[Show abstract][Hide abstract] ABSTRACT: Few studies consider how risk factors within multiple levels of influence operate synergistically to determine childhood obesity. We used recursive partitioning analysis to identify unique combinations of individual, familial, and neighborhood factors that best predict obesity in children, and tested whether these predict 2-year changes in body mass index (BMI).
Data were collected in 2005-2008 and in 2008-2011 for 512 Quebec youth (8-10 years at baseline) with a history of parental obesity (QUALITY study). CDC age- and sex-specific BMI percentiles were computed and children were considered obese if their BMI was ≥95(th) percentile. Individual (physical activity and sugar-sweetened beverage intake), familial (household socioeconomic status and measures of parental obesity including both BMI and waist circumference), and neighborhood (disadvantage, prestige, and presence of parks, convenience stores, and fast food restaurants) factors were examined. Recursive partitioning, a method that generates a classification tree predicting obesity based on combined exposure to a series of variables, was used. Associations between resulting varying risk group membership and BMI percentile at baseline and 2-year follow up were examined using linear regression.
Recursive partitioning yielded 7 subgroups with a prevalence of obesity equal to 8%, 11%, 26%, 28%, 41%, 60%, and 63%, respectively. The 2 highest risk subgroups comprised i) children not meeting physical activity guidelines, with at least one BMI-defined obese parent and 2 abdominally obese parents, living in disadvantaged neighborhoods without parks and, ii) children with these characteristics, except with access to ≥1 park and with access to ≥1 convenience store. Group membership was strongly associated with BMI at baseline, but did not systematically predict change in BMI.
Findings support the notion that obesity is predicted by multiple factors in different settings and provide some indications of potentially obesogenic environments. Alternate group definitions as well as longer duration of follow up should be investigated to predict change in obesity.
International Journal of Behavioral Nutrition and Physical Activity 12/2015; 12(1). DOI:10.1186/s12966-015-0175-7 · 4.11 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
Many systematic reviews have evaluated the effectiveness of interventions to prevent, delay, or decrease frailty symptoms, but no effort has been made to identify, map, and synthesize the findings from reviews across the full spectrum of interventions. Our objectives are to (1) synthesize findings from all existing systematic reviews evaluating interventions for preventing, delaying the onset, or decreasing the burden of frailty symptoms; (2) examine different conceptualizations of frailty that have been used in the development and implementation of interventions; and (3) inform policy by convening a stakeholder dialogue with Canadian health-system leaders.
We will conduct an overview of systematic reviews to identify and synthesize all of the systematic reviews addressing interventions to preventing, delaying the onset, or decreasing the burden of frailty symptoms. To identify relevant systematic reviews, we will conduct database searches for published and grey literature as well as contact key experts and search reference lists of included reviews. Two reviewers will independently review all search results for inclusion and then conceptually map, extract key findings (including the conceptualization/definition of frailty used) and assess the methodological quality of all included reviews. We will then synthesize the findings by producing a ‘gap map’ (i.e. mapping reviews in a matrix according to the interventions and outcomes assessed), and narratively synthesize the key messages across reviews related to type of interventions.
Following the completion of the synthesis, we will use the findings to develop an evidence brief that mobilizes the best available evidence about the problem related to preventing, delaying the onset, or decreasing the burden of frailty symptoms in older adults, policy and programmatic options to address the problem and implementation considerations. The evidence brief will then be used as the input into a stakeholder dialogue, which will engage 18–22 Canadian health-system leaders (including policymakers, health providers, researchers, and other stakeholders) in ‘off-the-record’ deliberations to inform future actions and policymaking.
Systematic review registration
Electronic supplementary material
The online version of this article (doi:10.1186/s13643-015-0110-7) contains supplementary material, which is available to authorized users.
[Show abstract][Hide abstract] ABSTRACT: This study examined individual and collective factors as predictors of change in global diet quality (DQ).
Subjects were 373 older adults (57 % female) aged 68-82 years at recruitment (T1) into the NuAge Cohort Study, and followed for three years. Data were collected by questionnaires, physical performance tests and anthropometric measurements. Diet was assessed at T1 and T4 using three non-consecutive 24-h diet recalls (24HR) and DQ (Canadian Healthy Eating Index), and was computed on the means of the 24HR. DQ change over three years was determined as "DQT4-DQT1". Baseline (T1) measures significantly correlated with DQ at T1 were entered into backward stepwise linear regression analyses along with selected theoretical constructs and controlled for baseline DQ to determine predictors of change in DQ over 3 years.
Among men, education (p = .009) and sensations of hunger (p = .01) were positive predictors of DQ change over time, while DQ at T1 (p < .0001), cognition (p = .003) and social network (p = .019) were negative predictors (adjusted R (2) = 30.4 %). Finally, among women, diet knowledge (p = .044) was a positive predictor of DQ change, while DQ at T1 (p < .0001) and social network (p = .033) were negative predictors of DQ change over 3 years (adjusted R (2) = 24.1 %).
These results can inform dietary intervention programmes targeting gender-specific determinants of diet quality in older adults.
European Journal of Nutrition 07/2015; DOI:10.1007/s00394-015-0986-y · 3.47 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background Walking has been associated with lower depressive symptoms. However, walking may be performed for different purposes and there is uncertainty regarding the optimal amount (duration and frequency) of walking among older adults. Objectives 1) To investigate whether walking for fitness purposes and walking for purposes other than fitness are differentially associated with depressive symptoms; 2) to investigate the effect of amounts of walking. Methods Participants (n = 436) were older adults from the VoisiNuAge Study. Regression analyses examined whether fitness walking and walking for purposes other than fitness were differentially associated with depressive symptoms, independent of physical activity other than walking, socio-demographic variables, stressful events, number of chronic illnesses, and neighborhood variables. For both fitness walking and walking for other purposes, three amounts of walking were investigated: moderate (≥30 min, ≥ 3 days a week), high (≥30 min, ≥ 5 days a week), and very high (≥30 min, 7 days a week) amounts of walking. Analyses were stratified by amounts of walking. Results Walking for fitness purposes, but not walking for purposes other than fitness, was significantly associated with lower depressive symptoms. However, the association between fitness walking and lower depressive symptoms was statistically significant when amount of walking was moderate or high but not when walking amount was very high. Discussion Walking is not necessarily associated with depressive symptoms per se: Rather, the joint influence of purposes and amounts of walking must be taken into account.
Mental Health and Physical Activity 02/2015; 8. DOI:10.1016/j.mhpa.2015.02.001
[Show abstract][Hide abstract] ABSTRACT: Objective:
To examine the degree of awareness and understanding of a multimedia communication campaign (WIXX) aimed at promoting physical activity among tweens (9-13years old) during the early phases of campaign implementation.
This study adopted a repeated posttest-only design. Two cross-sectional web-based surveys were conducted in Québec, Canada, among tweens three (T1; N=400) and nine (T2; N=403) months after the launch of the campaign in 2012. The activities of the WIXX campaign included website development, community events and paid advertisements. Recall, recognition and understanding of the campaign were the three outcomes. Logistic regression analyses were conducted to examine factors associated with the assessed outcomes.
The likelihood of having unaided/aided recall (OR=0.7; 95%CI: 0.5, 0.9) rather than no recall decreased between T1 and T2. A significant sex∗survey period interaction effect was observed for recall (p=.04). Tweens were also less likely to recognize the WIXX advertisements at T2 (OR=0.6; 95%CI: 0.5, 0.9) and a significant school grade∗survey period interaction was observed for recognition (p=.002).
The likelihood of recall and recognition decreased across survey periods. Girls were generally more likely to be aware of the WIXX multimedia campaign. Further efforts are required to maintain and increase awareness of WIXX among tweens.
Preventive Medicine 12/2014; 69. DOI:10.1016/j.ypmed.2014.10.018 · 3.09 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background:
Few international studies examine public bicycle share programs (PBSP) health impacts. We describe the protocol for the International Bikeshare Impacts on Cycling and Collisions Study (IBICCS).
A quasi-experimental non-equivalent groups design was used. Intervention cities (Montreal, Toronto, Boston, New York and Vancouver) were matched to control cities (Chicago, Detroit, and Philadelphia) on total population, population density, cycling rates, and average yearly temperature. The study used three repeated, cross-sectional surveys in intervention and control cities in Fall 2012 (baseline), 2013 (year 1), and 2014 (year 2). A non-probabilistic online panel survey with a sampling frame of individuals residing in and around areas where PBSP are/would be implemented was used. A total of 12,000 respondents will be sampled. In each of the 8 cities 1000 respondents will be sampled with an additional 4000 respondents sampled based on the total population of the city. Survey questions include measures of self-rated health, and self-reported height and weight, knowledge and experience using PBSP, physical activity, bicycle helmet use and history of collisions and injuries while cycling, socio-demographic questions, and home/workplace locations. Respondents could complete questionnaires in English, French, and Spanish. Two weights will be applied to the data: inverse probability of selection and post-stratification on age and sex.A triple difference analysis will be used. This approach includes in the models, time, exposure, and treatment group, and interaction terms between these variables to estimate changes across time, between exposure groups and between cities.
There are scientific and practical challenges in evaluating PBSP. Methodological challenges included: appropriate sample recruitment, exchangeability of treatment and control groups, controlling unmeasured confounding, and specifying exposure. Practical challenges arise in the evaluation of environmental interventions such as a PBSP: one of the companies involved filed for bankruptcy, a Hurricane devastated New York City, and one PBSP was not implemented. Overall, this protocol provides methodological and practical guidance for researchers wanting to study PBSP impacts on health.
BMC Public Health 10/2014; 14(1):1103. DOI:10.1186/1471-2458-14-1103 · 2.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Simultaneously advocating for sustainable development and promoting population health seems synergistic but few integrated interventions have been studied. We developed a logic model for the Montréal Quartiers 21 Program and assessed awareness of the Program among Montreal residents.
The Lancet 10/2014; 384:S15. DOI:10.1016/S0140-6736(14)61878-X · 45.22 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Accessibility to services and amenities is related to social participation in older adults. However, the mechanisms underlying this association are not clear. Transit use and walking may be potential mediating variables. The aim of this study was to investigate whether frequency of transit use and frequency of walking mediated the relationship between accessibility to services and amenities conducive to social participation (SACSP) and social participation itself among a sample of older adults. Participants were 519 older adults from the VoisiNuAge study. Multiple mediation and separate mediation analyses were conducted to investigate whether frequency of transit use and frequency of walking mediated the association between accessibility to SACSP and social participation, controlling for sociodemographic variables. Results showed that transit use was a significant mediator in multiple and separate mediation analyses. Walking frequency was not a significant mediator in multiple mediation analyses, and conflicting results were observed for separate mediation analyses involving walking. We conclude that the association between accessibility to SACSP and social participation seems to be partly mediated by transit use, but results involving walking should be interpreted cautiously.
[Show abstract][Hide abstract] ABSTRACT: Objective:
This study examines associations between area deprivation and perceived neighbourhood safety with active transport to school among preadolescents living in urban Quebec.
A sample of 809 preadolescents aged 9 to 13 years and one each of their parents living in urban Quebec were recruited by a polling firm for a telephone interview about the Opération WIXX multimedia communication campaign. Opération WIXX was launched in 2012 by Québec en forme to promote physical activity among preadolescents. Logistic regression models predicted active transportation to school (as reported by both the child and his or her parent) from area-level material and social deprivation and from parental and children's perceptions of neighbourhood safety while controlling for socio-demographic variables.
Child and parental reports of active commuting to school were highly concordant (Kendall's tau=0.70, p<0.001). Children whose parents felt at ease to let their children actively commute to school (OR=1.75, 95% CI 1.25-2.45; p=0.001) and who lived in areas characterized by the highest material (OR=2.02, 95% CI 1.09-3.76; p=0.026) and social (OR=3.69, 95% CI 2.12-6.42; p<0.001) deprivation were more likely to report actively commuting to school. Parents who felt at ease to let their children actively commute to school (OR=1.60, 95% CI 1.15-2.21; p=0.005) and who lived in neighbourhoods characterized by a higher social deprivation (OR=1.70, 95% CI 1.04-2.79; p=0.036, OR=2.01, 95% CI 1.23-3.29; p=0.006, OR=2.72, 95% CI 1.59-4.63; p<0.001) were more likely to report that their child actively commuted to school.
Active commuting to school is associated with parental perceptions of safety and area deprivation.
[Show abstract][Hide abstract] ABSTRACT: This natural experiment examines the effect of a public bicycle share program on cognitions and investigates the moderating influence of socioeconomic status on this effect. Two cross-sectional population-based surveys were conducted. Intention and self-efficacy to use the public bicycle share program were assessed by questionnaire. A difference-in-differences approach was adopted using logistic regression analyses. A significant effect of the public bicycle share program was observed on intention (exposure × time; odds ratio = 3.41; 95% confidence interval: 1.50-7.73) and self-efficacy (exposure; odds ratio = 1.61; 95% confidence interval: 1.28-2.01). A positive effect on intention was observed among individuals with low income (exposure × time; odds ratio = 27.85; 95% confidence interval: 2.51-309.25). Implementing a public bicycle share program is associated with increases in intention and self-efficacy for public bicycle share use, although some social inequalities persist.
Journal of Health Psychology 08/2014; DOI:10.1177/1359105314542820 · 1.22 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background Childhood poverty is associated with poorer food consumption but longitudinal data are limited. The objective was to assess if food consumption differs depending on age (6, 7, 10 and 12 years) and pattern of poverty.
Methods Participants were from the 1998–2010 ‘Quebec Longitudinal Study of Child Development’ birth cohort. Poverty was defined as income below the low-income thresholds established by Statistics Canada which adjusts for household size and geographic region. Multiple imputation was used for missing data, and latent class growth analysis identified poverty trajectories. Multivariable ordinal logistic regression assessed the association between poverty and greater consumption of milk, cheese, fruits, vegetables, sweets and sugar-sweetened beverages (SSB).
Results Four poverty trajectories were identified: 1 reference category (stable non-poor) and 3 higher-risk categories (stable poor, increasing and decreasing risk). The probability of more frequent consumption was lower among children from stable poor households compared to children from stable non-poor households for fruit (6, 10 and 12 years), milk and vegetables (6, 7, 10 and 12 years) but was higher for SSB (10 and 12 years). Among children from increasing and decreasing poverty households compared to stable non-poor households, the probability of greater consumption of fruits and vegetables was lower and greater consumption of SSB was higher by the age of 12 years.
Conclusions While experiencing continual exposure to poverty has detrimental effects on food consumption throughout childhood, the association for milk, fruits and vegetables does not differ across age. Intermittent exposure to poverty may also have long-lasting effects.
Journal of Epidemiology & Community Health 06/2014; 68(10). DOI:10.1136/jech-2014-203951 · 3.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background:
Favorable public opinion and support for policies are essential to favor the sustainability of environmental interventions. This study examined public perceptions and support for active living policies associated with implementing a public bicycle share program (PBSP).
Two cross-sectional population-based telephone surveys were conducted in 2009 and 2010 among 5011 adults in Montréal, Canada. Difference-in-differences analyses tested the impact of the PBSP on negative perceptions of the impact of the PBSP on the image of the city, road safety, ease of traveling, active transportation, health, and resistance to policies.
People living closer to docking stations were less likely to have negative perceptions of the effect of the PBSP on the image of the city (OR = 0.5; 95% CI, 0.4-0.8) and to be resistant to policies (OR = 0.8; 95% CI, 0.6-1.0). The likelihood of perceiving negative effects on road safety increased across time (OR = 1.4; 95% CI, 1.2-1.8). Significant interactions were observed for perceptions of ease of traveling (OR = 0.5; 95% CI, 0.4-0.8), active transportation (OR = 0.6; 95% CI, 0.4-1.0), and health (OR = 0.6; 95% CI, 0.4-0.8): likelihood of negative perceptions decreased across time among people exposed.
Findings indicate that negative perceptions were more likely to abate among those living closer to the PBSP.
Journal of physical activity & health 06/2014; 12(4). DOI:10.1123/jpah.2013-0206 · 1.95 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
Two thirds of the U.S. population is overweight or obese, but those living in poverty are disproportionately affected. Although 30%−50% of Americans report currently trying to lose weight, some strategies may be counterproductive. Little is known about how income may be associated with weight-loss strategies.
This study aims to determine the association between income and weight-loss strategies in the general U.S. population.
Cross-sectional data from the National Health and Nutrition Examination Survey were collected in 1999−2010 and analyzed in 2012. Annual household income was categorized as <$20,000, $20,000−$44,999, $45,000−$74,999, ≥$75,000 (ref). Analyses were stratified by age (youth: aged 8−19 years, n=3,184; adults: aged ≥20 years, n=5,643) and included sampling weights. Multivariable logistic regression assessed the likelihood of using specific strategies and utilizing strategies consistent with recommendations (such as exercising or reducing fat or sweets) and inconsistent (such as skipping meals or fasting) and adjusted for gender, age, ethnicity, and whether the person was overweight or obese. Analyses among adults were also adjusted for marital status and education.
Compared to the ref, both youth and adults with household income <$20,000/year were 33% (95% CI=0.5, 0.9) and 50% (95% CI=0.4, 0.6) less likely to use strategies consistent with recommendations to lose weight, respectively. Youth from households with income <$20,000/year were 2.5 times (95% CI=1.8, 3.5) more likely to use inconsistent strategies, but this association was not observed among adults.
Stronger efforts to emphasize weight-loss strategies consistent with recommendations and the distinction between consistent and inconsistent strategies are needed, especially among lower socioeconomic groups.
American Journal of Preventive Medicine 06/2014; 46(6):585–592. DOI:10.1016/j.amepre.2014.01.022 · 4.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: DNA methylation allows for the environmental regulation of gene expression and is believed to link environmental stressors to such mental-illness phenotypes as eating disorders. Numerous studies have shown an association between Bulimia Nervosa (BN) and variations in Brain-Derived Neurotrophic Factor (BDNF). BDNF has also been linked to Borderline Personality Disorder (BPD) and to such traits as reward dependence. We examined the extent to which BDNF methylation corresponded to bulimic or normal-eater status, and also to presence of comorbid Borderline Personality Disorder (BPD) and childhood abuse. Our sample consisted of 64 women with BN and 32 normal-eater (NE) control women. Participants were assessed for eating-disorder symptoms, comorbid psychopathology, and childhood trauma, and then provided blood samples for methylation analyses. We observed a significant site x group (BN vs. NE) interaction indicating that women with BN showed increases in methylation at specific regions of the BDNF promoter. Furthermore, examining effects of childhood abuse and BPD, we observed significant site x group interactions such that groups composed of individuals with childhood abuse or BPD had particularly high levels of methylation at selected CpG sites. Our findings suggest that BN, especially when co-occurring with childhood abuse or BPD, is associated with a propensity towards elevated methylation at specific BDNF promoter region sites. These findings imply that hypermethylation of the BDNF gene may be related to eating disorder status, developmental stress exposure, and comorbid psychopathology.
Progress in Neuro-Psychopharmacology and Biological Psychiatry 05/2014; 54. DOI:10.1016/j.pnpbp.2014.04.010 · 3.69 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Birth Preparedness and Complication Readiness (BPCR) interventions are widely promoted by governments and international agencies to reduce maternal and neonatal health risks in developing countries; however, their overall impact is uncertain, and little is known about how best to implement BPCR at a community level. Our primary aim was to evaluate the impact of BPCR interventions involving women, families and communities during the prenatal, postnatal and neonatal periods to reduce maternal and neonatal mortality in developing countries. We also examined intervention impact on a variety of intermediate outcomes important for maternal and child survival.
We conducted a systematic review and meta-analysis of randomized trials of BPCR interventions in populations of pregnant women living in developing countries. To identify relevant studies, we searched the scientific literature in the Pubmed, Embase, Cochrane library, Reproductive health library, CINAHL and Popline databases. We also undertook manual searches of article bibliographies and web sites. Study inclusion was based on pre-specified criteria. We synthesised data by computing pooled relative risks (RR) using the Cochrane RevMan software.
Fourteen randomized studies (292 256 live births) met the inclusion criteria. Meta-analyses showed that exposure to BPCR interventions was associated with a statistically significant reduction of 18% in neonatal mortality risk (twelve studies, RR = 0.82; 95% CI: 0.74, 0.91) and a non-significant reduction of 28% in maternal mortality risk (seven studies, RR = 0.72; 95% CI: 0.46, 1.13). Results were highly heterogeneous (I2 = 76%, p < 0.001 and I2 = 72%, p = 0.002 for neonatal and maternal results, respectively). Subgroup analyses of studies in which at least 30% of targeted women participated in interventions showed a 24% significant reduction of neonatal mortality risk (nine studies, RR = 0.76; 95% CI: 0.69, 0.85) and a 53% significant reduction in maternal mortality risk (four studies, RR = 0.47; 95% CI: 0.26, 0.87).Pooled results revealed that BPCR interventions were also associated with increased likelihood of use of care in the event of newborn illness, clean cutting of the umbilical cord and initiation of breastfeeding in the first hour of life.
With adequate population coverage, BPCR interventions are effective in reducing maternal and neonatal mortality in low-resources settings.
[Show abstract][Hide abstract] ABSTRACT: DNA methylation allows for the environmental regulation of gene expression and is believed to link environmental stressors to such mental-illness phenotypes as eating disorders. Numerous studies have shown an association between bulimia nervosa (BN) and variations in brain-derived neurotrophic factor (BDNF). BDNF has also been linked to borderline personality disorder (BPD) and to such traits as reward dependence. We examined the extent to which BDNF methylation corresponded to bulimic or normal-eater status, and also to the presence of comorbid borderline personality disorder (BPD) and childhood abuse. Our sample consisted of 64 women with BN and 32 normal-eater (NE) control women. Participants were assessed for eating-disorder symptoms, comorbid psychopathology, and childhood trauma, and then they were required to provide blood samples for methylation analyses. We observed a significant site × group (BN vs. NE) interaction indicating that women with BN showed increases in methylation at specific regions of the BDNF promoter. Furthermore, examining effects of childhood abuse and BPD, we observed significant site × group interactions such that groups composed of individuals with childhood abuse or BPD had particularly high levels of methylation at selected CpG sites. Our findings suggest that BN, especially when co-occurring with childhood abuse or BPD, is associated with a propensity towards elevated methylation at specific BDNF promoter region sites. These findings imply that hypermethylation of the BDNF gene may be related to eating disorder status, developmental stress exposure, and comorbid psychopathology.
Progress in Neuro-Psychopharmacology and Biological Psychiatry 01/2014; 54:43–49. · 3.69 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: 1) To describe grassroots projects aimed at the built environment and associated with active transportation on the Island of Montreal; and 2) to examine associations between the number of projects and indicators of neighbourhood material and social deprivation and the built environment.
We identified funding agencies and community groups conducting projects on built environments throughout the Island of Montreal. Through website consultation and a snowballing procedure, we inventoried projects that aimed at transforming built environments and that were carried out by community organizations between January 1, 2006, and November 1, 2010. We coded and validated information about project activities and created an interactive map using Geoclip software. Correlational analyses quantified associations between number of projects, neighbourhood characteristics and deprivation.
A total of 134 community organizations were identified, and 183 grassroots projects were inventoried. A large number of projects were aimed at increasing awareness of/improving active or public transportation (n=95), improving road safety (n=84) and enhancing neighbourhood beautification and greening (n=69). The correlation between the presence of projects and the extent of neighbourhood material deprivation was small (Kendall's t=0.26, p<0.001), but in areas with greater social deprivation there were more projects (Kendall's t=0.38, p<0.001). Larger numbers of projects were also associated with the presence of more extensive land-use mix (Kendall's t=0.23, p<0.001) and a greater proportion of road intersections with injured pedestrians, cyclists and motor vehicle users (Kendall's t=0.43, p<0.001).
There is significant community mobilization around built environments and active transportation. Investigations of the implementation processes and impacts are warranted.