John J. M. Dwyer

The Relationship between Vigorous Physical Activity and Juvenile Delinquency: A Mediating Role for Self-Esteem?

Many policy-related reviews of the potential social value of sport and physical activity list the prevention of juvenile delinquency. We examined the relationships among vigorous physical activity, self-esteem, and delinquent behavior among adolescents in a large cross-sectional survey of Ontario adolescents. Data are based on questionnaires from 3,796 students (range 11–20 years) derived from the 2005 Ontario Student Drug Use Survey. Negative binominal regression methods were used to estimate both additive and interactive models predicting delinquent behavior. Vigorous physical activity was positively associated with delinquent behavior; however, this pattern of association was observed only among male adolescents. There was no evidence of a mediating role for self-esteem. Our findings suggest that physical activity is not the solution for reducing juvenile delinquency.

School Disconnectedness: Identifying Adolescents at Risk in Ontario, Canada

BACKGROUND There is strong theoretical and empirical support for school connectedness as an important element of healthy youth development. The primary objective of this study was to replicate previous research identifying factors differentiating youth who do not feel connected to their schools in a sample of adolescents in Ontario, Canada. A secondary objective was to extend this work by assessing whether physical activity was an additional health behavior that differentiated youth who feel connected to their schools from those who do not. METHODS Data for this study were based on questionnaires from 2243 grade 7 to grade 12 students derived from the 2001 cycle of the Ontario Student Drug Use Survey. Logistic regression analysis was used to examine associations between physical activity, other health risk factors, and school disconnectedness. RESULTS The odds of feeling disconnected from their schools were substantially greater for female students who perceived their health or academic performance to be poor, engaged in no vigorous physical activity, reported 3 or more physician visits during the past year, and had low extracurricular involvement. None of the sociodemographic factors or substance use measures was significantly associated with school disconnectedness for any students. CONCLUSIONS Our results highlight sex differences in how school disconnectedness is related to health-compromising behaviors such as physical inactivity. Further research is required to examine how boys and girls perceive, interpret, and internalize the school climate. Increasing school connectedness should be a consideration for academic administrators and health-promotion advocates.

Internal structure of a measure of self-efficacy in physical activity among high school students

The preliminary development of a measure of self-efficacy to participate in vigorous physical activity when confronted with specific perceived barriers to physical activity is described. Measures used in previous research ([Hofstetter, C.R., Hovell, M.F., Sallis, J.F., 1990a. Social learning correlates of exercise self-efficacy: Early experiences with physical activity, Social Science and Medicine, 31, 1169-1176.]; [Hofstetter, C.R., Sallis, J.F., Hovell, M.F., 1990b. Some health dimensions of self-efficacy: Analysis of theoretical specificity, Social Science and Medicine, 31, 1051-1056.]; [Reynolds, K.D., Killen, J.D., Bryson, M.S., Maron, D.J., Taylor, C.B., Maccoby, N., Farquhar, J.W., 1990. Psychosocial predictors of physical activity in adolescents, Preventive Medicine, 19, 541-551.]; [Sallis, J.F., Pinski, R.B., Grossman, R.M., Patterson, T.L., Nader, P.R., 1988. The development of self-efficacy scales for health-related diet and exercise behaviors, Health Education Research, 3, 283-292.]) were adapted and original items were developed. The 20-item measure has a 5-point Likert format ranging from not at all confident (1) to very confident (5). An earlier pilot study of 200 secondary school students showed that the measure was free of social desirability. The data were derived from a survey of 1041 secondary school students from a Metropolitan Toronto board of education. Principal component analysis (PCA) with oblique rotation of the data yielded two factors: self-efficacy to overcome external barriers and self-efficacy to overcome internal barriers. The 12-item external barriers subscale had a coefficient alpha of 0.88 and the 8-item internal barriers subscale had a coefficient alpha of 0.87. The subscales significantly correlated with the frequency of participation in vigorous physical activity. In summary, the results provide some support for the internal consistency reliability, construct validity, criterion validity, and discriminant validity of the measure. Though further psychometric research is warranted, the self-efficacy measure shows promise for physical activity research.

A Social Ecological Perspective of the Influential Factors for Food Access Described by Low-Income Seniors

ABSTRACT Understanding the factors that affect food access and consumption by seniors will lead to improved comprehension and measurement of food security for this subgroup. Semi-structured interviews with low-income, community-living seniors (n = 18) were tape-recorded and transcribed. Interviews were coded and themes were identified using a constant comparison method of analysis. Applying a social ecological framework, three spheres of influence were described: intrapersonal (e.g., health and budget), interpersonal (e.g., informal assistance and socializing) and environmental (e.g., city transportation and grocery stores). Although preliminary, these results demonstrate the importance of interpersonal and environmental factors on food access and security for seniors.

Food Security in Older Adults: Community Service Provider Perceptions of Their Roles

L’insécurité alimentaire chez les adultes plus âgés est influencée par les contraintes financières, l’incapacité fonctionnelle, et l’isolation. Vingt-huit fournisseurs de services sociaux et communautaires ont participé à quatre groupes de discussion ayant porté sur: a) les perceptions et les expériences en matière d’insécurité alimentaire chez leurs clients plus âgés; b) leur perception quant à leur rôle visant à promouvoir la sécurité alimentaire; et c) leur opinion quant aux contraintes ayant eu une influence sur ces rôles. Une analyse par comparaison continue a permis d’identifier les principaux thèmes. Les fournisseurs de soins formels ont fait état de six rôles visant à améliorer la sécurité alimentaire: a) surveillance, b) coordination et c) promotion des services, d) éducation, e) défense des intérêts, et f) fourniture d’un environnement social. Le thème final résume ces rôles comme « le besoin de personnaliser les services ». Les fournisseurs de services sociaux et communautaires jouent un rôle qui peut promouvoir la santé des adultes plus âgés par le truchement de leur insécurité alimentaire. Les fournisseurs de services sociaux doivent être reconnus et soutenus dans leur rôle de promoteurs de la santé. Food insecurity in older adults is influenced by financial constraints, functional disability, and isolation. Twenty-eight social-and community-service providers participated in four focus groups to report (a) perceptions and experiences with food insecurity in their older clients, (b) beliefs about their potential role(s) in promoting food security, and (c) opinions about constraints that influenced these roles. A constant comparison analysis identified key themes. The formal caregivers reported six roles for improving food security: (a) monitoring, (b) coordination, and (c) promoting services, (d) education, (e) advocacy, and (f) providing a social environment. The final theme summarizes these roles as ‘‘the need for personalization of service’’. Social and community service providers are involved in roles that can promote the health of older adults by addressing their food insecurity. Social service providers need to be acknowledged and supported in this health promotion role.

ADOLESCENTS SELF-EFFICACY TO OVERCOME BARRIERS TO PHYSICAL ACTIVITY SCALE

This paper describes a revised measure of self-efficacy to overcome barriers to moderate and vigorous physical activity in a sample of 484 high school students in Toronto, Ontario. The students had a mean age of 15.3 years. Principal axis factoring with oblique rotation yielded five factors: self-efficacy to overcome internal, harassment, physical environment, social environment, and responsibilities barriers. Two problematic items were removed, which resulted in a 22-item measure. Subsequent analyses were conducted on responses to this shortened measure. Confirmatory factor analysis supported the five-factor model and demonstrated age- and sexinvariance. The subscales had good internal consistency reliability. Structural regressions demonstrated a strong relationship between the resulting factors and a physical activity measure (energy expenditure), showing predictive validity.

Eat smart! Workplace Cafeteria Program evaluation of the nutrition component.

Purpose: The nutrition component of the Eat Smart! Workplace Cafeteria Program (ESWCP) in a hospital was evaluated. We assessed staff’s frequency of visits to and purchases in the hospital cafeteria, attitudes about the program, short-term eating behaviour change, and suggestions to improve the ESWCP. Methods: Questionnaires were sent to hospital staff members who were not on leave (n=504). Dillman’s Tailored Design Method was used to design and implement the survey. Four mail-outs were used and yielded a 51% response rate. Results: Eighty-seven percent of respondents visited the hospital cafeteria at least once a week in an average seven-day week, and 69% purchased one to five meals or snacks there each week. Eighty-six percent of respondents said that they were aware of the hospital’s program. Notices on cafeteria tables were the primary method of learning about the program (67%). Reported program benefits included increased knowledge about healthy eating, convenience of having healthy foods in the cafe...

Best Practices Among Child Nutrition Programs in Ontario: Evaluation Findings

ABSTRACT Canada does not have federally funded child nutrition programs. Instead, programs are local endeavors. We evaluated programs in Ontario against the Breakfast for Learning Canadian Living Foundation Best Practices standards. Three hundred breakfast and snack programs were randomly selected; 39.4% responded. Data collection included a survey completed by program coordinators and site visits conducted by registered dietitians. Results indicate that programs are meeting some, but not all, of the best practices. Only 54.3% of breakfast and 66.0% of snack programs had paid program coordinators. Resources and strategies need to be developed to help all programs meet best practices.

Obesity services planning framework for interprofessional primary care organizations

Aim We report on a formative project to develop an organization-level planning framework for obesity prevention and management services. BACKGROUND It is common when developing new services to first develop a logic model outlining expected outcomes and key processes. This can be onerous for single primary care organizations, especially for complex conditions like obesity. METHODS The initial draft was developed by the research team, based on results from provider and patient focus groups in one large Family Health Team (FHT) in Ontario. This draft was reviewed and activities prioritized by 20 FHTs using a moderated electronic consensus process. A national panel then reviewed the draft. Findings Providers identified five main target groups: pregnancy to 2, 3-12, 13-18, 18+ years at health risk, and 18+ with complex care needs. Desired outcomes were identified and activities were prioritized under categories: raising awareness (eg, providing information and resources on weight-health), identification and initial management (eg, wellness care), follow-up management (eg, group programs), expanded services (eg, availability of team services), and practice initiatives (eg, interprofessional education). Overall, there was strong support for raising awareness by providing information on the weight-health connection and on community services. There was also strong support for growth assessment in pediatric care. In adults, there was strong support for wellness care/health check visits and episodic care to identify people for interventions, for group programs, and for additional provider education. CONCLUSIONS Joint development by different teams proved useful for consensus on outcomes and for ensuring relevancy across practices. While priorities will vary depending on local context, the basic descriptions of care processes were endorsed by reviewers. Key next steps are to trial the use of the framework and for further implementation studies to find optimally effective approaches for obesity prevention and management across the lifespan.

School and classroom effects on Daily Physical Activity (DPA) policy implementation fidelity in Ontario classrooms: a multi-level analysis

BackgroundThis paper examines school and classroom effects on Daily Physical Activity (DPA) policy implementation in classrooms in Ontario, Canada. In 2005 the Ontario Ministry of Education mandated a policy requiring school boards to “ensure that all elementary students, including students with special needs, have a minimum of twenty minutes of sustained MVPA each school day during instructional time”. Based on an adaptation of Chaudoir’s conceptual framework, this paper contributes to understanding the extent to which school factors (as reported by administrators) and classroom factors (as reported by teachers) are associated with policy implementation fidelity at the classroom level.MethodsCross-sectional online surveys were conducted in 2014 with elementary school administrators and teachers, based on representative random samples of schools and classrooms. A measure assessing implementation fidelity was developed from the six required components of the policy and for this paper fidelity at the classroom level is treated as the outcome variable. Several school- and classroom-level measures were also included in the surveys and a number of these were selected for inclusion here. Data from the two surveys were merged and selected variables were included in the multi-level analysis. Two-level logistic regression models were conducted to account for nesting of classrooms within schools and a series of models were conducted to identify factors associated with implementation fidelity.ResultsThe analytic sample for this study included 170 school administrators and 307 classroom teachers from corresponding schools. Findings from the multi-level logistic regression analyses indicated that only classroom/teacher-level factors were significantly associated with implementation fidelity at the classroom level. None of the school/administrator predictors were significantly related to fidelity. The most parsimonious model included five significant classroom/teacher predictors: teachers’ perception of DPA as realistic and achievable; confidence (self-efficacy); scheduling DPA in timetables; lack of space; and lack of time.ConclusionsFindings from the study indicate the theoretical and practical importance of addressing classroom and teacher factors since they are most proximal to implementation fidelity to the policy. Several of these factors also reflect complex structural and organizational contexts, indicating that a systems approach to understanding and supporting DPA implementation fidelity is warranted.