Daniel W. Sellen

The Canada Prenatal Nutrition Program (CPNP) is a federal initiative that addresses the critical impact of early nutrition and perinatal care on health outcomes by providing community‐based perinatal health and nutrition services to socially and economically vulnerable women and their infants. Using a flexible, locally adaptable community programming model, the CPNP aims to improve the health of women and their babies by promoting healthy birth weights and supporting breastfeeding; fostering community partnerships; and providing culturally sensitive support. To identify priorities for future research and outcome measurement within the program's monitoring and evaluation framework, we engaged CPNP personnel from 26 sites across the province of Ontario as expert knowledge holders in a Modified Delphi study. Among participating sites, 57% were hosted within a community‐based agency, 23% within an Indigenous‐led agency, and 20% within a public health unit. Participants ranked priorities based on what they believed best reflected CPNP clients' needs, contributed to evidence‐based program development, and aligned with the realities of community‐based service delivery. All priorities were viewed as important for programming. From the relative rankings, two research topics were highest‐ranked: assessing the impacts of the CPNP and conducting a needs assessment to identify community‐defined perinatal health needs. Maternal mental health was the highest‐ranked outcome measure, because of its perceived central role in supporting parent–infant health, well‐being, and social connectedness. Collectively, these applied findings offer strategic direction to advance the CPNP's adaptive program delivery model, and demonstrate the methodological value of engaging community knowledge holders to inform perinatal program delivery.

While the potential of school food programs (SFPs) to influence healthy eating behaviors and improve child health outcomes is recognized globally, Canada currently lacks a well-established nationally coordinated and funded SFP. Instead, the fragmented nature of SFPs across Canada has resulted in a limited understanding of their nutritional quality. This study builds upon prior research assessing the characteristics of Canadian SFPs and aims to provide a baseline of SFP nutritional quality before federal policy implementation to identify priority areas for improvement in the current school food landscape. SFP menu data was collected from a diverse sample of school food providers. The mean content of nutrients of public health concern was calculated and two indices of dietary quality representing adherence to national nutrition guidelines were applied to SFP menu data: Healthy Eating Food Index 2019 (HEFI-2019) and Healthy Eating Index Canada (HEI-C) 2010. Nutritional quality results from 67 SFPs serving over 20% of Canadian schools revealed approximately 51% adherence to the 2019 and 2007 Canada’s Food Guides, indicating similar adherence to national dietary guidelines as in the broader population. Snacks tended to be high in total sugars but low in protein and sodium was high across all meal types. Given the limited resources available to SFPs in Canada, these findings indicate that although school food providers are serving relatively healthful choices, a federally harmonized school food policy and program (including the development of national school food guidelines) can further improve the state of school food in Canada and its nutritional quality.

National school food programs (SFPs) have been implemented in several countries and can provide numerous benefits to children across the world. In June 2024, Canada released a National School Food Policy to support the development of a national SFP in Canada. As the enthusiasm to develop a national SFP grows, policymakers need evidence to inform a national SFP that can meet the needs of diverse communities in Canada. There is a paucity of recent information about the perceptions and needs of parents and caregivers in Canada regarding SFPs from various regions across the nation. To close this knowledge gap and gain insight into preferred program attributes, we conducted a mixed-methods study involving focus groups/interviews and surveys with parents and caregivers in the Greater Toronto Area and examined perceptions about the cultural aspects of SFPs among ethnic-specific sub-groups (South Asian, East Asian, and Southeast Asian households). The perceptions and needs identified from all parents and caregivers in the study were used to develop a framework that highlights attributes of a holistic and multicomponent SFP. This framework can be tested and modified with additional information from other locations and can validate other frameworks to inform policymakers on the most important objectives, attributes, and cultural considerations for a national SFP grounded in the perceptions and needs of parents and caregivers.

Canada remains one of few Organisation for Economic Co-operation and Development (OECD) countries without a well-established nationally harmonized and funded school food program (SFP); however, the Canadian federal government recently announced the development and implementation of a national SFP that might supersede the uncoordinated patchwork of SFPs currently delivered across Canada. We designed and conducted novel survey research to systematically identify the characteristics of organization-led SFPs, building on previous research that focused on the characteristics of provincial and territorial government involvement in school food programming. An electronic survey was developed to include items deemed most relevant based on applicable literature and expert content validation, and distributed to organizations involved in the purchasing, planning, and/or preparation of school foods. Responses were categorized post hoc into the RE-AIM categories to assess SFP Reach, Effectiveness, Adoption, Implementation, and Maintenance. Analysis identified key SFP implementation characteristics (including funding source, payment model, and student eligibility), program components, SFP goals/mandates, and factors that determine what foods are served; and assessed correlations among key characteristics. Results from 67 SFPs across 10 provinces indicate considerable variability in SFP characteristics. SFP-delivering organizations reported a predominant goal of reducing student food insecurity, while nutrition and cost were cited as the main factors determining food served. Collectively, organizations were found to rely primarily on donations, while provincial funding accounted for only 30% of total funding. These findings reveal strengths and areas for improvement within Canada's current school food landscape and highlight important gaps that could be addressed with federal involvement.

Objective: To assess the prevalence, severity and socio-demographic predictors of household food insecurity among vulnerable women accessing the Canada Prenatal Nutrition Program (CPNP) and to examine associations between household food insecurity and breastfeeding practices to 6 months.Design: Cohort investigation pooling data from two studies which administered the 18-item Household Food Security Survey Module at 6 months postpartum and collected prospective infant feeding data at 2 weeks and 2, 4 and 6 months. Household food insecurity was classified as none, marginal, moderate or severe. Logistic regression analyses were performed to assess predictors of household food insecurity and associations between household food security (any and severity) and continued and exclusive breastfeeding.Setting: Three Toronto sites of the CPNP, a federal initiative targeting socially and/or economically vulnerable women.Participants: 316 birth mothers registered prenatally in the CPNP from 2017 to 2020.Results: Household food insecurity at 6 months postpartum was highly prevalent (44 %), including 11 % in the severe category. Risk of household food insecurity varied by CPNP site (P< 0·001) and was higher among multiparous participants (OR 2·08; 95 % CI 1·28, 3·39). There was no association between the prevalence or severity of food insecurity and continued or exclusive breastfeeding to 6 months postpartum in the adjusted analyses.Conclusions: Household food insecurity affected nearly half of this cohort of women accessing the CPNP. Further research is needed on household food insecurity across the national CPNP and other similar programmes, with consideration of the implications for programme design, service delivery and policy responses.

Sources of Support statement: None Conflict of interest statement: There are no conflicts

Increasing job market demand for and availability of Canadian and U.S. global academic health programs in post-secondary education increases student demand to participate in internationally based fieldwork, while supportive resources remain weakly developed. Previous studies indicate provisions to protect the health, safety, and well-being of women students remain inadequately addressed during training, while more research to identify needs, expectations, gaps, and best practices would inform policy and practice to improve conditions for women working off-campus on global public health studies. One approach, reported here, is to document and better understand the lived experience of U.S. or Canadian women graduate students participating in global public health fieldwork. Participant in-depth phenomenological interviews and guided writing exercises aimed to capture lived experience descriptions for 25 women. A phenomenology of practice was applied throughout the research process, following Max van Manen’s qualitative methodology approach. Loss of environmental familiarity, combined with graduate students’ lack of power, created considerable hidden labor described by women in working to keep themselves safe from sexual and gender-based violence (SGBV) while participating in global public health fieldwork. Women shared specific experiences exemplifying how this can be both alleviated and/or intensified through a range of negotiated strategies, coping styles, and management techniques. Additionally, women recalled laboring as students to avoid or reduce instances of SGBV, that then, precluded them from having any material “of substance” to report once returned home. These findings offer new meaning structures, language for a foreign experience, or ways to describe, conceive of, and respond to global public health fieldwork that hold the potential to positively affect individuals’ experiences, institutional understanding, and thus practice, of future women students in global public health.

Objectives To examine whether use of expressed human milk in the first two weeks postpartum is associated with cessation of human milk feeding and non-exclusive human milk feeding up to 6 months. Design Pooled data from two prospective cohort studies Setting Three Canada Prenatal Nutrition Program (CPNP) sites serving vulnerable families in Toronto, Canada. Participants 337 registered CPNP clients enrolled prenatally from 2017 to 2020; 315 (93%) were retained to 6 months postpartum. Exclusions: pregnancy loss or participation in prior related study; Study B: preterm birth (Primary and secondary outcome measures Main exposure variable: any use of expressed human milk at 2 weeks postpartum. Outcomes: cessation of human milk feeding by 6 months; non-exclusive human milk feeding to 4 months and 6 months postpartum. Results All participants initiated human milk feeding and 80% continued for 6 months. Exclusive human milk feeding was practiced postdischarge to 4 months by 28% and to 6 months by 16%. At 2 weeks postpartum, 34% reported use of expressed human milk. Any use of expressed human milk at 2 weeks was associated with cessation of human milk feeding before 6 months postpartum (aOR 2.66; 95% CI 1.41 to 5.05) and with non-exclusive human milk feeding to 4 months (aOR 2.19; 95% CI 1.16 to 4.14) and 6 months (aOR 3.65; 95% CI 1.50 to 8.84). Trial registration numbers NCT03400605, NCT03589963.

Exclusive breastfeeding (EBF) for 6 months is a global public health goal, but measuring its achievement as a marker of population breastmilk feeding practices is insufficient. Additional measures are needed to understand variation in non‐EBF practices and inform intervention priorities. We collected infant feeding data prospectively at seven time points to 6 months post‐partum from a cohort of vulnerable women (n = 151) registered at two Canada Prenatal Nutrition Program sites in Toronto, Canada. Four categories of breastmilk feeding intensity were defined. Descriptive analyses included the (i) proportion of participants in each feeding category by time point, (ii) use of formula and non‐formula supplements to breastmilk, (iii) proportion of participants practising EBF continuously for at least 3 months; and (iv) frequency of transitions between feeding categories. All participants initiated breastmilk feeding with 70% continuing for 6 months. Only 18% practised EBF for 6 months, but 48% did so for at least 3 continuous months. The proportion in the EBF category was highest from 2 to 4 months post‐partum. Supplemental formula use was highest in the first 3 months; early introduction of solids and non‐formula fluids further compromised EBF at 5 and 6 months post‐partum. Most participants (75%) transitioned between categories of breastmilk feeding intensity, with 35% making two or more transitions. Our data show high levels of breastmilk provision despite a low rate of EBF for 6 months. Inclusion of similar analyses in future prospective studies is recommended to provide more nuanced reporting of breastmilk feeding practices and guide intervention designs.