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.

"I just got tired of their healthy tips": health promotion during public health crises. / « J'ai fini par en avoir assez de leurs conseils santé ¼ : la promotion de la santé en période de crise de santé publique.

This qualitative study highlights parents' perspectives on pandemic-related changes to health promotion programming. We conducted 60-minute, semi-structured telephone interviews with 15 parents (all mothers) of children in Grades 4 to 6 between December 2020 and February 2021 in two western Canadian provinces. Transcripts were analyzed through thematic analysis. While some parents found the health promotion materials helpful, most were overwhelmed and did not access the materials, finding them intrusive, being preoccupied with other things and facing their own personal stressors. This study highlights key factors to be addressed and further investigated to ensure the successful delivery of health promotion programming during future crises.

Schools modified health promotion programming in response to the COVID-19 pandemic lockdowns and relied on parents to facilitate health promotion at home. Qualitative interviews with parents of children in Grades 4 to 6 revealed that parents were overwhelmed and often did not access health promotion materials. In the event of a future public health crisis, we identified strategies that can be used to increase parental engagement in facilitating health promotion at home.

Les écoles ont modifié leurs programmes de promotion de la santé à la suite des fermetures liées à la pandémie de COVID­19 et ont compté sur les parents pour faciliter la promotion de la santé à la maison. Les entrevues qualitatives réalisées avec des parents d'enfants de la 4e à la 6e année ont révélé que les parents étaient débordés et qu'ils ont été peu nombreux à consulter les documents de promotion de la santé. Nous avons cerné des stratégies aptes à favoriser la participation des parents à la promotion de la santé à la maison dans l'éventualité d'une nouvelle crise de santé publique.

Comprehensive Nutrition Interventions in First Nation-Operated Schools in Canada.

Comprehensive school-based nutrition interventions offer a promising strategy to support healthy eating for First Nations children. A targeted strategic review was performed to identify nutrition interventions in 514 First Nation-operated schools across Canada through their websites. Directed content analysis was used to describe if interventions used 1 or more of the 4 components of the Comprehensive School Health (CSH) framework. Sixty schools had interventions. Nearly all (n = 56, 93%) schools offered breakfast, snack, and (or) lunch programs (social and physical environment). About one-third provided opportunities for students to learn about traditional healthy Indigenous foods and food procurement methods (n = 18, 30%) (teaching and learning) or facilitated connections between the school and students' families or the community (n = 16, 27%) (partnerships and services). Few schools (n = 10, 17%) had a nutrition policy outlining permitted foods (school policy). Less than 1% (n = 3) of interventions included all 4 CSH components. Results suggest that most First Nation-operated schools provide children with food, but few have nutrition interventions that include multiple CSH components. First Nation-operated schools may require additional financial and (or) logistical support to implement comprehensive school-based nutrition interventions, which have greater potential to support long-term health outcomes for children than single approaches.

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.

Enhancing cultural food security among the Syilx Okanagan adults with the reintroduction of Okanagan sockeye salmon.

For the Syilx Okanagan Nation, food sovereignty is foundational to ensuring their cultural food security and health. Salmon being a central Syilx food, the Nation has worked relentlessly since the 1990s to reintroduce Okanagan sockeye salmon into their traditional territory. This study describes the reach of this initiative and assesses its impact on Syilx households' income-related and cultural food security status. In total, 265 households participated in the study. Overall, 48.6% of participants ate Okanagan sockeye salmon during the year prior to the survey. Most participants (89.1%) reported that during the prior year their household accessed salmon from a community member or through trade (53.7%), community program (49.8%), a feast or ceremony (35.8%), or household harvest (27.2%). The number of ways that households accessed salmon was associated with a greater frequency of salmon consumption (p < 0.0001). Income-related (46.5%) and cultural (63.1%) food insecurity were prevalent. Households' access to salmon was significantly associated with cultural food security and the perceived importance of cultural food security. This study suggests Indigenous food sovereignty initiatives can increase traditional food access and consumption, thereby enhancing cultural food security. They should be supported by governments, organizations and corporations. Novelty: Indigenous food sovereignty initiatives can increase traditional food access and consumption, thereby enhancing cultural food security. Indigenous-led wild habitat restoration interventions can help reconcile past social and environmental injustices. This study was conducted on the unceded territory of the Syilx Okanagan People.

Development of an optimal grocery list based on actual intake from a cross-sectional study of First Nations adults in Ontario, Canada.

A multi-stage sampling strategy selected 1387 on-reserve First Nations adults in Ontario. Foods from a 24-hour dietary recall were assigned to the 100 most common food groups for men and women. Nutrients from market foods (MF) and traditional foods (TF) harvested from the wild as well as MF costs were assigned based on the proportions of total grams consumed. Linear programming was performed imposing various constraints to determine whether it was possible to develop diets that included the most popular foods while meeting Institute of Medicine guidelines. Final models were obtained for both sexes with the top 100 food groups consumed while limiting the nutrient-poor foods to no more than the actual observed intake. These models met all nutrient constraints for men but those for dietary fibre, linoleic acid, phosphorus, and potassium were removed for women. MF costs were obtained from community retailers and online resources. A grocery list was then developed and MF were costed for a family of 4. The grocery list underestimated the actual weekly food cost because TF was not included. Contemporary observed diets deviated from healthier historic First Nations diets. A culturally appropriate diet would include more traditional First Nations foods and fewer MF. Novelty: Linear programming is a mathematical approach to evaluating the diets of First Nations. The grocery list is representative of food patterns within Ontario First Nations and can be used as an alternative to the nutritious food basket used for public health food costing.

"It's Very Stressful for Children": Elementary School-Aged Children's Psychological Wellbeing during COVID-19 in Canada.

Emerging evidence suggests that the COVID-19 pandemic and associated public health measures, including lockdowns and school closures, have been negatively affecting school-aged children's psychological wellbeing. To identify supports required to mitigate the negative impacts of the COVID-19 pandemic, we gathered in-depth information on school-aged children's and parents' lived experiences of COVID-19 and perceptions of its impact on psychological wellbeing in grade 4-6 students in Canada. In this qualitative study, we conducted telephone-based semi-structured interviews with parents (n = 15) and their children (n = 16) from six schools in small and mid-sized northern prairie communities in Canada. Interviews were analyzed through thematic analysis. Three interrelated themes have emerged. First, the start of COVID-19 brought sudden and stressful changes to children's lives. Second, disruptions to daily life led to feelings of boredom and lack of purpose. Third, limited opportunities for social interaction led to loneliness and an increase in screen time to seek social connection with peers. Results underscore the need for resilience building and the promotion of positive coping strategies to help school-aged children thrive in the event of future health crises or natural disasters.

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.

Traditional Food, Health, and Diet Quality in Syilx Okanagan Adults in British Columbia, Canada.

In Canada, store-bought food constitutes the majority of First Nations (FN) people's diets; however, their traditional foods (TF; wild fish, game, fowl, and plants) remains vital for their health. This study compares health indicators and diet quality among 265 Syilx Okanagan adults according to whether or not they reported eating TF during a 24-h dietary recall. Three methods assessed diet quality: nutrient intakes and adequacy, Healthy Eating Index (HEI-C), and contributions of ultra-processed products (UPP) to %energy using the NOVA classification. Fifty-nine participants (22%) reported eating TF during the dietary recall; TF contributed to 13% of their energy intake. There were no significant differences in weight status or prevalence of chronic disease between TF eaters and non-eaters. TF eaters had significantly higher intakes of protein; omega-3 fatty acids; dietary fibre; copper; magnesium; manganese; phosphorus; potassium; zinc; niacin; riboflavin; and vitamins B6, B12, D, and E than non-eaters. TF eaters also had significantly better diet quality based on the HEI-C and the %energy from UPP. Findings support that TF are critical contributors to the diet quality of FN individuals. Strength-based FN-led interventions, such as Indigenous food sovereignty initiatives, should be promoted to improve access to TF and to foster TF consumption.

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.

School-based nutrition interventions for Indigenous children in Canada: a scoping review.

BACKGROUND: Indigenous children in Canada (First Nations, Inuit, and Métis) are disproportionately affected by nutrition-related chronic diseases such as obesity and diabetes. Comprehensive school-based nutrition interventions offer a promising strategy for improving children's access to healthy foods and sustaining positive eating behaviors. However, little is known about school-based nutrition interventions for Indigenous children. The objectives of this scoping review were to identify school-based nutrition interventions for Indigenous children in Canada and describe their components. METHODS: The scoping review consisted of searches in seven peer-reviewed databases and a general web search for grey literature. Eligibility criteria were applied by two reviewers, and data were extracted and charted by one reviewer using components of the comprehensive school health approach (social and physical environment, teaching and learning, policy, partnerships and services) and additional components with relevance to Indigenous interventions (cultural content, Indigenous control and ownership, funding source, evaluation). Numerical and descriptive summaries were used to present findings. RESULTS: Thirty-four unique interventions met the inclusion criteria. The majority (97%) of interventions targeted the social and physical environment, most often by offering food programs. Over half of interventions also incorporated teaching and learning (56%) and partnerships and services (59%), but fewer included a policy component (38%). Many interventions included a cultural component (56%) and most (62%) were owned and controlled by Indigenous communities (62%). Finally, over half of interventions disclosed their source(s) of funding (59%), but less than half (41%) included an evaluation component. CONCLUSIONS: The review suggests that school-based interventions for Indigenous children can be more comprehensive by incorporating culturally relevant nutrition education and professional development opportunities for teachers, written school nutrition policies, and activities that actively engage families and community members. The continued focus on Indigenous control and ownership and incorporation of content specific to individual communities may enhance cultural relevancy and sustainability of interventions. Furthermore, there is a need to increase intervention evaluation and the sharing of resources related to funding. These recommendations may be used by communities, as well as by researchers and professionals working with communities, in developing comprehensive school-based nutrition interventions to improve the eating behaviors of Indigenous children.

Alexander First Nations Parents' Perceptions of a School Nutrition Policy.

Purpose: A school nutrition policy (SNP) is one promising school-based health promotion strategy to improve the food environments of First Nations children. The aim of this study was to explore First Nations parents' perceptions of a SNP. Methods: A process evaluation of policy implementation was conducted using a mixed-methods design. Parents (n = 83) completed a 19-question survey to capture their perceptions of the policy. Survey responses informed questions in an 11-question semi-structured interview guide. Transcripts from interviews with parents (n = 10) were analyzed using content analysis to identify barriers and facilitators to policy implementation. Results: Parents were supportive of the SNP and the school's food programs, which they perceived as helping to address community concerns related to nutrition. However, some parents opposed the restriction of unhealthy foods at school celebrations and fundraisers. In addition, despite being aware of the SNP, parents were unable to demonstrate an understanding of the SNP content. Finally, parents struggled to provide their children with healthy foods to bring to school due to lack of affordable and accessible food in the community. Conclusions: Although SNPs may be well-received in First Nations communities, their implementation must be supported by parent involvement and consideration of wider socioeconomic conditions.

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.

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.

Modelling optimal diets for quality and cost: examples from Inuit and First Nations communities in Canada 1.

This review summarizes aspects of the 2017 Canadian Nutrition Society symposium, "Modelling diets for quality and cost: examples from Inuit and First Nations in Canada". Indigenous peoples in Canada experience a high prevalence of nutrition-related chronic disease because of the poor quality and high cost of their food supply. Since European colonization, they have transitioned from a diet of minimally processed traditional foods (game, fish, and plants) procured using pursuits such as hunting, fishing, gathering, and horticulture to a diet comprised mostly of processed market foods. This nutrition transition is the result of factors such as colonial policies and practices; climate change; environmental degradation; contaminants in traditional foods; and limited availability of, or access to, economical and healthful market foods. Presenters Malek Batal and Laurie Chan characterized the contemporary diets of First Nations and Inuit populations and demonstrated novel methods for modelling more optimal diets using 2 datasets: the First Nations Food, Nutrition, and Environment Study and the Inuit Health Survey. It was demonstrated how the NOVA classification characterized the portion of the diet consisting of processed foods. Dietary components were then manipulated to reduce ultra-processed food and drink intake to increase the Healthy Eating Index score. Linear programming was explained as a way to mathematically design theoretical diets that aim to optimize food cost, nutrition quality, and contaminant level of traditional foods. While diet-modelling methodologies have limitations, they provide a basis for engaging Indigenous peoples and governments to develop nutrition goals and policies anchored in contemporary food realities.

First Nations students' perceptions of school nutrition policy implementation: A mixed methods study.

AIM: School nutrition policies can improve healthy food access for Indigenous First Nations children in Canada. This study explored First Nations students' perceptions of a school nutrition policy. METHODS: The research was a process evaluation of school nutrition policy implementation using a mixed-methods design. Students in grades 4-12 (n = 94) completed a 17-question survey to capture their perceptions of the policy. Survey data informed an 11-question semi-structured interview guide. Transcripts from interviews with students (n = 20) were analysed using content analysis to identify barriers and facilitators to policy implementation. RESULTS: Key facilitating factors to policy implementation were student support for the policy and taste preferences. Most students (87%) agreed that only healthy foods should be served at school and, in interviews, expressed a preference for healthy food choices. Barriers to policy implementation included foods available at school and lack of communication between students and their teachers and parents. Half (50%) of surveyed students reported that their eating habits at school were average; interviews explained that their diets could be improved by consuming more fruit and vegetables at school. Both surveys and interviews found that communication between students and their parents and teachers about what they ate and drank at school was low. CONCLUSIONS: To support children's healthy eating at school, the school nutrition policy could provide clear guidelines on foods permissible in the school, while considering social and environmental barriers to healthy eating. The involvement of First Nations children in the implementation and evaluation of school nutrition policies is recommended.

Sociodemographic associations of the dietary proportion of ultra-processed foods in First Nations peoples in the Canadian provinces of British Columbia, Manitoba, Alberta and Ontario.

We investigated the food types consumed by 3276 First Nations citizens from the First Nations Food Nutrition and Environment Study (FNFNES) living on-reserve in Canada. Data from 24-h dietary recalls were classified into NOVA categories: fresh or minimally processed foods (MPF), processed culinary ingredients, processed foods, and ultra-processed foods (UPF). Individuals were classified as traditional food (TF) eaters if they ate MPF of their First Nations culture. UPF accounted for 54.0% of energy intake; 23% of participants ate TF. Increasing age and household size, living in British Columbia and TF eating were associated with a lower intake of energy from UPF. Eating TF appeared to be protective against intake of UPF.

Quantifying associations of the dietary share of ultra-processed foods with overall diet quality in First Nations peoples in the Canadian provinces of British Columbia, Alberta, Manitoba and Ontario.

OBJECTIVE: To quantify associations of the dietary share of ultra-processed foods (UPF) with the overall diet quality of First Nations peoples. DESIGN: A cross-sectional analysis of data from the First Nations Food, Nutrition and Environment Study, designed to contribute to knowledge gaps regarding the diet of First Nations peoples living on-reserve, south of the 60th parallel. A multistage sampling of communities was conducted. All foods from 24 h dietary recalls were categorized into NOVA categories and analyses were performed to evaluate the impact of UPF on diet quality. SETTING: Western and Central Canada. SUBJECTS: First Nations participants aged 19 years or older. RESULTS: The sample consisted of 3700 participants. UPF contributed 53·9 % of energy. Compared with the non-UPF fraction of the diet, the UPF fraction had 3·5 times less vitamin A, 2·4 times less K, 2·2 times less protein, 2·3 times more free sugars and 1·8 times more Na. As the contribution of UPF to energy increased so did the overall intakes of energy, carbohydrate, free sugar, saturated fat, Na, Ca and vitamin C, and Na:K; while protein, fibre, K, Fe and vitamin A decreased. Diets of individuals who ate traditional First Nations food (e.g. wild plants and game animals) on the day of the recall were lower in UPF. CONCLUSIONS: UPF were prevalent in First Nations diets. Efforts to curb UPF consumption and increase intake of traditional First Nations foods and other fresh or minimally processed foods would improve diet quality and health in First Nations peoples.