The impact of updated clinical blood pressure guidelines on hypertension prevalence among children and adolescents.

Background: To date, population estimates of hypertension prevalence among children and adolescents in Canada have been based on clinical guidelines in the National High Blood Pressure Education Program's 2004 Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents (NHBPEP 2004). In 2017, the American Academy of Pediatrics published updated guidelines in Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents (AAP 2017), followed by Hypertension Canada in 2020 with its publication of Comprehensive Guidelines for the Prevention, Diagnosis, Risk Assessment, and Treatment of Hypertension in Adults and Children (HC 2020). This study compares national child and adolescent hypertension prevalence estimates based on NHBPEP 2004, AAP 2017 and HC 2020. Data and methods: Six cycles of data spanning 2007 to 2019 from the Canadian Health Measures Survey were used to compare blood pressure (BP) categories and the prevalence of hypertension by sex and age group under all sets of guidelines for children and adolescents aged 6 to 17. The impact of applying AAP 2017 across time and selected characteristics, the resulting reclassification into a higher BP category under AAP 2017, and differences in hypertension prevalence resulting from applying HC 2020 versus AAP 2017 were examined. Results: Prevalence of Stage 1 hypertension was higher among children and adolescents aged 6 to 17 under AAP 2017 and HC 2020 than under NHBPEP 2004. Overall hypertension prevalence was also higher, and obesity was a major factor associated with being reclassified into a higher BP category under AAP 2017. Interpretation: Implementation of AAP 2017 and HC 2020 is associated with significant changes in the epidemiology of hypertension. Understanding the impact of applying updated clinical guidelines may help inform population surveillance efforts to track hypertension prevalence among Canada's children and adolescents.

Individual, family, and neighborhood correlates of independent mobility among 7 to 11-year-olds.

Objective. Independent mobility refers to the freedom that children have to move around their neighborhood without adult supervision. It is related to their physical activity and health. We examined the intrapersonal, family, and neighborhood correlates of independent mobility within children. Methods. 497 American parents of 6.9-11.9 year olds completed a survey (November, 2014) that assessed their child's independent mobility range, several intrapersonal characteristics of their child (gender, age, race, etc.), several characteristics of their family (family structure, socioeconomic status, parental physical activity, etc.), and their perceptions of the safety of their neighborhood (18 questions reduced to 4 components). Associations were determined using ordinal logistic regression. Results. Children's age, parent's perception that their neighborhood is safe for children, and parent's fear of neighborhood crime were the independent correlates of independent mobility. Compared to 6.9-7.9 year olds, the odds ratio (95% CI) for increasing independent mobility were 2.31 (1.47-3.64) in 8.0-9.9 year olds and 3.38 (2.13-5.36) in 10.0-11.9 year olds. Compared to children whose parents who did not perceive that their neighborhood was safe for children, the odds ratio for increasing independent mobility was 4.24 (2.68-6.70) for children whose parents perceived their neighborhood was safe for children. Compared to children whose parents had the lowest fear of neighborhood crime, the odds ratio for increasing independent mobility was 0.41 (0.27-0.62) for children whose parents had the highest fear of crime. Conclusions. Children's independent mobility was associated with their age, their parent's perception that their neighborhood was safe for children, and their parent's fear of crime.

Parental encouragement is positively associated with outdoor active play outside of school hours among 7-12 year olds.

Background. Physical activity is important for children's physical, mental, and social well-being. Outdoor active play is an important yet unstudied domain of children's physical activity. The objective of this study was to determine if parental encouragement is associated with the frequency that children engage in outdoor active play outside of school hours. Methods. Participants consisted of 514 children aged 7-12 years and one of their parents. Parents completed a survey that included four questions that assessed how frequently they used verbal cues to encourage their child to play outdoors. Points were assigned to each response and averaged across the 4 questions, and based on this average participants were assigned to quintiles. The survey included seven questions that asked parents to assess how frequently their child played outdoors outside of school hours. Points were assigned to each response and summed to create an active outdoor play frequency score. General linear models assessed associations between parental encouragement and outdoor play while controlling for individual, family, and neighborhood covariates. Results. The mean outdoor active play frequency score increased significantly across quintiles of the parental encouragement score as follows: 6.0 (standard error = 0.7) in quintile 1, 9.8 (0.6) in quintile 2, 11.4 (0.6) in quintile 3, 16.2 (0.9) in quintile 4, and 23.3 (1.3) in quintile 5. After adjusting for covariates, the mean outdoor active play frequency score was almost three times higher in the highest parental encouragement quintile than in the lowest quintile (20.4 vs. 7.8). Conclusions. Parents use of verbal cues to encourage their children to play outdoors was independently associated with outdoor active play among 7-12 year olds.