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Background: COVID-19 caused closures of movement supporting environments such as gyms and schools in Canada. This study evaluated the association between Ontario parents' and children's physical activity levels across time during COVID-19, controlling for variables that were identified as significant predictors of children's and parents' physical activity (e.g., children's age, parents' employment status). Methods: Parents (n = 243; mean age = 38.8 y) of children aged 12 and under (n = 408; mean age = 6.3 y) living in Ontario, Canada completed 2 online surveys, the first between August and December 2020 and the second between August and December 2021. At baseline, parents were asked to recall prepandemic physical activity levels. To determine the association between parent and child physical activity during COVID-19, a cross-lagged model was estimated to determine the cross-sectional and longitudinal associations between parents' and children's physical activity across time. Results: Bivariate associations revealed that parents' and children's physical activity levels were significantly related during lockdown and postlockdown but not prelockdown. The autoregressive paths from prelockdown to during lockdown were significant for children (β = 0.53, P <.001) and parents (β = 1.058, P <.001) as were the autoregressive paths from during lockdown to postlockdown for children (β = 0.61, P <.001) and parents (β = 0.48, P <.001). In fully adjusted models, the cross-lagged association between parents' physical activity prelockdowns was significantly positively associated with their children's physical activity during lockdowns (β = 0.19, P =.013). Conclusions: Resources are needed to ensure that children and parents are obtaining sufficient levels of physical activity, particularly during a pandemic. [ABSTRACT FROM AUTHOR]

Food retail businesses experienced a pronounced increase in sales when food hospitality outlets closed in the early stages of the COVID-19 pandemic in Canada. This study investigates how pandemic-related modifications to food retail businesses in Ontario, Canada affected the well-being of workers. Semi-structured interviews were conducted with 17 food retail employees between June 2020 and May 2021 as part of the Food Retail Environment Study for Health and Economic Resiliency (FRESHER). Transcripts were analyzed inductively, and themes were refined using the Effort Reward Imbalance Model. Themes were connected to the main components of this model: extrinsic effort, intrinsic effort, money, esteem, status control, and burnout. Results indicate that, for food retail employees, the presence of an imbalance between efforts and rewards threatens well-being via symptoms of burnout. Further study is needed to examine how this inequality and burnout among this population might be measured and addressed. [ABSTRACT FROM AUTHOR]

Transportation research has shown that socio‐demographic factors impact people's mobility patterns. During the COVID‐19 pandemic, some of these effects have changed in accordance with changing mobility needs adapting to the pandemic, including restrictions on in‐person gatherings, closure of in‐person businesses, and working from home. We investigate two gaps in current knowledge in this area of transportation research: to what extent the associations between socio‐demographic factors and mobility metrics have changed, and how these associations vary across geographic space. We used aggregate deidentified cell tower location data to measure two mobility metrics—movement time and radius of gyration—and socio‐demographic data from the 2016 Canadian Census to model these associations across Ontario, Canada in 2020 using a linear model and a geographically weighted regression model. We find that certain associations between socio‐demographics and mobility have changed from what we previously observed before the pandemic, and we can see the variation of these associations across space. These findings will improve our understanding of how socio‐demographic factors affect mobility patterns in different communities and demonstrate the importance of measuring these associations at a more fine‐grained level using models that consider spatial variation to best reflect the nature of these associations. Key messages: Geographically weighted regression was used to study associations between mobility and five socio‐demographic factors in Ontario, Canada during the COVID‐19 pandemic.All five variables exhibited positive and negative associations with mobility change for at least one period of analysis, highlighting the complexity of these relationships.Our results provide new information on the geographical relationships between mobility change during COVID‐19 and neighbourhood‐level socio‐demographic variables. [ABSTRACT FROM AUTHOR]

Background: Cannabis is associated with the onset and persistence of psychotic disorders. Evidence suggests that accessibility of substances is associated with an increased risk of use-related harms. We sought to examine the effect of residing in proximity to non-medical cannabis retailers on the prevalence of health service use for psychosis. Methods: We conducted a cross-sectional study using linked health administrative data, and used geospatial analyses to determine whether people in Ontario, Canada (aged 14–60 years) resided within walking (1.6 km) or driving (5.0 km) distance of non-medical cannabis retailers (open as of February-2020). We identified outpatient visits, emergency department (ED) visits, and hospitalizations for psychotic disorders between 01-April-2019 and 17-March-2020. We used zero-inflated Poisson regression models and gamma generalized linear models to estimate the association between cannabis retailer proximity and indicators of health service use. Results: Non-medical cannabis retailers were differentially located in areas with high levels of marginalization and pre-existing health service use for psychosis. People residing within walking or driving distance of a cannabis retailer had a higher rate of psychosis-related outpatient visits, ED visits, and hospitalizations, compared to people living outside these areas. This effect was stronger among those with no prior service use for psychosis. Conclusions: Proximity to a non-medical cannabis retailer was associated with higher health service use for psychosis, even after adjustment for prior health service use. These findings suggest that opening of non-medical cannabis retailers could worsen the burden of psychosis on mental health services in areas with high-risk populations. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence of university students who have ever engaged in self-harm and to examine its correlates. Frequency of thinking about self-harm was explored as a secondary outcome. Participants: Students at Western University in London, Ontario, Canada. Methods: This cross-sectional study was completed via an online questionnaire. Logistic regressions assessed the influence of sociodemographic and behavioral factors associated with lifetime self-harm and thoughts about self-harm. Results: The sample consisted of 2626 university students. Almost 25% engaged in self-harm in their lifetime and close to 33% have thought about harming themselves. A non-straight sexual orientation, marijuana use, prescription drugs not prescribed, and mental health problems increased the risk of both outcomes. Females were over two times more likely to engage in self-harm than males. Conclusion: This study provides evidence that is needed for developing effective interventions to reduce the risk of self-harm by targeting university students who are most at-risk. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic resulted in closures of physical-activity-supporting environments, including playgrounds, outdoor recreation facilities (e.g., basketball courts), and community centers, which impacted children's movement opportunities. This study evaluated changes in Ontario children's physical activity levels during the COVID-19 pandemic and explored the impact of family sociodemographic markers on children's activity. Parents (n = 243; Mage = 38.8 years) of children aged 12 and under (n = 408; Mage = 6.7 years) living in Ontario, Canada, completed two online surveys between August and December 2020 (survey 1) and August and December 2021 (survey 2). Generalized linear mixed-effects models were used to estimate changes in the proportion of children who accumulated 60 min of physical activity per day pre-lockdown, during lockdown, and post-lockdown in Ontario. Results revealed a significant non-linear trajectory whereby the proportion of children achieving 60 min of physical activity per day pre-lockdown (63%) declined during lockdown (21%) and then increased post-lockdown (54%). Changes in the proportion of children engaging in 60 min of daily physical activity were moderated by several demographic variables. Efforts are needed to provide parents of young children with a wider variety of resources to ensure children are obtaining sufficient levels of physical activity regardless of the presence of community lockdowns. [ABSTRACT FROM AUTHOR]

Introduction: This study examines correlates of lifetime (ie, ever vaped) and past month vape use among students aged 17 to 19 years, 20 to 25 years, and 26+ years from Western University in London, Ontario. The secondary objective is to assess lifetime and past month vape use among students not of legal age to purchase vaping products in Ontario (ie, those 17 to 18 years only). Methods: Using Qualtrics, a cross-sectional survey was sent via email to all students at Western University (N = 38 442), assessing their current and past risk-taking behaviors, mental health, sociodemographic characteristics, as well as questions pertaining to their family structure and socioeconomic background during childhood. Students were asked if they had ever vaped in their lifetime and about past month vape use. Logistic regression models were used to assess correlates of lifetime and past month vape use. Results: The sample consisted of 2626 university students. Compared to those ages 26+ years, teenage university students were 10 times more likely to have vaped in the past month and males were twice as likely as females to have vaped. Alcohol use doubled the odds of vaping in the past month, whereas cigarette, cannabis, or cocaine use approximately tripled the odds. Students who reported many sexual partners were far more likely to have vaped in the past month. Conclusion: Vape use is more common among teenage university students, males, those who drink alcohol, smoke, use cannabis or cocaine, and who report many sexual partners. [ABSTRACT FROM AUTHOR]

Urban areas have complex thermal distribution. We examined the association between extreme temperature and mortality in urban Ontario, using two temperature data sources: high-resolution and weather station data. We used distributed lag non-linear Poisson models to examine census division-specific temperature–mortality associations between May and September 2005–2012. We used random-effect multivariate meta-analysis to pool results, adjusted for air pollution and temporal trends, and presented risks at the 99th percentile compared to minimum mortality temperature. As additional analyses, we varied knots, examined associations using different temperature metrics (humidex and minimum temperature), and explored relationships using different referent values (most frequent temperature, 75th percentile of temperature distribution). Weather stations yielded lower temperatures across study months. U-shaped associations between temperature and mortality were observed using both high-resolution and weather station data. Temperature–mortality relationships were not statistically significant; however, weather stations yielded estimates with wider confidence intervals. Similar findings were noted in additional analyses. In urban environmental health studies, high-resolution temperature data is ideal where station observations do not fully capture population exposure or where the magnitude of exposure at a local level is important. If focused upon temperature–mortality associations using time series, either source produces similar temperature–mortality relationships. [ABSTRACT FROM AUTHOR]

Introduction: This qualitative study investigates children's perceptions of the influences of a Centrally Procured School Food Program on their dietary behaviours and their recommendations on how to improve the program. Methods: The observations of 208 students aged 9 to 14 years (Grades 5-8) at 21 elementary schools were collected through focus groups in 2017/18. The larger intervention consisted of a 10-week program offering daily snacks (i.e. fruit, vegetables, whole grains, dairy, meat alternatives) for elementary school children in southwestern Ontario, Canada. Results: The participants' overall impressions of the program were positive. They noted reduced hunger, increased energy and improved nutrition. Many children felt that the program changed their dietary patterns at home as well as at school, particularly in terms of eating more fruit and vegetables. The snack program also enabled children to try healthy foods. Conclusion: Most participants considered the program to be beneficial in promoting healthy eating. Participants recommended adding educational activities, expanding the variety of foods and increasing child involvement in selecting and preparing foods. [ABSTRACT FROM AUTHOR]

Primary care is the level of a health system that provides first point of access to health care services for all health-related needs and problems, providing person-focused care over time in a continuous and coordinated fashion (Primary Healthcare Planning Group [48]; Aggarwal and Hutchison [1]; Health Canada [20]). This paper undertakes a comprehensive examination of how primary care services are distributed across Southwestern Ontario (SWO), with a particular focus on understanding how the distribution is meeting the primary care needs of the senior population (i.e., people aged 65 years and older) and populations living in different geographic settings (i.e., the urban-rural continuum). PCPs were included in our research database if they were physicians or NPs that have a comprehensive primary care practice and have a roster of enrolled patients for whom they provide ongoing primary care (as of July 2015). Despite the high PCP-to-population ratios, the number of PCPs actually providing care in these rural and small population centre communities away from metropolitan influence zones is overestimated, as many PCPs provide other health services (e.g., emergency room doctors, specialists, service to long-term care). [Extracted from the article]

Nature exposure positively impacts children's physical, socio-emotional, and cognitive health and development. We know less about how children perceive their connection with nature and what nature means to them. This study uses focus groups to understand how rural Canadian children define, experience, and perceive benefits of nature. Using thematic analysis, we identified three primary themes. First, while children associate nature with specific activities, natural elements, and locations, they also conceptualize nature as 'a whole community.' Second, children experienced nature through doing, highlighting how activities connected them with nature while recognizing constraints on those engagements. Finally, children demonstrated agency in accessing nature to improve their emotional states. These findings indicate that from children's views, nature is more than just space with natural elements. Children are also knowledgeable about the health benefits of nature, and capitalize on this knowledge. These findings can inform interventions to increase children's interactions with outdoor environments. [ABSTRACT FROM AUTHOR]

This study assessed the strength of the association between socioeconomic status (SES) and low birth weight (LBW) and preterm birth (PTB) in Southwestern Ontario. Utilizing perinatal and neonatal databases at the London Health Science Centre, maternal postal codes were entered into a Geographic Information System to determine home neighbourhoods. Neighbourhoods were defined by dissemination areas (DAs). Median household income for each DA was extracted from the latest Canadian Census and linked to each mother. All singleton infants born between February 2009 and February 2014 were included. Of 26,654 live singleton births, 6.4% were LBW and 9.7% were PTB. Top risk factors for LBW were: maternal amphetamine use, chronic hypertension and maternal marijuana use (OR respectively: 17.51, 3.18, 2.72); previously diagnosed diabetes, maternal narcotic use and insulin-controlled gestational diabetes predicted PTB (OR respectively: 17.95, 2.69, 2.42). Overall, SES had little impact on adverse birth outcomes, although low maternal education increased the likelihood of a LBW neonate (OR: 1.01). [ABSTRACT FROM AUTHOR]

Place branding has increasingly been adopted as a municipal initiative to change the trajectory of local economic development. Specifically, local municipalities and communities have used place branding not only as a response to the influence of globalization and neo-liberalism, but also economic challenges and restructuring. Like any other initiative, the ultimate goal is to enhance the economic and social well-being of local jurisdictions. Although a popular strategy, it is not clearifandhowlocally specific factors mediate the process. By comparing two cross-border geographical areas, this study attempts to identify how regional variability in the manifestation of political-economic forces, as well as geographical influences, affects the use of place branding at local scales. Every municipality in Michigan (n = 1774) and Ontario (n = 414) was systematically examined for the presence and message of local place brands as presented through logos and slogans. The comparative analysis demonstrated that Ontario’s municipalities utilized place branding to a greater extent, and that the dominant messages differ by region. Further, this analysis shows that – beyond political differences – geographical context appears to have an effect on both local place branding usage and message. [ABSTRACT FROM PUBLISHER]

Objective: To advance the knowledge of determinants of diet quality in pregnancy by focusing on both personal characteristics and the food environment. Design: Cross-sectional study in which participants from the Prenatal Health Project were linked to a geographic dataset by home address. Access to fast food, convenience stores, and grocery stores was measured using a geographic information system (ArcGIS9.3). Setting: Pregnant women (n = 2,282) were recruited between 2002 and 2005 in London, Ontario, Canada. Main Outcome Measure: Dietary quality was measured using a validated food frequency questionnaire and the Canadian Diet Quality Index for Pregnancy. Analysis: Univariate and multivariate linear regressions were calculated with the predictor variables on the Canadian Diet Quality Index for Pregnancy. Results: Pregnant women who were born in Canada, common-law, nulliparous, less physically active, smokers, more anxious, or lacking family support had lower diet quality on average. Presence of fast- food restaurants, convenience stores, and grocery stores within 500 m of participants' homes was not associated with diet quality after controlling for personal variables. Conclusions and Implications: The food environment does not seem to have a large influence on diet quality in pregnancy. Further research is needed to determine other potential reasons for low diet quality among pregnant women. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess the implementation of a school snack program for children in elementary schools. School-level program volunteers' experiences were explored using semi-structured interviews. Fieldnotes were taken during on-site school visits. Quantitative data were collected through a General Information Form and Weekly Logbooks. Seven elementary schools in Southwestern Ontario were invited and agreed to participate. Interviews (n = 27) revealed that volunteers valued the program for its universality, the excitement it created, the opportunity for students to try new foods, and the social interactions that it generated. Challenges included the burden on snack volunteers to plan, procure, and prepare foods; the competition the program posed for school priorities; limited funding; and a lack of clear purpose for the program. Suggestions for improvement included providing adequate and sustained resources and an integration of the program into the curriculum. Data obtained from 15 on-site visits, 7 General Information Forms, and 59 (out of a total of 70) Weekly Logbooks confirmed the data obtained from interviews. This research provides insights into the challenges of volunteer-led school snack programs in Canada and may guide policy makers, practitioners, and researchers in the development of a universal, nationally funded school food program. [ABSTRACT FROM AUTHOR]

Farmers' markets play a vital role in local economic development by providing a site for local and small business incubation, creating an economic multiplier effect to neighboring businesses, and recycling customer dollars within the community. While several studies have evaluated characteristics of farmers' markets within single metropolitan areas, few have compared the impact of multiple markets in socioeconomically contrasting regions. This research compares shopping habits and economic impacts of customers at farmers' markets in two North American cities: Flint, Michigan, and London, Ontario. Overall, 895 market visitors completed surveys. We conducted statistical and spatial analyses to identify differences between these markets. Though geographically proximate and similar in metropolitan size, the two cities differ greatly in recent economic development, social vitality, and public health indicators. The objectives of this article are to quantify the impact that each market has on its local economy and contextualize these impacts in light of the place-specific attributes of each market. Results indicate that customers come from a mix of urban and suburban locations, but that key urban areas do not draw a substantial share of customers. Marketing efforts in nearby disadvantaged neighborhoods, therefore, might yield new customers and increase multiplier effects within the neighborhoods. The London market drew slightly younger customers who shopped less frequently, while the Flint market drew an older crowd that attended more regularly. This may be attributable to the relative age of the markets, and certainly reflects the marketing push of each market's managers. Given the opportunity to compare similarities and differences, much can be learned from each market in terms of opportunities for marketing, local economic development, and increased community vitality. [ABSTRACT FROM AUTHOR]

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]

The economies of modern cities are dependent on an advanced retail system; so too are the people who inhabit them. The origin and evolution of retailing in London, Canada, was studied using a historical geographic information system (GIS) to document the relationship between a city and its retail sector. Visualization and spatial-statistical techniques afforded by the historical GIS were implemented to study change over time. The locations of retailers and the types of the goods they sold were examined for four periods in the city's early history: 1844,1863,1881, and 1916. The distances traveled to shop were also calculated for a variety of goods. The results indicate that the retail system was ingrained in the development of the city, showing marked locational patterns and a high degree of rationality in the shopkeepers' business strategies. Mapping the retail landscape in each era using historical GIS allowed for the examination of the relationship between retail and residential development in the growing city. While the downtown area remained the primary retail district for the city, considerable retail expansion also occurred at the urban periphery during this early stage of the city's development. [ABSTRACT FROM AUTHOR]

In much of the developed world, the direction and patterns of urban growth have been the subject of public debate. Some scholars and practitioners believe that the current urban development pattern are too outward-oriented and are concerned about its possible negative consequences. Others defend outward expansion, arguing that it fulfils consumer preferences and promotes economic growth. Despite a sizeable literature on the topic, the discussion has been hampered by a lack of knowledge about how growth is perceived by key 'agents of change', those individuals whose decisions and activities affect the direction and patterns of urban growth. Additionally, the news media often represents the urban growth debate in simplistic, oppositional terms (e.g. 'pro-growth' versus 'anti-growth', 'pro-business' versus 'anti-environment') with little or no regard for local factors that affect development patterns in specific situations. As described in this article, we used a multi-method case study approach to address these limitations and to better understand recent urban growth issues. The primary goal of this study is to assess multiple perceptions of urban growth and management debate in London, Ontario. As elsewhere, the issue of urban growth patterns is intensely debated in this case study. However, we argue that discussion on this topic should change from simplistic generalisations to consideration of locale-specific factors that influence urban growth patterns. [ABSTRACT FROM AUTHOR]

Intensification of existing urban areas is currently a major item on the policy agenda of the Ontario and Canadian governments. As part of the urban intensification drive, brownfield sites have become major candidates for redevelopment. Governments at all levels have initiated policies and programmes to encourage their remediation and redevelopment. This paper reports the findings of a qualitative exploration of brownfield redevelopment in London, Canada. Through in-depth interviews (n = 17) with key stakeholders involved in brownfield redevelopment, the study explores the level of participation in brownfield redevelopment, barriers to brownfield redevelopment in the city, and perceptions about financial incentives in the city's Brownfield Community Improvement Plan. The study found that despite the availability of financial incentives, the overall private sector participation in brownfield redevelopment is low due to barriers such as competition from greenfield, risk, cost, negative public perception of brownfields, and complex remediation processes. The paper provides policy suggestions that may contribute to a more active participation in brownfield redevelopment in the city. [ABSTRACT FROM AUTHOR]

Background: A growing body of research suggests that the suburbanization of food retailers in North America and the United Kingdom in recent decades has contributed to the emergence of urban 'food deserts', or disadvantaged areas of cities with relatively poor access to healthy and affordable food. This paper explores the evolution of food deserts in a mid-sized Canadian city (London, Ontario) by using a geographic information system (GIS) to map the precise locations of supermarkets in 1961 and 2005; multiple techniques of network analysis were used to assess changing levels of supermarket access in relation to neighbourhood location, socioeconomic characteristics, and access to public transit. Results: The findings indicate that residents of inner-city neighbourhoods of low socioeconomic status have the poorest access to supermarkets. Furthermore, spatial inequalities in access to supermarkets have increased over time, particularly in the inner-city neighbourhoods of Central and East London, where distinct urban food deserts now exist. Conclusion: Contrary to recent findings in larger Canadian cities, we conclude that urban food deserts exist in London, Ontario. Policies aimed at improving public health must also recognize the spatial, as well as socioeconomic, inequities with respect to access to healthy and affordable food. Additional research is necessary to better understand how supermarket access influences dietary behaviours and related health outcomes. [ABSTRACT FROM AUTHOR]

Background: The nutrigenomics, overweight/obesity and weight management trial (NOW Trial) is a pragmatic randomized controlled trial of community-dwelling adults recruited from the Group Lifestyle Balance™ (GLB™) Program. The GLB™ Program (formerly referred to as the Diabetes Prevention Program) is an evidence-based, intensive weight management program, which was offered to overweight/obese patients (BMI ≥ 25.0 kg/m2) in a rural Ontario community.Methods: Patients enrolled in the GLB™ Program were invited to participate in this study. GLB™ groups were randomized 1:1 to receive either the standard GLB™ program + population-based lifestyle advice for weight management, or a modified GLB™ program + personalized, genetic-based lifestyle advice for weight management. The purpose of this study is to determine if the provision of genetic-based lifestyle guidelines is superior to the provision of population-based guidelines in a pragmatic clinical setting to promote changes in: body composition, weight, body mass index, dietary and physical activity habits, as well as attitudes, subjective norms, and behavioural control. The 12-month intervention protocol consists of 23 group-based sessions and 4 one-on-one sessions. Data collection time points include baseline in addition to 3, 6, and 12-month follow up. The comprehensive study design is described in the present manuscript, using both the extended CONSORT checklist for reporting pragmatic trials and the SPIRIT checklist as guidance during manuscript development.Discussion: Overall, this study seeks to pragmatically determine if the provision of DNA-based lifestyle advice leads to improved health and lifestyle outcomes compared to the provision of standard, population-based lifestyle advice. The results of this trial can be used to inform clinical and community nutrition practice guidelines.Trial Registration: This study was registered with clinicaltrials.gov : NCT03015012 on January 9, 2017. [ABSTRACT FROM AUTHOR]

To examine the extent to which socioeconomic status, mental health, and substance use are associated with teenage pregnancies in Southwestern Ontario (SWO), and whether these pregnancies are at an elevated risk for adverse birth outcomes, after controlling for medical, behavioral, and socioeconomic status factors. Retrospective cohort study using perinatal and neonatal databases. Tertiary care hospital in SWO. Women residing in SWO who gave birth to singleton infants without congenital anomalies between 2009 and 2014. Teenage pregnancies (19 years of age or younger) were compared with pregnancies of women 20-34 years and 35 years or older. None. Low birth weight (LBW), very LBW, term LBW, preterm birth, very preterm birth, low and very low Apgar score, and fetal macrosomia. Of 25,263 pregnant women, 1080 (4.3%) were 19 years of age or younger. Approximately 18% of teenage mothers lived in socioeconomically disadvantaged neighborhoods, compared with 11% of mothers aged 20-34 and 9% of women 35 years of age or older (P <.001). Teenage mothers had higher rates of depression during pregnancy (9.8%) than mothers 20-34 years (5.8%) and those 35 years of age or older (6.8%; P <.001). Young mothers self-reported higher tobacco, marijuana, and alcohol use during pregnancy than adult mothers (P <.001). Teenage pregnancy increased the risk of a low Apgar score (adjusted odds ratio, 1.56; 95% confidence interval, 1.21-2.02), but was not associated with other birth outcomes after adjusting for covariates. Teenage pregnancy is associated with a higher risk of socioeconomic disadvantage, mental health problems, and substance use during pregnancy, but is largely unrelated to adverse birth outcomes in SWO. [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]

Abstract: This study assessed the amount of physical activity engaged in by youth aged 11–13, in relation to: (1) the presence of neighborhood recreational opportunities, objectively measured within a geographic information system; and (2) parents’ perceptions of recreation opportunities in their neighborhoods. Students in grade 7 and 8 (n=811) in 21 elementary schools throughout London, Ontario completed the adapted Previous Day Physical Activity Recall and a questionnaire assessing environmental influences in the home and school neighborhoods. Parents/guardians of participants also completed a questionnaire eliciting demographic information and perceptions of the neighborhood environment. On average, students engaged in 159.9min/day of physical activity. Both subjective and objective measures of recreational opportunities were associated positively with physical activity (p<0.05). Greater access to recreational opportunities seem essential to facilitate youths’ healthy levels of physical activity. [Copyright &y& Elsevier]

• We used a time-series analyses of population-based health administrative data for Ontario, Canada. • Our post-legalization observation window was a period of strict regulation on cannabis retailers and product availability. • We did not find evidence of increases in health service use or incident cases of psychotic disorders during this initial 17-month period following the legalization of non-medical cannabis. • We found clear increasing trends in health service use and incident cases of substance-induced psychotic disorders over the entire observation window (2014–2020). Cannabis is a risk factor in the onset and persistence of psychotic disorders. There is concern that non-medical cannabis legalization in Canada may have population-level impacts on psychotic disorders. We sought to examine changes in health service use and incident cases of psychotic disorder following cannabis legalization, during a period of tight restrictions on retail stores and product types. We conducted a cross-sectional interrupted time-series analysis using linked population-based health administrative data from Ontario (Canada) from January 2014 to March 2020. We identified psychosis-related outpatient visits, emergency department visits, hospitalizations, and inpatient length of stay, as well as incident cases of psychotic disorders, among people aged 14 to 60 years. We did not find evidence of increases in health service use or incident cases of psychotic disorders over the short-term (17 month) period following cannabis legalization. However, we found clear increasing trends in health service use and incident cases of substance-induced psychotic disorders over the entire observation window (2014–2020). Our findings suggest that the initial period of tight market restriction following legalization of non-medical cannabis was not associated with an increase in health service use or frequency of psychotic disorders. A longer post-legalization observation period, which includes expansion of the commercial cannabis market, is needed to fully understand the population-level impacts of non-medical cannabis legalization; thus, it would be premature to conclude that the legalization of non-medical cannabis did not lead to increases in health service use and incident cases of psychotic disorder. [ABSTRACT FROM AUTHOR]

A growing body of research has examined the association between exposure to environmental factors during pregnancy and adverse birth outcomes; however, many studies do not control for potential covariates and findings vary considerably. To test the relative influence of environmental factors including exposure to air pollution, major roads, highways, industry, parks, greenspaces, and food retailers on low birth weight (LBW) and preterm birth (PTB) in Southwestern Ontario (SWO), Canada, while accounting for medical (e.g., previous preterm birth, gestational diabetes), behavioral (e.g., alcohol, smoking), demographic (e.g., maternal age, body mass index), and neighborhood-level socioeconomic (e.g., household income, education) factors. This retrospective cohort study consisted of a large sample of pregnant women from SWO who gave birth to singleton newborns between February 2009 and February 2014 at London Health Sciences Centre. Data on maternal postal codes were entered into a Geographic Information System to map the distribution of maternal residences and determine selected characteristics of their neighborhood environments (i.e., socioeconomic, built, natural). These variables were developed based on postal codes where the mothers lived prior to giving birth. Logistic regression was used to assess the relative effects of the physical environment, socioeconomic status, clinical history, and behavioral risk factors on mothers having a LBW or PTB infant. Out of 25,263 live births, 5.7% were LBW and 7.5% were PTB. Exposure to sulfur dioxide was a top predictor of both LBW and PTB. For every one-unit increase in sulfur dioxide, the odds of a LBW and PTB were 3.4 (95% CI: 2.2, 5.2) and 2.0 (95% CI: 1.4, 3.0) times higher, after controlling for other variables in the model, respectively (p < 0.001). Previous PTB was also highly associated with both birth outcomes. Health care providers should be informed about the hazards of air pollution to developing fetuses so that recommendations can be made to their pregnant patients about limiting exposure when air quality is poor. • Out of 25,263 live births, 5.7% were low birth weight and 7.5% were preterm birth. • Maternal exposure to sulfur dioxide was a top predictor of adverse birth outcomes. • Previous preterm birth was also highly associated with both birth outcomes. [ABSTRACT FROM AUTHOR]

The purpose of this study was to test a conceptual model linking parental support and parental physical activity (PA), with children's perception of parental support and children's PA. Baseline data were drawn from the Grade 5 ACT-i-Pass community-based PA intervention conducted in London, Ontario between May and October 2014. Parent and child PA were measured using the International Physical Activity Questionnaire and Physical Activity Questionnaire for Children, respectively. Questions pertaining to parental support and children's perception of that parental support were obtained via questionnaires. We employed structural equation modeling techniques to test the conceptual model. In total, 467 boys and 469 girls were included in the study. The model provided an acceptable model fit. Child's perception of parental support for PA had a positive effect on boys' (b=0.319) and girls' (b=0.326) PA. Parental PA was not significantly related to child's perception of parental support for PA. However, parent reported support for PA had a significant, positive effect on child's perception of parental support for boys (b=0.352) and girls (b=0.584). In terms of the indirect effects, the effect of parental PA on child's PA was not statistically significant; however, as expected, parental support for PA had a statistically significant indirect effect on child PA level in both groups. The findings of this study demonstrate the importance of children's perceptions of parental support in relation to their PA behaviours. Developing a better understanding of factors related to children's PA and identifying determinants and mediators of activity behaviours will help inform PA interventions. [ABSTRACT FROM AUTHOR]

There is a dearth of studies examining associations between active school travel and children's health-related quality of life. Additionally, studies have not examined how perceived neighbourhood characteristics may moderate these associations. This study aims to examine the relationship between regular active school travel, children's physical and psychosocial health-related quality of life, and the potential moderating effects of their perceived neighbourhood safety (interpersonal and traffic). This cross-sectional study used data from Ontario schoolchildren (aged 8-14) as part of the Spatial Temporal Environment and Activity Monitoring (STEAM) Project. Results showed no significant direct relationship between regular active school travel and children's physical or psychosocial functioning; but the relationships were moderated by perceived neighbourhood safety. Regular active school travelers with high levels of perceived neighbourhood interpersonal safety, had higher physical and psychosocial functioning than regular active school travelers with low levels of perceived neighbourhood interpersonal safety. Additionally, at higher levels of perceived neighbourhood traffic safety, regular active school travelers had higher psychosocial functioning than regular active school travelers with lower perceived neighbourhood traffic safety. Interventions promoting active school travel should consider the environments through which children will be traveling. [ABSTRACT FROM AUTHOR]

Background: COVID-19 caused closures of movement supporting environments such as gyms and schools in Canada. This study evaluated the association between Ontario parents' and children's physical activity levels across time during COVID-19, controlling for variables that were identified as significant predictors of children's and parents' physical activity (e.g., children's age, parents' employment status)., Methods: Parents (n = 243; mean age = 38.8 y) of children aged 12 and under (n = 408; mean age = 6.3 y) living in Ontario, Canada completed 2 online surveys, the first between August and December 2020 and the second between August and December 2021. At baseline, parents were asked to recall prepandemic physical activity levels. To determine the association between parent and child physical activity during COVID-19, a cross-lagged model was estimated to determine the cross-sectional and longitudinal associations between parents' and children's physical activity across time., Results: Bivariate associations revealed that parents' and children's physical activity levels were significantly related during lockdown and postlockdown but not prelockdown. The autoregressive paths from prelockdown to during lockdown were significant for children (β = 0.53, P < .001) and parents (β = 1.058, P < .001) as were the autoregressive paths from during lockdown to postlockdown for children (β = 0.61, P < .001) and parents (β = 0.48, P < .001). In fully adjusted models, the cross-lagged association between parents' physical activity prelockdowns was significantly positively associated with their children's physical activity during lockdowns (β = 0.19, P = .013)., Conclusions: Resources are needed to ensure that children and parents are obtaining sufficient levels of physical activity, particularly during a pandemic.

Purpose: This study aimed to explore children's lived experiences with the Ontario Student Nutrition Program (OSNP), a free, school-based snack program implemented in elementary schools in Southwestern, Ontario, Canada, to gain insights into future school food programs (SFP). Methods: Focus group discussions (n=17) were conducted with 105 children in Grades 5 to 8 in seven elementary schools. Focus groups were audio-recorded, transcribed, and coded for themes using inductive content analysis. Results: Overall, children appreciated the OSNP and felt that it filled a need in students. Children also reported a willingness to try novel food items. For future SFPs, participants recommended that input be sought from children to ensure food preferences were considered. Children also discussed wanting more appealing food offerings that may include some choice. Finally, children also mentioned wanting a fair and equitable distribution of food in classrooms. Conclusions: Children appreciated the OSNP and reported benefits to themselves and their peers. They also provided some valuable recommendations for future SFPs. If a nationally funded SFP is to be considered in Canada, children expressed the need to make the program equitable, while still allowing schools the flexibility to meet their unique needs and preferences.

Exposure assessment in the context of mobility-oriented health research often is challenged by the type of spatial measurement technique used to estimate exposures to environmental features. The purpose of this study is to compare smartphone global positioning system (GPS), shortest network path mobility, and buffer-based approaches in estimating exposure to outdoor food and beverage advertising among a sample of 154 teenagers involved in the SmartAPPetite study during 2018 in London, Ontario, Canada. Participants were asked to report their home postal code, age, gender identity, ethnicity, and number of purchases they had made at a retail food outlet in the past month. During the same time period, a mobile phone application was used to log their mobility and specifically record when a participant was in close proximity to outdoor advertising. The results of negative binomial regression modelling reveal significant differences in estimates of advertising exposure, and the relationship to self-reported purchasing. Spatial exposure estimation methods showed differences across regression models, with the buffer and observed GPS approaches delivering the best fitting models, depending on the type of retail food outlet. There is a clear need for more robust research of spatial exposure measurement techniques in the context of mobility and food (information) environment research., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

The COVID-19 pandemic has had a large influence on children's physical activity (i.e., play and sport) opportunities. The purpose of this study was to describe parents' perspectives of their children's (ages 0-12) physical activity experiences during the pandemic (i.e., since the onset in March 2020 until follow-up survey completion date [between August to December 2021]). As part of the 'Return to Play' study conducted in Ontario, Canada, two-parent report surveys were completed online via Qualtrics. Surveys measured parents' perspectives regarding their children's physical activity since the onset of the pandemic ( n = 17 items) and collected demographic information ( n = 16 items). Open-ended questions were included to gather a rich understanding of parents' experiences (i.e., supports, challenges) with facilitating their children's physical activity. Descriptive statistics were calculated to describe parents' perspectives of their children's physical activity experiences and to determine parent demographics. Open-ended questions were analyzed via deductive content analysis. Parents ( n = 382) reported that they noticed behavior changes in their children because of the pandemic (65.9%), and most (73.7%) reported challenges with supporting their children's activity during periods when public health measures were in place. Many parents (44.5%) stated that their children asked about returning to play/sport more than three times per week during periods when play/sport facilities were closed in Ontario. Qualitative data identified common supports parents used (e.g., getting active outdoors, forming mini social 'bubbles'), and challenges they faced (e.g., work, children's increased screen time, and home schooling), pertaining to their children's physical activity.

Intervention: Ontario's Harmonized Heat Warning and Information System (HWIS) brings harmonized, regional heat warnings and standard heat-health messaging to provincial public health units prior to periods of extreme heat., Research Question: Was implementation of the harmonized HWIS in May 2016 associated with a reduction in emergency department (ED) visits for heat-related illness in urban locations across Ontario, Canada?, Methods: We conducted a population-based interrupted time series analysis from April 30 to September 30, 2012-2018, using administrative health and outdoor temperature data. We used autoregressive integrated moving average models to examine whether ED rates changed following implementation of the harmonized HWIS, adjusted for maximum daily temperature. We also examined whether effects differed in heat-vulnerable groups (≥65 years or <18 years, those with comorbidities, those with a recent history of homelessness), and by heat warning region., Results: Over the study period, heat alerts became more frequent in urban areas (6 events triggered between 2013 and 2015 and 14 events between 2016 and 2018 in Toronto, for example). The mean rate of ED visits was 47.5 per 100,000 Ontarians (range 39.7-60.1) per 2-week study interval, with peaks from June to July each year. ED rates were particularly high in those with a recent history of homelessness (mean rate 337.0 per 100,000). Although rates appeared to decline following implementation of HWIS in some subpopulations, the change was not statistically significant at a population level (rate 0.04, 95% CI: -0.03 to 0.1, p=0.278)., Conclusion: In urban areas across Ontario, ED encounters for heat-related illness may have declined in some subpopulations following HWIS, but the change was not statistically significant. Efforts to continually improve HWIS processes are important given our changing Canadian climate., (© 2022. The Author(s) under exclusive license to The Canadian Public Health Association.)

Background: COVID-19 has drastically changed the everyday lives of children, including limiting interactions with peers, loss of regularly organized activities, and closure of schools and recreational facilities. While COVID-19 protocols are in place to reduce viral transmission, they have affected children's access to physical activity opportunities. The purpose of this study was to understand how COVID-19 has affected children's engagement in physical activity and to identify strategies that can support children's return to physical activity programming in public places., Methods: Parents of past participants in the Grade 5 ACT-i-Pass Program in London, Ontario, Canada were invited to participate in a semi-structured interview online (in November and December 2020) via Microsoft Teams. The script was comprised of questions about their child's physical activity levels (before, current, and anticipated following COVID-19), lifestyle changes due to COVID-19, and what service providers can do to assist children's return to public programming. Interviews were transcribed in Microsoft Teams, reviewed by a member of the research team, and analyzed in NVivo 12 using thematic analysis., Results: Twenty-seven parents participated in an interview. Four themes and two subthemes were identified during analysis: (1) modifications to everyday life (a. activity options available and b. altered social environment), (2) safety in public spaces, (3) accessibility of activities, and (4) utilizing outdoor spaces., Conclusions: COVID-19 protocols have decreased children's physical activity levels due to the loss of their regular activities, recreational spaces, and peer support. Implementing facility and activity-specific health protocols, providing outdoor activity options, and offering a variety of activity types, times, and locations are three strategies recommended by parents to help facilitate their children's return to public recreational places. Due to the negative consequences of physical inactivity on children's health and well-being, service providers need to implement programming and safety protocols that support children's engagement in physical activity throughout the remainder of, and the years following, the COVID-19 pandemic., (© 2022. The Author(s).)

Purpose: Knowledge is fundamental to helping children make nutritional choices that support lifelong healthy behaviours. This study ( i ) investigates elementary school children's knowledge about food and nutrition and ( ii ) identifies sociodemographic factors influencing children's reported knowledge. Methods: In 2017-2019, a survey was administered to 2443 students (grades 5-8) at 60 schools across southwestern Ontario, Canada, and a parent survey was used to validate self-reported sociodemographics. Multiple regression was used to analyse children's knowledge scores and related sociodemographic factors. A total knowledge score was calculated by summing correct responses derived from 46 individual questions in the student survey. Results: Mean total knowledge score was 29.2 out of a possible 46 points (63.5% correct). Students demonstrated some knowledge and awareness of strategies to encourage fruit and vegetable consumption, healthy food selection, nutrition, and food preparation skills, although knowledge of food guide recommendations and locally sourced produce were limited. Female sex, family income, and rurality were associated with higher knowledge scores. Conclusions: Results provide insight regarding strengths and gaps in elementary-school children's food and nutrition knowledge. Poor performance of students on specific food guide-related questions suggests that the general guidance of the 2019 Canada's Food Guide might be better understood by children and adolescents.

Background: The COVID-19 pandemic and associated public health measures have resulted in the closure of many physical activity-supporting facilities. This study examined Ontario parents' and children's perspectives of COVID-19's impact on children's physical activity behaviours, return to play/sport during COVID-19, as well as barriers/facilitators to getting active amid extended closures of physical activity venues., Methods: Parents/guardians of children aged 12 years and under living in Ontario, Canada were invited to participate in an interview. 12 parent/guardian and 9 child interviews were conducted via Zoom between December 2020 - January 2021, were audio-recorded, and transcribed verbatim. Thematic content analysis was undertaken to identify pronounced themes., Results: Themes for both parent and child interviews fell into one of three categories: 1) barriers and facilitators for getting children active amid COVID-19 closures of physical activity-supporting facilities; 2) changes in children's activity levels; and, 3) perspectives on return to play/sport during and post-pandemic. Various subthemes were identified and varied between parents and children. The most common facilitator for dealing with children's inactivity voiced by parents/guardians was getting active outdoors. Parents/guardians noted their willingness to have their children return to play/sport in the community once deemed safe by public health guidelines, and children's willingness to return stemmed primarily from missing their friends and other important authority figures (e.g., coaches) and sporting events (e.g., tournaments)., Conclusions: Findings from this study could inform families of feasible and realistic strategies for increasing children's physical activity during community closures, while also providing public health experts with information regarding what supports, or infrastructure might be needed during future lockdown periods and/or pandemics., (© 2021. The Author(s).)

Food waste remains a high priority greenhouse gas (GHG) emission problem and household curbside collection - green bin 1 - with mass treatment is often adopted as a viable solution for GHG reduction. The aim of this study is to explore attitudinal and situational predictors of support for residential curbside green bin programs. Using responses to 517 household surveys from the mid-sized Canadian cities of London, Ontario (proposed green bin program) and Kitchener-Waterloo (KW), Ontario (operating green bin program for 10+ years) comparison of means t-tests, correlations and linear regression are used to test five hypotheses derived from the food waste and waste diversion literatures that predict green bin support: situational factors, current food wasting, theory of planned behaviour attitudes, concern that green bin encourages food wasting, and concern that food waste ends up in the garbage regardless of green bin. There is some support for all five hypotheses. Residents in Kitchener-Waterloo were significantly more supportive (83%) than those in London (65%). While residents in both communities are supportive because of the perceived convenience and environmental benefits of the green bin, the number of regression model predictors is greater in London (16 compared to 9 for Kitchener-Waterloo). The findings overall suggest sustained municipal education at the implementation stage may lead to positive resident habituation to green bin and thus, durable public buy-in., (Crown Copyright © 2021. Published by Elsevier Ltd. All rights reserved.)

Objectives: On January 1, 2020, the Government of Ontario passed a regulation banning vaping advertisements by retailers, apart from specialty shops. A motivation for this ban was to limit youth exposure to vaping advertisements. The primary goal of this research was to evaluate the impact of this ban on the number and density of vaping advertisements surrounding secondary schools. Additionally, we examined whether the number of vaping advertisements varied by school socio-demographic characteristics., Methods: This study used a pre-post design. Audits were conducted December 2019 (pre-ban) and again January to February 2020 (post-ban), to identify vaping advertisements within 800 m surrounding secondary schools (n = 18) in London, Ontario., Results: Prior to the ban, there were 266 vaping advertisements within 800 m of secondary schools. After the ban, this was reduced to 58, a 78.2% reduction. The mean number of vaping advertisements surrounding schools significantly decreased from 18.1 before the ban to 3.6 after the ban (p < 0.001). A significant positive correlation was found, prior to the ban, between the number of vaping advertisements surrounding schools and school-level residential instability (r = 0.42, p = 0.02). After the ban, no significant correlations were found between the number of vaping advertisements and school socio-demographic characteristics., Conclusion: The provincial ban of vaping advertisements in select retail settings significantly reduced the number of vaping advertisements in the areas surrounding secondary schools in London, Ontario. The ban also reduced socio-demographic inequities in youths' potential exposure to marketing of vaping products. Continued monitoring of the geographic accessibility and promotion of vaping products is warranted.

Introduction: This qualitative study investigates children's perceptions of the influences of a Centrally Procured School Food Program on their dietary behaviours and their recommendations on how to improve the program., Methods: The observations of 208 students aged 9 to 14 years (Grades 5-8) at 21 elementary schools were collected through focus groups in 2017/18. The larger intervention consisted of a 10-week program offering daily snacks (i.e. fruit, vegetables, whole grains, dairy, meat alternatives) for elementary school children in southwestern Ontario, Canada., Results: The participants' overall impressions of the program were positive. They noted reduced hunger, increased energy and improved nutrition. Many children felt that the program changed their dietary patterns at home as well as at school, particularly in terms of eating more fruit and vegetables. The snack program also enabled children to try healthy foods., Conclusion: Most participants considered the program to be beneficial in promoting healthy eating. Participants recommended adding educational activities, expanding the variety of foods and increasing child involvement in selecting and preparing foods., Competing Interests: The authors declare that they have no conflicts of interest.

Objective: The objective was to examine the influence of weather on moderate-to-vigorous physical activity (MVPA) and light physical activity (LPA) levels of children aged 8-14 years from rural communities, an understudied Canadian population., Methods: Children (n = 90) from four communities in rural Northwestern Ontario participated in this study between September and December 2016. Children's MVPA and LPA were measured using an Actical accelerometer and demographic data were gathered from surveys of children and their parents. Weather data were collected from the closest weather station. Cross-classified regression models were used to assess the relationship between weather and children's MVPA and LPA., Results: Boys accumulated more MVPA than girls (b = 26.38, p < 0.01), children were more active on weekdays as compared with weekends (b = - 16.23, p < 0.01), children were less active on days with precipitation (b = - 22.88, p < 0.01), and higher temperature led to a significant increase in MVPA (b = 1.33, p  < 0.01). As children aged, they accumulated less LPA (b = - 9.36, p < 0.01) and children who perceived they had higher levels of physical functioning got more LPA (b = 25.18, p = 0.02). Similar to MVPA, children had higher levels of LPA on weekdays (b = - 37.24, p < 0.01) as compared to weekend days and children accumulated less LPA (b = -50.01, p < 0.01) on days with rain., Conclusion: The study findings indicate that weather influences rural children's MVPA and LPA. Future research is necessary to incorporate these findings into interventions to increase rural children's overall PA levels and improve their overall health.

Background: Several studies demonstrate that the provision of personalized lifestyle advice, based on genetics, can help motivate individuals to engage in greater nutrition and physical activity changes compared to the provision of population-based advice. The theoretical mechanism behind this phenomenon is poorly understood. The objective of this study was to determine the impact of providing genetically tailored and population-based lifestyle advice on key constructs of the Theory of Planned Behaviour (TPB)., Materials and Methods: A pragmatic, cluster randomized controlled trial ( n = 140) took place at the East Elgin Family Health Team, in Aylmer, Ontario, Canada. Participants were primarily Caucasian females enrolled in a weight management program (BMI ≥ 25.0 kg/m 2 ). Weight management program groups were randomized (1:1) to receive a population-based lifestyle intervention for weight management (Group Lifestyle Balance™ (GLB)) or a lifestyle genomics (LGx)-based lifestyle intervention for weight management (GLB+LGx). Attitudes, subjective norms and perceived behavioural control were measured at baseline, immediately after receiving a report of population-based or genetic-based recommendations and after 3-, 6- and 12-month follow-ups. Linear mixed models were conducted, controlling for measures of actual behavioural control. All analyses were intention-to-treat by originally assigned groups., Results: Significant changes ( p < 0.05) in attitudes, subjective norms, and perceived behavioural control tended to be short-term in the GLB group and long-term for the GLB+LGx group. Short-term and long-term between-group differences in measures of subjective norms were discovered, favouring the GLB+LGx group., Conclusions: The TPB can help provide a theoretical explanation for studies demonstrating enhanced behaviour change with genetic-based lifestyle interventions., Clinical Trial Registration: NCT03015012.

The purpose of this study was to measure the factors that influence children's moderate-to-vigorous physical activity (MVPA) during school curriculum time, recess time, and outside school time in a rural area. During the Fall and Winter of 2016, 34 boys and 55 girls aged 8-14 years from rural communities in rural Northwestern Ontario participated in the Spatial Temporal Environment and Activity Monitoring project. The children's MVPA was measured using an accelerometer, and child-level demographic, behavioral, and environmental data were gathered from surveys, passively logging global positioning units, and municipal datasets. Data on daily temperature and precipitation were gathered from the closest Environment Canada weather station. A mixed model was used to assess the relationship between child- and day-level factors and children's MVPA. On average, children were getting 12.9 min of MVPA during recess, 17.7 min during curriculum time, and 29.0 min of MVPA outside school time. During all three time points, boys were more active than girls. During curriculum time, children in lower grades were more active, and the weather had differing impacts depending on the time of day. The findings of this study illustrate the differences in MVPA and the factors that influence MVPA by time of day. Examining different time segments provides valuable information for understanding children's MVPA patterns.

Objective: The objective of this study is to examine the magnitude and pattern of small-area geographic variation in rates of preventable hospitalisations for ambulatory care-sensitive conditions (ACSC) across Canada (excluding Québec)., Design and Setting: A cross-sectional study conducted in Canada (excluding Québec) using data from the 2006 Canadian Census Health and Environment Cohort (CanCHEC) linked prospectively to hospitalisation records from the Discharge Abstract Database (DAD) for the three fiscal years: 2006-2007, 2007-2008 and 2008-2009., Primary Outcome Measure: Preventable hospitalisations (ACSC)., Participants: The 2006 CanCHEC represents a population of 22 562 120 individuals in Canada (excluding Québec). Of this number, 2 940 150 (13.03%) individuals were estimated to be hospitalised at least once during the 2006-2009 fiscal years., Methods: Age-standardised annualised ACSC hospitalisation rates per 100 000 population were computed for each of the 190 Census Divisions. To assess the magnitude of Census Division-level geographic variation in rates of preventable hospitalisations, the global Moran's I statistic was computed. 'Hot spot' analysis was used to identify the pattern of geographic variation., Results: Of all the hospitalisation events reported in Canada during the 2006-2009 fiscal years, 337 995 (7.10%) events were ACSC-related hospitalisations. The Moran's I statistic (Moran's I =0.355) suggests non-randomness in the spatial distribution of preventable hospitalisations. The findings from the 'hot spot' analysis indicate a cluster of Census Divisions located in predominantly rural and remote parts of Ontario, Manitoba and Saskatchewan and in eastern and northern parts of Nunavut with significantly higher than average rates of preventable hospitalisation., Conclusion: The knowledge generated on the small-area geographic variation in preventable hospitalisations can inform regional, provincial and national decision makers on planning, allocation of resources and monitoring performance of health service providers., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Intervention: This study examines the impact of London's Healthy Kids Community Challenge (HKCC) 'Water Does Wonders' interventions, which combined water infrastructure and education programs., Research Question: How effective were the HKCC interventions at increasing water and decreasing sugar-sweetened beverage (SSB) consumption among grade 4-8 children in London, Ontario?, Methods: Non-randomized controlled trial. Children's knowledge and beverage intake were measured before and after the interventions were implemented during the 2016-2017 school year. Children at intervention schools (n = 521) received education programs (Growing Chefs or UTRCA [Upper Thames River Conservation Authority]) and water bottle filling stations. Children at control schools (n = 410) received filling stations only. Multivariable linear mixed-model ANCOVAs were used to compare water and SSB consumption and knowledge across intervention groups, accounting for school-level clustering., Results: Children who received an education intervention and filling station compared with only a filling station consumed more water (β = 2.18 (95% CI - 1.87, 6.22) for Growing Chefs and β = 2.90 (95% CI - 0.23, 6.03) for UTRCA) and fewer SSBs (β = - 1.17 (95% CI - 3.83, 1.49) for Growing Chefs and β = - 2.56 (95% CI - 5.12, 0.001) for UTRCA) post-intervention, and had higher nutrition knowledge (β = 1.57 (95% CI - 1.68, 4.83) for Growing Chefs and β = 2.02 (95% CI - 0.35, 4.39) for UTRCA). These findings were not statistically significant., Conclusions: An intervention intended to promote healthy beverage consumption yielded effects in the expected direction; however, they were small and not statistically significant. This is likely because the educational interventions were not fully aligned with the goals of the 'Water Does Wonders' program, preventing them from evoking meaningful changes in dietary behaviours.

The aim of this study was to assess how children's personal exposure to fine particulate matter (PM 2.5 ) during the school commute is influenced by mode of travel and neighborhood environment in a mid-sized Canadian city. A total of 101 commutes to and from school were tracked using a GPS, and personal exposure to PM 2.5 along commute routes was assessed by spatially-referencing the monitored exposure levels with time-synchronized GPS data. Students who walked to and from school were exposed to lower PM 2.5 concentrations than those in cars or riding the school bus. There was also a significant difference in mean PM 2.5 concentrations by the built environment, with children who walked to school in suburban neighborhoods experiencing higher personal concentrations than children in urban neighborhoods. To reduce children's daily exposure to air pollutants, neighborhoods should be designed to maximize the number of children who are able to walk between home and school., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

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., (© 2019, American School Health Association.)

Many Canadians experience unequal access to primary care services, despite living in a country with a universal health care system. Health inequalities affect all Canadians but have a much stronger impact on the health of vulnerable populations. Health inequalities are preventable differences in the health status or distribution of health resources as experienced by vulnerable populations. A geospatial approach was applied to examine how closely the distribution of primary care providers (PCPs) in London, Ontario meet the needs of vulnerable populations, including people with low income status, seniors, lone parents, and linguistic minorities. Using enhanced two step floating catchment area (E2SFCA) method, an index of geographic access scores for all PCPs and PCPs speaking French, Arabic, and Spanish were separately developed at the dissemination area (DA) level. To analyze how PCPs are distributed, comparative analyses were performed in association with specific vulnerable groups. Geographical accessibility to all PCPs, and PCPs who speak specific minority languages vary considerably across the city of London. Access scores for French- and Arabic-speaking PCPs are found comparatively high (mean = 2.85 and 1.01 respectively) as compared to Spanish-speaking PCPs (mean = 0.47). Additionally, many areas with high proportions of vulnerable populations experience low accessibility. Despite its exploratory nature, this study offers insight into intra-urban distributions of geographical accessibility to primary care resources for vulnerable groups. These findings can facilitate health researchers and policymakers in the development of recommendations to increase levels of accessibility of specific population groups in underserved areas., Competing Interests: The authors have declared that no competing interests exist.