Which physical and social characteristics of Brazilian cities contribute to physical activity of adolescents?

This study aimed to analyze the association between adolescents' physical activity and the Brazilian capitals' built and social environment. The units of analysis of this ecological study were the 26 capitals and the Federal District, with data from the National Adolescent Health Survey (2012). The outcome variable was the reported regular physical activity (PA) of ninth graders in Brazilian schools. Exposure variables included characteristics of the natural environment, socioeconomic and educational indicators, urban infrastructure, urban violence, and sociocultural factors retrieved from several secondary sources of Brazilian databases. We adopted multiple linear regression to verify the association between PA and exposure variables. The percentage of active adolescents was 33.0% (95%CI: 32.1; 33.9). In the final model, higher PA was associated with lower temperature, higher Primary Education Development Index, the higher percentage of ramps for wheelchair users, and a higher percentage of leisure-time active adults. The data show that climatic and educational factors, the infrastructure, and the social environment of the capitals can contribute to Brazilian adolescents complying with the recommended weekly PA levels.

Examining Place-Based Neighborhood Factors in a Multisite Peer-Led Healthy Lifestyle Effectiveness Trial for People with Serious Mental Illness

People with severe mental illness (SMI) experience significantly higher obesity-related comorbidities and premature mortality rates than healthy populations. The physical and social characteristics of neighborhoods where people with SMI reside can play an important role in promoting or hindering healthy eating and physical activity. However, this is seldom considered when designing and testing health behavior interventions for these populations. This study used baseline data from an obesity control trial for low-income, minority people with SMI to demonstrate the utility of assessing neighborhood- and city-level place-based factors within the context of lifestyle interventions. GIS was used to create a zip-code-level social and built environment geodatabase in New York City and Philadelphia, where the trial occurred. Chi-square and t-tests were used to assess differences in the spatial distribution of health-related built and social environment characteristics between and within cities and diet and physical activity outcomes. All types of neighborhood characteristics showed significant environmental differences between and within cities. Several neighborhood characteristics were associated with participants' baseline healthy eating and physical activity behaviors, emphasizing that place-based factors may moderate lifestyle interventions for SMI patients. Future behavioral interventions targeting place-dependent behaviors should be powered and designed to assess potential moderation by place-based factors.

Associations between Park and Playground Availability and Proximity and Children's Physical Activity and Body Mass Index: The BEACH Study

A cross-sectional study was designed to evaluate the relationship between the availability and proximity to parks and playgrounds and physical activity (PA). Moreover, the accessibility to parks and playgrounds and its association with active commuting to/from school (ACS) and body mass index (BMI) were analyzed. The sample was composed of children aged 6-12 years old from the BEACH (Built Environment and Active CHildren) study in Valencia, Spain. The availability and proximity to parks and playgrounds were calculated at different buffer sizes (250, 500, 1000 and 1250 m) using geographical information system data. PA out of school was assessed using accelerometers. Sociodemographics and ACS were measured with a parent questionnaire. Objectively measured weight and height were used to calculate BMI. Mixed linear regression analyses were conducted for each exposure variable, adjusting for sociodemographics, neighborhood walkability level, and participant clustering. The number of parks and playgrounds were positively associated with moderate to vigorous PA (MVPA) and total PA (TPA); including light PA and MVPA, during weekdays, in different buffer sizes. A negative relationship between distance to the nearest playground and TPA during weekdays was found. In addition, the number of playgrounds was positively related to ACS in different buffer sizes, whereas park land area was negatively related to the BMI percentile. This study highlights the importance of assessing the availability and proximity to parks and playgrounds in children's neighborhoods when PA behavior and weight status are analyzed. Study findings may help policymakers when targeting interventions to promote health-enhancing behaviors in children.

Measuring the Built Environment in Studies of Child Health-A Meta-Narrative Review of Associations

Although the built environment (BE) is important for children’s health, there is little consensus about which features are most important due to differences in measurement and outcomes across disciplines. This meta-narrative review was undertaken by a multi-disciplinary team of researchers to summarise ways in which the BE is measured, and how this links to children’s health. A structured search of four databases across the relevant disciplines retrieved 108 relevant references. The most commonly addressed health-related outcomes were active travel, physical activity and play, and obesity. Many studies used objective (GIS and street audits) or standardised subjective (perceived) measurements of the BE. However, there was a wide variety, and sometimes inconsistency, in their definition and use. There were clear associations between the BE and children’s health. Objective physical activity and self-reported active travel, or obesity, were positively associated with higher street connectivity or walkability measures, while self-reported physical activity and play had the strongest association with reduced street connectivity, indicated by quieter, one-way streets. Despite the high heterogeneity found in BE measures and health outcomes, the meta-narrative approach enabled us to identify ten BE categories that are likely to support children’s health and be protective against some non-communicable disease risk factors. Future research should implement consistent BE measures to ensure key features are explored. A systems approach will be particularly relevant for addressing place-based health inequalities, given potential unintended health consequences of making changes to the BE.

Nature and Children's Health: A Systematic Review

CONTEXT

Daily outdoor play is encouraged by the American Academy of Pediatrics. Existing evidence is unclear on the independent effect of nature exposures on child health.

OBJECTIVE

We systematically evaluated evidence regarding the relationship between nature contact and children's health.

DATA SOURCES

The database search was conducted by using PubMed, Cumulative Index to Nursing and Allied Health Literature, PsychInfo, ERIC, Scopus, and Web of Science in February 2021.

STUDY SELECTION

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In all searches, the first element included nature terms; the second included child health outcome terms.

DATA EXTRACTION

Of the 10 940 studies identified, 296 were included. Study quality and risk of bias were assessed.

RESULTS

The strongest evidence for type of nature exposure was residential green space studies (n = 147, 50%). The strongest evidence for the beneficial health effects of nature was for physical activity (n = 108, 32%) and cognitive, behavioral, or mental health (n = 85, 25%). Physical activity was objectively measured in 55% of studies, and 41% of the cognitive, behavioral, or mental health studies were experimental in design.

LIMITATIONS

Types of nature exposures and health outcomes and behaviors were heterogenous. Risk of selection bias was moderate to high for all studies. Most studies were cross-sectional (n = 204, 69%), limiting our ability to assess causality.

CONCLUSIONS

Current literature supports a positive relationship between nature contact and children's health, especially for physical activity and mental health, both public health priorities. The evidence supports pediatricians in advocating for equitable nature contact for children in places where they live, play, and learn.

Mediation role of residential density on the association between perceived environmental factors and active commuting to school in Brazilian adolescents

The objective of this study was to verify whether residential density and connectivity between streets are mediators on the association between perceived environmental factors and active commuting to school (ACS) in Brazilian adolescents. This is a cross-sectional study with a random sample of 1,130 adolescents (52.7% girls) aged between 14 to 20 years, from Porto Alegre, Rio Grande do Sul State, Brazil. Adolescents' self-reported their usual mode of commuting to and from school using a questionnaire and the perceived environmental attributes by Neighborhood Environment Walkability Scale for Youth (NEWS-Y). Residential density and connectivity between streets were measured by gographic information systems (GIS), within 1km road network buffers around the participant's residential address. Regression models were fitted according to mediation analyses procedures. The results showed that residential density is a mediator on the association between ACS and perceived environmental factors, including land-use mix diversity (IE = 0.114; 95%CI: 0.130, 0.311; 32% mediation), neighborhood recreation facilities (IE = 0.064; 95%CI: 0.034, 0.105; 15% mediation), and access to services (IE = 0.045; 95%CI: 0.006, 0.104; 14% mediation). Connectivity between streets did not correlate with ACS, thus it was not tested in the mediation model. In conclusion, residential density is a mediator on the relationship between perceived environmental factors and ACS.

A national examination of neighborhood socio-economic disparities in built environment correlates of youth physical activity

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Most U.S. adolescents do not meet current physical activity guidelines.

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Built environments and neighborhood socioeconomic status may impact activity.

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Examined neighborhood walkability using geocoded home addresses and Census data.

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Living in areas with walkable attributes was associated with more physical activity.

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Walkability and activity associations varied by neighborhood socioeconomic status.

Adolescents in the U.S. do not meet current physical activity guidelines. Ecological models of physical activity posit that factors across multiple levels may support physical activity by promoting walkability, such as the neighborhood built environment and neighborhood socioeconomic status (nSES). We examined associations between neighborhood built environment factors and adolescent moderate-to-vigorous physical activity (MVPA), and whether nSES moderated associations. Data were drawn from a national sample of adolescents (12–17 years, N = 1295) surveyed in 2014. MVPA (minutes/week) were estimated from self-report validated by accelerometer data. Adolescents’ home addresses were geocoded and linked to Census data from which a nSES Index and home neighborhood factors were derived using factor analysis (high density, older homes, short auto commutes). Multiple linear regression models examined associations between neighborhood factors and MVPA, and tested interactions between quintiles of nSES and each neighborhood factor, adjusting for socio-demographics. Living in higher density neighborhoods (B(SE): 9.22 (2.78), p = 0.001) and neighborhoods with more older homes (4.42 (1.85), p = 0.02) were positively associated with adolescent MVPA. Living in neighborhoods with shorter commute times was negatively associated with MVPA (−5.11 (2.34), p = 0.03). Positive associations were found between MVPA and the high density and older homes neighborhood factors, though associations were not consistent across quintiles. In conclusion, living in neighborhoods with walkable attributes was associated with greater adolescent MVPA, though the effects were not distributed equally across nSES. Adolescents living in lower SES neighborhoods may benefit more from physical activity interventions and environmental supports that provide opportunities to be active beyond neighborhood walkability.

International Physical Activity and Built Environment Study of adolescents: IPEN Adolescent design, protocol and measures

INTRODUCTION

Only international studies can provide the full variability of built environments and accurately estimate effect sizes of relations between contrasting environments and health-related outcomes. The aims of the International Physical Activity and Environment Study of Adolescents (IPEN Adolescent) are to estimate the strength, shape and generalisability of associations of the community environment (geographic information systems (GIS)-based and self-reported) with physical activity and sedentary behaviour (accelerometer-measured and self-reported) and weight status (normal/overweight/obese).

METHODS AND ANALYSIS

The IPEN Adolescent observational, cross-sectional, multicountry study involves recruiting adolescent participants (ages 11-19 years) and one parent/guardian from neighbourhoods selected to ensure wide variations in walkability and socioeconomic status using common protocols and measures. Fifteen geographically, economically and culturally diverse countries, from six continents, participated: Australia, Bangladesh, Belgium, Brazil, Czech Republic, Denmark, Hong Kong SAR, India, Israel, Malaysia, New Zealand, Nigeria, Portugal, Spain and USA. Countries provided survey and accelerometer data (15 countries), GIS data (11), global positioning system data (10), and pedestrian environment audit data (8). A sample of n=6950 (52.6% female; mean age=14.5, SD=1.7) adolescents provided survey data, n=4852 had 4 or more 8+ hours valid days of accelerometer data, and n=5473 had GIS measures. Physical activity and sedentary behaviour were measured by waist-worn ActiGraph accelerometers and self-reports, and body mass index was used to categorise weight status.

ETHICS AND DISSEMINATION

Ethical approval was received from each study site's Institutional Review Board for their in-country studies. Informed assent by adolescents and consent by parents was obtained for all participants. No personally identifiable information was transferred to the IPEN coordinating centre for pooled datasets. Results will be communicated through standard scientific channels and findings used to advance the science of environmental correlates of physical activity, sedentary behaviour and weight status, with the ultimate goal to stimulate and guide actions to create more activity-supportive environments internationally.

Different neighborhood walkability indexes for active commuting to school are necessary for urban and rural children and adolescents

BACKGROUND

Literature focusing on youth has reported limited evidence and non-conclusive associations between neighborhood walkability measures and active commuting to and from school (ACS). Moreover, there is a lack of studies evaluating both macro- and micro-scale environmental factors of the neighborhood when ACS is analyzed. Likewise, most studies on built environment attributes and ACS focus on urban areas, whereas there is a lack of studies analyzing rural residential locations. Moreover, the relationship between built environment attributes and ACS may differ in children and adolescents. Hence, this study aimed to develop walkability indexes in relation to ACS for urban and rural children and adolescents, including both macro- and micro-scale school-neighborhood factors.

METHODS

A cross-sectional study of 4593 participants from Spain with a mean age of 12.2 (SD 3.6) years was carried out. Macro-scale environmental factors were evaluated using geographic information system data, and micro-scale factors were measured using observational procedures. Socio-demographic characteristics and ACS were assessed with a questionnaire. Several linear regression models were conducted, including all the possible combinations of six or less built environment factors in order to find the best walkability index.

RESULTS

Analyses showed that intersection density, number of four-way intersections, and residential density were positively related to ACS in urban participants, but negatively in rural participants. In rural children, positive streetscape characteristics, number of regulated crossings, traffic calming features, traffic lanes, and parking street buffers were also negatively related to ACS. In urban participants, other different factors were positively related to ACS: number of regulated crossings, positive streetscape characteristics, or crossing quality. Land use mix acted as a positive predictor only in urban adolescents. Distance to the school was a negative predictor on all the walkability indexes. However, aesthetic and social characteristics were not included in any of the indexes.

CONCLUSIONS

Interventions focusing on improving built environments to increase ACS behavior need to have a better understanding of the walkability components that are specifically relevant to urban or rural samples.

A GIS-Based Method for Analysing the Association Between School-Built Environment and Home-School Route Measures with Active Commuting to School in Urban Children and Adolescents

In the current call for a greater human health and well-being as a sustainable development goal, to encourage active commuting to and from school (ACS) seems to be a key factor. Research focusing on the analysis of the association between environmental factors and ACS in children and adolescents has reported limited and inconclusive evidence, so more knowledge is needed about it. The main aim of this study is to examine the association between different built environmental factors of both school neighbourhood and home-school route with ACS of children and adolescents belonging to urban areas. The ACS level was evaluated using a self-reported questionnaire. Built environment variables (i.e., density of residents, street connectivity and mixed land use) within a school catchment area and home-school route characteristics (i.e., distance and pedestrian route directness—PRD) were measured using a geographic information system (GIS) and examined together with ACS levels. Subsequently, the association between environmental factors and ACS was analysed by binary logistic regression. Several cut-off points of the route measures were explored using receiver operating characteristic (ROC) curves. In addition, the PRD was further studied regarding different thresholds. The results showed that 70.5% of the participants were active and there were significant associations between most environmental factors and ACS. Most participants walked to school when routes were short (distance variable in children: OR = 0.980; p = 0.038; and adolescents: OR = 0.866; p < 0.001) and partially direct (PRD variable in children: OR = 11.334; p < 0.001; and adolescents: OR = 3.513; p < 0.001), the latter specially for children. Mixed land uses (OR = 2.037; p < 0.001) and a high density of street intersections (OR = 1.640; p < 0.001) clearly encouraged adolescents walking and slightly discouraged children walking (OR = 0.657, p = 0.010; and OR = 0.692, p = 0.025, respectively). The assessment of ACS together with the environmental factors using GIS separately for children and adolescents can inform future friendly and sustainable communities.

Neighborhood Built Environment and Socioeconomic Status are Associated with Active Commuting and Sedentary Behavior, but not with Leisure-Time Physical Activity, in University Students

The role of neighborhood characteristics in promoting physical activity and sedentary behaviors (SB) has not been extensively studied in university students. The study purpose was to analyze the associations of neighborhood built environment and neighborhood socioeconomic status (SES) with active commuting, leisure-time physical activity (LTPA), and SB among university students. This is a cross-sectional study of 308 undergraduate students from two urban universities in Valencia, Spain. Participants' residential neighborhoods were classified according to walkability and SES levels. Walkability was defined as an index of three built environment attributes (i.e., residential density, land-use mix, and street connectivity) based on geographical information system data. Active commuting to and from university (ACU), active commuting in the neighborhood, LTPA, and SB were evaluated through a questionnaire. Mixed model regression analyses were performed. There were no significant SES-walkability interactions for any of the outcomes analyzed. However, university students living in more walkable areas reported two more ACU trips per week compared to those living in less walkable neighborhoods (p < 0.01). University students living in lower-SES neighborhoods reported more ACU trips per week than those living in higher-SES neighborhoods (p < 0.05). Regarding LTPA, there were no significant SES or walkability main effects. Neighborhood SES was negatively related to active commuting in the neighborhood and to time spent in SB (all p < 0.05). Participants living in lower-SES neighborhoods reported more active commuting per week and had the highest average minutes spent in SB. This study highlights the relevance of assessing university's residential environment when active transportation and SB are analyzed.