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There is evidence to suggest that dietary intake of children differs by rural/urban place of residence: rural children may have a higher intake of foods high in fat and sugar than those living in urban environments. The aim of this study was to examine the intake of fruits and vegetables (FV) and the frequency of sugar-sweetened beverage (SSB) consumption, among a sample of rural children in Northern Ontario, Canada, in two different seasons. Sociodemographic factors and children's FV and SSB intake were measured using two repeated cross-sectional surveys, and seasonal information was based on the month of data collection. Logistic regressions were used to examine the odds of children eating five or more FVs, and the odds of 'frequently or always' consuming SSBs. During the fall, children reported eating five or more FV more often, when compared to winter (53.9% vs. 48.3%). In the fall, 25.8% of children reported 'frequently or always' drinking SSB, compared with 16.9% in winter. Indigenous children were less likely to eat five or more FV (OR 0.34 (95% CI 0.12–0.95)) in the fall when compared to non-Indigenous children. Findings indicate that intake of FV among rural students in this region is low, and the frequency of SSB is high, when compared with national recommendations. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine potential child-level and day-level factors of accelerometer-measured sedentary time in a sample of rural Canadian children. Children (n = 86) from rural Northwestern Ontario participated in this study. Children's sedentary times were identified and logged using an accelerometer. Child-level data (socio-demographic, household, and environment) came from surveys of children and their parents and a passively logging global positioning unit. Day-level data on day type (weekday/weekend) and weather (temperature, precipitation) were based on the dates of data collection and meteorological data came from the closest Environment Canada weather station. Cross-classified regression models were used to assess the relationship between child-level and day-level correlates of sedentary time. Boys were less sedentary than girls (b = 30.53 p = 0.01). For each one-year age increase, children's sedentary time increased (b = 12.79 p < 0.01). This study indicates a difference in sedentary time based on a child's age and gender. However, family, environmental, and weather characteristics did not influence sedentary time in this sample. Health practitioners who deliver care for northern rural youth can provide targeted health advice regarding sedentary time and consider gender and age to be risk factors for these behaviors. [ABSTRACT FROM AUTHOR]

Objective: To examine the relationship between knowledge and beverage consumption habits among children.Design: Cross-sectional analysis. Linear regression was used to identify sociodemographic, dietary and behavioural determinants of beverage consumption and knowledge, and to describe the relationships between children's knowledge and water and sugar-sweetened beverage (SSB) consumption.Settings: Seventeen elementary schools in London, Ontario, Canada.Participants: A total of 1049 children aged 8-14 years.Results: Knowledge scores were low overall. Children with higher knowledge scores consumed significantly fewer SSB (β = -0·33; 95 % CI -0·49, -0·18; P < 0·0001) and significantly more water (β = 0·34; 95 % CI 0·16, 0·52; P = 0·0002). More frequent refillable water bottle use, lower junk food consumption, lower fruit and vegetable consumption, female sex, higher parental education, two-parent households and not participating in a milk programme were associated with a higher water consumption. Male sex, higher junk food consumption, single-parent households, lower parental education, participating in a milk programme, less frequent refillable water bottle use and permission to leave school grounds at lunchtime were associated with a higher SSB consumption. Water was the most frequently consumed beverage; however, 79 % of respondents reported consuming an SSB at least once daily and 50 % reported consuming an SSB three or more times daily.Conclusions: Elementary-school children have relatively low nutrition and water knowledge and consume high proportions of SSB. Higher knowledge is associated with increased water consumption and reduced SSB consumption. Interventions to increase knowledge may be effective at improving children's beverage consumption habits. [ABSTRACT FROM AUTHOR]

BACKGROUND: Some Canadian schools have modified their daily schedules from the traditional school day (TSD) schedule (two 15‐minute breaks and one 60‐minute break) to a balanced school day (BSD) schedule (two 40‐minute breaks). While this change increases daily planning and instructional time, it also changes the amount of time available for moderate‐vigorous physical activity (MVPA). METHODS: This study uses a case‐control design to examine differences in objectively measured MVPA between children in 3 schools using a BSD schedule and 3 schools using a TSD schedule. Study participants (aged 10‐12 years) were recruited from schools in Ontario, Canada. RESULTS: Regardless of schedule type, girls had lower MVPA than boys, and as both boys and girls got older their MVPA significantly decreased. The findings indicate there was no statistically significant difference in the total minutes of in‐school MVPA between children from BSD schools and children from TSD schools. MVPA was significantly higher for older girls attending BSD schools than older girls attending TSD schools, suggesting that implementing a BSD may help curb declining MVPA as girls enter adolescence. CONCLUSION: Despite encouraging findings, more rigorous studies (ie, pre‐post experiments with control) are needed to better understand how changing schedules impacts children's health. [ABSTRACT FROM AUTHOR]

Children's time and freedom for independent neighbourhood activity is severely declining, which may be adversely impacting their healthy development. This study integrates GPS activity monitoring and environmental analysis in a geographic information system with activity diaries, annotated maps, surveys, and map-enhanced interviews to conduct a deep pattern analysis of children's habitual neighbourhood behaviour (n = 23; aged 9-13 years) from each an urban and suburban school neighbourhood within London, Canada. Patterns in children's primary activities and settings, independent mobility (IM) levels, and perception and use of neighbourhood affordances are examined. Participants note a diverse range of local independent destinations, but habitually spend little time playing outdoors in neighbourhoods. Local activity related to free time available, perception of activity affordances, and license to travel independently. Social and environmental conditions of children's micro-neighbourhoods influenced independent destinations and domains. Neighbourhood planning should promote diversity of activity affordances and address conditions that support increased IM for youth. [ABSTRACT FROM AUTHOR]

This study examines the neighborhood activity spaces (NAS) of 9- to 13-year-old children (n = 143) from seven schools in London, Canada. Data from Global Positioning System (GPS) loggers worn for 7 days were used to isolate and test measures for children’s pedestrian-based neighborhood activity: the maximum distance traveled from home and relative time spent in neighborhood settings. Descriptive and linear regression analyses examined the influence of individual, perceptual, and environmental factors on neighborhood use and travel. Participants spent a large portion of their out-of-school time (75%) in their NAS. Although traveling far from home on occasion, 94.5% of children’s time on average was spent within a short distance of home; participants spent little of their free time in broader neighborhood settings. School travel mode and independent mobility were among the strongest predictors of both distance traveled and time spent close to home. Perceptions of neighborhood safety, neighborhood type, and nearby land uses also influenced local activity. [ABSTRACT FROM AUTHOR]

Background: Physical activity during childhood is associated with a multitude of physical, behavioural, and psychological health benefits. Identification of effective population level strategies for increasing children's physical activity levels is critical for improving the overall health of Canadians. The overall objective of this study is to assess how a naturally-occurring, community-level intervention which offers Grade 5 children in London, Canada a free access pass to physical activity opportunities (facilities and programs) for an entire school year can lead to increased physical activity among recipients.Methods/design: This study adopts a longitudinal cohort study design to assess the effectiveness of improving children's access to physical activity opportunities for increasing their physical activity levels. To meet our overall objective we have three aims: (1) to assess whether the provision of free access increases children's physical activity levels during and after the intervention compared to a control group; (2) to assess how and why child-specific trajectories of physical activity (between-children differences in level of physical activity measured across time) in the intervention group differ according to children's individual and household characteristics; and (3) to explore additional factors that are unaccounted for in the theoretical model to gain a further understanding of why the free access intervention had varying effects on changing physical activity levels. We will be addressing these aims using a mixed methods approach, including: a series of youth surveys conducted before, during, immediately after, and 4-months after the intervention; parent surveys before, during, and post-intervention; real-time tracking of the access pass use during the intervention; and focus groups at the conclusion of the intervention. Data compiled from the youth surveys will provide a subjective measure of physical activity to be used as our outcome measure to address our primary aims.Discussion: The results of this study can inform policy- and decision-makers about the sub-groups of the population that benefitted the most (or least) from the intervention to provide more specific information on how to develop and target future interventions to have a greater impact on the physical activity levels and overall health of children. [ABSTRACT FROM AUTHOR]

Various geospatial techniques have been employed to estimate children’s exposure to environmental cardiometabolic risk factors, including junk food. But many studies uncritically rely on exposure proxies which differ greatly from actual exposure. Misrepresentation of exposure by researchers could lead to poor decisions and ineffective policymaking. This study conducts a GIS-based analysis of GPS tracks—‘activity spaces’—and 21 proxies for activity spaces (e.g. buffers, container approaches) for a sample of 526 children (ages 9–14) in London, Ontario, Canada. These measures are combined with a validated food environment database (including fast food and convenience stores) to create a series of junk food exposure estimates and quantify the errors resulting from use of different proxy methods. Results indicate that exposure proxies consistently underestimate exposure to junk foods by as much as 68%. This underestimation is important to policy development because children are exposed to more junk food than estimated using typical methods. [ABSTRACT FROM AUTHOR]

ObjectiveTo examine the relationship between the neighbourhood food environment and dietary intake among adolescents.DesignCross-sectional design using: (i) a geographic information system to assess characteristics of the neighbourhood food environment and neighbourhood socio-economic status; (ii) the modified Healthy Eating Index (HEI) to assess participants’ overall diet quality; and (iii) generalized linear models to examine associations between HEI and home and school food environmental correlates.SettingMid-sized Canadian city in Ontario, Canada.ParticipantsGrade 7 and 8 students (n 810) at twenty-one elementary schools.ResultsStudents living in neighbourhoods with a lower diversity of land-use types, compared with their higher diversity counterparts, had higher HEI scores (P < 0·05). Students with more than 1 km between their home and the nearest convenience store had higher HEI scores than those living within 1 km (P < 0·01). Students attending schools with a distance further than 1 km from the nearest convenience store (P < 0·01) and fast-food outlet (P < 0·05) had higher HEI scores than those within 1 km. Those attending schools with three or more fast-food outlets within 1 km had lower HEI scores than those attending schools with no fast-food outlet in the school surroundings (P < 0·05).ConclusionsClose proximity to convenience stores in adolescents’ home environments is associated with low HEI scores. Within adolescents’ school environments, close proximity to convenience and fast-food outlets and a high density of fast-food outlets are associated with low HEI scores. [ABSTRACT FROM PUBLISHER]

This study examined environmental influences on a child's mode of travel between home and school. Grade 7 and 8 students (n = 614) from twenty-one schools throughout London, Ontario, participated in a school-based travel mode survey. Geographic information systems (GIS) were employed to examine environmental characteristics of the child's mode of travel between home and school measured at the scale of the likely travel route. Logistic regression was used to assess what factors influence both the to- and from-school trip. Over 62 percent of students living within 1.6 kilometers (1 mile) of school walked or biked to school and 72 percent walked or biked home from school. Actively commuting to school was positively associated with shorter trips, with distance being the most important correlate. Boys were significantly more likely to use active travel modes than girls. Higher traffic volume along the route was negatively related to rates of active travel and children from higher income neighborhoods were less likely to actively travel than children from lower income neighborhoods. In terms of environmental characteristics, the presence of street trees was positively associated and higher residential densities and mixed land uses were negatively associated with active travel to school. For the journey home, crossing major streets and increased intersection density were negatively associated with active travel. The findings of this research give evidence that active travel is associated with the environmental characteristics of walking routes. This information should be considered for urban planning and school planning purposes to improve children's walking environments. [ABSTRACT FROM PUBLISHER]

Background: Mental health (MH) problems are among the most important causes of morbidity and mortality for children and youth. Problems of lack of equity in child and youth MH services (CYMHS)—including, but not limited to, problems in inaccessibility and quality of services—are widespread. Characterizing the nature of equity in CYMHS is an ongoing challenge because the field lacks a consistent approach to conceptualizing equity. We will conduct a scoping review of how equity in MH services for children and youth has been defined, operationalized, and measured. Our objectives are to discover: (1) What conceptual definitions of equity are used by observational studies of CYMHS?; (2) What service characteristics of CYMHS care do indices of equity cover?; (3) What population dimensions have been used to operationalize equity?; (4) What statistical constructs have been used in indices that measure CYMHS equity?; and (5) What were the numerical values of those indices? Methods: The following databases will be searched: Medline, Embase, PsycINFO, Cochrane Controlled Register of Trials, CINAHL, EconLit, and Sociological Abstracts. Searches will be conducted from the date of inception to the end of the last full calendar year (December 2019). Studies will be included if they include an evaluation of a mental health service for children or youth (defined as those under 19 years of age) and which quantify variation in some aspect of child or youth mental health services (e.g., accessibility, volume, duration, or quality) as a function of socio-demographic and/or geographic variables. Study selection will occur over two stages. Stage one will select articles based on title and abstract using the liberal-accelerated method. Stage two will review the full texts of selected titles. Two reviewers will work independently on full-text reviewing, with each study screened twice using pre-specified eligibility criteria. One reviewer will chart study characteristics and indices to be verified by a second reviewer. Reviewers will resolve full-text screening and data extraction disagreements through discussion. Synthesis of the collected data will focus on compiling and mapping the types and characteristics of the indices used to evaluate MH services equity. Discussion: The planned, systematic scoping review will survey the literature regarding how equity in MH services for children and youth has been operationalized and help inform future studies of equity in CYMHS. Systematic review registration: Open Science Foundation ID SYSR-D-19-00371, https://osf.io/58srv/. [ABSTRACT FROM AUTHOR]

Children's perceptions of their environment have been associated with their physical activity (PA) levels, however a better understanding of the formation of perceptions within different contexts is needed. This will help to inform decision making related to physical inactivity trends in Canadian children. We examined socio-ecological factors influencing children's perceptions of barriers to PA in Ontario, Canada. Binary logistic regression models measured the relationship between perceptions of barriers and PA for 892 children in Ontario. At the intrapersonal level, girls reported the most barriers to PA. Interpersonally, children whose mother was employed reported the most barriers. At the physical environment level, children in urban and suburban neighbourhoods of large cities, and rural areas reported the most barriers, differing relative to population size. The major contribution of this paper is a new perspective of environmental influences on children's perceptions of PA, using an urbanicity spectrum, and highlighting place specific needs of Canadian children. [ABSTRACT FROM AUTHOR]

Physical inactivity among children is a significant public health concern. Active school travel (AST) methods, such as walking and wheeling to school, can be a valuable way to increase children's levels of daily physical activity. In Canada, Active and Safe Routes to School (ASRTS), a national health promotion initiative, has led the campaign for AST through its flagship school travel plan (STP) program. At present little is known about the on-the-ground implementation processes that impede or facilitate the success of STPs. Through a thematic analysis of 18 interviews with STP facilitators and 4 focus groups with the larger STP committees, our study evaluates the factors shaping the functioning of STP interventions at ten elementary schools participating in a regional ASRTS program in Southwestern Ontario. Our analysis yielded six themes that have implications for STP implementation and sustainability: 1) accounting for school context; 2) establishing committee capacity and leadership; 3) supporting STP action; 4) responsiveness to external and internal barriers; 5) engaging schools at the grassroots level; and 6) building future champions. We draw from Lewin's Field Theory and discuss the forces affecting STP committees to frame our findings in a way that can be discussed to support the building of efficient, effective, and viable AST intervention environments. [ABSTRACT FROM AUTHOR]

For children and youth, the journey to and from school represents a significant opportunity to increase daily levels of physical activity by using non-motorized modes of travel, such as walking and biking. Studies of active school travel have demonstrated that the likelihood a child will walk or bike is significantly influenced by the distance they must travel between home and school, which in turn, is influenced by built environment characteristics such as the configuration of the local road network. This study examines how shortcuts can facilitate active school travel by decreasing the distance children must travel to get to and from school. A geographic information system was used to compare shortest route distances along road networks with and without shortcuts in 32 elementary school zones in London, Ontario, Canada and provide evidence on the effectiveness of shortcuts to facilitate active school travel. This study contributes two key findings: (1) shortcuts have a greater impact in areas with low street connectivity and low population density and (2) children living farther from school are more likely to benefit from shortcuts. The findings suggest that planners should consider the location and maintenance of shortcuts in school neighbourhoods in order to promote increased physical activity, health and well-being among students. [ABSTRACT FROM AUTHOR]