A Census of Midsize to Large Supermarkets in Toronto: A Cross-Sectional Analysis of the Consumer Nutrition Environment.

OBJECTIVE: Assess the consumer nutrition environment in midsize to large supermarkets by supermarket type and area-level socioeconomic variables. DESIGN: Cross-sectional census of 257 supermarkets using the Toronto Nutrition Environment Measures Survey in Stores. SETTING: Toronto, Canada. VARIABLES MEASURED: Availability; price and linear shelf space of fruits and vegetables vs energy-dense snack foods by supermarket type; after-tax, low-income measure; and neighborhood improvement area. ANALYSIS: Multivariate linear regression. RESULTS: There was a high availability of fruits (7.7 of 8) and vegetables (9.5 of 11). There was similar linear shelf space for fruits and vegetables vs energy-dense snack foods (ratio, 1.1 m). Adjusted fruit prices were lowest in quintiles 1 (ß = -$1.30; P = .008), 2 (ß = -$1.41; P = .005), and 3 (ß = -$1.89; P < .001) vs quintile 5 (lowest percentage of people living with low income) and in ethnic (ß = -$3.47; P < .001) and discount stores (ß = -$5.64; P < .001) vs conventional. Adjusted vegetable prices were lowest in quintiles 2 (ß = -$1.87; P = .04), 3 (ß = -$1.78; P = .03), and 4 (ß = -$2.65; P = .001) vs quintile 5 and in ethnic (ß = -$7.10; P < .001) and discount (ß = -$5.49; P < .001) stores. They were highest in other (ß = + $3.08; P = .003) vs conventional stores. Adjusted soda and chips prices were lower in discount (ß = -$1.16; P < .001) and higher in other stores (ß = + $0.67; P < .001) vs conventional. CONCLUSIONS AND IMPLICATIONS: Findings do not indicate inequities in shelf space, availability, or price across diverse neighborhoods. Practitioners can use findings to help consumers navigate supermarkets to make healthy choices.

Bringing Menu Labelling to Independent Restaurants: Findings from a Voluntary Pilot Project in Toronto.

Toronto Public Health conducted a pilot project to assess the feasibility of menu labelling by independent restaurants. The pilot project was informed by consultations with the industry and other jurisdictions that have implemented a similar initiative. Public Health Dietitians worked closely with these restaurants to help them work toward posting calories and sodium on their menus. This paper reports on the findings of a feasibility assessment that took a mixed-methods approach resulting in a comprehensive process evaluation. Results showed that having highly motivated restaurants and early adopters of menu labelling is a necessary starting point. However, this alone is not sufficient to make voluntary menu labelling successful. It may be feasible only for select independent restaurants who: (i) are highly motivated and ready to make a substantial time commitment; (ii) value offering healthy food choices; (iii) have fairly standardized recipes to begin with; (iv) receive extensive specialized, individualized support; and (v) receive incentives, cost offsetting, and recognition. Full-scale implementation of a menu labelling program with Toronto independent restaurants was not justified given the current level of interest and capacity.

Development of a guide to applying precaution in local public health.

PURPOSE: The precautionary principle (PP) urges actions to prevent harm even in the face of scientific uncertainty. Members of Toronto Public Health (TPH) sought guidance on applying precaution. METHODS: We searched five bibliographic databases (yield 60 articles from 1996 to 2009 and 8 from 2009 to 2011) and Google (yield 11 gray literature sources) for material relevant to local public health. From these sources, we extracted questions until saturation was reached (n =55). We applied these questions retrospectively to eight case studies where TPH felt precaution was applied. We ranked questions for their importance in applying precaution. RESULTS: Our final guide included 35 questions in five domains: context, assessment, alternative interventions, implementation, and monitoring and evaluation. Importance rankings varied across cases, but the role of stakeholders in driving precautionary action was consistent. Monitoring and evaluation components could have been strengthened across cases. CONCLUSION: The TPH guide can assist municipal environmental health practitioners in applying precaution in a more transparent manner.

Ready for policy? Stakeholder attitudes toward menu labelling in Toronto, Canada.

OBJECTIVES: The purpose of this research was to assess key stakeholder attitudes regarding menu labelling in Toronto, the largest municipality in Canada. Menu labelling is a population health intervention where food-labelling principles are applied to the eating-out environment through disclosure of nutrient content of food items on restaurant menus at the point of sale. Menu-labelling legislation has been implemented in the United States, but has yet to be adopted in Canada. As provincial voluntary programs and federal analyses progress, municipal jurisdictions will need to assess the feasibility of moving forward with parallel interventions. METHODS: Data were collected and analyzed in late 2011 to early 2012, including: a consumer eating-out module incorporated into a public health surveillance telephone survey (n=1,699); an online survey of independent restaurant operators (n=256); in-depth key informant interviews with executives and decision makers at chain restaurants (n=9); and a policy consultation with local restaurant associations. RESULTS: Toronto residents, particularly men, younger adults, and those with higher income or education, frequently eat out. A majority indicated that nutrition information is important to them; 69% note that they currently use it and 78% reported they would use it if it were readily available. Resistance to menu-labelling requirements at the municipal level was articulated by franchise/chain restaurant executives and industry associations. Despite overall low interest among independent restaurant operators, 57% reported feeling some responsibility to provide nutrition information and 50% believed it could be good for business. CONCLUSIONS: This research supports earlier literature that indicates strong public support for menu labelling alongside perceived barriers among the restaurant and foodservices sector. Leverage points for effective operator engagement for menu-labelling adoption were identified, nonetheless, highlighting the need for public health support.

Impacts of cooking technique on polychlorinated biphenyl and polychlorinated dioxins/furan concentrations in fish and fish products with intake estimates.

Polychlorinated biphenyl (PCB) and polychlorinated dibenzo-p-dioxin (PCDD) and dibenzofuran (PCDF) concentrations were determined in composites of 18 different fish products and were prepared as raw, baked, boiled, and fried. ∑PCB concentrations were found to range from 0.12 ng·g(-1) whole weight (ww) in raw octopus to 33 ng·g(-1) ww in baked mackerel. Boiled monkfish was found to have the lowest ∑PCDD/F concentrations (0.41 pg·g(-1) ww), while maximum concentrations were observed in fried catfish (59 pg·g(-1) ww). PCB and PCDD/F concentrations in fish were generally reduced during cooking, although differences were small. The average PCB reduction in finfish was 7.9%, while an increase in PCB mass was observed in non-finfish (2.9%). PCDD/F losses, on average, were observed in both the finfish (3.6%) and non-finfish products (25%). Maximum ∑PCB, ∑PCDD/F, and TEQ(PCDD/F+DL-PCB) (toxic equivalency) intakes, based on 150 g serving size, were determined to be 3300 ng (mackerel), 6600 pg (catfish), and 270 pg (catfish), respectively. PCB and PCDD/F changes associated with cooking generally were small (<15%), although larger mean differences (∼40%) were observed in some fish products (e.g., catfish).

'A drop of water in the pool': information and engagement of linguistic communities around a municipal pesticide bylaw to protect the public's health.

The Multicultural Yard Health and Environment Project (MYHEP) used Toronto's Pesticide Bylaw roll-out process to examine how culturally specific perceptions and practices might influence the relevance of municipal public health information and community engagement strategies and the effectiveness of health protection initiatives. In Canada, and particularly in Toronto, such information is needed for governments to effectively engage with increasingly diverse populations. Focus groups and individual interviews were conducted with Spanish- and Cantonese-speaking participants to document opinions about pesticide use and regulation and views on municipal information and engagement strategies. MYHEP participants reported a need for more accessible environmental health messaging. There was confusion over the safety and legality of pesticide products available for sale in Toronto stores. Most participants indicated they were unwilling to make formal complaints about neighbours who were not complying with the bylaw (an important mechanism for enforcement). Results indicate that environmental health communication and engagement strategies need to be more carefully tailored to address local sociocultural and linguistic contexts in order to provide more equitable environmental health protection and promotion for all residents. These findings led Toronto Public Health to adapt its efforts so as to better engage communities regarding environmental health.

Municipal bylaw to reduce cosmetic/non-essential pesticide use on household lawns - a policy implementation evaluation.

BACKGROUND: Pesticide use on urban lawns and gardens contributes to environmental contamination and human exposure. Municipal policies to restrict use and educate households on viable alternatives deserve study. We describe the development and implementation of a cosmetic/non-essential pesticide bylaw by a municipal health department in Toronto, Ontario, Canada and assess changes in resident practices associated with bylaw implementation. METHODS: Implementation indicators built on a logic model and were elaborated through key informant interviews. Bylaw impacts on awareness and practice changes were documented through telephone surveys administered seasonally pre, during and post implementation (2003-2008). Multivariable logistic regression models assessed associations of demographic variables and gardening season with respondent awareness and practices. RESULTS: Implementation indicators documented multiple municipal health department activities and public involvement in complaints from commencement of the educational phase. During the enforcement phases only 40 warning letters and 7 convictions were needed. The number of lawn care companies increased. Among survey respondents, awareness of the bylaw and the Natural Lawn campaign reached 69% and 76% respectively by 2008. Substantial decreases in the proportion of households applying pesticides (25 to 11%) or hiring lawn care companies for application (15 to 5%) occurred. Parallel absolute increases in use of natural lawn care methods occurred among households themselves (21%) and companies they contracted (7%). CONCLUSIONS: Bylaws or ordinances implemented through education and enforcement are a viable policy option for reducing urban cosmetic pesticide use.

Healthy fish consumption and reduced mercury exposure: counseling women in their reproductive years.

OBJECTIVE: To provide family physicians with a practical, evidence-based approach to counseling women about healthy fish eating. SOURCES OF INFORMATION: MEDLINE was searched for articles published between 1999 and 2008. Most studies described in this article provide level II or III evidence. MAIN MESSAGE: Fish is an important component of a healthy diet for women in their reproductive years owing to the beneficial effects of omega-3 fatty acids on the neurologic development of the fetus. However, some fish species contain considerable methylmercury, which crosses the placenta and has harmful effects on neurobehavioural development. As many jurisdictions have issued fish consumption advisories, which can be confusing, women would benefit from individualized assistance from a trusted source, their family physicians, to clarify the risks and benefits of eating fish. CONCLUSION: We recommend that family physicians counsel women in their reproductive years about healthy choices regarding fish in their diet, and provide appropriate resources.

Risks and benefits of fish consumption for childbearing women.

Pregnant women's fish consumption provides both benefits and risks to the developing fetus. Docosahexaenoic acid (DHA) from fish may enhance fetal neurodevelopment, while methylmercury (MeHg) can have detrimental effects. Dietitians would benefit from information on the frequency with which fish species may be consumed to increase DHA intake among Canadian women of childbearing age, and on minimizing the risks from MeHg, especially for those who consume fish frequently. Eighteen fish species were selected for DHA and mercury analysis from retail markets in the Toronto area. Consumption scenarios using analytical results for these fish species indicate that women of childbearing age can consume nine of 18 fish species every day (14 servings a week) or often (up to four servings a week) and remain below toxicological benchmarks for mercury. Moreover, women can also attain the recommended DHA level by consuming six of those nine fish: four 75-g servings of smelt, porgie, or bluefish a week, or two 75-g servings of milkfish, silver pomfret, or tilapia a day. Our analysis indicates that the DHA level recommended for childbearing women can be attained through fish consumption alone, without the need for supplementation and without posing a risk to the woman (or the fetus) from mercury.

Cooking decreases observed perfluorinated compound concentrations in fish.

Dietary intake is a major route of exposure to perfluorinated compounds (PFCs). Although fish and seafood contribute significantly to total dietary exposure to these compounds, there is uncertainty with respect to the effect of cooking on PFC concentrations in these foods. Eighteen fish species purchased from markets in Toronto, Mississauga, and Ottawa, Canada were analyzed for perfluorooctanesulfonamide (PFOSAs)-based fluorochemicals and perfluorinated acids (PFAs) in raw and cooked (baked, boiled, fried) samples. Of 17 analytes, perfluorooctanesulfonic acid (PFOS) was detected most frequently; concentrations ranged from 0.21 to 1.68 ng/g ww in raw and cooked samples. PFOSAs were detected only in scallops at concentrations ranging from 0.20 ng/g ww to 0.76 ng/g ww. Total concentrations of PFAs in samples were 0.21 to 9.20 ng/g ww, respectively, consistent with previous studies. All cooking methods reduced PFA concentrations. Baking appeared to be the most effective cooking method; after baking samples for 15 min at 163 C (325 degrees F), PFAs were not detected in any of the samples. The margin of exposures (MOE) between the toxicological points of reference and the dietary intake of perfluorocarboxylates (PFCAs) and PFOS in fish and seafood muscle tissue were greater than 4 orders of magnitude. This indicates that reducing consumption of fish muscle tissue is not warranted on the basis of PFC exposure concerns at the reported levels of contamination, even for high fish consuming populations.

Assessing and managing exposure from arsenic in CCA-treated wood play structures.

BACKGROUND: Chromated copper arsenate (CCA)-treated wood has been widely used for outdoor play structures. There is a growing scientific concern about children's exposure to the arsenic that leaches from these structures. The purpose of this study was to measure arsenic from CCA-treated wood play structures owned by the City of Toronto to guide an appropriate exposure reduction strategy. METHODS: In the fall of 2002, 4 soil and 2 wood surface samples (dislodgeable arsenic) were collected from 217 play structures and analyzed for total arsenic content. Soil arsenic concentrations were compared to the federal soil guideline of 12 microg/g. Dislodgeable arsenic concentrations were compared to a Toronto Public Health-derived interim action level of 100 microg/100 cm2. RESULTS: Soil arsenic levels in samples taken from within one metre of CCA-treated wood were low (mean 2.1; range 0.5-10 microg/g). However, the means of the arsenic level in the composite soil samples taken from beneath an elevated platform were significantly greater (p<0.01) than the background soil sample and soil from within one metre of the CCA-treated wood (mean 20.3; range 12.4-47.5 microg/g). Composite soil samples exceeded the federal soil guideline of 12 microg/g at 32 play structures. Dislodgeable arsenic values varied widely (mean 41.9 microg/100 cm2; non-detectable to 521.5 microg/100 cm2). 32 play structures had dislodgeable arsenic levels that exceeded the interim action level. Mean arsenic concentrations on vertical surfaces were significantly higher than on horizontal surfaces (p<0.01). DISCUSSION: Our soil analysis indicates that arsenic does not migrate laterally but accumulates under elevated platforms at levels that can exceed the soil guideline. Dislodgeable arsenic values varied greatly and were not a useful predictor of soil arsenic (R2 = 0.0015).