Prevalence and perceptions of food insecurity and coping strategies in Fort Albany First Nation, Ontario
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Background: Food insecurity has been described as an urgent and pervasive public health issue for Aboriginal people (First Nations [FN], Métis, and Inuit) in Canada. However, national health surveys have generally excluded a large portion of the Aboriginal population (FN living on-reserve and Inuit), resulting in limited data on food insecurity in these individuals and communities. In addition, scales for measuring food insecurity have not been validated in Canadian Aboriginal populations. Food security challenges faced by Aboriginal people living in remote communities are unique and few studies have examined the perceptions of and coping strategies for food insecurity in this population. Objectives: The overall objective of this research was to explore various aspects of food insecurity (prevalence, perceptions, and coping strategies) in the remote, on-reserve First Nations community of Fort Albany, Ontario. This thesis consisted of five studies conducted in Fort Albany. The objectives for Study I were to quantitatively measure the prevalence of food insecurity using the Household Food Security Survey Module (HFSSM) and to use two qualitative interview questions to evaluate the relevance of the HFSSM. Study II used qualitative interview questions to examine the perceptions of and coping strategies for food insecurity. Studies III and IV investigated two programs in Fort Albany that had the potential to affect food security: the school snack program and a greenhouse project. Study III assessed the impact of the school snack program on student food intake. Study IV was a descriptive case study of the context and implementation of a community greenhouse project. Study V involved the development and formative evaluation of supplemental questions for the HFSSM intended to be relevant for measuring food security in First Nations households. Methods: One adult from each household in the community was invited to complete the 18-item HFSSM, demographic questions, and an interview with questions on the relevance of the HFSSM for First Nations food security and strategies used to cope with food insecurity. To evaluate the snack program, 24 hour diet recall data were collected using the Waterloo Web-based Eating Behaviour Questionnaire (WEB-Q) in November 2004 and December 2007 with grade six to 10 students attending Peetabeck Academy in Fort Albany. Food group consumption and nutrient intake of students participating in the school snack program were compared with students who chose not to participate. Five additional questions asked students about their participation, preferences, and impressions of the snack program. Data sources for the greenhouse project included semi-directed interviews with a purposive and snowball sample of community key informants, direct observations, written documentation, and photo-documentation. The case study was carried out over a period of 33 months; from early 2009 until October of 2011. The supplemental questions for the HFSSM were drafted based on themes that had emerged from the evaluation of the relevance of the HFSSM and relevant literature. Feedback on the importance, clarity, and cultural appropriateness of each proposed question was gathered from key informants (n=12) working on food security issues with Aboriginal groups, using an online survey. Results: For the HFSSM study, of 64 households (87% response), 70% were food insecure, 17% severely and 53% moderately. The prevalence of food insecurity in households with children was 76%. Among respondents from homes rated as having severe food insecurity, all (100%) reported worrying that food would run out; times when food didn’t last and there wasn’t money to buy more; and times when they couldn’t afford to eat balanced meals. When asked about the relevance of the HFSSM, the majority of respondents felt the HFSSM did not fully capture an accurate picture of food security for their situation. Aspects missing from the HFSSM included the high cost of market food and the incorporation of traditional food practices. For the coping strategies study, a thematic analysis of interviews (n=51) revealed that food sharing, especially with family, was regarded as one of the most significant ways to adapt to food shortages. The majority of participants reported consuming traditional food (wild meats) and suggested that hunting, preserving and storing traditional food has remained very important. However, numerous barriers to traditional food acquisition were mentioned. Other coping strategies included dietary change, rationing and changing food purchasing patterns. In order to improve access to healthy foods, improving income and food affordability, building community capacity and engagement, and community-level initiatives were suggested. Findings from the school snack program study showed that students participating in the snack program had significantly higher intakes from specific food groups and related nutrients compared to those who did not participate. With the exception of Meat and Alternatives in 2004, there was a trend for a higher percentage of students to meet dietary recommendations if they participated in the snack program. Students indicated that the three things they liked most about the school snack program were the juice, that the program kept them from feeling hungry at school, and that they got a snack at school every day. Students indicated that the snack program helped them to eat healthier by motivating them, eating more fruit, and making better dietary choices. Qualitative analysis of the greenhouse case study data generated gardening related themes: seasons, fertile ground, sustainability, gardeners, ownership, participant growth, and sunshine. Amongst the gardeners, local champions were critical to project success. Positive outcomes included the involvement of many community members, a host of related activities being carried out, and that the greenhouse had introduced an opportunity to gain knowledge about growing plants in a northern greenhouse setting. For the study on measuring food security in FN households, valuable feedback was provided by key informants (n=12) on clarifying the wording of the questions as well as providing perspectives on how the questions may or may not be applicable to different Aboriginal populations. A revised list of questions was created that incorporated the feedback from key informants. Conclusions: A very high prevalence of household food insecurity was reported in this community with the prevalence especially high in households with children. On-reserve remote FN communities may be more susceptible to food insecurity than off-reserve Aboriginal populations. Findings point to the continued importance of traditional food acquisition and food sharing, as well as community solutions for food systems change. These data highlight that traditional and store-bought food are both part of the strategies and solutions participants suggested for coping with food insecurity. Given the positive impact of the school snack program on the food and nutrient intake of student participants, it is clear that school snack programs can be an important venue to address the nutritional vulnerability of FN youth living in remote communities. Community and school greenhouse projects require local champions to be successful and foster community participation and ownership. Implementing a greenhouse project can engage community members, including children, and provide a great learning opportunity for gardeners in a remote, northern community. Finally, input from community participants and experts suggest additional questions that may add relevance to food security questionnaires for FN populations. Data highlight the urgency for public health policies and initiatives that promote food security for vulnerable FN populations. Findings can be used to inform assessment and program planning activities and to advocate for policies at the local, provincial and federal levels to strengthen community food security.