School-based nutrition interventions for Indigenous children in Canada: a scoping review

Indigenous communities in Canada (First Nations, Inuit, and Métis) face significant social and environmental barriers to healthy eating. Due in large part to these barriers, Indigenous children are disproportionally affected by nutrition-related chronic diseases such as obesity and diabetes. Comprehensive school-based nutrition interventions that integrate multiple components of the school environment (e.g., social and physical environments, teaching and learning, policy, and partnerships and services) offer a promising strategy for improving children’s access to healthy foods and sustaining positive eating behaviours. However, little is known about comprehensive school-based nutrition interventions for Indigenous children. The purpose of this thesis was to describe the current status of school-based nutrition interventions for Indigenous children, and to uncover the principles underlying their development, implementation, and evaluation.For this present thesis, two studies were conducted related to school-based nutrition interventions in Indigenous communities. Study 1 was a process evaluation of school nutrition policy implementation using a community-based participatory research approach. The evaluation was conducted using an explanatory sequential mixed methods design. Students in grades 4–12 (n=94) and parents of students attending the school (n=83) completed cross-sectional surveys to capture their perceptions of the policy. Survey data informed semi-structured interviews with students (n=20) and parents (n=10) to further identify barriers and facilitators to policy implementation. Study 2 was a scoping review that broadly searched the scientific and grey literature to identify school-based interventions that have been implemented to improve the nutrition of Indigenous children in Canada and to describe their components.Study 1 showed that facilitators of school nutrition policy implementation included parent and student support, student food preferences for healthy foods, and student interest in health education. The barriers to policy implementation identified included a lack of communication between students and their teachers and parents, lack of parent support for guidelines concerning celebrations and fundraisers, inadequate communication between the school and parents, and the broader socioeconomic conditions in the community. Study 2 found that few school-based nutrition interventions for Indigenous children in Canada are comprehensive, as there are limited examples of interventions that integrate multiple aspects of the school food environment. Although most interventions include components related to the social and physical environment (e.g., food programs) and engage in partnerships with the local community, few integrate teaching or policy components. Furthermore, few interventions have been evaluated to understand the factors influencing their implementation or effectiveness.Overall, the two studies discussed in this thesis indicate that school-based nutrition intervention in Indigenous communities require community engagement and evaluation components that involve a variety of stakeholders – including parents and students – to ensure interventions are relevant and sustainable. Comprehensive school-based nutrition interventions may benefit from incorporating two or more components (e.g., school food programs, classroom education, nutrition policies, and partnerships with local businesses) to improve student access to healthy foods. Moving forward, it is important that communities and researchers aim to disseminate knowledge about their interventions broadly. Increasing evidence-based knowledge concerning comprehensive school-based nutrition interventions may assist communities – and health promoters working with communities – to improve the school nutrition environments and health outcomes of Indigenous children in Canada.

School-based nutrition interventions play a crucial role in promoting healthy eating habits among children and adolescents, which are fundamental for preventing chronic diseases and fostering physical and mental development. This scoping review aims to examine the literature on the nature and extent of research conducted in school-based nutrition intervention programs in Italy and their effectiveness. Established and emerging programs and practices are reviewed to identify successful strategies in Italy. A scoping review of published studies using the PRISMA-ScR guidelines across 14 databases for school-based nutrition interventions implemented in Italy was conducted, and the results communicate literature published from 1990 to December 2024. The review included 42 studies, highlighting positive changes in dietary knowledge and behavior, with 33 studies reporting significant improvements. Interventions employing a sequence of education (knowledge), demonstration by teachers, and practice of good nutrition at home and/or school demonstrated sustained behavioral changes. Each study was conducted by a high number of authors, showing healthy collaboration. Studies were mainly applied using a Health Promotion Model, without reference to theories. However, gaps remain in addressing adolescent populations, employing social marketing techniques, and integrating environmental changes. While Italian schools have implemented diverse and culturally tailored interventions, challenges persist, including variability in program implementation, limited follow-up, and underutilized theoretical frameworks. Efforts to enhance collaboration among schools, families, and policymakers are essential for sustainable success. School-based nutrition interventions in Italy have demonstrated substantial potential in improving dietary behaviors among children and adolescents. Addressing identified gaps and promoting comprehensive, multicomponent approaches can further enhance the long-term success of these programs.

School-based nutrition interventions have the potential to promote dietary behaviors and other outcomes among children and adolescents. However, inconsistent reporting of outcomes and measurement tools limits evidence synthesis and the identification of effective intervention strategies. This umbrella review aimed to synthesize the range of outcomes related to diet, health, well-being, and education reported in systematic reviews of school-based nutrition interventions, along with the measurement tools used. The findings will be used to inform the development of a Core Outcome Set (COS) to guide future evaluations in this field. We conducted a systematic search across 7 databases (MEDLINE, Embase, Cochrane Database of Systematic Reviews, PsycINFO, CINAHL, Web of Science, and Scopus) to identify systematic reviews published from January 2018 to December 2023. Data on outcomes related to diet, health, well-being, and education were extracted from eligible systematic reviews. When available, information on outcome measurement tools was also extracted. Additional details were retrieved from primary studies referenced within systematic reviews as needed. Ninety-eight systematic reviews, comprising 965 unique studies, were included. Outcomes were categorized into 4 domains: (1) "diet" (68.8%), subdivided into "dietary intake" and "diet-related cognitive/attitudinal behaviors"; (2) "physical health" (44.8%), subdivided into "body composition" and "clinical/biochemical measures"; (3) "social and emotional well-being and behavior" (9.2%); and (4) "education" (6.4%). Substantial heterogeneity was observed across outcome domains, subdomains, and measurement tools, which presents challenges for evidence synthesis and limits comparability across studies. The findings of this review underscore the need for a stakeholder-informed, context-aware COS to standardize outcome reporting in school-based nutrition interventions. Such standardization is essential to improve the comparability of research findings, enhance evidence synthesis, and facilitate the translation of evidence into policy and practice. Subsequent phases of this work will involve diverse stakeholder engagement to finalize the COS and recommend appropriate tools for outcome measurement for evaluating school-based nutrition interventions. PROSPERO registration No. CRD42022378746.

In Canada, Indigenous families and children experience structurally-rooted marginalization due to longstanding and ongoing histories of colonization and discrimination. Indigenous children with autism spectrum disorder (ASD) are currently underrepresented in literature and databases on ASD in Canada, raising concerns about their equitable access to related services and optimal health outcomes. This critical scoping review maps out existing and emerging themes in literature pertaining to ASD and the provision of ASD services with Indigenous children and families in Canada. No previous reviews of literature have focused exclusively on ASD among Indigenous children in Canada. A literature search conducted across eight databases between 2011 and 2021 resulted in 362 potentially relevant publications, of which 19 met our inclusion criteria. Findings point to a clear lack of data on ASD and unmet health, social, and educational service needs among Indigenous children with ASD in Canada. ASD is also frequently discussed through a Western, deficit and medical discourse. The main contributors to the lack of data and unmet service needs relate to the historical positioning of colonial oppression, stigma, an overrepresentation of fetal alcohol spectrum disorder (FASD), lack of funding, and concerns about standardized diagnostic and assessment tools, and social determinants of health. Recommendations for policy, practice and research concerning Indigenous children with ASD are proposed.

Indigenous children in Canada represent one of the fastest-growing pediatric populations and experience severe health inequities. There is an ongoing need for new research on relevant methods to measure the health and wellbeing of Indigenous children that considers the cultural differences between communities. The Aaniish Naa Gegii: the Children's Health and Well-Being Measure (ACHWM) is a self-reported questionnaire that was developed to meet this need and to include the voices of Indigenous children. The purpose of this study was to assess the cultural relevance of the ACHWM for Wolastoqiyik children and to determine what revisions may be needed to ensure that the questions are well understood and culturally appropriate. We recruited a community-based sample of nine Wolastoqiyik children (ages 8 to 16 years), two caregivers, and a community Elder within the Madawaska Maliseet First Nation community in New Brunswick. Through a process of cognitive debriefing, we probed children's comprehension of the 62 questions of the First Nation French version of the ACHWM. We analyzed the information reported to determine the participants' understandings relative to the other participants and to the original intent of the ACHWM content. Each of the nine children identified at least one item they recommended for revision during the interview. We observed similarities in the suggestions offered by several respondents. A total of 23 questions were considered, and 14 questions (22.6%) were modified, taking into consideration all participants' suggestions. While measures like the ACHWM offer useful information, relying solely on a 'one size fits all' Indigenous questionnaire is insufficient. Our findings underline the importance of having methods that are easily accessible, adaptable, and culturally appropriate for assessing and addressing Indigenous children's unique health and wellbeing. Such information allows clinicians to develop interventions that are culturally relevant, addressing children's individual needs within the context of their distinct cultural identity.

Colonial projects in Canada have a long history of violently intervening into the personal lives and social structures of Indigenous peoples. These interventions are associated with elevated rates of addictions and mental health issues among Indigenous peoples. In this paper we employ an indigenized social determinants approach to mental health and addictions that accounts for the multiple, intersecting effects of colonial discourse upon the health of Indigenous peoples, and particularly the health effects of colonial interventions into the lives of First Nations Indigenous children in Canada. We focus on both historic and contemporary discourses about Indigenous peoples as deviant, discourses that include particular ideas and assumptions held by government officials about Indigenous peoples, the series of policies, practices, and institutional structures developed to ‘address’ Indigenous deviance over time (including contemporary child protections systems), and their direct impact upon healthy child development and overall Indigenous health. From a discursive perspective, addictions and mental health issues among Indigenous peoples can be accounted for in relation to the ideas, policies, and practices that identify and aim to address these issues, something that the social determinants literature has yet to incorporate into its model.

The international literature describes comprehensive nutrition interventions for children and adolescents, and gives recommendations for successful program planning. For Germany, only few studies on these issues are available, and there is a particular scarcity of data on implementation, acceptance and effectiveness of nutrition interventions. Thus the aim of this study was to record nutrition interventions at state and regional levels in Germany, and to assess their project design and evaluation quality. On the basis of these data, conclusions about implementation, acceptance and effectiveness of interventions are made. Quality indicators for project design, process and outcome evaluation were developed according to international literature and related quality assurance models. State ministries, public health departments, non-governmental institutions for health at state level and "Healthy Cities" (n=105) were surveyed about their nutrition interventions for children and adolescents including evaluation with a standardised questionnaire. The interventions were assessed using the developed quality criteria. The response rate was 70.5%. 42 primary preventive nutrition interventions were recorded. The quality criteria for program planning were only partly fulfilled. Encouraging results were, among others, that 54.8% of the projects combined behaviourally focused and environment focused criterions, 90.5% started in kindergarten or primary school, 88.1% involved parents, 85.7% cooperated with other institutions and 73.8% integrated nutrition specialists. 77.8% of the projects conducted a process evaluation (n=28), 60.7% of those had a good evaluation quality. Changing the environmental context proved to be the greatest challenge. The projects were well accepted by the target group. An outcome evaluation was conducted by 61.1% of the projects (n=22), 27.2% of those evaluations had a (very) good quality. Among these projects, 3 could improve nutrition knowledge, 3 environmental context and 3 nutrition behaviour. Improvements of medical parameters have not been recorded. In Germany, a high number of nutrition interventions for children and adolescents is being conducted. However, only five quality indicators were fulfilled by more than 75% of the projects. Because of inadequate evaluation quality, only little evidence for implementation, acceptance, and effectiveness could be found. More evaluation studies are needed to more successfully plan, implement and assess future interventions.

To evaluate the effect of school-based nutrition interventions (SBNI) involving schoolchildren and adolescents in sub-Saharan Africa (SSA) on child nutrition status and nutrition-related knowledge, attitudes and behaviour. A systematic review on published school nutrition intervention studies of randomised controlled trials, controlled clinical trials, controlled before-and-after studies or quasi-experimental designs with control. Nine electronic bibliographic databases were searched. To be included, interventions had to involve changes to the school's physical and social environments, to the school's nutrition policies, to teaching curriculum to incorporate nutrition education and/or to partnership with parents/community. Schools in SSA. School-aged children and adolescents, aged 5-19 years. Fourteen studies met our inclusion criteria. While there are few existing studies of SBNI in SSA, the evidence shows that food supplementation/fortification is very effective in reducing micronutrient deficiencies and can improve nutrition status. Secondly, school nutrition education can improve nutrition knowledge, but this may not necessarily translate into healthy nutrition behaviour, indicating that nutrition knowledge may have little impact without a facilitating environment. Results regarding anthropometry were inconclusive; however, there is evidence for the effectiveness of SBNI in improving cognitive abilities. There is enough evidence to warrant further trials of SBNI in SSA. Future research should consider investigating the impact of SBNI on anthropometry and nutrition behaviour, focusing on the role of programme intensity and/or duration. To address the high incidence of micronutrient deficiencies in low- and middle-income countries, food supplementation strategies currently available to schoolchildren should be expanded.

BackgroundIn the World Health Organization Western Pacific Region (WHO WPRO), most adolescents enroll in secondary school. Safe, healthy and nurturing school environments are critical for adolescent health and development. Yet, there were no systematic reviews found on the efficacy of school-based interventions among adolescents living in low and middle income countries (LMIC) in the Region. There is an urgent need to identify effective school-based interventions and facilitating factors for successful implementation in adolescent health in WPRO.MethodsFor this systematic review, we used five electronic databases to search for school-based interventions to promote adolescent health published from January 1995 to March 2019. We searched RCT and non-RCT studies among adolescents between 10 to 19 years old, done in LMIC of WHO WPRO, and targeted health and behaviour, school environment and academic outcomes. Quality of studies, risk of bias and treatment effects were analyzed. Effective interventions and implementation approaches were summarized for consideration in scale-up.ResultsDespite a broad key term search strategy, we identified only eight publications (with 18,774 participants). Most of the studies used knowledge, attitudes and behaviours as outcome measures. A few also included changes in the school policy and physical environment as outcome measures while only one used BMI, waist circumference and quality of life as their outcome measures. The topics in these studies included: AIDS, sexual and reproductive health, de-worming, nutrition, obesity, tobacco use, and suicide. Some interventions were reported to be successful in improving knowledge, attitudes and behaviours, but their impact and scale were limited. The interventions used by the different studies varied from those that addressed a single action area (e.g. developing personal skills) or a combination of action areas in health promotion, e.g. developing a health policy, creating a supportive environment and developing personal skills. No intervention study was found on other important issues such as screening, counseling and developing safe and nurturing school environments.ConclusionsOnly eight school-based health interventions were conducted in the Region. This study found that school-based interventions were effective in changing knowledge, attitudes, behaviors, healthy policies and environment. Moreover, it was clarified that policy support, involving multiple stakeholders, incorporating existing curriculum, student participation as crucial factors for successful implementation.

Background: Childhood and adolescent obesity is on the rise in Southeast Asia. Necessitating stronger actions from ASEAN governments to address this issue, because the significant financial and social welfare implications. Schools provide an effective platform for targeted interventions among children and adolescent groups. Objectives: This study provides an overview of school-based nutrition interventions implemented in ASEAN countries to address childhood and adolescent obesity. Methods: A literature review was conducted by searching multiple databases (Google Scholar, PubMed, ProQuest, ScienceDirect, and Web of Science) between April 1 and May 1, 2023. The search included computer-based searches and manual search in relevant journals. The articles considered were limited to publications from the past 10 years. Discussion: School-based nutrition interventions in ASEAN countries require further development, with attention to key factors such as intervention duration, sample size, and family involvement. Conclusions: Urgent large-scale research is needed to evaluate the effectiveness of existing school-based nutrition programs. Integrated and effective programs require support and collaboration from families, the private sector, and the government.

ABSTRACTThis pilot study evaluated the impact of a school-based intervention integrating garden-enhanced nutrition education, family and community partnerships, and improvements to school fruit and vegetable availability. Two elementary schools in Northern California were randomly assigned to control and intervention. Changes in lunchtime fruit and vegetable intake as well as changes in fruit and vegetable availability were compared between schools, with dietary outcomes assessed among fourth-grade students having complete fruit (n = 111) and vegetable (n = 112) intake data. There were greater increases in vegetable consumption, produce expenditures, and vegetable variety at the intervention than control school (p < 0.01) but no differences for fruit outcomes. The complementary nature of program components illustrates how the promotion of vegetables available at school meals can be connected to garden-enhanced nutrition education.

Compulsory education laws for Indigenous children in Canada based on Eurocentric knowledge systems have interrupted their normative holistic education, generated cognitive imperialism, induced cultural genocide and intergenerational trauma, and negatively affected their overall success outcomes for themselves and their self-determining communities. Contemporary educators, especially Indigenous educators, are now faced with ameliorative challenges for reconciling the traumatic, nihilistic effects of compulsory education, decolonizing the assimilation model, generating ethical space for Indigenizing the compulsory curricula, and creating a balanced compulsory curricula reform based on respect for constitutional rights of Aboriginal peoples and the United Nations Declaration of the Rights of Indigenous peoples. Accomplishing these challenges, the authors assert, a critical examination of public schooling and the Indigenizing of the academy are set to generate innovative, better educational systems for Indigenous children in Canada based on the hard lessons learned from the past.

Early social and economic deprivation, associated with poor nutrition and physical inactivity, may lead to adverse health trajectories. A cluster-randomized controlled-trial examining the effect of a school-based comprehensive intervention on nutrition knowledge, eating habits, and behaviors among low socioeconomic status (LSES) school-aged children was performed. LSES school-aged children (4–7 years) and their mothers were recruited from 11 schools, located in one town. The intervention was implemented on three levels: children, mothers, and teachers. The intervention (IArm) included nutrition classes for children, mothers, and teachers and physical activity (PA) classes for children; the control (CArm) received PA only. Interventions were conducted by professional personnel, who were trained during in a two-day session to deliver the specific program in schools. Family data were obtained by parental interviews. Food knowledge observations, packed lunch records, and anthropometric measurements were obtained in school at baseline, six months, and at the end of the school year. Of 258 children enrolled, 220 (87.6%) completed the six-month program. Only children in the IArm improved their nutrition knowledge and eating-habits and increased food variety and fruit and vegetable consumption, quality score of packed lunches (p < 0.001 for all), habitual water drinking increased (p = 0.02), and decreased sweet-drink consumption (p = 0.05). A school-based comprehensive nutrition intervention targeting LSES population improved eating habits, nutritional knowledge, and healthier packed lunches.

The current overrepresentation of Indigenous children in Canadian child welfare systems continues a history of government policies that have separated Indigenous families over the course of many generations. Political and legal developments in recent years are creating the possibility to both disrupt Indigenous children’s overrepresentation in child welfare proceedings and support Indigenous self-determination in decision-making related to child welfare. However, the potential to reduce the overrepresentation of Indigenous children in Canadian child welfare systems is still limited, in part, by the absence of a comprehensive framework for transforming existing child welfare legislation. Because the disproportionate representation of Indigenous children is driven largely by investigations of child neglect, there is particular need for a framework for understanding and shifting away from the current approach to assessing neglect cases. In this article, we examine theoretical and legislative conceptualizations of child neglect in terms of their relationship to the disproportionate involvement of Indigenous children in child welfare across Canada and, more specifically, in Quebec. We also briefly examine the concepts of child well-being and cultural safety which we see as useful complements to the current conceptualization of neglect. Our goal is to support ongoing critical dialogue related to the overrepresentation of Indigenous children in Canada’s child welfare systems, and in so doing contribute to the development of a new framework for understanding and operationalizing “neglect” in Indigenous contexts which at its core could bolster Indigenous self-determination.

Gestational diabetes mellitus (GDM) is associated with adverse outcomes and neonatal complications. Its prevalence has been rapidly increasing over the last decade; it is estimated that one in six pregnant women are diagnosed with GDM. Thus, an effective management approach is necessary for women with GDM. This study investigated the effect of a 12-h comprehensive nutrition care (12h-HNC) on the metabolism and outcomes of pregnant women with GDM and neonatal birth weight and hypoglycemia. The study included 312 pregnant women with GDM at 24-28 weeks of gestation who were treated in our department from January 2014 to December 2016. They were randomly assigned to receive a 12h-HNC (12h-HNC group, n=158) or traditional one-time nutrition guidance (control group, n=154). Maternal blood glucose levels and weight gain, as well as maternal and neonatal outcomes were evaluated and compared between the groups. Compared to those in the control group, patients in the 12h-HNC group had significantly lower 2-h postprandial glucose levels (P<0.05), lower average weight increase (P<0.05), and better outcomes (P<0.05). Neonatal birth weight and incidence of macrosomia were significantly lower in the 12h-HNC group. The incidence of cesarean section was similar in the two groups (P>0.05). The 12h-HNC enabled better blood glucose and weight increase control, improving both maternal and neonatal outcomes in women with GDM. This comprehensive nutrition intervention may achieve favorable effects in clinical practice.