Perceived Barriers to Physical Activity Among Youth Living in Rural and Urban Canadian Communities: A Nationally Representative Cross-Sectional Study.

BACKGROUND: We used nationally representative data to explore associations among location of residence (rural/urban) and perceived barriers to physical activity (PA) in Canadian youth. METHODS: We analyzed the 2017 Canadian Community Health Survey, Barriers to Physical Activity Rapid Response data for 12- to 17-year-old youth. Nine items from the survey assessing perceived barriers to PA were combined into 3 barrier domains: resources, motivational, and socioenvironmental. The likelihood of reporting barriers to PA based on rural-urban location was examined using survey-weighted binary logistic regression following a model fitting approach. Sociodemographic factors were modeled as covariates and tested in interaction with location. For each barrier domain, we derived the best-fitting model with fewest terms. RESULTS: There were no location-specific effects related to reporting any barrier or motivation-related PA barriers. We found a sex by location interaction predicting the likelihood of reporting resource-related barriers. Rural boys were less likely to report resource-related barriers compared with urban boys (odds ratio [OR] = 0.42 [0.20, 0.88]). Rural girls were more likely to report resource-related barriers compared with boys (OR = 3.72 [1.66, 8.30]). Regarding socioenvironmental barriers, we observed a significant body mass index by location interaction demonstrating that rural youth with body mass index outside the "normal range" showed a higher likelihood of reporting socioenvironmental barriers compared with urban youth (OR = 2.38 [1.32, 4.30]). For urban youth, body mass index was unrelated to reporting socioenvironmental barriers (OR = 1.07 [0.67, 1.71]). CONCLUSION: PA barriers are not universal among Canadian youth. Our analyses highlight the importance of testing interactions in similar studies as well as considering key sociodemographic characteristics when designing interventions.

Work, travel, or leisure: comparing domain-specific physical activity patterns based on rural-urban location in Canada.

BACKGROUND: Physical activity occurs across various domains including leisure/recreation, for transportation, or for work or household reasons. Rural and urban active living environments are characterized by different opportunities for physical activity within each domain which may translate into different patterns of behavior. The aim of this study was to compare rural-urban differences in physical activity across different domains, and explore interactions between sociodemographic factors, physical activity domains, and rurality. METHODS: We used self-reported data collected across three physical activity domains (active transportation, recreation, occupational/household) and relevant sociodemographic variables from the Canadian Community Health Survey. Adjusting for sociodemographic factors, we did two separate cross-sectional analyses: 1) binary logistic regression to determine the odds of reporting any activity in each domain, and 2) ordinary least squares regression using the sub-samples reporting > 0 min per week of activity to compare how much activity was reported in each domain. RESULTS: Our final survey weighted sample of Canadian adults (mean age 47.4 years) was n = 25,669,018 (unweighted n = 47,266). Rural residents were less likely to report any active transportation (OR = 0.59, 95% CI [0.51, 0.67], p < .0001). For recreational physical activity, rural males had lower odds (OR = 0.75, 95% CI [0.67, 0.83], p < .0001) and rural females had higher odds (OR = 1.19, 95% CI [1.08, 1.30], p = .0002) of reporting any participation compared to urban residents. Rural males (OR = 1.90, 95% CI [1.74, 2.07], p < .0001) and females (OR = 1.33, 95% CI [1.21, 1.46], p < .0001) had higher odds of reporting any occupational or household physical activity. CONCLUSIONS: Urban residents tend to participate in more active transportation, while rural residents participate in more occupational or household physical activity. Location-based differences in physical activity are best understood by examining multiple domains and must include appropriate sociodemographic interactions, such as income and sex/gender.

Rural-urban differences in individual and environmental correlates of physical activity in Canadian adults.

Considering interactions between barriers to physical activity, sociodemographic factors, and rurality can support an equity-focused approach to physical activity promotion. In this cross-sectional analysis of the Canadian Community Health Survey Barriers to Physical Activity Rapid Response module, we compared self-reported individual and social-environmental correlates of physical activity between rural and urban residents and explored interactions with sociodemographic factors. Lack of social support was associated with lower odds of meeting physical activity guidelines for rural residents (OR = 0.71 [0.57,0.89], p = 0.003), but not for urban residents (OR = 0.99 [0.84,1.17], p =.931). Limited access to low-cost facilities was associated with lower odds of meeting physical activity guidelines (OR = 0.85 [0.73,0.98], p = 0.030) regardless of location, but was reported more commonly as a barrier by rural males (27.3 % vs 8.6 % urban) and females (30.0 % vs 9.1 % urban). Inadequate social support was associated with lower odds of meeting physical activity guidelines in females (OR = 0.79 [0.66,0.94], p =.009), but not males (OR = 0.99 [0.84,1.17], p =.931). Individual-level barriers such as time, costs, enjoyment, and confidence were associated with meeting physical activity guidelines for both rural and urban residents. Social-environmental factors appear to be the main contributors to physical activity inequities between rural and urban residents. Interventions designed to bolster social connectedness may support physical activity engagement for people living in rural communities.

A Comparison of Meeting Physical Activity and Screen Time Recommendations between Canadian Youth Living in Rural and Urban Communities: A Nationally Representative Cross-Sectional Analysis.

Meeting the physical activity (PA) and recreational screen time recommendations for children and young people is associated with several health benefits. The purpose of this study was to compare the odds of meeting PA and recreational screen time recommendations between the Canadian youth living in urban versus rural communities. We analyzed nationally representative cross-sectional data collected as part of the 2017-2018 cycles of the Canadian Community Health Survey among young people aged 12-17 years. PA and screen time were self-reported. Sex-specific multivariable logistic regression models were used to estimate the odds of meeting individual and combined PA and recreational screen time recommendations by rural and urban status after adjusting for individual, socioeconomic, and seasonal covariates. The odds of meeting the PA recommendation were not statistically significantly different among males (OR = 1.01, 95% CI: 0.86-1.18) or females (OR 1.05, 95% CI: 0.99-1.11) living in urban versus rural communities. The odds of meeting the recreational screen time recommendations were statistically significantly lower among male (OR = 0.71, 95% CI: 0.65-0.77) and female (OR = 0.71, 95% CI: 0.59-0.86) youth living in urban compared to those in rural communities. The odds of meeting the combined PA and screen time recommendations were statistically significantly lower among urban males (OR = 0.75, 95% CI: 0.71-0.81) but not females (OR = 0.82, 95% CI: 0.58-1.15) than those from rural communities. These findings suggest that residential context (i.e., urban versus rural) may have a differential impact on meeting the combined PA and screen time recommendations among the male and female Canadian youth. Future research should investigate these differences using device-based measures.

Barriers to physical activity for adults in rural and urban Canada: A cross-sectional comparison.

BACKGROUND: Individual differences in physical activity behavior are associated with a collection of individual and environmental factors manifesting as barriers to participation. Understanding how barriers to physical activity differ based on sociodemographic characteristics can support identification and elimination of health inequities. OBJECTIVES: To compare the odds of reporting individual and environmental barriers to physical activity in rural and urban adults, and explore interactions between rural-urban location and sociodemographic factors to characterize patterns in barriers to physical activity. DESIGN: Cross-sectional. METHODS: We analyzed the 2017 Canadian Community Health Survey Barriers to Physical Activity Rapid Response, with a final weighted sample of 24,499,462 (unweighted n=21,967). The likelihood of reporting each barrier domain based on rural-urban location was examined using binary logistic regression following a model-fitting approach with sociodemographic characteristics as covariates or interaction terms. RESULTS: Adjusting for sociodemographic factors, rural residents showed 85% higher odds of reporting at least one social or built environmental barrier (OR=1.85 [1.66, 2.07]). Compared to urban residents, rural residents showed significantly higher odds of reporting barriers to facility access (OR=4.15 [3.58, 4.83]) and a lack of social support to be active (OR=1.17 [1.04, 1.32]). Urban residents reported lower preference for physical activity, lower enjoyment of physical activity and lower confidence in their ability to regularly engage in physical activity. Interactions between socioeconomic status and location were identified related to enjoyment and confidence to be active. There was no effect of location on predicting the odds of reporting an individual resource-related variable (e.g., time, energy). CONCLUSIONS: Despite being more likely than urban residents to prefer and enjoy physical activity, rural residents have fewer opportunities and receive less social support to be active. It is important to consider geographic location when characterizing barriers to physical activity and in the development of context-specific health promotion strategies.

Likelihood of meeting physical activity guidelines in rural and urban adults: cross-sectional analysis of the Canadian Community Health Survey.

OBJECTIVES: The goal of this study was to compare the odds of meeting physical activity (PA) guidelines among adults living in rural and urban areas of Canada. METHODS: Data from the 2017 cycle of the Canadian Community Health Survey were analyzed using binomial logistic regression with a sample of 47,266 adults representing a survey-weighted total of 25,669,018. The odds of meeting PA guidelines were determined based on self-reported moderate-to-vigorous PA (<150 min per week or ≥150 min per week). Communities were categorized as urban or rural based on population size and density. Individual-level correlates included in the model were self-identified sex, age, body mass index, highest level of education, household income, perceived health, and sense of belonging to community. RESULTS: Approximately 56.6% of rural and 59.3% of urban adults reported meeting recommended PA levels when location was examined as a sole predictor. The best-fit model adjusted for all individual-level factors showed a significant sex × location interaction. Males in rural communities were more likely to report meeting PA guidelines (odds = 0.90 or 47.4%) than males in urban areas (odds = 0.78 or 43.8%), whereas females living in rural communities (odds = 0.58 or 36.7%) were less likely to report meeting PA guidelines than females in urban areas (odds = 0.65 or 39.4%). CONCLUSION: The association between rural-urban residence and meeting PA guidelines appears to be contingent on self-identified sex differences. Future work should explore how gender- and location-related variables interact to influence self-reported PA engagement.

RéSUMé: OBJECTIFS: Le but de cette étude était de comparer les probabilités de respecter les recommandations en matière d'activité physique (AP) liées à la santé de la population chez les adultes vivant dans les communautés rurales et urbaines du Canada. MéTHODES: Les données du cycle 2017 de l'Enquête sur la santé dans les collectivités canadiennes ont été analysées à l'aide de régressions logistiques binomiales avec un échantillon pondéré de 47 266 participants adultes représentant 25 669 018 adultes. Les probabilités de respecter les lignes directrices de l'AP ont été déterminées en fonction de l'AP modérée à vigoureuse déclarée (<150 minutes par semaine ou ≥150 minutes par semaine) et les communautés ont été classées comme urbaines ou rurales selon la taille et la densité de la population. Les corrélats au niveau individuel inclus dans le modèle étaient les suivants : sexe auto-identifié, âge, indice de masse corporelle, niveau de scolarité le plus élevé, revenu du ménage, état de santé autoévalué et sentiment d'appartenance à la communauté. RéSULTATS: Environ 56,6 % des adultes vivant en milieu rural et 59,3 % des adultes en milieu urbain ont déclaré avoir atteint les niveaux d'AP recommandés lorsque l'emplacement a été examiné comme seul prédicteur de l'activité. Le meilleur modèle après ajustement pour tous les facteurs au niveau individuel a révélé une interaction significative entre les variables sexe x emplacement. Les hommes des communautés rurales étaient plus susceptibles de déclarer respecter les directives d'AP (odds = 0,90 ou 47,4 %) que ceux des zones urbaines (odds = 0,78 ou 43,8 %), tandis que les femmes vivant dans les communautés rurales (odds = 0,58 ou 36,7 %) étaient moins susceptibles de déclarer avoir respecté les directives d'AP par rapport à celles des communautés urbaines (odds = 0,65 ou 39,4 %). CONCLUSION: L'association entre la ruralité d'une communauté et la déclaration des AP semble dépendre des différences sexuelles auto-identifiées. Les travaux futurs devraient explorer comment les variables liées au sexe et au lieu interagissent pour influencer la participation rapportée des Canadiens aux taux AP rapportés.

Sleep Duration and Obesity in Children and Adolescents.

Increased rates of obesity internationally have drawn significant attention. In particular, researchers and practitioners are seeking new information about risk factors for obesity that could be areas for preventive interventions. Given that obesity rates in children and adolescents are increasing worldwide, particular attention to child and adolescent obesity is needed. A large, and growing, body of research indicates that inadequate sleep duration is linked to obesity. The current article reviews the extant literature concerning sleep duration and obesity in children and adolescents by reviewing current theories of obesity as well as available literature specifically evaluating the relationship of obesity and sleep in children and adolescents, including epidemiologic, experimental and intervention research. Overall, our literature review concludes that the relationship between shortened sleep and increased risk for obesity has research support internationally, including in the few Canadian articles available that are discussed in our review.

Nurses who work in rural and remote communities in Canada: a national survey.

BACKGROUND: In Canada, as in other parts of the world, there is geographic maldistribution of the nursing workforce, and insufficient attention is paid to the strengths and needs of those providing care in rural and remote settings. In order to inform workforce planning, a national study, Nursing Practice in Rural and Remote Canada II, was conducted with the rural and remote regulated nursing workforce (registered nurses, nurse practitioners, licensed or registered practical nurses, and registered psychiatric nurses) with the intent of informing policy and planning about improving nursing services and access to care. In this article, the study methods are described along with an examination of the characteristics of the rural and remote nursing workforce with a focus on important variations among nurse types and regions. METHODS: A cross-sectional survey used a mailed questionnaire with persistent follow-up to achieve a stratified systematic sample of 3822 regulated nurses from all provinces and territories, living outside of the commuting zones of large urban centers and in the north of Canada. RESULTS: Rural workforce characteristics reported here suggest the persistence of key characteristics noted in a previous Canada-wide survey of rural registered nurses (2001-2002), namely the aging of the rural nursing workforce, the growth in baccalaureate education for registered nurses, and increasing casualization. Two thirds of the nurses grew up in a community of under 10 000 people. While nurses' levels of satisfaction with their nursing practice and community are generally high, significant variations were noted by nurse type. Nurses reported coming to rural communities to work for reasons of location, interest in the practice setting, and income, and staying for similar reasons. Important variations were noted by nurse type and region. CONCLUSIONS: The proportion of the rural nursing workforce in Canada is continuing to decline in relation to the proportion of the Canadian population in rural and remote settings. Survey results about the characteristics and practice of the various types of nurses can support workforce planning to improve nursing services and access to care.

Associations between Sleep Duration and Indicators of Cardiometabolic Disease in Canadian Children and Adolescents: Analyses of the 2007-2009 Canadian Health Measures Survey.

BACKGROUND: Indicators of cardiometabolic disease-including obesity, hyperinsulinemia, and dyslipidemia-are associated with an increased risk of cardiovascular disease and type 2 diabetes. Rates of obesity and type 2 diabetes in Canadian children and adolescents have increased rapidly in recent years; research exploring modifiable risk factors is critical. Experimental and epidemiological research demonstrates that partial sleep loss is linked with deteriorations in indicators of cardiometabolic health. The objectives of this study are (1) to examine associations between short sleep duration and indicators of cardiometabolic disease in Canadian children and adolescents and (2) to identify determinants of short sleep duration in this population. METHODS: Logistic regression models were developed to examine associations between sleep duration and indicators of cardiometabolic disease and to identify predictors of short sleep duration. RESULTS: Compared with longer sleepers, children and adolescents with short sleep duration had greater odds of being overweight or obese. Sex- and age-stratified analyses indicated that short sleep duration was linked with greater odds of overweight/obesity in boys and adolescents only. Short sleepers did not have greater odds of having hyperinsulinemia, low HDL cholesterol, or high triglycerides. Age was a strong predictor of inadequate sleep duration. CONCLUSION: Future studies should include longitudinal designs that address whether short sleep duration in boys and in adolescents contributes directly to the development of overweight and obesity.