phd laurentian university - cpsi, lorrilee mcgregor, have no relevant financial relationships with...

Lorrilee McGregor, PhD CandidateLaurentian University

I, Lorrilee McGregor, have no relevant financial relationships with the manufacturer(s) of commercial services discussed in this CME activity.

I do not intend to discuss any unapproved/investigational use of a commercial product/device in this presentation.

Health Behaviour Children (0 – 11) Youth (12 – 17)

Eating a nutritious balanced diet

58.6% always/almost always36.4% sometimes

23.7% always or almost always53.6% sometimes18% rarely4.7% never

Physical activity 61.9% active20.2% moderately active17.9% inactive

49.3% active22.6% moderately active28.1% inactive

Children and youth ages 5 – 17:60 minutes of moderate to vigorous intensity physical activity DAILYVigorous‐intensity activities at least 3 days per weekActivities that strengthen bone at least 3 days per week

‐Canadian Society for Exercise Physiology

Activities Children (0 – 11) Youth (12 – 17)

Television More than 1.5 hrs/day – 37%Between 1 and 1.5 hrs/day – 24.6%30 minutes to 1 hour – 23.6%Less than 30 minutes – 14.7%

More than 1.5 hrs/day – 38.6%Between 1 and 1.5 hrs/day – 24.5%1 hour or less – 37%

Computer More than 1.5 hrs/day – 8.3%Between 1 and 1.5 hrs/day – 11.4%30 minutes to 1 hour – 24.5%Less than 30 minutes – 55.8%

More than 1.5 hrs/day – 27%Between 1 and 1.5 hrs/day – 19.8%30 minutes to 1 hour – 23.5%Less than 30 minutes – 29.6%

Video games More than 1.5 hrs/day – 20.6%Between 1 and 1.5 hrs/day – 14.2%30 minutes to 1 hour – 20.7%Less than 30 minutes – 44.5%

More than 1.5 hrs/day – 29.7%Between 1 and 1.5 hrs/day – 16.8% 30 minutes to 1 hour – 19.3%Less than 30 minutes – 34.2%

Children and youth ages 5 – 17:Limiting recreational screen time to no more than 2 hours per dayLimiting motorized transport, extended sitting and time spent indoors throughout the day

‐Canadian Society for Exercise Physiology

The rate of obesity among Aboriginal children and youth living off‐reserve was high (34.5%) in comparison to the rest of the population (26.1%) (Katzmarzyk, 2008).Results from the First Nations Regional Health Survey indicate that the rate of overweight and obesity was 62.5% among Aboriginal children between the ages of 2‐11 (parent‐reported) and 43% among Aboriginal youth between the ages of 12‐17 years (self‐reported) living on‐reserve (FNIGC, 2012). 

Community/Organization Health Staff

Educators Youth Staff

Elders

Aundeck Omni Kaning 3M’Chigeeng 3 15 1Mnaamodzawin 4Noojmowin Teg 11Sheguiandah 3 1Sheshegwaning 4 5 1Whitefish River 5 5 1Wikwemikong 3 6

Wholistic view: physical, mental, emotional, social, intellectual, spiritual and environmental aspectsBalance and connectionHealthy behaviours such as eating nutritious food, being physically active and getting enough sleepBeing able to function in daily activitiesSense of control over personal healthConscientious effort to be healthyResiliencePositive outlookHappinessIndividual, family and community health

Interested and connected to the natural environmentInterested in learning about their history, language and traditionsParticipate in traditional activities and spiritual practicesSense of identity as AnishinaabepeopleStrong connection with extended familySense of communal responsibility for children and youthAccess to programs and services in the communityParticipate in activities in school, in the community and off‐reserveAware of healthy behavioursSense of humourTechnologically sophisticatedOutspoken

Low levels of physical activityPoor nutrition choicesInsufficient sleepIncrease in screen timePoor social interactionsSubstance abuseSexuality and relationshipsGender differences – girls issues were different than boysEmotional and mental health issues

DiabetesObesityAddictionsHeart diseaseHypertensionAllergiesAsthmaDental cariesFASDHigh birth weight babies

Individual level ‐ Imbalance between energy intake and output however genetics, hormones, organs, and metabolites play a role in regulating body weight.Population level – Social determinants like access to health services, food security, and the physical environment have an impact on obesity in populations

Willows, Hanley & Delormier (2012). A socioecological framework to understand weight‐related issues in Aboriginal children in Canada. Applied Physiology, Nutrition & Metabolism, 37(1), 1‐13.

To describe the prevalence of overweight and obesity based on BMI and waist circumference among Anishinaabe children in Grades 6, 7 & 8 in six First Nation communities in Northeastern Ontario;To determine whether there is a relationship between obesity rates and health behaviours(fruit and vegetable intake, sweet beverage intake, physical activity, screen time and sleep time); andTo examine cultural beliefs and practices about food and physical activity.

A mixed methods approach was used to examine the health behaviours of Aboriginal children in Grades 6, 7 & 8 living in six First Nation communities in northeastern Ontario.The health behaviours of interest  were:

physical activity,fruit and vegetable intake,sweet beverage intake,screen timesleep time

These were measured via self‐reports by Aboriginal children and their parents in six First Nation communities.

Quantitative data was gathered from students using a web‐based questionnaire and anthropometric measurements were taken.

Body Mass Index for age and genderWaist circumference and abdominal obesity

Qualitative data was gathered through focus groups with parents in each of the six participating communities to identify how physical activity and nutrition has changed in families.

A. Lifestyle ChangesB. TechnologyC. Impact of colonial 

legacy on community programming

D. Keeping children safe

Playing outsideWalkingChores

“We played outside. We went swimming, we went running, we played Indian ball, we climbed trees, we you know, we made up our own stuff like, our own tree houses, we would do things.”

“It’s all the new technology that they don’t get out – well most kids, I can’t say all because there are some who still enjoy going out. But I can speak for my kids – they’re wrapped up in the technology. They’ll sit and play on their iPads or the computer. It can be a beautiful day out they’d be sitting there. ‘Get outside and do something!’ ‘Ah, just a minute’ ‘Okay, it’s two hours later and you’re still sitting in the same spot!’ Holy!” 

Low volunteerismLack of parental commitmentReliance on band government

“Then they always say ‘so who’s doing it?’ So who is responsible? Is it the parents? The [band] administration? I think it comes down to whose responsibility is it.”

Danger from animalsExposure to drugs and alcohol

Community environmentSafe home environment

Child welfare system“You know the governing or that piece and where again we’d do down to the beach. Yeah, there’s accidents that have happened along the years and I think it has made people paranoid and the fear factor and stuff like that but also the governing of, you know, ‘Well, you’re going to get your kids taken away.’”

Sexual assault

Food Systems:How food is procured, distributed, processed and prepared, the nutritional consequences and the sociocultural meanings

Food systems in First Nation communities have been influenced by colonial policies such as legislative restrictions and loss of traditional lands (Willows et al, 2012).Withholding food has been used as a weapon of colonization as early as the 1880’s when government agents would limit rations as a way of punishing tribes or to coerce Indigenous leaders into signing treaties so their people wouldn’t starve (Dickason & McNab, 2009).Indigenous peoples were discouraged from their traditional ways of obtaining food eg. hunting and gathering and encouraged to take up farming (Dickason & McNab, 2009). Residential school survivors have reported on the limited amount of food and the poor quality of food available to them as students (TRC, 2012). 

Food from the landHunting and fishingGardeningHarvestingRaising livestock

Food from the grocery store

Food insecurityAvailability of game and fishCostFood qualityTransportation

“Cost you twenty bucks just to get to town. Hard to get around to those good vegetables right off the shelf. It just doesn’t happen. I get to town maybe once a week if that. So yeah, transportation is a big thing.”

Cooking from scratchConvenience of processed foodPersonal preferences

“Well as a kid I remember my mom making everything from scratch like there was roast there was always potatoes and a vegetable. And now I don’t do that so much. I probably do it may four days out of the week. Not consecutively. Once in a while I like to keep it balanced and throw, like, French fries or some processed food [laughs].”

Knowledge about healthy foodsHealth concerns

“We’ve started pushing the vegetables on the boys and eating healthy. That’s a change for our whole household. That’s to prevent diabetes and get them into the habit of it.”

Identity‘lazy’Sharing in times of economic scarcity

“It’s just that after a day at work then you get home and it’s like, ugh, I don’t feel like doing the whole food prep of doing a big meal so I throw a pizza in the oven or we’ll order a pizza whatever the case may be. But there’s nights where I...same thing that lazy mode like, ugh. [laughter]”

Colonialism continues to impact on the health and well‐being of Aboriginal peoples living in these six First Nation communities.Addressing obesity in First Nation communities requires the recognition of effects of historical and contemporary colonialism on health behaviours. 

Healing can take place through the continued revitalization of ceremonies and practices that connect Indigenous peoples to their culture, with each other, and to the land. 

Canadian Society for Exercise Physiology (2012). Canadian Physical Activity Guidelines. Available at: http://www.csep.ca/guidelinesCanadian Society for Exercise Physiology (2012). Canadian Sedentary Behaviour Guidelines. Available at: http://www.csep.ca/guidelinesDe Schutter, Olivier (2012) Report of the Special Rapporteur on the right to food, Mission to Canada. United Nations General Assembly. Available at: http://www.srfood.org/en/country-missionDickason, O.P. & McNab, D. (2009) Canada’s First Nations: A History of Founding Peoples from Earliest Times. Toronto: Oxford University Press.First Nations Information Governance Centre (FNIGC) (2012). First Nations Regional Health Survey (RHS) 2008/10: National report on adults, youth and children living in First Nations communities. Ottawa: FNIGC. Manitowabi, D., & Shawande, M. (2012). The Meaning of Anishinabe Healing and Wellbeing on Manitoulin Island. Pimatisiwin: A Journal of Aboriginal & Indigenous Community Health, 9(2).Loppie Reading, C, & F Wien (2009). Health Inequalities and Social Determinants of Aboriginal People’s Health. Prince George, BC: National Collaborating Centre for Aboriginal HealthWillows, N. D., Hanley, A. J., & Delormier, T. (2012). A socioecological framework to understand weight-related issues in Aboriginal children in Canada. Applied Physiology, Nutrition, and Metabolism, 37(1), 1-13.Truth and Reconciliation Commission of Canada (2012) They Came for the Children: Canada, Aboriginal Peoples, and Residential Schools. Winnipeg. Willows, N.D., Hanley, A.J.G., & Delormier, T. (2012) A socioecological framework to understand weight-related issues in Aboriginal children in Canada. Applied Physiology and Nutrition. Vol. 37: 1 – 13.