| dc.description.abstract | INTRODUCTION:
Adolescence is a critical stage in the life course and inadequate cognitive, physical and social development during this time can have long-term, adverse effects on individuals, groups, and societies. The prevalence of overweight and obesity among adolescents is rising globally; in Canada, the 2012/2013 Canadian Health Measures Survey estimated that almost one in five 10 – 17-year-olds have obesity.
The 20th century saw an extraordinary shift in lifestyle for Indigenous Peoples: from physically active to less active, and from traditional foods to market foods. This is part of the phenomenon known as the ‘nutrition transition’ and has been shown to affect access to healthy foods and rates of obesity and chronic disease. Consistently, Indigenous peoples in Canada are reported to have poorer health than non-Indigenous Canadians, including youth, who are at greater risk of type 2 diabetes due to higher rates of obesity than youth in the general population. Many of these documented health challenges in Indigenous communities can be linked to this ‘nutrition transition’ and associated determinants, including colonisation. The sustained impact of injustices associated with colonisation has been linked to contemporary inequities, including the higher prevalence of both low incomes and food insecurity, and reduced access to health services. Indigenous communities are concerned about the health of their youth, the reclamation of traditional skills, and long-term food sovereignty among their people.
Evidence suggests that diet quality among the general population of school-aged children living in Canada needs improvement - many do not meet the national dietary guidelines for milk and alternatives, or fruit and vegetables. Dietary intake can be influenced by community-based healthy eating programmes, including those focused on school communities. Schools can facilitate nutrition education and health promotion and can influence dietary behaviours, for example through school gardens, or breakfast, school meal or snack programmes. Many Indigenous communities value school-based nutrition programmes and such programmes among Indigenous schools have shown moderate success. However, community-led approaches integrating the Indigenous holistic concepts of wellness along with what is considered ‘Western’ scientific approaches are lacking.
‘Learning Circles: Local Healthy Food to School’ (LC:LHF2S) was an innovative community engagement practice that worked at individual and community levels with a collective aim to promote partnerships between community members with a common interest in food. In each of four participating communities, a Learning Circle Evaluation Facilitator (LCEF) was employed to initiate community meetings in which matters relating to local, healthy and traditional foods were discussed. The LCEF worked with diverse stakeholders to plan and implement a range of activities aimed at enhancing access to local, healthy and traditional foods in school communities. The model could be adapted according to the wishes of the community and was therefore able to accommodate diversity in context.
OBJECTIVES:
The thesis research was supported by a grant from CIHR’s Pathways to Health Equity for Indigenous Peoples Initiative. The study examined the growth of the LC:LHF2S initiative within Haida Gwaii – the exemplar community, and extension of the model to three new, diverse First Nations (FN) contexts. This thesis aimed to examine the process and outcomes of the Learning Circle (LC) model within each of the four diverse Indigenous communities in the LC:LHF2S partnership (2016-9). The thesis is organised in two main sections. Study 1 used a case study methodology to: a) describe the four contexts; document changes in the food system of each across the study period; and b) synthesise and summarise themes and lessons relating to the LC model and influences on local food systems. Using the socio-ecological model, comparisons were made across communities. In addition, Haida Gwaii, B.C., and Ministikwan Lake, SK assessed the dietary intake and eating behaviours of students aged 12-18 and in study 2, findings were presented and compared with diet and food behaviour data from the 2017 Cancer Risk Assessment in Youth Survey (CRAYS) of self-identifying Indigenous youth versus non-Indigenous youth aged 12 – 18 across Canada.
METHODS:
Study 1: Data for case studies was summarised from annual interviews with key project community members and partners, end-of project community interviews, reports, minutes, photographs and food procurement data. The case studies are synthesised across the FN contexts, framed by the socio-ecological model.
Study 2 assessed dietary data collected from web-based surveys (24h recall, food frequency questionnaire (FFQ), self-reported source of breakfast and/or lunch, and perception of traditional foods) conducted among school children in two of the communities: Haida Gwaii, B.C., and Ministikwan Lake, SK. These data were compared with dietary data (FFQ and self-reported source of breakfast and lunch) from the cross-Canada CRAYS survey, 2017.
Qualitative data were coded, managed and analysed thematically in NVivo® 12 Pro (QSR International). Member checking and duplicate coding supported methodologic rigour. Survey data were analysed in MS Excel and SAS® Studio according to the 2015 Canadian Nutrient File (CNF) serving size specifications and nutrient analysis database, and the 2007 version of Canada’s Food Guide (CFG) for First Nations, Inuit and Métis. Macro- and micronutrient intakes were compared with the Dietary Reference Intakes, Estimated Average Requirements, Adequate Intake, and Acceptable Macronutrient Distribution Range; food group intakes were compared with CFG recommendations specific to age and sex, and dietary quality was assessed using a 2009 version of the Canadian Healthy Eating Index. Associations between dietary intake and/or behaviours and selected sociodemographic characteristics were calculated using p-values, Chi-squared tests and adjusted for differences in key variables using logistic regression. A p-value of < 0.05 was considered to indicate statistical significance.
RESULTS:
Across all four communities, 52 interviews, 39 activity tracking reports, 11 LC reports, 44 summaries of meeting minutes, and dietary data from two school surveys were collected and analysed.
Study 1: Haida Gwaii, B.C. (HG) has a rich food environment, a vibrant local and traditional food culture and a long history of protecting the land and culture. A variety of local food-related activities had been taking place in HG prior to the establishment of the LC initiative in 2013, and by 2016, the LC work was firmly established and included the new initiative of the local food pantries. Under the CIHR funding, the LC activities in HG focused on three main areas: schools, hospitals, and the work of the local food pantries. Within this work, LC participants worked towards increasing access to local and traditional foods, building knowledge and skills, fostering relationships, and transitioning to Haida leadership within the project. While the Hazelton/Upper Skeena region, B.C. (HZ) had some local food activities prior to 2016, there had been no organised community-wide commitment to the food culture and environment and so the LC initiative in this community focused on partnership development, gardens, community-wide skills work, and youth activities. Traditional food, knowledge and practices were prioritised in youth-based programmes. The Ministikwan Lake (MK) community in Saskatchewan is a small, remote community located an hour’s drive from the nearest well-stocked grocery store. Some local food-based activities were happening prior to 2016 but there had been no organised efforts towards local and healthy food work. The LC initiative focused on building knowledge and skills, gardening activities and the school lunch programme. Developing youth leadership was prioritised here, and connections between the youth and elders were fostered; the importance of a local champion and challenges related to reliance on local champions were noted. Black River, MB, (BR) had prior involvement with the Heart and Stroke Foundation Healthy Communities Initiative implemented over three school years from 2014 – 2017 and joined the initiative in 2017. While they have not had an “official” LC with others in the community, local food activities in BR have centred around the school. Activities involving youth have included berry picking, wild rice harvesting and fishing.
Study 2: The school surveys conducted in HG (n=92) and MK (n=79) show that, at the time of the survey, 33% of students in HG and 34% of students in MK did not eat breakfast the previous day; 17% of MK students did not eat dinner the previous day. This could, in part, reflect food insecurity which was noted frequently in open-ended survey feedback. Data from the national-level CRAYS survey indicates that Indigenous youth in this sample (n=1,284) appear to purchase food from convenience stores more frequently than non-Indigenous youth (n=11,267); encouragingly, the number of students from both HG and MK reporting consumption of meals from restaurants and fast-food outlets is low.
Dietary quality was suboptimal among students in both communities: based on the data available, the dietary intake of students attending both the school on the MK reserve and the schools in HG (outside of the reserves) appears to be energy dense and low in fruits, vegetables, milk and alternatives, and fibre. Sugary drink intake was high and seemed higher among students in MK: 17% and 6% of students report consuming at least once a day in MK and HG, respectively. Data from the national-level CRAYS survey affirm that Indigenous youth frequently consume sugary drinks and found that sugary drinks, energy drinks and foods high in fat and sugar were more frequently consumed by Indigenous than non-Indigenous youth. Rural Indigenous students were more likely to consume higher levels of “other” foods and sugary drinks than Indigenous students living in urban environments.
In HG, more than half of survey respondents for each of game, wild fish and locally grown vegetables ate them at least twice a week or more frequently. In MK, half of survey respondents ate locally grown vegetables at least twice a week and 41% ate game, though fish was consumed less frequently. Traditional foods (e.g., wild fish, moose meat) were enjoyed by students in both MK and HG, and in both communities, students indicated that they would eat more if these foods were served more frequently at home or in school.
DISCUSSION:
Results from these studies support other findings showing that Indigenous youth appear to have diets low in fruits and vegetables, milk and alternatives, and high in energy dense foods. While this is not unique to Indigenous youth populations in Canada, comparative data suggest that Indigenous youth more frequently consume sugary drinks. Moreover, open ended feedback from youth and community members point to concerns about food insecurity and even hunger in remote and rural Indigenous communities, suggesting that food access, availability and affordability are among the environmental factors that may contribute to the suboptimal diet quality. Community findings also point to strengths, including preference for nutrient-dense traditional foods and limited exposure to ‘fast’ foods and restaurant meals. The findings also underline the importance of school programmes. Students reported frequent consumption of lunch in school, and also enjoy eating and learning about traditional foods and culture.
The inherent flexibility of the LC model means that communities can prioritise activities of interest to them and tailor evaluation processes accordingly. Indigenous leadership and local champions are essential to the success of such initiatives. Consideration should be given to amount of funding available, and to funding timescales for projects that require a high level of community engagement. Recommendations based on community input may help to enhance uptake of the model in other contexts and ongoing local food initiatives in these and similar communities across Canada.
This study documents a large amount of work carried out by the four communities over three years and celebrates their creativity, commitment to youth and great achievements. There were many examples of a reclamation of traditional food culture and a transition to greater food sovereignty. Many unique Indigenous school food-related initiatives were debuted here that may serve as an inspiration for other communities.
CONCLUSION:
The LC approach is a feasible and appropriate way of engaging community to support access to local and traditional foods and associated knowledge and practices among Indigenous youth, and support food sovereignty among Indigenous communities in rural and remote locations. A reliance on school lunch and a desire to eat more traditional foods should be considered when programmes are developed in similar communities. | en |
