Parents' perception of neighbourhood environment as a determinant of screen time, physical activity and active transport

Correlates of Active Commuting to School among Portuguese Adolescents: An Ecological Model Approach

Active commuting to and from school can be an important contribution to improving health in adolescents. This study aimed to analyze the influence of multilevel variables of the ecological model in the active commuting of a representative sample of Portuguese adolescents. The 2018 Health Behaviour in School-Aged Children questionnaire was applied to 5695 adolescents with an average age of 15.5 years old (SD ± 1.8), 53.9% of whom were girls. The associations were studied by applying chi-square tests and multivariate logistic regression models. In this study, 36.5% of the participants reported walking or cycling to school. Active commuting to school was directly associated with age (OR = 1.2; p < 0.05), strong family support (OR = 1.2; p < 0.05), a moderate to low financial level of the family (OR = 1.3; p < 0.05) and living near the school (OR = 2.4; p < 0.05). The results revealed that an adolescent’s choice to travel to and from school using an active mode of transportation increased with strong family support. As a result, promotion campaigns should consider the adolescent’s family context.

Parental Perception of the Social and Physical Environment Contributes to Gender Inequalities in Children's Screen Time

BACKGROUND

This cross-sectional study aimed to explore how parental perceptions of the social and physical environment of the neighborhood was associated with 3- to 10-year-old children's use of traditional and modern screen devices.

METHODS

Participants were recruited under the scope of the project ObesInCrisis, conducted in 2016-2017 in the cities of Porto, Coimbra, and Lisbon (Portugal). Data from 6347 children aged 3-10 years were analyzed (3169 boys [49.9%]). A parental questionnaire was used to collect data on children's screen time (dependent variable) and parents' perceived social and physical environment (from the Environmental Module of the International Physical Activity Prevalence Study questionnaire; independent variable), parental education, and urbanization (used as covariates).

RESULTS

Neighborhood features were more correlated with girls' screen time, than with boys', particularly among younger children. Also, more social than physical characteristics of the neighborhood were positively associated with children's use of television and mobile devices (ie, tablet and smartphone).

CONCLUSIONS

Community-based approaches should improve the social environment and implement supervised after-school programs to encourage and support children to be outdoors and spend less time in sedentary pursuits.

The association between living environmental factors and adolescents' body weight: a cross-sectional study

BACKGROUND

The effect of the living environment on public health has received increasingly scholarly attention. This study aims to explore the relationship between adolescents' body weight and their living environmental factors.

METHODS

This cross-sectional study comprised 1362 middle-school students from Nanjing and 826 from Changzhou in China. We further collected information on living environmental factors based on their home address and ran multivariate logistic regressions to explore potential correlations after considering a range of potential confounding factors.

RESULTS

Approximately 25% (n = 303) of students from Nanjing and 26% (n = 205) of students from Changzhou were excessive body weight. In Nanjing, students' BMI (Body Mass Index) showed a strong negative correlation with the number of sports venues in their neighborhood (Adjusted Odds Ratio (AOR): 0.64, 95%CI: 0.40-0.94) after controlling for other covariates. In Changzhou, we observed a positive correlation between adolescents' body weight and the number of bus stops in their neighbourhood (AOR:1.63, 95%CI:1.11-2.38).

CONCLUSIONS

The living environment factors were independently associated with teenagers' excessive body weight. We hypothesis that the environmental risk factors might be associated with political management, which will consequently affect personal health outcomes. Further research and proactive measures are required to manage those potential risks and attenuate the problem.

Weekday-Weekend Sedentary Behavior and Recreational Screen Time Patterns in Families with Preschoolers, Schoolchildren, and Adolescents: Cross-Sectional Three Cohort Study

Background: Excessive recreational screen time (RST) has been associated with negative health consequences already being apparent in preschoolers. Therefore, the aim of this study was to reveal parent-child sedentary behavior, and RST patterns and associations with respect to the gender, age category of children, and days of the week. Methods: Our cross-sectional survey included 1175 parent-child dyads with proxy-reported RST data collected during a regular school week during the spring and fall between 2013 and 2019. The parent-child RST (age and RST) relationship was quantified using Pearson’s (r_P) correlation coefficient. Results: Weekends were characterized by longer RST for all family members (daughters/sons: +34/+33 min/day, mothers/fathers: +43/+14 min/day) and closer parent-child RST associations than on weekdays. The increasing age of children was positively associated with an increase in RST on weekdays (+6.4/+7.2 min per year of age of the daughter/son) and weekends (+5.8/+7.5 min per year of age of the daughter/son). Conclusions: Weekends provide a suitable target for implementation of programs aimed at reducing excessive RST involving not only children, but preferably parent-child dyads.

Active Transportation to School. Utopia or a Strategy for a Healthy Life in Adolescence

The way adolescents travel to school can be an important contribution to achieving their daily physical activity recommendations. The main objective of this research is to know which variables are associated with the mode of transportation used to and from school by Portuguese adolescents. The 2018 Health Behaviour in School-aged Children questionnaire was applied to 5695 adolescents with an average age of 15.5 (SD ± 1.8), 53.9% of whom were female. The associations were studied by applying χ2 tests and multivariate logistic regression models. In this study, 36.5% of the participants reported walking or cycling to school. Active transportation to school is associated with age (OR = 1.3; p < 0.05), sufficient physical activity (OR = 1.2; p < 0.05), adequate number of hours of sleep (OR = 1.2; p < 0.05), perception of happiness (OR = 1.2; p < 0.05) and living near the school (OR = 2.4; p < 0.05). The results revealed that adolescents' choice to travel to/from school using an active mode of transportation increased with age, physical activity, hours of sleep, perception of happiness, and living near the school.

Children's Active School Travel: Examining the Combined Perceived and Objective Built-Environment Factors from Space Syntax

Increasing active school travel (AST) among children may provide the required level of daily physical activity and reduce the prevalence of obesity. Despite efforts to promote this mode, recent evidence shows that AST rates continue to decrease in suburban and urban areas alike. The aim of this research study, therefore, is to facilitate our understanding of how objective and perceived factors near the home influence children's AST in an understudied city, İstanbul, Turkey. Using data from a cross-sectional sample of students aged 12-14 from 20 elementary schools (n = 1802) and consenting parents (n = 843), we applied a nominal logistic regression model to highlight important predictors of AST. The findings showed that street network connectivity (as measured by two novel space syntax measures, metric reach and directional reach) was the main deciding factor for active commuting to school, while parents' perceptions of condition of sidewalks and shade-casting street trees were moderately significant factors associated with AST. Overall, this study demonstrated the significance of spatial structure of street network around the homes in the potential for encouraging AST, and more importantly, the need to consider objective and perceived environmental attributes when strategizing means to increase this mode choice and reduce ill-health among children.

Development of a consensus statement on the role of the family in the physical activity, sedentary, and sleep behaviours of children and youth

BACKGROUND

Children and youth who meet the physical activity, sedentary, and sleep behaviour recommendations in the Canadian 24-Hour Movement Guidelines are more likely to have desirable physical and psychosocial health outcomes. Yet, few children and youth actually meet the recommendations. The family is a key source of influence that can affect lifestyle behaviours. The purpose of this paper is to describe the process used to develop the Consensus Statement on the Role of the Family in the Physical Activity, Sedentary, and Sleep Behaviours of Children and Youth (0-17 years) and present, explain, substantiate, and discuss the final Consensus Statement.

METHODS

The development of the Consensus Statement included the establishment of a multidisciplinary Expert Panel, completion of six reviews (three literature, two scoping, one systematic review of reviews), custom data analyses of Statistics Canada's Canadian Health Measures Survey, integration of related research identified by Expert Panel members, a stakeholder consultation, establishment of consensus, and the development of a media, public relations, communications and launch plan.

RESULTS

Evidence from the literature reviews provided substantial support for the importance of family on children's movement behaviours and highlighted the importance of inclusion of the entire family system as a source of influence and promotion of healthy child and youth movement behaviours. The Expert Panel incorporated the collective evidence from all reviews, the custom analyses, other related research identified, and stakeholder survey feedback, to develop a conceptual model and arrive at the Consensus Statement: Families can support children and youth in achieving healthy physical activity, sedentary and sleep behaviours by encouraging, facilitating, modelling, setting expectations and engaging in healthy movement behaviours with them. Other sources of influence are important (e.g., child care, school, health care, community, governments) and can support families in this pursuit.

CONCLUSION

Family is important for the support and promotion of healthy movement behaviours of children and youth. This Consensus Statement serves as a comprehensive, credible, and current synopsis of related evidence, recommendations, and resources for multiple stakeholders.

Understanding physical activity and sedentary behaviour among preschool-aged children in Singapore: a mixed-methods approach

OBJECTIVES

This study investigated physical activity (PA) and sedentary behaviour (SB) among preschool-aged children in Singapore and potential correlates at multiple levels of the socioecological model from in-school and out-of-school settings.

DESIGN

A cross-sectional study using a mixed-methods approach.

PARTICIPANTS

Parent-child dyads from six preschools in Singapore.

METHODS

PA and SB of children (n=72) were quantified using wrist-worn accelerometers for seven consecutive days. Three focus group discussions (FGDs) among 12 teachers explored diverse influences on children's activities, and System for Observing Play and Leisure Activity in Youth (SOPLAY) assessed PA environment and children's activity levels at preschools. Seventy-three parents completed questionnaires on home and neighbourhood factors influencing children's PA and SB. Descriptive analyses of quantitative data and thematic analysis of FGDs were performed.

RESULTS

Based on accelerometry, children (4.4±1.1 years) spent a median of 7.8 (IQR 6.4-9.0) hours/day in SB, and 0.5 (0.3-0.8) hours/day in moderate-to-vigorous physical activity (MVPA). MVPA was similar throughout the week, and SB was slightly higher on non-school days. In preschools, SOPLAY showed more children engaging in MVPA outdoors (34.0%) than indoors (7.7%), and absence of portable active play equipment. FGDs revealed issues that could restrict active time at preschool, including academic requirements of the central curriculum and its local implementation. The teachers had varying knowledge about PA guidelines and perceived that the children were sufficiently active. In out-of-school settings, parents reported that their children rarely used outdoor facilities for active play and spent little time in active travel. Few children (23.5%) participated in extracurricular sports, but most (94.5%) reported watching screens for 1.5 (0.5-3.0) hours/day.

CONCLUSION

MVPA was low and SB was high in preschool-aged children in an urban Asian setting. We identified diverse in-school and out-of-school correlates of PA and SB that should be taken into account in health promotion strategies.

Sedentary Behaviors in Today's Youth: Approaches to the Prevention and Management of Childhood Obesity: A Scientific Statement From the American Heart Association

This scientific statement is about sedentary behavior and its relationship to obesity and other cardiometabolic outcomes in youth. A deleterious effect of sedentary behavior on cardiometabolic health is most notable for screen-based behaviors and adiposity; however, this relation is less apparent for other cardiometabolic outcomes or when sedentary time is measured with objective movement counters or position monitors. Increasing trends of screen time are concerning; the portability of screen-based devices and abundant access to unlimited programming and online content may be leading to new patterns of consumption that are exposing youth to multiple pathways harmful to cardiometabolic health. This American Heart Association scientific statement provides an updated perspective on sedentary behaviors specific to modern youth and their impact on cardiometabolic health and obesity. As we reflect on implications for practice, research, and policy, what emerges is the importance of understanding the context in which sedentary behaviors occur. There is also a need to capture the nature of sedentary behavior more accurately, both quantitatively and qualitatively, especially with respect to recreational screen-based devices. Further evidence is required to better inform public health interventions and to establish detailed quantitative guidelines on specific sedentary behaviors in youth. In the meantime, we suggest that televisions and other recreational screen-based devices be removed from bedrooms and absent during meal times. Daily device-free social interactions and outdoor play should be encouraged. In addition, parents/guardians should be supported to devise and enforce appropriate screen time regulations and to model healthy screen-based behaviors.

Is the decline of active travel to school unavoidable by-products of economic growth and urbanization in developing countries?

BACKGROUND

Economic growth and urbanization may contribute to the decline of active travel to school (ATS). We aim to explain the change of ATS in China between 1997 and 2011 and to predict the prevalence of ATS in China within the next 30 years using various scenario.

METHODS

We developed a system dynamics model to study ATS and the model assumes the prevalence of ATS is determined by the dynamic interaction of four exogenous and eight endogenous variables.

RESULTS

The simulated prevalence of ATS is roughly consistent with empirical data. Economic development and urban sprawl are more influential than urban design and crime in terms of ATS. Under a relatively reasonable scenario, the prevalence of ATS is projected to decrease from 73% in 2011 to 65% in 2014, and the prevalence of childhood overweight & obesity is projected to increase from 24% in 2011 to 34% in 2041. With the maintaining of economic development grow, to control urban sprawl is the most effective measure to promote ATS and decrease childhood obesity.

CONCLUSIONS

Overall, the model enabled us to conduct experiments to test the possible effects of changing one or more factors taking into account their dynamic interrelationship, and our study may provide implications for policy intervention.

The role of physical activity enjoyment in the pathways from the social and physical environments to physical activity of early adolescent girls

Most girls experience a notable decline in physical activity (PA) in early adolescence, increasing their risk for harmful health outcomes. Enjoyment for PA (i.e., positive feelings toward PA) is a determinant of PA among girls during adolescence and sustained PA throughout adulthood. Previous studies recommended increasing girls' PA enjoyment in order to increase their PA, but did not include environmental-level strategies for how families, schools, or communities do this. To gain insight on such strategies, this study examines the role of PA enjoyment as a mediator of social and physical environments to moderate-to-vigorous intensity PA of early adolescent girls. Cross-sectional, secondary analyses, using structural equation modeling, were conducted on a U.S. national dataset of 1721 sixth grade girls from the Trial of Activity for Adolescent Girls in 2003. Mediation model fit parameters included χ2 (292, N = 1721) = 947.73 p < 0.001, CFI = 0.95, RMSEA = 0.04 (90% CI = 0.03, 0.04), and SRMR = 0.037 suggesting overall good fit. There were no indirect effects on PA through PA enjoyment from the social or physical environmental factors. To PA, there were significant direct effects only from social support from friends (β = 0.15, CI = 0.09, 0.22). To PA enjoyment, there were significant direct effects from social support from family (β = 0.15, CI = 0.08, 0.23), school climate (teachers β = 0.15, CI = 0.10, 0.21 and boys β = 0.15, CI = 0.09, 0.20), and neighborhood environment (β = 0.10, CI = 0.04, 0.17). The findings of this study identified several direct effects of the social and physical environment on PA enjoyment that can begin to inform environmental-level strategies for increasing PA enjoyment among early adolescent girls.

Role of parental and environmental characteristics in toddlers' physical activity and screen time: Bayesian analysis of structural equation models

Background

Guided by the Socialization Model of Child Behavior (SMCB), this cross-sectional study examined direct and indirect associations of parental cognitions and behavior, the home and neighborhood environment, and toddlers’ personal attributes with toddlers’ physical activity and screen time.

Methods

Participants included 193 toddlers (1.6 ± 0.2 years) from the Parents’ Role in Establishing healthy Physical activity and Sedentary behavior habits (PREPS) project. Toddlers’ screen time and personal attributes, physical activity- or screen time-specific parental cognitions and behaviors, and the home and neighborhood environment were measured via parental-report using the PREPS questionnaire. Accelerometry-measured physical activity was available in 123 toddlers. Bayesian estimation in structural equation modeling (SEM) using the Markov Chain Monte Carlo algorithm was performed to test an SMCB hypothesized model. Covariates included toddlers’ age, sex, race/ethnicity, main type of childcare, and family household income.

Results

In the SMCB hypothesized screen time model, higher parental barrier self-efficacy for limiting toddlers’ screen time was associated with higher parental screen time limiting practices (β = 0.451), while higher parental negative outcome expectations for limiting toddlers’ screen time was associated with lower parental screen time limiting practices (β = − 0.147). In turn, higher parental screen time limiting practices was associated with lower screen time among toddlers (β = − 0.179). Parental modeling of higher screen time was associated with higher screen time among toddlers directly (β = 0.212) and indirectly through the home environment. Specifically, higher screen time among parents was associated with having at least one electronic device in toddlers’ bedrooms (β = 0.146) and, in turn, having electronics in the bedroom, compared to none, was associated with higher screen time among toddlers (β = 0.250). Neighborhood safety was not associated with toddlers’ screen time in the SEM analysis. No significant correlations were observed between the SMCB variables and toddlers’ physical activity; thus, no further analyses were performed for physical activity.

Conclusions

Parents and their interactions with the home environment may play an important role in shaping toddlers’ screen time. Findings can inform family-based interventions aiming to minimize toddlers’ screen time. Future research is needed to identify correlates of toddlers’ physical activity.

Environments favorable to healthy lifestyles: A systematic review of initiatives in Canada

BACKGROUND

In recent years, a number of initiatives aimed at promoting healthy lifestyles in health-friendly environments have been implemented. The purpose of this review is to synthesize initiatives conducted in Canada and documented in publications for the period 1995-2015 in order to gain a better understanding of their objectives and impacts.

METHODS

A systematic review of Canadian initiatives published over the past 20 years was conducted from multiple databases (i.e., Scopus, SPORTDiscus, PubMed, Academic search complete, Reseausante.com, Cairn, and Erudit). In total, 264 publications were identified and retained for the final analysis based on 5 criteria: (1) publication between 1995 and 2015, (2) online availability, (3) research conducted in Canada, (4) main topic related to environments favorable to healthy lifestyles (EFHL), and (5) publication in French or English.

RESULTS

A sharp increase in the number of studies on EFHL was observed between 2010 and 2015 (57%). Two major lifestyle components-physical activity and nutrition-and 2 environmental aspects-neighborhood and built environment-were the elements most frequently examined regarding adults (48%), young people (34%), and seniors (9%), using quantitative (60%) and qualitative (18%) methods. Furthermore, the analysis reveals a greater focus on the municipal (53%) than the national or provincial levels (31%).

CONCLUSION

This work is a first map of Canadian studies related to EFHL. It clarifies the definition of EFHL and classifies its components. As well, it documents the issues raised, the research methods employed, and the role of stakeholders, while outlining a new research agenda that includes dimensions of EFHL formerly neglected by researchers, namely, political and sociocultural spheres of action.

Disparities in Adolescents' Residence in Neighborhoods Supportive of Physical Activity - United States, 2011-2012

In 2013, only 27% of adolescents in grades 9-12 met the current federal guideline for aerobic physical activity (at least 60 minutes of physical activity each day*), and sex and racial/ethnic disparities in meeting the guideline exist (1). The Community Preventive Services Task Force has recommended a range of community-level evidence-based approaches(†) to increase physical activity by improving neighborhood supports for physical activity.(§) To assess the characteristics of adolescents who live in neighborhoods that are supportive of physical activity, CDC analyzed data on U.S. children and adolescents aged 10-17 years (defined as adolescents for this report) from the 2011-2012 National Survey of Children's Health (NSCH). Overall, 65% of U.S. adolescents live in neighborhoods supportive of physical activity, defined as neighborhoods that are perceived as safe and have sidewalks or walking paths and parks, playgrounds, or recreation centers. Adolescents who were Hispanic and non-Hispanic black race/ethnicity; who lived in lower-income households, households with less educated parents, and rural areas; or who were overweight or obese were less likely to live in neighborhoods supportive of physical activity than were white adolescents and adolescents from higher income households, with a more highly educated parent, living in urban areas, and not overweight or obese. Within demographic groups, the largest disparity in the percentage of adolescents living in these neighborhoods was observed between adolescents living in households with a family income <100% of the Federal Poverty Level (FPL) (51%) and adolescents living in households with a family income ≥400% of the FPL (76%). Efforts to improve neighborhood supports, particularly in areas with a substantial percentage of low-income and minority residents, might increase physical activity among adolescents and reduce health disparities.

Adherence to Canadian physical activity and sedentary behaviour guidelines among children 2 to 13 years of age

Active living is relevant for healthy child development and disease prevention. In 2011-2012 new Canadian Physical Activity and Sedentary Behaviour Guidelines were developed for children under four and 5-17 years of age. This cross-sectional study assessed children's adherence to the national guidelines, using a large sample of Alberta children ages 2-4 and 5-13 years in 2013. The proportions of children achieving the average daily duration of physical activity and screen time recommended were determined, and child and parental predictors of non-achievement were identified. Participants were 631 parent and child dyads. Data were collected by parental reports of physical activity and screen time during weekdays, and analysed using univariate and multivariate techniques (p < 0.05). Logistic regression models were used to examine factors associated with children's non-achievement of physical activity and screen time recommendations while adjusting for covariates. Sixty-two percent of children aged 2-4 and 26% of children aged 5-13 did not meet physical activity time recommendations, and 64% of children aged 2-4 and 23% of children aged 5-13 exceeded the maximum screen time recommendation. Several associations between parental age and education with non-achievement were observed but associations were not consistent across age groups or behaviours. Among preschoolers, those with middle-age parents were more likely to not achieve physical activity recommendations. Evidence of high non-achievement of the recommendations among children 2-4 years highlights the need for increased programming targeting preschool children. Further research is required to identify modifiable risk factors that may inform future health promotion efforts.

Perceived and objective neighborhood support for outside of school physical activity in South African children

Background

The neighborhood environment has the potential to influence children’s participation in physical activity. However, children’s outdoor play is controlled by parents to a great extent. This study aimed to investigate whether parents' perceptions of the neighborhood environment and the objectively measured neighborhood environment were associated with children's moderate-to-vigorous intensity physical activity (MVPA) outside of school hours; and to determine if these perceptions and objective measures of the neighborhood environment differ between high and low socio-economic status (SES) groups.

Methods

In total, 258 parents of 9–11 year-old children, recruited from the South African sample of the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE), completed a questionnaire concerning the family and neighborhood environment. Objective measures of the environment were also obtained using Geographic Information Systems (GIS). Children wore an Actigraph (GT3X+) accelerometer for 7 days to measure levels of MVPA. Multilevel regression models were used to determine the association between the neighborhood environment and MVPA out of school hours.

Results

Parents’ perceptions of the neighborhood physical activity facilities were positively associated with children’s MVPA before school (β = 1.50 ± 0.51, p = 0.003). Objective measures of neighborhood safety and traffic risk were associated with children’s after-school MVPA (β = −2.72 ± 1.35, p = 0.044 and β = −2.63 ± 1.26, p = 0.038, respectively). These associations were significant in the low SES group (β = −3.38 ± 1.65, p = 0.040 and β = −3.76 ± 1.61, p = 0.020, respectively), but unrelated to MVPA in the high SES group.

Conclusions

This study found that several of the objective measures of the neighborhood environment were significantly associated with children’s outside-of-school MVPA, while most of the parents’ perceptions of the neighborhood environment were unrelated.

The period prevalence of risk behavior co-occurrence among Canadians

INTRODUCTION

While the benefits of complying with health recommendations is well documented, a considerable proportion of Canadians engage in multiple modifiable risk behaviors. The purpose of this multi-wave longitudinal study was to identify the individual period prevalence and co-occurrence of multiple modifiable risk behaviors, particularly excessive alcohol consumption, physical inactivity, and tobacco use, within a nationally representative sample of Canadians.

METHODS

Secondary data analysis was conducted on the first seven cycles of the National Population Health Survey. This longitudinal sample included 15,167 Canadians aged 12years of age or older. Gender-specific criteria were employed to define excessive alcohol consumption. Individuals expending <3.0kcal/kg/day during their leisure-time and smoking cigarettes (daily or occasionally) met the criteria for physical inactivity and tobacco use, respectively.

RESULTS

The period prevalence of the Canadian general population that participated in multiple risk behaviors was 21.5% in cycle 7. The most common pairwise combination of co-occurring risk behaviors was physical inactivity and smoking. The proportion of Canadians reporting the co-occurrence of all three risk behaviors in cycle 7 was 2.6%.

CONCLUSIONS

Understanding patterns of modifiable risk behaviors is an initial step in developing and implementing public health interventions. The co-occurrence of these three risk behaviors is a viable concern for one in five Canadians. For these individuals, the likelihood of encountering premature morbidity and mortality is escalated. As the majority of Canadians reported being physically inactive, allocating limited resources towards enhancing leisure-time physical activity levels could have significant population-level implications for improving the health of Canadians.

Racial differences in parental perceptions of the neighborhood as predictors of children's physical activity and sedentary behavior

Objective

Most U.S. children engage in insufficient physical activity (PA) and spend too much time in sedentary behaviors (SBs), leading to increased risk of obesity and chronic disease. Evidence remains inconsistent on relationships between parental perceptions of the neighborhood and children's PA and SB. This study examines parental neighborhood perceptions, stratified by race, as predictors of children's PA and SB.

Methods

Relationships were tested with regressions stratified by parental race. The sample included 196 parents, residing in St. Louis, Missouri with a child at home. Participants responded to a mailed survey in 2012. Parental neighborhood perceptions were examined by mean composite scores and individual items.

Results

For parents of all races, perceived barriers negatively predicted the number of days in a week children engaged in ≥ 60 min of PA. Examining parental neighborhood perceptions by individual item, the perception that drivers exceed neighborhood speed limits was a positive predictor of their children's SB only among white parents. Only among minority-race parents was perceived neighborhood crime rate a positive predictor of their children's SB.

Conclusions

While predictors of children's PA did not differ widely, several distinct predictors of children's SB by parental race lend support toward further examination of this topic.

•

We examine parental neighborhood perceptions by race and children's behaviors.

•

For all parents, perceived barriers negatively predict children's activity.

•

For white parents, speeding cars positively predict children's sedentary behavior.

•

For minority-race parents, crime positively predicts children's sedentary behavior.

•

Results could inform tailored strategies for reducing children's sedentary behavior.

Cross-continental comparison of the association between the physical environment and active transportation in children: a systematic review

BACKGROUND

The purpose of this systematic review was to determine the relationship between a wide range of physical environmental characteristics and different contexts of active transportation in 6- to 12-year-old children across different continents.

METHODS

A systematic search was conducted in six databases (Pubmed, Web of Science, Cinahl, SportDiscus, TRIS and Cochrane) resulting in 65 papers, eligible for inclusion. The investigated physical environmental variables were grouped into six categories: walkability, accessibility, walk/cycle facilities, aesthetics, safety, recreation facilities.

RESULTS

The majority of the studies were conducted in North America (n = 35), Europe (n = 17) and Australia (n = 11). Active transportation to school (walking or cycling) was positively associated with walkability. Walking to school was positively associated with walkability, density and accessibility. Evidence for a possible association was found for traffic safety and all forms of active transportation to school. No convincing evidence was found for associations between the physical environment and active transportation during leisure. General safety and traffic safety were associated with active transportation to school in North America and Australia but not associated with active transportation to school in Europe.

CONCLUSIONS

The physical environment was mainly associated with active transportation to school. Continent specific associations were found, indicating that safety measures were most important in relation to active commuting to school in North America and Australia. There is a need for longitudinal studies and studies conducted in Asia, Africa and South-America and studies focusing specifically on active transportation during leisure.

Housing need in Canada: Healthy lives start at home

Housing affects the health of children and youth. One-third of households in Canada live in substandard conditions or in housing need. The present statement reviews the literature documenting the impacts of housing on personal health and the health care system. Types of housing need are defined, including unsuitable or crowded housing, unaffordable housing and inadequate housing, or housing in need of major repairs. The health effects of each type of housing need, as well as of unsafe neighbourhoods, infestations and other environmental exposures are outlined. Paediatricians and other physicians caring for children need to understand the housing status of patients to fully determine their health issues and ability to access and engage in health care. Recommendations and sample tools to assess and address housing need at the patient, family, community and policy levels are described. Canada is the only G8 country without a national housing strategy. Recommendations also include advocating for enhanced action at all levels of government and for housing-supportive policies, including a national housing strategy.

Individual and family environmental correlates of television and computer time in 10- to 12-year-old European children: the ENERGY-project

Background

The aim was to investigate which individual and family environmental factors are related to television and computer time separately in 10- to-12-year-old children within and across five European countries (Belgium, Germany, Greece, Hungary, Norway).

Methods

Data were used from the ENERGY-project. Children and one of their parents completed a questionnaire, including questions on screen time behaviours and related individual and family environmental factors. Family environmental factors included social, political, economic and physical environmental factors. Complete data were obtained from 2022 child–parent dyads (53.8 % girls, mean child age 11.2 ± 0.8 years; mean parental age 40.5 ± 5.1 years). To examine the association between individual and family environmental factors (i.e. independent variables) and television/computer time (i.e. dependent variables) in each country, multilevel regression analyses were performed using MLwiN 2.22, adjusting for children’s sex and age.

Results and discussion

In all countries, children reported more television and/or computer time, if children and their parents thought that the maximum recommended level for watching television and/or using the computer was higher and if children had a higher preference for television watching and/or computer use and a lower self-efficacy to control television watching and/or computer use. Most physical and economic environmental variables were not significantly associated with television or computer time. Slightly more individual factors were related to children’s computer time and more parental social environmental factors to children’s television time. We also found different correlates across countries: parental co-participation in television watching was significantly positively associated with children’s television time in all countries, except for Greece. A higher level of parental television and computer time was only associated with a higher level of children’s television and computer time in Hungary. Having rules regarding children’s television time was related to less television time in all countries, except for Belgium and Norway.

Conclusions

Most evidence was found for an association between screen time and individual and parental social environmental factors, which means that future interventions aiming to reduce screen time should focus on children’s individual beliefs and habits as well parental social factors. As we identified some different correlates for television and computer time and across countries, cross-European interventions could make small adaptations per specific screen time activity and lay different emphases per country.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-2276-2) contains supplementary material, which is available to authorized users.

Perceived barriers to children's active commuting to school: a systematic review of empirical, methodological and theoretical evidence

Active commuting to school (ACS) may increase children's daily physical activity and help them maintain a healthy weight. Previous studies have identified various perceived barriers related to children's ACS. However, it is not clear whether and how these studies were methodologically sound and theoretically grounded. The purpose of this review was to critically assess the current literature on perceived barriers to children's ACS and provide recommendations for future studies. Empirically based literature on perceived barriers to ACS was systematically searched from six databases. A methodological quality scale (MQS) and a theory utilization quality scale (TQS) were created based on previously established instruments and tailored for the current review. Among the 39 studies that met the inclusion criteria, 19 (48.7%) reported statistically significant perceived barriers to child's ACS. The methodological and theory utilization qualities of reviewed studies varied, with MQS scores ranging between 7 and 20 (Mean =12.95, SD =2.95) and TQS scores from 1 to 7 (Mean =3.62, SD =1.74). A detailed appraisal of the literature suggests several empirical, methodological, and theoretical recommendations for future studies on perceived barriers to ACS. Empirically, increasing the diversity of study regions and samples should be a high priority, particularly in Asian and European countries, and among rural residents; more prospective and interventions studies are needed to determine the causal mechanism liking the perceived factors and ACS; future researchers should include policy-related barriers into their inquiries. Methodologically, the conceptualization of ACS should be standardized or at least well rationalized in future studies to ensure the comparability of results; researchers' awareness need to be increased for improving the methodological rigor of studies, especially in regard to appropriate statistical analysis techniques, control variable estimation, multicollinearity testing, and reliability and validity reporting. Theoretically, future researchers need to first ground their investigations in theoretical foundations; efforts should be devoted to make sure theories are used thoroughly and correctly; important theoretical constructs, in particular, need to be conceptualized and operationalized appropriately to ensure accurate measurement. By reviewing what has been achieved, this review offered insights for more sophisticated ACS studies in the future.

Understanding neighborhood environment related to Hong Kong children's physical activity: a qualitative study using nominal group technique

BACKGROUND

Relationships between the neighborhood environment and children's physical activity have been well documented in Western countries but are less investigated in ultra-dense Asian cities. The aim of this study was to identify the environmental facilitators and barriers of physical activity behaviors among Hong Kong Chinese children using nominal group technique.

METHODS

Five nominal groups were conducted among 34 children aged 10-11 years from four types of neighborhoods varying in socio-economic status and walkability in Hong Kong. Environmental factors were generated by children in response to the question "What neighborhood environments do you think would increase or decrease your willingness to do physical activity?" Factors were prioritized in order of their importance to children's physical activity.

RESULTS

Sixteen unique environmental factors, which were perceived as the most important to children's physical activity, were identified. Factors perceived as physical activity-facilitators included "Sufficient lighting", "Bridge or tunnel", "Few cars on roads", "Convenient transportation", "Subway station", "Recreation grounds", "Shopping malls with air conditioning", "Fresh air", "Interesting animals", and "Perfume shop". Factors perceived as physical activity-barriers included "People who make me feel unsafe", "Crimes nearby", "Afraid of being taken or hurt at night", "Hard to find toilet in shopping mall", "Too much noise", and "Too many people in recreation grounds".

CONCLUSIONS

Specific physical activity-related environmental facilitators and barriers, which are unique in an ultra-dense city, were identified by Hong Kong children. These initial findings can inform future examinations of the physical activity-environment relationship among children in Hong Kong and similar Asian cities.

Associations between socioeconomic, parental and home environment factors and fruit and vegetable consumption of children in grades five and six in British Columbia, Canada

Background

Regular fruit and vegetable (FV) consumption has been associated with reduced chronic disease risk. Evidence from adults shows a social gradient in FV consumption. Evidence from pre-adolescent children varies and there is little Canadian data. This study assessed the FV intake of school children in British Columbia (BC), Canada to determine whether socio-economic status (SES), parental and the home environment factors were related to FV consumption.

Methods

As part of the BC School Fruit and Vegetable Nutrition Program, 773 British Columbia fifth-and sixth-grade school children (Mean age 11.3 years; range 10.3-12.5) and their parents were surveyed to determine FV consumption and overall dietary intake. Students completed a web-based 24-hour dietary food recall, and a student measure of socio-economic status (The Family Affluence Scale). Parents completed a self-administered survey about their education, income, home environment and perceptions of their neighbourhood and children’s eating habits. Correlations and multiple regression analyses were used to examine the association between SES, parental and home environment factors and FV consumption.

Results

Approximately 85.8% of children in this study failed to meet minimum Canadian guidelines for FV intake (6 servings). Parent income and education were not significantly associated with child FV consumption but were associated with each other, child-reported family affluence, neighbourhood environment, access to FV, and eating at the table or in front of the television. Significant positive associations were found between FV consumption and child-reported family affluence, meal-time habits, neighbourhood environment and parent perceptions of the healthiness of their child’s diet; however, these correlations were weak (ranging from .089-.115). Multiple regression analysis showed that only child-reported family affluence significantly predicted FV consumption (std-β = 0.096 95% CI = 0.01 to 0.27).

Conclusions

The majority of children in our study were not meeting guidelines for FV intake irrespective of SES, parent perceptions or home environment, making this a population wide concern. An almost trivial socio-economic gradient was observed for the child-reported SES measure only. These results are consistent with several other studies of children. Longitudinal research is needed to further explore individual and social factors associated with FV consumption in childhood and their development over time.

Using remote sensing to define environmental characteristics related to physical activity and dietary behaviours: a systematic review (the SPOTLIGHT project)

We performed a systematic literature review on the use of free geospatial services as potential tools to assess built environmental characteristics related to dietary behaviour and physical activity. We included 13 studies, all published since 2010 and conducted in urban contexts, with Google Earth and Google Street View as the two main free geospatial services used. The agreement between virtual and field audit was higher for items related to objectively verifiable measures (e.g. presence of infrastructure and equipment) and lower for subjectively assessed items (e.g. aesthetics, street atmosphere, etc.). Free geospatial services appear as promising alternatives to field audit for assessment of objective dimensions of the built environment.

Parental physical activity, safety perceptions and children's independent mobility

BACKGROUND

Parents are likely to be a basic influence on their children's behavior. There is an absence of information about the associations between parents' physical activity and perception of neighborhood environment with children's independent mobility.The purpose of this study is to examine the contribution of parental physical activity and perception of neighborhood safety to children's independent mobility.

METHODS

In this cross-sectional study of 354 pupils and their parents, independent mobility, perceptions of neighborhood safety and physical activity were evaluated by questionnaire. Categorical principal components analyses were used to determine the underlying dimensions of both independent mobility and perceptions of neighborhood safety items.

RESULTS

The strongest predictor of independent mobility was the parental perception of sidewalk and street safety (beta = 0.132). Parent's physical activity was also a significant predictor. The final model accounted for 13.0% of the variance.

CONCLUSIONS

Parental perception of neighborhood safety and parents' self reported physical activity might be associated with children's independent mobility. Further research in this topic is needed to explore this possible association.

A family-centered lifestyle intervention to improve body composition and bone mass in overweight and obese children 6 through 8 years: a randomized controlled trial study protocol

BACKGROUND

Childhood obesity gives rise to health complications including impaired musculoskeletal development that associates with increased risk of fractures. Prevention and treatment programs should focus on nutrition education, increasing physical activity (PA), reducing sedentary behaviours, and should monitor bone mass as a component of body composition. To ensure lifestyle changes are sustained in the home environment, programs need to be family-centered. To date, no study has reported on a family-centered lifestyle intervention for obese children that aims to not only ameliorate adiposity, but also support increases in bone and lean muscle mass. Furthermore, it is unknown if programs of such nature can also favorably change eating and activity behaviors. The aim of this study is to determine the effects of a 1 y family-centered lifestyle intervention, focused on both nutrient dense foods including increased intakes of milk and alternatives, plus total and weight-bearing PA, on body composition and bone mass in overweight or obese children.

METHODS/DESIGN

The study design is a randomized controlled trial for overweight or obese children (6-8 y). Participants are randomized to control, standard treatment (StTx) or modified treatment (ModTx). This study is family-centred and includes individualized counselling sessions on nutrition, PA and sedentary behaviors occurring 4 weeks after baseline for 5 months, then at the end of month 8. The control group receives counselling at the end of the study. All groups are measured at baseline and every 3 months for the primary outcome of changes in body mass index Z-scores. At each visit blood is drawn and children complete a researcher-administered behavior questionnaire and muscle function testing. Changes from baseline to 12 months in body fat (% and mass), waist circumference, lean body mass, bone (mineral content, mineral density, size and volumetric density), dietary intake, self-reported PA and sedentary behaviour are examined.

DISCUSSION

This family-centered theory-based study permits for biochemical and physiological assessments. This trial will assess the effectiveness of the intervention at changing lifestyle behaviours by decreasing adiposity while enhancing lean and bone mass. If successful, the intervention proposed offers new insights for the management or treatment of childhood obesity.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT01290016.

Association between parental perceptions of residential neighbourhood environments and childhood obesity in Porto, Portugal

BACKGROUND

Portugal has one of the highest rates of childhood obesity in Europe. Few studies have explored the relationship between parents' perceptions of their residential neighbourhood (safety concerns and amenities of the built environment) and their children's weight status. This study aims to examine the associations between parents' perceptions of their residential neighbourhood and overweight/obesity among their children.

METHODS

Anthropometric measures of height and weight were taken for 2690 children in preschools and elementary schools in Porto. Body mass index (kg/m(2)) was calculated, and the International Obesity Taskforce (IOTF) cut-offs were used. Parents completed the 'Environmental Module' standard questionnaire of the International Physical Activity Prevalence Study. Chi-square tests and the logistic regression model adjusted for age, gender, maternal education and school cluster were used to examine the associations between parents' perceptions of their residential neighbourhood and overweight/obesity among their children.

RESULTS

In this sample, 31.8% of the children were overweight (including obese). Significant associations were found between child obesity and the following residential environmental characteristics: the odds of children being obese were lower if their parents believed that it was safe (low/no crime rate) to walk/cycle at night (OR = 0.65, 95% CI = 0.54-0.79) and during the day (OR = 0.70, 95% CI = 0.55-0.86) and that it was easy and pleasant (pedestrian safety) to walk in their neighbourhoods (OR = 0.73, 95% CI = 0.58-0.90) and when local sidewalks were well maintained and unobstructed (OR = 1.18, 95% CI = 1.01-1.40).

CONCLUSION

Parental perceptions of neighbourhood safety and the quality of local sidewalks are significantly associated with obesity values.

Latina mothers' perceptions of healthcare professional weight assessments of preschool-aged children

To understand Latina mothers' definitions of health and obesity in their children and perceptions of physician weight assessments. 24 low-income Spanish speaking Mexican mothers of children ages 2-5 years were recruited to participate in 4 focus groups. Half of the mothers had overweight or obese children and half had healthy weight children. Focus group comments were transcribed and analyzed using grounded theory. Themes and supporting comments were identified independently by 3 reviewers for triangulation. A fourth reader independently confirmed common themes. Mothers define health as a function of their child's ability to play and engage in all aspects of life. Obesity was defined with declining physical abilities. Mothers state health care provider assessments help determine a child's overweight status. Causative factors of obesity included family role-modeling and psycho-social stress, physical inactivity, and high-fat foods consumed outside the home. Controlling food intake was the primary approach to preventing and managing obesity but mothers described family conflict related to children's eating habits. These findings held constant with mothers regardless of whether their children were overweight, obese, or at a healthy weight. Mothers utilize physical limitations and health care professional's assessment of their child's weight as indicators of an overweight status. These results highlight the importance of calculating and communicating body mass indices (BMI) for Latino children. Eliminating non-nutritive foods from the home, increasing physical activity, and involving family members in the discussion of health and weight maintenance are important strategies for the prevention and management of childhood obesity.

Is the environment near home and school associated with physical activity and adiposity of urban preschool children?

Preventing sedentary behavior and adiposity in childhood has become a public health priority. We examined urban social and built environment characteristics as correlates of physical activity and anthropometry among 428 preschool children from low-income families in New York City. We measured the children's height, weight, skinfold thicknesses, physical activity by accelerometer, and covariates. We geocoded home and Head Start center addresses and estimated the following for an area within 0.5 km of those two locations using a detailed geographic database: neighborhood composition, walkability, crime and traffic safety, and aesthetic characteristics. Generalized estimating equations were used to examine the associations of area characteristics with physical activity or adiposity, adjusted for characteristics of the child, mother, and home. Participants were 2-5 years old, 53% female, 83% Hispanic, and 43% either overweight or obese. Of the walkability indicators, land use mix was associated with physical activity (26 more activity counts/minute per standard deviation increase in mixed land use, p = 0.015) and subway stop density was associated with adiposity (1.2 mm smaller sums of skinfold thicknesses sum per standard deviation increase in subway stop density, p = 0.001). The pedestrian-auto injury rate, an indicator of traffic safety problems, was associated with physical activity and adiposity (16 fewer activity counts/minute, p = 0.033, and 1.0 mm greater skinfold thickness per standard deviation increase in pedestrian-auto injuries, p = 0.018). Children living in areas with more street trees were more physically active and those living in areas with more park access had smaller skinfolds. However, many of the tested associations were not statistically significant and some trends were not in the hypothesized direction. Efforts to enhance walkability, safety, and green spaces in the local environment may be relevant to physical activity and adiposity, and therefore to the health of preschool-aged children from low-income families.

Urban and rural differences in sedentary behavior among American and Canadian youth

We examined relationships between urban-rural status and three screen time behaviors (television, computer, video games), and the potential mediating effect of parent and peer support on these relationships. Findings are based on American (n = 8563) and Canadian (n = 8990) youth in grades 6-10 from the 2005/06 Health Behavior in School-Aged Children Survey. Weekly hours of individual screen time behaviors were calculated. Urban-rural status was defined using the Beale coding system. Parent and peer support variables were derived from principal component analysis. In comparison to the referent group (non-metro adjacent), American youth in the most rural areas were more likely to be high television users and less likely to be high computer users. Conversely, Canadian youth in medium and large metropolitan areas were less likely to be high television users and more likely to be high computer users. Parent and peer support did not strongly mediate the relationships between urban-rural status and screen time. These findings suggest that interventions aiming to reduce screen time may be most effective if they consider residential location and the specific screen time behavior.

Associations between diet quality and physical activity measures among a southern Ontario regional sample of grade 6 students

The purpose of this study was to determine diet quality and physical activity behaviours of grade 6 students by sex and body weight status, and to determine the associations between diet quality and physical activity behaviours. The Web-based Food Behaviour Questionnaire, which included a 24-h diet recall and the modified Physical Activity Questionnaire for Older Children (PAQ-C), was administered to a cross-section of schools (n = 405 students from 15 schools). Measured height and weight were used to calculate body mass index and weight status (Cole et al. 2000). A Canadian version of the Healthy Eating Index (HEI-C) was used to describe overall diet quality. The mean HEI-C was 69.6 (13.2) with the majority (72%) falling into the needs improvement category. The overall mean physical activity score was 3.7 out of a maximum of 5, with obese subjects being less active compared with normal weight and overweight (p < 0.001). Ordinal logistic regression analysis (of HEI-C vs. all measures of the PAQ-C, sex, and weight status) revealed that HEI-C ratings were likely to be higher in students that walked to and from school 5 days per week (vs. 0 days per week; odds ratio 3.18, p = 0.010); and were active 1 evening per week (vs. none; odds ratio 3.48, p = 0.039). The positive association between diet quality and some aspects of physical activity suggests possible clustering of health behaviours. Future research should test the potential benefits of promoting 1 health behaviour (e.g., healthy eating) with another (e.g., physical activity).