The relationship between living in urban and rural areas of Scotland and children's physical activity and sedentary levels: a country-wide cross-sectional analysis

Built for movement: Neighborhoods and adolescent physical activity behaviors, and the moderating role of socioeconomic position and gender

This study examined whether the built environment was associated with physical activity among adolescents in Oslo, Norway, and the role of socioeconomic position and gender as potential moderators of this association. We used data from 897 adolescents who participated in the TACKLE cross-sectional study conducted in 2020. Built environment features (recreational facilities, parks, forest, public transport, traffic calming devices, and schools) were assessed objectively using Geographical Information Systems. Physical activity data included device-measured moderate-to-vigorous physical activity, total physical activity, and self-reported active transportation to school. Using general linear models and logistic regression, we found that most built environment features were unrelated to the participants' device-measured physical activity. Longer distances to school and to traffic calming devices were associated with decreased likelihood of participants reporting active transportation to school. Our moderated regression analysis showed that adolescents with low socioeconomic backgrounds seemed less affected by longer distances to school compared with their high socioeconomic counterparts. Furthermore, boys appeared to be more sensitive to traffic safety relative to girls. Implementing traffic calming devices may enhance active transportation to school and improve traffic safety for Norwegian adolescents.

Perceived Barriers to Physical Activity Among Youth Living in Rural and Urban Canadian Communities: A Nationally Representative Cross-Sectional Study

BACKGROUND

We used nationally representative data to explore associations among location of residence (rural/urban) and perceived barriers to physical activity (PA) in Canadian youth.

METHODS

We analyzed the 2017 Canadian Community Health Survey, Barriers to Physical Activity Rapid Response data for 12- to 17-year-old youth. Nine items from the survey assessing perceived barriers to PA were combined into 3 barrier domains: resources, motivational, and socioenvironmental. The likelihood of reporting barriers to PA based on rural-urban location was examined using survey-weighted binary logistic regression following a model fitting approach. Sociodemographic factors were modeled as covariates and tested in interaction with location. For each barrier domain, we derived the best-fitting model with fewest terms.

RESULTS

There were no location-specific effects related to reporting any barrier or motivation-related PA barriers. We found a sex by location interaction predicting the likelihood of reporting resource-related barriers. Rural boys were less likely to report resource-related barriers compared with urban boys (odds ratio [OR] = 0.42 [0.20, 0.88]). Rural girls were more likely to report resource-related barriers compared with boys (OR = 3.72 [1.66, 8.30]). Regarding socioenvironmental barriers, we observed a significant body mass index by location interaction demonstrating that rural youth with body mass index outside the "normal range" showed a higher likelihood of reporting socioenvironmental barriers compared with urban youth (OR = 2.38 [1.32, 4.30]). For urban youth, body mass index was unrelated to reporting socioenvironmental barriers (OR = 1.07 [0.67, 1.71]).

CONCLUSION

PA barriers are not universal among Canadian youth. Our analyses highlight the importance of testing interactions in similar studies as well as considering key sociodemographic characteristics when designing interventions.

Use of natural environments is associated with reduced inequalities in child mental wellbeing: A cross-sectional analysis using global positioning system (GPS) data

Exposure to natural environments may benefit child mental wellbeing whilst offering a lever to reduce health inequalities. However, understanding of these relationships is limited by evidence from indirect measures of exposure. We objectively measured children's direct use of natural environments-and use in low or high physical activity (PA) states-and associated this with their mental wellbeing. We then examined moderation by sex and household income. Using global positioning system and accelerometry data from children (n = 640), we measured mean daily time in natural environments ('total use'), which we stratified by PA level as 'passive use' (sedentary and light PA) and 'active use' (moderate and vigorous PA). Logistic regression associated exposures with dichotomised Strengths and Difficulties Questionnaire outcomes (internalising difficulties; externalising difficulties; prosocial behaviour), with interactions to examine moderation. A 10-minute increase in total use was associated with 10.5 % lower risk of abnormal internalising outcomes (OR: 0.895; 95 % CI 0.809, 0.990), and 13.2 % lower risk of abnormal externalising outcomes (OR: 0.868; 95 % CI 0.776, 0.990). This suggests that ∼ 60 min of daily total use was associated with 50 % lower risk of abnormal internalising and externalising outcomes. The relative effects of passive and active use were equal, but their associations were moderated by income independently for specific outcomes. For externalising outcomes, the risk of abnormal scores in lower-income children reduced as passive use increased (P = 0.027) but remained constant for higher-income children. For prosocial outcomes, the likelihood of normal scores increased with active use in lower-income children, but not higher-income children (P = 0.005). Sex did not moderate these associations. The findings suggest that targeted interventions supporting disadvantaged children to use natural environments could help address inequalities in mental wellbeing. Further, the moderated associations with types of use suggest the equigenic effects of natural environments may operate through multiple pathways.

Physical Activity Levels During School Recess in a Nationally Representative Sample of 10- to 11-Year-Olds

PURPOSE

School recess provides a valuable opportunity for children's daily moderate- to vigorous-intensity physical activity (MVPA). This study aimed to quantify MVPA during school recess in a representative sample of Scottish children and examine whether recess MVPA varied by gender, socioeconomic status, season, urban/rural residency, and recess length.

METHOD

Five-day accelerometry MVPA data were analyzed from 773 children (53.9% girls, 46.1% boys, 10- to 11-y-olds) from 471 schools. Binary logistic regression explored associations between meeting/not meeting the recommendation to spend 40% of recess time in MVPA and the aforementioned risk factors. Descriptive recess data were also analyzed.

RESULTS

Participants spent an average of 3.2 minutes (SD 2.1) in MVPA during recess. Girls engaged in 2.5 minutes (SD 1.7) of MVPA compared with 4.0 minutes (SD 2.2) for boys. Only 6% of children met the recess MVPA recommendation. The odds of girls (odds ratio 0.09; 95% confidence interval, 0.04-0.25) meeting the recommendation was lower (P < .001) compared with boys. No statistically significant differences were observed in meeting the recommendation for the other risk factors.

CONCLUSION

Levels of MVPA during school recess are very low in Scottish children, and interventions aimed at increasing MVPA during recess are needed.

Association of aerobic fitness and grip strength with cognitive and academic performance in Arab children

This study investigated the association between aerobic and muscular fitness with the cognitive control and academic performance of preadolescent Arab children. Ninety-three children aged 10-13years (mean=11.5, SD=0.5) representing eight Arab nations (Egypt, Saudi Arabia, Sudan, Syria, Jordan, Lebanon, Yemen, and Morocco) participated in this cross-sectional study. The participants completed tests for aerobic (progressive aerobic cardiovascular endurance run) and muscular (maximum grip strength) fitness, and cognitive control (flanker task). We assessed their academic performance based on their overall grade point average (GPA). Our analyses revealed that greater aerobic fitness was associated with higher GPA scores and greater muscular fitness was associated with a shorter response time in a task condition requiring extensive cognitive control (incongruent condition). No association was found between aerobic fitness and flanker task performance nor between muscular fitness and GPA. These results bridge the knowledge gap on the associations of physical fitness to the cognitive control and academic performance of Arab children, suggesting that the positive associations found in Western and Asian literature can be generalized to the Arab context.

Physical Activity Level Alterations Due to the Lockdowns: A Multi-Center Greek University-Based Study

OBJECTIVE

This cross-sectional study determines the impact of the pandemic lockdowns on physical activity, and evaluates the factors associated with physical activity cessation on students and personnel of eight Greek Higher Education Institutions.

MATERIALS AND METHODS

A total of 6,380 volunteer participants completed a survey reporting their physical activity levels and perceptions during the COVID-19 pandemic. The survey was made available through an online platform.

RESULTS

Both the conduct and intensity of physical activity were significantly reduced from the pre-pandemic era to the second lockdown (P<0.001). Walking was the most frequently selected type of physical activity, in all periods except for the second lockdown. Loss of interest (52.4%) was the main, self-reported factor for cessation of physical activity. Females had a 31% lower probability of ceasing physical activity during lockdowns.

CONCLUSION

The conduct and intensity of physical activity decreased significantly during the pandemic. Female gender, annual checkup attendance, and specific physical activity types during the pre-pandemic era were associated with a reduction in the risk of pausing physical activity during lockdowns. Lockdowns may be implemented in future health crises, hence measures for maintaining the physical activity of the general population, such as online group sessions and support from healthcare professionals, should be prepared.

Children's independent mobility during dark hours: a scoping review

Introduction

Independent mobility is every child's right and has implications for their health, wellbeing, and development. This scoping review addresses children's needs and experiences of light conditions in their everyday outdoor life. The review examines peer-reviewed scientific literature that analyses associations between different light conditions and children's independent mobility (CIM) during dark hours.

Methods

By formulating a Boolean search string, including terms related to children independent mobility, light and outdoor environment, five scientific databases were searched. The search resulted in 67 eligible papers that were analyzed through an inductive, thematic analysis.

Results

Four overarching themes representing the researched topics of the effects of light conditions with importance for CIM during dark hours were identified: (1) physical activity (PA) and active travel, (2) outdoor activities and place use, (3) safety perception, and (4) outdoor risks. The findings highlight that darkness constitutes a major obstacle for CIM, and that fear of darkness is common among children. It restricts the degree of CIM and influences children's safety perception as well as how they navigate through public places outdoors. The findings show that the type and design of outdoor settings during dark hours and children's familiarity with places during daytime could play a role in the degree of CIM after dark. The presence of outdoor lighting is related to children's increased PA and active travel, and outdoor lighting seems to also influence children's place use and interaction with the environment. The presence and extent of outdoor lighting and lighting quality may play a role in children's safety perception, which in turn can influence CIM.

Discussion

The findings suggest that promoting CIM during dark hours might not only contribute to the accumulation of children's PA, confidence, and skills, but also support mental health. The understanding of children's perspectives on the quality of outdoor lighting needs to be deepened to support CIM. Highlighting the child perspective would aid the development of current recommendations for outdoor lighting and the implementation of the Agenda 2030 of ensuring healthy lives and promoting wellbeing for all at all ages, and making cities inclusive, safe, resilient and sustainable throughout the day and seasons.

Incidence of HIV Infection among HIV-Exposed Iinfants at Gondar University Hospital from 2019-2021: A Prospective Cohort Study

Background

Mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) is decreasing worldwide; however, achieving the MTCT elimination target of 2% by 2020 and 0% by 2030 is challenging in resource-limited countries. Preventing mother-to-child transmission (PMTCT) is a key strategy in eliminating new pediatric human immunodeficiency virus (HIV) infection Strengthening PMTCT program is one of the key mechanisms for the elimination of Pediatric HIV infection and improving maternal and newborn survival. Assessing the incidence of HIV infection among HIV exposed infants is critical to devise an important preventive strategy which was the main objective of this study.

Methods

A prospective Cohort study was conducted at Gondar University Comprehensive Specialized Hospital, PMTCT clinic to assess the incidence of HIV infection among HIV exposed infants from 2019-2021.

Results

The overall incidence of HIV infection among HIV exposed infants was 3.6%. HIV infection rate was significantly increased among HIV exposed infants coming out of Gondar, Infants with developmental failure and Infants with Unknown fathers' HIV status compared to their counterpart.

Conclusions

The incidence of HIV infection among 307 HIV-exposed infants was 3.6% which is higher than the expected standard. The lost to follow up rate was also significant (9.4%). These finding showed that strengthening the PMCT service is mandatory.

Moderate-to-vigorous intensity physical activity during school hours in a representative sample of 10-11-year-olds in Scotland

OBJECTIVES

Growing concern about children and adolescent physical inactivity has made the promotion of physical activity a public health priority. International recommendations suggest children should accumulate at least 30 min of moderate-to-vigorous physical activity (MVPA) during school hours. This study assessed levels of objectively-measured MVPA in a large nationally representative sample of Scottish children aged 10-11. Risk factors for not meeting the school-hours MVPA recommendation were examined.

DESIGN

Cross-sectional.

METHODS

Mean time spent in MVPA during school hours across five weekdays was measured using Actigraph accelerometry (May 2015-May 2016). Binary logistic regression, presented as odds ratio (O.R.) and confidence intervals (C.I.), explored associations between meeting/not meeting the recommendation by sex, socioeconomic status (SES), season, and urban/rural residence in 2022.

RESULTS

Valid data were obtained from 773 children (53.9% girls, 46.1% boys) from 471 schools. Mean daily school-hours MVPA was 29 (SD 11) minutes; 42.7% of children reached the recommendation. The odds of girls (O.R. 0.43; C.I. 0.32, 0.57) meeting the recommendation was significantly lower (p < 0.001) compared to boys. Children living in rural areas had higher odds (O.R. 1.49; C.I. 1.04, 2.15) of meeting the recommendation compared with those in urban areas (p = 0.032). No significant differences in meeting the recommendation by SES (p = 0.700). The overall trend for season was significant (p < 0.001), with lower odds of meeting the recommendation in winter compared to summer.

CONCLUSIONS

Most Scottish children aged 10-11 did not meet the 30 minute MVPA recommendation. Interventions to increase MVPA during school hours are essential to promote public health.

Movement Behaviour and Health Outcomes in Rural Children: A Systematic Review

BACKGROUND

Studies with rural children are limited, and results are divergent regarding the information on movement behaviours.

PURPOSE

to (i) describe the physical activity and sedentary behaviour in children; (ii) synthetize the year and place of publication, methodological quality, and instruments used to measure physical activity and sedentary behaviour; and (iii) to analyse the relationship between physical activity, sedentary behaviour, and health outcomes in these children.

METHODS

We use the databases PubMed, Web of Science, SPORTDiscus, Scopus, Virtual Health Library, and SciELO, considering papers published until October 2021. A total of 12,196 studies were identified, and after the exclusion of duplicate, title and abstract screening, and the full-text assessment, a total of 68 were included in the study.

RESULTS

A cross-sectional design was dominant among the studies, with sample sizes ranging from 23 to 44,631 children of both sexes. One-third of the studies were conducted in North America and Europe, and most of them used device-based measurements. Inequalities were observed regarding sex, age, economic level, race, and physical activity domains within and between the places of residence. Sociodemographic characteristics were also related to health outcomes for children living in rural and urban areas.

CONCLUSION

It is necessary to increase the evidence on movement behaviours among children living in the countries of South America and Oceania, as well as to increase the level of evidence on the role of school for physical activity in children in rural areas, given the inconsistent findings.

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.

Inequalities in children's exposure to alcohol outlets in Scotland: a GPS study

BACKGROUND

Alcohol use is a leading cause of harm in young people and increases the risk of alcohol dependence in adulthood. Alcohol use is also a key driver of rising health inequalities. Quantifying inequalities in exposure to alcohol outlets within the activity spaces of pre-adolescent children-a vulnerable, formative development stage-may help understand alcohol use in later life.

METHODS

GPS data were collected from a nationally representative sample of 10-and-11-year-old children (n = 688, 55% female). The proportion of children, and the proportion of each child's GPS, exposed to alcohol outlets was compared across area-level income-deprivation quintiles, along with the relative proportion of exposure occurring within 500 m of each child's home and school.

RESULTS

Off-sales alcohol outlets accounted for 47% of children's exposure, which was higher than expected given their availability (31% of alcohol outlets). The proportion of children exposed to alcohol outlets did not differ by area deprivation. However, the proportion of time children were exposed showed stark inequalities. Children living in the most deprived areas were almost five times more likely to be exposed to off-sales alcohol outlets than children in the least deprived areas (OR 4.83, 3.04-7.66; P < 0.001), and almost three times more likely to be exposed to on-sales alcohol outlets (OR 2.86, 1.11-7.43; P = 0.03). Children in deprived areas experienced 31% of their exposure to off-sales outlets within 500 m of their homes compared to 7% for children from less deprived areas. Children from all areas received 22-32% of their exposure within 500 m of schools, but the proportion of this from off-sales outlets increased with area deprivation.

CONCLUSIONS

Children have little control over what they are exposed to, so policies that reduce inequities in alcohol availability should be prioritised to ensure that all children have the opportunity to lead healthy lives.

Ringing the bell for quality P.E.: What are the realities of remote physical education?

BACKGROUND

To date, few data on the quality and quantity of online physical education (P.E.) during the COVID-19 pandemic have been published. We assessed activity in online classes and reported allocated curriculum time for P.E. in a multi-national sample of European children (6-18 years).

METHODS

Data from two online surveys were analysed. A total of 8395 children were included in the first round (May-June 2020) and 24 302 in the second round (January-February 2021).

RESULTS

Activity levels during P.E. classes were low in spring 2020, particularly among the youngest children and in certain countries. 27.9% of students did not do any online P.E. and 15.7% were hardly ever very active. Only 18.4% were always very active and 14.9% reported being very active quite often. In winter 2020, we observed a large variability in the allocated curriculum time for P.E. In many countries, this was lower than the compulsory requirements. Only 65.7% of respondents had the same number of P.E. lessons than before pandemic, while 23.8% had less P.E., and 6.8% claimed to have no P.E. lessons. Rates for no P.E. were especially high among secondary school students, and in large cities and megapolises.

CONCLUSIONS

During the COVID-19 pandemic, European children were provided much less P.E. in quantity and quality than before the pandemic. Countermeasures are needed to ensure that these changes do not become permanent. Particular attention is needed in large cities and megapolises. The critical role of P.E. for students' health and development must be strengthened in the school system.

Seasonal Shifts in Children's Sedentary Behaviors, Physical Activity, and Sleep: A Systematic Review and meta-Analysis

Children's movement behaviors (ie, sedentary behaviors, physical activity, and sleep) are related to obesity risk and may vary throughout the year. The purpose of this systematic review is to summarize existing literature on the seasonal variation in physical activity and sleep in children. This study found that children's behaviors fluctuate seasonally and thus, interventions must target behaviors during the times when children's behaviors are the least healthy, specifically during the summer (when children are not in school) and winter. Finally, the paucity of data on seasonal variation in sleep indicates a need for further research in this area.

Moderating Influence of Home Location and School Type across Time on Cardiometabolic Risk and Active School Commuting: A Five-Year Longitudinal Study

Background: We examined the moderating influence of home location and school type across time on cardiometabolic risk and active school commuting over 5 years in a sample of children from southern Brazil. Methods: We recruited a sample of children (n = 154; baseline age = 9.6 ± 1.5 years old; 56.8% female) who were followed for 5 years from 2011/2012 to 2016/2017. We collected home location, school type, and school commute data using self-report methods and collected cardiometabolic risk measures to calculate a cardiometabolic composite risk score (cMetSyn). General and generalized linear mixed effects models were employed to examine the moderating influence of home location and school type across time on cardiometabolic risk and active school commuting. Results: We found a significant three-way home location × school type × time interaction on cMetSyn scores (b = 0.62, 95% confidence interval [CI]: 0.13-1.12, p = 0.014), indicating that children who were living within rural areas and enrolled in state schools during 2016/2017 had higher cardiometabolic risk compared with children enrolled in municipal schools and living in urban areas at the end of the study. Additionally, we found that children living in rural areas had an 86% lower rate of active school commuting compared with students living in urban areas (rate ratio = 0.14, 95% CI: 0.07-0.32, p < 0.001). Conclusions: The results suggest that Brazilian children enrolled in state schools and living in rural areas had higher cardiometabolic risk scores at the end of the study and that southern Brazilian children residing in rural areas had a much lower rate of actively commuting to school.

"… Exercise opportunities became very important": Scottish older adults' changes in physical activity during Covid19'

BACKGROUND

The purpose of this study was to explore perceived changes in physical activity (PA) due to Covid19 stay-at-home and social distancing guidance among older adults.

METHODS

Participants (n = 1429, 77% female, 84% ≥60 years) living in Scotland completed an online survey in Summer 2020 measuring PA and wellbeing (indexed through loneliness, and health-related quality of life). The survey included open- and closed-ended questions about how these variables changed in response to Covid19 social distancing and 'shielding' guidelines.

RESULTS

From the International Physical Activity Questionnaire (IPAQ), the majority reported high volumes of PA, indicative of being 'moderately' or 'highly' active. When asked specifically about strength training, 12% reported engagement on ≥2d/wk. Most participants reported that PA had changed during this time, citing reduced use of exercise facilities, increased active travel, and online PA classes; although only 16% reported engaging in PA online.

CONCLUSIONS

Higher levels of PA were found to be associated with better health-related quality of life. Additional efforts should be made to support PA engagement in older adults, including strength training and other tailored approaches to support individual needs.

Levels and Correlates of Objectively Measured Sedentary Behavior in Young Children: SUNRISE Study Results from 19 Countries

PURPOSE

There is a paucity of global data on sedentary behavior during early childhood. The purpose of this study was to examine how device-measured sedentary behavior in young children differed across geographically, economically, and sociodemographically diverse populations, in an international sample.

METHODS

This multinational, cross-sectional study included data from 1071 children 3-5 yr old from 19 countries, collected between 2018 and 2020 (pre-COVID). Sedentary behavior was measured for three consecutive days using activPAL accelerometers. Sedentary time, sedentary fragmentation, and seated transport duration were calculated. Linear mixed models were used to examine the differences in sedentary behavior variables between sex, country-level income groups, urban/rural settings, and population density.

RESULTS

Children spent 56% (7.4 h) of their waking time sedentary. The longest average bout duration was 81.1 ± 45.4 min, and an average of 61.1 ± 50.1 min·d-1 was spent in seated transport. Children from upper-middle-income and high-income countries spent a greater proportion of the day sedentary, accrued more sedentary bouts, had shorter breaks between sedentary bouts, and spent significantly more time in seated transport, compared with children from low-income and lower-middle-income countries. Sex and urban/rural residential setting were not associated with any outcomes. Higher population density was associated with several higher sedentary behavior measures.

CONCLUSIONS

These data advance our understanding of young children's sedentary behavior patterns globally. Country income levels and population density appear to be stronger drivers of the observed differences, than sex or rural/urban residential setting.

Urban-Rural Differences in Children's and Adolescent's Physical Activity and Screen-Time Trends Across 15 Years

BACKGROUND

Urban and rural areas have been experiencing major demographic and structural changes, characterized by an aging population in rural areas and a growth of cities in number and size. However, it is poorly researched how children's physical activity and screen time developed in urban and rural areas. To address this deficit, we investigated physical activity and screen-time trends in Germany's pediatric population across four urbanicity levels (rural, small town, medium-sized town, city).

METHOD

We obtained weighted data at three cross-sectional timepoints between 2003 and 2017, representative for Germany's child and adolescent population. Physical activity and screen time were self-reported. We analyzed trends using a structural equation modeling framework for the overall sample and calculated interactions between the trends and age and gender, respectively.

RESULTS

In total, 12,161 children and adolescents between 4 and 17 years participated in the study. Children and adolescents in rural areas experienced a downward trend in total physical activity. Outdoor play and leisure-time physical activity decreased across all areas, with the strongest decline in rural areas. Computer and gaming time increased across all areas except for cities, with the sharpest increase in rural areas. The decline in outdoor play and the incline in computer and gaming time were driven by adolescents. Females showed stronger increases in computer and gaming time than males.

CONCLUSION

Our findings suggest that in a representative sample of children and adolescents in Germany, detrimental trends in children's physical activity and screen time occur at a higher rate in rural areas compared with urban environments. This provides critical information for health policy: While all children and adolescents should be targeted for physical activity promotion, a special focus should be on tailoring interventions for rural areas to prevent and mitigate inequalities in physical activity across urban and rural areas.

Emergency general surgery: impact of distance and rurality on mortality

BACKGROUND

There is debate about whether the distance from hospital, or rurality, impacts outcomes in patients admitted under emergency general surgery (EGS). The aim of this study was to determine whether distance from hospital, or rurality, affects the mortality of emergency surgical patients admitted in Scotland.

METHODS

This was a retrospective population-level cohort study, including all EGS patients in Scotland aged 16 years or older admitted between 1998 and 2018. A multiple logistic regression model was created with inpatient mortality as the dependent variable, and distance from hospital (in quartiles) as the independent variable of interest, adjusting for age, sex, co-morbidity, deprivation, admission origin, diagnosis category, operative category, and year of admission. A second multiple logistic regression model was created with a six-fold Scottish Urban Rural Classification (SURC) as the independent variable of interest. Subgroup analyses evaluated patients who required operations, emergency laparotomy, and inter-hospital transfer.

RESULTS

Data included 1 572 196 EGS admissions. Those living in the farthest distance quartile from hospital had lower odds of mortality than those in the closest quartile (OR 0.829, 95 per cent c.i. 0.798 to 0.861). Patients from the most rural areas (SURC 6) had higher odds of survival than those from the most urban (SURC 1) areas (OR 0.800, 95 per cent c.i. 0.755 to 0.848). Subgroup analysis showed that these effects were not observed for patients who required emergency laparotomy or transfer.

CONCLUSION

EGS patients who live some distance from a hospital, or in rural areas, have lower odds of mortality, after adjusting for multiple covariates. Rural and distant patients undergoing emergency laparotomy have no survival advantage, and transferred patients have higher mortality.

A Comparison of Meeting Physical Activity and Screen Time Recommendations between Canadian Youth Living in Rural and Urban Communities: A Nationally Representative Cross-Sectional Analysis

Meeting the physical activity (PA) and recreational screen time recommendations for children and young people is associated with several health benefits. The purpose of this study was to compare the odds of meeting PA and recreational screen time recommendations between the Canadian youth living in urban versus rural communities. We analyzed nationally representative cross-sectional data collected as part of the 2017–2018 cycles of the Canadian Community Health Survey among young people aged 12–17 years. PA and screen time were self-reported. Sex-specific multivariable logistic regression models were used to estimate the odds of meeting individual and combined PA and recreational screen time recommendations by rural and urban status after adjusting for individual, socioeconomic, and seasonal covariates. The odds of meeting the PA recommendation were not statistically significantly different among males (OR = 1.01, 95% CI: 0.86–1.18) or females (OR 1.05, 95% CI: 0.99–1.11) living in urban versus rural communities. The odds of meeting the recreational screen time recommendations were statistically significantly lower among male (OR = 0.71, 95% CI: 0.65–0.77) and female (OR = 0.71, 95% CI: 0.59–0.86) youth living in urban compared to those in rural communities. The odds of meeting the combined PA and screen time recommendations were statistically significantly lower among urban males (OR = 0.75, 95% CI: 0.71–0.81) but not females (OR = 0.82, 95% CI: 0.58–1.15) than those from rural communities. These findings suggest that residential context (i.e., urban versus rural) may have a differential impact on meeting the combined PA and screen time recommendations among the male and female Canadian youth. Future research should investigate these differences using device-based measures.

Health Behaviors of Austrian Secondary School Teachers and Principals at a Glance: First Results of the From Science 2 School Study Focusing on Sports Linked to Mixed, Vegetarian, and Vegan Diets

Lifestyle behaviors are key contributors to sustainable health and well-being over the lifespan. The analysis of health-related behaviors is crucial for understanding the state of health in different populations, especially teachers who play a critical role in establishing the lifelong health behaviors of their pupils. This multidisciplinary, nationwide study aimed to assess and compare lifestyle patterns of Austrian teachers and school principals at secondary levels I and II with a specific focus on physical activity and diet. A total number of 1350 teachers (1.5% of the eligible Austrian sample; 69.7% females; 37.7% from urban areas; mean age: 45.8 ± 11.4 years; mean BMI: 24.2 ± 4.0) completed a standardized online survey following an epidemiological approach. Across the total sample, 34.4% were overweight/obese with a greater prevalence of overweight/obesity in males than females (49.5% vs. 29.2%, p < 0.01) and rural vs. urban environments (35.9% vs. 31.3%). Most participants (89.3%) reported a mixed diet, while 7.9% and 2.9% were vegetarians and vegans, respectively. The average BMI of teachers with mixed diets (24.4 ± 4.0 kg/m2) was significantly higher than vegetarians (23.1 ± 3.2 kg/m2) and vegans (22.7 ± 4.3 kg/m2). Vegans reported a lower level of alcohol intake (p < 0.05) among dietary groups. There was no between-group difference in smoking (p > 0.05). The prevalence of engagement in regular physical activity was 88.7% for leisure-time sports/exercises and 29.2% for club sports. Compared with the previous reports on general populations, the present data suggest an acceptable overall health status among Austrian teachers.

Changes in Physical Activity Patterns Due to the Covid-19 Pandemic: A Systematic Review and Meta-Analysis

With the outbreak of the Corona Virus Disease 19 (Covid-19) in late 2019, governments increasingly imposed containment strategies, including social distancing as well as restricted population movement, potentially having negative impacts on mental and physical health. A growing number of studies have examined the impact of the pandemic on different facets of physical activity (PA); an overview combining these (mixed) results, however, is missing. Thus, the objective of this systematic review and meta-analysis was to investigate whether and to which extent PA changed from before to during the Covid-19 pandemic, taking age, gender, and measurement method into account. The literature search was conducted using PubMed, Web of Science, and Scopus. Results of the main characteristics were descriptively synthesized and analyzed in a meta-analysis quantifying effects of the pandemic on PA divided by age groups, with additional subgroup analyses of the characteristics age, gender, and measurement method being narratively synthesized. Overall, 57 studies with a total sample size of 119,094 participants (N between 10 and 60,560 subjects) from 14 countries worldwide with participants aged between four and 93 years were included. Thirty-two studies revealed a significant decline in PA, whereas only five studies found a significant increase in PA during the Covid-19 pandemic. Fourteen studies revealed mixed results. PA decreased in all age groups, independent of gender. Most self-reported and all device-based measurement methods showed a reduction in PA. However, effects were not found to be significant in all age groups. Nevertheless, the declining trend should be noted and governments should strive to enable PA within periods of pandemic restrictions, or promote alternatives such as digital training to avoid negative health consequences within the population.

Health Behaviors of Austrian Secondary Level Pupils at a Glance: First Results of the From Science 2 School Study Focusing on Sports Linked to Mixed, Vegetarian, and Vegan Diets

Attaining healthy behaviors is essential at any life stage, particularly childhood, due to the strong link between children’s lifestyle and the subsequent adult state of health. This multidisciplinary study aimed to assess lifestyle behaviors of Austrian pupils of secondary schools I and II, with a specific focus on PA habits and diet types based on a large sample. In total, 8845 children/adolescents participated in the short standardized online survey on relevant health-related aspects nationwide. Valid and complete data was provided by 8799 pupils, including 1.14% of the eligible 771,525; 63% girls, 76% having a normal body weight, 70% attending secondary schools II, and more pupils/students living in rural vs. urban areas (3:1 ratio). Across the total sample, 11.8% were considered overweight/obese with a higher prevalence of overweight/obesity in boys than girls (15.5% vs. 9.6%) and urban vs. rural participants (13.9% vs. 10.8%; p < 0.05). The majority of participants (84.5%) reported a mixed diet, while 7.2% and 8.5% reported a vegan and vegetarian diet, respectively. Vegans reported a lesser alcohol intake (p < 0.05) compared to non-vegan pupils (no difference in dietary subgroups for smoking). Although overall PA and dietary behaviors suggest an appropriate health status among Austrian youth, attention should be focused on policies to increase healthy lifestyle habits at best through a dual approach to health permanently combining regular PA, sports, and exercise with a healthy diet, which would contribute to matching the current recommendations for improving individual and public health.

Youth’s Physical Activity and Fitness from a Rural Environment of an Azores Island

This study aimed to characterize and compare physical activity (PA) and fitness levels by sex in 109 students of a rural environment. The participants were between 15 and 20 years old, from the Santa Maria High School in the Azores’ Santa Maria island. PA levels were assessed by International Physical Activity Questionnaire (IPAQ)-short form. The physical fitness was evaluated by the Fitnessgram battery tests. The sample of this study were physically active, 67.9% were classified with high and moderate PA levels. Regarding the sex comparisons, no significant differences between PA levels were founded. However, males presented higher values of vigorous physical activity, whereas females spent more time in moderate activity, such as walking. Moreover, females had more time in sitting positions during the week and weekend. Regarding the physical fitness levels, males presented significantly higher performances in the upper strength (p < 0.001) and aerobic capacity tests (p < 0.001), whereas females showed higher values in the sit and reach test (p < 0.001), in the trunk lift test (p < 0.005), and in the fat mass values (p < 0.001). It seems reasonable to assume that there is a sociodemographic influence on the PA and physical fitness levels in our sample. We may speculate that rural life provides more opportunities for youth for being physically active than urban life. No differences were founded between sexes for physical activity. However, differences were found between sex for strength, flexibility, cardiorespiratory fitness, and body composition. That might be explained by the biological differences and the type of physical activity habits that each sex use to have in rural environmental.

Exposure to unhealthy product advertising: Spatial proximity analysis to schools and socio-economic inequalities in daily exposure measured using Scottish Children's individual-level GPS data

This study aimed to understand socio-spatial inequalities in the placement of unhealthy commodity advertisements at transportation stops within the Central Belt of Scotland and to measure advertisement exposure using children's individual-level mobility data. We found that children who resided within more deprived areas had greater contact with the transport network and also greater exposure to unhealthy food and drink product advertising, compared to those living in less deprived areas. Individual-level mobility data provide evidence that city- or country-wide restrictions to advertising on the transport network might be required to reduce inequalities in children's exposure to unhealthy commodity advertising.

Walkability indices and childhood obesity: A review of epidemiologic evidence

The lack of an active neighbourhood living environment can impact community health to a great extent. One such impact manifests in walkability, a measure of urban design in connecting places and facilitating physical activity. Although a low level of walkability is generally considered to be a risk factor for childhood obesity, this association has not been established in obesity research. To further examine this association, we conducted a literature search on PubMed, Web of Science and Scopus for articles published until 31 December 2018. The included literature examined the association between measures of walkability (e.g., walkability score and walkability index) and weight-related behaviours and/or outcomes among children aged under 18 years. A total of 13 studies conducted in seven countries were identified, including 12 cross-sectional studies and one longitudinal study. The sample size ranged from 98 to 37 460, with a mean of 4971 ± 10 618, and the age of samples ranged from 2 to 18. Eight studies reported that a higher level of walkability was associated with active lifestyles and healthy weight status, which was not supported by five studies. In addition to reviewing the state-of-the-art of applications of walkability indices in childhood obesity studies, this study also provides guidance on when and how to use walkability indices in future obesity-related research.

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.

Prevalence of Overweight and Obesity among People Aged 18 Years and Over between 2013 and 2018 in Hunan, China

Background: Recent overweight and obesity prevalence data are lacking for China. Methods: Data were from provincially representative surveys conducted in 2013 and 2018 in Hunan Province, China. Overweight and obesity were defined according to the Chinese standard. Complex sampling weights were considered in statistical analyses. 95% confidence interval (95% CI) of rate was calculated. Results: The overall prevalence rate between 2013 and 2018 significantly increased from 20.81% (95% CI: 17.68–23.95) to 26.97% (95% CI: 23.48–30.45) for overweight and from 4.09% (95% CI: 3.21–4.96) to 7.13% (95% CI: 5.10–9.15) for obesity in Hunan Province of China, respectively. Urban residents and males had higher crude prevalence rates of overweight and obesity than rural residents and females in 2013 and in 2018. Notably, the peak age groups of overweight and obesity both became younger between 2013 and 2018. After controlling for Engel coefficient, level of education and frequency of physical exercise per week, the overweight prevalence significantly increased in urban males aged 65+ (adjusted OR: 1.52) and rural males aged 45–54 years (adjusted OR: 1.52) and 65+ (adjusted OR: 1.88) and the obesity prevalence rate rose significantly in many groups (urban males: 18–24 years, 25–34 years, 35–44 years and 55–64 years; urban females: 25–34 years, 35–44 years, 45–54 years; rural males: 18–24 years, 25–34 years; rural females: 35–44 years, 55–64 years), with adjusted OR varying from 1.56 to 5.52. Conclusion: The adult prevalence rates of overweight and obesity significantly increased between 2013 and 2018 in Hunan Province, China. The increasing prevalence rates and varying prevalence changes across groups warrantee further research and policy interventions.

Children's Health in the Digital Age

Environmental studies, metabolic research, and state of the art research in neurobiology point towards the reduced amount of natural day and sunlight exposure of the developing child, as a consequence of increasingly long hours spent indoors online, as the single unifying source of a whole set of health risks identified worldwide, as is made clear in this review of currently available literature. Over exposure to digital environments, from abuse to addiction, now concerns even the youngest (ages 0 to 2) and triggers, as argued on the basis of clear examples herein, a chain of interdependent negative and potentially long-term metabolic changes. This leads to a deregulation of the serotonin and dopamine neurotransmitter pathways in the developing brain, currently associated with online activity abuse and/or internet addiction, and akin to that found in severe substance abuse syndromes. A general functional working model is proposed under the light of evidence brought to the forefront in this review.