Leia M. Minaker

Flavored Tobacco Use Among Canadian Students in Grades 9 Through 12: Prevalence and Patterns From the 2010–2011 Youth Smoking Survey

Introduction This study examined patterns of use of flavored tobacco products in a nationally generalizable sample of Canadian students in grades 9 through 12 after the implementation of a national ban on certain flavored tobacco products. Methods Data from the 2010–2011 Youth Smoking Survey, a nationally generalizable sample of Canadian students in grades 9 through 12 (n = 31,396), were used to examine tobacco product use. Logistic regression models were used to examine differences in use of flavored tobacco products (cigarettes, pipes, little cigars or cigarillos, cigars, roll-your-own cigarettes, bidis, smokeless tobacco, water pipes, and blunt wraps) by sociodemographic and regional characteristics. Results Approximately 52% of young tobacco users used flavored products in the previous 30 days. Flavored tobacco use varied by product type and ranged from 32% of cigarette smokers reporting menthol smoking to 70% of smokeless tobacco users reporting using flavored product in the previous 30 days. The percentage of last-30-day users who used flavored tobacco was significantly higher in Quebec than in Ontario and significantly higher among youths who received weekly spending money than among those who received no money. Conclusion More than half of tobacco users in grades 9 through 12 in Canada use flavored tobacco, despite a national ban on certain flavored tobacco products.

Retail food environments research in Canada: A scoping review

OBJECTIVES The field of retail food environments research is relatively new in Canada. The objective of this scoping review is to provide an overview of retail food environments research conducted before July 2015 in Canada. Specifically, this review describes research foci and key findings, identifies knowledge gaps and suggests future directions for research. METHODS A search of published literature concerning Canadian investigations of retail food environment settings (food stores, restaurants) was conducted in July 2015 using PubMed, Web of Science, Scopus, PsychInfo and ERIC. Studies published in English that reported qualitative or quantitative data on any aspect of the retail food environment were included, as were conceptual papers and commentaries. SYNTHESIS Eighty-eight studies were included in this review and suggest that the field of retail food environments research is rapidly expanding in Canada. While only 1 paper was published before 2005, 66 papers were published between 2010 and 2015. Canadian food environments research typically assessed either the socio-economic patterning of food environments (n = 28) or associations between retail food environments and diet, anthropometric or health outcomes (n = 33). Other papers profiled methodological research, qualitative studies, intervention research and critical commentaries (n = 27). Key gaps in the current literature include measurement inconsistency among studies and a lack of longitudinal and intervention studies. CONCLUSION Retail food environments are a growing topic of research, policy and program development in Canada. Consistent methods (where appropriate), longitudinal and intervention research, and close partnerships between researchers and key stakeholders would greatly advance the field of retail food environments research in Canada.

Can policy ameliorate socioeconomic inequities in obesity and obesity-related behaviours? A systematic review of the impact of universal policies on adults and children.

This systematic review examined the impact of universal policies on socioeconomic inequities in obesity, dietary and physical activity behaviours among adults and children. PRISMA‐Equity guidelines were followed. Database searches spanned from 2004 to August 2015. Eligible studies assessed the impact of universal policies on anthropometric, dietary or physical activity‐related outcomes in adults or children according to socioeconomic position. Thirty‐six studies were included. Policies were classified as agentic, agento‐structural or structural, and their impact on inequities was rated as positive, neutral, negative or mixed according to the dominant associations observed. Most policies had neutral impacts on obesity‐related inequities regardless of whether they were agentic (60% neutral), agento‐structural (68% neutral) or structural (67% neutral). The proportion of positive impacts was similar across policy types (10% agentic, 18% agento‐structural and 11% structural), with some differences for negative impacts (30% agentic, 14% agento‐structural and 22% structural). The majority of associations remained neutral when stratified by participant population, implementation level and socioeconomic position measures and by anthropometric and behavioural outcomes. Fiscal measures had consistently neutral or positive impacts on inequities. Findings suggest an important role for policy in addressing obesity in an equitable manner and strengthen the case for implementing a broad complement of policies spanning the agency‐structure continuum.

A comparison of adolescent smoking initiation measures on predicting future smoking behavior.

Objectives Evidence suggests that age at smoking initiation has implications for tobacco use, nicotine dependence, and resulting long-term health and chronic disease outcomes. The objective of the current study was to examine two different measures of smoking onset and to compare their validity in predicting future adolescent smoking survey. Methods Data from grades 9–12 students who participated in the 2012/2013 Youth Smoking Survey, a nationally-generalizable Canadian survey, and who had ever tried a cigarette, even a few puffs (n = 8126) were used in a multivariable logistic regression analysis to examine the association between age at smoking onset and current smoking behavior. Results Both “age at first puff” and “age at first whole cigarette” were significantly associated with current smoking status. Specifically, a delay of one year in the age at first puff was associated with lower odds of being a current smoker by 24% (AOR = 0.76, 95% CI = 0.73–0.79). Similarly, high school students who smoked their first whole cigarette at old age were less likely to report being a current smoker (AOR = 0.66, 95% CI = 0.62–0.71). Conclusion Efforts to prevent smoking uptake among youth, especially younger youth, are especially important in tobacco control efforts.

Policy options for healthier retail food environments in city-regions

Public policy is central to health promotion: it determines the distribution of resources in a society and establishes the structural context for the actions of both corporations and consumers. With this in mind, the purpose of this paper is to begin a discussion on promising policy options for a health-promoting retail food environment. Drawing on specific municipal examples, we examine four groups of policy options for healthier retail food environments in city-regions: planning for health; transforming consumer environments; economic and fiscal instruments; and a culture of transparency and participation. We introduce examples of policy options that are receiving increasing attention in the public health and urban planning literature and that function at the municipal level. We also highlight how public health professionals have an important role to play in policy that shapes retail food environments, especially in making explicit the linkages between health and other policy goals. In doing so, this commentary aims to motivate public health practitioners in a variety of community contexts to consider the policy supports they need to advance their exploration, development, testing and evaluation of interventions for healthier retail food environments.

Food Purchasing From Farmers’ Markets and Community-Supported Agriculture Is Associated With Reduced Weight and Better Diets in a Population-Based Sample

This study examines associations between local food purchasing and diet-related outcomes. A population-based sample of 2228 households containing 4902 individuals completed surveys. Multilevel linear regressions determined the extent to which purchasing foods from farmers’ markets and community-supported agricultural (CSA) groups predicted individuals’ diet-related outcomes. After controlling for age, sex, education, income, and car ownership, frequency of shopping at farmers’ markets and CSAs predicted lower body mass index, B = −0.34 (0.66), P < .05 and B = −0.81 (0.37), P < .05, respectively, and waist circumference, B = −1.09 (0.40), P < .01 and B = −2.31 (0.96), P < .05, respectively, and better diet quality (for CSA use only), B = 3.46 (1.57), P < .05. Higher frequency of shopping at farmers’ markets and CSAs is associated with reduced body mass index and waist circumference, which may have important implications for agricultural and food policy.

Associations between frequency of food shopping at different store types and diet and weight outcomes: findings from the NEWPATH study.

Objective The present study aimed to: (i) examine associations between food store patronage and diet and weight-related outcomes; and (ii) explore consumer motivations for visiting different types of food store. Design A stratified probability sample of residents completed household and individual-level surveys in 2009/2010 on food purchasing patterns and motivations, dietary intake, waist circumference (WC), weight and height. Diet quality was calculated using the Healthy Eating Index for Canada from a subset of participants (n 1362). Generalized estimating equations were created in 2015 to examine how frequency of patronizing different types of food store was associated with diet quality, intake of fruits and vegetable, mean intake of energy (kcal) sodium and saturated fat, WC and BMI. Setting Three mid-sized urban municipalities in Ontario, Canada. Subjects A representative sample of residents (n 4574). Results Participants who shopped frequently at food co-ops had significantly better diet quality (β=5·3; 99 % CI 0·3, 10·2) than those who did not. BMI and WC were significantly lower among those who frequently shopped at specialty shops (BMI, β=−2·1; 99 % CI −3·0, −1·1; WC, β=−4·8; 99 % CI −7·0, −2·5) and farmers’ markets (BMI, β=−1·4; 99 % CI −2·3, −0·5; WC, β=−3·8; 99 % CI −6·0, −1·6) compared with those who did not. Relative importance of reasons for food outlet selection differed by large (price, food quality) v. small (proximity, convenient hours) shopping trip and by outlet type. Conclusions Findings contribute to our understanding of food store selection and have implications for potentially relevant retail food intervention settings.

Exploring Low-Income Families’ Financial Barriers to Food Allergy Management and Treatment

Objectives. Low-income families may face financial barriers to management and treatment of chronic illnesses. No studies have explored how low-income individuals and families with anaphylactic food allergies cope with financial barriers to anaphylaxis management and/or treatment. This study explores qualitatively assessed direct, indirect, and intangible costs of anaphylaxis management and treatment faced by low-income families. Methods. In-depth, semistructured interviews with 23 participants were conducted to gain insight into income-related barriers to managing and treating anaphylactic food allergies. Results. Perceived direct costs included the cost of allergen-free foods and allergy medication and costs incurred as a result of misinformation about social support programs. Perceived indirect costs included those associated with lack of continuity of health care. Perceived intangible costs included the stress related to the difficulty of obtaining allergen-free foods at the food bank and feeling unsafe at discount grocery stores. These perceived costs represented barriers that were perceived as especially salient for the working poor, immigrants, youth living in poverty, and food bank users. Discussion. Low-income families report significant financial barriers to food allergy management and anaphylaxis preparedness. Clinicians, advocacy groups, and EAI manufacturers all have a role to play in ensuring equitable access to medication for low-income individuals with allergies.

Food, health, and complexity: towards a conceptual understanding to guide collaborative public health action.

BackgroundWhat we eat simultaneously impacts our exposure to pathogens, allergens, and contaminants, our nutritional status and body composition, our risks for and the progression of chronic diseases, and other outcomes. Furthermore, what we eat is influenced by a complex web of drivers, including culture, politics, economics, and our built and natural environments. To date, public health initiatives aimed at improving food-related population health outcomes have primarily been developed within ‘practice silos’, and the potential for complex interactions among such initiatives is not well understood. Therefore, our objective was to develop a conceptual model depicting how infectious foodborne illness, food insecurity, dietary contaminants, obesity, and food allergy can be linked via shared drivers, to illustrate potential complex interactions and support future collaboration across public health practice silos.MethodsWe developed the conceptual model by first conducting a systematic literature search to identify review articles containing schematics that depicted relationships between drivers and the issues of interest. Next, we synthesized drivers into a common model using a modified thematic synthesis approach that combined an inductive thematic analysis and mapping to synthesize findings.ResultsThe literature search yielded 83 relevant references containing 101 schematics. The conceptual model contained 49 shared drivers and 227 interconnections. Each of the five issues was connected to all others. Obesity and food insecurity shared the most drivers (n = 28). Obesity shared several drivers with food allergy (n = 11), infectious foodborne illness (n = 7), and dietary contamination (n = 6). Food insecurity shared several drivers with infectious foodborne illness (n = 9) and dietary contamination (n = 9). Infectious foodborne illness shared drivers with dietary contamination (n = 8). Fewer drivers were shared between food allergy and: food insecurity (n = 4); infectious foodborne illness (n = 2); and dietary contamination (n = 1).ConclusionsOur model explicates potential interrelationships between five population health issues for which public health interventions have historically been siloed, suggesting that interventions targeted towards these issues have the potential to interact and produce unexpected consequences. Public health practitioners working in infectious foodborne illness, food insecurity, dietary contaminants, obesity, and food allergy should actively consider how their seemingly targeted public health actions may produce unintended positive or negative population health impacts.

Cigarette smoking susceptibility among youth alternate tobacco product users: implications of flavoured tobacco from a national cross-sectional Canadian sample (YSS 2012/2013).

Objectives Declines in cigarette smoking have been accompanied by increases in alternative tobacco product (ATP) use, particularly among youth. This study examines smoking susceptibility and ATP use in a national sample of Canadian youth. Methods Data from grades 9–12 students who participated in the 2012/2013 Youth Smoking Survey, a nationally generalisable sample of Canadian students (n=27 404) were used to examine cigarette smoking susceptibility among never smokers (n=17 396). Logistic regression models were used to examine differences in smoking susceptibility by use of flavoured and all ATPs and by sociodemographic and lifestyle characteristics. Results Overall, 30% of Canadian grades 9–12 never smokers were susceptible to cigarette smoking. Compared to never users, those who had ever tried ATPs (OR=1.96, 95% CI 1.59 to 2.42) and those who had ever tried flavoured ATPs (OR=2.20, 95% CI 1.63 to 2.96) had significantly higher odds of being susceptible to cigarette smoking. Conclusions ATP use is associated with smoking susceptibility among youth never smokers. Findings from this study, along with existing evidence, can be used by policymakers to improve regulation around youth access to ATPs (particularly flavoured varieties).