A mixed methods inquiry into the determinants of traditional food consumption among three Cree communities of Eeyou Istchee from an ecological perspective

Figures & data

Fig. 1.  Process flow diagram of the procedures for this sequential explanatory mixed methods study.

Table I. Variables used in the quantitative analysis

	Variable	Definition	Source^a	Questions/items	Categorisation	Reference(s)	I/D^b
Individual level	Age	Age of participant during interview	Ind	What is your birth date?	Following previous study (18–39 year old, 40–90 year old)	Bonnier-Viger et al. (31), Lambden et al. (32)	I
	Sex	Sex of participant	Ind	What is your gender?	Male, female	–	I
	Body mass index (BMI)	Measured BMI	Ind	Weight and height were taken by a nurse	Following WHO classification (18.5–24.9 (normal), 25–29.9 (overweight) ≥30 (obese))	WHO (33)	I
	Daily walking	Number of minutes walked by the participant per day	Ind	From IPAQ short format: during the last 7 days, on how many days did you walk for at least 10 minutes at a times? What is the total amount of time you spent walking over the last 7 days?	Following public health recommendations promoting 30-minute walk per day (less than 30 min/day, more than 30 min/day)	Lemieux and Thibault (34)	I
	Education	Highest level of schooling completed by the participant	Ind	What is the highest level of schooling you have completed? Can you tell the last grade or year of school you have completed?	College/University, high school, no formal schooling/elementary school	–	I
	Hunter	Whether or not the participant hunt (regardless of the frequency of hunting activities)	Ind	Do you hunt?	Yes, no	–	I
	Smoking	Whether or not the participant smoke (smoker described regular and occasional smokers)	Ind	Do you smoke?	Smoker, non-smoker	–	I
	Employment status	Whether or not the participant has a job (employed indicated individuals working full-time, part-time and occasionally)	Ind	Which of the following best describes your present working status?	Employed, unemployed	–	I
	Health perception	Own participant perception of health	Ind	In general, would you say your health is …	Excellent to very good, good, fair to poor	–	I
	Worries about pollution	Participant concerned about environmental pollution	Ind	Are you worried about the pollution of the environment (land, water or air) in Iiyiyiu Aschii?	Very much, somewhat to fairly, not at all	–	I
Interpersonal level	English spoken at home	Whether or not the participant speaks English at home	Ind	What language, or language, do you usually speak at home?	English spoken at home, no English spoken	–	I
	No. of people in the household	Number of people living in the participant house	Ind	How many persons of the following age groups live in your house or apartment at this time?	1 to 4 persons, 5 persons or more	–	I
Community level	Community	Community of residence	–	Census from each community used to recruit participant	Mistissini, Wemindji, Eastmain	–	I
	Traditional food	Frequency of traditional food consumption over a week	TFF	Items from 5 traditional food groups examined (game, birds, fishes, greases and berries). Bannock, other plants food and tea were not gathered by the TFF questionnaire	Dichotomized based on a Cree campaign (less than 3 times/week, more than 3 times/week)	Wasayabin challenge, 2008–2009	D

^aInd=individual questionnaire; TFF=traditional food frequency questionnaire.

^bI=independent variable; D=dependent variable.

Table II. Questionnaire route

This focus group is about exploring the facilitators and obstacles that influence traditional food consumption.
1. Following statistical analysis: (visual support: simplified results table)   a. What do you think of these factors? Do you agree with our findings? Can you explain how they might have an influence?   b. What do you think of the factors that seem not to be linked? Do you agree?   c. Can you think of other factors that influence traditional food intake? 2. Is there anything you would like to add?

Table III. Characteristics of 3 communities in the multi-community environment and health longitudinal study in Iyiyuu Aschii

			Mistissini (n=156)	Wemindji (n=126)	Eastmain (n=92)	Total (n=374)
Data collection time period			2005	2007	2007	–	–
Nearest city with a population>7,000 – distance			88 km	850 km	691 km	–	–
			n (%)	n (%)	n (%)	n (%)	P
Individual level	Age	18–39 (n=235)	98 (62.8)	81 (64.3)	56 (60.9)	235 (62.8)	0.876
		40–90 (n=139)	58 (37.2)	45 (35.7)	36 (39.1)	139 (37.2)
	Sex	Male (n=150)	59 (37.8)	57 (45.2)	34 (37.0)	150 (40.1)	0.350
		Female (n=224)	97 (62.2)	69 (54.8)	58 (63.0)	224 (59.9)
	BMI	18.5–24.99 (n=27)	11 (7.1)	10 (7.9)	6 (6.5)	27 (7.2)	0.678
		25–29.99 (n=86)	41 (26.3)	28 (22.2)	17 (18.5)	86 (23.0)
		30 and+(n=261)	104 (66.7)	88 (69.8)	69 (75.0)	261 (69.8)
	Daily walking	Less than 30 minutes (n=174)	73 (46.8)	55 (43.7)	46 (50.0)	174 (46.5)	0.647
		30 minutes or more (n=200)	83 (53.2)	71 (56.3)	46 (50.0)	200 (53.5)
	Education	College/university (n=79)	32 (20.5)	31 (24.6)	16 (17.4)	79 (21.1)	0.008
		High school (n=220)	80 (51.3)	76 (60.3)	64 (69.6)	220 (58.8)
		No formal schooling/elementary school (n=75)	44 (28.2)	19 (15.1)	12 (13.0)	75 (20.1)
	Hunter	No (n=194)	82 (52.6)	57 (45.2)	55 (59.8)	194 (51.9)	0.102
		Yes (n=180)	74 (47.4)	69 (54.8)	37 (40.2)	180 (48.1)
	Smoking	Smoker (n=187)	79 (50.6)	61 (48.4)	47 (51.1)	187 (50)	0.907
		Non-smoker (n=187)	77 (49.4)	65 (51.6)	45 (48.9)	187 (50)
	Employment status	Employed (n=255)	100 (64.1)	80 (63.5)	75 (81.5)	255 (68.2)	0.007
		Unemployed (n=119)	56 (35.9)	46 (36.5)	17 (18.5)	119 (31.8)
	Health perception	Fair to poor (n=100)	44 (28.2)	29 (23.0)	27 (29.3)	100 (26.7)	0.021
		Good (n=176)	76 (48.7)	69 (54.8)	31 (33.7)	176 (47.1)
		Very good to excellent (n=98)	36 (23.1)	28 (22.2)	34 (37.0)	98 (26.2)
	Worries about pollution	Very much (n=122)	29 (18.6)	65 (51.6)	28 (30.4)	122 (32.6)	<0.001
		Somewhat to fairly (n=166)	84 (53.8)	44 (34.9)	38 (41.3)	166 (44.4)
		Not at all (n=86)	43 (27.6)	17 (13.5)	26 (28.3)	86 (23.0)
Interpersonal	English spoken at home	No English (n=187)	78 (50.0)	59 (46.8)	50 (54.3)	187 (50.0)	0.548
		English (n=187)	78 (50.0)	67 (53.2)	42 (45.7)	187 (50.0)
	No. of people in the household	1–4 persons (n=159)	105 (67.3)	73 (57.9)	46 (50.0)	224 (59.9)	0.023
		5 persons or more (n=215)	51 (32.7)	53 (42.1)	46 (50.0)	150 (40.1)
			Mean freq/wk (CI)	Mean freq/wk (CI)	Mean freq/wk (CI)	Mean freq/wk (CI)	P
	Traditional food frequency	Games	2.26 (1.76–2.77)	1.06 (0.85–1.28)	1.11 (0.61–1.61)	1.57 (1.31–1.84)	<0.001
		Birds	1.34 (1.00–1.68)	0.93 (0.78–1.09)	0.85 (0.67–1.02)	1.08 (0.92–1.24)	0.022
		Fishes	1.49 (0.99–1.98)	0.85 (0.61–1.10)	0.38 (0.11–0.65)	1.00 (0.77–1.24)	0.001
		Berries	0.56 (0.36–0.76)	0.31 (0.13–0.23)	0.31 (0.07–0.57)	0.42 (0.31–0.53)	0.094
		Greases	0.46 (0.33–0.59)	0.18 (0.20–0.43)	0.24 (0.15–0.32)	0.31 (0.31–0.25)	<0.001
		Total traditional food	6.11 (4.71–7.52)	3.34 (2.77–3.92)	2.88 (1.90–3.87)	4.39 (3.71–5.06)	<0.001

The bold values are the significative values with an alpha of 5%.

Table IV. Factors influencing traditional food weekly intake (<3 times– ≥3 times): a logistic regression (n=374)

		≥3 Times/week (%)	Crude OR	CI 95%	Adjust^a OR	CI 95%
Age	18–39 (n=235)	26.0	1.00		1.00
	40–90 (n=139)	65.5	5.41	3.43, 8.53	4.51	2.47, 8.26
Sex	Male (n=150)	48.7	1.00		1.00
	Female (n=224)	35.3	0.58	0.38, 0.88	1.10	0.50, 2.40
BMI	18.5–24.99 (n=27)	37.0	1.00		1.00
	25–29.99 (n=86)	37.2	1.01	0.41, 2.47	0.64	0.22, 1.81
	30 and+(n=261)	42.1	1.24	0.55, 2.81	1.08	0.42, 2.80
Daily walking	Less than 30 minutes (n=174)	35.1	1.00		1.00
	30 minutes or more (n=200)	45.5	1.55	1.02, 2.35	2.41	1.40, 4.13
Education	College/university (n=79)	34.3	1.00		1.00
	High school (n=220)	30.0	0.83	0.48, 1.43	0.87	0.45, 1.69
	No formal schooling/elementary school (n=75)	78.7	7.10	3.45, 14.62	5.53	2.20, 13.89
Hunter	No (n=194)	28.9	1.00		1.00
	Yes (n=180)	53.3	2.83	1.84, 4.32	3.86	1.78, 8.39
Smoking	Smoker (n=187)	30.5	1.00		1.00
	Non-smoker (n=187)	50.8	2.36	1.54, 3.60	1.15	0.65, 2.02
Employment status	Employed (n=255)	34.9	1.00		1.00
	Unemployed (n=119)	52.9	2.10	1.35, 3.27	1.17	0.63, 2.17
Health perception	Fair to poor (n=100)	46. 0	1.00		1.00
	Good (n=176)	37.5	0.70	0.43, 1.16	0.60	0.31, 1.15
	Very good to excellent (n=98)	40.8	0.81	0.46, 1.42	0.71	0.34, 1.49
Worries about pollution	Very much (n=122)	36.0	1.00		1.00
	Somewhat to fairly (n=166)	44.0	1.21	0.75, 1.95	1.30	0.70, 2.41
	Not at all (n=86)	39.3	0.87	0.49, 1.54	0.72	0.33, 1.58
English spoken at home	No English (n=187)	44.9	1.00		1.00
	English (n=187)	36.4	0.70	0.46, 1.06	1.12	0.64, 1.96
No. of people in the household	1–4 persons (n=159)	43.4	1.00		1.00
	5 persons or more (n=215)	38.6	0.82	0.54, 1.24	1.45	0.84, 2.50
Community	Eastmain (n=92)	26.1	1.00		1.00
	Wemindji (n=126)	36.5	1.63	0.90, 2.94	1.58	0.75, 3.32
	Mistissini (n=156)	52.6	3.14	1.79, 5.50	3.62	1.78, 7.36

^aAll variables included.

The bold values are the significative values with an alpha of 5%.

Table V. Focus group participants’ comments on the quantitative findings

Variables	Participants’ explanations	Quotations
Body mass index (BMI)	Participants disagreed with the non-association. 1. People with a higher BMI might be eating high-fat traditional foods, such as bear grease, or using high-fat cooking methods. 2. People with normal BMI use healthy cooking methods and eat less junk food. 3. People with higher BMI eat bigger portions.	1. I guess those people who are obese, they eat more, more greasy food. Bear fat. Siikusakin (bear fat cracklings) that's really delicious. 2. Because we don't know the non-obese and the obese people like are the non-obese people cooking more nutritional foods or adapting to new ways or the obese still practicing what we had in the past, that we don't really know. And the people that are obese, they still going to Kentucky Fried Chicken or the people that are non-obese are they still doing the same. 3. Big people serve themselves big portions. Like when I go over to Murray's lodge, these people that are big, they get a whole portion – almost double of what the smaller person is eating. And yet they would eat all of it.
Education	Participants agreed with the association. People with more education had to study outside the community, where they had less access to traditional foods and as a result their traditional knowledge or habits were altered.	They probably live the lifestyle of White people. They have more education so they don't care about the traditional Cree food.
Employment status	Participants disagreed with the non-association. 1. Having a job provides the means to pay for expenses related to hunting. However, being employed means you have less time to hunt. 2. People with a job tend to stay in the community while the unemployed live in the bush.	1. Those who are non-employed, where they get their money to get their bush food and those who are employed may have the money but they don't have the time. 2. I don't know if I would agree, because people that are employed tend to stay in their home in the community, Yah. More than the non-employed. Yup. And the non-employed Cree trappers. They live in the bush.
Health perception	1–2. Some participants disagreed with the way the question was phrased, stating that the definition of health can vary from 1 individual to another. 2–3. Some participants agreed with the non-association.	1. Even people that are healthy can feel unhealthy. 2. Whether you feel healthy or not it depends on what you eat so you might feel healthy because you eat traditional food all the time and some of us might feel different because we mostly eat commercial food. 3. Yeah. I'm not healthy, but I still eat beaver, goose, and moose meat. It's healing for the elders, like when they're sick in the hospital. Usually the doctors encourage them to eat traditional food. So, being healthy doesn't have to go with eating traditional food.
Worries about pollution	1. Some participants disagreed with the non-association. 2. Some participants agreed, saying that they were not worried about contaminants because they did not listen to the awareness campaign.	1. I don't know anybody that would not worry about it. That's why I'm stuck with this question. I don't know anybody who would not worry about contaminated food. That's inevitable. 2. Myself, I don't usually listen to that, you know. If I get a lake trout, I'll eat it (laughing). I won't pay any attention, you know. I won't follow to have it once a week or once a month the way they recommend we do, you know (laughing).
Community	1–2. Participants were surprised because Wemindji and Eastmain are more isolated than Mistissini, so they should be less influenced by non-aboriginal culture and the price of market foods should be higher; representing incentives to traditional food consumption. 3. Participants tried to explain the result: Presence of programs promoting traditional food in Mistissini.	1. I am surprised because they're more isolated. And they have less access to restaurant foods. The towns are more far away than us. We were exposed more to the Southern people than them. 2. They are isolated but their (market) food is more expensive. 3. I think the other thing too in Mistissini is having those programs there, Murray's lodge and the elder's point there, having those program will help, having people eating traditional food because they can go, you know to Murray's lodge or somewhere.

Fig. 2.  An ecological model of factors influencing the consumption of traditional food. *Bolded factors are statistically significant in logistic regression.

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