Socio-environmental influences on physical activity among young people: a qualitative study

Associations of family socioeconomic indicators and physical activity of primary school-aged children: a systematic review

BACKGROUND

Family socioeconomic indicators (education, occupation, and household income) are key determinants influencing children's physical activity (PA). This study aims to systematically review the current research about the association between family socioeconomic indicators and PA among primary school-aged children and to quantify the distribution of reported associations by childs' and parents' sex and according to analysis and assessment methods.

METHODS

A systematic literature research in multiple scientific databases (MEDLINE via PubMed, Web of Science, ScienceDirect, SPORTDiscus and ERIC) was performed for literature published between 1st January 2010 and 31st March 2022. Only studies reporting statistical associations between an SES indicator of at least one parent (education, occupation, income, or an SES index) and different types and intensities of PA in primary school-aged children (6 to 12 years) were included in the analysis. The distributions of the reported associations were evaluated across and differentiated by sub-group analysis of assessment methods (objectively measured vs. self-reported PA) and analysis methods (univariate vs. multivariate models).

RESULTS

Overall, 93 studies reported in 77 publications were included in this review. Most of the studies were conducted in Europe and used self-reports (questionnaires) to assess PA. Most studies used only a single SES indicator (commonly maternal education), and only two studies calculated an SES index. The majority of the studies focused on moderate-to-vigorous physical activity (MVPA), total physical activity (TPA), and organized physical activity (OPA). Results showed predominantly positive associations between SES indicators and OPA. In contrast, results regarding different intensities of daily PA (TPA, LPA, MPA, MVPA, VPA, LTPA) were heterogeneous, with overwhelmingly no associations.

CONCLUSION

Overall, the results expand the knowledge about the association between family socioeconomic indicators and children's PA and disprove the hypothesis of a clear positive association. However, large multicenter studies are lacking using a real SES index as a predictor and analyzing gender-specific multivariate models.

Sports Practice, Body Image Perception, and Factors Involved in Sporting Activity in Italian Schoolchildren

Regular physical activity is generally deemed to positively affect health, but studies on children are scarce. Among the kinds of physical activity, sports practice is the most common and easiest to quantify and report by children. This cross-sectional study aimed to compare the two genders and evaluate the association between organized sports practice and body dissatisfaction in a sample of 214 Italian schoolchildren (55.6% males) aged 5 to 12. Body image perception and data on sports practice expectations and facilitators were collected in individual face-to-face interviews; weight and stature were directly measured. Girls tended to be sportier than boys (91.6% of girls vs. 86.3% of boys practiced sports), with an earlier start in sports (5.48 ± 1.47 vs. 5.72 ± 1.38 years) and a greater amount of weekly sports (3.41 ± 2.95 vs. 3.01 ± 2.11 h/week). In both genders, the ideal silhouette was more slender than the feel silhouette, and in girls more than in boys. According to the outcomes of multiple regression models, years of organized sports participation were a significant predictor of the weekly amount of sports in both genders, in addition to the feel weight status minus actual weight status inconsistency score, fun in sports, and parental support only in boys and teacher support only in girls. Children's needs and interests and sports facilitators should be considered to promote an early active lifestyle.

Physical Activity Levels, Perceived Body Appearance, and Body Functioning in Relation to Perceived Wellbeing Among Adolescents

This study aimed to investigate self-reported physical activity levels, perceived body appearance, and body functioning in relation to perceived wellbeing among adolescents. A cross-sectional survey was performed in four upper secondary schools in one municipality in southern Sweden. Data were obtained from questionnaires completed by 1,491 adolescents (55.4% females; median age 16; range 15–17 years) during school hours. The participation rate was 71.4%. Logistic regression analyses were carried out with wellbeing as the dependent variable. The independent variables included gender, perceived family financial situation, perceived body appearance, perceived body function, and physical activity level. Perceived positive wellbeing was associated with being satisfied with their body's appearance (OR 3.4; CI 2.6–4.4) and function (OR 3.1; CI 2.2–4.2), being physically active three or more times per week (OR 1.5; CI 1.1–2.0), and a good perceived family financial situation (OR 3.3; CI 1.6–6.7). Gender was not significantly associated with wellbeing. A positive body image, which include both body appearance and body function, and high physical activity levels were significantly associated with wellbeing in adolescents, corroborating the importance of promoting physical activity among younger populations.

Children's perceptions of factors influencing their physical activity: a focus group study on primary school children

Purpose

Establishing healthy lifestyle behaviours in primary school children is important, as these behaviours are likely to track into adulthood. This study aimed to explore the factors influencing physical activity (PA) in primary school children through their perspectives.

Approach

Eleven focus group discussions and one interview were conducted with 52 children (n = 29 girls) aged 9–12 years from two primary schools in Singapore. Data analyses were conducted using thematic analysis, deductively following the socio-ecological model (SEM) and inductively for themes at each SEM level.

Results

At individual level, children’s perceived enjoyment, health benefits and expectation of rewards motivated them to engage in PA, while time constraints and their apathy towards PA hindered PA engagement. Children’s PA occasions at home were reported to be influenced by parental permission, priorities and availability, and the availability of preferred peers. Physical environmental factors such as opportunities for PA in school, access to facilities for PA and weather influenced children’s time spent on PA and the types of activities they engaged in.

Conclusion

This study summarized some factors that children have reported to influence their PA behaviour. These findings could help inform future interventions aimed at promoting PA among primary school children in Singapore.

Important park features for encouraging park visitation, physical activity and social interaction among adolescents: A conjoint analysis

Little is known about what park features adolescents perceive as most important for encouraging them to visit and be active and social in parks. This study examined the relative importance of park features for encouraging these behaviours among adolescents and explored differences according to gender and frequency of visitation. Adolescents were recruited from secondary schools in diverse areas of Melbourne, Australia. In Phase 1 (2018-2019), participants [n = 222; 14.0 years (SD 1.1); 46% female] rated photographs of 40 park features in an online survey, indicating the degree to which each feature encouraged them to visit, and be active and social in the park. In Phase 2 (2019-2020), the top ten-rated features from Phase 1 for each outcome (overall and by gender and frequency of visitation) were presented in Adaptive Choice-Based Conjoint tasks to another sample of participants [n = 244; 14.7 years (SD 1.3); 46% female]. The most important feature for encouraging visitation was large swings; for physical activity was sports courts; and for social interaction was a café. Grassy open space was important for all behaviours, and preferred park features varied among sub-groups. The results highlight which park features park planners and designers should prioritise to support active and social park use among adolescents.

It doesn't hurt to TRY - Experiences of youths participating in a TRYathlon event series

ISSUE ADDRESSED

Running since 1999, the Sanitarium Weet-Bix Kids TRYathlon (SWKT) is the world's largest triathlon series for children and adolescents up to 16 years. This report seeks to describe participants of the TRYathlon and their perceptions of the event.

METHODS

An online survey was made available to Australian parents/guardians of participants enrolled in the 2020 SWKT. Organisational data was also employed to describe the reach of the SWKT since its inception.

RESULTS

Parents/guardians (n = 568) reported that the average child age was 9.12 (SD = 1.95, range = 6-16) and 58.6% were male. Parents/guardians identified 12 children as Aboriginal and/or Torres Strait Islander (2.0%) and 87 (14.6%) spoke a language other than English. The majority of parents/guardians rated their child's physical activity (PA) competencies as pretty good, or really good, for cycling (87.5%), swimming (80.9%) and running (79.5%). Most parents (66.0%) stated that their child was glowing with pride after completing the event, enjoyed or really enjoyed the event (98.8%), and thought their child would maintain their PA levels following the event (72.9%).

CONCLUSIONS

The SWKT series has demonstrated longevity and an ability to reach a large number of participants, providing opportunities to build health promotion awareness. Importantly the event instils a sense of confidence and pride related to PA competency in its participants; however, its long-term effectiveness requires further exploration. SO WHAT?: Mass participation events such as SWKT could be incorporated into larger health promotion strategies to encourage childhood PA and foster healthy physical and psychosocial development.

A health and wellbeing programme for preadolescents in underserved Australian communities: child and stakeholder perspectives

Social inequities in childhood affect children's health and development. Active In-Betweens is a weekly, healthy lifestyle and outdoor activity after-school programme, tailor-made for preadolescent children (9-12 year olds), incorporating a strengths-based, trauma-informed, co-designed and place-based approach. This study evaluated the extent to which the programme strategies and activities met the anticipated short- to medium-term programme outcomes during its first year of operation in two socio-economically disadvantaged housing communities in New South Wales, Australia. A qualitative case study used data from semi-structured interviews with child participants (n = 11) and key stakeholders (n = 10). A broad range of positive outcomes were described. Children's feedback indicated they had experienced opportunities which facilitated the development of new physical activity skills; new healthy eating experiences and knowledge; positive relationships with peers and facilitators and new connections with neighbourhood programmes and outdoor environments. Stakeholders valued the programme for the positive outcomes they observed among the children and the strong organizational partnerships which resulted. The importance of skilled facilitators to deliver the programme, the engagement of local stakeholders and a long-term commitment to programme delivery, with secure funding to ensure continuity, were clearly identified as integral for effective, sustainable outcomes.

Insomnia in Relation to Academic Performance, Self-Reported Health, Physical Activity, and Substance Use Among Adolescents

Purpose: Insomnia affects up to one in four adolescents and has been shown to have a negative impact on their mental and physical health. This study aimed to investigate the association between insomnia, academic performance, self-reported health, physical activity, school start time, and substance use among adolescents. Methods: A survey with a cross-sectional design was completed by adolescents (15–17 years old; n = 1504) in southern Sweden. The Minimal Insomnia Symptoms Scale (MISS) was used to operationalize insomnia. A multiple logistic regression analysis was used to analyze the relationship between insomnia and self-reported health, failed school courses, substance use, school start time, family financial situation, screen time, and gender. Results: Insomnia (MISS ≥ 6) was associated with poor self-reported health (OR: 4.35), failed school courses (OR: 1.47), and use of alcohol and/or cigarettes (OR: 1.43). When the combined effect of self-reported health and physical activity were investigated, a combination of low physical activity (≤1 time/week) and poor self-reported health was strongly associated with insomnia (OR: 18.87). Conclusions: Insomnia was associated with other problems that in themselves are risk factors for poor health. This highlights the need for a holistic health-promoting approach to prevent insomnia, such as efforts to promote physical activity, school success, and the reduction of alcohol/cigarette use.

Impact of school and work status on diet and physical activity in rural Guatemalan adolescent girls: a qualitative study

In low‐ and middle‐income countries, gender norms and access to energy‐dense, nutrient‐poor foods are well‐studied determinants of food and physical activity choices for adolescent girls. However, most work has been done in urban and school settings. In many settings, a large proportion of the adolescent population is rural or not enrolled in school. We conducted in‐depth interviews with 20 adolescent girls (ages 15–19) in Tecpán, Guatemala, a rural, largely indigenous Maya community. Interviews were coded and themes analyzed for insights into eating habits, food choices, and physical activity. Twelve participants were enrolled in school and eight were employed and not in school. Girls enrolled in school had more disrupted eating schedules and consumed more energy‐dense, nutrient‐poor foods. Girls not enrolled in school had fewer opportunities for physical activity and were more sedentary. To our knowledge, this study is the first in a low‐ and middle‐income country to consider diet and physical activity of adolescent girls enrolled and not enrolled in school. Key implications include (1) the need to reduce exposure to nutrient‐poor foods and promote healthy eating schedules in schools, and (2) the need to create community‐based opportunities for the activity for girls no longer enrolled in school.

Factors influencing patient uptake of an exercise referral scheme: a qualitative study

Exercise referral schemes aim to increase physical activity amongst inactive individuals with or at risk of long-term health conditions. Yet many patients referred to these schemes (by health professionals) fail to take up the exercise opportunities on offer. Understanding factors influencing uptake to exercise referral schemes may help improve future attendance. Using the Socio-Ecological Model as a framework, this qualitative study aimed to explore factors influencing uptake to an exercise referral scheme based in the North West of England. Semi-structured interviews were conducted with referred patients (n = 38) about their reasons for referral, interactions with referring health professionals, events following referral and ideas to improve future uptake. Data were analysed thematically and mapped onto the constructs of the Socio-Ecological Model. Factors reported to influence uptake included intrapersonal (past PA experiences, motivation, competing priorities), interpersonal (scheme explanations, support) and organizational influences (scheme promotion, communication between service, cost). Whilst several intrapersonal-level factors influenced patient decisions to uptake the exercise referral scheme, modifiable interpersonal and organizational factors were identified as potential targets for intervention. Recommendations are made for improving awareness of exercise referral schemes and for enhancing communication between referring practitioners, patients and referral scheme staff.

Influence of individual and family factors on physical activity among Saudi girls: a cross-sectional study

BACKGROUND

Physical inactivity is a major public health problem and one of the main causes of noncommunicable diseases among children. The physical activity (PA) of children has been studied extensively in other countries, but not in Saudi Arabia, most especially among school-based girls.

OBJECTIVES

Assess the PA among older Saudi girls (10-15 years old) and determine the influence of various personal and family factors on PA.

DESIGN

Descriptive, cross-sectional study.

SETTING

Primary and middle schools in Riyadh, Saudi Arabia.

SUBJECTS AND METHODS

Using a multi-stage stratified sampling technique, school girls were surveyed using the Physical Activity Questionnaire for Older Children (PAQ-C). Personal and familial factors that influenced PA levels were assessed by multiple regression analysis.

MAIN OUTCOME MEASURES

PA levels of Saudi school girls.

SAMPLE SIZE

464 girls.

RESULTS

The mean (SD) score of the respondents in the PAQ-C was 2.63 (0.57, range=1.27-4.24). The majority of the older children re.ported a moderate level of PA in the last seven days (73.5%), whereas 22.4% and 4.1% of them reported low and high levels of PA, respectively. Employment status of the parents and monthly family income were significant factors that influenced the PA of children.

CONCLUSIONS

The findings reiterate the significance of improving the PA of school girls and the critical role of the family in improving chil.dren's PA. Multisectoral coordination between schools, health agencies, families, and other concerned agencies to plan and implement interventions should help increase the PA of school girls.

LIMITATIONS

The use of self-report may have introduced some levels of social desirability bias. The study was only conducted in a single city.

CONFLICT OF INTEREST

None.

Untapped Resources: 10- to 13-Year-Old Primary Schoolchildren's Views on Additional Physical Activity in the School Setting: A Focus Group Study

Schools are considered ideal venues to promote physical activity (PA) in children. However, a knowledge gap exists on how to adequately integrate PA into the school day and in particular, on the preferences of children regarding additional PA in school. Therefore, the aim of our qualitative study was to gain comprehensive insight into 10⁻13-year-old primary schoolchildren's perspectives on how to increase PA in the school setting. We conducted nine focus groups (32 girls and 20 boys) with children attending the final two grades of primary school in the Netherlands. We used inductive thematic analysis to analyze the data. The results showed that children were enthusiastic about additional PA in school. Children suggested various ways to increase PA, including more time for PA in the existing curriculum, e.g., physical education (PE), recess, and occasional activities, such as field trips or sports days; school playground adaptation; improving the content of PE; and implementing short PA breaks and physically active academic lessons. Children emphasized variation and being given a voice in their PA participation as a prerequisite to keep PA enjoyable and interesting in the long term. Finally, children mentioned the role of the teacher and making efforts to accommodate all children and their different preferences as important. Children have concrete ideas, acknowledging the challenges that accompany integrating additional PA in school. We therefore recommend actively involving children in efforts to increase school-based PA and to make "additional PA in school" a shared project of teachers and students.

Parent, school, and peer factors related to U.S. adolescents' diet and exercise

PURPOSE

Adolescent obesity is a significant public health problem in the United States. Developing interventions to prevent or improve adolescent obesity may positively affect physical and mental health across the lifespan. However, to ensure that interventions are effective, influential factors must first be identified. The purpose of this study was to examine associations among parent-, school-, and peer-related factors and diet and physical activity of the adolescents in the United States.

DESIGN AND METHODS

Using logistic regression analyses, cross-sectional data of 5,248 adolescents in grades 5-10 from 184 schools from the World Health Organization's 2009/2010 survey of Health Behavior in School-Aged Children (HBSC) for the United States were analyzed, including variables for parent, peer, and school factors.

RESULTS

Parent- and peer-related factors were associated with adolescents' diet and physical activity (PA). Peer factors were associated with time spent on PA, but not a parent or school factors. The type of school lunch program was the only school factor associated with diet; no school factors were associated with exercise.

PRACTICE IMPLICATIONS

Results of this secondary analysis extend prior work, which identified associations between parent- and peer factors and adolescents' diet and exercise. Findings will help identify targets for improving adolescents' diet and exercise behaviors.

Perceived barriers to achieving a healthy weight: a qualitative study using focus groups at public and private schools in Guatemala City

BACKGROUND

Overweight prevalence among Guatemalan girls is higher in public than in private schools. Little is known about adolescent girls' perceptions of the right ways to achieve a healthy weight. This study examines public and private school adolescent girls' perceptions of a "healthy weight," and barriers and facilitators to achieving it.

METHODS

We conducted 4 focus groups in public and private schools in Guatemala City with girls from 13 to 15 years old. The discussion guide included open-ended questions and activities aimed at examining perceptions of "healthy weight" and barriers and motivators to achieving it within the school environment. Focus groups were audio-recorded and transcribed. Data analyses followed established methods of content analysis.

RESULTS

Twenty-eight girls (private school, n = 12; public school, n = 16) of ages ranging from 13.1 to 15.9 years (median, 14, IQR, 13.6-14.9) participated in the study. Girls identified images of thin and fit women as healthy. They cited healthy eating and physical activity as ways to achieve a healthy weight. Within the school environment, barriers to maintaining a healthy weight included a lack of healthy food options and the prioritization of sports for boys over girls. In public schools, facilities were less than optimal; in private schools, girls' access to facilities was limited. Public school girls stated that their uniforms were inappropriate for exercising.

CONCLUSION

Our findings support the need to provide more healthy food options in Guatemalan schools. In addition, physical activity for girls should be promoted and facilities made available for their use.

The school environment and adolescent physical activity and sedentary behaviour: a mixed-studies systematic review

There is increasing academic and policy interest in interventions aiming to promote young people's health by ensuring that the school environment supports healthy behaviours. The purpose of this review was to summarize the current evidence on school-based policy, physical and social-environmental influences on adolescent physical activity and sedentary behaviour. Electronic databases were searched to identify studies that (1) involved healthy adolescents (11-18 years old), (2) investigated school-environmental influences and (3) reported a physical activity and/or sedentary behaviour outcome or theme. Findings were synthesized using a non-quantitative synthesis and thematic analysis. Ninety-three papers of mixed methodological quality were included. A range of school-based policy (e.g. break time length), physical (e.g. facilities) and social-environmental (e.g. teacher behaviours) factors were associated with adolescent physical activity, with limited research on sedentary behaviour. The mixed-studies synthesis revealed the importance of specific activity settings (type and location) and intramural sport opportunities for all students. Important physical education-related factors were a mastery-oriented motivational climate and autonomy supportive teaching behaviours. Qualitative evidence highlighted the influence of the wider school climate and shed light on complexities of the associations observed in the quantitative literature. This review identifies future research needs and discusses potential intervention approaches to be considered.

Immune-mediated Liver Injury in Hepatitis B Virus Infection

Hepatitis B virus (HBV) is responsible for approximately 350 million chronic infections worldwide and is a leading cause of broad-spectrum liver diseases such as hepatitis, cirrhosis and liver cancer. Although it has been well established that adaptive immunity plays a critical role in viral clearance, the pathogenetic mechanisms that cause liver damage during acute and chronic HBV infection remain largely known. This review describes our current knowledge of the immune-mediated pathogenesis of HBV infection and the role of immune cells in the liver injury during hepatitis B.

Age and time effects on children's lifestyle and overweight in Sweden

BACKGROUND

High physical activity, low sedentary behavior and low consumption of sugar-sweetened beverages can be markers of a healthy lifestyle. We aim to observe longitudinal changes and secular trends in these lifestyle variables as well as in the prevalence of overweight and obesity in 7-to-9-year-old schoolchildren related to gender and socioeconomic position.

METHODS

Three cross-sectional surveys were carried out on schoolchildren in grades 1 and 2 (7-to-9-year-olds) in 2008 (n = 833), 2010 (n = 1085), and 2013 (n = 1135). Information on children's level of physical activity, sedentary behavior, diet, and parent's education level was collected through parental questionnaires. Children's height and weight were also measured. Longitudinal measurements were carried out on a subsample (n = 678) which was included both in 2008 (7-to-9-year-olds) and 2010 (9-to-11-year-olds). BMI was used to classify children into overweight (including obese) and obese based on the International Obesity Task Force reference. Questionnaire reported maternal education level was used as a proxy for socioeconomic position (SEP).

RESULTS

Longitudinally, consumption of sugar-sweetened beverages ≥ 4 days/week increased from 7% to 16% in children with low SEP. Overall, sedentary behavior > 4 hours/day doubled from 14% to 31% (p < 0.001) and sport participation ≥ 3 days/week increased from 17% to 37% (p < 0.001). No longitudinal changes in overweight or obesity were detected. In the repeated cross-sectional observations sedentary behavior increased (p = 0.001) both in high and low SEP groups, and overweight increased from 13.8% to 20.9% in girls (p < 0.05). Overall, children with high SEP were less-often overweight (p < 0.001) and more physically active (p < 0.001) than children with low SEP.

CONCLUSIONS

Children's lifestyles changed longitudinally in a relatively short period of two years. Secular trends were also observed, indicating that 7-9-year-olds could be susceptible to actions that promote a healthy lifestyle. Socioeconomic differences were consistent and even increasing when it came to sugar-sweetened beverage consumption. Decreasing the socioeconomic gap in weight status and related lifestyle variables should be prioritized. Primary school is an arena where most children could be reached and where their lifestyle could be influenced by health promoting activities.

Low socio-economic environmental determinants of children's physical activity in Coventry, UK: A Qualitative study in parents

Background

Children's physical activity (PA) is affected by socio-economic status (SES) and the environment. Children are not fully autonomous in their decision making; parental decisions thus affect how children utilise their surrounding environments for PA. The aim was to examine environmental influences on children's PA from a qualitative perspective in parents from low SES wards in Coventry, UK.

Method

59 parents of children in year 4 (aged 8–9years) completed the ALPHA environmental questionnaire. 16 of these parents took part in focus group discussions examining environmental facilitators and barriers to their child's PA (March–April, 2013).

Results

Emerging themes related to physical (i.e. poor access, safety and quality of the neighbourhood) and social environment (i.e. ‘rough’ neighbourhood due to crime and anti-social behaviour) influences on the PA behaviour of children. The parents believed these environmental factors resulted in the children engaging in greater sedentary activity (watching TV) indoors. The school environment was perceived as a supportive physical environment for children's PA behaviour.

Conclusion

Parent's perceptions of an unsupportive physical and social environment restrict children's opportunities to play outside and be physically active and may lead to increased body fat (BF). Schools provide a supportive environment for children from low SES to be physically active in.

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Qualitative study exploring the effect of parental perceptions on child's physical activity.

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Poor perceptions of the physical and social environment limit children's physical activity.

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Parents' safety concerns limit children's physical activity to indoors.

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Religious practice limits time available for physical activity in Muslim children.