Little is known about patterns of physical activity engaged in by youth after they immigrate to a new country. This study aims to investigate relationships between immigrant generation and ethnicity with physical activity, and to determine if the relationship between immigrant generation and physical activity was modified by ethnicity.
The data sources were Cycle 6 (2009–2010) of the Canadian Health Behaviour in School-Aged Children Study and the 2006 Canada Census of Population. Participants (weighted n = 23,124) were young people from grades 6–10 in 436 schools. Students were asked where they were born, how long ago they moved to Canada, their ethnicity, and how many days a week they accumulated at least 60 minutes of moderate-to-vigorous physical activity (MVPA).
Youth born outside of Canada were less likely to be active than peers born in Canada; 11% vs 15% reported 7 days/week of at least 60 minutes of MVPA (p = .001). MVPA increased with time since immigration. Compared to Canadian-born youth, youth who immigrated within the last 1–2 years were less likely to get sufficient MVPA on 4–6 days/week (odds ratio: 0.66, 95% confidence interval: 0.53–0.82) and 7 days/week (0.62; 0.43–0.89). East and South-East Asian youth were less active, regardless of time since immigration: 4–6 days/week (0.67; 0.58–0.79) and 7 days/week (0.37; 0.29–0.48).
Time since immigration and ethnicity were associated with MVPA among Canadian youth. Mechanisms by which these differences occur need to be uncovered in order to identify barriers to physical activity participation among youth.
Citation: Kukaswadia A, Pickett W, Janssen I (2014) Time Since Immigration and Ethnicity as Predictors of Physical Activity among Canadian Youth: A Cross-Sectional Study. PLoS ONE 9(2): e89509. doi:10.1371/journal.pone.0089509
Editor: Harry Zhang, Old Dominion University, United States of America
Received: August 15, 2013; Accepted: January 21, 2014; Published: February 21, 2014
Copyright: © 2014 Kukaswadia et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: The HBSC is a WHO/Euro collaborative study; International Coordinator of the 2009–2010 study is Candace Currie, St. Andrews University, Scotland; Data Bank Manager is Oddrun Samdal, University of Bergen, Norway. The Canadian HBSC study (PI: John Freeman, William Pickett) was funded by the Public Health Agency of Canada, Health Canada, the Canadian Institutes of Health Research and the Heart and Stroke Foundation of Canada (MOP 97961; PCR 101415). Atif Kukaswadia was supported by a Canadian Institutes of Health Research Frederick Banting and Charles Best Canada Graduate Scholarships Doctoral Award and Ian Janssen was supported by a Tier 2 Canada Research Chair in Physical Activity and Obesity. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
An important determinant of the health of young people is involvement in regular physical activity.  It is recommended that youth accumulate at least 60 minutes of moderate-to-vigorous physical activity (MVPA) daily. – In Canada, only 9% of boys and 4% of girls meet these criteria.  Gender, age, and socio-economic status are well documented correlates of physical activity. ,  Despite its potential importance, the role of immigration as a determinant of physical activity is understudied. A migrant refers to someone who has moved to a new country.  When an individual immigrates to a new country, two different cultures meet and acculturation occurs.  Acculturation refers to behavioural and psychological changes that occur as individuals adopt the norms and values of their new or host culture, while balancing these norms with those of their heritage culture.  These may manifest as changes in health and health-related behaviours, such as physical activity , .
Acculturation can manifest in two types of health outcomes: psychological outcomes  and behavioural adaptation.  Psychological outcomes refer to internal adjustments made, and include emotional and psychological issues such as life satisfaction. ,  Behavioural adaptations are external changes made, and refer to acquiring culturally appropriate skills and knowledge, obtained through interaction with the host culture.  These changes can be associated with both positive and negative health outcomes. While youth who do not integrate have lower rates of obesity and higher levels of active transportation, ,  they are also more likely to be in physical fights and have higher levels of alcohol consumption. ,  These differences are especially noticeable when the host culture, i.e. Canada or the US, and the heritage culture, i.e. where the youth and their parents immigrated from, are very different. This is relevant to the US and Canada as immigrants from Asia and the Pacific account for over 40% of all new immigrants, and also in Europe where Asian immigrants are the fourth largest immigrant group, and have different cultural norms and values compared to European peers –.
One methodological problem faced by researchers is that acculturation is a multidimensional process that is difficult to measure. Immigrant generation or time since immigration are often used as proxy measures of acculturation, with the assumption that higher immigrant generation or longer time since immigration are associated with increased acculturation. With the exception of one study,  studies of the experiences of immigrant youth have concluded that physical activity levels are lower among foreign-born youth compared with those born in the host country , – However, this relationship may be confounded by time since immigration. Time since immigration may more accurately capture acculturation as a determinant of health. This has been explored among Canadian adults aged 20 and older in the Canadian Community Health Survey. This study found that recent immigrants (<10 years) are 2.68 (95% CI: 2.54–2.83) times more likely to get no meaningful physical activity compared to non-immigrants, which is far greater than the risk observed in established immigrants (>10 years) (OR: 1.30, 95% CI: 1.26–1.35).  However, prior research has focused on changes in adult physical activity over time. Youth are different than adults, and the etiology and determinants of physical activity among youth may be unique. In addition, due to the rapidly growing size of the immigrant youth population, this group warrants specific study.
Previous studies have typically focused on the experiences of a specific ethnic group living within a single geographical area, thus limiting their generalizability. , –, ,  One study examined a diverse national sample of US youth, and it found that immigrants are less active than those born in the host country.  These studies of differences between ethnic groups have limited generalizability to Canada as immigrants to the US and Europe are from different geographical regions than Canadian immigrants, and ethnicity is an important determinant of physical activity. –,  A Canadian study examined the relationship between immigrant generation and physical activity among youth from low-income, inner city neighbourhoods in Montreal, Quebec, found that youth who had spent less than 25% of their life in Canada were less active.  However, this study did not consider ethnicity or interactions between time youth lived in Canada or ethnicity, which could mitigate this relationship.  Thus, studies are needed that compare how different ethnicities adapt to new cultures and contexts.
Our aim was to investigate differences in MVPA levels between immigrant youth and their Canadian-born peers. Subanalyses investigated whether this relationship differs by time since immigration and ethnicity. We hypothesize that immigrant youth would have lower MVPA than non-immigrants, and that this differs by ethnicity.
Individual-level data were obtained from Cycle 6 (2010) of the Canadian Health Behaviour in School-Aged Children (HBSC) Study. HBSC is an international survey conducted in affiliation with the World Health Organization. It is a self-reported general health survey completed by students in the classroom setting.  The 2010 Canadian HBSC collected information from 26,078 youth in grades 6 through 10 in 436 schools from all provinces and territories, with the exception of Prince Edward Island and New Brunswick.  Different recruitment strategies were used in the participating Canadian provinces and territories. In each province, a systematic, multi-stage cluster sample approach was used. A list of schools within eligible and consenting boards was created, and classes within schools were randomly sampled from this list. When a school refused participation, the sampling protocol involved selecting a school that was similar as possible to the originally selected school. For the three territories, a census of all students in Grades 6 through 10 was attempted. Due to the sampling methods and coverage, sample weights were developed to promote generalizability of estimates nationally.
Approximately 57% of schools approached agreed to participate, and 77% of the estimated students in schools that gave consent participated in the study. Less than 10% declined to participate or spoiled their questionnaires intentionally, and remaining non-participants generally either failed to return consent forms, failed to receive parental consent, or were absent on the day of the survey.  From the original sample of 26,078 youth, 3296 were excluded due to missing data (Figure 1). This left a final unweighted sample of 22,786 (weighted sample of 23,124).
Figure 1. Study flow diagram of exclusion criteria used to eliminate observations from the original HBSC sample.doi:10.1371/journal.pone.0089509.g001
Area-level data were obtained from the 2006 Canada Census of Population.  Census-based measures included median neighbourhood income, percentage of immigrants in the community, and Statistics Canada Population Centre Category.  Census responses were linked to schools to describe the neighbourhoods in the 1 km radius around each school.
The Canadian HBSC received ethics approval from the Queen’s University General Research Ethics Board (File # GEDUC-430-09). The analyses for this paper received additional ethics approval from the Queen’s University Health Sciences Research Ethics Board (File # 6007744). Consent was sought at multiple levels. First, school jurisdictions were approached for permission to invite their students and schools to participate. Second, school principals were approached to participate. Finally, both active parent consent, in the form of a signed consent form, and passive parent consent, where students were allowed to participate if they did not return the parent consent form indicating their parents refused participation, were used. Participating school jurisdictions and schools selected the consent type that was consistent with local norms, as per ethics agreements at Queen’s University.
Primary Exposures – Immigrant Generation and Ethnicity
The primary exposure permitted categorization of youth by immigrant generation. This was assessed in the HBSC survey by asking “In which country were you born?” Youth born abroad were categorized as “foreign-born,” while youth born in Canada were classified as “Canadian-born.” Youth were then categorized into five groups by the length of time they have been in Canada by asking “How many years have you lived in Canada?” Response options were: “I was born in Canada,” “1 to 2 years,” “3 to 5 years” “6 to 10 years” and “11 or more years.” Due to small numbers, the last two responses were combined to form a “6+ years” group.
Youth were categorized into seven ethnic groups by asking “How do you describe yourself?” with 16 possible response options. Youth were able to select up to 3 response categories. Responses were used to create the following ethnic groups: “Canadian,” “Arab,” “African,” “South Asian,” “East and South East Asian,” “Latin American” and “Other.” These groups were based on ethnic groupings defined by the 2006 Canadian Census of Population, with three modifications.  First, European and North American immigrant youth were combined with Aboriginal youth to create a “Canadian” host culture group (Note: ethics restrictions prohibited separate study of Aboriginal youth).  Second, West Asian and South Asian youth were combined due to small numbers of West Asian youth. Finally, an additional group was created (“Other”) that included youth who identified with multiple ethnic groups.
Outcome – Moderate-to-Vigorous Physical Activity (MVPA)
MVPA was measured by taking an average of the responses to the questions: “Over the past 7 days, on how many days were you physically active for a total of at least 60 minutes per day?” and “Over a typical or usual week, on how many days are you physically active for a total of at least 60 minutes per day?”  Prior to being asked these questions, the questionnaire provided students with a description of MVPA and a list of common physical activities of this intensity. MVPA was categorized into three groups of: 0–3 days/week, 4–6 days/week and 7 days/week. Only the highest category (7 days/week) meets Canadian physical activity guidelines. ,  This measure is reasonably valid: Using a 7 day/week cut off, percent agreement is 69.6% between this self-reported measure and objective measures of MVPA determined using accelerometers.  This measure was developed using a diverse sample of US adolescents, and has been shown to be appropriate for use in different ethnic groups .
Individual-level covariates were age, gender and perceived family wealth, the latter measured through the Family Affluence Scale.  These were all found to be important predictors of physical activity among youth. , , ,  These variables were all obtained via self-report, and measured as part of the 2010 HBSC student questionnaire. ,  School-level covariates were obtained from the 2006 Canadian Census of Population, and were based on a 1 km radius buffer around the school. Previous research using the HBSC survey has found this to be an appropriate buffer by which to make inferences about other social constructs, such as neighbourhood socio-economic status.  At the area level, covariates included: Statistics Canada population centre category, percentage of immigrants in the community, and median income quartile .
All analyses used a multi-level approach due to the clustered nature of these data and the inclusion of school-level covariates; Level 1 includes individual-level factors and Level 2 includes school-level variables.  Cross-tabulations of youth physical activity levels by the exposure categories were performed. All p-values calculated for associated statistical tests used the Rao-Scott chi-square test to control for clustering at the school-level.
Second, etiologic analyses were used to explore the relationship between time since immigration and physical activity using multi-level nominal regressions. Only time since immigration and ethnicity were included in the modelling process, as immigrant generation and time since immigration are collinear. A nominal regression model was built with three outcomes: 0–3 days/week (referent), 4–6 days/week, and 7 days/week of 60 minutes or more of MVPA.
Several models were built, following the approach of Merlo et al.  First, an empty model was built. This investigated the random effect of school on the outcome of interest, and explains how much of the variation in MVPA is explained by school alone.  Second, a bivariate model was created that only included time since immigration and ethnicity as predictors of physical activity. The third and fourth models controlled for individual-level and school-level covariates respectively. The final model thus included all covariates found to be statistically significant in models three and four. Percentage changes in odds ratios were then calculated for the three iterative models compared to the base model, to determine the impact of these covariates on the effect estimates. Surprisingly, very few covariates created changes in estimates of the primary exposures of greater than 5%. Thus, all variables originally considered were included in the final model.
A third exploratory analysis was conducted that investigated the interaction between time since immigration and ethnicity. This stratified each ethnicity into 4 groups: Canadian-born, 1–2 years, 3–5 years and 6+ years. No variables were controlled for in these models due to insufficient cell sizes.
All analyses were conducted using SAS v9.3 using PROC SURVEYFREQ for cross-tabulations and PROC GLIMMIX for regression models. All analyses considered the sample weights and accounted for clustering at the school-level (SAS Institute, Cary, NC). The intra-class correlation revealed that the school-level accounted for 4.9% of the variation in MVPA, thereby justifying the use of multi-level models .
Our sample was comprised of predominantly Canadian-born youth (90.9%) (Table 1). Most self-identified as Canadian (77.3%). The other major ethnic groups were East and South East Asian (5.8%), African (4.3%), and East Indian and South Asian (3.1%). Only 14.6% of youth reported accumulated 60 minutes of MVPA every day of the week (Table 1), meeting Canadian guidelines and hence were classified as “active”.
Table 1. Description of key variables by level of physical activity (n = 23,124).doi:10.1371/journal.pone.0089509.t001
The distribution of the sample across the three physical activity groups implied that foreign-born youth were more physically active than Canadian-born peers (Table 1). After controlling for relevant covariates, youth who immigrated within the last 1–2 years reported being less likely to accumulate at least 60 minutes of MVPA on 4–6 days/week (OR: 0.66 (95% CI: 0.53–0.83)) and 7 days/week (0.62 (0.43–0.89)) in comparison to Canadian born youth (Table 2). Reported MVPA was not significantly different across Canadian born youth and youth who immigrated in the past 3–5 years and 6+ years (Table 2).
Table 2. Nominal regression modeling of determinants of moderate-to-vigorous physical activity.doi:10.1371/journal.pone.0089509.t002
Differences in MVPA were also observed by ethnicity. East and South East Asian, Latin American, and African ethnic groups had lower physical activity levels, with 32–39% accumulating the recommended 60 minutes of MVPA on only 0–3 days/week, compared to 26.8% within the Canadian ethic group (Table 1). These differences persisted after controlling for important covariates (Table 2).
Exploratory analyses tested the potential interaction between ethnicity and time since immigration (Table 3). Tests for interaction were not statistically significant (p = .12). Irrespective of their time since immigration, East/South East Asian youth were less active than Canadian born youth who identified as Canadian. For other ethnicities no trends emerged, although different relationships were seen with increased time since immigration.
The most important findings of the study of immigrant generation, ethnicity and physical activity among young people were as follows. First, immigrant youth in Canada are less active than their Canadian-born peers. Second, reported physical activity increases with increased time since immigration. Third, reported physical activity differs by ethnicity. Finally, exploratory tests of possible interactions between immigrant generation and ethnicity were generally negative, but do suggest that East and South East Asian youth have reduced physical activity levels irrespective of their immigration status and the length for which they have resided in Canada.
Our primary finding that the observed reduction in physical activity levels in immigrant youth decreased as time since immigration increased supports the theory of acculturation. That is, as immigrants live longer in a country, their physical activity behaviours more closely approximate those of the host culture. This finding is consistent with research findings for Canadian adults. Cross-sectional analyses of 400,055 adult participants in the Canadian Community Health Survey (2000–2005) indicate that recent immigrants (<10 years) are 2.68 (95% CI: 2.54–2.83) times more likely to get no meaningful physical activity compared to non-immigrants whereas established immigrants (>10 years) are only marginally more likely to get no meaningful physical activity (OR: 1.30, 95% CI: 1.26–1.35).  Our findings echo these results, except that they showed that immigrant youth match the physical activity behaviours of their Canadian-born peers within a few years. Findings of similar size and direction have been reported among a national sample of US youth. Foreign born youth had 1.39-fold (95% CI: 1.13–1.70) increased odds of obtaining no physical activity compared to US-born peers of US-born parents, i.e. 2nd (and higher) generation youth.  Studies of Swedish youth found similar findings, with foreign-born youth being less physical active in sports than Swedish born peers (54.4% vs 41.1%, p = .003)  Our results suggest these findings may be driven by certain ethnic groups, and are not generalizable to all immigrant youth.
We found that East and South East Asian youth had drastically reduced odds of being physical active regardless of time since immigration. These findings and the magnitude of these associations are supported by other Canadian studies. ,  A study of youth in Montreal found increased odds of no physical activity of similar effect sizes to our study, with Asian boys and girls reporting odds of 2.1 (1.4–3.1) and 1.8 (1.2–2.6), respectively, for no physical activity.  This difference remains consistent regardless of time since immigration. A study of Canadian adults reported slightly smaller effect sizes compared to our study, with established (>10 years) and recent (<10 years) East and South East Asian immigrant adults reporting odds of 0.6 (0.5–0.8) and 0.7 (0.6–0.9) for moderate-to-high physical activity, compared to White immigrants within the same time since immigration category.  These differences between East and South East Asian immigrants and Canadian adult peers may be due to 1) being involved in different forms of physical activity, 2) cultural differences in what constitutes physical activity, and 3) ethnic differences in extracurricular activity involvement. , ,  Studies of youth in the US have reported similar findings, although they focused on Hispanic and non-Hispanic Black youth. In both cases, they found that foreign born youth with both parents born abroad had increased odds of obtained no physical activity (OR: 2.13 (95% CI: 1.67–2.71) and 1.46 (95% CI: 0.88–2.41) respectively).  Studies in the US have focused on Korean and South Asian adults, and have reported similar findings, corroborating what we saw in our study among East and South East Asian youth. ,  Finally, studies in Europe have report ethnic minority adolescents are less active than Norwegian peers .
These findings reinforce the potential importance of tailoring physical activity immigrant-specific interventions by ethnicity, and including those born in Canada. A systematic review of studies of youth have found that multi-component interventions, incorporating the school environment, family and child have been most effective.  This has been shown among interventions performed in the US,  as well as similar programs in Europe. – Previous interventions have focused on youth as a homogenous group, and our findings support the hypothesis that ethnic differences exist within youth, and specifically the immigrant youth population. These differences have been shown to be barriers to participation in physical activity.  Thus acknowledging cultural norms and values as part of interventions may further their effectiveness.
These findings have significant implications for health promotion efforts in Canada. A large proportion (19.8%) of Canadians were born abroad.  One potential mechanism by which immigrant youth may be less active than Canadian-born peers is due to participation in sports. While 55% of children of Canadian-born parents participated in sports, only 32% of children of parents who immigrated to Canada in the last 10 years participate.  A second important implication is that a large number of European, Canadian and US immigrants are from Asia and the Pacific. – Our finding that these youth have drastically lower odds of obtaining sufficient MVPA, a finding that is supported by national studies of Canadian adults, suggests that these individuals may have lower physical activity levels throughout the life course. ,  The potential reasons for these differences demand further study and suggest the need for tailored and culturally sensitive interventions.
The main strength of this study is its novelty within the physical activity literature. Methodologically, we controlled for the potential confounding effects of both area and individual level factors. In addition, this study investigated both the main effects of ethnicity and time since immigration on physical activity, as well as the interaction between the two. However, this study also has several limitations. First, since this is a cross-sectional study, we cannot confirm the temporal sequence of the observed associations. Second, we cannot determine the levels of physical activity the youth may have had in their heritage country. Third, the individual-level measures were all obtained via self-report, although they have demonstrated reliability and validity. , ,  In addition, this analysis could not compare 1st, 2nd and 3rd generation youth, as there was no information available on parents’ country of birth, and this has been shown to be associated with child sport involvement in Canada.  Finally, we were unable to investigate Aboriginal youth separately from our “Canadian host culture” group, due to ethics restrictions. This is a group with unique health behaviours, attitudes and culture.
This study indicates that both immigration and ethnicity play important roles as determinants of physical activity in populations of young people. Future research should investigate mechanisms by which ethnic groups differ in physical activity levels, as these differences will provide tangible areas for interventions. These studies could include longitudinal analyses of specific ethnic groups to determine factors that change following immigration, mixed-methods or qualitative research with specific groups to uncover mechanisms responsible for these changes, or parent-child studies that investigate the role of the parent in child physical activity levels following immigration. For public health professionals, our findings suggest that creating ethnicity-specific interventions may be important, especially for the East and South East Asian population in Canada. These interventions can focus on both increasing activity and reducing sedentary behaviours, but require evidence to ensure they are effective. It is important to determine how best to encourage these youth to adopt healthy lifestyles and behaviours, as these behaviours may stay with them through the life course.
We thank Mr. Andrei Rosu for the collection of geographic information integral to this analysis and feedback and support regarding the geographical variables, and Mr Andrew Day for statistical support and feedback.
Conceived and designed the experiments: AK WP IJ. Performed the experiments: AK WP IJ. Analyzed the data: AK WP IJ. Contributed reagents/materials/analysis tools: AK WP IJ. Wrote the paper: AK WP IJ.
- 1. Janssen I, Leblanc AG (2010) Systematic review of the health benefits of physical activity and fitness in school-aged children and youth. Int J Behav Nutr Phy 7(40): 1–16. doi: 10.1186/1479-5868-7-40
- 2. Canadian Society for Exercise Physiology (2011) Canadian Physical Activity Guidelines for Youth 12–17 years [Internet] Available: http://www.csep.ca/CMFiles/Guidelines/CSEP-InfoSheets-youth-ENG.pdf.Accessed January 27 2014.
- 3. Canadian Society for Exercise Physiology (2011) Canadian Physical Activity Guidelines for Children 5–11 years [Internet] Available: http://www.csep.ca/CMFiles/Guidelines/CSEP-InfoSheets-child-ENG.pdf.Accessed January 27 2014.
- 4. Janssen I (2007) Physical activity guidelines for children and youth. Appl Physiol Nutr Metab 32: S109–S121. doi: 10.1139/h07-109
- 5. Colley RC, Garriguet D, Janssen I, Craig CL, Clarke J, et al. (2011) Physical activity of Canadian children and youth: Accelerometer results from the 2007 to 2009 Canadian Health Measures Survey. Health Reports 22: 15–23. doi: 10.1186/1471-2458-13-200
- 6. Ferreira I, Van Der Horst K, Wendel-Vos W, Kremers S, Van Lenthe FJ, et al. (2006) Environmental correlates of physical activity in youth - a review and update. Obes Rev 8: 129–54. doi: 10.1111/j.1467-789x.2006.00264.x
- 7. Spence JC, Lee RE (2003) Toward a comprehensive model of physical activity. Psychol Sport Exer 4: 7–24. doi: 10.1016/s1469-0292(02)00014-6
- 8. United Nations Department of Economic and Social Affairs Population Division (2008) Trends in International Migrant Stock: The 2008 Revision [Internet] Available: http://esa.un.org/migration/index.asp?panel=1.Accessed January 27 2014.
- 9. Sam DL, Berry JW (2010) Acculturation: When Individuals and Groups of Different Cultural Backgrounds Meet. Perspect Psychol Sci 5: 472–81. doi: 10.1177/1745691610373075
- 10. Newbold B (2009) The short-term health of Canada’s new immigrant arrivals: evidence from LSIC. Ethnic Health 14: 315–36. doi: 10.1080/13557850802609956
- 11. Singh Setia M, Quesnel-Vallee A, Abrahamowicz M, Tousignant P, Lynch JW (2012) Different outcomes for different health measures in immigrants: evidence from a longitudinal analysis of the National Population Health Survey (1994–2006). J Immigr Minor Health 14: 156–65. doi: 10.1007/s10903-010-9408-7
- 12. Schwartz SJ, Unger JB, Zamboanga BL, Szapocznik J (2010) Rethinking the concept of acculturation: implications for theory and research. Am Psychol 65: 237–251 doi:10.1037/a0019330.
- 13. Celenk O, Van de Vijver FJR (2011) Assessment of Acculturation: Issues and Overview of Measures. Online Readings in Psychology and Culture 8: 1–22. doi: 10.9707/2307-0919.1105
- 14. Van Selm K, Sam DL, Van Oudenhoven JP (1997) Life satisfaction and competence of Bosnian refugees in Norway. Scand J Psychol 38: 143–149 doi:10.1111/1467-9450.00020.
- 15. Gil A, Wagner E (2000) Acculturation, familism, and alcohol use among Latino adolescent males: Longitudinal relations. J Community Psychol 28: 443–458. doi: 10.1002/1520-6629(200007)28:4<443::aid-jcop6>3.3.co;2-1
- 16. Carvajal SC, Hanson CE, Romero AJ, Coyle KK (2002) Behavioural risk factors and protective factors in adolescents: a comparison of Latinos and non-Latino whites. Ethnic Health 7: 181–93. doi: 10.1080/1355785022000042015
- 17. Smokowski PR, Rose RA, Bacallao M (2009) Acculturation and aggression in Latino adolescents: modeling longitudinal trajectories from the Latino Acculturation and Health Project. Child Psychiatry Hum Dev 40: 589–608 doi:10.1007/s10578-009-0146-9.
- 18. Citizenship and Immigration Canada (2011) Facts and Figures: Immigration Overview Permanent and Temporary Residents [Internet] Available: http://www.cic.gc.ca/english/pdf/research-stats/facts2011.pdf. Accessed January 27 2014.
- 19. Vasileva K (2011) Population and Social Conditions [Internet] Available: http://epp.eurostat.ec.europa.eu/cache/ITY_OFFPUB/KS-SF-11-034/EN/KS-SF-11-034-EN.PDF. Accessed January 27 2014.
- 20. Monger R, Yankay J (2013) US Legal Permanent Residents: 2012 [Internet] Available: http://www.dhs.gov/sites/default/files/publications/ois_lpr_fr_2012_2.pdf. Accessed January 27 2014.
- 21. Unger JB, Reynolds K, Shakib S, Spruijt-Metz D, Sun P, et al. (2004) Acculturation, physical activity, and fast-food consumption among Asian-American and Hispanic adolescents. J Commun Health 29: 467–81. doi: 10.1007/s10900-004-3395-3
- 22. Hosper K, Klazinga NS, Stronks K (2007) Acculturation does not necessarily lead to increased physical activity during leisure time: a cross-sectional study among Turkish young people in the Netherlands. BMC Public Health 7: 230. doi: 10.1186/1471-2458-7-230
- 23. Liu J, Probst JC, Harun N, Bennett KJ, Torres ME (2009) Acculturation, physical activity, and obesity among Hispanic adolescents. Ethnic Health 14(5): 509–25. doi: 10.1080/13557850902890209
- 24. Taverno SE, Rollins BY, Francis LA (2010) Generation, language, body mass index, and activity patterns in Hispanic children. Am J Prev Med 38: 145–53. doi: 10.1016/j.amepre.2009.09.041
- 25. Singh GK, Yu SM, Siahpush M, Kogan MD (2008) High levels of physical inactivity and sedentary behaviors among US immigrant children and adolescents. Arch Pediatr Adolesc Med 162(8): 756–63. doi: 10.1001/archpedi.162.8.756
- 26. Renzaho AM, Swinburn B, Burns C (2008) Maintenance of traditional cultural orientation is associated with lower rates of obesity and sedentary behaviours among African migrant children to Australia. Int J Obes 32: 594–600. doi: 10.1038/ijo.2008.2
- 27. Dogra S, Meisner BA, Ardern CI (2010) Variation in mode of physical activity by ethnicity and time since immigration: a cross-sectional analysis. Int J Behav Nutr Phys Act 7: 75 doi:10.1186/1479-5868-7-75.
- 28. Martinez SM, Ayala GX, Arredondo EM, Finch B, Elder J (2008) Active transportation and acculturation among Latino children in San Diego County. Prev Med 47: 313–8. doi: 10.1016/j.ypmed.2008.01.018
- 29. Bryan SN, Tremblay MS, Pérez CE, Ardern CI, Katzmarzyk PT (2006) Physical Activity and Ethnicity: Evidence from the Canadian Community Health Survey. Can J Public Health 97: 271–6.
- 30. O’Loughlin J, Paradis G, Kishchuk N, Barnett T, Renaud L (1999) Prevalence and correlates of physical activity behaviors among elementary schoolchildren in multiethnic, low income, inner-city neighborhoods in Montreal, Canada. Ann Epidemiol 9: 397–407. doi: 10.1016/s1047-2797(99)00030-7
- 31. Tremblay MS, Bryan SN, Pérez CE, Ardern CI, Katzmarzyk PT (2006) Physical Activity and Immigrant Status: Evidence from the Canadian Community Health Survey. Can J Public Health 97: 277–82.
- 32. Freeman JG, King M, Pickett W, Craig W, Elgar F, et al. (2011) The Health of Canada’s Young People: a mental health focus [Internet] Available: http://www.phac-aspc.gc.ca/hp-ps/dca-dea/publications/hbsc-mental-mentale/assets/pdf/hbsc-mental-mentale-eng.pdf. Accessed January 27 2014.
- 33. Statistics Canada (2006) 2006 Census of Population [Internet] Available: http://www12.statcan.gc.ca/census-recensement/2006/index-eng.cfm. Accessed January 27 2014.
- 34. Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of Canada, and Social Sciences and Humanities Research Council (2010) Research Involving the First Nations, Inuit and Métis Peoples of Canada. Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans. Available: http://www.ethics.gc.ca/pdf/eng/tcps2/TCPS_2_FINAL_Web.pdf. Accessed January 27 2014.
- 35. Prochaska JJ, Sallis JF, Long B (2001) A physical activity screening measure for use with adolescents in primary care. Arch Pediat Adol Med 155: 554–9. doi: 10.1001/archpedi.155.5.554
- 36. Ridgers ND, Timperio A, Crawford D, Salmon J (2012) Validity of a brief self-report instrument for assessing compliance with physical activity guidelines amongst adolescents. J Sci Med Sport 15: 136–41. doi: 10.1016/j.jsams.2011.09.003
- 37. Schnohr CW, Kreiner S, Due EP, Currie C, Boyce W, et al. (2007) Differential Item Functioning of a Family Affluence Scale: Validation Study on Data from HBSC 2001/02. Soc Indic Res 89: 79–95. doi: 10.1007/s11205-007-9221-4
- 38. Clark W (2008) Kids’ sports. Can Soc Trends 85: 54–61.
- 39. Aizlewood A, Bevelander P, Pendakur R (2006) Recreational Participation Among Ethnic Minorities and Immigrants in Canada and the Netherlands. J Immigr Refug Stud 4: 1–32. doi: 10.1300/j500v04n03_01
- 40. Griebler R, Molcho M, Samdal O, Inchley J, Dür W, et al. (2010) Health Behaviour in School-Aged Children: A World Health Organization Cross National Study, Research Protocol for the 2009/2010 Survey. Vienna: LBIHPR and Edinburgh: CAHRU.
- 41. Simpson K, Janssen I, Craig WM, Pickett W (2005) Multilevel analysis of associations between socioeconomic status and injury among Canadian adolescents. J Epidemiol Community Health 59: 1072–7. doi: 10.1136/jech.2005.036723
- 42. Merlo J, Yang M, Chaix B, Lynch J, Råstam L (2005) A brief conceptual tutorial on multilevel analysis in social epidemiology: investigating contextual phenomena in different groups of people. J Epidemiol Community Health 59: 729–36. doi: 10.1136/jech.2004.023929
- 43. Kahlin Y, Werner S, Romild U, Alricsson M (2009) Self-related health, physical activity, BMI and musculoskeletal complaints: a comparison between foreign and Swedish high school students. Int J Adolesc Med Health 21: 327–341. doi: 10.1515/ijamh.2009.21.3.327
- 44. Tortolero SR, Masse LC, Fulton JE, Torres I, Kohl III HW (1999) Assessing physical activity among minority women: Focus group results. Health Iss 9: 135–42. doi: 10.1016/s1049-3867(99)00004-3
- 45. Darling N (2005) Participation in Extracurricular Activities and Adolescent Adjustment: Cross-Sectional and Longitudinal Findings. J Youth Adolescence 34: 493–505. doi: 10.1007/s10964-005-7266-8
- 46. Choi JW, Wilbur JE, Miller A, Szalacha L, McAuley E (2008) Correlates of leisure-time physical activity in Korean immigrant women. West J Nurs Res 30: 620–638. doi: 10.1177/0193945907310645
- 47. Daniel M, Wilbur J (2011) Physical activity among South Asian Indian immigrants: an integrative review. Public Health Nurs 28: 389–401. doi: 10.1111/j.1525-1446.2010.00932.x
- 48. Sagatun A, Kolle E, Anderssen SA, Thoresen M, Sogaard AJ, et al. (2008) Three-year follow-up of physical activity in Norwegian youth from two ethnic groups: associations with socio-demographic factors. BMC Public Health 8: 419 doi:10.1186/1471-2458-8-419.
- 49. Kriemler S, Meyer U, Martin E, van Sluijs EMF, Andersen LB, et al. (2011) Effect of school-based interventions on physical activity and fitness in children and adolescents: a review of reviews and systematic update. Brit J Sport Med 45: 923–30. doi: 10.1136/bjsports-2011-090186
- 50. Gentile DA, Welk G, Eisenmann JC, Reimer RA, Walsh DA, et al. (2009) Evaluation of a multiple ecological level child obesity prevention program: Switch what you Do, View, and Chew. BMC Med 7: 49 doi:10.1186/1741-7015-7-49.
- 51. Haerens L, De Bourdeaudhuij I, Maes L, Cardon G, Deforche B (2007) School-based randomized controlled trial of a physical activity intervention among adolescents. J Adolesc Health 40: 258–265 doi:10.1016/j.jadohealth.2006.09.028.
- 52. Simon C, Schweitzer B, Oujaa M, Wagner A, Arveiler D, et al. (2008) Successful overweight prevention in adolescents by increasing physical activity: A 4-year randomized controlled intervention. Int J Obes 32: 1489–1498 doi:10.1038/ijo.2008.99.
- 53. De Meij JSB, Chinapaw MJM, Kremers SPJ, Van der Wal MF, Jurg ME, et al. (2010) Promoting physical activity in children: The stepwise development of the primary school-based JUMP-in intervention applying the RE-AIM evaluation framework. Br J Sports Med 44: 879–887. doi: 10.1136/bjsm.2008.053827