Childhood Obesity: Indigenous Children and Health Disparities
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This article discusses the issue of childhood obesity in indigenous children, focusing on the impact on health and the factors contributing to health disparities. It explores the role of access to healthcare services and health literacy, as well as the importance of cultural competency in addressing the issue. The article also highlights primary care interventions, such as nutritional programs, and their effectiveness in reducing childhood obesity. Overall, it emphasizes the need for increased access to healthcare services and culturally competent healthcare professionals to address the prevalence of childhood obesity in indigenous children.
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Running head: CHILDHOOD OBESITY
CHILDHOOD OBESITY
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CHILDHOOD OBESITY
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Question 1:
Childhood obesity is a significant public health issue for indigenous children (Davison et
al. 2017). Being overweight increases the risk of a range of health conditions such as cancer,
cardiovascular disease, respiratory problem, diabetes type 2 (Kirmayer and Brass 2016). The
excess burden of obesity in the indigenous population estimated to contribute 16% of the health
gap. The indigenous children of 2 to 14 years are more likely to be overweight ( 8%) compared
to non-indigenous children (5%). The obesity rate in indigenous children is higher (30%)
compared to non-indigenous children (25%) (Ahha.asn.au. 2019). Consequently, it affected the
school performance of the children, decreases life expectancy and increases the risk of
developing chronic disease (Kim et al. 2017). The accumulated literature highlighted access to
health care services and health literacy are two different reasons behind inequity between
indigenous Australians and non-Indigenous Australians in relation to childhood obesity.
As discussed by Garg, Boynton-Jarrett and Dworkin (2016) access to health care is
widely acknowledged as the social determinants of health and lack of access to health care
services is well documented in Torres Strait Island. A considerate number of researchers
connected the lack of access to health care services with poverty and discrimination, cultural
barriers, socioeconomic disadvantages. Because of the high rate of unemployment in Torres
Strait Island, significant number of individuals are unable to seek health care services, as health
care cost of treating health issues are quite high and they lives in the disadvantageous area
(Fisher et al. 2016). Even if they have access to the health care services, significant number of
indigenous children and families are the victim of the discrimination where they experience the
racial discrimination from the health care providers because of inadequate knowledge of
Aboriginal cultural values and beliefs. The language barrier is another factor behind the lack of
CHILDHOOD OBESITY
Question 1:
Childhood obesity is a significant public health issue for indigenous children (Davison et
al. 2017). Being overweight increases the risk of a range of health conditions such as cancer,
cardiovascular disease, respiratory problem, diabetes type 2 (Kirmayer and Brass 2016). The
excess burden of obesity in the indigenous population estimated to contribute 16% of the health
gap. The indigenous children of 2 to 14 years are more likely to be overweight ( 8%) compared
to non-indigenous children (5%). The obesity rate in indigenous children is higher (30%)
compared to non-indigenous children (25%) (Ahha.asn.au. 2019). Consequently, it affected the
school performance of the children, decreases life expectancy and increases the risk of
developing chronic disease (Kim et al. 2017). The accumulated literature highlighted access to
health care services and health literacy are two different reasons behind inequity between
indigenous Australians and non-Indigenous Australians in relation to childhood obesity.
As discussed by Garg, Boynton-Jarrett and Dworkin (2016) access to health care is
widely acknowledged as the social determinants of health and lack of access to health care
services is well documented in Torres Strait Island. A considerate number of researchers
connected the lack of access to health care services with poverty and discrimination, cultural
barriers, socioeconomic disadvantages. Because of the high rate of unemployment in Torres
Strait Island, significant number of individuals are unable to seek health care services, as health
care cost of treating health issues are quite high and they lives in the disadvantageous area
(Fisher et al. 2016). Even if they have access to the health care services, significant number of
indigenous children and families are the victim of the discrimination where they experience the
racial discrimination from the health care providers because of inadequate knowledge of
Aboriginal cultural values and beliefs. The language barrier is another factor behind the lack of
3
CHILDHOOD OBESITY
access to health care services which contributed to poor health (Fisher et al. 2016). Children who
are obese because of underlying hereditary factors failed to seek health care services and
experience obesity-associated diseases. The health illiteracy is another reason behind inequity
between the indigenous and non-indigenous population in terms of obesity (Ahha.asn.au. 2019).
Majority of aboriginal families are unaware of their health condition and nutritional strategies
which would be suitable to remain healthy. Due to hurdles of life and unemployment indigenous
families are not motivated to gain health literacy or remain healthy or exposed to many stressors
which hinder their ability to nurture their children that leads to obesity (Kagie et al. 2016).
Moreover, lack of access to the nutritious food resulted in consumption of food which is
available to them. Consequently, children are the victim of unhealthy infant feeding practices,
child neglect and consuming a poorer diet which is available to their families (Russell et al.
2016).Consequently, 36.7% of the children in-between 2 to 14 years are overweight or obese and
they are at high risk of developing chronic diseases (Russell et al. 2016). Therefore, in order to
reduce the rate of childhood obesity, it is crucial to increase access to health care service and
increase health literacy.
Question 2:
Primary care health care services in the indigenous communities are increasingly
managed and delivered by the indigenous community controlled health services (Gifford et al.
2018). While the family-centered approach to childhood obesity has taken as primary care
interventions to provide education, training, employment to the families in order to nurture their
child, fruit, and vegetable subsidy program as a primary care intervention (nutritional
interventions) has gained the popularity (Triador et al. 2015). The nutritional intervention as
primary care intervention is only direct approach to reduce childhood obesity which provides an
CHILDHOOD OBESITY
access to health care services which contributed to poor health (Fisher et al. 2016). Children who
are obese because of underlying hereditary factors failed to seek health care services and
experience obesity-associated diseases. The health illiteracy is another reason behind inequity
between the indigenous and non-indigenous population in terms of obesity (Ahha.asn.au. 2019).
Majority of aboriginal families are unaware of their health condition and nutritional strategies
which would be suitable to remain healthy. Due to hurdles of life and unemployment indigenous
families are not motivated to gain health literacy or remain healthy or exposed to many stressors
which hinder their ability to nurture their children that leads to obesity (Kagie et al. 2016).
Moreover, lack of access to the nutritious food resulted in consumption of food which is
available to them. Consequently, children are the victim of unhealthy infant feeding practices,
child neglect and consuming a poorer diet which is available to their families (Russell et al.
2016).Consequently, 36.7% of the children in-between 2 to 14 years are overweight or obese and
they are at high risk of developing chronic diseases (Russell et al. 2016). Therefore, in order to
reduce the rate of childhood obesity, it is crucial to increase access to health care service and
increase health literacy.
Question 2:
Primary care health care services in the indigenous communities are increasingly
managed and delivered by the indigenous community controlled health services (Gifford et al.
2018). While the family-centered approach to childhood obesity has taken as primary care
interventions to provide education, training, employment to the families in order to nurture their
child, fruit, and vegetable subsidy program as a primary care intervention (nutritional
interventions) has gained the popularity (Triador et al. 2015). The nutritional intervention as
primary care intervention is only direct approach to reduce childhood obesity which provides an
4
CHILDHOOD OBESITY
opportunity to maintain a healthy weight through amending nutritional strategies and eating
nutritional foods (Gifford et al. 2018). Therefore, This intervention is aimed to engage
aboriginal families who have low socioeconomic status, especially aboriginal children and the
children who will attend preschool was provided with healthy vegetables and fruits . A
considerate number of children are a victim of unhealthy nutritional practice, poorer diet and
neglected since their families are dealing with stressors which are manifested with grief,
smoking, violence, and mental illness. These issues hindered the families to focus on childhood
development which resulted in widening the gap between indigenous and non-indigenous health.
As discussed by Kagie et al. (2016), this intervention of providing nutritious food to the children
as well as the family members of economically disadvantageous families provided a health
benefit to the children. The program was arranged by Bulgarr Ngaru Medical Aboriginal
Corporation to reduce and the program was combined with health assessments, including dental
checkups, hearing checkups, and other health checkups (Kagie et al. 2016). The primary aim of
the program was to promote healthier nutrients, providing health literacy to nurture their
children, increase the intake of fruit and vegetables for closing the gap between indigenous and
non-indigenous individuals. The programs have influenced the health status of aboriginal
children and families since apart from nutrition’s, proper health care services are available to
them. The impact of the program is that it provides the opportunity of adequate grocery to the
disadvantageous families which resulted in the reduction of the negligence of infant nurturing.
The program improved the biomarker of fruit and vegetable intake among children (Gwynn et al.
2019). The program reduced the rate of non-communicable and communicable diseases,
frequent episode of asthma because of overweight and other obesity-associated problems. The
intervention effectively improved the immune system of the children which further contribute to
CHILDHOOD OBESITY
opportunity to maintain a healthy weight through amending nutritional strategies and eating
nutritional foods (Gifford et al. 2018). Therefore, This intervention is aimed to engage
aboriginal families who have low socioeconomic status, especially aboriginal children and the
children who will attend preschool was provided with healthy vegetables and fruits . A
considerate number of children are a victim of unhealthy nutritional practice, poorer diet and
neglected since their families are dealing with stressors which are manifested with grief,
smoking, violence, and mental illness. These issues hindered the families to focus on childhood
development which resulted in widening the gap between indigenous and non-indigenous health.
As discussed by Kagie et al. (2016), this intervention of providing nutritious food to the children
as well as the family members of economically disadvantageous families provided a health
benefit to the children. The program was arranged by Bulgarr Ngaru Medical Aboriginal
Corporation to reduce and the program was combined with health assessments, including dental
checkups, hearing checkups, and other health checkups (Kagie et al. 2016). The primary aim of
the program was to promote healthier nutrients, providing health literacy to nurture their
children, increase the intake of fruit and vegetables for closing the gap between indigenous and
non-indigenous individuals. The programs have influenced the health status of aboriginal
children and families since apart from nutrition’s, proper health care services are available to
them. The impact of the program is that it provides the opportunity of adequate grocery to the
disadvantageous families which resulted in the reduction of the negligence of infant nurturing.
The program improved the biomarker of fruit and vegetable intake among children (Gwynn et al.
2019). The program reduced the rate of non-communicable and communicable diseases,
frequent episode of asthma because of overweight and other obesity-associated problems. The
intervention effectively improved the immune system of the children which further contribute to
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5
CHILDHOOD OBESITY
the improved health by reducing the gap between indigenous and non-indigenous individuals
(Gwynn et al. 2019). A study by Kagie et al. (2016), suggested that this intervention improved
the iron defiance and anemia in aboriginal children. Therefore, in order to close the gap between
indigenous and non-indigenous people and reduce childhood obesity, it is crucial to design
additional primary interventions
Question 3:
Cultural competency is broadly defined as a set of harmonious values principles and
attitude that enables health professionals to work efficiently in the multicultural clinical setting.
The aboriginal individuals who live in the Torres Strait Islanders have a set of cultural values,
beliefs, and principles which are different from the non-indigenous individuals and they
communicate in a language which is different from the non-indigenous population (Burgess
2017). Culture influences the concept of health and illness, symptoms of distress and health-
seeking behavior (Rawnsley et al. 2018). Therefore, access to primary care is affected and
compromised when the health care providers failed to respond to the concern of aboriginal
individuals with appropriate language and cultural factors influencing health and health behavior
(Rawnsley et al. 2018). The aboriginal individuals tend to feel offended; do not seek clinical
assistance when language and cultural barriers are present since health professionals failed to
show proper respect to the cultural norms and values. Sometimes, they are subjected to high
psychological distress if they were not provided with proper access to primary care, as primary
care is only the health care system which provides holistic care (Clifford et al. 2016). On a
different note, Lack of cultural knowledge and sensitivity creates the racial and colonial
discrimination which further hinders the aboriginal population to gain access to the primary care
services. Li (2017) suggested that health professionals who are better equipped with better
CHILDHOOD OBESITY
the improved health by reducing the gap between indigenous and non-indigenous individuals
(Gwynn et al. 2019). A study by Kagie et al. (2016), suggested that this intervention improved
the iron defiance and anemia in aboriginal children. Therefore, in order to close the gap between
indigenous and non-indigenous people and reduce childhood obesity, it is crucial to design
additional primary interventions
Question 3:
Cultural competency is broadly defined as a set of harmonious values principles and
attitude that enables health professionals to work efficiently in the multicultural clinical setting.
The aboriginal individuals who live in the Torres Strait Islanders have a set of cultural values,
beliefs, and principles which are different from the non-indigenous individuals and they
communicate in a language which is different from the non-indigenous population (Burgess
2017). Culture influences the concept of health and illness, symptoms of distress and health-
seeking behavior (Rawnsley et al. 2018). Therefore, access to primary care is affected and
compromised when the health care providers failed to respond to the concern of aboriginal
individuals with appropriate language and cultural factors influencing health and health behavior
(Rawnsley et al. 2018). The aboriginal individuals tend to feel offended; do not seek clinical
assistance when language and cultural barriers are present since health professionals failed to
show proper respect to the cultural norms and values. Sometimes, they are subjected to high
psychological distress if they were not provided with proper access to primary care, as primary
care is only the health care system which provides holistic care (Clifford et al. 2016). On a
different note, Lack of cultural knowledge and sensitivity creates the racial and colonial
discrimination which further hinders the aboriginal population to gain access to the primary care
services. Li (2017) suggested that health professionals who are better equipped with better
6
CHILDHOOD OBESITY
cultural competencies and awareness are able to reduce health care disparities. Culturally
competent health professionals have intensive knowledge of diverse culture have a minimum or
no tendency of promoting racial and colonial discrimination. They come up with initiatives to
address aboriginal issues and able to incorporate these cultural factors to promote empowerment,
compassion, and empathy. Taking an insight into the situation, as discussed above childhood
obesity is one of the major issues in aboriginal individuals where underlying reason is lack of
proper access to the health care services (Clifford et al. 2016). Considering the child health,
parental practice, decision making concerning the health of child and bereavement practices of
families are influenced by cultural values, beliefs, and norms. Therefore, cultural knowledge
and sensitivity reduces the discrimination behavior of the health professionals towards the
aboriginal children and their families and reduces language barriers (Clifford et al. 2016). The
health professional with cultural knowledge and sensitivity are able to provide comfort and safe
services by reflecting empathy, compassion and prioritizing the decision making of aboriginal
families regarding nutritional strategies, health assessment, and interventions for childhood
obesity (Antonio, Chung-Do and Braun 2015). The health professionals with cultural
knowledge and sensitivity are able to provide aboriginal families, a sense of security and
empowerment. Aboriginal families will feel safe to participate and able to collaborate with the
culturally competent health professionals in the primary health care system which further will
result in improvement of diet strategies of children and normal weight of children (Antonio,
Chung-Do and Braun 2015). Thus, in order to reduce the prevalence of childhood obesity in
Aboriginal children of Torres Strait Island, it is crucial to recruit culturally competent health
professionals to provide the access to the primary health care services.
CHILDHOOD OBESITY
cultural competencies and awareness are able to reduce health care disparities. Culturally
competent health professionals have intensive knowledge of diverse culture have a minimum or
no tendency of promoting racial and colonial discrimination. They come up with initiatives to
address aboriginal issues and able to incorporate these cultural factors to promote empowerment,
compassion, and empathy. Taking an insight into the situation, as discussed above childhood
obesity is one of the major issues in aboriginal individuals where underlying reason is lack of
proper access to the health care services (Clifford et al. 2016). Considering the child health,
parental practice, decision making concerning the health of child and bereavement practices of
families are influenced by cultural values, beliefs, and norms. Therefore, cultural knowledge
and sensitivity reduces the discrimination behavior of the health professionals towards the
aboriginal children and their families and reduces language barriers (Clifford et al. 2016). The
health professional with cultural knowledge and sensitivity are able to provide comfort and safe
services by reflecting empathy, compassion and prioritizing the decision making of aboriginal
families regarding nutritional strategies, health assessment, and interventions for childhood
obesity (Antonio, Chung-Do and Braun 2015). The health professionals with cultural
knowledge and sensitivity are able to provide aboriginal families, a sense of security and
empowerment. Aboriginal families will feel safe to participate and able to collaborate with the
culturally competent health professionals in the primary health care system which further will
result in improvement of diet strategies of children and normal weight of children (Antonio,
Chung-Do and Braun 2015). Thus, in order to reduce the prevalence of childhood obesity in
Aboriginal children of Torres Strait Island, it is crucial to recruit culturally competent health
professionals to provide the access to the primary health care services.
7
CHILDHOOD OBESITY
References:
Ahha.asn.au. (2019). Overweight and obesity among Indigenous children: individual and social
determinants. Retrieved from
https://ahha.asn.au/system/files/docs/publications/deeble_issue_brief_no_3_overweight_and_obe
sity_among_indigenous_children.pdf
Antonio, M.C., Chung-Do, J.J. and Braun, K.L., 2015. Systematic review of interventions
focusing on Indigenous pre-adolescent and adolescent healthy lifestyle changes. AlterNative: An
International Journal of Indigenous Peoples, 11(2), pp.147-163.
Burgess, C., 2017. Beyond cultural competence: Transforming teacher professional learning
through Aboriginal community-controlled cultural immersion. Critical Studies in Education,
pp.1-19.
Clifford, A., McCalman, J., Bainbridge, R. and Tsey, K., 2015. Interventions to improve cultural
competency in health care for Indigenous peoples of Australia, New Zealand, Canada and the
USA: a systematic review. International Journal for Quality in Health Care, 27(2), pp.89-98.
Davison, K.K., Charles, J.N., Khandpur, N. and Nelson, T.J., 2017. Fathers’ perceived reasons
for their underrepresentation in child health research and strategies to increase their
involvement. Maternal and child health journal, 21(2), pp.267-274.
Fisher, M., Baum, F.E., MacDougall, C., Newman, L. and McDermott, D., 2016. To what extent
do Australian health policy documents address social determinants of health and health
equity?. Journal of Social Policy, 45(3), pp.545-564.
CHILDHOOD OBESITY
References:
Ahha.asn.au. (2019). Overweight and obesity among Indigenous children: individual and social
determinants. Retrieved from
https://ahha.asn.au/system/files/docs/publications/deeble_issue_brief_no_3_overweight_and_obe
sity_among_indigenous_children.pdf
Antonio, M.C., Chung-Do, J.J. and Braun, K.L., 2015. Systematic review of interventions
focusing on Indigenous pre-adolescent and adolescent healthy lifestyle changes. AlterNative: An
International Journal of Indigenous Peoples, 11(2), pp.147-163.
Burgess, C., 2017. Beyond cultural competence: Transforming teacher professional learning
through Aboriginal community-controlled cultural immersion. Critical Studies in Education,
pp.1-19.
Clifford, A., McCalman, J., Bainbridge, R. and Tsey, K., 2015. Interventions to improve cultural
competency in health care for Indigenous peoples of Australia, New Zealand, Canada and the
USA: a systematic review. International Journal for Quality in Health Care, 27(2), pp.89-98.
Davison, K.K., Charles, J.N., Khandpur, N. and Nelson, T.J., 2017. Fathers’ perceived reasons
for their underrepresentation in child health research and strategies to increase their
involvement. Maternal and child health journal, 21(2), pp.267-274.
Fisher, M., Baum, F.E., MacDougall, C., Newman, L. and McDermott, D., 2016. To what extent
do Australian health policy documents address social determinants of health and health
equity?. Journal of Social Policy, 45(3), pp.545-564.
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Garg, A., Boynton-Jarrett, R. and Dworkin, P.H., 2016. Avoiding the unintended consequences
of screening for social determinants of health. Jama, 316(8), pp.813-814.
Gifford, J., Gwynn, J., Hardy, L., Turner, N., Henderson, L., Innes-Hughes, C. and Flood, V.,
2018. Review of Short-Form Questions for the Evaluation of a Diet, Physical Activity, and
Sedentary Behaviour Intervention in a Community Program Targeting Vulnerable Australian
Children. Children, 5(7), p.95.
Gwynn, J., Sim, K., Searle, T., Senior, A., Lee, A. and Brimblecombe, J., 2019. Effect of
nutrition interventions on diet-related and health outcomes of Aboriginal and Torres Strait
Islander Australians: a systematic review. BMJ open, 9(4), p.e025291.
Kagie, R., Lin, S.Y.N., Hussain, M.A. and Thompson, S.C., 2019. A Pragmatic Review to Assist
Planning and Practice in Delivering Nutrition Education to Indigenous Youth. Nutrients, 11(3),
p.510.
Kagie, R., Lin, S.Y.N., Hussain, M.A. and Thompson, S.C., 2019. A Pragmatic Review to
Assist Planning and Practice in Delivering Nutrition Education to Indigenous
Youth. Nutrients, 11(3), p.510.
Kim, S., Macaskill, P., Baur, L.A., Hodson, E.M., Daylight, J., Williams, R., Kearns, R.,
Vukasin, N., Lyle, D.M. and Craig, J.C., 2016. The differential effect of socio-economic status,
birth weight and gender on body mass index in Australian Aboriginal Children. International
Journal of Obesity, 40(7), p.1089.
Kirmayer, L.J. and Brass, G., 2016. Addressing global health disparities among Indigenous
peoples. The Lancet, 388(10040), pp.105-106.
CHILDHOOD OBESITY
Garg, A., Boynton-Jarrett, R. and Dworkin, P.H., 2016. Avoiding the unintended consequences
of screening for social determinants of health. Jama, 316(8), pp.813-814.
Gifford, J., Gwynn, J., Hardy, L., Turner, N., Henderson, L., Innes-Hughes, C. and Flood, V.,
2018. Review of Short-Form Questions for the Evaluation of a Diet, Physical Activity, and
Sedentary Behaviour Intervention in a Community Program Targeting Vulnerable Australian
Children. Children, 5(7), p.95.
Gwynn, J., Sim, K., Searle, T., Senior, A., Lee, A. and Brimblecombe, J., 2019. Effect of
nutrition interventions on diet-related and health outcomes of Aboriginal and Torres Strait
Islander Australians: a systematic review. BMJ open, 9(4), p.e025291.
Kagie, R., Lin, S.Y.N., Hussain, M.A. and Thompson, S.C., 2019. A Pragmatic Review to Assist
Planning and Practice in Delivering Nutrition Education to Indigenous Youth. Nutrients, 11(3),
p.510.
Kagie, R., Lin, S.Y.N., Hussain, M.A. and Thompson, S.C., 2019. A Pragmatic Review to
Assist Planning and Practice in Delivering Nutrition Education to Indigenous
Youth. Nutrients, 11(3), p.510.
Kim, S., Macaskill, P., Baur, L.A., Hodson, E.M., Daylight, J., Williams, R., Kearns, R.,
Vukasin, N., Lyle, D.M. and Craig, J.C., 2016. The differential effect of socio-economic status,
birth weight and gender on body mass index in Australian Aboriginal Children. International
Journal of Obesity, 40(7), p.1089.
Kirmayer, L.J. and Brass, G., 2016. Addressing global health disparities among Indigenous
peoples. The Lancet, 388(10040), pp.105-106.
9
CHILDHOOD OBESITY
Li, J.L., 2017. Cultural barriers lead to inequitable healthcare access for aboriginal Australians
and Torres Strait Islanders. Chinese Nursing Research, 4(4), pp.207-210.
Rawnsley, J., Woodroffe, D., Culic, E., Richards, J. and Clifton, L., 2018. Cultural Competency
in a Legal Service and Justice Agency for Aboriginal Peoples. Legal Educ. Rev., 28, p.1.
Russell, C.G., Taki, S., Laws, R., Azadi, L., Campbell, K.J., Elliott, R., Lynch, J., Ball, K.,
Taylor, R. and Denney-Wilson, E., 2016. Effects of parent and child behaviours on overweight
and obesity in infants and young children from disadvantaged backgrounds: systematic review
with narrative synthesis. BMC public health, 16(1), p.151.
Triador, L., Farmer, A., Maximova, K., Willows, N. and Kootenay, J., 2015. A school gardening
and healthy snack program increased Aboriginal First Nations children's preferences toward
vegetables and fruit. Journal of nutrition education and behavior, 47(2), pp.176-180.
CHILDHOOD OBESITY
Li, J.L., 2017. Cultural barriers lead to inequitable healthcare access for aboriginal Australians
and Torres Strait Islanders. Chinese Nursing Research, 4(4), pp.207-210.
Rawnsley, J., Woodroffe, D., Culic, E., Richards, J. and Clifton, L., 2018. Cultural Competency
in a Legal Service and Justice Agency for Aboriginal Peoples. Legal Educ. Rev., 28, p.1.
Russell, C.G., Taki, S., Laws, R., Azadi, L., Campbell, K.J., Elliott, R., Lynch, J., Ball, K.,
Taylor, R. and Denney-Wilson, E., 2016. Effects of parent and child behaviours on overweight
and obesity in infants and young children from disadvantaged backgrounds: systematic review
with narrative synthesis. BMC public health, 16(1), p.151.
Triador, L., Farmer, A., Maximova, K., Willows, N. and Kootenay, J., 2015. A school gardening
and healthy snack program increased Aboriginal First Nations children's preferences toward
vegetables and fruit. Journal of nutrition education and behavior, 47(2), pp.176-180.
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