title: Child and environmental factors associated with leisure participation in adolescents born extremely preterm.
abstract: BACKGROUND
  Developmental impairments persist among adolescents born extremely preterm, and these individuals are at an increased risk for chronic disease later in life. Participating in active and positive leisure activities may act as a buffer against negative outcomes, but involvement in active-physical and skill-based activities is low in youth born preterm.
  
  
  OBJECTIVE
  To explore the child and environmental determinants of leisure participation among adolescents born extremely preterm.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Participants were recruited from the hospital's Neonatal Follow-Up Program and included 128 adolescents born preterm (mean gestational age: 26.5 weeks).
  
  
  METHODS
  Leisure participation was assessed using the Children's Assessment of Participation and Enjoyment. Potential determinants were assessed using standardized tests and questionnaires. Selected factors were entered into five separate multivariable regression models.
  
  
  RESULTS
  Child and environmental factors contributed between 21% (skill-based) and 52% (active physical) of the adjusted variance for participation intensity. Lower gestational age was associated with greater participation in recreational activities. Male sex, higher maternal education and better motor competence were associated with involvement in active-physical activities. Being older and feeling socially accepted were associated with participation in social activities. Families oriented to hobbies and higher maternal education were associated with participation in skill-based activities. Preference was the strongest determinant of participation in all five leisure activities.
  
  
  CONCLUSIONS
  Activities should be adapted to individual skill level, include family and peers, foster social acceptance and be driven by the adolescent's preferences. Although certain factors cannot be modified, they can be used to identify adolescents at risk for low participation.
authors.affiliation: Montreal Children's Hospital, Montreal, Canada; School of Physical and Occupational Therapy, McGill University, Montreal, Canada.
authors.forename: Noémi
authors.initials: N
authors.lastname: Dahan-Oliel
authors.affiliation: School of Physical and Occupational Therapy, McGill University, Montreal, Canada; Jewish Rehabilitation Hospital, Laval, Canada.
authors.forename: Barbara
authors.initials: B
authors.lastname: Mazer
authors.affiliation: Department of Rehabilitation, University of Laval, Quebec City, Canada; Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Canada.
authors.forename: Désirée B
authors.initials: DB
authors.lastname: Maltais
authors.affiliation: Montreal Children's Hospital, Montreal, Canada.
authors.forename: Patricia
authors.initials: P
authors.lastname: Riley
authors.affiliation: Department of Rehabilitation, University of Laval, Quebec City, Canada; Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Canada.
authors.forename: Line
authors.initials: L
authors.lastname: Nadeau
authors.affiliation: Montreal Children's Hospital, Montreal, Canada; School of Physical and Occupational Therapy, McGill University, Montreal, Canada. Electronic address: annette.majnemer@mcgill.ca.
authors.forename: Annette
authors.initials: A
authors.lastname: Majnemer
mesh_terms: D000293:Adolescent; D002648:Child; D002657:Child Development / Q000502:physiology*; D003430:Cross-Sectional Studies; D005260:Female; D005865:Gestational Age; D006801:Humans; D062071:Infant, Extremely Premature / Q000502:physiology*; D007899:Leisure Activities / Q000523:psychology*; D008297:Male; D009048:Motor Skills / Q000502:physiology*; D011792:Quebec; D012044:Regression Analysis; D058992:Social Participation / Q000523:psychology*
keywords: Adolescents; Child factors; Environment; Leisure participation; Preterm