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To determine the association between physical activity (PA) intensities and cardiometabolic risk factors in youth.Cross-sectional study using data from the 2008 Healthy Hearts Prospective Cohort Study of Physical Activity and Cardiometabolic Health in Youth.Rural and urban communities in Alberta, Canada.A convenience sample of 605 youth aged 9 to 17 years. Youth were on average aged 12.1 years, 248 were boys (41%), and 157 were overweight or obese (26%).Actical accelerometer-measured PA intensity.The primary outcome was body mass index (calculated as weight in kilograms divided by height in meters squared) z score. Secondary outcome measures included waist circumference, systolic blood pressure, and cardiorespiratory fitness (maximal oxygen consumption [[Vdot]O2max]).Body mass index z score, waist circumference, and systolic blood pressure decreased and [Vdot]O2max increased in a dose-response manner across tertiles of vigorous PA (adjusted P.001). No significant differences in cardiometabolic risk factors were seen across tertiles of moderate or light PA in multivariable analyses. Achieving more than 7 minutes of vigorous PA daily was associated with a reduced adjusted odds ratio of overweight status (0.56; 95% CI, 0.33-0.95) and elevated systolic blood pressure (0.36; 95% CI, 0.16-0.79). The odds of overweight status and elevated blood pressure decreased with increasing time and intensity of PA.Only vigorous PA was consistently associated with lower levels of waist circumference, body mass index z score, systolic blood pressure, and increased cardiorespiratory fitness in youth. These findings underscore the importance of vigorous PA in guidelines for children and adolescents.

Objectives: To describe levels of tobacco control “effort” in public health organizations across provinces, and to test the hypothesis that “effort” is associated with the prevalence of daily smoking. Methods: Data were drawn from a national survey (Oct 2004-Apr 2005) of all public health organizations engaged in chronic disease prevention in Canada in 2004. We investigated the association between “effort” and decline in smoking prevalence (CTUMS, 1999-2009) across provinces in an ecologic study design. “Effort” was assessed using two indicators: percent of public health organizations engaged in tobacco control, and mean level of involvement in engaged organizations. Results: Of 216 organizations, 88% had undertaken tobacco control activities in the three years prior to data collection and were categorized as “engaged”. Level of involvement in tobacco control was highest in community-at-large settings; and it was generally higher for population- than for individual-level strategies. Nova Scotia reported higher levels of involvement than other provinces. There was substantial variability in “effort” across provinces. High-”effort” provinces (BC, NS, ON, QC) experienced, on average, improvement in the “change in smoking prevalence” score (1999 to 2009). Conclusion: The findings provide evidence that provincial tobacco control “effort” relates to declines in smoking prevalence. Given that smoking remains a critical public health issue, the kinds of data reported herein are needed to inform the debate on how best to invest in tobacco control infrastructure to combat the most important public health threat of our times. Key words: Tobacco control; public health; organizational survey; ecologic study; Canada

Background There is no cardiovascular disease (CVD) risk factor profile in a representative sample of Canadian children and adolescents according to weight status. The 2007-2009 Canadian Health Measures Survey, launched by Statistics Canada in partnership with Health Canada and the Public Health Agency of Canada, provides an opportunity to address this gap. Methods The Canadian Health Measures Survey collected information at 15 sites across Canada from March 2007 to March 2009 from Canadians aged 6 to 79 years living in private households. The survey consisted of a household interview and a visit to a mobile examination centre to perform physical measurements, including anthropometry, blood pressure, and biospecimen collection. The present analysis is based on data from 2087 children and adolescents aged 6 to 19 years. Results Children and adolescents who were overweight or obese had on average higher mean concentrations and higher prevalence of adverse levels of CVD risk factors (systolic and diastolic blood pressure, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, apolipoprotein B, C-reactive protein, homocysteine, and insulin levels) than did normal-weight children and adolescents. Adjustment for covariates (gender, age, household education, household income adequacy, and province of residence) and compliance with recommendations for daily steps, soft-drink intake, and sleep duration did not alter the differences in CVD risk factors between normal weight and overweight or obese children and adolescents. Conclusions Results of this study underscore the importance of excess weight as an independent risk factor for CVD health in early life and call for primary prevention of overweight and obesity in childhood to reduce CVD risk.

OBJECTIVE Body composition measured by dual-energy X-ray absorptiometry (DXA) is believed to be superior to crude measures such as BMI or waist circumference (WC) to assess health risks associated with adiposity in adults. We compared the ability of BMI, WC, waist-to-height ratio (WHtR), percentage body fat from skinfold thickness, and measures of total and central fat assessed by DXA to identify children with elevated blood pressure (BP). STUDY DESIGN The QUALITY Study follows 630 Caucasian families (father, mother, and child originally aged 8-10 years). BP, height, weight, WC, and skinfold thickness were measured according to standardized protocols. Elevated BP was defined as systolic or diastolic BP at least 90th age, sex, and height-specific percentile. Total and central fat were determined with DXA. The area under the receiver operating characteristic (ROC) curve (AUC) statistic was computed from logistic models that adjusted for age, sex, height, Tanner stage, and physical activity. RESULTS All adiposity indicators were highly correlated. WC and WHtR did not show superior ability over BMI to identify children with elevated SBP (P = 0.421 and 0.473). Measures of total and central fat from DXA did not show an improved ability over BMI or WC to identify children with elevated SBP (P = 0.325-0.662). CONCLUSION Results support the use of BMI in clinical and public health settings, at least in this age group. As all indicators had a limited ability to identify children with elevated BP, results also support measurement of BP in all children of this age independent of a weight status.

Background We sought to determine if the rate of increase in body mass index (BMI) differs between first generation immigrant children (child and both parents born outside Canada); second generation immigrant children (child born in Canada with at least one parent born outside Canada); and native-born children (child and both parents born in Canada), and if the rate of increase varies across ethnic groups. Methods Data were available from the evaluation of a 5-year heart health promotion program targeted to elementary school children from 24 schools in multi-ethnic, disadvantaged, inner-city neighborhoods in Montreal, Canada. Participants were 6392 children aged 9–12 years born in and outside of Canada. Height and weight were measured annually according to a standardized protocol. BMI increases with age were examined using individual growth models stratified by immigrant status grouping (first generation immigrant, second generation immigrant, native-born). Results On average, BMI increased by 0.59, 0.73, and 0.82 kg/m 2 with each year of age among first generation immigrant, second generation immigrant, and native-born children, respectively. These differences held across four family origin grouping (Europe, Asia, Central/South America, and Other). Conclusion The protective effect of immigrant status on BMI increases with age dissipated in second generation immigrant children, whose rate of increase was similar to that of native-born children. Because immigrants constitute the fastest growing segment of the Canadian population, it is important to understand the causes of the higher BMI increases with successive generations.

Background: Studies suggest that sex differences in blood pressure (BP) are established early in life. Sex differences in BP increases that occur during adolescence may be due to differences in changes in anthropometric characteristics. Methods: Using sex-specific individual growth models, we assessed the effect of height, body mass index (BMI; kg/m2), waist circumference, and triceps and subscapular skinfold thickness on changes in systolic BP in a cohort of 1293 adolescents in Montreal, Canada. BP and anthropometry were assessed biannually (1999/2000, 2002, 2004) at mean ages 12.8, 15.2, and 17.0. Results: On average, systolic BP increased by 11.1 mm Hg in boys and 3.2 mm Hg in girls during 5 years. Changes in height explained half of the overall increase in systolic BP in boys and virtually all of the increase in systolic BP in girls. No meaningful sex differences were observed in the association of changes in BMI, waist circumference, and triceps and subscapular skinfold thickness with systolic BP change during 5 years. Increases in 1 BMI unit, 1 cm waist circumference, or 1 mm triceps or subscapular skinfold thickness were associated with increases of 0.7, 0.24, 0.3, and 0.4 mm Hg systolic BP, respectively. Conclusions: Although sex differences in mean systolic BP changes during adolescence were largely attributable to differences in gains in height, the effect of gaining weight or body fat on systolic BP change was similar in boys and girls. Refereed/Peer-reviewed

The authors examined the potential association between changes in the number of moderate-to-vigorous physical activity (MVPA) sessions per week, adiposity, and systolic blood pressure (SBP) during adolescence. SBP and anthropometric factors were assessed biannually (1999/2000, 2002, and 2004) in a cohort of 1,293 Canadian adolescents aged 12–13 years in 1999. Self-reported 7-day recall data on MVPA sessions ≥5 minutes in duration were collected every 3 months over the 5-year period. Estimates of initial level and rate of decline in number of MVPA sessions per week from individual growth models were used as predictors of SBP in linear regression models. A decline of 1 MVPA session per week with each year of age was associated with 0.29-mm Hg and 0.19-mm Hg higher SBPs in girls and boys, respectively, in early adolescence (ages 12.8–15.1 years) and 0.40-mm Hg and 0.18-mm Hg higher SBPs, respectively, in late adolescence (ages 15.2–17.0 years). The associations were not attenuated by changes in body mass index, waist circumference, or skinfold thickness in girls during late adolescence. Although weaker, associations were evident in boys during late adolescence, as well as in both girls and boys during early adolescence. These results support prevention of declines in MVPA during adolescence to prevent higher blood pressure in youth. Refereed/Peer-reviewed

To describe the prevalence and co-occurrence of lifestyle risk factors for chronic disease by family origin.Cross-sectional analysis.Multiethnic, low-income, urban neighborhoods in Montreal, Canada.2033 adults (42.2% male), mean age 39.7 (standard deviation 6.4) yearsSmoking, level of physical activity, dietary habits, body mass index.Subjects completed self-report questionnaires on sociodemographic characteristics, height, weight, and lifestyle behaviors. We tested family origin (based on language first learned in childhood and country of birth) as an independent correlate of co-occurrence (having at least two lifestyle risk factors) in multivariate logistic regression analyses.The prevalence of smoking and poor diet was highest among participants of French Canadian family origin. Although physical inactivity was uniformly high across family origins, it was highest among participants of Portuguese, Italian, and Haitian family origin. Obesity was highest among Europeans. The prevalence of smoking was lowest among Haitians; poor diet was lowest among South Asians; and physical inactivity was lowest among Eastern Europeans. Obesity was lowest among Asians, with the exception that 55.9% of South Asians were overweight or obese. Relative to French Canadians, adults in all other family-origin groups had a lower risk of co-occurrence of lifestyle risk factors. Adults of Asian family origin had the lowest prevalence of co-occurrence of lifestyle risk factors.Variation in the distribution of lifestyle risk factors may explain in part differences in chronic disease morbidity and mortality across ethnic groups. Prevention programs should take differential distribution of lifestyle risk factors by ethnicity into account.

BackgroundParents play a central role in preventing childhood obesity. There is a need for innovative, scalable, and evidence-based interventions designed to enhance parents’ motivation to support and sustain healthy lifestyle behaviors in their children, which can facilitate obesity prevention. Objective(1) Develop an online screening, brief intervention, and referral to treatment (SBIRT) eHealth tool to enhance parents’ concern for, and motivation to, support children’s healthy lifestyle behaviors, (2) refine the SBIRT eHealth tool by assessing end-user acceptability, satisfaction, and usability through focus groups, and (3) determine feasibility and preliminary effectiveness of the refined SBIRT eHealth tool through a randomized controlled trial. MethodsThis is a three-phase, multi-method study that includes SBIRT eHealth tool development (Phase I), refinement (Phase II), and testing (Phase III). Phase I: Theoretical underpinnings of the SBIRT tool, entitled the Resource Information Program for Parents on Lifestyle and Education (RIPPLE), will be informed by concepts applied within existing interventions, and content will be based on literature regarding healthy lifestyle behaviors in children. The SBIRT platform will be developed in partnership between our research team and a third-party intervention development company. Phase II: Focus groups with parents, as well as health care professionals, researchers, and trainees in pediatrics (n=30), will explore intervention-related perceptions and preferences. Qualitative data from the focus groups will inform refinements to the aesthetics, content, structure, and function of the SBIRT. Phase III: Parents (n=200) of children—boys and girls, 5 to 17 years old—will be recruited from a primary care pediatric clinic while they await their children’s clinical appointment. Parents will be randomly assigned to one of five groups—four intervention groups and one control group—as they complete the SBIRT. The randomization function is built into the tool. Parents will complete the eHealth SBIRT using a tablet that will be connected to the Internet. Subsequently, parents will be contacted via email at 1-month follow-up to assess (1) change in concern for, and motivation to, support children’s dietary and physical activity behaviors (primary outcome), and (2) use of online resources and referrals to health services for obesity prevention (secondary outcome). ResultsThis research was successfully funded and received ethics approval. Development of the SBIRT started in summer 2012, and we expect all study-related activities to be completed by fall 2016. ConclusionsThe proposed research is timely and applies a novel, technology-based application designed to enhance parents concern for, and motivation to, support children’s healthy lifestyle behaviors and encourage use of online resources and community services for childhood obesity prevention. Overall, this research builds on a foundation of evidence supporting the application of SBIRTs to encourage or “nudge” individuals to make healthy lifestyle choices. Findings from Phase III of this project will directly inform a cluster randomized controlled trial to study the effectiveness of our intervention across multiple primary care-based settings. Trial RegistrationClinicalTrials.gov NCT02330588; http://clinicaltrials.gov/ct2/show/NCT02330588 (Archived by WebCite at http://www.webcitation.org/6WyUOeRlr).

BackgroundDespite growing evidence that supports the importance of 6-month exclusive breastfeeding, few Canadian mothers adhere to this, and early weaning onto solids is a common practice. This study assessed infant feeding transitions during the first 6 months postpartum and factors that predicted exclusive breastfeeding to 3 and 6 months.MethodsThis prospective cohort study was part of the Alberta Pregnancy Outcomes and Nutrition study (APrON). From an initial sample of 600 pregnant women recruited from Edmonton and Calgary, 402 mothers provided complete details at 3 months postpartum; 300 stayed on to provide information at 6 months postpartum. During pregnancy and at 3 and 6 months postpartum, data on maternal and infant socio-demographic, behavior, and feeding were collected.ResultsEven though there was a high rate of “ever having breastfed” (98.6%), exclusive breastfeeding rates for 3 and 6 months were 54.0% and 15.3%, respectively. After controlling for potential confounders, the study showed that mothers who held post-graduate university degrees were 3.76 times more likely to breastfeed exclusively for 6 months than those without a university degree (95% CI: 1.30-10.92; p = 0.015). In addition, mother of previous children were more likely to breastfeed exclusively for 6 months (OR: 2.21, 95% CI: 1.08-4.52; p = 0.031). Mothers who were in the highest quartile of the Iowa Infant Feeding Attitude Score were 4.29 and 5.40 times more likely to breastfeed exclusively for 3 months (95% CI: 1.31-14.08; p-trend ConclusionsThe 6-month exclusive breastfeeding rate in Alberta is considerably below national and international breastfeeding recommendations. Professional advice that focuses on prenatal maternal knowledge, attitudes, and misperceptions may promote adherence to World Health Organization breastfeeding guidelines. Knowing that exclusive breastfeeding is less likely to take place among lower-educated, primiparous women may help health practitioners focus their support and education for this group.

Results: After adjustment for age, sex, ethnicity and living alone status, dog ownership was associated with higher levels of walking in the fall/winter (1172 steps per day, 95% CI 191 to 2154) but not in the spring/summer (307 steps per day, 95% CI -696 to 1310). No associations were observed between dog ownership and BMI (fall/ winter: 0.7 kg/m 2 , 95% CI -1.8 to 3.1; spring/summer: -0.4 kg/m 2 , 95% CI -2.6 to 1.9). Conclusions: This study provides evidence that dog ownership may be an important factor in helping adults with DM2 achieve higher levels of walking in the fall/winter but not in the spring/ summer. Because the effects of dog ownership on BMI may emerge over time, additional longitudinal research is encouraged. Background: Parents help their sons and daughters to develop healthy lifestyle habits, which is particularly important for obesity management. Our purpose was to characterize the weight status, diet, and physical activity of parents of children and youth with obesity. Methods: Cross-sectional waist circumference, height, and weight data were measured in 242 parents of 8e18 years olds with obesity. Relative weight status categories were created using BMI. Parents recorded their dietary intake, physical activity, and leisure time screen time using a food record, pedometer, and physical activity record, respectively. Results: The proportions of parents categorized as normal weight, overweight, and obese were 17.4%, 25.2%, and 57.4%, respectively; 39.6% of parents had abdominal obesity. Based on Canada's Food Guide, 8%, 27%, 45%, and 62% consumed the recommended number of daily servings of Vegetables & Fruit (7-10), Milk & Alternatives (2-3), Grain Products (6-8), and Meat & Alternatives (2-3), respec- tively. Regarding physical activity, 23.2% accumulated � 10,000 steps/day, 48.7% participated in >30 minutes/day, and 46.1% limited leisure time screen time to

Objective To investigate the association between common carotid artery intima-media thickness (cIMT) and exposure to secondhand smoke (SHS) in children. Methods Data were available at baseline in the Quebec Adiposity and Lifestyle investigation in Youth (QUALITY) study, an ongoing longitudinal investigation of Caucasian children aged 8–10 years at cohort inception, who had at least one obese parent. Data on exposure to parents, siblings and friends smoking were collected in interviewer-administered child, and self-report parent questionnaires. Blood cotinine was measured with a high sensitivity ELISA. cIMT was measured by ultrasound. The association between blood cotinine and cIMT was investigated in multivariable linear regression analyses controlling for age, body mass index, and child smoking status. Results Mean (SD) cIMT (0.5803 (0.04602)) did not differ across age or sex. Overall 26%, 6% and 3% of children were exposed to parents, siblings and friends smoking, respectively. Cotinine ranged from 0.13 ng/ml to 7.38 ng/ml (median (IQR)=0.18 ng/ml)). Multivariately, a 1 ng/ml increase in cotinine was associated with a 0.090 mm increase in cIMT (p=0.034). Conclusion In children as young as age 8–10 years, exposure to SHS relates to cIMT, a marker of pre-clinical atherosclerosis. Given the wide range of health effects of SHS, increased public health efforts are needed to reduced exposure among children in homes an private vehicles.

To the Editor .— Foster et al1 must be congratulated for showing that policy-based school interventions can reduce both the incidence and prevalence of overweight over a short time frame (2 years). However, the average weight gain, assessed by the mean changes in BMI and BMI z score, was similar for the intervention and control groups—a counterintuitive finding the authors found “not surprising.”1 We suggest that the authors should consider changes in BMI z scores as an important …

PurposeTo determine primary care physicians’ counseling as well as patients’ driving behaviors following seizure and non-seizure events impairing consciousness in the community.MethodsPatients attending a rapid-referral first seizure clinic were entered into the study if they were deemed medically-unfit to drive according to national guidelines for driving licensure: had experienced a seizure or an unexplained episode of lost consciousness, and had a valid driver's license at the time of their index event. Risk of physician counseling in the community regarding driving cessation in the interval between initial primary care assessment and neurological consultation was examined as a primary outcome, and patient driving cessation was examined as a secondary outcome.Results106 of 192 (55%) patients attending clinic met guideline criteria requiring driver fitness counseling in the primary care community, and 89 patients (46%) were deemed medically-unfit to drive following the initial specialist consultation appointment. Among medically unfit driver cases, 73% were ultimately deemed to have experienced a seizure and 27% had experienced a non-seizure event (e.g. syncope, PNES). Driver fitness counseling was more likely for seizure than non-seizure cases (unadjusted odds ratio: 4.14, p

OBJECTIVE: To determine whether parental beliefs and support for physical activity (PA) are associated with normal-weight and overweight children’s self-reported PA and body weight using a population-based approach. METHODS: We analyzed cross-sectional survey data from 6,585 students and their parents in Alberta, Canada, collected in 2008 and 2010. Parental beliefs and support were collected through questions on “care about staying fit”, “encourage PA” and “engage in PA with their child”. Children’s PA was self-reported. Body mass index was calculated from measured height and weight. We applied random effects models to assess: 1) the association of parental beliefs and support with children’s PA; 2) differences in the associations for normal-weight and overweight children; 3) the association of parental beliefs and support with overweight. RESULTS: Parental care, encouragement, and engagement in PA were independently and positively associated with PA among both normal-weight and overweight children. Relative to children whose parents encouraged them “quite a lot”, those whose parents encouraged them “very much” were 22% less likely to be overweight (OR=0.78, 95% CI: 0.68-0.89). CONCLUSION: Health promotion strategies that target parents to encourage and engage in PA with their children may increase activity levels and reduce overweight among children.

Background Among youth, participation in extracurricular physical activities at school and organised physical activities in the community is associated with higher physical activity levels. The objective was to determine if participation in organised physical activities during early adolescence protects against declines in physical activity levels during adolescence. Methods Every 3 months for 5 years, students initially in grade 7 (aged 12–13 years) completed a 7-day physical activity recall and provided data on the number and type of (extracurricular) physical activities organised at school and in the community in which they took part. To study rates of decline in physical activity, only adolescents who reported an average of ≥5 moderate-vigorous physical activity sessions per week in grade 7 (n = 1028) were retained for analyses. They were categorised as to whether or not they were involved in organised physical activities in grade 7. We used generalized estimating equation Poisson regression to compare the rate of decline in number of moderate-vigorous physical activity sessions per week during adolescence between initially physically active students who participated in organised physical activity in grade 7 and those who did not. Results In grade 7, about 87% of physically active adolescents reported taking part in at least one organised physical activity. Compared to active adolescents not involved in organised physical activities, baseline involvement in physical activity was 42% (95% CI 26–59%) higher among those involved in organised physical activity (mean number of moderate-vigorous physical activity sessions per week = 14.6 ± 13.1 vs 10.4 ± 9.0). Physical activity declined by 8% per year in both groups. Results were similar in analyses that examined the effect of school or community-based physical activities separately. Conclusion Although participation in organised physical activities during early adolescence is associated with more physical activity throughout secondary school, participation in such activities does not protect against declines in physical activity over time.