Can differences in physical activity by socio-economic status in European adolescents be explained by differences in psychosocial correlates? A mediation analysis within the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) study

The influential role of parents' socioeconomic status and diet quality on their children's dietary behavior: results from the LIPOKAP study among the Iranian population

PURPOSE

There is a paucity of evidence regarding the influential factors on Iranian children's diet quality. To assess this issue, we explore the relationship between parental diet quality, socioeconomic status (SES), and nutritional knowledge with their children's diet quality using a cross-sectional sample of the Iranian population.

METHODS

In this study, paired parents along with one of their children (aged 6-18 years old) who lived with them were included. Dietary intake was assessed using a food frequency questionnaire (FFQ) and diet quality was determined using an Alternative Healthy Eating Index-2010 (AHEI). Nutritional knowledge and SES were also explored using validated questionnaires. Multiple linear regression analysis was used and beta (β) and corresponding 95% confidence interval (CI) were reported.

RESULTS

After controlling for potential confounders, the parents' AHEI was significantly associated with their children's diet quality (β = 12.34, 95% CI: 10.75, 13.93; P < 0.001). The nutritional knowledge of parents was significantly associated with children's AHEI after controlling for potential confounders (β = 1.63, 95% CI: 0.14, 3.11; P = 0.032). Moreover, the parents' SES was inversely associated with the AHEI of children (β=-3.76, 95% CI: -5.40, -2.11; P < 0.001); however, further adjustment for confounders attenuated this relationship (Model 3: β = 0.87, 95% CI: -0.76, 2.34; P = 0.269).

CONCLUSIONS

We found that the children's diet quality could be influenced by their parents' SES, nutritional knowledge, and diet quality. Our findings suggest that improving the nutritional knowledge of parents not only may improve the healthy eating pattern of parents but also could influence their children's diet quality.

Reliability, validity and internal consistency of social support and self-efficacy scales for physical activity in adolescents with 10 to 14 years of age

Objective:

To analyze the reliability, validity and internal consistency of the physical activity social support (SSS) and self-efficacy (SES) scales among adolescents aged 10–14 years.

Methods:

The reliability study included 171 adolescents (mean age=12.3±1.0 years, 59.6% female) and validity and consistency study with 1,107 (mean age=12.0±1.0 years, 52.7% female). The SSS had 15 items and the SES eight items. Reliability was determined by Spearman's correlation analysis (rho) and validity and internal consistency by factor analysis (exploratory — EFA and confirmatory — CFA) and the composite reliability (CR), respectively.

Results:

The reliability of SSS (father: rho=0.80; p<0.001 | mother: rho=0.76; p<0.001 | friends: rho=0.75; p<0.001) and SES (rho=0.72; p<0.001) were considered high. In the EFA, three factors were identified for the SSS (father, mother and friends — five items each) and one factor for SES (five items), confirmed in the CFA. Quality parameters of adjustment in the final models were satisfactory for SSS (chi-square=240.5 [p<0.001]; root mean square residual — RMR=0.05; root mean square error of approximation — RMSEA=0.04 [90%CI 0.04–0.05]; goodness of fit index — GFI=0.97; adjusted goodness of fit index — AGFI=0.96 and comparative fit index — CFI=0.97) and SES (chi-square=5.4 [p=0.07]; RMR=0.01; RMSEA=0.04 [90%CI 0.00–0.08]; GFI=0.99; AGFI=0.99 and CFI=0.97). Internal consistency was considered satisfactory for SSS (CR: father=0.79, mother=0.77, friends=0.78) and low for SES (CR=0.38).

Conclusions:

The scales showed satisfactory levels of reliability and of construct validity. However, only the SSS showed adequate levels of internal consistency.%

Clinical and psychosocial stress factors are associated with decline in physical activity over time in children with juvenile idiopathic arthritis

BACKGROUND

Physical activity (PA) patterns in children with juvenile idiopathic arthritis (JIA) over time are not well described. The aim of this study was to describe associations of physical activity (PA) with disease activity, function, pain, and psychosocial stress in the 2 years following diagnosis in an inception cohort of children with juvenile idiopathic arthritis (JIA).

METHODS

In 82 children with newly diagnosed JIA, PA levels, prospectively determined at enrollment, 12 and 24 months using the Physical Activity Questionnaire for Children (PAQ-C) and Adolescents (PAQ-A) raw scores, were evaluated in relation to disease activity as reflected by arthritis activity (Juvenile Arthritis Disease Activity Score (JADAS-71)), function, pain, and psychosocial stresses using a linear mixed model approach. Results in the JIA cohort were compared to normative Pediatric Bone Mineral Accrual Study data derived from healthy children using z-scores.

RESULTS

At enrollment, PA z-score levels of study participants were lower than those in the normative population (median z-score - 0.356; p = 0.005). At enrollment, PA raw scores were negatively associated with the psychosocial domain of the Juvenile Arthritis Quality of Life Questionnaire (r = - 0.251; p = 0.023). There was a significant decline in PAQ-C/A raw scores from baseline (median and IQR: 2.6, 1.4-3.1) to 24 months (median and IQR: 2.1, 1.4-2.7; p = 0.003). The linear mixed-effect model showed that PAQ-C/A raw scores in children with JIA decreased as age, disease duration, and ESR increased. The PAQ-C/A raw scores of the participants was also negatively influenced by an increase in disease activity as measured by the JADAS-71 (p <  0.001).

CONCLUSION

Canadian children with newly diagnosed JIA have lower PA levels than healthy children. The decline in PA levels over time was associated with disease activity and higher disease-specific psychosocial stress.

Prevalence and correlates of physical inactivity in adults across 28 European countries

Background

Physical activity/inactivity is impacted by a plethora of intertwined factors. There are a limited number of studies on physical activity/inactivity that provide a European cross-country perspective. This study aims to present the prevalence and correlates of physical activity in adults across the 28 European Union (EU) member states.

Methods

This is a secondary dataset analysis of the Special Eurobarometer 472 data on physical activity. The cross-sectional survey was conducted during December 2–11 in 2017 across 28 European countries. The data consisted of ∼1000 respondents aged ≧15 years per country. The current analysis was restricted to adults aged 18–64 years (n = 19 645).

Results

More than one in three (36.2%, 95% CI: 35.1–37.3) adults in the EU were physically inactive, with substantial cross-country differences noted. Women were less likely than men to be adequately or highly physically active (aOR: 0.86, 95% CI: 0.78–0.95). Similarly, adults at the age of 40–54 (aOR: 0.65, 95% CI: 0.52–0.81) and 55–64 (aOR: 0.61, 95% CI: 0.49–0.77) were less likely to have moderate or high levels of physical activity in comparison with those 18–24 years of age. Finally, high SES was positively associated with physical activity (aOR: 1.4, 95% CI: 1.16–1.69).

Conclusions

A notable percentage of adults in Europe are physically inactive. Further research is needed to elucidate the factors behind the cross-country differences and identify potential policy actions that may support adopting a physically active lifestyle and decrease the inequalities related to physical activity across Europe.

Influence of meteorological conditions on physical activity in adolescents

Background

It has been shown that meteorological conditions and season affect physical activity (PA) during adolescence. Today, meteorological conditions have never been combined to study their influence on PA level in a single sample of a large adolescent multicountries population. The aim of this study was to explore the influence of meteorological conditions on PA in adolescents from several European countries.

Methods

The study included 2024 healthy adolescents aged 12.5–17.4 years who participated in the Healthy Lifestyle in Europe by Nutrition in Adolescence cross-sectional study. Participants wore a uniaxial accelerometer for 7 consecutive days to measure total PA and moderate to vigorous physical activity (MVPA) in a one-off measurement manner. Comparison of PA according to meteorological conditions was done using linear mixed models.

Results

The highest difference of MVPA was observed in boys on free days when comparing the best meteorological conditions versus the worse (ie, +39% with highest temperature, +29% without rainfall, +39% with highest sunlight duration and +21% with highest length of day) and in girls on free days (ie, +26% with highest sunlight duration). This increase in MVPA contributed to a simultaneous increase in total PA when considering the same meteorological condition parameters.

Conclusions

Meteorological conditions act as a determinant of PA differentially between boys and girls. PA and MVPA in boys are mainly modified by meteorological conditions on free days whereas PA and MVPA in girls are modified by sunlight duration.

Is the association between sociodemographic variables and physical activity levels in adolescents mediated by social support and self-efficacy?

OBJECTIVE

Analyze whether the association between sociodemographic variables and physical activity levels is mediated by psychosocial factors.

METHODS

This is a cross-sectional epidemiological study of public and private high school students in João Pessoa, Paraíba state, Brazil. A total of 2540 adolescents (57.0% female) were analyzed (16.4±1.2 years). Physical activity was estimated using a questionnaire, self-efficacy, and parents' and friends' social support by scales, all previously validated.

RESULTS

The association between sex and the physical activity level of adolescents was partially mediated by the social support of parents (β=0.79; p<0.001) and friends (β=2.96; p<0.001), and the association between age and physical activity level was partially mediated by parents' social support (β=0.78; p<0.001). The associations between sex and age and physical activity levels of adolescents were mediated by the social support of parents and friends.

CONCLUSIONS

Differences in physical activity levels between adolescent females and males and between younger and older adolescents may be partially explained by differences in social support provided by parents and friends. Implementation strategies to increase the social support of parents and friends may help reduce the differences in physical activity levels between these subgroups of adolescents.

Health, psychological, social and environmental mediators between socio-economic inequalities and participation in exercise among elderly Japanese

This study examined which of the identified health, psychological, social and environmental mediators could most effectively explain the socio-economic status (SES)-based differences in participation in exercise among elderly Japanese. The candidates for mediators were composed based on the socio-ecological model. A representative sample of people 65 years and older living in two areas with different residential SES in Tokyo, Japan produced 739 effective participants. The intensity of exercise was evaluated based on whether the participants exercise for 30 minutes or longer twice a week, or for 20 minutes or longer three times a week. SES was evaluated by education and income. Mediators were assessed through four dimensions: (a) health, (b) psychological status, (c) social relations and (d) environmental context. As a result, SES's indirect effect through the mediators was evaluated using a multiple mediator model. The influence of both education and income on exercise was mediated by self-efficacy for exercise and social support for exercise. Self-efficacy for exercise had the strongest effect, while social support for exercise explained more of the income differences affecting participation in exercise than it did regarding educational differences. Self-efficacy for exercise may have the strongest effect as a mediator, which would explain the differences in participation in exercise among elderly Japanese based on education and income.

US Centers for Disease Control and Prevention-Based Physical Activity Recommendations Do Not Improve Fitness in Real-World Settings

BACKGROUND

The US Centers for Disease Control and Prevention (CDC) promotes school-based strategies to increase physical activity (PA). Implementation feasibility and effect of these interventions on cardiovascular fitness (CVF) is unknown.

METHODS

Forty-nine low-SES schools were randomly assigned to either (1) continue routine PA programs (N = 24 schools, 2399 students) or (2) implement 4 CDC-based PA strategies (N = 25 schools, 2495 students). CVF assessed by PACER (Progressive Aerobic Cardiovascular Endurance Run) was obtained at the beginning and end of the school year. A post-study questionnaire was administered at each school to assess adherence.

RESULTS

Overall, PACER z-scores were not augmented by CDC-based PA strategies. In boys, PACER z-scores increased similarly in both intervention and control schools. In girls, increased mean PACER z-score was greater in control schools (p < .01). Fifty-two percent of intervention school's staff reported inability to implement or sustain 4 CDC-based PA strategies.

CONCLUSIONS

Planned implementation of school-based CDC PA strategies did not increase CVF compared to routine PA programming. Lack of efficacy in girls suggests need for sex-specific targeted strategies. These findings highlight limited efficacy of CDC-based PA recommendations alone in low-SES schools. Schools may require additional support to successfully implement recommendations and meaningfully affect health outcomes.

Association between socio-economic status and physical activity is mediated by social support in Brazilian students

This study evaluated whether the relationship between socioeconomic status (SES) and moderate-to-vigorous physical activity (MVPA) is mediated by social support of peers and parents. A cross-sectional study included students (n = 1182) aged 11 to 18 years who were recruited in 2014 from public schools in Fortaleza, Brazil. Participants completed a questionnaire to assess all variables. Mediation analyses were performed to determine the role of parental support and peer support on the relationship between SES and MVPA. Also, moderated-mediation analyses with estimating of conditional indirect effects were performed in order to identify whether gender is a moderator of the mediating effect. A positive and significant association between SES and MVPA was found among Brazilian students, and social support of parents and peers were significant mediators of this relationship. Conditional indirect effects showed that both parental and peer support had a significant indirect effect among boys; only parental support had a significant indirect effect among girls. These results suggest that improving social support can help reduce the impact of SES on physical activity among Brazilian adolescents.

[From the influence of genes to the influence of family and urban environment on the nutritional status, activity, and physical condition of european urban adolescents]

HELENA was a cross-sectional study carried out from 2006 to 2007 in more than 3500 adolescents aged from 12.5 to 17.5 years old through 10 Europeans towns from 9 countries. Its objective was to assess adolescent nutritional status including: body composition, biological markers, physical activity and fitness. This study shown the high impact of socio-economic condition, life style and personal and collective environment, dietary pattern (including breastfeeding), some genetic mutations involved in adiposity and metabolism, physical activity level and fitness on adolescent nutritional status.

Is the intention-behaviour gap greater amongst the more deprived? A meta-analysis of five studies on physical activity, diet, and medication adherence in smoking cessation

Objectives

Unhealthy behaviour is more common amongst the deprived, thereby contributing to health inequalities. The evidence that the gap between intention and behaviour is greater amongst the more deprived is limited and inconsistent. We tested this hypothesis using objective and self‐report measures of three behaviours, both individual‐ and area‐level indices of socio‐economic status, and pooling data from five studies.

Design

Secondary data analysis.

Methods

Multiple linear regressions and meta‐analyses of data on physical activity, diet, and medication adherence in smoking cessation from 2,511 participants.

Results

Across five studies, we found no evidence for an interaction between deprivation and intention in predicting objective or self‐report measures of behaviour. Using objectively measured behaviour and area‐level deprivation, meta‐analyses suggested that the gap between self‐efficacy and behaviour was greater amongst the more deprived (B = .17 [95% CI = 0.02, 0.31]).

Conclusions

We find no compelling evidence to support the hypothesis that the intention–behaviour gap is greater amongst the more deprived.

Socio-economic and lifestyle parameters associated with diet quality of children and adolescents using classification and regression tree analysis: the DIATROFI study

Objective

To explore factors affecting children’s and adolescents’ diet quality, in the framework of a food aid and promotion of healthy nutrition programme implemented in areas of low socio-economic status of Greece, during the current financial crisis.

Design

From a total of 162 schools participating in the programme during 2012–2013, we gathered 15 897 questionnaires recording sociodemographic characteristics, lifestyle parameters and dietary habits of children and their families. As a measure of socio-economic status, the Family Affluence Scale (FAS) was used; whereas for the assessment of diet quality, the KIDMED score was computed. Associations between KIDMED and FAS, physical activity and socio-economic parameters were examined using regression and classification–regression tree analysis (CART).

Results

The higher the FAS score, the greater the percentage of children and adolescents who reported to consume, on a daily basis, fruits and vegetables, dairy products and breakfast (P<0·001). Results from CART showed that children and adolescents in the medium or high FAS groups had higher KIDMED score, compared with those in the low FAS group. For those in the low FAS group, KIDMED score is expected to increase by 12·4 % when they spend more than 0·25 h/week in sports activities. The respective threshold for the medium and high FAS groups is 1·75 h/week, while education of the mother and father affected KIDMED score significantly as well.

Conclusions

Diet quality is strongly influenced by socio-economic parameters in children and adolescents living in economically disadvantaged areas of Greece, so that lower family affluence is associated with worse diet quality.

Depressive symptoms are associated with excess weight and unhealthier lifestyle behaviors in urban adolescents

BACKGROUND

Adolescence is a critical period for the development of depressive symptoms and obesity. This study examined the association of depressive symptoms with standardized BMI (BMI z-score), lifestyle behaviors, and self-efficacy measures in a sample of urban adolescents.

METHODS

A school-based study was conducted among adolescents (N=1508) enrolled from 11 public schools. Depressive symptoms were assessed with Kandel's depressive symptoms scale for adolescents. Fruit and vegetable intake and intake of energy-dense foods were assessed by a short food frequency questionnaire. Sedentary behavior and physical activity (PA) were obtained by self-report. Height and weight were measured directly and BMI z-scores were calculated. Mixed-effects models were used to examine the association of depressive symptoms with BMI z-score and lifestyle behaviors, accounting for clustering at school level and adjusting for confounders. Self-efficacy measures were evaluated as potential mediators.

RESULTS

The sample was 53% female, 75% Hispanic, and 82% US born, with a mean age of 13.9 years. Higher depressive symptoms were associated with higher BMI z-score (β=0.02; p=0.02), intake of energy-dense foods (β=0.42; p<0.001), and sedentary behavior (β=0.48; p<0.001), but lower PA (β=-0.03; p=0.01). There was an interaction by gender in the association of depressive symptoms and PA. Self-efficacy mediated the association of depressive symptoms and PA.

CONCLUSIONS

Obesity prevention and treatment programs should consider addressing the role of negative emotions as part of their preventive strategies.