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Background: In the province of Québec, video lottery terminal (VLT) gambling has proliferated under government control since 1993. The aims of this study were to describe the spatial distribution of video lottery terminals (VLTs) in the municipalities of Montréal and Laval and to identify neighbourhood socio-economic conditions associated with their distribution.Method: Locations of all establishments holding VLT licences in Montréal and Laval (n = 834) were geocoded by their street address. Boroughs (n = 49) were characterized by socio-economic indicators (unemployment, educational attainment, lone parenthood), a neighbourhood distress index, and measures of VLT prevalence, VLT adoption and VLT density.Results: VLT prevalence, adoption and density were strongly correlated (p < 0.01) with lower borough socio-economic conditions. Although liquor establishments were also more likely to be located in poorer neighbourhoods, the adoption rate of VLT licences by bars in poorer neighbourhoods was systematically higher than in more affluent ones.Conclusions: The spatial distribution of VLTs in Montréal and Laval closely reflects local geographies of socio-economic disadvantage. Any public health effort to reduce the burden of gambling-related health and social problems must recognize the spatial distortion of gambling opportunities in the urban environment. [ABSTRACT FROM AUTHOR]

Abstract Background Trends in food retailing associated with the consolidation of smaller-format retailers into fewer, larger-format supercentres have left some rural areas with fewer sources of nutritious, affordable food. Access to nutritious, affordable food is essential for good dietary habits and combating health issues such as type-2 diabetes, obesity, and cardiovascular disease. Many studies on food environments use inaccurate or incomplete methods for locating food retailers, which may be responsible for mischaracterising food deserts. This study uses databases of every residence in and every food retailer in and around Middlesex County, Ontario, Canada. Residences were geocoded to their precise address, and network analysis techniques were performed in a geographic information system (GIS) to determine distances between every residence and different types of food retailers (grocery stores, fast food, fruit and vegetable sources, grocery stores plus fruit and vegetable sources, variety stores), both when considering and neglecting facilities outside the area of study, to account for a deficiency in analysis termed the 'edge effect'. Results Analysis of household accessibility to food outlets by neighbourhood socioeconomic distress level indicated that residents in the most distressed neighbourhoods tended to have better accessibility to all types of food retailers. In the most distressed neighbourhoods, 79 percent of residences were within walking distance of a grocery store, compared to only 10 percent in the least distressed neighbourhoods. When the edge effect was neglected, 37 percent of distance estimates proved inaccurate. Average accessibility to all food retailer types improved dramatically when food outlets adjacent to the study area were considered, thereby controlling for the edge effect. Conclusion By neglecting to consider food retailers just outside study area boundaries, previous studies may significantly over-report the actual distance necessary to travel for food. Research on food access spanning large rural regions requires methods that accurately geocode residents and their food sources. By implementing methods akin to those in this paper, future research will be better able to identify areas with poor food accessibility. Improving identification of food desert communities is a first step in facilitating more effective deployment of food policies and programs in those communities.

Abstract Background Hip fractures are expensive and a frequent cause of morbidity and mortality in the elderly. In most studies hip fractures have been viewed as a unitary fracture but recently the two main types of fracture (intertrochanteric and subcapital) have been viewed as two fractures with a different etiology and requiring a different approach to prevention. The relative proportion of intertrochanteric fractures increases with age in women. In previous studies no particular pattern in men has been noted. In this study, we explored changes in the relative proportion of the two fracture types with age in the two genders. Methods Patients of 50 years and older, with a diagnosis of hip fracture, discharged from two local acute care hospitals over a 5 year period (n = 2150) were analyzed as a function of age and gender to explore the relative proportions of intertrochanteric and subcapital fractures, and the change in relative proportion in the two genders with age. Results Overall, for the genders combined, the proportion of intertrochanteric fractures increases with age (p = .007). In women this increase is significant (p < .001), but in men the opposite pattern is observed, with the proportion of intertrochanteric fractures falling significantly with age (p = .025). Conclusions The pattern of hip fractures is different in men and women with aging. It is likely that the pattern difference reflects differences in type and rate of bone loss in the genders, but it is conjectured that the changing rate and pattern of falling with increasing age may also be important. The two main hip fracture types should be considered distinct and different and be studied separately in studies of cause and prevention.

Abstract 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.

E-cigarettes are a popular mode of delivery for nicotine, tobacco and cannabis. The prevalence of vaping among youth is increasing and this review aims to identify features of the neighbourhood environment, e.g., retailers, advertisements, and policies, that are associated with youth vaping. We included 48 studies. Of these, approximately 40% and 60% reported that presence of e-cigarette retailers, and advertisements, was associated with statistically higher odds of e-cigarette use in youth, respectively. Approximately 30% of studies reported that policies affecting e-cigarette availability were associated with statistically lower odds of vaping. Identifying these influential features of the neighbourhood environment will help formulate appropriate policies to reduce e-cigarette use among youth., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Context: Adolescence is a critical stage for improving nutrition. The popularity of smartphones makes them an ideal platform for administering interventions to adolescents. A systematic review has yet to assess the impact of smartphone app-based interventions exclusively on adolescents' dietary intake. Furthermore, despite the impact of equity factors on dietary intake and the claim for mobile health of increased accessibility, there is minimal research on the reporting of equity factors in the evaluation of smartphone app-based nutrition-intervention research., Objectives: This systematic review examines the effectiveness of smartphone app-based interventions on adolescents' dietary intake and the frequency with which equity factors and statistical analyses specific to equity factors are reported in these intervention studies., Data Sources: Databases (ie, Scopus, CINAHL, EMBASE, MEDLINE, PsycINFO, ERIC, and Cochrane Central Register for Randomized Control Trials) were searched for studies published from January 2008 to October 2022. Smartphone app-based intervention studies that were nutrition focused, evaluated at least 1 dietary intake variable, and included participants with a mean age between 10 and 19 years were included. All geographic locations were included., Data Extraction and Analysis: Study characteristics, intervention results, and reported equity factors were extracted. Because of the heterogeneity of dietary outcomes, findings were reported as a narrative synthesis., Conclusion: In total, 3087 studies were retrieved, 14 of which met the inclusion criteria. Eleven studies reported a statistically significant improvement in at least 1 dietary outcome because of the intervention. Reporting of at least 1 equity factor across articles' Introduction, Methods, Results, and Discussion sections was minimal (n = 5), and statistical analyses specific to equity factors were rare, occurring in only 4 of the 14 included studies. Future interventions should include a measurement of intervention adherence and report the impact of equity factors on the effectiveness and applicability of interventions for equity-deserving groups., (© The Author(s) 2023. Published by Oxford University Press on behalf of the International Life Sciences Institute. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: Adolescents are often exposed to food retailers selling unhealthy food items during their lunch breaks and school commutes. This systematic review examines the influence of school neighborhood food retail environments on adolescent food purchasing., Methods: A systematic search of 6 databases. Observational studies published from January 2012 to December 2022 that measured food availability, accessibility, or exposure, measured food purchasing, and focused on adolescents (aged 10-19 years) were eligible for inclusion., Results: Twelve studies with 97 findings were included. Thirty-one findings indicated that a school neighborhood with a high density of unhealthy food retail, a school with unhealthy food retail nearby, or exposure to unhealthy food retail on the journey to/from school was associated with higher prevalence and frequency of unhealthy food purchases., Discussion: Adolescents' food purchasing behaviors may be meaningfully affected by their school neighborhood food retail environment; however, the included studies have many methodological shortcomings., Implications for Research and Practice: Results identify the need for new studies that measure food purchasing, use comprehensive definitions of food retail environments, and adopt more rigorous methods to approximate exposure to food retail. More robust evidence would strengthen the rationale for policy or program interventions and potentially indicate specific targets for intervention., (Copyright © 2023 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.)

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.

Objective : Examine the impact of the campus food environment on postsecondary students' dietary behaviors (e.g., dietary intake) and food purchasing. Participants: Students currently attending a postsecondary institution, all ages and geographic locations included. Methods : A systematic search from January 2000-October 2022 was conducted in six databases using postsecondary education, food environment, and diet related keywords. Results : In total, 25 quantitative and 10 qualitative studies were extracted. All quantitative studies that conducted statistical analyses ( n  = 15) reported a statistically significant relationship between the campus food environment and dietary intake, including both positive and negative effects. All qualitative studies ( n  = 10) discussed students' experience of the campus food environment influencing their diet. Conclusions : This review found moderate evidence that the campus food environment has an impact on postsecondary students' dietary behaviors. A campus environment that has healthy foods accessible, affordable, and acceptable for postsecondary students may have a beneficial impact on students' dietary intake.

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.

Interventions to improve dietary quality and intake of fruits and vegetables (FV) among Canadian children have had modest success, and it has been suggested that food knowledge could be key to improvement. Programs have been criticized for insufficiently connecting food knowledge with food skills and decision making about dietary intake. The objective of this study was to investigate factors associated with FV consumption by elementary school children, aged 9-14 years, in Ontario, Canada, including food knowledge, socioeconomic status, sociodemographic characteristics, and the food environment. In 2017-2019, a cross-sectional survey was administered to 2443 students at 60 elementary schools across Southwestern Ontario (SWO), Canada. A parent survey was used to validate self-reported sociodemographic variables. The mean intake of FV reported by these participants was 2.6 (SD 1.1) and 2.4 (SD 1.2) servings/day, respectively. A FV intake below WHO guidelines was reported by 40.7% of respondents. Knowledge score, child age, and parent employment status significantly predicted higher reported intake of FV. This study shows that FV intake among this population group is low, and increased intake is associated with higher food knowledge. To encourage healthy eating, school-based food and nutrition programs that incorporate multiple components and emphasize food literacy are needed.

Introduction: Research has identified positive associations between green space and physical and mental health outcomes. Substance use outcomes, however, have received considerably less attention. This study investigates the association between residential greenness and substance use through an analysis of alcohol, tobacco, and marijuana use among youth and young adults., Methods: This study utilized three waves (2016-2018) of the Canadian Community Health Survey (CCHS), as well as residential greenness data from the Canadian Urban Environmental Health Consortium (CANUE). Multinomial logistic regression was used to explore variation in the pattern of substance use between greenness quartiles. The sample included 14,070 youth and young adults (15-25 years)., Results: Residential greenness was not associated with alcohol use in general but was associated with lower odds of frequent binge drinking. Residential greenness was also associated with lower odds of tobacco use and greater odds of marijuana use., Conclusion: This study provides evidence that residential greenness is associated with patterns of substance use. The strength and direction of association, however, is highly contingent upon the substance under investigation. Living in greener neighborhoods may confer certain benefits to substance use and abuse among youth and young adults., (Copyright © 2022 Elsevier Inc. All rights reserved.)

To halve per capita global food waste by 2030, policies and programs that effectively reduce household food waste generation are needed. Building upon a previous randomized controlled trial, this study evaluated the long-term effectiveness of the "Reduce Food Waste, Save Money" household food waste reduction intervention by comparing direct measurements of household food waste generated by treatment ( n  = 47) and control households ( n  = 52) over three time periods. The results indicate that there has been a long-term, sustained 30% reduction of avoidable food waste sent to landfill by treatment households following the implementation of this intervention. Additionally, this study assessed the impact of pandemic circumstances on the quantity and composition of household food waste by comparing direct measurements of food waste generated by the same households before (October 2017) and during (June 2020) the COVID-19 pandemic. During the first wave of the pandemic in Ontario, Canada, study households ( n  = 99) sent 2.98 kg of food waste to landfill per week, of which 54% was classified as avoidable food waste, and the remaining 46% as unavoidable food waste. During the pandemic, the generation of unavoidable food waste significantly increased by 65% ( p  < 0.01). There were also significant changes to the composition of wasted food, including a 78% increase in avoidable fruit and vegetables ( p  < 0.01), a 228% increase in avoidable other food ( p  < 0.01), and an 84% increase in unavoidable other food ( p  = 0.02)., Competing Interests: Competing InterestsThe authors declare no competing interests., (© The Author(s), under exclusive licence to Springer Nature Switzerland AG 2022, Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

The COVID-19 pandemic may have amplified the environmental, social, and economic implications of household food waste. A better understanding of household food wasting during the pandemic is needed to improve the management of waste and develop best practices for municipal waste management programs under crisis circumstances. A waste composition study was undertaken with 100 single-family households across the city of London, Ontario, Canada to determine the quantity and composition of household food waste disposed in June 2020, during the first wave of the COVID-19 pandemic. This study examines how household demographic, socioeconomic, and neighbourhood food environment characteristics influence household food wasting. On average, each household sent 2.81 kg of food waste to landfill per week, of which 52% was classified as avoidable food waste and 48% as unavoidable food waste. The quantity and composition of household food waste was found to be strongly influenced by the number of people and children in a household, and somewhat influenced by socioeconomic factors and neighbourhood food environment characteristics, including the availability, density, and proximity of retail food outlets., Competing Interests: None., (© 2021 Elsevier Ltd. All rights reserved.)

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

Background: Climate change is a threat to children's physical health, but there are also implications for mental well-being. Additionally, children may experience negative emotional responses stemming from an overarching awareness of the imminent threats to the planet due to climate change., Method: Using a scoping review, we examined the impact of climate change awareness on children's mental well-being and negative emotions. Our aim was to identify and describe the existing literature and highlight priorities for future research. Three specific objectives guided the review: (1) to identify and provide an overview of research regarding the impact of climate change awareness on children's mental well-being and negative emotions; (2) to summarize and clarify the terminology related to climate change awareness and children's mental well-being and negative emotions; and (3) to make recommendations for areas of future research., Results: Thirty-three articles were included in a narrative synthesis. Many articles were reviews or editorials/commentaries. Of the empirical research, most were from Europe, North America, and Australia. The articles emphasized a large range of negative emotions that children felt about climate change, with anxiety and worry being the most researched and discussed., Conclusions: The research on the impact of awareness of climate change on children's mental well-being and negative emotions is in its early phases. Efforts are needed to advance conceptual clarity and operationalize concepts. Additionally, there is a need for research into the impact of climate change awareness on children's mental well-being and negative emotions among a greater diversity of people and places. Existing studies provide an encouraging basis from which to develop future research., (© 2021 The Authors. Child and Adolescent Mental Health published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.)

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.

This study explored the implementation of the Centrally Procured School Food Program (CPSFP)-a free, universal, volunteer-led snack program for elementary school children. To assess participants' perceptions and experiences with the CPSFP, interviews were conducted in school-level participants (n = 33) using a semi-structured interview guide. Fifteen on-site visits also were conducted at each school to observe implementation practices. Quantitative data were obtained through a general information form where participants provided school characteristics and weekly logbooks where they described program operations and food quality. Most participants expressed positive perceptions of the CPSFP, identifying it as a valuable program for their students. Successful program implementation was associated with an appreciation for the CPSFP and the participation of the school community. Challenges to program implementation included concerns with the volume and types of food provided, issues with classroom food delivery and distribution and communication challenges. Suggestions for improvement included building capacities and enhancing student engagement in the program. Participants provided an in-depth assessment of the implementation of the CPSFP. The lessons learned and suggestions provided may help not only enhance the reach, feasibility and fidelity of the CPSFP, but inform the best practices for similar programs., (© The Author(s) 2021. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Qualitative research is lacking on the mental well-being of adolescents during the COVID-19 pandemic. The aim of this study was to explore the feelings and emotions adolescents experienced during the first wave of the COVID-19 pandemic and the coping strategies they identified and employed to manage those emotions., Methods: Participants living in Canada aged 13-19 years were recruited through social media platforms and youth-serving organizations. Qualitative data were gathered from 2 open-ended questions included in a youth-informed cross-sectional online survey: "What feelings and emotions have you experienced around the pandemic?" and "What coping strategies have you used during the pandemic?" We collected data from June 2020 to September 2020. A summative content analysis was undertaken to analyze survey responses inductively., Results: A total of 1164 open-ended responses from Canadian adolescents ( n = 851; mean age 15.6, standard deviation 1.7, yr) were analyzed. We identified 3 major themes within the category of feelings and emotions associated with the pandemic: sociospatial and temporal disconnections, emotional toll of the pandemic and positives amid the pandemic. Within the category of coping strategies used during the pandemic, 2 major themes were identified: connecting online and outdoors, and leisure and health-promoting activities., Interpretation: Although the emotional toll of the first wave of the COVID-19 pandemic is evident, participants in our study adopted various positive coping strategies to mitigate their distress, including physical activity, safe peer interactions and hobbies. The results have important implications for public health policy and practice during pandemic times, emphasizing the importance of accessible mental health resources for those experiencing psychological distress., Competing Interests: Competing interests: Kendra Nelson Ferguson and Gina Martin received postdoctoral trainee support from the Children’s Health Foundation through the Children’s Health Research Institute. No other competing interests were declared., (© 2021 CMA Joule Inc. or its licensors.)

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., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2021.)

Objective: Fruits and vegetables (FV) distribution interventions have been implemented as a public health strategy to increase children's intake of FV at school settings. The purpose of this review was to examine whether snack-based FV distribution interventions can improve school-aged children's consumption of FV., Design: Systematic review and meta-analysis of articles published in English, in a peer-reviewed journals, were identified by searching six databases up to August 2020. Standardised mean differences (SMD) and 95 % CI were calculated using a random effects model. Heterogeneity was quantified using I2 statistics., Setting: Population-based studies of interventions where the main focus was the effectiveness of distributed FV as snacks to schoolchildren in North America, Europe and Pacific were included., Results: Forty-seven studies, reporting on fifteen different interventions, were identified; ten studies were included in the meta-analysis. All interventions were effective in increasing children's consumption of FV, with only one intervention demonstrating a null effect. Pooled results under all classifications showed effectiveness in improving children's consumption of FV, particularly for multi-component interventions at post-intervention (SMD 0·20, 95 % CI 0·13, 0·27) and free distribution interventions at follow-up (SMD 0·19, 95 % CI 0·12, 0·27)., Conclusions: Findings suggest that FV distribution interventions provide a promising avenue by which children's consumption can be improved. Nonetheless, our results are based on a limited number of studies, and further studies should be performed to confirm these results. More consistent measurement protocols in terms of rigorous study methodologies, intervention duration and follow-up evaluation are needed to improve comparability across studies.

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.)

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., (Copyright © 2021. Published by Elsevier Ltd.)

Food literacy is a set of skills and knowledge that are integral to diet. It is common among teenagers to not have basic food literacy skills needed to consume a healthy diet. This study examined: (1) the current state of food and nutrition knowledge among adolescents 13-19 years of age in the census metropolitan area of London, ON, Canada; and (2) correlates of food knowledge and nutrition knowledge among adolescents. Data for this study were drawn from baseline youth and parent survey data collected from a larger population health intervention study. Statistical analysis of the survey data indicates that higher parental education and higher median neighbourhood family income, the use of mobile health applications, liking to cook, as well as confidence in reading and understanding food labels were all consistently associated with increased food and nutrition knowledge. Findings may help guide future research towards optimal methods for delivering food literacy interventions to effectively educate teenagers. Results of this study may help guide policy makers, researchers, and public health professionals in developing appropriate food and nutrition programs and curriculums to combat the decline in food literacy skills.

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.

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.

Despite the importance of process evaluation in program evaluations, research has focused primarily on the effectiveness of fruit and vegetables (FVs) distribution interventions on children's consumption, with little attention given to how these interventions achieve their outcomes. Five bibliographic databases (Embase, PubMed, ProQuest, Scopus, and Web of Science Core Collection) were searched in June 2019 for studies of interventions where the main focus was the implementation of distributed FVs to school-aged children as a snack. The Critical Appraisal Skills Programme (CASP) tool was used to appraise the risk of bias within included studies. Data were extracted based on study characteristics and findings. Results identified 24 studies reporting on 11 interventions and 1 policy. The findings of this systematic review indicate that the majority of the studies included limited references to implementation research. Recurring limitations include an absence of an evaluation theoretical framework and the data collection methods used. Also, several factors were identified as informing the success of snack-based FVs distribution programs, including participation of the school community, school characteristics, background knowledge, and parental engagement. Lack of timely FVs delivery, limited funding, inadequate awareness about the program, insufficient teachers' time, and food waste were identified as challenges to successful programming. Findings indicate that distributing FVs to school-aged children as a snack can increase their consumption, but only with proper implementation. Further evaluative research is required to better inform future implementation of snack-based FV distribution interventions in school settings., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2020 The Authors.)

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.

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

Objective: The aim of this study was to compare changes in body fat percentage (BFP), weight, and BMI between a standard intervention and a nutrigenomics intervention., Methods: The Nutrigenomics, Overweight/Obesity and Weight Management (NOW) trial is a parallel-group, pragmatic, randomized controlled clinical trial incorporated into the Group Lifestyle Balance TM (GLB) Program. Statistical analyses included two-way ANOVA and split-plot ANOVA. Inclusion criteria consisted of: BMI ≥ 25.0 kg/m 2 , ≥18 years of age, English speaking, willing to undergo genetic testing, having internet access, and not seeing another health care provider for weight-loss advice outside of the study. Pregnancy and lactation were exclusion criteria. GLB groups were randomly assigned 1 to 1 (N = 140) so that participants received either the standard 12-month GLB program or a modified 12-month program (GLB plus nutrigenomics), which included the provision of nutrigenomics information and advice for weight management. The primary outcome was percent change in BFP. Secondary outcomes were change in weight and BMI., Results: The GLB plus nutrigenomics group experienced significantly (P < 0.05) greater reductions in percent and absolute BFP at the 3-month follow-up and percent BFP at the 6-month follow-up compared with the standard GLB group., Conclusions: The nutrigenomics intervention used in the NOW trial can optimize change in body composition up to 6 months., (© 2020 The Obesity Society.)

Low levels of moderate-to-vigorous physical activity (MVPA) are consistently reported for children from industrialized countries. Perennially inadequate levels of MVPA have been linked to increased chronic disease risks. Very few studies have compared physical activity levels among children from geographically diverse places, and how they differ on weekdays versus weekends. The purpose of this research is to examine the factors that influence whether children achieve 60 min of MVPA on weekdays compared to weekend days. Data were analyzed on children (n = 532) aged 8-14 years from communities in Southern and Northern Ontario, Canada that participated in the study between 2009 and 2016. Children's MVPA was measured using an Actical accelerometer, environmental features measured with a geographic information system, and demographic data came from child/parent surveys. Variables were selected using a least absolute shrinkage and selection operator. The variables were entered into logistic regression models to assess the relationship between children meeting the MVPA guidelines. During the week, boys were more active than girls (OR = 4.652 p < 0.001) and as age increased children were less likely to reach the MVPA guidelines (OR = 0.758 p = 0.013). On weekends boys were still more likely to meet the guidelines (OR = 1.683 p = 0.014) and children living in rural Northern Ontario were more likely to reach the MVPA guidelines compared to all groups in Southern Ontario. The findings indicate that different variables influence whether children meet the MVPA guidelines on weekdays compared to weekends. Comparing weekdays and weekends provides more useful information for creating effective MVPA interventions., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2020 The Author(s).)

Study Objective: 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., Design: Retrospective cohort study using perinatal and neonatal databases., Setting: Tertiary care hospital in SWO., Participants: 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., Interventions: None., Main Outcome Measures: Low birth weight (LBW), very LBW, term LBW, preterm birth, very preterm birth, low and very low Apgar score, and fetal macrosomia., Results: 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., Conclusion: 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., (Copyright © 2019 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.)

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.

Objective: The purpose of this scoping review is to identify and describe the existing literature on the impact of the overarching awareness and concerns of climate change on children's mental health and well-being., Introduction: Children are widely acknowledged as being disproportionately at risk to the effects of climate change, yet research overlooks the impact that climate change has on their mental health. Children's overarching awareness of climate change, and its global effects, may influence their mental health and well-being., Inclusion Criteria: This review will include all research that addresses school-aged children's (aged 3-19) mental-health issues stemming from an awareness of climate change. It will not include research that examines direct impacts of climate change on children's mental health, such as trauma from a specific climate-related event., Methods: Searches will be conducted across eight research databases (Cochrane Database of Systematic Reviews, CINAHL, Embase, GreenFILE, PubMed, PsycINFO, Web of Science, and Scopus) and three unpublished/gray literature databases (ProQuest Dissertations and Theses, GreyLit.org, and OpenGrey). Data will be extracted for author(s), year of publication, country of origin, purpose, population, methodology, concepts of interest, outcomes, and key findings relating to the scoping review objectives. Findings will be presented as a narrative summary.

Objectives: The aim of the study was to assess the impact of a recreation access pass on grade 5 children's physical activity (PA) levels., Study Design: This is a pre-post evaluation of a population-level community-based intervention., Methods: All grade 5 students in (London, Ontario, Canada) were invited to participate in the [ACT-i-Pass] program (G5AP) in May 2014. A total of 643 children completed surveys, that included Physical Activity Questionnaire for Children (PAQ-C), at baseline (October 2014) and 6-month follow-up (April 2015). Difference in the means t-test compared PAQ-C scores between baseline and follow-up for the sample and subgroups. Multiple regression analysis tested associations between change in PAQ-C scores and intrapersonal-, interpersonal-, and physical environment-level variables., Results: PA increased significantly from baseline to 6-month follow-up. Girls, visible minorities, immigrants, and children with low parental support experienced significant increases in PA. Regression found girls benefitted from the G5AP significantly more than boys, and lower parental support is related to increases in PA., Conclusion: The findings indicate that collaboratively developed, community-based interventions can significantly increase children's PA levels, particularly among subgroups with traditionally lower PA. The pre-post evaluation of this community-based intervention provides useful evidence for developing policies and programs aimed at making population-level improvements in children's PA levels., (Copyright © 2019 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

A survey, based on an expanded Theory of Planned Behavior (TPB), was used to indirectly measure self-reported food wasting and its behavioral determinants. This was complemented with directly and objectively measured food waste in curbside garbage samples. Households (n = 189) reported throwing out avoidable food waste a mean of 5.48 times (SD = 5.58) and 6.63 portions (SD = 6.61) the week prior to completing the survey. These same households threw out a mean of 2,783 g/week of food waste (SD = 2,664) in a curbside garbage sample, with 63.27% of this consisting of avoidable food waste. There were weak to fair correlations between self-reported and curbside food waste samples. The direction and level of significance of all correlations of TPB behavioral determinants with self-reported and curbside food waste samples were similar, although the correlation coefficients were higher for self-reported food wasting. A linear regression (R 2  = 0.34, p < 0.001) on self-reported avoidable food waste frequency demonstrated that it was significantly (p < 0.05) associated with perceived behavioral control, personal attitude, number of people per household, gender and employment status. This was contrasted with a linear regression (R 2  = 0.19, p < 0.001) on curbside avoidable food waste which was also significantly (p < 0.05) associated with perceived behavioral control and number of people per household, but also housing tenure type (owner-occupancy vs tenancy) and the good provider identity. In general, self-reported results should be used with caution as they may underestimate food waste disposal and consideration should be given to supplement, if not replace, them with direct measurement of food waste disposal., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

The food-related information environment, comprised of food and beverage advertising within one's surroundings, is a growing concern for adolescent health given that food marketing disproportionately targets adolescents. Despite strong public interest concerning the effects of food marketing on child health, there is limited evidence focused on outdoor food advertising in relation to teenage diets, food purchasing, and perceptions. Further, limited research has considered both the exposure to and influence of such advertisements. This study used a novel multi-method approach to identify and quantify the features of outdoor food and beverage advertisements that are most effective at drawing teenagers into retail food establishments. An environmental audit of outdoor advertisements and consultations with youth were used to: (1) identify teen-directed food marketing techniques; (2) validate and weigh the power of individual advertising elements; and, (3) develop a teen-informed coding tool to measure the power of food-related advertisements. Results indicate that marketing power is a function of the presence and size of teen-directed advertisement features, and the relative nature of each feature is an important consideration. This study offers a quantitative measurement tool for food environment research and urges policymakers to consider teen-directed marketing when creating healthy communities.

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

Background: Children's sedentary lifestyles and low physical activity levels may be countered using population-level interventions. This study examines factors influencing the use of a free community-wide physical activity access pass for grade 5 students (G5AP)., Methods: A natural experiment with longitudinal data collection. A sample of 881 children completed the 9-month follow-up survey self-reporting where they used the G5AP. Two analyses were conducted: Getis-Ord GI* geographic cluster analysis of the spatial distribution of users, and logistic regression examining the relationship between use and accessibility (informational, economic, and geographic) and mobility options, while accounting for intrapersonal and interpersonal factors., Results: Overall, 44.9% of children used the G5AP with clusters of high use in urban areas and low use in the suburbs. Other factors significantly related to G5AP included gender (girls), informational accessibility (active recruitment), economic accessibility (median household income), geographic accessibility (facilities within 1.6 km of home), and mobility options (access to Boys & Girls Club bus)., Conclusions: This study found that a diverse population of children used the G5AP. To continue being successful, community-based physical activity interventions need to ensure that the intervention increases geographic, economic, and informational accessibility and provides mobility options that are available to the target population.

Background: 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., Objective: 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., Methods: 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., Results: 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., Conclusions: 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., (Copyright © 2018. Published by Elsevier Inc.)

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.

Given the power asymmetries between adults and young people, youth involvement in research is often at risk of tokenism. While many disciplines have seen a shift from conducting research on youth to conducting research with and for youth, engaging children and teens in research remains fraught with conceptual, methodological, and practical challenges. Arnstein's foundational Ladder of Participation has been adapted in novel ways in youth research, but in this paper, we present a new rendering: a 'rope ladder.' This concept came out of our youth-driven planning process to develop a Youth Advisory Council for the Human Environments Analysis Laboratory, an interdisciplinary research laboratory focused on developing healthy communities for young people. As opposed to a traditional ladder, composed of rigid material and maintaining a static position, the key innovation of our concept is that it integrates a greater degree of flexibility and mobility by allowing dynamic movement beyond a 2D vertical plane. At the same time, the pliable nature of the rope makes it both responsive and susceptible to exogenous forces. We argue that involving youth in the design of their own participatory framework reveals dimensions of participation that are important to youth, which may not be captured by the existing participatory models.

Most Canadian children are not meeting the recommended 60 min of moderate-to-vigorous physical activity per day. Research suggests that children's perceptions of their environment have an influence on their physical activity behaviours, but there is a lack of generalizability among previous work. The purpose of this study was to assess the mediating effect of children's perceptions of barriers to physical activity on the relationship between their environments and their level of moderate-to-vigorous physical activity (measured with accelerometers). Structural equation modelling stratified by gender was used to assess the research objective in a sample of 546 participants aged 8⁻14 years old from Northwestern and Southwestern Ontario, Canada. In both models stratified by gender, perceptions of barriers did not significantly mediate the relationship between urbanicity and physical activity. Independent of all other factors, there was no significant relationship between urbanicity and physical activity in girls, but there was in boys. These results offer insight into potential processes by which perceptions impact physical activity and provide initial information to further our understanding of the behavioural aspects of physical activity through multiple levels of analysis. Researchers must continue to improve efforts for quantifying the experience of children's daily activity contexts.

Children's perceptions of their environment have been associated with their physical activity (PA) levels, however a better understanding of the formation of perceptions within different contexts is needed. This will help to inform decision making related to physical inactivity trends in Canadian children. We examined socio-ecological factors influencing children's perceptions of barriers to PA in Ontario, Canada. Binary logistic regression models measured the relationship between perceptions of barriers and PA for 892 children in Ontario. At the intrapersonal level, girls reported the most barriers to PA. Interpersonally, children whose mother was employed reported the most barriers. At the physical environment level, children in urban and suburban neighbourhoods of large cities, and rural areas reported the most barriers, differing relative to population size. The major contribution of this paper is a new perspective of environmental influences on children's perceptions of PA, using an urbanicity spectrum, and highlighting place specific needs of Canadian children., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

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., (Copyright © 2018. Published by Elsevier Ltd.)

Background: Physical activity plays a fundamental role in the health and well-being of children. Walking is the most common form of physical activity and the journey to and from school provides an opportunity for children to be active every day. This study examines how child and parent perceptions of barriers to active school travel influences children's behaviour., Methods: Participants were recruited from 48 elementary schools in Southwestern Ontario, Canada. The study sample includes 1296 children (ages 9-14 years) who live within walking distance of their school, defined as 1.6 km network distance. Chi-square analysis examined differences between child and parent perceptions of barriers to active school travel. Logistic regression models examined how parent and child perceptions of barriers influence active school travel behaviour, while controlling for key intrapersonal, interpersonal, and physical environment factors., Results: The results indicate that there are significant differences in how parents and children perceive barriers to active school travel. Model results find older children, children without siblings, households with no vehicles, and children who live closer to school are most likely to use active school travel. Parent perceptions of barriers are found to have a greater influence on children's active school travel behaviour than children's perceptions. Different perceptions of barriers influence active school travel to school compared to returning home from school., Conclusions: Child and parent perceptions of barriers to active school travel differ and have different impacts on children's travel behaviour. Understanding how child and parent perceptions of barriers differ can help policymakers and practitioners develop specialized interventions aimed at increasing children's use of active school travel and children's overall physical activity. Interventions used to promote active school travel should focus on safety, as well as perceptions of distance to break parental habits of routinely driving their children to school. Overall, this study highlights the importance of considering both child and parent perceptions to create a safe and accessible environment to allow for an increase in active school travel behaviour among elementary school children who live within walking distance of their school.

Context: As children's lifestyles have become increasingly sedentary, active school travel can be a relatively accessible way to increase their daily physical activity. In recent years, several different models of interventions have been utilized to promote children participating in active school travel. This review documents and analyzes the different active school travel intervention methodologies that have been used in North America (Canada or U.S.) by collecting, organizing, and evaluating data relating to all phases of active school travel interventions., Evidence Acquisition: This systematic review developed a key word search and applied it in six databases (BIOSIS Previews, GeoBase, PubMed, SCOPUS, SPORTDiscus, Web of Science) to gather scholarly literature. A total of 22 studies evaluating children's active school travel interventions in a North American setting (four Canada, 18 U.S.) were identified for the period between January 2010 and March 2017., Evidence Synthesis: Applying the Safe Routes to School Education, Encouragement, Enforcement, Engineering, Equity, and Evaluation ("6 E's") framework, interventions were thematically assessed for their structure and organization, approaches and methods, and outcomes and discussions. Encouragement and education were the most commonly observed themes within the different methodologies of the studies reviewed. Details relating to intervention approaches and methods were common; whereas data relating to intervention structure and organization received much less attention., Conclusions: Kingdon's multiple streams approach was applied to frame the findings for program facilitators and evaluators. Within the multiple streams approach, several considerations are offered to address and potentially improve active school travel intervention conceptualization, partnerships, organization, and evaluation., (Copyright © 2018 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)