Health Canada is the federal department responsible for helping the people of Canada maintain and. improve their health We assess the safety of drugs and many consumer products help improve the safety of. food and provide information to Canadians to help them make healthy decisions We provide health services. to First Nations people and to Inuit communities We work with the provinces to ensure our health care system. serves the needs of Canadians,Published by authority of the Minister of Health. Measuring the Food Environment in Canada, is available on the Internet at the following address. www hc sc gc ca fn an nutrition pol index eng php,galement disponible en fran ais sous le titre. Mesure de l environnement alimentaire au Canada, This publication can be made available on request in a variety of alternative formats. Publications,Health Canada,Ottawa Ontario K1A 0K9,Tel 613 957 2991. Toll free 1 866 225 0709,Fax 613 941 5366,TTY 1 800 267 1245 Health Canada. Email publications hc sc gc ca, Her Majesty the Queen in Right of Canada represented by the Minister of Health 2013. This publication may be reproduced without permission provided the source is fully acknowledged. PDF Cat H164 155 2012E PDF,ISBN 978 1 100 20974 6,Pub 120182. M easuring the REPORT,F ood TITLE GOES,E nvironment in CHERE. ACKNOWLEDGEMENTS 3,1 Introduction 7,2 Literature synthesis 9. 2 1 Methodology 9, 2 2 An ecological approach to food environments 10. Conceptual models of the food environment 11, 2 3 Four relevant features of the food environment 13. Food environment assessment methods 15, 2 4 A closer look at objectively measured features of the food environment 17. Geographic food access 17,Food availability 19,Food affordability 20. Food quality 21, Some conclusions about objectively measured features of the food environment 22. 2 5 A closer look at subjectively measured features of the food environment 22. 2 6 Canadian food environments 24,Geographic areas and socio economic status 24. Canada s challenges in rural remote and northern communities 26. 2 7 Canadian evidence for the association of food environment with diet related outcomes 28. Canadian evidence on community nutrition environments 28. Canadian evidence for or against Lytle s hypothesis 29. 3 Unresolved issues and research gaps found in the literature 32. 3 1 Measuring geographic areas 32,Administrative boundaries 33. Buffer zones 33,Activity spaces 34, Challenges in defining neighbourhood food environments 34. M easuring the F ood E nvironment in C anada, 3 2 Suggested study design and measurement strategies for future research 35. Psychometric measurement approaches 35,Mixed methods study designs 35. Longitudinal study designs 36,Consistency and validity of measures 36. Community contexts 37,4 Canadian community food assessments 38. 5 Interviews with key informants 43, What primary purpose did you have for assessing the food environment 43. What types of food environment assessment methods did you use 44. What geographic scale or area did you consider most relevant 45. What outcomes did you consider relevant 45,What populations did you consider relevant 46. What are the important considerations and remaining questions 46. What are your strategies for knowledge transfer and exchange 50. 5 1 Summary of key informant interview findings 53. 6 Case studies 54, 6 1 Region of Waterloo The importance of a community university partnership 54. 6 2 Zoning regulations in Quebec The importance of champions 57. 6 3 Food access in Nunavut The importance of context 59. REFERENCES 62, APPENDIX A Reviews examining associations between food environments. and diet related outcomes 77, APPENDIX B Evidence for the existence of food deserts in Canada 80. APPENDIX C List of projects identified by key informants 83. APPENDIX D List of community food assessments completed or underway. in Canada not exhaustive 86,M easuring the REPORT,F ood TITLE GOES. E nvironment in CHERE,ACKNOWLEDGEMENTS, This paper was prepared for the Office of Nutrition Policy and Promotion Health Canada in collaboration. with a working group of the Federal Provincial Territorial Group on Nutrition The British Columbia Ministry. of Health the Government of the Northwest Territories Manitoba Health and Healthy Living and Aboriginal. Affairs and Northern Development Canada were represented on the working group. Health Canada and members of the working group helped to create the broad vision for the report and. provided input throughout the project,Key informants. The following people took part in telephone interviews or surveys They explained the ways in which. Canadian researchers and practitioners are conceptualizing and assessing food environments and using food. environment data Their varied experience and the diverse locales and communities in which they conducted. food environment research helped to paint a comprehensive picture of food environment research in. Canada The key informants were, Jill Aussant Public Health Nutritionist Chris Furgal Associate Professor. Health Promotion Department Saskatoon Indigenous Environmental Studies. Health Region Program and Co Director Nasivvik, Jennifer Black Assistant Professor Centre for Inuit Health and Changing. Food Nutrition and Health Faculty of Environments Trent University. Land and Food Systems University Rachael Goodmurphy Public Health. of British Columbia Dietitian Kingston Frontenac Lennox. Elsie DeRoose Territorial Nutritionist Addington Public Health Department. Prevention Services Child and Family Yvonne Hanson Researcher and Diversity. Services Division Northwest Territories Education Coordinator Prairie Women s. Rachel Engler Stringer Assistant Professor Health Centre of Excellence. Department of Community Health and Kristie Jameson Executive Director. Epidemiology University of Saskatchewan Food Security Network Newfoundland. Stefan Epp Koop Community Food and Labrador, Assessments Coordinator Food Matters Ellen Lo Project Manager Healthy. Manitoba Families B C British Columbia,Pat Fisher Public Health Planner Region. of Waterloo Public Health Department,M easuring the F ood E nvironment in C anada. Catherine Mah Scientist at the Centre Valerie Tarasuk Professor Department of. for Addiction and Mental Health and Head Nutritional Sciences Faculty of Medicine. of the Food Policy Research Initiative University of Toronto. Ontario Tobacco Research Unit Assistant Katie Temple Research Assistant. Professor Dalla Lana School of Public Sustainable Food Systems Project. Health University of Toronto Member Environmental Policy Institute Grenfell. Toronto Food Policy Council Campus Memorial University of. Deborah McPhail ISER Postdoctoral Fellow Newfoundland. in Community Health and Humanities Shirley Thompson Associate Professor. Faculty of Medicine Memorial University Natural Resources Institute University of. of Newfoundland Manitoba, Suzie Pellerin Director Qu bec Coalition Jennifer Wakegijig Territorial Public Health. on Weight Related Problems Coalition Nutritionist Department of Health and. qu b coise sur la probl matique du poids Social Services Government of Nunavut. Tarra Penney PhD candidate Dalhousie,University Research Associate Applied. Research Collaborations for Health,Nova Scotia,M easuring the REPORT. F ood TITLE GOES,E nvironment in CHERE, Healthy eating is central to overall health and reduces the risk of nutrition related chronic diseases and. obesity To maintain healthy eating patterns Canadians must have access to safe acceptable affordable. and nutritious foods In 2010 the Federal Provincial and Territorial FPT Ministers of Health and of. Health Promotion Healthy Living endorsed a Declaration on Prevention and Promotion and Curbing. Childhood Obesity A Federal Provincial and Territorial Framework for Action to Promote Healthy. Weights Framework, One of the policy priorities that the Framework identified is to increase the availability and accessibility of. nutritious foods particularly for vulnerable populations The food environment plays an important role in. influencing the availability of nutritious foods, The food environment includes features of the community such as the number and kinds of food outlets. in people s neighbourhoods which is often referred to as geographic food access It also features the. consumer experience such as the kinds of foods that are available affordable and of good quality Many. jurisdictions in Canada have begun to act on food environments Some have restricted geographic access. to certain kinds of food outlets such as fast food outlets or convenience stores where non nutritious. foods are readily available Others have created incentives for food outlets where nutritious foods are. readily available such as farmers markets and grocery stores. Research on the food environment is relatively new and the conflicting evidence to date dictates caution. when implementing policies or programs that aim to improve food environments That said the field of. research is promising and deserves attention and investment from a public policy perspective Environ. mental factors have the potential for a more sustained impact on health outcomes than programmatic. strategies More research in this area will help to inform the creation of effective sustainable solutions to. improve healthy eating in Canada, By means of a literature synthesis this report discusses the conceptual models and measurement approaches. currently in use in research on food environments It examines their application to the Canadian context. and the evidence available to date on the association of food environments with diet related outcomes. The report points out unresolved issues and gaps in the existing research methodology with an emphasis. on research approaches needed to address uniquely Canadian food environments such as in the North. The report then takes a closer look at the Canadian context with a review of 19 Canadian community food. assessments Through interviews with key informants across Canada the report highlights the experiences. and analysis of food researchers in communities across the country It examines in detail three case studies. of notable food environment measurement initiatives within different Canadian contexts. REH SEOG E LFTood,the I T T REOnvironment,PER in C anada. Here are the report s key findings, Most of the Canadian literature published to Food swamps neighbourhoods where. date shows associations between features of sources of high fat high calorie foods were. the food environment and residents diet plentiful were fairly consistently identified. related outcomes even after adjusting for in the community food assessments and. important confounding variables may be more important than food deserts in. In the academic literature there is not influencing residents diets. much evidence for the widespread There is not enough information about. existence of food deserts in Canada areas food environments in remote northern. where vulnerable populations have poor communities This is a significant research. geographic access to nutritious food But gap because rates of food insecurity and. there is evidence for the existence of food diet related chronic diseases are much. swamps areas of low socioeconomic higher in these communities than elsewhere. status with high geographic access to in Canada, non nutritious food sources There are many food environment assess. The review of Canadian community ments underway in Canada Community. food assessments and the key informant university partnerships can be an ideal way. interviews showed that food deserts may to conduct research that can be used for. be more common than has yet been policy and program development. identified in the academic literature,This reveals the importance of collecting. evidence from a variety of sources,REPORT TITLE GOES HERE 7. 1 INTRODUCTION, Healthy eating is central to overall health and reduces the risk of nutrition related chronic diseases. and obesity To maintain healthy eating patterns Canadians must have access to safe acceptable. affordable and nutritious foods In 2010 the Federal Provincial and Territorial FPT Ministers. of Health and of Health Promotion Healthy Living endorsed a Declaration on Prevention and. Promotion and Curbing Childhood Obesity A Federal Provincial and Territorial Framework. for Action to Promote Healthy Weights Framework, One of the policy priorities that the Framework identified is to increase the availability and. accessibility of nutritious foods particularly for vulnerable populations The food environment. plays an important role in influencing the availability of nutritious foods For the purposes of this. report we consider the food environment to be retail outlets where people can purchase foods. such as grocery stores and restaurants as well as environments where people acquire food in. traditional ways such as hunting and fishing This report does not examine the particular food. environments created in homes schools workplaces childcare centres and recreation facilities. However while the food environments within schools are out of scope for this report community. or consumer food environments around schools are the topic of much food environment research. and are within the scope of this report, The subject of food retail environments is increasing in popularity among both researchers and. policy makers Research has generally focused on differences in food environments based on. socio economic and demographic factors such as research on food deserts 1 4 or on associations. between food environments and diet related outcomes such as dietary behaviours food purchasing. weight status or diet related disease outcomes 5 12. Policy makers acknowledging the role of diet in supporting healthy communities have begun. to take action on food environments through zoning regulations mandatory menu labeling or. incentives for grocery stores in underserved areas 13 16 The evidence base for such policies has. REH SEOG E LFTood,the I T T REOnvironment,PER in C anada. yet to be solidified This is in part due to inconsistent methodology in assessing food environments. different definitions of place and the different contexts in which food environment studies have been. The purpose of this report is fivefold, 1 Describe current Canadian evidence on geographical access to nutritious food. 2 Look at the evidence of associations between food environments and diet related health outcomes. 3 Highlight the limitations and gaps in current research. 4 Explore current research aimed at measuring the food environment in Canada. 5 Describe how food environment assessment methods are being used in Canada. To fulfil objectives 1 2 and 3 we conducted a literature synthesis relying on evidence published in. academic journals up to February 2012 See Sections 2 and 3 Using the results of the literature synthesis. and with guidance from a working group of the Federal Provincial Territorial Group on Nutrition we. conducted an environmental scan and interviews with key informants to meet objectives 4 and 5 See. Sections 4 5 and 6 Key point summaries appear throughout the report. REPORT TITLE GOES HERE 9,2 LITERATURE SYNTHESIS,2 1 METHODOLOGY. We limited the literature review to studies conducted in developed countries as defined by the. World Bank The review included studies conducted among all age groups both sexes and all. ethnicities Several systematic literature reviews relevant to the food environment have emerged. over the past year 11 12 17 19 Two of the recent reviews examined food environment literature. published up until 2008 11 17 One reviewed literature published up until 2009 12 One which. examined built environment links with childhood obesity reviewed literature published up until. 2010 19 The existence of these recent studies meant that the literature review for this report could. be restricted to literature published since 2008 We also relied on 19 literature reviews published. since 2000 3 12 17 25, Four databases were searched for articles related to the food environment Web of Science. Scopus Urban Studies Planning A SAGE Full Text Collection and PubMed Medline. Searches were conducted using the following key words alone or in combination. food environment food scape food retail,grocery store supermarket. local environment neighbourhood OR neighborhood area community. nutrition diet food eating obesogenic overweight obes. food access food availability food quality food affordability OR food cost OR food pric. Asterisks represent a wild card For instance obes would search for the terms obese or. obesity pric would search for the terms price or pricing. M easuring the F ood E nvironment in C anada, Articles were kept for inclusion in the literature synthesis if. The search strings returned the deemed relevant to one or more of our five objectives listed. following hits in the Introduction After title and abstract scans 81 relevant. articles were retained The discussions in this report are. Scopus 873, informed by these findings as well as the 19 literature reviews. Web of Science 684, published since 2000 Articles related to the broader field of. Sage returned 150, obesity also inform the discussion but were not examined. PubMed 347,systematically,2 2 AN ECOLOGICAL APPROACH TO FOOD ENVIRONMENTS. In the past theories in the nutrition field about food choice have tended to emphasize factors that. influence individual decisions The idea was that with enough knowledge about healthy eating. individuals would choose nutritious diets to prevent future illness 26 However psychosocial predictors. such as beliefs and attitudes only explain a fraction of the differences in dietary patterns 27 An exclusive. focus on this approach ignores what is known about human behaviour and minimizes the importance of. evidence about the environmental assault on health 28 p 256. Obesity levels have continued to rise despite the many individual level interventions 29 Researchers and. policy makers have come to recognize that there are complex influences on individual dietary patterns. including factors such as the social and built environments 30 These are best viewed through the lens of. an ecological approach a way of approaching issues that accounts for interrelationships between. persons and settings 31 p 308 Many ecological models have been developed to try to explain the. relationships between food environments and diet related outcomes 32 The key feature of an ecological. approach is recognizing that a number of factors and contexts influence behaviour namely intrapersonal. factors such as feelings interpersonal factors such as relationships community and organizational. contexts and public policies 31 33 35, The ecological perspective has gained momentum over the past two decades 31 36 42 Our understanding. of food choices has shifted from being purely a matter of personal responsibility to a more complex. analysis embedded within various contexts,KEY POINTS. Dietary behaviour is best understood through an ecological perspective one that takes into. account many determinants at a number of levels including individual social environmental. organizational and public policies,M easuring the FREPORT TITLE GOES. ood E nvironment HERE,CONCEPTUAL MODELS OF THE FOOD ENVIRONMENT. The Framework presents a conceptual model of food availability access and utilization in the context of. food security The model is comprehensive with many determinants of healthy eating Here we discuss. two complementary conceptual models that have been developed to specifically address the food. environment which is the focus of this report, The first model by Glanz and colleagues 30 incorporates features of the food environment thought to be. related to eating patterns Figure 1, Figure 1 Model of Community Nutrition Environments 30. POLICY ENVIRONMENTAL INDIVIDUAL BEHAVIOR,VARIABLES VARIABLES VARIABLES. Community Organizational,Nutrition Nutrition,Environment Environment. Type Location of Home,Food Oultlets,stores restaurants School. Accessibility Sociodemographics,hours of operation Work. drive through,Other Psychosocial,Government Consumer Nutrition Environment. and Eating,Industry Perceived Patterns,Available healthy options. Policies Price promotion placement Nutrition,Nutrition information Environment. Information Environment,Media Advertising, In this model Community nutrition environments are reflected in measures of geographic food access. They are distinguished from consumer nutrition environments which represent characteristics of the food. environment important to consumers who have already reached their food store or restaurant destinations. For example in a consumer nutrition environment we might ask what types of foods are being promoted. And what is the relative cost of nutritious foods compared to less nutritious foods. M easuring the F ood E nvironment in C anada, Social and demographic factors such as income and age are seen as mediating or moderating the impact. of food environment variables on eating patterns In this report we look at features of the community and. consumer nutrition environments Organizational nutrition environments such as those found in homes. schools and workplaces are beyond the scope of this report. The second conceptual model developed by Lytle 43 considers how individual environmental and social. factors explain differences in eating behaviours This model proposes that the more people are restricted. by things like low income physical disability or lack of access to a vehicle or transit the more the food. environment explains about their eating behaviour, Figure 2 The relationship among individual environmental and social factors 43. 40 INDIVIDUAL FACTORS,PROPORTION OF VARIANCE,EATING BEHAVIORS. EXPLAINED FOR,0 ENVIRONMENTAL FACTORS,40 SOCIAL FACTORS. More restricted Less restricted,LEVEL OF RESTRICTION. M easuring the FREPORT TITLE GOES,ood E nvironment HERE. For example a low income person with no access to a vehicle living in a neighbourhood with poor public. transit may be more reliant on food sources within walking distance in his her neighbourhood and those. sources may offer fewer nutritious options This model suggests that eating behaviours of people who are. socially or economically disadvantaged would be more strongly associated with the quality of their food. environment whereas other factors may be more at play for people who are free to leave their immediate. food environments to access desirable retail food,KEY POINTS. Conceptual models can help organize how we think about different dietary influences and can. help us consider the differences in how food environment affects various populations. Glanz and colleagues model organizes food environment features into community geographic. food access and consumer foods available in local food outlets the cost of foods in local food. outlets and the quality of foods in local food outlets Lytle s model hypothesizes that local food. environments more strongly determine eating patterns for people who are more restricted to. staying in their neighbourhoods relative to those who can easily leave. Together these two models provide a comprehensive view of food environments and their. interactions with other variables to affect population dietary behaviours. 2 3 FOUR RELEVANT FEATURES OF THE FOOD ENVIRONMENT. Because this field is young the terminology used to describe the features of the food environment varies. In this report we use the terminology often used in the literature and this may vary from the language. used in the Framework For example the Framework defines availability of nutritious foods to mean the. supply of food to a region or community In this literature review that concept is expressed as geographic. food access The Framework defines accessibility as the ability of an individual or household to acquire. nutritious foods In this report that feature is expressed as food affordability. Four features of the food environment have been identified in the literature although terminology can. vary For the purposes of this report we define these features as follows. 1 Geographic food access refers to the geographic availability of different types of food stores. and restaurants There are various ways to measure geographic access For example one can. measure the proximity of homes to specific outlet types such as grocery stores or fast food outlets. Another measure is to count the number of convenience stores or fast food outlets within a given.
ASPCA Shelter Research Development GIS Checklist www.aspcapro.org 3 Step 1: Identify 85% of intake and spay/neuter operations in your community This might include organizations outside your own, so start a conversation with them about the goals of using GIS.
The Child Dissociative Checklist (CDC) Discussion by Ann Aukamp, MSW, BCD The CDC is a tool which compiles observations by an adult observer regarding a child's behaviors on a 20 item list. Behaviors which occur in the present and for the last 12 months are included. As a research tool, the CDC can quantify dissociative behavior for dimensional
epic Mahabharata but also as a paragon of gender and resistance in the wake of the injustices meted out on her. It is her ability to overcome adversity in a venerable manner that sets her apart from other women. As a result Draupadi becomes the most complex and controversial female character in the Hindu literature. On the one hand