Socioeconomic status moderates the association between perceived environment and active commuting to school

Global Physical Activity, Active Commuting to School, and Sedentary Behavior Among Latin American Adolescents: Global School-Based Student Health Survey and the National School Health Survey

BACKGROUND

This study aimed to compare the overall prevalence, stratified by sex and age group of global physical activity (GPA), active commuting to school (ACS), and sedentary behavior (SB) among adolescents from ten Latin American countries, and to assess the correlation of Development Index with the indicators.

METHODS

This research is grounded on data from the Global School-Based Student Health Survey (2009-2015) and the 2015 Brazilian National School Health Survey. The prevalence and 95% confidence intervals for GPA (≥5 d/wk), ACS (≥1 d/wk), and SB (>2 h/d) were calculated using the chi-square test to compare the sexes (male; female) and age group (≤13 y; 14 y; 15 y; ≥16 y). We also performed Pearson correlation analysis with the Human Development Index.

RESULTS

The prevalence of indicators ranged from 16.1% to 28.2% for GPA, from 56.7% to 71.2% for ACS, and from 20.7% to 62.6% for SB. Boys generally had a higher prevalence of GPA and ACS, and girls had a higher prevalence of SB. The prevalence of the indicators by age group varied between countries, with significant differences observed in some, depending on each indicator. A positive correlation was observed between Human Development Index, GPA, and SB.

CONCLUSION

Health promotion policies must include guidelines that encourage and promote a more active and less sedentary lifestyle among young people in Latin America, considering specific groups, the local socioeconomic context, and differences between countries.

Associations between environmental perception and self-rated health in the city hierarchy of China: Findings from a national cross-sectional survey

Identifying environmental determinants of health and clarifying their variations is crucial for health promotion in different cities by providing tailored intervention strategies. Although the association between perceived urban environment and health (e.g., self-rated health) has been repeatedly explored, most studies have focused on cities of a specific size, and it is still unknown whether either significant environment variables or the magnitude of the association would vary across different-sized cities. This study investigated how perceived urban environment variables significantly associated with individuals' self-rated health varied from small cities to mega cities in China, based on a national survey including 5963 valid respondents. The results showed that the relationship between self-rated health and city size was U-shaped, with respondents in medium and large cities reporting a low-level self-rated health. Perceived greenness, public facilities, housing supply, and medical services were positively and significantly associated with self-rated health, with the odds ratio (OR) of 1.37 (95%CI: 1.29-1.46), 1.27 (95%CI: 1.19-1.35), 1.14 (95%CI: 1.09-1.20), and 1.17 (95%CI: 1.10-1.24), respectively. Furthermore, the magnitude of the association was significantly larger in mega cities. These findings provide useful evidence for promoting public health in cities of different sizes for achieving health equity and indicate that smaller cities and their health-supportive environment need further attention.

Sociodemographic and environmental factors associated with dengue, Zika, and chikungunya among adolescents from two Brazilian capitals

Among the emerging and reemerging arboviral diseases, Zika, dengue and chikungunya deserve special attention due to their wide geographical distribution and clinical severity. The three arboviruses are transmitted by the same vector and can present similar clinical syndromes, bringing challenges to their identification and register. Demographic characteristics and individual and contextual social factors have been associated with the three arboviral diseases. However, little is known about such associations among adolescents, whose relationships with the social environment are different from those of adult populations, implying potentially different places, types, and degrees of exposure to the vector, particularly in the school context. This study aims to identify sociodemographic and environmental risk factors for the occurrence of Zika, dengue, and chikungunya in a cohort of adolescents from the Study of Cardiovascular Risks in Adolescents-ERICA-in the cities of Rio de Janeiro/RJ and Fortaleza/CE, from January 2015 to March 2019. Cases were defined as adolescents with laboratory or clinical-epidemiological diagnosis of Zika, dengue, or chikungunya, notified and registered in the Information System for Notifiable Diseases (SINAN). The cases were identified by linkage between the databases of the ERICA cohort and of SINAN. Multilevel Cox regression was employed to estimate hazard ratios (HR) as measures of association and respective 95% confidence intervals (95%CI). In comparison with adolescents living in lower socioeconomic conditions, the risk of becoming ill due to any of the three studied arboviral diseases was lower among those living in better socioeconomic conditions (HR = 0.43; 95%CI: 0.19-0.99; p = 0.047) and in the adolescents who attended school in the afternoon period (HR = 0.17; 95%CI: 0.06-0.47; p<0.001). When compared to areas whose Building Infestation Index (BII) for Aedes aegypti was considered satisfactory, a BII in the school region classified as "alert" and "risk" was associated with a higher risk of arboviral diseases (HR = 1.62, 95%CI: 0.98-2.70; p = 0.062; HR = 3.72, 95%CI: 1.27-10.9; p = 0.017, respectively). These findings indicate that living in less favored socioeconomic conditions, attending school in the morning, and having a high BII for Ae. aegypti in school's region can contribute to an increased risk of infection by Zika, dengue, or chikungunya in adolescents. The identification of residential or school areas based on those variables can contribute to the implementation of control measures in population groups and priority locations.

Socioeconomic position, built environment and physical activity among children and adolescents: a systematic review of mediating and moderating effects

BACKGROUND

Physical activity behaviors among children and adolescents are socioeconomically patterned. Understanding if, and how, the built environment contributes to socioeconomic inequalities in physical activity and for whom built environments are most important, can lead to the identification of intervention entry points to reduce inequalities in physical activity.

OBJECTIVE

To summarize the existing evidence among children and adolescents on (a) whether the built environment mediates the association between socioeconomic position and physical activity and (b) whether socioeconomic position moderates the association between the built environment and physical activity.

METHODS

A systematic literature search was conducted using PubMed, Embase, PsycINFO and Web of Science. Two independent reviewers screened articles for eligibility, extracted information from included studies and assessed risk of bias with the Quality Assessment Tool for Observational Cohort and Cross-Sectional studies. We performed a narrative evidence synthesis considering the totality of the evidence and by study characteristics such as geographic region, age group, and exposure-outcome assessment methodology. The reporting was conducted in agreement with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement.

RESULTS

A total of 28 papers were included. In general, the studies were of low methodological quality. There was no evidence to support that the built environment functions as a mediator in the relationship between socioeconomic position and physical activity. We observed inconclusive moderation patterns with five studies reporting stronger associations between features of the built environment and physical activity among high socioeconomic positioned youths. Seven studies reported stronger associations among low socioeconomic positioned youth and fourteen studies reported no difference in associations. We observed different moderation patterns across geographical regions (Europe vs. US) indicating that, in Europe, having a walkable neighborhood is important for low socioeconomic positioned youth only. No differences in moderation patterns were observed for younger vs. older children or activity domains.

CONCLUSION

Current evidence does not support a strong interplay between built environment and socioeconomic position on physical activity in youth. However, given the low quality of the evidence, firm conclusions cannot be made, and additional high-quality research is likely to have substantial impact on the evidence base.

Team sports, running, walking: activity-specific associations with perceived environmental factors in adolescents

This study aimed to analyze the association between the practice of different types of physical activity (PA) with perceived environmental factors in boys and girls adolescents. Were evaluated 1,130 adolescents from Porto Alegre, Brazil. To evaluate different PA, students answered whether or not they practiced walking, running, team sports, and others general PA. Perceived environmental factors were assessed through Neighborhood Environment Walkability Scale for Youth (NEWS-Y). Analyses were performed using logistic regression. Adolescents who reported perceiving a distance up to 20 minutes to walking/running track, had their chances of practicing all types of PA increased in the total sample and for girls. For walking, it was also found an association with access in adolescents. For girls, it was found an association between shortest distance to indoor recreation or exercise facility and other playing fields/court with running and team sports. Aesthetics and road safety were associated with team sports in adolescents. Other general PA were associated with park, bike/hiking/walking trails in the total sample and for girls. Therefore, for each type of PA, specific associations of perceived environmental factors were found.

Active Commuting and Healthy Behavior among Adolescents in Neighborhoods with Varying Socioeconomic Status: The NESLA Study

(1) Background: The World Health Organization recommends active commuting as a source of physical activity. Active commuting is determined by various factors, including the socioeconomic status (SES) of families and neighborhoods, distance to schools, perceived neighborhood safety, lifestyles and availability of walkways and biking paths. This study aimed to assess factors associated with modes of transportation to and from school among adolescents aged 16–19 living in a middle-sized city in Sweden. (2) Method: Three hundred and fourteen students, of whom 55% were females, from schools in the city of Västerås participated in the study. Printed as well as web-based self-administered questionnaires were used to collect the data. (3) Results: Adolescents living in high SES neighborhoods were 80% more likely to bike or walk to school (OR = 1.80; CI: 1.01, 3.20) than adolescents living in low SES neighborhoods. Furthermore, active commuting was associated with higher consumption of fruits and vegetables (OR = 1.77; CI: 1.05, 2.97) and less consumption of junk foods (OR = 0.43; CI: 0.26, 0.71), as compared to passive commuting. (4) Conclusions: Active commuting is a cost-effective and sustainable source of regular physical activity and should be encouraged at a societal level.

Systematic review of active transportation to school in youth – an update from Brazil’s Report Card

ABSTRACT The aim of this study was to update a systematic review on the use of active transportation to school in Brazilian children and adolescents. All studies were extracted from the LILACS; BIREME; SCIELO and MEDLINE. The search was carried out on manuscripts published in the period 2018-2019. The descriptors were used in Portuguese, English and Spanish. In overall, 8 manuscripts were included in this systematic review, with 1 presenting data from three periods (2009, 2012 and 2015). The study data were obtained between 2009 and 2015 and the age group found between 7 to 19 years old. Of the selected articles, 2 presented national data, 1 from the north, 2 from the northeast, 1 from the southeast and 2 from the south of Brazil. The use of active transportation was superior to passive transportation on 6 occasions and its use was common in boys than in girls (4 of 6 articles). The use of active transportation is still more common than passive transportation in most Brazilian regions, although some cities have the opposite. The results suggest that the prevalence of active transportation is higher in boys than girls. Public policies must be created to favor the use of active transportation among Brazilian youth.

Like Mother, like Son: Physical Activity, Commuting, and Associated Demographic Factors

A mother’s healthy conduct may lead to the healthy conduct of their children. Thus, this study aimed to verify the role of demographic factors in the relationship between mothers’ physical activity (PA) and commuting to work with children and adolescent’s PA and commuting to school. This cross-sectional study comprised 1421 children and adolescents aged 6 to 17 years and 1421 mothers, from Brazil. PA, commuting, socioeconomic status (SES), skin color/ethnicity, and living area were evaluated by questionnaire. Logistic binary regression models were used. Results indicated that mothers’ PA and commuting were associated with children and adolescent’s PA and commuting to school in crude and adjusted models. Considering the role of the demographic factors, an association was only observed for girls in the relationship between mother’s PA with children’s PA. In adolescents, an association was observed in both high/low SES, boys/girls, and rural/urban areas. Regarding children and adolescent active commuting to school, there was an association with mothers commuting. All demographic factors were strongly associated, except for rural areas. Therefore, mothers’ PA as well as commuting to work are associated with children and adolescent’s PA and commuting to school. Sex, living area, and SES are the related demographic factors.

Active commute to school: does distance from school or walkability of the home neighbourhood matter? A national cross-sectional study of children aged 10-11 years, Scotland, UK

OBJECTIVES

To study the extent to which home-to-school distance and neighbourhood walkability were associated with self-reported active travel to school (ATS) (eg, walking, cycling), and to explore how distance moderates the effect of walkability on ATS, among 10-11 years old.

DESIGN

Cross-sectional study.

SETTING

Data were collected between May 2015 and May 2016 in partnership with the Growing Up in Scotland Study, a nationally representative longitudinal cohort study.

PARTICIPANTS

713 children (male (n=330) and female (n=383) 10-11 years old) from Studying Physical Activity in Children's Environments across Scotland.

PRIMARY AND SECONDARY OUTCOME MEASURES

Children who actively travelled to/from school categorised as active all (100% of ATS) and active 60%+ (at least 60% of ATS); home-to-school road/path network distance (<0.5 km, 0.5 to <1 km, 1 to <1.5 km, 1.5 to <2 km, 2 km+); home neighbourhood walkability (i.e., composite measure of road/path intersection density and dwelling density) (in quintiles).

RESULTS

Distance and walkability were both associated with ATS. The likelihood of ATS for all or most journeys decreased with increasing distance. Compared with 'most' walkable areas (Q1), the odds of active all were significantly lower within least walkable areas (Q5 OR 0.45, 95% CI 0.21 to 0.99), and odds of active 60%+ were significantly less in Q2-Q5 (lowest odds Q5 OR 0.20, 95% CI 0.07 to 0.47). Regarding walkability and distance interactions, for all distance categories, higher walkability increased the probability of ATS (for most school journeys).

CONCLUSION

Walkability was positively associated with ATS within all distance categories, with the relationship between walkability and ATS more complex than the clear-cut association between distance and ATS. A more walkable environment had a larger effect on the probability of reaching the 60% threshold of school journeys using ATS than the probability of always travelling in an active manner. Investment is needed in existing less walkable neighbourhoods to provide infrastructure to support opportunities for children's ATS.