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Correlates of physical activity in First Nations youth residing in First Nations and northern communities in Canada.

The Maskwachees Declaration acknowledges the importance of physical activity (PA) for the promotion of holistic health among Aboriginal Peoples. (1-3) For First Nations (FN) youth, PA plays an important role in achieving balance among physical, mental, emotional and spiritual elements of health. (4,5)

While little is known about the PA levels of FN youth, available data suggest that inactivity is prevalent. For instance, a recent study of self-reported moderate-to-vigorous physical activity (MVPA) from 204 on-reserve 10-16 year olds found that only 14% of boys and 4% of girls met public health guidelines of at least 60 accumulated minutes of daily MVPA. (6)

Understanding the factors that influence the PA behaviour of FN youth represents a first step to fostering their positive PA habits. (7) In the mainstream literature, behaviour theories and models provide a systematic framework for examining the factors that influence PA. (8) Ecological models, commonly used in the PA literature, (8,9) and which are consistent with an Indigenous view of health and wellness, emphasize the relatedness of the self with the external world and the interconnectedness of humans to their physical, social and spiritual surroundings. (10,11) It is thus relevant to consider influences upon PA as occurring at multiple levels of human ecology, including individual (e.g., age, gender, cultural beliefs), interpersonal (e.g., relationships and characteristics of family) and community levels (e.g., social and economic conditions, facilities, and programs) to better inform the development of interventions to enhance PA in FN youth. (12) Gender, age, socio-economic status (SES), parent and environmental influences are among the most researched and consistent correlates of PA in youth. (13,14) Relatively little information is available about the ecological factors that influence PA among FN youth. (15)

The purpose of this study was to identify individual, family and community factors independently associated with PA among FN youth aged 12-17 years. We assessed these associations in the 2008/10 Regional Health Survey (RHS), which is a large and representative sample of FN persons who reside in FN on-reserve and northern communities across Canada.

METHODS

The RHS is a nationwide survey that addresses a holistic range of priority health issues for FN, including PA. Development of the questions was informed by FN experts from the First Nations Information Governance Centre (FNIGC) to be meaningful to FN youth. Questions were answered by youth during in-person interviews wherein local field workers, overseen by FNIGC staff, used a Computer Assisted Personal Interview (CAPI) system to record youth responses.

Participants

The RHS was designed to represent the FN population living in FN communities (e.g., on-reserve and in northern Canada above the 60th parallel) in all provinces and territories, except Nunavut. Indian and Northern Affairs Canada (INAC) registry counts were used to derive sample allocations, thereby ensuring adequate representation of the population. Within the FN communities, band membership lists were used to randomly select individuals. Overall, 216 communities were included in the RHS and 5.3% of the FN population living in FN communities was surveyed. The overall response rate among children, youth and adults was 72.5%. A total of 4,837 youth aged 12-17 years completed the RHS, representing approximately 54,000 FN youth. Data were weighted using INAC population counts, taking into account inclusion probabilities and non-response rates. Youth who answered 'do not know' or 'refused' were excluded from the study. The total weighted population represented in the final MVPA analysis was 41,664 persons (i.e., 77% of represented 12-17 year old FN youth living on-reserve and in northern FN communities). The corresponding numbers for the traditional activities analysis were 48,558 and 90% respectively.

The RHS sample design incorporated a two-stage sampling strategy. The first stage involved the selection of communities to participate in the survey. Initially, all FN communities in Canada were stratified by region, subregion, and community size [large (1,500+ people), medium (300-1,499 people), and small (<300 people)]. Large communities were automatically included, while medium and small communities were randomly selected with equal probability within their respective strata. When a randomly selected community chose not to participate, it was replaced randomly with another community in the same subregion and size grouping.

The second stage of sampling pertained to the selection of individuals within participating communities. All community members were identified using band membership lists. Community members were randomly selected within age/ gender groups from these lists. When a selected community member chose not to participate, they were substituted from the ordered randomly generated list. The sampling rate within each community was determined as a function of the overall subregion probability (within regions) and the probability of selection of the community (within subregion) as per INAC registry counts.

Individual factors

Demographics. We considered age (12-14 years, 15-17 years) and gender categories.

First Nations language. Use of FN language was grouped as follows: 'does not understand/speak a FN language', 'understands/speaks a FN language, but does not use most often in daily life', and 'use of a FN language most often in daily life'.

First Nations culture. Importance of FN culture was assessed by asking "How important are traditional cultural events in your life?" Response options were 'very important', 'somewhat important', 'not very important', and 'not important'.

Living in balance. Youth were asked how often they were in balance physically, emotionally, mentally and spiritually. Four response options for each aspect were anchored by 'almost none of the time' and 'all of the time'.

School attendance. Responses were grouped as 'yes' or 'no' based on school attendance.

Chronic conditions. Youth were asked whether they had 20 different chronic conditions, not including allergies. The number was summed and categorized as '0', '1', and '[greater than or equal to]2' chronic conditions.

Family factors

Family structure. Parental structure at home was grouped as: 'living with both biological parents', ' living with one biological parent', or 'living with no biological parents'. The number of people living within the household (excluding the respondent) was grouped as '<3', '3 or 4', '5 or 6', or '[greater than or equal to]7'.

Family socio-economic status. Parents' /guardians' highest level of education, determined by the education level of the most educated parent, was grouped as '<high school', 'high school graduate', or 'any post-secondary education'.

Family culture. Youth were asked "Who helps you in understanding your culture?" Responses included: parents, grandparents, aunts/uncles, and other relatives; these were summed as '0 relatives', '1 relative', '2 relatives', or '[greater than or equal to]3 relatives'.

Community factors

Community size. Respondents were considered to live within a small (<300 people), a medium-sized (300-1,499 people), or a large ([greater than or equal to]1,500 people) FN community.

Community culture. Youth were asked "Who helps you understand your culture?", with the following list provided: school teachers, community elders, and other community members. Responses were summed as '0', '1', '2', and '[greater than or equal to]3' community members.

Community challenges. Youth reported whether or not their community was facing challenges in education, alcohol and drug use, housing, loss of culture, lack of employment, destruction of natural environment, poor health, lack of funding, lack of control, and gang activity. Responses were summed as '0 or 1', '2 or 3', '4 or 5', and '6 or more' community challenges.

Community strengths. Participants were asked "What are the main strengths of your community?" Responses were placed into 'yes' or 'no' groups based on whether the participants checked off each of the following areas: good leisure/ recreation facilities, natural environment, and community health programs.

Physical activity

Youth were asked to report whether they had participated in 20 different common physical activities over the 12 months prior to the survey, including activities that reflect FN culture and tradition (e.g., berry picking, hunting/trapping, fishing, canoeing/ kayaking). For each activity, they reported on frequency and typical duration of participation. This information was used to estimate typical weekly minutes of MVPA. Because bowling and berry picking fall below the moderate intensity range (e.g., <4 times higher than resting energy expenditure), (16) these activities were removed from the MVPA calculation. Youth were placed into two groups based on degree of adherence to the MVPA guideline of 60 min per day: 'physically inactive' and 'physically active'. (17) Finally, to examine PA participation through a cultural lens, 'yes' and 'no' groups were created with respect to participation in at least one of the following traditional FN physical activities: berry picking, hunting/trapping, fishing, and canoeing/kayaking.

Statistical analysis

We conducted analyses using IBM SPSS Complex Samples, version 22. All analyses took into account the multi-stage stratified design of the RHS by incorporating the design information into the models to adjust for the disproportionate and cluster sampling. Initially, we calculated descriptive statistics. Next, we used bivariate logistic regression analysis to determine whether each of the individual, family and community independent variables predicted each of the PA dependent variables (e.g., accumulate [greater than or equal to]60 min/day of MVPA, participate in traditional physical activities). We then conducted unconditional multivariate logistic regression analysis. We used three steps to determine the final model. First, we added all of the individual-level factors to the model. These factors were only retained for the second step (i.e., adding family factors) and third step (i.e., adding community factors) if their p-values were less than or equal to 0.20. Because the analyses were exploratory, we selected a p [less than or equal to] 0.20 to ensure that we did not exclude variables in the model that could have achieved significance, but only after controlling for other variables in subsequent steps.

RESULTS

Descriptive characteristics

Table 1 provides a description of FN youth. Averaged over a year, 65% of FN youth reported engaging in an average of [greater than or equal to]60 min/ day of MVPA and 48% reported engaging in at least one traditional FN PA in a year.

Correlates of participation in [greater than or equal to]60 min/day of MVPA

The multivariate logistic regression analysis (Table 2) revealed that the adjusted odds ratios of participating in [greater than or equal to]60 min/day of MVPA were higher in youth who were male (OR = 1.47), had 1 chronic condition (OR = 1.55), attended school (OR = 1.50), used a FN language most often in their daily life (OR = 1.54), and lived in balance physically most (OR = 1.72) or all of the time (OR = 2.22).

As for the family factors (Table 3), the adjusted odds ratios of participating in [greater than or equal to]60 min/day of MVPA were higher in youth with parents who graduated high school (OR = 1.63) or had some post-secondary education (OR = 1.28) and youth who had 3 or more relatives helping them understand their culture (OR = 1.85).

At the community level, the multivariate analysis results in Table 4 show that the adjusted odds ratios for participating in [greater than or equal to]60 min/day of MVPA were higher in youth who reported that their community had 6 or more challenges (OR = 1.60) and youth who perceived that the leisure/recreation facilities were a strength of their community (OR = 1.48).

Correlates of participation in traditional First Nations physical activities

As shown in Table 2, the adjusted odds ratios for engaging in traditional FN physical activities were higher in youth who were male (OR = 2.16), understand (OR = 1.57) and often use (OR = 1.55) a FN language, live in balance spiritually most (OR = 1.43) or all of the time (OR = 1.68), and were lower in older youth (OR = 0.73).

At the family level, the adjusted odds ratios of engaging in traditional FN physical activities were higher in youth with one (OR = 1.34), two (OR = 1.55), or [greater than or equal to]3 relatives (OR = 1.71) helping them understand their culture. Youth living with one biological parent had lower odds (OR = 0.66) of engaging in traditional FN physical activities (Table 3).

The most relevant community factors associated with participation in traditional FN physical activities were community size, perceived natural environment, and perceived health programs of the community (p [less than or equal to] 0.05; Table 4). Youth who lived in communities with 300-1499 people (OR = 1.45) and with <300 people (OR = 2.30) had a higher adjusted odds of engaging in traditional FN activities than youth who lived in communities with [greater than or equal to]1,500 people.

DISCUSSION

When averaged across all days of the year, 65% of FN youth report accumulating at least 60 min/day of MVPA. This figure should be interpreted with caution as it may not mean that most FN youth are meeting current Canadian (17) or global (18) PA guidelines, which recommend 60 min of MVPA on a daily basis. Until PA is measured objectively in FN youth, true levels of daily PA will remain uncertain. (19)

The proportion of FN youth who participated in [greater than or equal to]60 min/day of MVPA was higher among males and those with fewer ([less than or equal to]1) chronic conditions. These findings are consistent with the mainstream literature. (19,20) We also found that FN youth who reported feeling physically balanced 'most of the time' or 'all of the time' were more likely to participate in [greater than or equal to]60 min/day of MVPA than those who feel physically balanced 'almost none of the time'. A similar, albeit non-significant, pattern in the multivariate analyses was noted for the mental, spiritual and emotional aspects of health. Living in balance is an important indicator of wellness for FN peoples and our findings are consistent with previous research showing that youth who live in balance are more likely to participate in regular PA. (4) In turn, evidence suggests that youth who regularly participate in PA and sport benefit physically, emotionally, intellectually and socially, (21-23) further reinforcing the notion of PA as culturally meaningful "good medicine". (5)

The connection between PA and culture was further supported by our finding at the family level, that youth with three or more relatives helping them understand their culture were more likely to participate in [greater than or equal to]60 min/day of MVPA than youth with fewer than three relatives helping them understand their culture. This finding suggests that family support for culture could be related to family support for PA, which would align with the mainstream literature showing that youth with family support for PA are typically more likely to be physically active. (20)

When asked to identify the main challenges their communities were currently facing, youth selected from a list of ten community-level challenges, including lack of education and training opportunities, alcohol and drug abuse, housing, loss of culture, lack of employment, destruction of natural environment and resources, poor health, lack of funding, lack of control, and gang activity. Youth identifying six or more challenges in their community were more likely to participate in [greater than or equal to]60 min/day of MVPA in comparison to youth who reported that their community had one or no challenge. Although seemingly counterintuitive, it may be that communities with more challenges try to offer more PA-related opportunities and programs to counter the community challenges. In support of this notion, we found that FN youth who perceived leisure/ recreation facilities as a strength of their community were more likely to participate in [greater than or equal to]60 min/day of MVPA in comparison to youth who did not report leisure/recreation facilities as a strength of their community.

Almost half of FN youth reported engaging in at least one traditional FN PA (i.e., berry picking, hunting/trapping, fishing, and canoeing/kayaking) in the previous year. Youth who were younger, male, had knowledge of a FN language, and who reported feeling spiritually balanced 'most of the time' or 'all of the time' were more likely to engage in traditional FN physical activities. The relationship between culture and physical expressions of the body is recurrent and strong in some youth, possibly reflecting the use of traditional FN activities as a way to reclaim cultural identity and to address the disenfranchising effects of colonial oppression upon the well-being of FN people. (1-3)

The number of relatives who help youth understand their culture was important for involvement in traditional FN physical activities. Family is central in traditional Aboriginal culture (24) and may play an especially critical role in enhancing youth involvement in traditional FN physical activities.

Youth living in small to medium communities (i.e., fewer than 1,500 people) were more likely to have engaged in traditional FN physical activities than youth living in larger communities. It may be that there is a stronger sense of community and more conformity among community members in less-populated areas.25 It is intuitive that youth who perceived the natural environment as a strength were more likely to have engaged in traditional FN physical activities (i.e., berry picking, hunting/ trapping, fishing, and canoeing/kayaking), given that these activities occur in nature. Participation in traditional FN physical activities may represent a salient way for youth to achieve balance in health and well-being. Previous evidence suggests that the integration of cultural practices and teachings in PA and sport can address the negative influences of colonization, offering a space for healing from intergenerational trauma (2,3,5) and an opportunity to promote youth living in balance during the critical developmental stage of adolescence. (26)

Consistent with the current findings, previous research on barriers to PA in Aboriginal youth identifies the influences as multi-level. (15) Our findings confirm the relevance of examining correlates for overall and traditional PA involvement from an ecological lens. (20) Influences on PA involvement by FN youth were found at each of the three ecological levels considered. The theme of culture was found to cut across all levels, confirming the importance of this construct for the examination of, and eventual intervention upon, PA and well-being among FN youth.

Overall, the magnitude of the associations examined was weak to modest and some limitations might be at play. Self-reported PA is known to be over-reported and only modestly correlated to objectively measured PA. (27) Thus, it is likely that the proportion of the population meeting the [greater than or equal to]60 min/day MVPA target was lower than reported. Specificity about the types of traditional activities performed was also lost because response options were grouped. In addition, given that the "participation in traditional PA" measure could reflect as little as once a year participation in a traditional activity, it should be noted as a limitation. Future studies should expand the list of traditional FN activities to reflect the variety of same (e.g., adding traditional dancing, drumming, tanning hides, etc.).

Despite these limitations, the current study provides new evidence for associations between PA in FN youth and several correlates at diverse ecological levels. Future work is needed to examine additional predictors of PA among youth living in FN communities.

REFERENCES

(1.) Heritage Canada, Sport Canada's Policy on Aboriginal Peoples' Participation in Sport. Minister of Public Works and Government Services Canada, Ottawa, ON, 2005. Available at: http://publications.gc.ca/pub?id=270312 & sl=0 (Accessed February 1, 2015).

(2.) Lavallee L. Balancing the Medicine Wheel through physical activity. J Aboriginal Health 2008;4(1):64-71.

(3.) Lavallee L. Physical activity and healing through the Medicine Wheel. Pimatisiwin: J Aboriginal Indig Community Health 2007;5(1):127-53.

(4.) Cargo M, Peterson L, Levesque L, Macaulay AC. Perceived wholistic health and physical activity in Kanien'keha: Ka youth. Pimatisiwin: J Aboriginal Indig Community Health 2007;5(1):87-110.

(5.) Lavallee L, Levesque L. Two-eyed seeing: Physical activity, sport, and recreation promotion in indigenous communities. In: Forsyth J, Giles A (Eds.), Aboriginal Peoples and Sport in Canada. Victoria, BC: UBC Press, 2013.

(6.) Lemstra M, Rogers M, Thompson A, Moraros J. Prevalence and correlates of physical activity within on-reserve First Nations youth. J Phys Act Health 2013;10:430-36.

(7.) Sallis JF, Owen N, Fotheringham MJ. Behavioral epidemiology: A systematic framework to classify phases of research on health promotion and disease prevention. Ann Behav Med 2000;22(4):294-98. PMID: 11253440. doi: 10.1007/BF02895665.

(8.) Sallis JF, Cervero RB, Ascher W, Henderson KA, Kraft MK, Kerr J. An ecological approach to creating active living communities. Annu Rev Public Health 2006;27:297-322. PMID: 16533119. doi: 10.1146/annurev.publhealth.27.021405. 102100.

(9.) Richard L, Gauvin L, Raine K. Ecological models revisited: Their uses and evolution in health promotion over two decades. Annu Rev Public Health 2011;32:307-26. PMID: 21219155. doi: 10.1146/annurev-publhealth-031210101141.

(10.) National Aboriginal Health Organization. First Nations Regional Longitudinal Health Survey (RHS) 2002/03: The Peoples' Report. Ottawa: National Aboriginal Health Organization, 2005.

(11.) First Nations Governance Centre. First Nations Regional Longitudinal Health Survey (RHS) 2008/09: National Report on adults, youth, and children living in First Nations communities. Ottawa: First Nations Governance Centre, 2012.

(12.) Stokols D. Establishing and maintaining healthy environments. Toward a social ecology of health promotion. Am Psychol 1992;47(1):6-22.

(13.) Sallis JF, Prochaska JJ, Taylor WC. A review of correlates of physical activity of children and adolescents. Med Sci Sports Exerc 2000;32(5):963-75.

(14.) Davison KK, Lawson CT. Do attributes in the physical environment influence children's physical activity? A review of the literature. Int J Behav Nutr Phys Act 2006;3:19.

(15.) Mason C, Koehli J. Barriers to physical activity for Aboriginal youth: Implications for community health, policy, and culture. Pimatisiwin: J Aboriginal Indig Community Health 2012;10(1):97-108.

(16.) Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, et al. Compendium of physical activities: An update of activity codes and MET intensities. Med Sci Sports Exerc 2000;32(9 Suppl):S498-S504. doi: 10.1097/00005768-200009001-00009.

(17.) Tremblay MS, Warburton DE, Janssen I, Paterson DH, Latimer AE, Rhodes RE, et al. New Canadian physical activity guidelines. Appl Physiol Nutr Metab 2011;36(1):36-46. doi: 10.1139/H11-009.

(18.) World Health Organization. Global Recommendations on Physical Activity for Health. Geneva, Switzerland: WHO, 2010. Available at: http://www.who.int/ dietphysicalactivity/factsheet_recommendations/en/index.html (Accessed March 26, 2014).

(19.) Colley RC, Garriguet D, Janssen I, Craig CL, Clarke J, Tremblay MS. Physical activity of Canadian children and youth: Accelerometer results from the 2007 to 2009 Canadian Health Measures Survey. Health Rep 2011;22(1):1523. PMID: 21510586.

(20.) Bauman AE, Reis RS, Sallis JF, Wells JC, Loos RJ, Martin BW. Correlates of physical activity: Why are some people physically active and others not? Lancet 2012;380(9838):258-71. doi: 10.1016/S0140-6736(12)60735-1.

(21.) Janssen I, Leblanc AG. Systematic review of the health benefits of physical activity and fitness in school-aged children and youth. Int J Behav Nutr Phys Act 2010;7(1):40. doi: 10.1186/1479-5868-7-40.

(22.) Strong WB, Malina RM, Blimkie CJ, Daniels SR, Dishman RK, Gutin B, et al. Evidence based physical activity for school-age youth. J Pediatr 2005; 146(6):732-37. PMID: 15973308. doi: 10.1016/j.jpeds.2005.01.055.

(23.) Biddle SJ, Asare M. Physical activity and mental health in children and adolescents: A review of reviews. Br J Sports Med 2011;45(11):886-95.

(24.) Castellano M. Aboriginal family trends: Extended families, nuclear families, families of the heart. Ottawa: Vanier Institute of the Family, 2002.

(25.) McMillan DW, Chavis DM. Sense of community: A definition and theory. J Community Psychol 1986;14:6-23. doi: 10.1002/1520-6629(198601)14:1<6:: AID-JCOP2290140103>3.0.CO;2-I.

(26.) Andersson N, Ledogar RJ. The CIET Aboriginal youth resilience studies: 14 years of capacity building and methods development in Canada. Pimatisiwin: J Aboriginal Indig Community Health 2008;6:65-88.

(27.) Adamo KB, Prince SA, Tricco AC, Connor-Gorber S, Tremblay M. A comparison of indirect versus direct measures for assessing physical activity in the pediatric population: A systematic review. Int J Pediatr Obes 2009;4(1):2-27. PMID: 18720173. doi: 10.1080/17477160802315010.

Received: May 1, 2014

Accepted: November 9, 2014

Lucie Levesque, PhD, [1] Ian Janssen, PhD, [1,2] Fei Xu, PhD, [3] First Nations Information Governance Centre [3]

Author Affiliations

[1.] School of Kinesiology and Health Studies, Queen's University, Kingston, ON

[2.] Department of Public Health Sciences, Queen's University, Kingston, ON

[3.] First Nations Information Governance Centre, Ottawa, ON

Correspondence: Lucie Levesque, School of Kinesiology and Health Studies, Queen's University, Kingston, ON K7L 3N6, Tel: *^613-533-6000, Ext. 78164, E-mail: levesqul@queensu.ca

Source of funding: Funding was provided by the First Nations Information Governance Centre.

Conflict of Interest: Lucie Levesque and Ian Janssen received consulting fees from the First Nations Information Governance Centre. Fei Xu is employed by the First Nations Information Governance Centre.
Table 1. Unweighted N and % for all variables included in the
analyses

Variable                 Unweighted N   %

Individual-level
  variable
Age, years
  12-14                      2326       50.0
  15-17                      2498       50.0
Sex
  Female                     2476       48.7
  Male                       2361       51.3
Physical activity
  [greater than              2917       65.0
    or equal to]
    60 min/day of
    moderate-to-
    vigorous
    activity
  Participate in             2276       47.7
    traditional
    First Nations
    activities
Number of chronic
    conditions
  0                          3392       71.6
  1                           906       18.4
  [greater than               456       10.1
    or equal to] 2
Attend school
  No                          465       12.3
  Yes                        4329       87.7
Knowledge of First
    Nations language
  Do not understand          2039       43.7
    or speak
  Understand but do          1566       34.9
    not use most
    often
  Understand and              996       21.4
    use most often
    in daily life
Importance: First
    Nations culture
  Not important               259       5.5
  Not very important          507       8.8
  Somewhat important         1884       40.2
  Very important             1985       45.5
Live in balance
    physically
  Almost none of              286       6.6
    the time
  Some of the time            872       18.4
  Most of the time           1894       39.5
  All of the time            1638       35.5
Live in balance
    emotionally
  Almost none                 440       10.1
    of the time
  Some of the time           1106       24.5
  Most of the time           1830       38.7
  All of the time            1290       26.6
Live in balance
    mentally
  Almost none of              660       15.5
    the time
  Some of the time            863       18.9
  Most of the time           1752       37.0
  All of the time            1375       28.6
Live in balance
    spiritually
  Almost none                 647       14.0
    of the time
  Some of the time           1142       25.2
  Most of the time           1651       35.8
  All of the time            1203       25.0
Family-level
  variable
Parental structure
  Live with no                791       16.4
    biological parents
  Live with 1                2224       45.6
    biological parent
  Live with both             1821       38.2
    biological parents
# People in household
    (excluding youth)
  [greater than or            736       18.7
    equal to] 7
  5-6                        1129       24.3
  3-4                        1945       38.2
  < 3                        1012       18.8
Family-level variable
Parental education
  < High school              1725       41.7
    graduate
  High school graduate       1178       25.2
  [greater than or           1550       33.1
    equal to] Some
    post-secondary
# Relatives who help
    youth understand
    culture
  0                           954       18.1
  1                          1752       39.9
  2                           953       18.5
  [greater than or           1177       23.5
    equal to] 3
Community-level
  variable
Community size
  [greater than or            590       7.3
    equal to] 1500
    people
  300-1499 people            2585       49.6
  < 300 people               1662       43.1
# Community members
    who help youth
    understand culture
  0                          2566       55.8
  1                          1467       27.6
  2                           569       11.6
  [greater than or            234       5.0
    equal to] 3
# Community challenges
    perceived by youth
  0 or 1                     1324       25.5
  2 or 3                     1412       27.6
  4 or 5                      939       19.9
  6 or more                  1130       27.0
Leisure/recreation
    facilities a
    strength of
    community
  No                         3893       79.9
  Yes                         912       20.1
Natural environment
    a strength of
    community
  No                         4112       85.9
  Yes                         693       14.1
Community health
    programs a
    strength of
    community
  No                         3563       72.6
  Yes                        1242       27.4

Table 2. Individual/level factors associated with participation
in [greater than or equal to] 60 min/day of moderate/to/vigorous
PA and with participation in traditional First Nations physical
activities in 12/17 year old youth participants of the 2008/10
First Nations Regional Health Survey

Individual-              Participation in [greater than or equal to]
level variable                      60 min/day of MVPA

                       % *      Unadjusted OR         Adjusted OR
                                   (95% CI)            (95% CI)
                                  ([dagger])       ([double dagger])

Age, years
  12-14                64.9      1 (referent)        1 (referent)
  15-17                65.0    1.00 (0.84-1.26)    1.06 (0.86-1.29)
Sex
  Female               60.9      1 (referent)        1 (referent)
  Male                 68.7   1.41 (1.16-1.72)#    1.47 (1.19-1.83)#
Number of chronic
    conditions
  [greater than        59.7      1 (referent)        1 (referent)
    or equal to] 2
  1                    68.1   1.44 (1.01-2.05)#    1.55 (1.07-2.24)#
  0                    65.3   1.27 (0.94-1.71)#    1.37 (1.00-1.89)
Attend school
  No                   54.9      1 (referent)        1 (referent)
  Yes                  66.5   1.64 (1.25-2.13)#    1.50 (1.11-2.02)#
Knowledge: First
    Nations language
  Do not understand    62.6      1 (referent)        1 (referent)
    nor speak
  Understand, do not   64.5    1.09 (0.88-1.34)    1.18 (0.95-1.45)
    use most often
  Understand, use      71.5   1.50 (1.19-1.89)#    1.54 (1.19-1.99)#
    most often
Importance: First
    Nations culture
  Not important        63.7      1 (referent)
  Not very important   62.2    0.94 (0.62-1.41)
  Somewhat important   64.2    1.02 (0.69-1.50)
  Very important       67.0    1.16 (0.78-1.72)           N/A
Live in balance
    physically
  Almost none of       52.1      1 (referent)        1 (referent)
    the time
  Some of the time     52.2    1.00 (0.67-1.52)    1.04 (0.66-1.64)
  Most of the time     66.0   1.79 (1.22-2.62)#    1.72 (1.11-2.68)#
  All of the time      72.7   2.46 (1.67-3.62)#    2.22 (1.42-3.47)#
Live in balance
    emotionally
  Almost none of       58.3      1 (referent)
    the time
  Some of the time     58.8    1.02 (0.73-1.42
  Most of the time     68.4   1.55 (1.14-2.10))#
  All of the time      68.9   1.58 (1.05-2.37)#           N/A
Live in balance
    mentally
  Almost none of       56.7      1 (referent)
    the time
  Some of the time     56.1    0.98 (0.68-1.39)
  Most of the time     68.8   1.68 (1.27-2.23)#
  All of the time      70.9    1.86 (1.34-2.59#           N/A
Live in balance
    spiritually
  Almost none of       55.7      1 (referent)
    the time
  Some of the time     59.3    1.16 (0.83-1.62)
  Most of the time     69.7   1.83 (1.33-2.51)#
  All of the time      69.5   1.82 (1.30-2.55)#           N/A

Individual-               Participation in traditional First Nations
level variable                       physical activities

                       % *      Unadjusted OR        Adjusted OR
                                  (95% CI)             (95% CI)
                                 ([dagger])       ([double dagger])

Age, years
  12-14                51.4     1 (referent)         1 (referent)
  15-17                43.9   0.74 (0.62-0.88)#   0.73 (0.61 -0.87)#
Sex
  Female               39.2     1 (referent)         1 (referent)
  Male                 55.8   1.96 (1.66-2.32)#   2.16 (1.81-2.57)#
Number of chronic
    conditions
  [greater than        52.4     1 (referent)             N/A
    or equal to] 2
  1                    46.4   0.79 (0.61 -1.01)
  0                    51.6   0.97 (0.71-1.32)
Attend school
  No                   43.4     1 (referent)             N/A
  Yes                  48.5   1.23 (0.96-1.58)
Knowledge: First
    Nations language
  Do not understand    41.5     1 (referent)         1 (referent)
    nor speak
  Understand, do not   53.0   1.59 (1.31-1.92)#   1.57 (1.22-1.97)#
    use most often
  Understand, use      53.8   1.64 (1.33-2.03)#   1.55 (1.28-1.92)#
    most often
Importance: First
    Nations culture
  Not important        43.0     1 (referent)             N/A
  Not very important   42.4   0.98 (0.70-1.37)
  Somewhat important   44.7   1.07 (0.80-1.43)
  Very important       52.3   1.45 (1.08-1.95)#
Live in balance
    physically
  Almost none of       35.3     1 (referent)             N/A
    the time
  Some of the time     41.7   1.31 (0.96-1.90)
  Most of the time     46.3   1.58 (1.11-2.24)#
  All of the time      54.6   2.20 (1.52-3.19)#
Live in balance
    emotionally
  Almost none of       48.3     1 (referent)             N/A
    the time
  Some of the time     42.9   0.81 (0.58-1.11)
  Most of the time     48.6   1.01 (0.74-1.39)
  All of the time      50.4   1.09 (0.74-1.61)
Live in balance
    mentally
  Almost none of       43.8     1 (referent)             N/A
    the time
  Some of the time     44.4   1.03 (0.80-1.32)
  Most of the time     47.3   1.15 (0.90-1.47)
  All of the time      52.6   1.43 (1.09-1.87)#
Live in balance
    spiritually
  Almost none of       37.2     1 (referent)         1 (referent)
    the time
  Some of the time     44.5   1.35 (1.00-1.82)#    1.28 (0.96-1.71)
  Most of the time     49.6   1.66 (1.25-2.20)#   1.43 (1.08-1.88)#
  All of the time      53.9   1.97 (1.50-2.60)#   1.68 (1.27-2.23)#

* % of participation in [greater than or equal to] 60 min/day in
MVPA and in First Nations traditional physical activities.

([dagger]) Unadjusted odds ratio (95% confidence interval).

([double dagger]) Adjusted odds ratio (95% confidence interval).
Adjusted for other individual/level, family and community
factors. N/A = not applicable as variable not included in final
model.

Bold numbers indicate statistically significant odds ratios (p <
0.05).

Note: The significant odds ratios (p < 0.05) are indicated with #.

Table 3. Family/level factors associated with participation in
[greater than or equal to] 60 min/day of moderate/to/vigorous PA
and with participation in traditional First Nations physical
activities in 12/17 year old youth participants of the 2008/10
First Nations Regional Health Survey

Family variable          Participation in [greater than or equal
                                to] 60 min/day of MVPA

                     % *      Unadjusted OR        Adjusted OR
                                (95% CI)            (95% CI)
                               ([dagger])       ([double dagger])

Parental structure
  Live with no       59.2     1 (referent)             N/A
    biological
    parents
  Live with 1        65.0   1.28 (0.99-1.66)
    biological
    parent
  Live with both     67.3   1.42 (1.10-1.85)#
    biological
    parents
# People in
    household
    (excluding
    youth)
  [greater than      63.8     1 (referent)             N/A
    or equal to] 7
  5-6                65.7   1.08 (0.84-1.39)
  3-4                64.1   1.01 (0.79-1.29)
  < 3                66.8   1.14 (0.87-1.50)
Parental education
  < High school      60.4     1 (referent)        1 (referent)
    graduate
  High school        69.8   1.52 (1.25-1.84)#   1.63 (1.31-2.03)#
    graduate
  [greater than      67.2   1.34 (1.06-1.70)#   1.28 (1.00-1.62)#
    or equal to]
    Some post-
    secondary
# Relatives who
    help youth
    understand
    culture
  0                  59.8     1 (referent)        1 (referent)
  1                  60.0   1.01 (0.79-1.30)    0.90 (0.76-1.28)
  2                  65.6   1.29 (0.96-1.73)    1.12 (0.81-1.56)
  [greater than      76.4   2.18 (1.63-2.94)#   1.85 (1.31-2.63)#
    or equal
    to] 3

Family variable        Participation in traditional First Nations
                                  physical activities

                     % *      Unadjusted OR        Adjusted OR
                                (95% CI)            (95% CI)
                               ([dagger])       ([double dagger])

Parental structure
  Live with no       49.8     1 (referent)        1 (referent)
    biological
    parents
  Live with 1        44.6   0.77 (0.61-0.96)#   0.66 (0.52-0.83)#
    biological
    parent
  Live with both     51.3   0.94 (0.74-1.19)    0.80 (0.64-1.00)
    biological
    parents
# People in
    household
    (excluding
    youth)
  [greater than      49.1     1 (referent)             N/A
    or equal to] 7
  5-6                46.9   0.91 (0.74-1.14)
  3-4                48.3   0.97 (0.78-1.19)
  < 3                46.7   0.91 (0.71-1.15)
Parental education
  < High school      45.9     1 (referent)             N/A
    graduate
  High school        48.0   1.09 (0.91 -1.31)
    graduate
  [greater than      49.1   1.14 (0.93-1.39)
    or equal to]
    Some post-
    secondary
# Relatives who
    help youth
    understand
    culture
  0                  39.6     1 (referent)        1 (referent)
  1                  45.5   1.27(1.03-1.58)#    1.34 (1.07-1.69)#
  2                  49.9   1.52(1.19-1.94)#    1.55 (1.19-2.02)#
  [greater than      55.9   1.93 (1.52-2.46)#   1.71 (1.32-2.21)#
    or equal
    to] 3

* % of participation in [greater than or equal to] 60 min/day
MVPA and in First Nations traditional physical activities.

([dagger]) Unadjusted odds ratio (95% confidence interval).

([double dagger]) Adjusted odds ratio (95% confidence interval).
Adjusted for other individual-level, family, and community
factors.

N/A = not applicable as variable not included in final model.

Bold numbers indicate statistically significant odds ratios
(p < 0.05).

Note: Thesignificant odds ratios (p < 0.05) are indicated with #.

Table 4. Community/level factors associated with participation in
[greater than or equal to] 60 min/day of moderate/to/vigorous PA
and with participation in traditional First Nations physical
activities in 12/17 year old youth participants of the 2008/10
First Nations Regional Health Survey

Community variable        Participation in [greater than or equal
                                  to] 60 min/day of MVPA

                      % *      Unadjusted OR        Adjusted OR
                                 (95% CI)            (95% CI)
                                ([dagger])       ([double dagger])

Community size
  [greater than       63.8     1 (referent)             N/A
    or equal to]
    1500 people
  300-1499 people     66.5   1.12 (0.91-1.39)
  < 300 people        61.1   0.89 (0.67-1.18)
# Community members
    who help youth
    understand
    culture
  0                   61.2     1 (referent)             N/A
  1                   67.2   1.30 (1.01-1.67)#
  2                   70.6   1.52 (1.13-2.06)#
  [greater than       80.6   2.64 (1.55-4.50)#
    or equal to] 3
# Community
    challenges
    perceived by
    youth
  0 or 1              58.7     1 (referent)        1 (referent)
  2 or 3              66.3   1.38 (1.10-1.74)#   1.30 (1.00-1.70)#
  4 or 5              63.6   1.23 (0.89-1.71)    1.24 (0.90-1.72)
  6 or more           70.2   1.66 (1.27-2.17)#   1.60 (1.20-2.14)#
Leisure/recreation
    facilities a
    strength of
    community
  No                  62.6     1 (referent)        1 (referent)
  Yes                 74.2   1.72 (1.34-2.20)#   1.48 (1.12-1.95)#
Natural environment
    a strength of
    community
  No                  64.6     1 (referent)             N/A
  Yes                 67.5   1.14 (0.87-1.49)
Community health
    programs a
    strength of
    community
  No                  63.2     1 (referent)             N/A
  Yes                 69.6   1.33 (1.09-1.63)

Community variable      Participation in traditional First Nations
                                   physical activities

                      % *      Unadjusted OR        Adjusted OR
                                 (95% CI)            (95% CI)
                                ([dagger])       ([double dagger])

Community size
  [greater than       43.2     1 (referent)        1 (referent)
    or equal to]
    1500 people
  300-1499 people     50.0   1.32 (1.11-1.56)#   1.45 (1.19-1.76)#
  < 300 people        58.5   1.85 (1.42-2.42)#   2.30 (1.17-3.17)#
# Community members
    who help youth
    understand
    culture
  0                   42.7     1 (referent)        1 (referent)
  1                   52.3   1.47 (1.23-1.77)#   1.11 (0.74-1.66)
  2                   58.1   1.89 (1.47-2.38)#   1.74 (1.31-2.30)#
  [greater than       54.8   1.63 (1.06-2.51)#   1.42 (1.18-1.72)#
    or equal to] 3
# Community
    challenges
    perceived by
    youth
  0 or 1              43.5     1 (referent)             N/A
  2 or 3              49.1   1.25 (1.01-1.54)#
  4 or 5              45.8   1.10 (0.85-1.42)
  6 or more           51.8   1.39 (1.11-1.75)#
Leisure/recreation
    facilities a
    strength of
    community
  No                  46.8     1 (referent)             N/A
  Yes                 51.6   1.21 (0.99-1.48)
Natural environment
    a strength of
    community
  No                  45.8     1 (referent)        1 (referent)
  Yes                 60.0   1.78 (1.38-2.29)#   1.55 (1.20-2.00)#
Community health
    programs a
    strength of
    community
  No                  45.0     1 (referent)        1 (referent)
  Yes                 55.3   1.51 (1.26-1.81)    1.40 (1.17-1.67)

* % of participation in [greater than or equal to] 60 min/day
MVPA and in First Nations traditional physical activities.

([dagger]) Unadjusted odds ratio (95% confidence interval).

([double dagger]) Adjusted odds ratio (95% confidence interval).
Adjusted for other individual-level, family, and community
factors.

N/A = not applicable as variable not included in final model.

Bold numbers indicate statistically significant odds ratios (p
[less than or equal to] 0.05).

Note: significant odds ratios (p [less than or equal to] 0.05)
are indicated with #.
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Article Details
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Title Annotation:QUANTITATIVE RESEARCH
Author:Levesque, Lucie; Janssen, Ian; Xu, Fei
Publication:Canadian Journal of Public Health
Article Type:Report
Geographic Code:1CANA
Date:Jan 1, 2015
Words:6751
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