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Relationships Between Measures of the Physical Activity-Related Built Environment and Excess Weight in Preschoolers: A Retrospective, Population-Level Cohort Study
Abstract
Background: The built environment can impact health outcomes. Our purpose was to examine relationships between built environment variables related to physical activity and excess weight in preschoolers. Methods: In this retrospective, population-level study of 4- to 6-year-olds, anthropometric measurements were taken between 2009 and 2017 in Calgary and Edmonton, Alberta, Canada. Based on BMI z-scores (BMIz), children were classified as normal weight (-2 ≤ BMIz <1) or excess weight (BMIz ≥1; overweight and obesity). Physical activity-related built environment variables were calculated (distances to nearest playground, major park, school; street intersection density; number of playgrounds and major parks within an 800 m buffer zone). Binomial logistic regression models estimated associations between physical activity-related built environment variables and excess weight. Results: Our analysis included 140,368 participants (females: n = 69,454; Calgary: n = 84,101). For Calgary, adjusted odds ratios (aORs) showed the odds of excess weight increased 1% for every 100-intersection increase [1.010 (1.006-1.015); p < 0.0001] and 13.6% when there were ≥4 playgrounds (vs. 0 or 1) within an 800 m buffer zone [1.136 (1.037-1.243); p = 0.0059]. For Edmonton, aORs revealed lower odds of excess weight for every 100 m increase in distances between residences to nearest major park [0.991 (0.986-0.996); p = 0.0005] and school [0.992 (0.990-0.995); p < 0.0001]. The odds of excess weight decreased as the number of major parks within the 800 m buffer zone increased from 0 to 1 [0.943 (0.896-0.992); p = 0.023] and from 0 to ≥3 [0.879 (0.773-0.999); p = 0.048]. Conclusion: The physical activity-related built environment was associated with excess weight in preschoolers, although relationships varied between cities that differed demographically and geographically.
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Purpose of Review
The aim of this study was to understand the influence of the physical environment on the physical activity (PA) behavior of preschool children (aged 2 to 6 years), in order to provide an overview of these influences from the perspective of the ecological model.
Recent Findings
PA is of great importance for the prevention of obesity and cardiovascular diseases since childhood. The physical environment has a direct relationship with the different domains, where people can spend their time being physically active. Nonetheless, despite the importance of the physical environment to engagement in PA, very few reviews have focused on this relationship in the context of the growing problem of physical inactivity among preschool children.
Summary
Studies that had analyzed the school domain had found that greater availability of a wider variety of portable play equipment, presence of certain fixed playground equipment, and presence of open spaces had favored PA levels. Furthermore, different studies had shown that the natural environment and the presence of hills were important for children’s PA. Thus, despite the associations with PA we were able to identify in this review, new studies will still be needed to link the physical environment with PA levels, especially regarding transportation and leisure time.
In conclusion, promoting studies on this subject from an early age will allow us to obtain information that could allow the adaptation, design, and construction of healthier homes, neighborhoods, and schools that promote children’s health.
In recent years, built environmental characteristics have been linked to childhood overweight, but the results remain inconsistent across studies. The present study examines associations between several built environmental features and body weight status (BMI) z-score among a large sample of preschool children in the city of Hannover, Germany. Walkability (Index), green space availability, and playground availability related to preschool children’s home environments were measured using data from OpenStreetMap (OSM). These built environment characteristics were linked to the data from the 2010–2014 school entry examinations in the Hannover city (n = 22,678), and analysed using multilevel linear regression models to examine associations between the built environment features and the BMI z-score of these children (4–8 years old). No significant associations of built environmental factors on children’s BMI were detected, but the effect between green space availability and BMI was modified by the parental educational level. In children with lower compared to higher educated parents, a higher spatial availability of greenspace was significantly associated with reduced body weight. Future research should continue to monitor the disparities in diverse built environment features and how these are related to children’s health.
Background
Physical activity is a modifiable behaviour that can help curtail the increasing worldwide problem of childhood obesity. Appropriate recreational opportunities, including neighbourhood parks, are particularly important for promoting physical activity among children. Because children’s use of parks is mainly under the influence of their parents, understanding parents’ preferences is essential for creating the most inviting and usable park space to facilitate children’s physical activity.
Methods
Eighty-two intercept interviews were conducted with a heterogeneous sample of parents/guardians watching their children at neighbourhood parks in London, Ontario. Parents/guardians were asked questions about how often they frequent the park, whether it is the closest to their residence, and their likes/dislikes for the park. Strategies to ensure trustworthiness of the data were employed.
Results
Interviewees attended their park of choice between 1–7 times per week with the average being 2.5 times per week. Only 49% of respondents frequented the park closest to their starting destination (home or daycare facility), and the majority travelled more than 4 km to get to the park. For those who chose to travel a significant distance to attend their park of choice, park location was not as important as the amenities they desired. Parents’ main reasons for choosing parks were: water attractions, shade, swings, and cleanliness.
Conclusions
The current study provides useful insights on park use with potentially important implications for increasing physical activity among children. Incorporating parents’ preferences into strategies for creating or modifying city parks will help to ensure that limited public resources are being targeted most effectively in support of children’s physical activity.
Street connectivity, as a neighbourhood built environmental factor, may affect individual physical activity (PA) and subsequently weight status. However, these associations remain inconclusive. This study aimed to systematically review the association between street connectivity and childhood obesity. A literature search was conducted in the Cochrane Library, PubMed, and Web of Science for articles published before January 1, 2019. All original studies that investigated the association between street connectivity and weight‐related behaviours or outcomes among children and adolescents were included. Forty‐seven articles were identified, including eight longitudinal and 41 cross‐sectional studies conducted in eight countries. The sample size ranged from 88 to 46 813. Street intersection density (SID), measured by Geographic Information Systems in 36 studies and reported in 13 studies, was the main indicator used to represent street connectivity. Forty‐four studies examined the association between SID and weight‐related behaviours, including overall PA (n = 15), moderate‐to‐vigorous PA (n = 13), active transport (n = 12), dog walking (n = 1), walking (n = 1), sedentary behaviours (n = 2), and TV viewing (n = 1). Fifteen studies focused on the association between SID and weight‐related outcomes. Overall, evidence from this systematic review and meta‐analyses suggested a positive association between street connectivity and PA. However, it was difficult to draw a conclusion on the association between street connectivity and BMI. More longitudinal evidence is needed to confirm the causal association between street connectivity and weight status.
Childhood obesity has reached epidemic levels in developed as well as in developing countries. Overweight and obesity in
childhood are known to have significant impact on both physical and psychological health. Overweight and obese children are
likely to stay obese into adulthood and more likely to develop non‑communicable diseases like diabetes and cardiovascular
diseases at a younger age. The mechanism of obesity development is not fully understood and it is believed to be a disorder
with multiple causes. Environmental factors, lifestyle preferences, and cultural environment play pivotal roles in the rising
prevalence of obesity worldwide. In general, overweight and obesity are assumed to be the results of an increase in caloric
and fat intake. On the other hand, there are supporting evidence that excessive sugar intake by soft drink, increased portion
size, and steady decline in physical activity have been playing major roles in the rising rates of obesity all around the world.
Childhood obesity can profoundly affect children’s physical health, social, and emotional well‑being, and self esteem. It is also
associated with poor academic performance and a lower quality of life experienced by the child. Many co‑morbid conditions
like metabolic, cardiovascular, orthopedic, neurological, hepatic, pulmonary, and renal disorders are also seen in association
with childhood obesity.
Urbanization and the shaping of the built environment have provided a number of socioeconomic benefits, but they have also brought unwanted side effects on health. We aimed to review the current epidemiological evidence of the associations between the built environment, closely related exposures, and child health. We focused on growth and obesity, neuropsychological development, and respiratory and immune health. We used existing review articles and supplemented these with relevant work published and not included in existing reviews. The present review shows that there is good evidence for an association between air pollution and fetal growth restriction and respiratory health, whereas for other exposure and outcome combinations, further evidence is needed. Future studies should make efforts to integrate the different built environment features and to include the evaluation of environments other than home, as well as accessibility, qualitative and perception assessment of the built environment, and, if possible, with improved and standardized tools to facilitate comparability between studies. Efforts are also needed to conduct longitudinal and intervention studies and to understand potential mechanisms behind the associations observed. Finally, studies in low- and middle-income countries are needed.
Background:
Previous studies have shown an increase in the prevalence of overweight and obesity among Canadian children from 23.3% to 34.7% during 1978-2004. We examined the most recent trends by applying current definitions of overweight and obesity based on World Health Organization (WHO) body mass index (BMI) thresholds and recently validated norms for waist circumference and waist:height ratio.
Methods:
We examined directly measured height and weight data from the Canadian Community Health Survey (2004-2005) and the Canadian Health Measures Survey (2009-2013). We calculated z scores for BMI, height and weight based on the 2014 WHO growth charts for Canada, including the new extension of weight-for-age beyond 10 years. To calculate z scores for waist circumference and waist:height ratios, we used new charts from the reference population in the US NHANES III (National Health and Nutrition Examination Survey, 1988-1994).
Results:
Data were available for 14 014 children aged 3-19 years for the period 2004-2013. We observed a decline in the prevalence of overweight or obesity, from 30.7% (95% confidence interval [CI] 29.7% to 31.6%) to 27.0% (95% CI 25.3% to 28.7%) (p < 0.001) and stabilization in the prevalence of obesity at about 13%. These trends persisted after we adjusted for age, sex and race/ethnicity. Although they declined, the median z scores for BMI, weight and height were positive and higher than those in the WHO reference population. The z scores for waist circumference and waist:height ratio were negative, which indicated that the Canadian children had less central adiposity than American children in historic or contemporary NHANES cohorts.
Interpretation:
After a period of dramatic growth, BMI z scores and the prevalence of overweight or obesity among Canadian children decreased from 2004 to 2013, which attests to progress against this important public health challenge.
Objectives:
This study examines environmental factors associated with BMI (body mass index) levels among adolescents with the aim of identifying potential interventions for reducing childhood obesity.
Methods:
Students (n=1,048) aged 10-14 years at 28 schools in London, ON, completed a survey providing information on age, sex, height, weight, home address, etc., which was used to construct age-sex adjusted BMI z-scores. The presence of recreation opportunities, fast-food outlets and convenience stores was assessed using four areal units around each participant's home and school neighbourhood: "circular buffers" encompassing territory within a straight-line distance of 500 m and 1000 m; and "network buffers" of 500 m and 1000 m measured along the street network. School neighbourhoods were also assessed using school-specific "walksheds". Multilevel structural equation modeling techniques were employed to simultaneously test the effects of school-environment (Level 2) and home-environment (Level 1) predictors on BMI z-scores.
Results:
Most participants (71%) had a normal BMI, 16.9% were overweight, 7.6% were obese, and 4.6% were considered underweight. Multilevel analyses indicated that built environment characteristics around children's homes and schools had a modest but significant effect on their BMI. The presence of public recreation opportunities within a 500 m network distance of home was associated with lower BMI z-scores (p<0.05), and fast-food outlets within the school walkshed was associated with higher BMI z-scores (p<0.05).
Conclusion:
Interventions and policies that improve children's access to publicly provided recreation opportunities near home and that mitigate the concentration of fast-food outlets close to schools may be key to promoting healthy lifestyles and reducing childhood obesity.
Background
Recent changes in home physical environments, such as decreasing outdoor space and increasing electronic media, may negatively affect health by facilitating sedentariness and reducing physical activity. As children spend much of their time at home they are particularly vulnerable. This study qualitatively explored family perceptions of physical environmental influences on sedentary behaviour and physical activity within the home space.Methods
Home based interviews were conducted with 28 families with children aged 9¿13 years (total n¿=¿74 individuals), living in Perth, Australia. Families were stratified by socioeconomic status and selected to provide variation in housing. Qualitative methods included a family interview, observation and home tour where families guided the researcher through their home, enabling discussion while in the physical home space. Audio recordings were transcribed verbatim and thematically analysed.ResultsEmergent themes related to children¿s sedentariness and physical activity included overall size, space and design of the home; allocation of home space; equipment within the home space; perceived safety of the home space; and the changing nature of the home space. Families reported that children¿s activity options were limited when houses and yards were small. In larger homes, multiple indoor living rooms usually housed additional sedentary entertainment options, although parents reported that open plan home layouts could facilitate monitoring of children¿s electronic media use. Most families reported changing the allocation and contents of their home space in response to changing priorities and circumstances.Conclusions
The physical home environment can enhance or limit opportunities for children¿s sedentary behaviour and physical activity. However, the home space is a dynamic ecological setting that is amenable to change and is largely shaped by the family living within it, thus differentiating it from other settings. While size and space were considered important, how families prioritise the use of their home space and overcome the challenges posed by the physical environment may be of equal or greater importance in establishing supportive home environments. Further research is required to tease out how physical, social and individual factors interact within the family home space to influence children¿s sedentary behaviour and physical activity at home.
Background:
Childhood obesity remains a prominent public health problem. Walkable built environments may prevent excess weight gain.
Objectives:
We examined the association of walkable built environment characteristics with body mass index (BMI) z-score among a large sample of children and adolescents.
Methods:
We used geocoded residential address data from electronic health records of 49,770 children and adolescents 4 to < 19 years of age seen at the 14 pediatric practices of Harvard Vanguard Medical Associates from August 2011 through August 2012. We used eight geographic information system (GIS) variables to characterize walkable built environments. Outcomes were BMI z-score at the most recent visit and BMI z-score change from the earliest available (2008-2011) to the most recent (2011-2012) visit. Multivariable models were adjusted for child age, sex, race/ethnicity, and neighborhood median household income.
Results:
In multivariable cross-sectional models, living in closer proximity to recreational open space was associated with lower BMI z-score. For example, children who lived in closest proximity (quartile 1) to the nearest recreational open space had a lower BMI z-score (β = -0.06; 95% CI: -0.08, -0.03) compared with those living farthest away (quartile 4; reference). Living in neighborhoods with fewer recreational open spaces and less residential density, traffic density, sidewalk completeness, and intersection density were associated with higher cross-sectional BMI z-score and with an increase in BMI z-score over time.
Conclusions:
Overall, built environment characteristics that may increase walkability were associated with lower BMI z-scores in a large sample of children. Modifying existing built environments to make them more walkable may reduce childhood obesity.
Sparse data exist on the combined associations between physical activity and sedentary time with cardiometabolic risk factors in healthy children.
To examine the independent and combined associations between objectively measured time in moderate- to vigorous-intensity physical activity (MVPA) and sedentary time with cardiometabolic risk factors.
Pooled data from 14 studies between 1998 and 2009 comprising 20 871 children (aged 4-18 years) from the International Children's Accelerometry Database. Time spent in MVPA and sedentary time were measured using accelerometry after reanalyzing raw data. The independent associations between time in MVPA and sedentary time, with outcomes, were examined using meta-analysis. Participants were stratified by tertiles of MVPA and sedentary time.
Waist circumference, systolic blood pressure, fasting triglycerides, high-density lipoprotein cholesterol, and insulin.
Times (mean [SD] min/d) accumulated by children in MVPA and being sedentary were 30 (21) and 354 (96), respectively. Time in MVPA was significantly associated with all cardiometabolic outcomes independent of sex, age, monitor wear time, time spent sedentary, and waist circumference (when not the outcome). Sedentary time was not associated with any outcome independent of time in MVPA. In the combined analyses, higher levels of MVPA were associated with better cardiometabolic risk factors across tertiles of sedentary time. The differences in outcomes between higher and lower MVPA were greater with lower sedentary time. Mean differences in waist circumference between the bottom and top tertiles of MVPA were 5.6 cm (95% CI, 4.8-6.4 cm) for high sedentary time and 3.6 cm (95% CI, 2.8-4.3 cm) for low sedentary time. Mean differences in systolic blood pressure for high and low sedentary time were 0.7 mm Hg (95% CI, -0.07 to 1.6) and 2.5 mm Hg (95% CI, 1.7-3.3), and for high-density lipoprotein cholesterol, differences were -2.6 mg/dL (95% CI, -1.4 to -3.9) and -4.5 mg/dL (95% CI, -3.3 to -5.6), respectively. Geometric mean differences for insulin and triglycerides showed similar variation. Those in the top tertile of MVPA accumulated more than 35 minutes per day in this intensity level compared with fewer than 18 minutes per day for those in the bottom tertile. In prospective analyses (N = 6413 at 2.1 years' follow-up), MVPA and sedentary time were not associated with waist circumference at follow-up, but a higher waist circumference at baseline was associated with higher amounts of sedentary time at follow-up.
Higher MVPA time by children and adolescents was associated with better cardiometabolic risk factors regardless of the amount of sedentary time.
Preventing sedentary behavior and adiposity in childhood has become a public health priority. We examined urban social and built environment characteristics as correlates of physical activity and anthropometry among 428 preschool children from low-income families in New York City. We measured the children's height, weight, skinfold thicknesses, physical activity by accelerometer, and covariates. We geocoded home and Head Start center addresses and estimated the following for an area within 0.5 km of those two locations using a detailed geographic database: neighborhood composition, walkability, crime and traffic safety, and aesthetic characteristics. Generalized estimating equations were used to examine the associations of area characteristics with physical activity or adiposity, adjusted for characteristics of the child, mother, and home. Participants were 2-5 years old, 53% female, 83% Hispanic, and 43% either overweight or obese. Of the walkability indicators, land use mix was associated with physical activity (26 more activity counts/minute per standard deviation increase in mixed land use, p = 0.015) and subway stop density was associated with adiposity (1.2 mm smaller sums of skinfold thicknesses sum per standard deviation increase in subway stop density, p = 0.001). The pedestrian-auto injury rate, an indicator of traffic safety problems, was associated with physical activity and adiposity (16 fewer activity counts/minute, p = 0.033, and 1.0 mm greater skinfold thickness per standard deviation increase in pedestrian-auto injuries, p = 0.018). Children living in areas with more street trees were more physically active and those living in areas with more park access had smaller skinfolds. However, many of the tested associations were not statistically significant and some trends were not in the hypothesized direction. Efforts to enhance walkability, safety, and green spaces in the local environment may be relevant to physical activity and adiposity, and therefore to the health of preschool-aged children from low-income families.
Greenspace is theoretically a valuable resource for physical activity and hence has potential to contribute to reducing obesity and improving health. This paper reports on a systematic review of quantitative research examining the association between objectively measured access to greenspace and (i) Physical activity, (ii) Weight status and (iii) Health conditions related to elevated weight. Literature searches were conducted in SCOPUS, Medline, Embase and PYSCHINFO. Sixty studies met the inclusion criteria and were assessed for methodological quality and strength of the evidence. The majority (68%) of papers found a positive or weak association between greenspace and obesity-related health indicators, but findings were inconsistent and mixed across studies. Several studies found the relationship varied by factors such as age, socioeconomic status and greenspace measure. Developing a theoretical framework which considers the correlates and interactions between different types of greenspace and health would help study design and interpretation of reported findings, as would improvement in quality and consistency of greenspace access measures. Key areas for future research include investigating if and how people actually use greenspace and improving understanding of the mechanisms through which greenspace can improve health and, in particular, if physical activity is one such mechanism.
Background
The recent increase in childhood obesity is expected to add significantly to the prevalence of chronic diseases. We used multivariate multilevel analysis to examine associations between parks/green space and childhood overweight/obesity across communities in Calgary, Canada, a city characterized by intensified urban sprawl and high car use.
Methods
Body Mass Index was calculated from measured height and weight data obtained from 6,772 children (mean age = 4.95 years) attending public health clinics for pre-school vaccinations. Each child's home postal code was geocoded using ESRI ArcGIS 9.2. We examined four measures of spatial access to parks/green space (based on Geographic Information Systems): 1) the number of parks/green spaces per 10,000 residents, 2) the area of parks/green space as a proportion of the total area within a community, 3) average distance to a park/green space, and 4) the proportion of parks/green space service area as a proportion of the total area within a community. Analyses were adjusted for dissemination area median family income (as a proxy for an individual child's family income) community-level education, and community-level proportion of visible minorities.
Results
In general, parks/green space at the community level was not associated with overweight/obesity in Calgary, with the exception of a marginally significant effect whereby a moderate number of parks/green spaces per 10,000 residents was associated with lower odds of overweight/obesity. This effect was non-significant in adjusted analyses.
Conclusion
Our null findings may reflect the popularity of car travel in Calgary, Canada and suggest that the role built environment characteristics play in explaining health outcomes may differ depending on the type of urban environment being studied.
Surname lists are useful for identifying cohorts of ethnic minority patients from secondary data sources. This study sought to develop and validate lists to identify people of South Asian and Chinese origin.
Comprehensive lists of South Asian and Chinese surnames were reviewed to identify those that uniquely belonged to the ethnic minority group. Surnames that were common in other populations, communities or ethnic groups were specifically excluded. These surname lists were applied to the Registered Persons Database, a registry of the health card numbers assigned to all residents of the Canadian province of Ontario, so that all residents were assigned to South Asian ethnicity, Chinese ethnicity or the General Population. Ethnic assignment was validated against self-identified ethnicity through linkage with responses to the Canadian Community Health Survey.
The final surname lists included 9,950 South Asian surnames and 1,133 Chinese surnames. All 16,688,384 current and former residents of Ontario were assigned to South Asian ethnicity, Chinese ethnicity or the General Population based on their surnames. Among 69,859 respondents to the Canadian Community Health Survey, both lists performed extremely well when compared against self-identified ethnicity: positive predictive value was 89.3% for the South Asian list, and 91.9% for the Chinese list. Because surnames shared with other ethnic groups were deliberately excluded from the lists, sensitivity was lower (50.4% and 80.2%, respectively).
These surname lists can be used to identify cohorts of people with South Asian and Chinese origins from secondary data sources with a high degree of accuracy. These cohorts could then be used in epidemiologic and health service research studies of populations with South Asian and Chinese origins.
Walking and cycling to school represent an opportunity for children to achieve regular physical activity. These behaviors may be influenced by characteristics of the environment around homes and schools, yet few studies have quantified the potential associations between these two sets of factors.
This study aims to assess whether objectively measured characteristics of the neighborhood, route, and school environments are associated with active commuting to school among children, and it explores whether distance acts as a moderator in this association.
A cross-sectional study was conducted of 2012 children (899 boys and 1113 girls) aged 9-10 years attending 92 schools in the county of Norfolk, United Kingdom. Questionnaires were completed by children and parents during Summer 2007. Attributes around the home and children's route to school were assessed using a GIS. School environments were assessed using a newly developed school audit and via questionnaires completed by head teachers. Data were analyzed in 2008.
Almost half of the children usually walked or cycled to school. Children who lived in a more deprived area and whose route to school was direct were less likely to walk or cycle to school, whereas those who had a higher density of roads in their neighborhood were more likely to walk. Further, children whose routes had a high density of streetlights were less likely to cycle to school. Distance did not moderate the observed associations.
Objectively measured neighborhood and route factors are associated with walking and cycling to school. However, distance did not moderate the associations found here. Creating safe environments by improving urban design may influence children's commuting behavior. Intervention studies are needed to confirm the findings from this observational cross-sectional study.
An assessment was made of the usefulness and accuracy of a computer program for the identification of the south Asian population through the classification of names on a disease register.
The computer program, Nam Pehchan, was used to classify names as either south Asian or non south Asian. The results were compared with a reference standard, which combined use of the program with visual inspection. The latter was facilitated by a computer-generated dictionary of common non south Asian names. The data set consisted of 356,555 cases of incident cancer (ICD9: 140-208) registered between 1990 and 1992 by Thames, Trent, West Midlands and Yorkshire cancer registries.
Nam Pehchan classified 5506 cases as south Asian. Visual inspection identified 2024 false positives (36.8 per cent of all cases identified as south Asian by Nam Pehchan) and 363 false negatives (9.5 per cent of those identified by the reference standard). Compared with the reference standard, Nam Pehchan had a sensitivity of 90.5 per cent and a positive predictive value of 63.2 per cent.
The Nam Pehchan program quickly identified a high proportion of the names classified as south Asian by the reference standard, but the high false positive rate means that the program alone is not an adequate single strategy. The time-consuming process of inspection of program negatives for large data sets can be substantially reduced by comparison with dictionaries of common non south Asian names.
Purpose
To determine the relationship between urban sprawl, health, and health-related behaviors.
Design
Cross-sectional analysis using hierarchical modeling to relate characteristics of individuals and places to levels of physical activity, obesity, body mass index (BMI), hypertension, diabetes, and coronary heart disease.
Setting
U.S. counties (448) and metropolitan areas (83).
Subjects
Adults (n = 206,992) from pooled 1998, 1999, and 2000 Behavioral Risk Factor Surveillance System (BRFSS).
Measures
Sprawl indices, derived with principal components analysis from census and other data, served as independent variables. Self-reported behavior and health status from BRFSS served as dependent variables.
Results
After controlling for demographic and behavioral covariates, the county sprawl index had small but significant associations with minutes walked (p = .004), obesity (p < .001), BMI (p = .005), and hypertension (p = .018). Residents of sprawling counties were likely to walk less during leisure time, weigh more, and have greater prevalence of hypertension than residents of compact counties. At the metropolitan level, sprawl was similarly associated with minutes walked (p = .04) but not with the other variables.
Conclusion
This ecologic study reveals that urban form could be significantly associated with some forms of physical activity and some health outcomes. More research is needed to refine measures of urban form, improve measures of physical activity, and control for other individual and environmental influences on physical activity, obesity, and related health outcomes.
Physical activity is a modifiable behaviour that can help curtail the increasing worldwide problem of childhood obesity. Appropriate recreational opportunities, including neighbourhood parks, are particularly important for promoting physical activity among children. Because children's use of parks is mainly under the influence of their parents, understanding parents' preferences is essential for creating the most inviting and usable park space to facilitate children's physical activity.
Eighty-two intercept interviews were conducted with a heterogeneous sample of parents/guardians watching their children at neighbourhood parks in London, Ontario. Parents/guardians were asked questions about how often they frequent the park, whether it is the closest to their residence, and their likes/dislikes for the park. Strategies to ensure trustworthiness of the data were employed.
Interviewees attended their park of choice between 1-7 times per week with the average being 2.5 times per week. Only 49% of respondents frequented the park closest to their starting destination (home or daycare facility), and the majority travelled more than 4 km to get to the park. For those who chose to travel a significant distance to attend their park of choice, park location was not as important as the amenities they desired. Parents' main reasons for choosing parks were: water attractions, shade, swings, and cleanliness.
The current study provides useful insights on park use with potentially important implications for increasing physical activity among children. Incorporating parents' preferences into strategies for creating or modifying city parks will help to ensure that limited public resources are being targeted most effectively in support of children's physical activity.
The purpose of this study was to examine how healthy weight status among youth was related to (i) three proximity-based park variables: number of parks within 1 km of home, total area of parkland within 1 km, and distance to the closest park from home, and (ii) the availability of 13 specific park facilities within 1 km of the home. Data were collected from parents of children living in four neighborhoods of a medium-sized Canadian city. Logistic regression analyses revealed that none of the three proximity-based park variables was significantly associated with healthy weight status among children in the sample. However, when availability of the 13 park facilities was examined, children with a park playground within 1 km were almost five times more likely to be classified as being of a healthy weight rather then at risk or overweight compared to those children without playgrounds in nearby parks. Results suggest that availability of certain park facilities may play a more important role in promoting physical activity and healthy weight status among children than availability of park space in general. Implications for park design are discussed.
Cities worldwide have declared aspirations to become “10, 15, or 20-minute cities.” This goal is often part of a strategy to reduce emissions and achieve sustainable and healthy urban design by encouraging walking and cycling. The 10, 15, or 20-minute city or neighbourhood — which, for generality, we refer to as the x-minute city — is a type of design aimed at reducing car dependence by enabling urban residents to walk or cycle to essential amenities within x minutes from their home. Due to the benefits which include sustainability, health, and social cohesion, the concept has been promoted by the international C40 Cities as part of their post-pandemic Green and Just Recovery Agenda. However, missing from the current rhetoric around these “cities of proximity” is clear guidance on evaluating progress towards this goal. In this paper, we contrast measurement approaches and discuss important considerations for planners adopting the x-minute city goal. To do this, we measure the proximity of the 500 largest cities in the USA and 43 urban areas of New Zealand. We also present an interactive tool to visualise and explore proximity within the urban areas.
This Academy of Nutrition and Dietetics Position Paper reports current evidence on pediatric overweight and obesity prevention interventions and discusses implications for registered dietitian nutritionists (RDNs). An overview of current systematic reviews provided evidence-based results from a range of nutrition interventions according to developmental age group (ages 2 to 5, 6 to 12, and 13 to 17 years). Twenty-one current systematic reviews of nutrition interventions demonstrated a beneficial effect of nutrition and physical activity interventions on body mass index measures and no adverse events were identified. RDNs impart nutrition expertise in a wide range of settings to provide comprehensive care for children and adolescents as their nutrition and developmental needs change over time. This Position Paper outlines the current roles of, and proposed directions for, RDNs engaged in pediatric overweight and obesity prevention. Prevention of pediatric overweight and obesity requires comprehensive strategies ranging from policy-level to individual-level interventions in settings that will have the most beneficial impact for children according to their developmental stage. This Position Paper advocates for increased availability of nutrition and food access programs and interventions to reduce risk of pediatric obesity and associated adverse health outcomes both now and for future generations.
We evaluated the epidemiological evidence on the built environment and its link to childhood obesity, focusing on environmental factors such as traffic noise and air pollution, as well as physical factors potentially driving obesity-related behaviors, such as neighborhood walkability and availability and accessibility of parks and playgrounds. Eligible studies were (i) conducted on human children below the age of 18 years, (ii) focused on body size measurements in childhood, (iii) examined at least one built environment characteristic, (iv) reported effect sizes and associated confidence intervals, and (v) were published in English language. A z test, as alternative to the meta-analysis, was used to quantify associations due to heterogeneity in exposure and outcome definition. We found strong evidence for an association of traffic-related air pollution (nitrogen dioxide and nitrogen oxides exposure, p < 0.001) and built environment characteristics supportive of walking (street intersection density, p < 0.01 and access to parks, p < 0.001) with childhood obesity. We identified a lack of studies that account for interactions between different built environment exposures or verify the role and mechanism of important effect modifiers such as age.
Given the previously established, social, economic, and healthful benefits of nearby nature in local environments, we argue that the provision of publicly funded street trees as a positive urban environmental exposure should be considered as an "environmental justice" issue. Accordingly, the study examines the distribution of street trees within a 10-minute walking radius around elementary schools in four communities of different sizes in Ontario, Canada, to assess potential levels of "exposure" to these positive natural features among school-age children of different sociodemographic backgrounds. A geographic information system incorporating detailed geodatabases of pubic trees and elementary schools in Stratford, Woodstock, Brantford, and London was used to analyze the spatial distribution of trees in relation to the socioeconomic characteristics of neighborhood walking zones around every elementary school. Our findings indicate that the spatial distribution of street trees in the immediate vicinity around the schools in the four southwestern Ontario cities studied closely mirrors the pattern of socioeconomic distress in those same cites. The findings point to a greater need for municipal planners, policymakers, and community-based organizations to carefully consider the socioeconomic characteristics of neighborhoods to ensure that future tree planting efforts are conducted in an equitable manner and targeted to the areas with the greatest need for the associated benefits they provide.
Introduction
Active commuting to school (ACS) contributes to children's overall physical activity levels, providing multiple health benefits. However, studies analyzing the modes of transport used among children of preschool age (3–5 years), as well as which factors affect ACS, are scant.
Methods
We performed a mixed-method study, initially taking a qualitative approach in collaboration with parents of preschool-aged children (i.e., focus groups), to identify their usual modes of commuting to school with their offspring. Following this, we asked parents, through a questionnaire, about the modes of transport to school they use with their children, as well as the weekly use-frequency of each mode. In addition, they were asked about perceived barriers to ACS and we also measured the distance from their home to school. The final sample consisted of 96 parents of preschool-aged children (51.6% girls) from the city of Valencia and its metropolitan area. Finally, we used mixed linear regression analysis to evaluate the relationship between each independent variable and ACS.
Results
The focus groups identified modes of transport that were not found in other age groups, including: the back of parent's bike, in a buggy, on a strider balance bike, or a bike with training wheels. Young children that live farther away from school showed lower levels of ACS (p = 0.012). Psychosocial and planning barriers negatively affected ACS (p = 0.011).
Conclusion
Our findings suggest that greater involvement of institutions and educational communities will be required to create education programs that provide tools for overcoming psychosocial and planning barriers to ACS in order to leave behind the comfort of motorized transport.
Background
We recently reported an encouraging decline in the prevalence of overweight (OW) or obesity (OB) in Canadian children from 31% to 27% with stabilization in OB rates at ~13% using national survey data between 2004 and 2013. Although rates were lower for toddlers, girls and those of European (White) race-ethnicity, secular trends persisted after adjustment. In this follow-up study, we explored the ability of socioeconomic status to explain or modify these relationships using the same data set.
Methods
We analyzed a decade of anthropometric data from 14,014 children aged 3 to 19 years. We explored the influence of income adequacy, education, immigration status, family type (e.g., single-parent) and geographic region by multivariable logistic regression. Data sets included Canadian Community Health Survey cycle 2.2 and Canadian Health Measures Surveys cycles 2 and 3.
Results
Children from higher-income families fared better than their lower-income counterparts in each survey era and demonstrated a significant decline in OW/OB from 29.1% (95% confidence interval [CI]: 27.3 to 30.8) in 2004 to 2005 to 22.2% (95% CI: 19.8 to 24.6) in 2012 to 2013, P<0.001. Regression models confirmed the effects of time, age, sex, race, income, education, immigration and region. Although single-parent families did less well in univariate analyses, this effect vanished after adjustment for other socioeconomic status variables, such as income and education. Regional variations persisted, with lower rates of OB and OW/OB in British Columbia and higher rates in Atlantic Canada.
Conclusions
These results confirm that progress is possible against this important public health challenge, underline the need to better understand sociodemographic risk factors and identify groups at higher risk for possible interventions.
Purpose:
To determine the relationship between urban sprawl, health, and health-related behaviors.
Design:
Cross-sectional analysis using hierarchical modeling to relate characteristics of individuals and places to levels of physical activity, obesity, body mass index (BMI), hypertension, diabetes, and coronary heart disease.
Setting:
U.S. counties (448) and metropolitan areas (83).
Subjects:
Adults (n = 206,992) from pooled 1998, 1999, and 2000 Behavioral Risk Factor Surveillance System (BRFSS).
Measures:
Sprawl indices, derived with principal components analysis from census and other data, served as independent variables. Self-reported behavior and health status from BRFSS served as dependent variables.
Results:
After controlling for demographic and behavioral covariates, the county sprawl index had small but significant associations with minutes walked (p = .004), obesity (p < .001), BMI (p = .005), and hypertension (p = .018). Residents of sprawling counties were likely to walk less during leisure time, weigh more, and have greater prevalence of hypertension than residents of compact counties. At the metropolitan level, sprawl was similarly associated with minutes walked (p = .04) but not with the other variables.
Conclusion:
This ecologic study reveals that urban form could be significantly associated with some forms of physical activity and some health outcomes. More research is needed to refine measures of urban form, improve measures of physical activity, and control for other individual and environmental influences on physical activity, obesity, and related health outcomes.
Current research depicts suburbs as becoming more heterogeneous in terms of socio-economic status. Providing a novel analysis, this paper engages with that research by operationalising suburban ways of living (homeownership, single-family dwelling occupancy and automobile use) and relating them to the geography of income across 26 Canadian metropolitan areas. We find that suburban ways of living exist in new areas and remain associated with higher incomes even as older suburbs, as places, have become more diverse. In the largest cities the relationship between income and suburban ways of living is weaker due to the growth of condominiums in downtowns that allow higher income earners to live urban lifestyles. Homeownership is overwhelmingly more important than other variables in explaining the geography of income across 26 metropolitan areas.
Evaluate effects of local weather conditions on physical activity in early childhood.
Longitudinal prospective cohort study of 372 children, 3 years old at enrollment, drawn from a major US metropolitan community. Accelerometer-measured (RT3) physical activity was collected every 4 months over 5 years and matched with daily weather measures: day length, heating/cooling degrees (degrees mean temperature < 65°F or ≥ 65°F, respectively), wind, and precipitation. Mixed regression analyses, adjusted for repeated measures, were used to test the relationship between weather and physical activity.
Precipitation and wind speed were negatively associated with total physical activity and moderate-vigorous physical activity (P<0.0001). Heating and cooling degrees were negatively associated with total physical activity and moderate-vigorous physical activity and positively associated with inactivity (all P<0.0001), independent of age, sex, race, BMI, day length, wind, and precipitation. For every 10 additional heating degrees there was a five-minute daily reduction in moderate-vigorous physical activity. For every additional 10 cooling degrees there was a 17-minute reduction in moderate-vigorous physical activity.
Inclement weather (higher/lower temperature, greater wind speed, more rain/snow) is associated with less physical activity in young children. These deleterious effects should be considered when planning physical activity research, interventions, and policies.
Emotional eating is the tendency to eat in response to negative emotions. Prior research has identified a relationship between parenting style and child emotional eating, but this has not been examined in clinical samples. Furthermore, the relationship between specific parenting practices (e.g., parent feeding practices) and child emotional eating has not yet been investigated. The current study examined relationships between child emotional eating and both general and specific parenting constructs as well as maternal symptoms of depression and binge eating among a treatment-seeking sample of overweight children. Participants included 106 mother-child dyads who attended a baseline assessment for enrollment in a behavioral intervention for overeating. Ages of children ranged from 8-12 years old. Mothers completed self-report measures of their child's emotional eating behavior, their own feeding practices, and symptoms of depression and binge eating. Children completed a self-report measure of their mother's general parenting style. A stepwise regression analysis was conducted to identify the parent variable that was most strongly related to child emotional eating, controlling for child age and gender. Emotional feeding behavior (i.e., a tendency to offer food to soothe a child's negative emotions) was the parent factor most significantly related to child emotional eating. Findings suggest that emotional feeding practices in parents may be related to emotional eating in children. Treatment with overweight children who engage in emotional eating may be improved by targeting parent feeding practices.
In spatial epidemiologic and public health research it is common to use spatially aggregated units such as centroids of postal/zip codes, census tracts, dissemination areas, blocks or block groups as proxies for sample unit locations. Few studies, however, address the potential problems associated with using these units as address proxies. The purpose of this study is to quantify the magnitude of distance errors and accessibility misclassification that result from using several commonly-used address proxies in public health research. The impact of these positional discrepancies for spatial epidemiology is illustrated by examining misclassification of accessibility to several health-related facilities, including hospitals, public recreation spaces, schools, grocery stores, and junk food retailers throughout the City of London and Middlesex County, Ontario, Canada. Positional errors are quantified by multiple neighborhood types, revealing that address proxies are most problematic when used to represent residential locations in small towns and rural areas compared to suburban and urban areas. Findings indicate that the shorter the threshold distance used to measure accessibility between subject population and health-related facility, the greater the proportion of misclassified addresses. Using address proxies based on large aggregated units such as centroids of census tracts or dissemination areas can result in very large positional discrepancies (median errors up to 343 and 2088 m in urban and rural areas, respectively), and therefore should be avoided in spatial epidemiologic research. Even smaller, commonly-used, proxies for residential address such as postal code centroids can have large positional discrepancies (median errors up to 109 and 1363 m in urban and rural areas, respectively), and are prone to misrepresenting accessibility in small towns and rural Canada; therefore, postal codes should only be used with caution in spatial epidemiologic research.
Increasing rates of childhood obesity in the USA and other Western countries are a cause for serious public health concern. Neighborhood and community environments are thought to play a contributing role in the development of obesity among youth, but it is not well understood which types of physical environmental characteristics have the most potential to influence obesity outcomes. This paper reports the results of a systematic review of quantitative research examining built and biophysical environmental variables associated with obesity in children and adolescents through physical activity. Literature searches in PubMed, PsychInfo and Geobase were conducted. Fifteen quantitative studies met the inclusion criteria for this systematic review. The majority of studies were cross-sectional and published after 2005. Overall, few consistent findings emerged. For children, associations between physical environmental variables and obesity differed by gender, age, socioeconomic status, population density and whether reports were made by the parent or child. Access to equipment and facilities, neighborhood pattern (e.g. rural, exurban, suburban) and urban sprawl were associated with obesity outcomes in adolescents. For most environmental variables considered, strong empirical evidence is not yet available. Conceptual gaps, methodological limitations and future research directions are discussed.
A new function for egen has been developed to allow transformation of child anthropometric data to z-scores using the LMS method and the reference data available from the 1990 British Growth Reference and the 2000 US CDC Growth Reference. An additional function allows for children to be categorized according to body mass index (weight/height 2) using international cutoff points recommended by the Childhood Obesity Working Group of the International Obesity Taskforce. Copyright 2004 by StataCorp LP.
We examined the relationship between overweight in preschool children and three environmental factors--the proximity of the children's residences to playgrounds and to fast food restaurants and the safety of the children's neighborhoods. We hypothesized that children who lived farther from playgrounds, closer to fast food restaurants, and in unsafe neighborhoods were more likely to be overweight.
This was a cross-sectional study of 7,020 low-income children, 36 through 59 months of age living in Cincinnati, OH. Overweight was defined as a measured body mass index > or =95th percentile. The distance between each child's residence and the nearest public playground and fast food restaurant was determined with geographic information systems. Neighborhood safety was defined by the number of police-reported crimes per 1,000 residents per year in each of 46 city neighborhoods.
Overall, 9.2% of the children were overweight, 76% black, and 23% white. The mean (+/- SD) distances from a child's home to the nearest playground and fast food restaurant were 0.31 (+/- 0.22) and 0.70 (+/- 0.38) miles, respectively. There was no association between child overweight and proximity to playgrounds, proximity to fast food restaurants, or level of neighborhood crime. The association between child overweight and playground proximity did not differ by neighborhood crime level.
Within a population of urban low-income preschoolers, overweight was not associated with proximity to playgrounds and fast food restaurants or with the level of neighborhood crime.
This study examined associations between perceptions of the local neighborhood and walking and cycling among children.
Children aged 5-6 years (n=291) and 10-12 years (n=919) were recruited from 19 Australian primary schools. Parents reported their child's usual walking or cycling to local destinations and their perceptions of their neighborhood. Ten- to twelve-year-olds were asked their perceptions of traffic, strangers, road safety and sporting venues, and their perceptions of their parent's views on these issues.
Five- to six-year-old boys whose parents believed there was heavy traffic in their area were 2.8 times more likely (95%CI=1.1-6.8), and 5- to 6-year-old girls whose parents owned more than one car were 70% less likely (95%CI=0.1-0.8), and whose parents believed that public transport was limited in their area were 60% less likely (95%CI=0.2-0.9) than other children to walk or cycle at least three times per week. Parental belief that there were no lights or crossings was associated with walking or cycling among 10- to 12-year-old boys (OR=0.4, 95%CI=0.2-0.7). Among older girls, parent's belief that their child needed to cross several roads to reach play areas (OR=0.4, 95%CI=0.2-0.8) and that there is limited public transport in their area (OR=0.7, 95%CI=0.4-0.97), and child's belief that there were no parks or sports grounds near home (OR=0.5, 95%CI=0.3-0.8) were associated with a lower likelihood of walking or cycling.
Perceptions of the local neighborhood may influence children's physical activity.
Surnames have the potential to accurately identify ancestral origins as they are passed on from generation to generation. In this study, we developed and validated a Chinese surname list to define Chinese ethnicity.
We conducted a literature review, a panel review, and a telephone survey in a randomly selected sample from a Canadian city in 2003 to develop a Chinese surname list. The list was then validated to data from the Canadian Community Health Survey. Both surveys collected information on self-reported ethnicity and surname.
Of the 112,452 people analyzed in the Canadian Community Health Survey, 1.6% were self-reported as Chinese. This was similar to the 1.5% identified by the surname list. Compared with self-reported Chinese ethnicity (reference standard), the surname list had 77.7% sensitivity, 80.5% positive predictive value, 99.7% specificity, and 99.6% negative predictive value. When stratifying by sex and marital status, the positive predictive value was 78.9% for married women and 83.6% for never married women.
The Chinese surname list appears to be valid in identifying Chinese ethnicity. The validity may depend on the geographic origins and Chinese dialects in given populations.
To determine associations of the neighborhood and home television environments with young children's physical activity.
32 boys and 27 girls age 4 to 7 years wore accelerometers for 3 weekdays and 1 weekend day. The number of televisions in the home and television watching of the child were monitored using TV Allowance units for 3 weeks. A geographic information system was used to measure neighborhood environment variables.
Hierarchical regression analysis was used to predict physical activity, initially controlling for sex, age, socioeconomic status, adiposity, and child television watching in step 1. In step 2, the number of televisions did not significantly increase the amount of variability accounted for in the prediction of physical activity. In step 3, housing density and the interaction of housing density by sex accounted for an incremental 12% (p < 0.05) of the variability and in step 4 percentage park plus recreation area accounted for a further 10% (p < 0.05) of the variability. Greater housing density predicted increased physical activity of boys, but not girls.
Neighborhoods with increased proximity between homes and a greater proportion of park area are associated with greater physical activity in young children.
We studied whether park size, number of features in the park, and distance to a park from participants' homes were related to a park being used for physical activity.
We collected observational data on 28 specific features from 33 parks. Adult residents in surrounding areas (n=380) completed 7-day physical activity logs that included the location of their activities. We used logistic regression to examine the relative importance of park size, features, and distance to participants' homes in predicting whether a park was used for physical activity, with control for perceived neighborhood safety and aesthetics.
Parks with more features were more likely to be used for physical activity; size and distance were not significant predictors. Park facilities were more important than were park amenities. Of the park facilities, trails had the strongest relationship with park use for physical activity.
Specific park features may have significant implications for park-based physical activity. Future research should explore these factors in diverse neighborhoods and diverse parks among both younger and older populations.
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