Mothers' Perceived Neighbourhood Environment and Outdoor Play of 2- to 3.5-Year-Old Children: Findings from the Healthy Beginnings Trial

Time Playing Outdoors Among Children Aged 3-5 Years: National Survey of Children's Health, 2021

INTRODUCTION

Federal guidelines recommend physical activity throughout the day for preschool-aged children. Time playing outdoors can support physical activity participation, health, and development. Estimates of time playing outdoors among U.S. children aged 3-5 years have not been published.

METHODS

Parent/caregiver-reported data on children aged 3-5 years from the 2021 National Survey of Children's Health were analyzed in 2022-23. Chi-square tests were used to identify differences in time playing outdoors by sociodemographic and neighborhood characteristics. Multiple logistic regression analyses were conducted with significant characteristics for weekdays and weekend days.

RESULTS

Among 11,743 children aged 3-5 years, 37% played outdoors for ≤1 hour on weekdays, and 24% played outdoors for ≤1 hour on weekend days. In 9 states, ≥40% of children played outdoors for ≤1 hour on weekdays. Adjusted models for weekdays and weekend days showed a greater likelihood of ≤1 hour playing outdoors among those in all racial/ethnic groups compared to non-Hispanic White, those who lived in metropolitan statistical areas, those who did not participate in child care, and those whose adult proxy disagreed with "we watch out for each other's children in this neighborhood." The weekday model showed additional differences by sex, with girls more likely to have ≤1 hour of time playing outdoors.

CONCLUSIONS

Nearly 40% of preschool-aged children play outdoors for ≤1 hour per day on weekdays, with differences by sociodemographic and neighborhood characteristics. Further study and interventions focused on building supportive, equitable communities might increase the amount of time preschool-aged children spend playing outdoors.

Playground Location and Patterns of Use

Playgrounds have features that benefit visitors, including opportunities to engage in outdoor physical activity. We surveyed 1350 adults visiting 60 playgrounds across the USA in Summer 2021 to determine if distance to the playground from their residence was associated with weekly visit frequency, length of stay, and transportation mode to the site. About 2/3 of respondents living within ½ mile from the playground reported visiting it at least once per week compared with 14.1% of respondents living more than a mile away. Of respondents living within ¼ mile of playgrounds, 75.6% reported walking or biking there. After controlling for socio-demographics, respondents living within ½ mile of the playground had 5.1 times the odds (95% CI: 3.68, 7.04) of visiting the playground at least once per week compared with those living further away. Respondents walking or biking to the playground had 6.1 times the odds (95% CI: 4.23, 8.82) of visiting the playground at least once per week compared with respondents arriving via motorized transport. For public health purposes, city planners and designers should consider locating playgrounds ½ mile from all residences. Distance is likely the most important factor associated with playground use.

Segregated by Wealth, Health, and Development: An Analysis of Pre-School Child Health in a Medium-Sized German City

The School Entry Examination (SEE) can be used to identify children with current health issues, developmental delays, and risk factors for later diseases. This study analyzes the health status of preschool children in a German city with considerable socio-economic differences among its quarters. We used secondary data from SEEs 2016-2019 from the entire city (8417 children), which we divided into quarters with low (LSEB), medium (MSEB), and high socioeconomic burden (HSEB). In HSEB quarters, 11.3% of children were overweight as opposed to 5.3% in LSEB quarters. In HSEB quarters, 17.2% of children had sub-par cognitive development in contrast to 1.5% in LSEB quarters. For overall sub-par development, LSEB quarters had a prevalence of 3.3%, whereas, in HSEB quarters, 35.8% of children received this result. Logistic regression was used to determine the influence of the city quarter on the outcome of overall sub-par development. Here, considerable disparities among HSEB and LSEB quarters remained after adjustment for parents' employment status and education. Pre-school children in HSEB quarters showed a higher risk for later disease than children in LSEB quarters. The city quarter had an association with child health and development that should be considered in the formulation of interventions.

The moderating role of parent perceptions in relationships between objectively measured neighbourhood environment attributes and pre-schooler's physical activity: Findings from the PLAYCE study

We examined the moderating effects of parent perceptions of the neighbourhood environment on associations between objectively measured neighbourhood environment attributes and physical activity among pre-schoolers. The number of neighbourhood parks was positively associated with pre-schooler energetic play when parents had above average perceptions of access to services. Objectively measured street connectivity was associated with fewer minutes of energetic play when pedestrian and traffic safety was perceived to be below average by parents. Greater understanding of the role played by parents in pre-schooler's exposure to physically active supportive environments is needed to inform environmental interventions for specific age groups.

Influence of Neighborhood Built Environments on the Outdoor Free Play of Young Children: a Systematic, Mixed-Studies Review and Thematic Synthesis

Urban environments shape early childhood exposures, experiences, and health behaviors, including outdoor free play, influencing the physical, cognitive, social, and emotional development of young children. We examined evidence for urban or suburban built environment influences on outdoor free play in 0-6-year-olds, considering potential differences across gender, culture, and geography. We systematically searched seven literature databases for relevant qualitative, quantitative, and mixed methods studies: of 5740 unique studies, 53 met inclusion criteria. We assessed methodological quality and thematically synthesized findings from included studies. Three broad themes, features of spaces for play, routes, and social factors intersected to influence the availability, accessibility, and acceptability of neighborhoods for young children's outdoor free play across diverse cultural and geographic contexts. Proximity to formal or informal space for play, protection from traffic, pedestrian environment, green and natural environments, and opportunity for social connection supported outdoor free play. Family and community social context influenced perceptions of and use of space; however, we did not find consistent, gendered differences in built environment correlates of outdoor free play. Across diverse contexts, playable neighborhoods for young children provided nearby space for play, engaging routes protected from traffic and facilitated frequent interaction between people, nature, and structures.

Preschool Children's Physical Activity and Community Environment: A Cross-Sectional Study of Two Cities in China

Research on the relationship between preschool children's physical activity (PA) and community environment is limited and inconclusive, yet understanding this relationship is important to acquire sufficient information to guide the development of intervention programs. This study aims to objectively measure preschool children's PA and examine associations between PA and the community environments. A total of 471 preschool children aged 3-6 years old were recruited from eight kindergartens in Beijing and Zhengzhou. PA was measured by accelerometers. Light PA (LPA), moderate PA (MPA), and vigorous PA (VPA) were computed on the basis of cutoff points developed for preschool children. Moderate-to-vigorous PA (MVPA), and total PA (TPA) were obtained by calculation. Children's active transportation modes were indicated by the frequency of active trips (FAT) reported by parents. The community environment was collected by parental scales. Multivariate linear regression was used to analyze the associations between PA and the community environment. In total, 304 preschool children (mean age 5.07 ± 0.94 years, 50.66% boys) were included in the final analysis. Children spent an average of 77.58 ± 18.78 min/day in MVPA and 173.26 ± 30.38 min/day in TPA. Linear regression showed that 'parental perception of appropriate walking distance' was associated with nearly half of the indicators of the children's PA. 'Public activity facilities near the community' was associated with FAT for overall children (B = 0.099, 95% CI = 0.014, 0.183). 'Community transportation environment' was associated with overall children's average day LPA (B = 4.034, 95% CI = 0.012, 8.056), weekend LPA (B = 8.278, 95% CI = 1.900, 14.657), MPA (B = 4.485, 95% CI = 0.613, 8.357), TPA (B = 14.777, 95% CI = 2.130, 27.424), and FAT for girls (B = -0.223, 95% CI = -0.443, -0.003). Furthermore, 'community personal safety' was associated with boys' weekday VPA (B = -3.012, 95% CI = -5.946, 0.079). Parental perception of appropriate walking distances, improvement of PA facilities, community personal safety, and the community transportation environment all contribute to the prevention of preschool children's PA patterns deterioration.

Parents' Perceptions of the Neighbourhood Built Environment Are Associated with the Social and Emotional Development of Young Children

The influence of the neighbourhood built environment on young children’s physical development has been well-documented; however, there is limited empirical evidence of an association with social and emotional development. Parental perceptions of the neighbourhood built environment may act as facilitators or barriers to young children’s play and interactions in their local environment. The aim of this study was to examine the associations between parents’ perceptions of the neighbourhood built environment and the social-emotional development of children aged two-to-five years. Parents’ positive perceptions of traffic safety (OR 0.74; 95% CI 0.55, 0.98), crime safety (OR 0.79; 95% CI 0.64, 0.99) and land use mix–access (OR 0.74; 95% CI 0.56, 0.98) were associated with lower odds of social-emotional difficulties, while positive perceptions of walking and cycling facilities were associated with higher odds of difficulties (OR 1.26; 95% CI 1.02, 1.55). Positive perceptions of land use mix–access (OR 1.32; 95% CI 1.03, 1.69), street connectivity (OR 1.35; 95% CI 1.10, 1.66) and neighbourhood aesthetics (OR 1.27; 95% CI 1.01, 1.60) were associated with higher odds of prosocial behaviours. Interventions to improve parents’ perceptions of built environment features may facilitate opportunities for play and interactions which contribute to healthy social-emotional development.

Systematic review of the correlates of outdoor play and time among children aged 3-12 years

BACKGROUND

Due to the myriad of benefits of children's outdoor play and time, there is increasing concern over its decline. This systematic review synthesized evidence on the correlates of outdoor play and outdoor time among children aged 3-12 years.

METHODS

A total of 12 electronic databases in five different languages (Chinese, English, Korean, Spanish, Portuguese) were searched between October 28, 2019 and July 27, 2020. Covidence software was used for screening and Microsoft Excel with a predesigned coding form was used for data extraction. Evidence was synthesized and correlates were categorized using the socioecological model framework.

RESULTS

Based on 107 studies representing 188,498 participants and 422 childcare centers from 29 countries, 85 studies examined potential correlates of outdoor play while 23 studies examined that of outdoor time (one examined both). The duration of outdoor play and outdoor time ranged between 60 and 165 min/d and 42-240 min/d, respectively. Out of 287 (outdoor play) and 61 (outdoor time) potential correlates examined, 111 correlates for outdoor play and 33 correlates for outdoor time were identified as significant correlates. Thirty-three variables were identified as key/common correlates of outdoor play/time, including eight correlates at the individual level (e.g., sex/gender, race/ethnicity, physical activity), 10 correlates at the parental level (e.g., parental attitude/support/behavior, parenting practice), nine at the microsystem level (e.g., proximal home/social environment such as residence type, peer influence), three at the macrosystem/community level (e.g., availability of space children can play), and three at the physical ecology/pressure for macrosystem change level (e.g., seasonality, rurality). No key correlates were found at the institutional level.

CONCLUSIONS

Individual, parental, and proximal physical (home) and social environments appear to play a role in children's outdoor play and time. Ecological factors (i.e., seasonality, rurality) also appear to be related to outdoor play/time. Evidence was either inconsistent or lacking at institutional and macrosystem/community levels. Standardizing terminology and measures of outdoor play/time is warranted. Future work should investigate the interactions and processes of multiple variables across different levels of socioecological modelling to better understand the mechanisms through which outdoor play/time opportunities can be optimized for children while paying special attention to varying conditions in which children are born, live, and play.

Does Facilitating Human–Place Bonds Alleviate the Negative Effects of Incivilities on Health?

The present study has two purposes—methodological and theoretical. The methodological purpose is to examine a method for the analysis of perceived incivilities and health in urban neighbourhoods. The current study investigates the direct and indirect relationships between the two variables. The theoretical purpose is to measure neighbourhood incivility as a second-order latent variable that represents physical and social incivilities, and investigates place identity and place attachment as mediators in the relationship between incivilities and health. Previous research has focused on a single dimension of incivility. By contrast, the current study considers a multidimensional form of incivility. This quantitative study comprises 265 residents from an urban neighbourhood in Penang, Malaysia. The results of the structural equation modelling suggest that perceptions towards neighbourhood play a mediating role in the relationship between incivility and health. The mediation roles of place identity and place attachment in the relationship between incivilities and health are also supported. Thus, facilitating human–place bonds alleviates the negative effects of incivilities on health in the study neighbourhood. Residents are less attached to neighbourhoods that are perceived as socially and physically deteriorated. Thus, reducing incivilities and improving place attachment may enhance neighbourhood health.

The Associations between Outdoor Playtime, Screen-Viewing Time, and Environmental Factors in Chinese Young Children: The "Eat, Be Active and Sleep Well" Study

The purpose of this study is to identify regional differences in outdoor activity time and screen-viewing time of preschool children in urban and rural areas and to provide data on the environmental factors to identify modifiable determinants for each region. This cross-sectional study was conducted on 1772 out of 2790 children between the age of 3 to 6 years living in northern China, with their consent. A cross-sectional study was conducted among preschool children living in urban (n = 1114) and rural areas (n = 658) in northern China. To assess environmental factors, the International Physical Activity Questionnaire was used for neighborhood environments, and the questionnaire included three items each for the physical home environment and socio-cultural environment domains. We observed the associations between outdoor play for urban children and sidewalks in the neighborhood, paths for cycles, aesthetic qualities, and “motor vehicles. In addition, in rural areas, screen-viewing time and environmental factors were found to be positively correlated with traffic, limited place and method of outdoor play, and were negatively correlated with the importance of academics and need for company in outdoor play. This has important implications for the development of effective intervention programs for preschool children in China in the future.

Association between parent and child physical activity: a systematic review

Background

Childhood represents an important life stage for establishment of physical activity (PA) habits. Parents are assumed to play an important role in influencing children’s PA. Earlier reviews have mainly focused on parental modelling, encouragement, and support for PA, rather than the actual PA levels of parents. Therefore, the purpose of this review was to systematically summarize the evidence on the relationship between parent and child PA.

Methods

Papers were identified using electronic databases and manual searches of reference lists. Papers reporting on associations between objectively measured child PA and at least one measure of parental PA were included. The quality of the papers was assessed using a modified version of the ROBINS-I tool. For interpretation of the results across studies, we produced albatross plots for all studies combined and by age-groups, sex of the parents, sex of the child, methodology of assessment of parental PA, and type of PA.

Results

Thirty-nine papers were included with sample size of parent-child dyads ranging from 15 to 1267 (mean = 319 dyads, median = 227 dyads). The majority of studies were published from 2008 to 2018 and used accelerometry to assess PA. Most of the studies were classified as having moderate, serious, or critical risk of bias. The albatross plot for all studies combined showed that the clear majority of studies observed a positive relationship between parent and child PA. The plot suggested an average magnitude of correlation across studies to be around 0.13, and the overall impression was that this was fairly similar across child age-groups and gender of parent-child dyads. Studies using objective assessment of parental PA showed stronger relationship between parent and child PA compared with studies using self-report (average magnitude of correlation around 0.16 vs 0.04 respectively). No clear evidence was found for the strength of relationship being dependent on type of PA measure of parent and child (total PA, moderate-to-vigorous PA, steps), however, the relationship for light PA appeared weaker.

Conclusion

This systematic review showed that the clear majority of studies observed a weak positive relationship between parent and child PA regardless of age of the child, the gender of the parent-child dyad, and type of PA.

Trial registration

Registration in PROSPERO: CRD42019093462.

Parental Correlates of Outdoor Play in Boys and Girls Aged 0 to 12-A Systematic Review

Outdoor play is one major source of physical activity (PA) in children. In particular, parents act as gatekeepers, because they can enable their children's outdoor play. This systematic review aims to provide an overview of parental correlates of outdoor play. A systematic literature research of six electronic databases (ERIC, PsycARTICLES, PsycINFO, PubMed/Medline, SCOPUS, and Web of Science Core Collection) was conducted with previously defined search terms, focusing on children 0⁻12 years old. In total, 1719 potentially publications were screened based on eligibility criteria. Included studies were scored for overall study quality. Findings were summarized using a semi-quantitative method. Twenty-one peer-reviewed publications which examined the relationship of parental correlates and outdoor play were included. Overall, five parental correlates were associated with children's amount of outdoor play: mothers' ethnicity, mothers' employment status, parents' education level, the importance parents assign to outdoor play, and perceived social cohesion in the neighborhood. Merely four studies reported sex/gender-stratified results. In summary, only parents' encouragement/support provided evidence for girls' amount of outdoor play. The findings are considered to be of public health relevance for developing intervention programs to increase outdoor play and for improving child's health. More research, especially considering sex/gender of the child, is required.

A Mixed Methods Study on the Barriers and Facilitators of Physical Activity Associated with Residential Relocation

Despite evidence suggesting that neighbourhood characteristics are associated with physical activity, very few mixed methods studies investigate how relocating neighbourhood, and subsequent changes in the built environment, influences physical activity. This sequential mixed methods study estimates associations between changes in overall physical activity and transportation walking and cycling and changes in objectively assessed neighbourhood walkability (quantitative phase) and describes perceived barriers and facilitators to physical activity following residential relocation (qualitative phase). During the quantitative phase, self-reported changes in transportation walking, transportation cycling, and overall physical activity following residential relocation were measured using a 5-point scale: (1) a lot less now, (2) a little less now, (3) about the same, (4) a little more now, and (5) a lot more now. Walkability improvers reported a slight increase in transportation walking (mean = 3.29, standard deviation (SD) = 0.87), while walkability decliners reported little or no perceived change in their transportation walking after relocation (mean = 2.96, SD = 1.12). This difference approached statistical significance (p=0.053). Furthermore, walkability decliners reported a slight decrease in transportation cycling (mean = 2.69, SD = 0.96), while walkability improvers reported little or no perceived change in their transportation cycling after relocation (mean = 3.02, SD = 0.84). This difference was statistically significant (p < 0.05). Change in walkability resulting from relocation was not significantly associated with perceived change in overall physical activity. Our qualitative findings suggest that moving to a neighbourhood with safe paths connecting to nearby destinations can facilitate transportation walking and cycling. Some participants describe adjusting their leisure physical activity to compensate for changes in transportation walking and cycling. Strong contributors to neighbourhood leisure physical activity included the presence of aesthetic features and availability of recreational opportunities that allow for the creation of social connections with community and family.