The Diets of On-reserve First Nations Youth: An Exploration of the Factors Associated with Healthy Food Choices and the Impact of School and Community Programs
Year: 2016
Type: dissertation
Abstract: Background. In Canada, First Nations (FN) people experience poorer health outcomes and shorter life expectancies than non-Aboriginal people. Of particular concern are the high and rising prevalence rates of overweight and obesity. This is especially true of on-reserve populations, who may be lacking in the opportunities and resources necessary to facilitate healthy lifestyles (e.g., reasonably priced healthy foods, access to organized sports or recreation facilities). The development of obesity for FN people is exceptionally complex and not well understood, although energy intake is a known contributor. The contributors to the food choices of young people are also numerous, interacting and complex. This is compounded by the severe and lasting effects of colonialism and marginalization, which have left much of the Canadian FN population disadvantaged with respect to many of the social determinants of health and distanced them from their culture. First Nations Canadians have, as a result, undergone a relatively rapid and recent transition towards a more ‘Western’ way of life that is increasingly reliant on store-bought foods and more sedentary in nature. The reduction in traditional, land-based food procurement and consumption among this population, given the known nutritional benefits of these foods and their importance to the holistic health of FN people, is of particular interest. Because of the high prevalence of food insecurity within on-reserve FN populations and the relative lack of economic opportunities in isolated and remote locations, these nutrient-rich traditional foods may sometimes be replaced with energy dense, nutrient poor store-bought alternatives. The food environment in many FN communities does not support or facilitate healthy choices. Healthy food may cost in excess of two times what it does in larger cities, and in remote and isolated locations, such foods may be inconsistently available and of unacceptable quality when they are. Access to traditional foods may be limited by high economic costs associated with their procurement, changes in the migratory patterns of traditional species, losses of traditional knowledge and fears of environmental contamination. If obesity and chronic disease are to be prevented in remote FN communities, children and adolescents are a logical target for population health interventions. In order to plan, initiate and evaluate program or policy initiatives, knowledge of the factors influencing the food intake of youth is necessary. \nObjectives. This thesis aimed to (a) review the current literature on the diets of Aboriginal youth in Canada, (b) explore the socioeconomic and sociocultural predictors of traditional food intake among a large nationwide sample of Canadian on-reserve FN youth, (c) explore the individual, behavioural and socioeconomic predictors of healthy store-bought food choices among a large nationwide sample of Canadian on-reserve FN youth, (d) assess the nutritional significance of traditional food consumption for youth in two remote, isolated FN communities in northern Ontario before and after a harvest sharing program, and (e) investigate the barriers and facilitators to the sustainability of a school-based healthy snack program for FN youth in a remote, isolated northern Ontario community and the impact of the program on diet. \nMethods. This thesis is presented as five individual studies. Study 1 presents a systematic literature review of refereed publications on the diets of school-aged Aboriginal youth residing in Canada, published between January 2004 and 2014. Using a predetermined search strategy, Medline (PubMed), Scopus, Education Resources Information Center, Web of Science and Google Scholar databases were scanned to identify the articles included. Each of the included articles was summarized for purpose, design, year, sample population, setting, dietary assessment method and main findings. Studies 2 and 3 utilized First Nations Regional Health Survey 2008/10 data, collected by the First Nations Information Governance Centre, to explore the individual, behavioural, socioeconomic and sociocultural predictors of traditional and store-bought food intake among 12-17 year-old youth living on reserves in Canada. Traditional and store-bought food intakes were elucidated via two separate food frequency questionnaires. The individual (i.e., age, sex, body mass index), behavioural (i.e., school attendance, physical activity, smoking, alcohol use), socioeconomic (i.e., number of children in the household, living with ones biological parents, parent education level) and sociocultural (i.e., use of a FN language, attending community cultural events, number of people helping to understand culture, food sharing) predictors of traditional food, milk and milk products, and vegetable intake were assessed via binary logistic regression modelling for four different age and sex subgroups. Studies 4 and 5 originated from longstanding research collaborations with the remote and isolated subarctic FN communities of the Mushkegowuk Territory on the western coast of James Bay in northern Ontario, Canada. Study 4 focused on two separate communities in which a harvest sharing program was initiated in May 2011 to support local access to lesser snow geese. Dietary data from grades 6-8 youth in both communities were collected via a validated web-based 24-hour dietary recall and food frequency questionnaire. The significance of snow goose consumption to food group and nutrient intake and the likelihood of achieving current dietary standards were assessed via Analysis of Variance and Pearson chi-square tests, where appropriate. Potential changes in diet from baseline to the post-pilot phase of the program were assessed via independent samples t-tests and Pearson chi-square tests. Study 5 focused on a healthy school snack program in one community, which was originally implemented in 2009 and previously evaluated for process and outcomes in 2010. The diets of grades 6-8 youth at baseline and at the four-year time point were assessed via a web-based 24-hour dietary recall, while qualitative information on the challenges and facilitators to the program’s sustainability were gathered via a focus group with the principal and coordinating committee. Possible changes in the food group and nutrient intakes of youth, as well as the proportion meeting current dietary standards were assessed via independent samples t-tests and Pearson chi-square tests. All quantitative analyses were conducted using Statistical Package for the Social Sciences (SPSS, v. 20 Complex Samples (Study 2 and Study 3) or v. 21 (Study 4 and Study 5), IBM Corporation, Armonk, New York) with a significance level of p≤0.05. Qualitative data were managed and analyzed inductively for themes by hand. The qualitative themes were substantiated by a second, independent researcher. \nResults. In Study 1, 24 studies were reviewed, all of which were cross sectional in design. The majority of studies (n=16, 67%) were from Ontario or Quebec, focused on FN youth (n=21, 88%) and took place in remote and/or isolated settings (n=18, 75%). Nearly all studies utilized the 24-hour recall approach to measure diet (n=19, 79%). On average, the diets of Aboriginal youth fall short of a number of important food groups and nutrients, with specific concerns for vegetables and fruit, milk and alternatives, fibre, folate, vitamin A, vitamin C, calcium and vitamin D across many studies, along with excess fast food and sugar sweetened beverage consumption. In Study 2, 31% of youth reported consuming traditional foods often (n=3587, representing a weighted population of 39 232, 50% 12-14 years old, 52% male). Frequent traditional food consumption was significantly associated with having a parent with a high school education (p=0.014), frequent participation in community cultural events (p<0.001), and often having traditional food shared with one’s household (p<0.001). For 12-14 year-old girls (n=834, weighted population of 9 451), the odds of consuming traditional foods often were increased for those who always or almost always participated in community cultural events as compared to those who rarely or never did (OR=2.43, CI=1.43-4.12, p<0.001), and those who often had traditional foods shared with their household as compared to those who had traditional foods shared with their household less often (OR=4.08, CI=2.26-7.34, p<0.001). For 15-17 year-old girls (n=960, weighted population of 9 376) there were increased odds of frequently consuming traditional foods for those who often had traditional foods shared with their household as compared to those who had foods shared with them less often (OR=4.61, CI=3.08-6.88, p<0.001). For 12-14 year-old boys (n=893, weighted population of 10 331), there were increased odds of frequently consuming traditional foods amongst those who spoke a FN language as compared to those who did not (OR=1.41, CI=1.01-1.96, p=0.024), those who always or almost always participated in community cultural events as compared to those who participated rarely or never (OR=1.76, CI=1.16-2.68, p=0.013), and those who often had traditional foods shared with their household as compared to those who had traditional foods shared with them less often (OR=5.13, CI=3.42-7.72, p<0.001). For boys aged 15-17 years (n=900, weighted population of 10 075), there were increased odds of often consuming traditional foods for those whose parents had a high school education as compared to those whose parents had not completed high school (OR=1.86, CI=1.17-2.95, p=0.024), those who always or almost always participated in community cultural events as compared to those who rarely or never did (OR=2.82, CI=1.63-4.88, p=0.001), and those who often had traditional food shared with their household as compared to those who had traditional food shared with them less often (OR=3.67, CI=2.54-5.30, p<0.001). With t
Source: UWSpace (University of Waterloo)
Author: Allison Gates
Language: English
Subfield: Health
Field: Social Sciences
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W2285884996