Guy Faulkner

A particular period of experimentation and a time in which substance use behaviours might be first adopted is adolescence. The purpose of my dissertation was, first, to examine if physical activity prevents substance use behaviour among youth; and second, to assess if school connectedness plays a role in this association. In study 1, a scoping review was conducted to examine the prospective associations between physical activity and substance use. Based on the findings from the scoping review, the second study utilized a cross-sectional design to examine physical activity (meeting MVPA guidelines; non-competitive or competitive school sport; outside-of-school sport) and associations with four current substance use behaviours (cigarette, e-cigarette, cannabis, binge drinking). Study 2 also tested if school connectedness moderated these associations. Finally, study 3 examined if changes in physical activity may be associated with the initiation of current substance use while evaluating the potential moderation and mediation of school connectedness. Studies 2 (n=73,672 ) and 3 (n=3,244) utilized a combined three years of the COMPASS study (Y:6 2017-2018, Y:7 2018-2018, Y:8 2019-2020). Within studies 2 and 3 multi-level logistic regressions were built with different predictors and outcomes to reflect the longitudinal nature of study 3. While results demonstrate evidence for cross-sectional and prospective associations between physical activity and substance use, not all associations were negative. Additionally, less evidence was found prospectively (study 3) than cross-sectionally (study 2) for the associations between physical activity and substance use. Study 2 provided evidence for school connectedness moderating the cross-sectional association between physical activity and substance use. Study 3 found evidence for school connectedness negatively mediating the association between two distinct types of sport participation (outside-of-school and competitive school sport) and current substance use (e-cigarette use and cannabis use). Overall, there was no evidence that physical activity confers broad, universal benefits in preventing substance use among youth. Sport participation may provide a contextual experience that enhances school connectedness which in turn is associated with substance use prevention. Future work should be considered to confirm this possibility.

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Children’s independent mobility is defined as a child’s freedom to travel and play in their neighbourhood without adult supervision. While independent mobility is associated with a range of benefits there is also evidence that a number of children today have less independent mobility than previous generations. The purpose of this dissertation was to explore children’s independent mobility and 1) identify and examine the social-ecological correlates of children’s independent mobility and 2) explore the nuances of children’s independent mobility from children’s and parents’ perspectives as a family unit. This multi-method dissertation adopted a social-ecological approach to examine children’s independent mobility. Study 1 was a systematic review (n=43 articles included) examining the correlates of children’s independent mobility in primarily Western, industrialized countries. This review identified significant correlates at every social-ecological level and highlighted that Canadian studies were geographically limited. Study 2 was a multi-site school-based study examining correlates of children’s independent mobility across different sites in Canada (n=1699 participants). Independent mobility varied across study sites, but parental perceptions of safety and the environment were consistently associated with independent mobility. Study 3 was a qualitative study exploring children’s and parents’ perspectives of children’s independent mobility within the family unit through face-to-face interviews (n=66 participants; n=22 families) across three neighbourhoods in the Greater Vancouver Area. This study highlighted key preconditions associated with helping children and their parents negotiate independent mobility including 1) parents’ positive interpretation of their childhood experiences of independent mobility, 2) a positive appraisal of children’s individual characteristics by both children and parents, 3) communication within the family unit, and 4) positive perceptions of the neighbourhood social environment. This dissertation builds on existing literature, highlights the complexities of independent mobility, and provides supporting evidence for multi-level and multi-sectoral initiatives that are aimed at promoting children’s independent mobility.

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Individuals with schizophrenia have a greatly reduced life expectancy compared to the general population due in part to higher rates of diabetes, obesity, and cardiovascular disease. Individuals with schizophrenia also engage in lower volumes of physical activity and engage in more sedentary behaviour, which contributes to poor overall health. Evaluating time spent in such movement behaviours accurately is necessary to engage in all phases of behavioural epidemiology and for developing interventions to induce behaviour change.This dissertation evaluates whether the most commonly used self-report questionnaire, the International Physical Activity Questionnaire (IPAQ), for measuring time spent in physical activity (Chapter 2) and sedentary behaviour (Chapter 3) among people with schizophrenia is an accurate representation of movement behaviours in people with schizophrenia compared to accelerometry derived scores. After quantifying the discrepancy between measurement methods, Chapter 4 explores individual level correlates of this discrepancy to understand what factors may contribute to less accurate IPAQ scores, and regression-calibration adjustments to IPAQ scores were evaluated using a 5-fold cross-validation approach as a possible method to improve score accuracy. Subsequently, Chapter 5 assesses whether accelerometry protocols were adhered to consistently in the sample and accelerometry data were used to evaluate the composition of movement behaviours in this sample across the week; an isotemporal substitution approach is used to determine whether replacing one movement behaviour with another (e.g. sedentary behaviour with moderate intensity physical activity) is associated with health and demographic factors while controlling for all other movement behaviours. The results of these studies suggests that IPAQ scores should no longer be used as a measure of time spent in movement behaviours in individuals with schizophrenia; researchers and medical professionals are recommended to use more direct methods of movement measurement such as accelerometry or leverage the already widespread adoption of consumer smart devices to collect movement behaviour data that better represents how individuals with schizophrenia spend their waking day.

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The purpose of this dissertation was to 1) use a systematic and phased process to develop an evidence-based resource (toolkit) about exercise and depression for health care providers working with adults with depression in Canada (based on treatment guidelines) and 2) provide a step by step guide for translating knowledge into action for health care interventions. This dissertation was guided by the Knowledge to Action Framework and the AGREE II (Appraisal of Guidelines for Research & Evaluation) instrument. Study 1 was a scoping review to identify the barriers and facilitators to engagement in physical activity (PA) and exercise for adults with depression. A behavioural analysis informed by the Theoretical Domains Framework (TDF) determined that future intervention should target the emotion and social influences domains. Study 2 was a scoping review to identify the barriers and facilitators to PA promotion by health care providers (HCP) working with individuals with mental illness. The most prominent barriers and facilitators were within the domains of beliefs about the consequences and environmental context & resources. Study 3 was a qualitative study to guide toolkit development. Interviews were conducted with adults with lived experience with depression (AWD) and HCP. Study 4 described the systematic and phased process used to develop the evidence-based ‘Exercise and Depression Toolkit’ for HCP working with AWD. The four phases included: reviews of relevant literature, formative interviews, an expert panel meeting, and final toolkit development. Various stakeholders were involved throughout the process including HCP, AWD, researchers, and exercise professionals. Study 5 evaluated the ‘Exercise and Depression Toolkit’ in practice by HCP working with AWD and attained feedback on the toolkit to inform national dissemination and uptake. The toolkit was found to be acceptable and have positive innovation attributes. Concerns about effort and time to use it in practice informed dissemination plans and selection of end users. Together, the studies in this dissertation have resulted in the first evidence-based resource, the ‘Exercise and Depression Toolkit’, to help health care providers and individuals with depression collaboratively consider exercise as a treatment.

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Educators working in early childhood education and care receive little to no training in physical activity or physical literacy. However, they are expected to adhere to government standards for physical activity and skill development during the childcare day. This dissertation sought to determine what characterizes a successful intervention aiming to train educators in physical activity and/or physical literacy, what barriers and facilitators educators identify in meeting daily activity standards, what the physical literacy of educators is, and if educator physical literacy is associated with their behaviours and intentions to provide physical activity or physical literacy activities regularly. A systematic review was undertaken to parse apart the distinct characteristics of effective training interventions in physical activity or physical literacy. Training programs that provided ongoing support, relied on a theoretical framework, and objectively measured study fidelity were more successful. Educators were interviewed (n=24) to assess facilitators and barriers they face when implementing policy mandated activity standards. Results demonstrated that the personal values of educators facilitated adherence, and if physical space was poor, or resources were low, adherence was inhibited. Finally, a cross-sectional study measured the physical literacy of educators (n=94), and utilized regression analysis to determine relationships between measured physical literacy and self-reported behaviours and intentions to provide physical activity and/or physical literacy opportunities daily. Physical activity behaviour and understanding were high, but the remaining components of physical literacy were moderate. A relationship was found between educator self-reported intentions and behaviours for providing physical activity opportunities and the physical literacy component of understanding, but no relationship was found for the other components of physical literacy. The results of these three studies demonstrate that educators are trainable in physical activity and physical literacy, but high-quality training programs that provide continued support and/or training for educators are needed. Training programs may not need to focus on the personal physical literacy of educators. Mandating training for educators to provide quality physical literacy opportunities to children should be a high public health priority.

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