'addictive' consumption would contribute to weight gain and diabetes. CONCLUSION: Perceived health concerns of SSB reflect dominant health issues in India, namely, food insecurity, food safety, and increasingly, diabetes. Policymakers tend to prioritize acute challenges over long-term concerns. As such, the capacity of any policy to address chronic nutritional concerns related to SSB are likely to be muted in the absence of improvements to food safety and security.

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.

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.

Employment Outcomes among Registered Dietitians following Graduation in Manitoba.

Purpose: The study objectives were to (i) describe employment outcomes among Registered Dietitians (RDs) who graduated from the University of Manitoba, (ii) test for differences in employment outcomes according to graduation year, and (iii) compare preferred area of practice and geography prior to employment with past and current employment. Methods: Graduates of the Human Nutritional Sciences program (2006-2015) were invited to participate in an online survey. Data on respondent demographics, education, and employment outcomes were collected. Results: Overall, 133 (68%) respondents self-identified as RDs. RDs who had graduated between 2006 and 2011 were significantly more likely to secure employment within 6 months post-graduation compared with RDs that graduated between 2012 and 2015. Geographically, although 56% of RDs did not wish to gain experience in rural/remote communities upon graduating, 44% of these respondents reported working part- or full-time in a rural/remote location at some point during their career. Conclusion: Findings indicate that a substantial number of RDs in Manitoba are employed in a rural or remote location despite acknowledging that it is not a preferred location. Future research is needed to explore the views and experiences of new and established RDs toward rural or remote practice, including preparedness for practice.

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.

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.

"Coke's not a food": A critical discourse analysis of sugar-sweetened beverage tax acceptability by white residents from an upper-middle class neighborhood in Winnipeg Manitoba.

Increasing concerns about the health impacts of sugar consumption has led to the proposition of a sugar-sweetened beverage (SSB) tax in Canada. However, competing concerns related to stigma and equity remain and have not been explored in a Canadian context. As part of a broader study examining the perspectives of various populations on SSB tax acceptability, we examined how residents of an upper-middle class neighborhood conceptualize SSB tax acceptability, and we explored the discourses that inform their discussion. We conducted and analyzed qualitative, semi-structured interviews with residents of an upper-middle class neighborhood in Winnipeg, Manitoba, Canada. Recruitment criteria were residence, adults, and English speaking. Critical discourse analysis methodology was used, and healthism (health moralism) and tax psychology informed the analysis. Eighteen participants volunteered: 15 females and 3 males; all self-identified as white, and all spoke about (grand)parenting. Healthist discourse was utilized in supportive discussion of SSB taxation. With the mobilization of healthism, ideal citizens and parents were described as "health conscious" and those who might be likely to reduce SSB intake because of taxation. Healthism also contributed to their identification of beverages targeted by a tax, versus those they deemed as having redeeming nutritional qualities. Limits to SSB tax support were expressed as fairness concerns, with a focus on the procedural justice of the tax. Participants supported SSB taxation and the discourses they employed suggested support for the tax was perceived as contributing to their construction of the kind of ideal, health-valuing citizens they hoped to embody. However, participants were also concerned about the fairness of implementation, although this did not outweigh the prioritization of good health.

Balancing on the redline: a qualitative study of the experiences purchasing sugar-sweetened beverages among Indigenous adults in a Canadian urban neighbourhood.

OBJECTIVE: Growing evidence suggests that inner-city residents actively navigate their food landscape to meet a wide range of socio-economic needs. Given the increasing focus of health policies on sugar-sweetened beverages (SSB) through price-based strategies, it is critical to understand purchasing habits of populations with higher SSB intake. This study examined urban Indigenous adults' SSB shopping behaviour and experiences. METHODS: We conducted a community-based participatory research study using semi-structured interviews with a purposive sample of Indigenous adults (≥ 18 years old) from the North End neighbourhood of Winnipeg. Interviews were audio recorded, transcribed verbatim, and thematically analyzed. RESULTS: All 20 participants (women = 10; men = 8; two-spirit = 2) consumed SSB on a regular, daily basis either at the time of the interview or at a prior period in their lives. Themes defining residents' SSB shopping behaviour and experiences of shopping for SSB included balancing on the redline, specifically (1) balancing SSB purchasing constraints and facilitators with savvy shopping approaches and (2) balancing (stereo)typical reactions with resilient coping approaches. Residents procured SSB in various stores within and beyond the boundaries of the North End neighbourhood. SSB is a considerable, reoccurring expense, requiring savvy price-shopping strategies in order to access. Indigenous adults experience judgement and stereotyping when purchasing SSB, including intersecting racial, class, and weight stigma. CONCLUSION: Purchasing SSB is perceived as a source of judgement when outside of inner-city neighbourhoods. Policymakers should consider how policies directed at SSB, which are consumed by Indigenous and food-insecure populations in greater quantities, may magnify existing racial, class, and weight-based discrimination.

RéSUMé: OBJECTIF: De l'évidence grandissante suggère que les résidents urbains naviguent activement leur environnement alimentaire pour rejoindre multiples niveaux socio-économiques. Étant donné l'intérêt grandissant envers nos principes de santé pour boissons sucrées (BS) en travers des stratégies à base de prix, il est critique de comprendre les habitudes d'achat des populations qui consomment le plus de BS. Cette étude a examiné les habitudes et expériences d'achats de BS d'adultes urbains Indigènes. MéTHODE: Nous avons fait une recherche participative dans une communauté utilisant des interviews semi-structurés utilisant un échantillon d'adultes Indigènes (≥ 18 ans) de la communauté « North End ¼ à Winnipeg. Les interviews ont été enregistrés, transcrits verbatim et analysés thématiquement. RéSULTATS: Tous les 20 participants (femmes = 10; hommes = 8, bispirituel = 2) ont consommé des BS régulièrement, à tous les jours, soit au temps de l'interview ou à un temps passé dans leur vie. Les thèmes qui définissent les habitudes d'achat de BS des résidents et leurs expériences d'achat de BS incluent : balancer sur la ligne rouge, en particulier (1) balancer les contraintes et facilitateurs d'achat de BS avec des approches d'achats astucieux et (2) balancer les réactions (stéréo)typiques aves des approches d'adaptation résilientes. Les résidents se procurent des BS dans multiples magasins à l'intérieur et à l'extérieur des limites de la communauté « North End ¼. Les BS sont une dépense considérable et récurrentes qui requiert des stratégies de prix d'achats astucieux. Les adultes indigènes expérience du jugement et des stéréotypes lors d'achats de BS, qui incluent des stigmatismes raciaux, classistes et à base de poids. CONCLUSION: L'achat de BS est perçu comme une source de jugement lorsqu'on sort des communautés du centre-ville. Les décideurs politiques devraient considérer que leur politique envers les BS, qui sont disproportionnellement consommés par les populations radicalisées et alimentairement insécures, peuvent aggraver les discriminations raciaux, classistes ou basées sur le poids.

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.

Winnipeg-based elementary school teachers' perspectives on food allergy management: a qualitative analysis.

BACKGROUND: Food allergy affects 7-8% of children worldwide. Teachers supervise children in school, where most children spend their day. Yet, teachers have variable food allergy-related knowledge. OBJECTIVE: We aimed to identify how Winnipeg-based elementary school teachers manage food allergy and prevent food-triggered allergic reactions in their classrooms and schools. METHODS: Kindergarten-Grade 6 public and private school teachers, from Winnipeg, Canada, were interviewed virtually upon providing written informed consent. Interviews were recorded and transcribed verbatim. The study followed a pragmatic framework. Data were analysed via thematic analysis by multiple researchers. RESULTS: We interviewed 16 teachers, who primarily identified as female (87.5%). Most teachers worked in public schools (87.5%) and, on average, had 5.8 years of teaching experience. We identified four themes within the data. Most teachers (68.9%) had direct or indirect experience with food allergy. Theme 1 described the minimal standardization and inconsistent enforcement of food allergy policies between and within schools. Teachers also had varied food allergy knowledge. Theme 2 reflected teachers' variable confidence/perceived knowledge towards food allergy management, including feeling of stress and anxiety. Theme 3 captured the lack of standardized food allergy education for teachers, and concerns about the adequacy of the current provincial program. Theme 4 described how teachers spoke of relying on other school staff, families and students to have effective communication. CONCLUSION: Teachers' food allergy management was informed by their knowledge and lived experience, guided by their school policies and individualized students' needs. Teachers identified gaps in knowledge and communication, and desired more training and resources.

Examining attitudes toward a proposed sugar-sweetened beverage tax among urban Indigenous adults: a qualitative study using a decolonizing lens.

BACKGROUND: Sugar-sweetened beverage taxation has been proposed as a public health policy to reduce consumption, and compared with other ethnic or racialized groups in Canada, off-reserve Indigenous populations consume sugar-sweetened beverages at higher frequencies and quantities. We sought to explore the acceptability and anticipated outcomes of a tax on sugar-sweetened beverages among Indigenous adults residing in an inner-city Canadian neighbourhood. METHODS: Using a community-based participatory research approach, we conducted semistructured interviews (November 2019-August 2020) with urban Indigenous adults using purposive sampling. Interviews were audio-recorded, transcribed verbatim and analyzed using theoretical thematic analysis. RESULTS: All 20 participants (10 female, 8 male and 2 two-spirit) consumed sugar-sweetened beverages on a regular, daily basis at the time of the interview or at some point in their lives. Most participants were opposed to and concerned about the prospect of sugar-sweetened beverage taxation owing to 3 interconnected themes: government is not trustworthy, taxes are ineffective and lead to inequitable outcomes, and Indigenous self-determination is critical. Participants discussed government's mismanagement of previous taxes and lack of prioritization of their community's specific needs. Most participants anticipated that Indigenous people in their community would continue to consume sugar-sweetened beverages, but that a tax would result in fewer resources for other necessities, including foods deemed healthy. INTERPRETATION: Low support for the tax among urban Indigenous people is characterized by distrust regarding the tax, policy-makers and its perceived effectiveness. Findings underscore the importance of self-determination in informing health policies that are equitable and nonstigmatizing.

Prevalence, risk factors and awareness of albuminuria on a Canadian First Nation: a community-based screening study.

BACKGROUND: Both diabetic and non-diabetic end stage renal disease (ESRD) are more common among Canadian First Nations people than among the general Canadian population. The purpose of this research was to determine the prevalence of and risk factors for albuminuria in a Canadian First Nation population at high risk for ESRD and dialysis. METHODS: Data from a community-based screening study of 483 residents of a Plains Ojibway First Nation in Manitoba was used. Participants provided random urine samples. Proteinuria was defined as any dipstick positive for protein (≥1 g/L) or those with ACR in the macroalbuminuric range (≥30 mg/mmol) on at least one sample. Microalbuminuria was defined as ACR ≥2 mg/mmol for males and ≥2.8 mg/mmol for females. Other measures included fasting glucose, haemoglobin A1c, triglycerides, cholesterol, blood pressure, height, weight and waist and hip circumferences. RESULTS: Twenty percent of study participants had albuminuria, (5% proteinuria and 15% microalbuminuria). Of participants with diabetes, 42% (56/132) had albuminuria compared to 26% (7/27) among those with impaired fasting glucose and 10% (30/303) among those with normal glucose tolerance. Only 5.3% of those with albuminuria were aware of any degree of renal disease. In a multivariate logistic regression, independent associations with albuminuria were male gender [p = 0.002], increasing fasting glucose [p <0.0001], years diagnosed with diabetes [p = 0.03], increasing systolic blood pressure [p = 0.009], and increasing body mass index (BMI) [p = 0.04]. CONCLUSIONS: The independent association between BMI and albuminuria has not been previously reported among indigenous populations. There is a high prevalence of albuminuria in this Canadian First Nation population; the high proportion of patients with diabetes and undiagnosed kidney disease demonstrates the need for screening, education and intervention to halt the progression and development of albuminuria and ultimately ESRD and CVD.

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.