Increasing rates of physical inactivity and sedentary behaviours among children and the youth are important determinants of chronic disease. Supporting children's participation in organised physical activities like sports has been promoted as a public health strategy to increase physical activity. Evidence shows that successful interventions are family-focused, although research on how parental eating and physical activity behaviours influence children's behaviours is deficient. In this commentary, we argue that interventions for countering physical inactivity and sedentary behaviours should include greater focus on home and social environments, specifically the influence and involvement of parents, siblings, and friends in supporting these health behaviours. We conclude that the design of interventions to prevent chronic diseases in children should also consider more carefully the conditions in which the behaviours of children and their parents occur. This means encouraging parents and children to be active together to address physical inactivity and sedentary behaviours, while being mindful of unintended consequences of focusing on one behaviour over another.

BACKGROUND Meal regularity is associated with many aspects of mental health. However, few studies have examined whether a relationship exists between meal regularity and self-esteem in children. OBJECTIVES The objective of this study was to determine whether an association exists between meal regularity and self-esteem in grade 5 children. METHODS Among 4009 grade 5 students (mean age = 11.0 years ± SEM = 0.006) from the 2011 Children's Lifestyle and School Performance Study (CLASS-II; Nova Scotia, Canada), cross-sectional meal regularity survey data (family supper, supper in front of the television, supper alone, skipping breakfast, and skipping lunch) were collected using the Harvard Youth/Adolescent Food Frequency Questionnaire and examined in relation to self-esteem. Multilevel mixed-effects logistic regression was used to determine the ORs and 95% CIs associated with low self-esteem. Analyses were stratified by sex and adjusted for sociodemographic and lifestyle covariates. RESULTS Compared to children who ate supper in front of the television or alone either never or less than once/week, children had greater odds of low self-esteem if 5 or more times/week they ate supper in front of the television (OR = 1.85; 95% CI, 1.40-2.43) or alone (OR = 4.23; 95% CI, 2.58-6.95). Compared to children who ate family supper 5 or more times/week, children who ate family supper never or less than once/week had greater odds of low self-esteem (OR: 1.97; 95% CI, 1.51-2.56). Skipping breakfast and skipping lunch were associated with greater odds of low self-esteem [OR = 2.92 (95% CI, 1.87-4.57) and OR = 4.82 (95% CI, 2.14-10.87) respectively]. CONCLUSIONS In our study of grade 5 children, all 5 indicators of meal regularity tested are significantly and consistently associated with self-esteem.

INTRODUCTION:Performance measurement has been recognized as key to transforming primary care (PC). Yet, performance reporting in PC lags behind even though high-performing PC is foundational to an effective and efficient health care system.OBJECTIVES:We used administrative data from three Canadian provinces, British Columbia, Ontario and Nova Scotia, to: 1) identify and develop a core set of PC performance indicators using administrative data and 2) examine their ability to capture PC performance.METHODS:Administrative data used included Physician Billings, Discharge Abstract Database, the National Ambulatory Care and Reporting System database, Census and Vital Statistics. Indicators were compiled based on a literature review of PC indicators previously developed with administrative data available in Canada (n=158). We engaged in iterative discussions to assess data conformity, completeness, and plausibility of results in all jurisdictions. Challenges to creating comparable algorithms were examined through content analysis and research team discussions, which included clinicians, analysts, and health services researchers familiar with PC.RESULTS:Our final list included 21 PC performance indicators pertaining to 1) technical care (n=4), 2) continuity of care (n=6), and 3) health services utilization (n=11). Establishing comparable algorithms across provinces was possible though time intensive. A major challenge was inconsistent data elements. Ease of data access, and a deep understanding of the data and practice context, was essential for selecting the most appropriate data elements.CONCLUSIONS:This project is unique in creating algorithms to measure PC performance across provinces. It was essential to balance internal validity of the indicators within a province and external validity across provinces. The intuitive desire of having the exact same coding across provinces was infeasible due to lack of standardized PC data. Rather, a context-tailored definition was developed for each jurisdiction. This work serves as an example for developing comparable PC performance indicators across different provincial/territorial jurisdictions.

Background: Skipping meals is an increasingly common practice to lose weight among North American adults. However, the long-term effect of this practice on incident type 2 diabetes mellitus (T2DM) remains unknown. We assessed whether skipping meals to lose weight is associated with T2DM risk and whether this association is modified by cardiometabolic risk factors. Methods: Skipping meals to lose weight was assessed by questionnaire in 2,288 adults from the 1995 Nova Scotia Health Survey and was linked to administrative health databases to determine T2DM incidence in the following 23 years. Multivariable-adjusted Cox proportional hazards models estimated hazard ratios (aHRs) and 95% confidence intervals (CIs) for T2DM. Results: During follow up, 378 T2DM cases were diagnosed. Compared with participants who did not skip meals to lose weight, those who did (2.2%) had a 125% higher risk of T2DM (aHR, 2.25; 95% CI, 1.31 to 3.86). This associationwas no longer present after further adjustment for baseline body mass index (BMI) (aHR, 1.66; 95% CI, 0.96 to 2.85). Skipping meals to lose weight was associated with T2DM among participants who were men (n=1,135; aHR, 2.09; 95% CI, 1.09 to 4.02) or had a BMI <30 kg/m(2) (n=1,676; aHR, 2.64, 95% CI, 1.15 to 6.06), elevated cholesterol (n=1,146; aHR, 2.11; 95% CI, 1.06 to 4.22), high blood pressure (n=1,133; aHR, 2.10; 95% CI, 1.10 to 4.01) and restless sleep (n=1,186; aHR, 2.19; 95% CI, 1.13 to 4.25), but not among women, those with a BMI of >= 30 kg/m(2) and those without elevated cholesterol, high blood pressure or restless sleep. Conclusions: Skipping meals to lose weight may be a predictive modifiable risk factor for developing T2DM over time, potentially working in connection with other T2DM risk factors. (C) 2020 Canadian Diabetes Association.

Eating habits such as skipping breakfast and snacking are increasingly common practices among North American adults; however, their long-term effects on incident coronary heart disease (CHD) outcomes remain unknown. Previous studies of breakfast skipping and/or eating frequency and cardiometabolic risk have suggested plausible biological pathways for either a protective or harmful relationship to exist, especially when other cardiometabolic risk factors such as diabetes, hypertension, and obesity are present. The objectives of this study were to assess whether long-term associations exist between eating habits (skipping breakfast and eating frequency) and incident CHD (hospitalization and mortality risk), and whether these are intensified by the presence of cardiometabolic risk factors. Skipping breakfast (yes/no) and eating frequency (times per day) were assessed via a 24-hour dietary recall in a nationally representative sample of 13,587 adults (aged ≥18 years) in the 2004 Canadian Community Health Survey (CCHS), who were free of CHD and cancer. Data from the CCHS 2.2 were linked to the population-based Discharge Abstract Database and Canadian Mortality Database to determine the incidence of CHD hospitalization and mortality in the subsequent 9 years. Multivariable Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI). During follow-up, 762 cases of CHD hospitalization and mortality were documented. Skipping breakfast was not associated with risk of CHD hospitalization and mortality in all participants together (multivariable-adjusted HR = 1.02, 95% CI: 0.74–1.39) or within baseline risk factor subgroups (hypertension: n = 2472; 0.95, 0.55–1.64; diabetes: n = 826; 1.38, 0.65–2.93; BMI ≥ 30 kg/m2: n = 2942; 1.43, 0.84–2.43). Similarly, no associations were observed between eating frequency and risk of CHD hospitalization and mortality. Skipping breakfast and eating frequency were not associated with either increased or decreased risk of CHD hospitalization and mortality in this cohort of Canadian adults. Nova Scotia Health Research Foundation Development and Innovative Grant and a Nova Scotia Health Authority Research Foundation New Investigator Grant to LEC.

Introduction: Skipping meals is an increasingly common practice to lose weight among North American adults of all bodyweights. However, due to a lack of long-term studies, the long-term effect of skipping meals to lose weight on cardiometabolic health outcomes such as a diagnosis of type 2 diabetes mellitus (T2DM) or incident coronary heart disease (CHD) remains unknown, although previous short-term studies of skipping meals and risk factors for T2DM and CHD have suggested plausible biological pathways for a relationship to exist in either direction, protective or harmful. Hypothesis: We assessed the hypotheses that skipping meals to lose weight was associated with long-term risk of incident T2DM and CHD in the Canadian 1995 Nova Scotia Health Survey (NSHS95), and that these associations were influenced by cardiometabolic risk factors. Methods: Skipping meals to lose weight was assessed via questionnaire in a cohort of 2,898 adults in the NSHS95 and was linked to population-based health care administrative databases to determine incidence of T2DM and/or CHD in the following 23 years. Multivariable Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for T2DM and CHD. Results: During 23 years of follow-up, 430 incident cases of T2DM and 632 incident cases of CHD were diagnosed. Compared to participants who did not skip meals to lose weight, those who did skip meals to lose weight (2.7%) had an 87% higher risk of T2DM (multivariable-adjusted HR=1.87, 95% CI: 1.11-3.17). This association was no longer present after adjustment for baseline body mass index (BMI) (HR=1.42, 0.83-2.42). After stratification by BMI, skipping meals was associated with T2DM among participants who had BMI <25 kg/m 2 (n=1,030; HR=4.42, 1.01-19.30) but not among participants with BMIs of 25-29.9 kg/m 2 (n=1,123; HR=1.07, 0.39-2.96) or 30+ kg/m 2 (n=586; HR=1.21, 0.61-2.39). The multivariable-adjusted (including BMI) association was also present within participants with elevated cholesterol (n=1,450; HR=1.88, 1.00-3.53) and high blood pressure (n=1,363; HR=2.07, 1.11-3.85), but not among those without. No significant association was observed between skipping meals to lose weight and CHD risk before (HR=1.14, 0.67-1.96) or after adjustment for BMI (HR=1.05, 0.61-1.81), or within subgroups. Conclusion: These findings suggest that skipping meals to lose weight may be a predictive modifiable risk factor for developing T2DM over time, especially among people with a BMI <25 kg/m 2 , potentially working in connection or iteration with other T2DM risk factors. With the growing number of popular diets that include skipping meals, future studies are warranted to understand perturbations of potential metabolic consequences.