Lunch is ready but not healthy: An analysis of lunches served in childcare centres in two Canadian provinces.

OBJECTIVES: Childcare centres (CCs) typically offer one meal and snacks daily. This study compared what is served in CCs with what the nutritional recommendations are; described and compared the nutritional composition of lunches served in CCs in New Brunswick and Saskatchewan; and examined differences between French and English, and urban and rural centres. METHODS: The study involved 61 randomly selected CCs in New Brunswick and Saskatchewan, Canada. Lunch content was measured on two consecutive days by weighing each food item served to children and by visually documenting the food items using digital photography. Food items were categorized into food groups according to Health Canada's Eating Well with Canada's Food Guide, and nutrients were analyzed using a nutritional analysis software. One-sample t tests compared lunch content with nutritional recommendations. Independent t tests compared the nutrient and food group content of lunches in New Brunswick and Saskatchewan, French and English, and urban and rural CCs. RESULTS: On average, CCs did not meet provincial recommendations. Lunches in both provinces were low in calories (<517 kcal) and fibre (<7 g). Overall, Saskatchewan centres served greater amounts of food than New Brunswick centres (p < 0.05). French-speaking centres provided less fat (p = 0.047), less saturated fat (p = 0.01), and fewer servings of meat and alternatives (p = 0.02), and more trans fat (p = 0.03) than English-speaking centres. There were no differences between rural and urban centres. CONCLUSIONS: Few CC lunches met nutritional recommendations. Interventions are required to improve the quality of foods offered in CCs. Reviewing or developing comprehensive nutrition guidelines is warranted.

Association between childcare educators' practices and preschoolers' physical activity and dietary intake: a cross-sectional analysis.

INTRODUCTION: Childcare educators may be role models for healthy eating and physical activity (PA) behaviours among young children. This study aimed to identify which childcare educators' practices are associated with preschoolers' dietary intake and PA levels. METHODS: This cross-sectional analysis included 723 preschoolers from 50 randomly selected childcare centres in two Canadian provinces. All data were collected in the fall of 2013 and 2014 and analysed in the fall of 2015. PA was assessed using Actical accelerometers during childcare hours for 5 consecutive days. Children's dietary intake was measured at lunch on 2 consecutive days using weighed plate waste and digital photography. Childcare educators' nutrition practices (modelling, nutrition education, satiety recognition, verbal encouragement and not using food as rewards) and PA practices (informal and formal PA promotion) were assessed by direct observation over the course of 2 days, using the Nutrition and Physical Activity Self-Assessment for Child Care tool. Associations between educators' practices and preschoolers' PA and dietary intake were examined using multilevel linear regressions. RESULTS: Overall, modelling of healthy eating was positively associated with children's intake of sugar (ß=0.141, 95% CI 0.03 to 0.27), while calorie (ß=-0.456, 95% CI -1.46 to -0.02) and fibre intake (ß=-0.066, 95% CI -0.12 to -0.01) were negatively associated with providing nutrition education. Not using food as rewards was also negatively associated with fat intake (ß=-0.144, 95% CI -0.52 to -0.002). None of the educators' PA practices were associated with children's participation in PA. CONCLUSIONS: Modelling healthy eating, providing nutrition education and not using food as rewards are associated with children's dietary intake at lunch in childcare centres, highlighting the role that educators play in shaping preschoolers' eating behaviours. Although PA practices were not associated with children's PA levels, there is a need to reduce sedentary time in childcare centres.

"Monkey see, monkey do": Peers' behaviors predict preschoolers' physical activity and dietary intake in childcare centers.

Preschoolers observe and imitate the behaviors of those who are similar to them. Therefore, peers may be role models for preschoolers' dietary intake and physical activity in childcare centers. This study examined whether peers' behaviors predict change in preschoolers' dietary intake and physical activity in childcare centers over 9months. A total of 238 preschoolers (3 to 5years old) from 23 childcare centers in two Canadian provinces provided data at the beginning (October 2013 and 2014) and the end (June 2014 and 2015) of a 9-month period for this longitudinal study. Dietary intake was collected at lunch using weighed plate waste and digital photography on two consecutive weekdays. Physical activity was assessed using accelerometers over five days. Multilevel linear regressions were used to estimate the influence of peers' behaviors on preschoolers' change in dietary intake and physical activity over 9months. Results showed that preschoolers whose dietary intake or physical activity level deviated the most from those of their peers at the beginning of the year demonstrated greater change in their intakes and activity levels over 9months, which enabled them to become more similar to their peers (all ß 95% CI ranged from -0.835 to -0.074). This study suggests that preschoolers' dietary intake and physical activity may be influenced by the behaviors of their peers in childcare centers. Since peers could play an important role in promoting healthy eating behaviors and physical activity in childcare centers, future studies should test interventions based on positive role modeling by children.

A multilevel intervention to increase physical activity and improve healthy eating and physical literacy among young children (ages 3-5) attending early childcare centres: the Healthy Start-Départ Santé cluster randomised controlled trial study protocol.

BACKGROUND: Childhood obesity is a growing concern for public health. Given a majority of children in many countries spend approximately 30 h per week in early childcare centers, this environment represents a promising setting for implementing strategies to foster healthy behaviours for preventing and controlling childhood obesity. Healthy Start-Départ Santé was designed to promote physical activity, physical literacy, and healthy eating among preschoolers. The objectives of this study are to assess the effectiveness of the Healthy Start-Départ Santé intervention in improving physical activity levels, physical literacy, and healthy eating among preschoolers attending early childcare centers. METHODS/DESIGN: This study follows a cluster randomized controlled trial design in which the childcare centers are randomly assigned to receive the intervention or serve as usual care controls. The Healthy Start-Départ Santé intervention is comprised of interlinked components aiming to enable families and educators to integrate physical activity and healthy eating in the daily lives of young children by influencing factors at the intrapersonal, interpersonal, organizational, community, physical environment and policy levels. The intervention period, spanning 6-8 months, is preceded and followed by data collections. Participants are recruited from 61 childcare centers in two Canadian provinces, New Brunswick and Saskatchewan. Centers eligible for this study have to prepare and provide meals for lunch and have at least 20 children between the ages of 3 and 5. Centers are excluded if they have previously received a physical activity or nutrition promoting intervention. Eligible centers are stratified by province, geographical location (urban or rural) and language (English or French), then recruited and randomized using a one to one protocol for each stratum. Data collection is ongoing. The primary study outcomes are assessed using accelerometers (physical activity levels), the Test of Gross Motor Development-II (physical literacy), and digital photography-assisted weighted plate waste (food intake). DISCUSSION: The multifaceted approach of Healthy Start-Départ Santé positions it well to improve the physical literacy and both dietary and physical activity behaviors of children attending early childcare centers. The results of this study will be of relevance given the overwhelming prevalence of overweight and obesity in children worldwide. TRIAL REGISTRATION: NCT02375490 (ClinicalTrials.gov registry).

Relationship between eating behaviors and physical activity of preschoolers and their peers: a systematic review.

OBJECTIVES: Children learn by observing and imitating others, meaning that their eating behaviors and physical activity may be influenced by their peers. This paper systematically reviews how preschoolers' eating behaviors and physical activity relate to their peers' behaviors, and discusses avenues for future research. METHODS: Six databases were searched for quantitative, peer-reviewed studies published up to July 2015 reporting on the correlates, predictors or effectiveness of peers on eating behaviors and physical activity in preschoolers. Risk of bias was independently assessed by two evaluators using the Quality Assessment Tool for Quantitative Studies. RESULTS: Thirteen articles were included: six measured physical activity, and seven assessed eating behaviors. Four of the six physical activity studies reported that children were more active when peers were present, while large peer group size was negatively associated with physical activity in two cross-sectional studies. All nutrition interventions reported that children's eating behaviors may be influenced by their peers. CONCLUSIONS: Although supported by weak evidence, peers appear to influence children's eating behaviors and physical activity. However, this influence may be moderated by the number of peers, gender, age and the perceived status of the role models. Future obesity prevention interventions should consider involving peers as agents for positive eating behaviors and physical activity in preschoolers.

Association Between School Policies and Built Environment, and Youth's Participation in Various Types of Physical Activities.

BACKGROUND: School environmental characteristics may be associated with youth's participation in different types of physical activities (PAs). This study aimed to identify which school policies and built environmental characteristics were associated with participation in organized, nonorganized, individual, and group-based activities. METHODS: This cross-sectional analysis included 776 students in grade 5 or 6 from 16 schools. The school environment was assessed through school-based questionnaires completed by school representatives. Types of PA and attainment of PA recommendations were obtained using self-administered student questionnaires. Associations between environment and student PA were examined using multilevel logistic regressions. RESULTS: Schools with favorable active commuting environments were positively associated with girls' participation in organized (odds ratio [OR] = 1.34, confidence interval [CI] = 1.04-1.74) and group-based PA (OR = 1.54, CI = 1.19-1.99) and with boys' odds of participating in individual activities (OR = 1.45, CI = 1.04-2.04). There was also a positive relationship between having a school environment favorable to active commuting and boys' odds of meeting PA recommendations (OR = 2.19, CI = 1.43-3.37). School policies supporting PA were positively associated with girls' odds of participating in nonorganized activities (OR = 1.18, CI = 1.00-1.40). CONCLUSIONS: School environments that favor active commuting may encourage participation in different types of PA. School policies promoting PA also may encourage girls to participate in organized activities.

Correlates, determinants, and effectiveness of childcare educators' practices and behaviours on preschoolers' physical activity and eating behaviours: a systematic review protocol.

BACKGROUND: Worldwide, approximately 12% of children under the age of 5 are either overweight or obese. As many young children spend 30 h or more per week in childcare centres with childcare educators. Targeting childcare educators as role models may prove an effective strategy for the promotion of healthy eating and physical activity. This manuscript describes the methods to systematically review existing literature relating to how childcare educators influence children's healthy eating and physical activity behaviours, as well as the links between specific practices and behaviours of childcare educators and children's healthy lifestyle behaviours. METHODS: Relevant peer-reviewed studies will be identified through a computerized literature search in six databases: PubMed, The Cochrane Library, Science Direct, CINAHL, Wiley and SportDiscus. Quantitative studies written in English or French reporting the correlates, predictors or effectiveness of childcare educators' practices and behaviours on preschoolers' healthy eating and physical activity behaviours will be included. The quality of retained studies will be assessed using the Quality Assessment Tool for Quantitative Studies. Descriptive summary statistics of study characteristics will be reported as well as the study designs and exposure and outcome measures. Inter-rater agreements for study selection and quality assessments will be reported and unadjusted, and adjusted results will be presented. Reporting of the systematic review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. DISCUSSION: This systematic review will contribute to a better understanding of the potential of childcare educators as role models for young children, as well as the influence (or impact) of their behaviours and intervention on children's short- and long-term health. It will provide important information that could be used to improve obesity prevention strategies and initiatives, as well as to guide the improvement or implementation of effective healthy eating and physical activity policies in childcare centres. SYSTEMATIC REVIEW REGISTRATION: PROSPERO ( CRD42014012973 ).

[Access to the early diagnosis of dementia in New Brunswick: perceptions of potential users of services depending on the language and the middle of life]. / Accès au diagnostic précoce de démence au Nouveau-Brunswick : perceptions d'usagers potentiels de services selon la langue et le milieu de vie.

OBJECTIVES: The early diagnosis of dementia (EDD) enables the identification of reversible causes of dementia and allows the timely implementation of secondary preventive and therapeutic interventions. This study explores New Brunswick seniors' perceptions of the accessibility and availability of EDD services as well as their satisfaction with them while taking into account their language of use and place of residence (urban or rural). METHOD: Self-administered survey exploring perceptions of EDD services in Francophone and Anglophone seniors from rural and urban areas of New Brunswick. Univariate and bivariate analyses were carried out. RESULTS: Of the 157 participants aged 65 years and over who filled out the survey and whose data were analyzed, 84 identified as Francophone, 72 of whom lived in rural areas. Bivariate analyses showed that linguistic groups were comparable with regard to their perceptions of the availability, access to, and satisfaction with EDD services. However, when taking the geographic dimension into account, linguistic intergroup and intragroup disparities were observed, notably in the areas pertaining to the type of services available in the area. CONCLUSIONS: These results suggest that seniors who live in rural areas of New Brunswick are a particularly vulnerable group with perceived limited access to EDD services in their area.

Recruiting doctors from and for underserved groups: Does New Brunswick's initiative to recruit doctors for its linguistic minority help rural communities?

OBJECTIVES: Within health care, there are underserved groups. New Brunswick's French-speaking minority, which also mostly lives in rural communities, is one such group. A physician shortage potentially prevents this population from accessing health promotion and clinical prevention services. This study analyzes whether New Brunswick Francophone doctors with rural backgrounds are more likely than doctors from urban regions to set up practice in rural communities of the province. METHODS: A questionnaire was sent to 390 New Brunswick Francophone physicians admitted in medicine between 1973 and 2000. It collected information on geographic origin and history of medical practice. Multivariate logistic regressions were used to identify whether a rural background is associated with the likelihood of ever and currently practicing in rural communities. We used the General Practice Rurality Index-simplified to quantify the rurality level of communities. RESULTS: In total, 264 (67%) physicians participated. A rural background was positively associated with the establishment of a first medical practice in a rural community. This relationship was only significant among family physicians. There was no statistically significant relationship between rurality of community of origin and rurality of current community of practice among either family or specialty physicians. CONCLUSION: Although Francophone doctors with a rural background were more likely than their urban counterparts to set up their first practice in a rural community, this effect was not sustained. This raises questions as to why they leave rural communities and highlights the importance of measures to retain doctors as a way to promote public health for underserved rural groups.

Enhancing undergraduate public health education through public health interest groups.

PURPOSE: Since 2007, all Canadian medical schools have had at least one established student-led public health interest group (PHIG). The Association of Faculties of Medicine of Canada (AFMC), the Public Health Task Group, and the Public Health Agency of Canada (PHAC) have supported these PHIGs. The authors describe the activities and structure of PHIGs in Canada from 2007 to 2011, plus the extent to which PHIGs met the objectives set out for them by the AFMC Public Health Task Group. METHOD: Using a standardized template, the authors analyzed funding applications and reports that PHIG executives submitted to the AFMC from 2007 through 2011. The authors created activity categories and collected simple counts of activities within categories. They then used these data to assess how successfully PHIGs have been able to meet their objectives. RESULTS: Fifty-two funding applications, 50 interim reports, and 48 final reports were available for analysis. All 17 Canadian medical schools had at least one established PHIG between 2007 and 2011, and 9 schools (53%) applied for PHIG funding in all four years. Academic activities such as lectures, seminars, and workshops were the most common activities conducted by PHIGs, followed by career exploration and networking. CONCLUSIONS: This study found that the AFMC, with funding support from PHAC, was instrumental in initiating PHIGs in 82% (n = 14) of Canadian medical schools. With consistent funding, national networking opportunities, and a common operating structure, PHIGs have been able to accomplish AFMC's objectives for increasing public health awareness amongst medical students.