The role of the built environment in a randomized controlled trial to increase physical activity among men with prostate cancer: the PROMOTE trial.

PURPOSE: The purpose of the study was to examine the association between the built environment and physical activity (PA) in prostate cancer survivors (PCS), as well as whether built environment factors (walkability, count of sports complexes) were effect modifiers of a PA intervention. METHODS: Our study included 165 PCS residing in Edmonton, Alberta, from the PROMOTE trial. The PROMOTE trial was a randomized controlled trial of a behaviour change intervention to increase PA and quality of life in PCS. In the PROMOTE trial, 423 PCS were randomly assigned to a standard physical activity recommendation, self-administered implementation intention, or telephone-assisted implementation intention group. PA and quality of life outcomes were assessed at baseline, 1, and 3 months. To explore the role of the built environment, this study examined walkability and count of sport complexes. RESULTS: Linear regression analyses revealed that the self-administered intervention group had an increase in self-reported PA minutes/week (ß = 133.4, 95% CI = -18.9 to 285.6); however, none of the built environment variables were found to be significantly associated with PA. The logistic regression showed that the self-administered intervention group had a significantly greater likelihood of meeting the PA guidelines (OR = 2.1, 95% CI = 0.9 to 4.9), though no built environment variables were associated with PA levels. CONCLUSIONS: Our findings suggest that the built environment was not associated with PA and was not an effect modifier in a PA behaviour change intervention for PCS. Further research is needed before clear conclusions can be generated ( ClinicalTrials.gov number NCT01410656).

Correlates of Initial Recall of a Multimedia Communication Campaign to Promote Physical Activity among Tweens: the WIXX Campaign.

This study examined factors associated with children's and parents' recall of a communication campaign aimed at promoting children's physical activity. A cross-sectional population-based telephone survey was conducted among 1001 children and their parents. Respondents were recruited through a random digit dialing procedure. Respondents' recall of the campaign, beliefs, sociodemographics as well as levels of physical activity and sedentary behaviors were self-reported. Logistic regression analyses were conducted for tweens and their parents separately. Girls (odds ratio [OR] = 2.1; 95%confidence interval (CI): 1.3, 3.5) were more likely to have unaided recall when compared to boys. Tweens in primary school (OR = 1.9; 95%CI: 1.0, 3.4 and OR = 2.1; 95%CI: 1.4, 3.0) and those speaking French (OR = 3.3; 95%CI: 1.4, 8.1 and OR = 2.9; 95%CI: 1.8, 4.7) were more likely to have unaided and aided recall, respectively. Among parents, tweens' unaided (OR = 12.0; 95%CI: 5.2, 28.1) and aided (OR = 3.3; 95%CI: 1.5, 7.3) recall, obesity status (OR = 2.6; 95%CI: 1.3, 5.3), and low income (OR = 5.2; 95%CI: 1.9, 14.3) were positively associated with recall. Additional beliefs were associated with tweens' and parents' recall of the campaign. The association between sex, language, and recall is in line with the branding strategy adopted and no clear evidence for communication inequalities was observed.

Short-Term Impact of a Multimedia Communication Campaign on Children's Physical Activity Beliefs and Behavior.

To examine the short-term impact of the WIXX multimedia communication campaign on children's physical activity (PA) beliefs and behaviors, 3 repeated cross-sectional telephone surveys were conducted before, 9 months after, and 21 months after the launch of the campaign. A random-digit dialing procedure was used to recruit children ages 9 to 13 years. Children's PA beliefs, behaviors, and recall of the WIXX ads were self-reported. Logistic regression models showed that girls exposed to the WIXX ads were more likely to believe that PA would help to make new friends (odds ratio [OR] = 1.4, 95% confidence interval [CI] [1.0, 1.9]) and that they can be active even if too busy (OR = 1.4, 95% CI [1.0, 1.8]) compared to girls not exposed. Boys exposed were more likely to believe that PA would help to spend time with friends (OR = 1.4, 95% CI [1.1, 1.9]). Boys (OR = 1.5, 95% CI [1.1, 2.0.]) and girls (OR = 1.4, 95% CI [1.1, 1.8]) exposed were more likely to report having tried new PAs. No significant impact of the campaign was observed on overall PA after we controlled for confounders. Recall of the WIXX ads was associated with a significant, albeit modest, impact on some PA beliefs and intermediate PA behaviors.

Association between junk food consumption and fast-food outlet access near school among Quebec secondary-school children: findings from the Quebec Health Survey of High School Students (QHSHSS) 2010-11.

OBJECTIVE: We investigated the association between junk food consumption at lunchtime (JCL) and fast-food outlet access near school among secondary-school children in Quebec. DESIGN: A geographic information system database was used to characterize the food environment around a sub-sample of 374 public schools in which 26 655 students were enrolled. The outcome variable was JCL during the previous week, dichotomized into low JCL (none or once) v. high JCL (twice or more). Access to fast-food outlets near school was assessed using an existing database of fast-food outlets in Quebec. Covariates included student (age, sex and self-rated perceived health), family (familial status and parental education) and school (urban/rural status and deprivation) variables. Hierarchical logistic regression models were employed for analyses using PROC GLIMMIX of SAS version 9.3. SETTING: Province of Quebec, Canada. SUBJECTS: We used data from the Quebec Health Survey of High School Students (QHSHSS) 2010-11, a survey of secondary-school Quebec students. RESULTS: Exposure to two or more fast-food outlets within a radius of 750 m around schools was associated with a higher likelihood of excess JCL (OR=1·50; 95 % CI 1·28, 1·75), controlling for the characteristics of the students, their families and their schools. CONCLUSIONS: The food environment surrounding schools can constitute a target for interventions to improve food choices among secondary-school children living in the province of Quebec. Transforming environments around schools to promote healthy eating includes modifying zoning regulations that restrict access to fast-food outlets around schools.

A cross-sectional study of the relationship between parents' and children's physical activity.

BACKGROUND: Though parents' physical activity (PA) is thought to be a predictor of children's PA, findings have been mixed. The purpose of this study was to examine the relationship between pedometer-measured steps/day of parents' and their children and potential moderators of this relationship. We also assessed the parent-child PA relationship as measured by questionnaires. METHODS: Six-hundred and twelve 7-8 year olds and one of their parents wore Steps Count (SC)-T2 pedometers for four consecutive days. Parents reported their PA from the last seven days and their child's usual PA. Hierarchical linear regressions were used to assess the parent-child PA relationships, controlling for covariates. Gender (parent, child), gender homogeneity, weight status (parent, child), weight status homogeneity, and socioeconomic status (SES) variables (parent education, household income, area-level SES) were tested as potential moderators of this relationship. Partial r's were used as an estimate of effect size. RESULTS: Parents' steps was significantly related to children's steps (r partial = .24). For every 1,000 step increase in parents' steps, the children took 260 additional steps. None of the tested interactions were found to moderate this relationship. Using questionnaires, a relatively smaller parent-child PA relationship was found (r partial = .14). CONCLUSION: Physically active parents tend to have physically active children. Interventions designed to get children moving more throughout the day could benefit from including a parent component. Future research should explore the mechanisms by which parents influence their children, and other parent attributes and styles as potential moderators.

Neighbourhood socioeconomic disadvantage and fruit and vegetable consumption: a seven countries comparison.

BACKGROUND: Low fruit and vegetable consumption is a risk factor for poor health. Studies have shown consumption varies across neighbourhoods, with lower intakes in disadvantaged neighbourhoods. However, findings are inconsistent, suggesting that socio-spatial inequities in diet could be context-specific, highlighting a need for international comparisons across contexts. This study examined variations in fruit and vegetable consumption among adults from neighbourhoods of varying socioeconomic status (SES) across seven countries (Australia, Canada, Netherlands, New Zealand, Portugal, Scotland, US). METHODS: Data from seven existing studies, identified through literature searches and knowledge of co-authors, which collected measures of both neighbourhood-level SES and fruit and vegetable consumption were used. Logistic regression was used to examine associations between neighbourhood-level SES and binary fruit and vegetable consumption separately, adjusting for neighbourhood clustering and age, gender and education. As much as possible, variables were treated in a consistent manner in the analysis for each study to allow the identification of patterns of association within study and to examine differences in the associations across studies. RESULTS: Adjusted analyses showed evidence of an association between neighbourhood-level SES and fruit consumption in Canada, New Zealand and Scotland, with increased odds of greater fruit intake in higher SES neighbourhoods. In Australia, Canada, New Zealand and Portugal, those residing in higher SES neighbourhoods had increased odds of greater vegetable intake. The other studies showed no evidence of a difference by neighbourhood-level SES. CONCLUSIONS: Acknowledging discrepancies across studies in terms of sampling, measures, and definitions of neighbourhoods, this opportunistic study, which treated data in a consistent manner, suggests that associations between diet and neighbourhood-level socioeconomic status vary across countries. Neighbourhood socioeconomic disadvantage may differentially impact on access to resources in which produce is available in different countries. Neighbourhood environments have the potential to influence behaviour and further research is required to examine the context in which these associations arise.

Influence of area deprivation and perceived neighbourhood safety on active transport to school among urban Quebec preadolescents.

OBJECTIVE: This study examines associations between area deprivation and perceived neighbourhood safety with active transport to school among preadolescents living in urban Quebec. METHODS: A sample of 809 preadolescents aged 9 to 13 years and one each of their parents living in urban Quebec were recruited by a polling firm for a telephone interview about the Opération WIXX multimedia communication campaign. Opération WIXX was launched in 2012 by Québec en forme to promote physical activity among preadolescents. Logistic regression models predicted active transportation to school (as reported by both the child and his or her parent) from area-level material and social deprivation and from parental and children's perceptions of neighbourhood safety while controlling for socio-demographic variables. RESULTS: Child and parental reports of active commuting to school were highly concordant (Kendall's tau=0.70, p<0.001). Children whose parents felt at ease to let their children actively commute to school (OR=1.75, 95% CI 1.25-2.45; p=0.001) and who lived in areas characterized by the highest material (OR=2.02, 95% CI 1.09-3.76; p=0.026) and social (OR=3.69, 95% CI 2.12-6.42; p<0.001) deprivation were more likely to report actively commuting to school. Parents who felt at ease to let their children actively commute to school (OR=1.60, 95% CI 1.15-2.21; p=0.005) and who lived in neighbourhoods characterized by a higher social deprivation (OR=1.70, 95% CI 1.04-2.79; p=0.036, OR=2.01, 95% CI 1.23-3.29; p=0.006, OR=2.72, 95% CI 1.59-4.63; p<0.001) were more likely to report that their child actively commuted to school. CONCLUSION: Active commuting to school is associated with parental perceptions of safety and area deprivation.

Development and reliability testing of a self-report instrument to measure the office layout as a correlate of occupational sitting.

BACKGROUND: Spatial configurations of office environments assessed by Space Syntax methodologies are related to employee movement patterns. These methods require analysis of floors plans which are not readily available in large population-based studies or otherwise unavailable. Therefore a self-report instrument to assess spatial configurations of office environments using four scales was developed. METHODS: The scales are: local connectivity (16 items), overall connectivity (11 items), visibility of co-workers (10 items), and proximity of co-workers (5 items). A panel cohort (N = 1154) completed an online survey, only data from individuals employed in office-based occupations (n = 307) were used to assess scale measurement properties. To assess test-retest reliability a separate sample of 37 office-based workers completed the survey on two occasions 7.7 (±3.2) days apart. Redundant scale items were eliminated using factor analysis; Chronbach's α was used to evaluate internal consistency and test re-test reliability (retest-ICC). ANOVA was employed to examine differences between office types (Private, Shared, Open) as a measure of construct validity. Generalized Linear Models were used to examine relationships between spatial configuration scales and the duration of and frequency of breaks in occupational sitting. RESULTS: The number of items on all scales were reduced, Chronbach's α and ICCs indicated good scale internal consistency and test re-test reliability: local connectivity (5 items; α = 0.70; retest-ICC = 0.84), overall connectivity (6 items; α = 0.86; retest-ICC = 0.87), visibility of co-workers (4 items; α = 0.78; retest-ICC = 0.86), and proximity of co-workers (3 items; α = 0.85; retest-ICC = 0.70). Significant (p ≤ 0.001) differences, in theoretically expected directions, were observed for all scales between office types, except overall connectivity. Significant associations were observed between all scales and occupational sitting behaviour (p ≤ 0.05). CONCLUSION: All scales have good measurement properties indicating the instrument may be a useful alternative to Space Syntax to examine environmental correlates of occupational sitting in population surveys.

Sport fields as potential catalysts for physical activity in the neighbourhood.

Physical activity is associated with access to recreational facilities such as sports fields. Because it is not clear whether objectively- or subjectively-assessed access to facilities exerts a stronger influence on physical activity, we investigated the association between the objective and perceived accessibility of sport fields and the levels of self-reported physical activity among adults in Edmonton, Canada. A sample of 2879 respondents was surveyed regarding their socio-demographics, health status, self-efficacy, levels of physical activity, as well as their perceptions of built environment in relation to physical activity. Neighbourhood-level data were obtained for each respondent based on their residence. Accessibility to facilities was assessed using the enhanced Two-Step Floating Catchment Area method. Geographic Information Systems were employed. A logistic regression was performed to predict physical activity using individual- and neighbourhood-level variables. Women, older individuals, and individuals with higher educational attainment were less likely to be physically active. Also, individuals with higher self-efficacy and higher objectively-assessed access to facilities were more likely to be physically active. Interventions that integrate provision of relevant programs for various population groups and of improved recreational facilities may contribute to sport fields becoming catalysts for physical activity by generating movement both on the site and in the neighbourhood.

Sociodemographic, behavioural and environmental correlates of sweetened beverage consumption among pre-school children.

OBJECTIVE: To identify sociodemographic and environmental correlates of sweetened beverages (regular soft drinks, fruit juice) among children of pre-school age. DESIGN: Children's dietary intake, food behaviours and screen time were measured by parental report. A Geographic Informational System was used to assess the number of grocery stores and fast-food restaurants available within 1 km of the children's residence. Multivariate log-binomial regression models were constructed to determine correlates of drinking soft drinks during the previous week. SETTING: Edmonton region, Canada. SUBJECTS: Children aged 4 and 5 years (n 2114) attending a public health unit for immunization were recruited for a cohort study on determinants of childhood obesity, between 2005 and 2007. RESULTS: Children from neighbourhoods with low socio-economic status (relative risk (RR) = 1·17, 95 % CI 0·98, 1·40) or who participated in >2 h of screen time daily (RR = 1·28, 95 % CI 1·13, 1·45) were significantly more likely to have consumed regular soft drinks within the last week. Those who lived within 1 km of a grocery store were significantly less likely to consume regular soft drinks (RR = 0·84, 95 % CI 0·73, 0·96). Children who participated in >2 h of screen time daily (RR = 1·16, 95 % CI 1·06, 1·27) were more likely to exceed the recommended weekly number of servings of fruit juice. CONCLUSIONS: Socio-economic and built environment factors are associated with soft drink consumption in children of pre-school age. These findings may help health professionals to advocate for policies that reduce soft drink consumption among children.

"Walkable by Willpower": resident perceptions of neighbourhood environments.

Resident perceptions of neighbourhood walkability, physical activity opportunities, food choice and factors influencing choice of neighbourhood were examined through focus group discussion in higher and lower walkability neighbourhoods. Almost all participants perceived their neighbourhoods as very or reasonably walkable with high food choice. Walking was described as primarily leisure or exercise focused and less frequently as destination or task-oriented. Factors influencing walking and physical activity included connectivity, path quality, weather and traffic. The ability to drive easily was a key factor in neighbourhood choice. Our findings identified important environmental factors perceived by residents as either positively or negatively influencing behaviour related to physical activity and food choice. Future research should examine the relationship between perceived and actual walkability features as well as residential selection.

A longitudinal and cross-sectional examination of the relationship between reasons for choosing a neighbourhood, physical activity and body mass index.

BACKGROUND: The purpose of this study was to examine the relationship between body mass index and neighborhood walkability, socioeconomic status (SES), reasons for choosing neighborhoods, physical activity, fruit and vegetable intake, and demographic variables. METHODS: Two studies, one longitudinal and one cross-sectional, were conducted. Participants included adults (n = 572) who provided complete data in 2002 and 2008 and a concurrent sample from 2008 (n = 1164). Data were collected with longitudinal and cross-sectional telephone surveys. Objective measures of neighborhood characteristics (walkability and SES) were calculated using census data and geographic information. RESULTS: In the longitudinal study, neighborhood choice for ease of walking and proximity to outdoor recreation interacted with whether participants had moved during the course of study to predict change in BMI over 6 years. Age, change in activity status, and neighborhood SES were also significant predictors of BMI change. Cross-sectionally, neighborhood SES and neighborhood choice for ease of walking were significantly related to BMI as were gender, age, activity level and fruit and vegetable intake. CONCLUSIONS: Results demonstrate that placing importance on choosing neighborhoods that are considered to be easily walkable is an important contributor to body weight. Findings that objectively measured neighbourhood SES and neighborhood choice variables contributed to BMI suggest that future research consider the role of neighborhood choice in examining the relationships between the built environment and body weight.

Association between neighborhood socioeconomic status and screen time among pre-school children: a cross-sectional study.

BACKGROUND: Sedentary behavior is considered a separate construct from physical activity and engaging in sedentary behaviors results in health effects independent of physical activity levels. A major source of sedentary behavior in children is time spent viewing TV or movies, playing video games, and using computers. To date no study has examined the impact of neighborhood socioeconomic status (SES) on pre-school children's screen time behavior. METHODS: Proxy reports of weekday and weekend screen time (TV/movies, video games, and computer use) were completed by 1633 parents on their 4-5 year-old children in Edmonton, Alberta between November, 2005 and August, 2007. Postal codes were used to classified neighborhoods into low, medium or high SES. Multiple linear and logistic regression models were conducted to examine relationships between screen time and neighborhood SES. RESULTS: Girls living in low SES neighborhoods engaged in significantly more weekly overall screen time and TV/movie minutes compared to girls living in high SES neighborhoods. The same relationship was not observed in boys. Children living in low SES neighborhoods were significantly more likely to be video game users and less likely to be computer users compared to children living in high SES neighborhoods. Also, children living in medium SES neighborhoods were significantly less likely to be computer users compared to children living in high SES neighborhoods. CONCLUSIONS: Some consideration should be given to providing alternative activity opportunities for children, especially girls who live in lower SES neighborhoods. Also, future research should continue to investigate the independent effects of neighborhood SES on screen time as well as the potential mediating variables for this relationship.

Seasonal variation in physical activity among preschool children in a northern Canadian city.

Little research has examined seasonal differences in physical activity (PA) levels among children. Proxy reports of PA were completed by 1,715 parents on their children in Edmonton, Alberta, Canada. Total PA (TPA) minutes were calculated, and each participant was classified as active, somewhat active, or inactive. Logistic regression models were conducted to examine associations between PA status and seasons. Significant seasonal differences were observed for TPA, weekday PA, weekend PA, and active play. Children were significantly more likely to be physically active in the summer and spring and somewhat physically active in the summer and fall, relative to winter Children living in cold climates are less likely to be physically active in the winter.

Relation between local food environments and obesity among adults.

BACKGROUND: Outside of the United States, evidence for associations between exposure to fast-food establishments and risk for obesity among adults is limited and equivocal. The purposes of this study were to investigate whether the relative availability of different types of food retailers around people's homes was associated with obesity among adults in Edmonton, Canada, and if this association varied as a function of distance between food locations and people's homes. METHODS: Data from a population health survey of 2900 adults (18 years or older) conducted in 2002 was linked with geographic measures of access to food retailers. Based upon a ratio of the number of fast-food restaurants and convenience stores to supermarkets and specialty food stores, a Retail Food Environment Index (RFEI) was calculated for 800 m and 1600 m buffers around people's homes. In a series of logistic regressions, associations between the RFEI and the level of obesity among adults were examined. RESULTS: The median RFEI for adults in Edmonton was 4.00 within an 800 m buffer around their residence and 6.46 within a 1600 m buffer around their residence. Approximately 14% of the respondents were classified as being obese. The odds of a resident being obese were significantly lower (OR = 0.75, 95%CI 0.59 - 0.95) if they lived in an area with the lowest RFEI (below 3.0) in comparison to the highest RFEI (5.0 and above). These associations existed regardless of the covariates included in the model. No significant associations were observed between RFEI within a 1600 m buffer of the home and obesity. CONCLUSION: The lower the ratio of fast-food restaurants and convenience stores to grocery stores and produce vendors near people's homes, the lower the odds of being obese. Thus the proximity of the obesogenic environment to individuals appears to be an important factor in their risk for obesity.

Influence of neighbourhood design and access to facilities on overweight among preschool children.

OBJECTIVE: Studies of the role of the built environment in relation to obesity in young children have reported inconsistent results. METHODS: We explored the association of objective measures of neighbourhood design (dwelling density, land use mix, intersection density, availability of facilities) with the bodyweight status of 501 preschool children (girls = 262; boys = 239) residing in Edmonton, Canada. RESULTS: Approximately 21% of the children were classified as overweight or at-risk of being overweight according to the Centers for Disease Control (CDC) growth charts, while 15% of the children were considered overweight or obese according to the International Obesity Task Force (IOTF) criteria. Controlling for measures of physical activity, junk food consumption and neighbourhood-level social class, significant interactions were found between sex of the child and walkability of the neighbourhood (composite index of dwelling density, land use mix, and intersection density) and sex of the child and intersection density regardless of the bodyweight status criteria. The odds of girls being overweight or obese were lower if they lived in walkable neighbourhoods (OR = 0.78, 95%CI, 0.66-0.91 CDC; OR = 0.73, 95%CI, 0.61-0.88 IOTF) with more intersections (OR = 0.57, 95%CI, 0.39-0.86 CDC; OR = 0.48, 95%CI, 0.30-0.76 IOTF). No significant associations were observed for boys. CONCLUSION: Thus, aspects of the built environment may differentially influence the bodyweight status of children depending upon sex.

The association between neighborhood socioeconomic status and exposure to supermarkets and fast food outlets.

This study examines whether exposure to supermarkets and fast food outlets varies with neighborhood-level socioeconomic status in Edmonton, Canada. Only market area and fast food proximity predicted supermarket exposure. For fast food outlets, the odds of exposure were greater in areas with more Aboriginals, renters, lone parents, low-income households, and public transportation commuters; and lower in those with higher median income and dwelling value. Low wealth, renter-occupied, and lone parent neighborhoods had greater exposure to fast food outlets, which was not offset by better supermarket access. The implications are troubling for fast food consumption among lone parent families in light of growing obesity rates among children.