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Background Active school transport (AST) is a promising strategy to increase children’s physical activity. A systematic review published in 2011 found large heterogeneity in the effectiveness of interventions in increasing AST and highlighted several limitations of previous research. We provide a comprehensive update of that review. Methods Replicating the search of the previous review, we screened the PubMed, Web of Science, Cochrane, Sport Discus and National Transportation Library databases for articles published between February 1, 2010 and October 15, 2016. To be eligible, studies had to focus on school-aged children and adolescents, include an intervention related to school travel, and report a measure of travel behaviors. We assessed quality of individual studies with the Effective Public Health Practice Project quality assessment tool, and overall quality of evidence with the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach. We calculated Cohen’s d as a measure of effect size. Results Out of 6318 potentially relevant articles, 27 articles reporting 30 interventions met our inclusion criteria. Thirteen interventions resulted in an increase in AST, 8 found no changes, 4 reported inconsistent results, and 5 did not report inferential statistics. Cohen’s d ranged from −0.61 to 0.75, with most studies reporting “trivial-to-small” positive effect sizes. Three studies reported greater increases in AST over longer follow-up periods and two Safe Routes to School studies noted that multi-level interventions were more effective. Study quality was rated as weak for 27/30 interventions (due notably to lack of blinding of outcome assessors, unknown psychometric properties of measurement tools, and limited control for confounders), and overall quality of evidence was rated as low. Evaluations of implementation suggested that interventions were limited by insufficient follow-up duration, incomplete implementation of planned interventions, and limited access to resources for low-income communities. Conclusions Interventions may increase AST among children; however, there was substantial heterogeneity across studies and quality of evidence remains low. Future studies should include longer follow-ups, use standardized outcome measures (to allow for meta-analyses), and examine potential moderators and mediators of travel behavior change to help refine current interventions. Trial registration Registered in PROSPERO: CRD42016033252

Accumulating evidence suggests that, independent of physical activity levels, sedentary behaviours are associated with increased risk of cardio-metabolic disease, all-cause mortality, and a variety of physiological and psychological problems. Therefore, the purpose of this systematic review is to determine the relationship between sedentary behaviour and health indicators in school-aged children and youth aged 5-17 years. Online databases (MEDLINE, EMBASE and PsycINFO), personal libraries and government documents were searched for relevant studies examining time spent engaging in sedentary behaviours and six specific health indicators (body composition, fitness, metabolic syndrome and cardiovascular disease, self-esteem, pro-social behaviour and academic achievement). 232 studies including 983,840 participants met inclusion criteria and were included in the review. Television (TV) watching was the most common measure of sedentary behaviour and body composition was the most common outcome measure. Qualitative analysis of all studies revealed a dose-response relation between increased sedentary behaviour and unfavourable health outcomes. Watching TV for more than 2 hours per day was associated with unfavourable body composition, decreased fitness, lowered scores for self-esteem and pro-social behaviour and decreased academic achievement. Meta-analysis was completed for randomized controlled studies that aimed to reduce sedentary time and reported change in body mass index (BMI) as their primary outcome. In this regard, a meta-analysis revealed an overall significant effect of -0.81 (95% CI of -1.44 to -0.17, p = 0.01) indicating an overall decrease in mean BMI associated with the interventions. There is a large body of evidence from all study designs which suggests that decreasing any type of sedentary time is associated with lower health risk in youth aged 5-17 years. In particular, the evidence suggests that daily TV viewing in excess of 2 hours is associated with reduced physical and psychosocial health, and that lowering sedentary time leads to reductions in BMI.

A diverse, cross-sectorial group of partners, stakeholders and researchers, collaborated to develop an evidence-informed Position Statement on active outdoor play for children aged 3–12 years. The Position Statement was created in response to practitioner, academic, legal, insurance and public debate, dialogue and disagreement on the relative benefits and harms of active (including risky) outdoor play. The Position Statement development process was informed by two systematic reviews, a critical appraisal of the current literature and existing position statements, engagement of research experts (N = 9) and cross-sectorial individuals/organizations (N = 17), and an extensive stakeholder consultation process (N = 1908). More than 95% of the stakeholders consulted strongly agreed or somewhat agreed with the Position Statement; 14/17 participating individuals/organizations endorsed it; and over 1000 additional individuals and organizations requested their name be listed as a supporter. The final Position Statement on Active Outdoor Play states: “Access to active play in nature and outdoors—with its risks— is essential for healthy child development. We recommend increasing children’s opportunities for self-directed play outdoors in all settings—at home, at school, in child care, the community and nature.” The full Position Statement provides context for the statement, evidence supporting it, and a series of recommendations to increase active outdoor play opportunities to promote healthy child development.

Background Negative parental perceptions of risk may restrict children’s opportunities for outdoor play. Excessively minimizing children’s exposure to risks in their environment may have a range of developmental consequences. The purpose of this cross-sectional study was to assess correlates of parental tolerance of risk among a large sample of Canadian parents. Methods In this cross-sectional study, a sample of 2,291 parents of 7–12 year olds completed online questionnaires assessing a range of potential individual (e.g., gender), social (e.g., neighbourhood cohesion), and environmental (e.g., walkability) correlates of parental tolerance of risk. Logistic regressions were created to examine associations between these factors and odds of being in the most risk averse quartile. The logistic regression was built in hierarchal steps relying on the Akaike information criterion (AIC) and pseudo R 2 for model progression. Results The final model had a pseudo R 2 of 0.18. Five out of seventeen correlates were associated with risk aversion in parents. Concerns about stranger danger were associated with a higher odds of risk aversion (OR = 2.33, 95%CI[1.93, 2.82]). A higher number of children in the home was associated with lower odds of risk aversion in parents (OR = 0.80, 95%CI[0.69, 0.92], and parents of children born outside of Canada had higher odds of being risk adverse when compared to parents born in Canada (OR = 2.13, 95%CI[1.54, 2.94]). Finally, being very concerned with COVID-19 increased the odds of risk aversion (OR = 3.07, 95%CI[1.93, 5.04], while having a household income of > 100,000 lowered the odds of risk aversion (OR = 0.56, 95%CI[0.36, 0.87]). Conclusions Tailored interventions that reframe perceptions of risk for parents are needed. Such interventions could reframe concerns about stranger danger which persist despite occurrences of stranger abduction being extremely rare. Interventions could also be targeted to immigrant families and those with fewer children as they appear to be more averse to risk. A complementary focus on examining how cultural background influences risk perceptions is needed in future research.

Objectives We aimed to identify factors correlated with completion, non-completion and cycling between completion and non-completion among clients admitted to Alberta Residential Withdrawal Management Services. Methods The study included data on clients from a provincial database ( N  = 20,020) admitted to residential withdrawal management units across Alberta between April 1, 2015, and March 31, 2022. We collapsed admission-level data into client-level data, where each individual's information is captured as a unique record. Multinomial logistic regression was performed to investigate correlates of completion, non-completion, and multiple cycles of completion and non-completion. Clients in these three categories were compared in their socio-demographics, primary substance of concern, and other program variables of admission count, length of stay, transition to treatment, facilities utilized, days of discharge, and years of admission. Results The study sample included 39,952 admissions, with an average of two per client. Overall, 55.8% ( n  = 11,170) of discharged clients completed the program, 25.5% ( n  = 5,106) were non-completed, and 18.7% ( n  = 3,744) cycled between completion and non-completion. Regression analysis indicated that clients who used a single substance, primarily alcohol, cocaine and marijuana, completed post-secondary education, were employed or had unstable employment, and were married had lower odds of non-completion. Other variables related to higher odds of completion were urban residence, multiple admissions to a facility, and longer lengths of stay. Conversely, clients who primarily used amphetamines, barbiturates, crystal meth, opiates, and tranquillizers had higher odds of non-completion. Female gender, being discharged on Saturday and Sunday, using detoxification as a standalone service without transitioning to residential treatment and admission to two or more facilities also correlated with higher odds of non-completion. Conclusion Results indicated that the type of substances, gender, education, marital status, employment, place of residence, and transition to residential services were associated with detoxication outcomes. These findings can inform the customization and allocation of services, targeted support, service intensity and areas requiring additional attention and investment to improve treatment outcomes.

Physical activity (PA) is associated with numerous health benefits among children and youth. However, few studies have examined how active transportation (AT) and device-based measures of PA vary within and between countries in sub-Saharan Africa. This cross-sectional study sought to investigate the prevalence and correlates of AT and device-measured PA among children living in urban, peri-urban and rural areas in three African countries representing Eastern, Western and Southern regions of Africa. 3,205 participants (53.3% girls; 46.7% boys) aged 10-12 years were recruited in Kenya, Nigeria and Mozambique. Data were collected using a child questionnaire, a parent/guardian questionnaire and PiezoRx® pedometers. ANCOVA and binary logistic regression analyses were used to examine the correlates of AT and PA while controlling for gender, age, parent education and vehicle ownership. Participants accumulated an average of 45.6±23.5 min/day of moderate-to-vigorous physical activity (MVPA) and 11,215±4,273 steps/day. Kenyan and Mozambican children were significantly more active than their Nigerian counterparts (p<0.001). Only 23% met the MVPA guidelines of 60 min/day. 65.1% of participants engaged in AT to school (and 67.8% for the trip back home) with no gender differences. Living in a rural area, lower parent education, lower vehicle ownership and higher motorcycle ownership were associated with higher odds of AT. Other correlates of AT were country-specific. Girls accumulated less daily MVPA than boys in all countries. MVPA was positively associated with living in less urbanized areas in Nigeria and Mozambique. In Kenya, lower parental education and AT were associated with higher MVPA. Nigerian children's daily MVPA decreased with age and the number of parent-perceived barriers to AT. Majority of children engaged in AT, but still failed to meet MVPA recommendations. Most correlates of AT and PA were country-specific, suggesting that strategies to encourage both behaviours should be informed by local evidence.

Background Active transportation (AT), independent mobility (IM), and outdoor time are promising ways to increase children’s physical activity. However, in order to create interventions to increase those forms of physical activity, it is important to understand the relationships between area-level socioeconomic status (SES) and type of urbanization with AT, IM, outdoor time, and physical activity, and this was the aim of the study. Methods One thousand six hundred ninety-nine children in grades 4 to 6 (mean age: 10.2 ± 1.0 years) from three Canadian regions participated. AT, IM, and outdoor time were assessed using questionnaires and physical activity was measured using the SC-StepRX pedometer. Area-level SES was assessed using the median household income of the census tract in which the school was located and type of urbanization was determined for each school using standardized procedures. Generalized linear and general linear mixed models were used to examine the relationships. Results Area-level SES and the type of urbanization were generally not related to AT, IM, or physical activity for either gender. However, we observed that both boys and girls living in lower SES areas had decreased odds of spending > 2 h outdoors on weekend days compared to their peers from higher SES areas. Girls living in suburban or rural areas were more likely to spend > 2 h outdoors on weekdays compared to their urban counterparts. Conclusions AT, IM, and physical activity are generally not associated with area-level SES or the type of urbanization in this sample of Canadian children. The finding regarding outdoor time showing that both boys and girls of lower SES areas had decreased odds of spending > 2 h outdoors on weekends compared to their peers from higher SES areas suggest that additional efforts should be implemented to offer outdoor play opportunities in lower SES areas.

This study explored the relationship between physical fitness and indicators of physical and psychosocial health in a nationally representative sample of Canadian children and youth aged 6-17 years. We conducted a secondary data analysis of Canadian Health Measures Survey (Cycles 1 and 2; 2007-2011) data. The physical fitness measures included cardiorespiratory fitness (CRF; modified Canadian Aerobic Fitness Test), strength (handgrip strength), flexibility (sit-and-reach), and muscular endurance (partial curl-ups). The physical health indicators included directly measured biomarkers (total and HDL [high-density lipoprotein] cholesterol, C-reactive protein, glucose, and HbA1c [glycohaemoglobin]) and measures of adiposity, resting heart rate, and blood pressure. Psychosocial health was assessed using the Strengths and Difficulties Questionnaire. Multiple linear regressions were used to determine the association between variables, stratified by age groups and sex. 3,800 (48.9% female) children and youth were retained for this analysis. CRF displayed significant favourable associations with most physical health indicators in male and female participants. There were less significant favourable associations with flexibility and muscular endurance compared with CRF across age and sex groups. Strength was associated with higher adiposity in males and females, and lower heart rate in male children (β = -1.9; 95% CI: -2.9, -1.0) and female youth (β = -2.0; 95% CI: -2.7, -1.2). There were few significant favourable associations between measures of physical fitness and psychosocial health in this sample of children and youth. These findings suggest that physical fitness, and especially CRF, is a significant indicator of physical health among Canadian children and youth aged 6-17 years.

The COVID-19 pandemic has had adverse impacts on mental health and substance use worldwide. Systematic reviews suggest eHealth interventions can be effective at addressing these problems. However, strong positive eHealth outcomes are often tied to the intensity of web-based therapist guidance, which has time and cost implications that can make the population scale-up of more effective interventions difficult. A way to offset cost while maintaining the intensity of therapist guidance is to offer eHealth programs to groups rather than more standard one-on-one formats. This systematic review aims to assess experimental evidence for the effectiveness of live health professional-led group eHealth interventions on mental health, substance use, or bereavement among community-dwelling adults. Within the articles selected for our primary aim, we also seek to examine the impact of interventions that encourage physical activity compared with those that do not. Overall, 4 databases (MEDLINE, CINAHL, PsycINFO, and the Cochrane Library) were searched in July 2020. Eligible studies were randomized controlled trials (RCTs) of eHealth interventions led by health professionals and delivered entirely to adult groups by videoconference, teleconference, or webchat. Eligible studies reported mental health, substance use, or bereavement as primary outcomes. The results were examined by outcome, eHealth platform, and intervention length. Postintervention data were used to calculate effect size by study. The findings were summarized using the Synthesis Without Meta-Analysis guidelines. Risk of bias was assessed using the Cochrane Collaboration Tool. Of the 4099 identified studies, 21 (0.51%) RCTs representing 20 interventions met the inclusion criteria. These studies examined mental health outcomes among 2438 participants (sample size range: 47-361 participants per study) across 7 countries. When effect sizes were pooled, live health professional-led group eHealth interventions had a medium effect on reducing anxiety compared with inactive (Cohen d=0.57) or active control (Cohen d=0.48), a medium to small effect on reducing depression compared with inactive (Cohen d=0.61) or active control (Cohen d=0.21), and mixed effects on mental distress and coping. Interventions led by videoconference, and those that provided 8-12 hours of live health professional-led group contact had more robust effects on adult mental health. Risk of bias was high in 91% (19/21) of the studies. Heterogeneity across interventions was significant, resulting in low to very low quality of evidence. No eligible RCT was found that examined substance use, bereavement, or physical activity. Live eHealth group interventions led by health professionals can foster moderate improvements in anxiety and moderate to small improvements in depression among community-based adults, particularly those delivered by videoconference and those providing 8-12 hours of synchronous engagement. PROSPERO CRD42020187551; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=187551. RR2-10.1186/s13643-020-01479-3.

Background COVID-19 has resulted in an increased demand for eHealth services globally. There is emerging evidence for the efficacy for group eHealth interventions that support population-based mental health and wellbeing, but a systematic review is lacking. The primary objective of this systematic review is to summarize the evidence for eHealth group counseling and coaching programs for adults. A second objective is to assess, within studies selected for our primary objective, the impact of programs that encourage PA on outcomes compared to those that do not. Methods Randomized controlled trials that assess the impact of eHealth group counseling or coaching programs on mental health, health behavior, or physical health activity among community-dwelling adults will be included. We will search the following electronic databases (from January 2005 onwards): MEDLINE, PsycINFO, CINHAL, and the Central Register of Controlled Trials. The primary outcomes will be changes in mental health conditions (e.g., depression, anxiety, stress, quality of life), behavioral health conditions (e.g., substance use, smoking, sexual behavior, eating behavior, medication adherence), and physical health conditions (e.g., coping with cancer, menopausal symptoms, arthritis pain). Secondary outcomes will be changes in physical activity. Two reviewers will independently screen all citations, full-text articles, and abstract data. Potential conflicts will be resolved through discussion with a third reviewer. A narrative synthesis without meta-analysis will be conducted. The strength of the body of evidence will be assessed using GRADE. The risk of bias in individual studies will be appraised using the Cochrane Risk of Bias 2.0 tool. Potential sources of gender bias in included studies will be considered at all stages of the planned review. Discussion This review will contribute to the literature by providing evidence on the effectiveness of eHealth counseling and coaching programs delivered to adults in a group format. Systematic review registration The protocol has been registered at the International Prospective Register of Systematic Reviews (PROSPERO: CRD42020187551 ).