Australian and Canadian financial wellbeing policy landscape during COVID-19: An equity-informed policy scan.

Background: This targeted and comprehensive policy scan examined how different levels of governments in Australia and Canada responded to the financial crisis brought on by the COVID-19 pandemic. We mapped the types of early policy responses addressing financial strain and promoting financial wellbeing. We also examined their equity considerations. Methods: Through a systematic search, snowballing, and manual search, we identified Canadian and Australian policies at all government levels related to financial strain or financial wellbeing enacted or amended in 2019-2020. Using a deductive-inductive approach, policies were categorized by jurisdiction level, focal areas, and target population groups. Results: In total, 213 and 97 policies in Canada and Australia, respectively, were included. Comparisons between Canadian and Australian policies indicated a more diversified and equity-targeted policy landscape in Canada. In both countries, most policies focused on individual and family finances, followed by housing and employment areas. Conclusions: The policy scan identified gaps and missed opportunities in the early policies related to financial strain and financial wellbeing. While fast, temporary actions addressed individuals' immediate needs, we recommend governments develop a longer-term action plan to tackle the root causes of financial strain and poor financial wellbeing for better health and non-health crisis preparedness. Statement on Ethics and Informed Consent: This research reported in this paper did not require ethical clearance or patient informed consent as the data sources were published policy documents. This study did not involve data collection with humans (or animals), nor any secondary datasets involving data provided by humans (or from animal studies).

Untangling Concepts of Financial Circumstances for Public Health Professionals and Scholars: A Glossary and Concept Map.

Public health discipline and practice have prioritized work on poverty and populations at high risk for material deprivation, with less consideration for the full spectrum of financial circumstances relative to well-being. Public health can make a much-needed contribution to this area, which is currently dominated by the financial industry, focused on individual behaviors, and lacking the definitional consensus needed for research and evaluation. A population-level lens can reveal the social determinants and health consequences of real or perceived poor financial circumstances. This article aims to improve conceptual understanding of financial circumstances among public health scholars and professionals. We identified concepts through a critical literature review of peer-reviewed and practice-based resources on financial well-being and financial strain. We developed a glossary of concepts related to financial circumstances and categorized concepts according to their level of influence using an approach informed by socioecological models. We provide a concept map that illustrates the relationships between concepts in the context of their levels of influence. This article will help to advance an agenda on financial well-being promotion in public health research and practice. (Am J Public Health. 2024;114(1):79-89. https://doi.org/10.2105/AJPH.2023.307449).

The Generative Mechanisms of Financial Strain and Financial Well-Being: A Critical Realist Analysis of Ideology and Difference.

BACKGROUND: Rapid, strategic action is required to mitigate the negative and unequal impact of the coronavirus disease 2019 (COVID-19) pandemic on the financial well-being (FWB) of global populations. Personal financial strain (FS) worsened most significantly among systematically excluded groups. Targeted government- and community-led initiatives are needed to address these inequities. The purpose of this applied research was to identify what works for whom, under what conditions, and why in relation to community and government initiatives that promote personal and household FWB and/or address FS in high income economies. METHODS: We employed a critical realist analysis to literature that reported on FWB/FS initiatives in high income countries. This included initiatives introduced in response to the pandemic as well as those that began prior to the pandemic. We included sources based on a rapid review. We coded academic, published literature (n=39) and practice-based (n=36) reports abductively to uncover generative mechanisms - ie, underlying, foundational factors related to community or government initiatives that either constrained and/or enabled FWB and FS. RESULTS: We identified two generative mechanisms: (1) neoliberal ideology; and (2) social equity ideology. A third mechanism, social location (eg, characteristics of identity, location of residence), cut across the two ideologies and demonstrated for whom the initiatives worked (or did not) in what circumstances. Neoliberal ideology (ie, individual responsibility) dominated initiative designs, which limited the positive impact on FS. This was particularly true for people who occupied systematically excluded social locations (eg, low-income young mothers). Social equity-based initiatives were less common within the literature, yet mostly had a positive impact on FWB and produced equitable outcomes. CONCLUSION: Equity-centric initiatives are required to improve FWB and reduce FS among systemically excluded and marginalized groups. These findings are of relevance now as nations strive for financial recovery in the face of the ongoing global pandemic.

Housing for vulnerable populations-identifying system cost implications: an analytic literature review.

We explored how investments in housing for vulnerable populations (including those experiencing homelessness) are described as leading to cost containment for the health, justice, and social service systems; the nature of any costs and benefits; and variations by housing type and over time. A structured search of peer-reviewed academic research focused on the core concepts of economic benefit, public housing programs, and vulnerable populations. Findings from 42 articles reporting on cost containment specific to health, justice, and social service systems at the municipal, regional, and/or state/provincial level were synthesized. Most of the studies focused on supportive housing interventions, targeted adults (mainly men) experiencing chronic homelessness in the USA, and reported results over 1-5 years. Approximately half of the articles reported on the costs required to house vulnerable populations. About half reported on funding sources, which is critical information for leadership decisions in cost containment for supportive housing. Most of the studies assessing program cost or cost-effectiveness reported a reduction in service costs and/or greater cost-effectiveness. Studies mostly reported impacts on health services, with hospital/inpatient care and emergency service use typically decreasing across the intervention types. All the studies that assessed cost impacts on the justice system reported a decrease in expenditures. Housing vulnerable populations was also found to decrease shelter service use and engagement with the foster care/welfare systems. Housing interventions may offer cost-savings in the short- and medium-term, with a limited evidence base also demonstrating long term benefit.

An action-oriented public health framework to reduce financial strain and promote financial wellbeing in high-income countries.

BACKGROUND: Perceived financial security impacts physical, mental, and social health and overall wellbeing at community and population levels. Public health action on this dynamic is even more critical now that the COVID-19 pandemic has exacerbated financial strain and reduced financial wellbeing. Yet, public health literature on this topic is limited. Initiatives targeting financial strain and financial wellbeing and their deterministic effects on equity in health and living conditions are missing. Our research-practice collaborative project addresses this gap in knowledge and intervention through an action-oriented public health framework for initiatives targeting financial strain and wellbeing. METHODS: The Framework was developed using a multi-step methodology that involved review of theoretical and empirical evidence alongside input from a panel of experts from Australia and Canada. In an integrated knowledge translation approach, academics (n = 14) and a diverse group of experts from government and non-profit sectors (n = 22) were engaged throughout the project via workshops, one-on-one dialogues, and questionnaires. RESULTS: The validated Framework provides organizations and governments with guidance for the design, implementation, and assessment of diverse financial wellbeing- and financial strain-related initiatives. It presents 17 priority actionable areas (i.e., entry points for action) likely to have long-lasting, positive effects on people's financial circumstances, contributing to improved financial wellbeing and health. The 17 entry points relate to five domains: Government (All Levels), Organizational & Political Culture, Socioeconomic & Political Context, Social & Cultural Circumstances, and Life Circumstances. CONCLUSIONS: The Framework reveals the intersectionality of root causes and consequences of financial strain and poor financial wellbeing, while also reinforcing the need for tailored actions to promote socioeconomic and health equity for all people. The dynamic, systemic interplay of the entry points illustrated in the Framework suggest opportunities for multi-sectoral, collaborative action across government and organizations towards systems change and the prevention of unintended negative impacts of initiatives.

Local Environment Action on Food project: impact of a community-based food environment intervention in Canada.

Children are exposed to food environments that make nutrient-poor, energy-dense food cheap, readily available and heavily marketed; all conditions with potential negative impacts on diet and health. While the need for programmes and policies that improve the status of food environments is clear, greater public support is needed for governments to act. The purpose of this qualitative collective case study was to examine if community engagement in the Local Environment Action on Food (LEAF) project, a community-based food environment intervention in Alberta, Canada, could build public support and create action to promote healthy food environments. Semi-structured interviews with a purposeful sample of 26 stakeholders from 7 communities explored LEAF's impact and stakeholder experiences creating change. Data collection and analysis were iterative, following Charmaz's constant comparative analysis strategy. Participants reported environmental and community impacts from LEAF. Notably, LEAF created a context-specific tool, a Mini Nutrition Report Card, that communities used to promote and support food environment action. Further, analysis outlined perceived barriers and facilitators to creating community-level food environment action, including level of engagement in LEAF, perceived controllability, community priorities, policy enforcement and resources. Findings from this study suggest that community-based interventions, such as LEAF, can help build community capacity and reduce existing barriers to community-level food environment action. Thus, they can provide an effective method to build public awareness, demand and action for healthier food environments.

Quantifying the contribution of modifiable risk factors to socio-economic inequities in cancer morbidity and mortality: a nationally representative population-based cohort study.

BACKGROUND: Compared with those with a higher socio-economic position (SEP), individuals with a lower SEP have higher cancer morbidity and mortality. However, the contribution of modifiable risk factors to these inequities is not known. This study aimed to quantify the mediating effects of modifiable risk factors to associations between SEP and cancer morbidity and mortality. METHODS: This study used a prospective observational cohort design. We combined eight cycles of the Canadian Community Health Survey (2000/2001-2011) as baseline data to identify a cohort of adults (≥35 years) without cancer at the time of survey administration (n = 309 800). The cohort was linked to the Discharge Abstract Database and the Canadian Mortality Database for cancer morbidity and mortality ascertainment. Individuals were followed from the date they completed the Canadian Community Health Survey until 31 March 2013. Dates of individual first hospitalizations for cancer and deaths due to cancer were captured during this time period. SEP was operationalized using a latent variable combining measures of education and household income. Self-reported modifiable risk factors, including smoking, excess alcohol consumption, low fruit-and-vegetable intake, physical inactivity and obesity, were considered as potential mediators. Generalized structural equation modelling was used to estimate the mediating effects of modifiable risk factors in associations between low SEP and cancer morbidity and mortality in the total population and stratified by sex. RESULTS: Modifiable risk factors together explained 45.6% of associations between low SEP and overall cancer morbidity and mortality. Smoking was the most important mediator in the total population and for males, accounting for 15.5% and 40.2% of the total effect, respectively. For females, obesity was the most important mediator. CONCLUSIONS: Modifiable risk factors are important mediators of socio-economic inequities in cancer morbidity and mortality. Nevertheless, more than half of the variance in these associations remained unexplained. Midstream interventions that target modifiable risk factors may help to alleviate inequities in cancer risk in the short term. However, ultimately, upstream interventions that target structural determinants of health are needed to reduce overall socio-economic inequities in cancer morbidity and mortality.

Community intervention strategies to reduce the impact of financial strain and promote financial well-being: a comprehensive rapid review.

Financial well-being describes when people feel able to meet their financial obligations, feel financially secure and are able to make choices that benefit their quality of life. Financial strain occurs when people are unable to pay their bills, feel stressed about money and experience negative impacts on their quality of life and health. In the face of the global economic repercussions of the COVID-19 pandemic, community-led approaches are required to address the setting-specific needs of residents and reduce the adverse impacts of widespread financial strain. To encourage evidence-informed best practices, a provincial health authority and community-engaged research centre collaborated to conduct a rapid review. We augmented the rapid review with an environmental scan and interviews. Our data focused on Western Canada and was collected prior to the pandemic (May-September 2019). We identified eight categories of community-led strategies to promote financial well-being: systems navigation and access; financial literacy and skills; emergency financial assistance; asset building; events and attractions; employment and educational support; transportation; and housing. We noted significant gaps in the evidence, including methodological limitations of the included studies (e.g. generalisability, small sample size), a lack of reporting on the mechanisms leading to the outcomes and evaluation of long-term impacts, sparse practice-based data on evaluation methods and outcomes, and limited intervention details in the published literature. Critically, few of the included interventions specifically targeted financial strain and/or well-being. We discuss the implications of these gaps in addition to possibilities and priorities for future research and practice. We also consider the results in relation to the COVID-19 pandemic and its economic consequences.

The time is now for public health to lead the way on addressing financial strain in Canada.

Financial strain was an issue for many Canadians long before the arrival of the global novel coronavirus pandemic in early 2020. However, it has worsened in recent months in relation to the pandemic and public health measures put in place to prevent the spread of COVID-19. Members of underserved groups and people who experience poverty are particularly vulnerable to financial strain and its negative health impacts. As public health professionals, we should be concerned. In this commentary, we discuss the concept of financial strain and its health consequences and highlight how existing research in the area is falling short and why. We suggest next steps to guide research and practice related to financial strain such that it reflects the core values of public health, including equity, life course approaches, and the social determinants of health. This commentary is a call to action for public health researchers and practitioners in Canada to take a more prominent role in shaping the agenda on financial strain to support financial well-being for all.

RéSUMé: De nombreux Canadiens subissaient une pression financière bien avant l'arrivée de la pandémie mondiale du nouveau coronavirus au début de 2020. Cette pression s'est toutefois aggravée ces derniers mois en raison de la pandémie et des mesures de santé publique mises en place pour prévenir la propagation de la COVID-19. Les membres des groupes mal desservis et les personnes aux prises avec la pauvreté sont particulièrement vulnérables à la pression financière et à ses effets néfastes sur la santé. En tant que professionnels de la santé publique, nous devrions nous en inquiéter. Dans notre commentaire, nous abordons la notion de pression financière et ses conséquences pour la santé et nous soulignons en quoi et pourquoi la recherche actuelle dans ce domaine n'est pas à la hauteur. Nous proposons des mesures pour orienter la recherche et la pratique liées à la pression financière afin qu'elles reflètent les valeurs fondamentales de la santé publique : l'équité, les approches axées sur la vie entière et les déterminants sociaux de la santé. Ce commentaire est un appel à l'action lancé aux chercheurs et aux praticiens en santé publique du Canada pour qu'ils jouent un plus grand rôle dans la définition des mesures à prendre face à la pression financière afin de favoriser le bien-être financier de tous.

Using the intervention ladder to examine policy influencer and general public support for potential tobacco control policies in Alberta and Quebec. / Utilisation d'une échelle d'intervention pour analyser le soutien à d'éventuelles politiques de lutte contre le tabagisme de la part du grand public et d'influenceurs en matière de politiques en Alberta et au Québec.

OBJECTIVE: To assess general public and policy influencer support for population-level tobacco control policies in two Canadian provinces. METHODS: We implemented the Chronic Disease Prevention Survey in 2016 to a census sample of policy influencers (n = 302) and a random sample of members of the public (n = 2400) in Alberta and Quebec, Canada. Survey respondents ranked their support for tobacco control policy options using a Likert-style scale, with aggregate responses presented as net favourable percentages. Levels of support were further analyzed by coding each policy option using the Nuffield Council on Bioethics intervention ladder framework, to assess its level of intrusiveness on personal autonomy. RESULTS: Policy influencers and the public considered the vast majority of tobacco control policy options as "extremely" or "very" favourable, although policy influencers in Alberta and Quebec differed on over half the policies, with stronger support in Quebec. Policy influencers and the public strongly supported more intrusive tobacco control policy options, despite anticipated effects on personal autonomy (i.e. for policies targeting children/youth and emerging tobacco products like electronic cigarettes). They indicated less support for fiscally based tobacco control policies (i.e. taxation), despite these policies being highly effective. CONCLUSION: Overall, policy influencers and the general public strongly supported more restrictive tobacco control policies. This study further highlights policies where support among both population groups was unanimous (potential "quick wins" for health advocates). It also highlights areas where additional advocacy work is required to communicate the population-health benefit of tobacco control policies.

Health gradients in emergency visits and hospitalisations for paediatric respiratory diseases: A population-based retrospective cohort study.

BACKGROUND: Socio-economically deprived children face a disproportionate burden of respiratory diseases. The association between area-level material and social deprivation and emergency department (ED) visits and hospitalisations for paediatric respiratory diseases has not been explored. OBJECTIVES: We evaluated health inequalities in emergency department (ED) visits and hospitalisations for paediatric respiratory diseases according to material and social deprivation indexes. METHODS: This population-based retrospective cohort study deterministically linked birth, ED visits and hospitalisation data, and census-based, area-level deprivation indexes for all singleton children born in the province of Alberta, Canada, between 2005 and 2010 who had at least one recorded ED visit or hospitalisation for respiratory diseases in their first five years of life. We classified ED visits and hospitalisations for seven respiratory diseases by deprivation indexes. Concentration indexes (CInd) and area-level concentration curves measured health gradients across deprivation groups. Rate ratios (RR) evaluated associations between deprivation indexes and respiratory episodes of care. RESULTS: The study cohort included 198 572 newborns. The highest CInd were found in ED visits for other acute lower respiratory tract infections (oLRTI; CInd -0.22, 95% confidence interval [CI] -0.32, -0.12) and bronchiolitis (CInd -0.21, 95% CI -0.29, -0.12), and for pneumonia hospitalisations (CInd -0.23, 95% CI -0.33, -0.13). Croup ED visits had a low inequality degree. Compared to social deprivation, the material deprivation index presented a more consistent health gradient of increased episodes of care with increasing deprivation. oLRTI ED visits (RR 2.60, 95% CI 2.34, 2.92) and pneumonia hospitalisations (RR 2.57, 95% CI 2.31, 2.86) presented the largest inequalities between the least and most materially deprived groups. CONCLUSIONS: We found a concentration of ED visits and hospitalisations for paediatric respiratory diseases in the most deprived groups. However, health inequalities are present across the material and social deprivation spectrum. Compared to the social deprivation index, the material index presented clearer paediatric respiratory health gradients.

Promotion of physical activity in rural, remote and northern settings: a Canadian call to action. / Promotion de l'activité physique en milieu rural ou éloigné et dans les régions du Nord : un appel pancanadien à l'action.

INTRODUCTION: The lack of policy, practice and research action on physical activity and features of the physical (built and natural) environments in rural, remote and northern settings is a significant threat to population health equity in Canada. This paper presents a synthesis of current evidence on the promotion of physical activity in non-urban settings, outcomes from a national priority-setting meeting, and a preliminary call to action to support the implementation and success of population-level initiatives targeting physical activity in non-urban settings. METHODS: We conducted a "synopses of syntheses" scoping review to explore current evidence on physical activity promotion in rural, remote, northern and natural settings. Next, we facilitated a collaborative priority-setting conference with 28 Canadian experts from policy, research and practice arenas to develop a set of priorities on physical activity in rural, remote and northern communities. These priorities informed the development of a preliminary Canadian call to action. RESULTS: We identified a limited number of reviews that focused on physical activity and the built environment in rural, remote and northern communities. At the prioritysetting conference, participants representing rural, remote and northern settings identified top priorities for policy, practice and research action to begin to address the gaps and issues noted in the literature. These priorities include self-identifying priorities at the community level; compiling experiences; establishing consistency in research definitions and methods; and developing mentorship opportunities. CONCLUSION: Coordinated action across policy, practice and research domains will be essential to the success of the recommendations presented in this call to action.

INTRODUCTION: L'absence d'interventions en matière de recherche, de pratiques et de politiques relativement à l'activité physique et les particularités de l'environnement physique (bâti et naturel) en milieu rural ou éloigné et dans les régions du Nord constituent des freins importants à l'équité en santé de la population au Canada. Cet article présente une synthèse des données probantes pertinentes sur l'activité physique en milieu non urbain, les résultats d'une rencontre sur l'établissement de priorités nationales ainsi qu'un appel préliminaire à l'action en vue de favoriser la mise en place et la réussite, à l'échelle de la population, d'initiatives axées sur l'activité physique en milieu non urbain. MÉTHODOLOGIE: Nous avons d'abord réalisé un examen de la portée des synopsis de synthèses pour étudier les données probantes pertinentes en lien avec la promotion de l'activité physique en milieu rural, éloigné ou naturel et dans les régions du Nord. Nous avons ensuite organisé une conférence à laquelle ont pris part 28 experts canadiens spécialisés en politiques, en recherche et en pratiques, afin de concevoir de manière concertée un ensemble de priorités sur l'activité physique en milieu rural ou éloigné et dans les régions du Nord. À la suite de cette rencontre, nous avons rédigé un appel à l'action préliminaire pour tout le Canada. RÉSULTATS: Nous avons relevé relativement peu de travaux axés sur l'activité physique et l'environnement bâti en milieu rural ou éloigné et dans les régions du Nord. Lors de la conférence sur l'établissement de priorités, des participants représentant des milieux ruraux ou éloignés et des collectivités du Nord ont formulé les grandes priorités d'action en matière de politiques, de pratiques et de recherche pour commencer à réduire les écarts et résoudre les problèmes soulevés dans la littérature : le besoin d'identification au niveau communautaire; la compilation d'expériences; l'assurance d'une cohésion dans les définitions et les méthodes de recherche et enfin la création de possibilités de mentorat. CONCLUSION: Une action concertée entre les domaines des politiques, des pratiques et de la recherche est essentielle au succès des recommandations formulées dans cet appel à l'action.

Adoption and diffusion of zoning bylaws banning fast food drive-through services across Canadian municipalities.

BACKGROUND: Healthy public policy is an important tool for creating environments that support human health and wellbeing. At the local level, municipal policies, such as zoning bylaws, provide an opportunity for governments to regulate building location and the type of services offered. Across North America, there has been a recent proliferation of municipal bylaws banning fast food drive-through services. Research on the utilization of this policy strategy, including bylaw adopters and adopter characteristics, is limited within the Canadian context. The aim of this study was to identify and characterize Canadian municipalities based on level of policy innovation and nature of their adopted bylaw banning fast food drive-through services. METHODS: A multiple case history methodology was utilized to identify and analyse eligible municipal bylaws, and included development of a chronological timeline and map of adopter municipalities within Canada. Grey literature and policy databases were searched for potential adopters of municipal fast food drive-through service bylaws. Adopters were confirmed through evidence of current municipal bylaws. Geographic diffusion and diffusion of innovations theories provided a contextual framework for analysis of bylaw documents. Analysis included assignment of adopter-types, extent and purpose of bans, and policy learning activities of each adopter municipality. RESULTS: From 2002 to 2016, 27 municipalities were identified as adopters: six innovators and twenty-one early adopters. Mapping revealed parallel geographic diffusion patterns in western and eastern Canada. Twenty-two municipalities adopted a partial ban and five adopted a full ban. Rationales for the drive-through bans included health promotion, environmental concerns from idling, community character and aesthetics, traffic concerns, and walkability. Policy learning, including research and consultation with other municipalities, was performed by nine early adopters. CONCLUSION: This study detailed the adoption of fast food drive-through bylaws across Canada. Understanding the adopter-type characteristics of municipalities and the nature of their bylaws can assist other jurisdictions in similar policy efforts. While the implications for research and practice are evolving and dynamic, fast food drive-through service bans may play a role in promoting healthier food environments. Further research is required to determine the viability of this strategy for health promotion and chronic disease prevention.

Community Lenses Revealing the Role of Sociocultural Environment on Physical Activity.

PURPOSE: To identify perceptions of how sociocultural environment enabled and hindered physical activity (PA) participation. DESIGN: Community-based participatory research. SETTING: Two semirural and two urban communities located in Alberta, Canada. PARTICIPANTS: Thirty-five people (74.3% females, 71.4% aged 25-64 years) across the four communities. METHOD: PhotoVoice activities occurred over 3 months during the spring of 2009. Participants were asked to document perceived environmental attributes that might foster or inhibit PA in their community. Photographs and narratives were shared in one-on-one interviews. Line-by-line coding of the transcripts was independently conducted by two researchers using an inductive approach. Codes were arranged into themes and subthemes, which were then organized into the Analysis Grid for Environments Linked to Obesity (ANGELO) framework. RESULTS: Six main themes (accompanied by subthemes) emerged: sociocultural aesthetics, safety, social involvement, PA motivation, cultural ideas of recreation, and car culture. Representative quotes and photographs illustrate enablers and obstacles identified by participants. CONCLUSION: This PhotoVoice study revealed how aspects of participants' sociocultural environments shaped their decisions to be physically active. Providing more PA resources is only one step in the promotion of supportive environments. Strategies should also account for the beautification and maintenance of communities, increasing feelings of safety, enhancement of social support among community members, popularization of PA, and mitigating car culture, among others.

Development of a report card on healthy food environments and nutrition for children in Canada.

OBJECTIVE: The purpose of the Report Card on Healthy Food Environments and Nutrition for Children is to assess how current environments and policies in Canada support or create barriers to improving children's dietary behaviours and body weights. METHOD: In 2014 we reviewed the literature to identify indicators of the quality of children's food environments and related policies. Scoring systems used to monitor and report on progress on a variety of public health activities were consulted during development of a grading scheme. The Report Card was revised following reviews by an Expert Advisory Committee. RESULTS: The Report Card assigns a grade to policies and actions (42 indicators and benchmarks) within 4 micro-environments (physical, communication, economic, social) and within the political macro-environment. Grade-level scores of A through F are assigned that reflect achievement of, supports for, and monitoring of indicator-specific benchmarks. A Canadian Report Card will be released annually starting in 2015. CONCLUSION: The Report Card is a novel tool to monitor the state of children's food environments and supportive policies, inform stakeholders of the state of these environments and policies, engage society in a national discussion, and outline a policy-relevant research agenda for further study.

Cancer beliefs and prevention policies: comparing Canadian decision-maker and general population views.

PURPOSE: The knowledge, attitudes, and beliefs of key policy influencers and the general public can support or hinder the development of public policies that support cancer prevention. To address gaps in knowledge concerning healthy public policy development, views on cancer causation and endorsement of policy alternatives for cancer prevention among government influencers (elected members of legislative assemblies and senior ministry bureaucrats), non-governmental influencers (school board chairs and superintendents, print media editors and reporters, and workplace presidents and senior human resource managers), and the general public were compared. METHODS: Two structured surveys, one administered to a convenience sample of policy influencers (government and non-governmental) and the other to a randomly selected sample of the general public, were used. The aim of these surveys was to understand knowledge, attitudes, and beliefs regarding health promotion principles and the priority and acceptability of policy actions to prevent four behavioral risk factors for cancer (tobacco use, alcohol misuse, unhealthy eating, and physical inactivity). Surveys were administered in Alberta and Manitoba, two comparable Canadian provinces. RESULTS: Although all groups demonstrated higher levels of support for individualistic policies (e.g., health education campaigns) than for fiscal and legislative measures, the general public expressed consistently greater support than policy influencers for using evidence-based policies (e.g., tax incentives or subsidies for healthy behaviors). CONCLUSIONS: These results suggest that Canadian policy influencers may be less open that the general public to adopt healthy public policies for cancer prevention, with potential detriment to cancer rates.

Understanding key influencers' attitudes and beliefs about healthy public policy change for obesity prevention.

OBJECTIVE: As overweight and obesity is a risk factor for chronic diseases, the development of environmental and healthy public policy interventions across multiple sectors has been identified as a key strategy to address this issue. METHODS: In 2009, a survey was developed to assess the attitudes and beliefs regarding health promotion principles, and the priority and acceptability of policy actions to prevent obesity and chronic diseases, among key policy influencers in Alberta and Manitoba, Canada. Surveys were mailed to 1,765 key influencers from five settings: provincial government, municipal government, school boards, print media companies, and workplaces with greater than 500 employees. A total of 236 surveys were completed with a response rate of 15.0%. RESULTS: Findings indicate nearly unanimous influencer support for individual-focused policy approaches and high support for some environmental policies. Restrictive environmental and economic policies received weakest support. Obesity was comparable to smoking with respect to perceptions as a societal responsibility versus a personal responsibility, boding well for the potential of environmental policy interventions for obesity prevention. CONCLUSIONS: This level of influencer support provides a platform for more evidence to be brokered to policy influencers about the effectiveness of environmental policy approaches to obesity prevention.

How community environment shapes physical activity: perceptions revealed through the PhotoVoice method.

A growing body of evidence shows that community environment plays an important role in individuals' physical activity engagement. However, while attributes of the physical environment are widely investigated, sociocultural, political, and economic aspects of the environment are often neglected. This article helps to fill these knowledge gaps by providing a more comprehensive understanding of multiple dimensions of the community environment relative to physical activity. The purpose of this study was to qualitatively explore how people's experiences and perceptions of their community environments affect their abilities to engage in physical activity. A PhotoVoice method was used to identify barriers to and opportunities for physical activity among residents in four communities in the province of Alberta, Canada, in 2009. After taking pictures, the thirty-five participants shared their perceptions of those opportunities and barriers in their community environments during individual interviews. Using the Analysis Grid for Environments Linked to Obesity (ANGELO) framework, themes emerging from these photo-elicited interviews were organized in four environment types: physical, sociocultural, economic, and political. The data show that themes linked to the physical (56.6%) and sociocultural (31.4%) environments were discussed more frequently than the themes of the economic (5.9%) and political (6.1%) environments. Participants identified nuanced barriers and opportunities for physical activity, which are illustrated by their quotes and photographs. The findings suggest that a myriad of factors from physical, sociocultural, economic, and political environments influence people's abilities to be physically active in their communities. Therefore, adoption of a broad, ecological perspective is needed to address the barriers and build upon the opportunities described by participants to make communities more healthy and active.

Exploring the process of capacity-building among community-based health promotion workers in Alberta, Canada.

Community capacity-building is a central element to health promotion. While capacity-building features, domains and relationships to program sustainability have been well examined, information on the process of capacity-building as experienced by practitioners is needed. This study examined this process as experienced by coordinators working within a community-based chronic disease prevention project implemented in four communities in Alberta (Canada) from 2005-2010 using a case study approach with a mixed-method design. Data collection involved semi-structured interviews, a focus group and program documents tracking coordinator activity. Qualitative analysis followed the constant comparative method using open, axial and selective coding. Quantitative data were analyzed for frequency of major activity distribution. Capacity-building process involves distinct stages of networking, information exchange, partnering, prioritizing, planning/implementing and supporting/ sustaining. Stages are incremental though not always linear. Contextual factors exert a great influence on the process. Implications for research, practice and policy are discussed.

Construct validation of 4 food-environment assessment methods: adapting a multitrait-multimethod matrix approach for environmental measures.

Few studies have assessed the construct validity of measures of neighborhood food environment, which remains a major challenge in accurately assessing food access. In this study, we adapted a psychometric tool to examine the construct validity of 4 such measures for 3 constructs. We used 4 food-environment measures to collect objective data from 422 Ontario, Canada, food stores in 2010. Residents' perceptions of their neighborhood food environment were collected from 2,397 households between 2009 and 2010. Objective and perceptual data were aggregated within buffer zones around respondents' homes (at 250 m, 500 m, 1,000 m, and 1,500 m). We constructed multitrait-multimethod matrices for each scale to examine construct validity for the constructs of food availability, food quality, and food affordability. Convergent validity between objective measures decreased with increasing geographic scale. Convergent validity between objective and subjective measures increased with increasing geographic scale. High discriminant validity coefficients existed between food availability and food quality, indicating that these two constructs may not be distinct in this setting. We conclude that the construct validity of food environment measures varies over geographic scales, which has implications for research, policy, and practice.