The effect of outdoor activities on the medical expenditure of older people: multiple chain mediating effects of health benefits.

BACKGROUND: With the global aging population, attention to the health and medical issues of older adults is increasing. By analyzing the relationship between older people's participation in outdoor activities and medical expenditure, this study aims to provide a scientific basis for improving their quality of life and reducing the medical burden. METHODS: Data on outdoor activity participation, medical expenditures, and relevant variables were collected through questionnaires and databases. A multi-chain mediation effect model was established to analyze the impact of outdoor activities on the medical expenditure of older people, considering mediation effects and heterogeneity. RESULTS: Results revealed that increased participation in outdoor activities among older adults correlated with lower medical expenditures. Outdoor activities positively influenced their health by improving mental health, cognition, eating habits, and activities of daily living, resulting in reduced medical expenditures. Robustness tests confirmed the consistent effect of outdoor activities on older people's medical expenditure. CONCLUSION: These findings contribute to understanding the relationship between outdoor activities, health, and medical expenditure in older people, guiding policy formulation and interventions. Encouraging and supporting older adults in outdoor activities can enhance their quality of life and alleviate medical resource strain. The study's conclusions can also inform health promotion measures for other populations and serve as a basis for future research in this area.

The association between work-related activities and leisure-time physical activity among Latinos.

OBJECTIVES: Latinos engage in high levels of occupational physical activity, yet low levels of leisure-time physical activity. Limited research has examined specific work-based activities that may contribute to leisure-time physical activity for meeting current physical activity recommendations among Latinos. The purpose of our study was to examine associations between frequency of work-related exertion and standing/walking with meeting the aerobic and muscle-strengthening physical activity guidelines among Latinos and whether associations varied by nativity. DESIGN: We used cross-sectional 2015 National Health Interview Survey data on Latinos ≥18 years of age (n = 3162). Logistic regression models were used to estimate associations between the frequency of work-related activities with meeting the aerobic and muscle-strengthening physical activity guidelines. Models were adjusted for age, sex, education, Latino subpopulation, shift work, and nativity. We also examined whether associations varied by nativity. RESULTS: In adjusted models, compared with those never engaging in exertion at work, participants always exerting themselves were significantly less likely to meet the aerobic activity guideline (Odds Ratio [OR]: 0.66, 95% Confidence Interval [CI]: 0.51-0.87). Compared with those never standing/walking at work, participants seldom standing/walking were also less likely to meet the aerobic activity guideline (OR: 0.57, 95% CI: 0.34, 0.95). Models were adjusted for age, sex, education, Latino subpopulation, shift work, and nativity. When stratified by nativity, the patterns in the strength of the associations were similar, while differences were observed in the associations of work-related activities with meeting guidelines. CONCLUSION: Our findings suggest that engaging in higher frequency of exertion and standing/walking at work are associated with being less likely to meet the aerobic physical activity guideline during leisure time among Latinos, with variation observed in meeting guidelines by nativity. Insight into physical activities performed at work could inform efforts aimed at promoting recommended levels of physical activity among Latinos.

Sociodemographic Factors, Leisure-Time Physical Activity and Mortality.

INTRODUCTION: Exploring sociodemographic effect modification is important to provide evidence for developing targeted recommendations and reducing health inequalities. This study evaluated how sociodemographic factors including age, sex, race/ethnicity and socioeconomic status (SES) modify the association between leisure-time physical activity (LTPA) and all-cause and major cause-specific mortality. METHODS: The study sample included 471,992 people from the 1997-2018 National Health Interview Survey (NHIS) and 41,830 people from the 1999-2018 National Health and Nutrition Examination Survey (NHANES). Data were analyzed in December 2022. Mortality data from the National Death Index were available to December 31, 2019. Sufficient LTPA was defined as at least 150 minutes of moderate and/or vigorous intensity per week. RESULTS: There were 46,289 deaths in NHIS participants and 4,617 deaths in NHANES participants during a mean follow-up of 10 years. Individuals with sufficient LTPA had lower risk of all-cause (NHIS: hazard ratio, 0.74, 95% CI: [0.74-0.74]; NHANES: 0.73 [0.68-0.79]) and cardiovascular mortality (NHIS: 0.75 [0.75-0.75]; NHANES: 0.80 [0.69-0.93]) compared with inactive participants. The subgroup analysis showed significant interactions between LTPA and all sociodemographic factors. Associations between LTPA and mortality were weaker among younger individuals, males, Hispanic adults or those of low SES, respectively. CONCLUSIONS: Sociodemographic factors significantly modified the associations between LTPA and mortality. The health benefits of sufficient LTPA were smaller in younger individuals, males, Hispanic adults or those of low SES. These findings can help identify target populations for promotion of physical activity to reduce health inequalities and the development of physical activity guidelines.

Leisure-Time Physical Activity in a Southern Brazilian City (2004-2021): Applying an Equity Lens to Time-Trend Analyses.

BACKGROUND: This study aimed to verify leisure-time physical activity trends over 15 years and monitor inequalities according to gender, self-reported skin color, and socioeconomic position in a Southern Brazilian city. A secondary aim is to evaluate intersectionalities in physical activity. METHODS: Trend analysis using 3 population-based surveys carried out in 2004, 2010, and 2021. Main outcome assessed was the prevalence of physical activity according to recommendations (150 min/wk). Inequalities dimensions measured were sex, self-reported skin color, and wealth. Intersectionalities were evaluated using Jeopardy index combining all inequality dimensions. Trend analysis was performed using least-squares weighted regression. RESULTS: We included data from 3090, 2656, and 5696 adults in 2004, 2010, and 2021, respectively. Prevalence of physical activity remains stable around 25% in the 3 years. In the 3 periods evaluated, men presented a prevalence in average 10 percentage points higher than women (SII2004 = -11.1 [95% confidence interval, CI, -14.4 to -7.8], SII2021 = -10.7 [95% CI, -13.7 to -7.7]). Skin color inequalities did not present a clear pattern. Richest individuals, in general presented a prevalence of leisure-time physical activity level 20pp higher than poorest ones (SII2004 = 20.5 [95% CI, 13.7 to 27.4]; SII2021 = 16.7 [95% CI, 11.3 to 22.0]). Inequalities were widely marked, comparing the most privileged group (represented by men, the wealthiest, and White) and the most socially vulnerable group (represented by women, the poorest, and Black/Brown). The Slope Index of Inequality for intersectionalities was -24.5 (95% CI, -31.1 to -17.9) in 2004 and -18.8 in 2021 (95% CI, -24.2 to -13.4). CONCLUSIONS: Our analysis shows that women, Black/Brown, and poor present lower leisure-time physical activity level. This group is often neglected regarding other health and social outcomes.

The Influence of Social Vulnerability and Culture on Physical Inactivity in the United States - Identifying Hot Spots in Need of Attention.

BACKGROUND: In the United States, ongoing efforts to increase individual- and population-level physical activity have made little to no progress over the past decade in reducing the percentage of individuals who report no leisure-time physical activity. The purpose of the current study is to further assess the relationship between social vulnerability and the prevalence of physical inactivity at the county level. METHODS: We merged county-level data on physical inactivity prevalence, the Social Vulnerability Index (SVI), and the American Nations regional cultures schematic. RESULTS: Physical inactivity significantly correlated (P < .001) with the overall SVI score and all subtheme scores to varying levels of strength. Clear and statistically significant heterogeneity in the SVI scores was apparent across distinct regions using the American Nations model, consistent with previously demonstrated patterns of physical inactivity prevalence. CONCLUSIONS: On a national level, physical inactivity prevalence is unacceptably high and has not appreciably improved over the past decade. Within the United States, high levels of social vulnerability and physical inactivity are concentrated within specific geographic regions that need tailored solutions to resolve health disparities.

[Conceptual framework of gambling and gambling-related harms]. / Marco conceptual del juego de apuestas y sus daños asociados.

Gambling is a legitimate leisure activity in many countries that many people use. However, some of them suffer significant harm because of gambling. This may involve economic, social, physical or mental harm. These harms are not only suffered by the individual gambler, but affect the family, the community and society. The aim of this text is to propose a conceptual framework for understanding the determinants of gambling and its related harms and thus, contribute to the development of prevention policies to reduce its impact on health. The framework proposed in this manuscript places present evidence in the model of health inequalities, analyzing the effect of the socioeconomic and political context, the axes of inequalities, individual and social factors, and the health system in generating the health inequalities of gambling suffered by the most vulnerable groups. The evidence gathered in this framework suggests that health determinants lead to health inequality in relation to gambling and its associated harms.

El juego de apuestas es una actividad de ocio legítima en muchos países, la cual muchas personas utilizan. Sin embargo, algunas de ellas experimentan daños significativos como resultado de estos juegos de apuestas. Estos daños, que pueden ser de carácter económico, social o de salud física y mental, no solo los sufre el individuo que juega, sino que afectan a la familia, a la comunidad y a toda la sociedad. El objetivo de este texto es proponer un marco conceptual para comprender los determinantes del juego de apuestas y sus daños asociados, que ayude a desarrollar políticas de prevención para reducir su impacto en la salud. El marco planteado en este manuscrito sitúa la evidencia actual en el modelo de desigualdades en salud y analiza la importancia del contexto socioeconómico y político, de los ejes de desigualdad, de los factores individuales y sociales, y del sistema sanitario en la desigualdad en salud asociada al juego de apuestas que sufren los grupos más vulnerables. La evidencia que se recoge en este marco sugiere que los determinantes de salud conllevan a una desigualdad en salud en relación con los juegos de apuestas y sus daños asociados.

Work, travel, or leisure: comparing domain-specific physical activity patterns based on rural-urban location in Canada.

BACKGROUND: Physical activity occurs across various domains including leisure/recreation, for transportation, or for work or household reasons. Rural and urban active living environments are characterized by different opportunities for physical activity within each domain which may translate into different patterns of behavior. The aim of this study was to compare rural-urban differences in physical activity across different domains, and explore interactions between sociodemographic factors, physical activity domains, and rurality. METHODS: We used self-reported data collected across three physical activity domains (active transportation, recreation, occupational/household) and relevant sociodemographic variables from the Canadian Community Health Survey. Adjusting for sociodemographic factors, we did two separate cross-sectional analyses: 1) binary logistic regression to determine the odds of reporting any activity in each domain, and 2) ordinary least squares regression using the sub-samples reporting > 0 min per week of activity to compare how much activity was reported in each domain. RESULTS: Our final survey weighted sample of Canadian adults (mean age 47.4 years) was n = 25,669,018 (unweighted n = 47,266). Rural residents were less likely to report any active transportation (OR = 0.59, 95% CI [0.51, 0.67], p < .0001). For recreational physical activity, rural males had lower odds (OR = 0.75, 95% CI [0.67, 0.83], p < .0001) and rural females had higher odds (OR = 1.19, 95% CI [1.08, 1.30], p = .0002) of reporting any participation compared to urban residents. Rural males (OR = 1.90, 95% CI [1.74, 2.07], p < .0001) and females (OR = 1.33, 95% CI [1.21, 1.46], p < .0001) had higher odds of reporting any occupational or household physical activity. CONCLUSIONS: Urban residents tend to participate in more active transportation, while rural residents participate in more occupational or household physical activity. Location-based differences in physical activity are best understood by examining multiple domains and must include appropriate sociodemographic interactions, such as income and sex/gender.

The difference in the elderly's visual impact assessment of pocket park landscape.

As an important part of urban public open space, pocket parks have become an important activity place for the elderly in the context of the aging society in China. With the pocket parks in Nanjing, Jiangsu province, China as research object, this paper set six landscape features to be studied, namely, Height of trees, Green color richness, Stratification of green landscapes, Green space ratio, Leisure facilities, and Water landscape. The elderly respondents with different demographic characteristics, such as age, gender, education level and residential type, were subjected to the picture stimulation experiment whose results were then statistically analyzed. The results indicate that gender and residential type exert certain influence on the elderly's visual impact assessment of pocket park landscape. To be specific, the male elderly prefer the pocket park landscape with 3-6 m high trees, medium green space ratio, and more leisure facilities; the female elderly are in greater favor of pocket park landscapes with 0-3 m high trees, five or more colors, three or more layers; the elderly who live with their families prefer pocket park landscapes with medium green space ratio and more leisure facilities; to the elderly who live alone, pocket park landscapes with trees which are 0-3 m high, five or more colors, and medium leisure facilities are more attractive. This study can provide valuable reference for pocket park design in China.

Problemas do sono em adultos assistidos na Estratégia de Saúde da Família / Sleep problems in adults assisted in the Family Health Strategy

Objetivo: Estimar a prevalência e investigar fatores associados aos problemas do sono em adultos cadastrados na Estratégia de Saúde da Família em 2016.Métodos: Estudo transversal, amostral, com 791 indivíduos, com idade igual ou superior a 18 anos, realizado entre 2017 e 2018. Os problemas de sono foram mensurados pelo Mini Sleep Questionnaire, questionário validado no Brasil.Resultados: A prevalência de problemas de sono foi de 49,6%. Destes, 10,4% tiveram alterações leves, 7,6% moderadas e 31,6% graves. Observou-se associação estatisticamente significante entre não ter uma atividade de trabalho remunerada, não ter atividade de lazer, hábito de fumar, presença de doença crônica e autoavaliação negativa da saúde com os problemas do sono.Conclusão: Observou-se elevada prevalência de problemas de sono. Esses resultados podem contribuir para uma melhor compreensão dos problemas do sono na população adulta e, assim, colaborar com a adoção de medidas mais eficazes para o enfrentamento desse problema

Objective: To estimate the prevalence and investigate factors associated with sleep problems in adults enrolled in the Family Health Strategy in 2016. Methods: Cross-sectional sample study with 791 individuals aged 18 years or over, carried out between 2017 and 2018. Sleep problems were measured using the Mini Sleep Questionnaire, a questionnaire validated in Brazil. Results: The prevalence of sleep problems was 49.6%. Of these, 10.4% had mild, 7.6% moderate, and 31.6% severe alterations. There was a statistically significant association between not having a paid work activity, not having leisure activities, smoking, chronic disease, and negative self-assessment of health with sleep problems. Conclusion: There was a high prevalence of sleep problems. These results can contribute to a better understanding of sleep problems in the adult population and, thus, collaborate with adopting more effective measures to treat them

Leisure Participation of Autistic Adults: An Ecological Momentary Assessment Feasibility Study.

Autistic adults participate less and express lower satisfaction in leisure activities than nonautistic adults, although literature is limited. The multifaceted nature of leisure participation makes it challenging to measure, with most measures being retrospective. Ecological momentary assessments (EMA) can reduce recall bias. This pilot study assessed the feasibility and acceptability of EMA among autistic adults. Participants (N = 40) were recruited via email and online. After completing a baseline interview, participants were asked to complete a once-daily survey for 30 days, in which they received survey links through a text messaging smartphone app. Surveys asked participants to report whether they participated in any leisure activities during the day, their level of enjoyment, with whom they interacted, and where they participated. The EMA appeared feasible in this sample, as participants completed the daily survey on average 27.05 (SD = 3.92) days. Regarding acceptability, most agreed that survey timing was convenient, that it was easy to enter responses and answer questions daily, and that they had enough response time. Overall, this study supports the use of EMA methodology among autistic adults. Future research should follow and improve upon these EMA data collection practices to examine daily behavior and well-being among autistic adults.

Current and future costs of cancer attributable to insufficient leisure-time physical activity in Brazil.

OBJECTIVES: Cancer is an increasing cause of death and disability in Brazil and a pivotal vector for growing health expenditures. Lower levels of leisure-time physical activity are associated with a higher risk of some cancers. We quantified the current and future cancer direct healthcare costs attributable to insufficient leisure-time physical activity in Brazil. METHODS: We performed a macrosimulation model using: (i) relative risks from meta-analyses; (ii) prevalence data of insufficient leisure-time physical activity in adults ≥ 20 years; (iii) national registries of healthcare costs of adults ≥ 30 years with cancer. We used simple linear regression to predict cancer costs as a function of time. We calculated the potential impact fraction (PIF) considering the theoretical-minimum-risk exposure and other counterfactual scenarios of physical activity prevalence. RESULTS: We projected that the costs of breast, endometrial, and colorectal cancers may increase from US$ 630 million in 2018 to US$ 1.1 billion in 2030 and US$ 1.5 billion in 2040. The costs of cancer attributable to insufficient leisure-time physical activity may increase from US$ 43 million in 2018 to US$ 64 million in 2030. Increasing leisure-time physical activity could potentially save US$ 3 million to US$ 8.9 million in 2040 by reducing the prevalence of insufficient leisure-time physical activity in 2030. CONCLUSION: Our results may be helpful to guide cancer prevention policies and programs in Brazil.

The impact of parents' physical activity goals and parental attitudes on physical activity during leisure time among children in middle childhood.

Introduction: Parents' supportiveness and health-promoting habits significantly affect the intensity of children's physical activity (PA) and the involvement of parents in their engagement in PA; in this domain, both the hours devoted to PA and PA goals can be assessed. The family plays an important role in shaping the physical and social organization of the environment for children aged 4-6 years. Methods: A total of 680 families with 5-year-old children (330 girls, 350 boys) took part in the study. Data were collected from these participants, who were recruited from preschools and primary schools in the Pomeranian region of Poland. The aim of this study was to determine whether the involvement of parents in PA mediates the influence of parental attitudes on the ways in which their children spend their leisure time. Results: The results showed that not all parental attitudes had direct impact on children's leisure time in PA and outside PA. Other aspects parental attitude had no significant impact on offspring's free time. Among fathers, only four aspects of parental attitude (namely, acceptance-rejection, inconsistency, autonomy, and overprotectiveness) had an impact on PA goals. Mothers' goals were influenced by the strength of a larger number of aspects of attitude (namely, acceptance-rejection, autonomy, inconsistency, over-demandingness, and overprotectiveness). Similarly, the strength of mothers' and fathers' acceptance-rejection attitudes, attitudes of autonomy, and overprotectiveness had an impact on their PA goals but were not directly linked to their children's leisure-time engagement in PA. Discussion: Not all parental attitudes have a direct impact on children's PA or non-PA leisure time. However, the goals of PA parents have been recognized influence the leisure time of children in PA and outside PA. The most statistically significant relationship for both mothers and fathers was between parental attitudes and PA goals. Parental attitudes do not play a significant role in explaining involvement in PA or lack of it in leisure time among 5-year-old children.

Out-of-pocket costs for families and people living with cerebral palsy in Australia.

The most recent cost estimates of cerebral palsy (CP) in Australia did not include out-of-pocket costs for families. This study aimed to: 1) describe and estimate out-of-pocket costs for people with CP and their families by age and gross motor function classification system (GMFCS) level; 2) measure financial distress. A cross-sectional quantitative survey design was used with qualitative approaches to analyse open-ended questions. A CP-specific out-of-pocket costs survey was co-designed with people with lived experience. Adults with CP and carers were recruited from Australian population-based CP Registers and via social media. Sociodemographic variables were analysed descriptively and median (IQR) expenses for health, assistive technology, personal care, housing, occupation, transport, leisure, respite and holidays, by age (0-6; 7-17; 18 years +) and gross motor function [GMFCS level I-II vs III-V] were calculated. The In Charge Financial Distress/Financial Wellbeing Scale measured financial distress. Regression analyses were conducted to investigate costs and financial distress. Additional out-of-pocket costs itemised in open-ended questions were charted. Comments were thematically analysed using the framework approach. 271 surveys were completed for children 0-6 years (n = 47), children/adolescents 7-17 years (n = 124) and adults (n = 100). 94% of participants had out-of-pocket costs associated with CP, with an overall annual median of $4,460 Australian dollars (IQR $11,955). After controlling for income, private insurance and disability funding, the GMFCS III-V group had costs two times higher than the GMFCS I-II group (2.01; 95% CI 1.15-3.51). Age was not significantly associated with costs. 36% of participants had high to overwhelming financial distress; this was not associated with age or GMFCS level after controlling for financial factors. Families had several additional disability costs. Open-ended responses revealed experiences of financial concern were influenced by funding scheme experiences, reduced income, uncertainty, access to support networks and an inability to afford CP-related costs. Cost estimates and financial distress indicators should inform policy, funding and clinical decisions when planning interventions to support people with CP and their families.

Conceptual foundations of a gender equality index.

Gender equality indexes (GEIs) have become a popular tool for the quantification of unequal resource distribution between males and females. Creating such an index implies an understanding of what gender inequality is, though this question has remained the province of theoretical feminism with little explicit treatment in the methodologically focussed literature. This paper presents an empirically minded, theoretical account of gender inequality, which can be used broadly to inform the development of GEIs. The account proceeds in three steps. First, we argue for a broad understanding of the types of resources that structure gender inequality. Drawing on the work of Bourdieu, we highlight the importance of including symbolic capitals (and indeed viewing gender itself as a symbolic capital). By considering gender as a symbolic capital, we are drawn to the ways that normative maleness hides some types of gender inequality. Thus, caregiving norms and leisure time inequality are brought to the foreground. Finally, in recognizing that there is no single unifying female experience, we describe the ways that gender inequality intersect with other forms of disadvantage, motivating the incorporation of (particularly) race into the index. The result is a comprehensive-and theoretically defensible-set of indicators for the measurement of gender inequality.

I Would Like to Do It Very Much! Leisure Participation Patterns and Determinants of Brazilian Children and Adolescents With Physical Disabilities.

PURPOSE: To describe the patterns, preferences, and predictors of participation in leisure activities of children and young people with physical disabilities from Brazil. METHODS: This is a cross-sectional study that included 50 children/young people with physical disabilities from the southeast of Brazil. The children were assessed using the Children's Assessment of Participation and Enjoyment and Preferences for Activities. RESULTS: Children/young people participated in an average of 38% of the activities, with a greater number and frequency of informal, recreational, social, and self-improvement activities. The average frequency of participation in the activities was twice in the previous 4 months. The enjoyment in the participated activities was high. There was a greater preference for recreational, social, and physical activities. Age and functional classification were predictors of participation. CONCLUSION: This study of children with disabilities from the southeast of Brazil supports studies in other low- and middle-income countries, demonstrating low diversity and intensity of participation in leisure activities, but with high levels of enjoyment.

Physical Activity and Sleep in Adults and Older Adults in Southern Brazil.

Good sleep quality is a well-known indicator of physical and mental health, well-being, and overall vitality. This study aimed to verify the association between the practice of physical activity and sleep duration and quality in adults and older adults in southern Brazil. A cross-sectional population-based study was carried out with 820 individuals of both sexes aged 18 years or more, where sociodemographic variables were collected and also health-related variables. This study included 523 (63.8%) women and 297 (36.2%) men, and the prevalence of adequate sleep hours was 41.5% (95%CI: 39.1; 44.9). People who performed leisure walking were 34% more likely to present adequate sleep duration (PR: 1.34; 95%CI: 1.10; 1.64) compared to those who did not perform leisure walking. Individuals who met the recommendations for moderate or vigorous physical activity were more likely to have good sleep quality (PR: 1.16; 95%CI: 1.01; 1.34). Future health behavior modification strategies to improve sleep quality at the population level should consider encouraging lifestyle improvements, thus increasing the practice of physical activities.

Understanding health inequalities through a practice-oriented 'capabilities' perspective. Motherhood and leisure time physical activity.

In this article, we explore how a capabilities perspective can advance practice theoretic conceptualisations of persistent health inequalities. Specifically, we seek to understand the capabilities necessary for recruitment to leisure time physical activity (LTPA) practices by low SES mothers, a group traditionally excluded from LTPA. Our study illuminates that mothers living a life of social disadvantage face difficulties in becoming recruited to LTPA practices despite, in many cases, the availability of elements required for performance. We identify that temporal, support and energy capabilities are necessary for low SES mothers to become recruitable to LTPA. The dispossession of these capabilities signals inequalities in the constellation of practices that configure this group's lived experiences, in turn giving rise to practice absence and further consolidating patterns of inequality. We offer a framework of practice capabilities and health inequalities to guide future practice-oriented scholarship in the sociology of illness and health, which signals how capabilities may enable or constrain recruitment to health-promoting practices, give rise to inequalities and condition the possibility of practice absence.

Revisiting socio-economic inequalities in sedentary leisure time in Sweden: An intersectional analysis of individual heterogeneity and discriminatory accuracy (AIHDA).

AIMS: Swedish public health reports have repeatedly provided information about socio-economic inequalities in sedentary leisure time, despite that, in the interest of health equity, physical activity should be equally distributed in the population. Such public health reports, however, neither consider the intersection of multiple socio-demographic factors nor the individual heterogeneity around group averages. Drawing on intersectionality theory, this study aimed to revisit previous findings on sedentary leisure time from Swedish public health surveys and demonstrate how the analysis of individual heterogeneity and discriminatory accuracy (AIHDA) can be used for analysing complex health inequalities. METHODS: Using data from Swedish national public health surveys (2004-2015), we applied the AIHDA to define 72 intersectional groups by categories of age, gender, educational achievement, migration status and household composition. We then calculated (a) the absolute and relative risk of sedentary leisure time and (b) the discriminatory accuracy (DA) of the intersectional grouping. RESULTS: The average risk of sedentary leisure time ranged from 5.8% among native-born, highly educated, young women living alone to 41.0% among immigrated young men, living alone, with low education. The risk was higher in strata comprising immigrated people with low education and lower in strata including native-born, highly educated people. However, the DA of the grouping was poor, indicating a substantial overlap of individual risk between groups. CONCLUSIONS: Using the AIHDA and drawing on intersectionality, this study provides an improved mapping of the socio-economic distribution of sedentary leisure time in Sweden, with the poor DA suggesting universal rather than targeted physical activity interventions.

Changes in occupational class differences in leisure-time physical activity and the contribution of retirement.

Occupational class differences in leisure-time physical activity (LTPA) are well recognized. Less is known about how these differences develop as individuals age, and how retirement is associated with this change. We investigated how occupational class differences in LTPA change in a cohort over a 15-17 years follow-up. We further examined, how the transition into mandatory or disability retirement contributed to the change in LTPA levels and occupational class differences. We used the data from the Helsinki Health Study surveying the aging City of Helsinki employees. In all, 8773 individuals were included in the analyses. We evaluated LTPA levels using weekly metabolic equivalent task (MET) hours and used generalized linear mixed effect models (GLMM) to estimate the development of LTPA levels. Commuting was included in the LTPA measure. Occupational class differences in LTPA emerged and widened during the follow-up. The physical activity levels decreased in the lower occupational class and slightly increased in the higher occupational class, resulting in a difference of 4.3 MET-hours at the end of follow-up, accounting for 50 min of brisk walking per week. The occupational class differences emerged during transition into mandatory retirement and persisted after this. Transition into disability retirement temporarily widened the occupational class differences in LTPA levels, but the differences diminished during the follow-up. Research on interventions to counteract the declining LTPA is needed to discover ways to prevent the widening of occupational health disparities during aging. The transition into old-age retirement could be an optimal period for focusing these interventions.

Leisure activities and cognitive impairment in old age: The role of life course socioeconomic status.

In the current literature on cognitive function, life course socioeconomic status (SES) and engaging in leisure activities are often viewed as parallel measures of cognitive reserve that independently affect cognitive impairment in old age. Some studies also suggest that leisure activity mediates the effect of SES on cognitive impairment. What is less examined is the modification effect of SES on the association between engaging in leisure activities and cognitive impairment, especially from a life course perspective. In this study, we focus on the interaction effects of specific measures of SES and leisure activities on cognitive impairment.We use data from the Chinese Longitudinal Healthy Longevity Survey, which includes five waves of interviews with adults aged 65 and older between 2002 and 2014. Cognitive impairment is measured by the Chinese version of the Mini-Mental Status Examination. Childhood and adulthood SES and participation in seven leisure activities are included in this analysis. We adopt a lagged independent variable approach and the Generalized Linear Mixed Model to conduct the analysis.Findings confirm that higher SES in both childhood and adulthood are associated with low levels of cognitive impairment in the older Chinese population. Furthermore, there are significant interaction effects between specific life course SES and leisure activities with a consistent pattern: Those of higher life course SES enjoy extra benefits from engaging in leisure activities.The findings point to a modification mechanism that connects life course SES, leisure activities, and cognitive health inequality among older adults.