Funcionamiento del display LCD

families living in geographically remote settings or on reserve (Elliot et al. 2012; Willows, 2005). In both Midland-Penetanguishene and London, caregivers spoke about difficulties accessing public transit as well as grocery stores being inconveniently located. However it is important to note that convenience and location were not the main hindrances to healthy food access, rather it was low income that made

accessing grocery stores so inconvenient. Many caregivers relied on public transit because they could not afford a car, hence the length or distance of the trips to grocery stores were affected as a result.

A number of programs and interventions in Canada place strong emphasis on educating children about healthy eating and nutrition in order to improve their health and weight status. However, little attention is paid to the applied skills that are necessary for eating healthy, such as meal preparation, harvesting, and cooking. It was interesting, albeit unsurprising, that caregivers in the focus groups expressed the need for more hands-on programs, as well as programs that educated and involved parents. They also discussed the importance of Aboriginal-specific programs which inherently took a more holistic approach to health.

There have been several Aboriginal-specific community health interventions which have proven to be effective. Two examples include the Kahnawake Schools Diabetes Prevention Project (KSDPP) and the Sandy Lake Health and Diabetes Project (SLHDP). Starting in 1994, the KSDPP aimed to reduce child obesity and prevent T2D in a First Nations community in Kahnawake, Quebec (KSDPP, 2011; Willows et al., 2012). The intervention took a community-based approach, and implemented a health education curriculum for children, school nutrition policies to support healthy eating, classroom and school activities for parents and children, as well as numerous programs within the community including walking clubs, cooking courses, and community gardens (KSDPP, 2011; Paradis et al., 2005; Willows et al., 2012). While an evaluation of the KSDPP found that children’s BMIs did not decrease over time, this may have been because the follow-up period was not long enough to observe changes in BMI.

Additionally, and the individual and family-level factors being addressed by the community initiatives are only part of the obesogenic environment children were exposed to (KSDPP, 2011; Paradis et al., 2005;

northern Ontario, and aimed to address high obesity and T2D prevalence rates as well (SLHDP, 2006; Willows et al., 2012). This project introduced educational radio programming about healthy lifestyles and activities in the community, healthy food labeling in local grocery stores, health promotion at community events and home visits, as well as walking clubs, to name a few activities (SLHDP, 2006). In 1998 to 1999, a school-based prevention program was developed which introduced a culturally sensitive

curriculum as well as a family component to involve parents as well (SLHDP, 2006). An evaluation of the school-based program found that children were more knowledgeable about nutrition and health, and had decreased the total fat in their diets overall (Saksvig et al., 2005; SLHDP, 2006). However this evaluation also did not reveal any changes to BMI or body fat percentage during the yearlong study period.

Nonetheless, this study also indicates that community-based, culture-specific programs have the potential to be more effective than other programming and have positive impacts on health behaviours (Saksvig et al., 2005; SLHDP, 2006).

One mechanism through which family-oriented programs are believed to be more effective is that family involvement allows the opportunity for role modeling. Caregivers’  behaviours  shape  the  family   environment and can reinforce either healthy or unhealthy eating and related activities (Golan & Weizman, 2001). During the focus groups, caregivers discussed role modeling healthy behaviours as an important facilitator of children eating and living healthy.

Also  consistent  with  the  literature  was  caregivers’  perception  of  traditional Aboriginal diets being healthier than market foods. In a study by Haman et al. (2010), traditional diets were identified as more nutritious than Western diets because of the focus on local, high protein foods, and absence of processed foods (Haman et al., 2010). Traditional methods of food acquisition including harvesting and hunting are also healthy behaviours because of the increased energy expenditure associated with these activities, as well as engagement with Aboriginal culture (Haman et al., 2010). While traditional foods were not explored in the APS analysis, First Nations and Métis caregivers spoke at length about the challenges they

traditional food options. As a result, children were often not introduced to traditional foods, which removed the opportunity to develop a taste for them. In a study with First Nations people living on reserve in northern Ontario, researchers found that the key barriers to traditional food consumption were food preparation and harvesting knowledge, the affordability of market foods and relative unaffordability of traditional foods, as well as access to lands where hunting was allowed (Haman et al., 2010).

Interestingly, all  of  these  issues  were  discussed  as  barriers  to  children’s  healthy  food  consumption, including traditional food consumption, by off-reserve First Nations and Métis caregivers. Another interesting point with respect to traditional food acquisition strategies was the issue of environmental contamination. Northern First Nations communities in Ontario have expressed similar concerns as several bodies of water within Canada have found contaminated fish (Haman et al., 2010). In most cases, the fear of risky environments are unwarranted, however it has resulted in decreased hunting and harvesting in areas that are suspected to be affected (Haman et al., 2010). While Midland-Penetanguishene and London are located in southern Ontario, contamination concerns as perpetuated by the media has also affected traditional food acquisition activities here as well. Irrespective of whether or not an issue actually exists, the perception is most important as it influences  caregivers’  behaviours  and  families’  diets.

Research has also established links between obesogenic food environments and  children’s  weight status. He et al. (2012) found that living in a neighbourhood that is in close proximity to convenience and fast food stores was associated with low Healthy Eating Index (HEI) scores among elementary school students (He et al., 2012). The HEI assesses diet based on the energy density of foods and provides a score out of 100, with higher numbers being associated with more healthful eating (He et al., 2012). Students who lived greater than one kilometer away from a convenience store or at least one kilometer away from three or more fast food outlets had significantly higher HEI scores than students who lived closer (He et al., 2012). Within the focus groups, the large numbers of fast food and convenience stores, as well as easy access of junk foods were discussed as important hindrances to healthy eating for children.

contributing to the obesity epidemic. Hence in addition to being role models, caregivers also sometimes play a role in creating an obesogenic environment (Golan & Weizman, 2001).

Community programs were an important strategy for improving  children’s  health,  as  well  as   coping with food insecurity. However caregivers felt that there were several barriers associated with the programming,  that  if  addressed,  would  increase  the  potential  for  these  programs’  effectiveness  and   outreach. Many caregivers in Midland-Penetanguishene and London visited food banks in order to provide food for their families. While these food banks helped ensure adequate quantity of food, the quality was often poor and not culturally appropriate, hence it did not contribute to the healthfulness of families’  diets.  Even  in  times  of  need,  caregivers  were  not  comfortable  visiting  food  banks  because  of  the   stigma associated with food charity. This deterred caregivers even in times of need, because they felt that they were being discriminated by the volunteers and also ashamed for needing to use the food bank. For Aboriginal and non-Aboriginal people alike, many people report shame associated with using food banks (Hamelin et al., 2002). This stigma is perhaps worse for Aboriginal peoples, who already tend to fall in the lower income groups and are more vulnerable to food insecurity. Hence insensitivity and

discrimination towards Aboriginal peoples in particular prevents many people from seeking help from community food initiatives like food banks (Stephens et al., 2006).