Neighbourhood urban form and individual-level correlates of leisure-based screen time in Canadian adults

Screen Use Time and Its Association With Mental Health Issues in Young Adults in India: Protocol for a Cross-Sectional Study

BACKGROUND

Screen use time has increased in the past decade owing to the increased availability and accessibility of digital devices and the internet. Several studies have shown an association between increased screen use time and mental health issues such as anxiety and depression. However, studies in the young adult population-a demographic with high screen use-and in low- and middle-income country settings are limited.

OBJECTIVE

This protocol describes a study that aims to measure self-reported screen use times and patterns in young adults (18-24 y) in India and assess if increased screen use time is associated with poorer mental well-being.

METHODS

This protocol describes a cross-sectional study of a pan-India, web-based convenience sample of young adults (18-24 y) with access to digital devices with a screen and a minimum of secondary school education. Participants will be recruited through people in the professional networks of the investigators, which includes pediatricians. The survey will also be distributed via the social media pages of our organization (X [X Corp], Instagram [Meta], Facebook [Meta], etc). Sociodemographic details will be collected through a questionnaire designed by the authors; screen use time and patterns will be assessed using an adaptation of the Screen Time Questionnaire to include data on different apps and websites used on digital devices; and mental health parameters will be gauged using the Warwick-Edinburgh Mental Well-Being Scale, Generalized Anxiety Disorder Scale, Perceived Stress Scale, and Patient Health Questionnaire. For statistical analysis, we will consider the following variables: (1) the primary independent variable is screen use time; (2) other independent variables include age, gender, residence: rural or urban, educational qualifications, employment status, stress associated with familial financial status, average sleep time, number of people living in a house or rooms in that house, BMI, substance use, and past psychiatric history; and (3) dependent variables include mental well-being, depression, anxiety, and perceived stress. To quantify the association between screen use time and mental health, we will perform a Bayesian multivariate multiple regression analysis that models the possibility of multiple alternative hypotheses while accounting for relevant sociodemographic covariables.

RESULTS

The survey instrument has been designed, and feedback has been obtained from the domain experts and members of our organization whose profile is similar to the potential study participants. The final data received after this study has been conducted will be analyzed and shared. As of January 2023, we have not yet initiated the data collection.

CONCLUSIONS

Based on the findings of this study, we will be able to establish a correlation between device- and use-specific screen use time and various mental health parameters. This will provide a direction to develop screen use time and mental health guidelines among young adults.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/39707.

The effect of neighborhood walkability on changes in physical activity and sedentary behavior during a 12-week pedometer-facilitated intervention

BACKGROUND

Pedometer-facilitated interventions encourage physical activity via the accumulation of steps. Mixed evidence suggests that neighborhood walkability might influence the effectiveness of physical activity interventions, including pedometer-facilitated interventions. Our study investigated the moderating effect of neighborhood walkability on immediate (4-week) and short-term (12-week) changes in self-reported neighborhood-specific leisure and transportation walking, leisure-based moderate and vigorous-intensity physical activity, and leisure-based screen time during a pedometer-facilitated intervention (UWALK).

METHODS

This quasi-experiment undertaken in Calgary (Canada) compared behavior changes during the 12-week intervention between two neighborhood groups classified as 'walkable' or 'car dependent' based on Walk Score®. Of the 573 volunteers (adults in the contemplation and preparation stages of physical activity behavior change), 466 participated in UWALK. Surveys captured sociodemographic characteristics, perceived neighborhood walkability, neighborhood preferences, motivation, physical activity and screen-based leisure. Covariate-adjusted linear mixed models estimated the differences in physical activity and leisure screen time between the neighborhood walkability groups at baseline, 4-weeks, and 12-weeks.

RESULTS

UWALK participants included mostly females (83%) and had an average age of 49.2 years. Weekly minutes of walking for transport inside the neighborhood was higher (p < .001) among participants from walkable versus car dependent neighborhoods at baseline (42.5 vs. 21.1), 4-weeks (81.2 vs. 48.2), and 12-weeks (87.2 vs. 48.0). Regardless of neighborhood walkability, all physical activity outcomes were higher and leisure screen time lower at 4-weeks and 12-weeks compared with baseline. We found no significant neighborhood group by time interactions.

CONCLUSIONS

Pedometer-facilitated interventions may be effective for supporting short-term changes in physical activity and sedentary behavior even among adults residing in low walkable neighborhoods.

The Associations Between Urban Form and Major Non-communicable Diseases: a Systematic Review

In the current century, non-communicable diseases (NCDs), particularly cardiovascular diseases, diabetes, cancer, and chronic respiratory diseases, are the most important cause of mortality all over the world. Given the effect of the built environment on people's health, the present study seeks to conduct a systematic review in order to investigate the relationship between urban form and these four major NCDs as well as their main risk factors. Two independent reviewers in November 2020 after an extensive search through PubMed and Scopus identified 77 studies. Studies published in English were included if they addressed one or more attributes of urban form in relation to any major NCDs and their main risk factors. Publication date, country, geographical scale, study design, methods of built environment measurement, and findings of the relationships among variables were extracted from eligible studies. The findings suggest that the elements of urban form (density, transportation and accessibility, characteristics of building and streetscape, land use, spatial layouts and configuration) could increase or inhibit these diseases through their effect on physical activity, diet, air pollution, blood pressure, and obesity. However, there are study shortages, contradictions, and ambiguities in these relationships which are mainly due to methodological and conceptual challenges. As a result, more in-depth research is needed to achieve solid and consistent results that could be made into clear guidelines for planning and designing healthier cities.

Associations between neighbourhood street connectivity and sedentary behaviours in Canadian adults: Findings from Alberta’s Tomorrow Project

Evidence suggests that neighbourhood street connectivity is positively associated with physical activity, yet few studies have estimated its associations with sedentary behaviour. We estimated the associations between space syntax derived street integration, a novel measure of street connectivity, and sedentary behaviours among Canadian adults. Data were sourced from a population-based study–Alberta’s Tomorrow Project (n = 14,758). Items from the International Physical Activity Questionnaire captured sedentary behaviour, including sitting and motor vehicle travel time and walking. Street integration was measured within a 1600m radius of participants’ homes. Covariate-adjusted linear regression models estimated the associations between street integration and sedentary behaviour. Street integration was significantly positively associated with daily minutes of sitting on week (b 6.44; 95CI 3.60, 9.29) and weekend (b 4.39; 95CI 1.81, 6.96) days, and for week and weekend days combined (b 5.86; 95CI 3.30, 8.41) and negatively associated with daily minutes of motor vehicle travel (b -3.72; 95CI -3.86, -1.55). These associations remained significant after further adjustment for daily walking participation and duration. More research is needed to understand the pathways by which street integration positively and or negatively affects sedentary behaviour.

THE EFFECTIVENESS OF AN 8-WEEK PHYSICAL ACTIVITY INTERVENTION INVOLVING WEARABLE ACTIVITY TRACKERS AND AN eHEATLH APPLICATION: A MIXED METHODS STUDY

BACKGROUND

Health promotion interventions incorporating wearable technology or eHealth applications can encourage participants to self-monitor and modify their physical activity and sedentary behavior. In 2020, a Calgary (Canada) recreational facility developed and implemented a health promotion intervention (Vivo Play Scientist program) that provided commercially-available wearable activity tracker (WT) and a customized eHealth dashboard to participants, free-of-cost.

OBJECTIVE

To independently evaluate the effectiveness of the Vivo Play Scientist program for modifying physical activity and sedentary behavior during the initial 8-weeks of the piloted intervention.

METHODS

Our concurrent mixed-methods study included a single-arm repeated-measures quasi-experiment and semi-structured interviews. Among the 318 eligible participants (≥18 years of age) registered for the program, 87 completed three self-administered online surveys (baseline, T0; 4-weeks, T1; and 8-weeks, T2). The survey captured physical activity, sedentary behavior, use of wearable technology and eHealth applications, and sociodemographic characteristics. Twenty-three participants were recruited using maximal variation sampling, and completed telephone-administered semi-structured interviews regarding their program experiences. Self-reported physical activity and sedentary behavior outcomes were statistically compared between the three time points using Friedman's tests. Thematic analysis was used to analyze the interview data.

RESULTS

The mean age of participants was 39.8 (SD 7.4) years and 74.7% were female. Approximately half of all participants had previously used wearable technology (46.0%) or an eHealth application (49.4%) prior to the intervention. On average, participants reported wearing the WT (Garmin Vivofit4) on 6.4 (SD 1.7) days in the past week at T1 and on 6.0 (SD 2.2) days in the past week at T2. On average participants reported using the dashboard on 1.6 (SD 2.1) days in the past week at T1 and 1.0 (SD 1.8) days in the past week at T2. The mean time spent walking at 8-weeks was significantly higher compared with baseline (T0 180.34 vs. T2 253.79 min/week, P=.005), with no significant differences for other physical activity outcomes. Compared to baseline, the mean time spent sitting was significantly lower at 4-weeks (T0 334.26 vs. T1 260.46 min/day, P<.001) and 8-weeks (T0 334.26 vs. T2 267.13 min/day, P<.001). Significant differences in physical activity and sitting between time points were found among subgroups based on the household composition, history of wearable technology use, and history of eHealth applications use. Participants described how wearing the Vivofit4 was beneficial in helping them to modify physical activity and sedentary behavior. The social support as a result of multiple members of the same household participating in the program, motivated changes in physical activity. Participants experienced improvements in their mental, physical, and social health.

CONCLUSIONS

Providing individuals with free-of-cost commercially-available wearable technology and an eHealth application has the potential to support increases in physical activity and reduce sedentary behavior in the short-term, even under COVID-19 public health restrictions.

CLINICALTRIAL

Associations between neighbourhood built characteristics and sedentary behaviours among Canadian men and women: findings from Alberta's Tomorrow Project

Evidence of associations between neighbourhood built characteristics and sedentary behaviours is mixed. The study aim was to investigate the associations between objectively-derived neighbourhood built characteristics and self-reported sedentary behaviours among Canadian men and women. This study sourced survey data from Alberta's Tomorrow Project (2008; n = 14,785), in which sitting and motor vehicle travel times during the last 7 days was measured. Geographic Information System was used to calculate neighbourhood built characteristics within a 400 m buffer of participant's home and a walkability score was estimated. To estimate the associations between neighbourhood characteristics and sedentary behaviours, covariate-adjusted generalized linear regression models were used. Walkability, 3-way intersections, and population count were positively associated with sitting time. Business destinations and greenness were negatively associated with sitting time. Walkability, 3-way, and 4-way intersections were negatively associated with motor vehicle travel time. Sex-specific associations between neighbourhood characteristics and sedentary behaviour were found. Among men, business destinations were negatively associated with sitting time, and 3-way intersections, population count, and walkability were negatively associated with motor vehicle travel time. Among women, Normalized Difference Vegetation Index was negatively associated with sitting time. Interventions to reduce sedentary behaviours may need to target neighbourhoods that have built characteristics which might support these behaviours. More research is needed to disentangle the complex relationships between different neighbourhood built characteristics and specific types of sedentary behaviour.

Perceived anxiety and physical activity behaviour changes during the early stages of COVID-19 restrictions in community-dwelling adults in Canada: a cross-sectional study

OBJECTIVES

The COVID-19 pandemic changed daily routines, including physical activity, which could influence physical and mental health. In our study, we describe physical activity and sedentary behaviour patterns in relation to the pandemic and estimate associations between anxiety and physical activity and sedentary behaviour in community-dwelling adults.

DESIGN

Cross-sectional study.

SETTING

Calgary, Alberta, Canada.

PARTICIPANTS

Between April and June 2020, a random sample of 1124 adults (≥18 years) completed an online questionnaire.

PRIMARY AND SECONDARY OUTCOMES

The online questionnaire captured current walking, moderate intensity, vigorous intensity and total physical activity and sedentary behaviour (ie, sitting and leisure-based screen time), perceived relative changes in physical activity, sedentary and social behaviours since the pandemic, perceived seriousness and anxiety related to COVID-19, and sociodemographic characteristics. Differences in sociodemographic characteristics, perceived relative change in behaviour and current physical activity and sedentary behaviour were compared between adults with low and high anxiety.

RESULTS

Our sample (n=1047) included more females (60.3%) and fewer older adults (19.2%). Most participants (88.4%) considered COVID-19 as extremely or very serious and one-third (32.9%) felt extremely or very anxious. We found no differences (p>0.05) in current physical activity or sedentary behaviour by anxiety level. The largest perceived change in behaviours included social distancing, driving motor vehicles, use of screen-based devices, watching television and interactions with neighbours. We found anxiety-related differences (p<0.05) in perceived changes in various behaviours.

CONCLUSIONS

Changes in physical activity, sedentary behaviour and social behaviour occurred soon after the COVID-19 pandemic was declared, and some of these changes differed among those with low and high anxiety.

Weather and climate in the assessment of tourism-related walkability

Walking is an important outdoor recreational and tourism activity, both in natural surroundings and in urban settings. Walkability is the extent to which the built environment promotes walking, and addresses issues such as comfort, connectivity, safety and aesthetic values. The paper explores a relatively overlooked domain of recreation- and tourism-related walkability: the extent to which weather and climatic conditions are incorporated into assessments of walkability and their influence on walking behaviour. Following a discussion of the assessment of walkability, the results of a scoping review of weather- and climate-related variables in walkability articles published up to June 2018 are presented. The review indicates there is little research on walkability from a tourist perspective, although there is substantial interest in walking for leisure and recreation. Four major themes were identified. The descriptive theme focuses on the general importance of weather and climate to walkability; the passive analyses the weather and climate conditions as barriers to, or as promoters of, walking; proactive studies refer to adapting to and managing weather, such as provision of shade or snow-clearing. The proactive perspective gains less attention than the passive analysis. Finally, statistical controlling was only employed by a minority of studies that adjusted their results to the impacts of weather conditions. The work concludes that the sub-field has been poorly served with respect to concept and variable definition and consistency of use mean that present knowledge is of limited scientific value. Strategies for future research are suggested.

Sensor-based physical activity, sedentary time, and reported cell phone screen time: A hierarchy of correlates in youth

BACKGROUND

Evidence on correlates relies on subjective metrics and fails to include correlates across all levels of the ecologic model. We determined which correlates best predict sensor-based physical activity (PA), sedentary time (ST), and self-reported cell phone screen time (CST) in a large sample of youth, while considering a multiplicity of correlates.

METHODS

Using sensor-based accelerometry, we assessed the PA and ST of 2179 youths. A χ² automatic interaction detection algorithm was used to hierarchize the correlates associated with too much ST (> 50th percentile), insufficient moderate-to-vigorous PA (MVPA) (<60 min/day), and prolonged CST (≥2 h/day).

RESULTS

Among youth 10-14 years old, the correlates for being inactive consisted of being a girl, not having sport facilities in the neighborhood, and not perceiving the neighborhood as a safe place, whereas in the youth 15-18 years old, the correlate for being inactive was not performing sports (9.7% chance of being active). The correlates for predicting high ST in the younger group was not performing sports (55.8% chance for high ST), and in the older group, the correlates were not owning a pet, perceiving the neighborhood as safe, and having inactive parents (63.7% chance for high ST). In the younger group, the greatest chances of having high CST were among those who were in the last elementary school years, who were girls, and who did not have friends in the neighborhood (73.1% chance for high CST), whereas in the older group, the greatest chance for having high CST was among those who were girls and had a TV in the bedroom (74.3% chance for high CST).

CONCLUSION

To counteract ST and boost MVPA among youths, a specific focus on girls, the promotion of sport participation and facilities, neighborhood safety, and involvement of family must be prioritized.

Evaluation of screen time activities and their relationship with physical activity, overweight and socioeconomic status in children 10-12 years of age in Sanandaj, Iran: A cross-sectional study in 2015

Background: Screen time (ST), including watching television and playing electronic games are the leading cause of a growing obesity epidemic. This study aimed to evaluate ST and its association with physical activity, overweight and socioeconomic status (SES) in children 10 to 12 years of age in Sanandaj. Methods: This study was designed as a cross-sectional study, which was conducted in Sanandaj in 2015. ST and physical activity data were collected using the Modifiable Activity Questionnaire (MAQ). Overweight indices are defined based on BMI age- and gender-specific percentiles, as proposed by WHO criteria. Considering household assets data, SES was calculated using principal component analysis (PCA). The relationship between ST and different determinants was assessed using logistic regression analysis. Results: Based on the results obtained in our study, 47.28% (95% CI: 45.33-49.24) of the participants spent more than two hours a day on television and video watching and electronic games playing. People who spend greater time on ST activities, independent of their physical activities, are more susceptible to overweight and obesity (p=0.002). People in higher socioeconomic groups spent more time on watching TV and video and playing electronic games (p=0.001). There was a direct relationship between the residential area and ST (P=0.052). ST in male was found to be greater (p=0.033). In addition, ST was also lower in school-aged children whose mothers had a greater education (p=0.56). Conclusion: Based on the results of this study, it is recommended to increase the education level and knowledge of mothers and design interventions consistent with children gender and residential location so that to reduce ST and its associated outcomes in children.

Transforming Life: A Broad View of the Developmental Origins of Health and Disease Concept from an Ecological Justice Perspective

The influential scientist Rene J. Dubos (1901–1982) conducted groundbreaking studies concerning early-life environmental exposures (e.g., diet, social interactions, commensal microbiota, housing conditions) and adult disease. However, Dubos looked beyond the scientific focus on disease, arguing that “mere survival is not enough”. He defined mental health as fulfilling human potential, and expressed concerns about urbanization occurring in tandem with disappearing access to natural environments (and elements found within them); thus modernity could interfere with health via “missing exposures”. With the advantage of emerging research involving green space, the microbiome, biodiversity and positive psychology, we discuss ecological justice in the dysbiosphere and the forces—financial inequity, voids in public policy, marketing and otherwise—that interfere with the fundamental rights of children to thrive in a healthy urban ecosystem and learn respect for the natural environment. We emphasize health within the developmental origins of health and disease (DOHaD) rubric and suggest that greater focus on positive exposures might uncover mechanisms of resiliency that contribute to maximizing human potential. We will entrain our perspective to socioeconomic disadvantage in developed nations and what we have described as “grey space”; this is a mental as much as a physical environment, a space that serves to insidiously reinforce unhealthy behavior, compromise positive psychological outlook and, ultimately, trans-generational health. It is a dwelling place that cannot be fixed with encephalobiotics or the drug-class known as psychobiotics.

Physical Environmental Correlates of Domain-Specific Sedentary Behaviours across Five European Regions (the SPOTLIGHT Project)

Background

The relation between neighbourhood environmental factors and domain-specific sedentary behaviours among adults remains unclear. This study firstly aims to examine the association of perceived and objectively measured neighbourhood safety, aesthetics, destinations and functionality with transport-related, work-related and leisure-time sedentary behaviour. Secondly, the study aims to assess whether these associations are moderated by age, gender or educational level.

Methods

In 60 randomly sampled neighbourhoods from 5 urban regions in Europe (Ghent and suburbs, Paris and inner suburbs, Budapest and suburbs, the Randstad, and Greater London), a virtual audit with Google Street View was performed to assess environmental characteristics. A total of 5,205 adult inhabitants of these neighbourhoods reported socio-demographic characteristics, sedentary behaviours, and neighbourhood perceptions in an online survey. Generalized linear mixed models were conducted to examine associations between physical environmental neighbourhood factors and sedentary behaviours. Interaction terms were added to test the moderating role of individual-level socio-demographic variables.

Results

Lower levels of leisure-time sedentary behaviour (i.e. all leisure activities except television viewing and computer use) were observed among adults who perceived greater numbers of destinations such as supermarkets, recreational facilities, or restaurants in their neighbourhood, and among adults who lived in a neighbourhood with more objectively measured aesthetic features, such as trees, water areas or public parks. Lower levels of work-related sedentary behaviour were observed among adults who perceived less aesthetic features in their neighbourhood, and among adults who lived in a neighbourhood with less objectively measured destinations. Both age, gender and educational level moderated the associations between neighbourhood environmental factors and sedentary behaviours.

Conclusion

Preliminary evidence was found for associations between neighbourhood environmental factors and domain-specific sedentary behaviours among adults. However, these associations varied according to objective or subjective environmental measures. More research is needed to confirm and clarify the associations.

Sedentary behavior among adults: The role of community belonging

Sedentary behavior is a modifiable determinant of health. Little is known about the ways in which contextual factors may influence this behavior. The objectives of this study were to: (1) examine the association between community belonging and adult sedentary behavior during leisure; (2) determine if this association was explained by perceived health. Data were derived from the 2010 Canadian Community Health Survey (N = 11,494 adults). Multinomial regression models and 99% confidence intervals were used to examine associations between sense of community belonging and sedentary behavior, adjusting for sociodemographic variables and perceived health. On average, adults were sedentary for 20–24 h per week during leisure. More than a third of the sample reported low sedentary behavior (≤ 19 h a week). In a fully adjusted model participants who were female, in middle adulthood, married, and/or living in higher income households were less sedentary during leisure. Adults with a strong sense of community belonging were also significantly less sedentary during leisure; this association remained significant after adjustment for perceived mental and overall health. Most efforts to address sedentary behavior have focused on individual-level interventions. The present finding highlights the role that larger contextual factors may play in sedentary behavior. Sense of community belonging is a contextual determinant of health that may serve as a useful target for interventions designed to reduce adult sedentary behavior during leisure.

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A strong sense of community belonging is associated with low sedentary behavior.

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Perceived health did not account for this association.

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Sense of community belonging may be a useful target for intervention strategies.