Background: Outdoor Loose Parts Play (OLPP) has been recognized for its potential to support children's fundamental movement skills (FMS) and physical activity (PA). However, few researchers have explored its association in after-school settings or observed how different outdoor spaces may influence these outcomes. Purpose: We observed patterns of children's FMS and PA across two after-school programs with varied outdoor spaces in Nova Scotia, Canada, following an OLPP intervention. We also explored how types of loose parts and fixed features were associated with specific FMS and PA intensities. Methods: Using a multi-site case study approach, behavioral mapping was conducted with children aged 4-12 years pre/post a six-week OLPP intervention. Movements (FMS) were recorded using the Movement Observations during Play (MOP) measure, and PA intensities were recorded using the Children's Activity Rating Scale (CARS). Proportions of FMS, PA intensities, and environmental interactions (LP and fixed features) pre-post were explored using descriptive analyses and McNemar's test (p < 0.05). Logistic regression examined how interaction with LP and fixed features was associated with the likelihood of observing different movements and PA intensities. Results: Pre-post patterns differed by site. At Site A (larger, suburban, natural outdoor space, pre-existing OLPP), a higher proportion of stability skills were observed, while PA intensity remained unchanged. At Site B (smaller, urban, manufactured outdoor space, limited prior OLPP), a higher proportion of object control skills and moderate-intensity PA were observed. Across both sites, loose manufactured and loose natural materials were more likely to include object control skills, while fixed natural features were more likely to include stability skills. Conclusion: OLPP was associated with site-specific patterns. Findings suggest that LP types and fixed feature affordances may shape opportunities for different movements and PA intensities. These findings can inform educators and policymakers in designing outdoor play spaces that optimize children's movement opportunities.

Background: Healthcare delivery incurs substantial economic and environmental costs, notably greenhouse gas emissions, which contribute to the climate crisis. Approximately 5% of Canada’s total anthropogenic greenhouse gas emissions originate from the health sector, with surgery, anaesthesia, and food services identified as emission hotspots. Despite food systems accounting for approximately 34% of anthropogenic greenhouse gas emissions, characterization of those arising from hospital food provisioning remains limited. Methods: Patient meal-ordering data (December 2023-November 2024) were extracted from CBORD, a digital inpatient meal management system, from five hospital sites in Nova Scotia, Canada. Meals were disaggregated into unique ingredients using specified recipes, and food masses were mapped to farm-to-fork global warming impact intensities using a Canadian-specific life cycle inventory database. Monthly global warming impacts were standardized per patient bed-day. A scenario analysis was used to model the impact of replacing beef with an equivalent mass of chicken. Findings: Approximately 81 tonnes of food flowed through these hospitals monthly, whose provision resulted in an average of 8·7 kgCO₂e global warming impact contributions per patient bed-day. Replacing beef with chicken could reduce impacts by 2·1 kgCO₂e per patient bed-day, representing a 20-30% reduction from a single protein substitution. Interpretation: Hospital food services present a practical opportunity for healthcare decarbonization. By identifying high-impact foods and modelling feasible substitutions, this study provides a foundation to support low-carbon dietary strategies in Nova Scotia and beyond.

Daniel G. Rainham and Sean D. Christie from Dalhousie University and Nova Scotia Health discuss the key areas where efforts should be directed to reduce the environmental impact of healthcare. The climate crisis presents a monumental challenge for global health systems, which paradoxically are significant contributors to environmental degradation. The transition to low-carbon healthcare, often called green or sustainable care, is imperative for mitigating the sector’s environmental impact while preserving planetary health and human wellbeing.

Objectives: Greener neighbourhoods may support physical activity; however, it is also important to consider whether greener neighbourhoods are walkable. We assessed whether neighbourhood greenness and walkability were independently and jointly associated with transportational (PATRA) and recreational (PAREC) physical activity among a nationally representative sample of urban-dwelling youth and adults in Canada. Methods: We analyzed repeated cross-sectional data from 132,927 urban-dwelling youth (12-17 years) and adults (>= 18 years) who participated in the Canadian Community Health Survey (2015-2018). To derive an indicator of neighbourhood greenness, for each survey year, we aggregated mean Normalized Difference Vegetation Index (NDVI) values within 2016 dissemination areas. As a proxy for neighbourhood walkability, we used 2016 Canadian Active Living Environments (Can-ALE) metrics. We used weighted linear regressions to examine whether, and the extent to which, neighbourhood NDVI and the Can-ALE index were independently and jointly associated with self-reported and log-transformed PATRA and PAREC, while adjusting for individual and neighbourhood characteristics. Results: Among adults, but not youth, higher NDVI was independently associated with higher PATRA ((3 = 0.2, 95 % CI 0.02, 0.36) and PAREC ((3 = 0.3, 95% CI 0.14, 0.47). Among both youth ((3 = 0.4, 95 % CI 0.21, 0.66) and adults ((3 = 0.3, 95 % CI 0.22, 0.35), NDVI and Can-ALE were jointly associated with PATRA. Conclusion: Living in a neighbourhood that is both greener and more walkable was more strongly associated with higher transportational, but not recreational, physical activity, than either feature alone. These novel findings highlight the importance of designing cities that are both greener and more walkable to promote active living.

Objective:This scoping review aims to characterize evidence on implementation strategies to reduce carbon dioxide equivalent emissions in acute care settings.Introduction:Decarbonizing health care sectors is important for the sustainability of health systems and mitigating greenhouse gas emissions. While evidence on the environmental impacts of health care is growing, there is limited understanding of how interventions to reduce emissions are implemented and what strategies support health care adaptation to reduce emissions.Eligibility criteria:Articles published in English since 1999 will be included if they report on interventions or implementation strategies to reduce carbon dioxide equivalent emissions in acute care settings. Eligible studies may use quantitative, qualitative, or mixed methods and involve any health care professional, staff, clinical specialty, or activity (eg, recycling, anesthesia, prescribing). Studies conducted outside acute care or lacking information related to reducing carbon dioxide equivalent emissions will be excluded.Methods:This review will follow JBI scoping review methodology. MEDLINE (Ovid), Embase (Elsevier), Scopus, and CINAHL (EBSCOhost) will be searched for peer-reviewed articles on emissions reduction in health care. Data will be extracted, synthesized, and categorized using the Expert Recommendations for Implementing Change (ERIC) taxonomy of implementation strategies and the behavior change technique taxonomy. Results will be presented in tables, creating an inventory of intervention types and implementation strategies for reducing emissions in health care. This review will provide a comprehensive overview of strategies for reducing carbon dioxide equivalent emissions in acute care, contributing to efforts to decarbonize health care systems and support climate change mitigation.Review registration:OSF https://osf.io/e8d4r

Purpose: Little research has focused on the potential impact that the environment plays in shaping cardiac rehabilitation (CR) patient sedentary time (ST) and physical activity (PA). To address this, the current study generated daily path areas (DPAs) based on the locations they visited during and after they completed CR. Methods: Patients in CR (n = 66) completed a survey and wore an accelerometer and Global Positioning System receiver for 7 days early (first month), late (last 2 weeks of program), and 3 months after completing CR. Results: Individual DPAs were approximately 24 km2 at baseline and remained stable over time. Location-based analyses showed that most patients’ ST and PA time was spent at home, followed by other residential, commercial, work, and CR locations. However, the time spent in certain locations (eg, parks and recreation locations) fluctuated during and after CR by intensity. Conclusions: CR patient DPA was stable over time. Within this space, they primarily engaged in ST and PA at home. However, when not home, the distribution of location use varied across a number of locations that extended well beyond their neighborhoods. Therefore, proximity to home may not be a barrier for CR patients in relation to their ST and PA.

This study explores how context-specific behavioral economic principles could be employed to tailor interventions to support patients’ efforts to modify day-to-day routines. Using adapted geo-ethnography techniques, interviews collected in-depth descriptions about facilitators and barriers to physical activity (PA), and contexts influencing decisions about day-to-day activities. Data were analyzed using the COM-B model for behavior change and MINDSPACE behavioral economic principles as coding frameworks. Twenty-nine patients (19 men, 10 women) aged 50–79 participated. Findings indicate patients were motivated and capable of increasing PA but were challenged to identify opportunities to adapt day-to-day routines for increasing PA. Patients described disrupting default routines, increasing commitments, changing the messenger, and introducing incentives as potentially useful behavioral economic principles to improve day-to-day decisions about increasing PA. Patients had insight into potential behavioral economic principles, although they were not previously educated, and were valuable partners in developing research and clinic-based behavioral economic intervention strategies.

IntroductionGreenness is considered to be a health-promoting feature of both natural and built environments and has the potential to influence mental health outcomes. However, most studies to date have neglected to address whether greenness differentially affects mental health outcomes for individuals across the socioeconomic spectrum. Our study explored if greenness is a moderating factor in the relationship between socioeconomic status (SES) and mental health using data from the Canadian Longitudinal Study on Aging (CLSA).MethodsA cross-sectional design was used to compare mental health outcomes between individuals with different levels of SES and residential greenness. We used self-rated social standing as a measure of SES and depression score measured using the Centre for Epidemiologic Studies 10-Item Depression Scale (CESD-10) as a measure of mental health. Greenness was measured using the annual maximum Normalized Difference Vegetation Index (NDVI) within a 1,000 m buffer area of participants' residential postal code locations.ResultsThere was a statistically significant moderating effect of greenness for the relationship between self-rated social standing and depression score. As greenness increased, individuals with lower self-rated social standing had the greatest decreases in depression score.DiscussionThe results of our study suggests that targeting greening interventions at individuals and communities with low SES may reduce depressive symptoms overall, as well as decrease socioeconomic inequalities in depression.

Climate change poses significant public health and health system challenges including increased demand for health services due to chronic and acute health impacts from vector-borne diseases, heat-related illness, and injury from severe weather. As climate change worsens, so do its effects on health systems such as increasing severity of weather extremes causing damage to healthcare infrastructure and interference with supply chains. Ironically, health sectors globally are significant contributors to climate change, generating an estimated 5% of global emissions. Achieving “net zero” health systems require large-scale change with shared decision-making to coordinate a pan-Canadian approach to creating climate-resilient and low-carbon healthcare. In this article, we discuss healthcare professionals’ and health leaders’ perceptions of responsibility for practicing and advocating for climate-resilient and low-carbon healthcare in Canada.

Background Misinformation, defined as a claim that is false or misleading, considers information that is both shared with the intention of causing harm, and information that is false with no ill intent. Early attempts to downplay the risk of monkeypox (mpox) by singling out men who have sex with men (MSM) may have had the ill effect of stigmatising this group in discussions online. The aim of this study was to evaluate themes present on Instagram related to the 2022 mpox outbreak under #monkeypox. Specifically, this study sought to determine if the pervasive narratives surrounding the coronavirus disease 2019 (COVID-19) pandemic, particularly related to government mistrust and conspiracy, were penetrating discussions about mpox. Methods A total of 255 posts under #monkeypox (the top 85 posts per day, every 10 days in July 2022) were collected on Instagram. A content analysis approach, which seeks to quantify themes present, was utilised to evaluate themes present in posts under #monkeypox. Results Contrary to previous research investigating public health misinformation online, the majority of posts under #monkeypox were categorised as accurate information (85.9%). Moreover, a surprising number of posts were classified as anti-misinformation (32.9%), whereby users actively worked to debunk false information being shared online related to mpox. Conclusions We hypothesise that early labelling of the disease as one that strictly affects online MSM communities has resulted in the digital community coming together to fact-check and debunk misinformation under #monkeypox on Instagram.

Canada, as one of the largest oil and gas producer in the world, is responsible for large emissions of methane, a powerful greenhouse gas. At low levels, methane is not a direct threat to human health; however, human health is affected by exposure to pollutants co-emitted with methane. The objectives of this research were to estimate and map pollutants emitted by the oil and gas industry, to assess the demographic of the population exposed to oil and gas activities, and to characterize the impact of well density on cardiovascular- and respiratory-related outcomes with a focus on Alberta. We estimated that ~13% and 3% people in Alberta reside, respectively, within 1.5 km of an active well and 1.5 km of a flare. Our analysis suggests that racial and socioeconomic disparities exist in residential proximity to active wells, with people of Aboriginal identity and people with less education being more exposed to active wells than the general population. We found increased odds of cardiovascular-related (1.13–1.29 for low active well density) and respiratory-related (1.07–1.19 for low active well density) outcomes with exposure to wells. Close to 100 countries produce oil and gas, making this a global issue. There is an important need for additional studies from other producing jurisdictions outside the United States.

Women are disproportionately affected by climate change, yet even though mental health and climate change is an emerging field, little research focuses on their mental health. The purpose of this study was to explore young women’s perceptions of climate change, gender, and mental health. A feminist poststructural (FPS) approach guided this research. FPS and discourse analysis were used to explore nine participants’ perceptions of their mental health in relation to the changing climate, and how their experiences were personally, socially, and institutionally constructed. Findings highlight participant relationships to discourses surrounding hopelessness, anxiety, grief and frustration, intersectionality, stereotypes, and gender-based violence (GBV). Study findings supported by broader literature provide recommendations for the discipline of health promotion regarding gender appropriate climate mitigation and adaptation strategies that prioritize and recognize mental health. We urge health promotion to recognize and integrate the fact that climate change amplifies existing inequities into health and climate change policies whenever possible. Climate change and health policies should ensure women are safe and protected before climate driven weather events to prevent instances of GBV. We recommend that health promotion media specialists recognize the dangers and ineffectiveness of fear mongering and attempt to promote climate solutions as opposed to only stories of despair and ecological degradation.

Background: Behavior change interventions are critical for the secondary prevention of cardiovascular disease and for reducing the risk of a repeat event or mortality. However, the effectiveness of behavior change interventions is challenged by a lack of spatiotemporal contexts, limiting our understanding of factors that influence the timing and location in which day-to-day activities occur and the maintenance of behavior change. This study explored how behavior change interventions could incorporate spatiotemporal contexts of patient activities for modifying behaviors. Methods: A mixed-methods approach with adapted geo-ethnography techniques was used to solicit detailed descriptions of patients’ day-to-day routines, including where, when, and how patients spend time. Data were gathered from patients in one cardiac intervention program in Nova Scotia, Canada, from June to September 2021. Results: A total of 29 individuals (19 men and 10 women) between the ages of 45 and 81 and referred to the program after a cardiac event participated. The results show three key findings: (1) most patients exceeded the minimum guidelines of 30 min of daily physical activity but were sedentary for long periods of time, (2) patient time-use patterns are heterogenous and unique to contexts of individual space-time activity paths, and (3) time-use patterns reveal when, where, and how patients spend significant portions of time and opportunities for adapting patients’ day-to-day health activities. Conclusions: This study demonstrates the potential for interventions to integrate tools for collecting and communicating spatial and temporal contexts of patient routines, such as the types of activities that characterize how patients spend significant portions of time and identification of when, where, and how to encourage health-promoting changes in routine activities. Time-use patterns provide insight for tailoring behavior change interventions so that clinic-based settings are generalizable to the contexts of where, when, and how patient routines could be adapted to mitigate cardiovascular risk factors.

The long-term economic viability of modern health care systems is uncertain, in part due to costs of health care at the end of life and increasing health care utilization associated with an increasing population prevalence of multiple chronic diseases. Control of health care spending and sustaining delivery of health care services will require strategic investments in prevention to reduce the risk of disease and its complications over an individual's life course. Behavior change interventions aimed at reducing a range of harmful and risky health-related behaviors including smoking, physical inactivity, excess alcohol consumption, and excess weight, are one approach that has proven effective at reducing risk and preventing chronic disease. However, large-scale efforts to reduce population-level chronic diseases are challenging and have not been very successful at reducing the burden of chronic diseases. A new approach is required to identify when, where, and how to intervene to disrupt patterns of behavior associated with high-risk factors using context-specific interventions that can be scaled. This paper introduces the need to integrate theoretical and methodological principles of health geography and behavioral economics as opportunities to strengthen behavior change interventions for the prevention of chronic diseases. We discuss how health geography and behavioral economics can be applied to expand existing behavior change frameworks and how behavior change interventions can be strengthened by characterizing contexts of time and activity space.

The relationships among neighbourhood greenness, physical activity, and mental health are unclear; therefore, we examined the independent and synergistic associations between neighbourhood greenness and self-rated mental health among a nationally representative sample of urban-dwelling adults in Canada (18-79 years) from the 2007-2019 Canadian Health Measures Survey (n = 12,531). We assessed neighbourhood greenness using the Normalized Difference Vegetation Index within a 500-meter radius of participants' residential postal codes. We measured physical activity using accelerometers and determined adherence to the recommended 150-minutes of moderate-to-vigorous intensity physical activity (MVPA) per week. We used weighted logistic regression models to test whether MVPA guideline adherence was an effect modifier in the association between neighbourhood greenness and self-rated mental health, adjusting for individual and neighbourhood characteristics. Neighbourhood greenness (aOR = 0.89 [0.62, 1.29]) and MVPA adherence (aOR = 1.22 [0.89, 1.69]) were not associated with self-rated mental health, and no interaction were found on the additive (Relative Excess Risk Due to Interaction = -0.45 [-1.24, 0.35], Attributable Proportion = -0.38 [-1.02, 0.26], Synergy Index = 0.28 [0.02, 3.20]) or multiplicative (OR = 0.7 [0.4, 1.3]) scales. Engaging in the recommended amount of MVPA did not change the finding that Canadian adults had similar self-rated mental health regardless of their neighbourhood greenness.

Globally, cancer is a leading cause of death and morbidity and its burden is increasing worldwide. It is established that medical approaches alone will not solve this cancer crisis. Moreover, while cancer treatment can be effective, it is costly and access to treatment and health care is vastly inequitable. However, almost 50% of cancers are caused by potentially avoidable risk factors and are thus preventable. Cancer prevention represents the most cost-effective, feasible and sustainable pathway towards global cancer control. While much is known about cancer risk factors, prevention programs often lack consideration of how place impacts cancer risk over time. Maximizing cancer prevention investment requires an understanding of the geographic context for why some people develop cancer while others do not. Data on how community and individual level risk factors interact is therefore required. The Nova Scotia Community Cancer Matrix (NS-Matrix) study was established in Nova Scotia (NS), a small province in Eastern Canada with a population of 1 million. The study integrates small-area profiles of cancer incidence with cancer risk factors and socioeconomic conditions, to inform locally relevant and equitable cancer prevention strategies. The NS-Matrix Study includes over 99,000 incident cancers diagnosed in NS between 2001 and 2017, georeferenced to small-area communities. In this analysis we used Bayesian inference to identify communities with high and low risk for lung and bladder cancer: two highly preventable cancers with rates in NS exceeding the Canadian average, and for which key risk factors are high. We report significant spatial heterogeneity in lung and bladder cancer risk. The identification of spatial disparities relating to a community's socioeconomic profile and other spatially varying factors, such as environmental exposures, can inform prevention. Adopting Bayesian spatial analysis methods and utilizing high quality cancer registry data provides a model to support geographically-focused cancer prevention efforts, tailored to local community needs.

Background The growth of urban dwelling populations globally has led to rapid increases of research and policy initiatives addressing associations between the built environment and physical activity (PA). Given this rapid proliferation, it is important to identify priority areas and research questions for moving the field forward. The objective of this study was to identify and compare research priorities on the built environment and PA among researchers and knowledge users (e.g., policy makers, practitioners). Methods Between September 2022 and April 2023, a three-round, modified Delphi survey was conducted among two independent panels of international researchers ( n = 38) and knowledge users ( n = 23) to identify similarities and differences in perceived research priorities on the built environment and PA and generate twin ‘top 10’ lists of the most important research needs. Results From a broad range of self-identified issues, both panels ranked in common the most pressing research priorities including stronger study designs such as natural experiments, research that examines inequalities and inequities, establishing the cost effectiveness of interventions, safety and injuries related to engagement in active transportation (AT), and considerations for climate change and climate adaptation. Additional priorities identified by researchers included: implementation science, research that incorporates Indigenous perspectives, land-use policies, built environments that support active aging, and participatory research. Additional priorities identified by knowledge users included: built environments and PA among people living with disabilities and a need for national data on trip chaining, multi-modal travel, and non-work or school-related AT. Conclusions Five common research priorities between the two groups emerged, including (1) to better understand causality, (2) interactions with the natural environment, (3) economic evaluations, (4) social disparities, and (5) preventable AT-related injuries. The findings may help set directions for future research, interdisciplinary and intersectoral collaborations, and funding opportunities.

Objectives Urban greenness has been shown to confer many health benefits including reduced risks of chronic disease, depression, anxiety, and, in a limited number of studies, loneliness. In this first Canadian study on this topic, we investigated associations between residential surrounding greenness and loneliness and social isolation among older adults. Methods This cross-sectional analysis of the Canadian Longitudinal Study on Aging included 26,811 urban participants between 45 and 86 years of age. The Normalized Difference Vegetation Index (NDVI), a measure of greenness, was assigned to participants’ residential addresses using a buffer distance of 500 m. We evaluated associations between the NDVI and (i) self-reported loneliness using the Center for Epidemiological Studies Depression Scale, (ii) whether participants reported “feeling lonely living in the local area”, and (iii) social isolation. Logistic regression models were used to characterize associations between greenness and loneliness/social isolation while adjusting for individual socio-economic and health behaviours. Results Overall, 10.8% of participants perceived being lonely, while 6.5% reported “feeling lonely in their local area”. Furthermore, 16.2% of participants were characterized as being socially isolated. In adjusted models, we observed no statistically significant difference (odds ratio (OR) = 0.99; 95% confidence interval (CI) 0.93–1.04) in self-reported loneliness in relation to an interquartile range (IQR) increase of NDVI (0.06). However, for the same change in greenness, there was a 15% (OR = 0.85; 95% CI 0.72–0.99) reduced risk for participants who strongly agreed with “feeling lonely living in the local area”. For social isolation, for an IQR increase in the NDVI, we observed a 7% (OR = 0.93; 95% CI 0.88–0.97) reduction in prevalence. Conclusion Our findings suggest that urban greenness plays a role in reducing loneliness and social isolation among Canadian urbanites.

Three industrial facilities (a kraft pulp mill, a tire manufacturing, and a coal-fired power generation plant), have operated in Pictou County, Nova Scotia, Canada for more than 50 years. The local population, including an Indigenous community, has raised concerns for several decades about the environmental and human health impacts of local air and effluent pollution. Numerous studies have reported negative air, water, sediment, and ecological and human health impacts in the region. However, previous studies mainly focused on wastewater effluent discharge from the kraft pulp mill, with only a few studies focused on air pollution. These limited air pollution studies pointed out the pulp mill as the primarily responsible for local emissions of fine particulate matter (PM2.5), but with high levels of uncertainty. This study analyzed hourly and daily PM2.5 concentrations measured at an air quality monitoring station in Pictou (part of the National Air Pollution Surveillance [NAPS] network) between 2004 and 2021. For events of high PM2.5 concentrations (which occurred predominantly in April and May in 2014 and 2015), air masses were tracked using the HYSPLIT model to evaluate if long-range transboundary pollution could have contributed to PM2.5 concentration. Results suggest that the pulp mill was likely the primary source of high PM2.5 concentrations recorded at the Pictou NAPS station. Measured PM2.5 concentrations only met the desirable air quality management concentrations after the pulp mill installed a recovery boiler electrostatic precipitator in October 2015 to reduce PM2.5 emissions.