Indigenous Identity and Household Food Insecurity are Associated with Poor Health Outcomes in Canada.

Purpose: To examine whether Indigenous identity and food insecurity combined were associated with self-reported poor health.Methods: Data from the 2015-2016 Canadian Community Health Survey and multiple logistic regression were employed to evaluate the association between Indigenous identity, household food insecurity, and health outcomes, adjusted for individual and household covariates. The Alexander Research Committee in Alexander First Nation (Treaty 6) reviewed the manuscript and commented on the interpretation of study findings.Results: Data were from 59082 adults (3756 Indigenous). The prevalence of household food insecurity was 26.3% for Indigenous adults and 9.8% for non-Indigenous adults (weighted to the Canadian population). Food-secure Indigenous adults, food-insecure non-Indigenous adults, and food-insecure Indigenous adults had significantly (p < 0.001) greater odds of poor health outcomes than food-secure non-Indigenous adults (referent group). Food-insecure Indigenous adults had 1.96 [95% CI:1.53,2.52], 3.73 [95% CI: 2.95,4.72], 3.00 [95% CI:2.37,3.79], and 3.94 [95% CI:3.02,5.14] greater odds of a chronic health condition, a chronic mental health disorder, poor general health, and poor mental health, respectively, compared to food-secure non-Indigenous adults.Conclusions: Health policy decisions and programs should focus on food security initiatives for all Canadians, including addressing the unique challenges of Indigenous communities, irrespective of their food security status.

Indigenous Youth Mentorship Program: essential characteristics of a Canadian multi-site community-university partnership with Indigenous communities.

The Indigenous Youth Mentorship Program (IYMP) is a peer-led health promotion program grounded in the teachings of Indigenous scholars. IYMP is delivered as a multi-sited community-university partnership (CUP) with Indigenous communities across Canada for elementary students. A local young adult health leader and high school youth mentors offer students healthy snacks, physical activity games, relationship building activities and traditional cultural teachings. IYMP aims to improve children's health and wellbeing and empower Indigenous youth and communities. The purpose of this descriptive qualitative study was to describe the essential characteristics of this multi-sited CUP as perceived by the IYMP principal investigators (PIs). Key informant interviews were conducted with 5 IYMP PIs (2 Indigenous) and analysed using content analysis. The overarching theme was forming a community of practice (CoP), where people with a common interest share best practices as they interact regularly. Four sub-themes were shared interest for Indigenous health/wellbeing and social justice, relationships, mentorship and taking a decolonizing research approach. The IYMP CoP allowed mentorship to occur across regions. The essential characteristics that made the IYMP CUPs successful could be used to inform other multi-sited CUPs with Indigenous communities. Those with mutual interests in Indigenous health and partnership with Indigenous communities could consider forming a CoP. Within a newly formed CoP, relationships and mentorship can be developed through discussion and activities. It is imperative within the CoP to take a decolonizing approach to research and acknowledge the impact that colonial policies and practices have had on generations of Indigenous peoples.

An Indigenous food sovereignty initiative is positively associated with well-being and cultural connectedness in a survey of Syilx Okanagan adults in British Columbia, Canada.

BACKGROUND: For the Syilx Okanagan Nation in Canada, salmon has vital nutritional, cultural, and spiritual significance. Yet, the Okanagan Sockeye salmon population came to near extinction, resulting in a drastic decline in salmon consumption from high historical levels. Thus, restoring and protecting salmon is crucial to Syilx well-being and way of life. A Syilx-led food sovereignty initiative re-established the Okanagan Sockeye salmon population, which has resulted in a rise in fish harvesting. The aim of this study was to assess whether engaging with this initiative was associated with health, well-being, and cultural connectedness (i.e., degree to which one is integrated in their culture) among Syilx adults. Eating Okanagan Sockeye salmon was conceptualized as a proxy for engaging with this Indigenous food sovereignty initiative. METHODS: 265 Syilx adults completed a survey including a traditional food frequency questionnaire and questions on health status (e.g., BMI, self-assessed physical health), well-being (e.g., life satisfaction, stress levels), and cultural connectedness (e.g., sense of belonging, importance of cultural practices). Participants were divided into 3 groups based on their wild salmon eating during the year prior to the survey: (1) adults who ate Okanagan Sockeye salmon, (2) adults who ate salmon but did not usually know the species of the salmon they ate, or who solely ate salmon that were not Okanagan Sockeye; and (3) adults who did not eat any salmon. RESULTS: A statistically significant gradient was observed for enhanced well-being and cultural connectedness, with individuals in group 1 having better indicators than those in group 2, and adults in groups 1 and 2 having better indicators than adults in group 3. No differences were observed in physical health outcomes between the three groups. CONCLUSION: Findings suggest that the initiative to re-establish Okanagan Sockeye salmon in the Okanagan River system may have led to better well-being and cultural connectedness among Syilx adults. This study highlights the importance of Indigenous food sovereignty as a way to enhance well-being and cultural connectedness among First Nations in Canada. Findings also reinforce the importance of assessing health and well-being in a wholistic way in Indigenous health research.

Indigenous Youth Mentorship Program: key implementation characteristics of a school peer mentorship program in Canada.

The Indigenous Youth Mentorship Program (IYMP) is a peer-led health promotion program developed for elementary school students in Indigenous school communities in Canada. A local young adult health leader (YAHL) and high school mentors offer students healthy snacks, physical activity games, relationship building activities and cultural teachings. IYMP aims to improve children's health and wellbeing and empower Indigenous youth and communities. The purpose of this focused ethnography was to describe the key characteristics of successful IYMP delivery. Two focus groups were conducted with 16 participants (8 YAHLS and 8 youth mentors) from 7 schools followed by 4 individual interviews (3 YAHLs, 1 youth peer mentor). Transcripts were analyzed using content analysis. Findings were triangulated with IYMP program field observations and notes from IYMP national team meetings. The five characteristics identified as important for IYMP delivery were a sense of ownership by those delivering the program, inclusion of Indigenous Elders/knowledge keepers, establishing trusting relationships, open communication among all stakeholder groups, including community and academic partners, and adequate program supports in the form of program funding, manuals that described program activities, and local and national gatherings between academic and community partners for sharing ideas about the program and its components. This study indicates the importance of respectful partnerships between community and academic leads for program success and sustainability. As IYMP is implemented in more communities and becomes community autonomous, program sustainability may be ensured and implementation challenges mitigated by embedding the identified five essential characteristics within the fabric of IYMP.

Optimisation modelling to improve the diets of First Nations individuals.

We examined the feasibility of linear programming (LP) to develop diets that were economical, included traditional (cultural, non-market) foods and met the dietary reference intakes (DRI) in a Canadian Indigenous population. Diet optimisation using LP is a mathematical technique that can develop food-based dietary guidelines for healthy eating in Indigenous populations where food insecurity, availability and cost are important considerations. It is a means of developing nutritionally optimal food combinations that are based on economical and culture-specific foods. Observed food consumption data were derived using 24-h food recalls from the First Nations Food, Nutrition and Environment Study. The LP models were constructed to develop diets meeting DRI, cost and food constraints. Achieving the recommended food intake was not feasible in a model meeting all nutrient requirements. Models that met most nutrient requirements at reduced cost were designed for men and women, separately. In women, it was necessary to increase energy intake to meet most nutrient requirements. Nutrient requirements could not be met for fibre, linoleic and linolenic acids, vitamin D, Ca and K in both sexes, P in women, and Mg and vitamin A in men. Using LP to develop optimal diets for First Nations people, we found simultaneous achievement of all DRI was difficult, suggesting that supplementation might be necessary which goes against recommendations for individuals to meet their nutrient needs through healthy eating patterns. Additionally, to make diets feasible, programmes to reduce market food costs and to support First Nations people in traditional food harvesting are recommended.

Vitamin D Sufficiency of Canadian Children Did Not Improve Following the 2010 Revision of the Dietary Guidelines That Recommend Higher Intake of Vitamin D: An Analysis of the Canadian Health Measures Survey.

In 2010, the dietary guidelines for vitamin D for Canadians and Americans aged 1-70 years were revised upward. It is unknown whether the vitamin D status of Canadian children improved after 2010. We compared the prevalence of vitamin D sufficiency (25-hydroxy vitamin D (25(OH)D) concentration of ≥50 nmol/L), 25(OH)D concentration and the frequency of consuming vitamin D-rich foods among children aged 6-18 years-old using data from the nationally representative 2007/2009 and 2012/2013 Canadian Health Measures Surveys. Associations of sociodemographic, anthropometric, seasonal, and regional variables with achieving vitamin D sufficiency, 25(OH)D concentration, and consumption of vitamin D-rich foods were assessed using multiple logistic and linear regression models. 79% and 68% of children in 2007/2009 and 2012/2013 respectively, were vitamin D sufficient. The main dietary source of vitamin D was milk. Between 2007/2009 and 2012/2013, the frequency of milk and fish consumption declined, but egg and red meat consumption was unchanged. Age, income, weight status, season and ethnicity were associated with 25(OH)D concentration and vitamin D sufficiency. Vitamin D status declined after the upward revision of dietary guidelines for vitamin D, consequently, dietary intake was inadequate to meet sufficiency. Public health initiatives to promote vitamin D-rich foods and supplementation for Canadian children are needed.

Vitamin D deficiency and sufficiency among Canadian children residing at high latitude following the revision of the RDA of vitamin D intake in 2010.

Recently, countries at high latitudes have updated their vitamin D recommendations to ensure adequate intake for the musculoskeletal health of their respective populations. In 2010, the dietary guidelines for vitamin D for Canadians and Americans aged 1­70 years increased from 5 µg/d to 15 µg/d, whereas in 2016 for citizens of the UK aged ≥4 years 10 µg/d is recommended. The vitamin D status of Canadian children following the revised dietary guidelines is unknown. Therefore, this study aimed to assess the prevalence and determinants of vitamin D deficiency and sufficiency among Canadian children. For this study, we assumed serum 25-hydroxy vitamin D (25(OH)D) concentrations <30 nmol/l as 'deficient' and ≥50 nmol/l as 'sufficient'. Data from children aged 3­18 years (n 2270) who participated in the 2012/2013 Canadian Health Measures Survey were analysed. Of all children, 5·6% were vitamin D deficient and 71% were vitamin D sufficient. Children who consumed vitamin D-fortified milk daily (77 %) were more likely to be sufficient than those who consumed it less frequently (OR 2·4; 95% CI 1·7, 3·3). The 9% of children who reported taking vitamin D-containing supplements in the previous month had higher 25(OH)D concentrations (ß 5·9 nmol/l; 95% CI 1·3, 12·1 nmol/l) relative to those who did not. Children who were older, obese, of non-white ethnicity and from low-income households were less likely to be vitamin D sufficient. To improve vitamin D status, consumption of vitamin D-rich foods should be promoted, and fortification of more food items or formal recommendations for vitamin D supplementation should be considered.

Parental Encouragement of Healthy Lifestyles for Their Children and Personally Caring about Healthy Lifestyles Is Positively Associated with Children Using Vitamin D Supplements.

Supplement users have better vitamin D status, and parenting is key to promoting a child's healthy behaviours. We examined the association of parental encouragement of and caring about healthy lifestyles with children's use of vitamin D supplements and multivitamins. A provincially representative sample of grade 5 students (n = 2686; 10-11 years) and their parents across the province of Alberta, Canada, was surveyed in 2014. Students were asked about use of multivitamins and/or vitamin D supplements. Parents were asked whether they cared about and encouraged healthy lifestyles. Mixed effect multiple logistic regression identified the association of parental responses with children's use of supplements; 29% and 54% of children took vitamin D supplements and multivitamins, respectively. They were more likely to take vitamin D supplements if their parents cared 'very much' vs. 'not at all/a little bit' about eating healthy foods (OR = 1.43; 95% CI = 1.08, 1.89), cared 'quite a lot' (OR = 1.55; 95% CI = 1.17, 2.04) and 'very much' (OR = 1.67; 95% CI = 1.26, 2.21) vs. 'not at all/a little bit' about physical activity, and encouraged 'very much' vs. 'not at all/a little bit' their children to eat healthy foods (OR = 1.51; 95% CI = 1.05, 2.17). Children whose parents personally cared for eating healthy foods were more likely to take multivitamins ('quite a lot' and 'very much' compared to 'not at all/a little bit' (OR = 1.60; 95% CI = 1.13, 2.28 and OR = 1.46; 95% CI = 1.04, 2.06, respectively). Education and parental encouragement of healthy lifestyles should be part of the public health initiatives to promote supplementation of vitamin D among children.

Analysis Grid for Environments Linked to Obesity (ANGELO) framework to develop community-driven health programmes in an Indigenous community in Canada.

Indigenous First Nations people in Canada have high chronic disease morbidity resulting in part from enduring social inequities and colonialism. Obesity prevention strategies developed by and for First Nations people are crucial to improving the health status of this group. The research objective was to develop community-relevant strategies to address childhood obesity in a First Nations community. Strategies were derived from an action-based workshop based on the Analysis Grid for Environments Linked to Obesity (ANGELO) framework. Thirteen community members with wide-ranging community representation took part in the workshop. They combined personal knowledge and experience with community-specific and national research to dissect the broad array of environmental factors that influenced childhood obesity in their community. They then developed community-specific action plans focusing on healthy eating and physical activity for children and their families. Actions included increasing awareness of children's health issues among the local population and community leadership, promoting nutrition and physical activity at school, and improving recreation opportunities. Strengthening children's connection to their culture was considered paramount to improving their well-being; thus, workshop participants developed programmes that included elders as teachers and reinforced families' acquaintance with First Nations foods and activities. The research demonstrated that the ANGELO framework is a participatory way to develop community-driven health programmes. It also demonstrated that First Nations people involved in the creation of solutions to health issues in their communities may focus on decolonising approaches such as strengthening their connection to indigenous culture and traditions. External funds were not available to implement programmes and there was no formal follow-up to determine if community members implemented programmes. Future research needs to examine the extent to which community members can implement programmes on their own and whether community action plans, when implemented, lead to short- and long-term benefits in health outcomes.

The prevalence and determinants of use of vitamin D supplements among children in Alberta, Canada: a cross-sectional study.

BACKGROUND: Limited cutaneous synthesis due to low sun exposure and inadequate dietary intake makes vitamin D supplementation a necessity for many Canadian children. Identification of the factors associated with supplement use is necessary for public health awareness campaigns, but they have not been identified previously. Therefore, the purpose of this study was to assess the prevalence and the determinants of the use of vitamin D supplements among children in the province of Alberta, Canada. METHODS: In 2014, a representative sample of grade five students (10-11 y) in Alberta (n = 2686) was surveyed. Data on dietary intake and use of vitamin D supplements were obtained using a modified Harvard Youth/Adolescent Food Frequency questionnaire. Mixed effect multiple logistic regression was employed to identify the key correlates of supplement use. RESULTS: Use of vitamin D supplements by children was 29.45 % although only 11.83 % took supplements daily. Children who resided in a metropolitan area (OR = 1.32; 95 % CI:1.06-1.65), were more physically active (2nd tertile: OR = 1.39; 95 % CI:1.09-1.78 and 3rd tertile: OR = 1.70; 95 % CI:1.33-2.16), or whose parents completed college (OR = 1.35; 95 % CI:1.05-1.74) were more likely to take vitamin D supplements. Prevalence of use was highest among those who had a high vitamin D diet and those with under/normal body weight status, although supplement use was not statistically associated with either dietary vitamin D intake or weight status. CONCLUSIONS: A considerable proportion of children did not take vitamin D supplements. Region of residence, physical activity level and parental education were determinants of supplement use, independent of child's gender, household income, weight status and dietary practices. We suggest prioritizing public health efforts to support strategies to make parents aware of the importance of providing the correct dose of vitamin D supplements for their children to meet dietary recommendations.

Dietary reference intakes for vitamin D based on the revised 2010 dietary guidelines are not being met by children in Alberta, Canada.

Canadian children have been shown to be not meeting the revised (2010) dietary recommended intake (DRI) for vitamin D through diet alone. However, no study has evaluated whether diet and supplementation together are supporting Canadian children in meeting the DRIs for vitamin D intake. This study assessed the adequacy of vitamin D intake through diet and supplements among Albertan children and the determinants of meeting dietary guidelines. 2686 grade 5 students aged 10 to 11 years in Alberta, Canada were surveyed. We hypothesized that less than 50% of children would meet the DRI. Vitamin D intake from diet and supplements was assessed using a food frequency questionnaire. The adequacy of vitamin D intake was estimated using the Estimated Average Requirement (EAR) of 400 IU (International Units) and Recommended Dietary Allowance (RDA) of 600 IU. Random effect multiple logistic regression was used to identify correlates of meeting DRIs. Forty five percent of children met the EAR and 22% met the RDA for vitamin D. When vitamin D intake from diet alone was considered, only 16% and 2% met the EAR and RDA, respectively. Parental education, household income and physical activity were positively correlated with meeting DRIs, and students attending metropolitan area schools were more likely to meet the EAR than students attending rural area schools (OR = 1.28; P = .043). The majority of children did not meet the DRI for vitamin D. Health promotion strategies aiming to improve the vitamin D status of Albertan children are necessary given the importance of vitamin D for children's health and development.

Partnering with Indigenous student co-researchers: improving research processes and outcomes.

OBJECTIVE: To examine the contribution of student co-researchers to a community-based participatory Photovoice investigation of Indigenous children's food-related lived experience. We examine co-researchers' contributions to the research process, their role in knowledge co-generation and dissemination, and factors that fostered research partnership with the teenage co-researchers. METHODS: High school students attending a First Nation community school in Canada were trained as research partners. They contributed to aspects of research design, conducted interviews with grades 3 and 4 Photovoice participants, and participated in data analysis and the development of a culturally relevant photobook. The study was initiated by the community's research committee. It is informed by critical consciousness theory and the positive youth development framework. RESULTS: Student co-researchers incorporated culturally appropriate strategies as they interviewed participants. Co-researchers adopted conversational approaches, built rapport by articulating personal and cultural connections, and engaged in mentoring and health promotion as they interviewed participants. They made critical contributions to dissemination by developing photobook content that promoted the importance of traditional foods and the vital role of family and community in healthy eating practices. Relationships and "dialogic" space were important to building partnership with and promoting capacity development among youth co-researchers. CONCLUSIONS: Partnership between university researchers and Indigenous student co-researchers holds great promise for health promotion in communities. Co-researchers developed research and leadership skills, gained understanding of health challenges facing their community, and initiated health and cultural promotion through the project's Photobook. This investigation supports the powerful potential of student co-researchers to meaningfully contribute to research processes and to build knowledge that is relevant and credible both within and outside of their communities. Findings have implications for youth, communities and researchers.

Dietary patterns of female university students with nutrition education.

Dietary patterns were examined in a convenience sample of 36 female University of Alberta students, all of whom had completed at least one nutrition course. Data from a validated food frequency questionnaire were used to determine if students had a dietary pattern similar to that recommended in Eating Well with Canada's Food Guide (EWCFG) or by the Traditional Healthy Mediterranean Diet Pyramid (THMDP), as measured using a Mediterranean Diet Quality Index Score. No student consumed the THMDP minimum number of portions of legumes, seeds, and nuts, of olive oil, or of whole grains. The majority did not meet the minimum EWCFG recommendations for any food group. The results suggest that nutrition education alone may be insufficient to ensure optimal dietary patterns among female university students. The methodology reported in this study is novel in assessing whether dietary patterns resemble the THMDP or the EWCFG.

Use of vitamin and mineral supplements among Canadian adults.

OBJECTIVE: To estimate the prevalence and determinants of use of vitamin and mineral supplements among adult Canadians. METHODS: Data from adult respondents of the Canadian Community Health Survey Cycle (CCHS) 2.2 were used. Participants were asked about their use of vitamin and mineral supplements in the month prior to being surveyed. The prevalence of vitamin and mineral supplement use was compared across various socio-demographic and lifestyle factors. Logistic regression analysis was used to assess determinants of supplement use. RESULTS: In the month prior to the interview, 40.1% of adult Canadians took supplements. In the fully adjusted model, females of all ages were more likely to be users than males 19-30 years. Physical activity, fruit/vegetable consumption, and higher levels of household education and income were positively related to supplement use. CONCLUSIONS: A substantial proportion of adult Canadians take vitamin and mineral supplements. The use was more prevalent among those with healthier lifestyles and of socio-economically advantaged backgrounds. Further investigation is needed to reveal the impact of supplements on nutrient adequacy and health.

Predominant breast-feeding from birth to six months is associated with fewer gastrointestinal infections and increased risk for iron deficiency among infants.

Iron deficiency (ID) is prevalent among infants world-wide and may be more likely among infants born to women living in disadvantaged environments. A strategy to address ID in this context is to feed iron-fortified formula, but this may create risk for gastrointestinal (GI) infection. Our objective was to investigate the relationship between infant feeding practices, iron status, and likelihood of a GI infection in the first 6 mo of life. We conducted a prospective study at a public hospital in Guadalajara, Mexico. Healthy women who gave birth to a healthy term infant were eligible to participate. Each month, mothers (n = 154) provided information on infant feeding methods and symptoms of GI infection. At 6 mo of age, infants' iron status was assessed [hemoglobin (Hb) and serum ferritin concentration]. When compared with nonpredominantly breast-fed [partially breast-feeding (PBF) and formula feeding (FF) combined], predominantly breast-fed (PRBF) infants to 6 mo had a lower incidence of GI infection from 0-6 mo [18 vs. 33%; P = 0.04; adjusted odds ratio (OR) = 0.4; 95% CI = 0.2, 1.0] but a higher risk for ID (serum ferritin < 12 microg/L) at 6 mo (22 vs. 4%; P = 0.001; adjusted OR = 9.2; 95% CI = 2.3, 37.0). Anemia (Hb < 110 g/L) prevalence did not differ among feeding groups (13% for PRBF, 19% for PBF, and 4% for FF; P = 0.09). In this low-income population, our results suggest that PRBF should be promoted and the risk for ID managed using public health and nutrition strategies.