Strategies and indicators to integrate health equity in health service and delivery systems in high-income countries: a scoping review.

OBJECTIVE: The objective of this review was to describe how health service and delivery systems in high-income countries define and operationalize health equity. A secondary objective is to identify implementation strategies and indicators being used to integrate and measure health equity. INTRODUCTION: To improve the health of populations, a population health and health equity approach is needed. To date, most work on health equity integration has focused on reducing health inequities within public health, health care delivery, or providers within a health system, but less is known about integration across the health service and delivery system. INCLUSION CRITERIA: This review included academic and gray literature sources that described the definitions, frameworks, level of integration, strategies, and indicators that health service and delivery systems in high-income countries have used to describe, integrate, and/or measure health equity. Sources were excluded if they were not available in English (or a translation was not available), were published before 1986, focused on strategies that were not implemented, did not provide health equity indicators, or featured strategies that were implemented outside the health service or delivery systems (eg, community-based strategies). METHODS: This review was conducted in accordance with the JBI methodology for scoping reviews. Titles and abstracts were assessed followed by a full-text review. The information extracted consisted of study design and key findings, such as health equity definitions, strategies, frameworks, level of integration, and indicators. Most data have been quantitatively tabulated and presented according to 5 review questions. Some findings (eg, definitions and indicators) were summarized using qualitative methods. Most findings are visually presented in charts and diagrams or presented in tabular format. RESULTS: Following review of 16,297 titles and abstracts and 824 full-text sources, we included 122 sources (113 peer-reviewed, 9 gray literature) in this scoping review. We found that health equity was inconsistently defined and operationalized. Only 17 sources included definitions of health equity and we found that both indicators and strategies were lacking adequate descriptions. The use of health equity frameworks was limited and, where present, there was little consistency or agreement in their use. We found that strategies were often specific to programs, services, or clinics, rather than broadly applied across health service and delivery systems. CONCLUSIONS: Our findings suggest that strategies to advance health equity work are siloed within health service and delivery systems and are not currently being implemented system-wide (ie, across all health settings). Healthy equity definitions and frameworks are varied in the included sources, and indicators for health equity are variable and inconsistently measured. Health equity integration needs to be prioritized within and across health service and delivery systems. There is also a need for system-wide strategies to promote health equity, alongside robust accountability mechanisms for measuring health equity. This is necessary to ensure that an integrated, whole-system approach can be consistently applied in health service and delivery systems internationally. REVIEW REGISTRATION: Dal Space dalspace.library.dal.ca/handle/10222/80835. SUPPLEMENTAL DIGITAL CONTENT IS AVAILABLE FOR THIS REVIEW: http://links.lww.com/SRX/A45.

Development and implementation of a municipal outdoor play policy for children and youth in Nova Scotia, Canada: a community case study.

Background: Children and youth benefit from outdoor play; however, environments and policies to support outdoor play are often limited. The purpose of this paper is to describe a case study of the development of a municipal outdoor play policy in Nova Scotia, Canada. The outdoor play policy was developed by the Town of Truro with support from the UpLift Partnership, a School-Community-University Partnership in Nova Scotia, Canada. UpLift supports the health and well-being of school-aged children and youth using a Health Promoting Schools approach which identifies the important role of municipal government in creating healthy school communities. The UpLift Partnership and the municipality hosted online workshops for municipal staff, community leaders and partners that included content about the importance of outdoor play, barriers and facilitators to outdoor play, best practices for youth engagement, the policy development process, and how policy actions can support outdoor play. Workshop participants developed policy actions for their community of Truro, Nova Scotia to increase opportunities for outdoor play for children and youth. Following the workshops, a small team from the municipality and UpLift drafted an outdoor play policy and submitted it to Truro town council for approval. The outdoor play policy was adopted in Fall 2021 and has since informed recreation and municipal planning decisions. By presenting a case study of the development of this outdoor play policy, we hope other communities may be inspired to develop and adopt their own outdoor play policies to benefit children and youth in their communities.

Process and experience of youth researchers within a Health Promoting Schools study in Nova Scotia, Canada.

Youth Participatory Action Research (YPAR) is an approach to research that engages youth across the research process. The peer researcher method is a technique used in YPAR where youth are trained in research and ethics to interview their peers. The purpose of this study was to: (i) describe the process of engaging youth as peer researchers in a Health Promoting Schools (HPS) and student engagement project and (ii) understand the peer researchers' perspectives of their experience throughout the project. Youth from across Nova Scotia, Canada in grades 7-10 (ages 12-16) were recruited as peer researchers in the Summer, 2022. The project included three stages: (i) peer researcher training, (ii) practicing, recruiting and conducting interviews and (iii) data interpretation workshop. To understand the peer researcher's experience, quantitative data were collected from an evaluation questionnaire. Outputs were produced using descriptive statistics. Qualitative data were collected through a focus group and interviews and analyzed using inductive content analysis. A total of 11 youth were recruited and completed peer researcher training. Most youth provided positive feedback on the training with a satisfaction score of 8.7/10. Qualitative analysis indicated benefits to the peer researchers including opportunities to build interview and social skills and learn about other's perspectives. This study provides a detailed overview of how to use a peer researcher method in a YPAR project to involve youth in research related to HPS and student engagement. The research also highlights the benefits of engaging youth in YPAR. Future research will report on the findings from the peer interviews.

Impact of an outdoor loose parts play intervention on Nova Scotian preschoolers' physical literacy: a mixed-methods randomized controlled trial.

BACKGROUND: Physical activity participation among preschoolers in childcare settings are low, and interventions to increase physical activity levels have produced mixed results. The Physical Literacy in the Early Years (PLEY) project implemented a six-month childcare-based outdoor loose parts play intervention in childcare centres in Nova Scotia, Canada. The purpose of this study was to examine the impact of the PLEY project on the development of domains of physical literacy (physical activity, physical competence, confidence and motivation, knowledge and understanding) in preschoolers attending childcare centres using mixed-methods. METHODS: Preschoolers (3-5 years) were recruited from 19 childcare centres in Nova Scotia and centres were randomized (parallel design) to the outdoor loose parts play intervention group (n = 11) or control (n = 8) group for 6 months. Participants, early childhood educators, and assessors were not blinded to group assignment. Quantitative and qualitative measures were used to comprehensively assess the impact of the PLEY project on all domains of physical literacy. At 3- and 6-months, early childhood educators participated in focus groups to assess how the intervention supported the development of 4 physical literacy domains: physical activity, physical competence, confidence and motivation, and knowledge and understanding. Physical activity and physical competence were also assessed with accelerometry and the Test of Gross Motor Development-3, respectively. RESULTS: Two hundred and nine preschoolers participated in the study (intervention group: n = 115; control group: n = 94). Accelerometer data showed that while baseline physical activity was similar between groups, children in the intervention group had higher physical activity at 3- (F(1,187) = 8.30, p = 0.004) and 6-months (F(1,187) = 9.90, p = 0.002) post-intervention. There was no intervention effect on physical competence scores. Thematic analysis of focus group data revealed that outdoor loose parts play contributed to development in all 4 physical literacy domains, including increased movement repertoires, social development, and enjoyment of physical activity. No adverse events or side effects of the intervention were reported. CONCLUSIONS: Participation in the PLEY project was associated with increased development of various domains of physical literacy and perceived physical literacy among preschoolers, and outdoor loose parts play may be encouraged as an effective strategy to increase physical literacy in early learning settings. TRIAL REGISTRATION: Biomed Central (ISRCTN14058106), 20/10/2017.

Physical Activity Trajectories in Early Childhood: Investigating Personal, Environmental, and Participation Factors.

INTRODUCTION/PURPOSE: To determine personal, environmental, and participation factors that predict children's physical activity (PA) trajectories from preschool through to school years. METHODS: Two hundred seventy-nine children (4.5 ± 0.9 yr, 52% boys) were included in this study. Physical activity was collected via accelerometry at six different timepoints over 6.3 ± 0.6 yr. Time-stable variables were collected at baseline and included child's sex and ethnicity. Time-dependent variables were collected at six timepoints (age, years) and included household income (CAD), parental total PA, parental influence on PA, and parent-reported child's quality of life, child's sleep, and child's amount of weekend outdoor PA. Group-based trajectory modeling was applied to identify trajectories of moderate-to-vigorous PA (MVPA) and total PA (TPA). Multivariable regression analysis identified personal, environmental, and participation factors associated with trajectory membership. RESULTS: Three trajectories were identified for each of MVPA and TPA. Group 3 in MVPA and TPA expressed the most PA over time, with increased activity from timepoints 1 to 3, and then declining from timepoints 4 to 6. For the group 3 MVPA trajectory, male sex (ß estimate, 3.437; P = 0.001) and quality of life (ß estimate, 0.513; P < 0.001) were the only significant correlates for group membership. For the group 3 TPA trajectory, male sex (ß estimate, 1.970; P = 0.035), greater household income (ß estimate, 94.615; P < 0.001), and greater parental total PA (ß estimate, 0.574; P = 0.023) increased the probability of belonging to this trajectory group. CONCLUSIONS: These findings suggest a need for interventions and public health campaigns to increase opportunities for PA engagement in girls starting in the early years. Policies and programs to address financial inequities, positive parental modeling, and improving quality of life are also warranted.

Peering in: youth perspectives on Health Promoting Schools and youth engagement in Nova Scotia, Canada.

Health Promoting Schools (HPS) is a whole-school approach that shapes the conditions necessary to support student health and well-being. Youth engagement is recognized as key to HPS implementation, yet research related to the involvement of youth voice in school health promotion initiatives is limited. The purpose of this study was to understand youth perspectives on HPS and school youth engagement. Ten youth (grades 9-10, ages 14-16) were trained as peer researchers using a Youth Participatory Action Research approach. The peer researchers interviewed 23 of their peers (grades 7-10, ages 12-16) on perspectives related to HPS and school youth engagement. All interviews were audio-recorded, transcribed and data were analysed using inductive 'codebook' thematic analysis. Themes related to a healthy school community were mapped onto the pillars of HPS: (i) Social and Physical Environment, (ii) Teaching and Learning, (iii) Partnerships and Services and (iv) School Policies. Participants placed more importance on the social and physical environment of the school including respect, inclusivity, supportive relationships and the design of spaces. Key factors for youth engagement were: (i) safe and supportive spaces, (ii) passion and interest, (iii) using their voice, (iv) power dynamics, (v) accessibility and (vi) awareness. With recognition that youth engagement is a crucial part of HPS, this work provides relevant and applicable information on areas of the healthy school community that are important to youth, and if/how they are meaningfully engaged in school decision-making.

Schools are a place for students to develop and learn about health. Schools in Nova Scotia have applied Health Promoting Schools (HPS) activities since 2005. HPS activities support students' health and well-being by developing safe spaces, offering healthy food options and increasing time for physical activity. There is a lack of research outlining what youth think about HPS or how they are involved. We trained youth to interview their peers to find out what parts of the school they think are healthy, and how they are involved in school decision-making. We found that youth wanted to be part of a school where they felt safe, included and respected. Students also described a healthy school as welcoming, and clean. Youth felt their involvement in decision-making was important. Youth shared that teacher support and personal interest helped them be involved in decision-making. Fear of sharing their opinions and not knowing how to be involved made it harder for youth to be part of decision-making. Our research identified what parts of the school youth think are important for their health, and what makes it easier or harder for them to be engaged. The results of this research can support HPS activities moving forward.

Regional differences in movement behaviours of children and youth during the second wave of the COVID-19 pandemic in Canada: follow-up from a national study.

OBJECTIVES: Public health restrictions varied by region during the COVID-19 pandemic and reduced opportunities for children to be physically active. The purpose of this study was to assess regional differences in movement behaviours of Canadian children and youth during the second wave of the COVID-19 pandemic. METHODS: A national sample of Canadian parents (n=1568; 58% women) of children and youth (5-17 years of age) completed an online survey. Participants were classified based on region of residence (British Columbia, Prairies, Ontario, Quebec, or Atlantic Canada). Differences in movement and play behaviours (physical activity, outdoor play, sleep, screen time) between children and youth living in different regions were examined. RESULTS: Compared to children and youth in Quebec (the region with the highest COVID-19 prevalence), children and youth in the Prairies (F(1,1563)=9.0, p=0.01) and Atlantic Canada (F(1,1563)=17.1, p<0.001) participated in more moderate-to-vigorous physical activity (MVPA). Compared to Quebec, living in Atlantic Canada increased the odds of meeting the MVPA guideline (odds ratio (OR)=2.1, p=0.02), living in Ontario decreased the odds of meeting the sleep guideline (OR=0.6, p=0.01), and living in Ontario (OR=0.7, p=0.04) or Atlantic Canada (OR=0.6, p=0.049) decreased the odds of meeting the screen time guideline. Children and youth in Atlantic Canada demonstrated smaller declines in outdoor play than their counterparts in Quebec. CONCLUSION: Movement and play behaviours varied between regions of Canada where the highest COVID-19 prevalence corresponded to lower odds of meeting the physical activity guidelines. Low compliance with 24-hour movement guidelines suggests that regional pandemic recovery plans need to prioritize opportunities for healthy movement.

RéSUMé: OBJECTIFS: Les restrictions sanitaires ont varié d'une région à l'autre durant la pandémie de COVID-19, et elles ont réduit les possibilités pour les enfants d'être actifs. Notre étude visait à évaluer les différences régionales dans les comportements liés au mouvement des enfants et des jeunes canadiens au cours de la deuxième vague de la pandémie. MéTHODE: Un échantillon national de parents canadiens (n = 1 568; 58 % de femmes) d'enfants et de jeunes (5­17 ans) ont répondu à un sondage en ligne. Les participants ont été classés selon leur région de résidence (Colombie-Britannique, Prairies, Ontario, Québec ou Canada atlantique). Les différences dans les comportements liés au mouvement et au jeu (activité physique, jeu à l'extérieur, sommeil, temps d'écran) entre les enfants et les jeunes de différentes régions ont été examinées. RéSULTATS: Comparativement aux enfants et aux jeunes du Québec (la région qui présentait la plus forte prévalence de COVID-19), les enfants et les jeunes des Prairies (F(1,1563) = 9,0, p = 0,01) et du Canada atlantique (F(1,1563) = 17,1, p < 0,001) ont fait plus d'activité physique modérée à vigoureuse (APMV). Comparativement au Québec, le fait de vivre au Canada atlantique a accru la probabilité de respecter les lignes directrices sur l'APMV (rapport de cotes (RC) = 2,1, p = 0,02), le fait de vivre en Ontario a réduit la probabilité de respecter les lignes directrices sur le sommeil (RC = 0,6, p = 0,01), et le fait de vivre en Ontario (RC = 0,7, p = 0,04) ou au Canada atlantique (RC = 0,6, p = 0,049) a réduit la probabilité de respecter les lignes directrices sur le temps d'écran. Les enfants et les jeunes du Canada atlantique ont présenté des baisses moins importantes du jeu à l'extérieur que les enfants et les jeunes du Québec. CONCLUSION: Les comportements liés au mouvement et au jeu ont varié d'une région à l'autre du Canada; là où la prévalence de la COVID-19 était la plus élevée, la probabilité de respecter les lignes directrices sur l'activité physique était la plus faible. La faible conformité aux lignes directrices sur le mouvement sur une période de 24 heures donne à penser que les plans de rétablissement régionaux après la pandémie devront accorder la priorité aux possibilités de mouvement sain.

The Impact of an After-School Physical Activity Program on Children's Physical Activity and Well-Being during the COVID-19 Pandemic: A Mixed-Methods Evaluation Study.

INTRODUCTION: This study evaluated the impact of the Build Our Kids' Success (BOKS) after-school program on children's physical activity (PA) and well-being during the COVID-19 pandemic. METHODS: Program leaders, children, and their parents were recruited from after-school programs in Nova Scotia, Canada, that delivered BOKS programming in Fall 2020. After participating, Grade 4-6 children (n = 14) completed the Physical Literacy Assessment for Youth Self (PLAYself), Physical Activity Questionnaire for Older Children (PAQ-C), the Physical Activity Enjoyment Scale (PACES), and 5 National Institutes of Health (NIH) Patient-Reported Outcomes Measures Information System (PROMIS) scales. Children (n = 7), parents (n = 5), and program leaders (n = 3) completed interviews, which were analyzed for themes inductively. RESULTS: The average PAQ-C score was 2.70 ± 0.48, PLAYself was 68.23 ± 13.12, and PACES was 4.22 ± 0.59 (mean ± SD). NIH PROMIS scores were below standard means (cognitive function, family relationships) or within normal limits (peer relationships, positive affect, and life satisfaction). A thematic analysis of interviews revealed that children's PA levels were impacted by the pandemic and that BOKS positively impacted children's physical well-being and integrated well with school-based activities. CONCLUSIONS: Participation in BOKS provided an overall positive experience and may have mitigated COVID-19-related declines in PA in well-being. The results of this evaluation can inform future physically-active after-school programming.

Barriers to and strategies to address COVID-19 testing hesitancy: a rapid scoping review.

BACKGROUND: Testing is a foundational component of any COVID-19 management strategy; however, emerging evidence suggests that barriers and hesitancy to COVID-19 testing may affect uptake or participation and often these are multiple and intersecting factors that may vary across population groups. To this end, Health Canada's COVID-19 Testing and Screening Expert Advisory Panel commissioned this rapid review in January 2021 to explore the available evidence in this area. The aim of this rapid review was to identify barriers to COVID-19 testing and strategies used to mitigate these barriers. METHODS: Searches (completed January 8, 2021) were conducted in MEDLINE, Scopus, medRxiv/bioRxiv, Cochrane and online grey literature sources to identify publications that described barriers and strategies related to COVID-19 testing. RESULTS: From 1294 academic and 97 grey literature search results, 31 academic and 31 grey literature sources were included. Data were extracted from the relevant papers. The most cited barriers were cost of testing; low health literacy; low trust in the healthcare system; availability and accessibility of testing sites; and stigma and consequences of testing positive. Strategies to mitigate barriers to COVID-19 testing included: free testing; promoting awareness of importance to testing; presenting various testing options and types of testing centres (i.e., drive-thru, walk-up, home testing); providing transportation to testing centres; and offering support for self-isolation (e.g., salary support or housing). CONCLUSION: Various barriers to COVID-19 testing and strategies for mitigating these barriers were identified. Further research to test the efficacy of these strategies is needed to better support testing for COVID-19 by addressing testing hesitancy as part of the broader COVID-19 public health response.

Preschool to School-Age Physical Activity Trajectories and School-Age Physical Literacy: A Longitudinal Analysis.

PURPOSE: The associations between longitudinal physical activity (PA) patterns across childhood and physical literacy have not been studied. The purpose of this study was to identify PA trajectories from preschool to school-age, and to determine if trajectory group membership was associated with school-age physical literacy. METHODS: Participants (n = 279, 4.5 [0.9] y old, 48% girls) enrolled in this study and completed annual assessments of PA with accelerometry over 6 timepoints. Physical literacy was assessed at timepoint 6 (10.8 [1.0] y old). Group-based trajectory analysis was applied to identify trajectories of total volume of PA and of moderate to vigorous PA and to estimate group differences in physical literacy. RESULTS: Three trajectories of total volume of PA and of moderate to vigorous PA were identified. Groups 1 (lowest PA) included 40% to 53% of the sample, groups 2 included 39% to 44% of the sample, and groups 3 (highest PA) included 8% to 16% of the sample. All trajectories declined from timepoint 1 to timepoint 6. School-age physical literacy was lowest in trajectory groups with the lowest total volume of PA or moderate to vigorous PA over time (P < .05). CONCLUSIONS: PA should be promoted across early and middle childhood, as it may play a formative role in the development of school-age physical literacy.

Play-Friendly Communities in Nova Scotia, Canada: A Content Analysis of Physical Activity and Active Transportation Strategies.

The Play-Friendly Cities framework describes key municipal actions and indicators which support a community's playability and can positively influence children's health behaviors and quality of life. The purpose of this study was to conduct a content analysis of Nova Scotia physical activity (PA) and active transportation (AT) strategies by applying the playability criteria in the Play-Friendly Cities framework. METHODS: PA and AT strategies from communities across Nova Scotia were assessed using the Play-Friendly Cities framework. Strategy content was analyzed based on indicators across four themes: participation of children in decision making, safe and active routes around the community, safe and accessible informal play environments, and evidence-informed design of formal play spaces. RESULTS: Forty-two (28 PA,14 AT) strategies were reviewed and all included statements reflective of at least one indicator (8 ± 4; range: 1-14). Content about safe and active routes around the community was most prevalent (41 plans, 812 mentions), while participation of children in decision making was least frequently presented (18 plans, 39 mentions). Content about safe and accessible informal play environments (31 plans, 119 mentions) and evidence-informed design of formal play spaces (28 plans, 199 mentions) was also present. CONCLUSIONS: All PA and AT strategies included some content reflective of a Play-Friendly City; however, there was great variability in the number of included indicators. This summary provides key information on opportunities, such as increasing meaningful involvement of children in decision making, that can inform future municipal actions and policies to improve a community's playability.

The Effect of an After-School Physical Activity Program on Children's Cognitive, Social, and Emotional Health during the COVID-19 Pandemic in Nova Scotia.

Children's physical activity participation declined during the COVID-19 pandemic, and these negative changes could lead to longer-term impacts on children's cognitive, social, and emotional health. PURPOSE: To determine parent/caregivers' perceptions of their children's cognitive function, peer and family relationships, life satisfaction, physical activity, sleep, positive affect, and global health, before and after participating in the Build Our Kids' Success (BOKS) programming at after-school programs in Fall 2020. METHODS: Parents of children participating in the BOKS programming at after-school programs in Nova Scotia, Canada, were recruited. At baseline, 159 parents completed the National Institutes of Health (NIH) Patient-Reported Outcomes Measures Information System (PROMIS) parent-proxy questionnaire, and 75 parents completed the measures at follow-up. Independent t-tests were used to determine if there were differences between baseline and follow-up Parent Proxy Questionnaire data. RESULTS: All NIH PROMIS outcome variables at baseline and follow-up were within normal limits (Adjusted T-Scores: 46.67 ± 7.15 to 50.04 ± 7.13). There were no significant differences in life satisfaction (t(188) = -1.05, p = 0.30), family relationships (t(189) = 0.31, p = 0.76), cognitive function (t(199) = -1.16, p = 0.25), peer relationships (t(192) = -1.86, p = 0.06), positive affect (t(195) = 0.25, p = 0.81), global health (t(216) = -0.43, p = 0.67), physical activity (t(202) = 0.787, p = 0.732), sleep disturbance (t(193) = 1.72, p = 0.087), or psychological stress (t(196) = 1.896, p = 0.059), from baseline to follow-up. CONCLUSIONS: Parent-proxy questionnaires suggested that the BOKS programming had a protective effect on children's health behaviours and cognitive, social, and emotional health as values remained within normal limits and were not impacted by the public health restrictions during the second wave of the COVID-19 pandemic in Nova Scotia.

Strategies and indicators to address health equity in health service and delivery systems: a scoping review protocol.

OBJECTIVE: The purpose of this review is to describe how health service and delivery systems support health equity, and to identify strategies and indicators being used to measure health equity. INTRODUCTION: It is widely acknowledged that a population health and equity approach is needed to improve the overall health of the population. The health service and delivery system plays an important role in this approach. Despite this, system transformation to address health inequities has been slow. This is due, in part, to the lack of evidence-based guidance on how health service and delivery systems can address and measure health equity integration. Most studies focus on health equity integration in the public health sector at a provincial or national level, but less is known about integration within the health service and delivery system. More information is needed to understand how that transformation is occurring, or could occur, to make a meaningful contribution toward improving population health outcomes. INCLUSION CRITERIA: This scoping review will identify studies that describe the strategies and indicators that health service and delivery systems are using to integrate health equity and how progress is measured. Evidence from qualitative, quantitative, mixed method studies, and gray literature will be included. METHODS: This review will be conducted in accordance with JBI methodology for scoping reviews. A comprehensive search strategy, developed with a librarian scientist, will be used to identify relevant sources. Titles, abstracts, and full texts will be evaluated against inclusion criteria. Information will be extracted by two independent reviewers. Data will be synthesized and presented narratively, with tables and figures where appropriate.

The Effects of the COVID-19 Pandemic on Health and Well-Being of Children and Youth in Nova Scotia: Youth and Parent Perspectives.

Objectives: The COVID-19 pandemic led to school closures, cancellations of major events, and loss of in-person social interactions for children and youth. These restrictions undoubtedly impacted the lives of children and youth. This study describes the well-being of children and youth in Nova Scotia during the COVID-19 pandemic and their thoughts and feelings about the return to school, from the perspectives of both youth and parents. Methods: A province-wide survey was conducted in August 2020 with parents of school-age children and youth and youth to measure youth well-being since the pandemic began. Results: Parents of children and youth in grades pre-primary to 12 (n = 699; 53% girls) and youth in grades 3-12 (n = 279; 69% girls) completed the online survey. Perceptions of parents about children's emotions during the pandemic were: bored, safe, lonely, happy, and anxious. Youth reported feeling bored, relaxed, depressed, safe, and worried. Sixty-three percent of youth and 72% of parents reported that they/their child felt they were missing important life events. Parents reported that being with parents, being physically active and being with friends made their child feel positive. Youth reported that being with friends, pets and watching TV made them feel good during this time. Seventy-six percent of parents and 62% of youth reported they/their child were getting more screen time than before the pandemic. With schools closed, participants most frequently shared that they missed friends and social interactions, in-person learning, and extra-curricular activities. Youth and parents expressed worries about COVID-19 outbreaks and related restrictions when schools re-opened to in-person learning. Conclusion: The well-being of children and youth in Nova Scotia was greatly impacted by the COVID-19 pandemic and related school closures in 2020. It is essential that pandemic recovery plans prioritize the health and well-being of children and youth.

Fare well to Nova Scotia? Public health investments remain chronically underfunded.

Inspired by Fiset-Laniel et al.'s (2020) article entitled "Public health investments: neglect or wilful omission? Historical trends in Quebec and implications for Canada", we assessed public health investments since the establishment of the Nova Scotia provincial health authority in 2015. We analyzed Nova Scotia Department of Health and Wellness budgets from 2015-2016 to 2019-2020 and observed that less than 1% of funding was budgeted for public health annually, an amount well below the recommendation that 5-6% of healthcare funding be spent on public health. Healthcare spending has increased annually since 2015-2016, but proportions of funding to different programs and services have remained static. Specifically, we did not observe a change in investment in public health over time, suggesting that while the government does not necessarily spend too much or too little on healthcare, it spends far too little on public health. This chronic under-funding is problematic given the high rates of non-communicable diseases in Nova Scotia and health inequities experienced within the population. The 2020 COVID-19 pandemic has highlighted the importance of public health work, and the need for a pandemic recovery plan that prioritizes investment in all areas of public health in Nova Scotia.

RéSUMé: Inspirés par l'article de Fiset-Laniel et coll. (2020) intitulé « Public health investments: neglect or wilful omission? Historical trends in Quebec and implications for Canada ¼, nous avons évalué les investissements en santé publique depuis la fondation de l'autorité sanitaire provinciale de la Nouvelle-Écosse en 2015. Nous avons analysé les budgets du ministère de la Santé et du Mieux-Être de la Nouvelle-Écosse de 2015−2016 à 2019−2020 et nous avons observé que moins de 1 % du financement était prévu pour la santé publique annuellement, un montant bien inférieur à la recommandation que 5−6 % du financement pour les soins de santé soit dépensé sur la santé publique. Les dépenses de santé ont augmenté annuellement depuis 2015−2016, mais les proportions du financement consacrés à différents programmes et services ont demeuré statiques. Spécifiquement, nous n'avons pas observé de changement dans l'investissement en santé publique au fil du temps, indiquant que tandis que le gouvernement ne dépense pas nécessairement trop ou trop peu sur les soins de santé, il dépense bien trop peu sur la santé publique. Ce sous-financement chronique est problématique étant donné les hauts taux de maladies non transmissibles en Nouvelle-Écosse et les inégalités en matière de santé qui existent au sein de la population. La pandémie de la COVID-19 de 2020 a souligné l'importance du travail lié à la santé publique, ainsi que la nécessité d'un plan de rétablissement suite à une pandémie qui priorise l'investissement dans tous les domaines de santé publique en Nouvelle-Écosse.

Physical Literacy, Physical Activity, and Health Indicators in School-Age Children.

It has been theorized that physical literacy is associated with physical activity and health. The purpose of this study is to investigate the associations between physical literacy and health, and if this relationship is mediated by moderate-to-vigorous physical activity (MVPA). Two hundred and twenty-two children (113 girls, 10.7 ± 1.0 years old) participated in this cross-sectional study. A physical literacy composite score was computed from measures of PLAYfun, PLAYparent, and PLAYself. Physical activity was measured over seven days with accelerometers, expressed as MVPA (min/day). Health indicators included: body composition (percent body fat), aerobic fitness (treadmill time and 60s heart rate recovery), resting systolic blood pressure, and quality of life. Physical literacy was significantly associated (p < 0.001) with percent body fat (R2 = 0.23), treadmill time (R2 = 0.21), 60 s heart rate recovery (R2 = 0.36), systolic blood pressure (R2 = 0.11), and quality of life (R2 = 0.11). The relationships between physical literacy and aerobic fitness, but not other health indicators, were directly mediated by MVPA. Higher physical literacy in children is associated with favorable health indicators, and the relationships between physical literacy and aerobic fitness were influenced by MVPA. Future work should examine these relationships longitudinally and determine if changes in physical literacy leads to changes in health.

Development of the Physical Literacy Environmental Assessment (PLEA) tool.

Physical literacy is becoming increasingly popular in sport, recreation, physical education and physical activity settings and programming. We developed an environmental assessment tool to evaluate the extent child and youth activity programs implement physical literacy across four domains: environment, programming, leaders and staff, and values and goals. The Physical Literacy Environmental Assessment (PLEA) tool was developed in 3 phases. First, the PLEA tool was created, content validity established, and physical literacy leaders were consulted. In the second phase, the PLEA tool was completed and tested by 83 child and youth programs and it was validated with individual physical literacy assessments completed on children in programs that scored in the top 10% and bottom 10% on the PLEA tool. Third, a National consultation was conducted, and program leaders provided feedback on the PLEA tool. In Phase 1, the PLEA tool was modified and shortened from 41 to 29 indicators, based on feedback from physical literacy content leaders. In Phase 2, participants in programs that scored in the top 10% had significantly higher scores on the upper body object control domain of PLAYfun (p = 0.018), and significantly higher PLAYself scores (p = 0.04) than participants in programs that scored in the bottom 10%. In Phase 3, over 80% of program leaders identified the PLEA tool was useful, and relevant to their areas of practice. The completed PLEA tool is a 20-item environmental assessment tool to evaluate to what degree child and youth programming implement physical literacy across four domains: environment, programming, leaders and staff, and values and goals. The application and validity of the PLEA tool beyond child and youth physical education, sport, dance and recreation sectors, such as in early years programs, should be investigated.

Tracking of physical activity and fitness during the early years.

The early years are characterized by rapid physical growth and the development of behaviours such as physical activity. The objectives of this study were to assess the 12-month changes in and the tracking of physical activity and fitness in 400 preschoolers (201 boys, 4.5 ± 0.9 years of age). Physical activity data, expressed as minutes per day and as the percentage of time spent at various intensities while wearing an accelerometer, were collected in 3-s epochs for 7 days. Short-term muscle power, assessed with a 10-s modified Wingate Anaerobic Test, was expressed as absolute (W) and relative (W/kg) peak power (PP) and mean power (MP). Aerobic fitness, assessed with the Bruce Protocol progressive treadmill test, was expressed as maximal treadmill time and heart rate recovery (HRR). Light physical activity decreased by 3.2 min/day (p < 0.05), whereas vigorous physical activity increased by 3.7 min/day (p < 0.001), from year 1 to year 2. Physical activity exhibited moderate tracking on the basis of Spearman correlations (r = 0.45-0.59, p < 0.001) and fair tracking on the basis of κ statistics (κ = 0.26-0.38). PP and MP increased from year 1 (PP, 94.1 ± 37.3 W; MP, 84.1 ± 30.9 W) to year 2 (PP, 125.6 ± 36.2 W; MP, 112.3 ± 32.2 W) (p < 0.001) and tracked moderately to substantially (PP, r = 0.89, κ = 0.61; MP, r = 0.86, κ = 0.56). Time to exhaustion on the treadmill increased from 9.4 ± 2.3 min to 11.8 ± 2.3 min (p < 0.001) and tracked strongly (r = 0.82, κ = 0.56). HRR was unchanged at 65 ± 14 beats/min (p = 0.297) and tracked fairly (r = 0.52, κ = 0.23). The findings indicate that fitness tracks better than physical activity over a 12-month period during the early years.