The problem of heteronormativity in family-based health promotion: centring gender transformation in Ontario, Canada.

OBJECTIVES: Social scientists have demonstrated that family health work is interlinked with heteronormative gender inequities. Yet family-based public health interventions rarely incorporate a gender transformative approach or address heteronormativity as a potential health barrier in North America. Instead, attention to gender surfaces primarily in family health interventions conducted in low- to middle-income countries with majority Black and racialized populations. The objective of this article is to establish the importance of designing health interventions that account for heteronormative relations in Ontarian families by drawing on empirical data from the Guelph Family Health Study (GFHS). METHODS: We draw on data (February-October 2019) from (1) semi-structured interviews with 20 families and with 4 health educators facilitating the GFHS home visits and (2) observational data of 11 GFHS home visits and 1 health educator training day. Informed by gender transformation theory, data were analyzed and coded to understand the impact of gender, sexuality, and place in family health interventions. RESULTS: Pre-existing heteronormative parenting relations were reinforced through GFHS participation: the GFHS was mother-led, increasing some mothers' stress levels. Fathers tended to consider paid work a justification for disengaging from the GFHS, and their detachment sometimes obstructed mothers' intervention efforts. Health educators (all women) were caught in these relations, feeling like because of their gender, they were viewed by parents as confidants and marriage counsellors. CONCLUSION: Findings emphasize the need for expanding the epistemic and methodological approaches to family-based health interventions, changing the demographic and geographic emphasis within the field, and designing interventions that focus on societal-level changes. Heterosexuality has not been analyzed as a risk factor within the public health field, but our findings indicate the need for further study.

RéSUMé: OBJECTIFS: Les spécialistes des sciences sociales ont démontré que le travail en santé familiale est indissociable des inégalités hétéronormatives entre les sexes. Il est pourtant rare que les interventions sanitaires axées sur la famille intègrent une approche transformatrice du genre ou abordent l'hétéronormativité en tant qu'obstacle possible à la santé en Amérique du Nord. Au lieu de cela, l'attention au genre fait principalement surface dans les interventions en santé familiale menées dans des pays à faible revenu et à revenu intermédiaire dont les populations sont majoritairement noires et racisées. Notre article vise à souligner l'importance de concevoir des interventions sanitaires qui tiennent compte des relations hétéronormatives dans les familles ontariennes en puisant dans les données empiriques de l'étude Guelph Family Health Study (GFHS). MéTHODE: Nous avons fait appel aux données (février­octobre 2019) : 1) d'entretiens semi-directifs avec 20 familles et avec 4 éducatrices sanitaires ayant facilité des visites à domicile dans le cadre de la GFHS; et 2) d'observation de 11 visites à domicile menées dans le cadre de la GFHS et d'une journée de formation des éducatrices sanitaires. Éclairées par la théorie de la transformation de genre, les données ont été analysées et codées pour nous aider à comprendre les effets du sexe, de la sexualité et du lieu dans les interventions en santé familiale. RéSULTATS: Les relations parentales hétéronormatives préexistantes ont été renforcées par la participation à l'étude GFHS : ce sont surtout des mères qui y ont participé, ce qui a accru les niveaux de stress chez certaines. Les pères ont eu tendance à considérer leur travail rémunéré comme une raison de se retirer de l'étude, et leur détachement a parfois fait obstacle aux efforts d'intervention des mères. Les éducatrices sanitaires (toutes des femmes) ont été prises en étau dans ces relations et ont senti qu'en raison de leur sexe, elles étaient vues par les parents comme des confidentes et des conseillères conjugales. CONCLUSION: Nos constatations soulignent le besoin d'élargir les approches épistémiques et méthodologiques des interventions en santé familiale, de changer l'accent sur les données démographiques et géographiques dans le domaine et de concevoir des interventions axées sur les changements sociétaux. L'hétérosexualité n'est pas analysée en tant que facteur de risque dans le domaine de la santé publique, mais nos constatations indiquent le besoin de pousser la recherche en ce sens.

The Game of Queer Family Life: Exploring 2SLGBTQI+ Parents' Experiences of Cisheteronormativity, Racism, and Colonialism Through Digital Storytelling in Ontario, Canada.

In this article we describe and analyze five videos created through an arts-informed research project, Precarious Inclusion: Studying Ontarian 2SLGBTQI+ parents' experiences childrearing in a post-legal parity framework. Precarious Inclusion used interviews and digital storytelling to investigate Ontario 2SLGBTQI+ parents' current experiences of inclusion and exclusion when navigating institutional and social interactions in everyday life in a post-legal parity context. The study centrally explored how intersecting identities with regards to sexuality, gender, geography, disability, class, race, Indigeneity, and ethnicity intersect with structural forces to influence 2SLGBTQI+ parents' inclusion and exclusion experiences. We examine research creation activities that supported 2SLGBTQI+ parents in making short videos about their experiences of parenting. Our analysis of the five videos created by Indigenous, racialized, trans, nonbinary, Two-Spirit, and disabled parents show how consistent experiences of exclusion mark 2SLGBTQI+ parents' everyday lives. We deepen theorizations of the material and psychological impacts of exclusion for 2SLGBTQI+ families through foregrounding three themes: 1) the operations of racism, white supremacy, and colonialism in makers' lives; 2) misrecognition and its psychic effects of bifurcation and disjuncture; and 3) love, joy, and multi-species kinship as powerful sites of healing and belonging. We further demonstrate how parents used their videos as self-advocacy for resisting precarious inclusion.

Exploring the dietary choices of Chinese women living with breast cancer in Vancouver, Canada.

PURPOSE: To explore how Chinese Canadian patients with breast cancer make dietary choices and to understand their nutritional information needs in order to inform oncology healthcare providers about provision of optimal supportive care for this population. METHODS: Using interpretive description methodology, semi-structured interviews were conducted with first- and second-generation Chinese Canadian women aged 41-73 years living in Vancouver, Canada, who were diagnosed with breast cancer within the last 5 years. A follow-up focus group was held to validate emergent themes. RESULTS: Nineteen women were interviewed; 6 participated in the focus group. Their accounts of dietary experiences following diagnosis focused on three areas: dietary change (including desired and implemented changes that participants believed would benefit their health), facilitators and barriers to dietary change, and information and resource needs. Dietary changes reported included avoiding or consuming greater amounts of certain foods, and taking traditional Chinese medicine (TCM) and natural health products. Barriers to desired dietary change included the interplay between food preferences and family and social life, work-life balance, and cost and availability of specialty foods. Support from family members, however, facilitated participants' consumption of more whole and natural foods after their cancer diagnosis. Participants obtained food and nutrition information from a variety of sources but had difficulty determining the reliability and accuracy of information. They requested timely, credible, culturally-relevant, and easily accessible dietary information. CONCLUSIONS: Oncology healthcare providers would benefit from increased understanding of the dietary practices, including TCM, of Chinese women living with breast cancer. To facilitate communication and improve quality of care, healthcare professionals should provide credible and culturally relevant diet-related information in a variety of forms.

Examining school-level implementation of British Columbia, Canada's school food and beverage sales policy: a realist evaluation.

OBJECTIVE: To identify key school-level contexts and mechanisms associated with implementing a provincial school food and beverage policy. DESIGN: Realist evaluation. Data collection included semi-structured interviews (n 23), structured questionnaires (n 62), participant observation at public events (n 3) and scans of school, school district and health authority websites (n 67). The realist heuristic, context + mechanism → outcome configuration was used to conduct the analysis. SETTING: Public schools in five British Columbia (BC), Canada school districts. PARTICIPANTS: Provincial and regional health and education staff, private food vendors and school-level stakeholders. RESULTS: We identified four mechanisms influencing the implementation of BC's school food and beverage sales policy. First, the mandatory nature of the policy triggered some actors' implementation efforts, influenced by their normative acceptance of the educational governance system. Second, some expected implementers had an opposite response to the mandate where they ignored or 'skirted' the policy, influenced by values and beliefs about the role of government and school food. A third mechanism related to economics demonstrated ways vendors' responses to school demand for compliance with nutritional Guidelines were mediated by beliefs about food preferences of children, health and food. The last mechanism demonstrated how resource constraints and lack of capacity led otherwise motivated stakeholders to not implement the mandatory policy. CONCLUSION: Implementation of the food and beverage sales policy at the school level is shaped by interactions between administrators, staff, parent volunteers and vendors with contextual factors such as varied motivations, responsibilities and capacities.

District-level implementation of British Columbia's school food and beverage sales policy: a realist evaluation exploring intervention mechanisms in urban and rural contexts.

INTERVENTION: British Columbia's (BC) provincial school food and beverage sales policy. RESEARCH QUESTION: What are the processes associated with district-level implementation of BC's school food and beverage sales policy? METHODS: We adopted a realist approach and a qualitative, multiple case study design that included three urban and two rural BC school districts. Data collection involved semi-structured interviews and questionnaires with health, education, and industry stakeholders, observations, document analysis and website scans. Analysis identified: (i) mechanisms influencing if and how stakeholders engage in implementation activities at the district level and (ii) specific dimensions of context influencing these mechanisms. RESULTS: We identified three mechanisms driving implementation processes at the school district level associated with BC's school food and beverage sales policy. These mechanisms are influenced by various dimensions of context that lead to a range of implementation outcomes. The 'mandatory mechanism' refers to the mandatory nature of the policy effectively triggering implementation efforts, influenced by a normative acceptance of the education system hierarchy. The 'money mechanism' refers to how this district demand leads vendors to create a compliant supply; it is influenced by beliefs about children's food preferences, health and food, and the existence of competition. Finally, the 'monitoring mechanism' refers to how systems of informal monitoring are used to promote compliance in the context of a competitive sales environment. CONCLUSION: The outcomes of these three policy mechanisms are influenced by complex dimensions of context. Identifying context-mechanism interactions can help inform public health policymakers interested in interventions for improving school food environments.

It's just the right thing to do: Conceptualizing a theory of change for a school food and beverage sales environment interv ention and implications for implementation evaluation.

School food environments are the target of nutrition interventions and evaluations across the globe. Yet little work to-date has articulated the importance of developing a theory of change upon which to base evaluation of both implementation and outcomes. This paper undertakes an interpretive approach to develop a retrospective theory of change for an implementation evaluation of British Columbia's school food and beverage sales Guidelines. This study contributes broadly to a nuanced conceptualization of this type of public health intervention and provides a methodological contribution on how to develop a retrospective theory of change with implications for effective evaluation. Data collection strategies included document analysis, semi-structured interviews with key stakeholders, and participant observation. Developing the logic model revealed that, despite the broad population health aims of the intervention, the main focus of implementation is to change behaviors of adults who create school food environments. Derived from the analysis and interpretation of the data, the emergent program theory focuses on the assumption that if adults are responsibilized through information and education campaigns and provided implementation tools, they will be 'convinced' to implement changes to school food environments to foster broader public health goals. These findings highlight the importance of assessing individual-level implementation indicators as well as the more often evaluated measures of food and beverage availability.

Randomized controlled trial assessing the efficacy of a reusable fish-shaped iron ingot to increase hemoglobin concentration in anemic, rural Cambodian women.

Background: Anemia affects 45% of women of childbearing age in Cambodia. Iron supplementation is recommended in populations in which anemia prevalence is high. However, there are issues of cost, distribution, and adherence. A potential alternative is a reusable fish-shaped iron ingot, which, when added to the cooking pot, leaches iron into the fluid in which it is prepared.Objective: We sought to determine whether there was a difference in hemoglobin concentrations in rural Cambodian anemic women (aged 18-49 y) who cooked with the iron ingot or consumed a daily iron supplement compared with a control after 1 y.Design: In Preah Vihear, 340 women with mild or moderate anemia were randomly assigned to 1) an iron-ingot group, 2) an iron-supplement (18 mg/d) group, or 3) a nonplacebo control group. A venous blood sample was taken at baseline and at 6 and 12 mo. Blood was analyzed for hemoglobin, serum ferritin, and serum transferrin receptor. Hemoglobin electrophoresis was used to detect structural hemoglobin variants.Results: Anemia prevalence was 44% with the use of a portable hemoglobinometer during screening. At baseline, prevalence of iron deficiency was 9% on the basis of a low serum ferritin concentration. There was no significant difference in mean hemoglobin concentrations between the iron-ingot group (115 g/L; 95% CI: 113, 118 g/L; P = 0.850) or iron-supplement group (115 g/L; 95% CI: 113, 117 g/L; P = 0.998) compared with the control group (115 g/L; 95% CI: 113, 117 g/L) at 12 mo. Serum ferritin was significantly higher in the iron-supplement group (73 µg/L; 95% CI: 64, 82 µg/L; P = 0.002) than in the control group at 6 mo; however, this significance was not maintained at 12 mo (73 µg/L; 95% CI: 58, 91 µg/L; P = 0.176).Conclusions: Neither the iron ingot nor iron supplements increased hemoglobin concentrations in this population at 6 or 12 mo. We do not recommend the use of the fish-shaped iron ingot in Cambodia or in countries where the prevalence of iron deficiency is low and genetic hemoglobin disorders are high. This trial was registered at clinicaltrials.gov as NCT02341586.

Participation in School Food and Nutrition Activities among Grade 6-8 Students in Vancouver.

This study examined student-reported participation in school food and nutrition activities in Vancouver, British Columbia (BC), and whether engagement differed by gender and between elementary and secondary school students. A cross-sectional survey of grade 6-8 public school students (n = 937) from 20 elementary and 6 secondary schools assessed student-reported participation in a range of food and nutrition activities. Statistical analyses included descriptive statistics and multilevel logistic regression to examine associations between participation with gender and school type. Overall, <50% of students reported engaging in most of the food and nutrition activities examined in the 2011-2012 school year, including: food preparation (36%), choosing/tasting healthy foods (27%), learning about Canada's Food Guide (CFG) (45%), learning about foods grown in BC (35%), gardening (21%), composting (32%), and recycling (51%). Females were more likely to report recycling and learning about CFG and BC-grown foods (P < 0.05). Secondary students were more likely to report activities focused on working with or learning about food/nutrition (P < 0.05). Despite local and provincial efforts to engage students in food and nutrition experiences, participation in most activities remains relatively low, with few students exposed to multiple activities. Continued advocacy is needed from the dietetics community to improve student engagement in food and nutrition activities.

Prenatal supplementation with Corn Soya Blend Plus reduces the risk of maternal anemia in late gestation and lowers the rate of preterm birth but does not significantly improve maternal weight gain and birth anthropometric measurements in rural Cambodian women: a randomized trial.

BACKGROUND: Corn Soya Blend (CSB) Plus is a fortified dietary supplement used to help Cambodian women meet their nutritional requirements in pregnancy, although little is known about its ability to improve pregnancy outcomes. OBJECTIVE: This study assessed the effect of prenatal CSB Plus supplementation on birth weight and secondary outcomes of low birth weight (<2500 g), small for gestational age, birth length and head circumference, preterm birth (<37 wk), maternal weight gain, and anemia at 24-28 wk, 30-32 wk, and 36-38 wk of gestation among rural Cambodian women. DESIGN: A cluster-randomized trial was conducted in 75 villages in Kampong Chhnang Province, in which 547 women received CSB Plus (treatment) during the first trimester until delivery or continued their normal diet (control) based on their village residence. All women received routine daily iron folic acid tablets and were treated with additional iron folic acid if they were anemic (hemoglobin <11 g/dL). Cluster-adjusted linear mixed-effect and logistic regression models were used to examine group differences. RESULTS: There was no significant difference in birth weight between the CSB Plus and control group (46 g; 95% CI: -31, 123 g; P = 0.24). Significant reductions were observed in preterm birth (OR = 0.33; 95% CI: 0.12, 0.89) and anemia at 36-38 wk (OR = 0.51; 95% CI: 0.34, 0.77). There were no significant differences in low birth weight, small for gestational age, birth length, head circumference, or maternal weight gain. A higher rate of fetal loss was observed in the treatment group (10.2% compared with 3.7%; P < 0.01). CONCLUSIONS: In Cambodian women, CSB Plus consumed during pregnancy did not significantly increase maternal weight gain or improve birth size but did reduce maternal anemia in late gestation and preterm birth in comparison with women consuming a normal diet. The unexpectedly higher rate of fetal loss in the treatment group is concerning and warrants further investigation. This trial was registered at clinicaltrials.gov as NCT01413776.

Factors affecting the acceptability and consumption of Corn Soya Blend Plus as a prenatal dietary supplement among pregnant women in rural Cambodia.

OBJECTIVE: Undernutrition is prevalent among pregnant women in Cambodia. The provision of fortified dietary supplements is one strategy to help pregnant women meet their nutritional needs. Corn Soya Blend Plus (CSBP) is a widely used prenatal dietary supplement in areas with high rates of undernutrition and food insecurity. However, little is known about its acceptability during pregnancy. The present study aimed to identify factors that affected the acceptability and consumption of CSBP supplements among pregnant women. DESIGN: Women completed a structured interview designed to provide information on facilitators of and barriers to utilization. In addition, six focus groups were conducted with a subset of women (n 70) to further explore attitudes, perceptions and experiences related to CSBP use. SETTING: Two districts in Kampong Chhnang Province, Cambodia. SUBJECTS: Pregnant women (n 288) participating in a cluster-randomized trial of CSBP. RESULTS: The acceptability of CSBP was influenced by sensory attributes, family support, peer influences, and attitudes related to diet, nutritional status and weight gain in pregnancy. Attaining adequate nutrition was considered less important than other concerns during pregnancy, particularly anxiety related to the costs of delivery and postpartum care. Acceptance was lower among new mothers due to fears of weight gain. Health benefits were common reasons for continued use and minor side-effects, such as nausea, were not major barriers to consumption. CONCLUSIONS: CSBP was generally well accepted in this population. However, organoleptic factors and perceptions regarding nutrition and weight gain in pregnancy, particularly for first-time mothers, were barriers to increasing acceptance among Cambodian women.

A Comparison of Dietary Practices at or En Route to School between Elementary and Secondary School Students in Vancouver, Canada.

BACKGROUND: There is evidence that dietary quality declines as children age in North America, but few studies have explored whether food environment exposures in secondary schools as opposed to elementary schools are associated with changes in students' school-day food choices. METHODS: This study examined differences in dietary practices (at or en route to and/or from school) between students in their last years of elementary school (grades 5 to 7) and first year of secondary school (grade 8) in Vancouver, Canada, controlling for sociodemographic characteristics and school-level socioeconomic status. Demographic characteristics and dietary data were collected through a cross-sectional survey (n=950 from 26 schools) and combined with school-level socioeconomic data derived from the 2006 Canadian Census. RESULTS: Multilevel logistic regression analyses indicated that secondary school students were significantly more likely to report daily consumption of fast foods (odds ratio=1.92; 95% CI 1.18 to 3.12) and minimally nutritious packaged snacks (eg, candy or chocolate bars) (odds ratio=1.60; 95% CI 1.05 to 2.45), and to report regular purchases from off-campus retailers (odds ratio=1.63; 95% CI 1.10 to 2.42). Gender, food insecurity, lower acculturation to Canada, and access to more weekly spending money were associated with nutritionally poor practices. Students attending schools drawing from lower-income neighborhoods were also significantly more likely to consume fast foods and packaged snacks daily. The majority of students sampled did not report consuming healthy foods, such as fruit and vegetables, daily at or en route to and/or from school. Intake of fruit, vegetables, and low-fat milk did not differ significantly between elementary and secondary school students. CONCLUSIONS: Findings suggest that research and intervention strategies should address modifiable school-level exposures and policies to improve dietary practices for both elementary and secondary school-aged youth, while at the same time addressing sociocultural factors associated with eating behavior.

Sustainability and public health nutrition at school: assessing the integration of healthy and environmentally sustainable food initiatives in Vancouver schools.

OBJECTIVE: To describe the development and application of the School Food Environment Assessment Tools and a novel scoring system to assess the integration of healthy and environmentally sustainable food initiatives in elementary and secondary schools. DESIGN: The cross-sectional study included direct observations of physical food environments and interviews with key school personnel regarding food-related programmes and policies. A five-point scoring system was then developed to assess actions across six domains: (i) food gardens; (ii) composting systems; (iii) food preparation activities; (iv) food-related teaching and learning activities; and availability of (v) healthy food; and (vi) environmentally sustainable food. SETTING: Vancouver, Canada. SUBJECTS: A purposive sample of public schools (n 33) from all six sectors of the Vancouver Board of Education. RESULTS: Schools scored highest in the areas of food garden and compost system development and use. Regular integration of food-related teaching and learning activities and hands-on food preparation experiences were also commonly reported. Most schools demonstrated rudimentary efforts to make healthy and environmentally sustainable food choices available, but in general scored lowest on these two domains. Moreover, no schools reported widespread initiatives fully supporting availability or integration of healthy or environmentally sustainable foods across campus. CONCLUSIONS: More work is needed in all areas to fully integrate programmes and policies that support healthy, environmentally sustainable food systems in Vancouver schools. The assessment tools and proposed indicators offer a practical approach for researchers, policy makers and school stakeholders to assess school food system environments, identify priority areas for intervention and track relevant changes over time.

Associations between socio-economic status and school-day dietary intake in a sample of grade 5-8 students in Vancouver, Canada.

OBJECTIVE: To examine associations between students' socio-economic status (SES) and school-day dietary intake, and the roles of parents and peers in shaping these associations. DESIGN: A cross-sectional survey measured school-day intake of vegetables, whole grains, low-fat milk, packaged snack foods and sugar-sweetened beverages. Logistic regression models examined associations between SES (parental education and food insecurity status) and dietary outcomes during or en route to or from school, and examined whether peer modelling or parental norms potentially mediated the associations between SES and dietary outcomes. SETTING: Twenty-six public schools in Vancouver, Canada in 2012. SUBJECTS: Nine hundred and fifty students in grades 5-8. RESULTS: Students whose parents completed some college, compared with those completing high school or less, were significantly more likely to consume vegetables daily (unadjusted OR = 1.85; 95 % CI 1.06, 3.22) and students whose parents completed college or university were significantly less likely to consume sugar-sweetened beverages daily (unadjusted OR = 0.67; 95 % CI 0.47, 0.94). Food secure students were also significantly less likely to consume sugar-sweetened beverages daily compared with food insecure students (unadjusted OR = 0.52; 95 % CI 0.29, 0.92). Parental norms, but not peer modelling, emerged as a potential mediator of the association between SES and vegetable intake. SES was not significantly associated with the remaining dietary outcomes. CONCLUSIONS: Higher SES was significantly associated with two of five school-day dietary outcomes and predicted higher likelihood of daily nutritious food choices at school. The present study suggests that there is room for improvement in school-day dietary quality for students from all SES backgrounds in Vancouver.

Vitamin D supplementation is associated with higher serum 25OHD in Asian and White infants living in Vancouver, Canada.

To prevent rickets, the Health Canada and the American Academy of Pediatrics recommend that breastfed infants receive a daily vitamin D supplement of 10 µg d(-1) . Compliance with this recommendation is variable and its effect on infant vitamin D status is unclear. We measured serum 25-hydroxyvitamin D (25OHD) in Asian immigrant (n=28) and White (n=37) mothers and their infants aged 2-4 months living in Vancouver (49°N). Mothers completed health and demographic questionnaires. All subjects were term infants who were primarily breastfed. Analysis of variance, χ(2) , multiple regression and logistic regression analysis were performed as appropriate. Mean 25OHD of the infants was 31 (95% confidence interval 28-34) ng mL(-1) . Only two infants had a 25OHD concentration indicative of deficiency, <10 ng mL(-1) . Of the infants, 14% (n=9) and 49% (n=32) were vitamin D insufficient based on two commonly used cut-offs of 20 and 30 ng mL(-1) , respectively. Fifty-eight (89%) infants had been given a vitamin D supplement. Mean 25OHD was 9.4 ng mL(-1) higher in infants consuming ≥10 µg d(-1) of vitamin D from supplements vs. those consuming less (P=0.003). Mother's 25OHD, season, skin colour or ethnicity (Asian vs. White) did not influence infant 25OHD. The infants in our study, most of whom received vitamin D supplements, were generally protected against low 25OHD. The study was limited by sample size and the nature of the cross-sectional study design.

The rural and the rotund? A critical interpretation of food deserts and rural adolescent obesity in the Canadian context.

Resting on the notion that rural spaces are "food deserts," rural adolescents are increasingly regarded as a "problem population" in Western obesity narratives. Using qualitative data gleaned from interviews with 51 teenage participants from rural areas across Canada, this paper focuses on the ways in which obesity is constructed as a rural disease in the Canadian context, demonstrating in particular how discourses of food deserts and related rural obesity rely on classist imaginings of obesity as a working-class embodiment. The paper will further question the understanding of the rural as a food desert, showing the ways in which rural teens acquire fresh, healthy foods in part through an informal economy of food growing and sharing.

Meanings of food, eating and health among African Nova Scotians: 'certain things aren't meant for Black folk'.

OBJECTIVE: Most research on food, ethnicity and health in Canada is focused on the dietary acculturation of first of second generation migrants. 'Failure' to adopt nutritional guidelines for healthy eating is generally understood as lack of education or persistence of cultural barriers. In this study we explore the meanings of food, health, and well-being embedded in the food practices of African Nova Scotians, a population with a 400-year history in Canada. DESIGN: Qualitative interviews were conducted with 2 or 3 members of each of 13 families who identified as African Nova Scotian. Interviews asked about eating patterns; the influence of food preferences, health concerns, cost, and culture; perceptions of healthy eating and good eating; how food decisions were made; and changes over time. In addition, research assistants observed a 'typical' grocery shopping trip and one family meal. RESULTS: Participants readily identified what they perceived to be distinctively 'Black ways of eating.' Beyond mainstream nutrition discourses about reduction of chronic disease risk, participants identified three ways of thinking about food, health, and well-being: physical well-being, emphasizing stamina, energy and strength; family and community well-being; and cultural or racial well-being, emphasizing cultural identity maintenance, but also resistance to racism. CONCLUSION: While culturally traditional eating patterns are often understood as costly in terms of health, it is equally important to understand that adopting healthy eating has costs in terms of family, community, and cultural identity. Dietary change unavoidably entails cultural loss, thus resisting healthy eating guidelines may signify resistance to racism or cultural dominance. Several suggestions are offered regarding how community strengths and beliefs, as well as cultural meanings of food and health, might inform effective healthy eating interventions.

"Too much of that stuff can't be good": Canadian teens, morality, and fast food consumption.

Recently, public health agents and the popular media have argued that rising levels of obesity are due, in part, to "obesogenic" environments, and in particular to the clustering of fast food establishments in Western urban centers that are poor and working class. Our findings from a multi-site, cross-national qualitative study of teenaged Canadians' eating practices in urban and rural areas offer another perspective on this topic, showing that fast food consumption is not simply a function of the location of fast food outlets, and that Canadian teens engage in complex ways with the varied dimensions of choosing (or rejecting) fast foods. Drawing on evidence gleaned from semi-structured interviews with 132 teenagers (77 girls and 55 boys, ages 13-19 years) carried out between 2007 and 2009, we maintain that no easy relationship exists between the geographical availability of fast food and teen eating behaviors. We use critical obesity literature that challenges widely accepted understandings about obesity prevalence and etiology, as well as Lamont's (1992, 2000) concept of "moral boundary work," to argue that teen fast food consumption and avoidance is multifaceted and does not stem exclusively nor directly from spatial proximity or social class. Through moral boundary work, in which teens negotiated with moralistic notions of healthy eating, participants made and re-made themselves as "good" and successful subjects by Othering those who were "bad" in references to socially derived discourses of healthy eating.

Gender relations, prostate cancer and diet: re-inscribing hetero-normative food practices.

Although diet might be a valuable adjunct to prostate cancer care, men typically have poorer diets than women and are less likely to change the way they eat after a cancer diagnosis. Gender theory suggests that dominant ideals of masculinity shape men's health and food practices; however, the role of female partners in men's diets is poorly understood. Through qualitative analysis of in-depth interviews, this article explores accounts of 14 Canadian couples' food practices guided by a gender relations framework to expose how tacit performances of masculinity and femininity interact to shape the diets of men with prostate cancer. Findings show that many men became more interested and involved in their diets after a prostate cancer diagnosis, practices that might be theorized as a counter hegemonic project or 'feminization', adding to other prostate cancer induced emasculations (i.e., treatment induced incontinence and impotence). At the same time, however, couples mutually limited men's engagement with diet while concurrently reinforcing women's traditional femininities in nurturing the men in their lives through food provision. Also embedded here were women's attempts to mitigate subordinate productions of masculinity by catering to their partner's tastes as well as monitoring their diets. Most couples mutually maintained traditional gender food 'roles' by positioning women as proficient leaders in domestic food provision and men as unskilled 'try-hard' and sometimes uninterested assistants. Findings also revealed complex gender power dynamics that predominated as complicit in sustaining hegemonic masculinity through women's deference to men's preferences and careful negotiation of instrumental support for men's diet changes. Overall men and women jointly worked to re-inscribe hetero-normative family food practices that shaped men's diets and nutritional health.

Associations of socio-demographic and behavioral variables with hair zinc of Vancouver preschoolers.

Marginal zinc deficiency (MZD) exists in children of industrialized societies and impairs growth and development. MZD is believed to be one of the most common deficiencies, even though there is no data available on its global prevalence. This is partly because of the lack of sensitivity and specificity of serum zinc, the most commonly used biomarker of zinc status, to detect MZD. In children, MZD is always accompanied by a decrease in hair zinc. This cross-sectional study was designed to explore if there are any associations between some socio-demographic and behavioral variables with hair zinc status in an attempt to understand the social determinants of MZD and the profile of at risk children. Our citywide survey (n = 719) indicated a mean hair zinc of 116 ± 43 µg/g with 17% below the cutoff. Logistic regression analysis indicated that age, maternal education, number of adults at home, being described as "eating unhealthy", and Child Behavior Questionnaire scores of "activity level" as the significant predictors of hair zinc status. Our study provides important information on the hair zinc status of Vancouver preschoolers and some factors in children and their environment associated with hair zinc, which may help in better understanding of hair zinc as a biomarker of MZD.

Men, food, and prostate cancer: gender influences on men's diets.

Although healthy eating might enhance long-term survival, few men with prostate cancer make diet changes to advance their well-being. Men's typically poor diets and uninterest in self-health may impede nutrition interventions and diet change. Food choice behavior is complex involving many determinants, including gender, which can shape men's health practices, diets, and prostate cancer experiences. Developing men-centered prostate cancer nutrition interventions to engage men (and where appropriate their partners) in promoting healthy diets can afford health benefits. This article presents an overview and synthesis of current knowledge about men's food practices and provides an analysis of diet and diet change behaviors for men with prostate cancer. Masculinity and gender relations theory are discussed in the context of men's food practices, and suggestions for future applications to nutrition and prostate cancer research and diet interventions are made.