A Multilevel Examination of Factors of the School Environment associated with Time Spent in Physical Activity among a sample of Secondary Students in Ontario, Canada.

Background: The high prevalence of children and adolescents not meeting the recommended 60 minutes of physical activity (PA) per day and the associated negative health consequences make it critical to increase PA. Ecological models suggest that the school environment may influence student health behaviour. However, few studies have examined the school environment in relation to student PA. Purpose: To examine between-school variability in students’ time spent in PA, and identify factors of the school built environment that account for the between-school variability in students’ time spent in PA overall as well as by gender and school location, while also considering school physical education (PE) and PA programming and controlling for student-level characteristics and potential environment-level confounders. Methods: This thesis consisted of a secondary data analysis of the School Health Action, Planning and Evaluation System (SHAPES) Ontario project, which included self-report data from administrators and 25,416 students in 76 secondary schools across Ontario. The student- and school-level survey data were supplemented with GIS-derived measures of the built environment within 1-km buffers of the 76 schools. Multilevel modeling was used to examine between-school variability in students’ time spent in PA, as well as environment-level factors associated with PA. Results: There was significant between-school variability in students’ time spent in PA overall as well as by gender and school location, respectively. Schools having another room for PA and schools offering daily PE were positively associated with students’ PA. Schools located in areas with higher land-use mix diversity and walkability were negatively associated with students’ PA. Results of the gender-specific multilevel analyses indicated schools should consider providing another room for PA, especially for offering flexibility activities directed at female students. Schools should also consider offering daily PE to male students in senior grades. Students attending schools in urban and suburban areas that provided another room for PA or were located within close proximity to a shopping mall or fast food outlet spent more time in PA. Conclusions: These findings support the ecological notion that the school environment can influence student PA behaviour. A better understanding of the relationship between the school environment and PA will assist in the development of effective school-based policies, programs and interventions to increase PA

Trajectories of Objectively Measured Physical Activity among Secondary Students in Canada in the Context of a Province-Wide Physical Education Policy: A Longitudinal Analysis

Lower levels of physical activity are associated with childhood obesity. School physical education (PE) policies have been identified as critical to improve child and adolescent physical activity levels but there has been little evaluation of such policies. In the province of Manitoba, Canada, the government implemented a mandatory PE policy in secondary schools designed to increase the daily physical activity levels of adolescents. The objective of this study was to examine the longitudinal changes in and the factors associated with the physical activity trajectories of adolescents in Manitoba during their tenure as secondary school students in the context of this school PE policy. The results found, despite the PE policy, a grade-related decline in the physical activity trajectories of adolescents; however, the decline in physical activity was attenuated among adolescents with low and moderate baseline physical activity compared to adolescents with high baseline physical activity and among adolescents who attended schools in neighbourhoods of low compared to high socioeconomic status. There are several possible explanations for these findings, including the influence of the PE policy on the PA patterns of adolescent subpopulations that tend to be at higher risk for inactivity in both childhood and adult life

Interrupted time series analysis of Canadian legal cannabis sales during the COVID‐19 pandemic

Introduction: There were repeated reports of increased cannabis sales, use, and health impacts in Canada during the COVID-19 pandemic. However, it was unclear whether the increases were due to pandemic effects or industry expansion. Methods: We performed interrupted time series regressions of monthly per capita legal cannabis sales from March 2019 to February 2021, first with national averages, then with provincial/territorial data after adjusting for store density. We considered two interruption alternatives: January 2020, when product variety increased; and March 2020, when pandemic restrictions began. Results: The provincial/territorial regression with the January interruption explained R2 = 69.6% of within-jurisdiction variation: baseline monthly per capita sales growth averaged $0.21 (95$1.02 (95% CI: -1.67, -0.37), and monthly growth thereafter increased by $0.16 (95$0.14 (95% CI: 0.06, 0.22), there was no immediate drop, and growth thereafter increased by $0.22 per month, (95% CI: 0.08, 0.35). Discussion: Increasing cannabis sales during the pandemic was consistent with pre-existing trends and increasing store numbers. The extra increased growth was more aligned with January’s new product arrivals than with March’s pandemic measures, though the latter cannot be ruled out. Conclusions: We found little evidence of pandemic impacts on Canada’s aggregate legal cannabis sales. We therefore caution against attributing increased population-level cannabis use or health impacts primarily to the pandemic.Canadian Institute for Health Research (CIHR) grant 45236

Numeric and Traffic Light Calorie Labels on Cafeteria Menus: Noticing, Use, and Perceptions Among Young Adults

This is a pre-copyedited, author-produced version of an article accepted for publication in Current Developments in Nutrition following peer review. The version of record Lee, K., Hammond, D., Price, M., Hobin, E., Wallace, M., Olstad, D., Minaker, L., & Kirkpatrick, S. (2020). Numeric and Traffic Light Calorie Labels on Cafeteria Menus: Noticing, Use, and Perceptions Among Young Adults. Current Developments in Nutrition, 4(Supplement_2), 1719. https://doi.org/10.1093/cdn/nzaa064_009 is available online at: https://doi.org/10.1093/cdn/nzaa064_009.Objectives The objective of this study was to examine the impact of numeric versus interpretive calorie labelling on consumer noticing, use, and perceptions of labels. We hypothesized that due to their at-a-glance format, interpretive labels would outperform numeric labels. Methods Using a pre-post quasi-experimental controlled trial design, three campus cafeterias were randomized to receive numeric calorie labelling, traffic light labelling (i.e., red, amber, or green symbol indicating the number of calories), or no labelling for two weeks. Exit surveys were conducted with cafeteria patrons prior to (n = 949) and following (n = 1110) implementation of labels. Surveys queried sociodemographic characteristics, the details of the most recent cafeteria purchase, and noticing, use, and perceptions of labels. Chi-squared tests and multinomial logistic regression were used to determine the impact of format on label noticing, use, and perceptions. Results Label noticing increased from 23% to 43% among those exposed to numeric labels and 28% to 63% among those exposed to traffic light labels, compared to no change in the control (15%) (P 0.05). Conclusions Cafeteria patrons exposed to calorie labels reported noticing and using them, with higher salience for traffic light labels. The implementation of such interpretive labels at the point-of-purchase may provide cues to enable consumers to make informed choices, consistent with front-of-pack labels on packaged foods under consideration in many jurisdictions.Funder 1,Kirsten Lee is funded by an Ontario Graduate Scholarship ||. Funder 2, This study is funded by the Canadian Foundation for Dietetic Research ||. Funder 3, an Ontario Ministry of Research and Innovation Early Researcher Award held by Sharon Kirkpatrick

A multilevel examination of gender differences in the association between features of the school environment and physical activity among a sample of grades 9 to 12 students in Ontario, Canada

<p>Abstract</p> <p>Background</p> <p>Creating school environments that support student physical activity (PA) is a key recommendation of policy-makers to increase youth PA. Given males are more active than females at all ages, it has been suggested that investigating gender differences in the features of the environment that associate with PA may help to inform gender-focused PA interventions and reduce the gender disparity in PA. The purpose of this cross-sectional study was to explore gender differences in the association between factors of the school environment and students' time spent in PA.</p> <p>Methods</p> <p>Among a sample of 10781 female and 10973 male students in grades 9 to 12 from 76 secondary schools in Ontario, Canada, student- and school-level survey PA data were collected and supplemented with GIS-derived measures of the built environment within 1-km buffers of the 76 schools.</p> <p>Results</p> <p>Findings from the present study revealed significant differences in the time male and female students spent in PA as well as in some of the school- and student-level factors associated with PA. Results of the gender-specific multilevel analyses indicate schools should consider providing an alternate room for PA, especially for providing flexibility activities directed at female students. Schools should also consider offering daily physical education programming to male students in senior grades and providing PA promotion initiatives targeting obese male students.</p> <p>Conclusions</p> <p>Although most variation in male and female students' time spent in PA lies between students within schools, there is sufficient between-school variation to be of interest to practitioners and policy-makers. More research investigating gender differentials in environment factors associated with youth PA are warranted.</p

Éditorial - Vers de nouvelles normes en environnement alimentaire pour le Canada

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Editorial - Seeking a new ‘normal’ in the Canadian food environment

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The Prevention Paradox and the Case for Universal Alcohol Policies

Background: Alcohol is a leading cause of death and disability in Canada. Governments in Ontario have been weakening universal alcohol policies, including controls on price and availability, while increasing investment in addiction treatment for high-risk individuals. According to Rose’s “prevention paradox”,1 more disease cases accrue in populations with low or moderate disease risk (i.e., low and medium volume users) because they are more numerous in the population than those at higher risk (i.e., high volume users). It is important to understand “who” experiences health harm from alcohol and at “what” level of consumption to inform policy that addresses alcohol-attributable health harm in Canada. Objective: To describe the distribution of alcohol-attributable healthcare encounters (emergency department (ED) visits and hospitalizations) across the drinking population in Ontario in 2019. Methods: The International Model of Alcohol Harms and Policies estimated alcohol-attributable healthcare encounters experienced across male and female drinking groups: (1) former (no past-year consumption); (2) low volume (≤5 standard drinks (SD)/week for females and males); (3) medium volume (&gt;5 to 10 SD/week for females and &gt;5 to 15 SD/week for males); and (4) high volume (&gt;10 SD/week for females and &gt;15 SD/week for males) (1 SD=13.45g ethanol). Healthcare encounters in Ontario included all fully and partially alcohol-attributable ED visits (n=231,914) in 2019 and hospitalizations (n=34,158) in 2018. Alcohol use exposure data were obtained from the Canadian Substance Use Exposure Database. Results: High volume drinkers (males: 23%, females: 13%) experienced a large portion of all alcohol-attributable ED visits (males: 65%, females: 49%) and hospitalizations (males: 71%, females: 50%). However, substantial healthcare encounters occurred among low and medium volume drinkers, especially among females. For example, 63% of females (males: 44%) were low volume drinkers who consumed 22% (males: 7%) of alcohol sold and experienced 31% and 20% (males: 14% and 7%) of alcohol-attributable ED visits and hospitalizations, respectively. Discussion: Evidence from Ontario supports the prevention paradox as substantial alcohol-attributable healthcare encounters were experienced among low and medium volume drinkers. Evidence-informed universal policy approaches are necessary to reduce population-level alcohol-attributable harm in Ontario. References McLaren L, McIntyre L, Kirkpatrick S. Rose’s population strategy of prevention need not increase social inequalities in health. Int J Epidemiol. 2010;39(2):372-377. doi:10.1093/ije/dyp31

The association between overweight and opportunity structures in the built environment:a multi-level analysis among elementary school youth in the PLAY-ON study

To examine school-level opportunity structures of the built environment and student characteristics associated with being overweight

Cancer warning labels on alcohol containers: a consumer's right to know, a Government's responsibility to inform, and an industry's power to thwart.

OBJECTIVE: Although the World Health Organization (WHO) declared alcohol a Class 1 carcinogen 30 years ago, few governments have communicated this fact to the public. We illustrate how alcohol industry groups seek to keep their customers in the dark about alcohol-related cancer risks. In Canada, a federally funded scientific study examining the introduction of cancer warning labels on containers was shut down following industry interference. We show that the industry complaints about the study had no legal merit. Of 47 WHO member countries with alcohol warning labels, only South Korea requires cancer warnings on alcohol containers. However, industry complaints, supported by sympathetic governments, helped weaken the warning labels' implementation. Ireland has legislated for cancer warnings but faces continuing legal opposition expressed through regional and global bodies. Cancer societies and the public health community have failed to counter industry pressures to minimize consumer awareness of alcohol's cancer risks. Placing cancer warnings on alcohol containers could make a pivotal difference in motivating both drinkers to consume less and regulators to introduce more effective policies to reduce the serious harms of alcohol consumption