12-Year Trends in Active School Transport across Four European Countries-Findings from the Health Behaviour in School-Aged Children (HBSC) Study

Adolescents' screen-based media use and the relationship with moderate-to-vigorous physical activity, sports club participation and active commuting

AIM

A worry regarding young people's physical activity engagement relates to a potentially competing development: the role of screen-based media (SBM) in their everyday lives. The present study aimed to assess time spent on different types of SBM, self-reported moderate-to-vigorous physical activity (MVPA) and physical activity in different domains and their interrelations.

METHODS

The study is based on data from 3737 participants aged 11, 13 and 15 years from Norway collected in 2021/2022 as part of the Health Behaviour in School-aged Children collaborative cross-national survey.

RESULTS

The findings revealed high amounts of total SBM time. There were age and gender differences in physical activity, especially with lower levels of active transport during leisure time among girls than among boys. A series of binary logistic regression analyses with adjustment for age, gender and socioeconomic status showed that high levels of total SBM time were negatively associated with involvement in club sports, active school transport, active travel to friends and leisure activities, and 60 min MVPA 5 days/week. Gaming and social media use were also negatively associated with most of the physical activity indicators. All SBM variables were negatively associated with involvement in club sports and 60 min MVPA 5 days/week.

CONCLUSIONS

The study demonstrates negative associations between SBM time among adolescents and physical activity in various domains. Actions to facilitate youth physical activity in the digital age seem crucial. Additional studies with nuanced data on these behaviours and longitudinal research design allowing for examining their interrelations over time are needed.

Correlates of active commuting to school across two generations: the Cardiovascular Risk in Young Finns Study

AIMS

Active commuting to school (ACS), a source of physical activity (PA), has declined in many countries over recent decades. This study investigates ACS and the factors associated with it among Finnish children and adolescents across two generations: those born between 1965-74 and 1998-2010. We also explore potential generational differences in these associations.

METHODS

School commuting was self-reported by 2075 participants of the ongoing population-based Young Finns Study in 1983 (generation 1 (G1), aged 9-18, 52% female), and by their 1137 offspring in 2018 (generation 2 (G2), aged 8-20, 53% female). Factors associated with ACS and the moderating effect of generation on these associations were examined using generalized estimating equation models for clustered binary data, for summer and winter seasons separately.

RESULTS

A greater distance to school (p < 0.001) and belonging to G2 (p ⩽ 0.049) were negatively associated with ACS during both seasons. High parental leisure-time PA (p ⩽ 0.025 for both seasons) and urban living area (p < 0.001 for summer) were positively associated with ACS. Generation moderated the associations of school grade and parental income with ACS in the summer (p ⩽ 0.015). Among G1 only, attending lower secondary school (vs. primary school) was negatively associated with ACS, while higher parental income was positively associated with ACS. Neither gender nor parental education was associated with ACS.

CONCLUSIONS

ACS was less common among the younger generation. Several correlates of ACS were identified, with generational differences. These findings can inform further research and guide policy decisions to promote ACS and ultimately enhance the PA of children and adolescents.

Children's Health in London and Luton (CHILL) cohort: a 12-month natural experimental study of the effects of the Ultra Low Emission Zone on children's travel to school

BACKGROUND

The Ultra-Low Emission Zone (ULEZ), introduced in Central London in April 2019, aims to enhance air quality and improve public health. The Children's Health in London and Luton (CHILL) study evaluates the impact of the ULEZ on children's health. This analysis focuses on the one-year impacts on the shift towards active travel to school.

METHODS

CHILL is a prospective parallel cohort study of ethnically diverse children, aged 6-9 years attending 84 primary schools within or with catchment areas encompassing London's ULEZ (intervention) and Luton (non-intervention area). Baseline (2018/19) and one-year follow-up (2019/20) data were collected at school visits from 1992 (58%) children who reported their mode of travel to school 'today' (day of assessment). Multilevel logistic regressions were performed to analyse associations between the introduction of the ULEZ and the likelihood of switching from inactive to active travel modes, and vice-versa. Interactions between intervention group status and pre-specified effect modifiers were also explored.

RESULTS

Among children who took inactive modes at baseline, 42% of children in London and 20% of children in Luton switched to active modes. For children taking active modes at baseline, 5% of children in London and 21% of children in Luton switched to inactive modes. Relative to the children in Luton, children in London were more likely to have switched from inactive to active modes (OR 3.64, 95% CI 1.21-10.92). Children in the intervention group were also less likely to switch from active to inactive modes (OR 0.11, 0.05-0.24). Moderator analyses showed that children living further from school were more likely to switch from inactive to active modes (OR 6.06,1.87-19.68) compared to those living closer (OR 1.43, 0.27-7.54).

CONCLUSIONS

Implementation of clean air zones can increase uptake of active travel to school and was particularly associated with more sustainable and active travel in children living further from school.

Changes in diet and physical activity following a community-wide pilot intervention to tackle childhood obesity in a deprived inner-London ward

BACKGROUND

Local authorities in England have an important role in shaping healthy local environments contributing to childhood obesity. This study examined changes in diet and physical activity in primary school children following a three-year, complex, community-based intervention in Golborne ward, the second most deprived ward in London.

METHODS

The Go-Golborne intervention aimed to shape the local environment across multiple settings with the engagement of a large number of local government and community stakeholders in a joint approach. Activities focused on six co-created themes to make changes to local environments and reduce sugary snacks and beverage consumption, increase fruit and vegetable intake, promote healthy snacks, increase active play and travel, and reduce screen time. We analysed changes in self-reported diet and physical activity, collected annually between 2016 and 2019, from 1,650 children aged 6-11 years through six local schools, who all received the intervention. We used multilevel, linear and logistic random-slope regression models adjusted for time on study, baseline age, gender, ethnicity, deprivation quintile, school, and baseline weight status.

RESULTS

After three years of follow-up, there were reductions in sugar-sweetened beverage consumption (adjusted beta -0·43 occasions/day, 95% CI -0·55 to -0·32), fruit and vegetable consumption (adjusted beta -0.22 portions, 95% CI -0.44 to 0.001) and car travel to and from school (adjusted OR 0·19, 95% CI 0·06 to 0·66), while screen time increased (high versus moderate/low: OR 2·30, 95% CI 1·36 to 3·90). For other behavioural outcomes, there was no statistically significant evidence of changes.

CONCLUSION

Local authorities have substantial powers to make positive changes to the obesogenic environment but programmes remain under-evaluated. Results from the ambitious Go-Golborne intervention demonstrated mixed results in health behaviours following programme implementation. These results underline the importance of a coordinated and comprehensive policy response to support changes in wider environmental and social conditions as well as appropriate and holistic evaluations of initiatives to inform local actions on obesogenic environments.

The built environment and child obesity: A review of Australian policies

Child obesity is a serious public health challenge affected by both individual choice and societal and environmental factors. The main modifiable risk factors for child obesity are unhealthy eating and low levels of physical activity, both influenced by aspects of the built environment. Coordinated government policy across jurisdictions, developed using strong research evidence, can enable built environments that better support healthy lifestyles. This study reviewed current Australian and Western Australian government policies to understand if and how they address the impact of the built environment on child obesity, physical activity, sedentary behavior, and diet. Current government policy documents related to the built environment and child health were analyzed using the Comprehensive Analysis of Policy on Physical Activity framework. Ten Australian and 31 Western Australian government policy documents were identified. Most referred to the role of the built environment in supporting physical activity. Very few policies mentioned the built environment's role in reducing sedentary behaviors, supporting healthy eating, and addressing obesity. Few recognized the needs of children, and none mentioned children in policy development. Future government policy development should include the voices of children and child-specific built environment features. Inter-organizational policies with transparent implementation and evaluation plans are recommended.

Active Commuting to School among Spanish Preschool Children: A Temporal Change Study between 2013 and 2017

BACKGROUND

Active commuting to school may increase the total daily physical activity and achieve health benefits among preschool children. Rates of active commuting to school among Spanish children and adolescents have been widely analysed, while the rates of active commuting to school among Spanish preschool children are unknown.

AIM

The main objective of this study was to examine the changes in the rates of active commuting to school in a sample of Spanish preschool children between 3 and 6 years old from 2013 to 2017.

METHODS

Data were found from five studies carried out across Spain. The study sample comprised 4787 preschool children (4.59 ± 0.77 years old; 51% males). The overall changes in active commuting to school were assessed using multilevel logistic regression analysis.

RESULTS

The rates of active commuting to school in Spanish preschool children are around 52%, and the active commuting to school rates have stayed stable throughout the period assessed (odds ratio from 0.40 to 0.58, all p > 0.05).

CONCLUSION

In preschool children, the present study obtained a favourable result on active commuting to school, showing a pattern stability in the examined period similar to other ages. It will be of great importance to promote this behaviour to obtain high levels of active commuting to school.

Parental perspectives on the decision-making process on transport mode choice in adolescents: a qualitative study with mothers and fathers

Objective

The present study aims to understand the familial decision-making process on transport mode choice in adolescents with a focus on the parental perspective within this process.

Background

Active travel contributes to adolescents' overall physical activity and its positive health effects. Based on the social-learning theory, especially parents are assigned a central role for adolescents' travel behavior. The aim of the present study was to examine how parents are involved in the decision-making process on transport mode choice in adolescents.

Method

The study is part of the cross-sectional mixed-methods ARRIVE study which includes semi-structured interviews with mothers (n = 12) and fathers (n = 7) of 11- to 14-year-old German adolescents. The interviews focused on travel behavior in adolescents and the decision-making process on transport mode choice from the parental perspective. All interviews were analyzed inductively using Thematic Analysis.

Results

Our study revealed that parents do not primarily decide for or against active travel in adolescents, but are mostly involved in the decision-making process, especially in case of a deviation from the main transport mode. Different forms of parental involvement in the decision-making process were identified. Some parents acted as main decision makers which is the highest form of involvement while others gave their children complete freedom of choose a transport mode for themselves. These parents accepted their child's choice fully which shows a low involvement in the decision-making process.

Conclusion

The results provide a deeper understanding of the familial decision-making process on travel behavior in adolescents. The results indicate an occasionally parental involvement in the decision-making process on the mainly used transport mode by adolescents, and that mothers and fathers are always involved when deviating from the main mode.

Implications

Further research should investigate changes in travel behavior from childhood to young adulthood to understand long-term travel decisions in families. Due to the findings that parents are often involved in the decision-making process on transport mode choice and that they mainly reported safety concerns as barriers to their children's active travel, further research should focus especially on the social and physical environment of adolescents.

Gender-specific social and environmental correlates of active travel to school in four European countries: the HBSC Study

Introduction

Despite the health benefits, a large proportion of girls and boys in Europe do not travel to school actively. A better understanding of the correlates associated with this behavior could guide interventions. This study examines perceived social and environmental correlates of active travel to school (ACTS) from the 2017/18 Health Behavior in School-Aged Children (HBSC) survey in four European countries, with a special emphasis on gender differences (n = 22,023).

Methods

Logistic regression was conducted to analyze associations between the perceived importance of each correlate and ACTS behavior for 11-, 13-, and 15-year-old girls and boys from Germany, Czechia, Poland, and Slovakia. All models were adjusted for age, family affluence, and meeting World Health Organization recommendations for moderate-to-vigorous physical activity.

Results

Rates of ACTS significantly differed between girls and boys. In Czechia, 65% of girls and boys traveled to school actively, followed by Slovakia (61.4% girls and 58.4% boys), Poland (57.7% girls and 60.2% boys), and Germany (42.6% girls and 48.6% boys). Girls were less likely to actively travel to school compared to boys (odds ratio [OR]: 0.92, 95% confidence interval [CI]: 0.87-0.97). Increasing age (OR: 0.95, 95% CI: 0.93-0.97) and a greater distance to school index (OR: 0.89, 95% CI: 0.88-0.90) were both negatively associated with ACTS. The perceived importance of living closer to school and of road and neighborhood safety was positively associated with ACTS, with a stronger association in boys than in girls for neighborhood safety. On the contrary, the perceived importance of having people to walk with was negatively associated with ACTS, with a stronger association in girls (OR: 0.74, 95% CI: 0.65-0.84) than in boys (OR: 0.77, 95% CI: 0.66-0.88).

Discussion

This study provides insights into perceived social and environmental correlates associated with ACTS behavior. Future research should include gender-specific perceptions and more in-depth investigations of correlates encouraging ACTS, especially considering social aspects, safety issues, and the structuring of the environment in different cultural settings.

Validating the Perceived Active School Travel Enablers and Barriers-Parent (PASTEB-P) Questionnaire to Support Intervention Programming and Research

A child's ability to participate in active school travel (AST) is complicated by several factors. Of particular note are parental controls, which are informed by their perceptions of the local built and social environments, assessments of their child's skills, and convenience preferences, among other considerations. However, there is currently a lack of AST-specific scales that include validated parental perception measures related to such notable barriers and enablers, or those that tend to frame their AST decision-making processes. Framed within the social-ecological model of health behaviour, the aims of the present paper were thus threefold, specifically to (1) outline and test the construct validity of measures delineating parental perceptions of barriers and enablers to AST, (2) evaluate the reliability and consistency of the developed measures, and (3) connect these measures to develop broader constructs for use in the Perceived Active School Travel Enablers and Barriers-Parent (PASTEB-P) questionnaire. To achieve these aims, a mixed-methods approach featuring cognitive interviews and surveys, along with qualitative (thematic analysis) and quantitative (Cohen's Kappa, McDonald's Omega, and confirmatory factor analysis) analyses, was applied across two studies. The validation processes of the two studies resulted in the development of fifteen items comprising seven distinct constructs (barriers: AST Skills, Convenience, Road Safety, Social Safety, and Equipment Storage; enablers: Supportive Environment and Safe Environment) related to parental perceptions of AST. The developed PASTEB-P questionnaire can be used to inform and evaluate AST intervention programming and can be applied for AST research purposes.

Associations of parents' and adolescents' active travel behavior across various destinations - a sex/gender analysis

BACKGROUND

Active travel behavior such as walking and cycling is associated with several health benefits. Especially the family environment seems to be important for active travel in children and adolescents. Currently, little is known regarding travel behavior in leisure time and associations of travel behavior within parent-adolescent dyads.

METHODS

The present analysis is based on the German ARRIVE study (Active tRavel behavioR in the famIly enVironmEnt), which incorporated a large scale, representative cross-sectional online survey including 517 parent-child dyads consisting of adolescents (N = 517; boys = 263, girls = 254) aged 11-15 years and one of their parents (N = 517; fathers = 259, mothers = 258). Based on that survey which took place in June 2021 (during the COVID-19 pandemic), we calculated the prevalence of active travel to four commonly visited destinations (school/work, friends/relatives, shopping stores and recreational activities) using an adapted version of the travel to school questionnaire by Segura-Diaz JM, Rojas-Jimenez A, Barranco-Ruiz Y, Murillo-Pardo B, Saucedo-Araujo RG, Aranda-Balboa MJ, et al. (Int J Environ Res Public Health 17(14), 2020). In addition, we investigated the associations between parents' and adolescents' travel behavior using scores for school/work, leisure time (friends/relatives, shopping stores and recreational activities) and overall (school/work and leisure time).

RESULTS

Across all destinations, prevalence of active travel in adolescents (63.08%) was higher than in parents (29.21%). Active travel to school (47.33%) as well as to work (20.43%) indicated the lowest prevalence. Linear regression models revealed significant associations in overall active travel between mothers and adolescents (girls: β = 0.308, p < 0.001; boys: β = 0.302, p = 0.001) and in leisure time active travel behavior between mothers and daughters (β = 0.316, p < 0.001). Related to school/work active travel there were no associations between parents and adolescents.

CONCLUSION

The associations between adolescents' and parents' travel behavior differ depending on gender: they are solely seen in mother-adolescents dyads. Furthermore, our findings conclude that travel is a routine and independent of the destination.

Active school commuting in adolescents from 28 countries across Africa, the Americas, and Asia: a temporal trends study

BACKGROUND

Evidence examining trends in active school commuting among adolescents are mainly single-country studies, and principally focused on high-income countries. Thus, the present study aims to examine temporal trends in adolescents' active school commuting and to examine if there are differences in such trends by sex. We used nationally representative samples of 28 countries, which were predominantly low- and middle-income countries (LMICs), covering 5 different WHO regions.

METHODS

Data from the Global School-based Student Health Survey 2004-2017 were analyzed in 177,616 adolescents [mean (SD) age: 13.7 (1.0) years; 50.7% girls]. Active school commuting was self-reported (frequency of walking or riding a bike to and from school in the past 7 days). The prevalence and 95%CI of active school commuting (i.e., ≥ 3 days/week) was calculated for the overall sample and by sex for each survey. Crude linear trends in active school commuting were assessed by linear regression models. Interaction analyses were conducted to examine differing trends among boys and girls.

RESULTS

Trends in active school commuting were heterogeneous across countries, with results showing stable patterns for the majority (16/28), decreasing trends for some (7/28) and increasing trends over time for a few (5/28). The majority of countries showed no differences in active school commuting trends between girls and boys.

CONCLUSIONS

The quantification of changes in adolescents' active school commuting over time, together with a deeper understanding of local determinants for such behaviors will provide valuable evidence to inform the development of tailored and context-specific actions.

Testing the Mystic School Mobile Application to Promote Active Commuting to School in Spanish Adolescents: The PACO Study

Active commuting to and/or from school (ACS) is an opportunity to increase daily physical activity (PA) levels in young people. Mobile-device interventions focused on promoting the practice of health-related PA can be more cost-effective than traditional interventions in this population.

OBJECTIVE

To analyze the adolescents' opinion of the mobile application (app) Mystic School, which was designed to promote ACS in Spanish adolescents.

METHODS

A total of 44 students (14-15 years old) from Granada and Jaén participated in the test of the Mystic School app during two phases: phase 1 (n = 10) for 2 weeks and phase 2 (n = 34) for 1 month. Each phase included an app presentation, a follow-up, and focus group sessions. The qualitative analysis was carried out through NVivo software.

RESULTS

In phase 1, adolescents reported improvements in the design and functioning, such as the avatar movement, virtual steps utilities, and multiplayer function. These suggestions were included in phase 2. After phase 2, adolescents reported that it is important to add the possibility of playing without an Internet connection to the game, to include more competitive options, prizes, and to increase the difficulty of the levels. In both phases, problems with the step number counting remained.

CONCLUSION

The Mystic School app can be a useful tool for the physical education teacher to integrate the content from this curriculum related to the promotion of PA, such as ACS.

Association between the Duration of the Active Commuting to and from School, and Cognitive Performance in Urban Portuguese Adolescents

This study aimed to analyze the differences between active commuting to school (ACS) and non-ACS in cognitive performance (CP), and the association of ACS duration with CP. This cross-sectional study included 370 adolescents (males n = 170), with a mean age of 15.28 ± 2.25 years. CP was assessed through an interview, and ACS, extracurricular physical activity, and socioeconomic status was assessed by self-report. Body composition was assessed using the FitnessGram test battery. One in two adolescents did ACS (51.6%). ACS was associated with boys (53.9%), younger adolescents (14.91 ± 2.15 vs. 15.69 ± 2.29), those having school social support (55.0%), and those doing one or more extracurricular physical activities (53.6%), compared to non-ACS participants (p < 0.05). The analysis of covariance, after controlling for age, sex, school social support, and participation in extracurricular physical activity, showed an effect of ACS on the total cognitive score (F_(2,362) = 3.304, p < 0.05). The CP was higher in adolescents with more than 30 min of ACS than non-ACS (p < 0.05). The influence of ACS duration can be seen in the dimensions of inductive reasoning (ß = 0.134, t = 2.587, p < 0.05) and working memory (ß = 0.130, t = 2.525, p < 0.05). The role of ACS for CP, as well as guidelines for future research, are discussed.

Patterns of Active Travel and Physical Activity among Adolescents in Israel

Active travel (AT) is a core physical activity (PA) indicator for children and youth; contributing to health and wellbeing, at both the individual and societal levels. This analysis explores patterns of adolescent active school travel (AST) and cycling and associations with different PA measures. Secondary analysis of the cross-sectional 2018-2019 Health Behaviour in School Age Children study in Israel included an extended PA module with walking, cycling and e-cycling modes. The nationally representative sample includes students in grades 6-12 (n = 4407). Analysis of weighted data included descriptive analyses, inferential statistics, and regression analyses. AST was reported by 61.9% of adolescents; 39.3% reported 20 min or more daily AST; 27.1% reported habitual cycling (HC) and 17.4% reported habitual e-cycling (HEC). There are mixed results for socio-economic status and environment. AST and HC were associated with less sedentary hours daily (odds ratio [OR] = 1.190 and 1.397, respectively); HC was associated with positive sports self-rating (OR = 2.394). Stepwise regression analysis found that lower AST duration, time in minutes, was associated with watching television with the family. Promotion of adolescent AT may be associated with increased PA and joint parent-adolescent AT, and was utilized across different socio-demographic groups in Israel.

Towards More Sustainable Sports: Analyzing the Travel Behavior of Adolescent Soccer Players in Southern Norway

Mitigating climate change is a global challenge demanding effort from all sectors, and sports are no exception. While transportation is one of the key issues regarding sustainable sports, the methods by which children and adolescents get to practice have not received much attention. The objectives of this study were, therefore, to present how adolescents in Southern Norway travel to soccer practice and assess how the mode of transportation is related to sex, socioeconomic status, age, ethnicity, and distance from home to practice. Cross-sectional data were collected from 558 adolescent soccer players (398 boys and 190 girls) representing 30 different clubs from settlements of varying rurality. While most of the participants lived within cycling distance from the field of practice, the majority opted for passive modes of transportation (55% passive vs. 45% active). A logistic regression analysis found that traveling distance and age were associated with active transportation habits, while sex, ethnicity, and socioeconomic status were not. Further research is needed to examine the main barriers to active travel for this already active population, as active transport represents an opportunity for sports to become more sustainable.