Examination of perceived neighborhood characteristics and transportation on changes in physical activity and sedentary behavior: The Trial of Activity in Adolescent Girls

Children's independent mobility during dark hours: a scoping review

Introduction

Independent mobility is every child's right and has implications for their health, wellbeing, and development. This scoping review addresses children's needs and experiences of light conditions in their everyday outdoor life. The review examines peer-reviewed scientific literature that analyses associations between different light conditions and children's independent mobility (CIM) during dark hours.

Methods

By formulating a Boolean search string, including terms related to children independent mobility, light and outdoor environment, five scientific databases were searched. The search resulted in 67 eligible papers that were analyzed through an inductive, thematic analysis.

Results

Four overarching themes representing the researched topics of the effects of light conditions with importance for CIM during dark hours were identified: (1) physical activity (PA) and active travel, (2) outdoor activities and place use, (3) safety perception, and (4) outdoor risks. The findings highlight that darkness constitutes a major obstacle for CIM, and that fear of darkness is common among children. It restricts the degree of CIM and influences children's safety perception as well as how they navigate through public places outdoors. The findings show that the type and design of outdoor settings during dark hours and children's familiarity with places during daytime could play a role in the degree of CIM after dark. The presence of outdoor lighting is related to children's increased PA and active travel, and outdoor lighting seems to also influence children's place use and interaction with the environment. The presence and extent of outdoor lighting and lighting quality may play a role in children's safety perception, which in turn can influence CIM.

Discussion

The findings suggest that promoting CIM during dark hours might not only contribute to the accumulation of children's PA, confidence, and skills, but also support mental health. The understanding of children's perspectives on the quality of outdoor lighting needs to be deepened to support CIM. Highlighting the child perspective would aid the development of current recommendations for outdoor lighting and the implementation of the Agenda 2030 of ensuring healthy lives and promoting wellbeing for all at all ages, and making cities inclusive, safe, resilient and sustainable throughout the day and seasons.

A multi-component, community-engaged intervention to reduce cardiovascular disease risk in perimenopausal Latinas: pilot study protocol

BACKGROUND

Cardiovascular disease (CVD) risk increases substantially during perimenopause. Latinas have a significantly worse CVD risk factor profile than non-Hispanic White women, potentially due to multiple sociocultural and environmental factors. To date, interdisciplinary interventions have not focused on improving nutrition, physical activity, stress management, and biologic CVD risk in perimenopausal Latinas. The purpose of this study is to examine the feasibility and initial efficacy of a multi-component intervention to reduce CVD risk in perimenopausal Latinas.

METHODS

This is a two-group, repeated measures experimental study. Eighty perimenopausal Latinas (age 40-55 years) from two community groups will be randomized: one group will complete the intervention; the other will be a wait-list control. The intervention consists of 12-weekly sessions (education, physical activity, stress management, coping skills training), followed by 3 months of continued support, and 6 months of skill maintenance on their own. The primary outcomes include arterial stiffness, blood pressure, lipids, and blood glucose. Secondary outcomes are health behaviors (nutrition, physical activity, sleep, coping strategies), self-efficacy, and other biological factors related to CVD risk (adiposity, C-reactive protein, hair cortisol, vasomotor symptoms). We will assess changes in outcomes from Time 1 (baseline) to Time 2 (6 months) and Time 3 (12 months) using general linear mixed models to test the hypotheses. We will also evaluate the feasibility of the intervention by assessing enrollment and retention rates, barriers, and facilitators to enrollment, intervention fidelity, the suitability of study procedures, and participant satisfaction with the intervention and study protocol. We hypothesize the intervention group will decrease biologic CVD risk and improve health behaviors and self-efficacy significantly more than the wait-list control.

DISCUSSION

Results from this study will contribute to knowledge on the feasibility of behavioral interventions, including stress management and coping skills training, which could reduce CVD burden among perimenopausal Latinas. Because Hispanic/Latinos are the largest ethnic minority in the United States (US), progress regarding CVD risk among perimenopausal Latinas may lead to significant improvement in the overall CVD burden in the US.

TRIAL REGISTRATION

Prospectively registered, NCT04313751 (03/19/2020), Protocol version 1.0.

Identification of Effective Programs to Improve Access to and Use of Trails among Youth from Under-Resourced Communities: A Review

The primary purpose of this paper is to identify and review studies evaluating the effectiveness of programs to increase access to trails and trails use (physical activity) among youth from under-resourced communities. Three additional goals include identifying: (1) Correlates of physical activity/trail use and features of transportation systems and/or built environment and land use destinations, that may inform and support the planning and implementation of programs to promote trail use among youth, (2) benefits associated with trail use, and (3) barriers to trail use. Under-resourced communities are defined as those lacking sufficient resources (i.e., under-funded).

METHODS

A review of the literature was conducted to identify, abstract, and evaluate studies related to programs to promote trail use among youth and youth from under-resourced communities. In anticipation of very few studies being published about this topic, studies were also reviewed to identify correlates of transportation systems and built environment and land use destinations related to increases in physical activity, and benefits of, and barriers to trail use. PUBMED, MEDLINE, PsycINFO, Sportdiscus, Annual Reviews, American Trails, and Google Scholar databases were searched using terms including trails, built environment, physical activity, exercise, walking, children, adolescents, and youth to identify studies that potentially related to the purposes for conducting this review. Review methods identified, 5278 studies based on our search terms. A review of study titles, abstracts, and select full article screens determined that 5049 studies did not meet the study inclusion criteria, leaving 221 studies included in this review.

RESULTS

No studies were located that evaluated programs designed to promote and increase trail use among youth, including youth from under-resourced communities. Eight studies used longitudinal or quasi-experimental designs to evaluate physical activity and neighborhood characteristics prospectively among adolescent girls (n = 1), the effects of the path or trail development on physical activity behaviors of children, youth, and adults (n = 4), marketing or media campaigns (n = 2), and wayfinding and incremental distance signage (n = 1) to promote increased trail use. Correlates of transportation systems (e.g., trail access, road traffic congestion related to safe active travel, lack of sidewalks, closer proximity to trails, access to transportation), destinations (e.g., park availability and access, park improvements, greenspaces), or both routes and destinations (e.g., perceptions of safety, lighting), were identified. These correlates may support the planning and implementation of programs to increase trail use among youth, or may facilitate the connection of trails or routes to destinations in communities. Barriers to trail use included costs, crime, lack of transportation, lack of role models using trails, and institutional discrimination.

CONCLUSIONS

Scientific evidence in support of addressing the underrepresentation of trail use by youth from under-resourced communities is lacking. However, there is a related body of evidence that may inform how to develop programs that support trail use by youth from under-resourced areas. Dedicated, deliberate, and systematic efforts will be required to address research and knowledge gaps, and to evaluate programs and practice related to trail use among youth from low income, often racially or ethnically diverse under-resourced neighborhoods or communities.

Impact of new rapid transit on physical activity: A meta-analysis

New rapid transit investments have been motivated by environmental, economic, and health benefits. Given transit's potential to increase active travel, recent research leverages transit changes for natural experiment studies to examine physical activity outcomes. We aimed to quantify the association size, critically examine existing literature, and make recommendations for future studies to advance research and policies on active travel, transportation, and physical activity. Studies of physical activity impacts following transit interventions were systematically reviewed using seven health and transport databases (May-July 2017). Two investigators extracted data on sample size, intervention, pre- and post-intervention physical activity, and relevant measurement information. Inconsistency of results and estimated overall mean physical activity change post-intervention were assessed. Forest plots were created from physical activity change in each study using a general variance-based random effects model. Of 18 peer-reviewed articles examining health behaviors, 15 addressed physical activity and five were natural experiment studies with pre- and post- intervention measurements. Studies varied by intervention, duration, outcome measurement, sampling location, and spatial method. Q (201) and I2 (98%) indicated high study heterogeneity. Among these five studies, after transit interventions, total physical activity decreased (combined mean - 80.4 min/week, 95% CI - 157.9, -2.9), but transport-related physical activity increased (mean 6.7 min/week, 95% CI - 10.1, 23.5). Following new transit infrastructure, total physical activity may decline but transport-related physical activity may increase. Positive transit benefits were location, sociodemographic, or activity-specific. Future studies should address context, ensure adequate follow-up, utilize controls, and consider non-residential environments or participants.

Social and Environmental Influences on Physical Activity Levels in Latina Adolescents

OBJECTIVE

To examine social and environmental factors that affect moderate to vigorous physical activity (MVPA) in mid-adolescent Hispanic females.

DESIGN AND SAMPLE

Secondary data analysis to examine social and environmental level factors related to MVPA levels in (n = 897) mid-adolescent Hispanic females.

MEASURES

Data were retrieved from the National Survey of Children's Health (2011/12). Logistic regression was used to estimate associations for factors with MVPA.

RESULTS

Significant mid-adolescent predictors were English speaking, OR 1.64 (95% CI, 1.03-2.61); parental attendance of activities, OR 0.50 (95% CI, 0.31-0.81); peer support, OR 2.74 (95% CI, 1.75-4.29); supportive neighborhood, OR 1.52 (95% CI, 1.03-2.32); and safe school environment, OR 1.67 (95% CI, 1.01-2.74).

CONCLUSION

Findings highlight the need for the development of age and culturally appropriate interventions to aid the improvement of participation levels in MVPA among the Latina adolescent population. Additionally, findings suggest recommendations for policy and future research.

A systematic review of determinants of sedentary behaviour in youth: a DEDIPAC-study

Sedentary behaviour (SB) has emerged as a potential risk factor for metabolic health in youth. Knowledge on the determinants of SB in youth is necessary to inform future intervention development to reduce SB. A systematic review was conducted to identify predictors and determinants of SB in youth. Pubmed, Embase, CINAHL, PsycINFO and Web of Science were searched, limiting to articles in English, published between January 2000 and May 2014. The search strategy was based on four key elements and their synonyms: (a) sedentary behaviour, (b) determinants, (c) types of sedentary behaviours, (d) types of determinants. The full protocol is available from PROSPERO (PROSPERO 2014:CRD42014009823). Cross-sectional studies were excluded. The analysis was guided by the socio-ecological model. 37 studies were selected out of 2654 identified papers from the systematic literature search. Most studies were conducted in Europe (n = 13), USA (n = 11), and Australia (n = 10). The study quality, using the Qualsyst tool, was high with a median of 82 % (IQR: 74–91 %). Multiple potential determinants were studied in only one or two studies. Determinants were found at the individual, interpersonal, environmental and policy level but few studies examined a comprehensive set of factors at different levels of influences. Evidence was found for age being positively associated with total SB, and weight status and baseline assessment of screen time being positively associated with screen time (at follow-up). A higher playground density and a higher availability of play and sports equipment at school were consistently related to an increased total SB, although these consistent findings come from single studies. Evidence was also reported for the presence of safe places to cross roads and lengthening morning and lunch breaks being associated with less total SB. Future interventions to decrease SB levels should especially target children with overweight or obesity and should start at a young age. However, since the relationship of many determinants with SB remains inconsistent, there is still a need for more longitudinal research on determinants of SB in youth.

Perceived and Police-Reported Neighborhood Crime: Linkages to Adolescent Activity Behaviors and Weight Status

PURPOSE

Inadequate physical activity and obesity during adolescence are areas of public health concern. Questions exist about the role of neighborhoods in the etiology of these problems. This research addressed the relationships of perceived and objective reports of neighborhood crime to adolescent physical activity, screen media use, and body mass index (BMI).

METHODS

Socioeconomically and racially/ethnically diverse adolescents (N = 2,455, 53.4% female) from 20 urban, public middle and high schools in Minneapolis/St. Paul, Minnesota responded to a classroom survey in the Eating and Activity in Teens 2010 study. BMI was measured by research staff. Participants' mean age was 14.6 (standard deviation = 2.0); 82.7% represented racial/ethnic groups other than non-Hispanic white. Linear regressions examined associations between crime perceived by adolescents and crime reported to police and the outcomes of interest (BMI z-scores, physical activity, and screen time). Models were stratified by gender and adjusted for age, race/ethnicity, socioeconomic status, and school.

RESULTS

BMI was positively associated with perceived crime among girls and boys and with reported crime in girls. For girls, there was an association between higher perceived crime and increased screen time; for boys, between higher reported property crime and reduced physical activity. Perceived crime was associated with reported crime, both property and personal, in both genders.

CONCLUSIONS

Few prior studies of adolescents have studied the association between both perceived and reported crime and BMI. Community-based programs for youth should consider addressing adolescents' safety concerns along with other perceived barriers to physical activity. Interventions targeting actual crime rates are also important.

A community-based intervention increases physical activity and reduces obesity in school-age children in North Carolina

BACKGROUND

Community-based interventions are promising approaches to obesity prevention, but few studies have prospectively evaluated them. The aim of this study was to evaluate a natural experiment—a community intervention designed to promote active living and decrease obesity within a small southern town.

METHODS

In 2011, community leaders implemented the Mebane on the Move intervention—a community-wide effort to promote physical activity (PA) and decrease obesity among residents of Mebane, North Carolina. We measured child PA and BMI before and after the intervention, using a nearby town not implementing an intervention as the comparison. In total, we assessed 64 children from Mebane and 40 from the comparison community 6 months before, as well as 34 and 18 children 6 months after the intervention. We assessed PA with accelerometers worn for 7 days and calculated BMI z-scores using children's height and weight. We conducted multivariable linear regressions examining pre- to postintervention change in minutes of PA and BMI z-score, adjusting for confounders.

RESULTS

At follow-up, children in Mebane modestly increased their moderate-to-vigorous PA (1.3 minutes per hour; 95% confidence interval (CI): 0.2, 2.3; p=0.03) and vigorous activity (0.8 minutes per hour; 95% CI: 0.1, 1.5; p=0.04) more than comparison children. In intervention children, BMI z-scores decreased 0.5 units (kg/m(2); 95% CI: -0.9, -0.02; p=0.045), compared to children in the comparison community.

CONCLUSIONS

We observed positive effects on PA level and weight status of children in Mebane, despite high rates of attrition, suggesting that the community-based intervention may have been successful.

Influence of the built environment on pedestrian route choices of adolescent girls

We examined the influence of the built environment on pedestrian route selection among adolescent girls. Portable global positioning system units, accelerometers, and travel diaries were used to identify the origin, destination, and walking routes of girls in San Diego, CA and Minneapolis, MN. We completed an inventory of the built environment on every street segment to measure the characteristics of routes taken and not taken. Route-level variables covering four key conceptual built environment domains (Aesthetics, Destinations, Functionality, and Safety) were used in the analysis of route choice. Shorter distance had the strongest positive association with route choice, while the presence of a greenway or trail, higher safety, presence of sidewalks, and availability of destinations along a route were also consistently positively associated with route choice at both sites. The results suggest that it may be possible to encourage pedestrians to walk farther by providing high quality and stimulating routes.

Environmental influences on children's physical activity

BACKGROUND

This paper aims to assess whether 7-year-olds' physical activity is associated with family and area-level measures of the physical and socioeconomic environments.

METHODS

We analysed the association of environments with physical activity in 6497 singleton children from the UK Millennium Cohort Study with reliable accelerometer data (≥2 days and ≥10 h/day). Activity levels were assessed as counts per minute; minutes of moderate to vigorous activity (MVPA); and whether meeting recommended guidelines (≥60 min/day MVPA).

RESULTS

Higher levels of children's physical activity were associated with households without use of a car and with having a television in a child's bedroom (for counts per minute only). Aspects of the home socioeconomic environment that were associated with more children's physical activity were lone motherhood, lower maternal socioeconomic position and education, family income below 60% national median, and not owning the home. Children's activity levels were higher when parents perceived their neighbourhood as poor for bringing up children and also when families were living in the most deprived areas. Relationships were independent of characteristics such as child's body mass index and ethnic group. When adjusted for physical and socioeconomic correlates, the factors remaining significant in all outcomes were: household car usage and maternal education.

CONCLUSIONS

Although physical and socioeconomic environments are associated with children's physical activity, much of the variation appears to be determined by the child's home socioeconomic circumstances rather than the wider environment where they live.

The relationship between neighborhood socioeconomic characteristics and physical inactivity among adolescents living in Boston, Massachusetts

OBJECTIVES

We sought to determine whether the socioeconomic environment was associated with no participation in physical activity among adolescents in Boston, Massachusetts.

METHODS

We used cross-sectional data from 1878 urban adolescents living in 38 neighborhoods who participated in the 2008 Boston Youth Survey, a biennial survey of high school students (aged 14-19 years). We used multilevel multiple regression models to determine the association between neighborhood-level exposures of economic deprivation, social fragmentation, social cohesion, danger and disorder, and students' reports of no participation in physical activity in the previous week.

RESULTS

High social fragmentation within the residential neighborhood was associated with an increased likelihood of being inactive (odds ratio = 1.53; 95% confidence interval = 1.14, 2.05). No other neighborhood exposures were associated with physical inactivity.

CONCLUSIONS

Social fragmentation might be an important correlate of physical inactivity among youths living in urban settings. Interventions might be needed to assist youths living in unstable neighborhoods to be physically active.

Longitudinal changes in objectively measured sedentary behaviour and their relationship with adiposity in children and adolescents: systematic review and evidence appraisal

This review aimed to determine longitudinal changes in objectively measured overall sedentary behaviour, and to examine their associations with adiposity in children and adolescents. A search for longitudinal studies was performed using several electronic databases. Of 161 potentially eligible papers, 10 for change in sedentary behaviour and 3 for longitudinal associations with change in adiposity were included. Weighted mean increase in daily sedentary behaviour per year was 5.7% for boys and 5.8% for girls. Only one paper included preschool children, and it showed a decrease in sedentary behaviour. Nine studies were from Western countries. Null associations were reported between sedentary behaviour and adiposity in two studies, the other found that increases in sedentary behaviour were associated with increases in adiposity, but only in those with body mass index above the 50th percentile. There was consistent evidence that sedentary behaviour increases with age in school-age children and adolescents, by approximately 30 min extra daily sedentary behaviour per year. There was little evidence on the influence of changes in sedentary behaviour on changes in adiposity. There is a need for more longitudinal research, for more evidence from outside the Western world, and for more studies that examine 'dose-response' associations between changes in sedentary behaviour and changes in adiposity.

The perceived and built environment surrounding urban schools and physical activity among adolescent girls

BACKGROUND

Neighborhood perceived/built environment and physical activity (PA) associations have been examined for adolescents around homes, but not surrounding schools.

PURPOSE

The purpose of this paper is to examine if positive perceptions/built environment in neighborhoods surrounding schools predict PA among low-income, urban adolescent girls.

METHODS

Measures include: minutes in moderate-vigorous PA (MVPA, ankle accelerometry), perceptions of the school environment (questionnaire), built environment (neighborhood audit). Analyses include multi-level models.

RESULTS

Two hundred twenty-four sixth and seventh grade girls [mean(sd) age = 12.1(0.7) years] from 12 schools serving low-income, primarily African American communities; mean MVPA 35.4 min (mean days assessed = 5.8). Girls in schools with more positive perceptions of the neighborhood environment surrounding the school were less active (β = 7.2, p = 0.043). Having "places to go within walking distance" (perceptions) and number of food stores near school (built environment) positively relate to MVPA (β = 5.5, p = 0.042 and β = 0.59, p = 0.047).

CONCLUSIONS

Among neighborhoods surrounding urban schools, positive perceptions do not predict PA; accessibility, via both perceived and built environment, support PA.

A cross-sectional and longitudinal study of travel by walking before and after school among eighth-grade girls

PURPOSE

To examine "travel by walking" (TBW) before and after school among eighth-grade girls.

METHODS

Participants attended 36 middle schools from Arizona, Maryland, Minnesota, Louisiana, California, and South Carolina participating in the Trial of Activity for Adolescent Girls. The cross-sectional sample consisted of 3,076 eighth-grade girls, and the longitudinal sample included 1,017 girls who participated in both sixth and eighth grades. Before- or after-school TBW status was determined from the 3-Day Physical Activity Recall. The main outcomes were body mass index and physical activity, which was measured by accelerometry, estimated for total physical activity (light, moderate, vigorous) and moderate-to-vigorous physical activity (MVPA).

RESULTS

Eighth-grade girls who reported TBW had 4 more minutes (95% confidence interval = 2.1-6.1) of MVPA before and after school than nonwalkers, and 2 more minutes of MVPA (95% confidence interval = 1.1-3.1) on an average weekday. In the longitudinal sample, girls who reported TBW before and after school in both sixth and eighth grades (consistent walkers) accumulated more minutes of MVPA for an average weekday than inconsistent walkers in both sixth (27 ± 2.2 vs. 25 ± 1.9 minutes; p = .03) and eighth (28 ± 2.6 vs. 25 ± 2.3 minutes; p = .003) grades. There were no differences in body mass index by walking status.

CONCLUSIONS

Adolescent girls who reported TBW before and after school accumulated more minutes of MVPA than nonwalkers. Efforts to prevent the decline in walking to school in middle school girls could contribute to their overall physical activity.

The relationship between built environments and physical activity: a systematic review

OBJECTIVES

We conducted a systematic review of the literature examining the relationship between built environments (e.g., parks, trails, sidewalks) and physical activity (PA) or obesity rates.

METHODS

We performed a 2-step inclusion protocol to identify empirical articles examining any form of built environment and any form of PA (or obesity rate) as the outcome. We extracted data from included abstracts for analysis by using a standard code sheet developed for this study.

RESULTS

Of 169 included articles, 89.2% reported beneficial relationships-but virtually all articles utilized simple observational study designs not suited for determining causality. Studies utilizing objective PA measures (e.g., pedometer) were 18% less likely to identify a beneficial relationship. Articles focusing on children in community settings (-14.2%), those examining direct measures of obesity (-6.2%), or those with an academic first author (-3.4%) were less likely to find a beneficial relationship.

CONCLUSIONS

Policymakers at federal and local levels should encourage more rigorous scientific research to determine whether altered built environments will result in increased PA and decreased obesity rates.

Urban environment and children's active lifestyle: softGIS revealing children's behavioral patterns and meaningful places

PURPOSE

To determine the relationship between (1) urban structure characteristics, (2) children's environmental experiences and active behavioral patterns, and (3) perceived health and body mass index (BMI).

DESIGN

Cross-sectional study.

SETTING

City of Turku, western coast of Finland, 175,000 inhabitants. Average residential density of the studied settings was 17 housing units per hectare, proportion of green structure 43%, and proportion of population under 15 years old 17%.

SUBJECTS

One thousand eight hundred thirty seven fifth (10-12 years old) and seventh (13-15 years old) graders from 54 schools in Turku.

MEASURES

Self-reported behavioral patterns (activity of school travel mode, territorial range, mobility licenses, and distance to meaningful places) and environmental experiences (localized meaningful places, likability index, environmental fears) were gathered on the basis of locality with an Internet-based softGIS method. Self-reported BMI, perceived health, and daily symptoms were also queried. Geographic information system-based measures of urban structure (residential density, proportion of green structure, proportion of children), calculated within a 500-m buffer of each respondent's home, were used as independent variables.

ANALYSIS

Mainly logistic regression analysis.

RESULTS

After controlling for gender, age, and neighborhood socioeconomic status (proportion of academically educated), residential density was significantly associated with active travel mode to school and short distances to the meaningful places of children. The proportions of green structure and children had an association with nonactive transport, long distance to meaningful places, and small territorial range. We also found significant associations between active school travel mode and reduced risk of being overweight when controlled for gender and age but not when the proportion of academically educated was also controlled. The negative association between likability index and daily symptoms and positive association with perceived health remained significant after controlling for all three background variables. The only urban structure variable directly associated with good perceived health was the proportion of green structure around the child's home.

CONCLUSION

Moderate urban density seems to have child-friendly characteristics such as an ability to promote active school journeys and to guarantee a short distance to meaningful places. The studied Finnish children expressed very few environmental fears, and the possibilities for them to independently use the opportunities of the urban environment were very high. The limitation of the study was that the socioeconomic background variables were extracted from register-based geographic grid data rather than from respondents. More refined measures of urban structure are also needed in future studies.

Out and about: association of the built environment with physical activity behaviors of adolescent females

Locational data, logged on portable GPS units and matched with accelerometer data, was used to examine associations of the built environment with physical activity and sedentary behaviors of adolescent females. In a sample of 293 adolescent females aged 15 to 18 years old in Minneapolis and San Diego, the built environment around each GPS point and its corresponding sedentary, light, and moderate-to-vigorous intensity physical activity was examined using random intercept multinomial logistic regression models. The odds of higher physical activity intensity (3-level outcome: sedentary, light, MVPA) were higher in places with parks, schools, and high population density, during weekdays, and lower in places with more roads and food outlets. Understanding the places where physical activity and sedentary behaviors occur appears to be a promising strategy to clarify relationships and inform policy aimed at increasing physical activity and reducing sedentary behaviors.