Int. J. Environ. Res. Public Health 2009, 6 4. Discussion 4.1. Place and Access to Health Resources 2494 Participants in two geographic regions of Ontario reflected on the challenges to CHD risk modification encountered in the places and activities of daily life. Patterns that constrain and support CHD risk modification manifested differently between geographic regions; they also differed between social groups within the same region. Our work may explain why Grace and colleagues [21] found that among Ontario residents with high risk for CHD, those from northern Ontario exercised with less frequency than urban or rural residents. Reliance on personal transportation, difficult access to gyms or outdoor exercise sites, low income, and harsh winter conditions all combined to limit opportunities for healthy activity levels among the Sudbury and Districts participants. In contrast to King and her colleagues [13], who found that rural Alberta residents believed their closeness to nature and their physically demanding work protected them from heart disease, our northern Ontario participants seemed more ambivalent about their natural surroundings. Although prevalence of physical inactivity is increasingly lower in the Sudbury & Districts region, isolation, severe weather, and stress associated with dangerous road conditions were believed to be detrimental to heart health. Limited public transportation further constrained access to health resources in Sudbury and Districts. Effective health education for CHD risk modification should be place-specific, recognizing the limitations imposed by climate, low population density, language, and inadequate access to health resources, including shortage of primary care providers. Although summer activities such as hiking or trail biking were enjoyed by some Sudbury participants, outdoor winter sports were less frequently mentioned. The isolation or monotony of winter may attract community members to indoor activities and programs, although the cost of gyms or fitness classes was a concern to many participants in this study. Improved infrastructures for the region, including public transportation and low-cost community recreation programs, would increase options for risk modification. 4.2. Time and Food Culture In both regions, participants struggled to avoid processed foods or unhealthy food items; however, many encountered social barriers that speak to the centrality of food in creating congenial space and group cohesion. This is consistent with findings of other qualitative studies [34,35], but there has been little research to date that illuminates the importance of traditional foods to cultural identity in francophone Ontarians. Immigrant Torontonians also remarked on their difficulties in eliminating high-fat or starchy traditional food items. As a team, we noticed how this phenomenon tended to problematize cultural identity for participants once they had been sensitized to the role of diet in cardiovascular disease. The complexities of dietary change extend into personal identity and social positionality. In food preparation, the “at risk” person may feel compelled to abandon the habitual “gestures of tradition” [36] (p. 210) and customary ingredients, and instead employ unfamiliar culinary approaches and food items. While this may inspire creation of hybrid diets with transnational exposure to new cuisines or information, it also may serve to subjugate valid traditional knowledge of food and