Identifying latent classes of physical activity profiles over time among adolescents in Ontario, Canada.

BACKGROUND: Physical activity behaviours are known to be highly correlated. Adolescents who participate in one type of physical activity (e.g., physical education) have a greater likelihood of participating in other physical activities (e.g., organized sports); however, little research has examined participation rates in various physical activity behaviours concurrently. This study identified longitudinal physical activity profiles among secondary school aged youth in Ontario, Canada. METHODS: We used data from the COMPASS Study, a school-based prospective cohort study of adolescents in Canada. Using a repeated measures latent class analysis, Ontario students who participated in grade 9 PE in 2015-16 were analysed through to 2018-19 (n = 1,917). Latent classes were defined by: PE participation, guideline adherence (≥ 60 min/day of moderate to vigorous activity over the last 7 days), and sport participation (varsity, community, and/or intramural). Multinomial logistic regression models were used to examine associations between latent class membership and student characteristics. RESULTS: Three distinct latent classes were identified for females and four were identified for males. These classes were: (1) Guidelines (high probability of guideline adherence; females: 44%; males: 16%), (2) PE & Sports (high probability of PE and sport participation; females: 33%; males: 43%), (3) Guidelines & Sports (high probability of guideline adherence and sport participation; females: 23%; males: 23%;), and (4) Inactive (low probability of all physical activity indicators; males: 18%). Strength training, sleep, and English grade were associated with class membership among females. Ethno-racial identity, weekly spending money, strength training, and English and math grades were associated with class membership among males. CONCLUSIONS: Findings suggest that latent physical activity profiles differ by sex. Guideline adherence was the most common class among females, indicating high levels of independent physical activity, whereas PE & Sport participation was the most common class among males, indicating greater tendency towards organized activities. Additionally, a substantial number of male students were not engaging in any physical activity. Participation in both PE and sports did not necessarily lead to meeting physical activity guidelines, highlighting that these activities alone may not be providing sufficient levels of physical activity that align with current recommendations for Canadian youth.

Development and evaluation of the Rural and Northern Community Focused Model of COPD Care (RaNCoM).

BACKGROUND: The prevalence of COPD continues to rise. To address the challenges to provide high quality COPD care in rural and northern communities, leaders in one rural and northern community in Western Canada sought to change the culture of COPD screening and care. Recognizing effective assessment, diagnosis, and treatment for patients with COPD are crucial to improve outcomes, a program was developed between 2012 and 2021 to enhance primary care for COPD patients. METHODS: A process evaluation was undertaken to assess program development, implementation, mechanisms of impact, and context of COPD program. Qualitative thematic analysis of stakeholder interviews (n = 11) and a document review (n = 60; ~ 500 pages) of key clinic documents was conducted. RESULTS: We describe five phases of the COPD program's development (Survive; Reorganize and Stabilize; Assess and Respond; Build and Refine; and Sustain and Share), highlighting areas of innovation. Outreach and localizing resources improved access to the program. Acquiring secured physician compensation, capturing quality data, and improving patient and provider self-efficacy built the capacity of the system and stakeholders within it. Finally, relationships were forged through building an integrated facility, collaborative networking, and patient engagement. Key elements of program implementation included the resources (infrastructure, software, operational) required to ensure operation. CONCLUSION: Team-based care and service integration enhanced care capacity and the health network. Focused use of infrastructure and resources supported the people in the care system. Upholding a shared value of relationship is critical to deliver robust and sustainable rural healthcare. Quality improvement requires investment in rural community healthcare resources.

Virtual barriers: unpacking the sustainability implications of online food spaces and the Yellowknife Farmers Market's response to COVID-19.

BACKGROUND: Through their support of local agriculture, relationships, and healthy diets, farmers markets can contribute to a sustainable food system. Markets like the Yellowknife Farmers Market (YKFM) are social spaces that support local food, yet the COVID-19 pandemic has forced changes to their current model. We explore the potential of online marketplaces to contribute to a resilient, sustainable food system through a case study of the YKFM. METHODS: In 2019, a collaborative mixed-method evaluation was initiated by the YKFM and university partners in the Northwest Territories (NWT), Canada. The evaluation included an in-person Rapid Market Assessment dot survey and questionnaire of market patrons from two YKFM dates prior to the pandemic. Due to COVID-19, a vendor survey and interviews were deferred. Data collected from the two patron surveys, alongside researcher observations, available literature, public announcements, and informal email and phone discussions, inform the discussion. RESULTS: For the patron surveys, 59 dot survey and 31 questionnaire participants were recruited. The top motivators for attendance were eating dinner, atmosphere, and supporting local businesses, and most patrons attended as couples and spent over half of their time talking to others. The YKFM did not move online; instead, they proposed and implemented a "Shop, don't stop" market. Informal conversations suggested the small scale of the market and technology challenges were perceived barriers to moving online. The physically-distanced market was well-attended and featured in local media. CONCLUSIONS: NWT food strategies rely on farmers markets to nurture a local food system. Data suggest a potential incongruence between an online model and important market characteristics such as the event-like atmosphere. Available literature suggests online markets can support local food by facilitating purchasing and knowledge-sharing, yet they do not replicate the open-air or social experience. The decision not to move online for the YKFM reflects market patron characteristics and current food context in Yellowknife and the NWT. While online adaptation does not fit into the YKFM plan today, online markets may prove useful as a complementary strategy for future emerging stressors to enhance the resiliency of local systems.

Game bird consumption in Dene communities of the Northwest Territories, Canada.

OBJECTIVE: Game bird consumption is an important part of the diet of Indigenous populations in Canada and, as part of country food consumption, is associated with improved nutritional status. The objective of this project was to document the consumption of game birds for Dene First Nations in the Northwest Territories (NWT), Canada. DESIGN: Participants were invited to complete a FFQ using an iPad to document the types of country foods consumed, as well as consumption frequency and preparation methods, including thirteen types of game birds. SETTING: The project was implemented in nine communities in the Dehcho and Sahtú regions of the NWT, Canada. PARTICIPANTS: A total of 237 children and adult participants from Dene First Nations in the Mackenzie Valley region of the NWT took part in the current study. RESULTS: FFQ findings indicated that game birds were frequently consumed in both Dehcho and Sahtú communities. Canada goose and mallard were found to be consumed by the largest number of participants. Five different species (including Canada goose and mallard) were found to be consumed by at least 25 % of participants over the last year. When consuming game birds, most participants reported consuming the meat as well as most, if not all, other parts of the bird. CONCLUSIONS: Differences were observed since the last country food assessment in the 1990s in the same regions. These findings increase knowledge of the current Dene diet patterns and support the understanding of diet transition.

Drivers and health implications of the dietary transition among Inuit in the Canadian Arctic: a scoping review.

OBJECTIVE: The current study undertook a systematic scoping review on the drivers and implications of dietary changes among Inuit in the Canadian Arctic. DESIGN: A keyword search of peer-reviewed articles was performed using PubMed, Web of Science, CINAHL, Academic Search Premier, Circumpolar Health Bibliographic Database and High North Research Documents. Eligibility criteria included all full-text articles of any design reporting on research on food consumption, nutrient intake, dietary adequacy, dietary change, food security, nutrition-related chronic diseases or traditional food harvesting and consumption among Inuit populations residing in Canada. Articles reporting on in vivo and in vitro experiments or on health impacts of environmental contaminants were excluded. RESULTS: A total of 162 studies were included. Studies indicated declining country food (CF) consumption in favour of market food (MF). Drivers of this transition include colonial processes, poverty and socio-economic factors, changing food preferences and knowledge, and climate change. Health implications of the dietary transition are complex. Micro-nutrient deficiencies and dietary inadequacy are serious concerns and likely exacerbated by increased consumption of non-nutrient dense MF. Food insecurity, overweight, obesity and related cardiometabolic health outcomes are growing public health concerns. Meanwhile, declining CF consumption is entangled with shifting culture and traditional knowledge, with potential implications for psychological, spiritual, social and cultural health and well-being. CONCLUSIONS: By exploring and synthesising published literature, this review provides insight into the complex factors influencing Inuit diet and health. Findings may be informative for future research, decision-making and intersectoral actions around risk assessment, food policy and innovative community programmes.

Sharing Indigenous Foods Through Stories and Recipes.

Participants at the second National Gathering of the Aboriginal Nutrition Network (ANN) were encouraged to submit their favourite traditional recipes. Approximately 40 were received, and a volunteer working group contacted contributors to assist in the creation of a recipe resource with a selection of 12 recipes that included traditional ingredients to promote Indigenous foodways. All contributors were interviewed to share stories about their recipes. Each recipe was then tested, photographed, and developed into a resource handout that was disseminated to a variety of stakeholders. Afterwards, a brief survey was conducted with ANN recipients of the recipes (n = 23) to evaluate the recipe collection. When asked, "Prior to learning about this resource, was a collection of recipes using traditional foods something that you or the communities you work with were interested in?" all respondents answered yes. Nearly all found the recipes easy to follow (91%), and that they were applicable to the interests or needs of the communities they work with (83%). Preserving recipes and building opportunities for dietitians and other health professionals to contribute to traditional food recipe collections facilitates increased knowledge transfer, enhanced cross-cultural understanding, and is generally a useful tool for those working with Indigenous Peoples in Canada.

Fostering implementation of knowledge into health practice: study protocol for the validation and redevelopment of the Knowledge Uptake and Utilization Tool.

BACKGROUND: Measurement of what knowledge is taken-up and how that information is used to inform practice and policies can provide an understanding about the effectiveness of knowledge uptake and utilization processes. In 2007, the Knowledge Uptake and Utilization Tool (KUUT) was developed to evaluate the implementation of knowledge into practice. The KUUT has been used by numerous large health organizations despite limited validity evidence and a narrow understanding about how the tool is used in practice and interpreted by users. As such, the overall purpose of this protocol is to redevelop the KUUT and gather validity evidence to examine and support its use in various health-related organizations. This protocol paper outlines a validation and redevelopment procedure for the KUUT using the unitary view of validity. METHODS: The protocol outlined in this article proceeds through four phases, starting with redeveloping the tool, then evaluating validity evidence based on: test content, response processes and internal structure. The initial phase gathers information to redevelop the tool, and evaluates item content and response format. The second phase evaluates response process validity evidence by examining how a variety of users interact with the tool. In the third phase, the tool will be pilot tested with knowledge users and, in the final phase, psychometric properties of the tool will be examined and a final scoring structure will be determined. A knowledge translation plan described herein outlines where the final tool will be housed and how the information about the tool will be disseminated. DISCUSSION: This protocol outlines a procedure to gather different sources of validity evidence for the KUUT. By addressing limitations in the original KUUT, such as complexities with scoring, a redeveloped KUUT supporting validity evidence will enhance the ability of health-related organizations to effectively use this tool for its intended purpose.

The complete genome sequence for putative H2- and S-oxidizer Candidatus Sulfuricurvum sp., assembled de novo from an aquifer-derived metagenome.

We reconstructed the complete 2.4 Mb-long genome of a previously uncultivated epsilonproteobacterium, Candidatus Sulfuricurvum sp. RIFRC-1, via assembly of short-read shotgun metagenomic data using a complexity reduction approach. Genome-based comparisons indicate the bacterium is a novel species within the Sulfuricurvum genus, which contains one cultivated representative, S. kujiense. Divergence between the species appears due in part to extensive genomic rearrangements, gene loss and chromosomal versus plasmid encoding of certain (respiratory) genes by RIFRC-1. Deoxyribonucleic acid for the genome was obtained from terrestrial aquifer sediment, in which RIFRC-1 comprised ∼ 47% of the bacterial community. Genomic evidence suggests RIFRC-1 is a chemolithoautotrophic diazotroph capable of deriving energy for growth by microaerobic or nitrate-/nitric oxide-dependent oxidation of S°, sulfide or sulfite or H2oxidation. Carbon may be fixed via the reductive tricarboxylic acid cycle. Consistent with these physiological attributes, the local aquifer was microoxic with small concentrations of available nitrate, small but elevated concentrations of reduced sulfur and NH(4)(+) /NH3-limited. Additionally, various mechanisms for heavy metal and metalloid tolerance and virulence point to a lifestyle well-adapted for metal(loid)-rich environments and a shared evolutionary past with pathogenic Epsilonproteobacteria. Results expand upon recent findings highlighting the potential importance of sulfur and hydrogen metabolism in the terrestrial subsurface.

Prevalence and severity of household food insecurity of First Nations people living in an on-reserve, sub-Arctic community within the Mushkegowuk Territory.

OBJECTIVE: To measure and describe the prevalence and severity of household food insecurity in a remote on-reserve First Nations community using the Household Food Security Survey Module (HFSSM) and to evaluate the perceived relevance of the HFSSM for this population. DESIGN: Household food security status was determined from the eighteen-item HFSSM following the classifications developed by Health Canada for the Canadian Community Health Survey, Cycle 2·2 Nutrition. One adult from each household in the community was invited to complete the HFSSM and to comment on its relevance as a tool to measure food security for First Nations communities. SETTING: Sub-Arctic Ontario, Canada. SUBJECTS: Households (n 64). RESULTS: Seventy per cent of households were food insecure, 17% severely and 53% moderately. The prevalence of food insecurity in households with children was 76%. Among respondents from homes rated as having severe food insecurity, all (100 %) reported worrying that food would run out, times when food didn't last and there wasn't money to buy more, and times when they couldn't afford to eat balanced meals. The majority of respondents felt the HFSSM did not capture an accurate picture of food security for their situation. Aspects missing from the HFSSM included the high cost of market food and the incorporation of traditional food practices. CONCLUSIONS: A high prevalence of household food insecurity was reported in this community. On-reserve remote First Nations communities may be more susceptible to food insecurity than off-reserve Aboriginal populations. Initiatives that promote food security for this vulnerable population are needed.

Correction: A guiding framework for needs assessment evaluations to embed digital platforms in partnership with Indigenous communities.

[This corrects the article DOI: 10.1371/journal.pone.0279282.].

Hexachlorobenzene and omega-3 fatty acid intake from traditional foods in the northern Yukon: A risk and benefit analysis.

A human biomonitoring study was conducted in the community of Old Crow, Yukon, in 2019, finding that levels of hexachlorobenzene (HCB) in plasma were elevated in the community relative to the general Canadian population. The aim of this study was to estimate dietary intake of both hexachlorobenzene, and the nutrient omega-3 fatty acids from locally harvested traditional foods in Old Crow, with the aim of identifying possible regional sources of exposure. A stochastic model was constructed to estimate intake of both hexachlorobenzene and the omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Average predicted hexachlorobenzene exposure levels from traditional food consumption in Old Crow were below the tolerable daily intake of 1600-1700 ng/kg body weight/day in both average (18 ng/kg body weight/day) and short-term maximum (27 ng/kg body weight/day) exposure models. The primary contributors to average hexachlorobenzene intake were caribou fat, bone marrow, ribs, and kidneys, and Chinook salmon muscle. Average estimated dietary EPA + DHA intake levels from traditional foods were below the recommendation of 2.1 to 3.2 g of EPA + DHA per week in the average (1.6 g/week) exposure model, but above this recommendation in the short-term maximum model (3.3 g/week). The primary contributors to average EPA + DHA intake were the meat of Chinook, coho, and, chum salmon muscle, and whitefish muscle and eggs. The results of this study support the message that traditional foods continue to be an important source of nutrients and other health benefits and that the health benefits of traditional foods generally outweigh contaminant risks.

The impacts of the Nutrition North Canada program on the accessibility and affordability of perishable, nutritious foods among eligible communities: a scoping review.

The Nutrition North Canada (NNC) program, introduced in April 2011 is a federal strategy to improve access to perishable, nutritious foods for remote and isolated communities in northern Canada by subsidising retailers to provide price reductions at the point of purchase. As of March 2023, 123 communities are eligible for the program. To evaluate existing evidence and research on the NNC program to inform policy decisions to improve the effectiveness of NNC. A scoping review of peer-reviewed articles was conducted in ten databases along with a supplemental grey literature search of government and non-government reports published between 2011 and 2022. The search yielded 172 publications for screening, of which 42 were included in the analysis. Narrative thematic evidence synthesis yielded 104 critiques and 341 recommendations of the NNC program across eight themes. The most-identified recommendations focus on transparency, communication, and support for harvesting, hunting, and community food initiatives. This review highlights recommendations informed by the literature to address critiques of the NNC program to improve food security, increase access to perishable and non-perishable items, and support community-based food initiatives among eligible communities. The review also identifies priority areas for future policy directions such as additional support for education initiatives, communication and transparency amidst program changes, and food price regulations.

Human biomonitoring of dioxins, furans, and non-ortho dioxin-like polychlorinated biphenyls (PCBs) in blood plasma from Old Crow, Yukon, Canada (2019).

Dioxins, furans, and dioxin-like polychlorinated biphenyls (PCBs) are a group of persistent and toxic chemicals that are known to have human health effects at low levels. These chemicals have been produced for commercial use (PCBs) or unintentionally as by-products of industry or natural processes (PCBs, dioxins, and furans). Additionally, dioxin-like PCBs were formerly used in electrical applications before being banned internationally (2004). These chemicals are widely dispersed in the environment as they can contaminate air and travel hundreds to thousands of kilometers before depositing on land or water, thereafter, potentially entering food chains. Community concerns surrounding the safety of traditional foods prompted a human biomonitoring project in Old Crow, Yukon Territory (YT), Canada (2019). Through collaborative community engagement, dioxins and like compounds were identified as a priority for exposure assessment from biobanked samples. In 2022, biobanked plasma samples (n = 54) collected in Old Crow were used to measure exposures to seven dioxins, ten furans, and four dioxin-like PCBs. 1,2,3,6,7,8-HxCDD, 1,2,3,7,8,9-HxCDD, 1,2,3,4,6,7,8-HpCDD, OCDD, 2,3,4,7,8-PeCDF, 1,2,3,6,7,8-HxCDF, PCB 126, and PCB 169 were detected in at least 50 % of samples. Among these analytes, the only congener at elevated levels was PCB 169, which was approximately ∼2-fold higher than the general population of Canada. No significant sex-based or body mass index (BMI) differences in biomarker concentrations were observed. Generally, the concentrations of the detected congeners increased with age, except for 1,2,3,4,6,7,8-HpCDD. For the first time, this research measures dioxin and like-compound exposures in Old Crow, advancing the information available on chemical exposures in the Arctic. Further research could be directed towards the investigation of PCB 169 exposure sources and temporal monitoring of exposures and determinants.

Giving voice to food insecurity in a remote indigenous community in subarctic Ontario, Canada: traditional ways, ways to cope, ways forward.

BACKGROUND: Food insecurity is a serious public health issue for Aboriginal people (First Nations [FN], Métis, and Inuit) living in Canada. Food security challenges faced by FN people are unique, especially for those living in remote and isolated communities. Conceptualizations of food insecurity by FN people are poorly understood. The purpose of this study was to explore the perceptions of food insecurity by FN adults living in a remote, on-reserve community in northern Ontario known to have a high prevalence of moderate to severe food insecurity. METHODS: A trained community research assistant conducted semi-directed interviews, and one adult from each household in the community was invited to participate. Questions addressed traditional food, coping strategies, and suggestions to improve community food security and were informed by the literature and a community advisory committee. Thematic data analyses were carried out and followed an inductive, data-driven approach. RESULTS: Fifty-one individuals participated, representing 67% of eligible households. The thematic analysis revealed that food sharing, especially with family, was regarded as one of the most significant ways to adapt to food shortages. The majority of participants reported consuming traditional food (wild meats) and suggested that hunting, preserving and storing traditional food has remained very important. However, numerous barriers to traditional food acquisition were mentioned. Other coping strategies included dietary change, rationing and changing food purchasing patterns. In order to improve access to healthy foods, improving income and food affordability, building community capacity and engagement, and community-level initiatives were suggested. CONCLUSIONS: Findings point to the continued importance of traditional food acquisition and food sharing, as well as community solutions for food systems change. These data highlight that traditional and store-bought food are both part of the strategies and solutions participants suggested for coping with food insecurity. Public health policies to improve food security for FN populations are urgently needed.

Integrating knowledge and action: learnings from an implementation program for food security and food sovereignty with First Nations communities within Canada.

BACKGROUND: Collaborative approaches to knowledge translation (KT) are important for advancing community-engaged research. However, there is a need for examples of participatory approaches that have effectively supported public health research, program development, and implementation with First Nations communities. To strengthen KT with communities, we proposed a set of guiding principles for participatory planning and action for local food system change. Principles emerged from a cross-community analysis of Learning Circles: Local Healthy Food to School (LC:LHF2S) a participatory program (2015-2019) for Indigenous food system action. The objective was to identify guiding principles for participatory planning and action from key learnings and successes on scaling-up of the Learning Circles (LC) model vertically in Haida Nation, British Columbia (BC), and horizontally in three distinct community contexts: Gitxsan Nation, Hazelton /Upper Skeena, BC; Ministikwan Lake. The application of these principles is discussed in the context of our ongoing partnership with Williams Treaties First Nations to support community planning to enhance food security and sovereignty. METHODS: A cross-community thematic analysis was conducted and guided by an implementation science framework, Foster-Fishman and Watson's (2012) ABLe Change Framework, to identify key learnings and successes from adapting the LC approach. Information gathered from interviews (n = 55) and meeting reports (n = 37) was thematically analyzed to inform the development of guiding principles. Community sense-making of findings informed applicability in a new community context embarking on food systems work. RESULTS: Emergent guiding principles for participatory food system planning and action are described within four main areas: (1) create safe and ethical spaces for dialog by establishing trust and commitment from the ground up, (2) understand the context for change through community engagement, (3) foster relationships to strengthen and sustain impact, and (4) reflect and embrace program flexibility to integrate learnings. CONCLUSIONS: Emergent principles offer guidance to supporting Indigenous community-led research and mobilization of knowledge into action. Principles are intended to support researchers and health system administrators with taking a collaborative approach that fosters relationships and integration of community leadership, knowledge, and action for food system change. Application of principles with implementation frameworks can strengthen KT in Indigenous contexts by incorporating community protocols and perspectives in support of Indigenous self-determined priorities.

Dietary Intake Estimated From a 24-Hour Recall Questionnaire in the Dene and Métis Communities of the Northwest Territories, Canada.

Background: Food security and nutrient deficiencies are frequent issues for people living in northern remote regions of Canada. Objective: The objective of this study is to describe the nutrient intake of residents living in the Dene/Métis communities of the Dehcho and Sahtú regions of the Northwest Territories. Methods: A 24-h dietary recall survey was used to collect information from participants of a study completed in 9 communities during the winter seasons of January 2016 to March 2018. Intakes for food groups, vitamins, macroelements, and microelements were calculated. Nutrient intakes were compared with the available DRIs. Results: In total, there were 197 participants. On average, 37% of their energy was consumed from fat, and fruit/vegetable consumption was low (2.8 servings). Some vitamin levels (i.e., folate and vitamins A, B-6, C, and D) indicated a risk of nutritional deficiency for at least half of the participants. Of the nutrients examined, the nutrients least likely to meet the DRIs, according to the age/sex category of respondents were vitamin D (6%-20%), fiber (0%-11%), and calcium (4%-30%). Males tended to have a higher rate of nutrient adequacy above the DRIs. Importantly, 52% of the childbearing age female participants appeared deficient in folate, 48% deficient in zinc, 41% deficient in B12, and 22% deficient in iron, which might affect pregnancy and children's development. Conclusions: A focus on supporting a higher intake of nutrient-dense foods would benefit the health of these communities. Nutrition and health promotion programs should be implemented to improve public health efforts in the region.

Sources of exposure to lead in Arctic and subarctic regions: a scoping review.

Understanding lead exposure pathways is a priority because of its ubiquitous presence in the environment as well as the potential health risks. We aimed to identify potential lead sources and pathways of lead exposure, including long-range transport, and the magnitude of exposure in Arctic and subarctic communities. A scoping review strategy and screening approach was used to search literature from January 2000 to December 2020. A total of 228 academic and grey literature references were synthesised. The majority of these studies (54%) were from Canada. Indigenous people in Arctic and subarctic communities in Canada had higher levels of lead than the rest of Canada. The majority of studies in all Arctic countries reported at least some individuals above the level of concern. Lead levels were influenced by a number of factors including using lead ammunition to harvest traditional food and living in close proximity to mines. Lead levels in water, soil, and sediment were generally low. Literature showed the possibility of long-range transport via migratory birds. Household lead sources included lead-based paint, dust, or tap water. This literature review will help to inform management strategies for communities, researchers, and governments, with the aim of decreasing lead exposure in northern regions.

How can climate change and its interaction with other compounding risks be considered in evaluation? Experiences from Vietnam.

While evaluations play a critical role in accounting for and learning from context, it is unclear how evaluations can take account of climate change. Our objective was to explore how climate change and its interaction with other contextual factors influenced One Health food safety programs. To do so, we integrated questions about climate change into a qualitative evaluation study of an ongoing, multi-sectoral program aiming to improve pork safety in Vietnam called SafePORK. We conducted remote interviews with program researchers (n = 7) and program participants (n = 23). Based on our analysis, researchers believed climate change had potential impacts on the program but noted evidence was lacking, while program participants (slaughterhouse workers and retailers) shared how they were experiencing and adapting to the impacts of climate change. Climate change also interacted with other contextual factors to introduce additional complexities. Our study underscored the importance of assessing climate factors in evaluation and building adaptive capacity in programming.

Dementia resources for eating, activity, and meaningful inclusion (DREAM) toolkit co-development: process, output, and lessons learned.

Promoting wellbeing of persons with dementia and their families is a priority of research and practice. Engaging diverse partners, including persons with dementia and their families, to co-develop interventions promotes relevant and impactful solutions. We describe the process, output, and lessons learned from the dementia resources for eating, activity, and meaningful inclusion (DREAM) project, which co-developed tools/resources with persons with dementia, care partners, community service providers, health care professionals, and researchers with the aim of increasing supports for physical activity, healthy eating, and wellbeing of persons with dementia. Our process included: (1) Engaging and maintaining the DREAM Steering Team; (2) Setting and navigating ways of engagement; (3) Selecting the priority audience and content; (4) Drafting the toolkit; (5) Iterative co-development of tools and resources; (6) Usability testing; and (7) Implementation and evaluation. In virtual meetings, the DREAM Steering Team confirmed the toolkit audiences (primary: community service providers; secondary: persons with dementia and care partners) and identified and evolved content areas. An environmental scan identified few existing, high-quality resources aligned with content areas. The Steering Team, additional multi-perspective partners, and external contractors iteratively co-developed new tools/resources to meet gaps over a 4-month virtual process that included virtual meetings, email exchange of documents and feedback, and one-on-one calls by telephone or email. The final DREAM toolkit includes a website with seven learning modules (on the diversity of dementia, rights and inclusion of persons living with dementia, physical activity, healthy eating, dementia-inclusive practices), a learning manual, six videos, nine handouts, and four wallet cards ( www.dementiawellness.ca ). Our co-development participants rated the process highly in relation to the principles and enablers of authentic partnership even though all engagement was virtual. Through use of the co-developed DREAM toolkit, we anticipate community service providers will gain the knowledge and confidence needed to provide dementia-inclusive wellness programs and services that benefit persons with dementia and their families.

Impact of a school snack program on the dietary intake of grade six to ten First Nation students living in a remote community in northern Ontario, Canada.

INTRODUCTION: School snack and breakfast programs may be especially important in remote northern communities where many households are food insecure. Despite the strong potential for school programs to improve the dietary intake and eating behaviours of children and youth, very few studies have reported on the effects of school nutrition programs in Aboriginal communities. The purpose of this study was to examine the impact of a school snack program on the dietary intake of grade six to ten First Nation students living in a remote community in northern Ontario. METHODS: Data were collected in November 2004 and December 2007 with grade six to ten (aged 10-18 years) students (n=63 and n=50, respectively) using a validated web-based 24 hour diet recall survey, the WEB-Q. Food group consumption and nutrient intake of students participating in the school snack program on the previous day were compared with students who chose not to participate. In each year, ANOVA was used to assess differences between participants and non-participants, genders, and grade groups. The second data collection in December of 2007 included five questions asking students about their participation, preferences, and impressions of the snack program. RESULTS: Students participating in the snack program during the 2004 data collection (37%; n=23) compared with those who did not (63%; n=40) had significantly (p<0.05) higher mean intakes from the 'Vegetables and Fruit' food group (7.5 vs 3.4 servings), folate (420 vs 270 µg), dietary fiber (18 vs 8 g), vitamin C (223 vs 94 mg), calcium (1055 vs 719 mg) and iron (16.5 vs 11.7 mg). For the 2007 data collection, snack program participants (52%; n=26) had higher intakes from the 'Milk and Alternatives' food group (3.3 vs 2.2 servings), vitamin A (697 vs 551 RE [retinol equivalents]), calcium (1186 vs 837 mg), and vitamin D (6.9 vs 4.4 µg) and significantly lower intakes of 'Other' foods (6.0 vs 7.2 servings) compared with non-participants (48%; n=24). For 2004 and 2007, differences in intake also occurred by gender and grade groupings, with no interaction effects between snack participation and gender or grade. With the exception of 'Meat and Alternatives' in 2004, there was a trend for a higher percentage of students to meet dietary recommendations if they participated in the snack program. Students indicated that the three things they liked most about the school snack program were the juice (50%), that the program kept them from feeling hungry at school (40%), and that they got a snack at school every day (32%). Students indicated that the snack program helped them to eat healthier by motivating them (74%), eating more fruit (86%), and making better dietary choices (68%). CONCLUSIONS: Given the positive impact of the program on the food and nutrient intake of school snack program participants, qualitative feedback will be used to enhance the program and participation. Clearly, school snack programs can be an important venue to address the nutritional vulnerability of First Nation youth living in remote communities.