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.

Awareness and knowledge of drug decriminalization among people who use drugs in British Columbia: a multi-method pre-implementation study.

BACKGROUND: In January 2023, British Columbia implemented a three-year exemption to Controlled Drugs and Substances Act, as granted by the federal government of Canada, to decriminalize the personal possession of small amounts of certain illegal drugs. This decriminalization policy, the first in Canada, was announced in response to the overdose emergency in British Columbia as a public health intervention that could help curb overdose deaths by reducing the impact of criminalization and increasing access to health and social services through stigma reduction. METHODS: The current multi-method study examines people who use drugs' awareness and knowledge of British Columbia's decriminalization model through cross-sectional quantitative surveys and qualitative interviews among people who use drugs from September-November 2022, immediately prior to the implementation of decriminalization. RESULTS: Quantitative findings show that two-thirds (63%) of people who use drugs were aware of the policy, but substantial knowledge gaps existed about the legal protections afforded (threshold amount, substances included, drug trafficking, confiscation). The qualitative findings suggest that people who use drugs misunderstood the details of the provincial decriminalization model and often conflated it with regulation. Results suggest that information sharing about decriminalization were minimal pre-implementation, highlighting areas for knowledge dissemination about people who use drugs' rights under this policy. CONCLUSIONS: Given that decriminalization in British Columbia is a new and landmark reform, and that the success of decriminalization and its benefits may be undermined by poor awareness and knowledge of it, efforts to share information, increase understanding, and empower the community, may be required to promote its implementation and benefits for the community.

Patterns and predictors of adherence to breast cancer screening recommendations in Alberta's Tomorrow Project.

Breast cancer screening is an important prevention component as it can reduce cancer mortality and improve survival. Understanding patterns of adherence to screening recommendations is essential to guide health promotion strategies and policy implementation efforts. The 1999 Alberta screening guidelines were used to determine screening status for eligible female participants in Alberta's Tomorrow Project (n = 4,972), a longitudinal province-based cohort. Screening patterns were derived based on screening status assessed at enrollment (2001-2008) and follow-up (2008-2011). Information on reason for screening was also collected at each time point. Multinomial logistic regression was used to assess potential predictors of adherence to screening recommendations. The majority of participants were up-to-date with screening at enrollment (79.3 %), and follow-up (75.2 %). Among all participants, 66.3 % were up-to-date at both time points (considered 'regular screeners'), 8.9 % were not up-to-date or never at enrollment but up-to-date at follow-up (considered 'new screeners'), 21.6 % were not up-to-date at follow-up (considered 'episodic screeners') and 3.2 % had never participated in screening (considered 'non-screeners'). Having a family doctor was the strongest factor associated with being a regular screener (OR (95 % CI): 0.37 (0.24 0.57) when compared with new screeners. Current smokers were more likely to be non-regular screeners. The primary reason for screening was routine screening or age. In conclusions, non-regular screening patterns were more prevalent among women without a family doctor. This finding suggests having a family doctor is an important mechanism to encourage screening. Further work is required to raise awareness of current recommendations and to understand and address reasons for non-adherence.

Meal regularity is associated with self-esteem among grade 5 children.

BACKGROUND: Meal regularity is associated with many aspects of mental health. However, few studies have examined whether a relationship exists between meal regularity and self-esteem in children. OBJECTIVES: The objective of this study was to determine whether an association exists between meal regularity and self-esteem in grade 5 children. METHODS: Among 4009 grade 5 students (mean age = 11.0 years ± SEM = 0.006) from the 2011 Children's Lifestyle and School Performance Study (CLASS-II; Nova Scotia, Canada), cross-sectional meal regularity survey data (family supper, supper in front of the television, supper alone, skipping breakfast, and skipping lunch) were collected using the Harvard Youth/Adolescent Food Frequency Questionnaire and examined in relation to self-esteem. Multilevel mixed-effects logistic regression was used to determine the ORs and 95% CIs associated with low self-esteem. Analyses were stratified by sex and adjusted for sociodemographic and lifestyle covariates. RESULTS: Compared to children who ate supper in front of the television or alone either never or less than once/week, children had greater odds of low self-esteem if 5 or more times/week they ate supper in front of the television (OR = 1.85; 95% CI, 1.40-2.43) or alone (OR = 4.23; 95% CI, 2.58-6.95). Compared to children who ate family supper 5 or more times/week, children who ate family supper never or less than once/week had greater odds of low self-esteem (OR: 1.97; 95% CI, 1.51-2.56). Skipping breakfast and skipping lunch were associated with greater odds of low self-esteem [OR = 2.92 (95% CI, 1.87-4.57) and OR = 4.82 (95% CI, 2.14-10.87) respectively]. CONCLUSIONS: In our study of grade 5 children, all 5 indicators of meal regularity tested are significantly and consistently associated with self-esteem.

Adherence to Life-Style Recommendations and Attention-Deficit/Hyperactivity Disorder: A Population-Based Study of Children Aged 10 to 11 Years.

OBJECTIVE: The incidence of attention-deficit/hyperactivity disorder (ADHD) among children and youth is high, and temporal increases have been paralleled by deteriorating life-styles. Poor diet quality, physical inactivity, poor sleep habits, and sedentary behaviors have all been associated with ADHD. However, no earlier prospective study has examined the independent and combined importance of meeting established life-style recommendations in childhood for ADHD in adolescence. We examined the associations of adherence to life-style recommendations with the incidence of ADHD and the utilization of health services associated with ADHD. METHODS: Life-style survey among 10- and 11-year-old students (N = 3436) was linked to administrative health data. Associations between adherence to nine established life-style recommendations with ADHD diagnosis and number of physician visits for ADHD until age 14 years were examined using Cox proportional hazard and negative binomial regression. RESULTS: Before age 14 years, 10.8% of students received an ADHD diagnosis. Meeting recommendations for vegetables and fruit, meat and alternatives, saturated fat, added sugar, and physical activity was associated with fewer ADHD diagnoses. Compared with children who met one to three recommendations, meeting seven to nine recommendations was associated with substantially lower incidence of ADHD and fewer physician visits related to ADHD (hazard ratio = 0.42 [95% confidence interval = 0.28-0.61]; rate ratio = 0.38 [95% confidence interval = 0.22-0.65]). CONCLUSIONS: Life-style recommendations exist to benefit development and physical health. Their promotion comes at no harm and may have benefits for ADHD. Experimental evidence is needed to clarify the potential bidirectional relationship between ADHD and adverse health behaviors.

Exploring the association between food insecurity and food skills among school-aged children.

OBJECTIVE: To examine the relationship between household food insecurity (FI) and children's involvement in family meal choices and food preparation, used as proxies for children's food skills, and to explore gender differences within these associations. DESIGN: Households were classified as food-secure or food-insecure using the six-item, short-form Household Food Security Survey Module. Children's involvement in family meal choices and food preparation were treated as proxies for children's food skills. Mixed-effects multinomial logistic regression models were used. SETTING: Public schools in Nova Scotia, Canada. PARTICIPANTS: 5244 children in the fifth grade (10-11 years old) participating in the Children's Lifestyle and School Performance Study (CLASS). RESULTS: Most children reported being involved in family meal choices or food preparation at least weekly (74 and 68 %). The likelihood of helping choose family meals once a week was 33 % lower among girls from food-insecure households compared to girls from food-secure households. No differences in boys' involvement in family meal choices were observed according to household FI status. Boys from food-insecure households were 65 % more likely than boys from food-secure households to assist with food preparation/cooking four times per week. No differences in girls' involvement in food preparation were observed according to household FI status. CONCLUSIONS: Findings support that household FI is not due to a lack of food skills but most likely due to inadequate access to resources. This supports the call for upstream policies targeting the structural issues underpinning household FI such as low income.

Economic Burden of Not Complying with Canadian Food Recommendations in 2018.

Poor diet has been identified as a major cause of chronic disease. In this study we estimated the 2018 economic burden of chronic disease attributable to not complying with Canadian food recommendations. We retrieved the chronic disease risk estimates for intakes of both protective (fruit, vegetables, milk, whole grains, nuts and seeds) and harmful foods (sugar-sweetened beverages, processed meat, red meat) from the Global Burden of Disease Study, and food intakes from the 2015 Canadian Community Health Survey 24-hour dietary recalls (n = 19,797). Population attributable fractions (PAFs) were calculated for all food-chronic disease combinations, and mathematically adjusted to estimate the 2018 annual direct (hospital, physician, drug) and indirect (human capital approach) economic burden for each disease. Not meeting the eight food recommendations was estimated to be responsible for CAD$15.8 billion/year in direct (CAD$5.9 billion) and indirect (CAD$9.9 billion) costs. The economic burden of Canadians under-consuming healthful foods exceeded the burden of overconsumption of harmful foods (CAD$12.5 billion vs. CAD$3.3 billion). Our findings suggest poor diet represents a substantial economic burden in Canada. Interventions may be more effective if they are wide in focus and promote decreased consumption of harmful foods alongside increased consumption of healthful foods, with emphasis on whole grains and nuts and seeds.

Lifestyle Behavior and Mental Health in Early Adolescence.

BACKGROUND AND OBJECTIVES: Mental illnesses affect >15% of Canadian adolescents. New preventive strategies are critically needed. We examined the associations of meeting established recommendations for diet, physical activity, sleep, and sedentary behavior in childhood with mental illness in adolescence. METHODS: Population-based prospective study (n = 3436) linking 2011 health behavior survey data of 10- to 11-year-olds with administrative health data from 2011 to 2014. Lifestyle behaviors were measured with the Harvard Food Frequency Questionnaire and self- and parental-proxy reports, expressed as meeting recommendations for vegetables and fruit, grain products, milk and alternatives, meat and alternatives, added sugar, saturated fat, sleep, screen time, and physical activity. Mental illness was defined by physician-diagnosed internalizing, externalizing, and other psychiatric conditions. Negative binomial regression was used to determine the independent and cumulative associations of meeting lifestyle recommendations with physician visits for mental illnesses. RESULTS: Of all participants, 12%, 67%, and 21% met 1 to 3, 4 to 6, and 7 to 9 recommendations, respectively, and 15% had a mental illness diagnosis during follow-up. Compared with meeting 1 to 3 recommendations, meeting 7 to 9 recommendations was associated with 56% (95% confidence interval: 38%-69%) fewer physician visits for mental illness during follow-up. Every additional recommendation met was associated with 15% fewer physician visits for mental illnesses (95% confidence interval: 9%-21%). CONCLUSIONS: Mental illness in adolescence is associated with compliance to lifestyle recommendations in childhood, with stronger associations seen when more recommendations are met. Emphasizing lifestyle recommendations in pediatric practice may reduce the future burden of mental illness.

Canadian Children from Food Insecure Households Experience Low Self-Esteem and Self-Efficacy for Healthy Lifestyle Choices.

The objectives of this cross-sectional study were to: (i) determine whether there are differences in self-esteem and self-efficacy for healthy lifestyle choices between children living in food secure and food insecure households; and (ii) determine whether the association between household food insecurity (HFI), self-esteem and self-efficacy differs by gender. Survey responses of 5281 fifth-grade students (10 and 11 years of age) participating in the Canadian Children's Lifestyle and School Performance Study II were analyzed using logistic and linear regression. HFI status was determined by the six-item short-form Household Food Security Survey Module (HFSSM). Students from food insecure households had significantly higher odds of low self-esteem, and significantly lower scores for global self-efficacy to make healthy choices, compared to students from food secure households. These associations were stronger for girls than for boys and appeared independent of parental educational attainment. Household income appeared to be the essential underlying determinant of the associations of food insecurity with self-esteem and self-efficacy. Upstream social policies such as improving the household income of low-income residents will reduce food insecurity and potentially improve self-esteem and self-efficacy for healthy choices among children. This may improve health and learning, and in the long term, job opportunities and household earnings.