Food Literacy: Definition and Framework for Action.

The term food literacy is emergent, and as a result the literature reflects a great variety of definitions. Simultaneously, new research and food literacy programming is being developed without an agreed upon definition of what food literacy is and how food skills, food security, and health literacy may fit with the definition. We undertook a scoping review and conceptual analysis to identify how the term is understood and to determine shared components of definitions. We found that although most definitions included a nutrition and food skills component, there was great variation in how the ability to access, process, and enjoy food was affected by our complex food system. We propose a definition of food literacy that includes the positive relationship built through social, cultural, and environmental experiences with food enabling people to make decisions that support health. We offer a framework that situates food literacy at the intersection between community food security and food skills, and we assert that behaviours and skills cannot be separated from their environmental or social context. The proposed definition and framework are intended to be guiding templates for academics and practitioners to position their work in education and advocacy, bringing together separate spheres for collective action.

Sustainable childhood obesity prevention through community engagement (SCOPE) program: evaluation of the implementation phase.

Childhood obesity rates are steadily rising. Sustainable Childhood Obesity Prevention Through Community Engagement (SCOPE) is a community-based participatory action research (PAR) program aimed at preventing childhood obesity. This study aimed to describe community perspectives on, and elicit feedback about, SCOPE's first phase of implementation in two pilot cities in British Columbia, Canada. A case study was implemented using interviews and questionnaires to obtain feedback about SCOPE from two groups: SCOPE coordinators and stakeholders (i.e., individuals and organizations that were a member of the community and engaged with SCOPE coordinators). Participants were recruited via email and (or) by telephone. Coordinators completed a telephone interview. Stakeholders completed a questionnaire and (or) a telephone interview. Thematic analysis was conducted. Participants included 2 coordinators and 15 stakeholders. Participants similarly interpreted SCOPE as a program focused on raising awareness about childhood obesity prevention, while engaging multiple community sectors. Overall, participants valued the program's role in facilitating networking and partnership development, providing evidence-based resources, technical expertise, and contributing funding. Participants felt that SCOPE is sustainable. However, participants felt that barriers to achieving healthy weights among children included those related to the built environment, and social, behavioral, and economic obstacles. Perspectives on factors that facilitated and acted as barriers to SCOPE's first phase of implementation were obtained from the SCOPE communities and may be used to enhance the sustainability of SCOPE and its applicability to other BC communities.

Differences in adolescents' physical activity from school-travel between urban and suburban neighbourhoods in Metro Vancouver, Canada.

OBJECTIVE: To investigate differences in moderate-to-vigorous physical activity (MVPA) from school-travel between adolescents in urban and suburban neighbourhoods and to describe its relative contribution to MVPA on school days. METHODS: We measured 243 adolescents (51% male, grades 8-10) from Vancouver's walkable downtown core and its largely car-dependent suburb Surrey (fall 2011, 2013). We estimated mean school-travel MVPA from accelerometry (hour before/after school on ≥ 2 days; n = 110, 39% male) and compared school-travel MVPA by neighbourhood type and school-travel mode. The influence of mean school-travel MVPA on mean school-day MVPA (≥ 600 min valid wear time on ≥ 2 days) was examined by linear regression. RESULTS: Over half of students used active modes (urban: 63%, suburban: 53%). Those using active travel and living in the urban neighbourhood obtained the most school-travel MVPA (22.3 ± 8.0 min). Urban passive travellers used public transit and obtained more school-travel MVPA than suburban students (16.9 ± 6.2 vs. 8.0 ± 5.3, p < 0.001), who were primarily driven. Regardless of mode or neighbourhood type, over one-third of school-day MVPA was explained by school-travel MVPA (R (2) = 0.38, p < 0.001). CONCLUSION: Urban dwelling may facilitate greater school-travel MVPA in adolescents. School-travel MVPA is an important contributor to adolescents' school-day MVPA. Where feasible, physically active options for school-travel should be promoted, including public transit.

Pilot study of a dog walking randomized intervention: effects of a focus on canine exercise.

OBJECTIVE: The promotion of dog walking among owners who do not walk their dogs regularly may be a viable physical activity intervention aperture, yet research is very limited and no intervention studies have employed control groups. Therefore, the purpose of this pilot study was to examine the viability of dog walking for physical activity intervention using messages targeting canine exercise. METHOD: Inactive dog owners (n=58) were randomized to either a standard control condition or the intervention (persuasive material about canine health from walking and a calendar to mark walks) after completing a baseline questionnaire package and wearing a pedometer for one week. Participants (standard condition n=28; intervention condition n=30) completed the six and 12 week follow-up questionnaire packages. RESULTS: Intention to treat analyses showed that both groups increased physical activity significantly across the 12 weeks (η(2)=0.09 to 0.21). The intervention group resulted in significantly higher step-counts compared to the control group (Δ 1823 steps) and showed significantly higher trajectories from baseline to 12 weeks in the self-reported physical activity measures (η(2)=0.11 to 0.27). CONCLUSION: The results are promising for the viability of increasing dog walking as a means for physical activity promotion and suggest that theoretical fidelity targeting canine exercise may be a helpful approach.

Redeeming behaviours: a push, not a shove.

By now, it's no secret that Canadians are struggling to maintain a healthy body weight, eat right and get enough physical activity to promote their health and prevent the early onset of or to manage, chronic disease. Considered with our tendency to have poor adherence rates to prescribed medications and difficulties overcoming addictive substances, this struggle threatens to shorten our life spans and overburden our healthcare system. To turn the tide, layered and coordinated initiatives at the population level are needed that educate, motivate and support individuals to embrace healthy living. In this commentary, the authors respond to Oliver's recent paper on the utility of user financial incentives and architectural choice interventions as mechanisms for facilitating voluntary behaviour change. They concur with many of his ideas and argue that a more comprehensive approach, particularly adhering to the principles and strategies of social marketing, is needed to stimulate and sustain behaviour change.

"It's a feel. That's what a lot of our evidence would consist of ": public health practitioners' perspectives on evidence.

This article describes how evidence is defined and used in two British Columbia public health departments during the implementation of a Healthy Living initiative in 2009. Through interviews with 21 public health staff and decision makers, the author sought to investigate how "evidence" was defined by both frontline and management staff and how it was used in decision making. The authors found public health staff, particularly frontline practitioners, to be drawn to grassroots and local "lived experience" evidence. This tacit wisdom, in combination with evidence from academia and clinical evidence accessed through disciplinary or professional networks, offered a knowledge transition opportunity to inform decision making, rather than what can be characterized in the literature as unidirectional knowledge translation. It is often difficult for staff to digest and interpret research as part of their work day because of the volume and density of information that typically counts as evidence. Moreover, there exist challenges to identify and gather indicators as evidence of their work.

Physical activity of children in family child care.

Physical activity was monitored for 65 boys and girls, during family child care, using accelerometry. Average accelerometer wear time was 7.0 h (SD = 0.83), and average counts per epoch were 104.6 (SD = 31.6). Mean minutes per hour of moderate-vigorous physical activity and sedentary behaviour were 1.76 min (SD = 0.90) and 39.49 min (SD = 4.50), respectively. The very low levels of moderate-vigorous physical activity suggest that the young children in this study may be insufficiently active during child care.

Physical activity behaviors and motivations in an adult First Nation population: a pilot study.

OBJECTIVES: To explore the potential utility of the theory of planned behavior in predicting physical activity behaviors and intentions in a sample of First Nation adults and to determine the behaviors and salient beliefs of First Nation adults as they relate to engaging in physical activity. DESIGN: 35 women and 18 men from the Westbank First Nation community completed a mail-out questionnaire based on the theory of planned behavior. Follow-up focus groups were used to elicit accessible beliefs and to determine actual behaviors (N = 12). RESULTS: Intention significantly explained 16% of the variance in behavior. Only affective attitude and perceived behavioral control predicted intention but explained 50% of the variance. Qualitative analyses revealed that despite similarities, First Nation adults may engage in culturally specific activities and may have unique salient beliefs compared with the general population. CONCLUSION: To increase intentions, interventions should focus on the affective benefits of being physically active and promote activities perceived as easy to do with facilities that are accessible.

The health buck stops where? Thematic framing of health discourse to understand the context for CVD prevention.

Using a constructed week methodology, we analyzed media summaries for the type of health discourse (health care delivery, disease-specific prevention, lifestyle risk factors, public/environmental health disease, social determinants of health) portrayed over a 5-year period as a means of describing the context within which health staff worked to prevent heart disease in one Canadian province. The results reveal that heart disease received very little media coverage, despite provincial health data revealing it to be the leading cause of mortality, morbidity, and health care costs. Coverage of the health care system dominated the media landscape over the 5-year period. The study findings also suggest that the health discourses in the media summaries were represented as primarily thematic, rather than as episodic narratives, relieving any one level of government as entirely responsible for the health of its constituents. Media advocacy strategies may be a means to redress the imbalance of health discourses presented by the media.

Factors influencing physical activity levels among Canadian youth.

OBJECTIVES: To describe the predisposing, enabling and reinforcing factors influencing the levels of physical activity among Canadian youth (ages 12-24). METHODS: Analyses of the 1996-97 National Population Health Survey (NPHS) were conducted using data collected from female (n=6195) and male (n=5925) Canadians aged 12-24 years. The data were analyzed using correlational, ANOVA and regression procedures with post hoc analyses (Bonferroni) employed where applicable. RESULTS: Compared to males, Canadian female youth were found to be less physically active, more concerned about being overweight, more depressed, and to consult mental health professionals more frequently. On the other hand, females were more likely to report greater social support than males and to be more socially involved. Those adolescents who smoke tend to be less physically active and, along with those who consume alcohol, have poorer health. DISCUSSION: The significant predisposing, enabling and reinforcing factors influencing youths' physical activity levels more profoundly affect females. The results are discussed in terms of strategies for enabling physical activity available in the literature. In addition to individual determinants influencing physical activity, a move toward understanding policy and environmental factors is recommended for further research.

Challenges of citizen participation in regional health authorities.

Citizen participation has been included as part of health reform, often in the form of lay health authorities. In Canada, these authorities are variously known as regional health boards or councils. A set of challenges is associated with citizen participation in regional health authorities. These challenges relate to: differences in opinion about whether there should be citizen participation at all; differences in perception of the levels and processes of participation; differences in opinion with respect to the roles and responsibilities of health authority members; differences in opinion about the appropriate composition of the authorities; differences in opinion about the requisite skills and attributes of health authority members; having a good support base (staff, good information, board development); understanding and operationalizing various roles of the board (governance and policy setting) versus the board staff (management and administration); difficulties in ensuring the accountability of the health authorities; and measuring the results of the work and decisions of the health authorities. Despite these challenges, regional health authorities are gaining support as both theoretically sound and pragmatically based approaches to health-system reform. This review of the above challenges suggests that each of the concerns remains a significant threat to meaningful public participation.

Social and political factors influencing the functioning of regional health boards in British Columbia (Canada).

Health reform is associated with changes in the way the health system works and in the roles of major stakeholders, such as governments, health professionals, and the lay public. This paper reviews the immediate relevance of these social and political elements to health boards, particularly those with lay board members; source documents include peer-reviewed articles, and government documents and news releases in Canada especially. Also presented are the perceptions of 130 regional health board members in British Columbia (BC), Canada, who responded to our 1996 survey questionnaire. Two sets of social and political factors are identified and discussed in this paper. The first set deals with the composition of health board members (qualifications, representation, and selection). Our findings suggest that there is now less attention focusing on the composition of health boards in BC. This may contribute to a re-focusing of attention on the boards' effectiveness in working with stakeholders and in influencing the health system. The other set of social and political factors deals with the relations of health boards with key stakeholder groups. The responses to our questionnaire suggest that the health boards in BC may have had some success in addressing the concerns of various stakeholder groups. However, the respondents also suggested that the stakeholder groups needed to be more understanding and involved in the regionalization (decentralization) process. Health boards that have lay representatives, including regional health authorities in Canada, face similar social and political factors immediate to their operation.