Validating the Perceived Active School Travel Enablers and Barriers-Parent (PASTEB-P) Questionnaire to Support Intervention Programming and Research.

A child's ability to participate in active school travel (AST) is complicated by several factors. Of particular note are parental controls, which are informed by their perceptions of the local built and social environments, assessments of their child's skills, and convenience preferences, among other considerations. However, there is currently a lack of AST-specific scales that include validated parental perception measures related to such notable barriers and enablers, or those that tend to frame their AST decision-making processes. Framed within the social-ecological model of health behaviour, the aims of the present paper were thus threefold, specifically to (1) outline and test the construct validity of measures delineating parental perceptions of barriers and enablers to AST, (2) evaluate the reliability and consistency of the developed measures, and (3) connect these measures to develop broader constructs for use in the Perceived Active School Travel Enablers and Barriers-Parent (PASTEB-P) questionnaire. To achieve these aims, a mixed-methods approach featuring cognitive interviews and surveys, along with qualitative (thematic analysis) and quantitative (Cohen's Kappa, McDonald's Omega, and confirmatory factor analysis) analyses, was applied across two studies. The validation processes of the two studies resulted in the development of fifteen items comprising seven distinct constructs (barriers: AST Skills, Convenience, Road Safety, Social Safety, and Equipment Storage; enablers: Supportive Environment and Safe Environment) related to parental perceptions of AST. The developed PASTEB-P questionnaire can be used to inform and evaluate AST intervention programming and can be applied for AST research purposes.

Perceived neighbourhood safety moderates the relationship between active school travel and health-related quality of life.

There is a dearth of studies examining associations between active school travel and children's health-related quality of life. Additionally, studies have not examined how perceived neighbourhood characteristics may moderate these associations. This study aims to examine the relationship between regular active school travel, children's physical and psychosocial health-related quality of life, and the potential moderating effects of their perceived neighbourhood safety (interpersonal and traffic). This cross-sectional study used data from Ontario schoolchildren (aged 8-14) as part of the Spatial Temporal Environment and Activity Monitoring (STEAM) Project. Results showed no significant direct relationship between regular active school travel and children's physical or psychosocial functioning; but the relationships were moderated by perceived neighbourhood safety. Regular active school travelers with high levels of perceived neighbourhood interpersonal safety, had higher physical and psychosocial functioning than regular active school travelers with low levels of perceived neighbourhood interpersonal safety. Additionally, at higher levels of perceived neighbourhood traffic safety, regular active school travelers had higher psychosocial functioning than regular active school travelers with lower perceived neighbourhood traffic safety. Interventions promoting active school travel should consider the environments through which children will be traveling.

Examining the Correlates of Adolescent Food and Nutrition Knowledge.

Food literacy is a set of skills and knowledge that are integral to diet. It is common among teenagers to not have basic food literacy skills needed to consume a healthy diet. This study examined: (1) the current state of food and nutrition knowledge among adolescents 13-19 years of age in the census metropolitan area of London, ON, Canada; and (2) correlates of food knowledge and nutrition knowledge among adolescents. Data for this study were drawn from baseline youth and parent survey data collected from a larger population health intervention study. Statistical analysis of the survey data indicates that higher parental education and higher median neighbourhood family income, the use of mobile health applications, liking to cook, as well as confidence in reading and understanding food labels were all consistently associated with increased food and nutrition knowledge. Findings may help guide future research towards optimal methods for delivering food literacy interventions to effectively educate teenagers. Results of this study may help guide policy makers, researchers, and public health professionals in developing appropriate food and nutrition programs and curriculums to combat the decline in food literacy skills.

Examining how changes in provincial policy on vape marketing impacted the distribution of vaping advertisements near secondary schools in London, Ontario.

OBJECTIVES: On January 1, 2020, the Government of Ontario passed a regulation banning vaping advertisements by retailers, apart from specialty shops. A motivation for this ban was to limit youth exposure to vaping advertisements. The primary goal of this research was to evaluate the impact of this ban on the number and density of vaping advertisements surrounding secondary schools. Additionally, we examined whether the number of vaping advertisements varied by school socio-demographic characteristics. METHODS: This study used a pre-post design. Audits were conducted December 2019 (pre-ban) and again January to February 2020 (post-ban), to identify vaping advertisements within 800 m surrounding secondary schools (n = 18) in London, Ontario. RESULTS: Prior to the ban, there were 266 vaping advertisements within 800 m of secondary schools. After the ban, this was reduced to 58, a 78.2% reduction. The mean number of vaping advertisements surrounding schools significantly decreased from 18.1 before the ban to 3.6 after the ban (p < 0.001). A significant positive correlation was found, prior to the ban, between the number of vaping advertisements surrounding schools and school-level residential instability (r = 0.42, p = 0.02). After the ban, no significant correlations were found between the number of vaping advertisements and school socio-demographic characteristics. CONCLUSION: The provincial ban of vaping advertisements in select retail settings significantly reduced the number of vaping advertisements in the areas surrounding secondary schools in London, Ontario. The ban also reduced socio-demographic inequities in youths' potential exposure to marketing of vaping products. Continued monitoring of the geographic accessibility and promotion of vaping products is warranted.

RéSUMé: OBJECTIFS: Le 1er janvier 2020, le gouvernement de l'Ontario adoptait un règlement interdisant les annonces publicitaires sur le vapotage dans les magasins de détail, sauf dans les boutiques spécialisées. L'une des raisons de cette interdiction était de limiter l'exposition des jeunes à la publicité sur le vapotage. Notre étude visait principalement à évaluer les incidences de l'interdiction sur le nombre et la densité des annonces publicitaires sur le vapotage autour des écoles secondaires. Nous avons aussi cherché à déterminer si le nombre d'annonces publicitaires sur le vapotage variait selon le profil sociodémographique des écoles. MéTHODE: Un protocole avant-après été utilisé pour cette étude. Des audits ont été menés en décembre 2019 (avant l'interdiction), puis de nouveau en janvier et février 2020 (après l'interdiction) pour dénombrer les annonces publicitaires sur le vapotage dans un rayon de 800 m des écoles secondaires (n = 18) de London, en Ontario. RéSULTATS: Avant l'interdiction, il y avait 266 annonces publicitaires sur le vapotage dans un rayon de 800 m des écoles secondaires. Après l'interdiction, ce nombre n'était plus que de 58, soit une baisse de 78,2 %. Le nombre moyen d'annonces publicitaires sur le vapotage autour des écoles a diminué de façon significative, passant de 18,1 avant l'interdiction à 3,6 après (p < 0,001). Une corrélation positive significative a été observée, avant l'interdiction, entre le nombre d'annonces publicitaires sur le vapotage autour des écoles et l'instabilité résidentielle au niveau des écoles (r = 0,42, p = 0,02). Après l'interdiction, aucune corrélation significative n'a été observée entre le nombre d'annonces publicitaires sur le vapotage et le profil sociodémographique des écoles. CONCLUSIONS: L'interdiction provinciale des annonces publicitaires sur le vapotage dans certains magasins de détail a considérablement réduit le nombre de ces annonces dans les environs des écoles secondaires de London, en Ontario. L'interdiction a aussi réduit les iniquités sociodémographiques de l'exposition potentielle des jeunes au marketing des produits de vapotage. Il est justifié d'assurer une surveillance continue de l'accessibilité géographique et de la promotion des produits de vapotage.

Examining weather-related factors on physical activity levels of children from rural communities.

OBJECTIVE: The objective was to examine the influence of weather on moderate-to-vigorous physical activity (MVPA) and light physical activity (LPA) levels of children aged 8-14 years from rural communities, an understudied Canadian population. METHODS: Children (n = 90) from four communities in rural Northwestern Ontario participated in this study between September and December 2016. Children's MVPA and LPA were measured using an Actical accelerometer and demographic data were gathered from surveys of children and their parents. Weather data were collected from the closest weather station. Cross-classified regression models were used to assess the relationship between weather and children's MVPA and LPA. RESULTS: Boys accumulated more MVPA than girls (b = 26.38, p < 0.01), children were more active on weekdays as compared with weekends (b = - 16.23, p < 0.01), children were less active on days with precipitation (b = - 22.88, p < 0.01), and higher temperature led to a significant increase in MVPA (b = 1.33, p < 0.01). As children aged, they accumulated less LPA (b = - 9.36, p < 0.01) and children who perceived they had higher levels of physical functioning got more LPA (b = 25.18, p = 0.02). Similar to MVPA, children had higher levels of LPA on weekdays (b = - 37.24, p < 0.01) as compared to weekend days and children accumulated less LPA (b = -50.01, p < 0.01) on days with rain. CONCLUSION: The study findings indicate that weather influences rural children's MVPA and LPA. Future research is necessary to incorporate these findings into interventions to increase rural children's overall PA levels and improve their overall health.

RéSUMé: OBJECTIF: Examiner l'influence de la météo sur les niveaux d'activité physique modérée à vigoureuse (APMV) et d'activité physique légère (APL) des enfants de 8 à 14 ans vivant en milieu rural, une population canadienne sous-étudiée. MéTHODE: Des enfants (n = 90) de quatre communautés rurales du Nord-Ouest de l'Ontario ont participé à l'étude entre septembre et décembre 2016. Leurs niveaux d'APMV et d'APL ont été mesurés à l'aide d'un accéléromètre de marque Actical, et leurs données démographiques ont été obtenues en sondant les enfants et leurs parents. Les données météorologiques ont été obtenues auprès de la station météorologique la plus proche. Des modèles de régression recoupés ont servi à analyser la relation entre la météo et l'APMV et l'APL des enfants. RéSULTATS: Les garçons ont accumulé plus d'APMV que les filles (b = 26,38 p < 0,01); les enfants étaient plus actifs les jours de semaine que les fins de semaine (b = -16,23 p < 0,01); les enfants étaient moins actifs les jours avec précipitations (b = -22,88 p < 0,01); et les températures élevées étaient associées à une augmentation significative de l'APMV (b = 1,33 p < 0,01). En grandissant, les enfants accumulaient moins d'APL (b = -9,36 p < 0,01) et les enfants qui pensaient avoir des niveaux d'activité physique plus élevés accumulaient plus d'APL (b = 25,18 p = 0,02). Comme pour l'APMV, les enfants avaient des niveaux d'APL plus élevés les jours de semaine (b = -37,24 p < 0,01) que les fins de semaine, et les enfants accumulaient moins d'APL (b = -50,01 p < 0,01) les jours de pluie. CONCLUSION: Les constatations de l'étude montrent que la météo influence l'APMV et l'APL des enfants en milieu rural. Il faudrait pousser la recherche pour intégrer ces constatations dans des interventions pour faire augmenter les niveaux d'activité physique globaux des enfants en milieu rural et améliorer leur santé globale.

Measuring Temporal Differences in Rural Canadian Children's Moderate-to-Vigorous Physical Activity.

The purpose of this study was to measure the factors that influence children's moderate-to-vigorous physical activity (MVPA) during school curriculum time, recess time, and outside school time in a rural area. During the Fall and Winter of 2016, 34 boys and 55 girls aged 8-14 years from rural communities in rural Northwestern Ontario participated in the Spatial Temporal Environment and Activity Monitoring project. The children's MVPA was measured using an accelerometer, and child-level demographic, behavioral, and environmental data were gathered from surveys, passively logging global positioning units, and municipal datasets. Data on daily temperature and precipitation were gathered from the closest Environment Canada weather station. A mixed model was used to assess the relationship between child- and day-level factors and children's MVPA. On average, children were getting 12.9 min of MVPA during recess, 17.7 min during curriculum time, and 29.0 min of MVPA outside school time. During all three time points, boys were more active than girls. During curriculum time, children in lower grades were more active, and the weather had differing impacts depending on the time of day. The findings of this study illustrate the differences in MVPA and the factors that influence MVPA by time of day. Examining different time segments provides valuable information for understanding children's MVPA patterns.

Examining Factors of Accelerometer-Measured Sedentary Time in a Sample of Rural Canadian Children.

The aim of this study was to examine potential child-level and day-level factors of accelerometer-measured sedentary time in a sample of rural Canadian children. Children (n = 86) from rural Northwestern Ontario participated in this study. Children's sedentary times were identified and logged using an accelerometer. Child-level data (socio-demographic, household, and environment) came from surveys of children and their parents and a passively logging global positioning unit. Day-level data on day type (weekday/weekend) and weather (temperature, precipitation) were based on the dates of data collection and meteorological data came from the closest Environment Canada weather station. Cross-classified regression models were used to assess the relationship between child-level and day-level correlates of sedentary time. Boys were less sedentary than girls (b = -30.53 p = 0.01). For each one-year age increase, children's sedentary time increased (b = 12.79 p < 0.01). This study indicates a difference in sedentary time based on a child's age and gender. However, family, environmental, and weather characteristics did not influence sedentary time in this sample. Health practitioners who deliver care for northern rural youth can provide targeted health advice regarding sedentary time and consider gender and age to be risk factors for these behaviors.

Understanding factors associated with children achieving recommended amount of MVPA on weekdays and weekend days.

Low levels of moderate-to-vigorous physical activity (MVPA) are consistently reported for children from industrialized countries. Perennially inadequate levels of MVPA have been linked to increased chronic disease risks. Very few studies have compared physical activity levels among children from geographically diverse places, and how they differ on weekdays versus weekends. The purpose of this research is to examine the factors that influence whether children achieve 60 min of MVPA on weekdays compared to weekend days. Data were analyzed on children (n = 532) aged 8-14 years from communities in Southern and Northern Ontario, Canada that participated in the study between 2009 and 2016. Children's MVPA was measured using an Actical accelerometer, environmental features measured with a geographic information system, and demographic data came from child/parent surveys. Variables were selected using a least absolute shrinkage and selection operator. The variables were entered into logistic regression models to assess the relationship between children meeting the MVPA guidelines. During the week, boys were more active than girls (OR = 4.652 p < 0.001) and as age increased children were less likely to reach the MVPA guidelines (OR = 0.758 p = 0.013). On weekends boys were still more likely to meet the guidelines (OR = 1.683 p = 0.014) and children living in rural Northern Ontario were more likely to reach the MVPA guidelines compared to all groups in Southern Ontario. The findings indicate that different variables influence whether children meet the MVPA guidelines on weekdays compared to weekends. Comparing weekdays and weekends provides more useful information for creating effective MVPA interventions.

Geographic variation in preventable hospitalisations across Canada: a cross-sectional study.

OBJECTIVE: The objective of this study is to examine the magnitude and pattern of small-area geographic variation in rates of preventable hospitalisations for ambulatory care-sensitive conditions (ACSC) across Canada (excluding Québec). DESIGN AND SETTING: A cross-sectional study conducted in Canada (excluding Québec) using data from the 2006 Canadian Census Health and Environment Cohort (CanCHEC) linked prospectively to hospitalisation records from the Discharge Abstract Database (DAD) for the three fiscal years: 2006-2007, 2007-2008 and 2008-2009. PRIMARY OUTCOME MEASURE: Preventable hospitalisations (ACSC). PARTICIPANTS: The 2006 CanCHEC represents a population of 22 562 120 individuals in Canada (excluding Québec). Of this number, 2 940 150 (13.03%) individuals were estimated to be hospitalised at least once during the 2006-2009 fiscal years. METHODS: Age-standardised annualised ACSC hospitalisation rates per 100 000 population were computed for each of the 190 Census Divisions. To assess the magnitude of Census Division-level geographic variation in rates of preventable hospitalisations, the global Moran's I statistic was computed. 'Hot spot' analysis was used to identify the pattern of geographic variation. RESULTS: Of all the hospitalisation events reported in Canada during the 2006-2009 fiscal years, 337 995 (7.10%) events were ACSC-related hospitalisations. The Moran's I statistic (Moran's I=0.355) suggests non-randomness in the spatial distribution of preventable hospitalisations. The findings from the 'hot spot' analysis indicate a cluster of Census Divisions located in predominantly rural and remote parts of Ontario, Manitoba and Saskatchewan and in eastern and northern parts of Nunavut with significantly higher than average rates of preventable hospitalisation. CONCLUSION: The knowledge generated on the small-area geographic variation in preventable hospitalisations can inform regional, provincial and national decision makers on planning, allocation of resources and monitoring performance of health service providers.

Promoting healthy beverage consumption habits among elementary school children: results of the Healthy Kids Community Challenge 'Water Does Wonders' interventions in London, Ontario.

INTERVENTION: This study examines the impact of London's Healthy Kids Community Challenge (HKCC) 'Water Does Wonders' interventions, which combined water infrastructure and education programs. RESEARCH QUESTION: How effective were the HKCC interventions at increasing water and decreasing sugar-sweetened beverage (SSB) consumption among grade 4-8 children in London, Ontario? METHODS: Non-randomized controlled trial. Children's knowledge and beverage intake were measured before and after the interventions were implemented during the 2016-2017 school year. Children at intervention schools (n = 521) received education programs (Growing Chefs or UTRCA [Upper Thames River Conservation Authority]) and water bottle filling stations. Children at control schools (n = 410) received filling stations only. Multivariable linear mixed-model ANCOVAs were used to compare water and SSB consumption and knowledge across intervention groups, accounting for school-level clustering. RESULTS: Children who received an education intervention and filling station compared with only a filling station consumed more water (ß = 2.18 (95% CI - 1.87, 6.22) for Growing Chefs and ß = 2.90 (95% CI - 0.23, 6.03) for UTRCA) and fewer SSBs (ß = - 1.17 (95% CI - 3.83, 1.49) for Growing Chefs and ß = - 2.56 (95% CI - 5.12, 0.001) for UTRCA) post-intervention, and had higher nutrition knowledge (ß = 1.57 (95% CI - 1.68, 4.83) for Growing Chefs and ß = 2.02 (95% CI - 0.35, 4.39) for UTRCA). These findings were not statistically significant. CONCLUSIONS: An intervention intended to promote healthy beverage consumption yielded effects in the expected direction; however, they were small and not statistically significant. This is likely because the educational interventions were not fully aligned with the goals of the 'Water Does Wonders' program, preventing them from evoking meaningful changes in dietary behaviours.

If You Make it Free, Will They Come? Using a Physical Activity Accessibility Model to Understand the Use of a Free Children's Recreation Pass.

BACKGROUND: Children's sedentary lifestyles and low physical activity levels may be countered using population-level interventions. This study examines factors influencing the use of a free community-wide physical activity access pass for grade 5 students (G5AP). METHODS: A natural experiment with longitudinal data collection. A sample of 881 children completed the 9-month follow-up survey self-reporting where they used the G5AP. Two analyses were conducted: Getis-Ord GI* geographic cluster analysis of the spatial distribution of users, and logistic regression examining the relationship between use and accessibility (informational, economic, and geographic) and mobility options, while accounting for intrapersonal and interpersonal factors. RESULTS: Overall, 44.9% of children used the G5AP with clusters of high use in urban areas and low use in the suburbs. Other factors significantly related to G5AP included gender (girls), informational accessibility (active recruitment), economic accessibility (median household income), geographic accessibility (facilities within 1.6 km of home), and mobility options (access to Boys & Girls Club bus). CONCLUSIONS: This study found that a diverse population of children used the G5AP. To continue being successful, community-based physical activity interventions need to ensure that the intervention increases geographic, economic, and informational accessibility and provides mobility options that are available to the target population.

Geospatial analyses of adverse birth outcomes in Southwestern Ontario: Examining the impact of environmental factors.

BACKGROUND: A growing body of research has examined the association between exposure to environmental factors during pregnancy and adverse birth outcomes; however, many studies do not control for potential covariates and findings vary considerably. OBJECTIVE: To test the relative influence of environmental factors including exposure to air pollution, major roads, highways, industry, parks, greenspaces, and food retailers on low birth weight (LBW) and preterm birth (PTB) in Southwestern Ontario (SWO), Canada, while accounting for medical (e.g., previous preterm birth, gestational diabetes), behavioral (e.g., alcohol, smoking), demographic (e.g., maternal age, body mass index), and neighborhood-level socioeconomic (e.g., household income, education) factors. METHODS: This retrospective cohort study consisted of a large sample of pregnant women from SWO who gave birth to singleton newborns between February 2009 and February 2014 at London Health Sciences Centre. Data on maternal postal codes were entered into a Geographic Information System to map the distribution of maternal residences and determine selected characteristics of their neighborhood environments (i.e., socioeconomic, built, natural). These variables were developed based on postal codes where the mothers lived prior to giving birth. Logistic regression was used to assess the relative effects of the physical environment, socioeconomic status, clinical history, and behavioral risk factors on mothers having a LBW or PTB infant. RESULTS: Out of 25,263 live births, 5.7% were LBW and 7.5% were PTB. Exposure to sulfur dioxide was a top predictor of both LBW and PTB. For every one-unit increase in sulfur dioxide, the odds of a LBW and PTB were 3.4 (95% CI: 2.2, 5.2) and 2.0 (95% CI: 1.4, 3.0) times higher, after controlling for other variables in the model, respectively (p < 0.001). Previous PTB was also highly associated with both birth outcomes. CONCLUSIONS: Health care providers should be informed about the hazards of air pollution to developing fetuses so that recommendations can be made to their pregnant patients about limiting exposure when air quality is poor.

Comparing Physical Activity Behavior of Children During School Between Balanced and Traditional School Day Schedules.

BACKGROUND: Some Canadian schools have modified their daily schedules from the traditional school day (TSD) schedule (two 15-minute breaks and one 60-minute break) to a balanced school day (BSD) schedule (two 40-minute breaks). While this change increases daily planning and instructional time, it also changes the amount of time available for moderate-vigorous physical activity (MVPA). METHODS: This study uses a case-control design to examine differences in objectively measured MVPA between children in 3 schools using a BSD schedule and 3 schools using a TSD schedule. Study participants (aged 10-12 years) were recruited from schools in Ontario, Canada. RESULTS: Regardless of schedule type, girls had lower MVPA than boys, and as both boys and girls got older their MVPA significantly decreased. The findings indicate there was no statistically significant difference in the total minutes of in-school MVPA between children from BSD schools and children from TSD schools. MVPA was significantly higher for older girls attending BSD schools than older girls attending TSD schools, suggesting that implementing a BSD may help curb declining MVPA as girls enter adolescence. CONCLUSION: Despite encouraging findings, more rigorous studies (ie, pre-post experiments with control) are needed to better understand how changing schedules impacts children's health.

Exploring the Effect of Perceptions on Children's Physical Activity in Varying Geographic Contexts: Using a Structural Equation Modelling Approach to Examine a Cross-Sectional Dataset.

Most Canadian children are not meeting the recommended 60 min of moderate-to-vigorous physical activity per day. Research suggests that children's perceptions of their environment have an influence on their physical activity behaviours, but there is a lack of generalizability among previous work. The purpose of this study was to assess the mediating effect of children's perceptions of barriers to physical activity on the relationship between their environments and their level of moderate-to-vigorous physical activity (measured with accelerometers). Structural equation modelling stratified by gender was used to assess the research objective in a sample of 546 participants aged 8⁻14 years old from Northwestern and Southwestern Ontario, Canada. In both models stratified by gender, perceptions of barriers did not significantly mediate the relationship between urbanicity and physical activity. Independent of all other factors, there was no significant relationship between urbanicity and physical activity in girls, but there was in boys. These results offer insight into potential processes by which perceptions impact physical activity and provide initial information to further our understanding of the behavioural aspects of physical activity through multiple levels of analysis. Researchers must continue to improve efforts for quantifying the experience of children's daily activity contexts.

Context Matters: Examining children's perceived barriers to physical activity across varying Canadian environments.

Children's perceptions of their environment have been associated with their physical activity (PA) levels, however a better understanding of the formation of perceptions within different contexts is needed. This will help to inform decision making related to physical inactivity trends in Canadian children. We examined socio-ecological factors influencing children's perceptions of barriers to PA in Ontario, Canada. Binary logistic regression models measured the relationship between perceptions of barriers and PA for 892 children in Ontario. At the intrapersonal level, girls reported the most barriers to PA. Interpersonally, children whose mother was employed reported the most barriers. At the physical environment level, children in urban and suburban neighbourhoods of large cities, and rural areas reported the most barriers, differing relative to population size. The major contribution of this paper is a new perspective of environmental influences on children's perceptions of PA, using an urbanicity spectrum, and highlighting place specific needs of Canadian children.

Understanding child and parent perceptions of barriers influencing children's active school travel.

BACKGROUND: Physical activity plays a fundamental role in the health and well-being of children. Walking is the most common form of physical activity and the journey to and from school provides an opportunity for children to be active every day. This study examines how child and parent perceptions of barriers to active school travel influences children's behaviour. METHODS: Participants were recruited from 48 elementary schools in Southwestern Ontario, Canada. The study sample includes 1296 children (ages 9-14 years) who live within walking distance of their school, defined as 1.6 km network distance. Chi-square analysis examined differences between child and parent perceptions of barriers to active school travel. Logistic regression models examined how parent and child perceptions of barriers influence active school travel behaviour, while controlling for key intrapersonal, interpersonal, and physical environment factors. RESULTS: The results indicate that there are significant differences in how parents and children perceive barriers to active school travel. Model results find older children, children without siblings, households with no vehicles, and children who live closer to school are most likely to use active school travel. Parent perceptions of barriers are found to have a greater influence on children's active school travel behaviour than children's perceptions. Different perceptions of barriers influence active school travel to school compared to returning home from school. CONCLUSIONS: Child and parent perceptions of barriers to active school travel differ and have different impacts on children's travel behaviour. Understanding how child and parent perceptions of barriers differ can help policymakers and practitioners develop specialized interventions aimed at increasing children's use of active school travel and children's overall physical activity. Interventions used to promote active school travel should focus on safety, as well as perceptions of distance to break parental habits of routinely driving their children to school. Overall, this study highlights the importance of considering both child and parent perceptions to create a safe and accessible environment to allow for an increase in active school travel behaviour among elementary school children who live within walking distance of their school.

Without Compromising Integrity: Research and Planning Around the Primary Healthcare Landscape in Southwestern Ontario.

Primary care is the foundation of any high-performing healthcare system. We report a subset of findings that characterize the existing primary care system in southwestern Ontario, Canada, and describe the experiences of primary healthcare providers (PHCPs). Between December 2015 and January 2016, in collaboration with the South West Local Health Integration Network (LHIN), we conducted a mixed-methods research study to gain a better understanding of experiences in providing primary care to support systems planning for primary care. We believe our approach allowed for integrity across both the research and planning process.

Children and Nature: Linking Accessibility of Natural Environments and Children's Health-Related Quality of Life.

A growing body of research suggests that increasing children's nature interactions can have positive benefits for their health-related quality of life (HRQOL); however, researchers have yet to examine how geographical context influences this relationship. The purpose of this study was to examine individual-level and environmental factors that are associated with HRQOL of children from different geographical contexts. Data were collected for 851 children from 34 elementary schools in Ontario, Canada. The natural environments around each child's home were computed using geospatial analyses in a geographic information system. Natural environment measures were combined with HRQOL and the demographics from child surveys to be used in a series of step-wise linear regression models. These models explored the relationship between children's HRQOL and the natural environment in urban/suburban and rural populations. In addition to important individual-level determinants, the findings revealed that characteristics of the natural environment, including the amount of greenness, park, and water, show significant relationships in the urban/suburban population. Interpersonal variables were the key predictors of HRQOL in the rural population. Where children live influences relationships between nature and HRQOL. These findings have implications for policymakers, health practitioners, educators, and parents in the design and the promotion of nature for children's HRQOL.

Examining individual, interpersonal, and environmental influences on children's physical activity levels.

The purpose of this study was to explore individual-level socio-demographic factors and interpersonal-level factors related to social support, as well as the potential role of neighborhood and school environments that may influence the physical activity (PA) levels of children (ages 9-11). Child and parent questionnaires included individual and interpersonal factors, and PA behaviour. Home postal codes were used to determine the neighbourhood the child resides within, as well as their geographic accessibility to recreation opportunities. The models were assessed using a series of cross-classified random-intercept multi-level regression models as children's PA may be affected by both the school they attend and the neighbourhood in which they live. In the unadjusted model, PA varied significantly across school environments (γ = 0.023; CI: 0.003-0.043), but not across neighbourhoods (γ = 0.007; CI: -0.008 to 0.021). Boys were found to be more active compared to girls (b = 0.183; CI: 0.092-0.275), while the level of PA was lower for children whose fathers achieved post-secondary education (b = - 0.197; CI: -0.376 to 0.018) than for those whose parents completed only high school. The addition of the individual-level correlates did not have a substantial effect on level 2 variances and the level 2 variance associated with school environment remained statistically significant. At the interpersonal level, children's perception of parental support (b = 0.117; CI: 0.091-0.143) and peer support (b = 0.111; CI: 0.079-0.142) were positively related to PA. The level 2 variance for the school environment became statistically non-significant when the interpersonal factors were added to the model. At the environmental level, geographic accessibility did not have a significant association with PA and they did not significantly affect level 1 or 2 variance. As many children do not accrue sufficient levels of PA, identifying modifiable determinants is necessary to develop effective strategies to increase PA.

Exploring the effect of parental influence on children's physical activity: The mediating role of children's perceptions of parental support.

The purpose of this study was to test a conceptual model linking parental support and parental physical activity (PA), with children's perception of parental support and children's PA. Baseline data were drawn from the Grade 5 ACT-i-Pass community-based PA intervention conducted in London, Ontario between May and October 2014. Parent and child PA were measured using the International Physical Activity Questionnaire and Physical Activity Questionnaire for Children, respectively. Questions pertaining to parental support and children's perception of that parental support were obtained via questionnaires. We employed structural equation modeling techniques to test the conceptual model. In total, 467 boys and 469 girls were included in the study. The model provided an acceptable model fit. Child's perception of parental support for PA had a positive effect on boys' (b=0.319) and girls' (b=0.326) PA. Parental PA was not significantly related to child's perception of parental support for PA. However, parent reported support for PA had a significant, positive effect on child's perception of parental support for boys (b=0.352) and girls (b=0.584). In terms of the indirect effects, the effect of parental PA on child's PA was not statistically significant; however, as expected, parental support for PA had a statistically significant indirect effect on child PA level in both groups. The findings of this study demonstrate the importance of children's perceptions of parental support in relation to their PA behaviours. Developing a better understanding of factors related to children's PA and identifying determinants and mediators of activity behaviours will help inform PA interventions.