Kim D. Raine

Ecological Models Revisited: Their Uses and Evolution in Health Promotion Over Two Decades

Since the 1980s, ecological models of health promotion have generated a great deal of enthusiasm among researchers and interventionists. These models emerged from conceptual developments in other fields, and only selected elements of the ecological approach have been integrated into them. In this article, we describe the tenets of the ecological approach and highlight those aspects that have been integrated into ecological models used in health promotion. We also analyze how ecological models have been applied to the study of two important public health issues, namely physical activity promotion and the increased consumption of fruits and vegetables, by conducting an archival study of published research. Finally, we make a statement regarding the usefulness of ecological models for research and practice and propose recommendations for future research, program planning, and evaluation.

The association between neighborhood socioeconomic status and exposure to supermarkets and fast food outlets

This study examines whether exposure to supermarkets and fast food outlets varies with neighborhood-level socioeconomic status in Edmonton, Canada. Only market area and fast food proximity predicted supermarket exposure. For fast food outlets, the odds of exposure were greater in areas with more Aboriginals, renters, lone parents, low-income households, and public transportation commuters; and lower in those with higher median income and dwelling value. Low wealth, renter-occupied, and lone parent neighborhoods had greater exposure to fast food outlets, which was not offset by better supermarket access. The implications are troubling for fast food consumption among lone parent families in light of growing obesity rates among children.

Relation between local food environments and obesity among adults

BackgroundOutside of the United States, evidence for associations between exposure to fast-food establishments and risk for obesity among adults is limited and equivocal. The purposes of this study were to investigate whether the relative availability of different types of food retailers around peoples homes was associated with obesity among adults in Edmonton, Canada, and if this association varied as a function of distance between food locations and peoples homes.MethodsData from a population health survey of 2900 adults (18 years or older) conducted in 2002 was linked with geographic measures of access to food retailers. Based upon a ratio of the number of fast-food restaurants and convenience stores to supermarkets and specialty food stores, a Retail Food Environment Index (RFEI) was calculated for 800 m and 1600 m buffers around peoples homes. In a series of logistic regressions, associations between the RFEI and the level of obesity among adults were examined.ResultsThe median RFEI for adults in Edmonton was 4.00 within an 800 m buffer around their residence and 6.46 within a 1600 m buffer around their residence. Approximately 14% of the respondents were classified as being obese. The odds of a resident being obese were significantly lower (OR = 0.75, 95%CI 0.59 – 0.95) if they lived in an area with the lowest RFEI (below 3.0) in comparison to the highest RFEI (5.0 and above). These associations existed regardless of the covariates included in the model. No significant associations were observed between RFEI within a 1600 m buffer of the home and obesity.ConclusionThe lower the ratio of fast-food restaurants and convenience stores to grocery stores and produce vendors near peoples homes, the lower the odds of being obese. Thus the proximity of the obesogenic environment to individuals appears to be an important factor in their risk for obesity.

Prevalence and sociodemographic risk factors related to household food security in Aboriginal peoples in Canada.

OBJECTIVE Canadas Aboriginal population is vulnerable to food insecurity and increasingly lives off-reserve. The Canadian Community Health Survey, Cycle 2.2 Nutrition, was used to compare the prevalence and sociodemographic correlates of food insecurity between non-Aboriginal and off-reserve Aboriginal households. DESIGN Food insecurity status was based on Health Canadas revised interpretation of responses to the US Household Food Security Survey Module. Logistic regression was used to assess if Aboriginal households were at higher risk for food insecurity than non-Aboriginal households, adjusting for household sociodemographic factors. SETTING Canada. SUBJECTS Households (n 35,107), 1528 Aboriginal and 33 579 non-Aboriginal. RESULTS Thirty-three per cent of Aboriginal households were food insecure as compared with 9 % of non-Aboriginal households (univariate OR 5.2, 95 % CI 4.2, 6.3). Whereas 14 % of Aboriginal households had severe food insecurity, 3 % of non-Aboriginal households did. The prevalence of sociodemographic risk factors for household food insecurity was higher for Aboriginal households. Aboriginal households were more likely to have three or more children (14 % v. 5 %), be lone-parent households (2 1 % v. 5 %), not have home ownership (52 % v. 31 %), have educational attainment of secondary school or less (43 % v. 26 %), have income from sources other than wages or salaries (38 % v. 29 %), and be in the lowest income adequacy category (33 % v. 12 %). Adjusted for these sociodemographic factors, Aboriginal households retained a higher risk for food insecurity than non-Aboriginal households (OR 2.6, 95 % CI 2.1, 3.2). CONCLUSIONS Off-reserve Aboriginal households in Canada merit special attention for income security and poverty alleviation initiatives.

The Association of Television Viewing with Snacking Behavior and Body Weight of Young Adults

Purpose. Investigate whether TV viewing and recognition of snack food advertisements were associated with snack food consumption and the odds of being overweight or obese. Design. Cross-sectional internet-based survey. Setting. University of Alberta, Edmonton, Canada. Subjects. Undergraduate university students aged 18 to 25 years (N = 613). Measures. Self-reported TV viewing, energy-dense snack consumption, snacking while viewing TV, and body weight. Analysis. Hypothesis testing was completed using multiple analysis of variance, analysis of covariance, and logistic regression. Results. Students reporting medium or high TV viewership snacked more frequently while watching TV and recognized more advertising than students who were considered low viewers. High viewers also reported more consumption of energy-dense snacks than low viewers. Snacking frequency appeared to be related to TV viewing and place of residence, but the association between snacking frequency and TV viewing was not accounted for by advertising. Conversely, the association between TV viewing and consumption of energy-dense snacks was accounted for by advertising recognition. Finally, male students (odds ratio [OR], 2.78; 99% confidence interval [CI], 1.68–4.59) and medium (OR, 3.11;99% CI, 1.37–7.08) and high (OR, 5.47; 99% CI, 1.97–15.16) TV viewers had higher odds of being overweight or obese. Conclusions. Associations were found among TV viewing, energy-dense snack consumption, and snacking behavior, and between TV viewing and body weight status.

Exploring Obesogenic Food Environments in Edmonton, Canada: The Association Between Socioeconomic Factors and Fast-food Outlet Access

Purpose. To explore the relationship between the placement of fast-food outlets and neighborhood-level socioeconomic variables by determining if indicators of lower socioeconomic status were predictive of exposure to fast food. Design. A descriptive analysis of the fast-food environment in a Canadian urban center, using secondary analysis of census data and Geographic Information Systems technology. Setting. Edmonton, Alberta, Canada. Measures. Neighborhoods were classified as High, Medium, or Low Access based on the number of fast-food opportunities available to them. Neighborhood-level socioeconomic data (income, education, employment, immigration status, and housing tenure) from the 2001 Statistics Canada federal census were obtained. Analysis. A discriminant function analysis was used to determine if any association existed between neighborhood demographic characteristics and accessibility of fast-food outlets. Results. Significant differences were found between the three levels of fast-food accessibility across the socioeconomic variables, with successively greater percentages of unemployment, low income, and renters in neighborhoods with increasingly greater access to fast-food restaurants. A high score on several of these variables was predictive of greater access to fast-food restaurants. Conclusion. Although a causal inference is not possible, these results suggest that the distribution of fast-food outlets relative to neighborhood-level socioeconomic status requires further attention in the process of explaining the increased rates of obesity observed in relatively deprived populations.

Associations among the food environment, diet quality and weight status in Cree children in Québec

OBJECTIVE To explore the relationship among childrens diet quality, weight status and food environment in subarctic Canada. DESIGN In the cross-sectional study, childrens BMI was calculated, diet quality was assessed using three 24 h dietary recalls and children were asked about their home food environment and source of meals. SETTING Two Aboriginal Cree communities in northern Québec. SUBJECTS Two hundred and one children in grades 4-6. RESULTS The majority (64.2%) of children were overweight (29.9%) or obese (34.3%). Weight status was not associated with reported restaurant meal frequency or the home food environment. The 18% of children who consumed three or more restaurant meals in the three days of recall consumed, on average, 2004 kJ (479 kcal) more energy daily than children consuming no restaurant meals and had higher intakes of fat, saturated fat, Ca and soda. Most foods contributing to energy and dietary fat were energy-dense market foods of low nutritional value such as sweetened beverages and snack foods. Only 68% of children reported often having fruits and vegetables in the home and 98.5% of children consumed less than 5 fruits and vegetables daily. Many children (42.8%) were at risk of Zn inadequacy. Only 19% of children consumed 2 or more servings of milk daily, and the mean intakes of Ca and vitamin D were below the recommended adequate intake. Traditional game meat was consumed infrequently, but contributed significantly to Fe and Zn intake. CONCLUSIONS Childhood obesity in subarctic communities prevailed in a food environment typified by high-energy-density commercial foods of low nutritional value.

The social determinants of the incidence and management of type 2 diabetes mellitus: are we prepared to rethink our questions and redirect our research activities?

This paper discusses the role played by social determinants of health in the incidence and management of type 2 diabetes mellitus (diabetes) among vulnerable populations. This issue is especially important in light of recent data from Statistics Canada indicating that mortality rates from diabetes have been increasing among Canadians since the mid‐1980s, with increases being especially great among those living in low‐income communities. Diabetes therefore appears – like cardiovascular disease – to be an affliction more common among the poor and excluded. It also appears to be especially likely to afflict poor women. Yet we know little about how these social determinants of health influence diabetes incidence and management. What evidence is available is provided and the case is made that the crisis in diabetes requires new ways of thinking about this disease, its causes, and its management.

Diet quality, nutrition and physical activity among adolescents: the Web-SPAN (Web-Survey of Physical Activity and Nutrition) project.

OBJECTIVE To assess the overall diet quality of a sample of adolescents living in Alberta, Canada, and evaluate whether diet quality, nutrient intakes, meal behaviours (i.e. meal skipping and consuming meals away from home) and physical activity are related. DESIGN A cross-sectional study design. Students completed the self-administered Web-Survey of Physical Activity and Nutrition (Web-SPAN). Students were classified as having poor, average or superior diet quality based on Canadas Food Guide to Healthy Eating (CFGHE). SETTING One hundred and thirty-six schools (37 %) within forty-four public and private school boards (75 %) in Alberta, Canada. SUBJECTS Grade 7 to 10 Alberta students (n 4936) participated in the school-based research. RESULTS On average, students met macronutrient requirements; however, micronutrient and fibre intakes were suboptimal. Median CFGHE food group intakes were below recommendations. Those with poor diet quality (42 %) had lower intakes of protein, fibre and low-calorie beverages; higher intakes of carbohydrates, fat and Other Foods (e.g. foods containing mostly sugar, high-salt/fat foods, high-calorie beverages, low-calorie beverages and high-sugar/fat foods); a lower frequency of consuming breakfast and a higher frequency of consuming meals away from home; and a lower level of physical activity when compared with students with either average or superior diet quality. CONCLUSIONS Alberta adolescents were not meeting minimum CFGHE recommendations, and thus had suboptimal intakes and poor diet quality. Suboptimal nutritional intakes, meal behaviours and physical inactivity were all related to poor diet quality and reflect the need to target these health behaviours in order to improve diet quality and overall health and wellness.

Physical activity and type 2 diabetes : Exploring the role of gender and income

PURPOSE The purpose of this study was to explore (1) patterns in physical activity behaviors and (2) the meaning and personal significance of social cognitive theory (SCT) constructs on physical activity, across gender and income groups among people with type 2 diabetes (T2DM). METHODS Albertans, 18 years and older (x- = 63, SD = 12.08) with T2DM (N = 1614) completed self-report measures of demographic characteristics and physical activity. Two-way, between-groups analyses of variance (ANOVAs) assessed main and interaction effects of gender and income on leisure time physical activity (LTPA). A subsample of these participants (n = 20) subsequently completed qualitative telephone interviews to provide contextual understanding of the quantitative data and to explore salient SCT influences on physical activity. RESULTS Significant findings indicated that men participate in more LTPA than women do, and those from the highest income group participate in more LTPA than low- or middle-income groups (P < .01). Interview results suggested that walking is the most popular form of physical activity; however, gender and income groups differ in other leisure and nonleisure physical activities. Furthermore, patterns for SCT constructs related to physical activity were apparent across gender and income, most noticeably for self-efficacy and environmental and situational influences. Specifically among men, noteworthy differences existed between income groups for self-control and reinforcement strategies. CONCLUSIONS The study highlights the need for more sensitive self-report measures and objective measures of physical activity to help distinguish whether true differences exist between certain demographic groups. Moreover, interventions that promote walking may be beneficial for people with T2DM, provided that appropriate environmental and policy changes occur to accommodate walking and other physical activity behaviors.