A Novel Anti-nucleocapsid Antibody Avidity Method for Identifying SARS-CoV-2 Reinfections.

Detecting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reinfections is challenging with current serology assays and is further complicated by the marked decrease in routine viral testing practices as viral transmission increased during Omicron. Here, we provide proof-of-principle that high-avidity anti-nucleocapsid (N) antibodies detects reinfections after a single infection with higher specificity (85%; 95% confidence interval [95% CI], 80%-90%) compared to anti-N antibody levels (72%; 95% CI, 66%-79%) in a vaccinated cohort. This method could be used to retroactively investigate the epidemiology and incremental long-term health consequences of SARS-CoV-2 reinfections.

Obesity-related parenting practices, styles, and family functioning: A natural experiment comparing pandemic and nonpandemic data.

The COVID-19 pandemic resulted in substantial changes to family life. This study examined associations between pandemic conditions and mothers' and fathers' food, physical activity, and media parenting practices and whether these associations were moderated by parenting styles and family functioning. Two independent samples of Canadian parents (nonpandemic n = 270; pandemic n = 357) self-reported their obesity-related parenting practices, styles, and family functioning. Covariate-adjusted regression models compared parenting practices between the samples. Interactions tested the moderating effects of family functioning and parenting styles on mothers' and fathers' parenting practices separately. Compared to nonpandemic mothers, pandemic mothers reported more frequent family meals, more screen time negotiation, and lower modeling of healthy screen time. Both pandemic mothers and fathers reported lower physical activity facilitation than nonpandemic parents. Parenting styles moderated some of these associations; for example, pandemic authoritative parents used less physical activity monitoring (mothers) and screen time negotiation (fathers) as opposed to uninvolved and permissive parents who reported higher use of these practices. The association between pandemic and parenting practices was also moderated by family functioning, especially among fathers. Among high-functioning families, pandemic fathers reported greater engagement in food monitoring, emotional feeding, coercive feeding, healthy screen time modeling, and emotional compensation with screens than nonpandemic fathers and low-functioning family fathers. Pandemic conditions may have negatively affected obesity-related parenting practices, but most associations were moderated by the familial context. The extent to which this will have long-lasting effects on adolescents' health needs to be further explored. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Recruiting families using social media versus pediatric obesity clinics: A secondary analysis of the Aim2Be RCT.

BACKGROUND: Recruitment of participants continues to be a challenge that researchers must overcome to yield successful study results. Over the past decade, there has been a dramatic increase in the use of social media platforms to recruit research participants. We conducted a secondary analysis of the Aim2Be randomized controlled trial (RCT) to examine if there was variability between participants recruited via social media versus pediatric obesity clinics. METHODS: Parents and their children living with overweight or obesity were recruited through social media (i.e., Facebook advertisements) (n = 119) or pediatric obesity management clinics (n = 95) to participate in the Aim2Be RCT. We compared recruitment costs, recruitment rate, participant retention, intervention engagement, obesity-related risk factors, and behavioral habits. RESULTS: Facebook recruitment resulted in more participant contacts, but higher attrition during 'high effort' stages of the recruitment process. Group differences emerged regarding costs (Facebook: $407 versus clinics: $699). There were no group differences in participant retention or intervention engagement. Families recruited from Facebook were younger parents (42.6 versus 46.0 years; p < 0.001) and children (12.2 versus 13.9 years; p < 0.001), a higher percentage male children, and fewer had previously participated in a pediatric weight management program. Parents recruited from Facebook self-reported greater screen time for themselves, and their children reported lower physical activity levels and higher caloric and sugar intake. CONCLUSIONS: Social media and clinical site recruitment are complementary strategies that appear to draw in families with different profiles, but regardless of how they were recruited, all families had the potential to benefit from pediatric obesity management.

Factors associated with physical activity policy and practice implementation in British Columbia's childcare settings: a longitudinal study.

BACKGROUND: In 2016-17, the government of British Columbia (BC) enacted a mandatory policy outlining Active Play Standards (AP Standards) alongside a capacity building initiative (Appetite to Play) focused on implementing policies and practices to support physical activity in childcare centres. We aimed to identify factors at the provider and organizational levels as well as attributes of the Standards hypothesized to influence implementation (i.e., changes in policies and practices). METHODS: We conducted surveys before (2016-2017) and after (2018-2019) enforcement of the AP Standards among 146 group childcare centres across BC. The 2018-19 surveys measured theoretically based constructs associated with implementation of policies and practices (9 childcare- and 8 provider- level characteristics as well as 4 attributes of the licensing standards). Characteristics that were associated in simple regression models were entered in multivariable regression models to identify factors associated with policy and practice changes related to fundamental movement skills (FMS), screen time, total amount of active play (AP) and total amount of outdoor AP from baseline to follow-up. RESULTS: In multivariable analyses, higher staff capacity (OR = 2.1, 95% 1.2, 3.7) and perceived flexibility of the standards (OR: 3.3, 95% 1.5, 7.1) were associated with higher odds of a policy change related to FMS. Higher staff commitment to the AP standards was associated with a higher odds of policy changes related to screen time (OR = 1.6, 95% CI: 1.1, 2.4) and amount of AP (OR: 1.5, 95% 1.0, 2.3). Higher institutionalization of PA policies was associated with a higher odds of policy changes related to the amount of AP (OR: 5.4, 95% CI: 1.5, 20). Higher self-efficacy was associated with a higher odds of policy changes related to outdoor AP (OR = 2.9, 95% 1.1, 7.8). Appetite to Play training was a positively associated with practice changes related to FMS (ß = 0.5, 95% CI: 0.1, 0.9). CONCLUSIONS: A hierarchy of theoretically defined factors influenced childcare providers' implementation of the AP Standards in BC. Future research should test the feasibility of modifying these factors to improve the implementation of PA policy and practice interventions in this setting.

Do Patients' Psychosocial Characteristics Impact Antibiotic Prescription Rates?

Previous research suggests that the characteristics of both patients and physicians can contribute to the overuse of antibiotics. Until now, patients' psychosocial characteristics have not been widely explored as a potential contributor to the overuse of antibiotics. In this study, the relationship between a patient's psychosocial characteristics (self-reported in postal surveys in 2003) and the number of antibiotics they were prescribed (recorded in Finnish national registry data between 2004-2006) were analyzed for 19,300 working-aged Finns. Psychosocial characteristics included life satisfaction, a sense of coherence, perceived stress, hostility, and optimism. In a structural equation model, patients' adverse psychosocial characteristics were not related to increased antibiotic prescriptions in the subsequent three years. However, these characteristics were strongly associated with poor general health status, which in turn was associated with an increased number of subsequent antibiotic prescriptions. Furthermore, mediation analysis showed that individuals who used healthcare services more frequently also received more antibiotic prescriptions. The current study does not support the view that patients' adverse psychosocial characteristics are related to an increased number of antibiotic prescriptions. This could encourage physicians to actively discuss treatment options with their patients.

SARS-CoV-2 cross-sectional seroprevalence study among public school staff in Metro Vancouver after the first Omicron wave in British Columbia, Canada.

OBJECTIVE: To determine the SARS-CoV-2 seroprevalence among school workers within the Greater Vancouver area, British Columbia, Canada, after the first Omicron wave. DESIGN: Cross-sectional study by online questionnaire, with blood serology testing. SETTING: Three main school districts (Vancouver, Richmond and Delta) in the Vancouver metropolitan area. PARTICIPANTS: Active school staff enrolled from January to April 2022, with serology testing between 27 January and 8 April 2022. Seroprevalence estimates were compared with data obtained from Canadian blood donors weighted over the same sampling period, age, sex and postal code distribution. PRIMARY AND SECONDARY OUTCOMES: SARS-CoV-2 nucleocapsid antibody testing results adjusted for test sensitivity and specificity, and regional variation across school districts using Bayesian models. RESULTS: Of 1850 school staff enrolled, 65.8% (1214/1845) reported close contact with a COVID-19 case outside the household. Of those close contacts, 51.5% (625/1214) were a student and 54.9% (666/1214) were a coworker. Cumulative incidence of COVID-19 positive testing by self-reported nucleic acid or rapid antigen testing since the beginning of the pandemic was 15.8% (291/1845). In a representative sample of 1620 school staff who completed serology testing (87.6%), the adjusted seroprevalence was 26.5% (95% CrI 23.9% to 29.3%), compared with 32.4% (95% CrI 30.6% to 34.5%) among 7164 blood donors. CONCLUSION: Despite frequent COVID-19 exposures reported, SARS-CoV-2 seroprevalence among school staff in this setting remained no greater than the community reference group. Results are consistent with the premise that many infections were acquired outside the school setting, even with Omicron.

Patterns of Physical Activity Parenting Practices and Their Association With Children's Physical Activity Behaviors.

Background: Little is known about how parents combine multiple physical activity (PA) parenting practices (PAPP) and their relationship with their child's activity level. This study examined patterns of PAPP and their associations with sociodemographic characteristics and children's PA. Methods: Parents of 5- to 12-year-olds (n = 618) completed the 65-items PAPP item-bank assessing their use of structured, autonomy promoting, and controlling PAPP, and reported their child's PA. Latent class analysis was used to uncover similar groups of parents based on their use of nine PAPP. Regression analyses evaluated associations between the latent classes, sociodemographic factors, and children's PA. Results: Four latent classes emerged: (1) Indifferent (30%)-parents who were unlikely to use any of the PAPP examined; (2) Coercive (23%)-parents using primarily controlling PAPP; (3) Involved (19%)-parents using most PAPP examined; and (4) Supportive (28%)-parents using primarily structured and autonomy promoting PAPP. Involved parents were younger than Indifferent and Supportive parents. Supportive parents reported the highest level of children's PA compared with all other groups, whereas Coercive parents reported the lowest level of children's PA. Conclusions: Our findings showed that different latent classes exist among Canadian parents and that the combination of structured and autonomy promoting PAPP, when used without control, was associated with the highest PA level among children. The emergent latent classes are novel, theoretically meaningful, and key to inform family-based PA interventions.

Associations between maternal depressive symptoms and selective serotonin reuptake inhibitor antidepressant treatment on internalising and anxiety behaviours in children: 12-year longitudinal study.

BACKGROUND: Prenatal selective serotonin reuptake inhibitor (SSRI) antidepressant exposure is associated with increased internalising and anxious behaviours in young children; whether this continues into early adolescence is unknown. Also, it is not well established whether it is the in utero exposure to SSRIs or the underlying maternal mood that contributes more to these associations. AIMS: To examine associations between maternal depressive symptoms, prenatal SSRI antidepressant treatment and internalising and anxiety behaviours from childhood into pre-adolescence. METHOD: From a prospective longitudinal cohort, measures of maternal depressive symptoms and SSRI use and child outcomes (n = 191 births) were obtained from the second trimester to 12 years. Maternal reports of internalising and anxiety behaviours in children were obtained at 3, 6 and 12 years. RESULTS: Multilevel mixed-effects models revealed that maternal depressed mood at the third trimester assessment, not prenatal SSRI exposure, was associated with longitudinal patterns of higher levels of internalising and anxiety behaviours across childhood from 3 to 12 years of age. At each age, hierarchical regressions showed that maternal mood at the third trimester, compared with current maternal depression or prenatal SSRI exposure, explained a greater proportion of the variance in internalising and anxiety behaviours. CONCLUSIONS: Even with prenatal SSRI treatment, maternal depressed mood during the third trimester still had an enduring effect as it was associated with increased levels of internalising and anxiety behaviours across childhood and into early adolescence. Importantly, we found no evidence of a 'main effect' association between prenatal SSRI exposure and internalising and anxiety behaviours in children.

Implementing active play standards: a qualitative study with licensed childcare providers in British Columbia, Canada.

With an increasing number of children attending regular early childhood education and care (ECEC), this setting presents an opportunity to develop physical activity habits and movement skills of children. These behaviours play an important role in the development and well-being of children. In 2017, an Active Play Standard was introduced in British Columbia, Canada, to mandate practices related to physical activity, screen time and movement skill development in licensed ECEC. A capacity-building initiative including training and online resources was released alongside these guidelines to support implementation. The purpose of this study was to qualitatively examine the barriers and facilitators ECEC practitioners faced in implementing the standard, and to explore the role of the capacity-building initiative. Data were collected via semi-structured telephone interviews with educators (n = 23). Data were coded using thematic analysis and sorted into three major themes influencing provision of physical activity opportunities: attributes and impact of the Active Play standard and capacity-building workshop, characteristics of providers and characteristics of ECEC settings. Future studies should consider targeting factors including organizational culture and climate, and provider capacity to provide physical activity and fundamental movement skill programming, and support for facility level policies and collaborative planning processes that create a positive physical activity culture.

Do Individual Characteristics and Social Support Increase Children's Use of an MHealth Intervention? Findings from the Evaluation of a Behavior Change MHealth App, Aim2Be.

Purpose: Mobile health (mHealth) apps may support improved health behavior practice among youth living in larger bodies. However, long-term use is low, limiting effectiveness. This study evaluated whether youths' motivation, satisfaction, engagement with social features, or parent co-participation supported long-term use of an app named Aim2Be. Methods: A secondary analysis of two versions of Aim2Be (preteen and teen versions) using covariate-adjusted multivariable regression was conducted. We evaluated associations between social support features (a virtual coach, a social poll, or a social wall), parent co-participation (time spent in the parent app), and app satisfaction on use (time spent in Aim2Be). Models were stratified by age and satisfaction was explored as a moderator. Results: Preteens (n = 83) engagement with the social poll (ß = 0.26, p < 0.001), virtual health coach (ß = 0.24, p = 0.01), app satisfaction (ß = 0.31, p = 0.01), and parent co-participation (ß = 0.24, p = 0.01) predicted use. In teens (n = 90), engagement with the virtual coach (ß = 0.31, p < 0.001) and full utilization of social wall features (ß = 0.41, p < 0.001) predicted use. Furthermore, satisfaction moderated the effects of partial utilization of the social wall among teens (ß = 0.32 p = 0.02). Conclusion: Social support in mHealth apps may impact users differently depending on age. Features that include health professionals or peers may be more advantageous across ages. App developers should consider age when designing interventions. Clinical Trial Registration NCT03651284.

"I'm going to change the WIFI password if you don't go outside!": a qualitative examination of changes in parenting practices over the course of the COVID-19 pandemic.

Introduction: Parenting practices are an important influence on the movement behaviours of children. Parenting practices are shaped by various contextual factors (e.g., culture, sociodemographic, community) and are susceptible to external pressures, such as health crises like the COVID-19 pandemic. Situated within the revised Family Ecological Model, the purpose of this study was to qualitatively explore changes in parenting practices over time in relation to the evolving nature of this global event. Methods: One-on-one semi-structured interviews with 40 parents of children (aged 7-11) in three Canadian provinces were conducted in August, 2021. A narrative thematic analysis was conducted to develop themes mapping changes in parenting practices and organize the temporal patterns of these changes into shared case trajectories over time. Results: Four themes were constructed to highlight changes in parenting practices: (1) Screen time permissiveness, (2) Force and coercion, (3) Agents of unstructured physical activity, and (4) Stepping back from structured physical activity. These themes were organized into three distinct case trajectories that each represent a shared, chronological narrative for how the first 18 months of the pandemic were broadly experienced by parents. The three trajectories were characterized by: (1) Resilience (2) Enduring impact and (3) Adaptive growth. Discussion: Parenting practices were changed in response to circumstances in both temporary and enduring manners that may continue beyond the pandemic. Further research is needed to longitudinally assess these trajectories in order to support families and enhance understanding of parenting practices in challenging circumstances.

Nurturing children's development through healthy eating and active living: Time for policies to support effective interventions in the context of responsive emotional support and early learning.

Fostering the growth, development, health, and wellbeing of children is a global priority. The early childhood period presents a critical window to influence lifelong trajectories, however urgent multisectoral action is needed to ensure that families are adequately supported to nurture their children's growth and development. With a shared vision to give every child the best start in life, thus helping them reach their full developmental potential, we have formed the International Healthy Eating Active Living Matters (HEALing Matters) Alliance. Together, we form a global network of academics and practitioners working across child health and development, and who are dedicated to improving health equity for children and their families. Our goal is to ensure that all families are free from structural inequality and oppression and are empowered to nurture their children's growth and development through healthy eating and physical activity within the context of responsive emotional support, safety and security, and opportunities for early learning. To date, there have been disparate approaches to promoting these objectives across the health, community service, and education sectors. The crucial importance of our collective work is to bring these priorities for early childhood together through multisectoral interventions, and in so doing tackle head on siloed approaches. In this Policy paper, we draw upon extensive research and call for collective action to promote equity and foster positive developmental trajectories for all children. We call for the delivery of evidence-based programs, policies, and services that are co-designed to meet the needs of all children and families and address structural and systemic inequalities. Moving beyond the "what" is needed to foster the best start to life for all children, we provide recommendations of "how" we can do this. Such collective impact will facilitate intergenerational progression that builds human capital in future generations.

Symptomatic and Asymptomatic Transmission of SARS-CoV-2 in K-12 Schools, British Columbia, Canada April to June 2021.

We prospectively studied SARS-CoV-2 transmission at schools in an era of variants of concern, offering all close contacts serial viral asymptomatic testing up to 14 days. From the 69 primary cases detected in schools, 392 close contacts were identified and offered asymptomatic testing. A total of 229 (58%) were close school contacts, and of these, 3 tested positive (1.3%), 2 of which were detected through asymptomatic testing. This is in contrast to the 117 household contacts, where 43 (37%) went on to become secondary cases. Routine asymptomatic testing of close contacts should be examined in the context of local testing rates, preventive measures, programmatic costs, and health impacts of asymptomatic transmission. IMPORTANCE There is concern that schools may be a setting where asymptomatic infections might result in significant "silent" transmission of SARS-CoV-2, particularly after the emergence of more transmissible variants of concern. After the programmatic implementation of a strategy of asymptomatic testing of close COVID-19 contacts as part of contact tracing in the school setting, the majority of the secondary cases were still found to have occurred in home or social contacts. However, for the 6.2% of secondary cases that occurred in close school contacts, the majority were detected through asymptomatic testing. The potential added yield of this approach needs to be considered within the overall setting, including consideration of the local epidemiology, ongoing goals of case and contact management, additional costs, logistical challenges for families, and possible health impacts of asymptomatic transmission.

The Aim2Be mHealth Intervention for Children With Overweight or Obesity and Their Parents: Person-Centered Analyses to Uncover Digital Phenotypes.

BACKGROUND: Despite the growing number of mobile health (mHealth) interventions targeting childhood obesity, few studies have characterized user typologies derived from individuals' patterns of interactions with specific app features (digital phenotypes). OBJECTIVE: This study aims to identify digital phenotypes among 214 parent-child dyads who used the Aim2Be mHealth app as part of a randomized controlled trial conducted between 2019 and 2020, and explores whether participants' characteristics and health outcomes differed across phenotypes. METHODS: Latent class analysis was used to identify distinct parent and child phenotypes based on their use of the app's behavioral, gamified, and social features over 3 months. Multinomial logistic regression models were used to assess whether the phenotypes differed by demographic characteristics. Covariate-adjusted mixed-effect models evaluated changes in BMI z scores (zBMI), diet, physical activity, and screen time across phenotypes. RESULTS: Among parents, 5 digital phenotypes were identified: socially engaged (35/214, 16.3%), independently engaged (18/214, 8.4%) (socially and independently engaged parents are those who used mainly the social or the behavioral features of the app, respectively), fully engaged (26/214, 12.1%), partially engaged (32/214, 15%), and unengaged (103/214, 48.1%) users. Married parents were more likely to be fullyengaged than independently engaged (P=.02) or unengaged (P=.01) users. Socially engaged parents were older than fullyengaged (P=.02) and unengaged (P=.01) parents. The latent class analysis revealed 4 phenotypes among children: fully engaged (32/214, 15%), partially engaged (61/214, 28.5%), dabblers (42/214, 19.6%), and unengaged (79/214, 36.9%) users. Fully engaged children were younger than dabblers (P=.04) and unengaged (P=.003) children. Dabblers lived in higher-income households than fully and partiallyengaged children (P=.03 and P=.047, respectively). Fully engaged children were more likely to have fully engaged (P<.001) and partiallyengaged (P<.001) parents than unengaged children. Compared with unengaged children, fully and partiallyengaged children had decreased total sugar (P=.006 and P=.004, respectively) and energy intake (P=.03 and P=.04, respectively) after 3 months of app use. Partially engaged children also had decreased sugary beverage intake compared with unengaged children (P=.03). Similarly, children with fully engaged parents had decreased zBMI, whereas children with unengaged parents had increased zBMI over time (P=.005). Finally, children with independently engaged parents had decreased caloric intake, whereas children with unengaged parents had increased caloric intake over time (P=.02). CONCLUSIONS: Full parent-child engagement is critical for the success of mHealth interventions. Further research is needed to understand program design elements that can affect participants' engagement in supporting behavior change. TRIAL REGISTRATION: ClinicalTrials.gov NCT03651284; https://clinicaltrials.gov/ct2/show/NCT03651284. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s13063-020-4080-2.

New or Recurrent Knee Injury, Physical Activity, and Osteoarthritis Beliefs in a Cohort of Female Athletes 2 to 3 Years After ACL Reconstruction and Matched Healthy Peers.

BACKGROUND: At 2 to 3 years after anterior cruciate ligament reconstruction (ACLR), the relationship between known modifiable osteoarthritis (OA) risk factors and recurrent knee injury is unknown. This study aimed to determine the odds of new or recurrent traumatic knee injury in a cohort of young female athletes with ACLR 2 to 3 years postsurgery compared with healthy control participants. Secondary objectives were to explore the relationships of moderate and vigorous physical activity (MVPA) and body mass index (BMI) with knee injury, and to document self-reported MVPA satisfaction and beliefs about OA. STUDY DESIGN: Prospective cohort. LEVEL OF EVIDENCE: Level 2. METHODS: A total of 51 female athletes with unilateral ACLR 1 to 2 years previously and 51 age and sport-matched control participants underwent assessment of MVPA (GT3X accelerometers) and BMI. One year later, participants self-reported knee injuries. Bivariable conditional logistic regression explored the association between knee injury, MVPA, and BMI in each group (injury/control). RESULTS: At 1-year follow-up (n = 101), 19.6% of the injured cohort and 6.0% of control participants sustained a new or recurrent knee injury. The odds of knee injury for the injury group increased 7-fold over controls [odds ratio (OR) = 7.00 (95% CI = 0.86, 56.90)], although this was not statistically significant. The OR for MVPA was 0.98 (95% CI = 0.93, 1.03) and BMI was OR = 1.24 (95% CI = 0.85, 1.82). Half (56.0%) of injury participants and 66% of controls were satisfied with their MVPA; 81.6% of injury participants believed they had increased knee OA risk compared with someone who had never had a knee injury. CONCLUSION: In the 2 to 3 years after ACLR, 1 in 5 young female athletes had a new or recurrent knee injury. Based on the point estimate, injured participants were more likely to suffer a traumatic knee injury than matched control participants. MVPA and BMI were not associated with increased odds of knee injury. CLINICAL RELEVANCE: Clinicians should be encouraged to have in-depth conversations with female athletes with previous ACLR regarding enjoyable and sustainable MVPA participation to promote long-term joint health.

COVID-19 Vaccine Intentions and Perceptions Among Public School Staff of the Greater Vancouver Metropolitan Area, British Columbia, Canada.

Background: The purpose of this study was to explore factors associated with COVID-19 vaccine intentions among school staff as high vaccine uptake is essential to ensure schools return to normal activities. Methods: Staff (e.g., teachers, administrators, student support workers) from three urban school districts in the Greater Vancouver Area of British Columbia, Canada completed a survey between February and June 2021 (n = 2,393) on COVID-19 vaccine intentions and perceptions (i.e., acceptance of routine vaccines, benefits and risks of vaccination, susceptibility to, and severity of COVID-19, recommendation by authority figures, information mistrust and conspiracy beliefs) as part of a COVID-19 seroprevalence study. Confirmatory factor analysis followed by multiple logistic regression models adjusting for relevant covariates were used to identify vaccine perceptions uniquely associated with (a) intention to get the COVID-19 vaccine (intention), and (b) intention to get vaccinated right away (urgency). Results: In total, 95.4% of participants of the seroprevalence study completed the vaccine questionnaire, corresponding to 17.7% of the target population. Vaccine intention was associated with staff who valued expert recommendations (AOR = 10.5, 95% CI = 7.39-14.90) accepted routine vaccines (AOR = 1.94, 95% CI = 1.26-2.98) and perceived higher benefits (AOR = 1.29, 95% CI = 1.01-1.65) and lower safety risks of vaccination (AOR = 0.40, 95% CI = 0.29-0.54). Comparable associations were found with vaccine urgency. Perceived susceptibility to the COVID-19 virus was uniquely associated with vaccine urgency (AOR = 1.30, 95% CI = 1.05-1.61). A significant interaction effect (p = 0.01) revealed that staff who expressed mistrust in COVID-19 information intended to get vaccinated only if they also perceived high benefits of vaccination. Conclusions: Education about the risks and benefits of COVID-19 vaccines from a trusted source had the strongest relationship with vaccine intentions among this occupational group. Notably, those who expressed mistrust in information still intended to get vaccinated if they also perceived strong benefits of the vaccine.

Parental Autonomy Support in the Context of Parent-Child Negotiation for Children's Independent Mobility: 'I Always Feel Safer With My Parents' to 'Boom! Bust Down Those Walls!'

Autonomy - acting volitionally with a sense of choice - is a crucial right for children. Given parents' pivotal position in their child's autonomy development, we examined how parental autonomy support and children's need for autonomy were negotiated and manifested in the context of children's independent mobility - children's ability to play, walk or cycle unsupervised. We interviewed 105 Canadian children between 10 and 13-years-old and their parents (n = 135) to examine child-parents' negotiation patterns as to children's independent mobility. Four patterns emerged, varying on parental autonomy support and children's need/motivation for independent mobility: (1) child/parent dyad wants to increase independent mobility; (2) child only wants to increase independent mobility while parents do not; (3) child does not want to increase independent mobility while parents do; and (4) child/parent dyad does not want to increase independent mobility. Findings illuminate the importance of recognizing children as active and capable agents of change.

Does an active play standard change childcare physical activity and healthy eating policies? A natural policy experiment.

BACKGROUND: In 2017, the provincial government of British Columbia (BC) implemented a mandatory policy outlining Active Play Standards (AP Standards) to increase physical activity (PA) levels, sedentary and motor skills among children attending licensed childcare centers. Concurrently, a capacity-building initiative was launched to help implement policies and practices supporting both PA and healthy eating (HE) in the early years. This study evaluated differences in center-level PA and HE policies and practices before and after the enforcement of the new provincial AP Standards. METHODS: Using a repeat cross-sectional design, surveys were distributed to managers and staff of licensed childcare facilities serving children aged 2-5 years before (2016-2017 or 'time 1') and after (2018-2019 or 'time 2') implementation of the AP Standards across BC. The total sample included 1,459 respondents (910 and 549 respondents at time 1 and time 2, respectively). Hierarchical mixed effects models were used to examine differences in 9 and 7 PA/sedentary policies and practices, respectively, as well as 11 HE policies between time 1 and time 2. Models controlled for childcare size and area-level population size, education, and income. RESULTS: Compared to centers surveyed at time 1, centers at time 2 were more likely to report written policies related to: fundamental movement skills, total amount of Active Play (AP) time, staff-led AP, unfacilitated play/free play, total amount of outdoor AP time, limiting screen time, breaking up prolonged sitting, staff role modeling of PA, and training staff about PA (P < 0.01 for all 9 policies examined). Compared to time 1, centers at time 2 reported more frequent practices related to ensuring children engaged in at least 120 min of AP, 60 min of outdoor AP daily, and limiting screen time (P < 0.01 for 3 out of 7 practices examined). Despite no additional policy intervention related to HE, centers were more likely to report having written policies related to: HE education for children, encouraging new foods, having family-style meals, offering only milk or water, limiting the amount of juice served, staff role modeling of HE, limiting the types of foods at parties/celebrations and foods brought from home (P < 0.05 for 9 out of 11 HE policies). CONCLUSION: Approximately a year after the implementation of a governmental policy targeting PA supported by a capacity-building initiative, childcare centers reported positive changes in all 9 PA/sedentary policies examined, all 3 out of 7 PA/sedentary practices and 9 out of 11 HE policies evaluated at the center-level.

SARS-CoV-2 seroprevalence among Vancouver public school staff in British Columbia, Canada: a cross-sectional study.

OBJECTIVES: Few studies reported COVID-19 cases in schools during the 2020/21 academic year in a setting of uninterrupted in-person schooling. The main objective was to determine the SARS-CoV-2 seroprevalence among school staff in Vancouver public schools. DESIGN: Cumulative incident COVID-19 cases among all students and school staff based on public health data, with an embedded cross-sectional serosurvey among a school staff sample that was compared to period, age, sex and geographical location-weighted data from blood donors. SETTING: Vancouver School District (British Columbia, Canada) from kindergarten to grade 12. PARTICIPANTS: Active school staff enrolled from 3 February to 23 April 2021 with serology testing from 10 February to 15 May 2021. MAIN OUTCOME MEASURES: SARS-CoV-2 seroprevalence among school staff, based on spike (S)-based (unvaccinated staff) or N-based serology testing (vaccinated staff). RESULTS: Public health data showed the cumulative incidence of COVID-19 among students attending in-person was 9.8 per 1000 students (n=47 280), and 13 per 1000 among school staff (n=7071). In a representative sample of 1689 school staff, 78.2% had classroom responsibilities, and spent a median of 17.6 hours in class per week (IQR: 5.0-25 hours). Although 21.5% (363/1686) of surveyed staff self-reported close contact with a COVID-19 case outside of their household (16.5% contacts were school-based), 5 cases likely acquired the infection at school based on viral testing. Sensitivity/Specificity-adjusted seroprevalence in 1556/1689 staff (92.1%) was 2.3% (95% CI: 1.6% to 3.2%), comparable to a sex, age, date and residency area-weighted seroprevalence of 2.6% (95% CI: 2.2% to 3.1%) among 5417 blood donors. CONCLUSION: Seroprevalence among staff was comparable to a reference group of blood donors from the same community. These data show that in-person schooling could be safely maintained during the 2020/21 school year with mitigation measures, in a large school district in Vancouver, Canada.

School staff and teachers during the second year of COVID-19: Higher anxiety symptoms, higher psychological distress, and poorer mental health compared to the general population.

Background: The aim of this study was to: 1) assess mental health symptoms in Canadian school staff during the second year of the pandemic (Spring 2021) and compare these same outcomes to national representative samples, and 2: examine whether the number of hours of direct contact with students was a significant predictor of anxiety symptoms. Methods: Online data on anxiety symptoms, psychological distress, overall mental health, and demographic information was collected from 2,305 school staff in the greater Vancouver area between February 3 and June 18, 2021, as part of a seroprevalence study. Results: School staff reported significantly higher anxiety symptoms than a national representative survey in Spring 2021 and higher exposure contact time with students was significantly associated with anxiety symptoms, in addition to sex and age, but not level of education and ethnicity. School staff also reported poorer mental health and higher levels of psychological distress compared to pre-pandemic population measures. Limitations: Cross-sectional design, self-report measures. Conclusions: These results show that priorities to reduce mental health challenges are critical during a public health crisis, not only at the beginning, but also one year later. Ongoing proactive prevention and intervention strategies for school staff are warranted.