Corrigendum to "Parents' attitudes regarding their children's play during COVID-19: Impact of socioeconomic status and urbanicity". [SSM - Popul. Health. (24) (2023) 101-549].

[This corrects the article DOI: 10.1016/j.ssmph.2023.101549.].

Association Between Children's and Parents' Physical Activity During the COVID-19 Pandemic: A Cross-Lagged Analysis.

BACKGROUND: COVID-19 caused closures of movement supporting environments such as gyms and schools in Canada. This study evaluated the association between Ontario parents' and children's physical activity levels across time during COVID-19, controlling for variables that were identified as significant predictors of children's and parents' physical activity (e.g., children's age, parents' employment status). METHODS: Parents (n = 243; mean age = 38.8 y) of children aged 12 and under (n = 408; mean age = 6.3 y) living in Ontario, Canada completed 2 online surveys, the first between August and December 2020 and the second between August and December 2021. At baseline, parents were asked to recall prepandemic physical activity levels. To determine the association between parent and child physical activity during COVID-19, a cross-lagged model was estimated to determine the cross-sectional and longitudinal associations between parents' and children's physical activity across time. RESULTS: Bivariate associations revealed that parents' and children's physical activity levels were significantly related during lockdown and postlockdown but not prelockdown. The autoregressive paths from prelockdown to during lockdown were significant for children (ß = 0.53, P < .001) and parents (ß = 1.058, P < .001) as were the autoregressive paths from during lockdown to postlockdown for children (ß = 0.61, P < .001) and parents (ß = 0.48, P < .001). In fully adjusted models, the cross-lagged association between parents' physical activity prelockdowns was significantly positively associated with their children's physical activity during lockdowns (ß = 0.19, P = .013). CONCLUSIONS: Resources are needed to ensure that children and parents are obtaining sufficient levels of physical activity, particularly during a pandemic.

Parents' attitudes regarding their children's play during COVID-19: Impact of socioeconomic status and urbanicity.

Objectives: The COVID-19 pandemic has had a profound impact on the daily routines of parents and children. This study explored the influence of socioeconomic status (SES) and urbanicity on parents' attitudes toward their children's active play opportunities 6 months and 1.5 years into COVID-19. Methods: A sample of 239 Ontario parents of children aged 12 and younger completed two online surveys (August-December 2020; 2021) to assess parents' intentions, beliefs, and comforts concerning their child's eventual return to play, in addition to various sociodemographic and physical activity variables. Descriptive analyses were run as well as an exploratory factor analysis (EFA) was conducted to group the 14 attitude items into subscales for analysis, to ensure reliability and validity of attitude measures. Results: In general, parents in communities with more urban features (e.g., densely populated areas), single-parents, full-time employed parents, and parents with lower-incomes were more hesitant to return their children to active play during the pandemic. Conclusion: Findings from this work highlight SES and urbanicity disparities that continue to exist during COVID-19.

The Effectiveness of Physical Activity Policies in Center-Based Childcare: A Systematic Review and Meta-Analysis.

Purpose: Many young children spend a significant portion of time in center-based childcare settings; however, these children are often not sufficiently active during care. Promoting physical activity through policy implementation is one mechanism which has the potential to increase physical activity. The purpose of this systematic review and meta-analysis was to provide an overview of physical activity policies implemented in childcare centers and determine their effect on children's physical activity. Methods: Electronic searches were conducted in CINAHL, Medline, PsycINFO, EMBASE, Scopus, SPORTDiscus, and Sports Medicine and Education Database. Two reviewers independently examined 3,286 articles to find peer-reviewed, original studies that assessed the impact of physical activity policies on children's physical activity. Random effects meta-analyses were used to determine the impact of policies. Results: A total of 13 articles met the inclusion criteria; in which 12 unique policies were implemented. Results of the meta-analyses suggest that introducing new physical activity policies did not increase children's moderate-to-vigorous physical activity (MVPA); however, compared to centers without a formalized physical activity policy, children in centers with a formalized policy engaged in significantly more MVPA and total physical activity. Conclusions: Introducing new physical activity policies alone may not be sufficient to increase children's engagement in physical activity, and it may be important to combine with capacity-building initiatives for childcare staff and early childhood educators. Results reinforce the value of childcare centers implementing their own formalized physical activity policies to support children's physical activity, which highlights the importance of regulating physical activity practices in childcare. Registration: CRD42022326037.

Early Childhood Educators' Knowledge, Self-Efficacy and Risk Tolerance for Outdoor Risky Play Following a Professional Risk Re-Framing Workshop.

Children's outdoor risky play is important for healthy development. However, Early Childhood Educators (ECEs) concern for child safety often restricts risky play affordances during childcare. To reduce this trend, an Outdoor Play Risk Re-Framing workshop was delivered to ECEs in London, Ontario, and the immediate/short-term impact of the workshop on ECEs' knowledge, self-efficacy, and risk tolerance for engaging children in outdoor risky play was examined. Via a natural experiment, using a quasi-experimental design, ECEs in the experimental group (n = 119) completed an Outdoor Play Risk Re-Framing workshop, while ECEs in the comparison group (n = 51) continued their typical curriculum. All ECEs completed the same survey assessing their knowledge (n = 11 items), self-efficacy (n = 15 items), and risk tolerance (n = 27 items) at baseline and 1-week post-intervention. A maximum likelihood linear mixed effects model was conducted, while deductive content analysis was used for open-ended items. The workshop intervention resulted in significant improvements in ECEs' self-efficacy (p = 0.001); however, no significant changes were observed for knowledge (i.e., awareness and practices; p = 0.01 and p = 0.49, respectively) or risk tolerance (p = 0.20). Qualitative data revealed similar findings across both groups, highlighting physical development as a benefit to outdoor risky play and fear of liability as a barrier. In conclusion, providing ECEs with an Outdoor Play Risk Re-Framing workshop shows promise for supporting their self-efficacy to promote this behavior but does not impact ECEs' knowledge or risk tolerance to lead outdoor risky play.

Development of a Physical Activity and Sedentary Behaviour Policy for Canadian Childcare Settings: A Delphi Study.

This study aimed to obtain consensus on physical activity (PA) and sedentary behaviour (SB) policy items for use in Canadian childcare settings. Purposeful sampling of Canadian experts in PA/SB (n = 19) and Early Childhood Education (ECE; n = 20) was used to form two distinct (i.e., PA/SB and ECE) panels for a 3-round Delphi study. In round 1, the PA/SB experts suggested their top 10 items for a Canadian childcare PA/SB policy. Policy items were then pooled to generate a list of 24 unique items. In round 2, experts in both panels rated the importance of the 24 policy items using a 7-point Likert scale (i.e., 1 = Not at all important to 7 = Extremely important). The ECE panel was also asked to report on the feasibility of the policy items using a 4-point Likert scale (i.e., 1 = Not at all feasible to 4 = Very feasible). Policy items that received an interquartile deviation (IQD) score of ≤ 1 (indicating consensus) and a median score of ≥ 6 (indicating importance) in both panels were considered shared priorities. In round 3, members of both panels re-rated the importance of the policy items that did not achieve consensus among their respective panel in round 2 and were asked to order items based on importance. Descriptive statistics were used to assess feasibility of policy items, and differences in panel ratings were quantified using Mann Whitney U tests. Consensus was achieved for 23 policy items in the PA/SB panel and 17 items in the ECE panel. Overall, 15 shared priorities were identified (e.g., provide 120 min of outdoor time per day, sedentary behaviour should not be used as a punishment), and six policy items exhibited a statistical difference in ratings across panels. Members of the ECE panel indicated that the policy item, "children should be permitted to go outside whenever they want, for as long as they want" (M = 1.78; SD = 0.65) was lowest in terms of feasibility, and the policy item, "children should receive opportunities to engage in both unstructured and structured physical activity opportunities daily" (M = 3.89; SD = 0.32) was the most feasible for daily implementation. Findings from this study can inform the development of an expert-generated and feasibility-informed institutional PA/SB policy for use in Canadian childcare settings. Supplementary Information: The online version contains supplementary material available at 10.1007/s10643-023-01473-z.

Parent-Reported Changes in Ontario Children's Physical Activity Levels during the COVID-19 Pandemic.

The COVID-19 pandemic resulted in closures of physical-activity-supporting environments, including playgrounds, outdoor recreation facilities (e.g., basketball courts), and community centers, which impacted children's movement opportunities. This study evaluated changes in Ontario children's physical activity levels during the COVID-19 pandemic and explored the impact of family sociodemographic markers on children's activity. Parents (n = 243; Mage = 38.8 years) of children aged 12 and under (n = 408; Mage = 6.7 years) living in Ontario, Canada, completed two online surveys between August and December 2020 (survey 1) and August and December 2021 (survey 2). Generalized linear mixed-effects models were used to estimate changes in the proportion of children who accumulated 60 min of physical activity per day pre-lockdown, during lockdown, and post-lockdown in Ontario. Results revealed a significant non-linear trajectory whereby the proportion of children achieving 60 min of physical activity per day pre-lockdown (63%) declined during lockdown (21%) and then increased post-lockdown (54%). Changes in the proportion of children engaging in 60 min of daily physical activity were moderated by several demographic variables. Efforts are needed to provide parents of young children with a wider variety of resources to ensure children are obtaining sufficient levels of physical activity regardless of the presence of community lockdowns.

Children's Physical Activity during COVID-19 in Ontario, Canada: Parents' Perspectives.

The COVID-19 pandemic has had a large influence on children's physical activity (i.e., play and sport) opportunities. The purpose of this study was to describe parents' perspectives of their children's (ages 0-12) physical activity experiences during the pandemic (i.e., since the onset in March 2020 until follow-up survey completion date [between August to December 2021]). As part of the 'Return to Play' study conducted in Ontario, Canada, two-parent report surveys were completed online via Qualtrics. Surveys measured parents' perspectives regarding their children's physical activity since the onset of the pandemic (n = 17 items) and collected demographic information (n = 16 items). Open-ended questions were included to gather a rich understanding of parents' experiences (i.e., supports, challenges) with facilitating their children's physical activity. Descriptive statistics were calculated to describe parents' perspectives of their children's physical activity experiences and to determine parent demographics. Open-ended questions were analyzed via deductive content analysis. Parents (n = 382) reported that they noticed behavior changes in their children because of the pandemic (65.9%), and most (73.7%) reported challenges with supporting their children's activity during periods when public health measures were in place. Many parents (44.5%) stated that their children asked about returning to play/sport more than three times per week during periods when play/sport facilities were closed in Ontario. Qualitative data identified common supports parents used (e.g., getting active outdoors, forming mini social 'bubbles'), and challenges they faced (e.g., work, children's increased screen time, and home schooling), pertaining to their children's physical activity.

Parents' Attitudes Regarding Their Children's Play and Sport During COVID-19.

The COVID-19 pandemic and associated public health measures have interrupted the daily routines of parents and children. The purpose of this study was to explore parents' attitudes regarding their children's play/sport during COVID-19. A secondary objective was to explore the influence of parent demographics and parent-reported physical activity levels and risk tolerance on these attitudes. Ontario parents of children aged 12 and younger completed an online survey (August-December 2020) that assessed their attitudes (grouped by support, safety and socialization-related attitudes; n = 14 items) regarding their child(ren)'s play/sport, their physical activity levels (n = 2 items), and demographic details (n = 16 items). Two open-ended items were used to gather a deeper understanding of attitudes. Parents' tolerance for risk was measured via the validated Tolerance of Risk in Play Scale. Descriptive statistics were calculated to describe attitudes and risk tolerance. Least Absolute Shrinkage and Selection Operator regressions were conducted to examine factors influencing parents' attitudes. Multiple linear models were computed using the identified predictors for each attitude category. Deductive content analysis was undertaken on open-ended responses. Participants (n = 819) reported the highest scores for safety-related attitude items (M = 3.54, SD = .63) followed by socialization and support, which all influenced attitudes regarding children's play/sport (p < .05). Demographics and parents' physical activity levels were identified as important predictors of parents' attitudes. Qualitative data revealed that parents had mixed levels of comfort with respect to their children's return to play/sport. Findings from this study reveal that increased support is needed to guide future play/sport decision-making.

Implementation Adherence and Perspectives of the Childcare PhysicaL ActivitY (PLAY) Policy: A Process Evaluation.

The Childcare PhysicaL ActivitY (PLAY) policy was an evidence-informed, eight-item institutional-level policy document targeting children's physical activity, outdoor play, and sedentary time. Nine childcare centers in London, Ontario, participated in this cluster, randomized controlled trial. Early Childhood Educators allocated to the experimental group, from five childcare centers in London, Ontario, implemented the policy for young children (18 months to 4 years) for 8 weeks and documented adherence to each policy item (i.e., dose) in daily logs. Program evaluation surveys (n = 21) and interviews (n = 10) were completed postintervention to assess Early Childhood Educators' perspectives of feasibility, context, enjoyment, communication between researchers and childcare staff, and likelihood of future implementation. Descriptive statistics were calculated, and thematic analysis was conducted. Adherence to policy items ranged from 16.5% (for delivery of shorter, more frequent outdoor periods) to 85.9% (for delivery of unstructured/child-directed play). Participants reported effective communication between the research team and childcare centers (0 = not at all effective to 5 = very effective; M = 4.20; SD = 0.83) but noted that they were unlikely to continue the implementation of more frequent outdoor periods (0 = not at all likely to 5 = extremely likely; M = 2.19; SD = 1.21). Interview themes included weather as a prominent barrier and the use of verbal prompts as a solution for implementing the policy. As this was a small and short-term intervention, this pilot study offers important insight on larger scale policy interventions aimed at increasing physical activity and minimizing sedentary time among children enrolled in childcare.

Children and parents' perspectives of the impact of the COVID-19 pandemic on Ontario children's physical activity, play, and sport behaviours.

BACKGROUND: The COVID-19 pandemic and associated public health measures have resulted in the closure of many physical activity-supporting facilities. This study examined Ontario parents' and children's perspectives of COVID-19's impact on children's physical activity behaviours, return to play/sport during COVID-19, as well as barriers/facilitators to getting active amid extended closures of physical activity venues. METHODS: Parents/guardians of children aged 12 years and under living in Ontario, Canada were invited to participate in an interview. 12 parent/guardian and 9 child interviews were conducted via Zoom between December 2020 - January 2021, were audio-recorded, and transcribed verbatim. Thematic content analysis was undertaken to identify pronounced themes. RESULTS: Themes for both parent and child interviews fell into one of three categories: 1) barriers and facilitators for getting children active amid COVID-19 closures of physical activity-supporting facilities; 2) changes in children's activity levels; and, 3) perspectives on return to play/sport during and post-pandemic. Various subthemes were identified and varied between parents and children. The most common facilitator for dealing with children's inactivity voiced by parents/guardians was getting active outdoors. Parents/guardians noted their willingness to have their children return to play/sport in the community once deemed safe by public health guidelines, and children's willingness to return stemmed primarily from missing their friends and other important authority figures (e.g., coaches) and sporting events (e.g., tournaments). CONCLUSIONS: Findings from this study could inform families of feasible and realistic strategies for increasing children's physical activity during community closures, while also providing public health experts with information regarding what supports, or infrastructure might be needed during future lockdown periods and/or pandemics.

Measuring Early Childhood Educators' Physical Activity and Sedentary Behavior-Related Self-Efficacy: A Systematic Review of Tools.

Early childhood educators' (ECEs) self-efficacy is often predictive of their ability and likelihood of promoting healthy activity behaviors in childcare settings. To date, ECEs' physical activity and sedentary behavior-related self-efficacy has been measured in a variety of ways in childcare-based research, creating difficulty when comparing across studies. To identify the different approaches ECEs' self-efficacy is assessed, the current study aimed to compare all existing tools that quantitatively measure physical activity and sedentary behavior-related self-efficacy of pre- and in-service ECEs. Seven online databases were searched for original, peer-reviewed, English-written journal articles. Articles were deemed eligible if they employed a tool which measured physical activity and/or sedentary behavior-related self-efficacy of pre- or in-service ECEs. A total of 16 studies were included in this review, and 13 unique tools were identified. All tools measured task self-efficacy (n = 13), while only 1 tool measured barrier self-efficacy, and approximately half of the tools (n = 7; 54%) reported on the validity and reliability. Great variability existed among the self-efficacy items included in the tools; however, common constructs included: teaching/leading physical activity, fundamental movement skill development, and physical activity programming. Very few tools mentioned sedentary behavior (n = 2) and outdoor/risky play (n = 2). Given the low number of studies that tested validity and reliability of their self-efficacy tools, the lack of consideration for barrier self-efficacy, and the paucity of tools that fully encompassed physical activity, sedentary behavior, and outdoor play considerations for ECEs, future research is needed to validate a new, reliable tool.

Impact of the Childcare Physical Activity (PLAY) Policy on Young Children's Physical Activity and Sedentary Time: A Pilot Clustered Randomized Controlled Trial.

Background: The importance of daily physical activity is crucial for healthy development during the early years. Currently, a formal written physical activity policy is lacking in Canadian childcare centers, but holds promise for offering consistent physical activity opportunities. With eight recommendations, the Childcare PLAY policy is an evidence-informed, institutional-level document, targeting children's physical activity, outdoor play, and sedentary time. The purpose of this study was to examine the impact of the Childcare Physical Activity (PLAY) policy on the physical activity and sedentary time of young children (18 months-4 years) in childcare. Methods: Nine childcare centers in London, Ontario participated in the cluster, randomized controlled trial. The centers in the control condition (n = 4) continued their typical daily routines, while the centers in the intervention condition (n = 5) implemented the PLAY policy for eight weeks. To assess physical activity levels, toddlers and preschoolers wore ActiGraph wGT3X-BT accelerometers for five consecutive days during childcare hours, at baseline, mid- and post-intervention, and at the six-month follow-up. Raw accelerometry data were converted to 15 s epochs, and age- and device-specific cut-points were applied. The participants with two or more days of at least 5 h/day of wear-time at baseline, and at one additional time point, were included in the linear mixed-effects models. An adjusted alpha (p < 0.017) was used to account for multiple comparison bias. Results: A total of 148 children (31.92 ± 7.41 months) had valid accelerometry data. The intervention resulted in a significant increase in light physical activity among the participants in the experimental group at the six-month follow-up (+1.07 min/h, an 11.16% increase; p = 0.0017). The intervention did not have a statistically significant effect on the total physical activity, moderate-to-vigorous physical activity, or sedentary time. Conclusions: The findings indicate that the Childcare PLAY policy was effective at increasing the toddlers' and preschoolers' light physical activity. This pilot intervention appears promising for supporting some improved movement behaviors among children in childcare settings; however, additional investigations are needed to explore the feasibility and effectiveness with larger and more-diverse samples.