There is accumulating evidence that greater availability of green space in a neighbourhood is associated with health benefits for the local population. One mechanism proposed for this association is that green space provides a venue for, and therefore encourages, physical activity. It has also been suggested that socio-economic health inequalities may be narrower in greener areas because of the equalised opportunity for physical activity green spaces provide. However, research exploring associations between the availability of green space and physical activity has produced mixed results. Limits to the assessment of the type and amount of physical activity which occurs specifically in green space may account for these mixed findings. This observational study was therefore concerned with the extent to which green space is a venue for physical activity and whether this could account for narrower socio-economic health inequalities in greener neighbourhoods.
Secondary analysis of cross sectional data on 3679 adults (16+) living in urban areas across Scotland matched with a neighbourhood level measure of green space availability. Associations between green space availability and both total physical activity, and activity specifically within green space, were explored using logistic regression models. Interactions between socio-economic position and physical activity were assessed. All models adjusted for age, sex and household income.
The availability of green space in a neighbourhood was not associated with total physical activity or that specifically in green space. There was no evidence that income-related inequalities in physical activity within green space were narrower in greener areas of Scotland.
Physical activity may not be the main mechanism explaining the association between green space and health in Scotland. The direct effect of perceiving a natural environment on physiological and psychological health may offer an alternative explanation.
Green space; Physical activity; Health inequalities
It remains unclear what people are attempting to communicate, in terms of objectively monitored behavior, when describing their physical activity and sedentary behavior through self-report. The purpose of this study was to examine various objectively monitored accelerometer variables (e.g., moderate-to-vigorous physical activity [MVPA], steps/day, sedentary time, etc.) across categories of self-reported MVPA (< 150 vs. ≥ 150 minutes/week), usual occupational/domestic activity (UODA; “mostly sitting” vs. “stand, walk, lift, or carry”), and leisure-time sedentary behavior (LTSB; ≥ 3 vs. < 3 hours/day) in a nationally representative sample of U.S. adults (≥ 20 years).
This is a secondary analysis of 3,725 participants from the 2005–2006 National Health and Nutrition Examination Survey (NHANES) who provided relevant questionnaire responses and ≥ 1 day of valid accelerometer data. Descriptive statistics were computed for various objectively monitored accelerometer variables across categories of self-reported MVPA, UODA, and LTSB. Pairwise comparisons were conducted to examine differences in objectively monitored behavior between categories of self-reported MVPA, UODA, and LTSB.
On average, adults reporting compliance with physical activity guidelines (≥ 150 minutes/week of MVPA) accumulated more objectively measured physical activity and similar amounts of sedentary time relative to those reporting not achieving guidelines. Adults reporting their daily UODA as “mostly sitting” or accruing ≥ 3 hours/day of LTSB accumulated less objectively monitored physical activity and more sedentary time than those who described their UODA as “stand, walk, lift, or carry” or accrued < 3 hours/day of LTSB. The most active cross-classified category (7,935 steps/day; ≥ 150 minutes/week of self-reported MVPA, “stand, walk, lift, or carry” UODA, and < 3 hours/day of LTSB) accumulated more than twice as many daily steps as the least active cross-classified category (3,532 steps/day; < 150 minutes/week of self-reported MVPA, “mostly sitting” UODA, and ≥ 3 hours/day of LTSB).
A number of objectively monitored physical activity indicators varied significantly between self-reported MVPA, UODA, and LTSB categories, while objectively monitored sedentary time only varied between UODA and LTSB categories. Cross-classifications of self-reported MVPA, UODA, and LTSB responses depict a greater range of physical activity than viewing dichotomous responses for these variables one-at-a-time.
Accelerometer; Questionnaire; Sitting; Leisure-time
Constructs based on Social Cognitive Theory have shown utility in understanding dietary behavior; however, little research has examined these relations in youth and parents concurrently. Unique demands of dietary management among families of youth with type 1 diabetes (T1D) suggest the importance of investigation in this population. The purpose of this study was to develop and evaluate youth and parent measures of self-efficacy, outcome expectations, and barriers for healthful eating, and parent modeling of healthful eating, in a sample of youth with type 1 diabetes and their parents.
Youth (n=252) ages 8–18 years with diabetes duration ≥1 year and parents completed self-report measures of healthful eating attitudes including self-efficacy, perceived barriers, positive and negative outcome expectations; youth reported parent modeling of healthful eating. Youth dietary intake from 3-day diet records was used to calculate the Healthy Eating Index 2005 and the Nutrient Rich Foods 9.3 index, measures of overall diet quality. The relations among parent and youth healthful eating attitudes, parent modeling, and youth diet quality were examined using structural equation modeling.
Internal consistency and test-retest reliability of the measures were acceptable. The structural equation model demonstrated acceptable fit (CFI/TLI=0.94/0.94; RMSEA=0.03), and items loaded the hypothesized factors. Parent modeling β^=.27,p=.02 and attitudes toward healthful eating (latent variable comprised of self-efficacy, barriers, outcome expectations) β^=.16,p=.04 had direct effects on youth diet quality. Parent modeling had a direct effect on youth attitudes β^=.49,p<.001; parent attitudes had an indirect effect on youth attitudes through parent modeling β^=.12,p,<.001. Youth attitudes were not associated with youth diet quality. Overall, the model accounted for 20% of the variance in child diet quality.
Parent diet-related behaviors demonstrated an impact on youth attitudes and diet quality, suggesting the importance of family-based clinical and public health efforts to improve diet.
Dietary intake; Social cognitive theory; Type 1 diabetes; Children; Adolescents
Activity friendly environments have been identified as promising strategies to increase physical activity levels in the population. Associations between perceived environmental attributes and physical activity in Latin America may vary from those observed in high income countries. The objective of this systematic review is to identify which perceived environmental attributes are associated with physical activity in Latin America.
Systematic literature search of articles published in English, Portuguese, and Spanish in four databases was conducted (PubMed, Virtual Health Library, EBSCO, and Web of Science). Associations with environmental attributes were analyzed separately for physical activity domains. Fifteen articles were included in the analysis.
All studies had cross-sectional designs. The majority of associations were statistically non-significant, and only four associations were found in the unexpected direction. Leisure-time and transport-related physical activity were the domains most frequently included in the studies and had higher number of associations in the expected direction. Leisure-time physical activity showed a convincing association in the expected direction with safety during the day. Transport-related physical activity had a convincing association with presence of street lighting.
This study shows that perceived environmental attributes and their relationship with physical activity appears to be domain, and context specific. In addition, findings from this study show inconsistencies with the information gathered from high-income countries.
Environment; Exercise; Review; Public health; Leisure; Transportation
Overweight adolescents are more likely to have dysfunctional eating behaviours compared to normal weight adolescents. Little is known about the effects of obesity treatment on the psychological dimensions of eating behavior in this population.
To examine the effects of a prescriptive dietary intervention on external eating (eating in response to food cues, regardless of hunger and satiety), emotional eating and dietary restraint and their relation to weight loss. Parental acceptability was also examined.
This is a secondary study of a 12-month randomized trial, the RESIST study, which examined the effects of two diets on insulin sensitivity. Participants were 109 obese 10- to 17-year-olds with clinical features of insulin resistance. The program commenced with a 3-month dietary intervention using a structured meal plan, with the addition of an exercise intervention in the next 3 months and followed by a 6 month maintenance period.This paper presents changes in eating behaviors measured by the Eating Pattern Inventory for Children and parent rated diet acceptability during the first 6 months of the trial. As there was no difference between the diets on outcome of interest, both diet groups were combined for analyses.
After 6 months, the proportion of participants who reported consuming more in response to external eating cues decreased from 17% to 5% (P = 0.003), whereas non- emotional eating increased from 48% to 65% (p = 0.014). Dietary restraint and parental pressure to eat remained unchanged. A reduction in external eating (rho = 0.36, P < 0.001) and a reduction in dietary restraint (r = 0.26, P = 0.013) were associated with greater weight loss at 3 and 6 months, respectively. Overall this approach was well accepted by parents with 72% of parents considered that their child would be able to follow the meal plan for the longer term.
In the short to medium term, a prescriptive dietary intervention approach is a well-accepted and suitable option for obese adolescents with clinical features of insulin resistance. It may reduce external and emotional eating, led to modest weight loss and did not cause any adverse effect on dietary restraint.
Australian New Zealand Clinical Trial Registration Number (ACTRN) 12608000416392 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=83071
Eating behavior; Structured meal plan; Dietary intervention; Obesity; Adolescent
The quantity and quality of studies in child and adolescent physical activity and sedentary behaviour have rapidly increased, but research directions are often pursued in a reactive and uncoordinated manner.
To arrive at an international consensus on research priorities in the area of child and adolescent physical activity and sedentary behaviour.
Two independent panels, each consisting of 12 experts, undertook three rounds of a Delphi methodology. The Delphi methodology required experts to anonymously answer questions put forward by the researchers with feedback provided between each round.
The primary outcome of the study was a ranked set of 29 research priorities that aimed to be applicable for the next 10 years. The top three ranked priorities were: developing effective and sustainable interventions to increase children’s physical activity long-term; policy and/or environmental change and their influence on children’s physical activity and sedentary behaviour; and prospective, longitudinal studies of the independent effects of physical activity and sedentary behaviour on health.
These research priorities can help to guide decisions on future research directions.
Physical activity; Sedentary behaviour; Research priorities; Children; Adolescents
The magnitude of the relationship between lifestyle risk factors for obesity and adiposity is not clear. The aim of this study was to clarify this in order to determine the level of importance of lifestyle factors in obesity aetiology.
A cross-sectional analysis was carried out on data on youth who were not trying to change weight (n = 5714), aged 12 to 22 years and from 8 ethnic groups living in New Zealand, Australia, Fiji and Tonga. Demographic and lifestyle data were measured by questionnaires. Fatness was measured by body mass index (BMI), BMI z-score and bioimpedance analysis, which was used to estimate percent body fat and total fat mass (TFM). Associations between lifestyle and body composition variables were examined using linear regression and forest plots.
TV watching was positively related to fatness in a dose-dependent manner. Strong, dose-dependent associations were observed between fatness and soft drink consumption (positive relationship), breakfast consumption (inverse relationship) and after-school physical activity (inverse relationship). Breakfast consumption-fatness associations varied in size across ethnic groups. Lifestyle risk factors for obesity were associated with percentage differences in body composition variables that were greatest for TFM and smallest for BMI.
Lifestyle factors were most strongly related to TFM, which suggests that studies that use BMI alone to quantify fatness underestimate the full effect of lifestyle on adiposity. This study clarifies the size of lifestyle-fatness relationships observed in previous studies.
Television; Soft drink; Breakfast; Physical activity; Obesity; Meta-analysis
Physical activity (PA) has many beneficial physical and mental health effects. Physical inactivity is considered the fourth leading risk factor for global mortality. At present there are no systematic reviews on PA patterns among South Asian adults residing in the region. The present study aims to systematically evaluate studies on PA patterns in South Asian countries. A five-staged comprehensive search of the literature was conducted in Medline, Web of Science and SciVerse Scopus using keywords ‘Exercise’, ‘Walking’, ‘Physical activity’, ‘Inactivity’, ‘Physical Activity Questionnaire’, ‘International Physical Activity Questionnaire’, ‘IPAQ’, ‘Global Physical Activity Questionnaire’ and ‘GPAQ’, combined with individual country names. The search was restricted to English language articles conducted in humans and published before 31st December 2012. To obtain additional data a manual search of the reference lists of articles was performed. Data were also retrieved from the search of relevant web sites and online resources. The total number of hits obtained from the initial search was 1,771. The total number of research articles included in the present review is eleven (India-8, Sri Lanka-2, Pakistan-1). In addition, eleven country reports (Nepal-3, Bangladesh-2, India-2, Sri Lanka-2, Bhutan-1, Maldives-1) of World Health Organization STEPS survey from the South-Asian countries were retrieved online. In the research articles the overall prevalence of inactivity was as follows; India (18.5%-88.4%), Pakistan (60.1%) and Sri Lanka (11.0%-31.8%). STEPS survey reports were available from all countries except Pakistan. Overall in majority of STEPS surveys females were more inactive compared to males. Furthermore, leisure related inactivity was >75% in studies reporting inactivity in this domain and people were more active in transport domain when compared with the other domains. In conclusion, our results show that there is a wide variation in the prevalence of physical inactivity among South-Asian adults within and between countries. Furthermore, physical inactivity in South Asian adults was associated with several socio-demographic characteristics. Majority of South Asian adults were inactive during their leisure time. These Factors need to be considered when planning future interventions and research aimed at improving PA in the region.
Physical activity; Inactivity; South Asia; Adults
Current population-based anti-obesity campaigns often target individuals based on either weight or socio-demographic characteristics, and give a ‘mass’ message about personal responsibility. There is a recognition that attempts to influence attitudes and opinions may be more effective if they resonate with the beliefs that different groups have about the causes of, and solutions for, obesity. Limited research has explored how attitudinal factors may inform the development of both upstream and downstream social marketing initiatives.
Computer-assisted face-to-face interviews were conducted with 159 parents and 184 of their children (aged 9–18 years old) in two Australian states. A mixed methods approach was used to assess attitudes towards obesity, and elucidate why different groups held various attitudes towards obesity. Participants were quantitatively assessed on eight dimensions relating to the severity and extent, causes and responsibility, possible remedies, and messaging strategies. Cluster analysis was used to determine attitudinal clusters. Participants were also able to qualify each answer. Qualitative responses were analysed both within and across attitudinal clusters using a constant comparative method.
Three clusters were identified. Concerned Internalisers (27% of the sample) judged that obesity was a serious health problem, that Australia had among the highest levels of obesity in the world and that prevalence was rapidly increasing. They situated the causes and remedies for the obesity crisis in individual choices. Concerned Externalisers (38% of the sample) held similar views about the severity and extent of the obesity crisis. However, they saw responsibility and remedies as a societal rather than an individual issue. The final cluster, the Moderates, which contained significantly more children and males, believed that obesity was not such an important public health issue, and judged the extent of obesity to be less extreme than the other clusters.
Attitudinal clusters provide new information and insights which may be useful in tailoring anti-obesity social marketing initiatives.
Obesity; Attitudes; Adults; Adolescents; Family; Social marketing
Social marketing integrates communication campaigns with behavioural and environmental change strategies. Childhood obesity programs could benefit significantly from social marketing but communication campaigns on this issue tend to be stand-alone.
A large-scale multi-setting child obesity prevention program was implemented in the Hunter New England (HNE) region of New South Wales (NSW), Australia from 2005–2010. The program included a series of communication campaigns promoting the program and its key messages: drinking water; getting physically active and; eating more vegetables and fruit. Pre-post telephone surveys (n = 9) were undertaken to evaluate awareness of the campaigns among parents of children aged 2–15 years using repeat cross-sections of randomly selected cohorts. A total of 1,367 parents (HNE = 748, NSW = 619) participated.
At each survey post baseline, HNE parents were significantly more likely to have seen, read or heard about the program and its messages in the media than parents in the remainder of the state (p < 0.001). Further, there was a significant increase in awareness of the program and each of its messages over time in HNE compared to no change over time in NSW (p < 0.001). Awareness was significantly higher (p < 0.05) in HNE compared to NSW after each specific campaign (except the vegetable one) and significantly higher awareness levels were sustained for each campaign until the end of the program. At the end of the program participants without a tertiary education were significantly more likely (p = 0.04) to be aware of the brand campaign (31%) than those with (20%) but there were no other statistically significant socio-demographic differences in awareness.
The Good for Kids communication campaigns increased and maintained awareness of childhood obesity prevention messages. Moreover, messages were delivered equitably to diverse socio-demographic groups within the region.
The purpose of this study was to examine the relationship between organized sports participation, weight status, physical activity, screen time, and important food habits in a large nationally representative sample of Australian adolescents.
Nationally representative cross-sectional study of 12,188 adolescents from 238 secondary schools aged between 12 and 17 years (14.47 ± 1.25 y, 53% male, 23% overweight/obese). Participation in organized sports, compliance with national physical activity, screen time, and fruit and vegetable consumption guidelines, and consumption of sugar-sweetened beverages and high-fat foods were self-reported. Weight status and adiposity (BMI, waist circumference) were measured.
Organized sports participation was higher among males and those residing in rural/remote areas. Underweight adolescents reported the lowest levels of participation. Higher levels of participation were associated with an increased likelihood of complying with national physical activity (OR = 2.07 [1.67-2.58]), screen time (OR = 1.48 [1.19-1.84]), and fruit and vegetable consumption guidelines (OR = 1.32 [1.05-1.67]). There was no association between organized sport participation and weight status, adiposity, consumption of sugar-sweetened beverages or high-fat foods.
Participation in organized sports was associated with a greater likelihood to engage in a cluster of health behaviors, including meeting physical activity guidelines, electronic screen time recommendations, and fruit and vegetable consumption guidelines. However, participation in organized sports was not associated with unhealthy dietary behaviors including the consumption of sugar-sweetened beverages and high-fat foods. There is no association between participation in organized sports and likelihood to be overweight or obese. The role of sports in promoting healthy weight and energy balance is unclear.
Overweight; Dietary behaviors; Physical activity; Screen time; Public health
Understanding children’s physical activity motivation, its antecedents and associations with behavior is important and can be advanced by using self-determination theory. However, research among youth is largely restricted to adolescents and studies of motivation within certain contexts (e.g., physical education). There are no measures of self-determination theory constructs (physical activity motivation or psychological need satisfaction) for use among children and no previous studies have tested a self-determination theory-based model of children’s physical activity motivation. The purpose of this study was to test the reliability and validity of scores derived from scales adapted to measure self-determination theory constructs among children and test a motivational model predicting accelerometer-derived physical activity.
Cross-sectional data from 462 children aged 7 to 11 years from 20 primary schools in Bristol, UK were analysed. Confirmatory factor analysis was used to examine the construct validity of adapted behavioral regulation and psychological need satisfaction scales. Structural equation modelling was used to test cross-sectional associations between psychological need satisfaction, motivation types and physical activity assessed by accelerometer.
The construct validity and reliability of the motivation and psychological need satisfaction measures were supported. Structural equation modelling provided evidence for a motivational model in which psychological need satisfaction was positively associated with intrinsic and identified motivation types and intrinsic motivation was positively associated with children’s minutes in moderate-to-vigorous physical activity.
The study provides evidence for the psychometric properties of measures of motivation aligned with self-determination theory among children. Children’s motivation that is based on enjoyment and inherent satisfaction of physical activity is associated with their objectively-assessed physical activity and such motivation is positively associated with perceptions of psychological need satisfaction. These psychological factors represent potential malleable targets for interventions to increase children’s physical activity.
Motivation; Physical activity; Children; Self-determination theory; Physical activity
Vegetable intake has been related to lower risk of chronic illnesses in the adult years. The habit of vegetable intake should be established early in life, but many parents of preschoolers report not being able to get their child to eat vegetables. The Model of Goal Directed Behavior (MGDB) has been employed to understand vegetable parenting practices (VPP) to encourage a preschool child’s vegetable intake. The Model of Goal Directed Vegetable Parenting Practices (MGDVPP) provides possible determinants and may help explain why parents use effective or ineffective VPP. Scales to measure effective and ineffective vegetable parenting practices have previously been validated. This manuscript presents the psychometric characteristics and factor structures of new scales to measure the constructs in MGDVPP.
Participants were 307 parents of preschool (i.e. 3 to 5 year old) children, used for both exploratory (EFA) and confirmatory factor analyses (CFA). Data were collected via an internet survey. First, EFA were conducted using the scree plot criterion for factor extraction. Next, CFA assessed the fit of the exploratory derived factors. Then, classical test theory procedures were employed with all scales. Finally, Pearson correlations were calculated between each scale and composite effective and ineffective VPP as a test of scale predictive validity.
Twenty-nine subscales (164 items) within 11 scales were extracted. The number of items per subscale ranged from 2 to 13, with three subscales having 10 or more items and 12 subscales having 4 items or less. Cronbach’s alphas varied from 0.13 to 0.92, with 17 being 0.70 or higher. Most alphas <0.70 had only three or four items. Twenty-five of the 29 subscales significantly bivariately correlated with the composite effective or ineffective VPP scales.
This was the initial examination of the factor structure and psychometric assessment of MGDVPP scales. Most of the scales displayed acceptable to desirable psychometric characteristics. Research is warranted to add items to those subscales with small numbers of items, test their validity and reliability, and characterize the model’s influence on child vegetable consumption.
Vegetable; Parenting practices; Psychometrics; Model of goal directed behavior; Self determination theory
Little research has explored who responds better to an automated vs. human advisor for health behaviors in general, and for physical activity (PA) promotion in particular. The purpose of this study was to explore baseline factors (i.e., demographics, motivation, interpersonal style, and external resources) that moderate intervention efficacy delivered by either a human or automated advisor.
Data were from the CHAT Trial, a 12-month randomized controlled trial to increase PA among underactive older adults (full trial N = 218) via a human advisor or automated interactive voice response advisor. Trial results indicated significant increases in PA in both interventions by 12 months that were maintained at 18-months. Regression was used to explore moderation of the two interventions.
Results indicated amotivation (i.e., lack of intent in PA) moderated 12-month PA (d = 0.55, p < 0.01) and private self-consciousness (i.e., tendency to attune to one’s own inner thoughts and emotions) moderated 18-month PA (d = 0.34, p < 0.05) but a variety of other factors (e.g., demographics) did not (p > 0.12).
Results provide preliminary evidence for generating hypotheses about pathways for supporting later clinical decision-making with regard to the use of either human- vs. computer-delivered interventions for PA promotion.
Physical activity; Intervention; Moderation; Interactive voice response; Behavioral intervention technology system; Targeting
Women living in socio-economically disadvantaged neighbourhoods are at increased risk for physical inactivity and associated health outcomes and are difficult to reach through personally tailored interventions. Targeting the built environment may be an effective strategy in this population subgroup. The aim of this study was to examine the mediating role of environmental perceptions in the relationship between the objective environment and walking for transportation/recreation among women from socio-economically disadvantaged neighbourhoods.
Baseline data of the Resilience for Eating and Activity Despite Inequality (READI) study were used. In total, 4139 women (18–46 years) completed a postal survey assessing physical environmental perceptions (aesthetics, neighbourhood physical activity environment, personal safety, neighbourhood social cohesion), physical activity, and socio-demographics. Objectively-assessed data on street connectivity and density of destinations were collected using a Geographic Information System database and based on the objective z-scores, an objective destinations/connectivity score was calculated. This index was positively scored, with higher scores representing a more favourable environment. Two-level mixed models regression analyses were conducted and the MacKinnon product-of-coefficients test was used to examine the mediating effects.
The destinations/connectivity score was positively associated with transport-related walking. The perceived physical activity environment mediated 6.1% of this positive association. The destinations/connectivity score was negatively associated with leisure-time walking. Negative perceptions of aesthetics, personal safety and social cohesion of the neighbourhood jointly mediated 24.1% of this negative association.
For women living in socio-economically disadvantaged neighbourhoods, environmental perceptions were important mediators of the relationship between the objective built environment and walking. To increase both transport-related and leisure-time walking, it is necessary to improve both objective walkability-related characteristics (street connectivity and proximity of destinations), and perceptions of personal safety, favourable aesthetics and neighbourhood social cohesion.
Physical activity; Adults; GIS; Physical environment
Prolonged sitting is an emerging health risk. However, multi-country comparative sitting data are sparse. This paper reports the prevalence and correlates of sitting time in 32 European countries.
Data from the Eurobarometer 64.3 study were used, which included nationally representative samples (n = 304-1,102) from 32 European countries. Face-to-face interviews were conducted during November and December 2005. Usual weekday sitting time was assessed using the International Physical Activity Questionnaire (short-version). Sitting time was compared by country, age, gender, years of education, general health status, usual activity and physical activity. Multivariable-adjusted analyses assessed the odds of belonging to the highest sitting quartile.
Data were available for 27,637 adults aged 15–98 years. Overall, mean reported weekday sitting time was 309 min/day (SD 184 min/day). There was a broad geographical pattern and some of the lowest amounts of daily sitting were reported in southern (Malta and Portugal means 194–236 min/day) and eastern (Romania and Hungary means 191–276 min/day) European countries; and some of the highest amounts of daily sitting were reported in northern European countries (Germany, Benelux and Scandinavian countries; means 407–335 min/day). Multivariable-adjusted analyses showed adults with low physical activity levels (OR = 5.10, CI95 = 4.60-5.66), those with high sitting in their main daily activity (OR = 2.99, CI95 = 2.74-3.25), those with a bad/very bad general health state (OR = 1.87, CI95 = 1.63-2.15) and higher education levels (OR = 1.48, CI95 = 1.38-1.59) were more likely to be in the highest quartile of daily sitting time. Adults within Greece (OR = 2.91, CI95 = 2.51-3.36) and Netherlands (OR = 2.56, CI95 = 2.22-2.94) were most likely to be in the highest quartile. High-sit/low-active participants comprised 10.1% of the sample. Adults self-reporting bad/very bad general health state (OR = 4.74, CI95 = 3.97-5.65), those within high sitting in their main daily activities (OR = 2.87, CI95 = 2.52-3.26) and adults aged ≥65 years (OR = 1.53, CI95 = 1.19-1.96) and were more likely to be in the high-sit/low-active group.
Weekday sitting time and its demographic correlates varied considerably across European countries, with adults in north-western European countries sitting the most. Sitting is prevalent across Europe and merits attention by preventive interventions.
Sitting; Adults; Europe; Prevalence; Correlates
Physical activity (PA) in older adults is influenced by a range of environmental, demographic, health-related, social, and psychological variables. Social cognitive psychological models assume that all influences on behaviour operate indirectly through the models constructs, i.e., via intention and self-efficacy. We evaluated direct, indirect, and moderating relationships of a broad range of external variables with physical activity levels alongside intention and self-efficacy.
We performed a cross-sectional survey of a representative and stratified (65–80 and 80+ years; deprived and affluent) sample of 584 community-dwelling people, resident in Scotland. Objectively measured physical activity and questionnaire data were collected.
Self-efficacy showed unique relationships with physical activity, controlling for demographic, mental health, social, environmental, and weather variables separately, but the relationship was not significant when controlling for physical health. Overall, results indicating support for a mediation hypothesis, intention and self-efficacy statistically mediate the relationship of most domain variables with physical activity. Moderation analyses show that the relationship between social cognitions and physical activity was stronger for individuals with better physical health and lower levels of socio-economic deprivation.
Social cognitive variables reflect a range of known environmental, demographic, health-related and social correlates of physical activity, they mediate the relationships of those correlates with physical activity and account for additional variance in physical activity when external correlates are controlled for, except for the physical health domain. The finding that the social cognition-physical activity relationship is higher for participants with better health and higher levels of affluence raises issues for the applicability of social cognitive models to the most disadvantaged older people.
Physical activity; Older adults; Social ecological model
Associations between socioeconomic position (SEP) and sedentary behaviour in children are unclear. Existing studies have used aggregate measures of weekly sedentary time that could mask important differences in the relationship between SEP and sedentary time at different times of the day or between weekdays and weekend days. These studies have also employed a variety of measures of SEP which may be differentially associated with sedentary time. This paper examines associations of multiple indicators of SEP and accelerometer-measured, temporally specific, sedentary time in school children.
Between 2006 and 2007 sedentary time data (minutes spent below 100 accelerometer counts per minute) for weekdays before-school (7.00-8.59AM), during school-time (9.00AM-2.59PM) and after-school (3.00PM-11.00PM), and weekend days were recorded for 629 10–11 year old children using accelerometers. Ordinary least squares regression was used to examine associations with 5 indicators of SEP (area deprivation, annual household income, car ownership, parental education and access to a private garden). Covariates were; gender, BMI, minutes of daylight, accelerometer wear time and school travel method. Analyses were conducted in 2012.
Following adjustments for covariates, having a parent educated to university degree level was associated with more minutes of school (5.87 [95% CI 1.72, 10.04]) and after-school (6.04 [95% CI 0.08, 12.16]) sedentary time. Quartiles of area deprivation (most to least deprived) were positively associated with after-school (Q2: 4.30 [95% CI −6.09, 14.70]; Q3: 10.77 [95% CI 0.47, 21.06]; Q4: 12.74 [95% CI 2.65, 22.84]; Ptrend = 0.04) and weekend (Q2: 26.34 [95% CI 10.16, 42.53]; Q3: 33.28 [95% CI 16.92, 49.65]; Q4: 29.90 [95% CI 14.20, 45.60]; Ptrend = 0.002) sedentary time. Having a garden was associated with less sedentary time after-school (−14.39 [95% CI −25.14, -3.64]) and at weekends (−27.44 [95% CI −43.11, -11.78]).
Associations between SEP and children’s sedentary-time varied by SEP indicator and time of day. This highlights the importance of measuring multiple indicators of SEP and examining context specific sedentary time in children in order to fully understand how SEP influences this behaviour. Further research should combine self-report and objective data to examine associations with specific sedentary behaviours in the contexts within which they occur, as well as total sedentary time.
Sedentary behaviour; Accelerometer; Socioeconomic position; Household income; Area deprivation; Car ownership; Parental education; Private gardens
This study provides insight into the long-term efficacy (i.e. 12 month results) of the Web-based or print-delivered tailored Active Plus intervention (with and without environmental approach) to promote physical activity (PA) among the over-fifties. Differences in effect among subgroups are studied as well.
Intervention groups (i.e. print-delivered basic (PB; N = 439), print-delivered environmental (PE; N = 435), Web-based basic (WB; N = 423), Web-based environmental (WE; N = 432)) and a waiting list control group (N = 411) were studied in a clustered randomized controlled trial. Intervention participants received tailored advice three times within 4 months. Long-term effects (12 months after the intervention has started, i.e. 8 months after the intervention was completed) on PA (i.e. self-reported weekly minutes and days of sufficient PA) were tested using multilevel linear regression analyses. Participants’ age, gender, BMI, educational level, PA intention and the presence of a chronic physical limitation were considered to be potential moderators of the effect.
Overall, the Active Plus intervention was effective in increasing weekly days of sufficient PA (B=0.49; p=.005), but ineffective in increasing weekly minutes of PA (B=84.59; p=.071). Per intervention condition analysis showed that the PB-intervention (Bdays=0.64; p=.002; Bmin=111.36; p=.017) and the PE-intervention (Bdays=0.70; p=.001; Bmin=157.41; p=.001) were effective in increasing days and minutes of PA. Neither Web-based conditions significantly increased PA, while the control group decreased their PA. In contrast to the intervention effect on minutes of PA, the effect on weekly days of PA was significantly moderated by the participants’ baseline intention to be sufficiently physically active.
In general, after 12 months the print-delivered interventions resulted in stronger effects than the Web-based interventions. The participants’ baseline intention was the only significant moderator of the intervention effect. All other assessed user characteristics did not significantly moderate the effect of the intervention, which might indicate that the intervention is sufficiently tailored to the different participant characteristics. Additional efforts should be taken to increase the sustainability of Web-based interventions.
Dutch Trial Register: NTR2297.
Tailored intervention; Physical activity; Effect; Implementation costs; Older adults; Print-delivered; Web-based
Walking for physical activity is associated with substantial health benefits for adults. Increasingly research has focused on associations between walking behaviours and neighbourhood environments including street characteristics such as pavement availability and aesthetics. Nevertheless, objective assessment of street-level data is challenging. This research investigates the reliability of a new street characteristic audit tool designed for use with Google Street View, and assesses levels of agreement between computer-based and on-site auditing.
The Forty Area STudy street VIEW (FASTVIEW) tool, a Google Street View based audit tool, was developed incorporating nine categories of street characteristics. Using the tool, desk-based audits were conducted by trained researchers across one large UK town during 2011. Both inter and intra-rater reliability were assessed. On-site street audits were also completed to test the criterion validity of the method. All reliability scores were assessed by percentage agreement and the kappa statistic.
Within-rater agreement was high for each category of street characteristic (range: 66.7%-90.0%) and good to high between raters (range: 51.3%-89.1%). A high level of agreement was found between the Google Street View audits and those conducted in-person across the nine categories examined (range: 75.0%-96.7%).
The audit tool was found to provide a reliable and valid measure of street characteristics. The use of Google Street View to capture street characteristic data is recommended as an efficient method that could substantially increase potential for large-scale objective data collection.
Physical activity; Walking; Environment; Street audit
A large percentage (68%) of children under age 3 use screen media, such as television, DVDs and video games, on a daily basis. Research suggests that increased screen time in young children is linked to negative health outcomes, including increased BMI, decreased cognitive and language development and reduced academic success. Reviews on correlates of screen time for young children have included preschool age children and children up to age 7; however, none have focused specifically on correlates among infants and toddlers. As research suggests that screen media use increases with age, examining correlates of early media exposure is essential to reducing exposure later in life. Thus, this paper systemically reviews literature published between January 1999 and January 2013 on correlates of screen time among children between 0 and 36 months of age.
Two methods were used to conduct this review: (1) Computerized searches of databases (PubMed, PsycINFO, ERIC, Medline); and (2) Reference sections of existing reviews and primary studies. Inclusion criteria were: (1) The article included separate data for children 36 months and younger, (2) English language, (3) peer reviewed article, (4) analysis reported for screen viewing as a dependent variable, (5) original research article and, (6) examined correlates or associations between screen time and other demographic, contextual or behavioral variables. Articles were compiled between 2011 and 2013 and evaluation occurred in 2012 and 2013.
The literature search identified 29 studies that met inclusion criteria. These studies investigated a total of 33 potential correlates, which were examined in this review. Findings suggest demographic variables most commonly correlated with high screen time among infants and toddlers are child’s age (older) and race/ethnicity (minority). Child BMI, maternal distress/depression, television viewing time of the mother and cognitive stimulation in the home environment were also associated with screen media use. Studies reported that child sex, first born status, paternal education, non-English speaking family, two-parent household, number of children in the home and non-parental childcare were not associated with screen time among children aged 0–36 months. Associations were unclear (fewer than 60% of studies report an association) for maternal age, maternal education and household income. The remaining correlates were investigated in fewer than three studies and thus not coded for an association.
The correlates identified in this study point to avenues for intervention to reduce screen time use in young children. However, further research is necessary to explore a number of environmental, socio-cultural and behavioral correlates that are under-examined in this population and may further inform prevention and intervention strategies.
Infants; Toddlers; Screen time; Television; Sedentary behavior; Correlates; Children; Review
Obesity is a major public health concern and there are increasing calls for policy intervention. As obesity and the related health conditions develop during childhood, schools are being seen as important locations for obesity prevention, including multifaceted interventions incorporating policy elements. The objective of this systematic review was to evaluate the effects of policies related to diet and physical activity in schools, either alone, or as part of an intervention programme on the weight status of children aged 4 to 11 years. A comprehensive and systematic search of medical, education, exercise science, and social science databases identified 21 studies which met the inclusion criteria. There were no date, location or language restrictions. The identified studies evaluated a range of either, or both, diet and physical activity related policies, or intervention programmes including such policies, using a variety of observational and experimental designs. The policies were clustered into those which sought to affect diet, those which sought to affect physical activity and those which sought to affect both diet and physical activity to undertake random effects meta-analysis. Within the diet cluster, studies of the United States of America National School Lunch and School Breakfast Programs were analysed separately; however there was significant heterogeneity in the pooled results. The pooled effects of the physical activity, and other diet related policies on BMI-SDS were non-significant. The multifaceted interventions tended to include policy elements related to both diet and physical activity (combined cluster), and although these interventions were too varied to pool their results, significant reductions in weight-related outcomes were demonstrated. The evidence from this review suggests that, when implemented alone, school diet and physical activity related policies appear insufficient to prevent or treat overweight or obesity in children, however, they do appear to have an effect when developed and implemented as part of a more extensive intervention programme. Additional evidence is required before recommendations regarding the focus of policies can be made and therefore, increased effort should be made to evaluate the effect of policies and policy containing intervention programmes upon weight status.
Policy; Obese; Nutrition; Physical education
Obesity is more prevalent for disabled people (estimated as being between 27-62%) compared to the general population (17-22%). Disabled people are more likely to report poorer general health and acquire a range of obesity-related secondary conditions. Although there are many physical activity and nutrition initiatives aimed at obesity prevention, little is known about whether these options are relevant and accessible for disabled people. The Living Well Study aimed to better understand the issues faced by disabled people when engaging in physical activity and healthy eating.
The study drew on a participatory action research design involving key stakeholders. There were two core cyclical phases (A and B), in which data collection was followed by a period of analysis, reflection and refinement. Focus groups and interviews were held with individuals who experience a range of disabilities, family members, service providers and representatives from disability advocacy groups. We sought to explore the importance and meaning of physical activity and healthy eating and factors that influenced engagement in these. Data in phase A were analysed using conventional content analysis drawing on constant comparative methods to identify themes of importance. In phase B, data analysis occurred alongside data collection, using a structured template to summarise participants’ agreement or disagreement with the draft themes and recommendations, until the themes and recommendations were refined based on participants’ corroboration.
146 participants aged between 10–69 years, from both rural and urban areas and of different cultural backgrounds participated. Seven interconnecting themes that related to engagement in living well behaviours emerged with a wide range of external factors (such as people, knowledge, time, cost, identity and the environment) impacting on living well options. The central theme - It depends: needs, values and competing factors - emphasised the complexity faced by a disabled person when balancing the external factors with their own personal values and needs in order to arrive at a decision to engage in healthy living behaviours.
Although disabled people experience similar issues when participating in healthy living behaviours as those living without disability, additional factors need to be addressed in order to improve opportunities for ‘living well’ in these populations. This information has implications for health professionals to target the relevance and content of interventions.
Disabled persons; Physical activity; Diet; Barriers; Qualitative; Behaviour
The home environment is an important influence on the sedentary behaviour and physical activity of children, who have limited independent mobility and spend much of their time at home. This article reviews the current evidence regarding the influence of the home physical environment on the sedentary behaviour and physical activity of children aged 8–14 years. A literature search of peer reviewed articles published between 2005 and 2011 resulted in 38 observational studies (21 with activity outcomes, 23 with sedentary outcomes) and 11 experimental studies included in the review. The most commonly investigated behavioural outcomes were television watching and moderate to vigorous physical activity. Media equipment in the home and to a lesser extent the bedroom were positively associated with children’s sedentary behaviour. Physical activity equipment and the house and yard were not associated with physical activity, although environmental measures were exclusively self-reported. On the other hand, physical activity equipment was inversely associated with sedentary behaviours in half of studies. Observational studies that investigated the influence of the physical and social environment within the home space, found that the social environment, particularly the role of parents, was important. Experimental studies that changed the home physical environment by introducing a television limiting device successfully decreased television viewing, whereas the influence of introducing an active video game on activity outcomes was inconsistent. Results highlight that the home environment is an important influence on children’s sedentary behaviour and physical activity, about which much is still unknown. While changing or controlling the home physical environment shows promise for reducing screen based sedentary behaviour, further interventions are needed to understand the broader impact of these changes. Future studies should prioritise investigating the influence of the home physical environment, and its interaction with the social environment, on objectively measured sedentary time and home context specific behaviours, ideally including technologies that allow objective measures of the home space.
Home environment; Physical activity; Sedentary behaviour; Children; Adolescents; Review
There are specific guidelines regarding the level of physical activity (PA) required to provide health benefits. However, the research underpinning these PA guidelines does not address the element of social health. Furthermore, there is insufficient evidence about the levels or types of PA associated specifically with psychological health. This paper first presents the results of a systematic review of the psychological and social health benefits of participation in sport by children and adolescents. Secondly, the information arising from the systematic review has been used to develop a conceptual model.
A systematic review of 14 electronic databases was conducted in June 2012, and studies published since 1990 were considered for inclusion. Studies that addressed mental and/or social health benefits from participation in sport were included.
A total of 3668 publications were initially identified, of which 30 met the selection criteria. There were many different psychological and social health benefits reported, with the most commonly being improved self-esteem, social interaction followed by fewer depressive symptoms. Sport may be associated with improved psychosocial health above and beyond improvements attributable to participation in PA. Specifically, team sport seems to be associated with improved health outcomes compared to individual activities, due to the social nature of the participation. A conceptual model, Health through Sport, is proposed. The model depicts the relationship between psychological, psychosocial and social health domains, and their positive associations with sport participation, as reported in the literature. However, it is acknowledged that the capacity to determine the existence and direction of causal links between participation and health is limited by the fact that the majority of studies identified (n=21) were cross-sectional.
It is recommended that community sport participation is advocated as a form of leisure time PA for children and adolescents, in an effort to not only improve physical health in relation to such matters as the obesity crisis, but also to enhance psychological and social health outcomes. It is also recommended that the causal link between participation in sport and psychosocial health be further investigated and the conceptual model of Health through Sport tested.
Sport; Health; Psychological; Psychosocial; Social