Objectively measured physical activity in population-representative parent-child pairs: parental modelling matters and is context-specific.

BACKGROUND: Evidence for the context-specific influence of parental modelling on physical activity (PA) in childhood remains inconclusive. This nationwide Swiss study assessed the cross-sectional association between objectively measured PA of parents and their children and whether it varied across different levels of sociodemographic and environmental factors. In a second step a structural equation-model (SEM) was used to assess, whether associations between children's PA and sociodemographic and environmental factors are mediated by the parental PA behaviour. METHODS: The population-based sample of the SOPHYA-study consisted of 889 children aged 6 to 16 years living in Switzerland and 1059 parents. PA was measured using accelerometers. Information on sociodemographics, sports behaviour, family characteristics, and perceived environment was obtained by telephone interview and parental questionnaire. Objective environmental data was allocated to each family's residential address using GIS (geographic information system). A structural equation model tested these factors for both independent associations with children's PA and associations mediated through the parental PA behaviour. RESULTS: Parental moderate to vigorous physical activity (MVPA) was associated with MVPA of their children in general (p < 0.001). Correlations between parents' and children's MVPA were stronger for children aged 10-12 years and for those living in the Italian speaking part of Switzerland. An increase of 1 min of mother's and of father's MVPA was associated with 0.24 and 0.21 min more MVPA in children, respectively. Father's PA was associated with that of their sons, but not with that of their daughters, whereas the association of mothers' and children's PA did not depend on the parent-offspring sex-match. The pathway analysis in our structural equation model showed direct effects on children's MVPA as well as indirect effects mediated by the parental PA behaviour. CONCLUSIONS: Parental modelling seems relevant for children's PA, but not to the same degree in all children. Interventions focusing on strengthening parental PA behaviour for the promotion of PA in the young must consider additional contextual factors related to the socio-cultural and structural environment.

Regular family breakfast was associated with children's overweight and parental education: Results from the ENERGY cross-sectional study.

INTRODUCTION: This study aims to assess (i) the prevalence of having regular family breakfast, lunch, dinner (i.e. 5-7days/week together with their family) among 10-12year olds in Europe, (ii) the association between family meals and child weight status, and (iii) potential differences in having family meals according to country of residence, gender, ethnicity and parental levels of education. METHODS: 7716 children (mean age: 11.5±0.7years, 52% girls) in eight European countries (Belgium, Greece, Hungary, The Netherlands, Norway, Slovenia, Spain, Switzerland) participated in a cross-sectional school-based survey in 2010. Data on family meals were self-reported by the parents and children's height and weight were objectively measured to determine overweight status. Binary regression analyses assessed the associations of having regular family meals (adjusted for potential confounders) with children's overweight/obesity and to assess potential differences in having family meals according to gender, ethnicity and parental education, in the total sample and for each country respectively. RESULTS: The prevalence of regular family meals was 35%, 37% and 76% for breakfast, lunch and dinner respectively. Having regular family breakfast, but not lunch or dinner, was inversely associated with overweight (OR=0.78 (95% CI 0.67-0.91)). Children of higher educated parents were more likely to have regular family breakfast (1.63 (95% CI 1.42-1.86)) and less likely to have regular family lunch (0.72 (95% CI 0.63-0.82)) compared to children of lower educated parents. CONCLUSION: This study showed that having regular family breakfast - but not other family meals- was inversely associated with children's weight status.

Weekend physical activity profiles and their relationship with quality of life: The SOPHYA cohort of Swiss children and adolescents.

INTRODUCTION: Quality of life (QoL) is an important health indicator among children and adolescents. Evidence on the effect of physical activity (PA)-related behaviors on QoL among youth remains inconsistent. Conventional accelerometer-derived PA metrics and guidelines with a focus on whole weeks may not adequately characterize QoL relevant PA behavior. OBJECTIVE: This study aims to a) identify clusters of accelerometer-derived PA profiles during weekend days among children and adolescents living in Switzerland, b) assess their cross-sectional and predictive association with overall QoL and its dimensions, and c) investigate whether the associations of QoL with the newly identified clusters persist upon adjustment for the commonly used PA metrics moderate-to-vigorous physical activity (MVPA) and time spent in sedentary behavior (SB). METHODS: The population-based Swiss children's Objectively measured PHYsical Activity (SOPHYA) cohort among children and adolescents aged 6 to 16 years was initiated at baseline in 2013. PA and QoL information was obtained twice over a five-year follow-up period. The primary endpoint is the overall QoL score and its six dimension scores obtained by KINDL® questionnaire. The primary predictor is the cluster membership of accelerometer-derived weekend PA profile. Clusters were obtained by applying the k-medoid algorithm to the distance matrix of profiles obtained by pairwise alignments of PA time series using the Dynamic Time Warping (DTW) algorithm. Secondary predictors are accelerometer-derived conventional PA metrics MVPA and SB from two combined weekend days. Linear regression models were applied to assess a) the cross-sectional association between PA cluster membership and QoL at baseline and b) the predictive association between PA cluster membership at baseline and QoL at follow-up, adjusting for baseline QoL. RESULTS: The study sample for deriving PA profile clusters consisted of 51.4% girls and had an average age of 10.9 [SD 2.5] years). The elbow and silhouette methods indicated that weekend PA profiles are best classified in two or four clusters. The most differentiating characteristic for the two-clusters classification ("lower activity" and "high activity"), and the four-clusters classification ("inactive", "low activity", "medium activity", and "high activity"), respectively was the participant's mean counts per 15-seconds epoch. Participants assigned to high activity clusters were younger and more often male. Neither the clustered PA profiles nor MVPA or SB were cross-sectionally or predictively associated with overall QoL. The only association of a conventional PA metrics with QoL while adjusting for cluster membership was observed between MVPA during the weekend days and social well-being with a mean score difference of 2.4 (95%CI: 0.3 to 4.5; p = 0.025). CONCLUSION: The absence of strong associations of PA metrics for the weekend with QoL, except for the positive association between MVPA during the weekend days and social well-being, is in line with results from two randomized studies not showing efficacy of PA interventions on youth QoL. But because PA decreases with age, its promotion and relevance to QoL remain important research topics. Larger longitudinal study samples with more than two follow-up time points of children and adolescents are needed to derive new novel accelerometer-derived PA profiles and to associate them with QoL dimensions.

Cross-Sectional but Not Prospective Association of Accelerometry-Derived Physical Activity With Quality of Life in Children and Adolescents.

Objectives: This study aims to quantify the cross-sectional and prospective associations between quality of life (QoL) and moderate-to-vigorous physical activity (MVPA). Methods: This study was based on the Swiss children's Objectively measured PHYsical Activity cohort. The primary endpoint is the overall QoL score and its six dimensions. The main predictor is the average time spent in MVPA per day. Linear mixed effects and linear regression models respectively were used to investigate the cross-sectional and prospective associations between MVPA and QoL. Results: There were 352 participants in the study with complete data from baseline (2013-2015) and follow-up (2019). MVPA was positively associated with overall QoL and physical wellbeing (p = 0.023 and 0.002 respectively). The between-subject MVPA was positively associated with the overall QoL, physical wellbeing, and social wellbeing (p = 0.030, 0.017, and 0.028 respectively). Within-subject MVPA was positively associated with physical wellbeing and functioning at school (p = 0.039 and 0.013 respectively). Baseline MVPA was not associated with QoL 5 years later. Conclusion: Future longitudinal studies should employ shorter follow-up times and repeat measurements to assess the PA and QoL association.

Self-reported TV and computer time do not represent accelerometer-derived total sedentary time in 10 to 12-year-olds.

Screen-time activities are often used as proxies for sedentary time. We studied associations of self-reported television (TV), computer and total screen-time with accelerometer-derived total sedentary time in European children (10-12 years). Analyses showed significant positive associations between TV, computer and total screen-time with total sedentary time for the total sample, however, the explained variance was low and stratified analyses only revealed a significant positive association between total screen-time and total sedentary time in boys and between computer time and total sedentary time in Dutch children. This suggests that self-reported TV and computer time do not adequately reflect total sedentary time in schoolchildren.

Associations between home- and family-related factors and fruit juice and soft drink intake among 10- to 12-year old children. The ENERGY project.

The aim of this study is to investigate associations of family-related factors with children's fruit drink/juice and soft drink consumption. A cross-sectional survey among 10- to 12-year-old children and their parents in eight European countries was conducted to gather this data. Key variables of interest were children's self-reported fruit drink/juice and soft drink intake per day (outcome) and family-related factors (based on parents' report) related to these two behaviors (modeling, automaticity, availability, monitoring, permissiveness, negotiating, communicating health beliefs, avoid negative modeling, self-efficacy, rewarding, and family consumption). 7915 Children (52% girls; mean age=11.7 ± 0.8 years) and 6512 parents (83% women; mean age=41.4 ± 5.3 years) completed the questionnaire. Multilevel regression analyses were used to examine the aforementioned associations. Three of the 11 family-related factors (modeling, availability, and family consumption) were positively associated with children's fruit drink/juice and soft drink intake. Additionally, three family-related factors (permissiveness, monitoring, and self-efficacy) were solely associated with soft drink intake and one family-related factor (communicating health beliefs) was related to fruit drink/juice intake. Future interventions targeting children's fruit drink/juice and soft drink intake should focus on the home environment, parents and their practices, especially on parents' fruit drink/juice and soft drink intake and availability of these beverages at home.

Differences in weight status and energy-balance related behaviors among schoolchildren in German-speaking Switzerland compared to seven countries in Europe.

BACKGROUND: Overweight in children and adolescents have increased significantly and are a major public health problem. To allow international comparisons, Switzerland joined the European study 'ENERGY' cross sectional survey consortium that investigated the prevalence of overweight and obesity as well as selected dietary, physical and sedentary behaviors of 10-12 years old pupils across seven other countries in Europe. The aims of the present study was to compare body composition and energy-balance related behaviors of Swiss schoolchildren to those of the seven European ENERGY-countries and to analyze overweight and energy-balance related behaviors of Swiss children according to socio-demographic factors. METHODS: A school-based cross-sectional study among 10-12 year old children was conducted in Switzerland and seven other European countries using a standardized protocol. Body height, weight and waist-circumference were measured by trained research assistants. Energy-balance related behaviors -i.e. selected dietary, physical activity and screen-viewing behaviors were assessed by questionnaires. Weight status and behaviors in Switzerland were compared to the seven European ENERGY countries. Within the Swiss sample, analyses stratified by gender, parental education and ethnicity were performed. RESULTS: Data of 546 Swiss children (mean age 11.6±0.8y, 48% girls) were obtained and compared to the ENERGY- results (N=7.148; mean age 11.5±0.8y, 48% girls). In Switzerland significantly less children were overweight (13.9%) or obese (2.3%) compared to the average across the ENERGY-countries (23.7% and 4.7%, respectively), and were even somewhat lower than the ENERGY countries with the lowest prevalence. Sugar sweetened beverage intakes and breakfast habits of Swiss children did not differ significantly from those of ENERGY. However, the mean time devoted by Swiss children to walking or cycling to school and attending sports activities was significantly higher and screen time significantly lower compared to the other ENERGY-countries. Within the Swiss, sample relatively large and consistent differences were observed between children from native and non-native ethnicity. CONCLUSIONS: The prevalence of overweight and obesity among Swiss children are substantial but significantly lower compared to all other European ENERGY-Partners, probably due to the fact that Swiss children were found to be more active and less sedentary comparing to the rest of the European sample.

Levels of physical activity and sedentary time among 10- to 12-year-old boys and girls across 5 European countries using accelerometers: an observational study within the ENERGY-project.

BACKGROUND: The study aim was to objectively assess levels of sedentary time, light, moderate and vigorous physical activity (PA) among 10-12 year olds across five European countries and to examine differences in sedentary time and PA according to gender and country. METHODS: 686 children (mean age = 11.6 ± 0.8 years, 53% girls, mean BMI = 19.0 ± 3.4 kg/m(2)) from Belgium, Greece, Hungary, the Netherlands and Switzerland wore Actigraph accelerometers and had at least 2 weekdays with minimum 10 h-wearing time and 1 weekend day with minimum 8 h-wearing time. Data were analyzed using multivariate analyses of covariance. RESULTS: Girls spent significantly more time sedentary (500 minutes/day) than boys (474 minutes/day) and significantly less time in light (267 minutes/day) and moderate-to-vigorous PA (32 minutes/day) than boys (284 minutes/day; 43 minutes/day respectively; p < 0.001). 4.6% of the girls and 16.8% of the boys met moderate-to-vigorous PA recommendations of at least 60 minutes/day. Greek boys were more sedentary (510 minutes/day; all at p < 0.05) than other boys. Dutch girls were less sedentary (457 minutes/day; all at p < 0.05) than other girls. Swiss girls displayed more moderate-to-vigorous PA (43 minutes/day; at p < 0.05) than other girls. CONCLUSIONS: Large proportions of children across different European countries did not meet PA recommendations and spent a lot of time sedentary. Mean time spent in moderate-to-vigorous PA was significantly lower than the recommended 60 minutes. Obesity prevention programmes focusing on both decreasing sedentary time and increasing light, moderate and vigorous PA are needed for European children, particularly girls.

Measuring and validating physical activity and sedentary behavior comparing a parental questionnaire to accelerometer data and diaries.

Accurately measuring children's physical activity and their sedentary behavior is challenging. The present study compared 189 parental responses to a questionnaire surveying physical activity and sedentary behavior of children aged 6-14 years, to accelerometer outputs and time activity diaries for the same group. Responses were analyzed taking age, sex and maternal education into account. Correlation coefficients between questionnaire reports and accelerometer-based physical activity across all age groups were acceptable (up to r = .55). Yet, adjustment for age markedly attenuated these associations, suggesting concomitant influences of biological and behavioral processes linked to age. The comparisons of general time indications in the questionnaire with 24h-diary records suggested that parents tended to under- and over-report single activities, possibly due to social desirability. We conclude that physical activity questionnaires need to be designed for specific age groups and be administered in combination with objective measurements.

Study protocol of physical activity and sedentary behaviour measurement among schoolchildren by accelerometry--cross-sectional survey as part of the ENERGY-project.

BACKGROUND: Physical activity and sedentary behaviour among children should be measured accurately in order to investigate their relationship with health. Accelerometry provides objective and accurate measurement of body movement, which can be converted to meaningful behavioural outcomes. The aim of this study was to evaluate the best evidence for the decisions on data collection and data processing with accelerometers among children resulting in a standardized protocol for use in the participating countries. METHODS/DESIGN: This cross-sectional accelerometer study was conducted as part of the European ENERGY-project that aimed to produce an obesity prevention intervention among schoolchildren. Five countries, namely Belgium, Greece, Hungary, Switzerland and the Netherlands participated in the accelerometer study. We used three different Actigraph models--Actitrainers (triaxial), GT3Xs and GT1Ms. Children wore the device for six consecutive days including two weekend days. We selected an epoch length of 15 seconds. Accelerometers were placed at children's waist at the right side of the body in an elastic belt. In total, 1082 children participated in the study (mean age = 11.7 ± 0.75 y, 51% girls). Non-wearing time was calculated as periods of more than 20 minutes of consecutive zero counts. The minimum daily wearing time was set to 10 hours for weekdays and 8 hours for weekend days. The inclusion criterion for further analysis was having at least three valid weekdays and one valid weekend day. We selected a cut-point (count per minute (cpm)) of <100 cpm for sedentary behaviour, <3000 cpm for light, <5200 cpm for moderate, and >5200 cpm for vigorous physical activity. We also created time filters for school-time during data cleaning in order to explore school-time physical activity and sedentary behaviour patterns in particular. DISCUSSION: This paper describes the decisions for data collection and processing. Use of standardized protocols would ease future use of accelerometry and the comparability of results between studies.

COVID-19 pandemic and health related quality of life in primary school children in Switzerland: a repeated cross-sectional study.

BACKGROUND: The COVID-19 pandemic and the resulting containment measures had and still have a profound impact on everyday life. Both the fear of infection and the imposed restrictions can have biopsychosocial consequences. The aim of the present study was to analyze whether there is a difference in the health-related quality of life (HRQoL) of primary school children in 2014/15 compared to in 2020, the first year of the COVID-19 pandemic. METHODS: The present study included 1,712 children aged 5 to 11 years who either participated in the baseline assessment of the SOPHYA cohort study in 2014/15 or were newly recruited during follow-up of the cohort in 2020. In both surveys, the children invited for participation were identified based on registry data. HRQoL was assessed with the validated KINDL-R questionnaire, which scores HRQoL along six different dimensions. RESULTS: The overall scores (82.4 [81.8; 83.0] vs. 79.6 [79,1; 80.2]), and in particular the emotional well-being scores (85.6 [84.6; 86.6] vs. 83.3 [82.4; 84.2]), were lower during the year of the pandemic (2020) compared to the survey year 2014/15. The highest decrease between 2014/15 and 2020 in the adjusted models was seen for the youngest age group (-3.9 points), followed by children from families with a high income (-3.2 points), girls (-3.1 points), Swiss citizens (-3.1 points) and children from the German-speaking part of Switzerland (-3.1 points). HRQoL was particularly low during periods with restrictions and at the height of the COVID-19 waves in 2020. CONCLUSION: The SOPHYA-study showed that HRQoL, and especially emotional well-being, was lower in 5 to 11-year-old children in Switzerland during the first year of the pandemic compared to the results from the survey conducted in 2014/15. In the year of the pandemic, the scores were lowest at the height of the COVID-19 waves and their associated restrictions. As it cannot be distinguished whether fear of the disease itself or the restrictions caused this decrease in HRQoL, containment policies should keep COVID-19 infections as low as possible, but still enable children to profit from protective factors such as leisure activities, physical activity and social contact.

Trend in active transportation to school among Swiss school children and its associated factors: three cross-sectional surveys 1994, 2000 and 2005.

BACKGROUND: Giving the rising trend in childhood obesity in many countries including Switzerland, strategies to increase physical activity such as promoting active school travel are important. Yet, little is known about time trends of active commuting in Swiss schoolchildren and factors associated with changes in walking and biking to school. METHODS: Between 1994 and 2005, information about mobility behaviour of children aged 6-14 years was collected within three Swiss population based national travel behaviour surveys. Mode of transport to school was reported for 4244 children. Weighted multivariate logistic regression analyses were used to assess active school travel time trends and their influencing factors. RESULTS: More than 70% of Swiss children walked or biked to school. Nevertheless, the proportion of children biking to school decreased (p = 0.05, linear trend), predominately in urban areas, and motorized transportation increased since 1994 (p = 0.02). Distance to school did not change significantly over time but availability of bikes decreased (p < 0.001) and number of cars per household increased (p < 0.001). The association between survey year and bike use was significantly modified by living in an urban area (OR (95%CI): 1.0, 0.63 (0.44-0.90), 0.71 (0.49-1.03), respectively for 1994, 2000 and 2005) and by distance to school (OR (95%CI): 1.0, 0.65 (0.40-1.05), 0.50 (0.23-0.79) for the same years and for children who lived more than a mile away from school). CONCLUSIONS: Programs to encourage safe biking and to limit car use as mode of transport to school are warranted to stop this trend.

Built environment, parents' perception, and children's vigorous outdoor play.

OBJECTIVES: To evaluate the combined effects and relative importance of socio-cultural factors as well as parents' subjectively perceived and objectively assessed environment on time children spent vigorously playing outdoors. METHODS: Cross-sectional study conducted in Berne, Biel-Bienne, and Payerne (Switzerland) during the school year 2004/2005. Included 1345 parental questionnaires from children out of three age groups (6/7, 9/10, and 13/14 years). A total of 1081 (80%) provided a home address, which could be linked to environmental data using a geographic information system (GIS). RESULTS: GIS-derived main street density in a buffer of 100 m around the home was inversely associated with time playing outdoors in adolescents and younger children, but only in more urbanized areas. In addition and independently of GIS-based main street density, parental concern about traffic safety was associated with less time playing outdoors in primary school children. Girls, adolescents, and children from the French speaking part of the country spent less time playing outdoors. A non-Swiss nationality and having younger siblings increased time playing vigorously outdoors in adolescents. CONCLUSION: In addition to socio-cultural factors, parents' perceptions and objectively measured environmental factors were significantly associated with the time spent vigorously playing outdoors. These associations differed by age group.

Patterns of cross-sectional and predictive physical activity in Swiss adults aged 52+: results from the SAPALDIA cohort.

BACKGROUND: Non-communicable diseases (NCDs) account for the vast majority of deaths in Switzerland. Insufficient physical activity (PA) is an established NCD risk factor and PA is known to be beneficial for physical and mental wellbeing. Sedentary behaviour (SB) is an additional, independent risk factor and associated with frailty in older adults. This study aimed at describing cross-sectional PA patterns in a general population sample of subjects aged 52 years and older (52+) from eight areas across different language regions of Switzerland. Additionally, the predictive association of self-reported PA for objectively measured PA was tested. METHODS: Participants 52+ of the Swiss Cohort Study on Air Pollution And Lung and Heart Disease In Adults (SAPALDIA) who completed accelerometer data collection at the most recent follow-up (SAPALDIA4 in 2017/18) and provided information on determinants of interest (sex, age, body mass index [BMI], language region, education, employment status, civil status, smoking) were included in the analysis (n = 1314). The accelerometer-derived average time spent in different PA intensities (SB, light PA [LPA], moderate-to-vigorous PA [MVPA]) was estimated according to participant characteristics with control for season and wear time using multiple linear regressions. In further analyses, the predictive effect of changes in self-reported PA over roughly ten years between SAPALDIA2 (2001/02) and SAPALDIA3 (2010/11) (remaining inactive [RI]; becoming inactive [BI]; becoming active [BA]; remaining active [RA]) on the objectively measured SB, LPA and MVPA obtained seven years later by accelerometry (SAPALDIA4), was assessed using multiple linear regression models. RESULTS: Overall, 21.7% of 52+ participants met the Swiss recommendations for subjectively assessed PA. Obese participants, 75+ year-olds, smokers and subjects living alone spent more time in SB and less time in LPA and MVPA compared with participants with a BMI below 25 kg/m2, between 52 and 64 years old, not smoking and being married, respectively. Residents living in the French-speaking part of Switzerland were less likely to engage in MVPA compared with residents from the German-speaking part and thus were less likely to meet the PA recommendations. A trend for increasing PA and decreasing SB was observed consistently across the four groups (RI, BI, BA, RA) of predictive self-reported PA patterns with participants remaining active over the course of roughly ten years showing highest levels of PA and lowest levels of SB measured objectively at SAPALDIA4. CONCLUSION: The high proportion of SB points to the need of physical activity promotion for the older part of the population in Switzerland. According to our data, behavioural changes in PA are possible and sustainable as we can see in the group of participants becoming active and this is essential for health promotion recommendations.

Assessment of intensity, prevalence and duration of everyday activities in Swiss school children: a cross-sectional analysis of accelerometer and diary data.

BACKGROUND: Appropriately measuring habitual physical activity (PA) in children is a major challenge. Questionnaires and accelerometers are the most widely used instruments but both have well-known limitations. The aims of this study were to determine activity type/mode and to quantify intensity and duration of children's everyday PA by combining information of a time activity diary with accelerometer measurements and to assess differences by gender and age. METHODS: School children (n = 189) aged 6/7 years, 9/10 years and 13/14 years wore accelerometers during one week in winter 2004 and one in summer 2005. Simultaneously, they completed a newly developed time-activity diary during 4 days per week recording different activities performed during each 15 min interval. For each specific activity, the mean intensity (accelerometer counts/min), mean duration per day (min/d) and proportion of involved children were calculated using linear regression models. RESULTS: For the full range of activities, boys accumulated more mean counts/min than girls. Adolescents spent more time in high intensity sports activities than younger children (p < 0.001) but this increase was compensated by a reduction in time spent playing vigorously (p = 0.04). In addition, adolescents spent significantly more time in sedentary activities (p < 0.001) and accumulated less counts/min during these activities than younger children (p = 0.007). Among moderate to vigorous activities, children spent most time with vigorous play (43 min/day) and active transportation (56 min/day). CONCLUSION: The combination of accelerometers and time activity diaries provides insight into age and gender related differences in PA. This information is warranted to efficiently guide and evaluate PA promotion.

Association of objectively measured and perceived environment with accelerometer-based physical activity and cycling: a Swiss population-based cross-sectional study of children.

OBJECTIVES: We tested whether objectively assessed neighbourhood characteristics are associated with moderate-to vigorous physical activity (MVPA) and cycling in Swiss children and adolescents and assessed the mediating role of the perception of the environment. METHODS: The cross-sectional analyses were based on data of 1306 participants aged 6-16 years of the population-based SOPHYA study. MVPA was measured by accelerometry, time spent cycling and the perceived environment by questionnaire. Objective environmental parameters at the residential address were GIS derived. In all analyses, personal, social and environmental factors were considered. RESULTS: MVPA showed significant positive associations with perceived personal safety and perceived access to green spaces but not with respective objective parameters. Objectively assessed main street density and shorter distance to the next public transport were associated with less cycling in adolescents. Parents' perceptions did not mediate the observed associations of the objectively assessed environment with MVPA and cycling. CONCLUSIONS: Associations between the environment and physical activity differ by domain. In spatial planning efforts to improve objective environments should be complemented with efforts to increase parental sense of security.

Reasons for Prehospital Delay in Acute Ischemic Stroke.

Background Prehospital delay reduces the proportion of patients with stroke treated with recanalization therapies. We aimed to identify novel and modifiable risk factors for prehospital delay. Methods and Results We included patients with an ischemic stroke confirmed by diffusion-weighted magnetic resonance imaging, symptom onset within 24 hours and hospitalized in the Stroke Center of the University Hospital Basel, Switzerland. Trained study nurses interviewed patients and proxies along a standardized questionnaire. Prehospital delay was defined as >4.5 hours between stroke onset-or time point of wake-up-and admission. Overall, 336 patients were enrolled. Prehospital delay was observed in 140 patients (42%). The first healthcare professionals to be alarmed were family doctors for 29% of patients (97/336), and a quarter of these patients had a baseline National Institute of Health Stroke Scale score of 4 or higher. The main modifiable risk factor for prehospital delay was a face-to-face visit to the family doctor (adjusted odds ratio, 4.19; 95% CI, 1.85-9.46). Despite transport by emergency medical services being associated with less prehospital delay (adjusted odds ratio, 0.41; 95% CI, 0.24-0.71), a minority of patients (39%) who first called their family doctor were transported by emergency medical services to the hospital. The second risk factor was lack of awareness of stroke symptoms (adjusted odds ratio, 4.14; 95% CI, 2.36-7.24). Conclusions Almost 1 in 3 patients with a diffusion-weighted magnetic resonance imaging-confirmed ischemic stroke first called the family doctor practice. Face-to-face visits to the family doctor quadrupled the odds of prehospital delay. Efforts to reduce prehospital delay should address family doctors and their staffs as important partners in the prehospital pathway. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02798770.

Correlates of weekday compliance to physical activity recommendations in Swiss youth non-compliant in weekend days.

Some children are inactive on weekends but active on weekdays. Correlates of such behavior remain to be clarified. We assessed school, out-of-school and family correlates of compliance with physical activity (PA) recommendations during weekdays among weekend non-compliant youth in Switzerland. Cross-sectional data collected in 2013-2015 from the SOPHYA study. PA was objectively measured during one week using waist-worn accelerometers. Compliance with PA recommendations (≥ 60 min/day of moderate-to-vigorous PA) was assessed separately for weekend and weekdays. Data on school sport, transport to school, sports club participation, household income, parent's PA and education were collected by phone interview and questionnaires. Data from 540 youth (316 girls) aged 6-16 years were available for analysis. Participants who were compliant to recommendations during weekdays were more frequently boys (50.3% vs. 31.4%, p < 0.001), more often participated in sports club (73.3% vs. 64.3%, p = 0.024), and were more prone to adopt active transport to school (75.8% vs. 62.0%, p = 0.001) than non-compliers. Multivariable adjustment showed male gender [odds ratio and (95% confidence interval): 4.30 (2.71-6.81)], sports club participation [1.91 (1.21-3.02)], and PA-active parent [1.98 (1.20-3.28)] were significantly associated with weekday compliance. Being a male, a sports club participant and having a physically active parent significantly increase compliance with PA recommendations during weekdays among Swiss youth who are inactive on weekends.

Sedentary Behaviour in Swiss Children and Adolescents: Disentangling Associations with the Perceived and Objectively Measured Environment.

Identifying correlates of sedentary behaviour across all levels of the ecological model and understanding their interrelations is a promising method to plan effective interventions. The present study examined whether the objectively assessed and the perceived neighbourhood are associated with children’s sedentary behaviour time (SBT). A comprehensive set of factors at different levels of influence across the ecological model were taken into account and analysed for mediating and modifying effects. Analyses were based on 1306 children and adolescents (6⁻16 years) participating in the population-based SOPHYA-study. Accelerometers were used to assess SBT, the perceived environment was examined by a validated parental questionnaire, and objective environmental data were allocated using GIS (ArcMap 10.2, Esri, Redlands, CA, USA) for each family’s residential address. A high perceived safety was associated with less SBT. Boys, those whose residential neighbourhood was characterized by dead ends in urban areas, a low main street density in the neighbourhood of children and greenness were less likely to exhibit SBT. The association of the objective environment with the respective parental perceptions was low and no significant mediating effect was found for the perceived environment. We conclude for land-use planning to reduce sedentary behaviour objective environments should be complemented with efforts to increase parental sense of security.