This page has only limited features, please log in for full access.
Background: The importance of daily physical activity is crucial for healthy development during the early years. Currently, a formal written physical activity policy is lacking in Canadian childcare centers, but holds promise for offering consistent physical activity opportunities. With eight recommendations, the Childcare PLAY policy is an evidence-informed, institutional-level document, targeting children’s physical activity, outdoor play, and sedentary time. The purpose of this study was to examine the impact of the Childcare Physical Activity (PLAY) policy on the physical activity and sedentary time of young children (18 months–4 years) in childcare. Methods: Nine childcare centers in London, Ontario participated in the cluster, randomized controlled trial. The centers in the control condition (n = 4) continued their typical daily routines, while the centers in the intervention condition (n = 5) implemented the PLAY policy for eight weeks. To assess physical activity levels, toddlers and preschoolers wore ActiGraph wGT3X-BT accelerometers for five consecutive days during childcare hours, at baseline, mid- and post-intervention, and at the six-month follow-up. Raw accelerometry data were converted to 15 s epochs, and age- and device-specific cut-points were applied. The participants with two or more days of at least 5 h/day of wear-time at baseline, and at one additional time point, were included in the linear mixed-effects models. An adjusted alpha (p< 0.017) was used to account for multiple comparison bias. Results: A total of 148 children (31.92 ± 7.41 months) had valid accelerometry data. The intervention resulted in a significant increase in light physical activity among the participants in the experimental group at the six-month follow-up (+1.07 min/h, an 11.16% increase; p = 0.0017). The intervention did not have a statistically significant effect on the total physical activity, moderate-to-vigorous physical activity, or sedentary time. Conclusions: The findings indicate that the Childcare PLAY policy was effective at increasing the toddlers’ and preschoolers’ light physical activity. This pilot intervention appears promising for supporting some improved movement behaviors among children in childcare settings; however, additional investigations are needed to explore the feasibility and effectiveness with larger and more-diverse samples.
Monika Szpunar; Molly Driediger; Andrew Johnson; Leigh Vanderloo; Shauna Burke; Jennifer Irwin; Jacob Shelley; Brian Timmons; Patricia Tucker. Impact of the Childcare Physical Activity (PLAY) Policy on Young Children’s Physical Activity and Sedentary Time: A Pilot Clustered Randomized Controlled Trial. International Journal of Environmental Research and Public Health 2021, 18, 7468 .
AMA StyleMonika Szpunar, Molly Driediger, Andrew Johnson, Leigh Vanderloo, Shauna Burke, Jennifer Irwin, Jacob Shelley, Brian Timmons, Patricia Tucker. Impact of the Childcare Physical Activity (PLAY) Policy on Young Children’s Physical Activity and Sedentary Time: A Pilot Clustered Randomized Controlled Trial. International Journal of Environmental Research and Public Health. 2021; 18 (14):7468.
Chicago/Turabian StyleMonika Szpunar; Molly Driediger; Andrew Johnson; Leigh Vanderloo; Shauna Burke; Jennifer Irwin; Jacob Shelley; Brian Timmons; Patricia Tucker. 2021. "Impact of the Childcare Physical Activity (PLAY) Policy on Young Children’s Physical Activity and Sedentary Time: A Pilot Clustered Randomized Controlled Trial." International Journal of Environmental Research and Public Health 18, no. 14: 7468.
Background Understanding social media use and digital literacy among young Canadian children is an increasing area of concern, given the importance of digital inclusion for full and informed participation in evolving educational, civic, corporate, social, and economic spaces. Objective The aim of this study was to explore internet and social media knowledge as well as social media use among Canadian children aged between 6 and 10 years. Methods We conducted interview surveys with 42 children aged between 6 and 10 years who participated in an after-school health promotion program in an urban community in Southwestern Ontario to understand their digital literacy skills and social media use. The data were analyzed using both quantitative and qualitative methods. Results Of the 42 children who participated in this study, 24 (57%) reported that they used social media, specifically YouTube (19/24, 79% reported use), Snapchat (16/24, 67% reported use), and Facebook (8/24, 33% reported use). While using social media, children reported sharing personal information, including videos or pictures of themselves (12/24, 50%), videos or pictures of others (8/24, 33%), and their birthday (12/24, 50%), whereas only one-third (9/24, 38%) of the children believed that only close family and friends had access to the content they shared. When reporting on the quality of life in the context of using social media, most (17/24, 71%) children never felt sad, half (12/24, 50%) never had difficulty making new friends, and nearly one-third (7/24, 30%) indicated that they never had difficulty wanting to play outside. Conclusions Owing to the rapidly evolving uptake and use of social media among young Canadians, the implementation of childhood digital health literacy education is vital to best support digital inclusion and well-being in Canada. The findings of our study highlight the need for future research to understand where children receive their digital literacy knowledge from and whether this knowledge is gained through self-directed social media use or observation from other actors, such as parents, siblings, or friends.
Lorie Donelle; Danica Facca; Shauna Burke; Bradley Hiebert; Emma Bender; Stephen Ling. Exploring Canadian Children’s Social Media Use, Digital Literacy, and Quality of Life: Pilot Cross-sectional Survey Study. JMIR Formative Research 2021, 5, e18771 .
AMA StyleLorie Donelle, Danica Facca, Shauna Burke, Bradley Hiebert, Emma Bender, Stephen Ling. Exploring Canadian Children’s Social Media Use, Digital Literacy, and Quality of Life: Pilot Cross-sectional Survey Study. JMIR Formative Research. 2021; 5 (5):e18771.
Chicago/Turabian StyleLorie Donelle; Danica Facca; Shauna Burke; Bradley Hiebert; Emma Bender; Stephen Ling. 2021. "Exploring Canadian Children’s Social Media Use, Digital Literacy, and Quality of Life: Pilot Cross-sectional Survey Study." JMIR Formative Research 5, no. 5: e18771.
The purpose of this study was to assess the impact of deliberate acts of kindness (DAKs) plus access to a stress management booklet (intervention), compared to the booklet alone (control) on the stress-related outcomes of resilience, social interaction anxiety, affect, and mood of undergraduate and graduate students. Participants’ study-related experiences were also explored, as were the types of DAKs. This repeated-measures, randomized controlled trial included 112 students (80 undergraduate and 32 graduate) with 56 in each condition. Four previously validated scales were implemented at baseline, immediate post-intervention, and 3-months post-intervention. A linear mixed effects model was utilized with group and time entered as fixed effects. Content analysis of open-ended question responses and DAKs logs was conducted. The KISS of Kindness II had a statistically significant interaction effect on the intervention group participants’ resilience (p = 0.0099), social anxiety (p = 0.0016), and negative affect (p = 0.0033), but had no significant impact on their positive affect or mood. Intervention participants described improvements in mental wellbeing. DAKs were plentiful (1,542 DAKs, 26 types), and show promise for university-based mental health interventions.
Katie J. Shillington; Andrew M. Johnson; Tara Mantler; Shauna M. Burke; Jennifer D. Irwin. Kindness as an Intervention for Student Social Interaction Anxiety, Resilience, Affect, and Mood: The KISS of Kindness Study II. Journal of Happiness Studies 2021, 1 -31.
AMA StyleKatie J. Shillington, Andrew M. Johnson, Tara Mantler, Shauna M. Burke, Jennifer D. Irwin. Kindness as an Intervention for Student Social Interaction Anxiety, Resilience, Affect, and Mood: The KISS of Kindness Study II. Journal of Happiness Studies. 2021; ():1-31.
Chicago/Turabian StyleKatie J. Shillington; Andrew M. Johnson; Tara Mantler; Shauna M. Burke; Jennifer D. Irwin. 2021. "Kindness as an Intervention for Student Social Interaction Anxiety, Resilience, Affect, and Mood: The KISS of Kindness Study II." Journal of Happiness Studies , no. : 1-31.
The purpose of this study was to investigate Ontario adults' reported sleep quantity, quality, and disturbances during the early months of the COVID-19 pandemic (April–July 2020). As part of a larger, chronic disease-focused, and ongoing longitudinal study designed to explore Ontario adults' health and wellness-related behaviors during the pandemic, participants completed an online survey that included demographic information and the Pittsburgh Sleep Quality Index (PSQI). The PSQI consists of 19 items, one of which is open-ended, designed to assess an individual's quantity, quality, and patterns of sleep on seven domains (ie, subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleep medication, and daytime dysfunction over the last month). Summative content analysis was used to analyze responses to the open-ended question regarding participants' sleep disturbances. This study included 2192 individuals, 85% of whom slept 6+ hours/night. The mean global PSQI score was 7.57, out of a possible 21 (SD = 4.09). The self-reported sleep disturbances of largest concern were: (1) general fear/anxiety/worry (n = 203); (2) children (n = 167); (3) mind wandering/overthinking (n = 118); (4) pain/injury (n = 78); (5) partner (n = 78); and (6) fear/anxiety/stress related to COVID-19 (n = 74). The global PSQI score was indicative of poor sleep quality, and Ontario adults experienced a number of sleep disturbances during early days of the COVID-19 pandemic. These findings are noteworthy as sleep is a crucial component in positive health and wellbeing.
Katie J. Shillington; Leigh M. Vanderloo; Shauna M. Burke; Victor Ng; Patricia Tucker; Jennifer D. Irwin. Not so sweet dreams: adults' quantity, quality, and disruptions of sleep during the initial stages of the COVID-19 pandemic. Sleep Medicine 2021, 1 .
AMA StyleKatie J. Shillington, Leigh M. Vanderloo, Shauna M. Burke, Victor Ng, Patricia Tucker, Jennifer D. Irwin. Not so sweet dreams: adults' quantity, quality, and disruptions of sleep during the initial stages of the COVID-19 pandemic. Sleep Medicine. 2021; ():1.
Chicago/Turabian StyleKatie J. Shillington; Leigh M. Vanderloo; Shauna M. Burke; Victor Ng; Patricia Tucker; Jennifer D. Irwin. 2021. "Not so sweet dreams: adults' quantity, quality, and disruptions of sleep during the initial stages of the COVID-19 pandemic." Sleep Medicine , no. : 1.
Adults and children in Canada are not meeting physical activity guidelines nor consuming sufficient nutrient-rich foods. High engagement in these unhealthy behaviours can lead to obesity and its associated diseases. Parent-child interventions aimed at obesity prevention/treatment have assisted families with making positive changes to their nutrition and physical activity behaviours. Given that the home environment shapes early health behaviours, it is important to target both parents and children when addressing diet and physical activity. One method that has been shown to improve health outcomes is co-active coaching. The current study explored the impact of a three-month co-active coaching and/or health education intervention on the dietary intake and physical activity behaviours of parents with overweight/obesity and their children (ages 2.5–10; of any weight). Body composition (i.e., body mass index [BMI] and waist circumference), changes in parental motivation with respect to physical activity and dietary behaviours, and parental perceptions of program improvements were collected. A concurrent mixed methods study comprised of a randomized controlled trial and a descriptive qualitative design was utilized. Fifty parent-child dyads were recruited and randomly assigned to the control (n = 25) or intervention (n = 25) group. Assessments were completed at baseline, mid-intervention (six weeks), post-intervention (three months), and six-month follow-up. A linear mixed effects model was utilized for quantitative analysis. Inductive content analysis was used to extract themes from parent interviews. No significant results were observed over time for the dependent measures. Parents in both control and intervention groups reported varied program experiences, including developing changes in perspective, increased awareness of habits, and heightened accountability for making positive changes in themselves, and consequently, their families. Parents also shared barriers they faced when implementing changes (e.g., time, weather, stress). Qualitatively, both groups reported benefitting from this program, with the intervention group describing salient benefits from engaging in coaching. This research expands on the utility of coaching as a method for behaviour change, when compared to education only, in parents with overweight/obesity and their children.
Shazya Karmali; Danielle S. Battram; Shauna M. Burke; Anita Cramp; Andrew M. Johnson; Tara Mantler; Don Morrow; Victor Ng; Erin S. Pearson; Robert J. Petrella; Patricia Tucker; Jennifer D. Irwin. Perspectives and Impact of a Parent-Child Intervention on Dietary Intake and Physical Activity Behaviours, Parental Motivation, and Parental Body Composition: A Randomized Controlled Trial. International Journal of Environmental Research and Public Health 2020, 17, 6822 .
AMA StyleShazya Karmali, Danielle S. Battram, Shauna M. Burke, Anita Cramp, Andrew M. Johnson, Tara Mantler, Don Morrow, Victor Ng, Erin S. Pearson, Robert J. Petrella, Patricia Tucker, Jennifer D. Irwin. Perspectives and Impact of a Parent-Child Intervention on Dietary Intake and Physical Activity Behaviours, Parental Motivation, and Parental Body Composition: A Randomized Controlled Trial. International Journal of Environmental Research and Public Health. 2020; 17 (18):6822.
Chicago/Turabian StyleShazya Karmali; Danielle S. Battram; Shauna M. Burke; Anita Cramp; Andrew M. Johnson; Tara Mantler; Don Morrow; Victor Ng; Erin S. Pearson; Robert J. Petrella; Patricia Tucker; Jennifer D. Irwin. 2020. "Perspectives and Impact of a Parent-Child Intervention on Dietary Intake and Physical Activity Behaviours, Parental Motivation, and Parental Body Composition: A Randomized Controlled Trial." International Journal of Environmental Research and Public Health 17, no. 18: 6822.
BACKGROUND Understanding social media use and digital literacy among young Canadian children is an increasing area of concern, given the importance of digital inclusion for full and informed participation in evolving educational, civic, corporate, social, and economic spaces. OBJECTIVE The aim of this study was to explore internet and social media knowledge as well as social media use among Canadian children aged between 6 and 10 years. METHODS We conducted interview surveys with 42 children aged between 6 and 10 years who participated in an after-school health promotion program in an urban community in Southwestern Ontario to understand their digital literacy skills and social media use. The data were analyzed using both quantitative and qualitative methods. RESULTS Of the 42 children who participated in this study, 24 (57%) reported that they used social media, specifically YouTube (19/24, 79% reported use), Snapchat (16/24, 67% reported use), and Facebook (8/24, 33% reported use). While using social media, children reported sharing personal information, including videos or pictures of themselves (12/24, 50%), videos or pictures of others (8/24, 33%), and their birthday (12/24, 50%), whereas only one-third (9/24, 38%) of the children believed that only close family and friends had access to the content they shared. When reporting on the quality of life in the context of using social media, most (17/24, 71%) children never felt sad, half (12/24, 50%) never had difficulty making new friends, and nearly one-third (7/24, 30%) indicated that they never had difficulty wanting to play outside. CONCLUSIONS Owing to the rapidly evolving uptake and use of social media among young Canadians, the implementation of childhood digital health literacy education is vital to best support digital inclusion and well-being in Canada. The findings of our study highlight the need for future research to understand where children receive their digital literacy knowledge from and whether this knowledge is gained through self-directed social media use or observation from other actors, such as parents, siblings, or friends.
Lorie Donelle; Danica Facca; Shauna Burke; Bradley Hiebert; Emma Bender; Stephen Ling. Exploring Canadian Children’s Social Media Use, Digital Literacy, and Quality of Life: Pilot Cross-sectional Survey Study (Preprint). 2020, 1 .
AMA StyleLorie Donelle, Danica Facca, Shauna Burke, Bradley Hiebert, Emma Bender, Stephen Ling. Exploring Canadian Children’s Social Media Use, Digital Literacy, and Quality of Life: Pilot Cross-sectional Survey Study (Preprint). . 2020; ():1.
Chicago/Turabian StyleLorie Donelle; Danica Facca; Shauna Burke; Bradley Hiebert; Emma Bender; Stephen Ling. 2020. "Exploring Canadian Children’s Social Media Use, Digital Literacy, and Quality of Life: Pilot Cross-sectional Survey Study (Preprint)." , no. : 1.
Background: Young children are prone to low levels of physical activity in childcare. This environment, inclusive of equipment, policies, and staff, has been identified as influencing young children’s activity behaviours. To date, no study has examined the feasibility and effectiveness of such policies in Canadian childcare centres, while the provision of physical activity policies in other countries has shown some promise for improving the activity levels of young children. As such, the primary objective of the Childcare PhysicaL ActivitY (PLAY) Policy study is to examine the feasibility of an evidence-based, stakeholder-informed, written physical activity and sedentary time policy for centre-based childcare (i.e., at the institutional level). The secondary objectives are to examine the impact of policy implementation on the physical activity levels and sedentary time of young children, subsequent environmental changes in childcare centres, and childcare providers’ self-efficacy to implement a physical activity policy. This study will examine both policy implementation and individual (behavioural) outcomes. Methods/Design: The Childcare PLAY Policy study, a pilot, cluster-randomized controlled trial, involves the random allocation of childcare centres to either the experimental (n = 4) or control (n = 4) group. Childcare centres in the experimental group will adopt a written physical activity policy for eight weeks (at which time they will be asked to stop enforcing the policy). Physical activity levels and sedentary time in childcare will be assessed via ActiGraph™ accelerometers with measurements at baseline (i.e., week 0), mid-intervention (i.e., week 4), immediately post-intervention (i.e., week 9), and at six-month follow-up. Policy implementation and feasibility will be assessed using surveys and interviews with childcare staff. The Environment and Policy Assessment and Observation Self-Report tool will capture potential changes to the childcare setting. Finally, childcare providers’ self-efficacy will be captured via a study-specific questionnaire. A nested evaluation of the impact of policy implementation on young children’s physical activity levels will be completed. A linear mixed effects models will be used to assess intervention effects on the primary and secondary outcomes. Descriptive statistics and thematic analysis will be employed to assess the feasibility of policy implementation. Discussion: The Childcare PLAY Policy study aims to address the low levels of physical activity and high sedentary time observed in childcare centres by providing direction to childcare staff via a written set of evidence-informed standards to encourage young children’s activity and reduce sedentary time. The findings of this work will highlight specific aspects of the policy that worked and will inform modifications that may be needed to enhance scalability. Policy-based approaches to increasing physical activity affordances in childcare may inform future regulations and programming within this environment.
Patricia Tucker; Molly Driediger; Leigh M. Vanderloo; Shauna M. Burke; Jennifer D. Irwin; Andrew M. Johnson; Jacob Shelley; Brian W. Timmons. Exploring the Feasibility and Effectiveness of a Childcare PhysicaL ActivitY (PLAY) Policy: Rationale and Protocol for a Pilot, Cluster-Randomized Controlled Trial. International Journal of Environmental Research and Public Health 2019, 16, 4400 .
AMA StylePatricia Tucker, Molly Driediger, Leigh M. Vanderloo, Shauna M. Burke, Jennifer D. Irwin, Andrew M. Johnson, Jacob Shelley, Brian W. Timmons. Exploring the Feasibility and Effectiveness of a Childcare PhysicaL ActivitY (PLAY) Policy: Rationale and Protocol for a Pilot, Cluster-Randomized Controlled Trial. International Journal of Environmental Research and Public Health. 2019; 16 (22):4400.
Chicago/Turabian StylePatricia Tucker; Molly Driediger; Leigh M. Vanderloo; Shauna M. Burke; Jennifer D. Irwin; Andrew M. Johnson; Jacob Shelley; Brian W. Timmons. 2019. "Exploring the Feasibility and Effectiveness of a Childcare PhysicaL ActivitY (PLAY) Policy: Rationale and Protocol for a Pilot, Cluster-Randomized Controlled Trial." International Journal of Environmental Research and Public Health 16, no. 22: 4400.
Children’s physical activity levels are higher at the start of outdoor playtime, which suggests that shorter, more frequent play periods might result in greater amounts of daily physical activity. In this extension of the Supporting Physical Activity in the Childcare Environment (SPACE) cluster randomized controlled trial, we explored the impact of four 30-min daily outdoor unstructured play periods on preschoolers’ moderate-to-vigorous-intensity physical activity (MVPA). Experimental childcare centres (n = 6) implemented four 30-min daily outdoor playtimes for 8 weeks, while control centres (n = 6) maintained their two 60-min outdoor sessions. Actical™ accelerometers were used to measure preschoolers’ physical activity pre- and post-intervention for 5 days during childcare hours. Linear mixed effects models were used to determine the impact of the intervention on preschoolers’ MVPA. Of the 185 preschoolers enrolled (54.20% female; mean age = 39.90 months, SD = 7.24), 127 (65 experimental and 62 control) were included in the analysis (30% and 9% loss to follow-up for experimental and control group preschoolers, respectively). No significant differences in MVPA were observed between groups over time (p = 0.36). Preschoolers’ MVPA did not improve after the introduction of shorter outdoor play periods. The loss of data due to wear time noncompliance and participant attrition may have influenced these findings. Trial registration: ISRCTN70604107 (October 8, 2014).
Molly Driediger; Stephanie Truelove; Andrew M. Johnson; Leigh M. Vanderloo; Brian W. Timmons; Shauna M. Burke; Jennifer D. Irwin; Patricia Tucker. The Impact of Shorter, More Frequent Outdoor Play Periods on Preschoolers’ Physical Activity during Childcare: A Cluster Randomized Controlled Trial. International Journal of Environmental Research and Public Health 2019, 16, 4126 .
AMA StyleMolly Driediger, Stephanie Truelove, Andrew M. Johnson, Leigh M. Vanderloo, Brian W. Timmons, Shauna M. Burke, Jennifer D. Irwin, Patricia Tucker. The Impact of Shorter, More Frequent Outdoor Play Periods on Preschoolers’ Physical Activity during Childcare: A Cluster Randomized Controlled Trial. International Journal of Environmental Research and Public Health. 2019; 16 (21):4126.
Chicago/Turabian StyleMolly Driediger; Stephanie Truelove; Andrew M. Johnson; Leigh M. Vanderloo; Brian W. Timmons; Shauna M. Burke; Jennifer D. Irwin; Patricia Tucker. 2019. "The Impact of Shorter, More Frequent Outdoor Play Periods on Preschoolers’ Physical Activity during Childcare: A Cluster Randomized Controlled Trial." International Journal of Environmental Research and Public Health 16, no. 21: 4126.
Background: Recently, our team implemented a 13-week group-based intervention for parents of children with obesity (“C.H.A.M.P. Families”). The primary objective of this study was to explore, qualitatively, parents’ perspectives of their experiences in and influence of C.H.A.M.P. Families, as well as their recommendations for future paediatric obesity treatment interventions. Methods: Twelve parents (seven mothers, five fathers/step-fathers) representing seven children (four girls, three boys) with obesity participated in one of two focus groups following the intervention. Focus groups were audio recorded and transcribed verbatim and data were analyzed using inductive thematic analysis. Results: Findings showed that parents perceived their participation in C.H.A.M.P. Families to be a positive experience. Participants highlighted several positive health-related outcomes for children, families, and parents. Parents also underscored the importance and positive impact of the group environment, specific educational content, and additional program components such as free child-minding. Recommendations for future interventions were also provided, including greater child involvement and more practical strategies. Finally, parents identified several barriers including socioenvironmental issues, time constraints, and parenting challenges. Conclusions: Researchers developing family-based childhood obesity interventions should consider the balance of parent and child involvement, as well as emphasize group dynamics strategies and positive family communication.
Kristen C. Reilly; Daniel Briatico; Jennifer D. Irwin; Patricia Tucker; Erin S. Pearson; Shauna M. Burke. Participants’ Perceptions of “C.H.A.M.P. Families”: A Parent-Focused Intervention Targeting Paediatric Overweight and Obesity. International Journal of Environmental Research and Public Health 2019, 16, 2171 .
AMA StyleKristen C. Reilly, Daniel Briatico, Jennifer D. Irwin, Patricia Tucker, Erin S. Pearson, Shauna M. Burke. Participants’ Perceptions of “C.H.A.M.P. Families”: A Parent-Focused Intervention Targeting Paediatric Overweight and Obesity. International Journal of Environmental Research and Public Health. 2019; 16 (12):2171.
Chicago/Turabian StyleKristen C. Reilly; Daniel Briatico; Jennifer D. Irwin; Patricia Tucker; Erin S. Pearson; Shauna M. Burke. 2019. "Participants’ Perceptions of “C.H.A.M.P. Families”: A Parent-Focused Intervention Targeting Paediatric Overweight and Obesity." International Journal of Environmental Research and Public Health 16, no. 12: 2171.
In Canada, a majority of children and adults are insufficiently active for health gains, and about one in seven children and over 20% of adults are overweight or obese. Overweight and obesity are risk factors for many chronic diseases in both adults and children and can result in lower quality and quantity of life. Children whose parents are overweight or obese are more likely to become overweight themselves. Thus, parent/child interventions are important for reducing obesity and promoting long-term healthy weights among members of the family unit. Programs using Co-Active coaching have resulted in positive behaviour changes among adults with overweight/obesity; however, little research has explored the effects of Co-Active coaching on parents, and the consequent impact on the family unit (i.e. all parents and children in the same household). This protocol paper provides a detailed methodological account of a coaching-based program targeting parent and child dyads, in hopes of enhancing health behaviours within the family unit. Using a randomized controlled trial design, the researchers aim to identify the impact of coaching plus education (intervention) compared to education only (control) on parents with overweight/obesity and their children (ages 2.5–10, of any weight). A total of 50 dyads are being recruited and randomly assigned using a 1:1 ratio into the control or intervention group. The control group receive 6 webinar-based education sessions focused on physical activity and nutrition. The intervention group receive the same education sessions and nine, 20-min telephone-based sessions with a certified coach. Coaching and health education sessions are conducted with the parent/guardian of the dyad. This paper provides a detailed methodological account of this program. The expected findings from this research will advance coaching literature, research, and practice on this topic by determining whether coaching and education are more effective than education alone at producing behaviour changes among a family unit. If proven effective, this approach may be applied more broadly through public health interventionists to parent and child populations in hopes of affecting change with both individuals and their families. ISRCTN ISRCTN69091372 . Retrospectively registered 24 September 2018.
Shazya Karmali; Victor Ng; Danielle Battram; Shauna Burke; Don Morrow; Erin S. Pearson; Patricia Tucker; Tara Mantler; Anita Cramp; Robert Petrella; Jennifer D. Irwin. Coaching and/or education intervention for parents with overweight/obesity and their children: study protocol of a single-centre randomized controlled trial. BMC Public Health 2019, 19, 345 .
AMA StyleShazya Karmali, Victor Ng, Danielle Battram, Shauna Burke, Don Morrow, Erin S. Pearson, Patricia Tucker, Tara Mantler, Anita Cramp, Robert Petrella, Jennifer D. Irwin. Coaching and/or education intervention for parents with overweight/obesity and their children: study protocol of a single-centre randomized controlled trial. BMC Public Health. 2019; 19 (1):345.
Chicago/Turabian StyleShazya Karmali; Victor Ng; Danielle Battram; Shauna Burke; Don Morrow; Erin S. Pearson; Patricia Tucker; Tara Mantler; Anita Cramp; Robert Petrella; Jennifer D. Irwin. 2019. "Coaching and/or education intervention for parents with overweight/obesity and their children: study protocol of a single-centre randomized controlled trial." BMC Public Health 19, no. 1: 345.
Early childhood educators greatly influence young children's physical activity and screen-viewing behaviours in childcare. However, educators have requested additional training in physical activity programming, and one logical place to provide this education is during their pre-service schooling. This study explored the physical activity and screen-viewing-related knowledge, training, and self-efficacy of early childhood education (ECE) candidates across Canada, to determine their confidence and ability to facilitate physical activity opportunities and limit screen-viewing among young children in childcare. Key program personnel at 61 (of 110) Canadian colleges/universities offering an ECE program agreed to participate in this cross-sectional study. An online survey (112 items; 9 domains), developed by experts using the Tailored Design Method, was administered via Qualtrics© to a sample of 1292 ECE candidates. Descriptive statistics, Mann-Whitney U-tests, and chi-square tests were used to report participant demographics and physical activity and screen-viewing-related knowledge (i.e., of physical activity and screen-viewing concepts), training (i.e., physical activity and screen-viewing courses/content received), and self-efficacy (i.e., to facilitate physical activity and limit screen-viewing in childcare) of candidates. ECE candidates exhibited the least amount of knowledge regarding the impact of screen-viewing on physiological outcomes (i.e., blood pressure) in young children. Further, only 32.2 and 26.7% of candidates reported completing physical activity or screen-viewing courses during their post-secondary training, respectively. Candidates who completed one or more physical activity or screen-viewing courses exhibited significantly greater (p <.05) self-efficacy than those without such training related to ensuring children were engaging in adequate moderate-to-vigorous physical activity (MVPA). Confidence to limit screen time did not differ. Candidates reporting meeting national physical activity recommendations (i.e., 150+ minutes of MVPA/week) exhibited significantly greater (p <.05) physical activity-related self-efficacy than those not meeting these guidelines. Findings from this work highlight both the need for and the potential of supplementary physical activity and screen-viewing content in post-secondary ECE programs to benefit candidates' knowledge and self-efficacy in these areas. Introducing this content at the post-secondary level will ensure that all early childhood educators are appropriately trained regarding physical activity and screen-viewing before entering a childcare-based profession, where they can positively influence young children's health behaviours.
Brianne A. Bruijns; Kristi B. Adamo; Shauna M. Burke; Valerie Carson; Jennifer D. Irwin; Patti-Jean Naylor; Brian W. Timmons; Leigh M. Vanderloo; Patricia Tucker. Exploring the physical activity and screen-viewing-related knowledge, training, and self-efficacy of early childhood education candidates. BMC Pediatrics 2019, 19, 5 .
AMA StyleBrianne A. Bruijns, Kristi B. Adamo, Shauna M. Burke, Valerie Carson, Jennifer D. Irwin, Patti-Jean Naylor, Brian W. Timmons, Leigh M. Vanderloo, Patricia Tucker. Exploring the physical activity and screen-viewing-related knowledge, training, and self-efficacy of early childhood education candidates. BMC Pediatrics. 2019; 19 (1):5.
Chicago/Turabian StyleBrianne A. Bruijns; Kristi B. Adamo; Shauna M. Burke; Valerie Carson; Jennifer D. Irwin; Patti-Jean Naylor; Brian W. Timmons; Leigh M. Vanderloo; Patricia Tucker. 2019. "Exploring the physical activity and screen-viewing-related knowledge, training, and self-efficacy of early childhood education candidates." BMC Pediatrics 19, no. 1: 5.
Childhood obesity represents a significant global health challenge, and treatment interventions are needed. The purpose of this paper is to describe the components and theoretical model that was used in the development and implementation of a unique parent-focussed paediatric overweight/obesity intervention. C.H.A.M.P. Families was a single-centre, prospective intervention offered to parents of children aged between 6–14 years with a body mass index (BMI) ≥85th percentile for age and sex. The intervention included: (1) eight group-based (parent-only) education sessions over 13-weeks; (2) eight home-based activities; and (3) two group-based (family) follow-up support sessions. The first section of the manuscript contains a detailed description of each intervention component, as well as an overview of ongoing feasibility analyses. The theoretical portion details the use of evidence-based group dynamics principles and motivational interviewing techniques within the context of a broader social cognitive theory foundation. This paper provides researchers with practical examples of how theoretical constructs and evidence-based strategies can be applied in the development and implementation of parent-focussed paediatric obesity interventions. Given the need for transparent reporting of intervention designs and theoretical foundations, this paper also adds to the areas of implementation science and knowledge translation research.
Kristen C. Reilly; Patricia Tucker; Jennifer D. Irwin; Andrew M. Johnson; Erin S. Pearson; Dirk E. Bock; Shauna M. Burke. “C.H.A.M.P. Families”: Description and Theoretical Foundations of a Paediatric Overweight and Obesity Intervention Targeting Parents—A Single-Centre Non-Randomised Feasibility Study. International Journal of Environmental Research and Public Health 2018, 15, 2858 .
AMA StyleKristen C. Reilly, Patricia Tucker, Jennifer D. Irwin, Andrew M. Johnson, Erin S. Pearson, Dirk E. Bock, Shauna M. Burke. “C.H.A.M.P. Families”: Description and Theoretical Foundations of a Paediatric Overweight and Obesity Intervention Targeting Parents—A Single-Centre Non-Randomised Feasibility Study. International Journal of Environmental Research and Public Health. 2018; 15 (12):2858.
Chicago/Turabian StyleKristen C. Reilly; Patricia Tucker; Jennifer D. Irwin; Andrew M. Johnson; Erin S. Pearson; Dirk E. Bock; Shauna M. Burke. 2018. "“C.H.A.M.P. Families”: Description and Theoretical Foundations of a Paediatric Overweight and Obesity Intervention Targeting Parents—A Single-Centre Non-Randomised Feasibility Study." International Journal of Environmental Research and Public Health 15, no. 12: 2858.
Despite the benefits associated with regular participation in physical activity, individuals with spinal cord injury (SCI) remain insufficiently active. The ability to self-manage participation may increase physical activity levels, but only if self-management interventions can be implemented in the ‘real world’. The purpose of this review was to examine the degree to which authors of published studies of LTPA self-management interventions for individuals with SCI have reported on factors that could increase the likelihood of translating this research into practice. A systematic search of five databases was conducted, yielding 33 eligible studies representing 31 interventions. Each intervention was assessed using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) Framework and the PRECIS-2 (PRagmatic-Explanatory Continuum Indicator Summary) tool. The most commonly reported RE-AIM dimensions were Effectiveness (51.0% of interventions) and Reach (18.5%), followed by Implementation (14.2%), Maintenance (13.8%), and Adoption (4.0%). Overall, interventions were scored as primarily explanatory in five of the nine PRECIS-2 domains (recruitment, primary analysis, organization, flexibility [delivery], follow-up) and primarily pragmatic in one domain (setting). These findings suggest that while some LTPA self-management interventions for individuals with SCI are intended to be translated to real world settings, limited information is available to understand the degree to which this has been accomplished. Enhanced reporting of factors that could increase the likelihood of translating these interventions into practice is recommended.
Shauna M. Burke; Jennifer R. Tomasone; Natalie V. Scime; Jasmin K. Ma; Samantha M. Harden; Dalton L. Wolfe. Physical activity self-management interventions for adults with spinal cord injury: Part 2 – Exploring the generalizability of findings from research to practice. Psychology of Sport and Exercise 2018, 37, 286 -295.
AMA StyleShauna M. Burke, Jennifer R. Tomasone, Natalie V. Scime, Jasmin K. Ma, Samantha M. Harden, Dalton L. Wolfe. Physical activity self-management interventions for adults with spinal cord injury: Part 2 – Exploring the generalizability of findings from research to practice. Psychology of Sport and Exercise. 2018; 37 ():286-295.
Chicago/Turabian StyleShauna M. Burke; Jennifer R. Tomasone; Natalie V. Scime; Jasmin K. Ma; Samantha M. Harden; Dalton L. Wolfe. 2018. "Physical activity self-management interventions for adults with spinal cord injury: Part 2 – Exploring the generalizability of findings from research to practice." Psychology of Sport and Exercise 37, no. : 286-295.
This study describes the process evaluation of the Supporting Physical Activity in the Childcare Environment (SPACE) intervention, consisting of educator physical activity training, provision of portable play equipment, and a modified outdoor schedule (i.e., 4 × 30-minute periods). Educators ( N = 49) from 11 childcare centers in London, Ontario, Canada, delivered the 8-week intervention to 200 preschoolers ( Mage = 3.38 years). Workshop attendance was documented while adherence to the outdoor schedule and number and timing of outdoor sessions offered (i.e., dose) were recorded in a daily log. Questionnaire-based program evaluation ( n = 41) and in-person group interviews ( n = 7) were completed postintervention to assess educator perspectives on the barriers and facilitators to implementation (i.e., context), the feasibility and perceived effectiveness of the intervention, educator and preschooler enjoyment, communication among researchers and childcare personnel, and the future implementation of the intervention. Descriptive statistics were calculated, and responses to open-ended questions were inductively coded. Educator workshop attendance was 96%, and 88% of classrooms adhered to the four daily outdoor periods. Educators delivered 90% of the scheduled outdoor sessions, and 87% of these met the 30-minute criteria. Educators expressed that the increase in number of transitions made the outdoor playtimes challenging to implement, yet rated the feasibility of the training and equipment as high. Educators perceived the intervention to be both enjoyable and effective at increasing preschoolers’ physical activity. They indicated effective communication and revealed that they intended to continue to use their physical activity knowledge and to offer the play equipment once the intervention had concluded. These findings demonstrate that the SPACE intervention is viable in center-based childcare.
Molly Driediger; Leigh M. Vanderloo; Shauna M. Burke; Jennifer D. Irwin; Anca Gaston; Brian W. Timmons; Andrew M. Johnson; Patricia Tucker. The Implementation and Feasibility of the Supporting Physical Activity in the Childcare Environment (SPACE) Intervention: A Process Evaluation. Health Education & Behavior 2018, 45, 935 -944.
AMA StyleMolly Driediger, Leigh M. Vanderloo, Shauna M. Burke, Jennifer D. Irwin, Anca Gaston, Brian W. Timmons, Andrew M. Johnson, Patricia Tucker. The Implementation and Feasibility of the Supporting Physical Activity in the Childcare Environment (SPACE) Intervention: A Process Evaluation. Health Education & Behavior. 2018; 45 (6):935-944.
Chicago/Turabian StyleMolly Driediger; Leigh M. Vanderloo; Shauna M. Burke; Jennifer D. Irwin; Anca Gaston; Brian W. Timmons; Andrew M. Johnson; Patricia Tucker. 2018. "The Implementation and Feasibility of the Supporting Physical Activity in the Childcare Environment (SPACE) Intervention: A Process Evaluation." Health Education & Behavior 45, no. 6: 935-944.
Being active offers many physical and emotional benefits contributing to a higher health-related quality of life (HRQoL); however, this relationship remains unexplored among preschoolers (aged 2.5–5 years). This study examined the impact of the Supporting Physical Activity in the Childcare Environment (SPACE), which was an intervention implemented using a cluster randomized controlled trial on preschoolers’ HRQoL. Childcare centres were randomly allocated to the experimental (n = 11) or control (n = 11) conditions, and preschoolers’ HRQoL was measured using the parent-report Pediatric Quality of Life Inventory 4.0 (3 subscales: physical, psychosocial, and total HRQoL) at baseline, post-intervention (i.e., week 8), and 6- and 12-month follow-up. A linear mixed-effects model was used to determine if preschoolers in the experimental condition displayed an increased HRQoL post-intervention and at follow-up compared with preschoolers in the control condition. Preschoolers (n = 234) with HRQoL data at baseline and one additional time-point were retained for analyses. Body mass index was not found to impact significantly on the intervention, and no statistically significant interaction effects were found for any of the 3 HRQoL variables. In conclusion, the SPACE intervention had no impact on preschoolers’ HRQoL. Given the scarcity of research in this population, additional exploration is necessary to better understand the potential impact of physical activity participation on preschoolers’ HRQoL.
Stephanie Truelove; Andrew M. Johnson; Leigh M. Vanderloo; Molly Driediger; Shauna M. Burke; Jennifer D. Irwin; Brian W. Timmons; Anca Gaston; Patricia Tucker. Preschoolers’ health-related quality of life following the implementation of a childcare physical activity intervention. Applied Physiology, Nutrition, and Metabolism 2018, 43, 453 -459.
AMA StyleStephanie Truelove, Andrew M. Johnson, Leigh M. Vanderloo, Molly Driediger, Shauna M. Burke, Jennifer D. Irwin, Brian W. Timmons, Anca Gaston, Patricia Tucker. Preschoolers’ health-related quality of life following the implementation of a childcare physical activity intervention. Applied Physiology, Nutrition, and Metabolism. 2018; 43 (5):453-459.
Chicago/Turabian StyleStephanie Truelove; Andrew M. Johnson; Leigh M. Vanderloo; Molly Driediger; Shauna M. Burke; Jennifer D. Irwin; Brian W. Timmons; Anca Gaston; Patricia Tucker. 2018. "Preschoolers’ health-related quality of life following the implementation of a childcare physical activity intervention." Applied Physiology, Nutrition, and Metabolism 43, no. 5: 453-459.
Shauna Burke; Kristen Reilly. C.H.A.M.P. Families: Feasibility of educating parents to prevent obesity in their children. http://isrctn.com/ 2018, 1 .
AMA StyleShauna Burke, Kristen Reilly. C.H.A.M.P. Families: Feasibility of educating parents to prevent obesity in their children. http://isrctn.com/. 2018; ():1.
Chicago/Turabian StyleShauna Burke; Kristen Reilly. 2018. "C.H.A.M.P. Families: Feasibility of educating parents to prevent obesity in their children." http://isrctn.com/ , no. : 1.
Physical activity levels among preschoolers in childcare are low and sedentary time high. The Supporting Physical Activity in the Childcare Environment (SPACE) intervention had three components: 1. portable play equipment; 2. staff training; and, 3. modified outdoor playtime (i.e., shorter, more frequent periods). This study aimed to examine the effectiveness of the SPACE intervention on preschoolers’ physical activity levels and sedentary time during childcare hours (compared to standard care). Via a single-blind cluster randomized controlled trial, 338 preschoolers (39.86 ± 7.33 months; 52% boys) from 22 centre-based childcare facilities (11 experimental, 11 control) were enrolled. Preschoolers wore an Actical™ accelerometer for 5 days during childcare hours at baseline, post-intervention, and 6- and 12-month follow-up, and were included in the analyses if they had a minimum of two valid days (5 h each day) at baseline and one additional time point. Intervention effectiveness was tested using a linear mixed effects model for each of the four outcome variables (i.e., sedentary time, light physical activity [LPA], moderate-to-vigorous physical activity [MVPA], and total physical activity [TPA]). Fixed effects were further evaluated with t-tests, for which degrees of freedom were estimated using a Satterthwaite approximation. One hundred and ninety-five preschoolers were retained for analyses. The intervention did not significantly impact LPA. MVPA was significantly greater among children in the experimental group when comparing post-intervention to pre-intervention, t(318) = 3.50, p = .0005, but no intervention effects were evident at 6- or 12-month follow-up. TPA was significantly greater for children in the intervention group at post-intervention when compared to pre-intervention, t(321) = 2.70, p = .007, with no intervention effects evident at later time periods. Finally, sedentary time was significantly lower among preschoolers in the experimental group when comparing post-intervention to pre-intervention, t(322) = 2.63, p = .009, with no significant effects at follow-up. The SPACE intervention was effective at increasing MVPA and TPA among preschoolers, while simultaneously decreasing sedentary time. The ability of the SPACE intervention to target higher intensity activity is promising, as MVPA levels have been documented to be low in centre-based childcare. The changes in physical activity were not sustained long term (6- or 12-month follow-up). ISRCTN70604107 (October 8, 2014).
Patricia Tucker; Leigh M. Vanderloo; Andrew M. Johnson; Shauna M. Burke; Jennifer D. Irwin; Anca Gaston; Molly Driediger; Brian W. Timmons. Impact of the Supporting Physical Activity in the Childcare Environment (SPACE) intervention on preschoolers’ physical activity levels and sedentary time: a single-blind cluster randomized controlled trial. International Journal of Behavioral Nutrition and Physical Activity 2017, 14, 1 -11.
AMA StylePatricia Tucker, Leigh M. Vanderloo, Andrew M. Johnson, Shauna M. Burke, Jennifer D. Irwin, Anca Gaston, Molly Driediger, Brian W. Timmons. Impact of the Supporting Physical Activity in the Childcare Environment (SPACE) intervention on preschoolers’ physical activity levels and sedentary time: a single-blind cluster randomized controlled trial. International Journal of Behavioral Nutrition and Physical Activity. 2017; 14 (1):1-11.
Chicago/Turabian StylePatricia Tucker; Leigh M. Vanderloo; Andrew M. Johnson; Shauna M. Burke; Jennifer D. Irwin; Anca Gaston; Molly Driediger; Brian W. Timmons. 2017. "Impact of the Supporting Physical Activity in the Childcare Environment (SPACE) intervention on preschoolers’ physical activity levels and sedentary time: a single-blind cluster randomized controlled trial." International Journal of Behavioral Nutrition and Physical Activity 14, no. 1: 1-11.
Establishing appropriate physical activity and sedentary behaviours during early childhood is important to ensure children accrue the many associated health benefits. While physical activity levels have been reported as low within early learning programs, little research has explored the physical activity and sedentary time of Canadian preschoolers classified as overweight within these facilities. The purpose of this study was to compare objectively measured physical activity and sedentary time among preschoolers classified as overweight and nonoverweight in early learning programs. Direct assessment of physical activity and sedentary time of 216 preschool-aged children was collected via Actical accelerometers during early learning hours, while body mass index percentile was calculated based on preschoolers’ objectively measured height and weight. Results of three 3-way ANOVAs suggest that rates of moderate to vigorous physical activity, total physical activity, and sedentary time (p > 0.05) did not significantly differ based on weight status, sex, and type of early learning facility. This study is one of few that has examined differences in overweight and nonoverweight preschoolers’ sedentary time, and adds to the limited research exploring physical activity levels among overweight and nonoverweight preschoolers during early learning hours. Given the high rates of sedentary time reported, programming within early learning facilities is necessary to support preschoolers, regardless of weight status, to achieve increased physical activity levels and decreased sedentary time.
Patricia Tucker; Alana M. Maltby; Shauna M. Burke; Leigh M. Vanderloo; Jennifer D. Irwin. Comparing physical activity and sedentary time among overweight and nonoverweight preschoolers enrolled in early learning programs: a cross-sectional study. Applied Physiology, Nutrition, and Metabolism 2016, 41, 971 -976.
AMA StylePatricia Tucker, Alana M. Maltby, Shauna M. Burke, Leigh M. Vanderloo, Jennifer D. Irwin. Comparing physical activity and sedentary time among overweight and nonoverweight preschoolers enrolled in early learning programs: a cross-sectional study. Applied Physiology, Nutrition, and Metabolism. 2016; 41 (9):971-976.
Chicago/Turabian StylePatricia Tucker; Alana M. Maltby; Shauna M. Burke; Leigh M. Vanderloo; Jennifer D. Irwin. 2016. "Comparing physical activity and sedentary time among overweight and nonoverweight preschoolers enrolled in early learning programs: a cross-sectional study." Applied Physiology, Nutrition, and Metabolism 41, no. 9: 971-976.
Chronic disease has become one of the largest health burdens facing the developed world. Men are at a higher risk of being diagnosed with chronic disease than women. Although lifestyle interventions have been shown to reduce the risk of chronic disease in participants, men are often underrepresented in such programs. The purpose of this study was to explore the individual-level and program-specific factors that affect male participation rates in chronic disease prevention and management (CDPM) programs. A scoping review methodology was selected, and 25 studies met the criteria for inclusion in the review. Results showed that traditional group-based programs that focused on topics such as nutrition and physical activity were often seen by men as inherently feminine, which served as a barrier for participation. Program-specific factors that attracted men to participate in interventions included a group component with like-minded men, the use of humor in the delivery of health information, the inclusion of both nutrition and physical activity components, and the presence of some manner of competition. A past negative health event, personal concern for health status, and motivation to improve physical appearance were cited by men as facilitators to CDPM program participation. Gaps in the research are identified, and results of this study can be used to inform the development of CDPM programs that will improve the engagement and participation of men.
Adam Gregory Gavarkovs; Shauna M. Burke; Robert J. Petrella. Engaging Men in Chronic Disease Prevention and Management Programs. American Journal of Men's Health 2016, 10, NP145 -NP154.
AMA StyleAdam Gregory Gavarkovs, Shauna M. Burke, Robert J. Petrella. Engaging Men in Chronic Disease Prevention and Management Programs. American Journal of Men's Health. 2016; 10 (6):NP145-NP154.
Chicago/Turabian StyleAdam Gregory Gavarkovs; Shauna M. Burke; Robert J. Petrella. 2016. "Engaging Men in Chronic Disease Prevention and Management Programs." American Journal of Men's Health 10, no. 6: NP145-NP154.
Chronic disease is becoming increasingly prevalent in Canada. Many of these diseases could be prevented by adoption of healthy lifestyle habits including physical activity and healthy eating. Men, especially those in rural areas, are disproportionately affected by chronic disease. However, men are often underrepresented in community-based chronic disease prevention and management (CDPM) programs, including those that focus on physical activity and/or healthy eating. The purpose of this study was to explore the experiences and perceptions of program delivery staff regarding the challenges in recruitment and participation of men in physical activity and healthy eating programs in rural communities, and suggestions for improvement. Semistructured interviews were conducted by telephone with 10 CDPM program delivery staff from rural communities in Southwest Ontario, Canada. Time and travel constraints, relying on spouses, and lack of male program leaders were cited as barriers that contributed to low participation levels by men in CDPM programs. Hiring qualified male instructors and engaging spouses were offered as strategies to increase men’s participation. The results of this study highlight many of the current issues faced by rural health organizations when offering CDPM programming to men. Health care organizations and program delivery staff can use the recommendations in this report to improve male participation levels.
Adam G. Gavarkovs; Shauna M. Burke; Kristen C. Reilly; Robert J. Petrella. Barriers to Recruiting Men Into Chronic Disease Prevention and Management Programs in Rural Areas. American Journal of Men's Health 2016, 10, NP155 -NP157.
AMA StyleAdam G. Gavarkovs, Shauna M. Burke, Kristen C. Reilly, Robert J. Petrella. Barriers to Recruiting Men Into Chronic Disease Prevention and Management Programs in Rural Areas. American Journal of Men's Health. 2016; 10 (6):NP155-NP157.
Chicago/Turabian StyleAdam G. Gavarkovs; Shauna M. Burke; Kristen C. Reilly; Robert J. Petrella. 2016. "Barriers to Recruiting Men Into Chronic Disease Prevention and Management Programs in Rural Areas." American Journal of Men's Health 10, no. 6: NP155-NP157.