To use or not to use behavioural science evidence in designing health promotion interventions: Identification of targets for capacity building.

OBJECTIVES: The behavioural sciences provide useful evidence to design effective health promotion interventions, but evidence is infrequently integrated in practice. This study examined associations between theoretical domains framework (TDF) constructs and public health practitioners' use of behavioural science evidence to plan public health actions. METHODS: Using a cross-sectional design, a convenience sample of 160 practitioners were recruited from public health agencies across Canada. Respondents completed an online questionnaire assessing TDF constructs and the use of behavioural science theory and approaches (i.e., evidence) in their practice. Logistic regression analyses allowed for identification of factors associated with evidence use and intentions. All analyses were adjusted for sex, years of experience, and type of public health agency. RESULTS: Greater skills (ORadj = 4.1, 95%CI 1.3, 13.5) and stronger intentions/aligned goals (ORadj = 9.2, 95%CI 2.3, 36.1) were associated with greater use of behavioural science evidence to plan public health actions. Greater perceived capacity to overcome widespread absence of use of behavioural science evidence in their organization (ORadj = 7.2, 95%CI 1.7, 30.3) was also associated with greater use. More knowledge (ORadj = 8.6, 95%CI 1.9, 39.1) and stronger beliefs about consequences (ORadj = 4.0, 95%CI 1.1, 14.7) were significantly associated with stronger intentions/aligned goals. CONCLUSION: Findings show that more knowledge, positive attitudes, and stronger perceived competence are associated with greater likelihood of using behavioural science evidence to plan interventions. The use of behavioural science evidence will also require strengthening the norm pertaining to this professional practice in public health organizations.

RéSUMé: OBJECTIFS: Les sciences du comportement fournissent de riches données probantes pour développer des interventions efficaces en promotion de la santé. Toutefois, ces connaissances issues de la recherche ne sont pas fréquemment intégrées dans la pratique. Cette étude examine les associations entre les construits du modèle des domaines théoriques (MDT) et le comportement d'utiliser les données probantes en science du comportement pour planifier les actions de santé publique auprès de professionnel.le.s de ce domaine. MéTHODES: Via l'utilisation d'un devis transversal, un échantillon de convenance de 160 professionel.le.s a été recruté au travers du Canada. Les répondants ont rempli un questionnaire en ligne qui mesurait les construits du MDT et l'utilisation des approches et théories des sciences du comportement (i.e., les données probantes) dans leur pratique professionnelle. Des analyses de régression logistique ont permis d'identifier les facteurs associés à ce comportement et les intentions. Toutes les analyses ont été ajustées pour le sexe, le nombre d'années d'expérience et le type d'agences de santé publique. RéSULTATS: De grandes habiletés (RCadj = 4,1, IC95%: 1,3­13,5) et des intentions fortes/buts cohérents (RCadj = 9,2, IC95%: 2,3, 36,1) étaient associés à une plus grande utilisation des données probantes en science du comportement pour planifier des actions de santé publique. Une plus grande capacité à surmonter l'absence généralisée de l'utilisation des données probantes en science du comportement dans son organisation (RCadj = 7,2, IC95%: 1,7, 30,3) était aussi associée à une plus grande utilisation. Des connaissances plus grandes (RCadj = 8,6, IC95%: 1,9, 39,1) et des croyances plus importantes concernant les résultats (RCadj = 4,0, IC95%: 1,1, 14,7) étaient significativement associées à de plus fortes intentions/cohérence dans les buts. CONCLUSION: Les résultats montrent que des connaissances plus grandes, des attitudes favorables et une plus forte perception en ses habiletés sont associées à de plus grandes possibilités d'utiliser les données probantes en science du comportement pour planifier des interventions. L'utilisation de ces données probantes en science du comportement va également demander un renforcement dans les normes entourant cette pratique professionnelle dans les organisations de santé publique.

Patient and professional perspectives on physical activity promotion in routine cancer care: a qualitative study.

BACKGROUNDS: Physical activity is associated with many benefits in reducing cancer symptoms and treatments side effects. Yet, studies consistently show that knowledge about physical activity is under-promoted among people diagnosed with cancer. Therefore, we aimed to contribute to filling this gap by ascertaining patient and professional perspectives regarding physical activity promotion. METHODS: This study took place in Montreal, Canada. We conducted individual, semi-structured interviews with cancer patients who participated in a physical activity program and professionals working in the healthcare system. Participants had to be aged over 18 years, be able to communicate verbally in either English or French, and consent to an audio-recorded interview. A hybrid deductive-inductive approach to content analysis was applied to analyze interview transcripts using Dedoose and Microsoft Excel software. RESULTS: Our sample comprised 21 patients (76.2% women) and 20 professionals (80% women). We identified 24 factors (barriers, facilitators, and improvement suggestions) influencing physical activity promotion across organizational, community, and social levels. Results suggest that to improve physical activity promotion in cancer care, it is necessary to showcase exercise specialists as a healthcare resource, to champion for this change within health organizations, to develop partnerships between public and private sectors of the health and fitness industries, and to reassess social norms concerning cancer survivorship and treatment. CONCLUSION: These findings shed light on the gaps and the bright lights in physical activity promotion for people diagnosed with cancer across numerous levels.

Reasons for High Emergency Department Use Among Patients With Common Mental Disorders or Substance-Related Disorders.

Aims: This study examined the reasons for high emergency department (ED) use among patients with common mental disorders (MDs), substance-related disorders (SRDs) or co-occurring MDs-SRDs. Method: Following content analysis, 42 high ED users (three-plus visits/year) recruited in two Quebec EDs were interviewed. Results: The reasons included barriers to outpatient care, patient disabilities and professional practices. Patients with SRDs trust outpatient services less, those with MDs had important unmet needs and those with MDs-SRDs faced care coordination issues. Conclusion: Improvements such as ED use monitoring, consolidating MD-SRD practices and continuous training are needed in EDs and outpatient services to enhance access and continuity of care.

Early family socioeconomic status and asthma-related outcomes in school-aged children: Results from seven birth cohort studies.

OBJECTIVE: To examine the associations between maternal education and household income during early childhood with asthma-related outcomes in children aged 9-12 years in the UK, the Netherlands, Sweden, Australia, the USA and Canada. METHODS: Data on 31 210 children were obtained from 7 prospective birth cohort studies across six countries. Asthma-related outcomes included ever asthma, wheezing/asthma attacks and medication control for asthma. Relative social inequalities were estimated using pooled risk ratios (RRs) adjusted for potential confounders (child age, sex, mother ethnic background and maternal age) for maternal education and household income. The Slope Index of Inequality (SII) was calculated for each cohort to evaluate absolute social inequalities. RESULTS: Ever asthma prevalence ranged from 8.3% (Netherlands) to 29.1% (Australia). Wheezing/asthma attacks prevalence ranged from 3.9% (Quebec) to 16.8% (USA). Pooled RRs for low (vs high) maternal education and low (vs high) household income were: ever asthma (education 1.24, 95% CI 1.13 to 1.37; income 1.28, 95% CI 1.15 to 1.43), wheezing/asthma attacks (education 1.14, 95% CI 0.97 to 1.35; income 1.22, 95% CI 1.03 to 1.44) and asthma with medication control (education 1.16, 95% CI 0.97 to 1.40; income 1.25, 95% CI 1.01 to 1.55). SIIs supported the lower risk for children with more highly educated mothers and those from higher-income households in most cohorts, with few exceptions. CONCLUSIONS: Social inequalities by household income on the risk of ever asthma, wheezing/asthma attacks, and medication control for asthma were evident; the associations were attenuated for maternal education. These findings support the need for prevention policies to address the relatively high risks of respiratory morbidity in children in families with low socioeconomic status.

Sociodemographic characteristics help predict Canadian urbanites' acceptability of restaurant food environment policies.

Introduction: Public acceptability of policies aiming to improve the healthfulness of the restaurant food environment is key to their successful implementation. Yet, the acceptability of these policies remains ambiguous, especially across diverse population groups. This study aims to examine associations between sociodemographic characteristics and acceptability levels of three restaurant food environment policies of varying degrees of intrusiveness across 17 urban Canadian jurisdictions. Methods: Data was extracted from the THEPA survey, one of the largest and most jurisdictionally comprehensive surveys on intervention acceptability (N = 27,162). To account for potential jurisdictional differences in acceptability, for each policy, multilevel logistic regression models were developed. Results: Results indicated that, on average, those in complete agreement with the implementation of the targeted policies represented 20.3%-26.9% of participants, depending on the policy. Acceptability varied according to policy intrusiveness, jurisdiction, and participants' sociodemographic characteristics. Women, individuals with household incomes of <$40,000/year, immigrants from a high-income country other than Canada, and Indigenous peoples were more likely to express complete agreement with all policies, versus men, participants with household incomes of $40,000-$79,999/year, Canadian-born individuals, and non-Indigenous individuals. A lower likelihood of expressing complete agreement with all policies was observed for those with a $80,000-$119,999/year household income, versus those with a $40,000-$79,999/year household income. For selected policies and models, other sociodemographic characteristics (i.e., age, education, and being born in a low-or middle-income country) predicted acceptability. The examined sociodemographic characteristics did not explain jurisdictional differences in acceptability. Discussion: Understanding jurisdictional differences in acceptability merits further research. Policy implications involve engaging diverse sociodemographic groups in conversations about acceptable ways in which their restaurant food environment could be rendered more healthful.

Evolution of Sleep Duration and Screen Time Between 2018 and 2022 Among Canadian Adolescents: Evidence of Drifts Accompanying the COVID-19 Pandemic.

PURPOSE: We quantified the joint evolution of sleep duration and screen time between 2018 and 2022 in a large sample of adolescents from Quebec, Canada, to ascertain changes that occurred during the COVID-19 pandemic. METHODS: A natural experiment design was used to compare variations from year to year and in association with the pandemic outbreak. Using structural equation modeling on data collected between 2018 and 2022 among adolescents attending 63 high schools, we analyzed the joint evolution of sleep duration and screen time while adjusting for previous year values, concurrent flourishing score, sex, age, and family level of material deprivation. RESULTS: A total of 28,307 adolescents, aged on average 14.9 years, were included in the analyses. Between 2019 and 2022, sleep duration increased by 9.6 (5.7, 13.5) minutes and screen time by 129.2 (120.5, 138.0) minutes on average. In 2022, the adolescents spent almost equal amounts of time sleeping and using screens. Lower flourishing scores were associated with shorter sleep duration and lengthier screen time. Girls' screen time became similar to boys' over time. DISCUSSION: Adolescents now spend almost equal amounts of time sleeping and using screens, a situation that calls for urgent public health actions. These findings highlight the importance of tracking changes in adolescents' behaviours over time, to design and implement interventions adapted to the changing health needs of different groups.

"In My Mind, It Was Just Temporary": A Qualitative Study of the Impacts of Cancer on Men and Their Strategies to Cope.

Individuals who are diagnosed and treated for cancer use a variety of strategies to manage its impacts. However, there is currently a lack of research on men's experience with managing cancer impacts, which is necessary to better support them throughout the cancer care continuum. This study explored the experience of men diagnosed with cancer, focusing on the impacts of the illness and its treatment and men's strategies to cope. A qualitative descriptive design was used. Thirty-one men (Mage = 52.7 [26-82] years) diagnosed with various cancer types were recruited to take part in individual telephone interviews (n = 14) or online focus groups (n = 17) addressing the impacts of cancer and strategies they used to cope with these impacts. Directed content analysis was performed, using Fitch's (2008) supportive care framework to guide the analysis. Cancer impacts and strategies used to cope were classified into six categories: physical, psychological, interpersonal, informational, practical, and spiritual. Results indicate that the cancer experience is diverse and multifaceted rather than homogeneous. Medical and supportive care services could be more effectively personalized to meet the diversity of men's needs by adopting a comprehensive and holistic approach to supportive care. Working in partnership with patients, it appears promising to recognize and identify men's needs and match them to appropriate resources to provide truly supportive care.

Perceived autonomy support from healthcare professionals and physical activity among breast cancer survivors: A propensity score analysis.

The majority of women treated for breast cancer are physically inactive although physical activity (PA) could attenuate many adverse effects of cancer and treatment. Autonomy support from healthcare professionals may improve PA initiation, adherence and maintenance. This study aimed to determine, using a causal inference approach, whether or not perceived autonomy support (PAS) from healthcare professionals is associated with light, moderate, and vigorous intensity PA among women treated for breast cancer. Data were drawn from the longitudinal study "Life After Breast Cancer: Moving On" (n = 199). PAS was measured with the Health Care Climate Questionnaire and PA was assessed using GT3X triaxial accelerometers. Associations between PAS and PA were estimated with linear regressions and adjusted estimations were obtained using propensity score-based inverse probability of treatment weights (IPTW). Results reveal no association between PAS and PA of light ([Formula: see text](95%CI) = -0.09 (-0.68, 0.49)), moderate ([Formula: see text] (95%CI) = -0.03 (-0.17, 0.11)), or vigorous ([Formula: see text](95%CI) = 0.00 (-0.03, 0.02)) intensity. Different forms of engagement and support by healthcare professionals should be explored to identify the best intervention targets to encourage women to adopt and maintain regular PA in the cancer continuum.

Milestones and turning points in the experience of physical activity throughout cancer care: a qualitative study to inform physical activity promotion.

PURPOSE: Physical activity (PA) is an important supportive care strategy to manage cancer and treatment-related side effects, yet PA participation is low among people diagnosed with cancer. This study examined patients', health professionals', and managers' perspectives on PA throughout cancer care to glean implications for PA promotion. METHODS: Random selection and purposeful sampling methods allowed for the recruitment of 21 patients (76.2% women) and 20 health professionals and managers (80% women) who participated in individual semi-structured interviews. Interview questions explored facilitators and barriers to PA participation and promotion across the cancer care continuum. Interviews were audio-recorded and transcribed. Then, qualitative thematic analysis was performed. RESULTS: The analysis produced five main themes describing milestones in PA participation throughout cancer care: (1) Getting Started, (2) Discovering PA Resources, (3) Taking Action, (4) Striving for Change, and (5) Returning to a "New Normal." The sub-themes underscored turning points, i.e., tasks and challenges to PA participation that had to be overcome at each milestone. Achieving milestones and successfully navigating turning points were dependent on clinical, social, and community factors. CONCLUSION: Cancer patients appear to progress through a series of milestones in adopting and maintaining PA throughout cancer care. Intervention strategies aimed at promoting PA could test whether support in navigating turning points could lead to greater PA participation. These findings require replication and extension, specifically among patients who are men, younger adults, and culturally diverse.

Increased urban greenspace in childhood associated with lower inattention deficit among adolescents.

PURPOSE: There is a growing interest in assessing the benefits of exposure to urban greenspace on mental health due to the increased urbanization of youth and concerns for their mental health. We investigated the prospective associations of residential greenspace in childhood and mental health in adolescence. Use of a well-characterized birth cohort permitted adjustment for a range of potential confounding factors including family and neighborhood characteristics in addition to prior mental health problems, and exploration of moderation effects by sex and family socioeconomic status. METHODS: We analyzed longitudinal data collected from 742 urban-dwelling participants of the Quebec Longitudinal Study of Children Development. The Normalized Difference Vegetation Index (NDVI) within 250, 500, and 1000 m buffer zones surrounding the home residence was used to indicate childhood exposure to greenspace. Six self-reported mental health problems at 15/17 years were examined using the Mental Health and Social Inadaptation questionnaire: inattention, hyperactivity/impulsivity, conduct, depression, anxiety, and suicidal ideation. RESULTS: Childhood urban greenspace was associated with lower inattention problems in both females and males. We observed a 0.14 reduced standard deviation (SD) (ß = - 0.14, SE = 0.05, p < 0.01) in relation to an interquartile range (IQR) increase of NDVI (0.15) at the 250 m buffer zone, and similar results were found in 500 m and 1000 m buffer zones. These associations only slightly attenuated after adjustment for individual (sex, childhood mental health), family (family SES, maternal age at birth, parental mental health, family composition), and neighborhood (material and social deprivation) characteristics (ß = - 0.13, SE = 0.06, p = 0.03). No association was found for other mental health problems, and no moderation associations of sex or family socioeconomic status were observed. CONCLUSION:  These findings suggest that increasing residential greenspace in cities may be associated with modest benefits in attentional capacities in youth, necessitating further research to elucidate the underlying mechanisms.

Barriers and facilitators of supportive care access and use among men with cancer: a qualitative study.

PURPOSE: Men diagnosed with cancer are underrepresented in existing supportive care programming and related research, with preliminary indications that men face unique challenges in accessing and engaging with such services. This study aims to identify barriers and facilitators related to the supportive care service access and use among men diagnosed with cancer. METHODS: From March to May 2021, thirty-one Quebec men (Mage = 52.7, range:(26-82 years) diagnosed with various cancer types were recruited to take part in individual telephone interviews (n = 14) or online focus groups (n = 17) addressing experiences of cancer supportive care services. Content analysis of qualitative data was performed. RESULTS: Barriers and facilitators to men's supportive care access and use were grouped into four categories: (1) alignment between services and men's needs and preferences; (2) delivery of services in an accessible, inclusive, and responsive way; (3) communication and promotion of services in ways that are acceptable, appealing, and attractive to men; and (4) social norms and perceptions of gender and masculinity affecting men's perceptions of and engagement with services. CONCLUSIONS: Barriers and facilitators influencing access and use of supportive care services in men are numerous and diverse. These findings may inform the development of new and the adaptation of current supportive care strategies to better address men's needs and preferences after a cancer diagnosis. IMPLICATIONS FOR CANCER SURVIVORS: Increased adequacy of services tailored to men's needs and preferences, with an emphasis on supporting men to take an active role in their recovery, could improve access and adherence to care. Services adopting a more integrated, patient-centered, and holistic approach to service delivery could positively impact the cancer care trajectory and health outcomes of men. Larger systemic changes may be needed to support men in engaging in currently existing activities and services.

Examining public health practitioners' perceptions and use of behavioural sciences to design health promotion interventions.

BACKGROUND: Behavioural sciences have been shown to support the development of more effective interventions aimed at promoting healthy lifestyles. However, the operationalization of this knowledge seems to be sub-optimal in public health. Effective knowledge transfer strategies are thus needed to optimize the use of knowledge from behavioural sciences in this field. To this end, the present study examined public health practitioners' perceptions and use of theories and frameworks from behavioural sciences to design health promotion interventions. METHODS: This study adopted an exploratory qualitative design. Semi-structured interviews were conducted among 27 public health practitioners from across Canada to explore current intervention development processes, the extent to which they integrate theory and framework from behavioural sciences, and their perceptions regarding the use of this knowledge to inform intervention design. Practitioners from the public sector or non-profit/private organizations who were involved in the development of interventions aimed at promoting physical activity, healthy eating, or other healthy lifestyle habits (e.g., not smoking) were eligible to participate. RESULTS: Public health practitioners generally agreed that behaviour change is an important goal of public health interventions. On the other hand, behavioural science theories and frameworks did not appear to be fully integrated in the design of public health interventions. The main reasons were (1) a perceived lack of fit with current professional roles and tasks; (2) a greater reliance on experiential-produced knowledge rather than academic knowledge (mainly for tailoring interventions to local setting characteristics); (3) the presence of a fragmented knowledge base; (4) the belief that theories and frameworks require too much time and resources to be operationalized; and 4) the belief that using behavioural sciences might undermine partnership building. CONCLUSIONS: This study provided valuable insights that may inform knowledge transfer strategies that could be optimally designed to support the integration of behavioural sciences theories and frameworks into public health practices.

Desire and craving measured using behavioral ratings and brain network topology differ significantly among moderate to heavy alcohol consumers.

BACKGROUND: "Craving" is a central concept in alcohol research, but the semantic interpretation of craving as a concept varies. Multiple studies that have investigated differences in operational definitions of craving have demonstrated a lack of agreement among them. This study investigated whether moderate to heavy drinkers would rate craving and "desire" for alcohol similarly and explored potential neurobiological differences underpinning feelings of craving and desire. METHODS: Thirty-nine individuals who consumed an average of at least 7 drinks/week for females and 14 drinks/week for males were studied across 3-day periods of their typical alcohol consumption and imposed abstinence. Ratings of desire and craving for alcohol were collected approximately every three hours during waking periods across the two experimental periods (n = 35, 17 males). At the end of each period, participants underwent functional MRI scanning during neutral and alcohol image viewing (n = 39, 17 males) followed by ratings of desire and craving for alcohol (n = 32, 16 males). Survey responses were analyzed using 2-level nested hierarchical modeling, image ratings were compared using a hierarchical mixed-effects regression, and brain networks constructed from fMRI data were assessed with a two-part mixed-effect regression (α = 0.05 in all analyses). RESULTS: Ratings of desire and craving differed significantly from one another in the survey data and in the ratings collected during image viewing. The strength of the desire experience was higher overall than craving, but the fluctuations over time were similar. Results for desire and craving differed on brain network attributes associated with distributed processing and those regional specific within the default mode network. Significant associations were found between ratings of desire and connection strength and between ratings of craving and connection probability. CONCLUSIONS: These results demonstrate that the difference between ratings of craving for alcohol and desire for alcohol is not trivial. The different ratings and their association with alcohol consumption or abstinence experiences may have significant biological and clinical implications.

Protocol for the Open Sky School: a two-arm clustered randomized controlled trial to test the effectiveness of a nature-based intervention on mental health of elementary school children.

BACKGROUND: This article outlines the protocol for a trial to test the effectiveness of a nature-based intervention called Open Sky School to reduce mental health problems among elementary school children. Experimental studies show that contact with nature (e.g. walks in parks) improve mental health. A growing number of teachers have been applying outdoor education within the regular school curriculum and evidence suggests that such teaching methods could improve students' mental health but a randomized controlled trial has never been conducted. METHODS: A two-arm clustered randomized controlled trial will be conducted in elementary schools across Québec, Canada. Following informed consent by teachers, parents and students, schools will be randomly assigned 1:1 to the intervention or the control group with a total of 2500 5-6th grade students and 100 teachers expected to participate. The intervention will take place outdoors in a green-space (2 h per week for 12 weeks) and include a toolkit of 30 activities to foster well-being (e.g. mindfulness) and academic competencies (e.g. mathematics). Questionnaires will be administered to teachers and students before, immediately after and 3 months after the intervention. The primary outcome will be reductions of mental health problems in children from pre-to-post test (Social Behavior Questionnaire: self and teacher reports). Secondary outcomes include depression, positive and negative affect, nature connectedness, and pro-environmental behaviors among children. We will explore, immediate benefits on teacher's well-being and positive and negative affect and sustained benefits among students at 3 months follow-up. For the primary outcome, we will explore moderators including child's sex, child's disability status, the green-space of neighbourhoods, the school's socio-economic position and teacher's experience. DISCUSSION: In conducting the first randomized controlled trial of the Open Sky School, our results could provide empirical evidence on the effectiveness of nature-based interventions in reducing mental health problems among elementary school children. TRIAL REGISTRATION: This study was registered with clinicaltrials.gov: NCT05662436 on December 22, 2022.

Differential Momentary Reports of Stress and Affect Associated With Alcohol Consumption in Middle-Aged Versus Younger Adults.

Background: Stress is a motivator to consume alcohol, a well-documented relapse risk, and is known to differentially affect biological and psychological processes as people age.Objectives: Because alcohol consumption is known to acutely decrease stress and increase affect, this study examined differences in ratings of stress and affect in middle-aged versus younger adults who regularly consume alcohol.Methods: A sample of younger (n = 17) and middle-aged (n = 18) drinkers was studied during a 3-day period of typical alcohol consumption. Resting levels of respiratory sinus arrhythmia (RSA) were measured during a baseline study visit since RSA is a well-documented biomarker of stress and is known to decrease with age. Ecological momentary assessment (EMA) survey ratings (n = 1,598) were modeled using hierarchical regression to assess differences in stress and affect throughout the day between the two age groups.Results: As anticipated, middle-aged participants had lower RSA than those who were younger. Although the middle-aged adults showed overall lower stress, generally they also experienced higher affect than the younger adults. Middle-aged adults experienced a significant reduction in stress following drinking while no such effect was observed in the younger adults.Conclusions: To our knowledge, this is the first investigation using EMA methodology to examine stress and affect between younger and middle-aged adults who habitually consume alcohol. These cross-sectional data suggest potential momentary stress relief to engaging with moderate alcohol consumption in a middle-aged population. Future work must address this important motivational process in curtailing maintenance of alcohol consumption and preventing escalation of consumption.

Employing the equity lens to understand multisectoral partnerships: lessons learned from a mixed-method study in Canada.

BACKGROUND: Multisectoral approaches to health are collaborations between stakeholders across multiple sectors, usually formed to address issues that affect health but go beyond the purview of one particular sector. The significance of multisectoral partnerships to attain health equity has been widely acknowledged. However, the extent which equity can be attained depends upon the perceptions of various stakeholders. We examine how multisectoral partnerships promoting healthy eating and active living conceptualized and employed an equity lens in their work. METHOD: This study is part of a larger pan-Canadian mixed-method research and knowledge sharing program entitled MUSE (Multisectoral Urban Systems for health and Equity in Canadian cities). Data collected from both quantitative and qualitative sources for two sites of the MUSE project-Saskatoon and Toronto were analyzed. In the qualitative part, 30 semi-structured key informant interviews were conducted with key stakeholders from six different multisectoral partnerships based in Saskatoon and Toronto. Data were analyzed in an inductive way. In the quantitative part, a survey with 37 representatives of stakeholder organizations was carried out. Simple descriptive statistics (means and percentages) were used to observe the distribution of data and to complement the qualitative analysis. RESULTS: Equity was not a central component in program design although participants addressing equity, did so by discussing accessibility. How much consideration was given to equity varied as a function of the type of partnership. Most participants emphasized geographical accessibility but a few mentioned financial accessibility. Collaborative leadership style facilitated a participatory decision-making process, and thereby upholding equity in the partnership decision-making process. Communication, networking, and negotiation skills were found to be core competencies of a leader that contributed in upholding equity in partnership dynamics. The study also showed some challenges to embed equity in partnership works, such as the lack of comprehensive understanding of population health and its equity tenet. CONCLUSIONS: Findings indicate that multisectoral partnerships aimed at promoting healthy eating and physical activity experience several challenges to attain equity within the partnership as well as in the partnership-based works aimed at reducing health equity in populations. Factors identified can support decision makers commit to and work to attaining equity within their partnerships as well as in the partnership-based work in the community and beyond.

Developing practice guidelines to integrate physical activity promotion as part of routine cancer care: A knowledge-to-action protocol.

BACKGROUND: Cancer is a leading cause of disease burden worldwide and the first cause of mortality in Canada with 30.2% of deaths attributable to cancer. Given aging of the population and the improvement of prevention and treatment protocols, the number of cancer survivors is steadily increasing. These individuals have unique physical and mental health needs some of which can be addressed by integrating physical activity promotion into ongoing and long-term care. Despite the benefits of being active, delivery of PA programs for cancer patients in both clinical and community settings remains challenging. This knowledge-to-action protocol-called Kiné-Onco-aims to develop a practice guideline for the delivery, implementation, and scaling-up of cancer-specific physical activity promotion programs and services in clinical and community settings located in Québec, Canada. METHOD: The Kiné-Onco project involves knowledge synthesis of scientific and grey literature to establish the benefits and added value of physical activity for cancer patients and survivors, describes current practices in delivering physical activity programs, analyses quantitative data from electronic health records (EHR) of patients participating in a novel hospital-based physical activity program, collects and analyses qualitative data from patients and healthcare providers interviews about lived experience, facilitators, and barriers to physical activity promotion, outlines deliberative workshops among multidisciplinary team members to develop implementation guidelines for physical activity promotion, and summarizes a variety of knowledge transfer and exchange activities to disseminate the practice guidelines. DISCUSSION: This paper describes the protocol for a knowledge-to-action project aimed at producing and sharing actionable evidence. Our aim is that physical activity promotion programs and services be scaled up in such a way as to successfully integrate physical activity promotion throughout cancer treatment and survivorship in order to improve the physical and mental health of the growing population of individuals having received a cancer diagnosis.

Comparative inequalities in child dental caries across four countries: Examination of international birth cohorts and implications for oral health policy.

Child dental caries (i.e., cavities) are a major preventable health problem in most high-income countries. The aim of this study was to compare the extent of inequalities in child dental caries across four high-income countries alongside their child oral health policies. Coordinated analyses of data were conducted across four prospective population-based birth cohorts (Australia, n = 4085, born 2004; Québec, Canada, n = 1253, born 1997; Rotterdam, the Netherlands, n = 6690, born 2002; Southeast Sweden, n = 7445, born 1997), which enabled a high degree of harmonization. Risk ratios (adjusted) and slope indexes of inequality were estimated to quantify social gradients in child dental caries according to maternal education and household income. Children in the least advantaged quintile for income were at greater risk of caries, compared to the most advantaged quintile: Australia: AdjRR = 1.18, 95%CI = 1.04-1.34; Québec: AdjRR = 1.69, 95%CI = 1.36-2.10; Rotterdam: AdjRR = 1.67, 95%CI = 1.36-2.04; Southeast Sweden: AdjRR = 1.37, 95%CI = 1.10-1.71). There was a higher risk of caries for children of mothers with the lowest level of education, compared to the highest: Australia: AdjRR = 1.18, 95%CI = 1.01-1.38; Southeast Sweden: AdjRR = 2.31, 95%CI = 1.81-2.96; Rotterdam: AdjRR = 1.98, 95%CI = 1.71-2.30; Québec: AdjRR = 1.16, 95%CI = 0.98-1.37. The extent of inequalities varied in line with jurisdictional policies for provision of child oral health services and preventive public health measures. Clear gradients of social inequalities in child dental caries are evident in high-income countries. Policy related mechanisms may contribute to the differences in the extent of these inequalities. Lesser gradients in settings with combinations of universal dental coverage and/or fluoridation suggest these provisions may ameliorate inequalities through additional benefits for socio-economically disadvantaged groups of children.

Household income and maternal education in early childhood and risk of overweight and obesity in late childhood: Findings from seven birth cohort studies in six high-income countries.

BACKGROUND/OBJECTIVES: This study analysed the relationship between early childhood socioeconomic status (SES) measured by maternal education and household income and the subsequent development of childhood overweight and obesity. SUBJECTS/METHODS: Data from seven population-representative prospective child cohorts in six high-income countries: United Kingdom, Australia, the Netherlands, Canada (one national cohort and one from the province of Quebec), USA, Sweden. Children were included at birth or within the first 2 years of life. Pooled estimates relate to a total of N = 26,565 included children. Overweight and obesity were defined using International Obesity Task Force (IOTF) cut-offs and measured in late childhood (8-11 years). Risk ratios (RRs) and pooled risk estimates were adjusted for potential confounders (maternal age, ethnicity, child sex). Slope Indexes of Inequality (SII) were estimated to quantify absolute inequality for maternal education and household income. RESULTS: Prevalence ranged from 15.0% overweight and 2.4% obese in the Swedish cohort to 37.6% overweight and 15.8% obese in the US cohort. Overall, across cohorts, social gradients were observed for risk of obesity for both low maternal education (pooled RR: 2.99, 95% CI: 2.07, 4.31) and low household income (pooled RR: 2.69, 95% CI: 1.68, 4.30); between-cohort heterogeneity ranged from negligible to moderate (p: 0.300 to < 0.001). The association between RRs of obesity by income was lowest in Sweden than in other cohorts. CONCLUSIONS: There was a social gradient by maternal education on the risk of childhood obesity in all included cohorts. The SES associations measured by income were more heterogeneous and differed between Sweden versus the other national cohorts; these findings may be attributable to policy differences, including preschool policies, maternity leave, a ban on advertising to children, and universal free school meals.