Advancing active living research in children: addressing active living measurement and evaluation while investigating the influence of diverse environmental exposures on physical activity and sedentary behaviour

The increasing prevalence of high sedentary behaviour and low physical activity has paved the way for upstream population health policy interventions that focus on modifying built environment to facilitate a population-wide decrease in sedentary behaviour and increase in physical activity. As a result of this, an inter-disciplinary field of study is gaining prominence to understand the influence of built environment on sedentary behaviour and physical activity ─ Active living research. Even though there is a growing body of evidence that indicates the influence of built environment on physical activity; active living research is still considered an emerging field due to critical gaps in its conceptualization and implementation. The purpose of this three study dissertation is to address some of these key gaps and lay the foundation for more rigorous active living research. With this dissertation being a quantitative component of an active living research initiative in Saskatoon, Saskatchewan, Canada, called Smart Cities Healthy Kids (www.smartcitieshealthykids.com), the primary gap addressed is the dearth of active living research among children. Moreover, the three independent studies that compose this dissertation build upon each other’s evidence by developing evidence-based methods to address measurement and evaluation of active living evidence. Study One: Although, physical activity and sedentary behaviour are increasingly measured with objective devices such as accelerometers, there still exists a possibility of inducing measurement bias due to the disproportionate amount of time these devices are worn (wear-time) by participants. This study specifically explores wear-time variation, both within and between participants, and thereafter, examines the influence of systematic wear-time variation on the accumulation of physical activity and sedentary behaviour. In doing so, this study proposes a data standardization methodology to minimize measurement bias due accelerometer wear-time variation. Study Two: Increasingly, research indicates that sedentary behaviour is independently associated with a wide range of health outcomes; however, thus far, active living research has predominantly focused on only physical activity. Moreover, even though physical activity and sedentary behaviour are two distinct behaviours, their inter-dependent relationship needs to be studied in the same environment. This study examines the influence of urban design, neighbourhood built and social environment, and household and individual factors (i.e., diverse environmental exposures) on objectively measured physical activity and sedentary behaviour in children aged 10-14 years. In doing this, this study combines its evidence with the World Health Organization physical activity guidelines to develop age-specific activity profiles. Generation of activity profiles enables a holistic picture of the influence of environment on the interplay between two distinct, yet related behaviours ─ physical activity and sedentary behaviour. The ultimate purpose of these activity profiles is to advance a consistent method to evaluate and compare active living evidence. Study Three: To date, active living research has predominantly been conducted without taking variation in weather into account. Moreover, emerging evidence indicates that studying the influence of environment on physical activity and sedentary behaviour without considering weather variation, especially in the Canadian context, could generate results of low validity. Thus, this study aims to understand the influence of variation in weather on objectively measured physical activity and sedentary behaviour in children aged 10-14 years. More importantly, as weather is non-modifiable, the greater focus of this study is to understand how diverse environmental exposures, including urban design, moderate the influence of weather on physical activity and sedentary behaviour during the transition from spring to summer in Saskatoon, Saskatchewan, Canada. Conclusions: The three studies in the dissertation sequentially address key gaps in active living research. Study one proposes a methodology to minimize measurement bias and improve the analysis rigour of objective physical activity and sedentary behaviour data. Study two, taking diverse environmental exposures into consideration, investigates the inter-dependent nature of physical activity and sedentary behaviour, and proposes age-specific activity profiles that can be used to evaluate and compare active living evidence. Finally, study three reiterates the need to include weather variation in active living research by examining how environmental exposures moderate the influence of weather variation on physical activity and sedentary behaviour. The factor that encompasses all three studies is the age group of the participants ─ 10 to 14 years. This age group reflects the transition from preadolescence to adolescence. Evidence indicates that physical activity and sedentary behaviour levels during adolescence track into adulthood, hence this dissertation aims to generate evidence that would advance active living interventions in this vital demographic. Specific to Saskatoon, preliminary evidence of this dissertation has aided the conceptualization of a Canadian Institutes of Health Research funded longitudinal study that will examine the influence of built environment on physical activity and sedentary behaviour in children aged 10-14 years in all four seasons of Saskatoon. Ultimately, in-depth evidence of this dissertation will also inform the implementation and analysis of the longitudinal study

Digital citizen science for ethical surveillance of physical activity among youth: mobile ecological momentary assessments vs. retrospective recall

Physical inactivity is the fourth leading risk factor of mortality globally. Hence, understanding the physical activity (PA) patterns of youth is essential to manage and mitigate non-communicable diseases. As digital citizen science approaches utilizing citizen-owned smartphones to ethically obtain PA big data can transform PA surveillance, this study aims to understand the frequency of PA reported by youth using smartphone-deployed retrospective validated surveys compared to prospective time-triggered mobile ecological momentary assessments (mEMAs). Using a digital citizen science methodology, this study recruited youth citizen scientists (N = 808) in 2018 (August 31- December 31) in Saskatchewan, Canada. Youth citizen scientists (age 13 to 21) reported their PA using prospective mEMAs and retrospective surveys over an eight-day period. A significant difference was found in reporting the frequency of PA retrospectively vs. prospectively via mEMAs (p < 0.000). Ethnicity, parental education, and strength training were associated with prospective PA frequency; however, no associations were significant with retrospective PA frequency. With access to ubiquitous digital devices growing worldwide, and youth having particularly high digital literacy, digital citizen science for the ethical surveillance of PA using mEMAs presents a promising approach for the management and prevention of non-communicable diseases among youth

Shaping Policy Change in Population Health: Policy Entrepreneurs, Ideas, and Institutions

Political realities and institutional structures are often ignored when gathering evidence to influence population health policies. If these policies are to be successful, social science literature on policy change should be integrated into the population health approach. In this contribution, drawing on the work of John W. Kingdon and related scholarship, we set out to examine how key components of the policy change literature could contribute towards the effective development of population health policies. Shaping policy change would require a realignment of the existing school of thought, where the contribution of population health seems to end at knowledge translation. Through our critical analysis of selected literature, we extend recommendations to advance a burgeoning discussion in adopting new approaches to successfully implement evidence-informed population health policies

Shaping Policy Change in Population Health: Policy Entrepreneurs, Ideas, and Institutions

Abstract Political realities and institutional structures are often ignored when gathering evidence to influence population health policies. If these policies are to be successful, social science literature on policy change should be integrated into the population health approach. In this contribution, drawing on the work of John W. Kingdon and related scholarship, we set out to examine how key components of the policy change literature could contribute towards the effective development of population health policies. Shaping policy change would require a realignment of the existing school of thought, where the contribution of population health seems to end at knowledge translation. Through our critical analysis of selected literature, we extend recommendations to advance a burgeoning discussion in adopting new approaches to successfully implement evidence-informed population health policies

Do school physical activity policies and programs have a role in decreasing multiple screen time behaviours among youth?

The final publication is available at Elsevier via http://dx.doi.org/10.1016/j.ypmed.2017.11.026 © 2018. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/Screen time in youth has been associated with a wide range of poor health outcomes. Evidence indicates the need to develop physical activity (PA) school policies and programs that are aimed at decreasing youth screen time behaviours. This study aims to understand the association between PA policies and programs embedded into the functioning of 89 schools across two provinces in Canada and multiple screen time behaviours. As part of the COMPASS Study, a total of 44,861 youth aged between 13 and 18 years and belonging to 89 schools in two Canadian provinces completed a validated questionnaire for health behaviours and outcomes data. PA policies and programs were measured using the School Policies and Practices Questionnaire, completed by the relevant school administrator. Participation in before-school, noon hour, or after-school intramural programs, participation in varsity sports, and access to indoor areas of PA during non-instructional time, was associated with significantly lower multiple screen time behaviours across both provinces. With exposure to multiple electronic and digital devices only predicted to increase among youth in the future, there is a need to conceptualize and integrate school-based screen time reducing PA policies and programs into the regular functioning of the schools.supported by a bridge grant from the Canadian Institutes of Health Research (CIHR) Institute of Nutrition, Metabolism and Diabetes (INMD) through the “Obesity - Interventions to Prevent or Treat” priority funding awards (OOP-110788; grant awarded to S. Leatherdale) Operating grant from the Canadian Institutes of Health Research (CIHR) Institute of Population and Public Health (IPPH) (MOP-114875; grant awarded to S. Leatherdale)

Global Matrix 3.0 Physical Activity Report Card Grades for Children and Youth: Results and Analysis From 49 Countries

Background: Accumulating sufficient moderate to vigorous physical activity is recognized as a key determinant of physical, physiological, developmental, mental, cognitive, and social health among children and youth (aged 5–17 y). The Global Matrix 3.0 of Report Card grades on physical activity was developed to achieve a better understanding of the global variation in child and youth physical activity and associated supports. Methods: Work groups from 49 countries followed harmonized procedures to develop their Report Cards by grading 10 common indicators using the best available data. The participating countries were divided into 3 categories using the United Nations’ human development index (HDI) classification (low or medium, high, and very high HDI). Results: A total of 490 grades, including 369 letter grades and 121 incomplete grades, were assigned by the 49 work groups. Overall, an average grade of “C-,” “D+,” and “C-” was obtained for the low and medium HDI countries, high HDI countries, and very high HDI countries, respectively. Conclusions: The present study provides rich new evidence showing that the situation regarding the physical activity of children and youth is a concern worldwide. Strategic public investments to implement effective interventions to increase physical activity opportunities are needed

Global matrix 4.0 physical activity report card grades for children and adolescents : results and analyses from 57 countries

Background: The Global Matrix 4.0 on physical activity (PA) for children and adolescents was developed to achieve a comprehensive understanding of the global variation in children’s and adolescents’ (5–17 y) PA, related measures, and key sources of influence. The objectives of this article were (1) to summarize the findings from the Global Matrix 4.0 Report Cards, (2) to compare indicators across countries, and (3) to explore trends related to the Human Development Index and geo-cultural regions. Methods: A total of 57 Report Card teams followed a harmonized process to grade the 10 common PA indicators. An online survey was conducted to collect Report Card Leaders’ top 3 priorities for each PA indicator and their opinions on how the COVID-19 pandemic impacted child and adolescent PA indicators in their country. Results: Overall Physical Activity was the indicator with the lowest global average grade (D), while School and Community and Environment were the indicators with the highest global average grade (C+). An overview of the global situation in terms of surveillance and prevalence is provided for all 10 common PA indicators, followed by priorities and examples to support the development of strategies and policies internationally. Conclusions: The Global Matrix 4.0 represents the largest compilation of children’s and adolescents’ PA indicators to date. While variation in data sources informing the grades across countries was observed, this initiative highlighted low PA levels in children and adolescents globally. Measures to contain the COVID-19 pandemic, local/international conflicts, climate change, and economic change threaten to worsen this situation