The Influence of Kindergarten Environment on the Development of Preschool Children's Physical Fitness.

The aim of this research is to find out to what extent the special qualifications of physical education teachers and the physical environment of kindergartens influence the physical development of preschoolers. Forty-four kindergartens across Estonia participated in the study, half of which had a physical education teacher (PEt), whereas the remaining 22 kindergartens were taught by non-qualified kindergarten teachers (NoPEt). Six Eurofit fitness tests were used to assess the physical development of children (n = 704; aged 6-7 years old, with an average age of 6.55 ± 0.5 years). An analysis of variance was used to compare the mean values of the fitness test results of the two groups. Linear regression analysis was applied to clarify the influence of individual and environmental factors on children's fitness scores. In kindergartens where the position of a PEt had been created, the results of children's physical fitness were statistically significantly better, more specifically in handgrip strength (m = 12.0, 95% CI = 11.8-12.3 vs. m = 11.5, 95% CI = 11.2-11.7) and in speed tests (m = 23.0, 95% CI = 22.8-23.2 vs. m = 23.6, 95% CI = 23.3-23.8). According to the teacher interviews, these kindergartens also had more rooms and areas specially created for physical exercises. The study revealed that the physical development of children is, when controlling for other individual and environmental factors, influenced by the professional qualification of the PE teacher (95% CI = 0.06-0.56) as well as children's participation in sports training (95% CI = 0.29-0.83). These findings are important for preschool institutions and municipalities in designing the optimal physical environment for facilitating children's physical fitness.

Family structure and the association with physical activity-Findings from 40 countries participating in the Health Behaviour in School-aged Children (HBSC) study.

BACKGROUND: The family has been acknowledged as central to developing physical activity (PA) beliefs and behaviours. However, increased diversity in family structures has developed over the last decades. This study examines the association between family structure and PA among adolescents and cross-national variations in the associations. METHODS: The data are from the 2013/14 Health Behaviours in School-Aged Children study, involving nationally representative samples of 11-, 13- and 15-year-olds (n = 211,798) from 40 countries. Multilevel Poisson regression analysis was used to examine the associations between family structure and moderate to vigorous physical activity (MVPA) and vigorous physical activity (VPA) by age, gender, socioeconomic status (SES), and geographic region. RESULTS: Living with one versus two parents was associated with a reduced likelihood of daily 60 min MVPA for boys (IRR = 0.96, 95% CI: 0.92, 0.99) and ≥ 4 times/week VPA (IRR 0.93, 95% CI: 0.91, 0.95). This impact on MVPA differed across individual-level SES (high SES; IRR = 0.92, (p <0.05), low SES; IRR = 1.04, (ns)), and was for VPA only significant for those with siblings (IRR = 0.93, 95% CI: 0.91, 0.96). Cross-country variations in the association between living with one versus two parents were observed, most pronounced for VPA. These differences varied by region, primarily explained by country-level SES differences between regions. The likelihood of daily 60 min MVPA also increased with siblings in the main house (IRR 1.11, 95% CI: 1.07, 1.14), and ≥ 4 times/week VPA decreased with grandparents in the main house (IRR 0.91, 95% CI: 0.89,0.94). CONCLUSIONS: Family structure correlated with PA, but cross-country differences exist. The findings are relevant for the development of policies and programs to facilitate PA, especially in countries where living with one versus two parents was unfavourable. Additional country-specific research is needed to identify challenges for engaging in PA related to family structure.

A cross-national comparison of problematic gaming behavior and well-being in adolescents.

BACKGROUND AND AIMS: The popularity of playing games among adolescents has increased during the last decades, possibly affecting the prevalence of problematic gaming behavior. The current study aimed to compare country-level prevalence rates of adolescents' problematic gaming behavior in five countries and identify cross-cultural similarities and differences in the relationship between problematic gaming and well-being (life satisfaction, psychological complaints, and peer support). METHODS: Cross-national data from the Health Behavior in School-aged Children (HBSC) study were used. The sample comprised 14,398 gamers (61% boys) aged 11 to 16 (average age between 13.31 and 13.85) from Azerbaijan, England, Serbia, Slovenia, and the Netherlands. RESULTS: The findings showed that the prevalence of problematic gaming differs between countries. The highest prevalence of problematic gaming was seen in Azerbaijan (16.1%) and the lowest in the Netherlands (4.3%). In contrast, Azerbaijan reported the lowest gaming intensity, whereas the Netherlands and England showed the highest gaming intensity. Additional analyses revealed that problematic gaming was associated with lower life satisfaction, more psychological complaints, and lower peer support in all countries, although the strength of these associations varied between countries. DISCUSSION AND CONCLUSIONS: The current study's results are consistent with the assumption that problematic gaming negatively affects adolescents' social and mental well-being. These findings are further discussed in light of the normalization theory which suggests that cultural gaming norms (i.e., the percentage of gamers per country) would influence the strength of the relationship between problematic gaming and adolescents' well-being. The present findings highlight the need for adequate prevention strategies aiming at problematic gaming among youngsters.

The Influence of Previous Lifestyle on Occupational Physical Fitness in the Context of Military Service.

The Estonian Defense Forces are the basis of military service, mandatory for all male citizens of the Republic of Estonia who are at least 17 years old. The physical load in military service, especially in the first stage, is significantly greater than for men in everyday life. Therefore, it is important to know if health promotion in civilian life adequately prepares young people for military service and to what extent pre-military health behaviors affect physical performance during service. The purpose of this work was to examine conscripts' physical fitness at different stages of military service and its relationships with previous lifestyle. Soldiers' physical fitness was estimated three times during military service using three tests: sit-ups, push-ups and 2-mile run. Lifestyle and socio-economic background data was collected by a web-based questionnaire (n = 235). Linear regression analysis was performed using Army Physical Fitness Test (APFT) scores as dependent variables and questionnaire data as independent variables. The socio-economic background variables had no effect on physical fitness scores throughout the training period (p > 0.05). Young men that were physically more active daily, did sports, had healthier diet and did not smoke before entering military service showed better physical fitness test results throughout the period of service (p < 0.05). The effect of participation in sports was evident, as the conscripts with previous sports experiences demonstrated higher fitness tests scores (p < 0.01). These findings show that health promotion initiatives or programs for promoting physical activity and healthy diet, and preventing obesity and tobacco use, can also have a positive effect on the physical performance of young men during military service.

Trends in Adolescent Substance Use: Analysis of HBSC Data for Four Eastern European Countries, 1994-2018.

The aim of the study was to analyze the trends of adolescent substance use in four eastern European countries over the time period from 1994 to 2018. The four countries in focus were selected based on their shared historical backgrounds and major economic and social transformations experienced. METHODS: Two decades (1993/1994-2017/2018) of repeated cross-sectional data from the Estonian, Latvian, Lithuanian, and Polish Health Behaviour in School-aged Children survey were used. Data comprised 42,169 school children 15 years of age (9th grade). The following categories of substance use were included: regular alcohol consumption and drunkenness, tobacco smoking, electronic cigarette smoking, and cannabis use. Trends in substance use over time were tested using Jonckheere's trend test. RESULTS: Prevalence of substance use among adolescents over time revealed that the Baltic states and Poland have faced relatively different temporal trends. In the Baltic states, there was a general increase during the period of 1994-2002, which was followed by a period of peaking or stability between 2002-2010, and then decreasing trends of these risky behaviors from 2010 onwards. In Poland, the same period had less consistent patterns, with decreasing trends starting much earlier on. The prevalence of cannabis use, which had been measured since 2006, had its own unique pattern with many fluctuations within and between countries. CONCLUSIONS: The findings on the prevalence of substance use among adolescents from 1994 to 2018 revealed that the Baltic states and Poland have faced relatively different temporal trends. These countries might be facing new public health challenges in a near future, e.g., use of electronic cigarettes and cannabis use among adolescents.

Physical Activity and Sports Participation among Adolescents: Associations with Sports-Related Knowledge and Attitudes.

The impact of physical activity and sport on the development of adolescents' knowledge and attitudes has not been studied sufficiently. We assume that young people with more knowledge of sports will continue to be physically active on their own. The aim of this study is to identify the differences in the sports and physical activity-related knowledge and attitudes of adolescents who engage in organised sports training and those who do not. A total of 1033 6th-grade students from (aged 12.7 ± 0.4 years) 52 schools in Estonia were involved in the study. Logistic regression analysis was used to examine the associations between sports-related knowledge and attitudes towards students participating in organised sports training. The main reasons which hindered adolescents from being active were a lack of suitable equipment, being weaker than others, and laziness. Knowledge of physical activity, higher perceived benefits, and lower barriers to physical activity were the predictors contributing to adolescents' participation in sports training. The results demonstrated that physically active students have better knowledge of sports and physical activity. Students participating in organised sports training have strong positive benefits from being regularly physically active and feel that sports training maintains their health.

Baltic Adolescents' Health Behaviour: An International Comparison.

The aim of the study is to assess the time trends in Baltic adolescents' physical activity, dietary habits and BMI and compare the results with the average of the Health Behaviour in School-aged Children (HBSC) study. The research used HBSC data from 2006 to 2018. The total number of respondents was 17,458 in Estonia, 18,416 in Latvia and 20,466 in Lithuania. A logistic regression analysis was applied to estimate time trends in health behaviour indicators. The results demonstrated that Baltic adolescents' physical activity has declined over the study years, except for Lithuanian girls. The prevalence of overweight adolescents has significantly increased since 2006. Dietary habits improved in all three Baltic countries, as consumption of vegetables increased, and soft drink consumption decreased during this time period. This research shows that a nationwide, highly representative study with health behaviour indicators enables us to assess regional differences compared to the HBSC average. The prevalence of overweight and obese adolescents in the Baltic countries has increased and moved closer to the HBSC average. Although Baltic adolescents' daily vegetable consumption has increased over the last decade, it is still lower than the HBSC average.

Development of the European Health Interview Survey - Physical Activity Questionnaire (EHIS-PAQ) to monitor physical activity in the European Union.

BACKGROUND: A domain-specific physical activity questionnaire (EHIS-PAQ) was developed in the framework of the second wave of the European Health Interview Survey (EHIS). This article presents the EHIS-PAQ and describes its development and evaluation processes. METHODS: Research institutes from Belgium, Estonia and Germany participated in the Improvement of the EHIS (ImpEHIS) Grant project issued by Eurostat. The instrument development process comprised a non-systematic literature review and a systematic HIS/HES database search for physical activity survey questions. The developed EHIS-PAQ proposal was reviewed by survey experts. Cognitive testing of the EHIS-PAQ was conducted in Estonia and Germany. The EHIS-PAQ was further tested in a pilot survey in Belgium, Estonia and Germany in different modes of data collection, face-to-face paper and pencil interview (PAPI) and computer assisted telephone interview (CATI). RESULTS: The EHIS-PAQ is a rather pragmatic tool aiming to evaluate how far the population is physically active in specific public health relevant settings. It assesses work-related, transport-related and leisure-time physical activity in a typical week. Cognitive testing revealed that the EHIS-PAQ worked as intended. The pilot testing showed the feasibility of using the EHIS-PAQ in an international health interview survey setting in Europe. It will be implemented in all 28 European Union Member States via European Union implementing regulation in the period between 2013 and 2015. This will be a first opportunity to get comparable data on domain-specific physical activity in all 28 EU MS and to publish indicators at the EU level. CONCLUSIONS: The EHIS-PAQ is a short, domain-specific PA questionnaire based on PA questions which have been used in large-scale health interview surveys before. It was designed by considering the respondents' perspective in answering PA questions.

Sleep duration and activity levels in Estonian and Swedish children and adolescents.

We aimed to examine the associations of sleep duration with time spent on sedentary, moderate and vigorous activities in children and adolescents. The sample consisted of 2,241 (53.5% girls) Estonian and Swedish children (9-10 years) and adolescents (15-16 years), from the European Youth Heart Study, in 1998-1999. Sleep duration was calculated by the difference between self-reported bedtime and time for getting up on a normal weekday. Sedentary time/physical activity was measured by accelerometry (valid data on 1,462 participants). Adolescents had lower odds than children, and Swedish higher odds than Estonian, of meeting the sleep recommendations (>9 h) (OR = 0.22, 95% CI 0.17-0.27; and 1.32, 1.07-1.61, respectively). Participants sleeping longer than 10 h spent more time on physical activities (all intensities) and less time on sedentary activities than those sleeping shorter durations (all P < 0.001). The associations with physical activity became non-significant after additional adjustment for age or sexual maturation (Tanner stages), whereas the associations with sedentary time became borderline significant (P = 0.09/0.03, for age and Tanner, respectively). In conclusion, these results do not suggest a link between sleep durations and activity in a relatively large sample of children and adolescents from two European countries. Consequently, the common assumption that physical activity is a mediator in the relationship between short sleep durations and obesity is not supported by our findings.

Active commuting to school in children and adolescents: an opportunity to increase physical activity and fitness.

AIMS: The purpose was to describe the patterns of commuting to school in young people and to examine its associations with physical activity (PA) and cardiorespiratory fitness. METHODS: The sample comprised 2271 Estonian and Swedish children and adolescents (1218 females) aged 9-10 years and 15-16 years. Data were collected in 1998/99. Mode of commuting to and from school was assessed by questionnaire. Time spent (min/day) in PA and average PA (counts/min) was measured by accelerometry. Cardiorespiratory fitness was assessed by means of a maximal cycle ergometer test. RESULTS: Sixty-one percent of the participants reported active commuting to school (ACS). Estonian youth showed lower levels of ACS than Swedish (odds ratio, 0.64; 95% confidence interval, 0.53-0.76) and girls reported lower levels than boys (0.74; 0.62-0.88). ACS boys showed higher PA levels than non-ACS boys for moderate, vigorous, MVPA, and average PA levels (all p ≤ 0.01). Participants who cycled to school had higher cardiorespiratory fitness than walkers or passive travellers (p < 0.001). CONCLUSIONS: Nearly two-thirds of the participants actively commuted to school. ACS may provide an opportunity to increase levels of daily PA, especially in boys, and cardiorespiratory fitness, especially if cycling. Public health strategies should develop and test ACS patterns to get more evidence and promote bike-friendly environments.

Associations between physical activity, body fat, and insulin resistance (homeostasis model assessment) in adolescents: the European Youth Heart Study.

BACKGROUND: More and better data are needed to understand the action of physical activity (PA) on insulin resistance and the concomitant relation with body fat in adolescence. OBJECTIVE: We examined the relation between total PA and intensity levels with insulin resistance under special consideration of waist circumference and skinfold thickness. DESIGN: This was a cross-sectional study of 613 adolescents (352 girls, 261 boys) with a mean (+/-SD) age of 15.5 +/- 0.5 y from Sweden and Estonia. Total, low, moderate, and vigorous PA was measured by accelerometry. Body fat estimators included waist circumference and the sum of 5 skinfold thicknesses. Fasting insulin and glucose were measured, and insulin resistance was calculated according to the homeostasis model assessment (HOMA). Linear regression analysis and analysis of covariance were used to determine the association between PA and insulin resistance while considering body fat. All estimates were adjusted for sex, country, pubertal status, and indicators of body fat when applicable. RESULTS: Total, moderate, and vigorous PA were inversely correlated with HOMA. Body fat estimators were positively correlated with HOMA. Significant contrasts in HOMA concentrations were seen when comparing the lower 2 tertiles with the upper tertile of PA indicators. Repeating the analysis with body fat estimators showed significant contrasts in HOMA concentrations when comparing the lower tertiles with the upper tertile. CONCLUSION: In view of an increase in obesity in young people, the results accentuate the role of PA in sustaining metabolic balance in adolescence and the potential benefit of an increase of time spent at higher PA levels for youth with relatively elevated amounts of body fat.

High cardiovascular fitness is associated with low metabolic risk score in children: the European Youth Heart Study.

The aim of the present study was to examine the associations of cardiovascular fitness (CVF) with a clustering of metabolic risk factors in children, and to examine whether there is a CVF level associated with a low metabolic risk. CVF was estimated by a maximal ergometer bike test on 873 randomly selected children from Sweden and Estonia. Additional measured outcomes included fasting insulin, glucose, triglycerides, HDLC, blood pressure, and the sum of five skinfolds. A metabolic risk score was computed as the mean of the standardized outcomes scores. A risk score <75th percentile was considered to indicate a low metabolic risk. CVF was negatively associated with clustering of metabolic risk factors in children. Receiver operating characteristic curve analysis showed a significant discriminatory accuracy of CVF in identifying the low/high metabolic risk in girls and boys (p < 0.001). The CVF level for a low metabolic risk was 37.0 and 42.1 mL/kg/min in girls and boys, respectively. These levels are similar to the health-related threshold values of CVF suggested by worldwide recognized organizations. In conclusion, the results suggest a hypothetical CVF level for having a low metabolic risk, which should be further tested in longitudinal and/or intervention studies.

Physical activity, motor ability, and school readiness of 6-yr.-old children.

The aim of this investigation was to study the relationships between physical activity, motor ability, and school readiness in 6-yr.-old children. In total, 294 healthy children from Tartu were studied (161 boys and 133 girls). The physical activity of children was reported by parents and teachers using the questionnaire of Harro. The motor ability of children was evaluated using various tests from the Eurofit test battery as well as the 3-min. endurance shuttle run test. The Controlled Drawing Observation rest was used as a predictor of school readiness and development of mental abilities. Indoor physical activities predicted 19-25% of total variance in motor scores for these preschool children. Motor ability tests, which demand children's total attention and concentration, appear related to the chosen measures of school readiness.

Changes in anthropometrical characteristics during two years in 6 year old children.

The purpose of this study was to investigate changes in anthropometrical characteristics during the last year (autumn-spring) in preschool and first year (autumn-spring) in school. Changes in anthropometrical characteristics during summer months were also studied (spring-autumn). The subjects were 130 boys and 122 girls, 6 years of age at the beginning of the investigation. The body height and mass were measured and the BMI (kg/m2) was calculated. In total, eight skinfolds, 10 girths and two bone widths were measured. In boys, the body height and mass were higher than in girls, while the skinfold thicknesses were thicker in girls. There were only very few significant differences between sexes in girth parameters. The width parameters were higher in boys. Our results indicated that there were more significant changes in skinfold thickness, girths and width parameters during winter in preschool in comparison with first year in school in boys, while there were only a very few significant changes during summer months in boys. In contrast, there were more significant changes in school in girls. The Spearman correlations between baseline and after 6, 12 and 18 months of study indicated that the tracking of body height was high in boys and girls. Body mass tracking was high in girls and moderate in boys, while BMI tracking was moderate in both groups. The tracking coefficients of skinfold thicknesses were relatively stable during the two years of study and mostly at the moderate level (r = 0.3-0.6). Tracking coefficients of girths measures were at moderate level, but lower in boys in comparison with girls. It was concluded that social changes and probably changes in the physical activity during transition from preschool to school slightly influenced the measured anthropometrical parameters.

Assessment of motor ability of 4- and 5-year-old children.

The aim of this investigation was to develop a test battery to measure the motor abilities of 4- and 5-year-old children. The subjects were 932 healthy kindergarten children from Tartu, Estonia: boys, 4 years, n = 205; boys, 5 years, n = 267; girls, 4 years, n = 224; girls, 5 years, n = 236. Height and body mass were measured, and the body mass index (BMI, kg/m2 ) was calculated. The following motor ability tests were used: 3-min run (cardiorespiratory endurance), standing long jump (explosive strength), 4 × 10 m shuttle-run (running speed, agility), situps for 30 sec (trunk strength), sit-and-reach (flexibility), and sand bag (150 g) throw with the dominant hand (explosive strength, coordination). The motor tests were repeated 1 week later in subgroups of 28-33 children. Most of the tests had an acceptable reliability (r > 0.75) and none had a poor reliability (r < 0.40). There were significant (P < 0.05-0.001) differences between 4- and 5-year-old boys and girls in all tests except the sit-and-reach between the 4- and 5-year-old girls. Performances of boys were generally better than those of girls of the same age. Test results were often dependent on height and body mass, but not on the BMI. When body size and age were statistically controlled with second-order partial correlations, the relationships were greatly reduced or no longer significant. Stepwise regression analysis revealed that age, height, and mass of the children accounted for only a small percentage of the variance in performances. The greatest contribution to total variance was accounted for by body size in the 3-min run in 4-year-old boys (6%). Am. J. Hum. Biol. 9:659-664, 1997. © 1997 Wiley-Liss, Inc.