Who Misses Lunch on School Days in Canada?

This study assessed the prevalence and predictors of not eating lunch on school days among Canadian children using dietary data from the 2015 Canadian Community Health Survey- Nutrition (n = 2,991 children aged 6–17 years). On a given school day, more than 1 in 20 students reported eating no lunch. Students were more likely to miss lunch if they were older, lived in a food insecure household, or smoked. Sex, ethnicity, income and weight status were not associated with lunch consumption. Future research is needed to fully understand the frequency, causes and consequences of missing lunch on school days in Canada.Land and Food Systems, Faculty ofNon UBCReviewedFacult

Differences in the Quantity and Types of Foods and Beverages Consumed by Canadians between 2004 and 2015

This study examined differences in food and beverage intake estimated from nationally representative surveys of Canadians in 2004 and 2015 collected through the Canadian Community Health Surveys. Differences in mean daily energy intake and amounts of food consumed were compared between 2004 and 2015 and across age groups for all energy reporters (aged 2 years+) and among only plausible energy reporters. From 2004 to 2015, mean energy intake decreased by 228 kcal/day (all energy reporters) and 74 kcal/day (plausible energy reporters). Canadians reported consuming more daily servings of meat and alternatives but fewer servings of vegetables and fruit and milk and alternatives in 2015 compared to 2004. Analyses of food subgroups revealed that Canadians reported consuming more daily servings of dark green and orange vegetables, dairy products, legumes, nuts and seeds, and eggs but fewer servings of potatoes, other vegetables, fruit juices, fluid milk, and sugar-sweetened beverages in 2015 compared to 2004. While some aspects of the Canadian diet have improved, daily mean intake of other nutritious foods either stagnated or worsened over time. Continued attention is needed to improve population-level intakes of vegetables, fruit, whole grains, and protein foods such as legumes, nuts, seeds, and lower fat dairy products.Land and Food Systems, Faculty ofNon UBCReviewedFacult

Correction : Tugault-Lafleur C.N. and Black J.L. “Differences in the Quantity and Types of Foods and Beverages Consumed by Canadians between 2004 and 2015” Nutrients 2019, 11, 526

We would like to submit the following corrections to our recently published paper [...]Other UBCReviewedFacult

Examining school day dietary intakes among Canadian children

Understanding how dietary intakes vary over the course of the school day can help inform targeted school-based interventions, but little is known about the distribution or determinants of school day dietary intakes in Canada. This study examined differences between school hour and non-school hour dietary intakes and assessed demographic and socio-economic correlates of school hour diet quality among Canadian children. Nationally representative data from the Canadian Community Health Survey were analyzed using 24-h dietary recalls falling on school days in 2004 (n = 4827). Differences in nutrient and food group densities during and outside of school hours and differences in School Heathy Eating Index (School-HEI) scores across socio-demographic characteristics were examined using survey-weighted, linear regression models. Children reported consuming, on average, 746 kcal during school hours (1/3 of their daily energy intakes). Vitamin A, D, B12, calcium, and dairy products densities were at least 20% lower during school hours compared to non-school hours. Differences in School-HEI scores were poorly explained by socio-demographic factors, although age and province of residence emerged as significant correlates. The school context provides an important opportunity to promote healthy eating, particularly among adolescents who have the poorest school hour dietary practices. The nutritional profile of foods consumed at school could be potentially improved with increased intake of dairy products, thereby increasing intakes of protein, vitamin A, D, calcium and magnesium.The accepted manuscript in pdf format is listed with the files at the bottom of this page. The presentation of the authors' names and (or) special characters in the title of the manuscript may differ slightly between what is listed on this page and what is listed in the pdf file of the accepted manuscript; that in the pdf file of the accepted manuscript is what was submitted by the author

Identifying and predicting food parenting practice profiles among Canadian parents

Background: Food parenting practices (FPP) can affect children’s eating behaviours, yet little is known about how various FPP co-occur. The primary aim was to identify profiles of FPPs use among Canadian parents. Secondary aims included examining sociodemographic correlates of FPP profiles and evaluating whether children’s eating behaviours differed across FPP profiles. Methods: Parents (n = 799) of 5–12-year-old children completed a validated FPP Item Bank and the Children’s Eating Behaviour Questionnaire. Latent Class Analysis (LCA) was used to identify distinct FPP profiles. Regression analyses were used to explore associations between FPP profiles, sociodemographic variables (race, sex and education) and children’s eating behaviours (emotional overeating, food responsiveness, food fussiness and satiety responsiveness). Results: LCA revealed 6 FPP profiles: healthy eating environment, high engagement, reactive, high structure, controlling and low engagement. Relative to their non-White counterparts, White parents were more likely to belong in the healthy eating environment, high structure and low engagement profiles. Relative to fathers, mothers were more likely to fall in the healthy eating environment compared to low engagement profile. Parents with some post-secondary education were more likely to belong in the healthy eating environment, high structure and reactive profiles compared to the controlling profile. Emotional overeating and food responsiveness scores were lowest for healthy eating environment, high structure, low engagement profiles. Parents in the healthy eating environment profile also reported lower food fussiness scores compared to parents in the high engagement, high structure, reactive and controlling profiles. Conclusions: Findings suggest that a continuum of 6 FPP profiles may be present among Canadian parents, representing parents who use either all (high engagement), some (healthy eating environment, reactive, high structure, controlling) or little (low engagement) of the FPP examined. Future longitudinal research should evaluate how various FPP profiles influence the development of children’s eating behaviors, dietary intakes and weight status.Medicine, Faculty ofOther UBCNon UBCPopulation and Public Health (SPPH), School ofReviewedFacult

Factors associated with physical activity policy and practice implementation in British Columbia’s childcare settings: a longitudinal study

Abstract Background In 2016–17, the government of British Columbia (BC) enacted a mandatory policy outlining Active Play Standards (AP Standards) alongside a capacity building initiative (Appetite to Play) focused on implementing policies and practices to support physical activity in childcare centres. We aimed to identify factors at the provider and organizational levels as well as attributes of the Standards hypothesized to influence implementation (i.e., changes in policies and practices). Methods We conducted surveys before (2016–2017) and after (2018–2019) enforcement of the AP Standards among 146 group childcare centres across BC. The 2018–19 surveys measured theoretically based constructs associated with implementation of policies and practices (9 childcare- and 8 provider- level characteristics as well as 4 attributes of the licensing standards). Characteristics that were associated in simple regression models were entered in multivariable regression models to identify factors associated with policy and practice changes related to fundamental movement skills (FMS), screen time, total amount of active play (AP) and total amount of outdoor AP from baseline to follow-up. Results In multivariable analyses, higher staff capacity (OR = 2.1, 95% 1.2, 3.7) and perceived flexibility of the standards (OR: 3.3, 95% 1.5, 7.1) were associated with higher odds of a policy change related to FMS. Higher staff commitment to the AP standards was associated with a higher odds of policy changes related to screen time (OR = 1.6, 95% CI: 1.1, 2.4) and amount of AP (OR: 1.5, 95% 1.0, 2.3). Higher institutionalization of PA policies was associated with a higher odds of policy changes related to the amount of AP (OR: 5.4, 95% CI: 1.5, 20). Higher self-efficacy was associated with a higher odds of policy changes related to outdoor AP (OR = 2.9, 95% 1.1, 7.8). Appetite to Play training was a positively associated with practice changes related to FMS (β = 0.5, 95% CI: 0.1, 0.9). Conclusions A hierarchy of theoretically defined factors influenced childcare providers’ implementation of the AP Standards in BC. Future research should test the feasibility of modifying these factors to improve the implementation of PA policy and practice interventions in this setting

Does an active play standard change childcare physical activity and healthy eating policies? A natural policy experiment

Background In 2017, the provincial government of British Columbia (BC) implemented a mandatory policy outlining Active Play Standards (AP Standards) to increase physical activity (PA) levels, sedentary and motor skills among children attending licensed childcare centers. Concurrently, a capacity-building initiative was launched to help implement policies and practices supporting both PA and healthy eating (HE) in the early years. This study evaluated differences in center-level PA and HE policies and practices before and after the enforcement of the new provincial AP Standards. Methods Using a repeat cross-sectional design, surveys were distributed to managers and staff of licensed childcare facilities serving children aged 2–5 years before (2016–2017 or ‘time 1’) and after (2018–2019 or ‘time 2’) implementation of the AP Standards across BC. The total sample included 1,459 respondents (910 and 549 respondents at time 1 and time 2, respectively). Hierarchical mixed effects models were used to examine differences in 9 and 7 PA/sedentary policies and practices, respectively, as well as 11 HE policies between time 1 and time 2. Models controlled for childcare size and area-level population size, education, and income. Results Compared to centers surveyed at time 1, centers at time 2 were more likely to report written policies related to: fundamental movement skills, total amount of Active Play (AP) time, staff-led AP, unfacilitated play/free play, total amount of outdoor AP time, limiting screen time, breaking up prolonged sitting, staff role modeling of PA, and training staff about PA (P < 0.01 for all 9 policies examined). Compared to time 1, centers at time 2 reported more frequent practices related to ensuring children engaged in at least 120 min of AP, 60 min of outdoor AP daily, and limiting screen time (P < 0.01 for 3 out of 7 practices examined). Despite no additional policy intervention related to HE, centers were more likely to report having written policies related to: HE education for children, encouraging new foods, having family-style meals, offering only milk or water, limiting the amount of juice served, staff role modeling of HE, limiting the types of foods at parties/celebrations and foods brought from home (P < 0.05 for 9 out of 11 HE policies). Conclusion Approximately a year after the implementation of a governmental policy targeting PA supported by a capacity-building initiative, childcare centers reported positive changes in all 9 PA/sedentary policies examined, all 3 out of 7 PA/sedentary practices and 9 out of 11 HE policies evaluated at the center-level.Education, Faculty ofMedicine, Faculty ofNon UBCEmergency Medicine, Department ofKinesiology, School ofPopulation and Public Health (SPPH), School ofReviewedFacult

Calibration of the food parenting practice (FPP) item bank: tools for improving the measurement of food parenting practices of parents of 5–12-year-old children

Purpose: There has been a call to improve measurement rigour and standardization of food parenting practices measures, as well as aligning the measurement of food parenting practices with the parenting literature. Drawing from an expert-informed conceptual framework assessing three key domains of food parenting practices (autonomy promotion, control, and structure), this study combined factor analytic methods with Item Response Modeling (IRM) methodology to psychometrically validate responses to the Food Parenting Practice item bank. Methods: A sample of 799 Canadian parents of 5–12-year-old children completed the Food Parenting Practice item bank (129 items measuring 17 constructs). The factorial structure of the responses to the item bank was assessed with confirmatory factor analysis (CFA), confirmatory bi-factor item analysis, and IRM. Following these analyses, differential Item Functioning (DIF) and Differential Response Functioning (DRF) analyses were then used to test invariance properties by parents’ sex, income and ethnicity. Finally, the efficiency of the item bank was examined using computerized adaptive testing simulations to identify the items to include in a short form. Results: Overall, the expert-informed conceptual framework was predominantly supported by the CFA as it retained the same 17 constructs included in the conceptual framework with the exception of the access/availability and permissive constructs which were respectively renamed covert control and accommodating the child to better reflect the content of the final solution. The bi-factor item analyses and IRM analyses revealed that the solution could be simplified to 11 unidimensional constructs and the full item bank included 86-items (empirical reliability from 0.78 to 0.96, except for 1 construct) and the short form had 48 items. Conclusion: Overall the food parenting practice item bank has excellent psychometric properties. The item bank includes an expanded version and short version to meet various study needs. This study provides more efficient tools for assessing how food parenting practices influence child dietary behaviours. Next steps are to use the IRM calibrated item bank and draw on computerized adaptive testing methodology to administer the item bank and provide flexibility in item selection.Education, Faculty ofMedicine, Faculty ofOther UBCNon UBCKinesiology, School ofPopulation and Public Health (SPPH), School ofReviewedFacult

Efficacy of the Aim2Be Intervention in Changing Lifestyle Behaviors Among Adolescents With Overweight and Obesity: Randomized Controlled Trial

BackgroundAim2Be is a gamified lifestyle app designed to promote lifestyle behavior changes among Canadian adolescents and their families. ObjectiveThe primary aim was to test the efficacy of the Aim2Be app with support from a live coach to reduce weight outcomes (BMI Z score [zBMI]) and improve lifestyle behaviors among adolescents with overweight and obesity and their parents versus a waitlist control group over 3 months. The secondary aim was to compare health trajectories among waitlist control participants over 6 months (before and after receiving access to the app), assess whether support from a live coach enhanced intervention impact, and evaluate whether the app use influenced changes among intervention participants. MethodsA 2-arm parallel randomized controlled trial was conducted from November 2018 to June 2020. Adolescents aged 10 to 17 years with overweight or obesity and their parents were randomized into an intervention group (Aim2Be with a live coach for 6 months) or a waitlist control group (Aim2Be with no live coach; accessed after 3 months). Adolescents’ assessments at baseline and at 3 and 6 months included measured height and weight, 24-hour dietary recalls, and daily step counts measured with a Fitbit. Data on self-reported physical activity, screen time, fruit and vegetable intake, and sugary beverage intake of adolescents and parents were also collected. ResultsA total of 214 parent-child participants were randomized. In our primary analyses, there were no significant differences in zBMI or any of the health behaviors between the intervention and control groups at 3 months. In our secondary analyses, among waitlist control participants, zBMI (P=.02), discretionary calories (P=.03), and physical activity outside of school (P=.001) declined, whereas daily screen time increased (P<.001) after receiving access to the app compared with before receiving app access. Adolescents randomized to Aim2Be with live coaching reported more time being active outside of school compared with adolescents who used Aim2Be with no coaching over 3 months (P=.001). App use did not modify any changes in outcomes among adolescents in the intervention group. ConclusionsThe Aim2Be intervention did not improve zBMI and lifestyle behaviors in adolescents with overweight and obesity compared with the waitlist control group over 3 months. Future studies should explore the potential mediators of changes in zBMI and lifestyle behaviors as well as predictors of engagement. Trial RegistrationClinicalTrials.gov NCT03651284; https://clinicaltrials.gov/ct2/show/study/NCT03651284 International Registered Report Identifier (IRRID)RR2-10.1186/s13063-020-4080-