Promoting children's health through community-led street interventions: analyzing sustained voluntarism in Canadian School Streets.

BACKGROUND: Active School Travel (AST) initiatives align with the Ottawa Charter for Health Promotion, which calls for 'creating supportive environments' and 'strengthening community action.' However, their reliance on volunteers poses sustainability challenges. The main objectives of this study were to document the motivations, satisfaction, and experiences of volunteers involved in sustaining two AST initiatives in Ontario for an entire school year. METHODS: Two volunteer-led School Street initiatives in Kingston, Ontario successfully operated during pick-up and drop-off times of each school day. The first initiative operated for the entire 2021-2022 school year, and the second operated for the entire 2022-2023 school year. These initiatives were the first of their kind in the province of Ontario, Canada. Volunteers from both sites (n = 56) participated in online surveys and their motivations, satisfaction, and experiences of their role were compared using the 2-sided Fisher's Exact Test. RESULTS: Over 80% of volunteers were highly motivated to promote safety and over 70% of volunteers were highly motivated to disrupt the status quo of unsupportive, car-centric urban environments by reimagining how streets can be used. By taking collective action to re-shape the environment around these public schools to support healthy, active living, our findings reveal that over 90% of volunteers were highly satisfied. Of the volunteers, 87% felt they contributed to child safety and 85% felt they had developed stronger community connections. They appreciated the short (i.e., 40 minute) time commitment of each shift, weekly email communications by the community organization leading the initiative, and the volunteer schedule. They also appreciated the positive social interactions during volunteer shifts, which they felt outweighed the minimal resistance they experienced. CONCLUSIONS: This research demonstrates the importance of logistical, motivational, and social factors in recruiting and retaining volunteers for community-led School Streets. Our findings support appealing to prospective volunteers' influence in achieving School Street objectives (e.g., improved safety) in recruitment efforts, as well as highlighting School Streets' innovative approach. Communicating with volunteers throughout School Street planning and implementation processes and limiting traffic in the closed street zone (i.e., by excluding the school staff parking lot and private driveways from the scope) are additional recommendations based on the findings of this study.

Residential moves, neighbourhood walkability, and physical activity: a longitudinal pilot study in Ontario Canada.

BACKGROUND: Numerous cross-sectional studies have consistently demonstrated an association between attributes of urban form or 'walkability' and individual- and population-level physical activity (PA) patterns. However, in the absence of longitudinal research, the self-selection problem undermines the claim that a walkable built form produces more physically active people. Through a longitudinal pilot study of 'imminent movers' in Ontario using a quasi-experimental approach, we sought to examine the feasibility of longitudinal methods that would produce stronger evidence for a causal relationship between the built environment and PA levels. METHODS: Participants were recruited using publicly available real estate listings. Successful recruits were sent a PA diary to track their activity for a week, and were also scheduled for a 45-min phone interview that collected demographic details, neighbourhood perceptions and self-efficacy for walking, and verified the PA diary. Following their move, participants were given the same tasks and then sorted into groups based on changes in their neighbourhood walkability (measured with Walk Score) from baseline to follow-up. RESULTS: There were challenges in recruiting a sufficient number of participants and counter-factuals to examine the relationship between changes in walkability and PA. Our limited sample showed a substantial decrease in Walk Score over the entire sample, from an average of 45.8 to 30.6, with most participants moving to less walkable areas. From baseline to follow-up, the largest declines in reported self-efficacy for walking were to grocery stores, banks, and for entertainment. For the entire sample, utilitarian PA decreased, while recreational and job-related PA increased. CONCLUSIONS: This pilot study highlighted the methodological challenges involved in collecting quasi-experimental evidence on the effect of walkable environments on PA. Additionally, the low sample size and the tendency for most participants to move to less walkable areas meant there were insufficient counter-factuals for study of the effect of walkability on PA. Despite these challenges, we saw important changes in self-efficacy for walking that were commensurate with changes to the built environment. In sum, while longitudinal research on health and the built environment is urgently needed, recruiting an adequate sample size for a quasi-experimental study such as this is extremely challenging.

Should Canadian health promoters support a food stamp-style program to address food insecurity?

Food insecurity is an urgent public health problem in Canada, affecting 4 million Canadians in 2012, including 1.15 million children, and associated with significant health concerns. With little political will to address this significant policy issue, it has been suggested that perhaps it is time for Canada to try a food stamp-style program. Such a program could reduce rates of food insecurity and improve the nutritional health of low-income Canadians. In this article, we explore the history of the US food stamp program; the key impetus of which was to support farmers and agricultural interests, not to look after the needs of people living in poverty. Though the US program has moved away from its roots, its history has had a lasting legacy, cementing an understanding of the problem as one of lack of food, not lack of income. While the contemporary food stamp program, now called Supplemental Nutrition Assistance Program (SNAP), reduces rates of poverty and food insecurity, food insecurity rates in the USA are significantly higher than those in Canada, suggesting a food stamp-style program per se will not eliminate the problem of food insecurity. Moreover, a food stamp-style program is inherently paternalistic and would create harm by reducing the autonomy of participants and generating stigma, which in itself has adverse health effects. Consequently, it is ethically problematic for health promoters to advocate for such a program, even if it could improve diet quality.

A passion for gambling: a generation-specific conceptual analysis and review of gambling among older adults in Canada.

The proliferation of gambling opportunities in Canada, coupled with an aging population, has led to an increased prevalence of gambling among older adults. Encouraged by this trend, gambling industries have modified their activities to attract and market to this group. Yet, older adults are not a homogeneous group. The life experiences, values, and attitudes shared by generations make a cohort-specific analysis of gambling among older adults a worthwhile pursuit. Drawing from the Dualistic Model of Passion (Vallerand et al. in J Pers Soc Psychol 85(4):756-767, 2003), we discuss the role of passion in shaping gambling behaviours, and the implications of a harmonious or obsessive passion on the benefits and risks to two distinct generations of older adults. Based on their generational attributes, we posit that members of the Silent Generation (those born between 1925 and 1942) stand to gain more from the benefits of recreational gambling, but also stand lose more from problem gambling, than their children's generation, the Baby Boomers (those born between 1942 and 1964). Preventative strategies to assist problem gambling seniors, along with recommendations for further research, are discussed.

Framing incremental expansions to public health insurance systems: the case of Canadian pharmacare.

Canada is the only country in the world to offer universal comprehensive public health insurance that excludes outpatient prescription medicines. Few scholars have attempted to explain this policy puzzle. We study media coverage of prescription drug financing from 1990 to 2010 to elucidate how the policy problem and potential solutions have been framed in media discourse and identify the actors that have dominated media texts. We confirm previous analyses that have revealed the significant role played by policy elites in media coverage of health reform debates. We also find that proposed expansions to public coverage are presented as a financial liability that could "crowd out" the existing (and popular) public insurance program. Within the context of a predominantly public funded system, framing of incremental expansion reorients away from values and toward discourse related to costs--both of the current system and of potential reforms. This may reflect a strategic narrative used by actors to maintain "silos of values" for coverage for prescription medicines versus those for other services. This has significant implications for the motivation for reform among the electorate and politicians alike, and for the extent to which policy developments, if they occurred, would legitimately reflect societal values for health financing.

Investigating social inequalities in children's independent mobility, active transportation and outdoor free play in two Canadian cities.

Background: Active transportation (AT) and free play (FP) are the primary ways in which children engage in unstructured physical activity in cities, with independent mobility (IM) gaining increased attention as a potential precursor of AT and FP. However, current trends show that children are engaging in less FP and AT, and have less IM, than previous generations and it is not well understood how these practices, and their interrelatedness, differ by neighbourhood-level socio-economic stats (SES) and municipal contexts. Objectives: This study aims to address the gaps in knowledge by quantifying, comparing, and correlating IM, AT, and FP practices in high and low-SES neighbourhoods within and across the cities of Montreal and Kingston, Canada. Methods: 584 questionnaires were distributed among children in grades 1 to 5, living in low- and high-SES neighbourhoods of these two citiesResultsEngagement in the three practices was low in every study neighbourhood, though all three practices were higher in high-SES compared to low-SES neighbourhoods in both cities. Levels of FP were higher in Kingston compared to Montreal, while AT was higher in Montreal than in Kingston. Conclusion: This study revealed social inequalities in all three of these practices based on socioeconomic status and city. Since IM is likely a precursor to both independent FP and AT, more research is warranted into how our cities can become more conducive to IM in children, particularly in low SES neighbourhoods where children have less freedom of movement independently and otherwise.

Children's right to the city and their independent mobility: why it matters for public health.

Automobile-centric community design, or 'motornormativity', severely restricts opportunities for children to engage in active transportation (AT) and outdoor free play (OFP). As these activities are critical to children's health and well-being, their decline has become a major public health concern. Meanwhile, independent mobility (IM) has emerged as a critical determinant of child development and well-being. Defined as 'the freedom for children to move about their neighbourhood without adult supervision', children's IM is in direct conflict with motornormativity. And yet, very few studies explore these three practices together, and very few public health interventions actively confront motornormativity to support children's IM. We hypothesise that IM is foundational to AT and OFP, and that efforts to increase AT and OFP are doomed to fail without a deep understanding of the barriers to children's IM. We conclude with ideas to study and support children's IM in public health research and practice.

Do great local minds think alike? Comparing perceptions of the social determinants of health between non-profit and governmental actors in two Canadian cities.

Cities are important sites for intervention on social determinants of health (SDOH); yet, little is known about how influential local actors, namely workers in municipal governments (GOVs) and community-based organizations (CBOs), perceive the SDOH. Capturing and comparing perceptions between these groups are important for assessing how SDOH discourse has permeated local actors' thinking--a meaningful endeavour as local-level health equity action often invokes inter-institutional partnerships. This paper compares SDOH perceptions between CBO workers in Hamilton, Ontario, with politicians and senior-level staff in GOVs in Vancouver, British Columbia, based on two studies with surveys containing identical questions on SDOH perceptions. Overall, there was high comparability between the groups in their relative ratings of the SDOH. Both groups assigned high levels of 'influence' and 'priority' to 'healthy lifestyles' and 'clean air and water' and lower levels to 'strong community' and 'income'. Given the importance of a shared vision in collaborative enterprises, the comparability of perceptions between the groups found here holds promise for the prospect of inter-institutional partnerships. However, the low rating assigned to more structural health determinants suggests that more work is needed from researchers and advocates to effectively advance a health equity agenda at the local level in Canada.

The role of urban municipal governments in reducing health inequities: A meta-narrative mapping analysis.

BACKGROUND: The 1986 Ottawa Charter for Health Promotion coincided with a preponderance of research, worldwide, on the social determinants of health and health inequities. Despite the establishment of a 'health inequities knowledge base', the precise roles for municipal governments in reducing health inequities at the local level remain poorly defined. The objective of this study was to monitor thematic trends in this knowledge base over time, and to track scholarly prescriptions for municipal government intervention on local health inequities. METHODS: Using meta-narrative mapping, four bodies of scholarly literature - 'health promotion', 'Healthy Cities', 'population health' and 'urban health' - that have made substantial contributions to the health inequities knowledge base were analyzed over the 1986-2006 timeframe. Article abstracts were retrieved from the four literature bodies using three electronic databases (PubMed, Sociological Abstracts, Web of Science), and coded for bibliographic characteristics, article themes and determinants of health profiles, and prescriptions for municipal government interventions on health inequities. RESULTS: 1004 journal abstracts pertaining to health inequities were analyzed. The overall quantity of abstracts increased considerably over the 20 year timeframe, and emerged primarily from the 'health promotion' and 'population health' literatures. 'Healthy lifestyles' and 'healthcare' were the most commonly emphasized themes in the abstracts. Only 17% of the abstracts articulated prescriptions for municipal government interventions on local health inequities. Such interventions included public health campaigns, partnering with other governments and non-governmental organizations for health interventions, and delivering effectively on existing responsibilities to improve health outcomes and reduce inequities. Abstracts originating from Europe, and from the 'Healthy Cities' and 'urban health' literatures, were most vocal regarding potential avenues for municipal government involvement on health inequities. CONCLUSIONS: This study has demonstrated a pervasiveness of 'behavioural' and 'biomedical' perspectives, and a lack of consideration afforded to the roles and responsibilities of municipal governments, among the health inequities scholarly community. Thus, despite considerable research activity over the past two decades, the 'health inequities knowledge base' inadequately reflects the complex aetiology of, and solutions to, population health inequities.

Neighbourhood quality and self-rated health: a survey of eight suburban neighbourhoods in the Vancouver Census Metropolitan Area.

We investigated the relationship between perceptions of neighbourhood quality and self-rated health for residents of eight suburban neighbourhoods with modestly contrasting income profiles in the Vancouver Census Metropolitan Area. Survey respondents from lower income neighbourhoods more often rated their health as fair/poor, and perceived their neighbourhood to be of poor quality. The strongest predictors for fair/poor health status were employment status, body mass index, neighbourhood satisfaction, and age, while modest predictors were annual household income, neighbourhood median income profile, and perceptions of neighbourhood safety. The unique contribution of this study is its demonstration that social gradients in self-rated health are observable between neighbourhoods of even modestly contrasting income profiles.

Knowledge into action? understanding ideological barriers to addressing health inequalities at the local level.

The objective of this study was to explore the presence of ideological barriers to addressing local health inequalities in Hamilton, Ontario, Canada. A survey of active citizens revealed low levels of awareness of the social determinants of health (SDOH) framework, and some incongruence between understanding and attitudes towards the SDOH. Support for addressing health inequalities was associated with awareness of the SDOH framework, liberal value-systems, and a cluster of socio-demographic characteristics. Liberal leaning participants were also more politically active than their conservative counterparts. Ideological barriers included lack of SDOH awareness, narrow understandings of the relative influences of the SDOH, resistance to de-prioritizing healthcare, and conservative values. Advancement of a SDOH policy agenda should incorporate wider dissemination efforts to citizens and local service providers to increase support for this framework, and utilization of existing support and political engagement from liberal-leaning demographics.

Are we expecting too much from print media? An analysis of newspaper coverage of the 2002 Canadian healthcare reform debate.

News media effects on their audiences are complex. Four commonly cited effects are: informing audiences; agenda-setting; framing; and persuading. The release in autumn 2002 of two reports on options for reforming Canada's healthcare system attracted widespread media attention. We explored the potential for each of the four media effects by examining Canadian newspaper representation of this healthcare policy debate. Clippings were gathered from regional and national newspapers. Two data collection methodologies were employed: the first involved two staggered "constructed weeks" designed to capture thematic news framing styles; the second collected "intensive" or episodic coverage immediately following the report releases. Health reform articles with a financing and/or delivery focus were included. Using a codebook, articles were coded to track article characteristics, tone, healthcare sector and reform themes, and key actors. A greater quantity of episodic (n=341 clippings) versus thematic coverage (n=77) was documented. Coverage type did not vary significantly by newspaper, reporting source (e.g., staff reporter versus staff editorialist) or article type (e.g., news versus letter). Thematic articles were significantly shorter in length compared to episodic clippings. Episodic coverage tended to have a positive tone, while thematic coverage ranged in tone. Most coverage was general in scope. Sector-specific coverage favoured physician and hospital care--the two providers accorded privileged financing arrangements under Canada's universal, provincially administered health-insurance plans. Coverage of healthcare financing arrangements favoured broad discussions of publicly financed healthcare, federal-provincial governmental relations, and the Canada Health Act that governs provincial plans. Governmental actors and the political institutions that they represent were the dominant actors. Professional associations were also visible, but played a less dominant role. Given its non-specific scope, it is unclear how informative this coverage was. The large quantity and short duration of the episodic coverage, and the preponderance of governmental actors, suggests these newspapers acted as conduits for the policy agenda. Differences in framing styles were observed by coverage type, newspaper, reporting source, article length and type of article. Finally, the dominance of governmental actors provided these actors with numerous opportunities to persuade the public.

Implicating municipalities in addressing household food insecurity in Canada: A pan-Canadian analysis of news print media coverage.

OBJECTIVES: Household food insecurity (HFI) affects approximately 13% of Canadian households and is especially prevalent among low-income households. Actions to address HFI have been occurring primarily at the local level, despite calls for greater income supports from senior governments to reduce poverty. News media may be reinforcing this trend, by emphasizing food-based solutions to HFI and the municipal level as the site where action needs to take place. The objective of this study was to examine the level and framing of print news media coverage of HFI action in Canada. METHODS: Using a quantitative newspaper content analysis approach, we analyzed 547 articles gathered from 2 national and 16 local/regional English-language newspapers published between January 2007 and December 2012. RESULTS: News coverage increased over time, and over half was produced from Ontario (33%) and British Columbia (22%) combined. Of the 374 articles that profiled a specific action, community gardens/urban agriculture was most commonly profiled (17%), followed by food banks/meal programs (13%); 70% of articles implicated governments to take action on HFI, and of these, 43% implicated municipal governments. Article tone was notably more negative when senior governments were profiled and more neutral and positive when municipal governments were profiled. CONCLUSION: News media reporting of this issue in Canada may be placing pressure on municipalities to engage in food-based actions to address HFI. A more systematic approach to HFI action in Canada will require more balanced media reporting that acknowledges the limitations of food-based solutions to the income-based problem of HFI.

Impacts of public transit improvements on ridership, and implications for physical activity, in a low-density Canadian city.

Public transit ridership offers valuable opportunities for modest amounts of daily physical activity (PA). Transit is a more feasible option for most Canadian commuters who live too far from work to walk or cycle, yet public transit usage in midsized Canadian cities has historically remained low due to inefficient transit service. The objectives of this longitudinal study were threefold: to assess whether the introduction of express transit service in the low-density city of Kingston, Ontario, has translated to greater transit use among a targeted employee group; to document the characteristics of those employees that have shifted to transit; and to examine the PA levels of employees using transit compared to other commute modes. An online survey was administered in October 2013 and October 2014 to all non-student employees at Queen's University. 1356 employees completed the survey in 2013, and 1123 in 2014; 656 of these employees completed the survey both years, constituting our longitudinal sample. Year-round transit ridership increased from 5.5% in 2013 to 8.5% in 2014 (p < 0.001). Employees who shifted to transit had fewer household-level opportunities to drive to work and more positive attitudes toward transit. Transit commuters accrued an average of 80 minutes/week of commute-related PA, and 50 minutes/week more total PA than those that commuted entirely passively. Kingston Transit's express service has stimulated an increase in transit ridership among one of their target employers, Queen's University. The findings from this study suggest that shifting to transit from entirely passive commuting can generate higher overall PA levels.

Examining the relationship between social support availability, urban center size, and self-perceived mental health of recent immigrants to Canada: a mixed-methods analysis.

The experiences of settlement in a new country (e.g., securing housing and employment, language barriers) pose numerous challenges for recent immigrants that can impede their health and well-being. Lack of social support upon arrival and during settlement may help to explain why immigrant mental health status declines over time. While most urban centers in Canada offer some settlement services, little is known about how the availability of social supports, and the health statuses of recent immigrants, varies by city size. The objective of this mixed-methods study was to examine the relationship between self-perceived mental health (SPMH), social support availability, and urban center size, for recent immigrants to Canada. The quantitative component involved analysis of 2009-2010 Canadian Community Health Survey data, selecting for only recent immigrants and for those living in either large or small urban centers. The qualitative component involved in-depth interviews with managers of settlement service organizations located in three large and three small urban centers in Canada. The quantitative analysis revealed that social support availability is positively associated with higher SPMH status, and is higher in small urban centers. In support of these findings, our interviews revealed that settlement service organizations operating in small urban centers offer more intensive social supports; interviewees attributed this difference to personal relationships in small cities, and the ease with which they can connect to other agencies to provide clients with necessary supports. Logistic regression analysis revealed, however, that recent immigrants in small urban centers are twice as likely to report low SPMH compared to those living in large urban centers. Thus, while the scope and nature of settlements services appears to vary by city size in Canada, more research is needed to understand what effect settlement services have on the health status of recent immigrants to Canada, especially in smaller urban centers.

Active Transportation in Kingston, Ontario: An Analysis of Mode, Destination, Duration, and Season Among Walkers and Cyclists.

BACKGROUND: Individuals that engage in active transportation (AT) have healthier weights and fitness levels. Most AT research has focused on work- or school-based destinations. Meanwhile, little is known about the differences between individuals that engage in the most common forms of AT--walking and cycling--and how these AT patterns vary by destination, duration, and season. METHODS: We recruited 1400 randomly sampled adults (350 per season) in Kingston, Ontario, Canada to complete a cross-sectional telephone survey. The survey captured the prevalence, destinations, and duration of AT, and we examined the observed differences by mode. RESULTS: The majority (72%) of respondents were AT-users; walking constituted 93% of overall mode share. Cyclists were more likely to be male, younger, and employed than walkers. Walkers tended to access neighborhood-based destinations, while cyclists were more likely to use AT to get to work. AT duration was comparable by mode, ranging from approximately 8 to 20 minutes. Overall rates of AT were lowest in the winter, but walking rates were reasonably high year-round. CONCLUSIONS: Beyond commuting to work and school, policy-makers and planners should consider the breadth of destinations accessed by different modes when aiming to increase physical activity through AT in their communities.

The untold story: examining Ontario's community health centres' initiatives to address upstream determinants of health.

BACKGROUND: Unlike traditional primary care centres, part of the Community Health Centre (CHC) mandate is to address upstream health determinants. In Ontario, CHCs refer to these activities as Community Initiatives (CIs); yet, little is known about how CIs operate. The objective of this study was to examine the scope, resource requirements, partnerships, successes and challenges among selected Ontario CIs. METHODS: We conducted qualitative interviews with 10 CHC staff members representing 11 CIs across Ontario. CIs were identified through an online inventory, recruited by e-mail and interviewed between March and June 2011. RESULTS: Most CIs aim to increase community participation, while addressing social isolation and poverty. They draw minimal financial resources from their CHC, and employ highly skilled staff to support implementation. Most enlist support from various partners, and use numerous methods for community engagement. Successes include improved community relations, increased opportunities for education and employment and rewarding partnerships, while insufficient funding was a commonly identified challenge. CONCLUSIONS: Despite minimal attention from researchers and funders, our findings suggest that CIs play key capacity-building roles in vulnerable communities across Ontario, and warrant further investigation.

Municipal-level responses to household food insecurity in Canada: a call for critical, evaluative research.

Household food insecurity (HFI) is a persistent public health problem affecting 3.8 million Canadians. While the causes of HFI are rooted in income insecurity, solutions to HFI have been primarily food-based, with the bulk of activity occurring at the municipal level across Canada. We conceptualize these municipal-level actions as falling within three models: "charitable", "household improvements and supports" and "community food systems". Many initiatives, especially non-charitable ones, generate widespread support, as they aim to increase participants' food security using an empowering and dignified approach. While these initiatives may offer some benefits to their participants, preliminary research suggests that any food-based solution to an income-based problem will have limited reach to food-insecure households and limited impact on participants' experience of HFI. We suspect that widespread support for the local-level food-based approach to HFI has impeded critical judgement of the true potential of these activities to reduce HFI. As these initiatives grow in number across Canada, we are in urgent need of comprehensive and comparative research to evaluate their impact on HFI and to ensure that municipal-level action on HFI is evidence-based.

Examining the capacities of municipal governments to reduce health inequities: a survey of municipal actors' perceptions in Metro Vancouver.

OBJECTIVES: Canada is an increasingly urban nation, with considerable health inequities (HI) within its urban centres. While Canadian municipalities have a range of policy and planning levers that could reduce the burden of HI, little is known about how municipal employees perceive the capacities of municipal governments to address HI within their jurisdictions. This study sought to capture these perceptions through a survey of politicians and senior-level staff working in Metro Vancouver municipalities. METHODS: The survey was administered by mail to 637 politicians and senior-level staff from 17 municipal governments in Metro Vancouver. The survey captured respondents' perceptions on the responsibilities of, opportunities for, and constraints on, municipal-level action to address HI, as well as respondents' input on existing municipal policies and programs that could reduce HI in their jurisdictions. RESULTS: Respondents perceived senior governments to bear greater responsibility for reducing HI than municipalities. Investing in "parks & recreation facilities" was considered the most promising policy lever for addressing HI, while "insufficient federal and provincial funding" was perceived to be the greatest constraint on municipal action. "Affordable housing" and "recreational programs" were the most commonly identified existing strategies to address HI in the municipalities sampled. CONCLUSIONS: Our findings revealed concerns about inter-governmental downloading of responsibilities, and behaviour-based assumptions of disease etiology. To advance an urban health equity agenda, more work is needed to engage and educate municipal actors from a range of departments on the social determinants of health inequities.