Prioritizing a research agenda on built environments and physical activity: a twin panel Delphi consensus process with researchers and knowledge users.

BACKGROUND: The growth of urban dwelling populations globally has led to rapid increases of research and policy initiatives addressing associations between the built environment and physical activity (PA). Given this rapid proliferation, it is important to identify priority areas and research questions for moving the field forward. The objective of this study was to identify and compare research priorities on the built environment and PA among researchers and knowledge users (e.g., policy makers, practitioners). METHODS: Between September 2022 and April 2023, a three-round, modified Delphi survey was conducted among two independent panels of international researchers (n = 38) and knowledge users (n = 23) to identify similarities and differences in perceived research priorities on the built environment and PA and generate twin 'top 10' lists of the most important research needs. RESULTS: From a broad range of self-identified issues, both panels ranked in common the most pressing research priorities including stronger study designs such as natural experiments, research that examines inequalities and inequities, establishing the cost effectiveness of interventions, safety and injuries related to engagement in active transportation (AT), and considerations for climate change and climate adaptation. Additional priorities identified by researchers included: implementation science, research that incorporates Indigenous perspectives, land-use policies, built environments that support active aging, and participatory research. Additional priorities identified by knowledge users included: built environments and PA among people living with disabilities and a need for national data on trip chaining, multi-modal travel, and non-work or school-related AT. CONCLUSIONS: Five common research priorities between the two groups emerged, including (1) to better understand causality, (2) interactions with the natural environment, (3) economic evaluations, (4) social disparities, and (5) preventable AT-related injuries. The findings may help set directions for future research, interdisciplinary and intersectoral collaborations, and funding opportunities.

A social network analysis of interactions about physical activity and nutrition among APPLE schools staff.

Comprehensive school health (CSH) is a holistic approach to school-based health promotion that involves active participation and buy-in of school community members, including school staff (e.g., support staff, teachers, school health champions, principals). Implementation and sustainability of CSH builds on complex relationships within the school that support school-level health promoting changes and understanding the social relationships that exist in a school setting is critical. Thus, the purpose of this study was to conduct a social network analysis to examine adviceseeking networks of staff within three schools involved with a CSH program called APPLE Schools (A Project Promoting healthy Living for Everyone in Schools) project approach. The degree to which school staff were central in the network (i.e., gave or sought physical activity or nutrition advice, were connected or disconnected to others; indegree/outdegree centrality and betweenness centrality) and the overall structure of the networks were assessed (i.e., optimal levels of density and centralization). School health champions and several other individuals in the network were shown to be key sources of physical activity or nutrition advice and were identified as central players in the network. Whole networks across schools had low density and betweenness centralization, with optimal levels of out-centralization, and low to optimal levels of incentralization. This research allowed us to gain an understanding of network structures and relationship patterns in CSH schools, with specific attention to the coordinating role of school health champions, and other central players within the network. These findings increase our understanding of advice relationships that exist in a school setting and how these relationships may support CSH implementation and sustainability.

Translation of school-learned health behaviours into the home: student insights through photovoice.

OBJECTIVE: Sedentary behaviours, physical inactivity, and poor diets in Canadian children are a major public health problem. Comprehensive school health (CSH) recognizes the importance of school and home collaboration; however, it is unknown how health behaviours promoted in school are adopted at home. The purpose of this research was to explore student perceptions of the translation of an intervention taking a CSH approach in Alberta, Canada, into the home environment. METHODS: The guiding method was focused ethnography, using photovoice as the data generation strategy. Grades 5 and 6 students were purposively sampled (n = 25), and asked to take photos of what CSH looks like in their home environment. Subsequent one-on-one interviews were conducted as part of the photovoice process to gain a deeper understanding of student perceptions. RESULTS: Two main themes emerged: students embraced the CSH philosophy, and students are driving change to create a healthy home culture. The underlying concept of leadership and independence was necessary for students to impact their health and the health of family members. Results demonstrated that students are catalyzing positive changes in the home environment by supporting changes in the home food environment, trying new things, facilitating improvements to healthy eating and active living, and monitoring unhealthy behaviours. CONCLUSION: This study illustrates students' abilities to positively impact the home environment as a result of their involvement in CSH. Student leadership and independence should be promoted and emphasized in CSH to facilitate transition of health behaviours into the home environment.

Healthy lifestyle behaviours are positively and independently associated with academic achievement: An analysis of self-reported data from a nationally representative sample of Canadian early adolescents.

INTRODUCTION: The lifestyle behaviours of early adolescents, including diet, physical activity, sleep, and screen usage, are well established contributors to health. These behaviours have also been shown to be associated with academic achievement. Poor academic achievement can additionally contribute to poorer health over the lifespan. This study aims to characterize the associations between health behaviours and self-reported academic achievement. METHODS: Data from the 2014 Canadian Health Behaviour in School-Aged Children Study (n = 28,608, ages 11-15) were analyzed. Students provided self-report of academic achievement, diet, physical activity, sleep duration, recreational screen time usage, height, weight, and socioeconomic status. Multi-level logistic regression was used to assess the relationship of lifestyle behaviours and body weight status with academic achievement while considering sex, age, and socioeconomic status as potential confounders. RESULTS: All health behaviours exhibited independent associations with academic achievement. Frequent consumption of vegetables and fruits, breakfast and dinner with family and regular physical activity were positively associated with higher levels of academic achievement, while frequent consumption of junk food, not meeting sleep recommendations, and overweight and obesity were negatively associated with high academic achievement. CONCLUSIONS: The present findings demonstrate that lifestyle behaviours are associated with academic achievement, potentially identifying these lifestyle behaviours as effective targets to improve academic achievement in early adolescents. These findings also justify investments in school-based health promotion initiatives.

The combined impact of diet, physical activity, sleep and screen time on academic achievement: a prospective study of elementary school students in Nova Scotia, Canada.

BACKGROUND: Few studies have investigated the independent associations of lifestyle behaviors (diet, physical activity, sleep, and screen time) and body weight status with academic achievement. Even fewer have investigated the combined effect of these behaviors on academic achievement. We hypothesize that the combined effect of these behaviors will have a higher impact on academic achievement than any behavior alone, or that of body weight status. METHODS: In 2011, 4253 grade 5 (10-11 years old) students and their parents were surveyed about the child's diet, physical activity, screen time and sleep. Students' heights and weights were measured by research assistants. Academic achievement was measured using provincial standardized exams in mathematics, reading and writing, and was expressed as 'meeting' or 'not meeting' expectations as per standardized criterion. Exams were written 1 year following the measurement of lifestyle behaviors. Lifestyle behaviors were measured with self- and parental proxy reports and expressed as meeting recommendations (yes/no) for each behavior. Mixed effects logistic regression models adjusting for demographic confounders and caloric intake were used to determine the independent and combined associations. RESULTS: Meeting dietary recommendations was associated with increased likelihood of meeting academic expectations for each of math, reading and writing. Meeting recommendations for screen time and sleep was associated with meeting expectations for writing. For all three subjects, meeting additional lifestyle behavior recommendations was associated with higher likelihood of meeting expectations. Children who met 7-9 lifestyle behavior recommendations had greater than three-times the odds of meeting expectations for reading compared to those who met 0-3 recommendations (OR: 3.07, 95% CI: 2.09, 4.51), and 1.47 and 2.77 times the odds of meeting expectations in mathematics and writing, respectively. Body weight status was not associated with academic achievement. CONCLUSIONS: We found that lifestyle behaviors, not body weight status, are strongly associated with student academic performance. Promoting compliance with established healthy lifestyle recommendations could improve both the health and educational outcomes of school-aged children. School-based health promotion initiatives that target multiple lifestyle behaviors may have a greater effect on academic achievement than those that focus on a single behavior.

Changes in dietary and physical activity risk factors for type 2 diabetes in Alberta youth between 2005 and 2008.

OBJECTIVE: Unhealthy dietary and physical inactivity patterns inspired many initiatives promoting healthy youth and healthy schools in Alberta between 2005 and 2008. The purpose of this study was to examine differences in the prevalence of lifestyle risk factors for type 2 diabetes (T2D) between two province-wide samples of Alberta adolescents (2005 and 2008). METHODS: The dietary and physical activity (PA) patterns of Alberta youth were assessed in two cross-sectional studies of grade 7-10 students, one in 2005 (n=4936) and one in 2008 (n=5091), using a validated web-survey. For each diabetes risk factor, participants were classified as either at risk or not at risk, depending on their survey results relative to cut-off values. Chi-square tests and logistic regression models were used to determine differences in risk factor prevalence between 2005 and 2008. RESULTS: Compared to 2005, mean BMI, energy intake, fat intake, glycemic index (GI) and glycemic load (GL) were lower in 2008 (p<0.05); and carbohydrate, protein, fibre and vegetable and fruit intakes were higher in 2008 (p<0.05). In 2008, a lower proportion of students were: overweight, obese, consuming high GI, high GL, high fat, low fibre, low veg/fruit intake (p<0.05). No differences existed in magnesium or PA levels between the two time points. CONCLUSIONS: Improvements were observed between 2005 and 2008 in terms of the proportion of adolescents having specific risk factors for T2D. The cause of these changes could not be determined. Continued monitoring of adolescent lifestyle habits and monitoring of exposure to health promotion programming is recommended.

Geography influences dietary intake, physical activity and weight status of adolescents.

Purpose. The purpose of this study was to assess rural and urban differences in the dietary intakes, physical activity levels and weight status of a large sample of Canadian youth in both 2005 and 2008. Materials and Methods. A cross-sectional study of rural and urban adolescents (n = 10, 023) in Alberta was conducted in both 2005 and 2008 using a web-based survey. Results. There was an overall positive change in nutrient intakes between 2005 and 2008; however, rural residents generally had a poorer nutrient profile than urban residents (P < .001). They consumed less fibre and a greater percent energy from saturated fat. The mean physical activity scores increased among rural youth between 2005 and 2008 (P < .001), while remaining unchanged among urban youth. Residence was significantly related to weight status in 2005 (P = .017), but not in 2008. Conclusion. Although there were small improvements in nutrient intakes from 2005 to 2008, several differences in the lifestyle behaviours of adolescents living in rural and urban areas were found. The results of this study emphasize the importance of making policy and program recommendations to support healthy lifestyle behaviours within the context of the environments in which adolescents live.

Adolescent weight status and related behavioural factors: web survey of physical activity and nutrition.

Purpose. To identify whether non-overweight students were different from their overweight or obese peers with respect to diet, suboptimal meal behaviours, and physical activity using a self-administered web-based survey. Methods. 4097 adolescents living in Alberta, Canada completed Web-SPAN (Web Survey of Physical Activity and Nutrition). Students were classified as overweight or obese, and differences were described in terms of nutrient intakes, physical activity, and meal behaviours. Results. Non-overweight students consumed significantly more carbohydrate and fibre, and significantly less fat and high calorie beverages, and had a higher frequency of consuming breakfast and snacks compared to overweight or obese students. Both non-overweight and overweight students were significantly more active than obese students. Conclusions. This research supports the need to target suboptimal behaviours such as high calorie beverage consumption, fat intake, breakfast skipping, and physical inactivity. School nutrition policies and mandatory physical education for all students may help to improve weight status in adolescents.

Diet quality, nutrition and physical activity among adolescents: the Web-SPAN (Web-Survey of Physical Activity and Nutrition) project.

OBJECTIVE: To assess the overall diet quality of a sample of adolescents living in Alberta, Canada, and evaluate whether diet quality, nutrient intakes, meal behaviours (i.e. meal skipping and consuming meals away from home) and physical activity are related. DESIGN: A cross-sectional study design. Students completed the self-administered Web-Survey of Physical Activity and Nutrition (Web-SPAN). Students were classified as having poor, average or superior diet quality based on Canada's Food Guide to Healthy Eating (CFGHE). SETTING: One hundred and thirty-six schools (37 %) within forty-four public and private school boards (75 %) in Alberta, Canada. SUBJECTS: Grade 7 to 10 Alberta students (n 4936) participated in the school-based research. RESULTS: On average, students met macronutrient requirements; however, micronutrient and fibre intakes were suboptimal. Median CFGHE food group intakes were below recommendations. Those with poor diet quality (42 %) had lower intakes of protein, fibre and low-calorie beverages; higher intakes of carbohydrates, fat and Other Foods (e.g. foods containing mostly sugar, high-salt/fat foods, high-calorie beverages, low-calorie beverages and high-sugar/fat foods); a lower frequency of consuming breakfast and a higher frequency of consuming meals away from home; and a lower level of physical activity when compared with students with either average or superior diet quality. CONCLUSIONS: Alberta adolescents were not meeting minimum CFGHE recommendations, and thus had suboptimal intakes and poor diet quality. Suboptimal nutritional intakes, meal behaviours and physical inactivity were all related to poor diet quality and reflect the need to target these health behaviours in order to improve diet quality and overall health and wellness.