Determinants of supplementation among Canadian university students: a theory of planned behavior perspective.

OBJECTIVE: The purpose of this study was to identify the psychosocial determinants of (1) intention to use dietary supplements (DS) and (2) the behavior of engaging in supplementation by testing the fit of the Theory of Planned Behavior (TPB). METHODS: A total of 778 students at a Canadian university in Ontario completed a cross-sectional survey assessing participants' attitude, injunctive norm, descriptive norm, perceived behavioral control and intention toward DS use. Data were analyzed using independent sample t-tests and linear and logistic regressions. RESULTS: Attitude, injunctive norm and perceived behavioral control were significant predictors of intention to use DS. Attitude, injunctive norm and intention were significant predictors of engaging in supplementation. The model explained 75.5% of the variance and correctly classified 89.6% of cases. The odds of using DS doubled with every one-unit increase in intention. CONCLUSIONS: This study confirms the utility of the TPB in predicting university students' supplementation habits.

Education Interventions to Improve Knowledge, Beliefs, Intentions and Practices with Respect to Dietary Supplements and Doping Substances: A Narrative Review.

The misuse of dietary supplements and doping substances is commonly associated with toxicity, nutritional imbalances, and health and psychological consequences. This is alarming especially in light of the increasing prevalence of the use of dietary supplements and doping, particularly among young adults including athletes. There is evidence that education interventions can lead to improved knowledge, intentions, and practices. However, no review has summarized and evaluated the effectiveness of such interventions. The aim of this article is to review the characteristics, contents and effects of education interventions that were designed and implemented to improve knowledge, attitudes, beliefs and intentions with respect to the use of dietary supplements and doping agents in different populations. PubMed, Scopus, CINAHL, PsycInfo and Google Scholar were searched for English-language education interventions targeting dietary supplements and doping substances. A total of 20 articles were identified and have generally provided consistent findings. Most interventions reported a significant improvement in knowledge on dietary supplements and doping agents. Unfortunately, the heavy reliance on self-reported assessment tools limits the validity of these interventions, with almost all articles targeting athletes and adolescents.

Registered Dietitians' Knowledge, Attitudes, and Behaviour Related to Physical Activity and Sedentariness.

Purpose: To explore knowledge, attitudes, and behaviour related to physical activity (PA) and sedentariness among registered dietitians (RDs) in family health teams in Ontario.Methods: This cross-sectional, descriptive study utilized a semi-structured interview guide to conduct qualitative interviews with 20 RDs. Self-administered questionnaires were used to assess personal PA (short version of the International Physical Activity Questionnaire) and sedentary behaviour (Sedentary Behavior Questionnaire).Results: Thematic analysis indicated that, in general, participants had good knowledge of PA and sedentariness. They were knowledgeable about the PA guidelines. They had positive attitudes toward PA and nonsedentariness, stating that both are important in the prevention and treatment of chronic conditions. Quantitative analysis indicated they had moderate-to-high PA levels and were fairly sedentary.Conclusions: This study supports the position that RDs can serve as excellent role models for PA. Though participants had basic knowledge, RDs may benefit from additional education regarding PA and sedentariness when counselling.

Dietary Supplementation Practices among Varsity Athletes at a Canadian University.

BACKGROUND: Given the risks of inadvertent doping associated with dietary supplement (DS) use, it is critical to explore the extent of dependence of varsity athletes on DS to improve performance and support recovery. The purpose of this study was to gain insight into dietary supplementation practices among varsity athletes in a university setting in Ontario, Canada. METHODS: An online DS use questionnaire was completed by 302 varsity athletes (30.5% male, 69.5% female; 20.5 ± 1.8-year old) who were competing in intermittent, power and endurance-based sports at the University of Guelph. The data from supplement users were analyzed using a Chi-square analysis to investigate type of DS consumption, frequency of use and reasons for use. RESULTS: Overall, 58.3% of athletes reported having used at least one type of DS in the past six months. Gender and age had significant associations with prevalence of DS use, with male athletes and athletes over 20-year old being more likely to be DS users. The most frequently reported reasons for consuming DS were to maintain good health, increase energy, promote recovery, correct or prevent micronutrient deficiencies and supply convenient forms of energy and/or macronutrients. Although, most athletes were using reliable sources of information, health care professionals, 58.6% still mentioned wanting to become more knowledgeable about DS. CONCLUSIONS: Findings from this study may guide the development of educational materials needed to address knowledge gaps on DS among varsity athletes.

Registered dietitians' beliefs and behaviours related to counselling patients on physical activity and sedentary behaviour from a theory of planned behaviour perspective.

BACKGROUND: Registered dietitians working in team-based primary care settings (e.g., family health teams [FHTs]) are positioned to counsel on physical activity and sedentary behaviour when providing nutrition-related services to promote health and prevent disease. This qualitative study explored FHT registered dietitians' beliefs and behaviours related to counselling patients on physical activity and sedentary behaviour. METHODS: Twenty registered dietitians in FHTs in Ontario, Canada were interviewed in person. Theory of planned behaviour guided the development of this cross-sectional, descriptive study. Thematic analysis was used to identify themes within each of the following theoretical constructs (topics): registered dietitians' behaviour (practice), behavioural intention, attitude, subjective norm, and perceived behavioural control related to physical activity and sedentary behaviour counselling. RESULTS: All participants counselled patients on physical activity, using some motivational interviewing strategies, and most counselled on sedentary behaviour. Many participants intended to continue their current physical activity counselling practices and increase sedentary behaviour counselling. Some participants had a positive attitude about the effectiveness of counselling on physical activity and sedentary behaviour, but their belief about effectiveness was dependent on factors such as time frame for behaviour change. Many participants felt that other health care professionals expected them to counsel on physical activity and they believed that other registered dietitians counsel on physical activity and sedentary behaviour. Facilitators to counselling included FHT dynamics and time with patients. In terms of barriers, almost all participants were confident in basic PA counselling only and contended that only this is within their scope of practice. Many participants posited that exercise prescription is outside their scope of practice. Other barriers included registered dietitians' lack of knowledge and not having a physical activity expert on the team. CONCLUSIONS: The results suggest that strategies are warranted to improve FHT registered dietitians' knowledge, attitude, and counselling skills related to physical activity and sedentary behaviour. This study provides a strong foundation to develop a theory-based, quantitative measure to assess physical activity and sedentary behaviour counselling practices and determinants among registered dietitians.

Understanding the Use of Dietary Supplements among Athlete and Non-Athlete University Students: Development and Validation of a Questionnaire.

BACKGROUND: The purpose of this study is to develop and test the validity and reliability of a questionnaire to evaluate dietary supplement use based on the Theory of Planned Behaviour (TPB). METHODS: The questionnaire has sections on demographics, physical activity, dietary supplements, and cognitive constructs based on the TPB. Three stages are followed. In Stage 1, elicitation interviews are conducted on five varsity athletes, five physically active non-athletes, and five physically inactive University of Guelph (UofG) students. In Stage 2, comments and ratings of the TPB-based statements are gathered from 10 subject matter experts to check for content validity. In Stage 3, Cronbach's α is calculated to determine the internal consistency of the cognitive constructs by a pilot test on 84 Applied Human Nutrition UofG students. RESULTS: Interviews assisted in the formulation of the cognitive constructs' statements, including intentions, attitudes, injunctive norms, descriptive norms, and perceived behavioural control. Content validity ensured that these constructs did not overlap. Few statements from the cognitive constructs were omitted based on findings from the reliability test, achieving acceptable Cronbach's α values across all constructs (≥0.70). CONCLUSIONS: This supplement use questionnaire will be used in a future study to investigate the use and determinants of dietary supplements among Canadian athlete and non-athlete UofG students.

Qualitative Pilot Study of Veterinarians' Perceptions of and Experiences with Counseling about Dog Walking in Companion-Animal Practice in Southern Ontario.

Dog walking is beneficial to dogs and their owners, and it supports One Health, an initiative devoted to improving the health of animals and humans. Despite the benefits of dog walking, many dogs and their owners are not engaging in adequate dog-walking exercise. One way to encourage dog walking is for veterinarians to counsel owners on dog walking during veterinary appointments. This pilot study used individual in-person or telephone interviews to understand veterinarians' perceptions of and experiences with counseling about dog walking in companion animal practice. Seventeen veterinarians licensed to provide canine care in Ontario participated in an interview in 2015. Thematic analysis was used to analyze the interview transcripts. Participants thought dog walking was important for both dogs and owners and discussed physical, social, and mental benefits of dog walking. Participants described barriers to dog-walking counseling including dog owners' lack of compliance or physical condition, dogs' behavior, and lack of time or low priority during appointments. Also, participants discussed how dog walking was not addressed in their professional veterinary education. These findings can be used to educate veterinary students and practicing veterinarians on the value of dog walking for people and dogs and the barriers they may face when counseling clients about dog walking.

School and classroom effects on Daily Physical Activity (DPA) policy implementation fidelity in Ontario classrooms: a multi-level analysis.

BACKGROUND: This paper examines school and classroom effects on Daily Physical Activity (DPA) policy implementation in classrooms in Ontario, Canada. In 2005 the Ontario Ministry of Education mandated a policy requiring school boards to "ensure that all elementary students, including students with special needs, have a minimum of twenty minutes of sustained MVPA each school day during instructional time". Based on an adaptation of Chaudoir's conceptual framework, this paper contributes to understanding the extent to which school factors (as reported by administrators) and classroom factors (as reported by teachers) are associated with policy implementation fidelity at the classroom level. METHODS: Cross-sectional online surveys were conducted in 2014 with elementary school administrators and teachers, based on representative random samples of schools and classrooms. A measure assessing implementation fidelity was developed from the six required components of the policy and for this paper fidelity at the classroom level is treated as the outcome variable. Several school- and classroom-level measures were also included in the surveys and a number of these were selected for inclusion here. Data from the two surveys were merged and selected variables were included in the multi-level analysis. Two-level logistic regression models were conducted to account for nesting of classrooms within schools and a series of models were conducted to identify factors associated with implementation fidelity. RESULTS: The analytic sample for this study included 170 school administrators and 307 classroom teachers from corresponding schools. Findings from the multi-level logistic regression analyses indicated that only classroom/teacher-level factors were significantly associated with implementation fidelity at the classroom level. None of the school/administrator predictors were significantly related to fidelity. The most parsimonious model included five significant classroom/teacher predictors: teachers' perception of DPA as realistic and achievable; confidence (self-efficacy); scheduling DPA in timetables; lack of space; and lack of time. CONCLUSIONS: Findings from the study indicate the theoretical and practical importance of addressing classroom and teacher factors since they are most proximal to implementation fidelity to the policy. Several of these factors also reflect complex structural and organizational contexts, indicating that a systems approach to understanding and supporting DPA implementation fidelity is warranted.

Eliciting Provider and Patient Perspectives on New Obesity Management Services in a Team-Based Primary Care Organization.

PURPOSE: Both providers and patients may have important insights to inform the development of obesity prevention and management services in Canadian primary care settings. In this formative study, insights for new obesity management services were sought from both providers and patients in 1 progressive citywide organization (150 physicians, team services, separate offices). METHODS: Seven focus groups with interprofessional health providers (n = 56) and 4 focus groups with patients (n = 34) were conducted. Two clinical vignettes (adult, child) were used to focus discussion. Four analysts coded for descriptive content and interpretative themes on possible tools and care processes using NVivo. RESULTS: Participants identified numerous strategies for care processes, most of which could be categorized into 1 or more of 11 themes: 6 directed at clinical care of patients (raising awareness, screening, clinical care, skill building, ongoing support, and social/peer support) and 5 directed at the organization (coordination/collaboration, creating awareness among health professionals, adding new expertise to the team, marketing, and lobbying/advocacy). CONCLUSIONS: The approach was successful in generating an extensive list of diverse activities to be considered for implementation studies. Both patients and providers identified that multiple strategies and systems approaches will be needed to address obesity management in primary care.

The experience of parental cancer among emerging adult university students.

Cancer is a disease that can have negative as well as some positive outcomes for the survivor, caregiver, and offspring. To date, there has been little research on the experiences of emerging adult offspring. When these offspring are also university students, they can experience unique challenges. In this phenomenological study, we explored the lived experience of parental cancer among emerging adult university students by interviewing 17 university students and using thematic analysis. The overarching themes were perceptions and beliefs about cancer, the outcomes of having a parent with cancer, influence of parental cancer on life as a university student, coping with having a parent with cancer, and attitudes and experiences around health and personal lifestyle. These results will be particularly useful to practitioners who provide services to university students experiencing parental cancer.

Intervention Mapping to Develop a Print Resource for Dog-Walking Promotion in Canada.

Promoting dog walking among dog owners is consistent with One Health, which focuses on the mutual health benefits of the human-animal relationship for people and animals. In this study, we used intervention mapping (a framework to develop programs and resources for health promotion) to develop a clearer understanding of the determinants of dog walking to develop curricular and educational resources for promoting regular dog walking among dog owners. Twenty-six adult dog owners in Ontario participated in a semi-structured interview about dog walking in 2014. Thematic analysis entailing open, axial, and selective coding was conducted. Among the reasons why the participating dog owners walk their dog were the obligation to the dog, the motivation from the dog, self-efficacy, the dog's health, the owner's health, socialization, a well-behaved dog, and having a routine. The main barriers to dog walking were weather, lack of time, the dog's behavior while walking, and feeling unsafe. We compared interview results to findings in previous studies of dog walking to create a list of determinants of dog walking that we used to create a matrix of change objectives. Based on these results, we developed a print resource to promote regular dog walking among dog owners. The findings can be used by veterinary educators to inform course content that specifically educates veterinary students on the promotion of dog walking among dog owners and the benefits to both humans and animals. The study also offers veterinarians a further understanding upon which to initiate a conversation and develop educational resources for promoting regular dog walking among dog-owning clients.

Undergraduate, Female, Nutrition Students' Perceptions of Curricular Influence on Attitudes toward Individuals with Obesity.

PURPOSE: This qualitative study, guided by a phenomenological approach, explored senior-level undergraduate, nutrition students' perceptions of how obesity and weight bias were addressed in the undergraduate curricula and how the curricula influenced their attitudes toward individuals with obesity. METHODS: Twenty senior-level undergraduate, nutrition students from the University of Guelph participated in interviews. Interviews were audio-recorded and transcribed verbatim. Thematic analysis entailed open, axial, and selective coding. RESULTS: Participants' sources of information about obesity in the curricula included nutrition courses, case studies, and non-nutrition courses. Regarding sources of information about weight bias in the curricula, they discussed nutrition courses, non-nutrition courses, and limited coverage of weight bias. Themes for curricular influence on attitudes toward people with obesity were increased knowledge of obesity, understanding the complexity of obesity, increased empathy toward individuals with obesity, and better ability to avoid stereotypes toward people with obesity. CONCLUSIONS: The perceptions among nutrition students varied regarding the amount and type of obesity and weight-bias information in the curricula, as well as the influence of the curricula on attitudes toward individuals with obesity, suggesting that obesity and weight bias warrant more coordinated coverage in the nutrition curricula.

Evaluation of Daily Physical Activity (DPA) policy implementation in Ontario: surveys of elementary school administrators and teachers.

BACKGROUND: School-based structured opportunities for physical activity can provide health-related benefits to children and youth, and contribute to international guidelines recommending 60 min of moderate-to-vigorous physical activity (MVPA) per day. In 2005, the Ministry of Education in Ontario, Canada, released the Daily Physical Activity (DPA) policy requiring school boards to "ensure that all elementary students, including students with special needs, have a minimum of twenty minutes of sustained MVPA each school day during instructional time". This paper reports on the first provincial study evaluating implementation fidelity to the DPA policy in Ontario elementary schools and classrooms. Using an adapted conceptual framework, the study also examined associations between implementation of DPA and a number of predictors in each of these respective settings. METHODS: Separate cross-sectional online surveys were conducted in 2014 with Ontario elementary school administrators and classroom teachers, based on a representative random sample of schools and classrooms. An implementation fidelity score was developed based on six required components of the DPA policy. Other survey items measured potential predictors of implementation at the school and classroom levels. Descriptive analyses included frequency distributions of implementation fidelity and predictor variables. Bivariate analyses examining associations between implementation and predictors included binary logistic regression for school level data and generalized linear mixed models for classroom level data, in order to adjust for school-level clustering effects. RESULTS: Among administrators, 61.4 % reported implementation fidelity to the policy at the school level, while 50.0 % of teachers reported fidelity at the classroom level. Several factors were found to be significantly associated with implementation fidelity in both school and classroom settings including: awareness of policy requirements; scheduling; monitoring; use of resources and supports; perception that the policy is realistic and achievable; and specific barriers to implementation. CONCLUSIONS: Findings from the surveys indicate incomplete policy implementation and a number of factors significantly associated with implementation fidelity. The results indicate a number of important implications for policy, practice and further research, including the need for additional research to monitor implementation and its predictors, and assess the impacts of study recommendations and subsequent outcomes of a reinvigorated DPA moving forward.

Adolescents' self-efficacy to overcome barriers to Physical Activity Scale.

This paper describes a revised measure of self-efficacy to overcome barriers to moderate and vigorous physical activity in a sample of 484 high school students in Toronto, Ontario. The students had a mean age of 15.3 years. Principal axis factoring with oblique rotation yielded five factors: self-efficacy to overcome internal, harassment, physical environment, social environment, and responsibilities barriers. Two problematic items were removed, which resulted in a 22-item measure. Subsequent analyses were conducted on responses to this shortened measure. Confirmatory factor analysis supported the five-factor model and demonstrated age- and sex-invariance. The subscales had good internal consistency reliability. Structural regressions demonstrated a strong relationship between the resulting factors and a physical activity measure (energy expenditure), showing predictive validity.

Clustering of specific health-related behaviours among Toronto adolescents.

PURPOSE: The clustering of specific health-related behaviours was examined among adolescents. METHODS: In 2005, cluster analysis was conducted to identify homogeneous groups of Toronto, Ontario, 14- to 17-year-old adolescents (n=445) with similar behaviour patterns according to self-reported measures of moderate to vigorous physical activity (metabolic equivalent [MET] hours a week of MVPA), sedentary behaviours (viewing television or videos, using a computer/the internet, doing homework, and talking with friends), fruit and vegetable consumption, and alcohol consumption. RESULTS: Three clusters of adolescents were identified: "active, high screen-time users," "active, low screen-time users," and "less active, least frequent drinkers." CONCLUSIONS: Identifying clusters of adolescents with similar health-related behaviour patterns suggests that researchers and practitioners should develop and implement interventions tailored to specific clusters.

The effect of parental feeding behaviours and participation of children in organized sports/activities on child body mass index.

PURPOSE: In this cross-sectional descriptive study, we explored the relationship of parental feeding practices and child physical activity levels with measured body mass index (BMI) in a sample of 97 Ontario preschoolers. METHODS: Child weight and height were measured; physical activity and sedentary behaviours were assessed by questionnaire. Preschoolers' parents used the Child Feeding Questionnaire to report their attitudes, concerns, and practices in relation to child feeding. Hierarchical multiple linear regression was used to determine relationships among variables. RESULTS: Up to 25% of the preschoolers were overweight and/or obese. The regression model accounted for 53% of the variance in child BMI. Child BMI was predicted to be higher when parents had concerns about and perceived their children to be overweight, and when they felt responsible for what their children ate. Children's BMIs were predicted to be lower for those whose parents pressured them to eat and also for those who engaged in organized sports or activities. CONCLUSIONS: This study suggests an association between BMI and parental perceptions, concerns, and practices related to child feeding and organized sports or activities. Public health initiatives related to healthy eating and/or obesity prevention should include a focus on parents of preschool-aged children with the home environment as a potential setting.

Challenges in assessing the implementation and effectiveness of physical activity and nutrition policy interventions as natural experiments.

The Ontario (Canada) government has instituted a policy requiring elementary schools to offer at least 20 min of daily physical activity for students in Grades 1-8 and replace non-nutritious vending machine foods with healthier choices. These policy interventions represent 'natural experiments' offering unique opportunities for conducting research and evaluation. The use of natural experiments to contribute evidence on the effectiveness of policy interventions is identified as an underused tool for public health [Tudor-Locke, C., Ainsworth, B. E. and Popkin, B. M. (2001) Active commuting to school: an overlooked source of children's physical activity? Sports Medicine, 31, 309-313; Petticrew, M., Cummins, S., Ferrell, C., Findlay, A., Higgins, C., Hoy, C. et al. (2005) Natural experiments: an underused tool for public health? Public Health, 119, 751-757]. To date, some Canadian school-based food and nutrition policies are being monitored, but their impact on child and youth obesity is unknown [Canadian Institute for Health Information. (2006) Improving the Health of Canadians: Promoting Healthy Weights, Ottawa, ON]. There are a number of challenges to the evaluation of policy interventions as natural experiments. Often, there are little or no baseline data available to use as the basis for assessing change. Government policies that result in the adoption of particular approaches across large jurisdictions, such as provinces, may result in wide variation in the design and implementation of interventions. Thus, in some cases, natural experiments may be at risk of having low potential to be adequately evaluated on key outcomes. In this paper, we discuss the context of these challenges in relation to the Ontario government school physical activity and nutrition policies.

Supporting healthy eating among preschoolers: challenges for child care staff.

PURPOSE: The child care setting can help preschoolers develop healthy eating habits. Establishing such habits may increase preschoolers' likelihood of carrying them into adulthood, which can decrease the risk of nutrition-related chronic diseases. Challenges in supporting preschoolers' healthy eating were investigated among child care staff. METHODS: Three focus group interviews were conducted with 29 child care staff members. Audiotapes of the sessions were transcribed. RESULTS: Several themes were identified from the analysis of the transcripts. An intrapersonal (individual) factor was children's picky eating. Interpersonal factors (interactions) included perceptions that parents do not encourage their children to eat in a healthy way, and that child care staff's use of practices were inconsistent with health professional recommendations. Physical environment factors included perceptions that healthy food was not accessible at child care centres and that children have unhealthy food at home. CONCLUSIONS: Program planners and health professionals can develop and implement strategies to overcome some of the identified challenges to supporting preschoolers' healthy eating.

The decline in physical activity among adolescent students: a cross-national comparison.

BACKGROUND: The decline in physical activity during adolescence is a key public health concern. This comparative study assesses whether the age-related decline in physical activity among high school students occurs similarly in the United States (U.S.) and Ontario, whether the decline in physical activity is steady throughout the age range, or whether any declines are age-specific. METHODS: Data are based on self-reports of 9th- to 12th-graders derived from the 2001 Youth Risk Behavior Survey (n=13,503) and the 2001 Ontario Student Drug Use Survey (n=1322). Physical activity is measured by the number of days of vigorous physical activity during the past 7 days. RESULTS: In both samples, there was a dominant and steady decline in physical activity between ages 14 and 18 years. The number of activity days was higher in the U.S. than in Ontario holding constant age and sex. However, a significant sample-by-age interaction showed that the decline in the percentage of U.S. students reporting 3 or more physical activity days was greater than it was in Ontario. CONCLUSIONS: While the pattern of decline was shown to be similar, the decline was stronger among US adolescents. Future research should examine additional factors influencing the decline in activity and the optimal timing of programs to reduce the decline.

The relationship between vigorous physical activity and juvenile delinquency: a mediating role for self-esteem?

Many policy-related reviews of the potential social value of sport and physical activity list the prevention of juvenile delinquency. We examined the relationships among vigorous physical activity, self-esteem, and delinquent behavior among adolescents in a large cross-sectional survey of Ontario adolescents. Data are based on questionnaires from 3,796 students (range 11-20 years) derived from the 2005 Ontario Student Drug Use Survey. Negative binominal regression methods were used to estimate both additive and interactive models predicting delinquent behavior. Vigorous physical activity was positively associated with delinquent behavior; however, this pattern of association was observed only among male adolescents. There was no evidence of a mediating role for self-esteem. Our findings suggest that physical activity is not the solution for reducing juvenile delinquency.