http://orcid.org/0000-0001-8945-513X
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ABSTRACT
Rationale: Cardiovascular risk varies across communities in Canada. Community-level differences in contextual factors may influence risk factor development.
Methods: We audited urban and rural Canadian communities using a standardized instrument to collect objective measures of demographic, public transport, tobacco, grocery, alcohol, and healthful restaurant options. We duplicated 209 audits to assess reliability.
Results: Of 2074 communities audited between 2014 and 2016, 83.5% were urban. Provincial and urban-rural differences exist in fruit and vegetable availability. Rural communities face higher food prices, are subject to more seasonal variation in fruit and vegetable selection, and generally see less promotion of healthy choices and nutritional information in restaurants than urban communities. In-store advertising for sweet drinks and junk food is more frequent than advertisements for tobacco products. Cigarette prices are lower and variety higher in urban than rural communities, and lowest in central Canada. Alcohol prices are lowest in Quebec. The intra-rater reliability of the audits was high. We created an on-line map for public use.
Conclusions: Provincial and urban-rural differences exist for contextual determinants of health. Public health and built environment professionals and government officials should use these data to develop unified federal and provincial strategies to reduce Canada’s chronic disease burden.
Acknowledgments
We acknowledge the dedication of our community auditors: Hannah Albani, Connor Arnott, Sukhmeet Bedi, Annie Bernatchez-Côté, Erin Bethune, Erica Corber, Veronica de Jong, Shira Gerstein, Neil Gandhi, Aditi Gupta, Vavandeep Kandola, Delia Lin, Lauren Lumsden, Matthew Madill, Adriana Maroleanu, Gift Madojemu, Crystal Narten, Sungpyo Park, Timothy Park, Anne-Marie Poirier, Tayler Poscai, Emma Price, Anjali Sergeant, and Geoffrey Thompson. We acknowledge Dr. Geoff Fong (University of Waterloo) for his assistance with the International Tobacco Control Policy Evaluation Project reports, and Sujane Kandasamy, M.Sc., for her assistance with preparing the ‘City Know-how’ summary. We thank the peer reviewers of this manuscript for their constructive suggestions.
Availability of data and material
An interactive map will be published on-line containing the data used to produce this paper. Requests for data can be addressed to Dr. Sonia S. Anand ([email protected]).
Disclosure statement
No potential conflict of interest was reported by the authors.
Ethics approval and consent to participate
The project has been approved by Hamilton Integrated Research Ethics Board: Project# 13–255. Some participating research centers also obtained secondary approval for data collection.
Supplementary material
Supplementary material for this article can be accessed here
Additional information
Funding
Notes on contributors
R. J. de Souza
R. J. de Souza is an Assistant Professor in the Department of Health Research Methods, Evidence, and Impact at McMaster University. He is a registered dietitian, and his research focuses on dietary patterns, health, and how the food environment shapes food choice and risk of cardiovascular disease.
L. Gauvin
Lise Gauvin is a principal scientist at Centre de recherche du Centre hospitalier de l’Université de Montréal . Her work focuses on how different neighbourhood characteristics can influence people’s lifestyle choices, what neighbourhood features can become the target of public health interventions, and on how these interventions can successfully shape urban residential areas.
N. C. Williams
Natalie Williams is a data manager working with the Alliance for Healthy Hearts and Minds.
S. A. Lear
Scott Lear is a Professor in the Faculty of Health Sciences at Simon Fraser University and the inaugural Pfizer/Heart and Stroke Foundation Chair in Cardiovascular Prevention.
A. P. Oliveira
A. P. Oliveira does not wish to have is biography printed.
D. Desai
Dipika Desai is a senior project manager with the Alliance for Healthy Hearts and Minds.
D. J. Corsi
Danel Corsi works with the OMNI Research Group at the Ottawa Hospital Research Institute.
S. V. Subramanian
S. V. Subramanian is a Professor of Population Health and Geography at Harvard University, and Director of a University-wide Initiative on Applied Quantitative Methods in Social Sciences.
A. Rana
Ayesha Rana was a M.Sc. student with Dr. Anand at the time of data collection and worked on developing and testing the audit plan. She is now a family medicine resident.
R. Arora
Rishi Arora is an undergraduate research student in the Faculty of Health Sciences, McMaster University.
G. L. Booth
Gillian Booth is an Endocrinologist and Scientist at the Li Ka Shing Knowledge Institute at St. Michael’s Hospital, Toornto. She leads the the “Healthy Cities, Healthier Lives” Research Program.
F. Razak
Fahad Razak an Internist and Scientist at the Li Ka Shing Knowledge Institute at St. Michael’s Hospital, Toornto. His research is focused on health interventions in low-income settings, and big data development and analytics.
J. R. Brook
Jeff Brook is the Principal Investigator and Scientific Director of the Canadian urban environmental health research consortium (CANUE). He has 25 years of experience as an Environment Canada scientist working at the science-policy interface.
J. V. Tu
Jack Tu was a senior scientist with the Institute for Clinical Evaluative Sciences in Torotno. He was an internationally recognized health services researcher, who published over 350 peer-reviewed journal articles.
S. S. Anand
Sonia S. Anand is a Professor Medicine and Epidemiology at McMaster University and a senior scientist at the Population Health Research Institute. Her research focuses on understanding the environmental and genetic causes of cardiovascular risk factors among women, and diverse ethnic groups, and clinical-population health interventions.