Imputing accelerometer non-wear time when assessing children's moderate-to-vigorous physical activity

BACKGROUND: Moderate-to-vigorous physical activity (MVPA) is an important determinant of children’s physical health, and is commonly measured using accelerometers. A major limitation of accelerometers is non-wear time, which is the time the participant did not wear their device. Given that non-wear time is traditionally discarded from the dataset prior to estimating MVPA, final estimates of MVPA may be biased. Therefore, alternate approaches should be explored. OBJECTIVES: The objectives of this thesis were to 1) develop and describe an imputation approach that uses the socio-demographic, time, health, and behavioural data from participants to replace non-wear time accelerometer data, 2) determine the extent to which imputation of non-wear time data influences estimates of MVPA, and 3) determine if imputation of non-wear time data influences the associations between MVPA, body mass index (BMI), and systolic blood pressure (SBP). METHODS: Seven days of accelerometer data were collected using Actical accelerometers from 332 children aged 10-13. Three methods for handling missing accelerometer data were compared: 1) the “non-imputed” method wherein non-wear time was deleted from the dataset, 2) imputation dataset I, wherein the imputation of MVPA during non-wear time was based upon socio-demographic factors of the participant (e.g., age), health information (e.g., BMI), and time characteristics of the non-wear period (e.g., season), and 3) imputation dataset II wherein the imputation of MVPA was based upon the same variables as imputation dataset I, plus organized sport information. Associations between MVPA and health outcomes in each method were assessed using linear regression. RESULTS: Non-wear time accounted for 7.5% of epochs during waking hours. The average minutes/day of MVPA was 56.8 (95% CI: 54.2, 59.5) in the non-imputed dataset, 58.4 (95% CI: 55.8, 61.0) in imputed dataset I, and 59.0 (95% CI: 56.3, 61.5) in imputed dataset II. Estimates between datasets were not significantly different. The strength of the relationship between MVPA with BMI and SBP were comparable between all three datasets. CONCLUSION: These findings suggest that studies that achieve high accelerometer compliance with unsystematic patterns of missing data can use the traditional approach of deleting non-wear time from the dataset to obtain MVPA measures without substantial bias.

Examination of body image among Canadian adolescents: Relations with physical activity and screen time

Background: Adolescence is a period of life associated with self-perceptions of negative body image. Physical activity levels are low and screen time levels are also high during this stage. These perceptions and behaviours are associated with poor health outcomes, making research on their determinants important. With adolescent populations, certain groups may be at higher risk of body dissatisfaction than others, and body dissatisfaction may influence individual physical activity and screen time levels. Objectives: The objectives of this thesis were to: 1) describe body image among young Canadians, examining possible health inequalities 2) estimate the strength and significance of associations between body satisfaction, physical activity and screen time, and 3) examine the potential etiological role of biological sex. Methods: Objective 1: The 2013/2014 Health Behaviour in School-aged Children study was employed. Sex-stratified Rao-Scott chi-square analyses were conducted to examine associations between socio-demographic factors and body satisfaction. Objective 2: The 2005/2006 and 2013/2014 cross-sectional and 2006 longitudinal HBSC data sets were used. Sex-stratified modified Poisson regressions were conducted and risk estimates and associated confidence intervals obtained. Results: Objective 1: Among males, being older, of East and Southeast Asian ethnicity, and reporting low SES all were associated with body dissatisfaction. Among females, being older, of Arab and West Asian or African ethnicity, being born in Canada, and reporting low SES were all associated with being body dissatisfied. Objective 2: Cross-sectionally, males who reported ‘too fat’ body dissatisfaction were more likely to be physically inactive. Adolescents of both sexes who reported ‘too fat’ body dissatisfaction were more likely to engage in high levels of screen time. Data from the longitudinal component supported the idea that male ‘too fat’ body dissatisfaction temporally leads to physical inactivity, but showed an inverse relationship between body dissatisfaction and screen time. Conclusions: Objective 1: Future prevention efforts in Canada should target subgroups to effectively help those at greatest risk of body dissatisfaction, and ameliorate potential inequalities at the population level. Objective 2: The presence of these relationships may inform future interventions as part of a multi-factorial etiology, in order to increase physical activity and decrease screen time among youth.

PHYSICAL ACTIVITY EXPERIENCES OF PERSIAN WOMEN RECENTLY IMMIGRATED TO CANADA

New immigrants to Canada are generally in similar or better physical and mental health than people born in Canada, however, many studies suggest that their health tends to decline quickly after immigration. Lower physical activity levels among new immigrants might be contributing to this phenomenon. There is a paucity of information regarding the physical activity behaviour of the Canadian immigrant population in general and of West Asian women, such as Iranians (Persians), in particular. Given that this group is characterised by an increasing population growth and lower rates of physical activity, it is critical to understand how best to address physical activity promotion in this population. Purpose: To understand the physical activity experiences of Persian women recently immigrated to Toronto, Canada in order to develop recommendations for the design and implementation of tailored physical activity programs. Methods: A qualitative interpretive description approach was chosen to collect and describe ideas, experiences, and perceptions of physical activity within 10 new immigrant women. Using an inductive approach, two fundamental techniques of immersion and crystallization were used throughout the analysis. Thematic analysis was conducted by performing a sequential process of open and axial coding. Emerged themes were further conceptualized through a socio-ecological lens. Results: The facilitators and barriers to physical activity among the women were situated within five overarching categories, 1) Perceptions about physical activity, 2) New physical environment and social structure, 3) Cultural heritage values, 4) Settlement and immigration factors, and 5) Physical activity program features. Discussion: Findings revealed that Persian new immigrant women’s engagement in physical activity after immigration is influenced by factors across the individual, sociocultural, environmental, institutional, and policy levels. Newcomer women’s physical activity was influenced by their transition from their society of origin to the host society and the challenges and successes experienced throughout the settlement and acculturation process. The most noticeable barrier to physical activity in Canada for the women emerged as the lack of communication of physical activity information to newcomers. A set of recommendations is provided for developing efficient physical activity programs for Persian immigrant women, which may also be relevant for other immigrant groups in Canada.