Int. J. Environ. Res. Public Health 2009, 6 2495 nutrition [37]. Supportive social ties may erode when individual risk modification efforts create tensions around dietary preferences of close family or other cultural members. Almost all participants described efforts to modify choices at fast food restaurants. Alter [38] recently determined that mortality and admission for acute coronary syndromes was higher in regions of Ontario with greater concentrations of fast food outlets; furthermore, this relationship was similar in high- and low-income communities. Our study indicates that there may be regional differences in the reasons why people gravitate to these outlets. Northern participants used these inexpensive restaurants as social space to connect with friends and ease the loneliness of isolation in wintertime. Urban participants often cited the lack of time to prepare meals, as well as the close concentration of multiple outlets. Although many such restaurants have added healthier menu items in response to advocacy from interest groups such as the Canadian Heart & Stroke Foundation, the majority of selections have poor nutritional value and contribute to risk for CHD [38]. Healthy public policy around food labeling and continued advocacy for improved fast food quality would further extend success in this domain. Community assessment and targeted health promotion can address unique regional needs. For example, more healthful meeting places and social activities could be identified or created within northern communities, and made available during evening hours. 4.3. Itineraries Participants‟ anecdotes highlighted their itineraries: short tours through the microgeographies of home and neighbourhood; longer, routine commutes to work or health services; or less frequent expeditions to vacation locales. These “travel stories”, as de Certeau [32,33] (p. 120) would call them, were replete with the minutiae of spatial practices and laden with references to the places that supported or impeded development of new health behaviours. New knowledge, distilled from the health sciences, became intertwined with and problematized habitual, practiced understandings of the everyday world. The shared and social character of spatial practices further challenged many participants. However, these practices are not necessarily hardened into place; rather, there is constant exposure to newness, addition, and expansion. In achieving even the most subtle change, many participants navigated through a complex maze of the long-practiced habits of the everyday, the limits imposed by material circumstance, and the possibilities opened by new information. For participants, the major achievement of creating or altering an itinerary was in the transformation of place into new, personally meaningful spaces [36] that were perceived to contribute to risk modification. Initial health education for risk modification usually covers content such as nutrition, exercise, smoking cessation, and stress management. Follow-up support might include mapping itineraries with program participants to acknowledge the complexity of change and consider options for further creativity. 4.4. Strengths and Limitations of the Study We used purposive sampling to recruit people from two regions of Ontario who were aware of their high risk for CHD, had been given information about risk modification, and had acted on this information. These participants could provide rich and detailed descriptions of contextual constraints