Active commuting from youth to adulthood and as a predictor of physical activity in early midlife: the young Finns study

Parental perspectives on the decision-making process on transport mode choice in adolescents: a qualitative study with mothers and fathers

Objective

The present study aims to understand the familial decision-making process on transport mode choice in adolescents with a focus on the parental perspective within this process.

Background

Active travel contributes to adolescents' overall physical activity and its positive health effects. Based on the social-learning theory, especially parents are assigned a central role for adolescents' travel behavior. The aim of the present study was to examine how parents are involved in the decision-making process on transport mode choice in adolescents.

Method

The study is part of the cross-sectional mixed-methods ARRIVE study which includes semi-structured interviews with mothers (n = 12) and fathers (n = 7) of 11- to 14-year-old German adolescents. The interviews focused on travel behavior in adolescents and the decision-making process on transport mode choice from the parental perspective. All interviews were analyzed inductively using Thematic Analysis.

Results

Our study revealed that parents do not primarily decide for or against active travel in adolescents, but are mostly involved in the decision-making process, especially in case of a deviation from the main transport mode. Different forms of parental involvement in the decision-making process were identified. Some parents acted as main decision makers which is the highest form of involvement while others gave their children complete freedom of choose a transport mode for themselves. These parents accepted their child's choice fully which shows a low involvement in the decision-making process.

Conclusion

The results provide a deeper understanding of the familial decision-making process on travel behavior in adolescents. The results indicate an occasionally parental involvement in the decision-making process on the mainly used transport mode by adolescents, and that mothers and fathers are always involved when deviating from the main mode.

Implications

Further research should investigate changes in travel behavior from childhood to young adulthood to understand long-term travel decisions in families. Due to the findings that parents are often involved in the decision-making process on transport mode choice and that they mainly reported safety concerns as barriers to their children's active travel, further research should focus especially on the social and physical environment of adolescents.

Effects of School-Based Health-Promoting Activities on Children's Health: A Pragmatic Real-World Study

More insight into the health effects of scaled-up school-based interventions in real-world settings is vital to sustainably integrate health in all schools. This study investigated the effectiveness of the scaled-up Healthy Primary School of the Future (HPSF) initiative in real-world school contexts on children's health (behaviours). From 2019 to 2022, eleven Dutch primary schools implemented HPSF-related activities. In 315 children from study years four to six (aged 7-11 years) from these schools, anthropometric measurements were performed, and questionnaires assessing the children's dietary behaviours and physical activity were administered. COVID-19 greatly limited the implementation of HPSF-related activities. Therefore, the results were compared between schools categorised as medium implementers and schools categorised as low implementers. After correction for baseline, waist circumference in the medium implementer group was significantly higher at one-year follow-up (B = 1.089, p = 0.003) and two-year follow-up (B = 1.665, p < 0.001) compared with waist circumference in the low implementer group. No significant effects were observed for other outcomes. This study showed hardly any effects of the scaled-up HPSF initiative, mainly due to the limited implementation caused by COVID-19. More research investigating the real-world effectiveness of HPSF and comparable programmes is greatly encouraged to advance the field of school-based health promotion.

Distinct patterns of adult transport-related physical activity (TRPA) behaviour exist independent of the TRPA behaviours of childhood: the childhood determinants of adult health study

BACKGROUND

Transport-related physical activity (TRPA) is recognised as a potential means of increasing total physical activity participation that may yield substantial health benefits. Public health campaigns focusing on promoting TRPA from a young age aim to develop life-long healthy habits. However, few studies have examined how TRPA changes across the lifecourse and whether childhood TRPA levels influence those observed later in life.

METHODS

Using the Australian Childhood Determinants of Adult Health study (baseline, 1985), latent class growth mixture modelling with adjustment for time-varying covariates was performed using four timepoints (ranging from 7 to 49 years) to assess behavioural patterns and retention of TRPA across the lifecourse. As child and adult adjusted TRPA measures could not be harmonised, trajectories of adult TRPA (n = 702) were instead identified, and log-binomial regression analysis was performed to determine whether childhood levels of TRPA (high/medium/low) influenced these trajectories.

RESULTS

Two stable groups of adult TRPA trajectories were identified: persistently low (n = 520; 74.2%), and increasingly high TRPA (n = 181; 25.8%). There was no significant relationship between childhood TRPA levels and patterns in adulthood (relative risk of high childhood TRPA yielding high adult TRPA trajectory membership = 1.06; 95% confidence interval = 0.95-1.09).

CONCLUSION

This study found childhood TRPA levels were not associated with TRPA patterns in adulthood. These findings suggest that while TRPA in childhood may have health, social, and environmental benefits, it does not appear to impact adult TRPA directly. Therefore, further intervention is required beyond childhood to promote the implementation of healthy TRPA behaviours into adulthood.

Validating the Perceived Active School Travel Enablers and Barriers-Parent (PASTEB-P) Questionnaire to Support Intervention Programming and Research

A child's ability to participate in active school travel (AST) is complicated by several factors. Of particular note are parental controls, which are informed by their perceptions of the local built and social environments, assessments of their child's skills, and convenience preferences, among other considerations. However, there is currently a lack of AST-specific scales that include validated parental perception measures related to such notable barriers and enablers, or those that tend to frame their AST decision-making processes. Framed within the social-ecological model of health behaviour, the aims of the present paper were thus threefold, specifically to (1) outline and test the construct validity of measures delineating parental perceptions of barriers and enablers to AST, (2) evaluate the reliability and consistency of the developed measures, and (3) connect these measures to develop broader constructs for use in the Perceived Active School Travel Enablers and Barriers-Parent (PASTEB-P) questionnaire. To achieve these aims, a mixed-methods approach featuring cognitive interviews and surveys, along with qualitative (thematic analysis) and quantitative (Cohen's Kappa, McDonald's Omega, and confirmatory factor analysis) analyses, was applied across two studies. The validation processes of the two studies resulted in the development of fifteen items comprising seven distinct constructs (barriers: AST Skills, Convenience, Road Safety, Social Safety, and Equipment Storage; enablers: Supportive Environment and Safe Environment) related to parental perceptions of AST. The developed PASTEB-P questionnaire can be used to inform and evaluate AST intervention programming and can be applied for AST research purposes.

Associations of active commuting to school in childhood and physical activity in adulthood

This study examined whether active commuting to school in childhood and adolescence predicted active commuting to work and overall physical activity (PA) in adulthood. Participants from the Young Finns Study (N = 2436) were aged 9-18 years in 1980 and followed up until 2018/2020. Their commuting modes to school were assessed with a self-reported questionnaire in 1980. Adulthood PA was assessed through self-reports regarding commuting modes to work (2001-2018), leisure-time physical activity (LTPA) (2001-2018), and objectively measured daily steps (2007-2018/2020). Associations between childhood commuting and adulthood PA were evaluated using regression analyses and multilevel models. Demographic, socioeconomic and environmental covariates were adjusted for in the analyses. Active commuting to school in childhood contributed favourably to LTPA in 2001 (B = .38, p < .001), in 2007 (B = .35, p < .001), and in 2018 (B = .28, p < .01). Active commuting in childhood was associated with higher number of daily aerobic steps (B = 299.00, p = .03) and daily aerobic steps during weekdays in 2011 (B = 312.15, p = .03). In 2018, active commuting associated favourably with daily aerobic steps (B = 370.42, p < .01), daily aerobic steps during weekdays (B = 347.65, p = .01), daily steps during weekends (B = 628.49, p = .02), and daily aerobic steps during weekends (B = 402.69, p = .03). Covariate adjustments attenuated the associations excluding the one between active commuting and LTPA in 2007 (B = .36, p = .01) and daily steps during weekends in 2018 (B = 782.25, p = .04). Active commuting to school in childhood might be one of the PA modes that contribute to PA in adulthood and is therefore encouraged to be promoted from an early age.

Associations of parents' and adolescents' active travel behavior across various destinations - a sex/gender analysis

BACKGROUND

Active travel behavior such as walking and cycling is associated with several health benefits. Especially the family environment seems to be important for active travel in children and adolescents. Currently, little is known regarding travel behavior in leisure time and associations of travel behavior within parent-adolescent dyads.

METHODS

The present analysis is based on the German ARRIVE study (Active tRavel behavioR in the famIly enVironmEnt), which incorporated a large scale, representative cross-sectional online survey including 517 parent-child dyads consisting of adolescents (N = 517; boys = 263, girls = 254) aged 11-15 years and one of their parents (N = 517; fathers = 259, mothers = 258). Based on that survey which took place in June 2021 (during the COVID-19 pandemic), we calculated the prevalence of active travel to four commonly visited destinations (school/work, friends/relatives, shopping stores and recreational activities) using an adapted version of the travel to school questionnaire by Segura-Diaz JM, Rojas-Jimenez A, Barranco-Ruiz Y, Murillo-Pardo B, Saucedo-Araujo RG, Aranda-Balboa MJ, et al. (Int J Environ Res Public Health 17(14), 2020). In addition, we investigated the associations between parents' and adolescents' travel behavior using scores for school/work, leisure time (friends/relatives, shopping stores and recreational activities) and overall (school/work and leisure time).

RESULTS

Across all destinations, prevalence of active travel in adolescents (63.08%) was higher than in parents (29.21%). Active travel to school (47.33%) as well as to work (20.43%) indicated the lowest prevalence. Linear regression models revealed significant associations in overall active travel between mothers and adolescents (girls: β = 0.308, p < 0.001; boys: β = 0.302, p = 0.001) and in leisure time active travel behavior between mothers and daughters (β = 0.316, p < 0.001). Related to school/work active travel there were no associations between parents and adolescents.

CONCLUSION

The associations between adolescents' and parents' travel behavior differ depending on gender: they are solely seen in mother-adolescents dyads. Furthermore, our findings conclude that travel is a routine and independent of the destination.

The Association Between Adolescent Active Commuting to School and Parent Walking Behavior: The FLASHE Study

PURPOSE

To examine the relationship between adolescent active commuting to school (ACS; walking or biking to/from school) and parent walking activity.

DESIGN

Cross-sectional.

SETTING

US nationwide online surveys.

SAMPLE

1367 parent-adolescent (12-17 years) dyads among the Family Life, Activity, Sun, Health, and Eating (FLASHE) study participants (29.4% response rate).

MEASURES

Online surveys asked about adolescent ACS and parent walking activity in the past week. Adolescents who reported ACS at least once in the past week were categorized as engaging in ACS. Parent walking frequency was categorized into 0-2, 3-5, and 6-7 days.

ANALYSIS

Logistic regression analysis was conducted to compare the probability of adolescent ACS by parent walking activity, adjusted for sociodemographic factors and adolescent-, parent-, and neighborhood-level covariates.

RESULTS

28.5% of adolescents engaged in ACS at least once in the past week. Compared to 0-2 days/week of parent walking activity, ORs for adolescent ACS for 3-5 and 6-7 days/week of parent walking activity were 1.98 (95% CI=1.38-2.87) and 1.81 (1.23-2.68), respectively. In stratified analyses by parent and adolescent sex, father-son dyads presented the strongest association between adolescent ACS and parent walking 3-5 and 6-7 days/week (ORs=4.17 [1.46-11.91] and 3.95 [1.45-10.77], respectively).

CONCLUSIONS

Adolescents with parents who engaged in walking activity ≥3 days/week were more likely to actively commute to school. Parent walking activity may have positive intergenerational effects on adolescent ACS and physical activity.

Exploring the implementation dynamics of the Health Promoting School approach in Europe: a qualitative study among school health representatives

Purpose

Adapting the Health Promotion School (HPS) approach to context specifics is acknowledged as being essential for implementation and achieving optimal effectiveness. This study aims to explore implementation variations on seven HPS spectra (such as top-down to bottom-up involvement of stakeholders) on which implementation of the HPS approach can vary, and the factors that relate to navigation on these spectra.

Design/methodology/approach

In 2020, fourteen HPS researchers and professionals from ten European countries participated in semi-structured interviews.

Findings

Navigation variations on the HPS spectra occurred throughout most spectra. Further, a tendency was found towards spectrum extremes of addressing multiple core-components, implementing non-disruptive Health Promotion (HP) programmes, and evaluating the HPS approach through an action-oriented research approach. Important general factors were resources, staff capacity and time available to staff members for implementing the HPS approach. Some spectra required more specific factors like organisational skills, leadership or a certain level of democracy.

Practical implications

The implementation of the HPS approach should be supported by implementation strategies addressing the spectrum-specific factors, but more generic factors such as staff capacity, resources and the level of democracy should also be considered.

Originality/value

This study explores navigation variations throughout HPS spectra rather than the HPS approach in general. It also nuances implementation diversity across and within different European contexts.

Descriptive epidemiology of the prevalence of adolescent active travel to school in Asia: a cross-sectional study from 31 countries

OBJECTIVE

This study aimed to examine the prevalence of adolescent active travel to school (ATS) across 31 countries and territories in Asia, overall and by age group, sex and body mass index (BMI) category.

DESIGN

Cross-sectional study.

SETTING

31 Asian countries.

PARTICIPANTS

152 368 adolescents aged 13-17 years with complete data for age, sex, measured weight and height and active travel to school from 31 Asian countries from the Global School-based student Health Survey (GSHS).

PRIMARY OUTCOME

Self-reported active travel to school categorised into passive (0 days) and active (1-7 days).

RESULTS

Overall prevalence of adolescent ATS in Asia based on random-effect meta-analysis was 55%, ranging from 18% (UAE) to 84% (Myanmar). There was limited subregional variation: 47% in the Eastern Mediterranean (EM), 56% in the South East Asia and 64% in the Western Pacific. Summarised by random-effect meta-analysis, being an older adolescent aged 16 years and older (vs younger age below 16 years: OR: 1.08; 95% CI: 1.00 to 1.16) was positively associated with ATS. This association was strongest in EM countries. Summarised by random-effect meta-analysis, females (vs males: OR: 0.79; 95% CI: 0.71 to 0.89) and adolescents with overweight/obesity (vs underweight and normal BMI: OR: 0.92; 95% CI: 0.86 to 0.99) were less likely to use ATS. Association with sex was strongest in EM countries. Heterogeneity was considerable in all meta-analyses.

CONCLUSION

The prevalence of adolescent ATS in Asia varies substantially. Overall, older and male adolescents, and adolescents with underweight and normal BMI category are more likely to actively travel to school. However, the main contributor to differences in ATS between and within regions remain unknown. Although there is substantial scope for improving ATS rates in Asia, any policy actions and interventions should be cognisant of local built, social and natural environmental contexts that may influence active travel behaviour.

Active commuting to school: A longitudinal analysis examining persistence of behavior over time in four New Jersey cities

Evidence suggests that healthy behaviors initiated during childhood may continue over time. The objective of this study was to determine whether active commuting to/from school (ACS) at baseline predicted continued ACS at follow-up two to five years later.

Two cohorts of households with 3–15 year-olds in four low-income New Jersey cities were randomly sampled and followed for two to five year periods between 2009 and 2017. Children who walked, bicycled, or skateboarded to/from school at least one day/week were classified as active commuters. Children with complete data at both time points were included in this analysis (n = 383). Multivariate logistic regression was used to examine the association between ACS at T1 and T2. Models adjusted for child age, sex, and race/ethnicity; parent’s education and nativity status (native-born vs foreign-born); household poverty level; car availability; neighborhood level characteristics; and distance from home to school.

Children who engaged in ACS at T1 had over seven times the odds of ACS at T2 compared to children who did not actively commute at T1 (p < 0.001), after adjusting for distance to school and other relevant covariates. Distance, regardless of active commuting status at T1 was inversely associated with active commuting at T2.

Policies and interventions encouraging ACS, and those that decrease the distance between a child’s home and school, may result in increased, habitual active commuting and physical activity behavior throughout childhood and possibly into adulthood.

A Reusable Multiplayer Game for Promoting Active School Transport: Development Study

BACKGROUND

Most children and adolescents in Sweden do not meet the recommended daily physical activity levels of the World Health Organization. Active school transport (AST) and gamification are potential methods for increasing children's daily physical activity. We previously developed a game named Tic-Tac-Training for promoting active transport at workplaces; however, the game has not been applied to AST.

OBJECTIVE

The objectives of this study are to investigate how Tic-Tac-Training functions to promote AST among schoolchildren in northern Sweden, improve the game to be more suitable for schoolchildren, and construct a road map for future development based on children's ideas.

METHODS

First, we developed Tic-Tac-Training using the Scrum agile software development method. Second, we conducted a questionnaire-based formative evaluation of the game with schoolchildren (n=16; 9/16, 56% male; 6/16, 38% female; and 1/16, 6% other aged 11-12 years) in Luleå, Sweden. Third, we conducted focus group interviews with 33 children (13/33, 39% male and 20/33, 61% female aged 12-13 years) to gather ideas for gamifying AST. We mapped the interview results to the Octalysis gamification framework and established a road map for future development.

RESULTS

The formative evaluation revealed several issues, including a lack of interesting game features, lack of support for continuous engagement, disliked competitive features, and lack of incentives for discourse and participation. New features such as rewards, collectibles, and levels were implemented based on the results. The focus group interviews revealed additional ideas for gamifying AST, such as using avatars, in-game currency and trading, and context-sensitive tasks.

CONCLUSIONS

The results have several potential impacts on how reusable, gamified AST interventions can be developed and what kind of gamification elements schoolchildren in northern Sweden wish to see. These results can interest game researchers and teachers who wish to apply gamification in school contexts. Finally, we aim to continue developing the game based on the road map.

Active travel behaviour in the family environment: protocol for the mixed-methods cross-sectional ARRIVE study

INTRODUCTION

Active travel is an important source of physical activity and a primary contributor to overall health among adolescents. To understand and promote active travel behaviour in adolescents, developing a more robust understanding of the predictors of active travel and its associated decision-making processes is needed. Situated within a theoretical socioecological framework for adolescent travel behaviour, the mixed-methods Active tRavel behavioR in the famIly enVironmEnt study aims to quantitatively assess the influence of several predictors of adolescent travel behaviour, and to qualitatively understand the associated decision-making processes of both adolescents and parents.

METHODS AND ANALYSIS

Our mixed-methods approach will feature online surveys and semistructured interviews. The online questionnaire, developed in accordance with a theoretical framework of adolescent active travel, will examine adolescent travel behaviour with respect to four different destinations while controlling for multiple relevant individual, social and physical environment factors. To enable the comparison of adolescent and parental perspectives, the questionnaire will be answered by a representative sample of German adolescents (11-15 years old) and their parents.Our semistructured interviews, likewise framed based on the central tenets of the theoretical framework of adolescent active travel, will seek to explore the decision-making process of families regarding travel mode choice via conducting interviews with each member (ie, father, mother, adolescent). To investigate travel decision-making processes, adolescents and their parents will be invited to talk about trips they undertook using both active and passive transport modes during the last week. Thematic analyses will be conducted to highlight the central concerns, priorities and values of participants' decision-making processes.

ETHICS AND DISSEMINATION

This study has received ethical approval from the ethics commission of the Friedrich-Alexander-University Erlangen-Nuremberg. Study results will be disseminated at scientific conferences and published in peer-reviewed journals. Additionally, study findings will be made publicly available to relevant health, policy, and research stakeholders and groups.

Individual, parental and built environmental features as influencing factors of active travel to school in northeast China: findings from a cross-sectional study

OBJECTIVES

Active travel to school (ATS)-associated factors had been studied in some developed countries but rarely in China. We studied the associated factors of ATS at individual, parental and built environment domains in northeast China.

DESIGN AND PARTICIPANTS

A cross-sectional survey was conducted among 4-6 grade students in 2017. Sociodemographic features and information of parents were collected using questionnaires, and SuperMap (a geographical information system software) was used to catch built environment features. Logistic regression models were used to examine the relationship between multilevel factors and ATS.

RESULTS

Our study sample comprised 3670 primary school students aged from 8 to 15 (boys=51.0%, ATS=48.8%). Perceived to be fat (OR 1.25, 95% CI 1.00 to 1.55, p<0.05), feeling easy to walk for a short distance (OR 1.63, 95% CI 1.21 to 2.20, p<0.05), mother unemployed (OR 1.52, 95% CI 1.13 to 2.06, p<0.05), higher land use mix (OR 1.23, 95% CI 1.11 to 1.37, p<0.001) and higher density of public transport stations (OR 1.22, 95% CI 1.09 to 1.37, p<0.05) were positively associated with increased possibility of ATS, while higher household annual income (OR 0.60, 95% CI 0.44 to 0.83, p<0.05) and possession of private vehicles (OR 0.56, 95% CI 0.45 to 0.69, p<0.001) were negatively associated with possibility of ATS.

CONCLUSIONS

The significant factors associated with ATS were at every examined level, which implies multilevel interventions are needed to encourage ATS. Further interventions could focus on the children's willingness to lead students to opt for healthy behaviours, and children from wealthier families should be encouraged to choose ATS. Also, the government should improve built environment walkability so as to encourage ATS.

Skip the wait and take a walk home! The suitability of point-of-choice prompts to promote active transportation among undergraduate students

Objectives: The objectives were to: determine undergraduate students' awareness of active transportation-promoting point-of-choice prompts; explore perceptions of the impact of the prompts on students' transportation choices; and obtain feedback regarding the suitability of the prompts. Participants: This cross-sectional study included a convenience sample of 346 undergraduate students. Methods: Prompts were displayed in March 2018 on one Canadian university campus. Thereafter, students completed a 20-question and study-specific online questionnaire containing a mix of closed- and open-ended questions. Results: Approximately 41% of respondents were aware of the prompts, with awareness levels being associated with the distribution and the design of the displays. Although students assessed them as suitable, the prompts did not impact the transportation choices of the majority of respondents who saw them. Conclusions: Findings contribute to the understanding of students' awareness levels of tailored and strategically-placed prompts, and the impact of this intervention on decisions to engage in active transportation.

Association of change in the school travel mode with changes in different physical activity intensities and sedentary time: A International Children's Accelerometry Database Study

Our aim was to assess the association between changes in active travel to school and changes in different intensities of physical activity (i.e. moderate - MPA and vigorous - VPA) and time spent sedentary (SED) among adolescents and assess the moderating effect of children's sex, age and weight status. Data from six cohort studies in the International Children's Accelerometry Database were used (4108 adolescents aged 10-13y at baseline, with 1.9±0.7y of follow-up). Participants self-reported travel mode to school at baseline and follow-up. Mutually exclusive categories of change were created using passive (e.g. by car) or active (cycling or walking) forms of transport (active/active, passive/active, active/passive, passive/passive). Multilevel linear regression analyses assessed associations with change in accelerometer-assessed time spent MPA, VPA and SED, adjusting for potential confounders. The moderation of sex, age and weight status was tested though the inclusion of interaction terms in the regression models. Relative to those remaining in active travel (active/active), participants classified as passive/active increased VPA (B: 2.23 min/d; 95%CI: 0.97-3.48), while active/passive (MPA: -5.38min/d; -6.77 to -3.98; VPA: -2.92min/d; -4.06 to -1.78) and passive/passive (MPA: -4.53min/d; -5.55 to -3.50; VPA: -2.84min/d; -3.68 to -2.01) decreased MPA and VPA. There were no associations with SED. An interaction was observed, age group moderated the association with change in VPA: among 12-13y-olds a greater increase in VPA was observed for the passive/active group compared to active/active. Promoting active travel to school can be a strategy to attenuate the decline in physical activity through adolescence.

Optimal movement behaviors: correlates and associations with anxiety symptoms among Chinese university students

Background

The Canadian 24-Hour Movement Guidelines for Adults was released in 2020. There is a dearth of evidence on the association between adherence to the 24 h movement guidelines and health indicators. This study aims to (a) explore the associations between potential correlates and meeting the 24 h movement guidelines using a sample of Chinese university students; and (b) examine if meeting 24 h movement guidelines is associated with the severity of anxiety symptoms.

Methods

Cross-sectional findings are based on 1846 Chinese university students (mean age = 20.7 years, 64.0% female). Movement behaviors (physical activity, sedentary behavior, and sleep duration), possible correlates, and anxiety symptoms were measured through self-reported online questionnaires. Logistic regression models were performed to examine the associations.

Results

We found that male students and those who had a mother with a master’s degree or above, more close friends and higher perceived family affluence were more likely to meet the overall 24 h guidelines. Meeting all 24 h movement guidelines presented the lower odds for severe anxiety symptoms than those meeting fewer recommendations in the 24 h movement guidelines.

Conclusions

As one of the first to examine the correlates of adherence to the 24 h movement guidelines and the relationship between anxiety symptoms and meeting the guidelines among Chinese university students, our findings contribute to the growing body of evidence linking movement behaviors, psychosocial correlates, and heath indicators. Schools and health providers can encourage movement behaviors that follow the guidelines on campus.

Development and Initial Validation of the PILCAST Questionnaire: Understanding Parents' Intentions to Let Their Child Cycle or Walk to School

Children generally do not meet the recommendation of 60 min of daily physical activity (PA); therefore, active school transportation (AST) is an opportunity to increase PA. To promote AST, the involvement of parents seems essential. Using the theory of planned behavior (TPB), the aim was to develop and validate the PILCAST questionnaire to understand parents’ intentions to let their child cycle or walk to school. Cross-sectional sampling was performed, where 1024 responses were collected from parents. Confirmatory factor analysis indicated acceptable fit indices for the factorial structure according to the TPB, comprising 32 items grouped in 11 latent constructs. All constructs showed satisfying reliability. The regression analysis showed that the TPB explained 55.3% of parents’ intentions to let the child cycle to school and 20.6% regarding walking, increasing by a further 18.3% and 16.6%, respectively, when past behavior was added. The most influential factors regarding cycling were facilitating perceived behavioral control, positive attitudes, subjective and descriptive norms, and for walking, subjective and descriptive norms. The PILCAST questionnaire contributes to a better understanding of the psychological antecedents involving parents’ decisions to let their child cycle or walk to school, and may therefore provide guidance when designing, implementing and evaluating interventions aiming to promote AST.

Patterns of Active Commuting to School in Spanish Preschool Children and Its Associations with Socio-Economic Factors: The PREFIT Project

The aims of this study were to describe patterns of active commuting to school (ACS) of preschool children, and to analyse the relationship between ACS and family socio-economic factors. A total of 2636 families of preschoolers (3-to-5 years old) were asked to complete a questionnaire at home about the mode of commuting to school of their children and marital status, educational level, and profession of both father and mother. Chi-square analyses were applied to compare ACS between school grades and gender of the children. To analyse the association of ACS with socio-economic factors, logistic regression analyses were performed. Almost 50% of participants reported ACS of their offspring, with a higher rate in 3rd preprimary grade (5 years old) than in 1st and 2nd preprimary grades (3- and 4-years old. All, p < 0.05). Those preschool children who had parents with lower educational level and no managerial work had higher odds to ACS than those who had parents with higher educational level and managerial work (all, p ≤ 0.001). Around half of the Spanish preschool children included in this study commuted actively to school and families with lower educational levels or worse employment situation were related to active commuting to school.

The Effects of the Healthy Primary School of the Future on Children's Fruit and Vegetable Preferences, Familiarity and Intake

Mere exposure is an often-described strategy to increase children’s food familiarity, preferences, and intake. Research investigating this method in less controlled settings is scarce. This study investigates the effects of repeated fruit and vegetable (FV) exposure through the Healthy Primary School of the Future (HPSF) on children’s FV familiarity, preferences, and intake. The study had a longitudinal quasi-experimental design comparing two full HPSFs (focus: nutrition and physical activity) with two partial HPSFs (focus: physical activity) in the Netherlands. Annual measurements (child-reported questionnaires) were conducted during 2015–2019 in 833 7–12-year-old children. The study was registered on ClinicalTrials.gov (NCT02800616). After correction for baseline, full HPSFs had, on average, a lower number of unfamiliar vegetable items after one (effect size (ES) = −0.28) and three years (ES = −0.35) and a higher number of disliked vegetable items after one year (ES = 0.24) than partial HPSFs. Unfavorable intervention effects were observed for fruit intake after one (odds ratio (OR) = 0.609) and four years (OR = 0.451). Repeated FV exposure had limited effects on children’s FV familiarity, preferences, and intake, likely due to insufficient taste exposure. Considering the widespread implementation of school-based mere exposure efforts, it is highly relevant to further investigate under which circumstances mere exposure effectively contributes to improvements in (determinants of) FV intake.

Study Protocol of a School-Based Randomized Controlled Trial to Promote Cycling to School Among Students in Germany Using Intervention Mapping: The ACTS Project

Background: Despite a high rate of bicycle ownership, the prevalence of cycling to school among children and adolescents in Germany has been constantly low. Cycling to school can contribute to meeting the physical activity recommendations, which the majority of children and adolescents in Germany do not meet.

Methods: By using intervention mapping, this study protocol describes the systematic planning process of a school-based intervention in Germany aimed to increase the number of days on which students cycle to school and to increase their physical activity levels. To make sure that the intervention will match the needs of students, we conducted a concept mapping study investigating what students need to cycle to school, as perceived by students, parents, and teachers. The logic model of change was based on an integration of the self–determination theory and the social–ecological model. We structured our intervention as two phases, a preparatory phase with weekly components for and a practical phase with a daily repeated component of the targeted behavior. In the 8-week preparatory phase, teachers, parents, and peers will be involved. The content of the 12-week practical phase will involve peers only and was considered promising based on the findings from a systematic review that we conducted to identify the effective strategies of school-based interventions to promote cycling to school among children and adolescents. Overall, our intervention includes 27 behavior change techniques. A researcher, student assistants, teachers, and other collaborators will implement the intervention; a whole-of-school approach with components performed before, during, and after school was chosen. As a study design, we decided to draft a two-arm three-level cluster randomized controlled trial. Both the effect and process evaluation were prepared. In the first instance, approximately 250 students of 12–15 years of age from grade 7 or 8, who attend a secondary school of intermediate or high educational level located in (sub)urban regions in Southern Germany, will pilot the intervention.

Discussion: We expect to provide an effective and sustainable intervention for students, which gives insights into the mechanisms of change concerning the behavior of cycling to school and its influence on physical activity levels.

Virtual Physical Education During COVID-19: Exploring Future Directions for Equitable Online Learning Tools

Introduction: School closures prompted by the COVID-19 pandemic reduced opportunities for US youth to be physically active and disproportionately impacted health disparities in this population. Physical education provides the largest intervention to support the physical activity of school-aged youth, but teachers' opinions about how to maintain quality programming during virtual learning periods remain unexplored. Applying a diversity, equity and inclusion framework, this study explored physical education teachers' perceived significance of different design features for an online teaching tool to promote physical activity equity during school closures. Methods: Previous literature and focus groups informed the development of a survey administered in summer/fall 2020. Survey participants (n = 60) were physical education teachers from 400 randomly selected US preschool-12th grade schools drawing from a national database. Participants rated the significance of four design features in relation to five key attributes of an online supplement to in-person physical education programs. One-way ANOVAs were used to assess differences in teachers' ratings by demographic characteristics. Results: Between-group differences were found in teacher ratings of design features related to the usability, accessibility, equitability, and formal assessment capabilities of an online physical education tool. Differences were based on teacher gender, school level, and geographic location. Conclusions: Future research to promote physical activity equity among preschool-12th grade youth should examine tailored virtual physical education learning tools that address what teachers perceive to be the most significant design features to support equitable physical education among diverse student groups.

Tracking and Changes in Daily Step Counts among Finnish Adults

PURPOSE

This study aimed to investigate the tracking and changes of steps per day in adults and their determinants over 13 yr.

METHODS

A total of 2195 subjects (1236 women) 30-45 yr of age were randomly recruited from the ongoing Cardiovascular Risk in Young Finns Study in 2007 and were followed up in 2020. Steps per day, including both total and aerobic steps per day, were monitored for seven consecutive days with a pedometer in 2007-2008 and 2011-2012 and with an accelerometer in 2018-2020. Tracking was analyzed using Spearman's correlation. Stability and changes of steps per day over time in both low-active and high-active groups (based on median values) were described by percentage agreements, kappa statistics, and logistic regression. Associations of sex, age, and body mass index with the initial number and changes in steps per day were analyzed using linear growth curve modeling.

RESULTS

Tracking correlations of total steps per day at 4-, 9-, and 13-yr intervals were 0.45-0.66, 0.33-0.70, and 0.29-0.60, while corresponding correlations for aerobic steps per day were 0.28-0.55, 0.23-0.52, and 0.08-0.55, respectively. Percentage agreements were higher than 54%, and kappa statistics ranged from slight to fair over time. Compared with the low-active group, the high-active group at baseline had a higher probability of being active later in adulthood. Female sex and higher age were associated directly with the initial number of steps per day and inversely with changes in the number of steps per day. Body mass index was inversely associated with the initial number of steps per day and changes in the number of total steps per day.

CONCLUSION

The 13-yr tracking of steps per day in adulthood was found to be low to moderately high. Daily ambulatory activity is essential to maintaining an active lifestyle throughout adulthood. Changes in the amount of adult steps per day vary by sex, age, and BMI.

Trends in active commuting to school from 2003 to 2017 among children and adolescents from Germany: the MoMo Study

BACKGROUND

Inactivity in children and adolescents is a global issue requiring interventions that target different domains of physical activity, such as active transport. The aim of this study was to assess the prevalence, historical trends and socio-demographic correlates of active commuting to school (ACS) in a nationwide sample of girls and boys from Germany.

METHODS

Data of commuting behaviour and socio-demographic factors were collected, covering three measurement points from 2003 to 2017. The MoMo Study derived its data from a representative sample of children and adolescents aged 4-17 years who answered a questionnaire (N = 11 387). Statistically significant differences between Baseline, Wave 1 and Wave 2 were determined via 95% confidence intervals (CIs) for complex samples.

RESULTS

Overall, ACS decreased from 84.4% at the first measurement point to 78.3% in the third measurement point. The proportion of cases in which children opted for passive modes of commuting increased predominantly in those aged 4-5 years, in children with a low-to-medium socio-economic status, and in children residing in small- or medium-sized towns. No gender differences were found in active commuting. The results of multinomial logistic regression identified age, migration background and residential area as correlates of walking for boys. For girls, the likelihood of walking, cycling and taking public transport instead of opting for motorized transport increased with age.

CONCLUSIONS

Intervention programmes to increase active transport in children and adolescents should target different age groups and also consider parental influence in determining the child's choice of transport mode.

Physical activity from adolescence to young adulthood: patterns of change, and their associations with activity domains and sedentary time

BACKGROUND

Longitudinal studies demonstrate an average decline in physical activity (PA) from adolescence to young adulthood. However, while some subgroups of adolescents decrease activity, others increase or maintain high or low activity. Activity domains may differ between subgroups (exhibiting different PA patterns), and they offer valuable information for targeted health promotion. Hence, the aim of this study was to identify PA patterns from adolescence to young adulthood; also to explore the associations of (i) changes in PA domains and in sedentary time, (ii) sociodemographic factors, and (iii) self-rated health with diverging PA patterns.

METHODS

The observational cohort study data encompassed 254 adolescents at age 15 and age 19. K-means cluster analysis for longitudinal data was performed to identify participant clusters (patterns) based on their accelerometry-measured moderate-to-vigorous PA (MVPA). Logistic regressions were applied in further analysis.

RESULTS

Five PA patterns were identified: inactivity maintainers (n = 71), activity maintainers (n = 70), decreasers from moderate (to low) PA (n = 61), decreasers from high (to moderate) PA (n = 32), and increasers (n = 20). At age 15, participation in sports clubs (SC, 41-97%) and active commuting (AC, 47-75%) was common in all the patterns. By age 19, clear dropout from these activities was prevalent (SC participation mean 32%, AC 31-63%). Inactivity maintainers reported the lowest amount of weekly school physical education. Dropout from SC - in contrast to non-participation in SC - was associated with higher odds of being a decreaser from high PA, and with lower odds of being an inactivity maintainer. Maintained SC participation was associated with higher odds of belonging to the decreasers from high PA, and to the combined group of activity maintainers and increasers; also with lower odds of being an inactivity maintainer. Maintenance/adoption of AC was associated with decreased odds of being an inactivity maintainer. Self-reported health at age 19 was associated with the patterns of maintained activity and inactivity.

CONCLUSIONS

PA patterns diverge over the transition to adulthood. Changes in SC participation and AC show different associations with diverging PA patterns. Hence, tailored PA promotion is recommended.

Teens on Wheels and Consequences: A Six-Year Population-Based Study of Bicycle and Moped Injuries

INTRODUCTION

 Road traffic accidents are a major contributor to morbidity and mortality in the pediatric and adolescent population. Among adolescents, bicycles and light motorized two wheelers are popular means of transportation and increase adolescents' autonomy. Most previous studies on injury risk and incidence have pooled different vehicles and age groups together but more distinct data are required to guide policy.

MATERIALS AND METHODS

 We gathered data on all 1,432 children and adolescents (age 7-15) who had been treated for injuries from bicycle(n = 841) or moped/motorized scooter (n = 591) accidents at our study centers during a 6-year period (2008-2013). In addition to clinical data, we reviewed Injury Severity Scores (ISS) and calculated incidence estimates for the population of 15-year-olds in the study area.

RESULTS

 Most bicyclists were injured after a fall (72%), whereas most moped/scooter riders were injured in a collision (51%), most often with a heavier motorized vehicle. Internal injuries, multiple injuries, and severe injuries (ISS >15) were more common among moped/scooter riders than bicyclists (p < 0·001 for all). Moped/scooter riders were more often hospitalized and underwent more operations than bicyclists (p < 0·001 for both). The annual estimated incidence rates of injury were roughly eightfold for 15-year-old moped/scooter riders compared to bicyclists of the same age.

CONCLUSION

 Cycling is in general a safe mode of transportation and rider safety could be further increased with the proper use of helmets. Although no patient deaths occurred in this study population, mopeds and motorized scooters led to significant morbidity.

Is active commuting associated with sedentary behaviour and physical activity in women with fibromyalgia? The al-Ándalus project

PURPOSE

This study aimed to examine the association between active commuting and sedentary time (ST) and physical activity (PA) in women with fibromyalgia.

MATERIALS AND METHODS

This cross-sectional study included 420 women with fibromyalgia (aged 30 to 74 years old) from Spain. The participants wore an accelerometer during seven days to record ST and PA. They also self-reported patterns of active commuting. Linear regression analyses were conducted to examine the relationships between commuting and accelerometer outcomes. Age, pressure pain threshold, and accelerometer wear time were used as confounders.

RESULTS

There was a negative association between active commuting and ST whereas active commuting was positively associated with moderate PA, moderate-to-vigorous PA, total PA, and step count (all p ≤ 0.01). No associations were observed in the older group.

CONCLUSION

Younger women with fibromyalgia who were active commuters spent less ST and were involved in greater PA than passive commuters. This study highlights the importance of promoting active commuting to increase PA among young women with fibromyalgia, while other sources of PA might be recommended for older patients if levels of active commuting are not increased.Implications for rehabilitationActive commuting is a source to increase PA in women with fibromyalgia.Active commuting alone does not seem to be enough to increase PA levels in older women with fibromyalgia and additional PA strategies should be implemented.Promotion of active commuting in young women with fibromyalgia is recommended.

Effects of Children's Outdoor Physical Activity in the Urban Neighborhood Activity Space Environment

The rapid development of cities results in many public health and built-up environmental problems, which have vital impacts on children's growth environment, the development of children, and city contradictions. There is a lack of children being a main concern when constructing new urban areas or reconstructing old districts. Children's activity spaces tend to be standardized and unified (kit, fence, and carpet) “KFC style” designs, which leads to the urban neighborhood space and the environment being insufficient to attract children to conduct activities. Therefore, starting from the urban neighborhood space environment, this paper explores what kind of spatial environment is needed for children's physical activity and its impact on children's physical activity. Taking six residential areas in the Changchun Economic Development Zone as the research object, based on the theory of children's ability development and game value, this paper uses the Woolley and Lowe evaluation tool to quantify the impact of the theory on the urban neighborhood space environment and children's physical activity. It can be confirmed that there is a significant correlation between the spatial characteristics of an urban neighborhood and the general signs of the environment on the duration and intensity of the physical activity of children. The results show that: (1) the differences in children's ages result in differences in the duration and intensity of children's physical activity in the urban neighborhood space environment; (2) the open space factor of the neighborhood space has the most significant influence on the duration of children's physical activity; (3) in terms of the environmental characteristics, whether children can be provided with education and learning opportunities has a significant impact on the duration of children's physical activity; (4) there is a significant positive correlation between children's age and the duration and intensity of the physical activity, exercise type, and imaginative activity. These results show that the urban neighborhood space environment can affect the duration of children's physical activity. In future urban residential area planning and design, urban children can meet the self-demand of physical activity in the neighborhood space through the reasonable balance and combination of neighborhood space characteristics and environmental characteristics.

Associations Between Major Life Changes and Pedometer-Determined Physical Activity Over 4 Years in Middle-Aged Adults in the Cardiovascular Risk in Young Finns Study

BACKGROUND

To examine if major life changes over a 4-year period among 34- to 49-year-old adults (mean = 41.8, SD = 5.0) were associated with a change in physical activity in men (37.7%) and women (62.3%).

METHODS

Daily steps and aerobic steps (steps that lasted for at least 10 min without interruption at a pace of >60 steps/min) were collected from 1051 participants in 2007 and 2011. Changes in marital status, work status, and residence and the birth of a child were determined from both time points. A latent change score model was used to examine mean changes in daily total steps, aerobic steps, and nonaerobic steps (total steps minus aerobic steps).

RESULTS

Women who had a first child in the 4-year period had a decrease in their nonaerobic steps (P = .001). Men who divorced in the 4-year period had a decrease in their nonaerobic steps (P = .020), whereas women who recoupled decreased their total steps (P = .030).

CONCLUSIONS

Counseling for parents having a first child on how to increase physical activity in their everyday life could potentially have an influence on an individual's physical activity.

Interventions Aiming to Promote Active Commuting in Children and Adolescents: An Evaluation From a Sex/Gender Perspective

Active commuting (AC) provides numerous health benefits and is one way to improve physical activity in children and adolescents. Boys are more likely to use active transport modes than girls. Girls and boys benefit differently from interventions that promote AC. The aim of this systematic review is to evaluate the effects of interventions on girls and boys and to appraise the extent to which previous studies have taken sex/gender into account. Eleven electronic databases were searched to identify all relevant randomized and non-randomized controlled trials based on a priori defined eligibility criteria. Two independent reviewers screened the literature for eligibility and assessed risk of bias. Semiquantitative analyses were conducted to evaluate the effects of intervention effects by taking sex/gender aspects into account. To evaluate sex/gender considerations in interventional studies, a recently developed sex/gender checklist was applied. Twelve studies were included that examined intervention effects on AC in girls and boys. Three intervention studies showed significant effects in increasing AC, with one study favoring girls, one favoring boys, and another focusing on a single sex/gender (only girls). According to the checklist, the overall sex/gender rating highlighted a lack of information in sex/gender consideration. Studies with and without significant effects indicated no differences in the sex/gender checklist. The results indicate that sex/gender is not considered adequately in primary interventional research on AC. To evaluate the effectiveness of intervention in boys and girls, detailed analyses of sex/gender are required, and better reporting about sex/gender-specific intervention content is necessary. In future health research to promote AC, sex/gender should be systematically taken into account.

Socio-Demographic Correlates of Cycling to School among 12- to 15-Year Olds in Southern Germany

Depending on the region and urbanization level, the rate of cycling to school in Germany varies largely. The influence of distance from home to school, educational level, the school’s region, and parents’ socio-demographic characteristics on cycling to secondary school in Germany is unclear. Therefore, this study analyzed students’ and parents’ socio-demographic correlates of cycling to school, including separate analyses by gender, among 12- to 15-year-olds attending different (sub)urban schools in Southern Germany. In 2019, 121 students (girls: 40.5%, boys: 59.5%) aged 13.1 ± 0.9 and 42 parents (mothers: 81%, fathers: 19%) aged 47.8 ± 5.5 participated. Students completed a self-report questionnaire; parents completed a self- and proxy-report questionnaire. In total, between 61.7% and 67.5% of students sometimes cycled to school. Binary logistic regressions revealed that being a girl, increasing age, attending an intermediate educational level combined with a suburban school region (small or medium-sized town), increasing distance from home to school, and having parents who did not cycle to work led to declining odds of cycling to school. Many 12- to 15-year-olds sometimes cycled to school in (sub)urban school regions in Southern Germany. As several socio-demographic characteristics correlated with cycling to school, this should be considered when developing a future school-based bicycle intervention.

Gender Influence on Students, Parents, and Teachers' Perceptions of What Children and Adolescents in Germany Need to Cycle to School: A Concept Mapping Study

Active commuting to school is highly recommended for several reasons, and in the decision-making process for doing so, a child interacts with parents and teachers. Until now, these three interactors' gender-specific perspectives on children and adolescents' need for cycling to school have been unavailable. Thus, our concept mapping study analyzed the needs of 12- to 15-year-olds in Germany for cycling to and from school daily, as perceived by students, parents, and teachers stratified by gender. From November 2019 to February 2020, 136 students, 58 parents, and 29 teachers participated. Although 87.8% of girls and 100% of boys owned a bicycle, only 44.4% of girls and 72.9% of boys cycled to school. On average, girls cycled to school on 1.6 ± 2.0 days a week and boys on 2.7 ± 2.0 days a week. A "bicycle and related equipment," the "way to school," and "personal factors" were reported needs, perceived by students and teachers of both genders and by mothers. Girls reported the additional gender-specific need for "social behavior in road traffic," mothers and female teachers reported "role of parents," and female teachers reported a "sense of safety." This study's findings could inspire the development of school-based bicycle interventions.

Characteristics of the schools' surrounding environment, distance from home and active commuting in adolescents from Curitiba, Brazil

INTRODUCTION

Active commuting to school could help increasing physical activity levels among adolescents. However, there is limited understanding on how the relationship between the environment in school surroundings, as well the distance to school, could affect this behavior.

AIM

To analyze the characteristics of the environment and distance between house and school with objective measures and their association with active commuting between adolescents of Curitiba, Brazil.

METHODS

493 adolescents were interviewed and 124 schools evaluated. The study variables included the schools' surroundings accessibility characteristics obtained through systematic observation, and the distance between home to school was determined through Geographic Information Systems (GIS) data.

RESULTS

The presence of "safety signs" was inversely associated with active commuting (PR = 0.78; 95%CI 0.67-0.91; p = 0.003), as well distance 1,501-3,000 m (PR = 0.53; 95%CI 0.40 - 0.71; p < 0.001) and ≥ 3,501 m (PR 0.29; 95%CI 0.18 - 0.45; p < 0.001). Overall, schools' surroundings showed walking friendly characteristics.

CONCLUSION

Traffic safety and distance to school were associated with active commuting to school among the study participants. Policies aiming at integrating access to school and traffic safety could help to promoting active commuting among adolescents.

Individual- and environmental-related correlates of moderate-to-vigorous physical activity in 11-, 13-, and 15-year-old Finnish children

The objective of this study was to analyze the associations of various individual- and environmental-related factors with subgroups of daily, frequent, moderate and low moderate-to-vigorous physical activity (MVPA) among children and adolescents. Data were obtained from the Finnish School-age Physical Activity (FSPA) study 2016 from 4677 national representative 11-, 13-, and 15-year-old children and adolescents. MVPA and individual- and environmental-related factors were assessed by a questionnaire and analyzed by two-level logistic regression. Seventeen of the twenty-one variables were statistically significantly associated with MVPA. However, only three variables were statistically significant in all MVPA subgroups, whereby self-directed PA at least twice a week, fewer perceived barriers, and higher peer support increased the odds of participating in more MVPA. The results from this study showed essential differences among the MVPA subgroups, also supporting previous findings, whereby various individual- and environmental-based factors are associated with children and adolescents’ levels of MVPA. Challenges to designing and implementing effective interventions are based on the need to account for individual differences within the population, as well as the varied connections between PA with different social and physical environments where children and adolescents’ PA takes place. PA interventions with various actions at multiple levels are warranted.

Active Commuting, Physical Activity, and Sedentary Behaviors in Children and Adolescents from Spain: Findings from the ANIBES Study

Active commuting (AC) has been proposed as a great opportunity to increase physical activity level (PA) in children and adolescents. The aim of the present study is to determine the associations between AC (walk and cycle commuting) and non-AC (motor vehicle commuting) with PA levels, and with AC and sedentarism in Spanish children and adolescents. A representative Spanish sample of 424 children and adolescents (38% females) was involved in the ANIBES (Anthropometry, Dietary Intake and Lifestyle in Spain) Study in 2013. Data on the levels of AC, non-AC, PA, and sedentarism were obtained using the International Physical Activity Questionnaire for adolescents. Stepwise backward univariate generalized linear and linear regression models were performed. In girls, walking was associated with playground PA, moderate PA, and moderate to vigorous PA (MVPA) (β = 0.007, p < 0.05; both β = 0.007, p < 0.01), respectively. In boys, walking was associated with all PA levels (p < 0.05); while cycling was related to moderate PA and MVPA (both β = 0.007, p < 0.05). A negative significant association was observed between AC and time spent studying without Internet use in boys (β = −0.184, p < 0.05). Commuting by walking contributes to increased daily PA in both sexes, whereas cycling was only related to moderate PA and MVPA in boys. Sedentary behaviors are not related to AC, but studying without Internet use was negatively associated with AC in boys.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Pedestrian injuries due to collisions with cyclists Melbourne, Australia

Over the past decade in Melbourne the popularity of cycling has increased both as a mode of transport and a recreational activity, while at the same time walking has consistently been the most prevalent form of physical activity. Increasing levels of active transport use and physical activity are seen as important public health issues, particularly as the rate of urbanisation continues to grow throughout the world. To date there has been limited research conducted in Australia looking at the prevalence of pedestrian injuries resulting from collisions with cyclists. However there is a potential for the issues surrounding pedestrian and cyclist conflict to increase, given the growing uptake of these modes of transport, the continued densification of the urban environment and the lack of cycling specific infrastructure in many Australian capital cities. This study investigated the prevalence of pedestrian injuries resulting from collisions with cyclists in Melbourne, Australia. The intention was to quantify the extent of these collisions and identify if the rate of collisions was increasing, which may highlight a growing road safety issue. Furthermore the study sought to identify any unique characteristic and injury outcomes associated with this collision type. Aggregate analyses of two Victorian data sources were undertaken to enhance our understanding of pedestrian injuries resulting from collisions with cyclists, the Victorian Injury Surveillance Unit (VISU) and Victorian Police Report Crash Data (Crash Stats). The analysis demonstrated that over the past ten years there does not appear to have been a substantial increase in the number of pedestrian injuries resulting from collisions with cyclists. Furthermore the prevalence of injuries was small, especially when compared to injuries sustained by pedestrians from collisions with motor vehicles. The findings highlight that efforts to increase active transport participation should be encouraged and there may be situations where is it suitable to increase interaction and sharing of space between pedestrians and cyclists.

Diversity of leisure-time sport activities in adolescence as a predictor of leisure-time physical activity in adulthood

Because sustained physical activity is important for a healthy life, this paper examined whether a greater diversity of sport activities during adolescence predicts higher levels of leisure-time physical activity (LTPA) in adulthood. From sport activity participation reported by 17-year-old twins, we formed five groups: 1, 2, 3, 4, and 5+ different sport activities. At follow-up in their mid-thirties, twins were divided into four activity classes based on LTPA, including active commuting. Multinomial regression analyses, adjusted for several confounders, were conducted separately for male (N=1288) and female (N=1770) participants. Further, conditional logistic regression analysis included 23 twin pairs discordant for both diversity of sport activities in adolescence and LTPA in adulthood. The diversity of leisure-time sport activities in adolescence had a significant positive association with adulthood LTPA among females. Membership in the most active adult quartile, compared to the least active quartile, was predicted by participation in 2, 3, 4, and 5+ sport activities in adolescence with odds ratios: 1.52 (P=.11), 1.86 (P=.02), 1.29 (P=.39), and 3.12 (P=5.4e-05), respectively. Within-pair analyses, limited by the small sample of twins discordant for both adolescent activities and adult outcomes, did not replicate the association. A greater diversity of leisure-time sport activities in adolescence predicts higher levels of LTPA in adulthood in females, but the causal nature of this association remains unresolved.

Why are adult women physically active? A systematic review of prospective cohort studies to identify intrapersonal, social environmental and physical environmental determinants

OBJECTIVE

This study aims to systematically review available evidence from prospective cohort studies to identify intrapersonal, social environmental and physical environmental determinants of moderate-to-vigorous intensity physical activity (MVPA) among working-age women.

METHODS

Six databases were searched to identify all prospective cohort studies that reported on intrapersonal (e.g. self-efficacy and socioeconomic status [SES]), social (e.g. crime, area SES and social support) and/or physical (e.g. weather, work and recreation) environmental determinants of MVPA in working-age (mean 18-65 years) women. A qualitative synthesis including harvest plots was completed.

PROSPERO

CRD42014009750 RESULTS: Searching identified 17,387 potential articles; 97 were used in the analysis. The majority (n = 87 studies) reported on ≥1 intrapersonal determinant. Very few (n = 34) examined factors in the social or physical environments, and none looked at social policy. Positive and consistent influencers included higher self-efficacy (n = 18/23), self-rated health (n = 8/13) and intentions (n = 10/11) and perceived behavioural control (n = 5/7) to be physically active. Having children in the household was negatively related to MVPA (n = 9/15).

CONCLUSIONS

Physical activity intervention studies should consider a woman's level of self-efficacy and perceived behavioural control to be physically active. Additional studies are needed on the impact of children in the household, having a spouse/partner and using group goal setting. More evidence is needed to evaluate the impact of environmental factors.

Decomposing socio-economic inequalities in leisure-time physical inactivity: the case of Spanish children

BACKGROUND

Physical inactivity is associated with an increased risk of all-cause mortality and entails a substantial economic burden for health systems. Also, the analysis of inequality in lifestyles for young populations may contribute to reduce health inequalities during adulthood. This paper examines the income-related inequality regarding leisure-time physical inactivity in Spanish children.

METHODS

In this cross-sectional study based on the Spanish National Health Survey for 2011-12, concentration indices are estimated to measure socioeconomic inequalities in leisure-time physical inactivity. A decomposition analysis is performed to determine the factors that explain income-related inequalities.

RESULTS

There is a significant socioeconomic gradient favouring the better-off associated with leisure-time physical inactivity amongst Spanish children, which is more pronounced in the case of girls. Income shows the highest contribution to total inequality, followed by education of the head of the household. The contribution of several factors (education, place of residence, age) significantly differs by gender.

CONCLUSIONS

There is an important inequity in the distribution of leisure-time physical inactivity. Public policies aimed at promoting physical activity for children should prioritize the action into the most disadvantaged subgroups of the population. As the influence of determinants of health styles significantly differ by gender, this study points out the need of addressing the research on income-related inequalities in health habits from a gender perspective.

Active Travel to School: Findings From the Survey of US Health Behavior in School-Aged Children, 2009-2010

BACKGROUND

Whereas children's active travel to school (ATS) has confirmed benefits, only a few large national surveys of ATS exist.

METHODS

Using data from the Health Behavior in School-aged Children (HBSC) 2009-2010 US survey, we conducted a logistic regression model to estimate the odds ratios of ATS and a linear regression model to estimate the adjusted mean differences of the percentage of ATS within a school.

RESULTS

Overall, 21.4% of children engaged in at least one way of active travel to or from school. ATS was less common for trips to school than from school. Greater distance to school was a major barrier preventing children from ATS. Children living in large cities were more likely to engage in ATS, and schools located in a large city had higher proportions of ATS rate. Children having lower family satisfaction, or engaging in a greater number of physically active days during the past week were all more likely to engage in ATS.

CONCLUSIONS

Although ATS is low among US children, significant variation exists. HBSC is a promising data source for an ATS study. As the first study to explore the variation of ATS at school level, this research contributes uniquely to current knowledge.

Pyschosocial factors associated with children's cycling for transport: A cross-sectional moderation study

Promoting children's cycling for transport is a useful strategy to increase their physical activity levels. No studies have examined to which extent children's psychosocial characteristics play a role in their transportation cycling. Furthermore, insights into the association between children's independent mobility (IM) and transportation cycling is lacking in Europe. This study examined (1) the association of children's psychosocial characteristics with transportation cycling and its moderating effect of child's gender, parents' educational attainment and IM, and (2) the association between children's IM and transportation cycling. Children (n=1232, aged 10-12yrs) completed an online questionnaire at school assessing their psychosocial characteristics related with transportation cycling. Parents reported child's usual transportation cycling and the distance their child is allowed to cycle unsupervised (IM). Hurdle models were used to estimate associations between independent variables and odds of being a cyclist and with minutes of transportation cycling among those cycling. Data were collected during November-December 2014 across Flanders, Belgium. Children's perceived parental modeling, parental norm, peers' co-participation, self-efficacy and IM were positively related to the odds of being a cyclist, perceived benefits were negatively associated. Parental modeling, siblings' modeling, self-efficacy and parental norm were more strongly related to the odds of being a cyclist among children with a low IM. Friends' modeling was significantly related with odds of being a cyclist among boys. IM and parental norm (only among boys) were positively related to the time spent cycling. Targeting children, their friends and parents seems therefore most appropriate when aiming to increase children's transportation cycling.

Impact of physical activity domains on subsequent physical activity in youth: a 5-year longitudinal study

This study evaluates how domains of physical activity (PA) in youth predict later PA and assesses factors influencing changes in sports participation. Young people from the Children's Sport Participation and Physical Activity study (n = 873; baseline age 10-18 years; 30.4% male) completed self-report surveys in 2009 and 2014. In a multiple linear regression analysis, participation frequency in club sport (β = 0.18) and extracurricular sport (β = 0.13) significantly predicted PA 5 years later, adjusted for age, sex and urban/rural classification (P < 0.01). Overall, rates of regular (at least once per week) youth sports participation were high (males 79.3-85.5%; females 74.8-83.2%). Uptake and dropout of specific sports varied widely. Despite high levels of migration into and out of Gaelic games, they remained popular at follow-up. Weight training was the only sport that increased in both sexes (P < 0.05). Fitness, friends and enjoyment were top motivations for taking up a new sport. Other commitments, a lack of interest and time were important factors leading to sports dropout. PA promotion strategies should include youth sport, take into consideration what sports are attractive to young people and address reasons for uptake and dropout.

Number of years of participation in some, but not all, types of physical activity during adolescence predicts level of physical activity in adulthood: Results from a 13-year study

Background

Adolescent physical activity (PA) levels track into adulthood. However it is not known if type of PA participated in during adolescence is associated with PA levels later in life. We aimed to identify natural groupings of types of PA and to assess whether number of years participating in these different groupings during adolescence is related to PA level in early adulthood.

Methods

673 adolescents in Montreal, Canada, age 12–13 years at baseline (54 % female), reported participation in 29 physical activities every 3 months over 5 years (1999–2005). They also reported their PA level at age 24 years (2011–12). PA groupings among the 29 physical activities were identified using factor analysis. The association between number of years participating in each grouping during adolescence and PA level at age 24 was estimated using linear regression within a general estimating equation framework.

Results

Three PA groupings were identified: “sports”, “fitness and dance”, and “running”. There was a positive linear relationship between number of years participating in sports and running in adolescence and PA level at age 24 years (β (95 % confidence interval) = 0.09 (0.04-0.15); 0.08 (0.01-0.15), respectively). There was no relationship between fitness and dance in adolescence and PA level at age 24.

Conclusions

The association between PA participation in adolescence and PA levels in young adulthood may be specific to certain PA types and to consistency of participation during adolescence. Results suggest that efforts to establish the habit of participation in sports and running in adolescence may promote higher PA levels in adulthood.

Risk factors of acute and overuse musculoskeletal injuries among young conscripts: a population-based cohort study

BACKGROUND

Military service in Finland is compulsory for all male citizens and annually about 80% of 19-year-old men enter into the service. The elevated risk for many chronic diseases and loss of function among those who are inactive and unfit can be often detected already in youth. On the other hand, activity-induced injuries among young are true public health issue. The purpose of the present prospective cohort follow-up study was to evaluate predictive associations between acute or overuse injuries and their various intrinsic risk factors.

METHODS

Four successive cohorts of conscripts who formed a representative sample of Finnish young men were followed for 6 months. At the beginning of the service, the risk factors of injuries were measured and recorded and then the acute and overuse injuries treated at the garrison clinic were identified. Predictive associations between injuries and their risk factors were examined by multivariate Cox's proportional hazard models.

RESULTS

Of the 1411 participants, 27% sustained an acute injury and 51% suffered from overuse injury. Concerning acute injuries, highest risk for severe injuries were detected among conscripts with low fitness level in both the standing long-jump and push-up tests (hazard rate, HR=5.9; 95% CI: 1.6‒21.3). A history of good degree in school sports was not a protective factor against acute injuries. High waist circumference and, on the other hand, being underweight according to BMI increased the HR for overuse injuries. Brisk leisure time physical activity before military entry was a protective factor against overuse injuries. Poor result in Cooper's test was a warning signal of elevated risk of overuse injuries.

CONCLUSION

We confirmed previous findings that low level of physical fitness is predictor for musculoskeletal injuries during intensive physical training. The U-shaped relationship between body composition and overuse injuries was noticed indicating that both obesity and underweight are risk factors for overuse injuries. Persons with excellent sports skills according to their earlier degrees in school sports had similar HR for acute injuries than those with poorer degrees. This indicates that school-age sports skills and fitness do not carry far and therefore preventive programmes are needed to prevent activity-induced injuries.