Perceived neighborhood safety related to physical activity but not recreational screen-based sedentary behavior in adolescents

Sleep Problems Among Black Youth Exposed to Police Violence on Digital Media

Findings from a recent survey of a community-based sample of Black youth ages 12 through 21 in Baltimore City, Maryland (n = 345) reveal that viewing fatal police violence videos is associated with significant increases in the odds of youth sleep disturbances, and about 30% of this association is attributable to emotional distress after viewing the videos.

Predictors of physical activity and public safety perception regarding technology adoption for promoting physical activity in Jeddah, Saudi Arabia

Background

This study aims to identify the predictors of levels of physical activity among the residents of Jeddah, Saudi Arabia. Additionally, it seeks to understand the public's safety perception regarding the adoption of technology for promoting physical activity.

Method

This is an analytical cross-sectional study using self-administered web-based survey. A stratified sampling technique was used to select participants from adult population in Jeddah and data collection took place from May 2023 to December 2023. Multivariable logistic regression models were applied to identify predictors of low-intensity (walking steps) and high-intensity physical activities.

Result

A total of 462 participated in the study. Gender significantly influenced walking habits, with males more likely to walk than females (AOR = 2.37; 95 % CI: 1.55-3.62; P < 0.001). Smoking status was also a predictor, with smokers more inclined to walk compared to non-smokers (AOR = 2.15; 95 % CI: 1.20-3.82; P = 0.010). High-intensity physical activity strongly correlated with increased walking, especially among those active 3-7 days per week (AOR = 3.03; 95 % CI: 1.91-4.78; P < 0.001). Chronic diseases negatively impacted walking frequency (AOR = 0.57; 95 % CI: 0.34-0.95; P = 0.031). Furthermore, males were likelier to engage in high-intensity activities compared to females (AOR = 1.61; 95 % CI: 1.04-2.50; P = 0.033). Those walking ≥ 10,000 steps weekly were more likely to participate in high-intensity activities (AOR = 3.07; 95 % CI: 1.95-4.82; P < 0.001). Excellent self-rated health was associated with higher participation in such activities (AOR = 2.00; 95 % CI: 1.30-3.06; P = 0.002). Most respondents (84.9 %) felt safe on public walkways, and 78.1 % indicated safety perceptions influenced their walkway use. Technology use was divided, with about half (49.1 %) using apps for tracking physical activity. The majority (90.9 %) supported adding motivational features to the 'Sehhaty' app, and 73.6 % favored financial rewards for walking. However, only 45.5 % believed that public walkways are designed to encourage walking.

Conclusion

The study highlights significant predictors of physical activity among general population in Jeddah. The study also revealed the impact of safety perceptions and technology use on physical activity, with strong support for motivational features in health apps. However, there is a need for improved design of public walkways to encourage walking.

Child Opportunity Index and clinical characteristics at diabetes diagnosis in youth: type 1 diabetes versus type 2 diabetes

INTRODUCTION

Among youth with type 1 diabetes (T1D), longitudinal poor glycemic control is associated with adverse socioeconomic conditions at the neighborhood level. Child Opportunity Index (COI), which encompasses measures of education, health, environment, social, and economic factors, is associated with obesity in youth but has not been evaluated in youth with new-onset T1D or type 2 diabetes (T2D). We hypothesized that lower COI would be associated with adverse clinical outcomes at diabetes diagnosis, and due to differing risk factors and pathophysiology, that youth with new-onset T2D would have lower COI than youth with T1D.

RESEARCH DESIGN AND METHODS

Retrospective cohort of youth with new-onset diabetes admitted to a large academic pediatric hospital. COI was compared by diabetes type using t-tests and Χ2 tests. Multivariable linear and logistic regression analyses were used to evaluate associations between COI and clinical characteristics, stratified by diabetes type and adjusted for age and sex.

RESULTS

The cohort (n=484) differed in race and age by diabetes type (T1D: n=389; 10.0% black, 81.2% white; age 9.6±0.2 years; T2D: n=95; 44.2% black, 48.4% white; age 14.8±0.3 years). Youth with T2D had lower COI (p<0.001). Low COI was associated with diabetic ketoacidosis in T1D and T2D. Black youth with low COI had the highest hemoglobin A1c among youth with T2D and the highest obesity prevalence among youth with T1D.

CONCLUSIONS

COI is associated with differing characteristics at diagnosis in youth-onset T1D and T2D but is worse among youth with T2D overall. These findings underscore the need to address socioeconomic adversity when designing interventions to reduce T2D risk and to improve outcomes at diabetes diagnosis in youth.

Cardiorespiratory fitness and physical activity in the lens of social justice - Reporting on the disparities that exist

Cardiorespiratory fitness (CRF), heavily influenced by physical activity (PA), represents a strong and independent risk factor for a wide range of health conditions, most notably, cardiovascular disease. Substantial disparities in CRF have been identified between white and non-white populations. These disparities may partly account for group differences in susceptibility to poor health outcomes, including non-communicable disease. Race and ethnic differences in CRF may partly be explained by social injustices rooted in persistent structural and systemic racism. These forces contribute to environments that are unsupportive for opportunities to achieve optimal CRF levels. This review aims to examine, through the lens of social justice, the inequities in key social ecological factors, including socioeconomic status, the built environment, and structural racism, that underly the systemic differences in CRF and PA in vulnerable communities. Further, this review highlights current public health initiatives, as well as opportunities in future research, to address inequities and enhance CRF through the promotion of regular PA.

The Role of the Perceived Neighborhood Social Environment on Adolescent Sedentary Behavior and Physical Activity: Findings from Add Health

Few studies have examined the role of perceived neighborhood characteristics such as neighborhood safety, social cohesion, and contentedness on sedentary behavior (SB) and physical activity (PA) among adolescents. Furthermore, no studies have investigated how these associations are moderated by gender and race. This study aimed to examine the associations of the perceived neighborhood social environment with (SB) and moderate-to-vigorous physical activity (MVPA). Data from 6504 adolescents (aged 15.4 ± 0.03 years) who participated in the National Longitudinal Study of Adolescent Health was used. SB and PA were considered continuously and dichotomously. PNSE variables include safety, social cohesion, and contentedness, where higher values of PNSE indicate a more favorable neighborhood perception. Weighted linear and logistic regression models were used to examine the association of PNSE with continuous total SB (hours/week) and MVPA (bouts/week), and binary excessive SB (14 h/week) and meeting MVPA guidelines (≥ 5 bouts/week), respectively. Associations were stratified by gender and race to test moderation effects. Models were adjusted for demographic, health, parental, and neighborhood covariates. This study found that neighborhood safety and contentedness were negatively associated with SB, whereas neighborhood social cohesion and contentedness were positively associated with PA. Gender-specific and race-specific results remained somewhat consistent with overall findings; however, neighborhood safety was not associated with SB among female and non-White adolescents, respectively. Similarly, neighborhood safety and contentedness were not associated with MVPA for non-White adolescents. Findings suggest that an adolescent's neighborhood environment, gender, and race should be considered when implementing strategies to reduce SB and increase PA.

Subjective and objective indicators of neighbourhood safety and physical activity among UK adolescents

BACKGROUND

The health benefits of regular physical activity in adolescence are well-documented and many health-related behaviours are established in adolescence. The neighbourhood environment is a key setting for physical activity for adolescents and feeling unsafe in their neighbourhood may be a potential barrier to physical activity.

AIM

This study aimed to examine associations between neighbourhood safety and physical activity using objective and subjective measures for both.

METHODS

Participants (n = 10,913) came from the Millennium Cohort Study, a nationally representative UK longitudinal birth cohort. Linear regression and Zero Inflated Poisson models were used to examine associations between subjective and objective indicators of safety (self-reported safety, Index of Multiple Deprivation crime, Reported Crime Incidence) and physical activity (self-reported weekly and device-measured physical activity).

RESULTS

Adolescents who feel unsafe in their neighbourhood, or who live in areas with high IMD crime or violent crime rates report 0.29 (95% CI -0.49, -0.09) 0.32 (95% CI -0.47, -0.16) and 0.20 (95% CI -0.39, -0.20) fewer days of physical activity, respectively. No associations were found between Reported Crime Incidence and either objective or subjective measures of physical activity.

CONCLUSIONS

This study demonstrates varying associations between subjective safety and objective crime with physical activity levels in adolescence, highlighting the complexities around subjective and objective measurements and their associations with health outcomes.

Physical Activity Engagement: Perspectives From Adolescents With Comorbid Asthma and Overweight/Obesity and Their Caregivers

OBJECTIVE

Most adolescents do not meet physical activity (PA) guidelines, and engagement rates are even lower among adolescents with asthma and overweight/obesity (OW/OB). Understanding barriers and facilitators to PA engagement that are unique to youth with comorbid asthma and OW/OB is important for PA promotion. The current qualitative study identified caregiver- and adolescent-reported factors contributing to PA among adolescents with comorbid asthma and OW/OB across the four domains of the Pediatric Self-Management Model: individual, family, community, and health care system.

METHODS

Participants were 20 adolescents (Mage = 16.01; 55% male) with asthma and OW/OB and their caregiver (90% mothers). Caregivers and adolescents participated in separate semistructured interviews about influences, processes, and behaviors related to adolescent PA engagement. Interviews were analyzed using thematic analysis.

RESULTS

Factors contributing to PA varied across four domains. The individual domain included influences (e.g., weight status, psychological and physical challenges, asthma triggers and symptoms) and behaviors (e.g., taking asthma medications, self-monitoring). At the family level, influences included support, lack of modeling, and independence; processes included prompts and praise; and behaviors included engaging in shared PA and providing resources. Community-level influences included surrounding and settings, social support, and cornonavirus disease-2019-related changes, while behaviors included engaging in PA with others and extracurricular activities.

CONCLUSIONS

Influences, processes, and behaviors across multiple domains interact to impact adolescent PA engagement, highlighting factors that may be potential leverage points in prevention and intervention efforts to promote adolescent PA.

Spatial machine learning for predicting physical inactivity prevalence from socioecological determinants in Chicago, Illinois, USA

The increase in physical inactivity prevalence in the USA has been associated with neighborhood characteristics. While several studies have found an association between neighborhood and health, the relative importance of each component related to physical inactivity or how this value varies geographically (i.e., across different neighborhoods) remains unexplored. This study ranks the contribution of seven socioecological neighborhood factors to physical inactivity prevalence in Chicago, Illinois, using machine learning models at the census tract level, and evaluates their predictive capabilities. First, we use geographical random forest (GRF), a recently proposed nonlinear machine learning regression method that assesses each predictive factor's spatial variation and contribution to physical inactivity prevalence. Then, we compare the predictive performance of GRF to geographically weighted artificial neural networks, another recently proposed spatial machine learning algorithm. Our results suggest that poverty is the most important determinant in the Chicago tracts, while on the other hand, green space is the least important determinant in the rise of physical inactivity prevalence. As a result, interventions can be designed and implemented based on specific local circumstances rather than broad concepts that apply to Chicago and other large cities.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10109-023-00415-y.

Community Violence Exposure and Stress Reactivity in African American and Non-Latino White Adolescents With Overweight/Obesity

Adolescents who experience community violence are exposed to toxic stressors at a critical period of growth and development. The purpose of this study was to examine the relationship between community violence exposure and stress reactivity in African American and non-Latino white adolescents with overweight/obesity. Fifty-one adolescents (47% female, 55% African American; aged 14-19) participated in this study. Community violence was assessed using the Survey of Children's Exposure to Community Violence. Stress reactivity was assessed via salivary cortisol and alpha-amylase area under the curve (AUC) during a Trier Social Stress Test (TSST). Race was a significant predictor of alpha-amylase reactivity (β = 10740±3665, p = 0.0006), with a higher alpha-amylase AUC observed in African American compared to non-Latino white adolescents. There was also a significant difference in the relationship between community violence exposure and alpha-amylase AUC by race (β = -3561±1226, p = 0.007). At similar increases in violence exposure, African Americans demonstrated a significant decline in alpha-amylase AUC while non-Latino whites demonstrated a significant increase in alpha-amylase AUC. Neither race nor violence exposure were significant predictors of cortisol AUC and there were no significant differences in the relationship between community violence exposure and cortisol AUC by race (all p's > .05). These preliminary findings suggest exposure to community violence may act to exacerbate autonomic dysregulation in African American adolescents with overweight/obesity. Longitudinal studies are needed to confirm the mechanisms by which community violence exposure differentially impacts stress responses by race.

Measuring Obesogenicity and Assessing Its Impact on Child Obesity: A Cross-Sectional Ecological Study for England Neighbourhoods

Both major influences on changing obesity levels (diet and physical activity) may be mediated by the environment, with environments that promote higher weight being denoted obesogenic. However, while many conceptual descriptions and definitions of obesogenic environments are available, relatively few attempts have been made to quantify obesogenic environments (obesogenicity). The current study is an ecological study (using area units as observations) which has as its main objective to propose a methodology for obtaining a numeric index of obesogenic neighbourhoods, and assess this methodology in an application to a major national dataset. One challenge in such a task is that obesogenicity is a latent aspect, proxied by observed environment features, such as poor access to healthy food and recreation, as well as socio-demographic neighbourhood characteristics. Another is that obesogenicity is potentially spatially clustered, and this feature should be included in the methodology. Two alternative forms of measurement model (i.e., models representing a latent quantity using observed indicators) are considered in developing the obesogenic environment index, and under both approaches we find that both food and activity indicators are pertinent to measuring obesogenic environments (though with varying relevance), and that obesogenic environments are spatially clustered. We then consider the role of the obesogenic environment index in explaining obesity and overweight rates for children at ages 10-11 in English neighbourhoods, along with area deprivation, population ethnicity, crime levels, and a measure of urban-rural status. We find the index of obesogenic environments to have a significant effect in elevating rates of child obesity and overweight. As a major conclusion, we establish that obesogenic environments can be measured using appropriate methods, and that they play a part in explaining variations in child weight indicators; in short, area context is relevant.

Risk and Protective Factors for Physical Activity Engagement Among Adolescents With Comorbid Asthma and Obesity

OBJECTIVE

The current study identifies levels of physical activity (PA) engagement among adolescents with neither asthma nor overweight/obesity (OW/OB), one, or both conditions. Risk and protective factors are examined across groups.

METHODS

Data from 8th, 9th, and 11th graders were obtained from the 2019 Minnesota Student Survey (N = 125,164). One-way analysis of variance was used to assess PA levels across risk groups. Linear regressions were used to examine patterns of risk and protective factors for adolescent PA engagement across four groups (neither asthma nor OW/OB, asthma only, OW/OB only, and comorbid asthma + OW/OB). Results were stratified by race/ethnicity.

RESULTS

Adolescents with OW/OB only or asthma + OW/OB had significantly lower PA levels than youth with asthma only or neither condition (M = 3.65-3.67 days/week, SD = 2.20 vs M = 4.15-4.19 days/week, SD = 2.16-2.17, p < .001). The following variables were associated with adolescent PA (p < .001): Adult community care across all risk groups (β ranges = .13-.16), depressive symptoms among those with neither and both asthma + OW/OB (β's = -.10), and extracurriculars among those with asthma + OW/OB (β = .10). Extracurriculars and parent connectedness were protective for Hispanic adolescents.

CONCLUSIONS

Adolescents with OW/OB had significantly lower levels of PA compared to those without, regardless of asthma status. Individual and relational factors influenced adolescent PA. Future research investigating factors influencing adolescent PA should consider depressive symptoms, connectedness to adults in the community, non-sport-related extracurricular activity involvement, and address disparities among minoritized youth.

Social epidemiology of early adolescent problematic screen use in the United States

OBJECTIVE

To determine sociodemographic correlates of problematic screen use (social media, video games, mobile phones) among a racially/ethnically and socioeconomically diverse population-based sample of 10-14-year-old early adolescents.

STUDY DESIGN

We analyzed cross-sectional data from the Adolescent Brain Cognitive Development Study (Year 2, 2018-2020; N = 8753). Multiple linear regression analyses were used to estimate associations between sociodemographic factors (age, sex, race/ethnicity, primary language, household income, parental education) and adolescent-reported problematic video game (Video Game Addiction Questionnaire), social media (Social Media Addiction Questionnaire), and mobile phone use (Mobile Phone Involvement Questionnaire).

RESULTS

Boys reported higher problematic video game use while girls reported higher problematic social media and mobile phone use. Native American, black, and Latinx adolescents reported higher scores across all problematic screen measures compared to non-Latinx white adolescents. Having unmarried/unpartnered parents was associated with higher problematic social media use. Although higher household income was generally protective against problematic video game use, these associations were weaker for black than white adolescents (p for interaction <0.05).

CONCLUSIONS

Given the sociodemographic differences in problematic screen use, digital literacy education strategies can focus on at-risk populations, encourage targeted counseling by pediatricians, and adapt family media use plans for diverse backgrounds.

IMPACT

While sociodemographic differences in screen time are documented, we examined sociodemographic differences in problematic screen use in a large, diverse sample of early adolescents in the US. Boys reported higher problematic video game use while girls reported higher problematic social media and mobile phone use. Native American, black, and Latinx adolescents reported higher scores across all problematic screen measures compared to non-Latinx white adolescents. Although higher household income was generally protective against problematic video game use, these associations were weaker for black than white adolescents. Beyond time spent on screens, pediatricians, parents, and educators should be aware of sociodemographic differences in problematic screen use.

Sociodemographic Correlates of Contemporary Screen Time Use among 9- and 10-Year-Old Children

OBJECTIVE

To determine sociodemographic correlates of contemporary screen time use among a diverse population-based sample of 9- and 10-year-old children.

STUDY DESIGN

In 2021, we analyzed cross-sectional baseline (2016-2018) data from the Adolescent Brain Cognitive Development study (n = 10 755). Multiple linear regression analyses were conducted to estimate associations between sociodemographic factors (sex, race/ethnicity, country of birth, household income, parental education) and 6 contemporary forms of screen time (television, videos [eg, YouTube], video games, social networking, texting, and video chat).

RESULTS

On average, children reported 3.99 hours of screen time per day across 6 modalities, with the most time spent watching/streaming television shows/movies (1.31 hours), playing video games (1.06 hours), and watching/streaming videos (1.05 hours). On average, Black children reported 1.58 more hours of screen time per day and Asian children reported 0.35 less hours of screen time per day compared with White children (mean 3.46 hours per day), and these trends persisted across most modalities. Boys reported higher overall screen time (0.75 hours more) than girls, which was primarily attributed to video games and videos. Girls reported more time texting, social networking, and video chatting than boys. Higher income was associated with lower screen time usage across all modalities except video chat. However, in high-income households, Latinx children reported 0.65 more hours of screen time per day than White children.

CONCLUSIONS

Given the sociodemographic differences in child screen use, guideline implementation strategies can focus on key populations, encourage targeted counseling by pediatricians, and adapt Family Media Use Plans for diverse backgrounds.

Associations of the perceived neighborhood environment and screen time in adolescents living in a medium-sized city in Brazil: a cross-sectional study

Individual attributes have been investigated to explain sedentary behavior. However, few studies have evaluated this association at the neighborhood level. This study aimed to determine the association between screen time (ST) among adolescents and perceived neighborhood characteristics. This cross-sectional study was conducted using a multistage household survey in Vespasiano, Brazil, in 2015-2016. Logistic regression analyses were performed to assess the associations between the adolescent self-reported ST (television, computer, and video game > 2 h/day) and neighborhood characteristics (green space, sidewalk maintenance, street lighting, social disorder, safety during the day, and risk of violence) reported by an adult. Four hundred and twenty-three adolescents aged 11-17 participated in the study. ST was reported by 74.0% of the adolescents. After adjustment for confounder variables, neighborhood characteristics did not remain associated with ST. The results evidence no associations between ST among adolescents and perceived neighborhood environment and indicate the need for future studies of this relation.

Identifying risk profiles for excess sedentary behaviour in youth using individual, family and neighbourhood characteristics

There are few known determinants of sedentary behaviour (SB) in children. We generated and compared profiles associated with risk of excess SB among children (n = 294) both at 8-10 and 10-12 years of age (Visits 1 and 2, respectively), using data from the QUebec Adipose and Lifestyle InvesTigation in Youth. Excess SB was measured by accelerometry and defined as >50% of total wear time at <100 counts/minutes. Recursive partitioning analyses were performed with candidate individual-, family-, and neighbourhood-level factors assessed at Visit 1, and distinct groups at varying risk of excess SB were identified for both timepoints. From the ages of 8-10 to 10-12 years, the prevalence of excess SB more than doubled (24.5% to 57.1%). At Visit 1, excess SB was greatest (73%) among children simultaneously not meeting physical activity guidelines, reporting >2 h/day of weekday non-academic screen time, living in low-dwelling density neighbourhoods, having poor park access, and living in neighbourhoods with greater disadvantage. At Visit 2, the high-risk group (70%) was described by children simultaneously not meeting physical activity guidelines, reporting >2 h/day of non-academic screen time on weekends, and living in neighbourhoods with low disadvantage. Risk factors related to individual lifestyle behaviours are generally consistent, and neighbourhood factors generally inconsistent, as children age from late childhood to pre-adolescence. Multiple factors from developmental, behavioural and contextual domains increase risk for excess sedentary behaviour; these warrant consideration to devise effective prevention or management strategies.

Feelings of safety during daytime walking: associations with mental health, physical activity and cardiometabolic health in high vacancy, low-income neighborhoods in Detroit, Michigan

INTRODUCTION

Individuals living in low-income neighborhoods have disproportionately high rates of obesity, Type-2 diabetes, and cardiometabolic conditions. Perceived safety in one's neighborhood may influence stress and physical activity, with cascading effects on cardiometabolic health.

METHODS

In this study, we examined relationships among feelings of safety while walking during the day and mental health [perceived stress (PSS), depression score], moderate-to-vigorous physical activity (PA), Body Mass Index (BMI), and hemoglobin A1C (A1C) in low-income, high-vacancy neighborhoods in Detroit, Michigan. We recruited 69 adults who wore accelerometers for one week and completed a survey on demographics, mental health, and neighborhood perceptions. Anthropometrics were collected and A1C was measured using A1CNow test strips. We compiled spatial data on vacant buildings and lots across the city. We fitted conventional and multilevel regression models to predict each outcome, using perceived safety during daytime walking as the independent variable of interest and individual or both individual and neighborhood-level covariates (e.g., number of vacant lots). Last, we examined trends in neighborhood features according to perceived safety.

RESULTS

In this predominantly African American sample (91%), 47% felt unsafe during daytime walking. Feelings of perceived safety significantly predicted PSS (β = - 2.34, p = 0.017), depression scores (β = - 4.22, p = 0.006), and BMI (β = - 2.87, p = 0.01), after full adjustment. For PA, we detected a significant association for sex only. For A1C we detected significant associations with blighted lots near the home. Those feeling unsafe lived in neighborhoods with higher park area and number of blighted lots.

CONCLUSION

Future research is needed to assess a critical pathway through which neighborhood features, including vacant or poor-quality green spaces, may affect obesity-via stress reduction and concomitant effects on cardiometabolic health.

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.

Global Matrix 3.0 physical activity report card for children and youth: a comparison across Europe

OBJECTIVES

The Global Matrix of report card grades on physical activity serves as a public health awareness tool by summarising the status of child and youth physical activity prevalence and action. The objectives were to: (1) provide a detailed examination of the evidence informing the 'School' and 'Community and Environment' indicators across all participating European Global Matrix 3.0 countries; (2) explore the comparability of the grades for these two indicators across Europe; (3) detail any limitations or issues with the methods used to assign grades; and (4) provide suggestions on how future grading of the indicators could be improved.

STUDY DESIGN

A comparative review of published methods on the grading of Global Matrix 3.0 indicators across European countries.

METHODS

Key documents relating to the European countries involved in the 2018 Global Matrix 3.0 were collated and a template used to extract data for both the 'School' and 'Community and Environment' indicators.

RESULTS

Seventeen of the 20 European Report Card countries (85%) had a grade for schools, and 15 countries (75%) had a grade for community and environment. All countries considered between one and five factors when assigning the grade for these indicators. There were wide disparities in the number and sources of evidence used to assign the grades for both indicators, limiting the comparability of the evidence between different countries.

CONCLUSION

To enable comparability, the authors recommend moving towards an agreed standardised set of metrics for grading each indicator. Furthermore, it would be useful to develop and share common tools, methods and instruments to collect data in a uniform way across countries, where possible. Such action will ultimately make the Global Matrix a more robust and useful tool for the future.

Are neighborhood characteristics associated with sedentary behavior in adolescents? A systematic review

Sedentary behavior (SB) has emerged as a potential risk factor for chronic diseases. SB includes activities requiring low energy expenditure (≤1.5 metabolic equivalents) performed in a sitting or reclining posture. Our study aimed to gather evidence on the association between SB outcomes in adolescents (10-19 years) and neighborhood characteristics. This systematic review (PROSPERO registration number: CRD42018076877) examined studies indexed in PubMed Central®, LILACS, ScienceDirect, and SPORTDiscus databases. Sixteen articles were included. Insecurity during daytime hours, crime incidence, physical and social disorders, a higher neighborhood socioeconomic level, and time spent with peers were associated with higher levels of SB. Traffic, availability of a favorable environment for physical activity, and higher residential density were associated with lower levels of SB. Despite great variability in the SB cutoff points and methodology used for evaluating SB and neighborhood characteristics among studies, the evidence suggests that adolescent SB might be influenced by neighborhood characteristics.

Sleep, screen time, and family meal frequency in preschool children: A pilot study

This exploratory pilot study identified the prevalence and perceptions of three healthy habits in preschool-age children by surveying their parents/caregivers. Researchers examined children's hours of sleep, screen time, and number of family meals per week.

Individual- and environmental-related correlates of moderate-to-vigorous physical activity in 11-, 13-, and 15-year-old Finnish children

The objective of this study was to analyze the associations of various individual- and environmental-related factors with subgroups of daily, frequent, moderate and low moderate-to-vigorous physical activity (MVPA) among children and adolescents. Data were obtained from the Finnish School-age Physical Activity (FSPA) study 2016 from 4677 national representative 11-, 13-, and 15-year-old children and adolescents. MVPA and individual- and environmental-related factors were assessed by a questionnaire and analyzed by two-level logistic regression. Seventeen of the twenty-one variables were statistically significantly associated with MVPA. However, only three variables were statistically significant in all MVPA subgroups, whereby self-directed PA at least twice a week, fewer perceived barriers, and higher peer support increased the odds of participating in more MVPA. The results from this study showed essential differences among the MVPA subgroups, also supporting previous findings, whereby various individual- and environmental-based factors are associated with children and adolescents’ levels of MVPA. Challenges to designing and implementing effective interventions are based on the need to account for individual differences within the population, as well as the varied connections between PA with different social and physical environments where children and adolescents’ PA takes place. PA interventions with various actions at multiple levels are warranted.

'Home is where the health is': Housing quality and adult health outcomes in the Survey of Income and Program Participation

Nearly a quarter of the homes in the United States were considered unhealthy or inadequate, but whether these housing characteristics have direct effects on health or whether they are driven by other contextual housing and neighborhood characteristics remains unclear. The purpose of this study was to quantify the independent associations between poor housing quality and adult health outcomes, adjusting for socioeconomic factors (e.g. income to poverty ratio, food insecurity) and other contextual housing characteristics (e.g. rental status, number of people per household, unsafe neighborhood). Using in-person household interview data from wave 1 of the 2014 Survey of Income and Program Participation (SIPP), a secondary analysis was performed using a series of logistic regression models. The 2014 SIPP sample is a multistage stratified sample of 53,070 housing units designed to represent the civilian, noninstitutionalized population of the United States (N = 55,281 adults ages 18 and older). Our results indicate that each additional poor housing characteristic was associated with poorer health status (OR: 1.17, CI [1.11, 1.23]), higher medical utilization (OR: 1.11 CI: [1.06, 1.16]), and a higher likelihood of hospitalization (OR: 1.07, CI [1.02, 1.12]). Non-housing-related government assistance, food security, and safe neighborhoods only partially explained associations between housing quality and health outcomes. Evaluating current local, state, and federal policy on housing quality standards may help determine if these standards decrease the number of Americans residing in inadequate homes or result in improvements in health and reductions in healthcare costs. Simply put, the home is where [we suggest] the health is.

Dover Micro Open Street Events: Evaluation Results and Implications for Community-Based Physical Activity Programming

Open Streets events provide opportunities for residents to be active. The current program developed and implemented five smaller scale, Micro Open Streets Events (MOSE) in Dover, DE that provided a range of opportunities for physical activity over a <0.5 miles stretch of closed road. Our objective was to evaluate the capacity of this approach to reach residents and improve knowledge and intention to engage in physical activity once the event was over. We used individual surveys, observational, and neighborhood audit factors to assess MOSE participation and conduciveness to physical activity. Our results showed that MOSE attendance ranged from 40 to 500 adults from a high-risk demographic (i.e., non-Caucasian, middle-age, overweight), who demonstrated a strong liking of the MOSE and increased knowledge of, and intention to engage in physical activity following the event. Our data suggest that where a full-scale Open Streets event is not feasible, a MOSE may be a viable alternative.

Aggregated aluminium exposure: risk assessment for the general population

Aluminium is one of the most abundant elements in earth's crust and its manifold uses result in an exposure of the population from many sources. Developmental toxicity, effects on the urinary tract and neurotoxicity are known effects of aluminium and its compounds. Here, we assessed the health risks resulting from total consumer exposure towards aluminium and various aluminium compounds, including contributions from foodstuffs, food additives, food contact materials (FCM), and cosmetic products. For the estimation of aluminium contents in foodstuff, data from the German "Pilot-Total-Diet-Study" were used, which was conducted as part of the European TDS-Exposure project. These were combined with consumption data from the German National Consumption Survey II to yield aluminium exposure via food for adults. It was found that the average weekly aluminium exposure resulting from food intake amounts to approx. 50% of the tolerable weekly intake (TWI) of 1 mg/kg body weight (bw)/week, derived by the European Food Safety Authority (EFSA). For children, data from the French "Infant Total Diet Study" and the "Second French Total Diet Study" were used to estimate aluminium exposure via food. As a result, the TWI can be exhausted or slightly exceeded-particularly for infants who are not exclusively breastfed and young children relying on specially adapted diets (e.g. soy-based, lactose free, hypoallergenic). When taking into account the overall aluminium exposure from foods, cosmetic products (cosmetics), pharmaceuticals and FCM from uncoated aluminium, a significant exceedance of the EFSA-derived TWI and even the PTWI of 2 mg/kg bw/week, derived by the Joint FAO/WHO Expert Committee on Food Additives, may occur. Specifically, high exposure levels were found for adolescents aged 11-14 years. Although exposure data were collected with special regard to the German population, it is also representative for European and comparable to international consumers. From a toxicological point of view, regular exceedance of the lifetime tolerable aluminium intake (TWI/PTWI) is undesirable, since this results in an increased risk for health impairments. Consequently, recommendations on how to reduce overall aluminium exposure are given.

Cross-Sectional Associations of Environmental Perception with Leisure-Time Physical Activity and Screen Time among Older Adults

This study investigated associations of perceived environmental factors with leisure-time physical activity (LTPA) and screen time (ST) among older adults. A cross-sectional study was conducted by administering computer-assisted telephone interviews to 1028 older Taiwanese adults in November 2016. Data on personal factors, perceived environmental factors, LTPA, and ST were included. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to examine associations of environmental perception with LTPA and ST by using logistic regression analyses. The results showed that after adjusting for potential confounders, older adults who perceived their neighborhood with good access to shops (AS) and to public transportation (AT) were more likely to have sufficient LTPA (AS: OR = 1.64, 95% CI: 1.16–2.32; AT: OR = 1.43; 95% CI, 1.00–2.03) and less likely to have excessive ST (AS: OR = 0.70; 95% CI: 0.50–0.97; AT: OR = 0.64; 95% CI: 0.46–0.90). Different perceived environmental factors were also associated with LTPA and ST, respectively. This study highlights environment perception as a crucial factor for LTPA and ST. These findings suggest that policy makers and physical activity intervention designers should develop both common and individual environmental strategies to improve and increase awareness of the neighborhood environment to promote LTPA and reduce ST among older adults.