Physical activity and recreational screen time change among adolescents in Canada: Examining the impact of COVID-19 in worsening inequity.

The purpose of this study was to assess if sub-populations of adolescents in Canada (i.e., race/ethnicity, sex/gender, and socioeconomic status [SES]) experienced a larger change in physical activity and screen time between the 2019-2020 (pre-pandemic) and the 2020-2021 (mid-pandemic) school years. Longitudinally linked data from pre-pandemic and mid-pandemic school years of a prospective cohort study of secondary school students in Canada (n = 8209) were used for these analyses. Multivariable regression modelling tested the main effects of race/ethnicity, sex/gender, and SES on changes in moderate-to-vigorous physical activity (MVPA) and screen time duration as well as adherence to Canada's 24-h Movement Guidelines. Overall between groups difference were assessed using type II analysis of deviance tests. Interactions between variables of interest were subsequently tested with a series of regression models compared to the main effects model using likelihood-ratio test. Post-hoc comparisons found Male participants' MVPA time decreased less compared to their female counterparts (M [95% CI] = -16.3 [-13.5, -19.2] min/day), but also reported greater increases in screen time compared to females (23.7 [14.7, 32.8] min/day) during the same period. MVPA in White participants decreased less than Asian participants (-10.7 [-19.5, -1.9] min/day) with a similar non-significant pattern observed in Black and Latin participants. Adolescents in higher SES categories fared better on adherence to MVPA (highest vs. lowest OR = 1.41 [0.97, 2.06]) and screen time recommendations(highest vs. lowest AOR = 3.13 [0.91, 11.11]). Results support the hypothesis that existing inequitable sociodemographic differences in MVPA participation and screen time have worsened throughout the pandemic.

Rising through the pandemic: a scoping review of quality improvement in public health during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic generated a growing interest in and need for evidence-based tools to facilitate the implementation of emergency management strategies within public health practice. Quality improvement (QI) is a key framework and philosophy to guide organizational emergency response efforts; however, the nature and extent to which it has been used in public health settings during the COVID-19 pandemic remains unclear. METHODS: We conducted a scoping review of literature published January 2020 - February 2021 and focused on the topic of QI at public health agencies during the COVID-19 pandemic. The search was conducted using four bibliographic databases, in addition to a supplementary grey literature search through custom Google search engines and targeted website search methods. Of the 1,878 peer-reviewed articles assessed, 15 records met the inclusion criteria. An additional 11 relevant records were identified during the grey literature search, for a total of 26 records included in the scoping review. RESULTS: Records were organized into five topics: 1) collaborative problem solving and analysis with stakeholders; 2) supporting learning and capacity building in QI; 3) learning from past emergencies; 4) implementing QI methods during COVID-19; and 5) evaluating performance using frameworks/indicators. CONCLUSIONS: The literature indicates that QI-oriented activities are occurring at the organizational and program levels to enhance COVID-19 response. To optimize the benefits that QI approaches and methodologies may offer, it is important for public health agencies to focus on both widespread integration of QI as part of an organization's management philosophy and culture, as well as project level activities at all stages of the emergency management cycle.

Exploring Factors Contributing to the Implementation of Ontario's Healthy Kids Community Challenge: Surveys and Key Stakeholder Interviews with Program Providers.

(1) Background: To explore factors contributing to the Healthy Kids Community Challenge (HKCC) program implementation; (2) Methods: Data were collected through a quantitative survey (n = 124) and in-depth telephone interviews (n = 16) with program providers. Interviews were recorded and transcribed for thematic analysis using NVivo; (3) Results: Provincial funding and in-kind support from community partners were key. Initiatives were feasible to implement, and key messages were well-received by communities. Specific practices and process were commonly discussed, and strong local program leadership was crucial to implementation; (4) Conclusions: Results have implications for planning and implementing future multi-component, community-based health promotion programs that include similar partnerships.

Bi-directional relationships between physical activity and mental health among a large sample of Canadian youth: a sex-stratified analysis of students in the COMPASS study.

OBJECTIVE: The aim of this research was to examine the bidirectional association between self-reported symptoms of mental disorder and physical activity among a large sample of Canadian secondary school students over time. METHODS: Linked survey data were obtained from 28,567 grade 9 to 12 students across Canada participating in two waves of the COMPASS Study (2017-18; 2018-19). Autoregressive cross-lagged models were run to examine the reciprocal relationships between self-reported moderate-to-vigorous physical activity (MVPA) and symptoms of depression (CESD-10) and anxiety (GAD-7). Models were stratified by gender, and accounted for grade, ethno-racial identity, and school-level clustering. RESULTS: Autoregressive associations show that neither symptoms of anxiety nor depression, at baseline, were predictive of mean MVPA at follow-up - consistent for the full sample and among both males and females. Higher MVPA among males at baseline was associated with lower symptoms of both anxiety (ß = - 0.03, p = 0.002) and depression (ß = - 0.05, p < 0.001) at follow-up. However, among females, higher MVPA at baseline was associated with greater symptoms of anxiety (ß = 0.03, p < 0.001), but not symptoms of depression (ß = 0.01, p = 0.073), at follow-up. CONCLUSION: In our large sample of Canadian secondary school students, associations between physical activity and symptoms of mental disorder were not bi-directional, and these relationships differed in males and females. This study illustrates the complex nature of the relationship between physical activity and symptoms of mental disorder among youth. While results support the benefits of promoting physical activity among males to prevent or manage internalizing symptoms, the relationship among females warrants further investigation.

Can We Reverse this Trend? Exploring Health and Risk Behaviours of Grade 12 Cohorts of Ontario Students from 2013-2019.

Adolescents engage in multiple health risk behaviours that put them at risk of future chronic disease. By the time students graduate from secondary school, they may be engaging in behaviours that set them on a particular health trajectory. It is important to monitor the co-occurrence of health risk behaviours of cohorts of grade 12 students over time to highlight important areas for intervention. The purpose of this study was to examine trends in health and risk behaviours over six waves among subsequent cohorts of grade twelve students from Ontario, Canada. A total of 44,740 grade 12 students participated in the COMPASS study across the six waves (2013/14 to 2018/19), and self-reported movement (physical activity, screen time, sleep), dietary (fruit and vegetables, breakfast), and substance use (smoking, vaping, binge drinking, and cannabis use) behaviours. Over 91.0% of students reported engaging in three or more health risk behaviours, with increases in the number of students reporting inadequate sleep, not eating breakfast on every school day, and vaping over time. Although modest, the wave 6 cohort reported slightly more risk behaviours compared with the wave 1 cohort, highlighting the importance of multidimensional health promotion strategies across multiple settings.

Weight control intentions and mental health among Canadian adolescents: a gender-based analysis of students in the COMPASS study. / Intentions en matière de contrôle du poids et santé mentale chez les adolescents canadiens : analyse comparative entre les sexes chez les élèves participant à l'étude COMPASS.

INTRODUCTION: Little is known about gender differences in associations between weight control intentions and mental health in adolescents. Our objective was to examine these associations in a large sample of adolescent girls and boys. METHODS: Using data from Year 6 (2017-18) of the COMPASS study (n = 57 324), we performed a series of multivariable linear regressions to examine whether weight control intentions (gain, lose, stay the same, no intention) were associated with depression, anxiety and self-concept, while adjusting for relevant covariates including body mass index. Models were stratified by self-reported gender. RESULTS: Compared to those with no intentions, girls who intended to lose weight reported higher symptoms of depression (B = 0.52, p < 0.001) and anxiety (B = 0.41, p < 0.001) and poorer self-concept (B = 2.06, p < 0.001). Girls who intended to gain weight also reported higher symptoms of depression (B = 0.54, p < 0.001), anxiety (B = 0.50, p < 0.001) and self-concept (B = 1.25, p < 0.001). Boys who intended to lose weight reported greater symptoms of depression (B = 0.26, p < 0.001) and anxiety (B = 0.33, p < 0.001) and poor self-concept (B = 1.10, p < 0.001). In boys, weight-gain intentions were associated with greater symptoms of anxiety (B = 0.17, p < 0.05), but not depression or self-concept. CONCLUSION: Intentions to gain or lose weight were associated with symptoms of mental disorder and poor self-concept in our large sample of adolescents, and these relationships differed in boys and girls. These findings have important implications for school-based programs promoting healthy weight and body image.

Priority setting for school nutrition research: developing a collaborative research agenda.

Priority setting in health research can assist stakeholders to identify research and policies that have the greatest potential for benefits to public health. Priority setting has been utilized by researchers to identify barriers, facilitators, and recommendations for future public health research. This commentary describes how a priority-setting approach was used as part of a workshop activity on the school nutrition environment in Ontario, Canada, to facilitate brainstorming, sorting, and rating of concepts related to the school nutrition environment. This work demonstrates an interesting and concrete case of priority setting, of interest for various planning activities (both programming and research), particularly those around school-based healthy eating programs or a related research agenda.

RéSUMé: L'établissement de priorités de recherche en santé peut aider les acteurs à déterminer la recherche et les politiques les plus susceptibles de présenter des avantages pour la santé publique. Les chercheurs utilisent l'établissement des priorités pour repérer les éléments favorables et défavorables et pour formuler des recommandations de recherche en santé publique à mener à l'avenir. Nous décrivons ici l'utilisation d'une démarche d'établissement des priorités lors d'un atelier sur la nutrition en milieu scolaire tenu en Ontario (Canada) dans le cadre d'une activité ayant consisté à animer une séance de remue-méninges et à trier et évaluer des concepts liés à la nutrition en milieu scolaire. Cela représente un cas concret d'établissement des priorités qui pourrait être intéressant pour diverses activités de planification (de programmes ou d'études de recherche), surtout celles qui s'articulent autour de programmes d'alimentation saine en milieu scolaire ou de priorités de recherche connexes.

An early implementation assessment of Ontario's Healthy Kids Community Challenge: results from a survey of key stakeholders.

BACKGROUND: In Ontario Canada, the Healthy Kids Community Challenge (HKCC) is a program intended to reduce the prevalence and prevent childhood overweight and obesity through community-based initiatives to improve health behaviours. Guided by the RE-AIM framework and Durlak and DuPre's Ecological Framework for Understanding Effective Implementation, the evaluation focused on two objectives: 1) to describe the organization of the program at the community level; and, 2) to identify opportunities for improvement through an early assessment of factors contributing to implementation. METHODS: Participants (n = 320) - members of the HKCC local steering committee, including the local project manager - completed a cross-sectional survey using SurveyMonkey and descriptive statistics were calculated. A sample (20%) of qualitative open-ended responses was thematically analyzed. RESULTS: Results indicated strong respondent agreement that the HKCC enhanced individual knowledge of access to health-promoting programs (88.3%) and messaging regarding healthy behaviours for healthy kids, with less for its effectiveness in reducing weight (53.1%). There was a high-level of adherence to HKCC social marketing messages and overall program structure, with few Local Project Manager reports of adaptations to theme one (9.2%) and theme two messages (15.4%). Fewer Local Project Managers (50%) reported the existence of private partnerships. While most respondents agreed they had the appropriate information to complete mandatory reporting, the usefulness of the HKCC online networking platform was in question (only 47% of Local Project Managers agreed that it was useful). Results reveal sufficient funding from the province to support program implementation, with a moderate level of local political commitment (63% of respondents). CONCLUSIONS: Results indicate that the HKCC was considered beneficial for enhancing access to health promoting programs, could be feasibly implemented with adherence to centrally-developed social marketing messages, and was amendable to local adaptation. Despite this, few private partnerships were reported. Going forward, there is opportunity to further evaluate factors contributing to HKCC program implementation, particularly as it relates to buy-in from intervention providers, and strategies for forming private sector partnerships to support long-term program sustainability.

Noncomprehensive and Intermittent Obesity-Related School Programs and Policies May Not Work: Evidence from the COMPASS Study.

BACKGROUND: The school environment has the potential to influence student body mass index (BMI) through programs and policies. Our objective was to examine the effect of modifying obesity-related school policies and programs on youths' BMI trajectories. METHODS: Obesity-related school policies and programs related to physical activity and healthy eating were collected from 41 schools across Ontario at baseline (2012-2013) and year 2 (2013-2014) of the COMPASS study. Self-reported height and weight were collected from the 4951 grades 9 and 10 students who attended those schools for 3 years. Linear mixed effects regression models examined the effect of modifying obesity-related school policies and programs on youths' BMI trajectories. RESULTS: Between Y1 and Y2 , 26 of the 41 schools implemented distinct new obesity-related programs or policies related to physical activity or healthy eating. Five of the interventions were associated with BMI trajectories of students attending those schools compared to students attending a pooled sample of control schools, predicting a higher BMI trajectory. CONCLUSIONS: Isolated programs and policies may not successfully improve youths' BMI trajectories. Further research is required to test the implementation of policies and programs that follow a comprehensive school health (CSH) approach, targeting BMI and associated behaviors.

Behavioural patterns only predict concurrent BMI status and not BMI trajectories in a sample of youth in Ontario, Canada.

BACKGROUND: Youth are engaging in multiple risky behaviours, increasing their risk of overweight, obesity, and related chronic diseases. The objective of this study was to examine the effect of engaging in unique clusters of unhealthy behaviours on youths' body mass index (BMI) trajectories. METHODS: This study used a linked-longitudinal sample of Grades 9 and 10 students (13 to 17 years of age) participating in the COMPASS host study. Students reported obesity-related and other risky behaviours at baseline and height and weight (to derive BMI) at baseline (2012/2013) and annually for 2 years post-baseline (2013/14 and 2014/15). Students were grouped into behavioural clusters based on response probabilities. Linear mixed effects models, using BMI as a continuous outcome measure, were used to examine the effect of engaging in clusters of risky behaviours on BMI trajectories. RESULTS: There were significant differences in BMI of the four behavioural clusters at baseline that remained consistent over time. Higher BMI values were found among youth classified at baseline to be Typical High School Athletes (ß = 0.232 kg/m2, [confidence interval (CI): 0.03-0.50]), Inactive High Screen-User (ß = 0.348 kg/m2, CI: 0.11-0.59) and Moderately Active Substance Users (ß = 0.759 kg/m2, CI: 0.36-1.15) compared to students classified as Health Conscious. Despite these baseline differences, BMI appeared to increase across all behavioural clusters annually by the same amount (ß = 0.6097 kg/m2, (CI) = 0.57-0.64). CONCLUSIONS: Although annual increases in BMI did not differ by behavioural clusters, membership in a particular behavioural cluster was associated with baseline BMI, and these differences remained consistent over time. Results indicate that intervening and modifying unhealthy behaviours earlier might have a greater impact than during adolescence. Health promotion strategies targeting the highest risk youth as they enter secondary school might be promising means to prevent or delay the onset of obesity.

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

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.

Clustering of risk-related modifiable behaviours and their association with overweight and obesity among a large sample of youth in the COMPASS study.

BACKGROUND: Canadian youth exhibit a number of risky behaviours, some of which are associated with overweight and obesity. The purpose of this study was to examine the prevalence of 15 modifiable risk behaviours in a large sample of Canadian youth, to identify underlying subgroups based on patterns of health behaviours, and to examine the association between identified subgroups and overweight/obesity. METHODS: Data from 18,587 grades 9-12 students in Year 1 (2012-13) of the COMPASS study and latent class analysis were used to identify patterns and clustering among 15 health behaviours (e.g., physical inactivity, sedentary behaviour, unhealthy eating, substance use). A logistic regression model examined the associations between these clusters and overweight/obesity status. RESULTS: Four distinct classes were identified: traditional school athletes, inactive screenagers, health conscious, and moderately active substance users. Each behavioural cluster demonstrated a distinct pattern of behaviours, some with a greater number of risk factors than others. Traditional school athletes (odds ratio (OR) 1.15, 95% CI 1.03-1.29), inactive screenagers (OR 1.33; 1.19-1.48), and moderately active substance users (OR 1.27; 1.14-1.43) were all significantly more likely to be overweight/obese compared to the health conscious group. CONCLUSIONS: Four distinct subpopulations of youth were identified based on their patterns of health and risk behaviours. The three clusters demonstrating poorer health behaviour were all at an increased risk of being overweight/obese compared to their somewhat healthier peers. Obesity-related public health interventions and health promotion efforts might be more effective if consideration is given to population segments with certain behavioural patterns, targeting subgroups at greatest risk of overweight or obesity.

An analysis of weight perception and physical activity and dietary behaviours among youth in the COMPASS study.

PURPOSE: Weight misperceptions appear common among youth, potentially influencing their motivation to engage in health-related behaviours; however, the direction of impact remains unclear. The current study examined how weight perception influences physical activity (PA) and diet among youth. METHODS: This study used 2-year linked data of 19,322 grade 9-12 students from Year 2 (Y2:2013-2014) and 3 (Y3:2014-2015) of the COMPASS study. Generalized Estimating Equation models tested the effect of Y3 weight perception on the various Y3 PA and dietary behaviour measures, adjusting for Y3 covariates (grade, race/ethnicity, weekly spending money), school cluster, school area median household income, and the Y2 outcome. Models were stratified by gender and body mass index (BMI) classification. RESULTS: Regardless of BMI status, overweight perceptions among boys and girls were associated with lower likelihoods of playing school sports, physical education class enrollment, meeting resistance exercise recommendations, eating breakfast regularly, and less vigorous-intensity PA, and among boys only, lower odds of meeting PA guidelines, compared to their peers who perceived their weight as "about right". In boys with normal-weight BMIs, underweight perceptions predicted less vigorous-intensity PA, and lower odds of physical education class enrollment, and of meeting PA and resistance exercise recommendations, than "about right" perceptions. Among girls, underweight perceptions predicted lower likelihoods of engaging in adequate resistance exercise and playing intramurals, and greater odds of eating fast food on weekends, purchasing snacks, and drinking energy drinks and sugar-sweetened beverages. Girls with overweight/obese BMIs who perceived their weight as such were less likely to consume adequate fruits and vegetables relative to their counterparts with "about right" weight perceptions. CONCLUSIONS: Overall, weight perceptions of "about right" appear more favourable for health behaviours among youth across the weight range. Results suggest obesity prevention strategies aiming to increase awareness of weight status may have unintended effects.

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

BACKGROUND: Few researchers have the data required to adequately understand how the school environment impacts youth health behaviour development over time. METHODS/DESIGN: COMPASS 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. DISCUSSION: COMPASS 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.

The proportion of excessive fast-food consumption attributable to the neighbourhood food environment among youth living within 1 km of their school.

The study objective was to estimate the proportion of excessive fast-food consumption by youth that is attributable to living and attending school in a neighbourhood with a moderate or high density of fast-food restaurants. This was a cross-sectional study of 6099 Canadian youths (aged 11-15 years) from 255 school neighbourhoods. All participants lived within 1 km of their school. The density of chain fast-food restaurants within a 1-km circular buffer surrounding each school was determined using geographic information systems. Excessive fast-food consumption (≥2 times per week) was assessed by questionnaire. Multilevel logistic regression analysis was used to examine associations. The population attributable risk estimates of excessive fast-food consumption due to neighbourhood exposure to fast-food restaurants were determined based on the prevalence of exposure and the results from the logistic regression. Eight percent of participants were excessive fast-food consumers. After adjusting for sociodemographic factors (i.e., gender, race, and socioeconomic status), it was found that youths from neighbourhoods with a moderate (odds ratio (OR), 1.68; 95% confidence interval (CI), 1.11-2.54) or high (OR 1.70; 95% CI 1.12-2.56) density of chain fast-food restaurants were more likely to be excessive fast-food consumers than were youths from neighbourhoods with no chain fast-food restaurants. Approximately 31% of excessive consumption was attributable to living in neighbourhoods with a moderate or high density of fast-food restaurants. Thus, the fast-food retail environment within which youth live and go to school is an important contributor to their eating behaviours.

The proportion of youths' physical inactivity attributable to neighbourhood built environment features.

OBJECTIVE: We investigated the independent association between several neighbourhood built environment features and physical inactivity within a national sample of Canadian youth, and estimated the proportion of inactivity within the population that was attributable to these built environment features. METHODS: This was a cross-sectional study of 6626 youth aged 11-15 years from 272 schools across Canada. Participants resided within 1 km of their school. Walkability, outdoor play areas (parks, wooded areas, yards at home, cul-de-sacs on roads), recreation facilities, and aesthetics were measured objectively within each school neighbourhood using geographic information systems. Physical inactivity (<5 days/week of 60 minutes of moderate-to-vigorous physical activity) was assessed by questionnaire. Multilevel logistic regression analyses, which controlled for several covariates, examined relationships between built environment features and physical inactivity. RESULTS: The final regression model indicated that, by comparison to youth living in the least walkable neighbourhoods, the risks for physical inactivity were 28-44% higher for youth living in neighbourhoods in the remaining three walkability quartiles. By comparison to youth living in neighbourhoods with the highest density of cul-de-sacs, risks for physical inactivity were 28-32% higher for youth living in neighbourhoods in the lowest two quartiles. By comparison to youth living in neighbourhoods with the least amount of park space, risks for physical inactivity were 28-37% higher for youth living in the neighbourhoods with a moderate to high (quartiles 2 and 3) park space. Population attributable risk estimates suggested that 23% of physical inactivity within the population was attributable to living in walkable neighbourhoods, 16% was attributable to living in neighbourhoods with a low density of cul-de-sacs, and 15% was attributable to living in neighbourhoods with a moderate to high amount of park space. CONCLUSIONS: Of the neighbourhood built environment exposure variables measured in this study, the three that were the most highly associated with inactivity were walkability, the density of cul-de-sacs, and park space. The association between some of these features and youths' activity levels were in the opposite direction to what has previously been reported in adults and younger children.

Reliability and validity of the weight status and dietary intake measures in the COMPASS questionnaire: are the self-reported measures of body mass index (BMI) and Canada's food guide servings robust?

BACKGROUND: The COMPASS study is designed to follow a cohort of ~30,000 grade 9 to 12 students attending ~60 secondary schools for four years to understand how changes in school characteristics (policies, programs, built environment) are associated with changes in youth health behaviours. Since the student-level questionnaire for COMPASS (Cq) is designed to facilitate multiple large-scale school-based data collections using passive consent procedures, the Cq is only comprised of self-reported measures. The present study assesses the 1-week (1 wk) test-retest reliability and the concurrent validity of the Cq measures for weight status and dietary intake. METHODS: Validation study data were collected from 178 grade 9 students in Ontario (Canada). At time 1 (T1), participants completed the Cq and daily recoding of their dietary intake using the web-based eaTracker tool. After one week, (T2), students completed the Cq again, participants submitted their daily eaTracker logs and staff measured their height and weight. Test-retest reliability of the self-reported (SR) weight status and dietary intake measures at T1 and T2, and the concurrent validity of the objectively measured and SR weight status and dietary intake measures at T2 were examined using intraclass correlation coefficients (ICC). RESULTS: Test-retest reliability for SR height (ICC 0.96), weight (ICC 0.99), and BMI (ICC 0.95) are considered substantial. The concurrent validity for SR height (ICC 0.88), weight (ICC 0.95), and BMI (ICC 0.84) are also considered substantial. The test-retest reliability for SR dietary intake for fruits and vegetables (ICC 0.68) and milk and alternatives (ICC 0.69) are considered moderate, whereas meat and alternatives (ICC 0.41), and grain products (ICC 0.56) are considered fair. The concurrent validity for SR dietary intake identified that fruits and vegetables (ICC 0.53), milk and alternatives (ICC 0.60), and grain products (ICC 0.41) are considered fair, whereas meat and alternatives (ICC 0.34) was considered slight. CONCLUSIONS: While the test-retest reliability of the measures used in this study were all high, the concurrent validity of the measures was considered acceptable. The results support the use of the self-reported COMPASS weight status and dietary intake measures for use in research where objective measures are not possible.

Food and eating environments: in Canadian schools.

PURPOSE: This national study was conducted to examine healthy eating programs, healthy eating education, and the food retail environments of schools. METHODS: A total of 436 Canadian schools were studied. Administrators completed a questionnaire designed to assess school healthy eating programs, healthy eating education, and food retail environment. The number of chain fast food restaurants, chain cafés/coffee shops, and convenience stores within 1 km of schools was measured using geographic information systems food retailer measures from DMTI Spatial Inc. and the Yellow Pages. RESULTS: During the preceding year, 67% of schools had initiated healthy eating lunch programs while 18% had junk food-free days. The majority of schools offered cooking classes (59%) and healthy eating media literacy education (67%), while a minority offered gardening activities (15%) and field trips to farmers' markets (27%) and grocery stores (36%). Fifty-three percent had a school cafeteria, and most had a school tuck shop (75%) and pop/juice vending machines (76%). Fifty percent had a chain fast food restaurant, 33% had a chain café/coffee shop, and 41% had a convenience store within 1 km. CONCLUSIONS: An important aspect of addressing childhood obesity will be improving the food environments of schools and their surrounding neighbourhoods, and providing healthy eating education for all students.