ObjectivesThe number of quit attempts it takes a smoker to quit successfully is a commonly reported figure among smoking cessation programmes, but previous estimates have been based on lifetime recall in cross-sectional samples of successful quitters only. The purpose of this study is to improve the estimate of number of quit attempts prior to quitting successfully.DesignWe used data from 1277 participants who had made an attempt to quit smoking in the Ontario Tobacco Survey, a longitudinal survey of smokers followed every 6 months for up to 3 years beginning in 2005. We calculated the number of quit attempts prior to quitting successfully under four different sets of assumptions. Our expected best set of assumptions incorporated a life table approach accounting for the declining success rates for subsequent observed quit attempts in the cohort.ResultsThe estimated average number of quit attempts expected before quitting successfully ranged from 6.1 under the assumptions consistent with prior research, 19.6 using a constant rate approach, 29.6 using the method with the expected lowest bias, to 142 using an approach including previous recall history.ConclusionsPrevious estimates of number of quit attempts required to quit may be underestimating the average number of attempts as these estimates excluded smokers who have greater difficulty quitting and relied on lifetime recall of number of attempts. Understanding that for many smokers it may take 30 or more quit attempts before being successful may assist with clinical expectations.

Survivor stories may be most effective when audience members identify with the survivor. Finding key characteristics that can reliably match the two will advance cancer communication science and practice.

Objective We sought to examine whether asthma risk is lower in second-generation immigrants (i.e., Canadian-born children with at least one foreign-born parent) and first-generation immigrants (i.e., foreign-born children) compared with non-immigrants (i.e., Canadian-born children to Canadian-born parents). Methods Data were obtained from the Canadian National Longitudinal Survey of Children and Youth from 1994 to 2008, which measured child health and developmental factors from birth to early adulthood. The sample included 15,799 participants aged 2-26 years. Asthma was defined as diagnosis by a health professional as having asthma, having wheezing or whistling in the chest, or use of medication for asthma. Results Prevalence of asthma (defined as a combination of any three factors) was lower in first-generation (32%) and secondgeneration (34%) immigrants compared with non-immigrants (46%). After controlling for covariates, first-and secondgeneration immigrants had 0.21 (AOR = 0.21; 95% CI = 0.07-0.67) and 0.19 (AOR = 0.19; 95% CI = 0.09-0.39) lower odds of reporting asthma compared with non-immigrants, respectively. For every year the parent(s) of second-generation immigrants resided in Canada, the odds for asthma increased by 5% (AOR = 1.05; 95% CI = 1.02-1.06). Conclusion Immigrant children and youth in Canada, regardless of whether they are first-or second-generation, have lower odds for asthma compared with non-immigrants. Résumé Objectif Nous avons voulu déterminer si le risque d'asthme est plus faible chez les immigrants de deuxième génération (enfants nés au Canada ayant au moins un parent né à l'étranger) et les immigrants de première génération (enfants nés à l'étranger) que chez les non-immigrants (enfants nés au Canada de parents nés au Canada). Méthode Nos données provenaient de l'Enquête longitudinale nationale sur les enfants et les jeunes (1994 à 2008), qui mesurait la santé des enfants et les facteurs développementaux de la naissance au début de l'âge adulte. L'échantillon comptait 15 799 participants âgés de 2 à 26 ans. La définition de l'asthme comprenait un diagnostic d'asthme par un professionnel de la santé, une respiration bruyante ou sifflante, ou l'utilisation de médicaments contre l'asthme. Résultats La prévalence de l'asthme (définie comme une combinaison de ces trois facteurs) était plus faible chez les immigrants de première génération (32 %) et de deuxième génération (34 %) que chez les non-immigrants (46 %). Compte tenu des covariables, la probabilité de déclarer de l'asthme était plus faible de 0,21 (rapport de cotes ajusté [RCa] = 0,21; IC de 95% = 0,07-0,67) chez les immigrants de première génération et de 0,19 (RCa = 0,19; IC de 95% = 0,09-0,39) chez les immigrants de deuxième génération que chez les non-immigrants. Chez les immigrants de deuxième génération, pour chaque année de résidence des parents au Canada, la probabilité d'asthme augmentait de 5 % (RCa = 1,05; IC de 95% = 1,02-1,06).

Background This study contributes to the limited number of studies that have explored the impact of not meeting the recommendations for moderate-to-vigorous physical activity, screen time, fruit and vegetable consumption and sleep on overweight and obesity among adolescents. Methods A cross-sectional study of data from the 2015 Ontario Student Drug Use and Health Survey (OSDUHS), a provincially representative survey of students in publically funded schools in Ontario, Canada, was conducted. This study included self-reported data from students aged 11–17 years ( n = 9866). The main outcome variable was overweight or obesity, classified using WHO BMI cut-points. Four independent variables for healthy weight behaviours were examined: (1) moderate-to-vigorous physical activity (MVPA) (≥ 60 mins vs. < 60 mins everyday over the last seven days); (2) screen time (< 2 h daily vs. ≥ 2 h daily); (3) fruit and vegetable consumption (≥ 5 times/day vs. < 5 times/day); (4) sleep (adequate based on guidelines vs. inadequate). Covariates included sex, age, Subjective Social Status (SSS), parental education and ethnicity. Binomial and multinomial logistic regression models were fitted to determine whether not meeting the recommendations for healthy weight behaviours was associated with overweight or obesity status. Results Only 2% of students in Ontario met the recommendations for all four healthy weight behaviours and 33% of students did not meet any of the four recommendations. In both the binomial and multinomial models, not meeting the recommendations for MVPA was the only significant healthy weight behaviour associated with both overweight and obesity (AOR: 1.29, 95% CI: 1.03–1.62), and solely obesity (AOR: 1.45, 95% CI: 1.05–1.99). Males, students with lower SSS ratings, and students with parents with an education of ‘High School’ or less were also at significantly greater odds of being obese. Conclusion Findings from this study show that inadequate levels of MVPA is a critical behavioural predictor of obesity status in adolescents between the ages of 11–17 years, after controlling for differences in screen time, fruit and vegetable consumption, sleep, and demographics. Findings from this study could have implications toward policies and programs targeted at reducing obesity, and increasing the physical activity rates of adolescents.

BackgroundThis paper examines school and classroom effects on Daily Physical Activity (DPA) policy implementation in classrooms in Ontario, Canada. In 2005 the Ontario Ministry of Education mandated a policy requiring school boards to “ensure that all elementary students, including students with special needs, have a minimum of twenty minutes of sustained MVPA each school day during instructional time”. Based on an adaptation of Chaudoir’s conceptual framework, this paper contributes to understanding the extent to which school factors (as reported by administrators) and classroom factors (as reported by teachers) are associated with policy implementation fidelity at the classroom level.MethodsCross-sectional online surveys were conducted in 2014 with elementary school administrators and teachers, based on representative random samples of schools and classrooms. A measure assessing implementation fidelity was developed from the six required components of the policy and for this paper fidelity at the classroom level is treated as the outcome variable. Several school- and classroom-level measures were also included in the surveys and a number of these were selected for inclusion here. Data from the two surveys were merged and selected variables were included in the multi-level analysis. Two-level logistic regression models were conducted to account for nesting of classrooms within schools and a series of models were conducted to identify factors associated with implementation fidelity.ResultsThe analytic sample for this study included 170 school administrators and 307 classroom teachers from corresponding schools. Findings from the multi-level logistic regression analyses indicated that only classroom/teacher-level factors were significantly associated with implementation fidelity at the classroom level. None of the school/administrator predictors were significantly related to fidelity. The most parsimonious model included five significant classroom/teacher predictors: teachers’ perception of DPA as realistic and achievable; confidence (self-efficacy); scheduling DPA in timetables; lack of space; and lack of time.ConclusionsFindings from the study indicate the theoretical and practical importance of addressing classroom and teacher factors since they are most proximal to implementation fidelity to the policy. Several of these factors also reflect complex structural and organizational contexts, indicating that a systems approach to understanding and supporting DPA implementation fidelity is warranted.

Purpose: Explore Canadians’ dietary intake in relation to the 2019 Canada’s Food Guide (CFG) Plate using novel volume-based food analyses, by age and meal occasion. Methods: Foods reported in 24-hour recalls by 20,456 Canadians in the 2015 Canadian Community Health Survey – Nutrition were classified as: Vegetables and Fruits, Whole Grain Foods, Protein Foods, Non-Whole Grain Foods or Other Foods (high in fat, sugar, sodium). Food volumes were used to calculate percent contributions of each grouping to total intake, stratified by age (1–6; 7–12; 13–17; 18–64; 65+years) and meal (breakfast, lunch, supper, snack), applying sample survey weights and bootstrapping. Results: By volume, the Canadian population diet included: 29% Vegetables and Fruits, 22% Protein Foods, 7% Whole Grains, 24% Non-Whole Grain Foods, and 18% Other Foods. Intakes of Protein Foods (1–6 years) and Other Foods (7–12; 13–17 years) were higher in children than adults by volume, relative to total intake. Whole Grains intake was highest at breakfast. Other Foods intake was highest at snack. Conclusions: The volume-based population diet of Canadians reported on a single day includes a substantial proportion of non-recommended foods. There are opportunities to design interventions that target specific foods, ages, and meals to align intake with recommendations.

We explore key lessons arising out of target-setting agendas in tobacco control. Two real-world examples are described that illustrate the pitfalls of choosing an omnibus target for a comprehensive strategy: (a) a target to reduce wholesale cigarette sales in Ontario and (b) a First Ministers’ target to reduce current smoking. Changing contexts brought about by shifts in illicit tobacco sales made it problematic to interpret success in both cases. The discussion draws attention to key considerations in setting targets, including unintended consequences, data quality, ideal number, and the importance of context such as stakeholder roles in target selection and reporting.