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Carducci B, Dominguez G, Kidd E, Oh C, Jain R, Khan A, Bhutta ZA. Promoting healthy school food environments and nutrition in Canada: a systematic review of interventions, policies, and programs. Nutr Rev 2024:nuae030. [PMID: 38767979 DOI: 10.1093/nutrit/nuae030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
CONTEXT The school food environment is a critical interface for child and adolescent nutrition, and there is a need to understand existing literature on Canadian school food environments to identify equity gaps and opportunities, and empower decision-makers to plan for future action. OBJECTIVE Literature on Canadian school food and nutrition interventions, policies, programs, and their effects on diets and nutritional status are synthesized and appraised in this systematic review. DATA SOURCES A search strategy was developed for each database used (Medline, Embase, PsycINFO, ERIC, Cochrane Collaboration, Canadian Electronic Library, BiblioMap), with a combination of free text and controlled vocabulary, for articles published from 1990 to 2021. Unpublished data and grey literature were also searched. DATA EXTRACTION Quantitative and qualitative studies with an observational or intervention study design, reviews, or program evaluations conducted in Canadian schools with participants aged 5-19.9 years were included. Key study characteristics and risk of bias were extracted independently by 2 investigators using a standardized tool. DATA ANALYSIS A total of 298 articles were included (n = 192 peer reviewed and 106 from the grey literature), which were mostly conducted in Ontario (n = 52), British Columbia (n = 43), and Nova Scotia (n = 28). Twenty-four interventions, 5 nonevaluated programs, and 1 policy involved Indigenous populations. Overall, 86 articles measured and reported on effectiveness outcomes, including dietary intake; anthropometry; knowledge, attitudes, and practices; and physical activity. The literature remains largely heterogenous and primarily focused on nutrition education programs that use subjective assessments to infer changes in nutrition. A key facilitator to implementation and sustainability was community engagement, whereas key barriers were staff capacity, access to resources and funding, and consistent leadership. CONCLUSIONS This review provides insight into Canadian school food and nutrition interventions, programs, and policies and uncovers important evidence gaps that require careful examination for future evaluations. Governments must create supportive environments that optimize nutrition for children and adolescents through equitable policies and programs. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42022303255.
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Affiliation(s)
- Bianca Carducci
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research, and Learning, Toronto, ON, Canada
- Department of Nutritional Sciences, University of Toronto, Faculty of Medicine, University of Toronto, Medical Sciences Building, Toronto, ON, Canada
| | - Georgia Dominguez
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research, and Learning, Toronto, ON, Canada
| | - Emily Kidd
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research, and Learning, Toronto, ON, Canada
| | - Christina Oh
- Western University, Schulich School of Medicine and Dentistry, London, ON, Canada
| | - Reena Jain
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research, and Learning, Toronto, ON, Canada
| | - Amira Khan
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research, and Learning, Toronto, ON, Canada
- Department of Nutritional Sciences, University of Toronto, Faculty of Medicine, University of Toronto, Medical Sciences Building, Toronto, ON, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research, and Learning, Toronto, ON, Canada
- Department of Nutritional Sciences, University of Toronto, Faculty of Medicine, University of Toronto, Medical Sciences Building, Toronto, ON, Canada
- Centre of Excellence in Women, and Child Health, Aga Khan University, Karachi, Pakistan
- Dalla Lana School of Public, Health University of Toronto Health Sciences Building, Toronto, ON, Canada
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Camaréna S. Artificial Intelligence (AI) for Sustainable Institutional Food Systems: Implementation of AI Tools for School Nutrition Program Management in the United States of America. FRONTIERS IN SUSTAINABLE FOOD SYSTEMS 2022. [DOI: 10.3389/fsufs.2022.743810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
School food programs can improve the nutritional status at community level, and can be a powerful tool to facilitate a transition to sustainable food systems, particularly through their purchasing methods and meal/waste management. Artificial Intelligence (AI) can enable or inhibit transitions to sustainability, due to its capacity to facilitate transformational change and disruption. Thus, AI can have major impacts on achieving the United Nations' Sustainable Development Goals (SDGs), including those related to food systems. This paper focuses on critically exploring different aspects during the implementation of a software project in US schools that used AI techniques to enable agility and provide healthy food options for schoolchildren. Participant observation, semi-structured interviews, and document analysis were used to inform the case study and uncover the new processes developed using the technology. As a key barrier to the effective management of school food programs and nutrition is the administrative load associated with statutory compliance, this case study demonstrates the difference that AI-powered tools can make in alleviating the weight of administrative processes. An Information and Communication Technology (ICT)-enabled boundary spanning framework is used to extend the case study toward an analysis of the systems, boundaries, relationships and perspectives which starts mapping the areas where the private sector, public institutions and civil society can meet to fast-track sustainable transition activities, particularly in the context of food systems. This article presents some possible approaches to facilitating these activities, inviting policy makers to bridge the gap with businesses and use business agility to support common societal goals to achieve sustainable food systems.
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O'Mahony B, Kerins C, Murrin C, Kelly C. Barriers and facilitators to the implementation of nutrition standards for school food: a mixed-methods systematic review protocol. HRB Open Res 2021; 3:20. [PMID: 32743340 PMCID: PMC7372527 DOI: 10.12688/hrbopenres.13041.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 06/30/2024] Open
Abstract
Background: The importance of nutrition during childhood and the high prevalence of child and adolescent obesity has resulted in several countries implementing nutritional standards for school food as a way of providing healthy school food environments. Yet, there has been less focus on the barriers and facilitators influencing the process of implementing school food standards. This mixed-methods systematic review aims to address this evidence gap by synthesising the empirical evidence on the factors that may influence the implementation of school food standards. Methods: This mixed-methods systematic review will use qualitative, quantitative and mixed-methods evidence from peer-reviewed publications retrieved from the following databases; PubMed, CINAHL, Scopus, EMBASE, Medline, PsycINFO and Web of Science. Grey literature will be accessed through Google Scholar, Open Access Theses and Dissertations, OpenGrey, RIAN, EThOS, ProQuest, WorldCat, Networked Digital Library of Theses and Dissertations, and public health organisation websites will also be accessed. Screening reference lists and citation chaining of all included studies will also be undertaken. No restrictions on publication date or language will be applied, however, only primary research studies relevant to supply-side stakeholders will be eligible for inclusion. Study quality will be assessed using the Mixed Methods Appraisal Tool. Study titles and abstracts will be screened to decide whether the full-text manuscript should be retrieved. For screening reliability, a second review author will assess a random sample of 20%. Kappa statistics will be used to assess inter-rater reliability, with values of 0.75 and higher representing high agreement. Two authors will independently extract data and factors reported to influence implementation. This will be synthesized using the Theoretical Domains Framework. Discussion: A comprehensive understanding of these factors can provide guidance to relevant stakeholders to enhance the adoption, implementation and sustainability of nutrition standards for school meals. Systematic review registration: PROSPERO CRD42019117904.
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Affiliation(s)
- Breda O'Mahony
- Home Economics Department, St. Angela's College, Sligo, Ireland
- Discipline of Health Promotion, National University of Ireland Galway, Galway, Ireland
| | - Claire Kerins
- Discipline of Health Promotion, National University of Ireland Galway, Galway, Ireland
| | - Celine Murrin
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Colette Kelly
- Health Promotion Research Centre, School of Health Sciences, National University of Ireland Galway, Galway, Ireland
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O'Mahony B, Kerins C, Murrin C, Kelly C. Barriers and facilitators to the implementation of nutrition standards for school food: a mixed-methods systematic review protocol. HRB Open Res 2021; 3:20. [PMID: 32743340 PMCID: PMC7372527 DOI: 10.12688/hrbopenres.13041.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 11/20/2022] Open
Abstract
Background: The importance of nutrition during childhood and the high prevalence of child and adolescent obesity has resulted in several countries implementing nutritional standards for school food as a way of providing healthy school food environments. Yet, there has been less focus on the barriers and facilitators influencing the process of implementing school food standards. This mixed-methods systematic review aims to address this evidence gap by synthesising the empirical evidence on the factors that may influence the implementation of school food standards. Methods: This mixed-methods systematic review will use qualitative, quantitative and mixed-methods evidence from peer-reviewed publications retrieved from the following databases; PubMed, CINAHL, Scopus, EMBASE, Medline, PsycINFO and Web of Science. Grey literature will be accessed through Google Scholar, Open Access Theses and Dissertations, OpenGrey, RIAN, EThOS, ProQuest, WorldCat, Networked Digital Library of Theses and Dissertations, and public health organisation websites will also be accessed. Screening reference lists and citation chaining of all included studies will also be undertaken. No restrictions on publication date or language will be applied, however, only primary research studies relevant to supply-side stakeholders will be eligible for inclusion. Study quality will be assessed using the Mixed Methods Appraisal Tool. Study titles and abstracts will be screened to decide whether the full-text manuscript should be retrieved. For screening reliability, a second review author will assess a random sample of 20%. Kappa statistics will be used to assess inter-rater reliability, with values of 0.75 and higher representing high agreement. Two authors will independently extract data and factors reported to influence implementation. This will be synthesized using the Theoretical Domains Framework. Discussion: A comprehensive understanding of these factors can provide guidance to relevant stakeholders to enhance the adoption, implementation and sustainability of nutrition standards for school meals. Systematic review registration: PROSPERO
CRD42019117904
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Affiliation(s)
- Breda O'Mahony
- Home Economics Department, St. Angela's College, Sligo, Ireland.,Discipline of Health Promotion, National University of Ireland Galway, Galway, Ireland
| | - Claire Kerins
- Discipline of Health Promotion, National University of Ireland Galway, Galway, Ireland
| | - Celine Murrin
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Colette Kelly
- Health Promotion Research Centre, School of Health Sciences, National University of Ireland Galway, Galway, Ireland
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O'Mahony B, Kerins C, Murrin C, Kelly C. Barriers and facilitators to the implementation of nutrition standards for school food: a mixed methods systematic review protocol. HRB Open Res 2020; 3:20. [DOI: 10.12688/hrbopenres.13041.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2020] [Indexed: 11/20/2022] Open
Abstract
Background: The importance of nutrition during childhood and the high prevalence of child and adolescence obesity has resulted in several countries implementing nutritional standards for school food as a way of providing healthy school food environments. Yet there has been less focus on the barriers and facilitators influencing the process of implementing school food standards. This mixed methods systematic review aims to address this evidence gap by synthesising the empirical evidence on the factors that may influence implementation of school food standards. Methods: This mixed methods systematic review will use qualitative, quantitative and mixed methods evidence from peer reviewed publications retrieved from the following databases; PubMed, CINAHL, Scopus, EMBASE, Medline, PsycINFO and Web of Science. Grey literature will be accessed through Google Scholar, Open Access Theses and Dissertations, OpenGrey, RIAN, EThOS, ProQuest, WorldCat, Networked Digital Library of Theses and Dissertations, and public health organisation websites will also be accessed. Screening reference lists and citation chaining of all included studies will also be undertaken. No restrictions on publication date or language will be applied, however, only primary research studies relevant to supply-side stakeholders will be eligible for inclusion. Study quality will be assessed using the Mixed Methods Appraisal Tool. Study titles and abstracts will be screened to decide whether the full text manuscript should be retrieved. For screening reliability, a second review author will assess a random sample of 20%. Kappa statistics will be used to assess inter-rater reliability, with values of 0.75 and higher representing high agreement. Two authors will independently extract data and factors reported to influence implementation. This will be synthesized using the Theoretical Domains Framework. Discussion: A comprehensive understanding of these factors can provide guidance to relevant stakeholders to enhance the adaption, implementation and sustainability of nutrition standards for school meals. Systematic review registration: PROSPERO CRD42019117904
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Vine MM, Leatherdale ST, Laxer RE. Priority setting for school nutrition research: developing a collaborative research agenda. Canadian Journal of Public Health 2020; 111:1020-1023. [PMID: 32529554 DOI: 10.17269/s41997-020-00331-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 04/28/2020] [Indexed: 11/17/2022]
Abstract
Priority setting in health research can assist stakeholders to identify research and policies that have the greatest potential for benefits to public health. Priority setting has been utilized by researchers to identify barriers, facilitators, and recommendations for future public health research. This commentary describes how a priority-setting approach was used as part of a workshop activity on the school nutrition environment in Ontario, Canada, to facilitate brainstorming, sorting, and rating of concepts related to the school nutrition environment. This work demonstrates an interesting and concrete case of priority setting, of interest for various planning activities (both programming and research), particularly those around school-based healthy eating programs or a related research agenda.
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Affiliation(s)
- Michelle M Vine
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
| | - Scott T Leatherdale
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
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Godin KM, Patte KA, Leatherdale ST. Examining Predictors of Breakfast Skipping and Breakfast Program Use Among Secondary School Students in the COMPASS Study. THE JOURNAL OF SCHOOL HEALTH 2018; 88:150-158. [PMID: 29333646 DOI: 10.1111/josh.12590] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 05/19/2017] [Accepted: 05/24/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Many Canadian schools offer breakfast programs; however, students' engagement in these programs is low, while breakfast skipping is highly prevalent among youth. This study examined whether the availability of breakfast programs supports adolescents' regular breakfast eating, and identified characteristics of breakfast skippers who are not using these programs. METHODS Data from 30,771 secondary school students from Ontario and Alberta, Canada, participating in Year 3 (2014-2015) of the COMPASS study were used for descriptive and logistic regression analyses. Participants were categorized by self-reported breakfast eating and school breakfast program use. RESULTS Sixteen percent of participants reported using school breakfast programs. Breakfast skipping was highly prevalent among participants, regardless of their breakfast program use. Characteristics significantly associated with program use included traveling to school via public transit or a school bus, being a bullying victim, and having a high school connectedness score. A desire to lose weight and non-involvement in school sports were significantly associated with being a "breakfast skipper/nonprogram user." CONCLUSIONS School breakfast programs do not consistently support regular breakfast eating, even among adolescents actively engaged in these programs. Future research should identify and evaluate practices to bolster participation in breakfast programs and promote regular breakfast eating among adolescents.
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Affiliation(s)
- Katelyn M Godin
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Karen A Patte
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Scott T Leatherdale
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
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Vine MM, Harrington DW, Butler A, Patte K, Godin K, Leatherdale ST. Compliance with school nutrition policies in Ontario and Alberta: An assessment of secondary school vending machine data from the COMPASS study. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2017; 108:e43-e48. [PMID: 28425898 PMCID: PMC6972344 DOI: 10.17269/cjph.108.5701] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 01/04/2017] [Accepted: 10/23/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We investigated the extent to which a sample of Ontario and Alberta secondary schools are being compliant with their respective provincial nutrition policies, in terms of the food and beverages sold in vending machines. METHODS This observational study used objective data on drinks and snacks from vending machines, collected over three years of the COMPASS study (2012/2013-2014/2015 school years). Drink (e.g., sugar-containing carbonated/non-carbonated soft drinks, sports drinks, etc.) and snack (e.g., chips, crackers, etc.) data were coded by number of units available, price, and location of vending machine(s) in the school. Univariate and bivariate analyses were undertaken using R version 3.2.3. In order to assess policy compliancy over time, nutritional information of products in vending machines was compared to nutrition standards set out in P/PM 150 in Ontario, and those set out in the Alberta Nutrition Guidelines for Children and Youth (2012) in Alberta. RESULTS Results reveal a decline over time in the proportion of schools selling sugar-containing carbonated soft drinks (9% in 2012/2013 vs. 3% in 2014/2015), crackers (26% vs. 17%) and cake products (12% vs. 5%) in vending machines, and inconsistent changes in the proportion selling chips (53%, 67% and 65% over the three school years). Conversely, results highlight increases in the proportion of vending machines selling chocolate bars (7% vs. 13%) and cookies (21% vs. 40%) between the 2012/2013 and 2014/2015 school years. CONCLUSION Nutritional standard policies were not adhered to in the majority of schools with respect to vending machines. There is a need for investment in formal monitoring and evaluation of school policies, and the provision of information and tools to support nutrition policy implementation.
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Affiliation(s)
- Michelle M Vine
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON.
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Godin KM, Kirkpatrick SI, Hanning RM, Stapleton J, Leatherdale ST. Examining Guidelines for School-Based Breakfast Programs in Canada: A Systematic Review of the Grey Literature. CAN J DIET PRACT RES 2017; 78:92-100. [PMID: 28145767 DOI: 10.3148/cjdpr-2016-037] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
School breakfast programs are widespread and serve varying objectives regarding youth health promotion. Evidence-based guidelines for breakfast programs may be important in maximizing their effectiveness related to student outcomes, yet it is unclear what is available in Canada. A systematic review was conducted to identify and compare Canadian guidelines related to breakfast programs. Data sources included grey literature databases, customized search engines, targeted websites, and content expert consultations. Eligible guidelines met the following criteria: government and nongovernment sources at the federal and provincial/territorial levels, current version, and intended for program coordinators. Recommendations for program delivery were extracted, categorized, and mapped onto the 4 environments outlined in the ANGELO framework, and they were classified as "common" or "inconsistent" across guidelines. Fifteen sets of guidelines were included. No guidelines were available from federal or territorial governments and 4 provincial governments. There were few references to peer-reviewed literature within the guidelines and despite many common recommendations for program delivery, conflicting recommendations were also identified. Potential barriers to program participation, including a lack of consideration of allergies and other dietary restrictions, were identified. Future research should identify how guidelines are implemented and evaluate what effect their implementation has on program delivery and student outcomes.
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Affiliation(s)
- Katelyn M Godin
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON
| | - Sharon I Kirkpatrick
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON
| | - Rhona M Hanning
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON
| | - Jackie Stapleton
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON
| | - Scott T Leatherdale
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON
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Godin K, Stapleton J, Kirkpatrick SI, Hanning RM, Leatherdale ST. Applying systematic review search methods to the grey literature: a case study examining guidelines for school-based breakfast programs in Canada. Syst Rev 2015; 4:138. [PMID: 26494010 PMCID: PMC4619264 DOI: 10.1186/s13643-015-0125-0] [Citation(s) in RCA: 357] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 09/30/2015] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Grey literature is an important source of information for large-scale review syntheses. However, there are many characteristics of grey literature that make it difficult to search systematically. Further, there is no 'gold standard' for rigorous systematic grey literature search methods and few resources on how to conduct this type of search. This paper describes systematic review search methods that were developed and applied to complete a case study systematic review of grey literature that examined guidelines for school-based breakfast programs in Canada. METHODS A grey literature search plan was developed to incorporate four different searching strategies: (1) grey literature databases, (2) customized Google search engines, (3) targeted websites, and (4) consultation with contact experts. These complementary strategies were used to minimize the risk of omitting relevant sources. Since abstracts are often unavailable in grey literature documents, items' abstracts, executive summaries, or table of contents (whichever was available) were screened. Screening of publications' full-text followed. Data were extracted on the organization, year published, who they were developed by, intended audience, goal/objectives of document, sources of evidence/resources cited, meals mentioned in the guidelines, and recommendations for program delivery. RESULTS The search strategies for identifying and screening publications for inclusion in the case study review was found to be manageable, comprehensive, and intuitive when applied in practice. The four search strategies of the grey literature search plan yielded 302 potentially relevant items for screening. Following the screening process, 15 publications that met all eligibility criteria remained and were included in the case study systematic review. The high-level findings of the case study systematic review are briefly described. CONCLUSIONS This article demonstrated a feasible and seemingly robust method for applying systematic search strategies to identify web-based resources in the grey literature. The search strategy we developed and tested is amenable to adaptation to identify other types of grey literature from other disciplines and answering a wide range of research questions. This method should be further adapted and tested in future research syntheses.
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Affiliation(s)
- Katelyn Godin
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
| | - Jackie Stapleton
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
| | - Sharon I Kirkpatrick
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
| | - Rhona M Hanning
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
| | - Scott T Leatherdale
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
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