Patterns of sedentary behaviour and physical activity among adolescents in the United Kingdom: Project STIL

Clusters of 24-hour movement behavior and diet and their relationship with health indicators among youth: a systematic review

Movement-related behaviors (physical activity [PA], sedentary behavior [SB], and sleep) and diet interact with each other and play important roles in health indicators in youth. This systematic review aimed to investigate how PA, SB, sleep, and diet cluster in youth by biological sex; and to examine which cluster are associated with health indicators. This study was registered in PROSPERO (number: CRD42018094826). Five electronic databases were assessed. Eligibility criteria allowed studies that included youth (aged 19 years and younger), and only the four behaviors {PA, SB, sleep, and diet (ultra-processed foods [UPF]; fruits and vegetables [FV])} analyzed by applying data-based cluster procedures. From 12,719 articles screened; 23 were included. Of these, four investigated children, and ten identified clusters by biological sex. Sixty-six mixed cluster were identified including, 34 in mixed-sex samples, 10 in boys and 11 in girls. The most frequent clusters in mixed-sex samples were "High SB UPF Low Sleep", "Low PA High SB Satisfactory Sleep", and "High PA". The main difference in profiles according to sex was that girls' clusters were characterized by high sleep duration, whereas boys' clusters by high PA. There were a few associations found between cluster types and health indicators, highlighting that youth assigned to cluster types with low PA exhibited higher adiposity. In conclusion, the youth presented a range of clusters of behaviors, typically exhibiting at least one unhealthy behavior. Similar patterns were observed in both sexes with the biggest difference in time of sleep for girls and PA for boys. These findings underscore the importance of intervention strategies targeting multiple behaviors simultaneously to enhance health risk profiles and indicators in children and adolescents.

A systematic review of the clustering and correlates of physical activity and sedentary behavior among boys and girls

Identifying the clustering and correlates of physical activity (PA) and sedentary behavior (SB) is very important for developing appropriate lifestyle interventions for children and adolescents. This systematic review (Prospero CRD42018094826) aimed to identify PA and SB cluster patterns and their correlates among boys and girls (0-19 years). The search was carried out in five electronic databases. Cluster characteristics were extracted in accordance with authors' descriptions by two independent reviewers and a third resolved any disagreements. Seventeen studies met the inclusion criteria and the population age ranged from six to 18 years old. Nine, twelve, and ten cluster types were identified for mixed-sex samples, boys, and girls, respectively. While girls were in clusters characterized by "Low PA Low SB" and "Low PA High SB", the majority of boys were in clusters defined by "High PA High SB" and "High PA Low SB". Few associations were found between sociodemographic variables and all cluster types. Boys and girls in "High PA High SB" clusters had higher BMI and obesity in most of the tested associations. In contrast, those in the "High PA Low SB" clusters presented lower BMI, waist circumference, and overweight and obesity. Different cluster patterns of PA and SB were observed in boys and girls. However, in both sexes, a better adiposity profile was found among children and adolescents in "High PA Low SB" clusters. Our results suggest that it is not enough to increase PA to manage the adiposity correlates, it is also necessary to reduce SB in this population.

Congruence between Physical Activity Patterns and Dietary Patterns Inferred from Analysis of Sex Differences in Lifestyle Behaviors of Late Adolescents from Poland: Cophylogenetic Approach

Global trends toward physical inactivity and the replacement of healthy dietary behaviors with unhealthy food consumption, particularly in late adolescence, were commonly observed. Thus, the aim of this work was twofold: (1) to examine congruence between PAPs and DPs by identifying sex differences in healthy and unhealthy behaviors and (2) to assess the explanation behind why certain participants were classified into clusters using BMI and fat mass covariates. Late adolescents (19-21 years of age, n = 107) were selected to study. PAPs and DPs were assessed with questionnaires (IPAQ, QEB) and body height, weight, and fat mass percentage were self-reported (the accuracy and reliability of self-reported data were empirically verified). A cophylogenetic approach with several clustering procedures (heatmaps and tanglegrams) was the way to solve the stated problems. Results showed that students achieved the minimal level of physical activity, lower than students from other regions in Poland, Czech Republic, or Germany. There was congruence between PAPs and DPs in some males' and females' behaviors. Significant similarities in sex patterns of behaviors were revealed (Mantel tests-PAPs: r = 0.70, p < 0.001; DPs: r = 0.84, p < 0.001). Similarities in PAPs were related to transportation cycling and school/work activities behaviors. Non-healthy triads in dietary behaviors were found: fast-food, sweetened beverages, and alcoholic drinks in the first, and sweets, fried meals, and yellow cheese in the second. One healthy diad was revealed: vegetables and fruits. Only females' dietary behaviors were reflected in body mass index (F = 3.19, p = 0.049), percentage of body fat (F = 3.87, p = 0.027), and fat mass index (F = 3.83, p = 0.028). The usefulness of the cophenetic approach in patterns study was verified. Sex similarities and specific disparities could help preparing targeted tailored intervention programs that improve healthy habits in late adolescents. This is especially important in relation to females, who more strongly reflected dietary behaviors in body composition.

Clustering of Physical Activity, Sleep, Diet, and Screen-Based Device Use Associated with Self-Rated Health in Adolescents

BACKGROUND

Little is known about how the interplay among health-related behaviors impacts self-rated health (SRH). We examined the clustering of physical activity (PA), sleep, diet, and specific screen-based device use, and the associations between the emergent clusters and SRH among Brazilian adolescents.

METHOD

The data used in this cross-sectional study were from the baseline of the Movimente Program. Self-reported data were analyzed. SRH was recorded as a 5-point scale (from poor to excellent). Daily duration of exposure to the computer, the television, the cell phone, and games; PA; sleep; and weekly consumption of fruits and vegetables and ultra-processed foods were included in a Two-Step cluster analysis. Multilevel ordered logistic regressions assessed the associations between the clusters and SRH.

RESULTS

The data of 750 students (girls: 52.8%, 13.1 ± 1.0 years) were analyzed. Good SRH was more prevalent (52.8%). Three clusters were identified: the Phubbers (50.53%; characterized by the longest cell phone use duration, shortest gaming and computer use, lowest PA levels, and low consumption of fruits and vegetables), the Gamers (22.80%; longest gaming and computer use duration, PA < sample average, highest intake of ultra-processed foods), and a Healthier cluster (26.67%; physically active, use of all screen-based devices < sample average, and healthier dietary patterns). For both Gamers (-0.85; 95% CI -1.24, -0.46) and Phubbers (-0.71; 95% CI -1.04, -0.38), it was found a decrease in the log-odds of being in a higher SRH category compared with the Healthier cluster.

CONCLUSION

Specific clusters represent increased health-related risk. Assuming the interdependence of health-related behaviors is indispensable for accurately managing health promotion actions for distinguishable groups.

From Secondary School to University: Associations Between Domain-Specific Sedentary Behaviors and Lifestyle Risk Behaviors

This study examined associations between changes in domain-specific sedentary behaviors and changes in health-related lifestyles of Spanish secondary school students (n = 113) to their first year of university. During the transitions from the end of high school to the beginning of university, engagement in sedentary behaviors have emerged as potential additional behavioral risk factors. Understanding how sedentary behaviors interconnect with other (un)healthy behaviors will inform interventions on multiple risk behaviors across this critical life period. A 3-year longitudinal survey assessed associations between domain-specific sedentary behaviors and leisure time physical activity (IPAQ), alcohol and tobacco consumption, and fruit and vegetable intake (24-h dietary recall), using Generalized Estimating Equations. Spending time on sedentary transportation was associated with a greater likelihood of smoking, whereas sedentary weekend homework was associated with a reduced likelihood of consuming alcohol. The lowest and highest tertiles for sedentary screen use and leisure-time PA were also less likely not to meet the recommendations for fruit and vegetable consumption. For specific sedentary behaviors, associations were gender-based or affected by leisure time physical activity. From secondary school to university, specific sedentary behaviors are linked to lifestyle risk factors. Over this transitional period, public health interventions targeting reduced sedentary behaviors may bring multiple benefits by also preventing other harmful behaviors.

Magnitude of Overweight, Obesity and Insufficient Physical Sports Activities Among Secondary School Students in Kinondoni Municipal, Dar es Salaam

INTRODUCTION

There is an overwhelming increase of Non-Communicable Disease worldwide such as diabetes and cardiovascular diseases. Overweight and obesity are highly associated with development of these diseases. Unhealthy lifestyle such as excessive sugar, alcohol intake and lack of adequate physical activities has been associated with development of obesity. However, these risk factors are not well elucidated among adolescents in Tanzania. We conducted this survey to determine obesity, overweight, self-reported physical activities, and preferred foods among secondary school students in Kinondoni Municipal in Dar es salaam, Tanzania.

METHODS

A cross sectional descriptive survey was conducted among secondary school students at Kambangwa and Makumbusho secondary schools in Kinondoni municipal in Dar es Salaam city. A simple random sampling technique was used to select participating schools with systemic random selection procedure was used to select participants. A pre structured, self-administered questionnaire was used to collect demographic information from the participants. Anthropometric measurement for Body Mass Index (BMI) was done using standard tools. Interpretation of the findings was done using World Health Organization (WHO) standard charts for age and sex. Data were analysed using Statistical Package for Social Sciences (SPSS version 20; SPSS Inc., Chicago, US).

RESULTS

A total of 234 participants were enrolled in the study. A total of 204 (87.2%) of study participants reported to regularly participate in physical sports activities. Furthermore, Males reported to participate more in physical sports activities compared to females (χ2 (1) =8.13., p = 0.004). During sex-wise comparison, 30 (46.2%) of males reported to participate in sports once per week compared to 71 (51.5%) of females. Reported frequency was influenced by participants' sex (χ2 (3) =16.4., p= 0.001). A total of 28 (12%) participants reported fruits as their favourite food. Food preference was influenced by the participants' sex (X 2 (5) =13.1., p < 0.02). 32(47.7%) of males reported fresh fruits juice as their favourite drink compared to 106(63.5%) of females) while 6(9%) of males reported to prefer commercial industrial juice compared to 4 (2.4%) of females.

CONCLUSION

Obesity and overweight are prevalent among secondary school adolescents in Kinondoni Municipal, Dar es salaam. In addition, the magnitude of physical activities was below the recommended amount. Therefore, awareness campaigns and advocacy programs aiming at preventive measures against NCDs such as healthy eating behaviour and promotion of physical activities among adolescents should be given high priority.

Healthy movement behaviours in children and youth during the COVID-19 pandemic: Exploring the role of the neighbourhood environment

This paper explores patterns of increased/ decreased physical activity, sedentary and sleep behaviours among Canadian children and youth aged 5-17 years during the COVID-19 pandemic, and examines how these changes are associated with the built environment near residential locations. A cluster analysis identified two groups who were primarily distinguished by the changes in outdoor activities. Compliance to 24-hour movement guidelines was low among both groups. For children, houses (versus apartments) was correlated with increased outdoor activities; proximity to major roads was a barrier. For youth, low dwelling density, and access to parks in high-density neighbourhoods, increased the odds of increased outdoor activities during the pandemic. Our findings can inform future urban and health crisis planning practices by providing new insights into the desirable public health messaging and characteristics of healthy and resilient communities.

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.

Ecological correlates of activity-related behavior typologies among adolescents

Background

Adolescents engage in various combinations (typologies) of physical activity and sedentary behaviors, which impact their health and wellbeing in different ways. As such, there is a need to understand the factors that may inhibit or facilitate engagement in combinations of activity-related behaviors to help inform effective intervention strategies targeting those most in need. The aim of this study was to identify ecological correlates of adolescent physical activity and sedentary behavior typologies.

Methods

Cross-sectional study of 473 adolescents (15.0 ± 1.6 years, 41.4% boys) from 18 secondary schools in Melbourne, Australia. Intrapersonal, interpersonal and neighborhood-physical environmental factors were assessed via self-report surveys and Geographic Information Systems. Multinomial logistic regression models determined the relative risk ratio of membership of three homogenous activity-related behavior typologies based on the potential correlates.

Results

Higher levels of self-efficacy for physical activity, parental screen-time restriction rules, parental support for physical activity, sibling screen-time co-participation and perceptions of neighborhood pedestrian/traffic safety were associated with greater likelihood of adolescents being in the typology defined as highly active and low sedentary compared to the physically inactive, highly sedentary typology. Higher frequency of co-participation in screen-time with friends was associated with greater likelihood of adolescents being in the typology defined as moderately active, high screen-time compared to physically inactive, highly sedentary.

Conclusions

A range of intrapersonal, interpersonal and environmental correlates appear to play a role in adolescent activity-related typology membership. The findings may inform public health interventions targeting unique adolescent subgroups most at risk of poor health outcomes based on their engagement in combinations of activity-related behaviors.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7386-9) contains supplementary material, which is available to authorized users.

Methodology Used in Ecological Momentary Assessment Studies About Sedentary Behavior in Children, Adolescents, and Adults: Systematic Review Using the Checklist for Reporting Ecological Momentary Assessment Studies

Background

The use of ecological momentary assessment (EMA) to measure sedentary behavior (SB) in children, adolescents, and adults can increase the understanding of the role of the context of SB in health outcomes.

Objective

The aim of this study was to systematically review literature to describe EMA methodology used in studies on SB in youth and adults, verify how many studies adhere to the Methods aspect of the Checklist for Reporting EMA Studies (CREMAS), and detail measures used to assess SB and this associated context.

Methods

A systematic literature review was conducted in the PubMed, Scopus, Web of Science, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and SPORTDiscus databases, covering the entire period of existence of the databases until January 2018.

Results

This review presented information about the characteristics and methodology used in 21 articles that utilized EMA to measure SB in youth and adults. There were more studies conducted among youth compared with adults, and studies of youth included more waves and more participants (n=696) than studies with adults (n=97). Most studies (85.7%) adhered to the Methods aspect of the CREMAS. The main criteria used to measure SB in EMA were self-report (81%) with only 19% measuring SB using objective methods (eg, accelerometer). The main equipment to collect objective SB was the ActiGraph, and the cutoff point to define SB was <100 counts/min. Studies most commonly used a 15-min window to compare EMA and accelerometer data.

Conclusions

The majority of studies in this review met minimum CREMAS criteria for studies conducted with EMA. Most studies measured SB with EMA self-report (n=17; 81.0%), and a few studies also used objective methods (n=4; 19%). The standardization of the 15-min window criteria to compare EMA and accelerometer data would lead to a comparison between these and new studies. New studies using EMA with mobile phones should be conducted as they can be considered an attractive method for capturing information about the specific context of SB activities of young people and adults in real time or very close to it.

Clustering of unhealthy lifestyle behaviours and associations with perceived and actual weight status among primary school children in China: A nationally representative cross-sectional study

Few studies have focused on clustering of unhealthy lifestyle behaviours among primary school children and potential associations with perceived and actual weight status. An index was constructed from adding up 13 unhealthy behaviours measured by survey responses. Multilevel linear regressions were used to analyse associations between child personal characteristics, perceived and actual weight status with the unhealthy lifestyle index among 11,157 children in primary schools across China. Parental and area factors were also taken into account, including education, weight status, physical activity, urban/rural and area socioeconomic circumstances. The unhealthy lifestyle index normally distributed, with 84.5% of children reporting between 2 and 6 unhealthy behaviours. Boys reported more unhealthy behaviours compared with girls (coefficient 0.32, 95%CI 0.26 to 0.37) and children in urban areas had fewer unhealthy behaviours than their rural counterparts (-0.29, 95%CI -0.56 to -0.03). An interaction revealed stronger 'protective' effects of living in cities for girls than boys, which were not explained by differences in child overweight/obesity. More unhealthy behaviours were characteristic of children in more affluent areas, and of those born to mothers and/or fathers with lower educational attainment. Children who perceived themselves as overweight or underweight both scored higher on the unhealthy lifestyle index. Unhealthy behaviours that could increase the risk of childhood obesity are common among Chinese primary school children, particularly among boys in cities, those in more affluent areas and with parents with lower education. There was no effect of actual weight status on number of unhealthy behaviours. Perceived, but not actual weight status, was also a significant correlate of unhealthy behaviours. Clustering of unhealthy lifestyle behaviours that could increase the risk of childhood obesity are common among Chinese primary school children, particularly among boys in cities, those in more affluent areas and with parents with lower education. Perceived, but not actual weight status, was also a significant correlate of unhealthy lifestyle. This has important implications for public health because understanding clustering of unhealthy lifestyle behaviours can be used to assist in the development of targeted obesity prevention initiatives.

Association of individual and neighbourhood socioeconomic status with physical activity and screen time in seventh-grade boys and girls in Berlin, Germany: a cross-sectional study

OBJECTIVES

Few studies have explored the impact of neighbourhood socioeconomic status (SES) on health behaviours in youths in Germany. Our aim was to investigate the association of individual and neighbourhood SES with physical activity (PA) and screen time (ST) in students aged 12-13 years in Berlin.

DESIGN

Cross-sectional study.

SETTING

Secondary schools (high schools and integrated secondary schools) in Berlin, Germany.

PARTICIPANTS

A total of 2586 students aged 12-13 years (seventh grade).

MAIN OUTCOME MEASURES

Sociodemographics, anthropometric data and health behaviours were assessed by self-report during classes. Primary outcome was the association of individual and neighbourhood SES with meeting daily PA and exceeding daily ST recommendations. Students' characteristics were described with means or percentages. Comparisons were performed using generalised linear mixed model yielding ORs with 95% CIs.

RESULTS

Mean (±SD) age was 12.5±0.5 years, 50.5% were girls and 34.1% had a migrant background. When adjusting for individual covariates, associations of low versus high individual SES were 0.85 (0.48; 1.52) for PA and 2.08 (1.26; 3.43) for ST. Associations of low versus high neighbourhood SES were 1.76 (1.12; 2.75) for PA and 1.54 (1.10; 2.17) for ST. After additional adjustment for school type and school neighbourhood SES, associations comparing low versus high individual and neighbourhood SES were attenuated for PA (individual SES 0.74 (0.41; 1.33) and neighbourhood SES 1.51 (0.93; 2.46)) and ST (individual SES 1.88 (1.12; 3.14) and neighbourhood SES 1.40(0.98; 2.00).

CONCLUSIONS

Lower individual and neighbourhood SES were associated with higher ST. Lower neighbourhood but not individual SES was associated with higher PA. After consideration of school type and school neighbourhood SES associations were attenuated and became insignificant for the relationship between neighbourhood SES, PA and ST. Further research is warranted to unravel the complex relationships between individual SES, neighbourhood SES and school environment to develop more targeted health promotion strategies in the future.

A Systematic Review of Methods and Procedures Used in Ecological Momentary Assessments of Diet and Physical Activity Research in Youth: An Adapted STROBE Checklist for Reporting EMA Studies (CREMAS)

BACKGROUND

Ecological momentary assessment (EMA) is a method of collecting real-time data based on careful timing, repeated measures, and observations that take place in a participant's typical environment. Due to methodological advantages and rapid advancement in mobile technologies in recent years, more studies have adopted EMA in addressing topics of nutrition and physical activity in youth.

OBJECTIVE

The aim of this systematic review is to describe EMA methodology that has been used in studies addressing nutrition and physical activity in youth and provide a comprehensive checklist for reporting EMA studies.

METHODS

Thirteen studies were reviewed and analyzed for the following 5 areas of EMA methodology: (1) sampling and measures, (2) schedule, (3) technology and administration, (4) prompting strategy, and (5) response and compliance.

RESULTS

Results of this review showed a wide variability in the design and reporting of EMA studies in nutrition and physical activity among youth. The majority of studies (69%) monitored their participants during one period of time, although the monitoring period ranged from 4 to 14 days, and EMA surveys ranged from 2 to 68 times per day. More than half (54%) of the studies employed some type of electronic technology. Most (85%) of the studies used interval-contingent prompting strategy. For studies that utilized electronic devices with interval-contingent prompting strategy, none reported the actual number of EMA prompts received by participants out of the intended number of prompts. About half (46%) of the studies failed to report information about EMA compliance rates. For those who reported, compliance rates ranged from 44-96%, with an average of 71%.

CONCLUSIONS

Findings from this review suggest that in order to identify best practices for EMA methodology in nutrition and physical activity research among youth, more standardized EMA reporting is needed. Missing the key information about EMA design features and participant compliance might lead to misinterpretation of results. Future nutrition and physical activity EMA studies need to be more rigorous and thorough in descriptions of methodology and results. A reporting checklist was developed with the goal of enhancing reliability, efficacy, and overall interpretation of the findings for future studies that use EMAs.

National youth sedentary behavior and physical activity daily patterns using latent class analysis applied to accelerometry

Background

Applying latent class analysis (LCA) to accelerometry can help elucidated underlying patterns. This study described the patterns of accelerometer-determined sedentary behavior and physical activity among youth by applying LCA to a nationally representative United States (US) sample.

Methods

Using 2003–2006 National Health and Nutrition Examination Survey data, 3998 youths 6–17 years wore an ActiGraph 7164 accelerometer for one week, providing > =3 days of wear for > =8 h/day from 6:00 am-midnight. Cutpoints defined sedentary behavior (<100 counts/minute), light activity (100–2295 counts/minute), moderate to vigorous physical activity (MVPA; > = 2296 counts/minute), and vigorous activity (> = 4012 counts/minute). To account for wear time differences, outcomes were expressed as percent of day in a given intensity. LCA was used to classify daily (Monday through Sunday) patterns of average counts/minute, sedentary behavior, light activity, MVPA, and vigorous activity separately. The latent classes were explored overall and by age (6–11, 12–14, 15–17 years), gender, and whether or not youth attended school during measurement. Estimates were weighted to account for the sampling frame.

Results

For average counts/minute/day, four classes emerged from least to most active: 40.9 % of population (mean 323.5 counts/minute/day), 40.3 % (559.6 counts/minute/day), 16.5 % (810.0 counts/minute/day), and 2.3 % (1132.9 counts/minute/day). For percent of sedentary behavior, four classes emerged: 13.5 % of population (mean 544.6 min/day), 30.1 % (455.1 min/day), 38.5 % (357.7 min/day), and 18.0 % (259.2 min/day). For percent of light activity, four classes emerged: 12.3 % of population (mean 222.6 min/day), 29.3 % (301.7 min/day), 41.8 % (384.0 min/day), and 16.6 % (455.5 min/day). For percent of MVPA, four classes emerged: 59.9 % of population (mean 25.0 min/day), 33.3 % (60.9 min/day), 3.1 % (89.0 min/day), and 3.6 % (109.3 min/day). For percent of vigorous activity, three classes emerged: 76.8 % of population (mean 7.1 min/day), 18.5 % (23.9 min/day), and 4.7 % (47.4 min/day). Classes were developed by age, gender, and school attendance since some patterns differed when stratifying by these factors.

Conclusion

The models supported patterns for average intensity, sedentary behavior, light activity, MVPA, and vigorous activity. These latent class derived patterns can be used in other youth studies to explore correlates or outcomes and to target sedentary behavior or physical activity interventions.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-016-0382-x) contains supplementary material, which is available to authorized users.

Ecological Momentary Assessment in Eating Disorder and Obesity Research: a Review of the Recent Literature

Our current understanding of the etiology and maintenance of eating disorders and obesity continues to be far from complete. Similarly, our understanding of determinants of both successful and unsuccessful weight loss surgery is also quite limited. While a number of research methodologies have been applied to these areas, one methodology that has recently seen a rise in popularity is the use of ecological momentary assessment (EMA). EMA allows one to study a variety of variables of interest in the natural environment. The study of eating disorders, obesity, and bariatric surgery has all been conducted using EMA recently. The current study is a review of these areas and summarizes the recent literature (past 3 years) in eating disorders, obesity, and bariatric surgery using EMA methodology.

Managing the screen-viewing behaviours of children aged 5-6 years: a qualitative analysis of parental strategies

OBJECTIVES

The present study used qualitative methods to: (1) examine the strategies that were used by parents of children aged 5-6 years to manage screen viewing; (2) identify key factors that affect the implementation of the strategies and (3) develop suggestions for future intervention content.

DESIGN

Telephone interviews were conducted with parents of children aged 5-6 years participating in a larger study. Interviews were transcribed verbatim and analysed using an inductive and deductive content analysis. Coding and theme generation was iterative and refined throughout.

SETTING

Parents were recruited through 57 primary schools located in the greater Bristol area (UK).

PARTICIPANTS

53 parents of children aged 5-6 years.

RESULTS

Parents reported that for many children, screen viewing was a highly desirable behaviour that was difficult to manage, and that parents used the provision of screen viewing as a tool for reward and/or punishment. Parents managed screen viewing by setting limits in relation to daily events such as meals, before and after school, and bedtime. Screen-viewing rules were often altered depending on parental preferences and tasks. Inconsistent messaging within and between parents represented a source of conflict at times. Potential strategies to facilitate reducing screen viewing were identified, including setting screen-viewing limits in relation to specific events, collaborative rule setting, monitoring that involves mothers, fathers and the child, developing a family-specific set of alternative activities to screen viewing and developing a child's ability to self-monitor their own screen viewing.

CONCLUSIONS

Managing screen viewing is a challenge for many parents and can often cause tension in the home. The data presented in this paper provide key suggestions of new approaches that could be incorporated into behaviour change programmes to reduce child screen viewing.

Developing an Internet- and Mobile-Based System to Measure Cigarette Use Among Pacific Islanders: An Ecological Momentary Assessment Study

BACKGROUND

Recent prevalence data indicates that Pacific Islanders living in the United States have disproportionately high smoking rates when compared to the general populace. However, little is known about the factors contributing to tobacco use in this at-risk population. Moreover, few studies have attempted to determine these factors utilizing technology-based assessment techniques.

OBJECTIVE

The objective was to develop a customized Internet-based Ecological Momentary Assessment (EMA) system capable of measuring cigarette use among Pacific Islanders in Southern California. This system integrated the ubiquity of text messaging, the ease of use associated with mobile phone apps, the enhanced functionality offered by Internet-based Cell phone-optimized Assessment Techniques (ICAT), and the high survey completion rates exhibited by EMA studies that used electronic diaries. These features were tested in a feasibility study designed to assess whether Pacific Islanders would respond to this method of measurement and whether the data gathered would lead to novel insights regarding the intrapersonal, social, and ecological factors associated with cigarette use.

METHODS

20 young adult smokers in Southern California who self-identified as Pacific Islanders were recruited by 5 community-based organizations to take part in a 7-day EMA study. Participants selected six consecutive two-hour time blocks per day during which they would be willing to receive a text message linking them to an online survey formatted for Web-enabled mobile phones. Both automated reminders and community coaches were used to facilitate survey completion.

RESULTS

720 surveys were completed from 840 survey time blocks, representing a completion rate of 86%. After adjusting for gender, age, and nicotine dependence, feeling happy (P=<.001) or wanting a cigarette while drinking alcohol (P=<.001) were positively associated with cigarette use. Being at home (P=.02) or being around people who are not smoking (P=.01) were negatively associated with cigarette use.

CONCLUSIONS

The results of the feasibility study indicate that customized systems can be used to conduct technology-based assessments of tobacco use among Pacific Islanders. Such systems can foster high levels of survey completion and may lead to novel insights for future research and interventions.

Do Media Use and Physical Activity Compete in Adolescents? Results of the MoMo Study

Purpose

The displacement hypothesis predicts that physical activity and media use compete in adolescents; however, findings are inconsistent. A more differentiated approach at determining the co-occurrence of physical activity and media use behaviors within subjects may be warranted. The aim of this study was to determine the co-occurrence of physical activity and media use by identifying clusters of adolescents with specific behavior patterns including physical activity in various settings (school, sports club, leisure time) and different types of media use (watching TV, playing console games, using PC / Internet).

Methods

Cross-sectional data of 2,083 adolescents (11–17 years) from all over Germany were collected between 2009 and 2012 in the Motorik-Modul Study. Physical activity and media use were self-reported. Cluster analyses (Ward’s method and K-means analysis) were used to identify behavior patterns of boys and girls separately.

Results

Eight clusters were identified for boys and seven for girls. The clusters demonstrated that a high proportion of boys (33%) as well as girls (42%) show low engagement in both physical activity and media use, irrespective of setting or type of media. Other adolescents are engaged in both behaviors, but either physical activity (35% of boys, 27% of girls) or media use (31% of boys and girls) predominates. These adolescents belong to different clusters, whereat in most clusters either one specific setting of physical activity or a specific combination of different types of media predominates.

Conclusion

The results of this study support to some extent the hypothesis that media use and physical activity compete: Very high media use occurred with low physical activity behavior, but very high activity levels co-occurred with considerable amounts of time using any media. There was no evidence that type of used media was related to physical activity levels, neither setting of physical activity was related to amount of media use in any pattern.

Profiles of sedentary and non-sedentary young men - a population-based MOPO study

BACKGROUND

Sedentary behavior is associated with poor well-being in youth with adverse trajectories spanning to adulthood. Still, its determinants are poorly known. Our aim was to profile sedentary and non-sedentary young men and to clarify their differences in a population-based setting.

METHODS

A total of 616 men (mean age 17.9, SD 0.6) attending compulsory conscription for military service completed a questionnaire on health, health behavior, socioeconomic situation and media use. They underwent a physical (body composition, muscle and aerobic fitness) and medical examination. Profiles were formed by principal component analysis (PCA).

RESULTS

A total of 30.1 % men were sedentary (daily leisure-time sitting ≥5 h) and 28.9 % non-sedentary (sitting ≤2 h). The sedentary men had more body fat, more depressive symptoms, but lower fitness and life satisfaction than non-sedentary men. However, according to PCA, profiles of unhealthy eating, life-dissatisfaction, and gaming were detected both among sedentary and non-sedentary men, as well as high self-rated PA and motives to exercise.

CONCLUSION

Determinants of sedentary and non-sedentary lifestyles were multiple and partially overlapping. Recognizing individual patterns and underlying factors of the sedentary lifestyle is essential for tailored health promotion and interventions.

Why Are Children Different in Their Daily Sedentariness? An Approach Based on the Mixed-Effects Location Scale Model

This study aimed to investigate the between- and within-individual variability in sedentary time over seven days, using a mixed-effects location scale model. The sample comprised 686 Portuguese children (381 girls) aged 9–11 years, from 23 schools. Sedentary time was estimated by the Actigraph GT3X+ accelerometer, which was used 24 hours/day for 7 consecutive days; height, sitting height, and weight were measured, BMI was computed (WHO cut-points were used to classify subjects as normal weight or overweight/obese), and maturity offset was estimated. Information regarding the home environment was obtained by questionnaire. Results revealed that (i) children were more sedentary on Friday, but less so on Saturday and Sunday (compared to Monday), with significant variation between- and within-subjects (between-subject variance=0.800, within-subject variance=1.793, intra-subject correlation=0.308); (ii) there is a sex effect on sedentariness, with boys being less sedentary than girls (p<0.001), and the between-subject variance was 1.48 times larger for boys than girls; (iii) in terms of the within-subject variance, or erraticism, Tuesday, Wednesday and Friday have similar erraticism levels as Monday (Thursday has less, while Saturday and Sunday have more); in addition, girls (variance ratio=0.632, p<0.001), overweight/obese children (variance ratio=0.861, p=0.019), and those later mature (variance ratio=0.849, p=0.013) have less erraticism than their counterparts; (iv) the within-subject variance varied significantly across subjects (scale std dev=0.342±0.037, p<0.001); and (v) in the fixed part of the model, only biological maturation was positively related to sedentariness. This study demonstrated that there is significant between- and within-subject variability in sedentariness across a whole week. This implies that a focus on intra-individual variability, instead of only on mean values, would provide relevant information towards a more complete map of children’s sedentary behaviour, which can be helpful when developing more efficient strategies to reduce sedentariness.

Reducing youth screen time: qualitative metasynthesis of findings on barriers and facilitators

OBJECTIVE

An integrated perspective on the relevant qualitative findings on the experience of screen time in youth can inform the development of hypotheses to be tested in future research and can guide the development of interventions to decrease sedentary behavior. The purpose of this qualitative metasynthesis was to explore parent, youth, and educational professionals' perceptions of barriers to, and facilitators of, reducing youth screen time.

METHOD

Qualitative metasynthesis techniques were used to analyze and synthesize 15 qualitative studies of screen time among youth (11-18 years) meeting inclusion criteria. The phrases, quotes, and/or author interpretations (i.e., theme or subtheme) were recorded in a data display matrix to facilitate article comparisons. Codes were collapsed into 23 categories of similar conceptual meaning and 3 overarching themes were derived using thematic analysis procedures.

RESULTS

Study sample sizes ranged from 6 to 270 participants from 6 countries. Data collection methods included focus groups (n = 6), interviews (n = 4), focus group and interviews (n = 4), and naturalistic observation (n = 1) with youth and/or parents. Data analysis techniques included thematic analysis (n = 9), content analysis (n = 3), grounded theory (n = 1), observation (n = 1), and interpretive phenomenological analysis (n = 1). Three thematic categories were identified: (a) youth's norms-screen time is an integral part of daily life, and facilitates opportunities for entertainment, social interaction, and escapism; (b) family dynamics and parental roles-parents are conflicted and send mixed messages about the appropriate uses and amounts of screen time; and, (c) resources and environment-engagement in screen time is dependent on school, community, neighborhood, and home environmental contexts.

CONCLUSIONS

Screen time is an established norm in many youth cultures, presenting barriers to behavior change. Parents recognize the importance of reducing youth screen time, but model and promote engagement themselves. For youth and parents, mutually agreed rules, limits, and parental monitoring of screen time were perceived as likely to be effective.

Longitudinal associations of health-related behavior patterns in adolescence with change of weight status and self-rated health over a period of 6 years: results of the MoMo longitudinal study

Background

Promoting a healthy lifestyle especially in adolescents is important because health-related behaviors adopted during adolescence most often track into adulthood. Longitudinal studies are necessary for identifying health-related risk groups of adolescents and defining target groups for health-promoting interventions. Multiple health behavior research may represent a useful approach towards a better understanding of the complexity of health-related behavior. The aim of this study was to examine the longitudinal association of health-related behavior patterns with change of weight status and self-rated health in adolescents in Germany.

Methods

Within the framework of the longitudinal German Health Interview and Examination Survey for Children and Adolescents (KiGGS) and the Motorik-Modul (MoMo), four clusters of typical health-related behavior patterns of adolescents have been previously identified. Therefor the variables ‘physical activity’, ‘media use’ and ‘healthy nutrition’ were included. In the current study longitudinal change of objectively measured weight status (N = 556) and self-rated health (N = 953) in the four clusters was examined. Statistical analyses comprised T-tests for paired samples, McNemar tests, multinomial logistic regression analysis and two-way ANOVA with repeated measures.

Results

The prevalence of overweight increased in all four clusters. The health-related behavior pattern of low activity level with high media use and low diet quality had the strongest increase in prevalence of overweight, while the smallest and non-significant increase was found with the behavior pattern of a high physical activity level and average media use and diet quality. Only some significant relationships between health-related behaviour patterns and change in self-rated health were observed.

Conclusions

High-risk patterns of health-related behavior were identified. Further, cumulative as well as compensatory effects of different health-related behaviors on each other were found. The information gained in this study contributes to a better understanding of the complexity of health-related behavior and its impact on health parameters and may facilitate the development of targeted prevention programs.

Using ecological momentary assessment to evaluate current physical activity

Objective. The purpose of this study was to assess the value of ecological momentary assessment in evaluating physical activity among children, adolescents, and adults. It also determines whether ecological momentary assessment fulfills the criteria of validity, reliability, objectivity, norms, and standardization applied to the tools used for the evaluation of physical activity. Methods. The EBSCO-CINHAL, Medline, PsycINFO, PubMed, and SPORTDiscuss databases were reviewed in December 2012 for articles associated with EMA. Results. Of the 20 articles examined, half (10) used electronic methods for data collection, although various methods were used, ranging from pen and paper to smartphone applications. Ten studies used objective monitoring equipment. Nineteen studies were performed over 4 days. While the validity of the EMA method was discussed in 18 studies, only four found it to be objective. In all cases, the EMA procedures were precisely documented and confirmed to be feasible. Conclusions. Ecological momentary assessment is a valid, reliable, and feasible approach to evaluate activity and sedentary behavior. Researchers should be aware that while ecological momentary assessment offers many benefits, it simultaneously imposes many limitations which should be considered when studying physical activity.

Cross-sectional associations between the screen-time of parents and young children: differences by parent and child gender and day of the week

BACKGROUND

Greater time spent screen-viewing (SV) has been linked to adverse health outcomes. The aim of this study was to examine whether parental SV time is associated with child SV time on week and weekend days.

METHODS

Cross-sectional survey of 1078 children aged 5-6 and at least 1 parent. Child and parent SV was reported for weekday and weekend days. Logistic regression examined whether parental SV time was associated with child SV time, with separate analyses for mothers and fathers and interaction terms for child gender.

RESULTS

12% of boys, 8% of girls and 30% of mothers and fathers watched ≥ 2 hours of TV each weekday. On a weekend day, 45% of boys, 43% of girls, 53% of mothers and 57% of fathers spent ≥ 2 hours watching TV. Where parents exceeded 2 hours TV-watching per weekday, children were 3.4 times more likely to spend ≥ 2 hours TV-watching if their father exceeded the threshold with odds of 3.7 for mothers. At weekends, daughters of fathers who exceeded 2 hours watching TV were over twice as likely as sons to exceed this level. Evidence that parent time spent using computers was associated with child computer use was also strongest between fathers and daughters (vs. sons) (OR 3.5 vs. 1.0, p interaction=0.027).

CONCLUSIONS

Strong associations were observed between parent and child SV and patterns were different for weekdays versus weekend days. Results show that time spent SV for both parents is strongly associated with child SV, highlighting the need for interventions targeting both parents and children.

The clustering of diet, physical activity and sedentary behavior in children and adolescents: a review

Diet, physical activity (PA) and sedentary behavior are important, yet modifiable, determinants of obesity. Recent research into the clustering of these behaviors suggests that children and adolescents have multiple obesogenic risk factors. This paper reviews studies using empirical, data-driven methodologies, such as cluster analysis (CA) and latent class analysis (LCA), to identify clustering patterns of diet, PA and sedentary behavior among children or adolescents and their associations with socio-demographic indicators, and overweight and obesity. A literature search of electronic databases was undertaken to identify studies which have used data-driven methodologies to investigate the clustering of diet, PA and sedentary behavior among children and adolescents aged 5–18 years old. Eighteen studies (62% of potential studies) were identified that met the inclusion criteria, of which eight examined the clustering of PA and sedentary behavior and eight examined diet, PA and sedentary behavior. Studies were mostly cross-sectional and conducted in older children and adolescents (≥9 years). Findings from the review suggest that obesogenic cluster patterns are complex with a mixed PA/sedentary behavior cluster observed most frequently, but healthy and unhealthy patterning of all three behaviors was also reported. Cluster membership was found to differ according to age, gender and socio-economic status (SES). The tendency for older children/adolescents, particularly females, to comprise clusters defined by low PA was the most robust finding. Findings to support an association between obesogenic cluster patterns and overweight and obesity were inconclusive, with longitudinal research in this area limited. Diet, PA and sedentary behavior cluster together in complex ways that are not well understood. Further research, particularly in younger children, is needed to understand how cluster membership differs according to socio-demographic profile. Longitudinal research is also essential to establish how different cluster patterns track over time and their influence on the development of overweight and obesity.

Clustering of children's obesity-related behaviours: associations with sociodemographic indicators

BACKGROUND/OBJECTIVES

Research suggests obesity-related behaviours cluster together in children and adolescents, but how these cluster patterns differ by sociodemographic indicators remains unclear. Furthermore, few studies examining clustering of behaviours have included younger children or an objective measure of physical activity (PA) and sedentary behaviour. Therefore, the aim of this study was to examine clustering patterns of diet, PA and sedentary behaviour in 5- to 6- and 10- to 12-year-old children, and their cross-sectional associations with sociodemographic indicators.

SUBJECTS/METHODS

In this cross-sectional study, data from the baseline wave (2002/2003) of the Health Eating and Play study (HEAPS) were used. Questionnaires were completed by parents of Australian children aged 5-6 (n=362) and 10-12 years (n=610). Children wore accelerometers for up to 7 days. K-medians cluster analysis identified groups of children with similar diet, PA and sedentary behaviours. Chi-square tests assessed cluster differences by gender, maternal education and marital status.

RESULTS

For each age group, three reliable and meaningful clusters were identified and labelled 'most healthy', 'energy-dense (ED) consumers who watch TV' and 'high sedentary behaviour/low moderate-to-vigorous PA (MVPA)'. Clusters varied by sociodemographic indicators. For example, a higher proportion of older girls comprised the 'high sedentary behaviour/low MVPA' cluster (χ(2)=22.4, P<0.001). Among both age groups, the 'ED consumers who watch TV' cluster comprised more children with lower educated mothers (younger children: χ(2)=34.9, P<0.001; older children: χ(2)=27.3, P<0.001).

CONCLUSIONS

Identification of cluster patterns of obesity-related risk factors in children, and across sociodemographic groups may assist the targeting of public health initiatives, to those most in need.

Screen-based media use clusters are related to other activity behaviours and health indicators in adolescents

Background

Screen-based media (SBM) occupy a considerable portion of young peoples’ discretionary leisure time. The aim of this paper was to investigate whether distinct clusters of SBM use exist, and if so, to examine the relationship of any identified clusters with other activity/sedentary behaviours and physical and mental health indicators.

Methods

The data for this study come from 643 adolescents, aged 14 years, who were participating in the longitudinal Western Australian Pregnancy Cohort (Raine) Study through May 2003 to June 2006. Time spent on SBM, phone use and reading was assessed using the Multimedia Activity Recall for Children and Adults. Height, weight, muscle strength were measured at a clinic visit and the adolescents also completed questionnaires on their physical activity and psychosocial health. Latent class analysis (LCA) was used to analyse groupings of SBM use.

Results

Three clusters of SBM use were found; C1 ‘instrumental computer users’ (high email use, general computer use), C2 ‘multi-modal e-gamers’ (both high console and computer game use) and C3 ‘computer e-gamers’ (high computer game use only). Television viewing was moderately high amongst all the clusters. C2 males took fewer steps than their male peers in C1 and C3 (-13,787/week, 95% CI: -4619 to -22957, p = 0.003 and -14,806, 95% CI: -5,306 to -24,305, p = 0.002) and recorded less MVPA than the C1 males (-3.5 h, 95% CI: -1.0 to -5.9, p = 0.005). There was no difference in activity levels between females in clusters C1 and C3.

Conclusion

SBM use by adolescents did cluster and these clusters related differently to activity/sedentary behaviours and both physical and psychosocial health indicators. It is clear that SBM use is not a single construct and future research needs to take consideration of this if it intends to understand the impact SBM has on health.

Patterns of physical activity outside of school time among Japanese junior high school students

BACKGROUND

Physical activity is beneficial for adolescent health. The physical activity patterns of Japanese adolescents are relatively unknown. Therefore, this study aimed to describe the current patterns of physical activity and to identify sex and grade differences among them.

METHODS

The participants comprised 714 Japanese adolescents aged 12 to 15 years old (boys N = 372, girls N = 342) from a public junior high school in Okayama, Japan. Physical activity at school, outside of school after hours, and during lunch recess as well as the total leisure time in a usual week was assessed with a 5-item questionnaire. To assess the differences in the physical activity patterns by sex and grade, independent t tests and analysis of variance (ANOVA) were conducted, respectively.

RESULTS

Boys spent significantly more time in physical activity both inside and outside of school settings than girls (p < .05). Higher grade students were significantly less active than lower grade students (p < .05). Furthermore, the physical activity patterns across the grades differed between settings (at school, outside of school during the after-school period, lunchtime recess, and at home).

CONCLUSION

To increase physical activity levels among Japanese adolescents, implementation of after-school programs or environmental modifications developed within the school setting could be effective strategies.

Sedentary Behavior and Health Outcomes in Children and Adolescents

The purpose of this review was to summarize findings from epidemiological studies that determined if sedentary behavior was associated with obesity, metabolic risk factors, and cardiorespiratory fitness in children and adolescents. We noted if studies adjusted for moderate-to-vigorous physical activity (MVPA), dietary intakes, and/or sleep duration. Articles were identified through PubMed using the search terms: (sedentary OR sitting OR television) AND (adiposity OR blood pressure OR body mass index OR cardiometabolic OR metabolic risk OR waist circumference). The search was limited to ages 6 to 18 years, humans, and published between January 1, 2008 and September 26, 2012. Cross-sectional and longitudinal studies observed associations between more sedentary behavior, especially screen-based sedentary behavior, and measures of obesity; and most associations were independent of MVPA and dietary intake. Cross-sectional and longitudinal studies reported associations between screen-based sedentary behavior and lower cardiorespiratory fitness, and most associations were independent of MVPA and obesity. Cross-sectional studies observed associations between more screen-based and objectively measured sedentary behavior and lower insulin sensitivity; and most associations were independent of MVPA and obesity. There was little-to-no evidence that sedentary behavior was associated with increased blood pressure and increased blood lipids.

Sweetened drink and snacking cues in adolescents: a study using ecological momentary assessment

The objective of this study was to identify physical, social, and intrapersonal cues that were associated with the consumption of sweetened beverages and sweet and salty snacks among adolescents from lower SES neighborhoods. Students were recruited from high schools with a minimum level of 25% free or reduced cost lunches. Using ecological momentary assessment, participants (N=158) were trained to answer brief questionnaires on handheld PDA devices: (a) each time they ate or drank, (b) when prompted randomly, and (c) once each evening. Data were collected over 7days for each participant. Participants reported their location (e.g., school grounds, home), mood, social environment, activities (e.g., watching TV, texting), cravings, food cues (e.g., saw a snack), and food choices. Results showed that having unhealthy snacks or sweet drinks among adolescents was associated with being at school, being with friends, feeling lonely or bored, craving a drink or snack, and being exposed to food cues. Surprisingly, sweet drink consumption was associated with exercising. Watching TV was associated with consuming sweet snacks but not with salty snacks or sweet drinks. These findings identify important environmental and intrapersonal cues to poor snacking choices that may be applied to interventions designed to disrupt these food-related, cue-behavior linked habits.

Adolescent time use clusters: a systematic review

PURPOSE

Recent research suggests that patterns or clusters of time use may affect health in ways that cannot be explained by the effect of individual behaviors alone. The aim of this research was to systematically review the literature examining adolescent time use clusters and associated correlates.

METHODS

Systematic searches of six online databases for relevant observational studies were conducted. At least two authors reviewed abstract and full text selection meeting eligibility criteria. Included studies were quality scored, had data extracted, and cluster types and cluster associations interpreted.

RESULTS

Nineteen studies were identified for inclusion, and 18 of them investigated cluster-correlate associations. Twenty-nine cluster types were identified, characterized by both individual (e.g., church) and co-occurring behaviors (e.g., physical activity and screen [technoactive]). Nineteen correlate categories were identified (e.g., socioeconomic and weight status). Consistent patterns of cluster-correlate association were found. For example, the technoactive cluster type is more likely to be male and to have low school orientation.

CONCLUSIONS

Despite the between-study differences, consistent cluster and cluster-correlate patterns were still evident. Cluster analysis of adolescent time use behaviors appears to be an emerging and useful classification technique, one which may have implications for targeted health-related interventions.

Patterns of sedentary behaviours in Irish female adolescents

Engagement in excessive sedentary behaviour represents a health risk for adolescents. The current study aimed to investigate patterns of sedentary behaviour amongst Irish female adolescents aged between 15 and 19 years old. 314 adolescents completed a questionnaire on their sedentary behaviour habits, health behaviours (physical activity, smoking, and alcohol use), enjoyment of sedentary behaviour, value on health, and sedentary facilitators in their home. Parents provided information on parental education, the child's weight and height, and parental sedentary behaviour habits. Cluster analysis found that five distinct sedentary clusters existed in this sample: Unproductive/Social Sedentary, Reading/Productive Behaviours, Mixed Sedentary Interests, Restricted Interests/High Television, and Academic Sedentary. The clusters differed on smoking and alcohol use, enjoyment of sedentary behaviour, and parental engagement in sedentary behaviour. The findings from this study support the use of a socio-ecological framework for investigating the development of sedentary behaviour patterns.

Screen-based sedentary behavior and cardiorespiratory fitness from age 11 to 13

PURPOSE

The study's purpose was to determine whether time spent in screen-based sedentary behavior is associated with change in cardiorespiratory fitness (CRF) levels in children from age 11 to 13, adjusting for vigorous physical activity (VPA).

METHODS

Participants were children (n = 2097) enrolled in the control arm of the HEALTHY Study, who performed 20-m shuttle run tests at ages 11 and 13. Self-reported screen time was used as a measure of sedentary behavior. Longitudinal quantile regression was used to model the influence of predictors on changes at the 10th, 25th, 50th, 75th, and 90th shuttle run lap percentiles. Screen time (h·d(-1)) was the main predictor, and adjustment was also made for VPA, body mass index, and household education.

RESULTS

In boys, more screen time was associated with fewer shuttle run laps completed from age 11 to 13 at the 25th, 50th, and 75th shuttle run lap percentiles; the strongest association was at the 75th shuttle run percentile (-0.57, 95% confidence interval = -0.93 to -0.21). In girls, more screen time was associated with fewer shuttle run laps completed from age 11 to 13 at the 50th, 75th, and 90th shuttle run lap percentiles; the strongest association was at the 90th shuttle run percentile (-0.65, -1.01 to -0.30). Borderline negative associations were found between screen time and shuttle run laps at the 10th shuttle run percentile in boys and girls (-0.28, -0.57 to 0.01, and -0.17, -0.41 to 0.06, respectively).

CONCLUSIONS

More screen time was associated with lower CRF from age 11 to 13, independent of VPA. However, the association was weakest at the lower tail of the CRF distribution.

A prospective study of sedentary behavior in a large cohort of youth

PURPOSE

The study's purpose was to describe longitudinal patterns of objectively measured sedentary behavior from age 12 to 16.

METHODS

Children participating in the Avon Longitudinal Study of Parents and Children wore accelerometers for 1 wk at ages 12, 14, and 16. Participants included boys (n = 2591) and girls (n = 2845) living in a single geographic location in the United Kingdom (Bristol). Total minutes per day spent in sedentary behavior and time spent in blocks of sedentary behavior lasting 10-19, 20-29, and ≥ 30 min are described. Growth curve models were used to determine the rate of change in sedentary behavior from age 12 to 16.

RESULTS

At age 12, the boys and girls, on average, were sedentary for 418.0 ± 67.7 and 436.6 ± 64.0 min·d(-1), respectively, and sedentary behavior increased over time to 468.0 ± 74.3 and 495.6 ± 68.9 min·d(-1) at age 14 and to 510.4 ± 76.6 and 525.4 ± 67.4 min·d(-1) at age 16. Growth curve analyses found that total sedentary behavior increased at a rate of 19.5 ± 0.7 and 22.8 ± 0.7 min·d(-1)·yr for the boys and girls, respectively. The absolute mean increase in total sedentary behavior (+92.4 and +88.8 min·d(-1) for the boys and girls, respectively) closely matched the mean decrease in light physical activity (-82.2 and -82.9 min·d(-1) for the boys and girls, respectively) from age 12 to 16. Time spent in continuous sedentary behavior lasting ≥ 30 min increased by 121% from age 12 to 16.

CONCLUSIONS

Sedentary behavior increased with age, at the expense of light physical activity. The increase in sedentary behavior lasting ≥ 30 min in duration contributed greatly to the increase in total sedentary behavior.

Clustering of specific health-related behaviours among Toronto adolescents

PURPOSE

The clustering of specific health-related behaviours was examined among adolescents.

METHODS

In 2005, cluster analysis was conducted to identify homogeneous groups of Toronto, Ontario, 14- to 17-year-old adolescents (n=445) with similar behaviour patterns according to self-reported measures of moderate to vigorous physical activity (metabolic equivalent [MET] hours a week of MVPA), sedentary behaviours (viewing television or videos, using a computer/the internet, doing homework, and talking with friends), fruit and vegetable consumption, and alcohol consumption.

RESULTS

Three clusters of adolescents were identified: "active, high screen-time users," "active, low screen-time users," and "less active, least frequent drinkers."

CONCLUSIONS

Identifying clusters of adolescents with similar health-related behaviour patterns suggests that researchers and practitioners should develop and implement interventions tailored to specific clusters.

Beyond Screen Time: Assessing Recreational Sedentary Behavior among Adolescent Girls

Most studies of sedentary behavior have focused on television use or screen time. This study aims to examine adolescent girls' participation in a variety of recreational sedentary behaviors (e.g., talking on the phone and hanging around), and their association with physical activity (PA), dietary behaviors, and body mass index. Data were from a sample of 283 adolescent girls. Recreational sedentary behavior, PA, and dietary behaviors were self-reported, and girls' height and weight were measured. Over 95% of girls engaged in at least one recreational sedentary behavior during the recall period. Watching television and hanging around were the most common behaviors. Watching television, using the Internet, and hanging around were associated with less PA; watching television, hanging around, and talking on the phone were associated with less healthful dietary behaviors. No associations were found with body mass index. Interventions may benefit from capitalizing on and intervening upon girls' common recreational sedentary behaviors.

Cross-sectional analysis of levels and patterns of objectively measured sedentary time in adolescent females

Background

Adolescent females have been highlighted as a particularly sedentary population and the possible negative effects of a sedentary lifestyle are being uncovered. However, much of the past sedentary research is based on self-report or uses indirect methods to quantity sedentary time. Total time spent sedentary and the possible intricate sedentary patterns of adolescent females have not been described using objective and direct measure of body inclination. The objectives of this article are to examine the sedentary levels and patterns of a group of adolescent females using the ActivPAL™ and to highlight possible differences in sedentary levels and patterns across the week and within the school day. A full methodological description of how the data was analyzed is also presented.

Methods

One hundred and eleven adolescent females, age 15-18 yrs, were recruited from urban and rural areas in the Republic of Ireland. Participants wore an ActivPAL physical activity monitor for a 7.5 day period. The ActivPAL directly reports total time spent sitting/lying every 15 seconds and accumulation (frequency and duration) of sedentary activity was examined using a customized MATLAB^® computer software programme.

Results

While no significant difference was found in the total time spent sitting/lying over the full 24 hour day between weekday and weekend day (18.8 vs. 18.9 hours; p = .911), significantly more sedentary bouts of 1 to 5 minutes and 21 to 40 minutes in duration were accumulated on weekdays compared to weekend days (p < .001). The mean length of each sedentary bout was also longer (9.8 vs. 8.8 minutes; p < .001). When school hours (9 am-3 pm) and after school hours (4 pm-10 pm) were compared, there was no difference in total time spent sedentary (3.9 hours; p = .796) but the pattern of accumulation of the sedentary time differed. There were a greater number of bouts of > 20 minutes duration during school hours than after school hours (4.7 vs. 3.5 bouts; p < .001) while after school time consisted of shorter bouts < 20 minutes.

Conclusions

School is highlighted as a particularly sedentary setting for adolescent females. Interventions to decrease sedentary time at school and the use of wearable devices which distinguish posture should be encouraged when examining sedentary patterns and behaviors in this population.

Technology for behavioral assessment and intervention in bariatric surgery

Patients' behaviors have a substantial effect on postoperative outcomes after bariatric surgery. Thus, studying patients' behaviors is essential to learning how to optimize postoperative outcomes. To be most effective, this research should use the best tools available for assessing patient behavior. However, the traditional methods of behavioral assessment (e.g., questionnaires and clinical interviews) rely primarily on patients' retrospective self-report, which is often inaccurate. Despite their significant shortcomings, these types of assessments continue to predominate. However, technological advances now allow for much greater accuracy in the assessment of patient behaviors by way of devices, such as accelerometers and palmtop computers. Accelerometers allow for patients' physical activity to be measured objectively in great detail, in real-time, in the patients' natural environment. Ecologic momentary assessment using a palmtop computer or mobile telephone allows the assessment of important behaviors, such as eating and activity behaviors, to be measured, with many of the same advantages. Furthermore, new computer-assisted technologies are in development that will further facilitate behavioral assessment. Technology also has the potential to play an important role in the delivery of behavioral interventions aimed at bariatric surgery patients, given that Internet-based treatments have already proved effective for nonoperative weight loss and are often highly cost-effective and easily disseminable. Future research should evaluate the efficacy of these programs for bariatric patients.

Physical activity and sedentary activity patterns among children and adolescents: a latent class analysis approach

BACKGROUND

While much is known about the overall levels of physical activity and sedentary activity among youth, few studies have attempted to define clusters of such behaviors. The purpose of this study was to identify and describe unique classes of youth based on their participation in a variety of physical activity and sedentary behaviors.

METHODS

Latent class analysis was used to characterize segments of youth based on patterns of self-reported and accelerometer-measured participation in 12 behaviors. Children and adolescents (N=720) from 6th-11th grade were included in the analysis. Differences in class membership were examined using multinomial logistic regression.

RESULTS

Three distinct classes emerged for boys and girls. Among boys, the 3 classes were characterized as "Active" (42.1%), "Sedentary" (24.9%), and "Low Media/Moderate Activity" (33.0%). For girls, classes were "Active" (18.7%), "Sedentary" (47.6%), and "Low Media/Functional Activity" (33.7%). Significant differences were found between the classes for a number of demographic indicators including the proportion in each class who were classified as overweight or obese.

CONCLUSIONS

The behavioral profiles of the classes identified in this study can be used to suggest possible audience segments for intervention and to tailor strategies appropriately.

What is the meaning and nature of active play for today's children in the UK?

Background

Preventing the decline in physical activity which occurs around 10-11 years of age is a public health priority. Physically active play can make unique contributions to children's development which cannot be obtained from more structured forms of physical activity. Encouraging active play in children's leisure time has potential to increase physical activity levels while promoting optimal child development. Aspired wisdom states that contemporary British children no longer play outdoors, but systematic evidence for this is lacking. We need to build a more informed picture of contemporary children's play before we consider interventions to increase it.

Methods

Eleven focus groups were conducted with 77, 10-11 year old children from four primary schools in Bristol, UK. Focus groups examined: 1) children's perceptions of 'play'; 2) how much of their play is active play; and 3) contexts of children's active play. All focus groups were audio-taped and transcribed verbatim. Data were analysed using a thematic approach.

Results

Children's perceptions of play were broad and included both physically active and sedentary behaviours. Children reported that they frequently engaged in active play and valued both the physical and social benefits it provided. Whereas boys frequently reported having a 'kick about' or riding bikes as their preferred forms of active play, girls were less likely to report a specific activity. Additionally, boys reported greater independent mobility in their active play compared to girls. Finally, boys were more likely to report playing with neighbourhood friends but girls more frequently reported playing with family members.

Conclusions

Promoting active play in children's leisure time may increase the physical activity of children, but interventions may need to be tailored according to gender.

Clustering of lifestyle factors and association with overweight in adolescents of the Kiel Obesity Prevention Study

OBJECTIVE

To identify lifestyle clusters in adolescents and to characterize their association with overweight and obesity.

DESIGN

Cross-sectional and longitudinal data of the Kiel Obesity Prevention Study.

SETTING

Schools in Kiel, Germany.

SUBJECTS AND METHODS

Cross-sectional data of 1894 adolescents aged 14 years and 4-year longitudinal data of a subsample of 389 children aged 10 and 14 years. Self-reported data of physical activity, modes of commuting to school, media time, nutrition, alcohol consumption and smoking were used to identify lifestyle clusters with two-step cluster analysis. Obesity indices (height, weight, waist circumference and fat mass (FM)) were measured.

RESULTS

Three lifestyle clusters were identified: a 'low activity and low-risk behaviour' cluster (cluster 1: n 740, 39·1 %); a 'high media time and high-risk behaviour' cluster (cluster 2: n 498, 26·3 %); and a 'high activity and medium-risk behaviour' cluster (cluster 3: n 656, 34·6 %). Strictly speaking, none of these clusters was considered to be markedly healthy. The prevalence of overweight and obesity tended to be lower in cluster 3 (15·9 %) than in clusters 1 (20·4 %) and 2 (20·5 %; P = 0·053). Longitudinally, 4-year changes in FM were found to be lowest in cluster 2, but the 4-year incidence rate of obesity was lowest in cluster 3.

CONCLUSIONS

Explicit healthy lifestyles do not exist, but an active lifestyle reduces the incidence of obesity. In adolescents, health promotion should take into account the diversity of lifestyles and address specific lifestyle clusters.

Descriptive epidemiology of screen and non-screen sedentary time in adolescents: a cross sectional study

Background

Much attention has been paid to adolescents' screen time, however very few studies have examined non-screen sedentary time (NSST). This study aimed to (1) describe the magnitude and composition of screen sedentary time (SST) and NSST in Australian adolescents, (2) describe the socio-demographic correlates of SST and NSST, and (3) determine whether screen time is an adequate surrogate for total sedentary behaviour in this population.

Methods

2200 9-16 year old Australians provided detailed use of time data for four days. Non-screen sedentary time (NSST) included time spent participating in activities expected to elicit <3 METs whilst seated or lying down (other than sleeping), excluding screen-based activities (television, playing videogames or using computers). Total sedentary time was the sum of screen time and NSST.

Results

Adolescents spent a mean (SD) of 345 (105) minutes/day in NSST, which constituted 60% of total sedentary time. School activities contributed 42% of NSST, socialising 19%, self-care (mainly eating) 16%, and passive transport 15%. Screen time and NSST showed opposite patterns in relation to key socio-demographic characteristics, including sex, age, weight status, household income, parental education and day type. Because screen time was negatively correlated with NSST (r = -0.58), and exhibited a moderate correlation (r = 0.53) with total sedentary time, screen time was only a moderately effective surrogate for total sedentary time.

Conclusions

To capture a complete picture of young people's sedentary time, studies should endeavour to measure both screen time and NSST.

Screen time of adolescents in an economically developing country: the case of Turkey

BACKGROUND

Most studies of screen time of adolescents have been carried out in well-developed countries. There is little information concerning screen time of adolescents in developing countries such as Turkey.

AIM

This study examined the screen time of adolescents with regard to gender, school type and sport participation in Turkey, selected as an example of an economically developing country.

SUBJECTS AND METHODS

A total of 916 high school students participated in this study. The household activities and sport indexes of the Physical Activity Assessment Questionnaire were administered to the participants.

RESULTS

Male students had higher screen time (hours/day) than female students and the screen time of the adolescents was longer at the weekends than on weekdays (p < 0.01). The students attending private schools spent more screen time on both weekdays and weekends than those attending public schools (p < 0.01). The results did not reveal significant screen time differences with regard to participation duration in sport activities (p>0.05).

CONCLUSIONS

Male adolescents and students attending private schools had a higher screen time rate than their counterparts, both on weekdays and at the weekend. Participating in sport for different durations did not make any difference to the screen time of these adolescents.

Is television viewing a suitable marker of sedentary behavior in young people?

BACKGROUND

Television (TV) viewing is a highly prevalent sedentary behavior in young people and has played a significant role in the assessment of sedentary behaviors. An important question to be addressed is to what extent TV viewing is a suitable indicator, or marker, of overall levels of sedentary behavior in children and adolescents. This has not yet been attempted in youth, but has already been attempted in Australian adults.

PURPOSE

This study was conducted to test whether TV viewing in UK teenagers is a marker of sedentary behavior more broadly and to see if the results mirror those of Australian adults.

METHODS

Ecological momentary assessment time-use diaries were completed by 561 boys and 923 girls (mean age 14.67 years) in which weekday and weekend out-of-school time behaviors were recorded every 15 min.

RESULTS

TV viewing was negatively associated with other leisure-time sedentary behaviors for both boys and girls for weekdays and weekends. Higher levels of TV viewing were associated with less time in other key sedentary behaviors, such as computer use in boys and motorized transport in girls.

CONCLUSIONS

TV viewing appears not to reflect additional time in other sedentary behaviors in British teenagers, in contrast to data from Australian women. Studies of sedentary behavior should encompass as wide a range of behaviors as possible.