Perceived community environment and physical activity involvement in a northern-rural Aboriginal community

Built and natural environment correlates of physical activity of adults living in rural areas: a systematic review

BACKGROUND

According to social-ecological models, the built and natural environment has the potential to facilitate or hinder physical activity (PA). While this potential is well researched in urban areas, a current systematic review of how the built and natural environment is related to PA in rural areas is lacking.

METHODS

We searched five databases and included studies for adults (18-65 years) living in rural areas. We included quantitative studies investigating the association between any self-reported or objectively measured characteristic of the built or natural environment and any type of self-reported or objectively measured PA, and qualitative studies that reported on features of the built or natural environment perceived as barriers to or facilitators of PA by the participants. Screening for eligibility and quality assessment (using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields) were done in duplicate. We used a narrative approach to synthesize the results.

RESULTS

Of 2432 non-duplicate records, 51 quantitative and 19 qualitative studies were included. Convincing positive relationships were found between the availability and accessibility of places for exercise and recreation and leisure-time PA as well as between the overall environment and leisure-time PA. Possible positive associations were found between the overall environment and total and transport-related PA, between greenness/natural environment and total PA, between cycling infrastructure and aesthetics and MVPA, and between pedestrian infrastructure and total walking. A possible negative relationship was found between safety and security and total walking. Qualitative studies complemented several environmental facilitators (facilities for exercise and recreation, sidewalks or streets with low traffic, attractive natural environment) and barriers (lack of facilities and destinations, lack of sidewalks, speeding traffic and high traffic volumes, lack of street lighting).

CONCLUSIONS

Research investigating the relationship between the built and natural environment and PA behaviors of adults living in rural areas is still limited and there is a need for more high-quality and longitudinal studies. However, our most positive findings indicate that investing in places for exercise and recreation, a safe infrastructure for active transport, and nature-based activities are possible strategies that should be considered to address low levels of PA in rural adults.

TRIAL REGISTRATION

PROSPERO: CRD42021283508.

Physical Activity Among Older Women Living in Rural Areas in Canada: A Scoping Review

Although there is strong evidence linking physical activity in older age with wellbeing and health benefits, these relationships tend to be under-researched in a rural context. A scoping review was conducted to identify what is known about physical activity among older women living in rural Canada. The search strategy was intentionally broad, with eight databases, academic journals, and websites scanned for research and grey literature related to Canada, in English, from 2000 to 2022. 33 studies, reviews, and reports were included in the final selection. These articles indicate that physical activity among older women living in rural Canada is influenced by a multitude of layers, contexts, conditions, and environments, with outcomes dependent on a mixture of personal, relational, community, societal, and governmental factors. In general, the women are committed to creating and maintaining an active lifestyle, and supporting their local rural community to enable these activities. While the social environment can proscribe physical activity through ageist attitudes and restrictive socio-cultural norms, social support from family and community members mitigates against these constraints. Rural infrastructure, geography, climate (seasons and weather), as well as transportation and policy issues may also impede the physical activity opportunities of the women. Some of the problems related to sustaining and resourcing recreational activity in rural communities are partly addressed through the implications presented in the articles. Among others, these suggestions relate to leadership and learning opportunities, public engagement, and the partnership working involved in supporting physical activity in rural areas. However, further research is long overdue.

First Nations Peoples' Eating and Physical Activity Behaviors in Urban Areas: A Mixed-Methods Approach

The dietary transition from traditional to commercial foods and a decrease in physical activity (PA) have impacted the health of the First Nations people of Quebec (Canada), resulting in many suffering from multiple chronic diseases. This study had two objectives: (1) to examine eating and PA behaviors among First Nations peoples in urban areas and (2) to explore the associated health representations. To achieve these objectives, a mixed-methods approach, including a questionnaire (n = 32) and a semi-structured interview (n = 14), was used to explore the participants' lifestyle profiles and health experiences. The questionnaire focused on the eating and PA behaviors of First Nations people and their underlying motivations. At the same time, the interviews investigated their health views on diet and PA behaviors based on the conceptual framework of health and its determinants. According to the participants, health is the autonomy to live without pain by maintaining a balance between physical and psychological aspects, eating healthy and exercising. Family and work influence participants' PA and eating behaviors. Exploring First Nations people's beliefs and perceptions and the motivations underlying their health behaviors could help encourage the maintenance of a healthy lifestyle despite multiple chronic health conditions.

Health and Wellness Impacts of Traditional Physical Activity Experiences on Indigenous Youth: A Systematic Review

Traditional physical activities have numerous physiological and psychosocial benefits for Indigenous youth around the world. Little is known about the positive health and wellness impacts of traditional physical activity experiences on Indigenous youths. The aim of this systematic review is to explore the holistic health and wellness impacts of traditional physical activities on Indigenous youth from certain North American and Oceania geographic areas. A systematic search of four electronic databases (PubMed, ERIC, Scopus and Web of Science) was conducted to identify peer-reviewed publications of qualitative research exploring the diverse health experiences of traditional physical activities for Indigenous youth in Canada, the United States of America, New Zealand and Australia. A qualitative synthesis of studies between 2006 and 2018 were included, and findings were synthesized using an integrated Indigenous-ecological model, which broadly captures health and wellness impacts under intrapersonal, interpersonal, organizational, community and policy level outcomes using medicine wheel teachings. In total, nine studies were identified via this search. Overall, the literature described numerous emotional, mental and spiritual benefits of traditional physical activity, and youth experiences were affected by familial and communal relationships, and systemic factors. Among Indigenous youth, this research shows the importance of including traditional physical activity in future programs and partnerships with community expertise.

Affective response as a mediator of the association between the physical and social environment and physical activity behavior

Perceptions of the physical and social environment have been shown to be predictive of physical activity (PA) behavior. However, the mechanisms of this association have not been examined. Affective response to PA was examined as a putative mediator of the association between perceptions of the PA environment and subsequent PA behavior. As part of a PA promotion study, 59 low-active overweight or obese but otherwise healthy adults completed real-time assessments of the perceived physical and social PA environment, affective response to PA, and PA behavior over a 6-month period. As hypothesized, decreased latency to and greater duration of subsequent PA was predicted by engaging in PA with a partner (b = 17.24, SE = .45, p < .01), engaging in PA outdoors versus indoors (b = 3.70, SE = 0.67, p < .01), and perceived pleasantness of the physical (b = 0.59, SE = .17, p < .01) and social settings (b = 0.68, SE = .16, p < .01). Affective response to PA (a shift toward feeling good versus bad during PA) mediated the association between engaging in PA with a partner (a path: 0.53(.11), p < .01, b path: 0.42(.12), p < .01, ab path: 0.22(.08), 95% CI .09-.41) and perceived pleasantness of the physical (a path: .38(.02), p < .01; b path: .65(.23), p = .01; ab path: .25(.09), 95% CI .08-.43) and social setting (a path: .35(.02), p < .01; b path: .57(.23), p = .01; ab path: .20(.08), 95% CI .03-.37) and PA behavior, but not the association between engaging in PA outdoors versus indoors and PA behavior. These findings suggest that perceived environmental variables may have their effects on PA through the process of psychological hedonism.

Cultural connectedness as a determinant of physical activity among Indigenous adults in Saskatchewan

Cultural connectedness has been associated with increased self-esteem and mental health among Indigenous Peoples. Physical activity is an important contributor to health, although the importance of culture as a determinant of physical activity for Indigenous Peoples in Canada is unclear. The purpose of this study is to evaluate differences in cultural connectedness between Indigenous adults in Canada achieving high and low physical activity levels. Questionnaires evaluated cultural connectedness and physical activity. Indigenous adults were classified into high and low physical activity groups at the specific group mean and as meeting or not meeting musculoskeletal activity guidelines of twice per week. First Nations and specifically Cree/Nehiyaw First Nations adults who were more physically active reported greater identity, spirituality, traditions, exploration, commitment, affirmation/belonging, and overall cultural connectedness. Cultural connectedness elements of commitment, exploration, identity, affirmation/belonging, traditions, spirituality, and overall cultural connectedness were not different between high and low physical activity Métis adults. Musculoskeletal activity was not associated with any elements of cultural connectedness among any Indigenous identity. Cultural connectedness is a protective factor for physical activity among First Nations and Cree/Nehiyaw First Nations adults, but not among Métis adults in Canada. Novelty Musculoskeletal activity was not associated with cultural connectedness. Cultural connectedness is a protective factor of physical activity for First Nations adults. Moving away from one's home community was associated with lower cultural connectedness for Indigenous Peoples.

The linkage between the perception of neighbourhood and physical activity in Guangzhou, China: using street view imagery with deep learning techniques

BACKGROUND

Neighbourhood environment characteristics have been found to be associated with residents' willingness to conduct physical activity (PA). Traditional methods to assess perceived neighbourhood environment characteristics are often subjective, costly, and time-consuming, and can be applied only on a small scale. Recent developments in deep learning algorithms and the recent availability of street view images enable researchers to assess multiple aspects of neighbourhood environment perceptions more efficiently on a large scale. This study aims to examine the relationship between each of six neighbourhood environment perceptual indicators-namely, wealthy, safe, lively, depressing, boring and beautiful-and residents' time spent on PA in Guangzhou, China.

METHODS

A human-machine adversarial scoring system was developed to predict perceptions of neighbourhood environments based on Tencent Street View imagery and deep learning techniques. Image segmentation was conducted using a fully convolutional neural network (FCN-8s) and annotated ADE20k data. A human-machine adversarial scoring system was constructed based on a random forest model and image ratings by 30 volunteers. Multilevel linear regressions were used to examine the association between each of the six indicators and time spent on PA among 808 residents living in 35 neighbourhoods.

RESULTS

Total PA time was positively associated with the scores for "safe" [Coef. = 1.495, SE = 0.558], "lively" [1.635, 0.789] and "beautiful" [1.009, 0.404]. It was negatively associated with the scores for "depressing" [- 1.232, 0.588] and "boring" [- 1.227, 0.603]. No significant linkage was found between total PA time and the "wealthy" score. PA was further categorised into three intensity levels. More neighbourhood perceptual indicators were associated with higher intensity PA. The scores for "safe" and "depressing" were significantly related to all three intensity levels of PA.

CONCLUSIONS

People living in perceived safe, lively and beautiful neighbourhoods were more likely to engage in PA, and people living in perceived boring and depressing neighbourhoods were less likely to engage in PA. Additionally, the relationship between neighbourhood perception and PA varies across different PA intensity levels. A combination of Tencent Street View imagery and deep learning techniques provides an accurate tool to automatically assess neighbourhood environment exposure for Chinese large cities.

A systematic review and meta-analysis of cardiorespiratory fitness among Indigenous populations in North America and circumpolar Inuit populations

Indigenous populations experience health disparities including increased obesity, diabetes and cardiovascular disease rates. Cardiorespiratory fitness is beneficial for maintaining positive health outcomes. The objective of this systematic review is to evaluate cardiorespiratory fitness among Indigenous populations including comparisons across genders, Indigenous identities, age groups, decades, socio-demographic variables and in comparison to non-Indigenous groups. Included articles reported various cardiorespiratory fitness measures using maximal treadmill or cycle ergometer tests, 20 m shuttle run, 1 mile run/walk test and 6 min walk test. From 14 databases searched in March 2017, including MEDLINE, EMBASE and Scopus, 1069 citations were evaluated and 39 articles included, representing 32 investigations and 10,579 individuals. First Nations/American Indian (FN/AI) adults have greater cardiorespiratory fitness than Inuit. Inuit and FN/AI men and boys have higher cardiorespiratory fitness than women and girls. Lower cardiorespiratory fitness is associated with obesity, metabolic syndrome and a western lifestyle. Cardiorespiratory fitness has declined among Inuit adults, averaging 51.7 ± 7.9 mL·kg^-1·min^-1 in 1970 to 37.7 ± 6.9 mL·kg^-1·min^-1 in 2000. Among men, FN/AI have greater cardiorespiratory fitness compared to European-descents, and European-descents have greater cardiorespiratory fitness compared to Inuit. The 1 mile run/walk time showed that FN/AI boys, girls, and youth had faster times compared to European-descendants, but 20 m shuttle run showed that European-descent boys and youth advanced to further stages compared to FN/AI populations. Cardiorespiratory fitness is declining, and among some Indigenous populations to lower levels than European-descent populations. Improving cardiorespiratory fitness for Indigenous populations should be considered a primary health strategy.

A systematic review of physical activity interventions to improve physical fitness and health outcomes among Indigenous adults living in Canada

The Indigenous population of Canada faces an increased burden of chronic disease, leading to decreased life expectancy. Physical activity is an important health behaviour that improves chronic disease risk factors and physical fitness. The objective of this systematic review was to evaluate physical activity interventions in the Indigenous population in Canada to determine effects on physical activity rates, physical fitness, and health outcomes. MEDLINE, PsycINFO, EMBASE, and CINAHL were searched for peer-reviewed journal articles. Inclusion criteria were studies that examined a physical activity intervention delivered in Indigenous communities in Canada for adults over 18 years of age. Data was extracted and two authors independently rated quality of the evidence. Five studies were included in the narrative synthesis. Interventions were community-based, and three were multi-component interventions focused on preventing or managing type II diabetes. The interventions varied in their success in altering physical activity rates, with increases (n = 2), a decrease (n = 1), or non-significant changes reported (n = 2). No study reported any measure of physical fitness. BMI was reported in four studies, with only one reporting a significant decrease. Decreases in systolic blood pressure and total cholesterol were reported in two studies. There is limited evidence and a lack of robust interventions that examine the impacts of physical activity on health and fitness status in the Canadian Indigenous population. Validated, culturally relevant tools for measuring physical activity may aid in program evaluation and focused educational materials could better support population health initiatives.

TRIAL REGISTRATION

The review protocol was registered prospectively with PROSPERO (registration number: CRD42017055363).

Environmental Influences on Physical Activity among Rural Adults in Montana, United States: Views from Built Environment Audits, Resident Focus Groups, and Key Informant Interviews

Rural populations in the United States have lower physical activity levels and are at a higher risk of being overweight and suffering from obesity than their urban counterparts. This paper aimed to understand the environmental factors that influence physical activity among rural adults in Montana. Eight built environment audits, 15 resident focus groups, and 24 key informant interviews were conducted between August and December 2014. Themes were triangulated and summarized into five categories of environmental factors: built, social, organizational, policy, and natural environments. Although the existence of active living features was documented by environmental audits, residents and key informants agreed that additional indoor recreation facilities and more well-maintained and conveniently located options were needed. Residents and key informants also agreed on the importance of age-specific, well-promoted, and structured physical activity programs, offered in socially supportive environments, as facilitators to physical activity. Key informants, however, noted that funding constraints and limited political will were barriers to developing these opportunities. Since building new recreational facilities and structures to support active transportation pose resource challenges, especially for rural communities, our results suggest that enhancing existing features, making small improvements, and involving stakeholders in the city planning process would be more fruitful to build momentum towards larger changes.

A Qualitative Study of Environmental Factors Important for Physical Activity in Rural Adults

PURPOSE

Despite increasing evidence that the physical environment impacts on physical activity among urban-dwellers, little attention has been devoted to understanding this relationship in rural populations. Work in this area is further hindered by a lack of environmental measures specifically designed for rural settings. This qualitative study aimed to explore the salience of urban physical activity environment constructs among rural adults.

METHODS

In 2011, 49 rural men and women from three distinct areas (coastal, animal-based farming, forestry/plant-based farming) of rural Tasmania, Australia, were purposively recruited to participate in semi-structured interviews. Interviews explored features of the built and social environment commonly examined in studies of urban adults, including functional characteristics (eg, lighting, footpaths, roads/verges), road and personal safety, availability and accessibility of places to be active, destinations, and aesthetics. Interviews were recorded, transcribed verbatim and analysed using a content-thematic approach using QSR NVivo software.

FINDINGS

While some urban environmental constructs were salient to these rural adults, such as availability of and accessibility to places to be active, some constructs were operationalised differently, such as road safety (where large trucks and winding roads rather than traffic density was of concern), or were not considered relevant (eg, personal safety related to crime, availability of walkable destinations, aesthetics).

CONCLUSIONS

The measurement of the physical environment in rural populations may require reconsideration and/or modification to ensure salience and appropriate quantification of associations with physical activity in future studies.

Bird harvesting practices and knowledge, risk perceptions, and attitudes regarding avian influenza among Canadian First Nations subsistence hunters: implications for influenza pandemic plans

BACKGROUND

There is concern of avian influenza virus (AIV) infections in humans. Subsistence hunters may be a potential risk group for AIV infections as they frequently come into close contact with wild birds and the aquatic habitats of birds while harvesting. This study aimed to examine if knowledge and risk perception of avian influenza influenced the use of protective measures and attitudes about hunting influenza-infected birds among subsistence hunters.

METHODS

Using a community-based participatory research approach, a cross-sectional survey was conducted with current subsistence hunters (n = 106) residing in a remote and isolated First Nations community in northern Ontario, Canada from November 10-25, 2013. Simple descriptive statistics, cross-tabulations, and analysis of variance (ANOVA) were used to examine the distributions and relationships between variables. Written responses were deductively analyzed.

RESULTS

ANOVA showed that males hunted significantly more birds per year than did females (F1,96 = 12.1; p = 0.001) and that those who hunted significantly more days per year did not perceive a risk of AIV infection (F1,94 = 4.4; p = 0.040). Hunters engaged in bird harvesting practices that could expose them to AIVs, namely by cleaning, plucking, and gutting birds and having direct contact with water. It was reported that 18 (17.0%) hunters wore gloves and 2 (1.9%) hunters wore goggles while processing birds. The majority of hunters washed their hands (n = 105; 99.1%) and sanitized their equipment (n = 69; 65.1%) after processing birds. More than half of the participants reported being aware of avian influenza, while almost one third perceived a risk of AIV infection while harvesting birds. Participants aware of avian influenza were more likely to perceive a risk of AIV infection while harvesting birds. Our results suggest that knowledge positively influenced the use of a recommended protective measure. Regarding attitudes, the frequency of participants who would cease harvesting birds was highest if avian influenza was detected in regional birds (n = 55; 51.9%).

CONCLUSIONS

Our study indicated a need for more education about avian influenza and precautionary behaviours that are culturally-appropriate. First Nations subsistence hunters should be considered an avian influenza risk group and have associated special considerations included in future influenza pandemic plans.

Assessing environmental support for better health: active living opportunity audits in rural communities in the southern United States

OBJECTIVE

Leisure-time physical activity in the United States is lower rural areas and the South and has been linked to socioeconomic and environmental aspects of where people live. The purpose of this study is to assess the built environment and policies for physical activity in rural communities.

METHODS

Eight rural communities in Alabama and Mississippi were assessed in 2011 using the Rural Active Living Assessment (RALA) street segment (SSA), town-wide (TWA), and town program and policies (PPA) assessment tools. Community Health Advisors Trained as Research Partners (CHARPS) and local staff conducted the assessments. The TWA and PPA were scored by domain and total scores. Data were analyzed using descriptive and nonparametric statistics.

RESULTS

117 segments were assessed in 22 towns in 8 counties. Built environmental barriers existed in all communities. Sidewalks were available in only 10-40% of the segments. TWA identified parks and playgrounds as the most available community feature. PPA scores indicated few policies for physical activity outside of school settings with mean scores higher in Mississippi compared to Alabama (61 vs. 49, respectively).

CONCLUSIONS

Multiple components of rural communities can be successfully assessed by CHARPs using RALA tools, providing information about resources and barriers for physical activity.

Associations between perceived and observational physical environmental factors and the use of walking paths: a cross-sectional study

Background

How to promote physical activity is an important public health problem that is attracting increasing attention. Although the application of environmental approaches is believed to promote resident walking, there remains insufficient evidence of the effectiveness of these interventions.

Methods

This study employed direct observation and questionnaires. Observations were performed on each Tuesday, Thursday, Saturday, and Sunday from April 13th to May 16th. Fourteen trained observers observed six community walking paths, and an additional walking path in a park. The trained observers filled out 2388 observation forms in the field, including 228 forms rating the permanent environment, and 1080 forms assessing the current environment and counting the number of walkers. A total of 1800 questionnaireswere administered to community residents.

Results

The results of both observation and questionnaires showed good association regarding the characteristics of walking path users (for observation, female = 54.4%; for questionnaire interviews, female, OR = 1.441), and the environmental features associated with walking path utilization (for observation, positive associations were observed between the utilization index and observational environmental variables; for questionnaire interviews, roads and aesthetics were important, OR = 1.044). There were positive associations between path use and time, a preference for brisk walking, and the observed current and permanent environmental variables. Female participants were more likely to use walking paths than males (OR = 1.441, 95% confidence interval [CI] 1.126–1.846). BMI and traffic hazard safety were significantly negatively associated with walking path use (OR = 0.948, 95% CI 0.915–0.981, and OR = 0.933, 95% CI 0.887–0.981, respectively). Roads, aesthetics, and knowledge of physical activity were significantly positively correlated with use of walking paths (OR = 1.044, 95% CI 1.017–1.072, and OR = 1.175, 95% CI 1.043–1.323). Participants that resided further than 1 km from the park were less likely to use walking paths (OR = 0.703, 95% CI 0.530–0.933). Gender-specific associations were also found.

Conclusions

Both perceived and objective environmental factors were associated with walking path use. Data suggested that the permanent and current conditions of the paths might influence walking path utilization, and that gender-specific promotion strategies should be considered.

The Association between walking and perceived environment in Chinese community residents: a cross-sectional study

Background

The neighborhood environment, as a determinant of walking, has been assessed in several developed countries. However, few studies have investigated these associations in Chinese populations.

Objective

To examine the association between the perceived neighborhood environment and walking for recreation or transportation purposes among Chinese community residents.

Methods

We used a multi-stage stratified random sampling design to conduct a cross-sectional study of 1528 Chinese adults in Shanghai. Environmental and walking variables were assessed using a revised Abbreviated Neighborhood Environment Walkability Scale for Chinese subjects and a long version of International Physical Activity Questionnaire. Self-reported demographic variables including gender, age, employment status, and location of community were also collected. Multiple logistic regression analysis was applied to examine the association between the neighborhood environment and walking.

Results

Based on the results of IPAQ, 13.7% of the overall subjects were physical inactive, which was considered to be lowly active. For all participants, accessibility to services was significantly associated with walking for both recreation and transportation (odds ratio = 1.062, 95% confidence interval: 1.016, 1.110; odds ratio = 1.053; 95% confidence interval: 1.008, 1.100, respectively). In males, accessibility to services was significantly associated both with walking for recreation and walking for transportation. However, a significantly negative association was found between the neighborhood surroundings and walking for recreation. In contrast, females who perceived good traffic safety tended to walk for recreation. Data also revealed a difference between working and retired individuals. Among working participants, perceived environmental variables were not significantly associated with walking for recreation and transportation.

Conclusions

The association between neighborhood environment and walking varied depending on the reason for walking and the characteristics of the participants. Our findings suggest that interventions to promote walking in community residents should include improving the neighborhood environment, particularly accessibility to services such as building more stores, parks, and public transit facilities.

Prevalence and severity of household food insecurity of First Nations people living in an on-reserve, sub-Arctic community within the Mushkegowuk Territory

OBJECTIVE

To measure and describe the prevalence and severity of household food insecurity in a remote on-reserve First Nations community using the Household Food Security Survey Module (HFSSM) and to evaluate the perceived relevance of the HFSSM for this population.

DESIGN

Household food security status was determined from the eighteen-item HFSSM following the classifications developed by Health Canada for the Canadian Community Health Survey, Cycle 2·2 Nutrition. One adult from each household in the community was invited to complete the HFSSM and to comment on its relevance as a tool to measure food security for First Nations communities.

SETTING

Sub-Arctic Ontario, Canada.

SUBJECTS

Households (n 64).

RESULTS

Seventy per cent of households were food insecure, 17% severely and 53% moderately. The prevalence of food insecurity in households with children was 76%. Among respondents from homes rated as having severe food insecurity, all (100 %) reported worrying that food would run out, times when food didn't last and there wasn't money to buy more, and times when they couldn't afford to eat balanced meals. The majority of respondents felt the HFSSM did not capture an accurate picture of food security for their situation. Aspects missing from the HFSSM included the high cost of market food and the incorporation of traditional food practices.

CONCLUSIONS

A high prevalence of household food insecurity was reported in this community. On-reserve remote First Nations communities may be more susceptible to food insecurity than off-reserve Aboriginal populations. Initiatives that promote food security for this vulnerable population are needed.

Giving voice to food insecurity in a remote indigenous community in subarctic Ontario, Canada: traditional ways, ways to cope, ways forward

BACKGROUND

Food insecurity is a serious public health issue for Aboriginal people (First Nations [FN], Métis, and Inuit) living in Canada. Food security challenges faced by FN people are unique, especially for those living in remote and isolated communities. Conceptualizations of food insecurity by FN people are poorly understood. The purpose of this study was to explore the perceptions of food insecurity by FN adults living in a remote, on-reserve community in northern Ontario known to have a high prevalence of moderate to severe food insecurity.

METHODS

A trained community research assistant conducted semi-directed interviews, and one adult from each household in the community was invited to participate. Questions addressed traditional food, coping strategies, and suggestions to improve community food security and were informed by the literature and a community advisory committee. Thematic data analyses were carried out and followed an inductive, data-driven approach.

RESULTS

Fifty-one individuals participated, representing 67% of eligible households. The thematic analysis revealed that food sharing, especially with family, was regarded as one of the most significant ways to adapt to food shortages. The majority of participants reported consuming traditional food (wild meats) and suggested that hunting, preserving and storing traditional food has remained very important. However, numerous barriers to traditional food acquisition were mentioned. Other coping strategies included dietary change, rationing and changing food purchasing patterns. In order to improve access to healthy foods, improving income and food affordability, building community capacity and engagement, and community-level initiatives were suggested.

CONCLUSIONS

Findings point to the continued importance of traditional food acquisition and food sharing, as well as community solutions for food systems change. These data highlight that traditional and store-bought food are both part of the strategies and solutions participants suggested for coping with food insecurity. Public health policies to improve food security for FN populations are urgently needed.

A community-based participatory approach and engagement process creates culturally appropriate and community informed pandemic plans after the 2009 H1N1 influenza pandemic: remote and isolated First Nations communities of sub-arctic Ontario, Canada

BACKGROUND

Public health emergencies have the potential to disproportionately impact disadvantaged populations due to pre-established social and economic inequalities. Internationally, prior to the 2009 H1N1 influenza pandemic, existing pandemic plans were created with limited public consultation; therefore, the unique needs and characteristics of some First Nations communities may not be ethically and adequately addressed. Engaging the public in pandemic planning can provide vital information regarding local values and beliefs that may ultimately lead to increased acceptability, feasibility, and implementation of pandemic plans. Thus, the objective of the present study was to elicit and address First Nations community members' suggested modifications to their community-level pandemic plans after the 2009 H1N1 influenza pandemic.

METHODS

The study area included three remote and isolated First Nations communities located in sub-arctic Ontario, Canada. A community-based participatory approach and community engagement process (i.e., semi-directed interviews (n = 13), unstructured interviews (n = 4), and meetings (n = 27)) were employed. Participants were purposively sampled and represented various community stakeholders (e.g., local government, health care, clergy, education, etc.) involved in the community's pandemic response. Collected data were manually transcribed and coded using deductive and inductive thematic analysis. The data subsequently informed the modification of the community-level pandemic plans.

RESULTS

The primary modifications incorporated in the community-level pandemic plans involved adding community-specific detail. For example, 'supplies' emerged as an additional category of pandemic preparedness and response, since including details about supplies and resources was important due to the geographical remoteness of the study communities. Furthermore, it was important to add details of how, when, where, and who was responsible for implementing recommendations outlined in the pandemic plans. Additionally, the roles and responsibilities of the involved organizations were further clarified.

CONCLUSIONS

Our results illustrate the importance of engaging the public, especially First Nations, in pandemic planning to address local perspectives. The community engagement process used was successful in incorporating community-based input to create up-to-date and culturally-appropriate community-level pandemic plans. Since these pandemic plans are dynamic in nature, we recommend that the plans are continuously updated to address the communities' evolving needs. It is hoped that these modified plans will lead to an improved pandemic response capacity and health outcomes, during the next public health emergency, for these remote and isolated First Nations communities. Furthermore, the suggested modifications presented in this paper may help inform updates to the community-level pandemic plans of other similar communities.

An evaluation of the physical activity and health status of British Columbian Aboriginal populations

Aboriginal people have experienced elevated rates of obesity, diabetes, cardiovascular disease, and other chronic conditions that are disproportionate to the general Canadian population. We sampled British Columbian Aboriginal populations to determine the current health status of this population. A total of 882 Aboriginal adults ≥16 years of age from 25 locations around the province were sampled from 2007–2011. Health measurements evaluated included body mass index, waist circumference, physical activity, smoking behaviours, and resting blood pressure as well as histories of diabetes, cardiovascular disease, and hypertension. Nonfasting measures of blood sugar, total cholesterol, and high-density lipoprotein cholesterol were also recorded. We used logistical regression to quantify variations in diabetes and cardiovascular disease risk factors with age, gender, geographic location, on- and off-reserve and urban–rural areas of residence, smoking, and physical activity behaviour. The prevalence of diabetes, hypertension, and high total cholesterol were found to be greater among males, while females experienced greater rates of abdominal obesity and physical inactivity. Rates of chronic conditions were similar across on- and off-reserve, urban–rural areas, and geographic region residences, though rural, on-reserve, and northern residents experienced greater risk of poor health status. Larger proportions of on-reserve, rural, and interior individuals were found to be more physically inactive. Aboriginal populations still experience substantially poorer health status in comparison with the general population. Initiatives to improve the health of this population are urgently needed addressing all sectors of the Aboriginal population, all geographic regions, and all areas of residence, with special emphasis on rural, on-reserve, and northern populations.

Assessing the influence of the built environment on physical activity for utility and recreation in suburban metro Vancouver

BACKGROUND

Physical inactivity and associated co-morbidities such as obesity and cardiovascular disease are estimated to have large societal costs. There is increasing interest in examining the role of the built environment in shaping patterns of physical activity. However, few studies have: (1) simultaneously examined physical activity for leisure and utility; (2) selected study areas with a range of built environment characteristics; and (3) assessed the built environment using high-resolution land use data.

METHODS

Data on individuals used for this study are from a survey of 1602 adults in selected sites across suburban Metro Vancouver. Four types of physical activity were assessed: walking to work/school, walking for errands, walking for leisure and moderate physical activity for exercise. The built environment was assessed by constructing one-kilometre road network buffers around each respondent's postal code. Measures of the built environment include terciles of recreational and park land, residential land, institutional land, commercial land and land use mix.

RESULTS

Logistic regression analyses showed that walking to work/school and moderate physical activity were not associated with any built environment measure. Living in areas with lower land use mix, lower commercial and lower recreational land increased the odds of low levels of walking for errands. Individuals living in the lower third of land use mix and institutional land were more likely to report low levels of walking for leisure.

CONCLUSIONS

These results suggest that walking for errands and leisure have a greater association with the built environment than other dimensions of physical activity.

The 2009 H1N1 pandemic response in remote First Nation communities of Subarctic Ontario: barriers and improvements from a health care services perspective

OBJECTIVES

To retrospectively examine the barriers faced and opportunities for improvement during the 2009 H1N1 pandemic response experienced by participants responsible for the delivery of health care services in 3 remote and isolated Subarctic First Nation communities of northern Ontario, Canada.

STUDY DESIGN

A qualitative community-based participatory approach.

METHODS

Semi-directed interviews were conducted with adult key informants (n=13) using purposive sampling of participants representing the 3 main sectors responsible for health care services (i.e., federal health centres, provincial hospitals and Band Councils). Data were manually transcribed and coded using deductive and inductive thematic analysis.

RESULTS

Primary barriers reported were issues with overcrowding in houses, insufficient human resources and inadequate community awareness. Main areas for improvement included increasing human resources (i.e., nurses and trained health care professionals), funding for supplies and general community awareness regarding disease processes and prevention.

CONCLUSIONS

Government bodies should consider focusing efforts to provide more support in terms of human resources, monies and education. In addition, various government organizations should collaborate to improve housing conditions and timely access to resources. These recommendations should be addressed in future pandemic plans, so that remote western James Bay First Nation communities of Subarctic Ontario and other similar communities can be better prepared for the next public health emergency.

Environmental risk conditions and pathways to cardiometabolic diseases in indigenous populations

This review examines environments in relation to cardiometabolic diseases in Indigenous populations in developed countries. Environmental factors are framed in terms of context (features of places) and composition (features of populations). Indigenous peoples are seen to have endured sociopolitical marginalization and material disadvantage spanning generations. Past adverse collective experiences, modified by culture, are reflected by current heterogeneity in environmental context and composition. As risk conditions, unfavorable contextual and compositional exposures influence the expression of cardiometabolic risk for individuals. Minimal research has evaluated heterogeneity in risk conditions against heterogeneity in cardiometabolic diseases between or within Indigenous populations. Thus far, the features of populations, not of places themselves, have been implicated in relation to cardiometabolic diseases. Behavioral, psychosocial, and stress-axis pathways may explain the relationships between risk conditions and cardiometabolic diseases. Implications of environmental factors and their pathways as well as important research needs are discussed in relation to ecological prevention to reduce cardiometabolic diseases.

Effects of the built environment on physical activity of adults living in rural settings

OBJECTIVE

To conduct a systematic review of the literature to examine the influence of the built environment (BE) on the physical activity (PA) of adults in rural settings.

DATA SOURCE

Key word searches of Academic Search Premier, PubMed, CINAHL, Web of Science, and Sport Discus were conducted.

STUDY INCLUSION AND EXCLUSION CRITERIA

Studies published prior to June 2008 were included if they assessed one or more elements of the BE, examined relationships between the BE and PA, and focused on rural locales. Studies only reporting descriptive statistics or assessing the reliability of measures were excluded.

DATA EXTRACTION

Objective(s), sample size, sampling technique, geographic location, and definition of rural were extracted from each study. Methods of assessment and outcomes were extracted from the quantitative literature, and overarching themes were identified from the qualitative literature.

DATA SYNTHESIS

Key characteristics and findings from the data are summarized in Tables 1 through 3.

RESULTS

Twenty studies met inclusion and exclusion criteria. Positive associations were found among pleasant aesthetics, trails, safety/crime, parks, and walkable destinations.

CONCLUSIONS

Research in this area is limited. Associations among elements of the BE and PA among adults appear to differ between rural and urban areas. Considerations for future studies include identifying parameters used to define rural, longitudinal research, and more diverse geographic sampling. Development and refinement of BE assessment tools specific to rural locations are also warranted.

Physical environmental correlates of childhood obesity: a systematic review

Increasing rates of childhood obesity in the USA and other Western countries are a cause for serious public health concern. Neighborhood and community environments are thought to play a contributing role in the development of obesity among youth, but it is not well understood which types of physical environmental characteristics have the most potential to influence obesity outcomes. This paper reports the results of a systematic review of quantitative research examining built and biophysical environmental variables associated with obesity in children and adolescents through physical activity. Literature searches in PubMed, PsychInfo and Geobase were conducted. Fifteen quantitative studies met the inclusion criteria for this systematic review. The majority of studies were cross-sectional and published after 2005. Overall, few consistent findings emerged. For children, associations between physical environmental variables and obesity differed by gender, age, socioeconomic status, population density and whether reports were made by the parent or child. Access to equipment and facilities, neighborhood pattern (e.g. rural, exurban, suburban) and urban sprawl were associated with obesity outcomes in adolescents. For most environmental variables considered, strong empirical evidence is not yet available. Conceptual gaps, methodological limitations and future research directions are discussed.