Active school transport in an urban environment:prevalence and perceived barriers.

BACKGROUND: Active school transport (AST) can increase children's and adolescents' physical activity. The proportion of children and adolescents who engage in AST has declined internationally in recent decades. This study examines the prevalence, correlates, and perceived barriers to AST in the city of Leipzig, Germany. METHODS: The study sample includes 1070 participants, 364 children and 706 adolescents, aged between 6 and 18 years, as well as their parents. The parents as well as adolescents age 10 and above completed questionnaires concerning sociodemographic variables, means of transport/AST and perceived barriers to AST. The distance between home and school was calculated as the network distance from the home to school address using the Dijkstra algorithm. Based on these data, logistic models were fitted in a two-step variable selection process, using AST as the dependent variable. RESULTS: Approximately half of the children (59%) and adolescents (51%) engaged in AST. The prevalence of AST exhibited a negative correlation with age (Odds Ratio (OR) = 0.94, 95% confidence interval (CI) = 0.9-0.99, p = 0.015) and did not significantly differ by gender (children: ORgirls = 1.5, CI = 0.95-2.25, p = 0.075, adolescents: ORgirls = 1.01, CI = 0.75-1.37, p = 0.924). A high socioeconomic status was positively correlated to AST on the morning trip (OR = 1.7, CI 1.3-2.21, p < 0.01) but negatively on the afternoon trip (OR = 0.7, CI = 0.53-0.9, p < 0.01) in the summer. Common barriers for children (from their parents' perspective) and for adolescents (from their own and their parents' perspective) were distance and a heavy load to carry. The parents of adolescents did not perceive any other specific barriers as a serious impediment. Further significant barriers perceived by the younger children's parents were adults giving a lift on the way to other errands, no other children to walk or cycle with, and too much traffic. Too much traffic was also a significant barrier for adolescents, as were taking too much time and bad weather conditions. CONCLUSIONS: Future interventions promoting AST in an urban environment should be guided by the identified perceived barriers. TRIAL REGISTRATION: LIFE Child has been retrospectively registered with ClinicalTrials.gov (NCT02550236).

[Community-based prevention of obesity in children]. / Gemeinwesen-basierte Prävention und kindliche Adipositas.

Besides individual determinants, obesity is also caused by obesogenic environmental conditions. Thus, prevention of obesity in children should aim at creating health-promoting environments. This is especially important for children of socially disadvantaged families and communities who are hardly reached and often profit less by behavior-oriented interventions. The main question is which environmental conditions should be changed and how in order to be accepted and sustainable? According to our experiences from the project "Grünau moves" (Grünau bewegt sich), the consideration of environmental and social conditions in the intervention field as well as the inclusion of the professional expertise of local agents and the lifeworld perspective (subjective meanings and realities) of families and children are crucial. Based on the fact that the understanding and weighting of health varies between individuals, the starting points for interventions and environmental change must be sought according to the interests and resources of the local community. Combining a medical and social work perspective and focusing on the community work approach can help to link and bundle different perspectives and interests in order to create appropriate and context-specific health-promoting environments.

Purchasing Behavior, Setting, Pricing, Family: Determinants of School Lunch Participation.

Despite growing school lunch availability in Germany, its utilization is still low, and students resort to unhealthy alternatives. We investigated predictors of school lunch participation and reasons for nonparticipation in 1215 schoolchildren. Children reported meal habits, parents provided family-related information (like socioeconomic status), and anthropometry was conducted on-site in schools. Associations between school lunch participation and family-related predictors were estimated using logistic regression controlling for age and gender if necessary. School was added as a random effect. School lunch participation was primarily associated with family factors. While having breakfast on schooldays was positively associated with school lunch participation (ORadj = 2.20, p = 0.002), lower secondary schools (ORadj = 0.52, p < 0.001) and low SES (ORadj = 0.25, p < 0.001) were negatively associated. The main reasons for nonparticipation were school- and lunch-related factors (taste, time constraints, pricing). Parents reported pricing as crucial a reason as an unpleasant taste for nonparticipation. Nonparticipants bought sandwiches and energy drinks significantly more often on school days, whereas participants were less often affected by overweight (OR = 0.66, p = 0.043). Our data stress school- and lunch-related factors as an important opportunity to foster school lunch utilization.

Well-being and COVID-19-related worries of German children and adolescents: A longitudinal study from pre-COVID to the end of lockdown in Spring 2020.

BACKGROUND: There is concern that pandemic measures put a strain on the health and well-being of children. We investigated the effects of the COVID-19 pandemic, the lockdown, and social distancing on the well-being, media use, and emotions of children and adolescents between 9 and 18 years. METHODS: We used linear and proportional odds logistic regression correcting for age, sex, and socioeconomic status (SES) and to compare media use, peers/social support, physical, and psychological well-being between 2019 (pre-COVID baseline) and two time points shortly after the start of the lockdown (last week of March and April 2020, respectively) in 391 9-19-year-old healthy children and adolescents of the LIFE Child cohort. COVID-19-related feelings and their relationship to age, sex, and SES were assessed at two time points during lockdown. RESULTS: We found significantly lower scores in physical and psychological well-being during lockdown compared to baseline. The effect was significantly stronger in children with medium/low SES. Perceived social support scores were also significantly lower during the lockdown. The percentage of children who had no contact with their peers (in-person or online) increased from 3% pre-COVID to 14% and 13% in April and March 2020, respectively. About 80% of the children missed in-person contacts with friends. Most of the children worried more about the health of their families than their own. Sixty percent worried about the international situation at least moderately, whereas only 20% were afraid of COVID-19 itself. The percentage of children who believed it would never be as before COVID-19 rose from 7.4% at the beginning lockdown end of March to 16.2% a month later. In contrast, all other COVID-19-related worries, showed a (nonsignificant) decline during the same period. CONCLUSION: Our study supports the notion that pandemic measures have to be balanced against adverse public health effects. Especially vulnerable groups have to be protected.

And yet Again: Having Breakfast Is Positively Associated with Lower BMI and Healthier General Eating Behavior in Schoolchildren.

Given the high prevalence of childhood overweight, school-based programs aiming at nutritional behavior may be a good starting point for community-based interventions. Therefore, we investigated associations between school-related meal patterns and weight status in 1215 schoolchildren. Anthropometry was performed on-site in schools. Children reported their meal habits, and parents provided family-related information via questionnaires. Associations between nutritional behavior and weight status were estimated using hierarchical linear and logistic regression. Analyses were adjusted for age, socio-economic status, school type, migration background, and parental weight status. Having breakfast was associated with a lower BMI-SDS (ßadj = -0.51, p = 0.004) and a lower risk of being overweight (ORadj = 0.30, p = 0.009), while having two breakfasts resulting in stronger associations (BMI-SDS: ßadj = -0.66, p < 0.001; risk of overweight: ORadj = 0.22, p = 0.001). Likewise, children who regularly skipped breakfast on school days showed stronger associations (BMI-SDS: ß = 0.49, p < 0.001; risk of overweight: OR = 3.29, p < 0.001) than children who skipped breakfast only occasionally (BMI-SDS: ß = 0.43, p < 0.001; risk of overweight: OR = 2.72, p = 0.032). The associations persisted after controlling for parental SES and weight status. Therefore, our data confirm the school setting as a suitable starting point for community-based interventions and may underline the necessity of national programs providing free breakfast and lunch to children.

Loss of childcare and classroom teaching during the Covid-19-related lockdown in spring 2020: A longitudinal study on consequences on leisure behavior and schoolwork at home.

AIM: In spring 2020, the first Covid-19-related lockdown included the closing of kindergartens and schools. Home schooling, the lack of social contacts with peers and the care of the children at home posed an enormous challenge for many families. METHODS: The present study investigated the leisure behavior of 285 one- to 10-year-old German children at two time points (t1 and t2) during the Covid-19-related lockdown in spring 2020. In the subsample of primary school children (n = 102), we also explored children's attitudes towards schoolwork at home. Analyses focused on the change of behavior from t1 to t2, on differences in these changes depending on socio-economic status (SES), and on associations of behavior with SES, the number of children at home, and the frequency of receiving learning materials from school. RESULTS: While the frequency of playing outside increased significantly from t1 to t2, the frequency of handicrafts, playing board games, indoor sports, and motivation to do schoolwork decreased. The observed changes between t1 and t2 did not differ depending on SES. However, a lower SES was associated with higher media use, less outdoor activity, and (though only marginally significant) a reduced time doing schoolwork and a reduced ability to concentrate on schoolwork at t1. In households with more children, children played outside more often, but were read to less frequently and (though only marginally significant) watched movies and series less frequently. Children receiving learning materials from school on a regular basis spent significantly more time doing schoolwork at home than children receiving materials only irregularly. CONCLUSIONS: A continuing loss of childcare in day-care facilities and schools entails the danger of declining education in the form of (inter)active indoor activities and schoolwork.

[Primordial prevention in childhood to avoid chronic diseases]. / Primordiale Prävention im Kindesalter zur Vermeidung chronischer Erkrankungen.

Primordial prevention targets the healthy population. It aims at supporting people in developing and maintaining a healthy lifestyle to minimize the development of risk factors for noncommunicable diseases. Childhood offers special starting points and opportunities for this. Essentially for this is the creation of health-promoting conditions. This requires the participation of medical and non-medical professionals. Community organizing can significantly foster this process of interdisciplinary and setting-related work. Primordial prevention in childhood cannot be achieved without the active participation of pediatricians.

Associations of Green Spaces and Streets in the Living Environment with Outdoor Activity, Media Use, Overweight/Obesity and Emotional Wellbeing in Children and Adolescents.

Aspects of the living environment can affect health and wellbeing of children and adolescents. Whereas most previous studies assessed the more distant residential urban environment, less is known on possible effects of the close environment. The present study investigated associations of the proportion of streets and green spaces in the immediate urban living environment (50, 100 and 400 m around the home) with media use, outdoor activity, overweight/obesity and emotional problems in two samples of younger (age 3-10, n = 395) and older children (age 10-19, n = 405). Independently of socioeconomic parameters, a higher proportion of streets was associated with overweight/obesity (in younger and older children), higher media use (in younger children), less outdoor activity and more emotional problems (in older children). Older children's outdoor activity in winter increased with increasing proportions of green spaces. The observations suggest that the immediate urban living environment is a factor that can affect leisure behavior and health in children.

"Movement-enhancing footpaths" - A natural experiment on street design and physical activity in children in a deprived district of Leipzig, Germany.

Despite the beneficial effects of physical activity (PA), only 26% of children in Germany meet the WHO's recommendations. Because active play contributes to PA and is accepted by families, the creation of "playable" environments could promote PA. This study is a natural experiment that was conducted to investigate whether slight changes in the physical environment can increase PA in children. In autumn 2016, 140 students from two primary schools located in a deprived district of Leipzig (Germany) gathered ideas on PA-promoting street designs. After protracted negotiations with the city administration, two footpaths were decorated with colored markings (hopscotch grids, labyrinths, "mirror me") in September 2019. 48 observations were made before (August 2019) and after (September/October 2019) the implementation using the System for Observing Play and Recreation in Communities (SOPARC). Age, gender, activity level, bike use, and interactions with the colored markings were recorded. A total of 5455 individuals (including 1099 cyclists) were observed. Almost one fifth of the observed children (0 to 12 years) interacted with the markings. There was a slight increase in vigorous activity in all observed individuals after the implementation (2.9% vs. 6.4%, p < 0.001). The chance for vigorous activity was higher on decorated footpaths (OR 2.45, CI 1.54-3.89, p < 0.001), for children (OR 19.32, CI 13.07-28.56, p < 0.001), and on Sundays (OR 3.39, CI 2.33-4.94, p < 0.001). The participatory development and design of footpaths that support spontaneous active play "on the way" might be one component that can be used to support changes in children's PA behaviors and social interactions.

[Neighbourhood deprivation and community nutrition environment: associations between the social and built environment and food availability]. / Stadtteildeprivation und Lebensmittelumwelt: Zusammenhänge von sozialen und baulichen Merkmalen der Wohnumgebung und Lebensmittelverfügbarkeit.

OBJECTIVE: Eating habits are influenced by individual socioeconomic status (SES). As the association between neighbourhood characteristics and food availability is still unclear, we investigated the community nutrition environment in different neighbourhoods. METHODS: Using official data of the city of Leipzig, we selected three neighbourhoods which differed in terms of their social (2 deprived vs. 1 affluent) and built (1 large housing estates vs. 2 historic buildings) environment. Data on food outlets were assessed via direct observation (ground truthing). RESULTS: Social and residential environment characteristics are associated with food availability. The proportion of fast food outlets is higher in deprived neighbourhoods compared to the affluent one (25%, 30.4% vs. 13.5%). Neighbourhoods with historic buildings offer a greater variety of food outlets. CONCLUSION: The greater availability of unhealthy food may contribute to the development of obesity. Preventive measures should consider the physical and social environment.

Challenges in doing multi-disciplinary health promotion research in Germany.

Health problems such as obesity are increasingly addressed by complex intervention programmes which operate at multiple levels of influence (e.g. families, schools, neighbourhoods) involving partners from various academic, professional and cultural backgrounds. Following a complex participatory health promotion approach is challenging, because conflicting interests as well as contextual constraints may occur which are rarely discussed empirically. Process evaluations of some programmes investigate factors influencing the implementation process. However, researchers' perspectives on inter- and transdisciplinary work are mostly neglected. This paper aims at illustrating and critically analysing challenges that arose in the planning and implementation of a health promotion project in a socially deprived neighbourhood in Germany. Drawing on minutes, email conversations, and research diary entries we reflect on discrepancies and difficult interactions within the research team, with collaborating (academic) institutions (interdisciplinary work) and with the community partners (transdisciplinary work) respectively. Differences in language, interests, success criteria, professional preferences and habits as well as contextual factors are worked out and coping strategies or solutions are proposed. According to our experiences, bringing to light researchers' positions, preferences and interactions with the community is necessary to find a balance between research and practice, to develop adequate solutions for challenging situations and to evaluate the process, effectiveness and transferability of a programme. Health promotion research should report not only on the effectiveness of interventions but also on struggles, unsuccessful attempts and useful (or useless) strategies to fuel discourse on opportunities in and the efficacy and transferability of health promotion projects.

The association between physical environment and health: indicating the direction of effects using German panel data.

BACKGROUND: A growing body of research has identified an association between health and physical residential environmental characteristics. However, the direction of effects remains unclear, and further research is needed to determine whether the residential environment influences health. OBJECTIVES: To specify the direction of the association between environmental disadvantage and self-reported health. METHODS: Longitudinal data were obtained from the German Socioeconomic Panel and were examined at two points in time. Participants were grouped by relocation status assessed across a five-year period. Structural equation modeling was used to examine the effect of baseline environmental disadvantage on baseline health and on health five years later. RESULTS: In both groups, environmental disadvantage was cross-sectionally correlated with poor health. Only among people who did not relocate was baseline environmental disadvantage significantly related to health five years later in bivariate analyses. Results from the structural equation model found that environmental disadvantage was no longer significantly related to poor health five years later within the group of non-movers (ß = -.02, p = .052). In addition, there was no effect in this direction within the group of movers (ß = .02, p = .277). CONCLUSIONS: Our results suggest the existence of a weak contextual effect as group differences in longitudinal associations indicated the direction of ecological effects.

Obesogenic environments: environmental approaches to obesity prevention.

Childhood obesity is a major concern for public health. There are multiple factors (e.g., genetic, social, and environmental) that contribute to unhealthy weight gain. Drawing from findings on "obesogenic environments" and core principles of preventive strategies to reduce health inequalities, this paper gives an overview of recent childhood prevention programs that target aspects of the physical environment ("environmental changes"). Out of the ten reviews we screened (including more than 300 studies), we identified very few that addressed aspects of the environment. We focus here on 14 programs that follow different approaches to environmental changes (e.g., access to/quality of playgrounds, changes in school cafeterias). Altering the environment offers opportunities for healthier behaviors and seems to be an effective strategy to prevent childhood obesity. However, the evaluation of those (mostly) multidimensional interventions does not allow drawing firm conclusions about the single effect of environmental changes. We conclude that obesity prevention programs should combine person-based and environmental approaches.

The independent relations of both residential self-selection and the environment to physical activity.

Residential self-selection is supposed to bias the relation between residential environments and physical activity, but empirical analyses are still rare. This study examines the association while simultaneously considering the effect of residential self-selection criteria. One thousand two hundred and forty-five German students were asked to report their physical activity, their perceived environment, and their reasons for choosing their neighbourhood. Structural equation modelling was employed. Reasons for choosing a neighbourhood were related to actual environmental characteristics. Utilitarian reasons were related to less physical activity, hedonic reasons were related to higher physical activity. The street network was related to higher physical activity independent of residential self-selection. Our results support the weight of both individual preferences and the street network on physical activity. The residential environment has an impact on people's amount of physical activity regardless of their reasons for choosing a neighbourhood and should therefore be considered a resource in health prevention and promotion.

[The influence of perceived discrimination on health in migrants]. / Der Einfluss von Diskriminierungserfahrungen auf die Gesundheit von MigrantInnen.

OBJECTIVE: The aim of the study was to investigate the influence of racial discrimination on subjective health in migrants. METHODS: The sample included 1.844 migrants from the SOEP. Discrimination was assessed by two items. Socioeconomic status, country of origin, and health behavior were included in multivariate regression models to control for effects on health. Differential models with regard to gender and origin were analysed. RESULTS: Migrants who experienced discrimination report a worse health status. Discrimination determines mental and physical health of migrants. There are differences in models due to gender and origin. CONCLUSIONS: In addition to socioeconomic factors experienced discrimination should be taken into account as a psycho-social stressor of migrants.