Summary
What is already known about this subject
Short sleep duration is a risk factor for obesity.
Television (TV) in the bedroom has been shown to be associated with excess body weight in children.
...Children increasingly use other electronic entertainment and communication devices (EECDs) such as video games, computers, and smart phones.
What this study adds
Access to and night‐time use of EECDs are associated with shortened sleep duration, excess body weight, poorer diet quality, and lower physical activity levels.
Our findings reinforce existing recommendations pertaining to TV and Internet access by the American Academy of Pediatrics and suggest to have these expanded to restricted availability of video games and smart phones in children's bedrooms.
Background
While the prevalence of childhood obesity and access to and use of electronic entertainment and communication devices (EECDs) have increased in the past decades, no earlier study has examined their interrelationship.
Objective
To examine whether night‐time access to and use of EECDs are associated with sleep duration, body weights, diet quality, and physical activity of Canadian children.
Methods
A representative sample of 3398 grade 5 children in Alberta, Canada, was surveyed. The survey included questions on children's lifestyles and health behaviours, the Harvard Youth/Adolescent Food Frequency questionnaire, a validated questionnaire on physical activity, and measurements of heights and weights. Random effect models were used to assess the associations of night‐time access to and use of EECDs with sleep, diet quality, physical activity, and body weights.
Results
Sixty‐four percent of parents reported that their child had access to one or more EECDs in their bedroom. Access to and night‐time use of EECDs were associated with shortened sleep duration, excess body weight, poorer diet quality, and lower physical activity levels in a statistically significant manner.
Conclusions
Limiting the availability of EECDs in children's bedrooms and discouraging their night‐time use may be considered as a strategy to promote sleep and reduce childhood obesity.
Consequences of obesity for mental health and cognitive development are not established to the same degree as those for chronic diseases. This study aims to document the interrelationships between ...body weight, self-esteem and school performance in childhood. Height and weight measurements and self-report of self-esteem, diet quality and physical activity of 4945 grade 5 students were linked with standardized literacy test results. Structural equation models were applied to confirm hypothesized relationships between body weight, self-esteem and school performance, and revealed that body weight affected self-esteem negatively and that school performance affected self-esteem positively. Body weight did not affect school performance, and self-esteem did affect neither body weight nor school performance. Subsequent multi-level logistic regression showed that obese students, relative to normal weight students, were more likely (1.44; 95% CI: 1.12-1.84), and students with good school performance, relative to those performing poor, were less likely (0.39; 95% CI: 0.26-0.58), to have low self-esteem. Diet quality and active living had positive effects on both school performance and self-esteem. The study findings further establish obesity as a risk factor for low self-esteem and add to the rationale to promote healthy eating and active living among children and youth as this will prevent chronic diseases and improve mental health and cognitive development.
Aims/hypothesis We explored the relationship between glucose-lowering agents and cancer mortality rates in type 2 diabetes patients, hypothesising a decreased risk of cancer mortality with metformin ...use and a dose-risk gradient for insulin therapy. Methods This was a population-based cohort study using administrative data from Saskatchewan Health, Canada. We identified new users of metformin or sulfonylureas from 1 January 1991 to 31 December 1996, with follow-up until death, departure from the province or 31 December 1999. Cox regression analyses were used to estimate the HR of death from cancer, accounting for time-varying exposure to metformin, sulfonylurea, and exogenous insulin therapy. Results We identified 10,309 new users of metformin or sulfonylurea. The average follow-up was 5.4 (1.9) years, during which 407 (4.0%) cancer deaths occurred. Adjusting for age, sex and chronic disease score, the adjusted HR for metformin use was 0.80 (95% CI 0.65-0.98) compared with sulfonylurea monotherapy users. Adjusted HRs for subsequent insulin use were 2.22 (0.99-5.00), 3.33 (2.26-4.89) and 6.40 (4.69-8.73) for <3, 3 to 11 and ≥12 insulin dispensations/year, respectively, compared with patients not on insulin. We observed a similar risk gradient among the sub-cohort of new insulin users. Conclusions/interpretation Our results support previous reports of a decreased risk of cancer outcomes associated with metformin use relative to sulfonylurea monotherapy. We also provide new evidence of a gradient of cumulative insulin dispensations and cancer mortality rates.
Background: Despite enormous public sector expenditures, the effectiveness of universal coverage for health care in reducing socioeconomic disparities in health has received little attention. Study ...objectives: To evaluate whether universal coverage for health care reduces socioeconomic disparities in health. Design: Information on participants of the 1990 Nova Scotia Nutrition Survey was linked with eight years of administrative health services data and mortality. The authors first examined whether lower socioeconomic groups use more health services, as would be expected given their poorer health status. They then investigated to what extent differential use of health services modifies socioeconomic disparities in mortality. Finally, the authors evaluated health services use in the last years of life when health is poor regardless of a person’s socioeconomic background. Setting: The Canadian province of Nova Scotia, which provides universal health care coverage to all residents. Participants: 1816 non-institutionalised adults, aged 18–75 years, from a two stage cluster sample stratified by age, gender, and region. Main results: People with lower socioeconomic background used comparatively more family physician and hospital services, in such a way as to ameliorate the socioeconomic differences in mortality. In contrast, specialist services were comparatively underused by people in lower socioeconomic groups. In the last three years of life, use of specialist services was significantly higher in the highest income group. Conclusions: Universal coverage of family physician and hospital services ameliorate the socioeconomic differences in mortality. However, specialist services are underused in lower socioeconomic groups, bearing the potential to widen the socioeconomic gap in health.
Adequate amounts of physical activity, sleep, and screen time along with a healthy diet have been demonstrated to have positive associations with academic achievement. No longitudinal study has ...investigated the simultaneous relationship between all of these behaviours and academic achievement. Data from 11,016 adolescent participants of the COMPASS study in Alberta and Ontario were analysed. Students self-reported their adherence to Canadian recommendations for health behaviours and academic achievement in Math and English on school-based surveys administered in the 2015/16 and 2016/17 waves of COMPASS. Multinomial generalized estimating equations were used to evaluate the association between longitudinal changes in adherence to recommendations and academic achievement at follow-up. Models were adjusted for self-reported sociodemographic information, body weight status, and baseline academic achievement. Students who adhered to a greater number of recommendations performed better than students who adhered to fewer recommendations. Meeting recommendations for Meat and Alternatives (protein-rich foods) and screen time were consistently associated with higher academic achievement compared to students who did not meet these recommendations. A change from not meeting recommendations for Vegetables and Fruit to meeting the recommendation in the following year was associated with higher achievement in both subjects. There was no association between sleep behaviours or physical activity and academic achievement. Results indicate that adherence to recommendations for protein-rich foods, screen time, and vegetables and fruit show promise as behavioural targets for higher academic achievement among youth. Further study using objectives measurements of behaviours and further consideration of socioeconomic variables is merited.
•Meeting more recommendations was better for Math and English grades.•Meeting recommendations for protein-rich foods and screen time led to better grades.•Sleep and physical activity were not associated with school performance.•School-based health promotion could support better grades in teens.
To examine the longitudinal associations between different physical activity (PA) intensities and cardiometabolic risk factors among a sample of Canadian youth.
The findings are based on a 2-year ...prospective cohort study in a convenience sample of 315 youth aged 9-15 years at baseline from rural and urban schools in Alberta, Canada. Different intensities (light, moderate and vigorous) of PA were objectively assessed with Actical accelerometers. The main outcome measures were body mass index (BMI) z-score, waist circumference, cardiorespiratory fitness and systolic blood pressure at 2-year-follow-up and conditional BMI z-score velocity. A series of linear regression models were conducted to investigate the associations after adjusting for potential confounders.
At follow-up, cardiorespiratory fitness increased (quartile 1 vs quartile 4=43.3 vs 50.2; P(trend)<0.01) and waist circumference decreased (quartile 1 vs quartile 4=79.0 vs 72.6; P(trend)=0.04; boys only) in a dose-response manner across quartiles of baseline vigorous-intensity PA. A similar trend was observed for systolic blood pressure (quartile 1 vs quartile 4=121.8 vs 115.3; P(trend)=0.07; boys only). Compared with quartile 1 of vigorous-intensity PA, BMI z-score at follow-up and conditional BMI z-score velocity were significantly lower in the quartile 2 and 3 (P<0.05). Waist circumference at follow-up also decreased (quartile 1 vs quartile 4=75.3 vs 73.8; P(trend)=0.04) across quartiles of baseline moderate-intensity PA.
Time spent in vigorous-intensity PA was associated with several positive health outcomes 2 years later. These findings suggest that high-intensity activities in youth help to reduce the risk for several chronic diseases.
Purpose To assess how vitamin D status is associated with health-related quality of life (HRQOL) among older residents of Canada. Design We analysed baseline data of 1,493 Canadians aged 50 years and ...over in Alberta on HRQOL (EQ-5D-5L) and serum 25-hydroxyvitamin D (25(OH)D) as a measure of vitamin D status. We applied multivariable regression methods to examine the association between vitamin D status and each of the five dimensions and the summary index of the EQ-5D-5L. Results Participants with higher serum 25(OH)D levels were significantly less likely to report problems with mobility, usual activities, and depression and anxiety. Specifically, age- and gender-adjusted odds ratios for reporting problems with mobility, usual activities, and depression and anxiety were 0.58 (95 % confidence interval 0.44–0.78), 0.67 (0.50–0.89), and 0.67 (0.51–0.88) per 100 nmol/L increase in 25(OH)D, respectively. No significant associations were observed for problems with self-care and with pain and discomfort. HRQOL scores combining the responses of each of the five dimensions increased significantly with increasing serum 25(OH)D levels. Conclusions This is the first study to reveal the importance of vitamin D for the five dimensions of HRQOL in a community-based sample. The observed associations of vitamin D and HRQOL call for intervention studies to strengthen the evidence of the potential benefits of vitamin D supplementation for HRQOL among older adults.
Objectives The objective of the study is to derive a scoring system for the EQ-5D child-friendly version (EQ-5D-Y) from a population-based sample of children based on their own health state ...assessments on the descriptive system and the visual analogue scale (VAS). Methods We used data from the 2008 and 2010 Raising Healthy Eating and Active Living Kids in Alberta surveys of grade five students aged primarily 10–11 years and their parents in the Canadian province of Alberta. We applied a random split sample approach. Two-thirds of the sample (modeling sample) was used for the estimation of the EQ-5D-Y VAS. The remaining one-third sample (validation sample) was used for the examination of the prediction accuracy of the estimation model. Multilevel linear regression was used to estimate EQ-5D-Y VAS score and produce EQ-5D-Y index values from the children's self-rated states described in the EQ-5D-Y and the accompanying VAS values. Results The mean EQ-5D-Y VAS-based index value was 0.891 (SD 0.133) in the modeling sample and 0.885 (SD 0.134) in the validation sample. The own VAS-based index generally showed logical consistency, with lower values for health states that were logically worse. There was no statistically significant difference between the observed and the predicted VAS values in this sample. Conclusions This study elicited a value set for health states defined by the EQ-5D-Y that is based on respondents' own VAS ratings from a large representative sample of Canadian children. Future study is needed to validate this type of value set among different age groups of children.
Vitamin D deficiency and insufficiency are prevalent worldwide, but relatively few studies have examined vitamin D status in working populations.
To assess the prevalence of vitamin D deficiency and ...insufficiency in Canadian workers and investigate risk factors in this population.
A cross-sectional study using data from a health programme enrolling workers mostly from Northern Alberta, Canada. As part of the programme, volunteers were invited to complete a lifestyle questionnaire. Blood was taken to determine plasma 25-hydroxyvitamin D (25(OH)D) levels. Logistic and linear regressions were used to investigate the relationships between individual characteristics and vitamin D status.
Between October 2007 and December 2012, 6101 eligible workers enrolled in the health programme. The prevalence of vitamin D deficiency (plasma 25(OH)D, levels <27.5 nmol/l) and insufficiency (<37.5 nmol/l) were 3 and 8%, respectively. Male employees were significantly more likely to be vitamin D deficient and insufficient than females. Residing at a more northern latitude increased the likelihood of vitamin D deficiency and insufficiency. Age, assessments made in summer, better general health and physical activity and use of vitamin D supplementation were all related to lower likelihood of deficiency and insufficiency.
Vitamin D deficiency and insufficiency are a concern in this sample of Canadian workers. Vitamin D supplementation is recommended to reduce the prevalence of deficiency and insufficiency in this group.
Objectives To describe the health-related quality of life (HRQOL) of grade-five students in Alberta, Canada, and to assess how this correlates with sociodemographic and neighbourhood characteristics. ...Methods In 2008, we conducted a comprehensive population-based survey among 3,421 grade-five students aged primarily 10-11 years from 148 schools and their parents that included questions on sociodemographic and neighbourhood factors. The HRQOL of the students was assessed using the EQ-5D Canadian English child version (EQ-5DY). We applied multilevel multivariable linear regression to examine the independent importance of sociodemographic and neighbourhood factors for the EQ-5D-Y index and EQ-5D-Y Visual Analogue Scale (VAS) score. Results In five EQ-5D-Y dimensions, problems with ' walking', ' looking after myself, ' usualactivities', ' pain or discomfort' and ' worried, sad or unhappy' were reported by 8.1% (n = 288), 6.5% (n = 215), 11.8% (n = 431), 46.0% n = 1600), and 37.7% (n = 1292) of students, respectively. Their mean EQ-5D-Y index was 0.86 and mean EQ-5D-Y VAS was 80.4. Children from families reporting higher educational attainment reported higher HRQOL both in terms of a higher EQ-5D-Y index and in terms of a higher EQ-5D-Y VAS. Also, children residing in neighbourhood characterized as providing good satisfaction and facilities reported higher HRQOL. Conclusions Public health initiatives to improve HRQOL among children are suggested to take into account the influence of different sociodemographic and neighbourhood characteristics such that priority is given to those residing in towns, rural areas and dissatisfying neighbourhoods with poor access to recreational facilities and stores for fresh products.
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