Scott T. Leatherdale

Active video games and health indicators in children and youth: a systematic review

Background Active video games (AVGs) have gained interest as a way to increase physical activity in children and youth. The effect of AVGs on acute energy expenditure (EE) has previously been reported; however, the influence of AVGs on other health-related lifestyle indicators remains unclear. Objective This systematic review aimed to explain the relationship between AVGs and nine health and behavioural indicators in the pediatric population (aged 0–17 years). Data sources Online databases (MEDLINE, EMBASE, psycINFO, SPORTDiscus and Cochrane Central Database) and personal libraries were searched and content experts were consulted for additional material. Data selection Included articles were required to have a measure of AVG and at least one relevant health or behaviour indicator: EE (both habitual and acute), adherence and appeal (i.e., participation and enjoyment), opportunity cost (both time and financial considerations, and adverse events), adiposity, cardiometabolic health, energy intake, adaptation (effects of continued play), learning and rehabilitation, and video game evolution (i.e., sustainability of AVG technology). Results 51 unique studies, represented in 52 articles were included in the review. Data were available from 1992 participants, aged 3–17 years, from 8 countries, and published from 2006–2012. Overall, AVGs are associated with acute increases in EE, but effects on habitual physical activity are not clear. Further, AVGs show promise when used for learning and rehabilitation within special populations. Evidence related to other indicators was limited and inconclusive. Conclusions Controlled studies show that AVGs acutely increase light- to moderate-intensity physical activity; however, the findings about if or how AVG lead to increases in habitual physical activity or decreases in sedentary behaviour are less clear. Although AVGs may elicit some health benefits in special populations, there is not sufficient evidence to recommend AVGs as a means of increasing daily physical activity.

Social–Ecological Correlates of Active Commuting to School Among High School Students

PURPOSE It has been suggested that health benefits from physical activity may be accrued through active commuting to school. Considering that active commuting is modifiable via policy and that there is limited research examining active commuting among high school students, this is a domain that warrants further investigation. The purpose of this study is to explore the relationships between demographic, behavioral, social/psychological, and environmental correlates of active commuting to school among a sample of high school students. METHODS Students (N = 21,345) from 76 Ontario high schools (grades 9-12) completed the School Health Action, Planning and Evaluation System Physical Activity Module between 2005-2006. Demographic (gender, grade, body mass index), behavioral (smoking status, physical activity, sedentary time), social/psychological (perceived athletic ability, weight status, parental encouragement), and environmental (school location, type, weather) predictors of active commuting (daily or mixed mode) were assessed. RESULTS Only 42.5% of high school students reported actively commuting to school. Students were less likely to actively commute to school if they were girls, in grade 12, smoked daily, were low-moderate in physical activity, or attended a rural school. CONCLUSIONS Patterns of active commuting to school are influenced by multiple factors, some of which are modifiable through intervention. This has important implications for future school-based programming designed to enhance health and physical activity of adolescents through using active modes of transportation to school.

Modifiable characteristics associated with sedentary behaviours among youth

OBJECTIVE Childhood overweight and obesity is a major public health issue. A better understanding of factors associated with sedentary behaviours would provide valuable insight for tailoring interventions to prevent or reduce overweight among youth. METHODS Data were collected from 25,416 grade 9 to 12 students attending 76 secondary schools in Ontario, Canada, using the Physical Activity Module of the School Health Action, Planning and Evaluation System (SHAPES). Sex specific multivariate logistic regression analyses were then used to examine how physical activity, BMI, social influences, and smoking behaviour were associated with screen time, time spent reading, and time spent on homework. RESULTS The average screen time per day was 2.7 (+/-1.7) hours, yet 48.1% of students reported spending less than one hour reading per week and 30.2% spent less than an hour of time on homework per week. Among males, being underweight (< or = 5% percentile BMI, adjusted for age and sex) was associated with more screen time (OR 1.23, 95%CI 1.01-1.50) and time spent reading (OR 1.19, 95%CI 1.00-1.43), whereas being at risk of overweight (> or = 85% percentile BMI, adjusted for age and sex) was associated with less time spent on homework (OR 0.75, 95%CI 0.65-0.85). Conversely, among females, being at risk of overweight was associated with more screen time (OR 1.24, 95%CI 1.10-1.41), and time spent reading (OR 1.19, 95%CI 1.05-1.35). Aside from BMI, other factors associated with sedentary behaviours included physical activity, parental encouragement and support for physical activity, close friend physical activity behaviour, and smoking status. DISCUSSION We found that students are highly involved in screen-based sedentary behaviours, but spend a limited time on more productive sedentary behaviours, like reading and homework. Developing a better understanding of sedentary behaviours is critical for preventing and reducing obesity among youth populations.

The Relationship Between Student Smoking in the School Environment and Smoking Onset in Elementary School Students

This study examined how perceptions of student smoking in the school environment and the actual smoking rate among senior students at a school are related to smoking onset. Multilevel logistic regression analysis was used to examine correlates of ever smoking in a sample of 4,286 grade 6 and 7 students from 57 elementary schools in Ontario, Canada. Students are at increased risk for smoking if they (a) often see students smoking near their school, (b) report that students at their school smoke where they are not allowed, and (c) attend a school with a relatively high senior student smoking rate. Each 1% increase in the smoking rate among grade 8 students increased the odds that a student in grades 6 or 7 was an ever smoker versus never smoker (odds ratio, 1.05; 95% confidence interval, 1.02-1.08). A low-risk student (no family or friends who smoke) was over twice as likely to try smoking if he/she attended a high-risk school. Prevention programs should target both at-risk schools and at-risk students, and strongly enforced policies preventing students from smoking on or near school property should be implemented.

The COMPASS study: a longitudinal hierarchical research platform for evaluating natural experiments related to changes in school-level programs, policies and built environment resources

BackgroundFew researchers have the data required to adequately understand how the school environment impacts youth health behaviour development over time.Methods/DesignCOMPASS is a prospective cohort study designed to annually collect hierarchical longitudinal data from a sample of 90 secondary schools and the 50,000+ grade 9 to 12 students attending those schools. COMPASS uses a rigorous quasi-experimental design to evaluate how changes in school programs, policies, and/or built environment (BE) characteristics are related to changes in multiple youth health behaviours and outcomes over time. These data will allow for the quasi-experimental evaluation of natural experiments that will occur within schools over the course of COMPASS, providing a means for generating “practice based evidence” in school-based prevention programming.DiscussionCOMPASS is the first study with the infrastructure to robustly evaluate the impact that changes in multiple school-level programs, policies, and BE characteristics within or surrounding a school might have on multiple youth health behaviours or outcomes over time. COMPASS will provide valuable new insight for planning, tailoring and targeting of school-based prevention initiatives where they are most likely to have impact.

Tobacco, alcohol and illicit drug use among Aboriginal youth living off-reserve: results from the Youth Smoking Survey

Background Despite the high prevalence of smoking among Aboriginal youth, there is a paucity of research related to tobacco use and other risk behaviours among Aboriginal youth living off-reserve in Canada. We used data from the national Youth Smoking Survey to characterize non-traditional tobacco use, exposure to second-hand smoke, and alcohol and drug use among Aboriginal youth living off-reserve. We examined whether these youth were at increased health risk compared with non-Aboriginal youth. Methods We examined cigarette smoking behaviour, use of other tobacco products, use of alcohol and other drugs, and exposure to second-hand smoke among 2620 Aboriginal youth living off-reserve and 26 223 non-Aboriginal youth in grades 9 to 12 who participated in the 2008/09 Youth Smoking Survey. Results The prevalence of current smoking among the Aboriginal youth was more than double that among non-Aboriginal youth (24.9% v. 10.4%). Aboriginal youth also had a higher prevalence of regular exposure to second-hand smoke at home (37.3% v. 19.7%) and in cars (51.0% v. 30.3%). Aboriginal youth were more likely than non-Aboriginal youth to be current smokers, to be regularly exposed to second-hand smoke, to have tried marijuana and other illicit drugs, and to engage in binge drinking. They were less likely than non-Aboriginal youth to have tried to quit smoking. Interpretation Current national estimates of smoking, and alcohol and illicit drug use among youth underestimate the prevalence of these behaviours among Aboriginal youth living off-reserve. Our findings highlight the need for culturally appropriate prevention and cessation policies and programs for this at-risk population.

The substance use profile of Canadian youth: exploring the prevalence of alcohol, drug and tobacco use by gender and grade.

The current study examined the prevalence of alcohol, tobacco and drug use and comorbid use of these substances among 45,425 students in grades 7 to 12 as part of the 2008-09 Canadian Youth Smoking Survey. The results of this paper suggest that alcohol, tobacco, marijuana and illicit drugs are currently used by a substantial number of youth in Canada, and that comorbid use is also very widespread among users. Alcohol was the most prevalent substance used by youth and it was rare to find youth who had used tobacco or drugs without also currently using alcohol. By grade 12, the majority of students were current users of alcohol, tobacco or drugs. Future research should consider developing a better understanding of how to prevent substance use among this population.

Energy expenditure while playing active and inactive video games.

PURPOSE To examine energy expenditure (EE) when playing active and inactive videogames (VG). METHODS Predicted EE was measured among 51 undergraduate students while playing active and inactive VG (Ontario, Canada). RESULTS Predicted EE was significantly higher playing the active VG compared to the inactive VG according to heart rate monitor (97.4 kcal vs 64.7 kcal) and SenseWear armband (192.4 kcal vs 42.3 kcal) estimates. CONCLUSION Active VG may be a viable intervention tool for increasing EE among students who would otherwise be spending time in sedentary screen-based behaviors.

Applying systematic review search methods to the grey literature: a case study examining guidelines for school-based breakfast programs in Canada.

BackgroundGrey 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.MethodsA 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.ResultsThe 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.ConclusionsThis 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.

Integrating Research, Policy, and Practice in School-Based Physical Activity Prevention Programming: The School Health Action, Planning, and Evaluation System (SHAPES) Physical Activity Module

The School Health Action, Planning, and Evaluation System (SHAPES) is a data collection and feedback system designed to support population-based intervention planning, evaluation, and field research related to youth. The Physical Activity Module of SHAPES consists of: (a) a machine readable questionnaire to collect physical activity data from all students (grades 6 to 12) in a school, (b) a school administrator questionnaire to assess school policies, programs, and resources related to physical activity, and (c) a school-specific feedback report documenting student behavior and school programs and policies. This SHAPES module provides schools with feedback that enables them to take stock of patterns of activity and obesity within their school, recognize what is (and what is not) in place to support physical activity, and how to plan and evaluate their own prevention efforts. SHAPES enables researchers and stakeholders to identify what interventions work, in what contexts, with what students.