Contextual determinants of health behaviours in an aboriginal community in Canada: pilot project

BMC Public Health

Sonia S Anand³  Andrew Mente³  Clara Chow¹  Ananya Banerjee⁴  Honey McCarthy²  Karen Hill²  Ruby Miller²  A Darlene Davis²  Pamela Joseph³ 

[1] Population Health Research Institute, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada;Six Nations Health Services, 1745 Chiefswood Road, Ohsweken, ON, N0A 1M0, Canada;Chanchlani Research Centre, McMaster University, 1280 Main St. W., MDCL Rm. 3204, Hamilton, Ontario, L8S 4K1, Canada;Department of Medicine and Epidemiology, McMaster University, 1280 Main St, Hamilton, Ontario, L8S 4K1, Canada

关键词: Environment design;    Health behaviours;    Aboriginal health;    Obesity;   

Others  :  1162877
DOI  :  10.1186/1471-2458-12-952

 received in 2012-06-29, accepted in 2012-10-31,  发布年份 2012

【 摘 要 】

Background

Rapid change in food intake, physical activity, and tobacco use in recent decades have contributed to the soaring rates of obesity, type 2 diabetes and cardiovascular disease (CVD) in Aboriginal populations living in Canada. The nature and influence of contextual factors on Aboriginal health behaviours are not well characterized.

Methods

To describe the contextual determinants of health behaviours associated with cardiovascular risk factors on the Six Nations reserve, including the built environment, access and affordability of healthy foods, and the use of tobacco.

In this cross-sectional study, 63 adults from the Six Nations Reserve completed the modified Neighbourhood Environment Walkability Scale (NEWS), questionnaire assessing food access and availability, tobacco pricing and availability, and the Environmental Profile of Community Health (EPOCH) tool.

Results

The structured environment of Six Nations Reserve scored low for walkability, street connectivity, aesthetics, safety, and access to walking and cycling facilities. All participants purchased groceries off-reserve, although fresh fruits and vegetables were reported to be available and affordable both on and off-reserve. On average $151/week is spent on groceries per family. Ninety percent of individuals report tobacco use is a problem in the community. Tobacco is easily accessible for children and youth, and only three percent of community members would accept increased tobacco taxation as a strategy to reduce tobacco access.

Conclusions

The built environment, access and affordability of healthy food and tobacco on the Six Nations Reserve are not perceived favourably. Modification of these contextual factors described here may reduce adverse health behaviours in the community.

【 授权许可】

   
2012 Joseph et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Anand SS, Yusuf S, Jacobs R, Davis AD, Yi Q, Gerstein H, Montague PA, Lonn E: Risk factors, atherosclerosis, and cardiovascular disease among aboriginal people in Canada: The study of health assessment and risk evaluation in aboriginal peoples (SHARE-AP). Lancet 2001, 358(9288):1147-1153.
• [2]Harris SB, Gittelsohn J, Hanley A, Barnie A, Wolever TM, Gao J, Logan A, Zinman B: The prevalence of NIDDM and associated risk factors in native Canadians. Diabetes Care 1997, 20(2):185-187.
• [3]Story M, Evans M, Fabsitz RR, Clay TE, Holy Rock B, Broussard B: The epidemic of obesity in American Indian communities and the need for childhood obesity-prevention programs. Am J Clin Nutr 1999, 69(4 Suppl):747S-754S.
• [4]Anand SS, Davis AD, Ahmed R, Jacobs R, Xie C, Hill A, Sowden J, Atkinson S, Blimkie C, Brouwers M, Morrison K, de Koning L, Gerstein H, Yusuf S, SHARE-AP ACTION Investigators: A family-based intervention to promote healthy lifestyles in an aboriginal community in Canada. Can J Public Health 2007, 98(6):447-452.
• [5]Ho LS, Gittelsohn J, Rimal R, Treuth MS, Sharma S, Rosecrans A, Harris SB: An integrated multi-institutional diabetes prevention program improves knowledge and healthy food acquisition in Northwestern Ontario First Nations. Health Educ Behav 2008, 35:561-573.
• [6]Paradis G, Levesque L, Macaulay AC, Cargo M, McComber A, Kirby R, Receveur O, Kishchuk N, Potvin L: Impact of a diabetes prevention program on body size, physical activity, and diet among kanien’keha:Ka (mohawk) children 6 to 11 years old: 8-year results from the kahnawake schools diabetes prevention project. Pediatrics 2005, 115(2):333-339.
• [7]Saksvig BI, Gittelsohn J, Harris SB, Hanley AJ, Valente TW, Zinman B: A pilot school-based healthy eating and physical activity intervention improves diet, food knowledge, and self-efficacy for native Canadian children. J Nutr 2005, 135(10):2392-2398.
• [8]Caballero B, Clay T, Davis SM, Ethelbah B, Rock BH, Lohman T, Norman J, Story M, Stone EJ, Stephenson L, Pathways Study Research Group: Pathways: A school-based, randomized controlled trial for the prevention of obesity in American Indian schoolchildren. Am J Clin Nutr 2003, 78(5):1030-1038.
• [9]Block JP, Scribner RA, DeSalvo KB: Fast food, race/ethnicity, and income: A geographic analysis. Am J Prev Med 2004, 27(3):211-217.
• [10]Reidpath DD, Burns C, Garrard J, Mahoney M, Townsend M: An ecological study of the relationship between social and environmental determinants of obesity. Health Place 2002, 8(2):141-145.
• [11]Sallis JF: Measuring physical activity environments: a brief history. Am J Prev Med 2009, 36(4 Suppl):S86-S92.
• [12]Sallis JF, Saelens BE, Frank LD, Conway TL, Slymen DJ, Cain KL, Chapman JE, Kerr J: Neighborhood built environment and income: examining multiple health outcomes. Soc Sci Med 2009, 68(7):1285-1293.
• [13]Leslie E, Saelens B, Frank L, Owen N, Bauman A, Coffee N, Hugo G: Residents’ Perceptions of walkability attributes in objectively different neighbourhoods: a pilot study. Health Place 2005, 11(3):227-236.
• [14]Wendel-Vos W, Droomers M, Kremers S, Brug J, van Lenthe F: Potential environmental determinants of physical activity in adults: a systematic review. Obes Rev 2007, 8(5):425-440.
• [15]Gittelsohn J, Sharma S: Physical, consumer, and social aspects of measuring the food environment among diverse low-income populations. Am J Prev Med 2009, 36(4 Suppl):S161-S165.
• [16]Donkin AJM, Dowler EA, Stevenson SJ, Turner SA: Mapping access to food in a deprived area: the development of price and availability indices. Public Health Nutr 2000, 3:31-38.
• [17]Hopkins DP, Briss PA, Ricard CJ, Husten CG, Carande-Kulis VG, Fielding JE, Alao MO, McKenna JW, Sharp DJ, Harris JR, Woollery TA, Harris KW, Task Force on Community Prevention Services: Reviews of evidence regarding interventions to reduce tobacco use and exposure to environmental tobacco smoke. Am J Prev Med 2001, 20(2, Supplement 1):16-66.
• [18]Community Profile: Six nations. 2007. Available online at: http://www.sixnations.ca/CommunityProfile.htm webcite (accessed January 19, 2012)
• [19]Statistics Canada: Six nations (part) 40, Ontario (Code3528037) (table)2006 Community Profiles. 2006 Census. Statistics Canada. Catalogue no. 92-591-XWE. Ottawa. Released March 13, 2007. 2007. http://www12.statcan.ca/census-recensement/2006/dp-pd/prof/92-591/index.cfm?Lang=E webcite (accessed January 19, 2012)
• [20]Saelens BE, Sallis JF, Black JB, Chen D: Neighbourhood-based differences in physical activity: an environmental scale evaluation. Am J Public Health 2003, 93:1552-1558.
• [21]Adams MA, Ryan S, Kerr J, Sallis JF, Patrick K, Frank LD, Norman GJ: Validation of the neighborhood environment walkability scale (NEWS) items using geographic information systems. J Phys Act Health 2009, 6(Suppl 1):S113-S123.
• [22]Brownson RC, Chang JJ, Eyler AA, Ainsworth BE, Kirtland KA, Saelens BE, Sallis JF: Measuring the environment for friendliness toward physical activity: a comparison of the reliability of 3 questionnaires. Am J Public Health 2004, 94(3):473-483.
• [23]Huang SJ, Hung WC, Sharpe PA, Wai JP: Neighborhood environment and physical activity among urban and rural schoolchildren in taiwan. Health Place 2010, 16(3):470-476.
• [24]Teo K, Chow CK, Vaz M, Rangarajan S, Yusuf S, PURE Investigators-Writing G: The prospective urban rural epidemiology (PURE) study: Examining the impact of societal influences on chronic noncommunicable diseases in low-, middle-, and high-income countries. Am Heart J 2009, 158(1):1-7. e1
• [25]Badland HM, Schofield GM, Witten K, Schluter PJ, Mavoa S, Kearns RA, Hinckson EA, Oliver M, Kaiwai H, Jensen VG, et al.: Understanding the relationship between activity and neighbourhoods (URBAN) study: research design and methodology. BMC Publ Health 2009, 9:224.
• [26]Baranowski T, Missaghian M, Broadfoot A, Watson K, Cullen K, Nicklas T, Fisher J, Baranowski J, O’Donnell S: Fruit and vegetable shopping practices and social support scales: a validation. J Nutr Educ Behav 2006, 38(6):340-351.
• [27]Beebe TJ, Harrison PA, Sharma A, Hedger S: The community readiness survey. development and initial validation. Eval Rev 2001, 25(1):55-71.
• [28]Chow CK, Lock K, Madhavan M, Corsi DJ, Gilmore AB, Subramanian SV, Li W, Swaminathan S, Lopez-Jaramillo P, Avezum A, Lear SA, Dagenais G, Teo K, McKee M, Yusuf S: Environmental profile of a community’s health (EPOCH): An instrument to measure environmental determinants of cardiovascular health in five countries. PLoS One 2010, 5(12):e14294.
• [29]Merchant AT, Dehghan M, Behnke-Cook D, Anand SS: Diet, physical activity, and adiposity in children in poor and rich neighbourhoods: a cross-sectional comparison. Nutr J 2007, 6(1):1.
• [30]Statistics Canada: Spending patterns in Canada 2009. Income statistics division. Statistics Canada. Catalogue no. 62-202-X. Ottawa. 2010. http://www.statcan.gc.ca/pub/62-202-x/62-202-x2008000-eng.pdf webcite (accessed January 21, 2012)
• [31]Statistics Canada: Ontario (Code35) (table). aboriginal population profile. 2006 census. Statistics Canada. catalogue no. 92-594-XWE. Ottawa; 2007. Released January 15, 2008. http://www12.statcan.ca/census-recensement/2006/dp-pd/prof/92-594/index.cfm?Lang=E webcite (accessed January 21, 2012)
• [32]Statistics Canada: Census trends for Ontario (table). census trends. 2006 census. Statistics Canada. Catalogue no. 92-596-XWE.Released December 4, 2007. Ottawa; 2007. http://www12.statcan.gc.ca/census-recensement/2006/dp-pd/92-596/index-eng.cfm webcite (accessed January 21, 2012)
• [33]Baker PRA, Francis DP, Soares J, Weightman AL, Foster C: Community wide interventions for increasing physical activity. Cochrane Database Syst Rev 2011, (4):CD008366.
• [34]Giskes K, Van Lenthe FJ, Brug J, Mackenbach JP, Turrell G: Socioeconomic inequalities in food purchasing: the contribution of respondent-perceived and actual (objectively measured) price and availability of foods. Prev Med 2007, 45(1):41-48.
• [35]Casagrande SS, WhittGlover MC, Lancaster KJ, OdomsYoung AM, Gary TL: Built environment and health behaviors among African Americans: a systematic review. Am J Prev Med 2009, 36(2):174-181.
• [36]Lucan SC, Barg FK, Long JA: Promoters and barriers to fruit, vegetable, and fast-food consumption among urban, low-income african americans–a qualitative approach. Am J Public Health 2010, 100(4):631-635.
• [37]Giskes K, van Lenthe F, Avendano-Pabon M, Brug J: A systematic review of environmental factors and obesogenic dietary intakes among adults: Are we getting closer to understanding obesogenic environments? Obes Rev 2011, 12(5):e95-e106.
• [38]Gittelsohn J, Rowan M: Preventing diabetes and obesity in American Indian communities: the potential of environmental interventions. Am J Clin Nutr 2011, 93(5):1179S-1183S.
• [39]Schinke SP, Tepavac L, Cole KC: Preventing substance use among native American youth: three-year results. Addict Behav 2000, 25(3):387-397.
• [40]Secker-Walker RH, Gnich W, Platt S, Lancaster T: Community interventions for reducing smoking among adults. Cochrane Database Syst Rev 2002, (3):CD001745.
• [41]COMMIT Research Group: Community intervention trial for smoking cessation (COMMIT): I. cohort results from a four-year community intervention. Am J Public Health 1995, 85(2):183-192.
• [42]Department of Justice: Indian Act. R.S.C., 1985, c.1-5. (section 87 taxation). 2011.
• [43]RC4072 First nations Tax (FNT). Canadian revenue agencyAvailable online at: http://www.cra-arc.gc.ca/E/pub/gp/rc4072/README.html webcite (Accessed November 25, 2011)
• [44]Graham J, Bruhn J: In praise of taxes: the link between taxation and good governance for first nations communities (policy brief No. 32). 2009. [Institute of governance] Available online at: http://iog.ca/en/publications/praise-of-taxes-link-between-taxation-and-good-governance-first-nations-context webcite (Accessed November 25, 2011)
• [45]Wardman AE, Khan NA: Registered Indians and tobacco taxation: a culturally-appropriate strategy? Can J Public Health 2005, 96(6):451-453.
• [46]Stephens T, Pederson LL, Koval JJ, Macnab J: Comprehensive tobacco control policies and the smoking behaviour of Canadian adults. Tob Control 2001, 10:317-322.
• [47]Yach D, Hawkes C, Epping-Jordan JE, Galbraith S: The world health organization’s framework convention on tobacco control: Implications for global epidemics of food-related deaths and disease. J Public Health Policy 2003, 24(3–4):274-290.
• [48]Martin-Moreno JM, Apfel F, Sanchez JLA, Galea G, Jakab Z: The social nature of chronic noncommunicable diseases and how to tackle them through communication technology, training, and outreach. J Health Commun 2011, 16:94-106.
• [49]Caspi C, Sorensen G, Subramanian SV, Kawachi I: The local food environment and diet: a systematic review. Health Place 2012, 18(5):1172.
• [50]Feng J, Glass TA, Curriero FC, Stewart WF, Schwartz BS: The built environment and obesity: a systematic review of the epidemiologic evidence. Health Place 2010, 16(2):175-190.
• [51]Gebel K, Bauman A, Owen N: Correlates of non-concordance between perceived and objective measures of walkability. Ann Behav Med 2009, 37(2):228-238.
• [52]McKinnon RA, Reedy J, Morrissette MA, Lytle LA, Yaroch AL: Measures of the food environment: a compilation of the literature. 1990–2007. Am J Prev Med 2009, 36(4 Suppl):S124-S133.
• [53]Teufel-Shone NI, Fitzgerald C, Teufel-Shone L, Gamber M: Systematic review of physical activity interventions implemented with american indian and alaska native populations in the united states and Canada. Am J Health Promot 2009, 23(6):S8-S32.
• [54]Sharma S, Gittelsohn J, Rosol R, Beck L: Addressing the public health burden caused by the nutrition transition through the healthy foods north nutrition and lifestyle intervention programme. J Hum Nutr Diet 2010, 23(Suppl 1):120-127.