Characterizing Trends in the Use of Food Donations and Other Food-Related Community-Based Social Assistance Programs in a Cohort of New Food Bank Users in Quebec, Canada.

Objective: To characterize 12-month trends in the use of food donations and other food-related community-based social assistance programs (CB-SAPs) during the first year following the enrollment of new food bank (FB) users in Quebec, Canada. Methods: A cohort of 1,001 newly registered FB-users in Quebec from the Pathways Study were followed-up during 12-month following baseline assessment. Outcomes were monthly use of food donations and other food-related CB-SAPs. Main predictors were alternative food source utilization (AFSU) profiles: 1) exclusive-FB-users; 2) FB+fruit/vegetable-market-users; and 3) Multiple/diverse-AFS-users. Covariates included sociodemographic characteristics, health status, and major life events. We fit Bayesian hierarchical mixed-effect models, accounting for spatial clustering, temporal correlation, and censoring. Results: We observed an overall downward trend of food donation use among study completers (n = 745). Each AFSU profile had a distinctive monthly trend of food donation use, but probabilities of use across the three profiles overlapped, between 44% and 55%. The use of other food-related CB-SAPs was low and not correlated with AFSU profiles. Conclusion: De novo FB-users use food donations in different ways over time according to specific contextual AFSU profiles.

Les pratiques de l'action intersectorielle locale pour l'équité en santé : étude du cas Quartier nourricier de la Corporation de développement communautaire Centre-Sud à Montréal.

INTRODUCTION: Afin d'agir sur les inégalités de santé et les ressources locales promotrices de santé, les praticiens et les décideurs doivent être outillés pour pratiquer l'action intersectorielle locale. Planifier et optimiser ces partenariats demeure pourtant un défi en raison du manque de connaissances sur les processus menant à l'atteinte de leurs objectifs - ce qu'ils font et comment. Cette étude documente empiriquement, à l'aide d'une étude de cas, les pratiques de conception de l'action intersectorielle locale dans la démarche Quartier nourricier (QN) à Montréal. MÉTHODES: Une analyse secondaire d'un sous-ensemble des données originales du programme de recherche Valeur de l'action intersectorielle locale a été effectuée. Les données qualitatives sont issues d'une collecte de données prospective ayant suivi l'évolution du système d'action complexe QN entre mars et novembre 2014. Les traces observables de l'action ont été relevées dans des notes d'observation, des documents et des entretiens téléphoniques, puis codifiées dans une matrice chronologique d'évènements critiques et une matrice ordonnée par rôle. L'analyse inductive des matrices a identifié les éléments significatifs pour expliquer le déroulement de l'action. RÉSULTATS: Trois opérations interdépendantes et concomitantes affectent à la fois la relation entre les partenaires et la conception du projet : (a) l'idéation sous contraintes, (b) la négociation de priorités, et (c) la représentation politique. Chaque opération présente un ensemble de pratiques qui font progresser l'action intersectorielle locale. CONCLUSION: Mettre en lumière les pratiques du terrain, en les ancrant dans trois opérations nécessaires pour effectuer des transformations dans les environnements locaux favorables à la santé, permet de guider la planification des stratégies et la conduite des actions pour mener des partenariats intersectoriels. MOTS CLÉS: Action communautaire, action intersectorielle locale, collaboration/partenariats, conception, développement des capacités (y compris les compétences), environnements favorables à la santé, étude de cas, promotion de la santé, réalisme critique, urbanisme/santé urbaine/milieu urbain.

The Pathways study: a cohort study of new food-aid users in rural, semi urban, and urban areas of Quebec, Canada.

BACKGROUND: While considerable research has been conducted on household food insecurity (HFI), little research has examined the effects of food donation programs on users' living conditions. The Pathways study was established to investigate the long-term effects of food donation programs on food insecurity as well as other critical outcomes, such as diet, health, and social support. Herein, we describe the design of the Pathways Study and the participants' characteristics at baseline. METHODS: The Pathways study is a prospective cohort study of 1001 food-aid users in Quebec (Canada). We recruited newly registered users of food donation programs from 106 community-based food-aid organizations that partnered with the study. Baseline data were collected through face-to-face interviews from September 2018 to January 2020, with planned follow-up interviews at 12 and 24 months after enrollment. Household food insecurity, diet, food competencies, food shopping behaviors, perceived food environment, health status, social support and isolation, sociodemographic characteristics, housing conditions, negative life events, and the impacts of COVID-19 were assessed with validated questionnaires. RESULTS: The cohort included 1001 participants living in rural (n = 181), semi-urban (n = 250), and urban areas (n = 570). Overall, household food insecurity was reported as severe among 46.2% and moderate in 36.9% of participants. Severe household food insecurity was more prevalent in rural (51.4%) and urban (47.8%) areas compared to semi-urban (39%) areas. Overall, 76.1% of participants reported an annual income below C$20,000. Half (52%) had low education levels (high school or lower), 22.0% lived in single-parent households, and 52.1% lived alone. Most (62.9%) experienced at least one major financial crisis in the preceding year. CONCLUSIONS: Results show that newly registered users of food donation programs often have low-income and severe food insecurity, with major differences across geographical locations. The Pathways study is the first study designed to follow, over a 2-year period, a cohort of newly registered users of food donation programs and to quantify their trajectories of service use. Findings from the Pathways study might help adapt the community response to the strategies used by food-insecure households to feed themselves.

Health-Promoting School Culture: How Do We Measure it and Does it Vary by School Neighborhood Deprivation?

BACKGROUND: The context in which school-based health-promoting interventions are implemented is key for the delivery and success of these interventions. However, little is known about whether school culture differs by school deprivation. METHODS: Using data from PromeSS, a cross-sectional study of 161 elementary schools in Québec, Canada, we drew from the Health Promoting Schools theoretical framework to develop four measures of health-promoting school culture (i.e., school physical environment, school/teacher commitment to student health, parent/community engagement with the school, ease of principal leadership) using exploratory factor analysis. One-way ANOVA with post-hoc Tukey-Kramer analyses was used to examine associations between each measure and social and material deprivation in the school neighborhood. RESULTS: Factor loadings supported the content of the school culture measures and Cronbach's alpha indicated good reliability (range: 0.68-0.77). As social deprivation in the school neighborhood increased, scores for both school/teacher commitment to student health and parent/community engagement with the school decreased. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Implementation of health-promoting interventions in schools located in socially deprived neighborhoods may require adapted strategies to address challenges related to staff commitment and parental and community involvement. CONCLUSION: The measures developed herein can be used to investigate school culture and interventions for health equity.

Global, regional and national prevalence of copper, selenium and zinc deficiencies in women of childbearing age: protocol for systematic review and meta-analysis.

INTRODUCTION: Micronutrient deficiencies are common in low-income and middle-income countries and are usually related to inadequate food intake, poor diet quality and low bioavailability. Copper, selenium and zinc are essential minerals in several enzymatic reactions and their deficiencies are associated with worse prognosis in pregnancy, compromising maternal health as well as her offspring. Thus, the objective of the present systematic review will be to describe the prevalence of copper, selenium and zinc deficiencies in women of childbearing age. METHODS AND ANALYSIS: The search will be performed by independent reviewers. The bases used will be PubMed/MEDLINE, Science direct, Lilacs, Adolec, Scopus, EMBASE, CINAHL, Web of Science, CENTRAL, IMSEAR, PAHOS, WPRIM, IMEMR, AIM for grey literature OpenGrey and OVID. National data will be searched in BDTD. A first search will be performed and a second search will be performed just before submission. Risk of bias assessment will be performed using the Joanna Briggs group prevalence study checklist. Combinable studies will be performed meta-analysis. Heterogeneity will be tested using Cochran's Q test and quantified by the inconsistency test (I²). In the presence of high heterogeneity, meta-analysis will be performed using the random effects model with Stata metaprop. Summary prevalence will be generated for each outcome, presented in Forest plot figures. ETHICS AND DISSEMINATION: This systematic review will be solely based on published and retrievable literature, no ethics approval will be obtained. Our dissemination strategy will involve the presentation in scientific meetings, as well as the publication of article(s), posters and presentations in congresses. PROSPERO REGISTRATION NUMBER: CRD42020165352.

Housing as a determinant of Inuit mental health: associations between improved housing measures and decline in psychological distress after rehousing in Nunavut and Nunavik.

INTERVENTION: In 2014-2015, more than 400 public housing units were constructed in Nunavut and Nunavik, two of the four Inuit regions in Canada. This provided the opportunity to assess the impact of improved housing conditions from a population health perspective in 12 Inuit communities where housing needs were the most severe. The aim of the research is to examine the associations between changes in housing conditions and changes in psychological distress pre-post rehousing. METHODS: A pre-post uncontrolled study was conducted in collaboration with Nunavut- and Nunavik-based organizations. Applicants at the top of public housing waitlists were recruited by local housing officers; participants completed questionnaires 1-6 months before rehousing, and 15-18 months after. Change in psychological distress was measured with the Kessler 6-item scale. Changes in three housing measures were examined: number of adults per household, number of children per household, and sense of home score. For each housing measure, a categorical variable stratified participants into three categories. The reference category included participants reporting significant change in the concerned housing measure; the two other categories included participants reporting little or no change. Associations were tested with linear multilevel regression models for change. RESULTS: A total of 102 Inuit adults completed the study. A reduction in the number of adults per household (living with 2 adults or less after rehousing) and an increase in sense of home were associated with significant decline in psychological distress pre-post rehousing (p < 0.001). CONCLUSION: Increased investments leading to such improvements in housing circumstances are promising ways to promote mental health in Inuit regions.

RéSUMé: INTERVENTION: En 2014-2015, plus de 400 logements sociaux ont été construits au Nunavut et au Nunavik, deux des quatre régions inuites du Canada, permettant ainsi d'évaluer l'impact de l'amélioration des conditions de logement sur la santé. Cette étude vise à examiner les associations entre les changements dans les conditions de logement et les changements dans la détresse psychologique avant et après le déménagement, dans 12 communautés inuites où les besoins en logement étaient les plus criants. MéTHODES: Une étude pré-post non contrôlée a été menée en collaboration avec des organisations du Nunavut et du Nunavik. Les participants figurant en tête des listes d'attente pour le logement social ont rempli les questionnaires de recherche 1-6 mois avant le déménagement et 15-18 mois après. Les changements de la détresse psychologique ont été mesurés à l'aide de l'échelle Kessler 6-item. Les changements des trois conditions de logement suivantes ont été examinés : le nombre d'adultes par ménage, le nombre d'enfants par ménage et le sentiment d'avoir un chez-soi. Pour chaque condition de logement, une variable catégorielle a été créée pour stratifier les participants ayant rapporté des changements (référence) et les participants n'ayant rapporté que peu ou pas de changement. Les associations ont été testées avec des modèles de régression linéaire multiniveaux. RéSULTATS: Un total de 102 adultes Inuit ont complété l'étude. Une réduction du nombre d'adultes par ménage (vivre avec 2 adultes ou moins après le déménagement) et une augmentation du sentiment d'avoir un chez-soi étaient associées à une baisse significative de la détresse psychologique (p < 0,001). CONCLUSION: Des investissements accrus menant à de telles améliorations des conditions de logement représentent une avenue prometteuse pour promouvoir la santé mentale dans les régions inuites.

Using the Behaviour Change Wheel to develop an oral hygiene self-care intervention for Punjabi immigrant adults: an illustrative example.

Background: This article describes the development of an oral hygiene self-care behaviour change intervention (Safeguard Your Smile [SYS]) for Punjabi immigrant adults, using the Behaviour Change Wheel (BCW) theoretical framework. Methods: The 3 stages and 8 steps of the BCW were followed to develop the face-to-face SYS intervention. Identification of the problem in behavioural terms was enabled by referring to the results of a qualitative focus group (FG) previously conducted by the research team. Following the BCW method, the sources of behaviour were defined in terms of capability, opportunity, and motivation. Appropriate intervention functions, policy categories, behaviour change techniques (BCTs), and modes of delivery were then identified, selected, and mapped. Concrete strategies were chosen to bring about the desired oral hygiene self-care behavioural change. Results: Two main barriers to oral hygiene self-care faced by Punjabi immigrant adults were identified from the original FG: 1) inadequate knowledge and 2) inconsistent daily routine. Oral hygiene self-care behaviour was designated as a target behaviour, detailing frequency, duration, and technique. Five intervention functions (education, training, modelling, environmental restructuring, and enablement) and 2 policy categories (communication and service provision) were identified to influence the capability, opportunity, and motivation related to oral hygiene self-care behaviour. Nine BCTs were selected to influence desired oral hygiene self-care behaviour among adults. Conclusion: The development process for this SYS intervention may be employed by researchers to design a behaviour change intervention for other populations. However, additional strategies tailored to each specific context and population must be incorporated.

Contexte: Cet article décrit le développement d'une intervention de changement de comportement en matière de soins personnels d'hygiène buccodentaire à l'intention des immigrants pendjabis appelée Safeguard Your Smile (SYS), en utilisant le cadre théorique de la « roue de changement de comportement ¼ (RCC). Méthodologie: Les 3 stades et les 8 étapes de la RCC ont été suivis pour élaborer l'intervention de SYS en personne. Cibler le problème en matière de comportement a été rendu possible en se référant aux résultats d'un groupe de discussion qualitatif (GD) précédemment mené par l'équipe de recherche. Les sources du comportement ont été définies en matière de capacité, d'opportunité et de motivation, selon la méthode de la RCC. Les rôles d'intervention, les catégories de politiques, les techniques de changement de comportement (TCC) et les modes de prestation appropriés ont ensuite été ciblés, sélectionnés et répertoriés. Des stratégies concrètes ont été choisies pour obtenir le changement de comportement souhaité en matière de soins personnels d'hygiène buccodentaire. Résultats: Deux principaux obstacles aux soins buccodentaires personnels auxquels sont confrontés les immigrants pendjabis ont été ciblés dans le GD initial : 1) des connaissances inadéquates et 2) des habitudes quotidiennes incohérentes. Le comportement de soins personnels d'hygiène buccodentaire a été défini comme un comportement cible, détaillant la fréquence, la durée et la technique. Cinq rôles d'intervention (éducation, formation, modelage, restructuration de l'environnement et habilitation) et 2 catégories de politiques (communication et prestation de services) ont été ciblés pour influencer la capacité, l'opportunité et la motivation liées au comportement de soins personnels d'hygiène buccodentaire. Neuf TCC ont été sélectionnés pour influencer le comportement souhaité en matière d'hygiène buccodentaire chez les adultes. Conclusion: Le processus de développement de cette intervention SYS peut être utilisé par les chercheurs pour concevoir une intervention de changement de comportement pour d'autres populations. Cependant, des stratégies supplémentaires adaptées à chaque contexte et population spécifiques doivent être incorporées.

"We're Home Now": How a Rehousing Intervention Shapes the Mental Well-Being of Inuit Adults in Nunavut, Canada.

This study explores the ways in which a rehousing intervention shapes the mental well-being of Inuit adults living in Nunavut, Canada, where the prevalence of core housing need is four times the national average. More specifically, it compares the housing experiences of participants who were rehoused in a newly built public housing unit, to the experiences of participants on the public housing waitlist. The study was developed in collaboration with organizations based in Nunavut and Nunavik. Semi-structured interviews were transcribed, and a deductive-inductive thematic analysis was performed based on Gidden's concept of ontological security, and Inuit-specific mental health conceptualization. Twenty-five Inuit adults participated (11 rehoused, 14 waitlist). Three themes were identified to describe how the subjective housing experiences of participants improved their mental well-being after rehousing: (1) refuge creation; (2) self-determination and increased control; (3) improved family dynamics and identity repair. Implicit to these themes are the contrasting housing experiences of participants on the waitlist. Construction initiatives that increase public housing stock and address gaps in the housing continuum across Inuit regions could promote well-being at a population level. However, larger socio-economic problems facing Inuit may hamper beneficial processes stemming from such interventions.

Lessons from past pandemics: a systematic review of evidence-based, cost-effective interventions to suppress COVID-19.

BACKGROUND: In an unparalleled global response, during the COVID-19 pandemic, 90 countries asked 3.9 billion people to stay home. Yet other countries avoided lockdowns and focused on other strategies, like contact tracing. How effective and cost-effective are these strategies? We aimed to provide a comprehensive summary of the evidence on past pandemic controls, with a focus on cost-effectiveness. METHODS: Following PRISMA guidelines, MEDLINE (1946 to April week 2, 2020) and EMBASE (1974 to April 17, 2020) were searched using a range of terms related to pandemic control. Articles reporting on the effectiveness or cost-effectiveness of at least one intervention were included. RESULTS: We found 1653 papers; 62 were included. The effectiveness of hand-washing and face masks was supported by randomized trials. These measures were highly cost-effective. For other interventions, only observational and modelling studies were found. They suggested that (1) the most cost-effective interventions are swift contact tracing and case isolation, surveillance networks, protective equipment for healthcare workers, and early vaccination (when available); (2) home quarantines and stockpiling antivirals are less cost-effective; (3) social distancing measures like workplace and school closures are effective but costly, making them the least cost-effective options; (4) combinations are more cost-effective than single interventions; and (5) interventions are more cost-effective when adopted early. For 2009 H1N1 influenza, contact tracing was estimated to be 4363 times more cost-effective than school closure ($2260 vs. $9,860,000 per death prevented). CONCLUSIONS AND CONTRIBUTIONS: For COVID-19, a cautious interpretation suggests that (1) workplace and school closures are effective but costly, especially when adopted late, and (2) scaling up as early as possible a combination of interventions that includes hand-washing, face masks, ample protective equipment for healthcare workers, and swift contact tracing and case isolation is likely to be the most cost-effective strategy.

Engaging with community organizations to recruit and retain vulnerable adults: The Pathways Study.

•Researchers must overcome multiple barriers in recruiting and retaining research participants living in conditions of vulnerability.•A comprehensive recruitment strategy that combines various elements tailored to vulnerable populations is required.•Most studies describing recruitment and retention of participants from vulnerable populations pertain to clinical settings.•This study describes strategies and challenges in recruiting participants through community organizations.•This paper provides recommendations on recruiting and retaining people living in conditions of extreme vulnerability.

We Need to Talk About Social Inequalities in Language Development.

PURPOSE: This article aims to raise speech-language pathologists' (SLPs') awareness about the extent of social inequalities in the language development of children, and their social determinants. METHOD: This article draws on empirical evidence and theoretical foundations from the field of public health to highlight the roots and distribution of social inequalities in the language development of children. The Total Environment Assessment Model for Early Child Development is presented as a means to understand the social determinants of early child development, and its relevance to the context of early language development is discussed. Informed by these theoretical notions, this article encourages SLPs to reflect on actions directed toward the social determinants of language. Drawing from health promotion approaches, a conceptualization of language interventions and intervention outcomes as "events in systems" is suggested. CONCLUSION: The public health-inspired approach to language interventions shared in this article invites institutions and SLPs to direct their gaze to the social determinants of language and broaden the scope of actions that are included in individual or group interventions aimed at supporting the language development of children.

Health promotion innovations scale up: combining insights from framing and actor-network to foster reflexivity.

There are numerous hurdles down the road for successfully scaling up health promotion innovations into formal programmes. The challenges of the scaling-up process have mainly been conceived in terms of available resources and technical or management problems. However, aiming for greater impact and sustainability involves addressing new contexts and often adding actors whose perspectives may challenge established orientations. The social dimension of the scaling-up process is thus critical. Building on existing conceptualizations of interventions as dynamic networks and of evolving framing of health issues, this paper elaborates a social view of scaling up that accounts for the transformations of innovations, using framing analysis and the notion of 'expanding scaling-up networks'. First, we discuss interventions as dynamic networks. Second, we conceptualize scaling-up processes as networks in expansion within which social learning and change occur. Third, we propose combining a 'representational approach' to frame analysis and an 'interactional approach' that illustrates framing processes related to the micro-practices of leading public health actors within expanding networks. Using an example concerning equity in early childhood development, we show that this latter approach allows documenting how frames evolve in the process. Considering the process in continuity with existing conceptualizations of interventions as actor-networks and transformation of meanings enriches our conceptualization of scaling up, improves our capacity to anticipate its outcomes, and promotes reflexivity about health promotion goals and means.

Health promotion research has come of age! Structuring the field based on the practices of health promotion researchers.

Health promotion is mostly framed as a discourse and practices based on a set of values and principles that promote changes at various levels (individual, community and global). There is no well-defined knowledge base and no widely agreed knowledge development methods. During the past decades, health promotion knowledge has developed following a potluck model. Researchers from various disciplinary backgrounds attracted to the values and transformative vision of health promotion have used their disciplinary-based research methods and theories to conduct studies about the various practices that are associated with health promotion. Although health promotion research has acquired many attributes of a distinct field, researching practices from various disciplinary perspectives is not sufficient to create a coherent knowledge base for health promotion. We propose three dimensions to further structure health promotion research. The first relates to the object for which knowledge is produced. For health promotion research this relates to health social practices. The second dimension relates to the purpose and ethics of research. In the case of health promotion research it pursues the dual purpose of producing knowledge (epistemic aim) and contributing to social changes (transformative aim). The third dimension concerns the knowledge produced and the conditions for valid knowledge. In the case of health promotion research, the condition of knowledge production should include a recognition of the complexity of social practice and the necessary dialogue between scientific. True to health promotion principles, we propose a bottom-up process for structuring the field through the creation of a 'Global Handbook of Health Promotion Research' that would draw on the research practices of those involved in health promotion research.