Publications

We examined recent global secular trends in 5 indicators of child and adolescent physical activity and sedentary behavior (Overall Physical Activity, Organized Sport and Physical Activity, Active Play, Active Transportation, and Sedentary Behavior) and 4 influences on these (Family and Peers, School, Community and Environment, and Government).Active Healthy Kids Global Alliance letter grades (A+ to F) were assigned numbers from 15 to 2, with 0 assigned for missing/incomplete grades. Trends from Active Healthy Kids Global Alliance Global Matrices 1.0 (2014) to 4.0 (2022) were analyzed using linear mixed-effects models with level of economic development and gender inequity considered as potential moderators.Report card grades were generally relatively stable. Trends generally did not differ significantly by level of economic development (except for Active Transportation and Active Play), but gender inequality did significantly moderate trends for most of the indicators, with higher gender inequality associated with more adverse changes in grades. The number of "incomplete" grades decreased over time, but this did not reach statistical significance.While trends varied within and between countries, physical activity and sedentary behaviors, and the influences on these behaviors globally, were relatively stable over the past decade or so, albeit at undesirable levels.

Purpose The brand equity pyramid is a theory that explains how people develop loyalty and an attachment to a brand. The purpose of this study is to test whether the predictions made by the theory hold when applied to the brand of ParticipACTION, a Canadian non-profit organization that promotes active living. A secondary objective was to test whether this theory predicted intentions to be more physically active. Design/methodology/approach A research agency conducted a cross-sectional, online brand health survey on behalf of ParticipACTION. Exploratory factor analysis and confirmatory factor analysis established the factor structure. Structural equation modeling was used to test the hypothesized model. Findings A nationally representative sample of Canadian adults (N = 1,191) completed the survey. Exploratory factor analysis and confirmatory factor analysis supported a hypothesized five-factor brand equity framework (i.e. brand identity, brand meaning, brand responses, brand resonance and intentions). A series of structural equation models also provided support for the hypothesized relationships between the variables. Practical implications Though preliminary, the results provide a guide for understanding the branding process in the activity-promotion context. The constructs identified as being influential in this process can be targeted by activity-promotion organizations to improve brand strength. A strong organizational brand could augment activity-promotion interventions. A strong brand may also help the organization better compete against other brands promoting messages that are antithetical to their own. Originality/value This is the first study to test the brand equity pyramid using an activity-promotion brand. Results demonstrate that the brand equity pyramid may be useful in this context.

Existing research has documented inconsistent findings for the associations among breakfast frequency, physical activity (PA), and sedentary time in children. The primary aim of this study was to examine the associations among breakfast frequency and objectively-measured PA and sedentary time in a sample of children from 12 countries representing a wide range of human development, economic development and inequality. The secondary aim was to examine interactions of these associations between study sites.This multinational, cross-sectional study included 6228 children aged 9-11 years from the 12 International Study of Childhood Obesity, Lifestyle and the Environment sites. Multilevel statistical models were used to examine associations between self-reported habitual breakfast frequency defined using three categories (breakfast consumed 0 to 2 days/week [rare], 3 to 5 days/week [occasional] or 6 to 7 days/week [frequent]) or two categories (breakfast consumed less than daily or daily) and accelerometry-derived PA and sedentary time during the morning (wake time to 1200 h) and afternoon (1200 h to bed time) with study site included as an interaction term. Model covariates included age, sex, highest parental education, body mass index z-score, and accelerometer waking wear time.Participants averaged 60 (s.d. 25) min/day in moderate-to-vigorous PA (MVPA), 315 (s.d. 53) min/day in light PA and 513 (s.d. 69) min/day sedentary. Controlling for covariates, breakfast frequency was not significantly associated with total daily or afternoon PA and sedentary time. For the morning, frequent breakfast consumption was associated with a higher proportion of time in MVPA (0.3%), higher proportion of time in light PA (1.0%) and lower min/day and proportion of time sedentary (3.4 min/day and 1.3%) than rare breakfast consumption (all p ≤ 0.05). No significant associations were found when comparing occasional with rare or frequent breakfast consumption, or daily with less than daily breakfast consumption. Very few significant interactions with study site were found.In this multinational sample of children, frequent breakfast consumption was associated with higher MVPA and light PA time and lower sedentary time in the morning when compared with rare breakfast consumption, although the small magnitude of the associations may lack clinical relevance.The International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) is registered at (Identifier NCT01722500 ).

<p><strong>Background</strong></p> <p>The primary aim of this study was to determine if screen use in early childhood is associated with overall vulnerability in school readiness at ages 4 to 6 years, as measured by the Early Development Instrument (EDI). Secondary aims were to: (1) determine if screen use was associated with individual EDI domains scores, and (2) examine the association between screen use and EDI domains scores among a subgroup of high screen users.</p> <p><strong>Methods</strong></p> <p>This prospective cohort study was carried out using data from young children participating in a large primary care practice-based research network in Canada. Logistic regression analyses were run to investigate the association between screen use and overall vulnerability in school readiness. Separate linear regression models examined the relationships between children’s daily screen use and each separate continuous EDI domain.</p> <p><strong>Results</strong></p> <p>A total of 876 Canadian participants participated in this study. Adjusted logistic regression revealed an association between increased screen use and increased vulnerability in school readiness (<em>p</em> = 0.05). Results from adjusted linear regression demonstrated an association between higher screen use and reduced language and cognitive development domain scores (<em>p</em> = 0.004). Among high screen users, adjusted linear regression models revealed associations between increased screen use and reduced language and cognitive development (<em>p</em> = 0.004) and communication skills and general knowledge domain scores (<em>p</em> = 0.042).</p> <p><strong>Conclusions</strong></p> <p>Screen use in early childhood is associated with increased vulnerability in developmental readiness for school, with increased risk for poorer language and cognitive development in kindergarten, especially among high users.</p>

Objective To comprehensively review observational and experimental studies examining the relationship between sedentary behavior and cognitive development during early childhood (birth to 5years). Method Electronic databases were searched in July, 2014 and no limits were imposed on the search. Included studies had to be peer-reviewed, published, and meet the a priori determined population (apparently healthy children aged birth to 5years), intervention (duration, types, and patterns of sedentary behavior), comparator (various durations, types, or patterns of sedentary behavior), and outcome (cognitive development) study criteria. Data extraction occurred in October and November 2014 and study quality and risk of bias were assessed in December 2014. Results A total of 37 studies, representing 14,487 participants from nine different countries were included. Thirty-one studies used observational study designs and six studies used experimental study designs. Across study designs, increased or higher screen time (most commonly assessed as television viewing (TV)), reading, child-specific TV content, and adult-specific TV content had detrimental (negative) associations with cognitive development outcomes for 38%, 0%, 8%, and 25% of associations reported, respectively, and beneficial (positive) associations with cognitive development outcomes for 6%, 60%, 13%, and 3% of associations reported, respectively. Ten studies were moderate quality and 27 studies were weak quality. Conclusions The type of sedentary behavior, such as TV versus reading, may have different impacts on cognitive development in early childhood. Future research with reliable and valid tools and adequate sample sizes that examine multiple cognitive domains (e.g., language, spatial cognition, executive function, memory) are needed. Registration no. CRD42014010004.

Daily activity data are by nature compositional data. Accordingly, they occupy a specific geometry with unique properties that is different to standard Euclidean geometry. This study aimed to estimate the difference in adiposity associated with isotemporal reallocation between daily activity behaviours, and to compare the findings from compositional isotemporal subsitution to those obtained from traditional isotemporal substitution. We estimated the differences in adiposity (body fat%) associated with reallocating fixed durations of time (isotemporal substitution) between accelerometer-measured daily activity behaviours (sleep, sedentary time and light and moderate-to-vigorous physical activity (MVPA)) among 1728 children aged 9–11 years from Australia, Canada, Finland and the UK (International Study of Childhood Obesity, Lifestyle and the Environment, 2011–2013). We generated estimates from compositional isotemporal substitution models and traditional non-compositional isotemporal substitution models. Both compositional and traditional models estimated a positive (unfavourable) difference in body fat% when time was reallocated from MVPA to any other behaviour. Unlike traditional models, compositional models found the differences in estimated adiposity (1) were not necessarily symmetrical when an activity was being displaced, or displacing another (2) were not linearly related to the durations of time reallocated, and (3) varied depending on the starting composition. The compositional isotemporal model caters for the constrained and therefore relative nature of activity behaviour data and enables all daily behaviours to be included in a single statistical model. The traditional model treats data as real variables, thus the constrained nature of time is not accounted for, nor reflected in the findings. Findings from compositional isotemporal substitution support the importance of MVPA to children's health, and suggest that while interventions to increase MVPA may be of benefit, attention should be directed towards strategies to avoid decline in MVPA levels, particularly among already inactive children. Future applications of the compositional model can extend from pair-wise reallocations to other configurations of time-reallocation, for example, increasing MVPA at the expense of multiple other behaviours.

The present study evaluated awareness of the Canadian Society for Exercise Physiology’s 2011 Canadian Physical Activity Guidelines for Adults and assessed correlates. Reported awareness of the physical activity (PA) guidelines was 12.9% (204/1586) of the total sample surveyed. More than half (55%) self-reported meeting PA guidelines of ≥ 150 min of moderate to vigorous PA per week. Awareness of PA guidelines was significantly related to participants’ level of PA (χ 2 (1) = 30.63, p < 0.001, φ = –0.14), but not to any demographic variables.

In response to growing concerns over high levels of physical inactivity among young people, the Active Healthy Kids Global Alliance developed a series of national Report Cards on physical activity for children and youth to advocate for the promotion of physical activity. This article provides updated evidence of the impact of the Report Cards on powering the movement to get children and youth moving globally.This assessment was performed using quantitative and qualitative sources of information, including surveys, peer-reviewed publications, e-mails, gray literature, and other sources.Although it is still too early to observe a positive change in physical activity levels among children and youth, an impact on raising awareness and capacity building in the national and international scientific community, disseminating information to the general population and stakeholders, and on powering the movement to get kids moving has been observed.It is hoped that the Report Card activities will initiate a measurable shift in the physical activity levels of children and contribute to achieving the 4 strategic objectives of the World Health Organization Global Action Plan as follows: creating an active society, creating active environments, creating active lives, and creating active systems.

This study examines the awareness and use of Canada’s children’s fitness tax credit (CFTC), using taxfilers’ income tax return data from 2007 through 2009 as well as national survey data that explore parents’ perceptions of the CFTC. The income tax return data from Statistics Canada allow us to examine what taxfilers did, while the national survey data allow us to investigate the extent to which Canadians with children under the age of 18 were aware of the CFTC, their perceptions of its importance, and its relation to their decisions to enrol their children in organized physical activity programs. Collectively, these two data sources offer a more complete picture of who is using the CFTC and help in identifying possible reasons why others are not claiming the credit.In the analysis of the income tax return data, multiple logistic regression procedures were used to examine statistical associations between the use of and the amounts claimed for the CFTC and socioeconomic and demographic data, such as income, province/territory of residence, urban/rural residence, parental age, immigration status, family structure, gender of the child, and number of children.Our results show that families headed by a single parent, those with at least one male child, and those living in urban areas were all more likely to claim the CFTC and claimed greater amounts through the CFTC. The likelihood of claiming the CFTC was between 4 percent and 30 percent greater in families at annual income levels above $20,000 compared to those earning less than $20,000 annually. In most cases, the amount claimed also increased with increasing income such that families earning $100,000 to $200,000 and those earning more than $200,000 had CFTC claims that were, on average, $125 and $250 higher, respectively, than those making less than $20,000.We employed similar statistical methods in our analysis of nationally representative survey data, in order to calculate frequencies and prevalence estimates by participant characteristic and to test for associations between parental awareness and perceptions of the CFTC and key sociodemographic variables. Our results show that awareness of the CFTC was high, with approximately 65 percent of respondents reporting that they had heard of the credit. Gender, age, education, and income were all significantly associated with CFTC awareness: women, parents between 40 and 49 years of age, those with postsecondary education, and those earning more than $40,000 annually were all more likely to be familiar with the CFTC.Among those familiar with the CFTC, fewer than one-third felt that the CFTC motivated them or encouraged them, or made it easier for them, to register their children in physical activity programs. Our results offer objective information regarding the use of the CFTC and raise questions regarding the equity and potential effectiveness of the program. With the spread of tax credits similar to the federal CFTC to other provincial jurisdictions, it is increasingly important to critically evaluate these programs and implement the changes necessary to address their limitations, and thereby maximize the return on this public investment.

Background Participation in outdoor play has been extensively documented as beneficial for the health, well-being, and development of children. Canadian early childhood education centers (ECECs) are important settings in young children’s lives and provide opportunities to participate in outdoor play. However, there are barriers to the provision of outdoor play opportunities at ECECs, such as adverse weather conditions, poorly designed outdoor spaces, outdoor time policies, and early childhood educator comfort levels. Objective The PROmoting Early Childhood Outside (PRO-ECO) study is a wait-list control cluster randomized trial that evaluates the impact of the PRO-ECO intervention, an innovative outdoor play intervention, on children’s outdoor play behavior. The purpose of this paper was to provide a detailed overview of the pilot study protocol and the methods that will be used to develop, implement, and evaluate the PRO-ECO intervention. Methods A total of 8 ECECs delivering licensed care to children aged 2.5 to 6 years in the Greater Vancouver region of British Columbia, Canada, and operated by the YMCA of Greater Vancouver (YMCA GV) are included in this study. Using a wait-list control cluster randomized trial design, we randomly allocated ECECs to either the PRO-ECO intervention arm (n=4) or the wait-list control arm (n=4). The primary outcome measures include changes in the proportion and diversity of observed outdoor play behavior during dedicated outdoor times at the ECECs as measured through observational behavior mapping. Secondary outcome measures include changes in educator attitudes; quality of ECECs’ outdoor play space; and children’s psychosocial strengths, physical activity levels, and social behaviors. A process evaluation of the acceptability of the PRO-ECO intervention in the 8 YMCA GV ECECs will also be assessed. Outcome data will be collected at baseline, 6-month follow-up, and 12-month follow-up. Mixed effect models will test the effect of the PRO-ECO intervention on quantitative outcomes. Baseline and postintervention data will be included in the analysis, controlling for the cluster design. Qualitative data will support quantitative findings and provide evidence for the acceptability of implementation. Results Participant recruitment for this study began in August 2021, and baseline data collection was completed at all 8 ECECs in November 2021. As of April 2022, a total of 130 children have been recruited to participate in this study. Conclusions The PRO-ECO pilot study will develop, implement, and evaluate the PRO-ECO intervention within 8 YMCA GV ECECs in the Vancouver region of British Columbia, Canada. The findings of this study will be useful for early childhood educators, ECEC providers, and policy makers to consider means for enhancing outdoor play provision and assessing the sustainability of the intervention in ECEC settings. Trial Registration ClinicalTrials.gov NCT05075580; https://clinicaltrials.gov/ct2/show/NCT05073380 International Registered Report Identifier (IRRID) DERR1-10.2196/38365

<sec> <title>Introduction</title> ParticipACTION is a Canadian physical activity communications and social marketing organization relaunched in 2007. The purpose of this study was to qualitatively investigate organizational capacity for physical activity promotion among Canadian organizations, and the influence of ParticipACTION on capacity five years after relaunch. </sec> <sec> <title>Methods</title> Using a purposive sampling strategy, semi-structured telephone interviews were conducted with 44 key informants representing national, provincial, and local organizations with a mandate to promote physical activity. Interview data were analyzed using a thematic analytic approach. </sec> <sec> <title>Results</title> Organizational capacity in terms of partnerships and collaborations, and the general climate for physical activity promotion have improved since ParticipACTION’s relaunch. Although financial resources reduced the ability of organizations to fulfil their mandates, internal factors such as skilled employees and sponsorships, and external factors such as technological improvements in communication and information sharing helped to offset this strain. There were mixed feelings on ParticipACTION’s contribution to capacity. While ParticipACTION has brought more attention to inactivity, this was perceived as a complement to work already taking place. While some organizations perceived ParticipACTION’s relaunch as competition to funding and access to popular media, others found it as an opportunity to co-brand social marketing campaigns, utilizing ParticipACTION’s products and reputation. </sec> <sec> <title>Conclusion</title> According to participants, organizational capacity to promote physical activity in Canada has increased since 2007 in subtle but important ways because of a strong climate for physical activity promotion, skilled employees, and information sharing technology. Organizational capacity changes were minimally attributed to ParticipACTION. </sec>

Importance Approximately half of all youths with concussions report sleep disturbance, including short and long sleep durations, in the first week of recovery. Limited longitudinal research exists regarding the association between sleep duration and symptom burden during acute pediatric concussion recovery. Objective To investigate the association between mean nightly sleep duration over 1 week (days 1 to 7) and 2 weeks (days 1 to 14) postinjury and subsequent symptom burden at 1, 2, and 4 weeks following pediatric concussion. Design, Setting, and Participants This cohort study used data from a randomized clinical trial conducted in 3 emergency pediatric departments in Ontario, Canada, from March 2017 to December 2019 (with secondary analysis conducted between September 2022 and September 2024). Eligible participants were between ages 10 years and 18 years who received treatment for a concussion within 48 hours. Exposure Sleep postinjury was measured with waist-worn accelerometers 24 hours per day for 2 weeks and daily sleep logs. Main Outcomes and Measures Symptom burden was measured with the Health and Behavior Inventory at 1 week, 2 weeks, and 4 weeks postconcussion. A nonlinear mixed-effects model was applied that estimated symptom burden at 1, 2, and 4 weeks from mean sleep duration over days 1 to 7 and days 1 to 14. Logistic regressions were performed to assess the odds of being reliably symptomatic at 2 and 4 weeks by mean sleep duration. Conservative ( z ≥ 1.65) and liberal ( z ≥ 1.28) definitions of reliable change in symptoms were evaluated. All models compared 10th vs 50th, 25th vs 75th, and 50th vs 90th percentile contrasts, and were adjusted for prognostic pre-injury demographic and baseline injury variables. Results A total of 291 participants (median [IQR] age, 13.2 [11.6-14.9] years; 128 female [44.0%]) were included in the main analysis. Mean nightly sleep duration beyond 9.5 hours in the first week postconcussion was associated with higher symptom burden at 1 week (75th percentile [10.5 h] vs 25th percentile [9.5 h]: estimate, 1.3 [95% CI, 0.25-2.28]; 90th percentile [11.3 h] vs 50th percentile [10.0 h]: estimate, 2.9 [95% CI, 1.22-4.69]). Mean sleep duration beyond 9.9 hours in the first 2 weeks postconcussion was associated with higher symptom burden at 2 weeks (90th percentile [10.9 h] vs 50th percentile [9.9 h]: estimate, 2.2 [95% CI, 0.85-3.47]) and 4 weeks (estimate, 2.2 [95% CI, 0.85-3.47]), and increased odds of persisting symptoms at 4 weeks (conservative: odds ratio [OR], 1.73 [95% CI, 0.91-3.26]; liberal: OR, 1.93 [95% CI, 1.07-3.47]). Conclusions and Relevance In this observational study of adolescents, average nightly sleep durations beyond 9.9 hours over the first 2 weeks of concussion recovery were associated with high symptom burden and persistent symptoms. Clinicians should monitor youths’ sleep after concussions.