Michelle Gates

Assessing the Impact of Pilot School Snack Programs on Milk and Alternatives Intake in 2 Remote First Nation Communities in Northern Ontario, Canada

BACKGROUND Canadian Aboriginal youth have poorer diet quality and higher rates of overweight and obesity than the general population. This research aimed to assess the impact of simple food provision programs on the intakes of milk and alternatives among youth in Kashechewan and Attawapiskat First Nations (FNs), Ontario, Canada. METHODS A pilot school snack program was initiated in Kashechewan in May 2009 including coordinator training and grant writing support. A supplementary milk and alternatives program was initiated in Attawapiskat in February 2010. Changes in dietary intake were assessed using Web-based 24-hour dietary recalls in grade 6 to 8 students, pre- and 1-week post-program, with a 1-year follow-up in Kashechewan. Student impressions were collected after 1 week using open-ended questions in the Web survey. Teacher and administrator impressions were collected via focus groups after 1 year in Kashechewan. RESULTS After 1 week, calcium intake increased in Kashechewan (805.9 ± 552.0 to 1027.6 ± 603.7 mg, p = .044); however, improvements were not sustained at 1 year; milk and alternatives (1.7 ± 1.7 servings to 2.1 ± 1.4 servings, p = .034) and vitamin D (2.5 ± 2.6 to 3.5 ± 3.4 µg, p = .022) intakes increased in Attawapiskat. Impressions of the programs were positive, though limited resources, staff, facilities, and funding were barriers to sustaining the consistent snack provision of the 1-week pilot phase. CONCLUSION These illustrations show the potential of snack programs to address the low intakes of milk and alternatives among youth in remote FNs. Community-level constraints must be addressed for sustained program benefits.

A Pilot Comprehensive School Nutrition Program Improves Knowledge and Intentions for Intake of Milk and Milk Alternatives Among Youth in a Remote First Nation

OBJECTIVE To evaluate the impact of a pilot comprehensive school nutrition program modeled on Social Cognitive Theory on knowledge, intentions, self-efficacy, and intake of milk and milk alternatives (MMA) in First Nations youth. METHODS A pilot school nutrition program was implemented at Peetabeck Academy in Fort Albany, Ontario in May, 2010. The Knowledge, Self-Efficacy, and Intentions Questionnaire (KSIQ) and Waterloo Web-based Eating Behavior Questionnaire (WEB-Q) were used to assess change in attitudes and behavior from pre- to postprogram. RESULTS The KSIQ preprogram (n = 26), postprogram (n = 19); WEB-Q preprogram (n = 30), postprogram (n = 10). Improved knowledge (6.0 ± 1.5 vs. 6.9 ± 1.5, P = .05) and intention scores (9.6 ± 4.4 vs. 11.3 ± 4.1, P = .01) were observed. CONCLUSIONS AND IMPLICATIONS A comprehensive school nutrition program can improve knowledge and intentions for intake of MMA in First Nations youth. Environmental constraints beyond the school environment need to be addressed.

Vegetable and Fruit Intakes of On-Reserve First Nations Schoolchildren Compared to Canadian Averages and Current Recommendations

This study investigated, in on-reserve First Nations (FN) youth in Ontario, Canada, the following: (a) the intakes of vegetable and fruit, “other” foods and relevant nutrients as compared to current recommendations and national averages, (b) current prevalence rates of overweight and obesity and (c) the relationship between latitude and dietary intakes. Twenty-four-hour diet recalls were collected via the Waterloo Web-Based Eating Behaviour Questionnaire (WEB-Q) (n = 443). Heights and weights of participants were self reported using measured values and Body Mass Index was categorized using the International Obesity Task Force cutoffs. Food group and nutrient intakes were compared to current standards, Southern Ontario Food Behaviour data and the Canadian Community Health Survey, Cycle 2.2, using descriptive statistics. Mean vegetable and fruit, fibre and folate intakes were less than current recommendations. Girls aged 14–18 years had mean intakes of vitamin A below current recommendations for this sub-group; for all sub-groups, mean intakes of vegetables and fruit were below Canadian averages. All sub-groups also had intakes of all nutrients and food groups investigated that were less than those observed in non-FN youth from Southern Ontario, with the exception of “other” foods in boys 12–18 years. Prevalence rates of overweight and obesity were 31.8% and 19.6%, respectively, exceeding rates in the general population. Dietary intakes did not vary consistently by latitude (n = 248), as revealed by ANOVA. This study provided a unique investigation of the dietary intakes of on-reserve FN youth in Ontario and revealed poor intakes of vegetables and fruit and related nutrients and high intakes of “other” foods. Prevalence rates of overweight and obesity exceed those of the general population.

Intakes of milk and alternatives among on-reserve First Nations youth in northern and southern Ontario, Canada.

OBJECTIVE To assess the adequacy of milk and alternatives, Ca and vitamin D intakes in First Nations (FN) youth in Ontario, Canada. Intakes were compared with the general population and dietary standards. Variation in intakes by community (proxy for remoteness) and BMI was examined. DESIGN Data were collected by 24 h recall between November 2003 and June 2010. Intakes were analysed descriptively. Variation in intakes, by community and BMI category, was assessed using ANOVA. SETTING Five remote FN communities of the Mushkegowuk Territory (northern Ontario, Canada) and two less-remote southern Ontario FN communities. SUBJECTS Schoolchildren (n 457) in grades 6 to 12. RESULTS Compared with Canadas Food Guide recommendations, 72.6 to 84.7% had an inadequate intake of milk and alternatives depending on age and sex group; 86.2% of individuals fell below the RDA for Ca; 96.4% fell below the RDA for vitamin D. Community variation in intakes was detected, although in all cases Fort Albany had higher intakes, even when it was the more northern (remote) community. A BMI × sex interaction was found for intake of milk and alternatives (P = 0.041): an inverse relationship between intake and BMI was seen in females; in males, those who were overweight had the highest intake, followed by normal-weight and obese youth. CONCLUSIONS The nutritional inadequacies parallel the results of other Canadian studies of Aboriginal populations. Population health interventions to improve intakes are warranted. Moreover, community variation in intakes exists among FN youth in the present study (Fort Albany pairs only), but results were not as expected.

Inadequate Nutrient Intakes in Youth of a Remote First Nation Community: Challenges and the Need for Sustainable Changes in Program and Policy

Background. The current study established baseline nutrient intakes of youth and examined the potential for sustainability of a pilot school snack program in the remote First Nation of Kashechewan, Ontario, Canada. Methods. Twenty-four-hour dietary recalls established baseline intakes in grade 6–8 students (𝑛=43). Subsequently, a pilot healthy school snack program was initiated. Dietary recalls were completed one week (𝑛=43) and one year after the program (𝑛=67). Paired Wilcoxon signed-ranks tests were used to detect changes in intakes. Impressions of the teachers (𝑛=16), principal, and students were collected qualitatively. Results. Most youth had dietary intakes below current standards. Although vitamin C (𝑃=0.024) and fibre (𝑃=0.015) intakes improved significantly after one week, these improvements were not sustained over the following year. Program impressions were positive. Conclusion. The need for a nutrition program is clear. While benefits were realized in the short term, improvements could not be maintained. Policy changes are needed to address barriers to sustainability.

Peer-led nutrition education programs for school-aged youth: a systematic review of the literature

To date, the impacts of school-based, peer-led nutrition education initiatives have not been summarized or assessed collectively. This review presents the current evidence, identifies knowledge gaps, and provides recommendations for future research. PubMed, Scopus, ERIC and Google Scholar were searched for refereed Canadian and American primary studies published between January 2000 and November 2013, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Seventeen articles (11 programs) from Canada (24%) and the United States (76%) were identified. The results were summarized in terms of the study population, program design and main outcomes. Common outcome measures included healthy eating knowledge (n = 5), self-efficacy or attitudes towards healthy eating (n = 13), dietary measures (n = 9) and body mass index (n = 4), all of which tended to improve as a result of the programs. More research is needed to ascertain the effect of improvements in knowledge, self-efficacy and attitudes towards healthy eating on food behaviors. When evaluated, programs were generally well received, while the long-term maintenance of positive impacts was a challenge. Studies of sustainability and feasibility to promote long-term impact are a logical next step.

The Food and Nutrient Intakes of First Nations Youth Living in Northern Ontario, Canada: Evaluation of a Harvest Sharing Program

ABSTRACT Locally harvested food consumption is declining among Canadian First Nations (FN) youth. The objective of this study was to investigate, among youth in 2 FN communities, the frequency of lesser snow goose (Chen caerulescens caerulescens) consumption, its contribution to nutritional intake, and the nutritional outcomes of a harvest sharing program. A cross-sectional survey and pre–posttest design was used. Food intakes were assessed via 24-hour recall and food frequency questionnaire. At baseline (n = 84, 12.38 ± 1.07 years, 49% male) 48% of participants consumed snow goose. Consumption frequency was associated with meat and alternatives (P = .019), protein (P = .004), vitamin B12 (P = .004), iron (P = .011), and zinc (P = .006). At postprogram (n = 73, 12.34 ± .99 years, 44% male), consumption prevalence increased, significantly for girls (P = .015). Harvest sharing supports snow goose consumption, which imparts nutritional benefits.