Associations of Cultural Characteristics with Sedentary Behaviour and Screen Time Among Indigenous Adults in Saskatchewan

BACKGROUND

Indigenous Peoples: First Nations, Métis and Inuit, have experienced significant disruptions of physical, mental, emotional and spiritual health and well-being through centuries of ongoing colonization and assimilation. Consequently, breakdown of cultural connections, increasingly sedentary lifestyles and high levels of screen time contribute to health inequity experiences.

PURPOSE

The purpose of this study is to examine associations of cultural connectedness with sedentary behaviour and the influence of relocation from home communities for Indigenous Peoples in Saskatchewan.

METHODS

Cultural connectedness, sedentary and screen time behaviour were evaluated through online questionnaires among 106 Indigenous adults. Within Indigenous identities, 2 × 2 factorial ANOVA compared cultural connectedness scores with sedentary behaviour and traditional activity participation by relocation from home communities.

RESULTS

Among First Nations and specifically Cree/Nehiyawak who relocated from home communities, positive associations of cultural connectedness scores with sedentary behaviour and screen time were identified, with no associations identified among those not relocating. Among Métis who did not relocate, greater ethnic identity, identity, spirituality and cultural connectedness (57.8 ± 5.36 vs. 81.25 ± 16.8; p = 0.02) scores were reported among those reporting 5 or more hours of continuous sitting.

CONCLUSIONS

Cultural connectedness associations with sedentary behaviour depend on relocation from home communities and differ between First Nations and Métis. Understanding associations of sedentary behaviour specific to First Nations and Métis populations may enable appropriate strategies to improve health outcomes.

The 2022 India Report Card on physical activity for children and adolescents

Background

With strong evidence of physical inactivity's link to chronic disease and economic burden - particularly with childhood active living behaviors tracking into adulthood - it is imperative to promote physical activity among children and adolescents in India.

Objectives

To evaluate active living patterns among Indian children and adolescents.

Methods

The India Report Card (IRC) team, which consists of experts in India and Canada, systematically collected and appraised evidence on 11 indicators of active living, including 5 behavioral (Overall Physical Activity, Organized Sport Participation, Active Play, Active Transportation, Sedentary Behavior), 2 individual-level (Physical Fitness, Yoga) and 4 sources of influence (Family and Peers, School, Community and Built Environment, Government). Peer-reviewed articles were appraised based on national representativeness, sample size, and data quality. Grey literature was appraised based on comprehensiveness, validity of the sources, and representativeness. All indicators were assessed against parameters provided by the Active Healthy Kids Global Alliance.

Results

Active Transportation and Government Strategies were ranked highest with a B- and C+ grade, respectively. Overall Physical Activity and Schools were assigned a C grade, while Sedentary Behavior and Community and Built Environment were given D grades. Yoga was the lowest ranking indicator with a D- grade. Organized Sport Participation, Active Play, Family and Peers, and Physical Fitness were all graded incomplete.

Conclusions

Active Transportation, Government Strategies, and Overall Physical Activity have improved since the 2018 IRC, a positive trend that needs to be translated to other indicators. However, Sedentary Behavior has consistently worsened, with grades C, C-, and D-, in 2016, 2018, and 2022, respectively. Evidence generated by the 2022 IRC suggests opportunities for improvement not only in India, but also the 56 other countries taking part in Global Matrix 4.0.

The complex association of barriers and interest in internet-delivered cognitive behavior therapy for depression and anxiety: informing e-health policies through exploratory path analysis

BACKGROUND

Internet-delivered cognitive behavioral therapy (ICBT) provides critical remote access to mental health care to at-risk populations. However, to our knowledge, no investigation has been conducted to understand complex pathways through which barriers to care (i.e. structural, attitudinal and technological) correlate with patient interest in ICBT.

AIM

The objective of this study is to develop and test a pathway analysis framework using structural equation modeling to understand direct and mediating associations of barriers to care with interest in ICBT.

METHODS

This cross-sectional observational study was conducted among adult (>18 years) urban and rural residents (n = 200) in Saskatchewan, Canada. An online survey assessed interest in ICBT, barriers to ICBT, demographics, and depression and anxiety symptoms. Utilizing structural equation modeling, a path analysis framework was developed.

RESULTS

Path analysis results showed how associations between complex barriers and demographic variables correlate with interest in ICBT. For instance, the negative association of perceived financial concerns and life chaos on interest in ICBT was mediated by perceived access to care.

CONCLUSION

The findings identify specific barriers that could be addressed through targeted population health interventions to improve uptake of ICBT.

P03-05 State of the Evidence of Active Living among Children and Youth in India: A Scoping Review Informing the Global Matrix 4.0

Background

There is strong evidence of physical inactivity's link to global disease and economic burden. Physical inactivity among Indian children and youth has particular consequences for the global economy, as youth in India make up a substantial proportion of the world's workforce. As part of the 60-country Active Healthy Kids Alliance Global Matrix 4.0 initiative, a systematic scoping review was conducted to appraise the current state of evidence of active living among children and youth in India.

Methods

A systematic search of peer-reviewed and grey literature published over the last decade was conducted for 11 indicators of active living: overall physical activity, organized sport participation, active play, active transportation, sedentary behavior, family and peers, school programs and policies, community and built environment, government strategies, physical fitness, and yoga. Data sources included national, state (i.e., province) and city-level surveys, as well as primary data from ongoing longitudinal studies. Relevant grey literature, including government reports and school board policies, were also reviewed.

Results

Physical activity levels vary widely across India, with children and youth in rural settings accumulating greater moderate-to-vigorous activity and lower screen time compared to their urban counterparts. The majority of Indian children and youth report active transportation, however; they are not meeting recommended physical activity and sedentary behaviour guidelines. Despite the availability of many non-profit and organized programs, several indicators of active living including organized sports, active play, and yoga programming have not been evaluated for uptake or impact. Physical activity type and levels varied significantly across gender and socioeconomic status, with girls belonging to lower socioeconomic status having the greatest disadvantage due to cultural and safety perceptions.

Conclusions

While the vast majority of Indian children and youth are not accumulating recommended physical activity levels, there are encouraging signs of active transportation and active play?a phenomenon that needs to be further explored in India and other high-, middle- and low-income countries. The findings point to widespread disparities in access to active living resources and infrastructure between urban and rural settings. Targeted programs, policies, and resource allocation are necessary to improve built environment and safety for children and youth.

Social Determinants Associated with Physical Activity among Indigenous Adults at the University of Saskatchewan

Colonization impacts Indigenous Peoples' way of life, culture, language, community structure and social networks. Links between social determinants of health and physical activity (PA) among Indigenous Peoples in Saskatchewan, with 16% Indigenous residents, are unclear. This cross-sectional study guided by Indigenous Community Advisors, compared moderate-to-vigorous PA (MVPA), traditional Indigenous PA and musculoskeletal PA with social determinants of Indigenous, (n=124), including First Nations (n=80, including 57 Cree/Nehiyawak) and Métis (n=41), adults in Saskatchewan. Participants completed Godin-Shephard Leisure-Time PA, Social Support Index and traditional Indigenous PA participation questionnaires. Regression associated positive perception of social support with MVPA (R=0.306, p=0.02), while residential school experiences (R=0.338, p=0.02) and community support (R=0.412, p=0.01) were associated with traditional Indigenous PA participation. Among Métis, discrimination experiences were associated with traditional Indigenous PA participation (R=0.459, p=0.01). Traditional Indigenous PA participation was associated with community support among First Nations (R=0.263, p=0.04), and also foster care placement (R=0.480, p=0.01) for Cree/Nehiyawak First Nations specifically. Among Cree/Nehiyawak, family support (R=0.354, p=0.04), discrimination experiences (R=0.531, p=0.01) and positive perceptions of support (R=0.610, p=0.003) were associated with musculoskeletal PA. Greater community, family and perceived social support, and experiences of discrimination, residential school and foster care are associated with more PA for Indigenous Peoples. Novelty: • Positive support perceptions predict physical activity among Indigenous Peoples • Family support, discrimination experiences and positive support perceptions predict physical activity for Cree/Nehiyawak First Nations. Traditional physical activity was predicted by residential school experiences and community support (Indigenous Peoples), discrimination experiences (Métis), community support (First Nations), and foster care experiences (Cree/Nehiyawak).

A systematic review of the evolution of GPS use in active living research: A state of the evidence for research, policy, and practice

This is the first systematic review to comprehensively capture Global Positioning Systems' (GPS) utilization in active living research by investigating the influence of physical contexts and social environment on all intensities of physical activity and sedentary behavior among all age groups. An extensive search of peer-reviewed literature was conducted using six databases. Out of 2026 articles identified, 129 studies met the inclusion criteria. After describing the evolution of GPS use across four themes (study designs and methods, physical contexts and social environment, active transportation, and behaviors), evidence-based recommendations for active living research, policy, and practice were generated.

A Global Digital Citizen Science Policy to Tackle Pandemics Like COVID-19

The coronavirus disease (COVID-19) pandemic is an extremely complex existential threat that requires cohesive societal effort to address health system inefficiencies. When our society has faced existential crises in the past, we have banded together by using the technology at hand to overcome them. The COVID-19 pandemic is one such threat that requires not only a cohesive effort, but also enormous trust to follow public health guidelines, maintain social distance, and share necessities. However, are democratic societies with civil liberties capable of doing this? Mobile technology has immense potential for addressing pandemics like COVID-19, as it gives us access to big data in terms of volume, velocity, veracity, and variety. These data are particularly relevant to understand and mitigate the spread of pandemics such as COVID-19. In order for such intensive and potentially intrusive data collection measures to succeed, we need a cohesive societal effort with full buy-in from citizens and their representatives. This article outlines an evidence-based global digital citizen science policy that provides the theoretical and methodological foundation for ethically sourcing big data from citizens to tackle pandemics such as COVID-19.

Cultural connectedness as a determinant of physical activity among Indigenous adults in Saskatchewan

Cultural connectedness has been associated with increased self-esteem and mental health among Indigenous Peoples. Physical activity is an important contributor to health, although the importance of culture as a determinant of physical activity for Indigenous Peoples in Canada is unclear. The purpose of this study is to evaluate differences in cultural connectedness between Indigenous adults in Canada achieving high and low physical activity levels. Questionnaires evaluated cultural connectedness and physical activity. Indigenous adults were classified into high and low physical activity groups at the specific group mean and as meeting or not meeting musculoskeletal activity guidelines of twice per week. First Nations and specifically Cree/Nehiyaw First Nations adults who were more physically active reported greater identity, spirituality, traditions, exploration, commitment, affirmation/belonging, and overall cultural connectedness. Cultural connectedness elements of commitment, exploration, identity, affirmation/belonging, traditions, spirituality, and overall cultural connectedness were not different between high and low physical activity Métis adults. Musculoskeletal activity was not associated with any elements of cultural connectedness among any Indigenous identity. Cultural connectedness is a protective factor for physical activity among First Nations and Cree/Nehiyaw First Nations adults, but not among Métis adults in Canada. Novelty Musculoskeletal activity was not associated with cultural connectedness. Cultural connectedness is a protective factor of physical activity for First Nations adults. Moving away from one's home community was associated with lower cultural connectedness for Indigenous Peoples.

Link between Physical Activity Type in Adolescence and Body Composition in Adulthood

PURPOSE

We investigated whether type of physical activity (PA) (sports, running, and fitness/dance) engaged in during adolescence is associated with body composition in late adolescence or early adulthood.

METHODS

Data were drawn from 631 participants in the Nicotine Dependence in Teens study, a prospective investigation of students ages 12-13 yr at inception. Self-report PA data were collected at baseline, in grade 7, and every 3-4 months thereafter during the 5 yr of high school (1999-2005). Anthropometric indicators (height, weight, waist circumference, triceps, and subscapular skinfold thickness) were measured at ages 12, 16, and 24 yr. On the basis of prior exploratory factor analysis, PA was categorized into one of three types (sports, running, and fitness/dance). Regression models estimated the association between number of years participating in each PA type (0-5 yr) during high school and body composition measures in later adolescence or early adulthood.

RESULTS

In multivariable models accounting for age, sex, and parent education, more number of years participating in running during adolescence was associated with lower body mass index, waist circumference, and skinfold thickness in later adolescence and early adulthood (all P < 0.01). This association was no longer apparent in models that accounted for body composition at age 12 yr. The number of years participating in sports was positively associated with body mass index in early adulthood (P = 0.02), but fitness/dance was not statistically significantly associated with any outcome.

CONCLUSION

Sustaining participation in running, but not in other PA types, during adolescence was related to lower body composition in later adolescence and adulthood. However, more research is needed to determine whether this association is attributable to a relationship between PA and body composition in early adolescence.

The association of school connectedness and bullying involvement with multiple screen-time behaviours among youth in two Canadian provinces: a COMPASS study

INTRODUCTION

Screen time, a proxy for sedentary behaviours, has emerged as a critical health determinant among youth in contemporary societies, where most aspects of youth life involve access to screen-time devices. An understudied approach to reducing screen time among youth is bullying reduction. This study aims to understand the association between bullying perpetration, victimization, youth perception of the school environment and multiple screen-time behaviours.

METHODS

A total of 44,861 youth aged between 13 and 18 years in two Canadian provinces completed a validated questionnaire that collected student data on health behaviours and outcomes, including multiple screen-time behaviours, bullying perpetration and victimization, and school connectedness. The outcome variables were total screen time, time spent watching television, playing video games, internet surfing, and communication- based screen-time behaviours. Using a random intercept, the final models were built using PROC MIXED in SAS 9.4. These models were adjusted for age, ethnicity, weekly disposable income, daylight hours, and weather variables.

RESULTS

Compared to youth who reported non-involvement in bullying, youth who were bullies, victims, or both bullies and victims spent on average more minutes per day in front of screens across all screen time categories. Youth who felt happy and safe at school, and who perceived their teachers as being fair, reported lower levels of multiple screen-time behaviours.

CONCLUSION

With non-involvement in bullying showing a strong negative association with multiple screen-time behaviours, school policies to address bullying and screen time through school connectedness could offer a novel approach in minimizing these harmful behaviours.

Shaping Policy Change in Population Health: Policy Entrepreneurs, Ideas, and Institutions

Political realities and institutional structures are often ignored when gathering evidence to influence population health policies. If these policies are to be successful, social science literature on policy change should be integrated into the population health approach. In this contribution, drawing on the work of John W. Kingdon and related scholarship, we set out to examine how key components of the policy change literature could contribute towards the effective development of population health policies. Shaping policy change would require a realignment of the existing school of thought, where the contribution of population health seems to end at knowledge translation. Through our critical analysis of selected literature, we extend recommendations to advance a burgeoning discussion in adopting new approaches to successfully implement evidence-informed population health policies.

Bifurcation of Health Policy Regimes: A Study of Sleep Apnea Care and Benefits Coverage in Saskatchewan

Background:

A complex, poorly understood bifurcated health policy regime exists for Canada's First Nations people for extended health benefits coverage. This research adds to a small body of literature on the regime's impact on access and quality of care and its role in perpetuating health inequities in First Nations populations.

Methods:

Using a case study of sleep apnea care in Saskatchewan, we identified issues of health service access and coverage through a literature review of extended benefits programs, legislation and policies and through 10 key informant interviews with federal and provincial extended benefit program administrators and sleep medicine physicians.

Results:

Important access and coverage differences were found for First Nations populations, many of which were recognized by federal and provincial policy makers. Despite these, government respondents recommended few policy ameliorations, perhaps due to system complexities, constitutional constraints or political sensitivities.

Conclusions:

We suggest three policy options to ameliorate current hardships wrought by this policy bifurcation.

A methodology to leverage cross-sectional accelerometry to capture weather's influence in active living research

OBJECTIVES

While active living interventions focus on modifying urban design and built environment, weather variation, a phenomenon that perennially interacts with these environmental factors, is consistently underexplored. This study's objective is to develop a methodology to link weather data with existing cross-sectional accelerometry data in capturing weather variation.

METHODS

Saskatoon's neighbourhoods were classified into grid-pattern, fractured grid-pattern and curvilinear neighbourhoods. Thereafter, 137 Actical accelerometers were used to derive moderate to vigorous physical activity (MVPA) and sedentary behaviour (SB) data from 455 children in 25 sequential one-week cycles between April and June, 2010. This sequential deployment was necessary to overcome the difference in the ratio between the sample size and the number of accelerometers. A data linkage methodology was developed, where each accelerometry cycle was matched with localized (Saskatoon-specific) weather patterns derived from Environment Canada. Statistical analyses were conducted to depict the influence of urban design on MVPA and SB after factoring in localized weather patterns.

RESULTS

Integration of cross-sectional accelerometry with localized weather patterns allowed the capture of weather variation during a single seasonal transition. Overall, during the transition from spring to summer in Saskatoon, MVPA increased and SB decreased during warmer days. After factoring in localized weather, a recurring observation was that children residing in fractured grid-pattern neighbourhoods accumulated significantly lower MVPA and higher SB.

CONCLUSION

The proposed methodology could be utilized to link globally available cross-sectional accelerometry data with place-specific weather data to understand how built and social environmental factors interact with varying weather patterns in influencing active living.

Exploring policy driven systemic inequities leading to differential access to care among Indigenous populations with obstructive sleep apnea in Canada

BACKGROUND

In settler societies such as Australia, Canada, New Zealand and the United States, health inequities drive lower health status and poorer health outcomes in Indigenous populations. This research unravels the dense complexity of how historical policy decisions in Canada can influence inequities in health care access in the 21(st) century through a case study on the diagnosis and treatment of obstructive sleep apnea (OSA). In Canada, historically rooted policy regimes determine current discrepancies in health care policy, and in turn, shape current health insurance coverage and physician decisions in terms of diagnosis and treatment of OSA, a clinical condition that is associated with considerable morbidity in Canada.

METHODS

This qualitative study was based in Saskatchewan, a Western Canadian province which has proportionately one of the largest provincial populations of an Indigenous subpopulation (status Indians) which is the focus of this study. The study began with determining approaches to OSA care provision based on Canadian Thoracic Society guidelines for referral, diagnosis and treatment of sleep disordered breathing. Thereafter, health policy determining health benefits coverage and program differences between status Indians and other Canadians were ascertained. Finally, respirologists who specialized in sleep medicine were interviewed. All interviews were audio-recorded and the transcripts were thematically analyzed using NVIVO.

RESULTS

In terms of access and provision of OSA care, different patient pathways emerged for status Indians in comparison with other Canadians. Using Saskatchewan as a case study, the preliminary evidence suggests that status Indians face significant barriers in accessing diagnostic and treatment services for OSA in a timely manner.

CONCLUSIONS

In order to confirm initial findings, further investigations are required in other Canadian jurisdictions. Moreover, as other clinical conditions could share similar features of health care access and provision of health benefits coverage, this policy analysis could be replicated in other provincial and territorial health care systems across Canada, and other settler nations where there are differential health coverage arrangements for Indigenous peoples.

Capturing the Interrelationship between Objectively Measured Physical Activity and Sedentary Behaviour in Children in the Context of Diverse Environmental Exposures

Even though physical activity and sedentary behaviour are two distinct behaviours, their interdependent relationship needs to be studied in the same environment. This study examines the influence of urban design, neighbourhood built and social environment, and household and individual factors on the interdependent relationship between objectively measured physical activity and sedentary behaviour in children in the Canadian city of Saskatoon. Saskatoon’s built environment was assessed by two validated observation tools. Neighbourhood socioeconomic variables were derived from 2006 Statistics Canada Census and 2010 G5 Census projections. A questionnaire was administered to 10–14 year old children to collect individual and household data, followed by accelerometry to collect physical activity and sedentary behaviour data. Multilevel logistic regression models were developed to understand the interrelationship between physical activity and sedentary behaviour in the context of diverse environmental exposures. A complex set of factors including denser built environment, positive peer relationships and consistent parental support influenced the interrelationship between physical activity and sedentary behaviour. In developing interventions to facilitate active living, it is not only imperative to delineate pathways through which diverse environmental exposures influence physical activity and sedentary behaviour, but also to account for the interrelationship between physical activity and sedentary behaviour.

Longitudinal active living research to address physical inactivity and sedentary behaviour in children in transition from preadolescence to adolescence

BACKGROUND

Children can be highly active and highly sedentary on the same day! For instance, a child can spend a couple of hours playing sports, and then spend the rest of the day in front of a screen. A focus on examining both physical activity and sedentary behaviour throughout the day and in all seasons in a year is necessary to generate comprehensive evidence to curb childhood obesity. To achieve this, we need to understand where within a city are children active or sedentary in all seasons. This active living study based in Saskatoon, Canada, aims to understand the role played by modifiable urban built environments in mitigating, or exacerbating, seasonal effects on children's physical activity and sedentary behaviour in a population of children in transition from preadolescence to adolescence.

METHODS/DESIGN

Designed as an observational, longitudinal investigation this study will recruit 800 Canadian children 10-14 years of age. Data will be obtained from children representing all socioeconomic categories within all types of neighbourhoods built in a range of urban designs. Built environment characteristics will be measured using previously validated neighbourhood audit and observational tools. Neighbourhood level socioeconomic variables customized to Saskatoon neighbourhoods from 2011 Statistics Canada's National Household Survey will be used to control for neighbourhood social environment. The validated Smart Cities Healthy Kids questionnaire will be administered to capture children's behaviour and perception of a range of factors that influence their activity, household (including family socioeconomic factors), parental, peer and neighbourhood influence on independent mobility. The outcome measures, different intensities of physical activity and sedentary behaviour, will be collected using global positioning system equipped accelerometers in all four seasons. Each accelerometry cycle will be matched with weather data obtained from Environment Canada. Extensive weather data will be accessed and classified into one of six distinct air mass categories for each day of accelerometry. Computational and spatial analytical techniques will be utilized to understand the multi-level influence of environmental exposures on physical activity and sedentary behaviour in all seasons.

DISCUSSION

This approach will help us understand the influence of urban environment on children's activity, thus paving the way to modify urban spaces to increase physical activity and decrease sedentary behaviour in children in all four seasons. Lack of physical activity and rising sedentariness is associated with rising childhood obesity, and childhood obesity in turn is linked to many chronic conditions over the life course. Understanding the interaction of children with urban spaces will reveal new knowledge, and when translated to actions will provide a strong basis for informing future urban planning policy.

Towards uniform accelerometry analysis: a standardization methodology to minimize measurement bias due to systematic accelerometer wear-time variation

Accelerometers are predominantly used to objectively measure the entire range of activity intensities - sedentary behaviour (SED), light physical activity (LPA) and moderate to vigorous physical activity (MVPA). However, studies consistently report results without accounting for systematic accelerometer wear-time variation (within and between participants), jeopardizing the validity of these results. This study describes the development of a standardization methodology to understand and minimize measurement bias due to wear-time variation. Accelerometry is generally conducted over seven consecutive days, with participants' data being commonly considered 'valid' only if wear-time is at least 10 hours/day. However, even within 'valid' data, there could be systematic wear-time variation. To explore this variation, accelerometer data of Smart Cities, Healthy Kids study (www.smartcitieshealthykids.com) were analyzed descriptively and with repeated measures multivariate analysis of variance (MANOVA). Subsequently, a standardization method was developed, where case-specific observed wear-time is controlled to an analyst specified time period. Next, case-specific accelerometer data are interpolated to this controlled wear-time to produce standardized variables. To understand discrepancies owing to wear-time variation, all analyses were conducted pre- and post-standardization. Descriptive analyses revealed systematic wear-time variation, both between and within participants. Pre- and post-standardized descriptive analyses of SED, LPA and MVPA revealed a persistent and often significant trend of wear-time's influence on activity. SED was consistently higher on weekdays before standardization; however, this trend was reversed post-standardization. Even though MVPA was significantly higher on weekdays both pre- and post-standardization, the magnitude of this difference decreased post-standardization. Multivariable analyses with standardized SED, LPA and MVPA as outcome variables yielded more stable results with narrower confidence intervals and smaller standard errors. Standardization of accelerometer data is effective in not only minimizing measurement bias due to systematic wear-time variation, but also to provide a uniform platform to compare results within and between populations and studies. Key pointsSystematic variation in accelerometer wear-time both, within and between participants results in measurement bias.Standardization of data after controlling for wear-time produces stable outcome variables.Descriptive and multivariate analyses conducted with standardized outcome variables minimize measurement bias.