Patterns of neighborhood environment attributes related to physical activity across 11 countries: a latent class analysis.

BACKGROUND: Neighborhood environment studies of physical activity (PA) have been mainly single-country focused. The International Prevalence Study (IPS) presented a rare opportunity to examine neighborhood features across countries. The purpose of this analysis was to: 1) detect international neighborhood typologies based on participants' response patterns to an environment survey and 2) to estimate associations between neighborhood environment patterns and PA. METHODS: A Latent Class Analysis (LCA) was conducted on pooled IPS adults (N=11,541) aged 18 to 64 years old (mean=37.5±12.8 yrs; 55.6% women) from 11 countries including Belgium, Brazil, Canada, Colombia, Hong Kong, Japan, Lithuania, New Zealand, Norway, Sweden, and the U.S. This subset used the Physical Activity Neighborhood Environment Survey (PANES) that briefly assessed 7 attributes within 10-15 minutes walk of participants' residences, including residential density, access to shops/services, recreational facilities, public transit facilities, presence of sidewalks and bike paths, and personal safety. LCA derived meaningful subgroups from participants' response patterns to PANES items, and participants were assigned to neighborhood types. The validated short-form International Physical Activity Questionnaire (IPAQ) measured likelihood of meeting the 150 minutes/week PA guideline. To validate derived classes, meeting the guideline either by walking or total PA was regressed on neighborhood types using a weighted generalized linear regression model, adjusting for gender, age and country. RESULTS: A 5-subgroup solution fitted the dataset and was interpretable. Neighborhood types were labeled, "Overall Activity Supportive (52% of sample)", "High Walkable and Unsafe with Few Recreation Facilities (16%)", "Safe with Active Transport Facilities (12%)", "Transit and Shops Dense with Few Amenities (15%)", and "Safe but Activity Unsupportive (5%)". Country representation differed by type (e.g., U.S. disproportionally represented "Safe but Activity Unsupportive"). Compared to the Safe but Activity Unsupportive, two types showed greater odds of meeting PA guideline for walking outcome (High Walkable and Unsafe with Few Recreation Facilities, OR=2.26 (95% CI 1.18-4.31); Overall Activity Supportive, OR=1.90 (95% CI 1.13-3.21). Significant but smaller odds ratios were also found for total PA. CONCLUSIONS: Meaningful neighborhood patterns generalized across countries and explained practical differences in PA. These observational results support WHO/UN recommendations for programs and policies targeted to improve features of the neighborhood environment for PA.

Perceived neighborhood environment and physical activity in 11 countries: do associations differ by country?

BACKGROUND: Increasing empirical evidence supports associations between neighborhood environments and physical activity. However, since most studies were conducted in a single country, particularly western countries, the generalizability of associations in an international setting is not well understood. The current study examined whether associations between perceived attributes of neighborhood environments and physical activity differed by country. METHODS: Population representative samples from 11 countries on five continents were surveyed using comparable methodologies and measurement instruments. Neighborhood environment × country interactions were tested in logistic regression models with meeting physical activity recommendations as the outcome, adjusted for demographic characteristics. Country-specific associations were reported. RESULTS: Significant neighborhood environment attribute × country interactions implied some differences across countries in the association of each neighborhood attribute with meeting physical activity recommendations. Across the 11 countries, land-use mix and sidewalks had the most consistent associations with physical activity. Access to public transit, bicycle facilities, and low-cost recreation facilities had some associations with physical activity, but with less consistency across countries. There was little evidence supporting the associations of residential density and crime-related safety with physical activity in most countries. CONCLUSION: There is evidence of generalizability for the associations of land use mix, and presence of sidewalks with physical activity. Associations of other neighborhood characteristics with physical activity tended to differ by country. Future studies should include objective measures of neighborhood environments, compare psychometric properties of reports across countries, and use better specified models to further understand the similarities and differences in associations across countries.

Screen-viewing and the home TV environment: the European Youth Heart Study.

OBJECTIVE: Examine if home environmental factors are associated with screen-viewing. METHODS: Data are for 2670, 3rd and 9th grade participants in Denmark, Portugal, Estonia and Norway collected between 1997 and 2000. Outcomes were spending >2 h after-school watching television (TV) and >1 h per day playing computer games. Child Autonomy and the home TV Environment were exposures. RESULTS: Each unit increase in Child Autonomy was associated with 9% increase in risk of watching more than 2 h of TV per day after school and a 19% increase in risk of spending more than an hour per day playing computer games. TV Environment was associated with a 31% per unit increase in risk of watching >2 h of TV after school and 11% increase in risk of spending >1 h playing computer games. CONCLUSIONS: A family environment in which after-school TV viewing is part of the home culture and homes where children have more autonomy over their own behavior are associated with an increased risk of watching >2 h of TV per day after school and spending more >1 h per day playing computer games. The home screen-viewing environment and Child Autonomy may be malleable targets for changing screen-viewing.

Psycho-social and environmental correlates of location-specific physical activity among 9- and 15- year-old Norwegian boys and girls: the European Youth Heart Study.

OBJECTIVE: Little is known about the existence of independent location- or context specific forms of physical activity. This study sought to identify location-specific forms of physical activity in a sample of 9 and 15 years-olds Norwegian boys and girls, and examined their associations to psycho-social and environmental factors. METHODS: A cross-sectional study of 9 and 15-year-olds (N = 760; 379 boys and 381 girls) was conducted in which participants responded to a computer-based questionnaire (PEACH) tapping potentially location specific forms of physical activity as well as psycho-social and environmental correlates. RESULTS: Exploratory factor analysis indicated that the nine and fifteen year-olds self-reported their physical activity as located in three separate and specific contexts: a) school commuting, b) informal games play at school and c) organized sport, structured exercise and games play in leisure time. Dependent of location, psycho-social and environmental correlates explained between 15 and 55 percent of the variance in physical activity. The impact of peer support, enjoyment and perceived competence in physical activity generalized across the three locations. Enjoyment of physical education classes, parental support and teacher support, in contrast, confined to particular location-specific forms of physical activity. Generally, behavioural beliefs and environmental factors represented marginal correlates of all location-specific forms of activity. CONCLUSION: Young peoples' physical activity was identified as taking place in multiply genuine locations, and the psychosocial correlates of their physical activity seem to some extent to be location specific. Results may inform intervention efforts suggesting that targeting specific sets of psycho-social factors may prove efficient across physical activity locations, gender and age groups. Others, in contrast may prove effective in facilitating location specific physical activity, in which age may come to moderate the efficiency of intervention efforts.

Physical activity levels and patterns of 9- and 15-yr-old European children.

PURPOSE: The purpose of this study was to assess physical activity levels and patterns from children participating in the European Youth Heart Study (EYHS). Very limited physical activity data exist that have been collected from representative samples of children and even fewer data collected where physical activity has been measured using objective methods. METHODS: Subjects were 2185 children aged 9 and 15 yr from Denmark, Portugal, Estonia, and Norway. Physical activity data were obtained using MTI (formerly CSA) accelerometers. The primary outcome variable was established as the child's activity level (accelerometer counts per minute). Children wore the accelerometer for 3 or 4 d, which included at least 1 weekend day. RESULTS: Boys were more active than girls at age 9 (784 +/- 282 vs 649 +/- 204 counts.min-1) and 15 yr (615 +/- 228 vs 491 +/- 163 counts.min-1). With respect to time engaged in moderate-intensity activity, gender differences were apparent at age 9 (192 +/- 66 vs 160 +/- 54 min.d-1) and age 15 (99 +/- 45 vs 73 +/- 32 min.d-1). At age 9, the great majority of boys and girls achieved current health-related physical activity recommendations (97.4% and 97.6%, respectively). At age 15, fewer children achieved the guidelines and gender differences were apparent (boys 81.9% vs girls 62.0%). CONCLUSIONS: Accelerometers are a feasible and accurate instrument for use in large epidemiological studies of children's activity. Boys tend to be more active than girls, and there is a marked reduction in activity over the adolescent years. The great majority of younger children achieve current physical activity recommendations, whereas fewer older children do so-especially older girls.

A 5-yr change in Norwegian 9-yr-olds' objectively assessed physical activity level.

PURPOSE: To describe changes in objectively assessed physical activity by socioeconomic status (SES) between 1999-2000 and 2005 in 9-yr-old children living in Oslo, Norway. METHODS: Two cross-sectional studies were conducted in 1999-2000 and 2005. The participation rate was 70.9% in 1999-2000 and 91.4% in 2005. Participants were identified by SES based on whether the school they attended was in an area designated as high, middle, or low mean income. Physical activity was assessed objectively by accelerometers. A total of 718 children (1999-2000, n = 340; 2005, n = 378) provided valid physical activity assessments that met all inclusion criteria. General linear models were used to assess the changes in physical activity between 1999-2000 and 2005. RESULTS: A significant increase in mean physical activity level and physical activity during weekends was observed between the two study periods (P = 0.02 and <0.001, respectively), with the patterns being similar for girls and boys. Interactions were found between change in physical activity and SES. Although the mean physical activity level and moderate-to-vigorous physical activity (MVPA) among children from low-SES groups showed no change over time, an increase was seen among children from middle-SES groups. Moreover, in high-SES groups, an increase was observed for mean physical activity level (girls only) between study periods, whereas no change was seen for MVPA participation. CONCLUSIONS: Nine-year-old children living in Oslo, Norway, have increased both their mean and weekend physical activity level between 1999-2000 and 2005. However, because these opportunities are not equal across SES groups, interventions are required to focus on the needs of children from low-SES groups.