Tarun R. Katapally

A community-based participatory research methodology to address, redress, and reassess disparities in respiratory health among First Nations

BackgroundTo date, determinants of respiratory health in First Nations people living on reserves and means of addressing and redressing those determinants have not been well established. Hence the Saskatchewan First Nations Lung Health Project (FNLHP) is a new prospective cohort study of aboriginal people being conducted in two First Nations reserves to evaluate potential health determinants associated with respiratory outcomes. Using the population health framework (PHF) of Health Canada, instruments designed with the communities, joint ownership of data, and based on the 4-phase concept of the First Nations Regional Longitudinal Health Survey, the project aims to evaluate individual factors, contextual factors, and principal covariates on respiratory outcomes. The objective of this report is to clearly describe the methodology of (i) the baseline survey that consists of two components, an interviewer-administered questionnaire and clinical assessment; and (ii) potential intervention programs; and present descriptive results of the baseline data of longitudinal FNLHP.MethodsThe study is being conducted over 5 years (2012–2017) in two phases, baseline and longitudinal. Baseline survey has been completed and consisted of (i) an interviewer-administered questionnaire-based evaluation of individual and contextual factors of importance to respiratory health (with special focus on chronic bronchitis, chronic obstructive pulmonary disease, asthma and obstructive sleep apnea), and (ii) clinical lung function and allergy tests with the consent of study participants. The address-redress phase consists of potential intervention programs and is currently being rolled out to address-at community level (via green light program and environmental study), and redress-at policy level (via obesity reduction and improved diagnosis and treatment of obstructive sleep apnea) the issues that have been identified by the baseline data.ResultsInterviewer-administered surveys were conducted in 2012–2013 and collected data on 874 individuals living in 406 households from two reserve communities located in Saskatchewan, Canada. Four hundred and forty six (51%) females and 428 (49%) males participated in the FNLHP.ConclusionsThe information from this project will assist in addressing and redressing many of the issues involved including the provision of adequate housing, health lifestyle practices, and in planning for health service delivery.

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.

Factoring in weather variation to capture the influence of urban design and built environment on globally recommended levels of moderate to vigorous physical activity in children.

Objectives In curbing physical inactivity, as behavioural interventions directed at individuals have not produced a population-level change, an ecological perspective called active living research has gained prominence. However, active living research consistently underexplores the role played by a perennial phenomenon encompassing all other environmental exposures—variation in weather. After factoring in weather variation, this study investigated the influence of diverse environmental exposures (including urban design and built environment) on the accumulation of globally recommended moderate to vigorous physical activity levels (MVPA) in children. Design This cross-sectional observational study is part of an active living initiative set in the Canadian prairie city of Saskatoon. As part of this study, Saskatoons neighbourhoods were classified based on urban street design into grid-pattern, fractured grid-pattern and curvilinear types of neighbourhoods. Moreover, diverse environmental exposures were measured including, neighbourhood built environment, and neighbourhood and household socioeconomic environment. Actical accelerometers were deployed between April and June 2010 (spring-summer) to derive MVPA of 331 10–14-year-old children in 25 1-week cycles. Each cycle of accelerometry was conducted on a different cohort of children within the total sample and matched with weather data obtained from Environment Canada. Multilevel modelling using Hierarchical Linear and Non-linear Modelling software was conducted by factoring in weather variation to depict the influence of diverse environmental exposures on the accumulation of recommended MVPA. Results Urban design, including diversity of destinations within neighbourhoods played a significant role in the accumulation of MVPA. After factoring in weather variation, it was observed that children living in neighbourhoods closer to the city centre (with higher diversity of destinations) were more likely to accumulate recommended MVPA. Conclusions The findings indicate that after factoring in weather variation, certain types of urban design are more likely to be associated with MVPA accumulation.

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

BackgroundChildren 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/DesignDesigned 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.DiscussionThis 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.

The Influence of Weather Variation, Urban Design and Built Environment on Objectively Measured Sedentary Behaviour in Children

With emerging evidence indicating that independent of physical activity, sedentary behaviour (SB) can be detrimental to health, researchers are increasingly aiming to understand the influence of multiple contexts such as urban design and built environment on SB. However, weather variation, a factor that continuously interacts with all other environmental variables, has been consistently underexplored. This study investigated the influence of diverse environmental exposures (including weather variation, urban design and built environment) on SB in children. This cross-sectional observational study is part of an active living research initiative set in the Canadian prairie city of Saskatoon. Saskatoons neighbourhoods were classified based on urban street design into grid-pattern, fractured grid-pattern and curvilinear types of neighbourhoods. Diverse environmental exposures were measured including, neighbourhood built environment, and neighbourhood and household socioeconomic environment. Actical accelerometers were deployed between April and June 2010 (spring-summer) to derive SB of 331 10–14 year old children in 25 one week cycles. Each cycle of accelerometry was conducted on a different cohort of children within the total sample. Accelerometer data were matched with localized weather patterns derived from Environment Canada weather data. Multilevel modeling using Hierarchical Linear and Non-linear Modeling software was conducted by factoring in weather variation to depict the influence of diverse environmental exposures on SB. Both weather variation and urban design played a significant role in SB. After factoring in weather variation, it was observed that children living in grid-pattern neighbourhoods closer to the city centre (with higher diversity of destinations) were less likely to be sedentary. This study demonstrates a methodology that could be replicated to integrate geography-specific weather patterns with existing cross-sectional accelerometry data to understand the influence of urban design and built environment on SB in children.

The SMART Study, a Mobile Health and Citizen Science Methodological Platform for Active Living Surveillance, Integrated Knowledge Translation, and Policy Interventions: Longitudinal Study

Background Physical inactivity is the fourth leading cause of death worldwide, costing approximately US

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

67.5 billion per year to health care systems. To curb the physical inactivity pandemic, it is time to move beyond traditional approaches and engage citizens by repurposing sedentary behavior (SB)–enabling ubiquitous tools (eg, smartphones). Objective The primary objective of the Saskatchewan, let’s move and map our activity (SMART) Study was to develop a mobile and citizen science methodological platform for active living surveillance, knowledge translation, and policy interventions. This methodology paper enumerates the SMART Study platform’s conceptualization, design, implementation, data collection procedures, analytical strategies, and potential for informing policy interventions. Methods This longitudinal investigation was designed to engage participants (ie, citizen scientists) in Regina and Saskatoon, Saskatchewan, Canada, in four different seasons across 3 years. In spring 2017, pilot data collection was conducted, where 317 adult citizen scientists (≥18 years) were recruited in person and online. Citizen scientists used a custom-built smartphone app, Ethica (Ethica Data Services Inc), for 8 consecutive days to provide a complex series of objective and subjective data. Citizen scientists answered a succession of validated surveys that were assigned different smartphone triggering mechanisms (eg, user-triggered and schedule-triggered). The validated surveys captured physical activity (PA), SB, motivation, perception of outdoor and indoor environment, and eudaimonic well-being. Ecological momentary assessments were employed on each day to capture not only PA but also physical and social contexts along with barriers and facilitators of PA, as relayed by citizen scientists using geo-coded pictures and audio files. To obtain a comprehensive objective picture of participant location, motion, and compliance, 6 types of sensor-based (eg, global positioning system and accelerometer) data were surveilled for 8 days. Initial descriptive analyses were conducted using geo-coded photographs and audio files. Results Pictures and audio files (ie, community voices) showed that the barriers and facilitators of active living included intrinsic or extrinsic motivations, social contexts, and outdoor or indoor environment, with pets and favorable urban design featuring as the predominant facilitators, and work-related screen time proving to be the primary barrier. Conclusions The preliminary pilot results show the flexibility of the SMART Study surveillance platform in identifying and addressing limitations based on empirical evidence. The results also show the successful implementation of a platform that engages participants to catalyze policy interventions. Although SMART Study is currently geared toward surveillance, using the same platform, active living interventions could be remotely implemented. SMART Study is the first mobile, citizen science surveillance platform utilizing a rigorous, longitudinal, and mixed-methods investigation to temporally capture behavioral data for knowledge translation and policy interventions.

The association of school connectedness and bullyinginvolvement with multiple screen-time behaviours amongyouth in two Canadian provinces: a COMPASS study

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 (Saskatoonspecific) 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.RésuméOBJECTIFS: Les interventions de promotion de la vie active cherchent surtout à modifier l’aménagement urbain et le milieu bâti, mais les variations météorologiques, un phénomène qui interagit perpétuellement avec ces facteurs environnementaux, sont systématiquement sousexplorées. Notre étude vise à élaborer une méthode pour relier les données météorologiques aux données transversales existantes obtenues par accélérométrie pour capter les variations météorologiques.MÉTHODE: Nous avons classé les quartiers de Saskatoon en quartiers à agencement quadrillé, en quartiers scindés à agencement quadrillé et en quartiers à agencement curviligne. Par la suite, nous avons utilisé 137 accéléromètres Actical pour recueillir des données sur l’activité physique d’intensité modérée à élevée (APIME) et le comportement sédentaire (CS) auprès de 455 enfants au cours de 25 cycles séquentiels d’une semaine entre avril et juin 2010. Ce déploiement séquentiel était nécessaire pour surmonter la différence de ratio entre la taille de l’échantillon et le nombre d’accéléromètres. Nous avons élaboré une méthode de maillage de données où chaque cycle d’accélérométrie était assorti aux conditions atmosphériques locales (propres à Saskatoon) selon Environnement Canada. Nous avons mené des analyses statistiques pour dépeindre l’influence de l’aménagement urbain sur l’APIME et le CS après la prise en compte des conditions atmosphériques locales.RÉSULTATS: L’intégration de l’accélérométrie transversale et des conditions atmosphériques locales a permis de saisir les variations météorologiques au cours d’une même transition saisonnière. Globalement, durant la transition du printemps à l’été à Saskatoon, l’APIME a augmenté et le CS a diminué les jours les plus chauds. Après la prise en compte des conditions météorologiques locales, nous avons observé à plusieurs reprises que les enfants vivant dans les quartiers scindés à agencement quadrillé présentaient cumulativement une APIME significativement plus faible et un CS significativement plus élevé.CONCLUSION: La méthode proposée pourrait servir à relier des données transversales obtenues par accélérométrie disponibles mondialement et des données météorologiques propres à un lieu pour comprendre comment le milieu bâti et les facteurs de l’environnement social interagissent avec diverses conditions atmosphériques pour influencer la vie active.

Do school physical activity policies and programs have a role in decreasing multiple screen time behaviours among youth

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.

Catalyzing Action on First Nations Respiratory Health Using Community-based Participatory Research: Integrated Knowledge Translation through Strategic Symposia

Screen time in youth has been associated with a wide range of poor health outcomes. Evidence indicates the need to develop physical activity (PA) school policies and programs that are aimed at decreasing youth screen time behaviours. This study aims to understand the association between PA policies and programs embedded into the functioning of 89 schools across two provinces in Canada and multiple screen time behaviours. As part of the COMPASS Study, a total of 44,861 youth aged between 13 and 18years and belonging to 89 schools in two Canadian provinces completed a validated questionnaire for health behaviours and outcomes data. PA policies and programs were measured using the School Policies and Practices Questionnaire, completed by the relevant school administrator. Participation in before-school, noon hour, or after-school intramural programs, participation in varsity sports, and access to indoor areas of PA during non-instructional time, was associated with significantly lower multiple screen time behaviours across both provinces. With exposure to multiple electronic and digital devices only predicted to increase among youth in the future, there is a need to conceptualize and integrate school-based screen time reducing PA policies and programs into the regular functioning of the schools.