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PURPOSE: To examine energy expenditure (EE) when playing active and inactive videogames (VG). METHODS: Predicted EE was measured among 51 undergraduate students while playing active and inactive VG (Ontario, Canada). RESULTS: Predicted EE was significantly higher playing the active VG compared to the inactive VG according to heart rate monitor (97.4 kcal vs 64.7 kcal) and SenseWear® armband (192.4 kcal vs 42.3 kcal) estimates. CONCLUSION: Active VG may be a viable intervention tool for increasing EE among students who would otherwise be spending time in sedentary screen-based behaviors. [ABSTRACT FROM AUTHOR]

Objectives: Declines in cigarette smoking have been accompanied by increases in alternative tobacco product (ATP) use, particularly among youth. This study examines smoking susceptibility and ATP use in a national sample of Canadian youth., Methods: Data from grades 9-12 students who participated in the 2012/2013 Youth Smoking Survey, a nationally generalisable sample of Canadian students (n=27,404) were used to examine cigarette smoking susceptibility among never smokers (n=17,396). Logistic regression models were used to examine differences in smoking susceptibility by use of flavoured and all ATPs and by sociodemographic and lifestyle characteristics., Results: Overall, 30% of Canadian grades 9-12 never smokers were susceptible to cigarette smoking. Compared to never users, those who had ever tried ATPs (OR=1.96, 95% CI 1.59 to 2.42) and those who had ever tried flavoured ATPs (OR=2.20, 95% CI 1.63 to 2.96) had significantly higher odds of being susceptible to cigarette smoking., Conclusions: ATP use is associated with smoking susceptibility among youth never smokers. Findings from this study, along with existing evidence, can be used by policymakers to improve regulation around youth access to ATPs (particularly flavoured varieties)., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Purpose: Few national surveys currently assess hookah smoking among youth. This study describes the prevalence, patterns of use, and perceptions about hookah in a nationally representative survey of Canadian grades 9-12 students., Methods: The Youth Smoking Survey 2012/2013 was administered to 27,404 Canadian grades 9-12 students attending schools in nine Canadian provinces representing 96 % of Canadian population. Relevant dichotomous outcomes included ever use, use in the last 30 days, and the belief that hookah use is less harmful than cigarette smoking. Covariates included smoking status, sex, grade, province of residence, race/ethnicity, and amount of weekly spending money. Logistic regression models were used to examine: covariates related to the odds of ever and last-30-day hookah use; covariates related to perceptions about the harms of hookah smoking; the extent to which perceptions were associated with odds of hookah use; and whether survey year (2010/2011 or 2012/2013) was associated with hookah use, and marginal effects were calculated., Results: In Canada, 5.4 % of students in grades 9-12 currently use hookah and 14.3 % report ever using hookah. In 2012/2013, students had significantly higher odds of using hookah compared to students in 2010/2011 (OR 1.5, 95 % CI 1.2, 2.1). About half of hookah users (51 %) used flavored hookah. Students who believed that hookah use was less harmful than cigarette smoking had significantly higher odds of current hookah use (OR 2.6, 95 % CI 1.9, 3.5), as did students who reported higher amounts of weekly spending money. Current smokers had an 18 % higher predicted probability of currently using hookah compared to non-smokers., Conclusions: Hookah use among youth is of growing concern in Canada. Findings can be used to inform policy development related to youth hookah smoking.

Background: Smoking susceptibility has been found to be a strong predictor of experimental smoking. This paper examined which student- and school-level factors differentiated susceptible never smokers from non-susceptible never smokers among a nationally representative sample of Canadian students in grades 9 to 12., Methods: Student-level data from the 2008-2009 Canadian Youth Smoking Survey were linked with school-level data from the 2006 Census, and one built environment characteristic (the density of tobacco retailers surrounding schools). These data were examined using multilevel logistic regression analyses., Results: The likelihood of a never smoker being susceptible to smoking significantly varied across schools (p=0.0002). Students in this study were more likely to be susceptible never smokers if they reported low self-esteem, held positive attitudes towards smoking, used alcohol or marijuana, had close friends who smoked, and came from homes without a total ban on smoking. The school location (rural versus urban), the socioeconomic status of the neighbourhood surrounding a school, and the density of tobacco retailers that were located within 1-km radius of each school were not associated with students' smoking susceptibility., Conclusion: These findings underscore the continued need to develop school-based tobacco use prevention policies and/or programs that enhance students' self-esteem, address tobacco use misinformation and substance use, and include strategies targeting friends who smoke, and students who come from homes without a total ban on smoking., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

This article examines the time trends in patterns of school travel mode among Canadian children and youth to inform the Active Transportation (AT) indicator of the 2013 Active Healthy Kids Canada Report Card on Physical Activity for Children and Youth. The AT grade was assigned based on a comprehensive synthesis of the 2000 and 2010 Physical Activity Monitor studies from the Canadian Fitness and Lifestyle Research Institute and the 1992, 1998, 2005, and 2010 General Social Survey from Statistics Canada. The results showed that in 2013, AT was graded a D, because less than half of Canadian children and youth used only active modes of transportation to get to and from school. The proportion of Canadian children and youth who used only inactive modes of transportation for school travel increased significantly from 51% to 62% over the last decade. Children and youth from larger communities and those with lower household income levels were significantly more likely to use AT than those living in smaller communities and those in higher income households, respectively. In conclusion, motorized transport for school travel has increased steadily over the last decade across Canada. Regional and socio-demographic disparities should be considered in efforts to increase the number of children using AT.

Background: The Active Healthy Kids Canada (AHKC) Report Card consolidates and translates research and assesses how Canada is being responsible in providing physical activity opportunities for children (3- to 11-years-old) and youth (12- to 17-years-old). The primary aim of this article is to summarize the results of the 2014 AHKC 10th Anniversary Report Card., Methods: Ten physical activity indicators were graded using the AHKC Report Card development process, which includes a synthesis of the best available research, surveillance, policy and practice findings, and expert consensus., Results: Grades assigned were for: 'Behaviors that Contribute to Overall Physical Activity Levels' (Overall Physical Activity Levels, D-; Organized Sport Participation, C+; Active Play, INCOMPLETE; Active Transportation, D; Sedentary Behaviors, F), 'Settings and Sources of Influence' (Family and Peers, C; School, C+; and Community and the Built Environment, B+), and 'Strategies and Investments' (Government Strategies and Investments, C; and Non-Government Strategies and Investments, A-)., Conclusions: Despite good availability of policies, programs, and infrastructure, the overall physical activity levels of Canadian children and youth remain low while sedentary behavior levels remain high. As with many nations, there is room for improvement in most physical activity behaviors and some sources of influence.

Objective: In order to understand the factors that differentiate adolescents who have tried smoking from those who have become established smokers, this study examined which student- and school-level factors differentiated current smokers from experimental smokers among a nationally representative sample of Canadian secondary school students., Method: Student-level secondary data from the 2008-2009 Canadian Youth Smoking Survey was linked with school-level data from the 2006 Census and one built environment characteristic, and examined using multilevel logistic regression analyses., Results: The current smoking rates varied (P<0.001) across schools. The number of tobacco retailers surrounding the schools was associated with current smoking when adjusting for student characteristics. Additionally, students were more likely to be current smokers if they were: male, in higher grades, believed that smoking can help when they are bored, reported low school connectedness, used marijuana, had a sibling or close friend who smoked, and had no smoking bans at home., Conclusions: These study findings suggest that school anti-smoking strategies need to target males, increase students' attachment to their school, address tobacco-related beliefs, and include interventions targeting smoking siblings and friends. The government should consider zoning restrictions to limit sales of tobacco products near schools., (Copyright © 2013 Elsevier Inc. All rights reserved.)

This paper describes the survey development, design and data collection protocol for the 2008/2009 Youth Smoking Survey (YSS) and the changes to the YSS survey and protocols across the 5 survey cycles (1994, 2002, 2004/2005, 2006/2007, 2008/2009). Canada's Youth Smoking Survey is a nationally representative school-based survey of students (grades 6 to 12 in 2008/2009) from randomly sampled public and private schools in the ten provinces. The main objective of the YSS is to provide benchmark data on national smoking prevalence rates for youth. Key features of the 2008/2009 YSS include consistent measures across survey cycles, a survey team of researchers and non-governmental organizations, a link to school and student level measures, provision of tailored feedback reports to schools and publicly available datasets.

Objective: The objective of this study was to explore students' perceptions of school policy characteristics that influence the location of smoking while at school., Methods: Data were collected from a nationally representative sample of Canadian youth in grades 7-12 as part of the 2006-2007 Youth Smoking Survey. We used multilevel logistic regression to examine how students' perceptions of school policies predicted smoking behavior on and off school grounds in 11,881 students who had ever smoked. Separate analyses were conducted for grades 7-9 and 10-12., Results: In both grades 7-9 and 10-12, perceiving clear rules about smoking decreased the likelihood that a student would smoke on school grounds, while perceiving that a high percentage of peers smoke, that there are school rules about smoking, that students obey the rules, and that students can be fined for smoking increased the likelihood that a student would smoke off school grounds., Conclusions: Clearly perceived rules about smoking encourage students not to smoke on school grounds; however, perceptions of rules, along with strong enforcement, may displace behavior off of school grounds. Non-smoking policies should be part of a comprehensive approach, that supports cessation.

Objectives: Schools represent an important environment for physical activity (PA) promotion among youth. Schools can promote PA through policies and programs but our understanding of how these school characteristics associate with student PA levels is largely unknown. Developing this understanding is critical for implementing new prevention interventions. The aim of this study was to identify the school- and student-related characteristics associated with moderate and high levels of PA in a sample of Ontario elementary schools., Methods: Using multi-level logistic regression analyses, we explored the school- and student-level characteristics associated with being moderately and highly active using data collected from administrators and from students in grades 5 to 8 at 30 elementary schools in Ontario. Students' PA levels, sex, grade, and the number of physical education classes per week were linked to school environment data--specifically, a school's chosen implementation model for daily physical activity and whether it offers intramural and interschool PA programming., Results: Findings indicate that there was significant between-school variation for being moderately and highly active. Students were less likely to be moderately or highly active if they attended a school offering interschool PA programming. An important student characteristic positively associated with student PA levels included participating in at least two physical education classes per week., Conclusion: The residual differences in PA by school suggest that school-level characteristics facilitate higher levels of student PA beyond individual-level factors. Although most variation in student PA lies between students within schools, there is sufficient between-school variation to be of interest to practitioners and policy-makers.

Background: Schools can be an efficient venue for promoting physical activity (PA) among adolescents. Physical education (PE) requires investigation because it is a variable associated with adolescent PA levels and its existence in schools represents a significant opportunity for strategies to combat declining PA levels among this population. This article examines the between-school variability in student rates of PE enrollment among a large sample of high schools in Ontario, Canada, and identifies the school- and student-level characteristics associated with PE enrollment., Methods: This cross-sectional study utilized self-reported school- and student-level data from administrators and students at 73 high schools. Students' enrollment in PE, demographic, behavioral, and psychosocial variables was linked to school environment data comprising of school demographics and administrator assessed quality of policies, facilities, and programs related to PA. Analysis involved multilevel modeling., Results: The mean rate of PE enrollment among the 73 high schools was 62.4%, with rates by school ranging from 28.9% to 81.1%. When student demographics, behavioral, and psychosocial factors were controlled for, there was still a school effect for student PE enrollment. The school effect was explained by the provision of daily PE and school median household income., Conclusions: This is the first study to examine the extent to which PE enrollment varies between schools and to identify school factors associated with school variability in rates of PE enrollment. Although most variation in PE enrollment lies between students within schools, there is sufficient between-school variation to be of interest to practitioners and policy makers.

Research has yet to examine how physical activity, body mass index (BMI) and concerns about weight among youth populations are associated with susceptibility to smoking among never smokers. The Physical Activity Module of the School Health Action, Planning and Evaluation System (SHAPES) was completed by 25,060 students in grades 9 to 12 within 76 secondary schools in Ontario (Canada) to examine how being overweight, weight concerns, and physical activity are associated with susceptibility to smoking in a large sample of youth. Among the 14,795 students who were never smokers, 3,809 (25.8%) were classified as susceptible to future smoking and 10,986 (74.2%) were classified as non-susceptible to future smoking. Smoking susceptibility was negatively associated with being highly active or at risk of overweight and positively associated with perceptions of being slightly overweight or slightly underweight. Students who report 1 or more hours of screen or phone time per day were also more likely to be susceptible. This is the first study to identify that susceptibility to future smoking among never smokers is associated with physical activity, overweight and concerns about weight. This is valuable new insight for tailoring and targeting future school-based tobacco control and/or physical activity programming to youth populations.

Although adolescents who overestimate peer smoking prevalence are more likely to smoke, little research has focused on the factors associated with why the majority of adolescents overestimate peer smoking rate. The purpose of this study was to examine demographic, social, environmental and behavioural characteristics related to overestimation of peer smoking prevalence among secondary school students. The current study analysed data collected in two Canadian studies that used the Tobacco Module of the School Health Action, Planning and Evaluation System, a school-based questionnaire. One study surveyed 23 458 students (Grades 9-13) in 29 schools during 2001-02, and the other surveyed 25 452 students in 39 schools in 2003. Results of multiple logistic regression indicate that grade, gender, close friends' smoking, seeing smoking at school, family members' smoking, smoking in the home and smoking status have a clear association with overestimation; school smoking rate and susceptibility to smoking show a tentative relationship and warrant further study. Other factors may also be important for prevalence estimation, and further research is needed to identify these factors. Since adolescents tend to overestimate peer smoking prevalence and perceived prevalence is in turn linked to smoking behaviour, interventions should focus on creating realistic perceptions of smoking prevalence.

Objectives: To better understand the co-occurrence of smoking and physical inactivity., Methods: A review of 5 databases identified 50 articles reporting empirical relationships between smoking and physical activity (PA)., Results: Almost 60% of the articles reported a definitely negative association, but this relationship was often attenuated or reversed among adolescents and males and for moderate (vs vigorous) exercise. Stages of change for smoking and PA were relatively unrelated., Conclusion: Smoking and PA are largely incongruent behaviors. Potential explanations for the observed relationships are described. These ranged from physiological (eg, lung function) to psychological (eg, depression) to socio-demographic (eg, education) factors.

Purpose: To determine the reliability and validity of the School Health Action, Planning and Evaluation System (SHAPES) physical activity questionnaire, a machine-readable questionnaire designed to collect data from all students in a school from grades 6 to 12 and to provide feedback to the school for planning and evaluation., Methods: Study 1 assessed test-retest reliability by administering the questionnaire twice, 1 wk apart to 2812 students in grades 9-12. Study 2 assessed criterion validity using MTI accelerometers worn consecutively for 7 d, and measured height and weight (N = 67, grades 6-12)., Results: The overall kappa/weighted kappa coefficient for the 1-wk test-retest reliability of the questionnaire items indicated moderate agreement (mean 0.57 +/- 0.24). Self-reported and accelerometer-measured average daily time spent performing moderate to vigorous physical activity were significantly correlated (Spearman r = 0.44, P < 0.01); however, students tended to overreport physical activity. Height and weight were not consistently over- or underreported. Self-reported and measured body mass index were significantly correlated (Spearman r = 0.90, P < 0.001). Classification of weight status by body mass index was similar using self-reported values compared with measured values., Conclusion: The findings of these studies suggest that the SHAPES physical activity questionnaire has acceptable reliability and validity and is suitable for use in large-scale school-based data collections for child and adolescent populations.

Background: An outcome evaluation of a high school tobacco control intervention using extracurricular activities developed by teachers and students is reported., Methods: Eligible subjects (n = 3,028) had participated in a randomized trial of an elementary school smoking prevention curriculum. Their high schools were matched in pairs; one school in each pair was randomly assigned to the intervention condition, the second to a "usual-care" control condition. Data were collected at the end of Grades 9 and 10., Results: For Grade 8 never smokers, regular smoking rates were significantly lower for males from intervention schools (9.8 vs 16.2%, P = 0.02) at the end of Grade 10. There were no significant differences among Grade 10 smoking rates for females, or for students of either gender with previous smoking experience in Grade 8., Conclusions: The extracurricular activities approach to tobacco control is practical to implement and has promise.

Objectives: This study determined the effect of provider (nurse or teacher) and training method (workshop or self-preparation) on outcomes of a social influences smoking prevention program., Methods: One hundred elementary schools were stratified by school risk score (high risk = high smoking rate among senior students) and assigned randomly to conditions: (1) teacher/self-preparation, (2) teacher/workshop, (3) nurse/self-preparation, (4) nurse/workshop, and (5) control. Intervention occurred in grades 6 to 8. Smoking status at the end of grade 8 was the primary endpoint variable., Results: Intervention reduced grade 8 smoking rates in high-risk schools (smoking rates of 26.9% in control vs 16.0% in intervention schools) but not in low-risk schools. There were no significant differences in outcome as a function of training method and no significant differences in outcome between teacher-provided and nurse-provided interventions in high- and medium-risk schools. Although nurses achieved better outcomes than did teachers in low-risk schools, neither provider type achieved outcomes superior to the control condition in those schools., Conclusions: Workshop training did not affect outcomes. Teachers and nurses were equally effective providers. Results suggest that programming should target high-risk schools.

Within the context of a framework for cancer control, this article reviews evidence and suggests research directions for 3 types of school-based smoking interventions: elementary school prevention, secondary school interventions and interventions linking community and school. Directions for smoking research in elementary schools include improving adoption through the provision of effectiveness criteria, tailoring interventions to schools and training. Monitoring at micro and macro levels may help planning and implementation, but clearer evidence is required of its feasibility. Fundamental research should explore new options to understand why youth do not start smoking. Smoking intervention research at the secondary school level is less well established, with only 1 effectiveness trial reported. We recommend testing models that involve youth in developing their own solutions and examining the interaction of various control measures. Sustainability issues have led researchers to embed school-based smoking interventions in community-wide activities. Intervention research of this sort still needs to determine how to apply approaches (e.g., comprehensive school health) and what the appropriate roles are (such as technical assistance) for community agencies. All research using these school-community approaches needs to include process measures to explain potential failures to obtain significant differences between components. In addition, we call for research on the training of educators and health personnel, to increase the priority given to smoking prevention and improve the implementation of existing programs. Research on policy initiatives that lead to effective training needs to be explored. Finally, we argue that application of the principles incorporated into the cancer control framework (e.g., through participatory research methods) strengthens the research process and results.

Obesity is a common condition which has important effects on health status and longevity. This review examines the efficacy of treatments for both moderate and severe obesity. A plan of treatment combining diet, exercise, and behavioral strategies is outlined. Surgery and its complications are reviewed. Eight management issues, including rate of weight loss, self-help groups, and fringe therapies, are presented. Management recommendations are based on a critical review of the weight loss literature.