Protecting traditional cultural food practices: Trends in diet quality and intake of ultra-processed foods by Indigenous status and race/ethnicity among a nationally representative sample of adults in Canada.

Background: The traditional cultural food practices of Indigenous people and adults from racial/ethnic minority groups may be eroded in the current food system where nutrient-poor and ultra-processed foods (UPF) are the most affordable and normative options, and where experiences of racism may promote unhealthy dietary patterns. We quantified absolute and relative gaps in diet quality and UPF intake of a nationally representative sample of adults in Canada by Indigenous status and race/ethnicity, and trends between 2004 and 2015. Methods: Adults (≥18 years) in the Canadian Community Health Survey-Nutrition self-reported Indigenous status and race/ethnicity and completed a 24-h dietary recall in 2004 (n = 20,880) or 2015 (n = 13,970) to calculate Healthy Eating Index-2015 (HEI-2015) scores from 0 to 100 and proportion of energy from UPF. Absolute and relative dietary gaps were quantified for Indigenous people and six racial/ethnic minority groups relative to White adults and trends between 2004 and 2015. Results: Adults from all six racial/ethnic minority groups had higher mean HEI-2015 scores (58.7-61.9) than White (56.3) and Indigenous adults (51.9), and lower mean UPF intake (31.0%-41.0%) than White (45.9%) and Indigenous adults (51.9%) in 2015. As a result, absolute gaps in diet quality were positive and gaps in UPF intake were negative among racial/ethnic minority groups-indicating more favourable intakes-while the reverse was found among Indigenous adults. Relative dietary gaps were small. Absolute and relative dietary gaps remained largely stable. Conclusions: Adults from six racial/ethnic minority groups had higher diet quality and lower UPF intake, whereas Indigenous adults had poorer diet quality and higher UPF intake compared to White adults between 2004 and 2015. Absolute and relative dietary gaps remained largely stable. Findings suggest racial/ethnic minority groups may have retained some healthful aspects of their traditional cultural food practices while highlighting persistent dietary inequities that affect Canada's Indigenous people.

The local restaurant environment in relation to eating out and sugary drink intake among Canadian children and youth.

Background: Accessibility of food retail in communities may play a role in shaping the food choices of local residents. However, previous studies have shown mixed results. This study examined associations between the local restaurant environment and the frequency of eating food from restaurants and intake of sugary drinks among Canadian children and youth. Data and methods: The study cohort consisted of 23,776 participants (aged 1 to 17 years) in the 2019 Canadian Health Survey on Children and Youth who resided in large urban population centres across the Canadian provinces. Measures of geographic access to various restaurant types within walking distance of participants' residential areas came from the 2018 Canadian Food Environment Dataset. Poisson regression models with robust standard errors assessed associations between measures of absolute densities (number per km²) of full-service, fast-food and other restaurants, and the relative density of fast-food restaurants (as a percentage of total restaurants) with the frequency of eating food from fast-food or full-service restaurants and sugary drink intake in the previous seven days. Results: After adjustment for a range of sociodemographic covariates, there were no consistent associations between absolute and relative measures of restaurant access and the frequency of eating food from restaurants or intake of sugary drinks. Interpretation: Results reveal no consistent relationships between local restaurant exposures and the frequency of eating food from restaurants or sugary drink intake among Canadian children and youth. Efforts to create environments that foster healthy food choices among young people will remain important but will likely need to target multiple activity spaces beyond the local neighbourhood.

Sleep duration, sleep quality and obesity in the Canadian Armed Forces.

Background: Research has identified an association between sleep and obesity in the general population. It is also important to examine this association in a military population. Data and methods: Data from the 2019 Canadian Armed Forces Health Survey (CAFHS) were used to estimate the prevalence of sleep duration, sleep quality characteristics, overweight and obesity for Regular Force members. The relationship of sleep duration and sleep quality with obesity was assessed with multivariable logistic regression that controlled for sociodemographic, work and health characteristics. Results: Females were significantly more likely than males to report meeting recommended sleep duration (7 hours to less than 10 hours; 48.7% vs. 40.4%), trouble falling or staying asleep (32.3% vs. 23.5%), or that sleep was not refreshing (64.0% vs. 57.7%). Difficulty staying awake did not differ significantly between males and females (6.3% vs. 5.4%). Obesity, but not being overweight, was significantly more prevalent among those who had short (less than 6 hours) or borderline (6 hours to less than 7 hours) sleep duration, or poor sleep quality. Compared with recommended sleep duration, short sleep duration (adjusted odds ratio [AOR] 1.3; 95% confidence interval [CI]: 1.2 to 1.6) and borderline sleep duration (AOR 1.2; 95% CI: 1.1 to 1.4) were associated with obesity for males, but not females, in fully controlled models. Sleep quality indicators were not independently associated with obesity. Interpretation: This study adds to the body of evidence that identifies an association between sleep duration and obesity. The results emphasize the importance of sleep as one of the components of the Canadian Armed Forces Physical Performance Strategy.

Household food insecurity in Canada early in the COVID-19 pandemic.

BACKGROUND: Food insecurity linked to insufficient income is an important determinant of health. Whether the COVID-19 pandemic has exacerbated levels of food insecurity in Canada, particularly among vulnerable groups, is unclear. This study estimated the proportion of Canadians reporting experience of household food insecurity six to nine months into the COVID-19 pandemic, and drew comparisons with pre-pandemic levels. DATA AND METHODS: Data on household food security status during the pandemic came from the population-based cross-sectional Canadian Community Health Survey (CCHS) collected from September to December 2020. Analyses were based on 26,831 respondents aged 12 and older residing in the 10 provinces. The Household Food Security Survey Module was used to categorize respondents' household food security status within the previous 12 months as food secure or marginally, moderately or severely insecure. The percentage of Canadians reporting some experience of household food insecurity was estimated for the overall population and for various sociodemographic groups. T-tests were used to draw comparisons with pre-pandemic rates from the 2017/2018 CCHS. RESULTS: In fall 2020, 9.6% of Canadians reported having experienced some level of food insecurity in their household in the prior 12 months, which is lower than the estimate of 12.6% from 2017/2018. Overall estimates were also lower in fall 2020 when examined within levels of household food insecurity (i.e., marginal, moderate or severe). The percentage of Canadians reporting experience of household food insecurity was either unchanged or lower than in 2017/2018 among sociodemographic groups vulnerable to experiencing income-related food insecurity, including renters and those with lower levels of education. INTERPRETATION: During the second wave of the COVID-19 pandemic in fall 2020, about 1 in 10 Canadians aged 12 and older reported experience of food insecurity in their household in the previous 12 months. This proportion was lower compared with 2017/2018, both overall and among several groups at higher risk of food insecurity. Monitoring household food insecurity will continue to be important during the COVID-19 pandemic and throughout the years of recovery ahead.

Eating away from home in Canada: impact on dietary intake.

BACKGROUND: Public health measures related to the COVID-19 pandemic have upended the way Canadians eat and shop for food. Since the pandemic began, many Canadians have reported consuming food away from home (FAFH) less often. FAFH tends to be less healthful than food prepared at home. Little is known about patterns of Canadians' FAFH consumption before the pandemic. This study used 2015 national-level nutrition data, the most recent available, to characterize patterns of FAFH consumption and selected markers of dietary intake. DATA AND METHODS: National-level food intake data came from the first 24-hour dietary recall provided by 20,475 respondents aged 1 or older to the 2015 Canadian Community Health Survey-Nutrition. Mean daily intakes of selected food subgroups and nutrients, adjusted for total energy intake, were compared between those who had consumed any food in a restaurant on the previous day and those who had not. Estimates were generated overall and for eight age and sex groups. RESULTS: In 2015, overall, 21.8% of Canadians had consumed FAFH in a restaurant on the previous day. Eating out was most common among males aged 19 to 54 (27.7%) and least common among young children aged 1 to 5 (8.4%). Compared with Canadians who had not eaten out on the previous day, those who had eaten out had consumed, on that day, fewer servings of whole fruit; whole grains; dark green and orange vegetables; other vegetables (excluding potatoes); milk and fortified soy-based beverages; and legumes, nuts and seeds, on average. Those who had eaten out had consumed, on average, less fibre and total sugar, and more total fat, saturated fat and sodium on that day. There were few differences for meat and poultry, fish and seafood, and protein intake. DISCUSSION: On the day that Canadians ate out in a restaurant, their dietary intake was generally less favourable than that of Canadians who did not eat out. If Canadians continue to eat at home more and to consume less FAFH, as early pandemic-period reports suggest, then results can be used to gauge the potential dietary implications of these shifts.

Consumption of ultra-processed foods is associated with obesity, diabetes and hypertension in Canadian adults.

OBJECTIVE: To assess the association between consumption of ultra-processed foods and obesity, diabetes, hypertension and heart disease in a nationally representative sample of Canadian adults. METHODS: This study used cross-sectional data from 13,608 adults (aged 19+ years) from the 2015 Canadian Community Health Survey-Nutrition. The survey provided data on food consumption (from 24-h recall) and prevalent obesity (BMI ≥ 30 kg/m2) and self-reported diabetes, hypertension and heart disease. All foods and drinks consumed were classified according to the extent and purpose of industrial processing using the NOVA classification. Ultra-processed food consumption was estimated as proportion of total daily energy intake. Multivariable logistic regression models assessed the association between ultra-processed food consumption and obesity, diabetes, hypertension and heart disease, adjusting for a range of socio-demographic and lifestyle factors. RESULTS: In 2015, ultra-processed food contributed, on average, to 24% of total daily energy intake in the lowest tertile of ultra-processed food consumption and 73% in the highest tertile. Compared with those in the lowest tertile, adults in the highest tertile of ultra-processed food consumption had 31% higher odds of obesity (OR = 1.31, 95% CI: 1.06-1.60), 37% higher odds of diabetes (OR = 1.37, 95% CI: 1.01-1.85) and 60% higher odds of hypertension (OR = 1.60, 95% CI: 1.26-2.03), adjusting for a range of covariates. CONCLUSION: Higher consumption of ultra-processed foods is associated with higher prevalence of obesity, diabetes and hypertension among Canadian adults. A comprehensive set of strategies and policies is needed to discourage consumption of ultra-processed foods in Canada and to make unprocessed or minimally processed foods more affordable, available and appealing.

RéSUMé: OBJECTIF: Évaluer l'association entre la consommation d'aliments ultra-transformés et l'obésité, le diabète, l'hypertension et les maladies cardiaques dans un échantillon nationalement représentatif d'adultes canadiens. MéTHODES: Cette étude a utilisé des données transversales provenant de 13 608 participants adultes (âgés de 19+ ans) dans le cadre de l'Enquête sur la santé dans les collectivités canadiennes 2015­nutrition. L'enquête a fourni des données sur la consommation alimentaire (rappel de 24h) et la prévalence de l'obésité mesurée (IMC ≥ 30 kg/m2), et le diabète, l'hypertension et les maladies cardiaques auto-rapportés. Tous les aliments et boissons consommés ont été classés selon la classification NOVA. La consommation d'aliments ultra-transformés a été estimée en utilisant l'apport énergétique relatif des aliments ultra-transformés. Des modèles de régression logistique multiple ont été utilisés pour vérifier l'association entre la consommation d'aliments ultra-transformés et l'obésité, le diabète, l'hypertension et les maladies cardiaques, en ajustant pour plusieurs facteurs sociodémographiques et comportementaux. RéSULTATS: En 2015, les aliments ultra-transformés ont contribué, en moyenne, à 24 % de l'apport énergétique quotidien total dans le tertile le plus bas de la consommation d'aliments ultra-transformés et 73 % dans le tertile le plus élevé. Comparativement au premier tertile, les adultes du tertile supérieur de la consommation d'aliments ultra-transformés avaient de chance 31 % plus élevée d'avoir l'obésité (RC = 1,31, IC 95% : 1,06-1,60), 37 % plus élevée d'avoir le diabète (RC = 1,37, IC 95% : 1,01-1,85), et 60 % plus élevée d'avoir l'hypertension (RC = 1,60, IC 95% : 1,26-2,03), en ajustant pour une gamme de variables. CONCLUSION: Une consommation plus élevée d'aliments ultra-transformés est associée à une prévalence plus élevée d'obésité, de diabète et d'hypertension chez les adultes canadiens. Des stratégies et des politiques sont nécessaires pour décourager la consommation d'aliments ultra-transformés au Canada, ainsi que des stratégies qui rendent les aliments non transformés ou peu transformés plus abordables, disponibles et attrayants.

Food insecurity and mental health during the COVID-19 pandemic.

BACKGROUND: Food insecurity has been linked to adverse mental health outcomes. This study assessed the association between household food insecurity and self-perceived mental health status and anxiety symptoms among Canadians in the early months of the COVID-19 pandemic. DATA AND METHODS: The Canadian Perspectives Survey Series 2 collected cross-sectional data from May 4 to 10, 2020, on Canadians aged 15 years or older residing in the ten provinces. The brief six-item Household Food Security Survey Module was used to measure participants' households as food secure or marginally, moderately or severely food insecure within the previous 30 days. Logistic regression was used to assess associations between food security status and self-perceived fair or poor mental health and moderate or severe anxiety symptoms, adjusting for sociodemographic covariates. RESULTS: Approximately one in seven Canadians (14.6%) lived in a household that experienced some level of food insecurity. Of these individuals, 9.3% reported recently accessing free food from a community organization. About one in five Canadians self-perceived their mental health as fair or poor (22.0%), or self-reported moderate or severe anxiety symptoms (18.2%). With covariate adjustment, individuals in households with moderate food insecurity had nearly three times higher odds of reporting fair or poor mental health, and moderate or severe anxiety symptoms, compared with individuals in food-secure households. Among those with severe food insecurity, adjusted odds ratios were 4.0 (95% confidence interval [CI]: 2.0 to 7.9) for fair or poor mental health, and 7.6 (95% CI: 3.9 to 14.7) for moderate or severe anxiety symptoms. DISCUSSION: In the early period of the COVID-19 epidemic in Canada, household food insecurity was independently associated with poorer mental health outcomes. Monitoring both food insecurity and mental health will be important as the COVID-19 pandemic continues.

Consumption of ultra-processed foods in Canada.

BACKGROUND: A larger share of ultra-processed foods and drinks (UPF) in the diet is increasingly linked with poor diet quality, weight gain and elevated risk of diet-related chronic disease. This study used 2015 national-level data, the most recent available, to characterize the intake of UPF among Canadians and to examine changes since 2004. DATA AND METHODS: The 2004 and 2015 Canadian Community Health Surveys provided 24-hour dietary recall data for Canadians aged 2 or older. All food and drink items were classified according to type of food processing using the NOVA classification. The mean energy contribution of UPF (as a percentage of total daily energy intake) was compared across survey years for the overall population and for eight age-sex groups. The National Cancer Institute's methodology was used to assess the distribution of usual energy contributed by UPF. RESULTS: On average, UPF contributed 47.8% (95% CI: 47.3% to 48.3%) of total daily energy in 2004 and 45.7% (95% CI: 45.0% to 46.4%) in 2015 among the overall population, and more than half of total daily energy among children and adolescents. Both the mean energy contribution of UPF and their usual energy distribution shifted downward since 2004 for all age-sex groups, except among adults aged 55 or older. The energy contributions of soft drinks, fruit juices and fruit drinks declined, particularly among children and adolescents. Ultra-processed breads contributed more energy in 2015 for nearly all age-sex groups. DISCUSSION: As in 2004, the overall dietary share of UPF in Canada remained high in 2015, but intakes of some UPF, particularly beverages, declined. The energy contribution of UPF remained highest among children and adolescents, and increased among adults aged 55 or older.

Change in vegetable and fruit consumption in Canada between 2004 and 2015.

BACKGROUND: Eating plenty of vegetables and fruits on a daily basis is the foundation of a healthy diet. This study investigated patterns in Canadians' vegetable and fruit consumption in 2015 and compared these with 2004 data. DATA AND METHODS: The 2015 Canadian Community Health Survey (CCHS) - Nutrition and the 2004 CCHS - Nutrition (Cycle 2.2) provided nationally representative 24-hour dietary recall data on Canadians' vegetable and fruit intakes. The frequency of consumption and the average quantity of daily intake for total vegetables, fruits and subgroups were calculated overall and by age and sex group for each survey year. The National Cancer Institute's methodology was used to assess the distribution of usual total vegetable and fruit intake and how it relates to recommendations in the 2007 Canada's Food Guide. RESULTS: Overall, Canadians reported consuming fewer total servings of vegetables and fruits in 2015 (4.5 average daily servings) than in 2004 (5.3 average daily servings). Lower total fruit intakes were explained by significantly lower intakes of fruit juice across nearly all age and sex groups, resulting in a decline of 0.3 average total daily fruit servings in the overall population. Lower vegetable consumption was largely driven by lower intakes of potatoes and, to a lesser extent, lettuce. Intakes of whole fruits and other vegetables remained largely unchanged. In both years, the majority of Canadians did not usually consume the number of total vegetable and fruit servings recommended for their age and sex group in the 2007 Canada's Food Guide. DISCUSSION: Canadians reported consuming fewer vegetables and fruits in 2015 compared with 2004. This was largely driven by substantially lower consumption of fruit juice and, to a lesser extent, potatoes. These findings can serve as valuable baseline data to assess any changes in patterns of vegetable and fruit consumption in Canada.

Health-related concerns and precautions during the COVID-19 pandemic: A comparison of Canadians with and without underlying health conditions.

BACKGROUND: The risk of experiencing adverse outcomes from the coronavirus disease 2019 (COVID-19), such as hospitalization, admission to intensive care units and death, is elevated for older individuals and those with certain underlying health conditions including diabetes, chronic conditions affecting lungs, heart or kidneys, and a compromised immune system. DATA AND METHODS: Data collected between March 29 and April 3, 2020 from the Canadian Perspectives Survey Series 1: Impacts of COVID-19 (n=4,627) were used to estimate the prevalence of underlying health conditions, health concerns and precautionary behaviours among Canadians aged 15 or older living in the provinces. Multivariate analyses examined associations between these variables after accounting for age, sex and education. RESULTS: Close to 1 in 4 Canadians (24%) had an underlying health condition that increased their risk of adverse outcomes from COVID-19. Overall, 36% of the population were very or extremely concerned about the impact of COVID-19 on their own health. Individuals with underlying health conditions had higher odds (odds ratio: 2.0, 95% confidence interval: 1.6 to 2.5) of being highly concerned than those without these conditions, after adjustment for demographic characteristics. High percentages of Canadians took precautions to reduce the risk of infection regardless of whether or not they had underlying health conditions. DISCUSSION: Health status was associated with higher levels of concern for one's own health in the early period of the COVID-19 pandemic. Most Canadians were taking precautions recommended by public health authorities to protect themselves and others.

Health outcomes related to the provision of free, tangible goods: A systematic review.

BACKGROUND: Free provision of tangible goods that may improve health is one approach to addressing discrepancies in health outcomes related to income, yet it is unclear whether providing goods for free improves health. We systematically reviewed the literature that reported the association between the free provision of tangible goods and health outcomes. METHODS: A search was performed for relevant literature in all languages from 1995-May 2017. Eligible studies were observational and experimental which had at least one tangible item provided for free and had at least one quantitative measure of health. Studies were excluded if the intervention was primarily a service and the free good was relatively unimportant; if the good was a medication; or if the data in a study was duplicated in another study. Covidence screening software was used to manage articles for two levels of screening. Data was extracted using an adaption of the Cochrane data collection template. Health outcomes, those that affect the quality or duration of life, are the outcomes of interest. The study was registered with PROSPERO (CRD42017069463). FINDINGS: The initial search identified 3370 articles and 59 were included in the final set with a range of 20 to 252 246 participants. The risk of bias assessment revealed that overall, the studies were of medium to high quality. Among the studies included in this review, 80 health outcomes were statistically significant favouring the intervention, 19 health outcomes were statistically significant favouring the control, 141 health outcomes were not significant and significance was unknown for 28 health outcomes. INTERPRETATION: The results of this systematic review provide evidence that free goods can improve health outcomes in certain circumstances, although there were important gaps and limitations in the existing literature.

Comparing individual and area-based income measures: impact on analysis of inequality in smoking, obesity, and diabetes rates in Canadians 2003-2013.

OBJECTIVES: The aims of this study were to examine (1) the concordance between income measured at the individual and area-based level and (2) the impact of using each measure of income on inequality estimates for three health indicators-the prevalence, respectively, of diabetes, smoking, and obesity. METHODS: Data for the health indicators and individual income among adults came from six cycles of the Canadian Community Health Survey (cycles 2003 through 2013). Area-based income was obtained by linking respondents' residential postal codes to neighbourhood income quintiles derived from the 2006 Canadian census. Relative and absolute inequality between the lowest and highest income quintiles for each measure was assessed using rate ratios and rate differences, respectively. RESULTS: Concordance between the two income measures was poor in the overall sample (weighted Kappa estimates ranged from 0.19 to 0.21 for all years), and for the subset of participants reporting diabetes, smoking, or obesity. Despite the poor concordance, both individual and area-based income measures identified generally comparable levels of relative and absolute inequality in the rates of diabetes, smoking, and obesity over the 10-year study period. CONCLUSION: The results of this study show that individual and area-based income measures categorize Canadians differently according to income quintile, yet both measures reveal striking income-related inequalities in rates of diabetes and smoking, and obesity among women. This suggests that either individual or area-level measures can be used to monitor income-related health inequalities in Canada; however, whenever possible, it is informative to consider both measures since they likely represent distinct social constructs.

Status report - Geographic retail food environment measures for use in public health. / Rapport d'étape - Indicateurs géographiques de l'environnement alimentaire de la vente au détail pour l'intervention en santé publique.

The Association of Public Health Epidemiologists in Ontario (APHEO) Core Indicators Work Group standardizes definitions and calculation methods for over 120 public health indicators to enhance accurate and standardized community health status reporting across public health units in Ontario. The Built Environment Subgroup is a multi-disciplinary group made up of planners, researchers, policy analysts, registered dietitians, geographic information systems (GIS) analysts and epidemiologists. The Subgroup selected and operationalized a suite of objective, standardized indicators intended to help public health units and regional health authorities assess their community retail food environments. The Subgroup proposed three indicators that use readily available data sources and GIS tools to characterize geographic access to various types of retail food outlets within neighbourhoods in urban settings. This article provides a status report on the development of these food environment indicators.

RÉSUMÉ: Le groupe de travail sur les indicateurs de base de l'Association des épidémiologistes en santé publique de l'Ontario (AESPO) a pour mandat d'uniformiser les définitions et les méthodes de calcul de plus de 120 indicateurs de la santé publique dans le but de fournir un cadre précis et commun à l'ensemble des bureaux de santé publique de l'Ontario pour la production de rapports sur l'état de santé des communautés. Le sous-groupe chargé de l'environnement bâti est une équipe multidisciplinaire composée de planificateurs, de chercheurs, d'analystes des politiques, de diététistes agréés, d'analystes de système d'information géographique (SIG) et d'épidémiologistes. Le sous-groupe a sélectionné et opérationnalisé un certain nombre d'indicateurs objectifs et uniformes en vue d'aider les bureaux de santé publique et les autorités sanitaires régionales à évaluer les environnements alimentaires de vente au détail de leur communauté. Le sous-groupe a proposé trois indicateurs s'appuyant sur des sources de données facilement accessibles et sur des données obtenues par suite d'analyses SIG pour caractériser l'accessibilité géographique à divers types de commerces d'alimentation au détail dans des quartiers urbains. Le présent article propose un rapport d'étape sur la mise au point de ces indicateurs de l'environnement alimentaire.

Relative and absolute availability of fast-food restaurants in relation to the development of diabetes: A population-based cohort study.

OBJECTIVES: To determine whether residents living in areas with a high proportion of fast-food restaurants (FFR) relative to all restaurants are more likely to develop diabetes and whether the risk varies according to the volume of FFR. METHODS: The study cohort consisted of adult respondents (20-84 years) to the Canadian Community Health Survey (cycles 2005, 2007/2008, 2009/2010) who resided within walking distance (720 m) of at least one restaurant in Toronto, Brampton, Mississauga or Hamilton, ON. The development of diabetes was established by linking participants to the Ontario Diabetes Database. Cox proportional hazards models were used to estimate hazard ratios (HRs) of incident diabetes associated with relative and absolute measures of restaurant availability. RESULTS: During a median follow-up of 5 years, 347 of 7,079 participants (4.6%) developed diabetes. Among younger adults (20-65 years, n = 5,806), a greater proportion of fast-food relative to all restaurants was significantly associated with incident diabetes after adjustment for a range of individual and area-level covariates, but only in areas with high volumes of fast-food retailers (3+ outlets) (HR = 1.79, 95% confidence interval: 1.03-3.12, across the interquartile range). Adjusting for body mass index rendered this association non-significant. No significant associations were observed in areas with low volumes of FFR or among older adults (65-84 years, n = 1,273). Absolute availability (number) of fast-food and other restaurants was generally unrelated to incident diabetes. CONCLUSION: Areas with the double burden of a high volume of FFR and few dining alternatives may represent an adverse environment for the development of diabetes.

Absolute and relative densities of fast-food versus other restaurants in relation to weight status: Does restaurant mix matter?

BACKGROUND: Given the continuing epidemic of obesity, policymakers are increasingly looking for levers within the local retail food environment as a means of promoting healthy weights. PURPOSE: To examine the independent and joint associations of absolute and relative densities of restaurants near home with weight status in a large, urban, population-based sample of adults. METHODS: We studied 10,199 adults living in one of four cities in southern Ontario, Canada, who participated in the Canadian Community Health Survey (cycles 2005, 2007/08, 2009/10). Multivariate models assessed the association of weight status (obesity and body mass index) with absolute densities (numbers) of fast-food, full-service and other restaurants, and the relative density (proportion) of fast-food restaurants (FFR) relative to all restaurants within ~10-minute walk of residential areas. RESULTS: Higher numbers of restaurants of any type were inversely related to excess weight, even in models adjusting for a range of individual covariates and area deprivation. However, these associations were no longer significant after accounting for higher walkability of areas with high volumes of restaurants. In contrast, there was a direct relationship between the proportion of FFR relative to all restaurants and excess weight, particularly in areas with high volumes of FFR (e.g., odds ratio for obesity=2.55 in areas with 5+ FFR, 95% confidence interval: 1.55-4.17, across the interquartile range). CONCLUSIONS: Policies aiming to promote healthy weights that target the volume of certain retail food outlets in residential settings may be more effective if they also consider the relative share of outlets serving more and less healthful foods.

Health and growth status of immigrant and refugee children in Toronto, Ontario: A retrospective chart review.

OBJECTIVE: To describe selected anthropometric and health status variables among immigrant and refugee children ≤6 years of age within an inner city clinic in Toronto, Ontario. METHODS: A retrospective chart review of patients born between January 1, 1998 and December 31, 2008, was conducted at a Toronto community health centre serving a primarily immigrant and refugee population. Outcome measures included calculated age-specific percentiles for height and weight, and the prevalence of anemia, iron deficiency, enteric parasites, elevated lead levels, HIV and hepatitis B. Postal codes were collected and used to determine the patient's neighbourhood income quintile. RESULTS: A total of 331 patients, born between January 1, 1998 and December 31, 2008, were identified. Of these, a total of 210 charts were manually reviewed. The prevalence of height-for-age and weight-for-age under the third percentile on the Centers for Disease Control and Prevention Growth Charts were 7.2% and 11.6%, respectively, and 8.4% and 5.0%, respectively, on the WHO Growth Standards Chart. Prevalence rates were also calculated for anemia (22.8%), iron deficiency (53.3%), hepatitis B (2.5%), parasitic infections (33.6%), elevated blood lead levels (4.9%) and HIV (0%). Neighbourhood income quintiles revealed that 46.7% of patients were residing in the lowest (ie, poorest) income quintile neighbourhoods. CONCLUSION: These findings reveal a high burden of illness within the population presenting to an immigrant/refugee health clinic, and illustrate the need for further research in this area, as well as increased efforts to ensure appropriate screening within clinics serving a high volume of newcomer patients.

OBJECTIF: Décrire certaines variables anthropométriques et liées à la santé d'enfants immigrants et réfugiés de moins de six ans dans une clinique des quartiers pauvres de Toronto, en Ontario. MÉTHODOLOGIE: Les chercheurs ont procédé à une analyse rétrospective des dossiers de patients nés entre le 1er janvier 1998 et le 31 décembre 2008 dans un centre de santé communautaire de Toronto qui dessert une population surtout composée d'immigrants et de réfugiés. Les mesures de résultats incluaient le calcul des percentiles propres à l'âge pour la taille et le poids ainsi que la prévalence d'anémie, de carence en fer, de parasites entériques, de taux élevés de plomb, de VIH et d'hépatite B. Ils ont recueilli et utilisé les codes postaux pour déterminer le quintile de revenu du quartier de résidence des patients. RÉSULTATS: Au total, les chercheurs ont repéré 331 patients, nés entre le 1er janvier 1998 et le 31 décembre 2008, et révisé manuellement 210 dossiers. La prévalence de taille et de poids par rapport à l'âge se situant sous le troisième percentile selon les courbes de croissance des Centers for Disease Control and Prevention s'élevait à 7,2 % et 11,6 %, respectivement, et à 8,4 % et 5,0 %, respectivement, selon les courbes de croissance standard de l'OMS. Les chercheurs ont également calculé la prévalence d'anémie (22,8 %), de carence en fer (53,3 %), d'hépatite B (2,5 %), d'infections parasitaires (33,6 %), de taux élevés de plomb dans le sang (4,9 %) et de VIH (0 %). Les quintiles de revenu des quartiers de résidence ont révélé que 46,7 % des patients habitaient dans les quartiers aux quintiles de revenu les plus faibles (c'est-à-dire les plus pauvres). CONCLUSION: Ces observations révèlent un fardeau élevé de mala-die au sein des populations qui consultent dans une clinique de santé pour les immigrants et les réfugiés et démontrent la nécessité de pour-suivre les recherches dans ce domaine ainsi que d'accroître les efforts pour garantir un dépistage convenable dans les cliniques qui desservent un fort volume de nouveaux arrivants.

Foodscapes of southern Ontario: neighbourhood deprivation and access to healthy and unhealthy food retail.

OBJECTIVES: We examined whether access to retail sources of healthy and unhealthy food varies according to level of neighbourhood material deprivation in three Ontario regions and whether urban form characteristics help to explain any such variations. METHODS: Food retail (FR) outlets were identified from a commercial database for 804 urban neighbourhoods in Toronto, Brampton/Mississauga and Hamilton, Ontario. The median number of healthy and unhealthy FR outlets and percentage of outlets that were unhealthy were derived using 720-metre network buffers based on dissemination blocks and aggregated up to neighbourhood level (census tract). The 2006 Canadian Census was used to derive a composite index of material deprivation and three urban form measures related to zoning and urbanization. Multivariate regression models assessed the association between material deprivation, urban form and each measure of FR access. RESULTS: Compared with the least deprived areas, the most materially deprived neighbourhoods had 2 to 4 times more healthy and unhealthy FR outlets within 720 metres (~ a 10-minute walk) of where most people lived, with the exception of Toronto, where unhealthy FR was more plentiful in less deprived areas. Urban form measures attenuated these associations for Brampton/Mississauga and Hamilton more so than for Toronto. The percentage of unhealthy outlets was generally unrelated to level of neighbourhood deprivation or urban form characteristics. CONCLUSION: More deprived neighbourhoods had greater access to both healthy and unhealthy FR outlets, with some variation across study regions. Plentiful access to local retail sources of unhealthy food suggests a possible point of intervention for healthy public policy.

Using a Web-based system to monitor practice profiles in primary care residency training.

OBJECTIVE: To explore the use of Web-based resident practice profiles (RPPs) as a means of tracking the clinical experiences of residents to ensure an adequate educational experience. DESIGN: Quantitative analysis of recorded patient encounters with residents. SETTING: The Department of Family and Community Medicine at St Michael's Hospital in Toronto, Ont. PARTICIPANTS: Twenty-seven residents enrolled in the department's training program between July 1, 2006, and June 30, 2007. MAIN OUTCOME MEASURES: The clinical experiences of residents with respect to patient demographic information, procedures performed, and diagnoses. Resident data were stratified by age, sex, training status, and source of medical degree, and RPPs were compared with patient profiles of physicians at the study site, at the university, and in provincial practices. RESULTS: A total of 9108 patient visits were recorded by the 27 residents during the academic year. Patient visit characteristics were very similar across all the resident variables except with respect to sex. The top 8 diagnoses encountered by residents were very similar to those of the comparison groups; anxiety or neurosis was the most common problem. Injections and Papanicolaou smears were the most common procedures, with 17.9 and 11.6 procedures, respectively, performed on average per resident during the study period. CONCLUSION: The RPP is an excellent Web-based tool to capture the clinical experience of postgraduate trainees. The practice profiles of the resident group were very similar to those of physicians in the study site, the university, and the province, demonstrating that common diagnoses made in practice correlate well with the clinical experience in residency.

Are women with psychosis receiving adequate cervical cancer screening?

OBJECTIVE: To investigate the rates of cervical cancer screening among female patients with psychosis compared with similar patients without psychosis, as an indicator of the quality of primary preventive health care. DESIGN: A retrospective cohort study using medical records between November 1, 2004, and November 1, 2007. SETTING: Two urban family medicine clinics associated with an academic hospital in Toronto, Ont. PARTICIPANTS: A random sample of female patients with and without psychosis between the ages of 20 and 69 years. MAIN OUTCOME MEASURES: Number of Papanicolaou tests in a 3-year period. RESULTS: Charts for 51 female patients with psychosis and 118 female patients without psychosis were reviewed. Of those women with psychosis, 62.7% were diagnosed with schizophrenia, 19.6% with bipolar disorder, 17.6% with schizoaffective disorder, and 29.4% with other psychotic disorders. Women in both groups were similar in age, rate of comorbidities, and number of full physical examinations. Women with psychosis were significantly more likely to smoke (P < .0001), to have more primary care appointments (P = .035), and to miss appointments (P = .0002) than women without psychosis. After adjustment for age, other psychiatric illnesses, number of physical examinations, number of missed appointments, and having a gynecologist, women with psychosis were significantly less likely to have had a Pap test in the previous 3 years compared with women without psychosis (47.1% vs 73.7%, respectively; odds ratio 0.19, 95% confidence interval 0.06 to 0.58). CONCLUSION: Women with psychosis are more than 5 times less likely to receive adequate Pap screening compared with the general population despite their increased rates of smoking and increased number of primary care visits.

Antimalarial therapy selection for quinolone resistance among Escherichia coli in the absence of quinolone exposure, in tropical South America.

BACKGROUND: Bacterial resistance to antibiotics is thought to develop only in the presence of antibiotic pressure. Here we show evidence to suggest that fluoroquinolone resistance in Escherichia coli has developed in the absence of fluoroquinolone use. METHODS: Over 4 years, outreach clinic attendees in one moderately remote and five very remote villages in rural Guyana were surveyed for the presence of rectal carriage of ciprofloxacin-resistant gram-negative bacilli (GNB). Drinking water was tested for the presence of resistant GNB by culture, and the presence of antibacterial agents and chloroquine by HPLC. The development of ciprofloxacin resistance in E. coli was examined after serial exposure to chloroquine. Patient and laboratory isolates of E. coli resistant to ciprofloxacin were assessed by PCR-sequencing for quinolone-resistance-determining-region (QRDR) mutations. RESULTS: In the very remote villages, 4.8% of patients carried ciprofloxacin-resistant E. coli with QRDR mutations despite no local availability of quinolones. However, there had been extensive local use of chloroquine, with higher prevalence of resistance seen in the villages shortly after a Plasmodium vivax epidemic (p<0.01). Antibacterial agents were not found in the drinking water, but chloroquine was demonstrated to be present. Chloroquine was found to inhibit the growth of E. coli in vitro. Replica plating demonstrated that 2-step QRDR mutations could be induced in E. coli in response to chloroquine. CONCLUSIONS: In these remote communities, the heavy use of chloroquine to treat malaria likely selected for ciprofloxacin resistance in E. coli. This may be an important public health problem in malarious areas.