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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).

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

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.

Background: Parental support plays an important role in facilitating the participation of children in physical activity. However, there is evidence that parents overestimate their child's level of physical activity -- this may lead to inaction in promotion attempts by parents. This potential disconnect between parental perceptions and reality was recently the focus of the 'Think Again' social marketing campaign developed by PartipACTION. Purpose: To qualitatively explore parents' perceptions of the Think Again advertisements, and the possible disconnect between perceptions and reality regarding their children's physical activity levels. Method: Semi-structured interviews were conducted with 12 mothers and 12 fathers of children aged 5-11 years attending a supervised recreation class. A thematic analysis was applied to the collected data. Results: The advertisements were generally well received by the parents in serving as a reminder of how much physical activity their children should be getting. Less than half of parents believed their children were attaining physical activity guidelines although the majority believed they were sufficiently active given perceived time constraints for both them and their child. Most parents believed they could accurately estimate how active their child was but that other parents may have difficulty due to reliance on schools and organized recreation to provide opportunities for physical activity. Conclusion: PSAs have a role to play in increasing parental awareness of physical activity guidelines and communicating the importance of physical activity. More creative approaches will be needed to address the disconnect in the perceptions between sufficient and recommended levels of physical activity.

The transition from primary to secondary school is a major life event associated with large decreases in physical activity levels. Cross-sectional studies also suggest that secondary school students are less likely to engage in active school transport (AST; e.g. walking and cycling to/from school). To our knowledge, no longitudinal study has previously examined the correlates of AST immediately before and after the school transition. This pilot-study assessed: 1) the concordance between child- and parent-perceived barriers to AST (with Spearman correlations); 2) the associations of AST with child- and parent-perceived barriers to AST, parental neighborhood selection factors and socio-demographic characteristics (using Fisher's exact test). Participants were recruited in four K-6 schools (where children are required to change school after grade 6) located in census tracts with varying population density in Ottawa (Canada). All assessments were done at baseline and follow-up with respectively 49 and 29 participants. Substantial concordance was found between child- and parent-perceived barriers to AST at baseline, but not at follow-up; this might reflect the novelty of the route and the secondary school environment. Distance between home and school was the strongest barrier to AST while road safety concerns and the perception of having too much stuff to carry were also important barriers to AST. Children were more likely to engage in AST when their parents reported that they chose their neighborhood so that their children could easily walk or bike to school; thus future studies should take parental neighborhood selection into account. These findings should contribute to inform future research informing the development of policies and interventions to promote AST.