Neighbourhood food typologies, fast food outlet visitation and snack food purchasing among adolescents in Melbourne, Australia.

OBJECTIVE: Despite the increased attention on neighbourhood food environments and dietary behaviours, studies focusing on adolescents are limited. This study aims to characterise typologies of food environments surrounding adolescents and their associations with fast food outlet visitation and snack food purchasing to/from school. DESIGN: The number of food outlets (supermarket; green grocers; butcher/seafood/deli; bakeries; convenience stores; fast food/takeaways; café and restaurants) within a 1 km buffer from home was determined using a Geographic Information System. Adolescents' self-reported frequency of fast food outlet visitation and snack food purchasing to/from school. Latent Profile Analysis was conducted to identify typologies of the food environment. Cross-sectional multilevel logistic regression analyses were conducted to examine the relationships between food typologies, fast food outlet visitations and snack food purchasing to/from school. SETTING: Melbourne, Australia. PARTICIPANTS: Totally, 410 adolescents (mean age= 15·5 (sd = 1·5) years). RESULTS: Four distinct typologies of food outlets were identified: (1) limited variety/low number; (2) some variety/low number; (3) high variety/medium number and (4) high variety/high number. Adolescents living in Typologies 1 and 2 had three times higher odds of visiting fast food outlets ≥1 per week (Typology 1: OR = 3·71, 95 % CI 1·23, 11·19; Typology 2: OR = 3·65, 95 % CI 1·21, 10·99) than those living in Typology 4. No evidence of association was found between typologies of the food environments and snack food purchasing behaviour to/from school among adolescents. CONCLUSION: Local government could emphasise an overall balance of food outlets when designing neighbourhoods to reduce propensity for fast food outlet visitation among adolescents.

What do adults want in parks? A qualitative study using walk-along interviews.

BACKGROUND: Parks provide opportunities for physical activity and social interaction and are critical for enhancing public health. It is therefore important to better understand the needs and preferences of park features among adults to help park designers to create parks that optimise use. This qualitative study provided an in-depth examination of factors and characteristics that influence visitation, park-based physical activity, and social interaction among adults (19-64 years). We also explored perceptions of parks and park use and impacts of COVID on park usage and needs. METHODS: Participants (n = 27, 40.4 years [+ 11.9], 70% female) were interviewed from 2017 to 2020 while walking through one of eight diverse parks located in varying socioeconomic areas of metropolitan Melbourne, Australia. Participants were prompted to discuss their experiences, opinions and preferences regarding park features. All interviews were transcribed verbatim and analysed using NVivo 12 software. RESULTS: Park features and characteristics highly valued for visitation related to aesthetics and atmosphere, including trees, gardens, spaciousness, and water features. Features most valued for physical activity included walking and bike tracks, basketball rings, nice aesthetics, and sports walls. Features most valued for social interaction included seating and tables, and picnic/barbecue areas. CONCLUSIONS: This study highlights features and characteristics that may be important to prioritise, to encourage active and social park visits among adults. This evidence will help policy and decision makers, urban planners, landscape architects, and local, state, and national government organisations to create parks that support adults to lead healthy and active lives. Future research should examine the relative importance of the features identified in this study to inform future park design/redesign.

From motorised to active travel: using GPS data to explore potential physical activity gains among adolescents.

BACKGROUND: A high proportion of adolescents worldwide are not doing enough physical activity for health benefits. Replacing short motorised trips with walking or cycling has the potential to increase physical activity at the population level. This study aimed to estimate the proportion of short distance motorised trips that could be replaced with walking or cycling, and the potential physical activity gains by sociodemographic and trip characteristics. METHODS: Data were from a subsample of the NEighbourhood Activity in Youth (NEArbY) study conducted among adolescents in Melbourne. A total of 217 adolescents with at least one motorised trip completed a survey and wore a Global Positioning Systems (GPS) device for eight consecutive days. Classification of travel modes were based on speed. GPS data points were geocoded in ArcGIS. Motorised trips within walkable (1.3 km) and cyclable (4.2 km) distances were identified (threshold based on 80th percentile of walking and cycling trip distances among Victorian adolescents), and the additional physical activity minutes that could be accrued by replacing walkable or cyclable motorised trip to active trips were quantified. Multilevel linear regression was used to assess differences in physical activity minutes gain by sociodemographic and trip characteristics. RESULTS: A total of 4,116 motorised trips were made. Of these, 17% were walkable and 61% were cyclable. Replacing motorised trips by walking and cycling resulted in estimated gains of six minutes and 15 min of physical activity per day, respectively. CONCLUSION: The sizable proportion of replaceable trips and potential physical activity gains from this shift calls for attention to improve safe and connected infrastructure to support active travel.

Outdoor public recreation spaces and social connectedness among adolescents.

BACKGROUND: Outdoor public recreation spaces are important settings for leisure and physical activity. Adolescents' use of these spaces may contribute to social connectedness via social interaction with peers and the community in these settings. However, research on this topic is limited. This exploratory study examined associations of frequency of visitation and physical activity in outdoor public recreation spaces with social connectedness among adolescents in Melbourne, Australia. METHODS: Adolescents self-reported their frequency of visitation to parks, trails, beach/lake, and sports facilities; frequency of physical activity in a park, local street or path, and their street; and social connectedness. Separate analyses were conducted for visitation (n = 349, 15.4 ± 1.6 years, 58% female) and physical activity (n = 441, 15.4 ± 1.6 years, 59% female) using multilevel linear regression models. RESULTS: No significant associations were observed for frequency of visitation to a park (B = 0.86, 95% CI = - 0.26, 1.99), trails (B = 0.41, 95% CI = - 0.61, 1.44), beach/lake (B = - 0.44, 95% CI = - 1.46, 0.57), or sports facilities (B = 0.64, 95% CI = - 0.43, 1.70), nor for frequency of physical activity in their street (B = - 0.07, 95% CI = - 0.46, 0.31), local street/path (B = - 0.05, 95% CI = - 0.43, 0.33) or in a park (B = 0.23, 95% CI = - 0.14, 0.60) with adolescents' social connectedness. CONCLUSIONS: The findings did not support the hypothesis that visiting and being active in outdoor public recreation spaces are associated with adolescents' social connectedness. Future research should consider the duration and context of outdoor public recreation space use (e.g., sports, socialising, relaxing alone) and whether different types and/or a combination of public spaces are more/less conducive to social connectedness.

"Everything kind of revolves around technology": a qualitative exploration of families' screen use experiences, and intervention suggestions.

BACKGROUND: Managing children's screen time is challenging for most families. Interventions have had limited success in reducing screen time, potentially due to a lack of understanding of the experiences, needs and recommendations of families. This study aimed to 1) understand the screen time experiences of families, particularly during COVID-19 lockdowns; and 2) explore parent and child suggestions for the design, components, and content of a screen time management program. METHODS: Parents and children from 30 families living in Victoria, Australia completed a semi-structured interview (63 interviews) via Zoom in October-November 2021. Parents were maged 40.8 (± 8.9) years and predominantly female (90%). Children were maged 11.4 (± 2.4) years and 47% female. The interviews were audio recorded, transcribed verbatim and analysed using inductive thematic analysis combined with a summative content analysis approach. RESULTS: Three themes under Aim 1 emerged. Theme 1) 'Screen time management experiences and practices', including rules and strategies, challenges, and the impact of COVID-19 lockdowns. Theme 2) 'Impact of screens on family interaction and communication' including conflicts within the family, reduced face-to-face interactions, and negative impact on child's behaviour and wellbeing. Theme 3) 'Benefits of increased screen time due to COVID-19 lockdowns' including continuation of social interactions, extracurricular activities, improved technology skills and using screens as a 'babysitter'. Findings from Aim 2 suggest that families want a screen time management program delivered online to parents and children, which includes static and interactive content that incorporates health information, alternative activities, cyber-safety information, tips for goal setting and rewards, screen monitoring tools, links to reputable information, and parent social connections. Reminders via text message or through the online platform would help maintain engagement in the program. CONCLUSIONS: Families are experiencing challenges in managing the complex balance between the increased need for screens and the impact it has on the family. These findings provide valuable parent and child insights to assist in developing screen time management programs that are created with an understanding of the needs and challenges of families.

Socioecological correlates associated with muscle-strengthening exercise at home during COVID-19 among adolescents: The our life at home study.

This study examined adolescent muscle-strengthening exercise (MSE) participation at home and associated socioecological correlates during Australia's initial COVID-19 lockdown restrictions. Adolescents (N = 731, Mage = 16.3, SD = 1.2 years, 73% female) self-reported their MSE participation in February 2020 (pre-lockdown; at a gym or at home) and April/May (during lockdown; at home only as gyms were closed). They also reported a range of potential individual, family, and home environment correlates. Remoteness and area-level socioeconomic disadvantage were also considered. Logistic regression models examined potential correlates of participation in any MSE and MSE engagement ≥3 times/week during April/May. Fewer adolescents participated in MSE during April/May (48%) than February (54%), however, the proportions that engaged in MSE ≥3 times/week were the same (30%). Prioritising being active every day (OR = 2.43, 95% CI = 1.52, 3.90), being active with sibling/s ≥ 5 days/week (OR = 2.24, 95% CI = 1.00, 5.00) and access to weights at home (OR = 2.98, 95% CI = 1.94, 4.57) were associated with higher odds of any MSE participation at home during April/May. These variables were also positively associated with MSE participation at home ≥3 times/week. Understanding how to support adolescents to prioritise being active, engage in MSE with siblings, and provide equipment may assist adolescents to engage in home-based MSE.

Understanding children's preference for park features that encourage physical activity: an adaptive choice based conjoint analysis.

BACKGROUND: Parks are a key setting for physical activity for children. However, little is known about which park features children prefer and which features are most likely to encourage them to be active in parks. This study examined the relative importance of park features among children for influencing their choice of park for engaging in park-based physical activity. METHODS: Children (n = 252; 8-12 years, 42% male) attending three primary schools in Melbourne, Australia completed a survey at school. They were required to complete a series of Adaptive Choice-Based Conjoint analysis tasks, with responses used to identify the part-worth utilities and relative importance scores of selected park features using Hierarchical Bayes analyses within Sawtooth Software. RESULTS: For the overall sample and both boys and girls, the most important driver of choice for a park that would encourage them to be active was presence of a flying fox (overall conjoint analysis relative importance score: 15.8%; 95%CI = 14.5, 17.1), followed by a playground (13.5%; 95%CI = 11.9, 15.2). For the overall sample, trees for climbing had the third highest importance score (10.2%; 95%CI = 8.9, 11.6); however, swings had 3rd highest importance for girls (11.1, 95%CI = 9.3, 12.9) and an obstacle course/parkour area had the 3rd highest importance score for boys (10.7, 95%CI = 9.0, 12.4). For features with two levels, part-worth utility scores showed that the presence of a feature was always preferred over the absence of a feature. For features with multiple levels, long flying foxes, large adventure playgrounds, lots of trees for climbing, large round swings, large climbing equipment, and large grassy open space were the preferred levels. CONCLUSION: To ensure parks appeal as a setting that encourages children to engage in physical activity, park planners and local authorities and organisations involved in park design should prioritise the inclusion of a long flying fox, large adventure playgrounds, lots of trees for climbing, large round swings and obstacle courses/parkour areas.

Reliability of streetscape audits comparing on-street and online observations: MAPS-Global in 5 countries.

BACKGROUND: Microscale environmental features are usually evaluated using direct on-street observations. This study assessed inter-rater reliability of the Microscale Audit of Pedestrian Streetscapes, Global version (MAPS-Global), in an international context, comparing on-street with more efficient online observation methods in five countries with varying levels of walkability. METHODS: Data were collected along likely walking routes of study participants, from residential starting points toward commercial clusters in Melbourne (Australia), Ghent (Belgium), Curitiba (Brazil), Hong Kong (China), and Valencia (Spain). In-person on the street and online using Google Street View audits were carried out by two independent trained raters in each city. The final sample included 349 routes, 1228 street segments, 799 crossings, and 16 cul-de-sacs. Inter-rater reliability analyses were performed using Kappa statistics or Intraclass Correlation Coefficients (ICC). RESULTS: Overall mean assessment times were the same for on-street and online evaluations (22 ± 12 min). Only a few subscales had Kappa or ICC values < 0.70, with aesthetic and social environment variables having the lowest overall reliability values, though still in the "good to excellent" category. Overall scores for each section (route, segment, crossing) showed good to excellent reliability (ICCs: 0.813, 0.929 and 0.885, respectively), and the MAPS-Global grand score had excellent reliability (ICC: 0.861) between the two methods. CONCLUSIONS: MAPS-Global is a feasible and reliable instrument that can be used both on-street and online to analyze microscale environmental characteristics in diverse international urban settings.

Are park availability and satisfaction with neighbourhood parks associated with physical activity and time spent outdoors?

BACKGROUND: There is substantial scope for enhancing population health through increased park visits and active use of parks; however, a better understanding of factors that influence park visitation is needed. This cross-sectional study examined how parent-reported satisfaction and perceived availability of parks were associated with adults' physical activity and children's physical activity and time spent outdoors, and whether these associations were mediated by park visitation. METHODS: Self-reported surveys were completed by adults living within 5 km of two parks located in Melbourne, Australia. Participants reported their satisfaction with neighbourhood park quality, walking duration from home to the nearest park, and park visitation in the past 7 days. Participants with a child aged 2-15 years also answered similar questions in relation to their child. The primary outcome variable for adults was leisure-time physical activity (LTPA) and for children was proxy-reported time spent outside. The secondary outcome for adults was combined transportation and LTPA and for children (5-15 years) was the number of days physical activity recommendations were met in the past 7 days. RESULTS: Significant positive associations between park availability and park visitation in the past 7 days, and between park visitation and the outcome variables were observed among both adults (n = 1085, Mage = 48.9, SD 13.4) and children (n = 753, Mage = 8.8, SD = 3.7). The association between park satisfaction and park visitation was only significant among adults. Park visitation mediated associations between park availability and park satisfaction and the outcome variables among both adults and children. CONCLUSIONS: Improving park availability and users' satisfaction with parks may increase visitation and consequently increase physical activity and time spent outdoors.

The Use of Digital Platforms for Adults' and Adolescents' Physical Activity During the COVID-19 Pandemic (Our Life at Home): Survey Study.

BACKGROUND: Government responses to managing the COVID-19 pandemic may have impacted the way individuals were able to engage in physical activity. Digital platforms are a promising way to support physical activity levels and may have provided an alternative for people to maintain their activity while at home. OBJECTIVE: This study aimed to examine associations between the use of digital platforms and adherence to the physical activity guidelines among Australian adults and adolescents during the COVID-19 stay-at-home restrictions in April and May 2020. METHODS: A national online survey was distributed in May 2020. Participants included 1188 adults (mean age 37.4 years, SD 15.1; 980/1188, 82.5% female) and 963 adolescents (mean age 16.2 years, SD 1.2; 685/963, 71.1% female). Participants reported demographic characteristics, use of digital platforms for physical activity over the previous month, and adherence to moderate- to vigorous-intensity physical activity (MVPA) and muscle-strengthening exercise (MSE) guidelines. Multilevel logistic regression models examined differences in guideline adherence between those who used digital platforms (ie, users) to support their physical activity compared to those who did not (ie, nonusers). RESULTS: Digital platforms include streaming services for exercise (eg, YouTube, Instagram, and Facebook); subscriber fitness programs, via an app or online (eg, Centr and MyFitnessPal); facilitated online live or recorded classes, via platforms such as Zoom (eg, dance, sport training, and fitness class); sport- or activity-specific apps designed by sporting organizations for participants to keep up their skills (eg, TeamBuildr); active electronic games (eg, Xbox Kinect); and/or online or digital training or racing platforms (eg, Zwift, FullGaz, and Rouvy). Overall, 39.5% (469/1188) of adults and 26.5% (255/963) of adolescents reported using digital platforms for physical activity. Among adults, MVPA (odds ratio [OR] 2.0, 95% CI 1.5-2.7), MSE (OR 3.3, 95% CI 2.5-4.5), and combined (OR 2.7, 95% CI 2.0-3.8) guideline adherence were higher among digital platform users relative to nonusers. Adolescents' MVPA (OR 2.4, 95% CI 1.3-4.3), MSE (OR 3.1, 95% CI 2.1-4.4), and combined (OR 4.3, 95% CI 2.1-9.0) guideline adherence were also higher among users of digital platforms relative to nonusers. CONCLUSIONS: Digital platform users were more likely than nonusers to meet MVPA and MSE guidelines during the COVID-19 stay-at-home restrictions in April and May 2020. Digital platforms may play a critical role in helping to support physical activity engagement when access to facilities or opportunities for physical activity outside the home are restricted.

Increasing translation of research evidence for optimal park design: a qualitative study with stakeholders.

BACKGROUND: The design of parks is critical to ensure they are appealing, meet the needs of the community and optimise opportunities for physical activity, relaxation, exposure to nature and social interaction. There is currently a lack of understanding on how research evidence is informing park design and how to reduce the many challenges associated with research-practice-policy translation. Understanding how organisations use evidence for decision-making regarding park design is critical for reducing the research-practice-policy gap and ensuring evidence based strategies inform park design to support healthy active living. This study explored stakeholder perceptions regarding factors that influence the use of research evidence to inform park planning and design, and potential strategies to enhance effective translation of research evidence for optimal park design into policy and practice. METHODS: One-on-one in-depth interviews were conducted with 23 stakeholders within the park design, planning and management sector. Participants shared experiences regarding: influences on park development and design; current park development policies; ways to facilitate use of evidence; and priorities for future research. Interviews were recorded and transcribed verbatim and content analysis performed using NVivo 12. RESULTS: Research evidence is used and considered important for park planning; however, several barriers were highlighted: time and cost constraints; difficulties accessing research; and limited research relevant to specific needs. Developing partnerships between researchers and park developers and providing evidence in a more accessible format such as short summaries/reports, infographics, presentations, research updates and dedicated research databases emerged as key enablers. The main research gaps identified included research into park features to encourage visitation and cost-benefit analyses studies. CONCLUSIONS: This research is a first step to better understand strategies to promote more effective uptake and use of evidence to inform park planning. Researchers must develop multi-sectoral collaborations and generate policy-relevant research in a readily accessible, timely and user-friendly format to ensure evidence is used to enhance park design and ultimately public health.

Changes in and the mediating role of physical activity in relation to active school transport, fitness and adiposity among Spanish youth: the UP&DOWN longitudinal study.

BACKGROUND: Longitudinal changes in child and adolescent active school transport (AST), and the mediating role of different intensities of daily physical activity (PA) levels in relation to AST and physical fitness and adiposity indicators is unclear. This study aimed to: 1) describe longitudinal changes in AST, light PA (LPA), moderate- to vigorous-intensity PA (MVPA), physical fitness and adiposity indicators over three time-points; and 2) investigate the mediating role of LPA and MVPA levels on associations between AST and physical fitness and adiposity indicators over three time-points among children and adolescents. METHODS: This longitudinal study comprised 1646 Spanish children and adolescents (48.8% girls, mean age 12.5 years ±2.5) at baseline, recruited from schools in Cádiz and Madrid. Mode of commuting to school was self-reported at baseline (T0, 2011-12), 1-year (T1) and 2-year follow-up (T2). PA was assessed using accelerometers. Handgrip strength, standing long jump and cardiorespiratory fitness (CRF) assessed physical fitness. Height, weight, body mass index, waist circumference, and triceps and subscapular skinfold thickness were measured. Multilevel linear regression analyses assessed changes in AST, PA levels, physical fitness and adiposity indicators over three time-points (T0-T1-T2). Additionally, longitudinal path analysis (n = 453; mean age [years] 12.6 ± 2.4) was used to test the mediating effects of LPA and MVPA levels on the association between AST and physical fitness and adiposity indicators. RESULTS: Multilevel analyses observed decreases in LPA between T0-T1 (ß = - 11.27; p < 0.001) and T0-T2 (ß = - 16.27; p < 0.001) and decreases in MVPA between T0-T2 (ß = - 4.51; p = 0.011). Moreover, changes over time showed increases in handgrip between T0-T1 (ß = 0.78; p = 0.028) and T0-T2 (ß = 0.81; p = 0.046). Path analyses showed that AST was directly positively associated with MVPA at T1 (all, ß ≈ 0.33; p < 0.001). MVPA at T1 mediated associations between AST and CRF at T2 (ß = 0.20; p = 0.040), but not the other outcomes. LPA did not mediate any associations. CONCLUSIONS: Results from longitudinal path analysis suggest that participation in more AST may help attenuate declines in MVPA that typically occur with age and improve CRF. Therefore, we encourage health authorities to promote AST, as a way to increase MVPA levels and CRF among youth.

Home-based screen time behaviors amongst youth and their parents: familial typologies and their modifiable correlates.

BACKGROUND: Excessive screen time behaviors performed by children and parents at home is a major public health concern. Identifying whether child and parent screen time behaviors cluster and understanding correlates of these familial clusters can help inform interventions for the whole family. This study characterized familial typologies of screen time behaviors and identified key modifiable correlates of these typologies. METHODS: Parents participating in the cross-sectional Sitting in the Home (SIT) study reported the duration (mins/day) they and their child (aged 11.2 ± 2.62 years) spent in six screen time behaviors at home (computer/laptop for home/work, computer/laptop for leisure, TV/videos/DVDs, tablet/smart phone for home/work, tablet/smart phone for leisure, and electronic games) and completed items related to 21 potential correlates framed by an adapted Social Cognitive Theory, Family Perspective. Latent Class Analysis was used to identify typologies based on parent and child data for the six behaviors. Multinomial logistic regression analysis assessed the relative risk of typology membership for each potential correlate, adjusting for child and parent age and sex. RESULTS: The sample comprised 542 parent-child dyads (parents: 40.7 ± 6.3 yrs., 94% female; children: 11.2 ± 2.6 yrs., 46% female). Three typologies were identified: 1) high computer/moderate TV (n = 197); 2) high TV/tablet/smartphone, low computer (n = 135); and 3) low-screen users (n = 210). 'Low-screen users' spent the least amount of time in all screen time behaviors (assigned as reference category). Greater child preference for screen time behaviors, parental support for screen time behaviors and frequency of homework requiring a tablet/laptop were associated with higher odds of being in the 'high computer/moderate TV' typology. The odds of being in the 'high TV/tablet/smartphone, low computer' typology were greater amongst children with a higher preference for screen time behaviors, and lower among more active parents. CONCLUSIONS: Three familial typologies of screen time behaviors were identified. The findings highlight that screen time in the home can be influenced by the home environment, parental behaviours and role modelling, child preferences as well as school policies. Findings can inform the development of family screen time interventions, however more research exploring the influence of factors outside of the home is warranted.

Is greenery associated with mental health among residents of aged care facilities? A systematic search and narrative review.

Objectives: Older adults living in residential aged care facilities (RACFs) may be vulnerable to mental health issues. Evidence suggests greenery is beneficial for adults' mental health in community settings. This review aims to summarise evidence of associations between greenery in RACFs and residents' mental health.Method: Six databases were searched with three sets of terms related to: (1) exposure (e.g. garden, green); (2) outcome (e.g. mental health, well-being); and (3) setting (e.g. aged care, nursing home). The inclusion criteria were peer-reviewed journal articles published in English up to 2017, reporting quantitative/qualitative associations between greenery and mental health in RACFs.Results: Of the nine articles identified, seven reported positive associations between greenery (in particular, garden use) at RACFs and some aspect of residents' mental well-being (e.g. quality of life); however, four out of seven studies used observations and perceptions of staff and relatives. One study examined depression and reported reduction in depression following garden use, while one examined physiological indicators of stress (blood pressure, heart rate) and found no association with garden use. Seven studies examined garden use and four examined the presence of greenery (two examined both exposures).Conclusion: Exposure to greenery and use of greenspace in RACFs show promise for promoting mental health. However, the findings relied mainly on non-validated measures of mental health. More robust evidence based on valid and reliable mental health measures is needed. Future studies also need to examine the effect of visual exposure to greenery and the effect of greenery on stress reduction.

The impact of a park refurbishment in a low socioeconomic area on physical activity: a cost-effectiveness study.

BACKGROUND: Physical inactivity is the fourth highest cause of death globally and is a major contributor to increases in healthcare expenditure. Improving public open spaces such as parks in areas of low socio-economic position (SEP) may increase recreational physical activity in disadvantaged populations. We assessed the cost-effectiveness of the installation of a play-space in a large metropolitan park in a low socioeconomic area based on changes in physical activity. METHODS: Observational data of visitor counts and activities undertaken in the park before the installation of the new play-scape (T1), at two months (T2) and 14 months post-installation (T3) were obtained for the intervention and a control park (with no refurbishment) located in a high SEP metropolitan area. Observed sitting, standing, and moderate and vigorous-intensity physical activity were converted to yearly MET-h according to age. Costs of the play-scape and ongoing maintenance were obtained from the organisation managing the refurbishment. The incremental cost-effectiveness ratio (ICER) (ratio of incremental cost to incremental effect) was calculated based on the incremental increase in MET-h from T1 to T3 assuming a 20-year lifetime of the play-scape. Observation counts combining moderate and vigorous activity were used in the sensitivity analysis. RESULTS: When compared with T1, at T3 the new play-scape resulted in an overall incremental net gain of 114,114 MET-h (95% UI: 80,476 - 146,096) compared with the control park and an incremental cost effectiveness ratio (or cost per MET-h gained per park visitor) of AUD $0.58 (95% UI: $0.44-$0.80). The sensitivity analysis combining moderate and vigorous activity into one category showed an increase in estimated incremental MET-h of 118,190 (95% CI: 83,528 - 149,583) and a lower incremental cost per MET-h gained of AUD $0.56 (95% UI: $0.43-$0.77). CONCLUSIONS: Using a benchmark of cost-effectiveness for physical activity interventions of AUD $0.60-$1.30, this study suggests that the installation of a play-scape located in a low SEP area is cost-effective based on its potential to facilitate increases in MET-h. It provides much needed preliminary evidence and requires replication elsewhere.

Built environment and physical activity among adolescents: the moderating effects of neighborhood safety and social support.

BACKGROUND: Increasing emphasis has been placed on improving physical activity levels through multilevel interventions. This study aims to examine moderating effects of neighborhood safety (crime and traffic) and social support (from parent and sibling/peer) for physical activity in the relationship between the built environment and moderate-to-vigorous physical activity (MVPA) outside school hours among adolescents in Melbourne. METHODS: Data were from the NEighbourhood Activity in Youth study conducted among adolescents in Melbourne, Australia (n = 358, 15.3 (SD = 1.5) years). MVPA outside school hours was assessed by accelerometer. Built environment features within 1 km and 2 km residential buffers including recreation facilities, park area, and walkability and its components were assessed using Geographic Information Systems. Neighborhood safety, social support for physical activity and sociodemographic information were self-reported by adolescents. Multilevel linear regression models were used to estimate associations. RESULTS: Support for physical activity from sibling/peer positively moderated the relationship between recreation facilities (1 km), residential density (2 km) and MVPA. Recreation facility (count within 2 km), walkability (1 km and 2 km) and residential density (1 km) had significant positive associations with MVPA outside school hours. CONCLUSION: The built environment appeared to have stronger facilitating effects on MVPA among adolescents who had favourable support for physical activity from their sibling or peer. Multilevel interventions that target the built environment and social factors are needed to promote MVPA outside school hours among adolescents.

Development and validation of the neighborhood environment walkability scale for youth across six continents.

BACKGROUND: The IPEN International Physical Activity and Environment Network Adolescent project was conducted using common study protocols to document the strength, shape, and generalizability of associations of perceived neighborhood environment attributes with adolescents' physical activity and overweight/obesity using data from 15 countries. Countries did not use identical versions of the Neighborhood Environment Walkability Scale for Youth (NEWS-Y) to measure perceived neighborhood environment attributes. Therefore, this study derived a measurement model for NEWS-Y items common to all IPEN Adolescent countries and developed a scoring protocol for the IPEN Adolescent version of the NEWS-Y (NEWS-Y-IPEN) that maximizes between-country comparability of responses. Additionally, this study examined between- and within-country variability, and construct validity of the NEWS-Y-IPEN subscales in relation to neighborhood-level socio-economic status and walkability. METHODS: Adolescents and one of their parents (N = 5714 dyads) were recruited from neighborhoods varying in walkability and socio-economic status. To measure perceived neighborhood environment, 14 countries administered the NEWS-Y to parents and one country to adolescents. Confirmatory factor analysis was used to derive comparable country-specific measurement models of the NEWS-Y-IPEN. Country-specific standard deviations quantified within-country variability in the NEWS-Y-IPEN subscales, while linear mixed models determined the percentage of subscale variance due to between-country differences. To examine the construct validity of NEWS-Y-IPEN subscales, we estimated their associations with the categorical measures of area-level walkability and socio-economic status. RESULTS: Final country-specific measurement models of the factor-analyzable NEWS-Y-IPEN items provided acceptable levels of fit to the data and shared the same factorial structure with five latent factors (Accessibility and walking facilities; Traffic safety; Pedestrian infrastructure and safety; Safety from crime; and Aesthetics). All subscales showed sufficient levels of within-country variability. Residential density had the highest level of between-country variability. Associations between NEWS-Y-IPEN subscales and area-level walkability and socio-economic status provided strong evidence of construct validity. CONCLUSIONS: A robust measurement model and common scoring protocol of NEWS-Y for the IPEN Adolescent project (NEWS-Y-IPEN) were derived. The NEWS-Y-IPEN possesses good factorial and construct validity, and is able to capture between-country variability in perceived neighborhood environments. Future studies employing NEWS-Y-IPEN should use the proposed scoring protocol to facilitate cross-study comparisons and interpretation of findings.

Ecological correlates of activity-related behavior typologies among adolescents.

BACKGROUND: Adolescents engage in various combinations (typologies) of physical activity and sedentary behaviors, which impact their health and wellbeing in different ways. As such, there is a need to understand the factors that may inhibit or facilitate engagement in combinations of activity-related behaviors to help inform effective intervention strategies targeting those most in need. The aim of this study was to identify ecological correlates of adolescent physical activity and sedentary behavior typologies. METHODS: Cross-sectional study of 473 adolescents (15.0 ± 1.6 years, 41.4% boys) from 18 secondary schools in Melbourne, Australia. Intrapersonal, interpersonal and neighborhood-physical environmental factors were assessed via self-report surveys and Geographic Information Systems. Multinomial logistic regression models determined the relative risk ratio of membership of three homogenous activity-related behavior typologies based on the potential correlates. RESULTS: Higher levels of self-efficacy for physical activity, parental screen-time restriction rules, parental support for physical activity, sibling screen-time co-participation and perceptions of neighborhood pedestrian/traffic safety were associated with greater likelihood of adolescents being in the typology defined as highly active and low sedentary compared to the physically inactive, highly sedentary typology. Higher frequency of co-participation in screen-time with friends was associated with greater likelihood of adolescents being in the typology defined as moderately active, high screen-time compared to physically inactive, highly sedentary. CONCLUSIONS: A range of intrapersonal, interpersonal and environmental correlates appear to play a role in adolescent activity-related typology membership. The findings may inform public health interventions targeting unique adolescent subgroups most at risk of poor health outcomes based on their engagement in combinations of activity-related behaviors.

The REVAMP natural experiment study: the impact of a play-scape installation on park visitation and park-based physical activity.

BACKGROUND: Designing parks that optimise visitation and support visitors to be active is important for public health. Yet there is very little evidence about whether playground refurbishment achieves these objectives. This study examined the impact of the installation of a play-scape in a large metropolitan park in Melbourne, Australia. METHODS: Natural experiment study (intervention vs control). At both parks, park visitation and physical activity were assessed before (T1, 2013) and after the intervention at 12 (T2, 2014) and 24 months (T3, 2015). At each time point, measures included: observations of park visitors using the System for Observing Play and Recreation in Communities on four weekdays and four weekend days, objective monitors to record usage of the walking paths and the number of cars entering the park; and intercept surveys with adult park visitors. Cross-sectional surveys were conducted with local residents at T1 and T3. RESULTS: The observational data showed a 176% increase in park visitor counts from T1 to T2 (Incidence Rate Ratio (IRR) = 2.76, 95% CI = 1.04-7.33), at the intervention park relative to the control park. The intervention park had a 119% increase in counts of visitors observed engaging in MVPA from T1 to T2 (IRR = 2.19, 95% CI = 1.14-4.20), and a 128% increase from T1 to T3 (IRR = 2.28, 95% CI = 1.19-4.38), relative to the control park. The relative increases in visitation  at the intervention park play-scape compared with the control park playground were highly statistically significant from both T1 to T2 (IRR = 18.12, 95% CI = 5.51-59.59) and T1 to T3 (IRR = 15.05, 95% CI = 4.61-49.16). Similarly, there was a significant interaction between time and park with regard to the number of visitors observed engaging in MVPA in the play-scape/playground areas. The intercept survey data showed an increased odds of children's regular visitation to the intervention park at T2 (OR = 2.67, 95% CI = 1.08, 6.64), compared with T1, relative to the control park. The remaining results from the intercept survey, objective monitors and resident surveys showed no significant differences in visitation between the two parks. CONCLUSIONS: These findings confirm that a well-designed play-scape installation has the potential to increase park visitation and encourage visitors to be physically active. TRIAL REGISTRATION: Current controlled trial ISRCTN50745547 .

Development and reliability of a streetscape observation instrument for international use: MAPS-global.

BACKGROUND: Relationships between several built environment factors and physical activity and walking behavior are well established, but internationally-comparable built environment measures are lacking. The Microscale Audit of Pedestrian Streetscapes (MAPS)-Global is an observational measure of detailed streetscape features relevant to physical activity that was developed for international use. This study examined the inter-observer reliability of the instrument in five countries. METHODS: MAPS-Global was developed by compiling concepts and items from eight environmental measures relevant to walking and bicycling. Inter-rater reliability data were collected in neighborhoods selected to vary on geographic information system (GIS)-derived macro-level walkability in five countries (Australia, Belgium, Brazil, Hong Kong-China, and Spain). MAPS-Global assessments (n = 325) were completed in person along a ≥ 0.25 mile route from a residence toward a non-residential destination, and a commercial block was also rated for each residence (n = 82). Two raters in each country rated each route independently. A tiered scoring system was created that summarized items at multiple levels of aggregation, and positive and negative valence scores were created based on the expected effect on physical activity. The intraclass correlation coefficient (ICC) was computed for scales and selected items using one-way random models. RESULTS: Overall, 86.6% of individual items and single item indicators showed excellent agreement (ICC ≥ 0.75), and 13.4% showed good agreement (ICC = 0.60-0.74). All subscales and overall summary scores showed excellent agreement. Six of 123 items were too rare to compute the ICC. The median ICC for items and scales was 0.92 with a range of 0.50-1.0. Aesthetics and social characteristics showed lower ICCs than other sub-scales, but reliabilities were still in the excellent range (ICC ≥ 0.75). CONCLUSION: Evaluation of inter-observer reliability of MAPS-Global across five countries indicated all items and scales had "good" or "excellent" reliability. The results demonstrate that trained observers from multiple countries were able to reliably conduct observations of both residential and commercial areas with the new MAPS-Global instrument. Next steps are to evaluate construct validity in relation to physical activity in multiple countries and gain experience with using MAPS-Global for research and practice applications.