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BackgroundOutdoor risky play, such as climbing, racing, and independent exploration, is an important part of childhood and is associated with various positive physical, mental, and developmental outcomes for children. Parental attitudes and fears, particularly mothers’, are a major deterrent to children’s opportunities for outdoor risky play. ObjectiveThe aim of this study was to evaluate the efficacy of 2 versions of an intervention to reframe mothers’ perceptions of risk and change parenting behaviors: a web-based intervention or an in-person workshop, compared with the control condition. MethodsThe Go Play Outside! randomized controlled trial was conducted in Canada from 2017 to 2018. Participants were recruited through social media, snowball sampling, and community notices. Mothers of children aged 6-12 years were self-assessed through eligibility questions, and those eligible and consented to participate in the study were randomized into a fully automated web-based intervention, the in-person workshop, or the control condition. The intervention was underpinned by social cognitive theory, incorporating behavior change techniques. Participants progressed through a series of self-reflection exercises and developed a goal for change. Control participants received the Position Statement on Active Outdoor Play. The primary outcome was increase in tolerance of risky play and the secondary outcome was goal attainment. Data were collected online via REDCap at baseline, 1 week, and 3 months after the intervention. Randomization was conducted using sealed envelope. Allocations were concealed to researchers at assignment and data analysis. We conducted mediation analyses to examine whether the intervention influenced elements of social cognitive theory, as hypothesized. ResultsA total of 451 mothers were randomized and completed baseline sociodemographic assessments: 150 in the web-based intervention, 153 in the in-person workshop, and 148 in the control condition. Among these, a total of 351 mothers completed the intervention. At 1 week after the intervention, 113, 85, and 135 mothers completed assessments for each condition, respectively, and at 3 months after the intervention, 105, 84, and 123 completed the assessments, respectively. Compared with mothers in the control condition, mothers in the web-based intervention had significantly higher tolerance of risky play at 1 week (P=.004) and 3 months after the intervention (P=.007); and mothers in the in-person workshop had significantly higher tolerance of risky play at 1 week after the intervention (P=.02). No other significant outcomes were found. None of the potential mediators were found to significantly mediate the outcomes. ConclusionsThe trial demonstrates that the web-based intervention was effective in increasing mothers’ tolerance for risk in play. Trial RegistrationClinicalTrials.gov NCT03374683; https://clinicaltrials.gov/ct2/show/NCT03374683 International Registered Report Identifier (IRRID)RR2-10.1186/s13063-018-2552-4

BackgroundThe Carrot Rewards app was developed as part of an innovative public-private partnership to reward Canadians with loyalty points, exchangeable for retail goods, travel rewards, and groceries for engaging in healthy behaviors such as walking. ObjectiveThis study examined whether a multicomponent intervention including goal setting, graded tasks, biofeedback, and very small incentives tied to daily step goal achievement (assessed by built-in smartphone accelerometers) could increase physical activity in two Canadian provinces, British Columbia (BC) and Newfoundland and Labrador (NL). MethodsThis 12-week, quasi-experimental (single group pre-post) study included 78,882 participants; 44.39% (35,014/78,882) enrolled in the Carrot Rewards “Steps” walking program during the recruitment period (June 13–July 10, 2016). During the 2-week baseline (or “run-in”) period, we calculated participants’ mean steps per day. Thereafter, participants earned incentives in the form of loyalty points (worth Can $0.04 ) every day they reached their personalized daily step goal (ie, baseline mean+1000 steps=first daily step goal level). Participants earned additional points (Can $0.40) for meeting their step goal 10+ nonconsecutive times in a 14-day period (called a “Step Up Challenge”). Participants could earn up to Can $5.00 during the 12-week evaluation period. Upon meeting the 10-day contingency, participants could increase their daily goal by 500 steps, aiming to gradually increase the daily step number by 3000. Only participants with ≥5 valid days (days with step counts: 1000-40,000) during the baseline period were included in the analysis (n=32,229).The primary study outcome was mean steps per day (by week), analyzed using linear mixed-effects models. ResultsThe mean age of 32,229 participants with valid baseline data was 33.7 (SD 11.6) years; 66.11% (21,306/32,229) were female. The mean daily step count at baseline was 6511.22. Over half of users (16,336/32,229, 50.69%) were categorized as “physically inactive,” accumulating

BackgroundBehavioral economics has stimulated renewed interest in financial health incentives worldwide. The Carrot Rewards app was developed as part of a public-private partnership to reward Canadians with loyalty points (eg, movies and groceries) for downloading the app, referring friends, and completing an average of 1 to 2 educational health quizzes per week (“micro-learning”), with long-term objectives of increasing health knowledge and encouraging healthy behaviors. ObjectiveThe main objective of this study was to evaluate uptake of a loyalty points-based mHealth app during the exclusive 3-month launch period in British Columbia (BC), Canada. The secondary aims were to describe the health and sociodemographic characteristics of users, as well as participation levels (eg, proportion of quizzes completed and friends referred). MethodsThe app was promoted via loyalty program email campaigns (1.64 million emails). Number of downloads and registrations (users enter age, gender, and valid BC postal code to register) were collected. Additional sociodemographics were inferred by linking postal codes with census data at the local health area (LHA) level. Health risk assessments were also deployed. Participation levels were collected over 3 months and descriptive data were presented. ResultsIn 3 months, 67,464 individuals downloaded the app; in its first week, Carrot Rewards was the most downloaded health app in Canada. Among valid users (n=57,885; at least one quiz completed), the majority were female (62.96%; 36,446/57,885) and aged 18 to 34 years (54.34%; 31,459/57,885). More than half of the users (52.40%; 30,332/57,885) resided in LHAs where the median personal income was below the provincial average (Can $28,765). Furthermore, 64.42% (37,291/57,885) of users lived in metropolitan (ie, urban) LHAs, compared with 56.17% of the general BC population. The most prevalent risk factors were “not” meeting physical activity guidelines (72.70%; 31,765/43,692) and “not” getting the flu shot last year (67.69%; 30,286/44,739). Regarding participation, 60.05% (34,761/57,885) of users were classified as “very high” engagers (>75% quiz completion rate). ConclusionsEarly results suggest that loyalty points may promote mHealth app uptake. The app was downloaded by younger females especially, and BC residents from higher and lower income regions were equally represented. Loyalty points appear to have driven participation throughout the inaugural 3-month period (ie, quiz completion).

Background: Population physical activity promotion (PPAP) is one of the most effective noncommunicable disease prevention strategies, yet coordination is lacking around the world. Whole-of-system approaches and complex systems methods are called for to advance PPAP. This paper reports on a project which (1) used an Attributes Framework with system mapping (group model building and causal loop diagramming of feedback loops) and (2) identified potential leverage points to address the challenge of effective coordination of multisectoral PPAP in British Columbia. Methods: Key findings from stakeholder interviews and workshops described the current system for PPAP in terms of attributes and dimensions in the framework. These were translated into variables and used in group model building. Participants prioritized the importance of variables to address the coordination challenge and then created causal loop diagrams in 3 small groups. One collective causal loop diagram was created, and top priority variables and associated feedback loops were highlighted to explore potential leverage points. Results: Leverage points included the relationships and feedback loops among priority variables: political leadership, visible policy support and governance, connectivity for knowledge translation, collaborative multisector grants, multisector collaboration, and integrating co-benefits. Leveraging and altering "vicious" cyclical patterns to increase coordinated multisector PPAP are key. Conclusions: The Attributes Framework, group model building and causal loop diagrams, and emergent feedback loops were useful to explore potential leverage points to address the challenge of multisectoral coordination of PPAP. Future research could apply the same methods in other jurisdictions and compare and contrast resultant frameworks, variables, feedback loops, and leverage points. [ABSTRACT FROM AUTHOR]

Financial health incentives, such as paying people to lose weight, are being widely implemented by Western nations and large corporations. A growing number of studies have tested the impact of incentives on health behaviors, though few have evaluated the approach on a population-scale. In this issue of the Journal of Medical Internet Research, Liu et al add to the evidence-base by examining whether a single incentive can motivate enrollment and engagement in a preventive eHealth program in a sample of 142,726 Canadian adults. While the incentives increased enrollment significantly (by a factor of about 28), a very high level of program attrition was noted (90%). The “foot in the door” incentive technique employed was insufficient; enrollees received incentives for signing-up for, but not for engaging with, the eHealth program. To supplement this technique and drive sustained behavior change, several theoretically- and empirically-based strategies are proposed. Specifically, incentives indexed to behavioral achievements over time are highlighted as one approach to boost engagement in this population in the future.

BackgroundWhile physical activity in individuals tends to decline steadily with age, there are certain periods where this decline occurs more rapidly, such as during early adulthood. Interventions aimed at attenuating the declines in physical activity during this transition period appear warranted. ObjectiveThe purpose of the study was to test the feasibility and efficacy of a theoretically informed, website-delivered physical activity intervention aimed at students entering university. MethodsUsing a quasi-experimental design, 65 participants (44 females; mean age 18.51, SD 0.91) were assigned to either an intervention (receiving website access plus weekly prompts) or comparison condition (receiving unprompted website access only), completing questionnaires at baseline and follow-up 8 weeks later. The intervention website, “Active Transition”, was specifically designed to target students’ physical activity cognitions and self-regulatory skills. ResultsIntervention usage was low, with only 47% (18/38) of participants assigned to the intervention condition logging into the website 2 or more times. Among the broader student sample, there were significant declines in students’ physical activity behaviors (F1,63=18.10, P

Background: Active school transportation (AST) is an important source of physical activity for children and a potentially important climate change mitigation strategy. However, few studies have examined factors associated with AST in the context of the COVID-19 pandemic. Methods: We used baseline data from a longitudinal survey to investigate correlates of AST during the second wave of COVID-19 (December 2020). We collected survey data from 2291 parents of 7- to 12-year-olds across Canada and linked this information with data on neighborhood walkability and weather from national databases. We assessed potential correlates representing multiple levels of influence of the social–ecological model. We used gender-stratified binary logistic regression models to determine the correlates of children's travel mode to/from school (dichotomized as active vs motorized), while controlling for household income. We examined the correlates of travel mode for both the morning and afternoon trips. Results: Consistent correlates of AST among Canadian children during the COVID-19 pandemic included greater independent mobility, warmer outdoor temperature, having a parent who actively commuted to work or school, living in a household owning fewer vehicles, and living in a more walkable neighborhood. These findings were largely consistent between boys and girls and between morning and afternoon school trips. Conclusions: Policymakers, urban planners, and public health workers aiming to promote AST should focus on these correlates while ensuring that neighborhoods are safe for children. Future research should monitor the prevalence and correlates of AST as COVID-19 restrictions are removed. [ABSTRACT FROM AUTHOR]

Background: Calls to action addressing the interconnections between physical (in)activity and the climate crisis are increasing. The current study aimed to investigate public support for policy actions that potentially have co-benefits for physical activity promotion and climate change mitigation. Methods: In 2023, a survey through the Angus Reid Forum was completed by 2507 adults living in Canada. Binary logistic regressions were conducted. Separate models were created to reflect support or opposition to the 8 included policy items. Several covariates were included in the models including age, gender, political orientation, physical activity levels, income, urbanicity climate anxiety, and attitudes surrounding physical activity and climate change. The data were weighted to reflect the gender, age, and regional composition of the country. Results: Most individuals living in Canada strongly or moderately supported all actions (ranging from 71% to 85%). Meeting the physical activity guidelines, higher self-reported income, and scoring high on personal experience of climate change were associated with higher odds of supporting the policy actions related to climate actions. Conclusions: Most adults living in Canada support policies that align with the recommended policy actions related to physical activity and climate change. National campaigns enhancing awareness and understanding of the bidirectional relationship between physical activity and climate change are warranted, and these should consider the consistent demographic differences (eg, gender, age, and political orientation) seen in public support for physical activity-related policies. [ABSTRACT FROM AUTHOR]

Background: There is evidence of school-level variability in children's active behaviors. This study investigated the associations between school environments, policies and practices, and children's physical activity (PA) and active school transportation (AST), in a school ecology context. Methods: We recruited children (N = 1699, age = 10.2 ± 1.0 years, 55.0% girls) in 37 schools from 3 diverse regions of Canada. We then collected data using questionnaires (child, parent) and pedometers. In each school, an official completed a School Health Environment Survey. Multilevel regression models were used to examine associations with children's daily steps, and frequency and volume (frequency*distance) of AST. Results: Between-school variation ranged from 4.7% to 22.2% demonstrating that school environments are associated with children's active behaviors. None of the school environment variables were significantly associated with children's PA or frequency of AST. Nevertheless, their inclusion improved the PA model. Children's volume of AST increased in schools that reported more initiatives to promote AST. Conclusions: Our findings suggest that multiple components are needed to effectively promote active behaviors in children. Schools should determine the areas in which they can improve and assess the feasibility of implementing measures to make their school environments, policies, and practices more conducive to PA and AST.

The early years are critical for physical literacy (PL) and physical activity (PA). With increasing numbers of children attending early childhood education and care (ECEC), educators play a significant role in childhood development and may influence young children's PL journey. Educators receive minimal training in PL and PA, but receive increasing direction to integrate these concepts into ECEC learning. The purpose of this study was to assess educators' PL, then determine which components of their PL were associated with self-reported intentions and behaviours to promote PL and PA. Educator PL was moderate, while self-reported intentions and behaviours to provide PL and PA opportunities were high. Only one component of PL was associated with intentions and behaviours. The PL of educators may not inform their intentions and behaviours to provide PL and PA within ECEC frameworks.

Purpose: The purposes of the current study were to identify risk profiles for nonadherence among children and youth (5–17 y) at the 6-month mark of the COVID-19 pandemic and to discuss similarities and differences between risk profiles identified in the current study and those identified at the 1-month mark of the pandemic. Methods: Data were part of a nationally representative sample of 1143 parents (Mage = 43.07 y, SD = 8.16) of children and youth (5–17 y) living in Canada. Survey data were collected in October 2020. Results: Results showed that 3.8% met all movement behavior recommendations, 16.2% met the physical activity recommendation, 27% met the screen time recommendation, and 63.8% met the sleep recommendation. Characteristics associated with nonadherence to all movement behaviors included low parental perceived capability to restrict screen time and decreased overall time spent outdoors. Characteristics associated with nonadherence to the physical activity and screen time recommendations included youth (12–17 y), low parental perceived capability to restrict screen time, decreased time spent outdoors, and increased screen time. Conclusion: Results emphasized the importance of parental perceived capability to restrict screen time and children's and youth's outdoor time and showed that pandemic-related factors have impacted children and youth differently. [ABSTRACT FROM AUTHOR]

Children and youth with impairments in social skills and/or cognition face many barriers to community participation specifically physical activity (PA) (e.g., limited staff training). Inclusive PA settings may provide opportunities for children and youth with and without impairments to engage together and promote physical and social skill development. The purpose of this scoping review was to critically evaluate the literature on out-of-school PA programs (i.e., non-curriculum programming) that included children and/or youth with impairments in social skills and/or cognition. A keyword search of seven databases followed by eligibility screening led to ten articles for this scoping review. For each included study, two research team members independently extracted and synthesized the data, and appraised the study reporting quality using the published quality assessment tool (QATSDD). Experts' evaluation of the research literature was obtained. Ten studies, which varied from low to high reporting quality, collectively addressed the following outcomes, with all showing mixed impacts: anthropometrics and fitness; motor and sport skills; psychological well-being; and socialization. Experts suggested routes forward for research and practice including longitudinal designs and programming variety to meet individual needs. Out-of-school PA programs that include children and/or youth with impairments in social skills and/or cognition provide an opportunity to improve multiple areas of health and wellness. However, limited high-quality research has been conducted to-date. Further evaluation of program effectiveness is warranted.

Psychological need satisfaction, from a self-determination theory (SDT) perspective, has been applied extensively to understand predictors of exercise behaviour. Dweck proposed a psychological needs framework that includes basic needs (optimal predictability, competence, acceptance), compound needs derived from combinations of basic needs (self-esteem/status, trust, control), and a superordinate compound need for self-coherence that includes identity and meaning. The purpose was to examine whether psychological needs operationalized within Dweck's model account for variance in exercise behaviour in ways that the SDT model does not. A community sample of 403 adults completed measures of demographics, psychological needs, and exercise motivation at Time 1, and self-reported moderate-to-vigorous minutes of exercise at both Times 1 and 2 four weeks later. Two structural equation models operationalizing Dweck's needs framework and SDT (basic needs and motivation) were examined in relation to exercise behaviour. In both models, exercise identity and integrated regulation (conceptually similar) were the most salient correlates of prospectively measured exercise behaviour, and both accounted for the relationship between competence and exercise behaviour. The results support the importance of identity in the context of exercise behaviour. Future research should investigate factors associated with adopting and maintaining an exercise identity. [ABSTRACT FROM AUTHOR]