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Background: During the first wave of COVID-19 there was little evidence to guide appropriate child and family programs and policy supports.Methods: We compared policies and programs implemented to support early child health and well-being during the first wave of COVID-19 in Australia, Canada, the Netherlands, Singapore, the UK, and the USA. Program and policy themes were focused on prenatal care, well-baby visits and immunization schedules, financial supports, domestic violence and housing, childcare supports, child protective services, and food security.Results: Significant heterogeneity in implementation of OECD-recommended policy responses was found with all of the included countries implementing some of these policies, but no country implementing supports in all of the potential areas.Conclusions: This analysis gives insight into initial government reactions to support children and families, and opportunities for governments to implement further supportive programs and policies during the current pandemic and future emergencies. [ABSTRACT FROM AUTHOR]

Objectives: To establish the factorial structure and internal consistency of the Internet Addiction Test (IAT) in parents, the level and correlates of problematic internet use, and patterns and types of screen use. Study design: Data were collected through an online questionnaire about preconception health among Canadian women and men with ≥1 child. The questionnaire included the IAT and questions about time spent on screens by device type, use of screens during meals and in the bedroom, and perceptions of overuse. Factor analysis was completed to determine the factorial structure of the IAT, with multivariable linear regression used to determine correlates of the IAT. Results: The sample included 1,156 respondents (mean age: 34.3 years; 83.1% female). The IAT had two factors: "impairment in time management" and "impairment in socio-emotional functioning" of which respondents had more impairment in time management than socio-emotional functioning. Based on the original IAT, 19.4% of respondents would be classified as having a mild internet use problem with 3.0% having a moderate or severe issue. In the multivariable model, perceived stress (b =.28, SE =.05, p <.001) and depressive symptoms (b =.24, SE =.10, p =.017) were associated with higher IAT scores. Handheld mobile devices were the most common type of screen used (mean = 3 hours/day) followed by watching television (mean = 2 hours/day). Conclusion: Parents spent a significant portion of their time each day using screens, particularly handheld mobile devices. The disruption caused by mobile devices may hinder opportunities for positive parent-child interactions, demonstrating the need for resources to support parents ever-growing use of technologies. [ABSTRACT FROM AUTHOR]

During the COVID-19 pandemic, multiple child health experts postulated that the stay-at-home orders would negatively impact child abuse and neglect. We aimed to examine the impact of the COVID-19 pandemic on child abuse and neglect in children ages 18 and under; and review author recommendations for future emergency lockdown procedures. We completed a systematic search of articles across five databases. Review-level studies were included if they examined any abuse or neglect related outcomes in children and youth (e.g., injuries, case openings), and were published in English. We completed quality appraisals of each included article using the Health Evidence™ tool. We categorized the findings by data source including administrative and survey data, or other data sources. We also narratively summarized reported recommendations. In total, 11 reviews were included. Two reviews were of strong quality, 7 moderate, and 2 were weak. Overall, studies within reviews that reported from administrative data sources demonstrated decreased child abuse and neglect outcomes compared to before the pandemic. Studies using cross-sectional data demonstrated increases. Reviews with mixed results often reported increases in emotional, neglect and psychological abuse cases and decreases physical and sexual abuse cases. This study found consistent results across reviews; depending on the data source and study design, child abuse and neglect outcomes either increased or decreased during the COVID-19 pandemic. Future work should enhance data collection methods for surveillance and intervention of child abuse and neglect during public health emergencies when traditional mechanisms are limited, with an increased focus on the rigor of reporting. [ABSTRACT FROM AUTHOR]

Background: eHealth and web-based service delivery have become increasingly common during the COVID-19 pandemic. Digital interventions may be highly appealing to young people; however, their effectiveness compared with that of the usual face-to-face interventions is unknown. As nutrition interventions merge with the digital world, there is a need to determine the best practices for digital interventions for children. Objective: The aim of this study is to examine the effectiveness of digital nutrition interventions for children on dietary outcomes compared with status quo interventions (eg, conventional face-to-face programming or nondigital support). Methods: We conducted an umbrella review of systematic reviews of studies assessing primary research on digital interventions aimed at improving food and nutrition outcomes for children aged <18 years compared with conventional nutrition education were eligible for inclusion. Results: In total, 11 systematic reviews published since 2015 were included (7/11, 64%, were of moderate quality). Digital interventions ranged from internet, computer, or mobile interventions to websites, programs, apps, email, videos, CD-ROMs, games, telehealth, SMS text messages, and social media, or a combination thereof. The dose and duration of the interventions varied widely (single to multiple exposures; 1-60 minutes). Many studies have been informed by theory or used behavior change techniques (eg, feedback, goal-setting, and tailoring). The effect of digital nutrition interventions for children on dietary outcomes is small and inconsistent. Digital interventions seemed to be the most promising for improving fruit and vegetable intake compared with other nutrition outcomes; however, reviews have found mixed results. Conclusions: Owing to the heterogeneity and duration of digital interventions, follow-up evaluations, comparison groups, and outcomes measured, the effectiveness of these interventions remains unclear. High-quality evidence with common definitions for digital intervention types evaluated with validated measures is needed to improve the state of evidence, to inform policy and program decisions for health promotion in children. Now is the time for critical, robust evaluation of the adopted digital interventions during and after the COVID-19 pandemic to establish best practices for nutrition interventions for children. [ABSTRACT FROM AUTHOR]

Background: Previous literature reports inconsistent associations between obesity and mental health. The objective of this study was to determine the association between weight status and mental health service utilization in Ontario children and youth. Methods: A cross-sectional study of children 0 to 18 years, identified using primary care electronic medical records from the EMRPC database in Ontario, Canada was conducted. Height and weight data were extracted to calculate BMI and linked to administrative data on mental health related outpatient visits, emergency department visits, and hospitalizations. Multivariable logistic regression models were performed. Results: A total of 50,565 children were included. Overall, 2.2% were underweight, 70.4% had a normal weight, 18.3% were overweight, 6.9% had obesity and 2.2% had severe obesity. 28.2% of all children had at least one mental health visit. Multivariable analyses showed children with overweight, obesity, and severe obesity were 1.11 (95% CI 1.05-1.17), 1.18 (95% CI 1.08-1.27) and 1.39 (95% CI 1.22-1.59) times more likely to have an outpatient mental health visit compared to children with normal weight. Conclusion: Increased weight status was associated with mental health related outpatient visits and emergency department visits. This study may inform policy makers' planning of mental health resources for children with obesity and severe obesity. [ABSTRACT FROM AUTHOR]

Background: As public health services are modernized in Ontario, Canada, there is a need to inform the system‐level roles and responsibilities of government agencies. The aim of this study was to identify how Public Health Ontario (PHO) can optimally support evidence‐based planning and programming in Healthy Growth and Development (HGD) across Ontario. Methods and Design: A situational assessment was conducted with key informants from public health and other HGD fields. Sample: Key informants were identified using purposeful snowball sampling and included public health nurses, health promoters, and medical officers of health. Analytic strategy: Twenty telephone interviews and seven focus groups were used to collect data. A thematic analysis was conducted concurrently with data collection. Results: Five themes were identified: (a) Transition to the new Ontario Public Health Standards (OPHS) included experiences of adopting the new OPHS within local public health units (PHUs). (b) Collaborating and networking referred to the ability to work with community partners. (c) Data, evidence, and research described the presence of data, evidence, and research to support practice. (d) Decision making, planning, and priority setting described resources available that influenced decision making. (e) Current and emerging issues in HGD included high‐priority topics. Conclusion: Public health practice in HGD is complex with many challenges in data and evidence, and making programming decisions without adequate or measurable indicators. A specialized position at PHO is an opportunity to support some of these system‐wide needs. [ABSTRACT FROM AUTHOR]

Background: To effectively impact the significant population burden of injury, we completed a situational assessment of injury prevention practice within a provincial public health system to identify system-wide priorities for capacity-building to advance injury prevention in public health.Methods: A descriptive qualitative study was used to collect data on the current practice, challenges and needs of support for injury prevention. Data was collected through semi-structured interviews (n = 20) and focus groups (n = 19). Participants included a cross-section of injury prevention practitioners and leadership from public health units reflecting different population sizes and geographic characteristics, in addition to public health researchers and experts from academia, public health and not-for-profit organizations. Thematic analysis was used to code all of the data by one reviewer, followed by a second independent reviewer who coded a random selection of interview notes. Major codes and sub codes were identified and final themes were decided through iterations of coding comparisons and categorization. Once data were analysed, we confirmed the findings with the field, in addition to participating in a prioritization exercise to surface the top three needs for support.Results: Major themes that were identified from the data included: current public health practice challenges; capacity and resource constraints, and; injury as a low priority area. Overall, injury prevention is a broad, complex topic that competes with other areas of public health. Best practices are challenged by system-wide factors related to resources, direction, coordination, collaboration, and emerging injury public health issues. Injury is a reportedly under prioritized and under resourced public health area of practice. Practitioners believe that increasing access to data and evidence, and improving collaboration and networking is required to promote best practice.Conclusions: The results of this study suggest that there are several system level needs to support best practice in public health injury prevention in Ontario including reducing research to practice gaps and supporting opportunities for collaboration. Our research contributes to the literature of the complexity of public health practice, and presents several mechanisms of support to increase capacity at a system level to improve injury prevention practice, and eventually lessen the population burden of injury. [ABSTRACT FROM AUTHOR]

Background: There are no current estimates of severe obesity in Canadian children. The objectives of this study were to determine the prevalence of severe obesity in children aged 18 years or less in Ontario and to determine temporal trends from 2004 to 2015. Methods: This was a repeated cross-sectional study using height/length and weight of children aged 18 years or less from the Electronic Medical Record Administrative data Linked Database (EMRALD), a database of primary care electronic medical records in Ontario. We calculated body mass index (for age and sex) z-scores (zBMI). Two years of data (2014 and 2015) were used to determine the period prevalence of severe obesity. We used multivariable linear regression generalized estimating equations to estimate the association of calendar year and mean zBMI. Results: In total, 55 233 children were included. The prevalence of severe obesity (zBMI > 3) increased with increasing age: it was 0.9% (95% confidence interval [CI] 0.7% to 1.0%) among children less than 5 years of age, 2.7% (95% CI 2.3% to 3.1%) among 5- to 9-year-olds, 2.9% (95% CI 2.4% to 3.3%) among 10- to 14-year-olds and 3.7% (95% CI 3.1% to 4.3%) among those aged 15–18. Boys aged 5–9 years had a significantly higher prevalence of severe obesity than their female counterparts (3.5% [95% CI 2.9% to 4.2%] v. 1.7% [95% CI 1.3% to 2.2%]). From 2004 to 2015, the mean zBMI decreased by 0.015 (95% CI −0.018 to −0.012) units per year, with the overall prevalence of severe obesity in all ages highest in 2005 (3%) and a decrease to 2% in 2015. Interpretation: The prevalence of severe obesity among children and adolescents in Ontario is consistent with that in other developed countries with the exception of the United States. There is evidence of plateauing of estimates and a small decrease in zBMI over time. Further understanding of the impact of prevention efforts on these estimates is an important next step. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the misclassification resulting from the use of body mass index (BMI) cut-points defined by rounded percentiles instead of Z-scores in early childhood. Using data from the TARGet Kids primary care network we conducted a cross-sectional study among 5836 children < 6 years of age. The World Health Organization growth standards were used to calculate BMI-for-age Z-scores. BMI Z-score cut-points of < - 2.0, > 1.0, > 2.0, > 3.0 are recommended to define wasted, at risk of overweight, overweight and obese. However, rounded percentiles of the 3rd, 85th, 97th, and 99.9th are commonly used. Misclassification was calculated comparing the frequency distributions for BMI categories defined by rounded percentiles and Z-score cut-points. Results: Using rounded percentiles, the proportion of children who were wasted, at risk of overweight, overweight, and obese was 4.2, 12.5, 4.3 and 0.8%, whereas the distribution using Z-scores was: 3.6, 13.8, 3.4 and 1.0%, respectively. Overall, 117 (2%) children were misclassified when using percentiles instead of Z-scores; however, 13% (33/245) of children who were wasted and 14% (8/57) of children who were obese were misclassified. Misclassification of child growth results from the use of cut-points defined by rounded percentiles instead of Z-scores and limits comparability between studies. [ABSTRACT FROM AUTHOR]

The Applied Research Group for Kids (TARGet Kids!) is an ongoing open longitudinal cohort study enrolling healthy children (from birth to 5 years of age) and following them into adolescence. The aim of the TARGet Kids! cohort is to link early life exposures to health problems including obesity, micronutrient deficiencies and developmental problems. The overarching goal is to improve the health of Canadians by optimizing growth and developmental trajectories through preventive interventions in early childhood. TARGet Kids!, the only child health research network embedded in primary care practices in Canada, leverages the unique relationship between children and families and their trusted primary care practitioners, with whom they have at least seven health supervision visits in the first 5 years of life. Children are enrolled during regularly scheduled well-child visits. To date, we have enrolled 5062 children. In addition to demographic information, we collect physical measurements (e.g. height, weight), lifestyle factors (nutrition, screen time and physical activity), child behaviour and developmental screening and a blood sample (providing measures of cardiometabolic, iron and vitamin D status, and trace metals). All data are collected at each well-child visit: twice a year until age 2 and every year until age 10. Information can be found at: http://www.targetkids.ca/contact-us/. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Measuring ethnicity accurately is important for identifying ethnicity variations in disease risk. We evaluated the degree of agreement and accuracy of maternal ethnicity measured using the new standardized closed-ended geographically based ethnicity question and geographic reclassification of open-ended ethnicity questions from the Canadian census. Methods: A prospectively designed study of respondent agreement of mothers of healthy children aged 1–5 years recruited through the TARGet Kids! practice-based research network. For the primary analysis, the degree of agreement between geographic reclassification of the Canadian census maternal ethnicity variables and the new geographically based closed-ended maternal ethnicity variable completed by the same respondent was evaluated using a kappa analysis. Results: Eight hundred sixty-two mothers who completed both measures of ethnicity were included in the analysis. The kappa agreement statistic for the two definitions of maternal ethnicity was 0.87 (95% confidence interval, 0.84–0.90) indicating good agreement. Overall accuracy of the measurement was 93%. Sensitivity and specificity ranged from 83% to 100% and 96% to 100%, respectively. Conclusions: The new standardized closed-ended geographically based ethnicity question represents a practical alternative to widely used open-ended ethnicity questions. It may reduce risk of misinterpretation of ethnicity by respondents, simplify analysis, and improve the accuracy of ethnicity measurement. [Copyright &y& Elsevier]

Background: Adverse childhood experiences (ACEs) are potentially traumatic exposures experienced during childhood, for example, neglect. There is growing evidence that the coronavirus disease 2019 (COVID-19) pandemic and related socioeconomic conditions contributed to an increased risk of ACEs. As public health programs/services are re-evaluated and restored following the state of emergency, it is important to plan using an ACEs-informed lens. The aim of this study was to identify and prioritize initiatives or activities that Public Health Ontario (PHO) could undertake to support Ontario public health units' work towards ACEs-informed pandemic recovery plans. Methods: The Child Health and Nutrition Research Initiative method was adapted to conduct a priority-setting exercise (May–October 2022). Two online surveys were administered with members of the Healthy Growth and Development (HGD) Evidence Network, comprised of public health unit staff working in child and family health/HGD from Ontario's 34 public health units. In the first survey, participants were asked to propose activities or initiatives that PHO could undertake to support Ontario public health units' work towards ACEs-informed planning. In the second survey, participants were asked to score the final list of options against pre-determined prioritization criteria (for example, relevance). Responses were numerically coded and used to calculate prioritization scores, which were used to rank the options. Results: In all, 76% of public health units (n = 26) responded to the first survey to identify options. The 168 proposed ideas were consolidated into a final list of 13 options, which fall under PHO's scientific and technical support mandate areas (data and surveillance, evidence synthesis, collaboration and networking, knowledge exchange and research). A total of 79% of public health units (n = 27) responded to the follow-up survey to prioritize options. Prioritization scores ranged from 76.4% to 88.6%. The top-ranked option was the establishment of a new provincial ACEs community of practice. Conclusions: Over three quarters of public health units contributed to identifying and ranking 13 options for PHO to support public health units in considering and addressing ACEs through pandemic recovery planning. In consultation with the ACEs and Resilience Community of Practice, recently formed on the basis of this exercise, PHO will continue to use the ranked list of options to inform work-planning activities/priorities. [ABSTRACT FROM AUTHOR]

Purpose: Considerable debate centered on the impact of school closures and shifts to virtual learning on adolescent mental health during the COVID-19 pandemic. We evaluated whether mental health changes differed by school learning modes during the pandemic response among Canadian adolescents and whether associations varied by gender and perceived home life. Methods: We used prospective survey data from 7270 adolescents attending 41 Canadian secondary schools. Conditional change linear mixed effects models were used to examine learning mode (virtual optional, virtual mandated, in-person, and blended) as a predictor of change in mental health scores (depression [Centre for Epidemiologic Studies – Depression], anxiety [Generalized Anxiety Disorder-7], and psychosocial well-being [Flourishing scale]), adjusting for baseline mental health and covariates. Gender and home life happiness were tested as moderators. Least square means were calculated across interaction groups. Results: Students learning in a blended learning mode had greater anxiety increases relative to their peers in other learning modes. Females learning fully in-person and males learning virtually when optional reported less of an increase in depression scores relative to their gender counterparts in other learning modes. Learning virtually when optional was associated with greater declines in psychosocial well-being in students without happy home lives relative to other learning modes. Conclusion: Findings demonstrate the importance of considering gender and home environments as determinants of mental health over the pandemic response and when considering alternative learning modes. Further research is advised before implementing virtual and blended learning modes. Potential risks and benefits must be weighed in the context of a pandemic. [ABSTRACT FROM AUTHOR]

Background: Measuring body mass index (BMI) has been proposed as a method of screening for preventive primary care and population surveillance of childhood obesity. However, the accuracy of routinely collected measurements has been questioned. The purpose of this study was to assess the reliability of height, length and weight measurements collected during well-child visits in primary care relative to trained research personnel.Methods: A cross-sectional study of measurement reliability was conducted in community pediatric and family medicine primary care practices. Each participating child, ages 0 to 18 years, was measured four consecutive times; twice by a primary care team member (e.g. nurses, practice personnel) and twice by a trained research assistant. Inter- and intra-observer reliability was calculated using the technical error of measurement (TEM), relative TEM (%TEM), and a coefficient of reliability (R).Results: Six trained research assistants and 16 primary care team members performed measurements in three practices. All %TEM values for intra-observer reliability of length, height, and weight were classified as 'acceptable' (< 2%; range 0.19% to 0.70%). Inter-observer reliability was also classified as 'acceptable' (< 2%; range 0.36% to 1.03%) for all measurements. Coefficients of reliability (R) were all > 99% for both intra- and inter-observer reliability. Length measurements in children < 2 years had the highest measurement error. There were some significant differences in length intra-observer reliability between observers.Conclusion: There was agreement between routine measurements and research measurements although there were some differences in length measurement reliability between practice staff and research assistants. These results provide justification for using routinely collected data from selected primary care practices for secondary purposes such as BMI population surveillance and research. [ABSTRACT FROM AUTHOR]

Objective: To assess public health nutrition practice within the public health system in Ontario, Canada to identify provincial-wide needs for scientific and technical support.Design: A qualitative descriptive study was conducted to identify activities, strengths, challenges and opportunities in public health nutrition practice using semi-structured key informant interviews (n 21) and focus groups (n 10). Recorded notes were analysed concurrently with data generation using content analysis. System needs were prioritised through a survey.Setting: Public health units.Participants: Eighty-nine practitioners, managers, directors, medical officers of health, researchers and other stakeholders were purposively recruited through snowball and extreme case sampling.Results: Five themes were generated: (i) current public health nutrition practice was broad, complex, in transition and collaborative; (ii) data/evidence/research relevant to public health needs were insufficiently available and accessible; (iii) the amount and specificity of guidance/leadership was perceived to be mismatched with strong evidence that diet is a risk factor for poor health; (iv) resources/capacity were varied but insufficient and (v) understanding of nutrition expertise in public health among colleagues, leadership and other organisations can be improved. Top ranked needs were increased understanding, visibility and prioritisation of healthy eating and food environments; improved access to data and evidence; improved collaboration and coordination; and increased alignment of activities and goals.Conclusions: Collective capacity in the public health nutrition can be improved through strategic system-wide capacity-building interventions. Research is needed to explore how improvements in data, evidence and local contexts can bridge research and practice to effectively and efficiently improve population diets and health. [ABSTRACT FROM AUTHOR]

We examine how organizational actors use global legal, humanitarian, and development discourses in their work supporting educational services for refugees to better understand how the transfer of ideas and norms emanating within global organizations affects educational programming for refugees. We ask: (1) To what extent do organizations reference global legal, humanitarian, and development documents in their work? And, (2) How do linkages with United Nations (UN) organizations (namely UNHCR, UNESCO, and UNICEF) influence organizations' usage of global documents? We find that different organizations draw on global discourses depending on their level of embeddedness in global society and that diverse types of relationships with UN agencies—financial and normative— mediate the extent to which they reference global policy documents. [ABSTRACT FROM AUTHOR]

Objectives: The Healthy Kids Community Challenge is a large-scale, centrally-coordinated, community-based intervention in Ontario, Canada that promotes healthy behaviours towards improving healthy weights among children. With the goal of exploring tools available to evaluators, we leveraged electronic medical records from primary care physicians to assess child weights prior to launch of the Healthy Kids Community Challenge. This study compares the baseline (i.e. pre-intervention) prevalence of overweight and obesity in children 1–12 years of age living within and outside Healthy Kids Community Challenge communities. Design: Cross-sectional analysis of a primary care patient cohort. Setting: Electronic Medical Record Administrative data Linked Database (EMRALD) in Ontario, Canada. Participants: A cohort of 19 920 Ontario children who are rostered to an EMRALD physician. Children were 1–12 years of age at a primary care visit with recorded measured height and weight, between January 1, 2014 and December 31, 2015. Outcome measure: Overweight and obesity as determined by age- and sex-standardized body mass index using World Health Organization’s Growth Standards. Results: In Healthy Kids Community Challenge communities, 25.6% (95% CI 24.6–26.6%) of children had zBMI above normal (i.e. >1) compared to 26.7% (95% CI 25.9–27.5%) for children living outside of Healthy Kids Community Challenge communities. Conclusions: Despite some differences in sociodemographic characteristics, zBMI of children aged 1–12 years were similar inside and outside of Healthy Kids Community Challenge community boundaries prior to program launch. [ABSTRACT FROM AUTHOR]

The article discusses the growth monitoring recommendations by the Canadian Task Force on Preventive Health Care for all children visiting primary care facilities to screen for overweight and obesity. The usefulness of height and weight data from electronic medical records (EMRs) is explained. The Task Force is said to have suggested standards for height and weight measurement.

Summary: Many obesity risk factors have increased during the COVID‐19 pandemic, including physical inactivity, poor diet, stress, and poverty. The aim of this systematic review was to evaluate the impact of the COVID‐19 pandemic, as well as associated lockdowns or restrictions, on weight change in children and adults. We searched five databases from January 2020 to November 2021. We included only longitudinal studies with measures from before and during the pandemic that evaluated the change in weight, body mass index (BMI) (or BMI z‐scores for children), waist circumference, or the prevalence of obesity. Random effects meta‐analyses were conducted to obtain pooled estimates of the mean difference in outcomes. Subgroups were evaluated for age groups and diabetes or obesity at baseline. The risk of bias was assessed using a modified version of the Newcastle‐Ottawa Scale, and the certainty of the evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. A total of 74 studies were included (3,213,776 total participants): 31 studies of children, 41 studies of adults, and 2 studies of children and adults. In children, the pooled mean difference was 1.65 kg (95% confidence interval [CI]: 0.40, 2.90; 9 studies) for weight and 0.13 (95% CI 0.10, 0.17; 20 studies) for BMI z‐scores, and the prevalence of obesity increased by 2% (95% CI 1%, 3%; 12 studies). In adults, the pooled mean difference was 0.93 kg (95% CI 0.54, 1.33; 27 studies) for weight and 0.38 kg/m2 (95% CI 0.21, 0.55; 25 studies) for BMI, and the prevalence of obesity increased by 1% (95% CI 0%, 3%; 11 studies). In children and adults, the pooled mean difference for waist circumference was 1.03 cm (95% CI −0.08, 2.15; 4 studies). There was considerable heterogeneity observed for all outcomes in both children and adults, and the certainty of evidence assessed using GRADE was very low for all outcomes. During the first year of the COVID‐19 pandemic, small but potentially clinically significant increases in weight gain, BMI, and increased prevalence of obesity in both children and adults were observed. Increases were greater in children, and targeted prevention interventions may be warranted. [ABSTRACT FROM AUTHOR]

Objectives The objective of this study is to describe the clustering of medical, behavioural and social preconception and interconception health risk factors and determine demographic factors associated with these risk clusters among Canadian women. Design Cross-sectional data were collected via an online questionnaire assessing a range of preconception risk factors. Prevalence of each risk factor and the total number of risk factors present was calculated. Multivariable logistic regression models determined which demographic factors were associated with having greater than the mean number of risk factors. Exploratory factor analysis determined how risk factors clustered, and Spearman’s r determined how demographic characteristics related to risk factors within each cluster. Setting Canada. Participants Participants were recruited via advertisements on public health websites, social media, parenting webpages and referrals from ongoing studies or existing research datasets. Women were eligible to participate if they could read and understand English, were able to access a telephone or the internet, and were either planning a first pregnancy (preconception) or had ≥1 child in the past 5 years and were thus in the interconception period. Results Most women (n=1080) were 34 or older, and were in the interconception period (98%). Most reported risks in only one of the 12 possible risk factor categories (55%), but women reported on average 4 risks each. Common risks were a history of caesarean section (33.1%), miscarriage (27.2%) and high birth weight (13.5%). Just over 40% had fair or poor eating habits, and nearly half were not getting enough physical activity. Three-quarters had a body mass index indicating overweight or obesity. Those without a postsecondary degree (OR 2.35; 95% CI 1.74 to 3.17) and single women (OR 2.22, 95% CI 1.25 to 3.96) had over twice the odds of having more risk factors. Those with two children or more had 60% lower odds of having more risk factors (OR 0.68, 95% CI 0.52 to 0.86). Low education and being born outside Canada were correlated with the greatest number of risk clusters. Conclusions Many of the common risk factors were behavioural and thus preventable. Understanding which groups of women are prone to certain risk behaviours provides opportunities for researchers and policy-makers to target interventions more efficiently and effectively. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess if sub-populations of adolescents in Canada (i.e., race/ethnicity, sex/gender, and socioeconomic status [SES]) experienced a larger change in physical activity and screen time between the 2019–2020 (pre-pandemic) and the 2020–2021 (mid-pandemic) school years. Longitudinally linked data from pre-pandemic and mid-pandemic school years of a prospective cohort study of secondary school students in Canada (n = 8209) were used for these analyses. Multivariable regression modelling tested the main effects of race/ethnicity, sex/gender, and SES on changes in moderate-to-vigorous physical activity (MVPA) and screen time duration as well as adherence to Canada's 24-h Movement Guidelines. Overall between groups difference were assessed using type II analysis of deviance tests. Intera c tions between variables of interest were subsequently tested with a series of regression models compared to the main effects model using likelihood-ratio test. Post-hoc comparisons found Male participants' MVPA time decreased less compared to their female counterparts (M [95% CI] = −16.3 [−13.5, −19.2] min/day), but also reported greater increases in screen time compared to females (23.7 [14.7, 32.8] min/day) during the same period. MVPA in White participants decreased less than Asian participants (−10.7 [−19.5, −1.9] min/day) with a similar non-significant pattern observed in Black and Latin participants. Adolescents in higher SES categories fared better on adherence to MVPA (highest vs. lowest OR = 1.41 [0.97, 2.06]) and screen time recommendations(highest vs. lowest AOR = 3.13 [0.91, 11.11]). Results support the hypothesis that existing inequitable sociodemographic differences in MVPA participation and screen time have worsened throughout the pandemic. • Adolescent physical activity and screen use change in 2020 was inequitable. • Male adolescents' physical activity decreased less than female peers. • Sex differences were smaller in Asian compared to White adolescents. • Male screen use increased more than females. • Lower socioeconomic status was related to worse guideline adherence. [ABSTRACT FROM AUTHOR]

Objective: To determine if children aged 1-6 years from non-Western immigrant families have lower serum 25-hydroxyvitamin D (25(OH)D) levels than children from Western-born families and examine which factors influence this relationship.Design: Cross-sectional study.Setting: Toronto, Canada.Subjects: Healthy children (n 1540) recruited through the TARGet Kids! practice-based research network. Serum 25(OH)D concentrations of non-Western immigrants were compared with those of children from Western-born families. Children from non-Western immigrant families were defined as those born, or their parents were born, outside a Western country. Univariate and multiple linear regression analyses were used to identify factors which might influence this relationship.Results: Median age was 36 months, 51 % were male, 86 % had 'light' skin pigmentation, 55 % took vitamin D supplements, mean cow's milk intake was 1·8 cups/d and 27 % were non-Western immigrants. Median serum 25(OH)D concentration was 83 nmol/l, with 5 % having 25(OH)D < 50 nmol/l. Univariable analysis revealed that non-Western immigrant children had serum 25(OH)D lower by 4 (95 % CI 1·3, 8·0) nmol/l (P = 0·006) and increased odds of 25(OH)D < 50 nmol/l (OR = 1·9; 95 % CI 1·3, 2·9). After adjustment for known vitamin D determinants the observed difference attenuated to 0·04 (95 % CI -4·8, 4·8) nmol/l (P = 0·99), with higher cow's milk intake (P < 0·0001), vitamin D supplementation (P < 0·0001), summer season (P = 0·008) and increased age (P = 0·04) being statistically significant covariates. Vitamin D supplementation was the strongest explanatory factor of the observed difference.Conclusions: There is an association between non-Western immigration and lower 25(OH)D in early childhood. This difference appears related to known vitamin D determinants, primarily vitamin D supplementation, representing opportunities for intervention. [ABSTRACT FROM AUTHOR]

ObjectiveTo determine if children aged 1–6 years from non-Western immigrant families have lower serum 25-hydroxyvitamin D (25(OH)D) levels than children from Western-born families and examine which factors influence this relationship.DesignCross-sectional study.SettingToronto, Canada.SubjectsHealthy children (n 1540) recruited through the TARGet Kids! practice-based research network. Serum 25(OH)D concentrations of non-Western immigrants were compared with those of children from Western-born families. Children from non-Western immigrant families were defined as those born, or their parents were born, outside a Western country. Univariate and multiple linear regression analyses were used to identify factors which might influence this relationship.ResultsMedian age was 36 months, 51 % were male, 86 % had ‘light’ skin pigmentation, 55 % took vitamin D supplements, mean cow's milk intake was 1·8 cups/d and 27 % were non-Western immigrants. Median serum 25(OH)D concentration was 83 nmol/l, with 5 % having 25(OH)D < 50 nmol/l. Univariable analysis revealed that non-Western immigrant children had serum 25(OH)D lower by 4 (95 % CI 1·3, 8·0) nmol/l (P = 0·006) and increased odds of 25(OH)D < 50 nmol/l (OR = 1·9; 95 % CI 1·3, 2·9). After adjustment for known vitamin D determinants the observed difference attenuated to 0·04 (95 % CI −4·8, 4·8) nmol/l (P = 0·99), with higher cow's milk intake (P < 0·0001), vitamin D supplementation (P < 0·0001), summer season (P = 0·008) and increased age (P = 0·04) being statistically significant covariates. Vitamin D supplementation was the strongest explanatory factor of the observed difference.ConclusionsThere is an association between non-Western immigration and lower 25(OH)D in early childhood. This difference appears related to known vitamin D determinants, primarily vitamin D supplementation, representing opportunities for intervention. [ABSTRACT FROM PUBLISHER]

Background: Modifiable behaviours during early childhood may provide opportunities to prevent disease processes before adverse outcomes occur. Our objective was to determine whether young children's eating behaviours were associated with increased risk of cardiovascular disease in later life. Methods: In this cross-sectional study involving children aged 3-5 years recruited from 7 primary care practices in Toronto, Ontario, we assessed the relation between eating behaviours as assessed by the NutriSTEP (Nutritional Screening Tool for Every Preschooler) questionnaire (completed by parents) and serum levels of non-high-density lipoprotein (HDL) cholesterol, a surrogate marker of cardiovascular risk. We also assessed the relation between dietary intake and serum non-HDL cholesterol, and between eating behaviours and other laboratory indices of cardiovascular risk (low-density lipoprotein [LDL] cholesterol, apolipoprotein B, HDL cholesterol and apoliprotein A1). Results: A total of 1856 children were recruited from primary care practices in Toronto. Of these children, we included 1076 in our study for whom complete data and blood samples were available for analysis. The eating behaviours subscore of the Nutri STEP tool was significantly associated with serum non- HDL cholesterol (p = 0.03); for each unit increase in the eating behaviours subscore suggesting greater nutritional risk, we saw an increase of 0.02 mmol/L (95% confidence interval [CI] 0.002 to 0.05) in serum non-HDL cholesterol. The eating behaviours subscore was also associated with LDL cholesterol and apolipoprotein B, but not with HDL cholesterol or apolipoprotein A1. The dietary intake subscore was not associated with non-HDL cholesterol. Interpretation: Eating behaviours in preschoolaged children are important potentially modifiable determinants of cardiovas cular risk and should be a focus for future studies of screening and behavioural interventions. [ABSTRACT FROM AUTHOR]