Community experiences with police and implications for public health: A focus group study.

Interactions with the police can impact an individual's short and long-term physical, mental, and social wellbeing, as well as levels of violence and unrest within a community. As such, this study aimed to explore experiences with the police among individuals experiencing socioeconomic disadvantages in Edmonton, Canada. For this qualitative study, participants (n = 39) were recruited from an emergency shelter for women, a drop-in community organization supporting individuals experiencing socioeconomic disadvantages, and a centre providing settlement support for newcomers to Canada. During the recruitment process, the research information sheet, including the scope and goals of the study, was presented, and participants who had any experience with the police were recruited. Each participant joined one of seven focus groups, during which experiences with the police were discussed; data from the focus groups were analyzed utilizing thematic analysis. Factors that contributed to satisfactory experiences with the police included the police demonstrating responsiveness and compassion, as well as an individual's understanding of police work. Factors that contributed to unsatisfactory experiences included the experiences of discrimination, stigmatization, and disrespect during interactions with the police. Participants suggested that community-police relationships could be improved by police being less judgemental and suspicious in their approach, undergoing regular training in sociocultural sensitivity, and being more open in their communication and community outreach. Overall, adopting a less discriminatory and more empathetic approach within a police force is essential for creating and maintaining a positive community-police relationship. By considering the socioeconomic context of people's behaviours and actions, police can better support the health and wellbeing of individuals and communities.

Dietary Adequacy among Multi-Ethnic Urban Youth in Edmonton: Findings from the Wellness and Health in Youth - Aboriginal and All Communities in Transition NOW (WHY ACT NOW) Project.

OBJECTIVE: The development of obesity and chronic diseases in adulthood often results from a childhood pattern of dietary excesses. This study aimed to identify dietary inadequacies and excesses of multiethnic youth in Edmonton. METHODS: A cross-sectional survey of a convenience sample of 473 multiethnic youth between 11 and 18 years was conducted in 12 schools in Edmonton between October 2013 and March 2014. Data were analyzed to determine for each participant mean daily energy and nutrient intakes, dietary adequacy, and nutrient densities. Participants were divided by self-identified ethnicity (Indigenous, European, African and Middle Eastern, and Asian). RESULTS: For all nutrients examined, the mean percentage of calories from fat was higher among European (31.7%) and Indigenous youth (31.8%) compared to African and Middle Eastern (28.3%) and Asian youth (29.0%), while Asian youth had the highest percentage of calories from protein (17.7%) compared to other ethnic groups (Indigenous = 15.5%; African & Middle Eastern = 16.5%; European = 16.2%). The majority of youth fell below the recommended values for dietary fiber (83.3-92.0%), vitamins D (84.4-90.2%), and E (89.5-92.0%). More than 50% fell below the dietary reference intakes (DRIs) for vitamin A, vitamin B5, calcium, and magnesium; >30% were below the DRI for folate, zinc, and vitamins B6, and C. The diet of girls contained a greater density of fiber compared to boys (9.3 vs. 8.0 g/1000 kcal; p-value = 0.002). CONCLUSIONS: Inadequate dietary intake is evident among the majority of multiethnic youth in Edmonton. There is a need to develop strategies to reduce the burden of poor nutrition status for youth.

Elevated Blood Pressure and Associations with Sodium Intake Among Multiethnic Youth in Edmonton, Canada: Findings from WHY ACT NOW.

INTRODUCTION: This study examined the prevalence of pre-hypertension (PHT) and hypertension (HT) in urban youth, and assessed the effects of sodium intake and obesity on blood pressure (BP) by ethnicity. METHODS: A convenience sample of 557 multiethnic youth, aged 11-23 years, was recruited from 12 schools and institutions in Edmonton, Alberta, Canada. Participants were divided by self-identified ethnicity into four groups (Indigenous, African and Middle Eastern (AME), Asian, and European). RESULTS: Between October 2013 and March 2014, one-on-one interviews were conducted to collect data on demographics, physical activity, diet, and Body Mass Index (BMI). BP was obtained at two different times during the interview and measured a third time in cases of high variability. The standard deviation scores (SDS) of systolic BP (SBP) and diastolic BP (DBP) were used to estimate associations with sodium intake (per 1000 mg/day). Overall, 18.2% and 5.4% of the participants had PHT and HT, respectively. Indigenous and AME participants showed the highest rates of PHT (23.1%). Indigenous and European participants showed higher rates of HT (8.3% and 5.3%, respectively) than other ethnic groups (AME = 4.4%, Asian = 3.9%). There was a positive association between 1000 mg/day increase in sodium intake and SDS of SBP by 0.041 (95% CI 0.007-0.083; p = 0.04) among pre-hypertensive participants. Over 85% of participants exceeded the recommended dietary sodium intake. Mean BMI and dietary sodium intake were higher among pre-hypertensive participants (4219 mg/day) than normotensive (3475 mg/day). CONCLUSIONS: The prevalence of HT varied by ethnicity. High dietary sodium intake was of concern. There is a need for culturally-tailored, population-based interventions to reduce sodium intake.

Opportunities for improving patient experiences among medical travellers from Canada's far north: a mixed-methods study.

OBJECTIVES: This paper explores patient experiences and identifies barriers and opportunities for improving access to healthcare for patients from the Canadian north who travel to receive medical care in a Southern province. DESIGN: A mixed-methods, cross-sectional study involved one-on-one interviews, focus group discussions and key informant interviews. PARTICIPANTS: 52 one-on-one interviews with Northwest Territories (NWT) patients and patient escorts and two focus group discussions (n=10). Fourteen key informant interviews were conducted with health workers, programme managers and staff of community organisations providing services for out-of-province patients. A Community Advisory Board guided the development of the questionnaires and interpretation of results. RESULTS: Respondents were satisfied with the care received overall, but described unnecessary burdens and bureaucratic challenges throughout the travel process. Themes relating to access to healthcare included: plans and logistics for travel; level of communication between services; clarity around jurisdiction and responsibility for care; indirect costs of travel and direct costs of uninsured services; and having a patient escort or advocate available to assist with appointments and navigate the system. Three themes related to healthcare experiences included: cultural awareness, respect and caring, and medical translation. Respondents provided suggestions to improve access to care. CONCLUSIONS: Patients from NWT need more information and support before and during travel. Ensuring that medical travellers and escorts are prepared before departing, that healthcare providers engage in culturally appropriate communication and connecting travellers to support services on arrival have the potential to improve medical travel experiences.

Prevalence of Known Risk Factors for Type 2 Diabetes Mellitus in Multiethnic Urban Youth in Edmonton: Findings From the WHY ACT NOW Project.

OBJECTIVES: The Canadian Diabetes Risk Assessment Questionnaire (CANRISK) is a validated, evidence-based, self-administered tool to assess the risk for type 2 diabetes mellitus in multiethnic Canadian adults. Identifying individuals at high risk for type 2 diabetes allows early intervention that improves modifiable risk factors. This study examined the risk factors for type 2 diabetes in multiethnic urban youth in Edmonton, Alberta. METHODS: An interviewer-administered questionnaire was developed based on CANRISK variables, such as age, gender, ethnicity, family history of diabetes, medical history of high blood sugar or high blood pressure, anthropometric measurements, physical activity and dietary intake. Between October 2013 and March 2014, data were collected from a convenience sample of 557 (328 girls and 229 boys) multiethnic youth 11 to 23 years of age in 12 institutions in Edmonton, such as public schools, after-school programs and colleges. RESULTS: Participating youth (N=529) with self-identified ethnicity were included in the analyses: 109 Indigenous (20.6%); 96 African and Middle Eastern (18.1%); 129 Asian (24.4%); and 195 European (36.9%). More than 70% of the youth had 2 or more risk factors for type 2 diabetes. The participants were classified as low risk (75.6%; n=400); moderate risk (21.2%; n=112); or high risk (3.2%; n=17), with the highest proportion of moderate- and high-CANRISK score categories (52.7%) found in the Asian youth. Boys (p<0.0001) and Indigenous participants (p<0.001) were more likely to have a greater number of risk factors for type 2 diabetes compared to girls and non-Indigenous youth, respectively. Of the participants, 26.7% (n=141) were overweight or obese, more than 45% of the participants (n=245) were physically inactive, and 17.8% of the participants (n=94) did not consume sufficient amounts of fruits and vegetables to meet daily recommendations. CONCLUSIONS: Almost 25% of the participating multiethnic youth 11 to 23 years of age scored in the moderate or high category of CANRISK. The most prevalent risk factors were ethnicity, followed by physical inactivity, overweight or obesity and low fruit and vegetable consumption. A validated type 2 diabetes screening tool for youth as well as culturally appropriate, evidence-based and multidisciplinary diet and lifestyle interventions aiming to improve modifiable type 2 diabetes risk factors in multiethnic youth, particularly targeting socioeconomically disadvantaged and immigrant children and youth, should be developed, implemented and evaluated.

Identification and prioritization of food insecurity and vulnerability indices in iran.

BACKGROUND: Food security is a multi-dimensional phenomenon. The objective of this study was to identify and prioritize major indices for determining food insecurity in Iran. METHODS: Descriptive study using the Delphi method was conducted through an email-delivered questionnaire. Forty-three senior experts at national or provincial level were selected based on their work experience and educational background through study panel consultation and snowballing from Tehran and other cities of Iran. During two rounds of Delphi, participants were asked to identify priority indicators for food security at provincial level in Iran. RESULTS: Sixty five percent of Delphi panel participated in the first round and eighty-nine percent of them participated in the second round of Delphi. Initially, 243 indices were identified through review of literature; after excluding indictors, which was not available or measurable at provincial level in Iran, 103 indictors remained. The results of study showed that experts identified "percentage of individuals receiving less than 70% of daily energy requirement" with a median score of 90, as the most influential index for determining food insecurity. "Food expenses as a proportion of the overall expenses of the family", "per capita of dietary energy supply", and "provision of micro-nutrient supply requirement per capita" with median of 80 were in the second rank of food security priority indicators. CONCLUSION: Out of 243 identified indicators for food security, 38 indicators were selected as the most priority indicators for food security at provincial level in Iran.

Knowledge, attitudes, and behaviours towards cancer screening in indigenous populations: a systematic review.

Cancer mortality among indigenous peoples is increasing, but these populations commonly under use cancer-screening services. This systematic review explores knowledge, attitudes, and behaviours towards cancer screening among indigenous peoples worldwide. Searches of major bibliographic databases identified primary studies published in English up to March, 2014; of 33 eligible studies, three were cohort studies, 27 cross-sectional, and three case-control. Knowledge of and participation in screening was greater for breast cancer than for other cancers. Indigenous peoples tended to have less knowledge, less favourable attitudes, and a higher propensity to refuse screening than non-indigenous populations. The most common factors affecting knowledge, attitudes, and behaviours towards cancer screening included access to screening, knowledge about cancer and screening, educational attainment, perceived necessity of screening, and age. Greater understanding of knowledge, attitudes, and behaviours towards cancer screening in diverse indigenous cultures is needed so that culturally appropriate cancer prevention programmes can be provided.