BackgroundAPPLE Schools is a Comprehensive School Health (CSH) project, started in schools in socioeconomically disadvantaged areas where dietary habits are poor, physical activity (PA) levels are low, and obesity rates are high. Earlier research showed program effects whereby energy intake, PA and weight status of students in APPLE Schools had reached similar levels as that of students in other schools. However, it is unknown whether the effects of CSH are sustained when children grow into adolescents. Effects of APPLE Schools on health-related knowledge, attitudes, self-efficacy, diet, PA, and weight status, seven years after the start of the project, when students were in junior high and high school were assessed. We hypothesised that APPLE School graduates and comparison school graduates will remain at similar levels for these indicators.MethodsIn the 2015/16 school year, junior high and high school graduates (grades 7–12) in Northern Alberta, Canada participated in a Youth Health Survey. Participants included graduates from APPLE elementary schools (n = 202) and comparison elementary schools (n = 338). Health-related knowledge, attitudes, self-efficacy, diet (24-h dietary recall), PA (pedometer step count) and weight status were assessed. Mixed effects regression was employed to assess differences in these outcomes between APPLE School graduates and comparison school graduates. Comparisons between elementary school (2008/09) and junior high/high school (2015/16) of self-efficacy, PA and weight status were also conducted.ResultsAPPLE School graduates did not significantly differ from comparison school graduates on any outcomes (i.e. knowledge, attitudes, self-efficacy, diet, PA, and weight status). Additionally, no significant differences existed in the comparisons between 2008/09 and 2015/16.ConclusionOur findings of no difference between the APPLE School graduates and comparison school graduates suggest that the effects of APPLE Schools may continue into adolescence or the new school environment may have an equalizing effect on the students. Since lifestyle practices are adopted throughout childhood and adolescence, and the school environment has an important influence on development, an extension of CSH initiatives into junior high/high schools should be considered. This will help to consolidate and support the continuance of healthy lifestyle messages and practices throughout childhood and adolescence.
Mahatma Gandhi observed that "the true measure of any society can be found in how it treats its most vulnerable members." Ethnocultural communities, defined by their unique shared characteristics (e.g., cultural traditions, language, country of origin), 1 face greater challenges and have higher rates of poverty and illness than the general Canadian population. Migration results in conditions that affect all social determinants of health and disproportionally affect health outcomes, herein referred to as vulnerable circumstances. 2,3 The emergence of major outbreaks of SARS-CoV-2 infections in ethnocultural communities highlights both the vulnerable circumstances of these communities and the disparities they face in accessing high-quality, culturally appropriate information and support. [4][5][6][7] Studies have shown substantial variation in deaths attributed to COVID-19 based on factors such as age, sex, ethnicity, length of time in Canada, income and education. [8][9][10][11] However, given the well-known gap in reporting comprehensive COVID-19 data in relation to race and ethnicity, efforts to measure its impact are hampered. [8][9][10][11][12] There is an urgent need to understand the evolving challenges of COVID-19 to inform action and public policy that can mitigate these challenges.
Background Providing contextually appropriate care and interventions for people with diabetes and/or obesity in vulnerable situations within ethnocultural newcomer communities presents significant challenges. Because of the added complexities of the refugee and immigrant context, a deep understanding of their realities is needed. Syndemic theory sheds light on the synergistic nature of stressors, chronic diseases and environmental impact on immigrant and refugee populations living in vulnerable conditions. We used a syndemic perspective to examine how the migrant ethnocultural context impacts the experience of living with obesity and/or diabetes, to identify challenges in their experience with healthcare. Methods This qualitative participatory research collaborated with community health workers from the Multicultural Health Brokers Cooperative of Edmonton, Alberta. Study participants were people living with diabetes and/or obesity from diverse ethnocultural communities in Edmonton and the brokers who work with these communities. We conducted 3 focus groups (two groups of 8 and one of 13 participants) and 22 individual interviews (13 community members and 9 brokers). The majority of participants had type 2 diabetes and 4 had obesity. We conducted a thematic analysis to explore the interactions of people’s living conditions with experiences of: 1) diabetes and obesity; and 2) healthcare and resources for well-being. Results The synergistic effects of pre- and post-immigration stressors, including lack of social network cultural distance, and poverty present an added burden to migrants’ lived experience of diabetes/obesity. People need to first navigate the challenges of immigration and settling into a new environment in order to have capacity to manage their chronic diseases. Diabetes and obesity care is enhanced by the supportive role of the brokers, and healthcare providers who have an awareness of and consideration for the contextual influences on patients’ health. Conclusions The syndemic effects of the socio-cultural context of migrants creates an additional burden for managing the complexities of diabetes and obesity that can result in inadequate healthcare and worsened health outcomes. Consequently, care for people with diabetes and/or obesity from vulnerable immigrant and refugee situations should include a holistic approach where there is an awareness of and consideration for their context.
Key points:•The impact of the widespread availability of highly active anti-retroviral (ART) therapy on HIV/AIDS prevention practices in Sub-Saharan Africa is understudied.•In Rwimi, Uganda, the fear of human immunodeficiency virus and acquired immune deficiency syndrome (HIV/ AIDS) persists; however, with the availability of life-prolonging ART, this fear is reduced.•HIV/AIDS prevention practices in Rwimi are influenced by socio-cultural norms such as gender roles, relationship dynamics and trust which should be considered when designing HIV prevention programs. AbstractThe impact of the widespread availability of antiretroviral therapy (ART) on the human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS) related attitudes, behaviours and practices of the general population in Sub-Saharan Africa is understudied. We assessed the impact of ART availability on the fear of HIV/ AIDS (measured at both community and personal levels) and HIV prevention practices in Rwimi, Uganda using a cross-sectional survey. The fear of HIV/AIDS was described as a perceived threat to either self and/or community regarding the risk of contracting the disease, whereby the higher the perception of the threat, the greater the fear. We assessed associations between the outcomes of the dependent variables on both the community and personal fear of HIV/AIDS, and the independent variables of HIV/AIDS-related knowledge and demographics. Qualitative data was also generated from focus group discussions (FGD) on the context of the fear of HIV/AIDS and HIV pre-vention practices. The majority of participants (89.4%; males -86.8%; females -90.8%) felt that ART availability has reduced the fear of HIV/AIDS in the community. In contrast, fewer participants (22.4%; males -24.4%; females -21.2%) mentioned that their personal fear of HIV/AIDS has been reduced with the availability of ART. From the qualitative study, factors identified as influencing the fear of HIV/AIDS included stigma, fear of infection, and the inconvenience of being on ART. Although fear of HIV/AIDS persists, the fear is reduced because of the availability of life-prolonging ART. HIV prevention practices are influenced by socio-cultural norms (gender roles, relationship dynamics, power and trust), which, we argue, should be considered when designing sustainable HIV/AIDS prevention programs.
Adolescence is an important life phase in which future patterns of adult health are established. Therefore, there is a need to understand the barriers and enhancers of adolescents’ health to better support their development. We explored adolescents’ perspectives on factors influencing their health behaviours using a qualitative descriptive approach. In-depth interviews were conducted with 22 junior high and high school students in Northern Alberta, who had participated in a 2015/16 Youth Health Survey. Thematic analyses revealed three themes: 1) knowledge, 2) contextual factors (home environment and school environment) and 3) individual factors (self-motivation and personal responsibility). Overall, the students were extensive in their description of healthy lifestyles, but their use of this knowledge was dependent on contextual and individual factors. They described the importance of the home and school environment in supporting healthy lifestyles, particularly by providing the right kind of knowledge and opportunities to cultivate and maintain a healthy lifestyle. They also identified self-motivation and personal responsibility as individual factors of influence on their health behaviours and practices. The students placed a great emphasis on personal responsibility for their health behaviours, despite the necessity of environmental and social supports for encouraging healthy lifestyles. School-based health promotion programs, which take a comprehensive health approach fosters a supportive environment for healthy lifestyle behaviours.
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