Healthier You | Winter 2018 by Prince George Citizen

Healthier You Winter

2018

HARM REDUCT ION: HOW

YOU CA N HELP

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THE TRUTH ABOUT YOUR “FRIEND” TOBACCO CONNECTING WITH YOUR KIDS IN THE KITCHEN

Healthier You

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Winter

Volume 6, Issue 4

2018

HEALTHY RELATIONSHIPS THROUGH HARM REDUCTION

featurestory

Reanne Sanford shares what a healthy relationship looks like through the eyes of harm reduction, and how easy it is to participate.

CEO WELCOME �� PAGE 4 THE CONNECTION BETWEEN ADVERSE CHILDHOOD EXPERIENCES (ACES) AND LIFELONG HEALTH �� PAGE 5 Identifying Adverse Childhood Experiences (ACEs) helps patients today.

PEDIATRIC RESIDENTS GET AS MUCH AS THEY GIVE IN GITGA’AT �� PAGE 7

RELATING TO THE TEEN IN YOUR LIFE p.20

Tips on keeping up with your teen throughout adolescence.

MAKING FRIENDS WITH FOOD FOR YOUR HEALTH �� PAGE 16 Learn how to make peace with hunger and better your relationship with food.

FEEL LIKE YOU’RE LOSING YOUR BEST FRIEND?

�� PAGE 22

Tobacco may seem like a dear friend, but it’s only pretending.

Residents go the distance in the Gitga’at territory, deepening their cultural awareness while providing health services.

FOUNDRY: CHANGING HOW YOUTH ACCESS HEALTH AND WELLNESS �� PAGE 10 Josh Van Der Meer breaks down Foundry – a centre specializing in youth health and wellness.

’ IMAGINE GRANTS: AGWIIYEET’INIM̓AHL ’ WE PASS IT ON TO OUR CHILDREN GAHLGIM̓-

�� PAGE 12

Community granting helps increase pre/post natal services in the northwest.

FOOD AND FUN: BUILDING HEALTHY RELATIONSHIPS IN THE KITCHEN �� PAGE 14 Lise Luppens explains the importance, and joy, of building a healthy relationship cooking with kids.

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welcomemessage

Healthy relationships matter

Cathy Ulrich President and Chief Executive Officer, Northern Health Where can you find Healthier You?

• Doctors’ offices • Walk-in clinics • Pharmacies • Other community settings

When you think of a healthy relationship, what comes to mind? Not surprisingly, this question can mean a variety of things to many different people. For some, it means simply spending time with their kids. To others, it can mean getting in touch with their community through work, volunteering, or recreation. Someone may even describe a healthy relationship as something they can have with themselves by eating well and kicking bad habits! However you define these connections, there is no doubt that spending time nurturing all relationships in our lives help contribute to our overall health and wellness. As you read through the following articles, I hope you appreciate the stories and experiences told from our northern B.C. authors, and recognize the opportunities you may have in your day-to-day life to build these types of relationships.

Relationships like Lise Luppens and her daughter have in the kitchen, experiencing cooking together for the first time (page 14). When you read about something that at its core is so simple, but has such a large, lasting impact on someone else’s life, it may inspire you to try similar things in your own home! Alternatively, you might enjoy Nancy Viney’s take on social connections with tobacco, and how sometimes the best way to engage in healthy relationships is to cut out unhealthy ones. Learn how and where you can get free resources to stop smoking and more on page 22. We’ve truly been inspired reading the different ways people all over our region are enhancing their lives, and those around them, by investing in stronger, healthier relationships – and we hope you will too! As always, if you have a wellness or healthy community story that you’d like to see in a future issue of Healthier You, please contact our health promotions team at healthpromotions@northernhealth.ca.

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Healthier You Volume 6, Issue 4 – Winter 2018

Published by:

the northern way of caring

www.glaciermedia.ca

PUBLISHED BY NORTHERN HEALTH & THE PRINCE GEORGE CITIZEN

Contributors / Healthier You is produced by the Northern Health health promotions team with contributions from Northern Health staff and partner organizations, in partnership with The Prince George Citizen.

Advertising Sales Prince George Citizen

Advertisements in this magazine are coordinated by The Prince George Citizen. Northern Health does not endorse products or services. Any errors, omissions or opinions found in this magazine should not be attributed to the publisher. The authors, the publisher and the collaborating organizations will not assume any responsibility for commercial loss due to business decisions made based on the information contained in this magazine. Speak with your doctor before acting on any health information contained in this magazine. No part of this publication may be reproduced or transmitted without crediting Northern Health and The Prince George Citizen. Printed in Canada. Please recycle.

childhoodhealth

UNDERSTANDING HOW OUR CHILDHOOD EXPERIENCES CAN AFFECT OUR LIFELONG HEALTH

I had the pleasure of sitting down and chatting with Dr. Brenckmann in her office to discuss ACEs and her work as a physician. Continued on page 6



Haylee Seiter, Health Promotions, Northern Health

You never know how you’ll come across your next great idea. It could be something seen in passing, an article, or words exchanged between friends. In Dr. Christine Brenckmann’s case, the idea to use the Adverse Childhood Experience (ACEs) questionnaire in her own practice came in the form of a social media post by someone attending the ACEs summit in Vancouver last November. WINTER 2018

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Continued from page 5

What made you first interested in family medicine?

Does a history of adversity impact one’s health?

My career actually started in public health; I was keen to look at the broader social determinants of health. During my work in the field, I often found myself wondering where I could make a difference the most. That’s how I became interested in family medicine and eventually decided to pursue it. I think of health as a bank account. You have no choice where, or into what circumstances you are born. Some people are born with more in their bank account than others and I think the health care system can help to even out those bank accounts.

A traumatic past affects how our brain and body develop. It also affects the habits that we develop and how we cope with stresses in our lives. Studies show that as the ACEs score increases, so does the risk for negative health outcomes. A person with more than seven ACEs is likely to die twenty years earlier than a person with no ACEs, which is quite shocking. Fortunately, with support, there are things we can do to change these habits and change our future.

What are Adverse Childhood Experiences (ACEs) and why do they matter?

People need to know that the things that happened to them are not their fault. We need to be compassionate rather than judgmental, understanding the “why” rather than just the “what.” We discuss what the person’s goals are moving forward and what support they would like from us or from other community resources.

ACEs is a term given to describe all types of abuse, neglect, and other traumatic experiences that occur to individuals under the age of 18. A study was conducted that showed the number of ACEs suffered by a person in childhood and teen years is powerfully correlated with negative lifelong health outcomes. It’s also highly correlated with social, educational, and employment outcomes. So how does the ACEs questionnaire work? It’s a simple questionnaire consisting of 10 questions. Patients tell their doctor their score and it is recorded similarly to measurements like blood pressure. Is conducting an ACEs questionnaire helpful? At first I was skeptical of using the ACEs questionnaire in clinical practice. I was worried that we would re-traumatize patients and not have much to offer them. Fortunately, the opposite has been true. Patients appreciate me asking, as it helps me to understand them better. Sometimes when people talk about their ACEs, they often say, “It’s in the past and doesn’t affect me anymore,” or, “I can’t believe this is still affecting me today.” People sometimes aren’t aware that their early experiences have had such a profound and lasting impact on their lives. Some people are not aware that what happened to them was wrong, undeserved, or not “the norm.” Having a questionnaire also helps patients share information about their past without having to talk about it. Trauma-informed care shifts the thinking from “what’s the matter with you?” to “what happened to you?” There are now more and more tools being developed to help people with a history of trauma, or who have experienced adverse events in their childhood. In short, the questionnaire is a simple way to gather information about the root causes of a problem. (Note: Dr. Brenckmann pointed out that the ACEs questionnaire is not comprehensive as it does not address war, residential school, or refugees.)

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What can be done for those who have experienced ACEs?

ACEs are often caused by unhealthy relationships. What does a healthy relationship mean to you? To me, a healthy relationship means three things: mutual respect, compassion, and safety. If you have these things, the rest will follow. Healthy relationships help protect ACEs from happening, and can help us heal from past traumas. What’s one message you’d like to share with Healthier You readers? I’d like to share a saying from one of my community health professors, Dr. Don Langille, which has stuck with me. He once said that it all boils down to how we treat each other. Not a single thing is unaffected by relationships. How do we treat those who are alone and traumatized, or who have experienced unhealthy relationships, or ACEs? It all goes back to respect, compassion, and safety.

MORE INFORMATION More information about ACEs and resources to get help • Nadine Burke Harris: How childhood trauma affects health across a lifetime: ted.com/talks/ nadine_burke_harris_how_childhood_trauma_ affects_health_across_a_lifetime • ACES and Complex Trauma: complextrauma.ca/ aces-complex-trauma/ • Adverse Childhood Experiences (ACEs): albertafamilywellness.org/what-we-know/aces

firstnationshealthauthority

HEALTHCARE GOES THE DISTANCE WITH GITGA’AT FIRST NATIONS Carol Whetter, Northern Region Staff Writer, First Nations Health Authority

Reprinted with permission from the First Nations Health Authority

In the isolated coastal village of Hartley Bay, B.C., home of the Gitga’at First Nation, students spend a couple of minutes in the morning and after lunch brushing and flossing their teeth. Historically the results are that they have gone from being 8% to 32% cavityfree. What debuted in the early 2000s as the Brighter Smiles program to improve children’s overall health and specifically oral health, has been revamped, expanded, and restarted recently to include visits from not only pediatric dental specialists twice yearly, but pediatric medical residents three times a year. This year, 10 residents will be in the Bay. And they are supervised by the province’s top physicians from UBC and BC Children’s Hospital (BCCH)—the Division Head of Oncology, Dr. Caron Strahlendorf, has been in community three times since the inception of the program.

The experience is eye-opening for all involved. At the Hartley Bay Nursing Station, the nurse-in-charge is Brenda Spires. She sees the new Brighter Smiles program as a win-win all around. Collaborating with BCCH/UBC staff and students, the health team focuses on community identified needs: nutrition, diabetes screening and awareness, and oral health. Parents sit down with the doctors and residents too and become more informed partners in their child’s health team. “It’s best when services come to us,” said Spires. “It can be daunting for adults to have to take their children into unfamiliar urban settings.” The regular Brighter Smiles program helps to build relationships, and establishes trust and rapport. With high-speed internet, cell service, and TeleHealth technology, Hartley Bay enhances local service delivery. How do Vancouverites feel about working in Gitga’at territory? BCCH residents Samara Laskin and Matt Carwana had new insights: “For example, we now understand why it is challenging to arrange for children in remote communities to have weekly blood work— that can be difficult to accomplish when the nearest lab is a 4-hour ferry or a 1-hour float plane ride from the local nursing station! Additionally, as residents, we are often responsible for providing telephone advice to nursing stations in small communities. We now have a Continued on page 8 WINTER 2018

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Continued from page 7

much greater understanding of what those stations look like, and the medical resources that are available.” Sometimes unintended consequences arise because of health professionals’ visits. One attending pediatrician brought his wife, an oncologist. Having met people first hand, she was able to change the course of treatment for a local patient, knowing the logistical challenges he faced. Another specialist told a patient to “message me when you get here (Vancouver).” That doctor’s friendly face was comforting in a huge city hospital and helped reduce stress.

MORE INFORMATION The community of Gitga’at • Territory: 7500 km2 (approx.) including land and water, mainland and islands. • The traditional name for Hartley Bay is Txalgiu. • Gitga’at is 145 km southeast of Prince Rupert

Gitga’at Health Director, David Benton, has a wish list: that the Brighter Smiles program be expanded to every First Nation village, and that each First Nation child in B.C. be seen by a pediatrician in their first year and again by age five. David also believes that a provincial investment in a vitamin D protocol would be an inexpensive way to ensure long-term improved health outcomes. BCCH has recommended a vitamin D protocol for Hartley Bay kids.

• There is a 3.5 hour ferry ride to Prince Rupert twice a week and a 50 minute float plane trip (weather permitting).

The commitment between Gitga’at, UBC and BC Children’s Hospital was formalized by officials signing a Memorandum of Understanding on September 28, 2017, where they agreed to collaborate on this project for the next five years. After official business was over, nearly the entire community and guests shared an excellent dinner of fresh caught seafood, solidifying personal connections and community involvement over sharing traditional foods.

• Gitga’at is home to Spirit Bears, grey whales, bald eagles and wolves.

There is nothing quite like spending time with people in their community to truly appreciate them and to develop a deeper understanding of how to support wellness. Residents Laskin and Carwana reflected on their experience in Hartley Bay and concluded: “I have never spent any significant length of time within a First Nations community. Visiting Hartley Bay deepened our awareness of the rich culture of the Gitga’at people, from the importance of family, to their unique culinary practices and local spiritual beliefs. It reaffirmed our commitment to improve health for Indigenous communities, and deepened our humility from our history as white settlers.”

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• Population is 180 in community. • Lax Galts’ap (Old Town) was the traditional winter village and has one of the largest collections of petroglyphs in the world.

• High speed internet and full cell service is available. • Cultural activities include harvesting seaweed in May and June, visits to longhouses, partaking in a Feast, and learning Tsimshian words.

Residents and dentists in clinic.

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youthhealthservices

LEARN WHY IF YOU’RE BETWEEN THE AGE OF 12 AND 24, FOUNDRY SHOULD BE YOUR ONE STOP SHOP FOR ALL THINGS HEALTH

Robbie Pozer, Health Promotions, Northern Health

In any successful community, it’s important to take care of all populations, including our youth. That’s why I was so excited to sit down with Josh Van Der Meer, Youth Mental Health and Addictions Councillor, to learn more about a new service in northern BC; Foundry Prince George. This is a place where any youth in the community, or their families, can find quick and easy access to the help they need, when they need it. Foundry transforms how mental health and substance use services are delivered, providing early intervention, in the form of resources, info, and support to youth between the ages of 12 and 24. Van Der Meer helped share some more info with me about this exciting new initiative. Where did the idea of Foundry come from? Foundry piloted in downtown Vancouver. From its success in the lower mainland, more Foundry’s began to pop up around B.C., and fast forward to fall 2017, Foundry Prince George was established. Largely, the concept was an effort to fill the obvious gap that had been recognized for mental health services for youth in communities. A young person’s life is always changing, and having a place they can receive mental health support and a variety of other services is important. What’s the most frequently used service at Foundry? Although we have a variety of services available, our mental health information and services have been the most used – which is awesome. Mental health has been such a taboo subject in the past, and to have young people of all ages and ethnicities come in and talk to our team members… it’s pretty special. 10

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A reason our mental health services are so popular is because of their accessibility. If someone walks in through our doors, there’s no scheduling for an appointment later - you’re going to see a mental health professional that day, and probably within a few minutes. When a person discusses what’s bothering them emotionally, it usually makes for a deep conversation, which in turn gives the support person an opportunity for a rich assessment. This assessment leads to a plan for next steps: whether that’s coming in for another discussion, or direction to resources from other health services. What do healthy connections mean to Foundry, and how does Foundry help make them happen (staff approach, mindset, etc.)? To us at Foundry Prince George, a healthy relationship is when people come together and get the support they need. We have the opportunity here to connect young people to professionals, giving them access to exactly that, including bringing in families as well (if needed and requested). We understand that the mental and physical needs of young people don’t stop at 18 years old, and we can be the gateway to better health and wellness for them as they transition into adulthood. What makes Foundry unique or different from similar facilities? The difference here at Foundry is that youth can get access to a huge variety of health and wellness services all in one place, almost immediately. If we don’t have the particular service the person requires, our staff does they best they can to find out where it is and how the client can get it. Foundry is also unique in the fact that it’s the product of an awesome group of community partners, and

the cooperation between several health and wellness agencies. Favourite part about Foundry? My favourite part about working at Foundry is that I’m the first person who gets to help people that come in. When a young person first comes in for mental health services, they’re nervous, they’re not sure, they’re scared sometimes. Opening up and speaking to a mental health professional often takes those feelings away, like a weight off their chest. When I see that sort of relief on someone’s face at the end of a session, and they’re thankful and relaxed… I know they have left with something. And that’s pretty special.

Services offered at Foundry • • • • • • • • •

Primary care services (health care) Sexual health services Mental health information and services Substance use information and services Family involvement worker Groups (to be developed in 2018) Housing support Employment information and support Education information and support

Location:1148 7th Ave., Prince George, BC Phone: 236-423-1571 Hours of Operation: Monday - Friday,10:00am - 5:00pm

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communitygranting

NISGA’A EVENT BRINGS TRADITIONS AND WELLNESS TOGETHER, PROMOTING HEALTHY GENERATIONAL RELATIONSHIPS ALONG THE WAY Robbie Pozer, Health Promotions, Northern Health

When Liza Haldane, LELP Coordinator, applied for an IMAGINE grant on behalf of the Lisims Early Learning Partnership, she wanted to honour the early learning table’s goals of celebrating their pre- and postnatal families by hosting an event that also raised awareness of the gaps in services for vulnerable members of the Nisga’a Nation: Laxgalts’ap, Gingolx, Gitlaxt’aamiks and Gitwinksihlkw (northwest of Terrace). For a goal like this to be achieved, she recognized that including the traditional and cultural values of the Nisga’a region would be very important. The relationships between generations and families would also have to be considered in the planning process and the event would have to carefully balance different traditions alongside the needed pre- and postnatal services. With all that in ‘ ‘ ahl gahlgim - We pass it mind, project “Agwiiyeet’inim on to our children” was born! The goals of the project and event included: 1. Honour the families who are expecting or who have newborn infants, and celebrate newborns in a traditional ceremony. 2. Raise community awareness of the importance of supporting families who are expecting and who have newborn infants. 3. Work together and practice Nisga’a law of Saytk’ilim-goot (one heart; to be united) by sharing services and resources for the betterment of Nisga’a families. 4. Register families for existing programs and services.

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How it happened: Part of raising community awareness for supporting new or expecting families was done by welcoming entire families and the community to the event. This meant, during the event, families were circled and a prayer was said, making a commitment to support these families in raising their children. At the event, prenatal families were invited to the front of the hall, honoured with a poem, and given a canvas painting to acknowledge their commitment to bringing a baby into this world. Families with newborns had the opportunity to have their questions answered, via a customized questionnaire that was provided. The babies were welcomed into their community with a beautiful house crest blanket, adorned upon them by their Wilp family members (members of a Wilp are all descendants of a common female ancestor). The total number of babies: 23 altogether! In order to share existing resources and programs, LELP partners, including early learning centers, public health nurses, community health representatives, Success By Six, and village governments, worked together and were united in delivering the ceremonies. Having partners experience and share equal time in the ceremonies helped balance tradition and incorporate wellness. After the ceremony, registration forms were made available and parents registered their children for the Imagination Library (books to kids program). Service providers spoke during the post-ceremony meal, promoting Daxgadim Anluuhlkw (translates to Strong Nest, which is a delivery and development strong start program), Welcome Baby Bags, and other relevant services.

“

These events were so emotional. To see two to three generations of families proudly welcoming their babies into the community evoked emotions of happiness, pride, and so much love! At the end, we encircled the families in a community prayer, holding them up with words of strength and encouragement - it was very spiritual and moving. A Chief got up and spoke at the end of the Laxgalt’sap/Gingolx event - he was full of gratitude and blessings for the ceremony. He said after tonight, he was once again filled with hope for our community, our culture and traditions. It brought many of us to tears.

What’s next? As a result of this successful event and the sparked interest in traditional child rearing, organizers delivered a “Yask” workshop (rights of passage) for pre- and postnatal families and are working together to deliver another set of welcome baby ceremonies. These workshops will eventually rotate into smaller communities. The plan is to deliver ceremonies annually!

-Liza Haldane

”

MORE INFORMATION What is a Northern Health IMAGINE grant? IMAGINE Community Grants provide funding to community organizations, service agencies, First Nations bands and organizations, schools, municipalities, regional districts, not-for-profits, and other partners with projects that make northern communities healthier. We look for applicants that will support our efforts to prevent chronic disease and injury, and improve overall well-being in our communities. Check out the link below for more IMAGINE grant information. northernhealth.ca/YourHealth/ HealthyLivingCommunities/ImagineGrants.aspx WINTER 2018

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healthyeating

LITTLE HELPERS LOVE TO EXPERIENCE THE REWARDS OF COOKING ALMOST AS MUCH AS WE DO! Lise Luppens, Population Health Dietitian, Northern Health

My daughter recently had her second birthday and she’s already a budding chef! She will declare “want cook,” and proceed to push a chair to the kitchen counter, ask for exactly two bowls, a big spoon, and “more spices please.” She then mixes things together, perhaps adds a little water, decants from one bowl to the other, and, yes, makes a bit of a mess. At other times, she “helps” me with a recipe. She has stirred the dry ingredients together for apple crisp and has “beaten” eggs for homemade muffins. Of course, I help her to “help” me. Why do I support these messy kitchen adventures? Is it because it keeps her happily occupied for a few minutes so I can get something else done? Well, yes… but I also have ulterior motives. Children are exposed to the world of food through the role modeling, attitudes and habits of their families, friends, caregivers, and educators. Cooking with kids can help to build a foundation for healthy relationships with food. How is this? •

“Want cook!” Cooking together supports positive attitudes about food and eating. Food is a pleasure, and food preparation can be fun.

•

“What dis, mama?” Food preparation activities help kids get familiar and comfortable with a greater variety of foods. And this, in turn, helps them to (eventually) enjoy eating a variety of food.

•

“Me cook!” Cooking teaches food skills. At this age, cooking with kids helps to normalize the fact that we can make tasty dishes from simple ingredients. This builds their confidence that they will eventually be able to do this too. 14

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Cooking with kids helps to build their lifelong relationship with food, and it’s also important in the “here and now.” Time in the kitchen is quality time, a way to connect, an investment in adult-child relationships. And cooking together is not only fun for the kids - it’s rewarding for adults too: “The child feels independent and it’s kind of a milestone… They think: OK, if I can do this, if I can just mix this, then I can do that too. It’s baby steps towards bigger things.” ~ Mother “It’s something we can do together; they get excited about it and it makes me feel good.” ~ Father Taken from bcdairy.ca (A hands on Approach to Family, Food and Fun)

MORE INFORMATION What opportunity do you have to cook with kids? Wondering where to start? Have a look at our “Cooking with Kids” poster to see what children of various ages are capable of doing in the kitchen. You might also enjoy kids’ cooking videos from the annual “Hands-On CookOff contest” (bettertogetherbc.ca/contest).

Cooking With Kids... • • • •

Increases kids’ knowledge, skills and comfort around food Improves nutrition intake Is fun family time Teaches math, science, reading and food safety skills

years old

• • • • • •

wipe table tops break cauliflower scrub vegetables snap green beans wash salad greens put paper cups into muffin tins

Tips to get started:

years old

• • • • • •

years old

• • • •

peel oranges set the table knead dough mash soft vegetables and fruit • peel hard-boiled eggs • unload the dishwasher • make a simple sandwich

6-8

years old

• toast bread in a toaster • beat ingredients with a wire whisk • set or help clean up the table • toss salad with dressing • write a grocery list • invent a simple recipe

10-12 years old

• • • •

use an oven for baking use an electric mixer separate eggs cook with minimal supervision • Plan a meal with all four food groups

spread soft spreads pour liquids pour cereal place things in the trash clear their place at the table help find foods in the fridge or pantry

years old

• measure ingredients • break eggs into bowl • assemble simple foods, like a fruit and yogurt parfait • use a dull knife to cut soft foods • stir baking ingredients together

• Cooking with kids is messy, but it also helps them learn about cleaning up. • Wash hands before working with food. • Choose simple recipes that are simple enough to handle small errors in counting and measuring. • Use real foods, such as carrots, peppers, cucumbers, chickpeas, kidney beans, eggs, yogurt, and whole grains. • Make fun, interactive meals and snacks such as tacos, pizza, and veggies and dip.

8-10 years old

• use a knife to cut, chop, dice and mince • grate cheese • stir hot mixtures • use a blender, toaster oven and a microwave • use a can opener • prepare simple recipes with few ingredients

For more kid-friendly recipes and ideas, check out: www.bettertogetherbc.ca To speak with a Registered Dietitian at 8-1-1 HealthLink BC, dial 811

the northern way of caring

Developed by Population Health Registered Dietitians. 10-421-6042 (IND02/15)

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healthyeating

IF YOU’RE ASKING QUESTIONS ABOUT YOUR EATING HABITS, INTUITIVE EATING MIGHT BE FOR YOU Rilla Reardon, Registered Dietitian, Northern Health

When we think about healthy relationships, most of us think about our marriage or our relationship with our kids, but do you ever consider your relationship with food? We live in a world where it’s pretty easy to have negative thoughts about what and how we eat. We are bombarded with messages about diets, “good” or “bad” foods, and should/should-nots when it comes to our eating choices. Healthy eating brings to mind visions of perfectly portioned, balanced meals, prepped and packed snacks, and not a cookie or chip in sight. But what if healthy eating was about more than nutrition? Let’s expand our thoughts on healthy eating to include something that affects our psychological, emotional, and social health just as much as our physical health: building a healthy relationship with food. What is a healthy relationship with food? This looks different for everyone, but it’s a place where we are at peace with food. Food is more than providing your body with energy and nutrition, it also represents enjoyment, fun, family, culture, and experience. A healthy relationship with food allows us to eat for all of these reasons, without feelings of guilt. It includes ALL foods. It’s where we are practicing selfcompassion when it comes to our eating habits, and letting go of perfection. I’ve worked as a registered dietitian with Northern Health for five years, and seen first hand the many ways that people struggle with eating. Whether it’s emotional eating, yo-yo dieting, struggling to keep a change, or low self-esteem related to our eating choices, I always encourage moving the conversation past “what I should be eating/not eating” to “why am I eating the way I am?” The majority of our decisions about food throughout the day aren’t necessarily about nutrition and physical hunger; what about habit, 16

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cravings, emotions, boredom, reward, etc.? If we only talk about nutrition in discussions about change, we aren’t addressing all the factors that play into our decisions about food. Examining our relationship with food and looking at the reasons behind WHY we are eating allows us to build a foundation for sustainable and positive change to our eating habits and behaviors. So, how do you build a positive relationship with food? Start with intuitive eating! Intuitive eating is an approach that helps us listen to our internal cues like hunger, fullness, and satisfaction to make decisions about what, when, and how much food to eat. As adults we are influenced by external cues like time of day, diets, food rules, and other messages about how to eat. Intuitive eating takes the focus off these external cues to help us learn to trust our bodies and be comfortable with our eating. It takes time to learn and master a new way of thinking about food and eating. To get started, here are the first four principles of intuitive eating: 1. Reject the diet mentality. We live in a world that is obsessed with dieting. However, 95% of diets fail. Get rid of diet books and magazines, unfollow “fitspiration” Instagram accounts, and opt out of conversations about diets and weight loss.

2. Honour your hunger. Keep your body nourished with regular, balanced meals and snacks. If you let yourself get too hungry, you may trigger a primal drive to overeat and override mindful decisions about food. Eating regularly and adequately helps establish the foundation to re-build trust in your relationship with food. 3. Make peace with food. Give yourself unconditional permission to eat what and how much of foods that you like and want. When you tell yourself you shouldn’t eat certain foods, it contributes to feelings of deprivation that can lead to intense cravings. 4. Challenge the food police. Stop labelling food as “good” or “bad.” These labels give us messages that we are “good” for eating “good” foods and “bad” for eating “bad” foods, and sets the stage for having emotional reactions to food that cloud our internal cues for hunger, fullness, and satisfaction. Giving ourselves permission to eat for many different reasons (for enjoyment, social interaction, comfort, or just because, etc.) allows us to begin to trust our bodies to be able to make choices about food that make sense for us.

MORE INFORMATION

What is Craving Change? Craving Change is a free group program offered in Prince George and designed to help people build a better relationship with food. It is a five week workshop facilitated by a registered dietitian and nurse that aims to help people understand WHY they eat the way they do, and provides awareness building tools and change strategies to help people change their thinking in order to build positive eating relationships. Designed for adults who: • Struggle to maintain healthy eating habits • Say they eat for comfort or in response to strong feelings • Want to feel more in control of their eating How to sign up for Craving Change: • Craving Change is open to the public and sign up is by self-referral. It is currently being offered four times per year in Prince George. Please call 250-565-7479 and ask to be put on the Craving Change wait list.

To learn more about building a healthy relationship with food and intuitive eating, work with a Registered Dietitian, sign up for a program like Craving Change™, or check out some of these resources: • Intuitive Eating website: intuitiveeating.org/ • If you have any questions about healthy eating, food, or nutrition, call 8-1-1 toll-free in B.C. to speak with a registered dietitian. • Body Kindness: bodykindnessbook.com/blog • Intuitive Eating: A Revolutionary Program that Works by Evelyn Tribole and Elyse Resch (book) • Secrets of Feeding a Healthy Family: How to Eat, How to Raise Good Eaters, How to Cook by Ellyn Satter (book) • Eat What You Love, Love What You Eat: How to Break Your Eat-Repent-Repeat Cycle by Michelle May (book) • Podcast: dietitiansunplugged.libsyn.com/

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Healthier You

harmreduction

FROM RANCHING TO REACHING OUT, REANNE EXPLAINS HER ROLE IN HARM REDUCTION, AND HOW YOU CAN TAKE PART Reanne Sanford, Regional Nursing Lead for Harm Reduction, Northern Health

I grew up in the North, and I feel blessed to be able to live and practice in my hometown of Quesnel. Guiding my work, I have two strong influences from my childhood: medicine and ranching. On my mother’s side I come from several generations of nurses and doctors; my father’s family were pioneers and moved to this community 100 years ago. Growing up as a ranch kid helped me to develop a strong belief that all living things have value and worth. This has helped me to recognize that our own advancement and success is based on how we honour relationships in our lives, and for me growing up, these were family and cattle. When I was asked to write an article about my work in harm reduction and how it relates to healthy relationships, I had to sit with it for several days. Before my current role, I worked as a generalist public health nurse for 13 years, and part of my role was as the local street nurse, but for some reason, in my mind, I couldn’t get the two to connect. The more I thought about it though, the more I began to realize the reason for my difficulty was that these two concepts are inseparable. From my experience, it would be extremely 18

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difficult to apply the principles of harm reduction within health care without considering the importance of healthy, trusting relationships. Harm reduction involving drugs and people who use drugs is a social justice movement that strives to uphold basic human rights. It means believing in, respecting, and supporting people who use drugs, whether abstinence is their goal or not. This kind of harm reduction is supported by evidence based research, and proven to be effective in reducing risks and ultimately reducing the burden on the health care system. A good example of this method of harm reduction is the distribution of harm reduction supplies to people who use drugs. Providing clean, sterile equipment has also shown to reduce new infections of HIV and Hepatitis C within our communities. Healthy Relationships Another benefit of distributing harm reduction supplies to clients, is the opportunity for service providers to develop meaningful relationships with the client; these connections can ultimately lead to greater access to health care. We know that when people engage in services where they feel supported and accepted by staff, they are more likely to make positive changes and further access supports. Relationship building is at the core of harm reduction work. When you show up for people and allow them to be seen and heard, they feel valued and worthy. This is so important within a demographic of individuals who often feel marginalized and ostracized in our communities.

This is mutually beneficial, as we, the service provider, can ask clients questions in order to gain a greater understanding of the barriers and challenges they face, and better understand the world they live in. This connection allows staff to hear real, lived experiences that can ultimately help them implement change. The caring bonds and healthy connections created through harm reduction is lifesaving for clients. Over the past few years, the landscape of working with people who use drugs has changed drastically. In the past, we worried about keeping people safe, preventing HIV transmission, and other harms related to drug use; now, we’re worrying about keeping people alive.

What is Harm Reduction? Harm reduction, in the simplest terms, is about reducing harm, big or small. People generally engage in many high risk activities on a daily basis and often practice harm reduction. This could mean using a seatbelt while driving, putting on a helmet for a bike ride, or using sunscreen on a hot summer day. In my line of work, harm reduction most often gets pulled into the conversation when drug use is involved, but it is so much more than that! • Northern Health Stop Stigma: northernhealth.ca/ YourHealth/Stigma.aspx • Stop Overdose: stopoverdosebc.ca

In order for clients to engage in our services, receive education on how to safely use drugs, take harm reduction steps towards wellness, and to enter into treatment (if that is what they choose), they must be with us. It is well known that the number of people dying across the province due to unintentional illicit drug overdoses has continued to rise in 2017, despite exceptional work on the frontlines. Reducing Stigma and Judgment In today’s society, it’s important to use a thoughtful approach and be compassionate with our messaging. Stigma and judgment towards people who use drugs creates a climate where people do not feel safe to share experiences, and in turn, forces them to isolate themselves. Working closely with harm reduction has shown me how vast and diverse this population is in our communities. Reducing stigma and judgment in our communities takes a collaborative approach. Northern Health has championed anti-stigma work in B.C. as a part of our overdose prevention strategy. You can make a difference by changing the conversation: • Describe peers as individuals (i.e. “person with a substance use disorder” vs “drug user”). • Decide not to share or engage in fear-based messaging about overdoses and drug use on social media. • Be mindful of how you talk about people who use drugs; choose not to use discriminating language like “user,” “junkie,” or “addict.” These small steps can work to help eliminate the feelings of isolation and judgment. Harm reduction in the context of substance use is about advocacy and caring. It is understanding that people use drugs for a variety of reasons, and many will never become dependent or deal with an addiction. Above all, harm reduction services exist to support everyone in staying as safe and healthy as possible – and that’s what we’re all after: staying safe, healthy, and happy. Together.

WINTER 2018

Healthier You

mentalhealth

LIFE CHANGES! BE THERE FOR THEM Stacie Weich, Regional Program Lead for Mental Wellness, Prevention of Substance Harms, Food & Health, Northern Health

The relationship you have with the teen(s) in your life is likely filled with moments of hope, joy, pride, challenge, frustration, fear, confusion, and everything in between. So how can parents and connected adults navigate these relationships and foster positive, mutually respectful relationships that can withstand a few bumps along the way?

There are so many changes in the adolescent period, including social, emotional, physical, and cognitive. Social and emotional development is big at this time, and you can expect to see changes in the way teens interact and behave. Searching for identity, independence, responsibility, and adventure; placing more importance on friendships, peers, and dating; and communicating differently are all hallmarks of life during adolescence. This time of change creates a fabulous opportunity for an adult to become a safe person to talk to, to create a safe environment, and to create a sense of freedom for exploration with the structure and support to do that safely. Building a solid foundation in the earlier years will certainly support this new challenge, but if this teen is new to your world, or your relationship has been less connected as you had hoped, don’t fear. With some energy, support, and information, you can become a meaningful person in the life of teens you care about. Here are some things to keep in mind: • Adult-teen relationships are NOT friendships, but they include components found in healthy friendships such as open communication, sharing, respect, and trust. • We want teens to talk to us and ask questions, so be ready and make time when they approach you. You want to be ready to talk when they are, we don’t want to miss the opportunity. Make sure you are completely present and listening. • Plan ahead and prepare yourself to speak

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knowledgeably about substances, mental and emotional health, sexuality, and identity. Leave the judgment and dramatic statements at the door, and have factual information to share in a context that makes sense for your teen. • Encourage and support your teen’s involvement in a variety of activities, clubs, and groups that highlight their strengths, provide opportunity for building self-esteem and connections to youth with similar interests. Having a few different spaces and groups to connect to also provides social options for when challenges come up with one group of friends. • Be a part of your teen’s life. Get to know their friends, and welcome them into your home. • Remember to treat your teen like you want to be treated. And model the behaviour you want to see. If no phones or devices are allowed at the dinner table, put yours away too. While there is no guide or fool-proof plan to make these relationships successful, it is certainly worth the effort. Positive adult and teen relationships are linked with a host of positive outcomes, such as social emotional well-being, better academic achievements, and delayed or reduced substance use and risky behaviours. To learn more, visit Healthy Families BC (healthyfamiliesbc.ca).

MORE INFORMATION Creating a safe space for teens to ask questions without fear of rejection, judgment, or discipline is key. There are lots of resources out there to support your learning. Two websites to check for up-to-date information are: • Kelty Mental Health (keltymentalhealth.ca) • Canadian Centre on Substance Abuse (ccdus.ca)

WINTER 2018

Healthier You

tobaccoreduction

CUTTING OUT YOUR “FRIEND” TOBACCO MIGHT BE THE BEST DECISION OF YOUR LIFE Nancy Viney, Registered Nurse, Population Health, Tobacco Reduction, Northern Health

Most tobacco users do want to quit and many have tried without success. The majority of us know that tobacco use is the leading cause of preventable death and increases the risk of heart disease, lung disease, and cancer, and harms every organ of the body. Yet still, over one out of five people in northern B.C. continue to smoke. A feeling of loss along with the discomfort of nicotine withdrawal and cravings makes it difficult to stop smoking or chewing tobacco.

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Many people who smoke or chew tobacco find that it helps them through the tough times of their life - kind of like a friend. They use it to feel better when they feel lonely, anxious, depressed, or even when they’re bored. They may enjoy it socially when they are with friends, or routinely throughout their day. Tobacco’s effect The reward centre in the brain is stimulated by nicotine within 10 seconds of inhalation, causing a feeling of well-being, improved mood, and increased attention. These feelings can help deal with the stresses of life. It can help you feel more positive, more in control and reduces hunger. No wonder when someone tries to quit, it feels like they’re giving up a best friend! Unfortunately, these feelings are soon replaced with the discomfort of withdrawal and the cravings for more tobacco. Some smokers who have used tobacco for a while find that smoking simply relieves withdrawal and no longer is even pleasurable.

If tobacco feels like a friend to you, consider this: would a friend damage your health? Take your money? Risk your life? Tobacco is the unhealthy relationship that you CAN cut from your life! The good news is that once you have quit, the withdrawal symptoms and cravings will reduce and you won’t need to smoke to feel good! Most people do want to quit, and often do for these reasons:

Access to free nicotine patches, gum, lozenges or inhalers are available through the BC Smoking Cessation Program at your local pharmacy. You also may be eligible for assistance to purchase smoking cessation medications.

Share this information with your friends and family who use tobacco.

• Concern about their health. • Concern about the cost of smoking or chewing. • Concern about the health of the people around them. • There are fewer places where they are allowed to smoke. • Embarrassment that they use tobacco. The addiction to smoking is hard to kick, but with a plan that supports and reduces withdrawal, removes the triggers that increase cravings, and helps develop other ways to improve mood, tobacco users can successfully quit! For free counselling and resources, visit quitnow.ca, call 1-877-455-2233, or text QUITNOW to 654321.

WINTER 2018

Healthier You