Context-specific outdoor time and physical activity among school-children across gender and age: Using accelerometers and GPS to advance methods

Introduction: Being outdoors has a positive influence on health among children. Evidence in this area is limited and many studies have used self-reported measures. Objective context-specific assessment of physical activity patterns and correlates, such as outdoor time, may progress this field.Aims: To employ novel objective measures to assess age and gender differences in context-specific outdoor weekday behavior patterns among school-children (outdoor time and outdoor MVPA) and to investigate associations between context-specific outdoor time and MVPA.Methods: A total of 170 children had at least one weekday of nine hours combined accelerometer and GPS data and were included in the analyses. The data were processed using the Personal Activity and Location Measurement System and a purpose-built PostgreSQL database resulting in context-specific measures for outdoor time, outdoor MVPA and overall daily MVPA. In addition, four domains (leisure, school, transport and home) and 11 subdomains (e.g. urban green space, sports facilities) were created and assessed. Multilevel analyses provided results on age and gender differences and the association between outdoor time and MVPA.Results: Girls compared to boys had fewer outdoors minutes (pConclusion:A new methodology to assess context-specific outdoor time and physical activity patterns has been developed and can be expanded to other populations. Different context-specific patterns were found for gender and age, suggesting different strategies may be needed to promote physical activit

Mental health and physical activity in vocational education and training schools students:a population-based survey

BACKGROUND: The prevalence of young people not adhering to the World Health Organization (WHO) physical activity guidelines is high, especially among students in vocational education and training, compared to fellow peers. Also, low levels of mental health have been found in this group, however, to a lesser degree than peers in general education. As positive mental health aspects have more generally been found to be associated with increased likelihood of physical activity in young people, this study examined the association between mental health and physical activity among Danish students in vocational education and training. METHODS: Students in vocational education and training (N = 5277, mean age 24.3 years, range 15.8–64.0 years) responded to a national representative survey assessing four aspects of mental health (well-being, self-efficacy, self-esteem and life satisfaction) and physical activity. Physical activity was dichotomized as adherence to the WHO minimum guidelines or not. Logistic regression was used to examine if each mental health aspect was associated with physical activity in crude and adjusted models. RESULTS: A positive dose–response association was found between all aspects of mental health and adherence to WHO physical activity guidelines. However, the association between self-esteem and physical activity was modified by gender, with a dose–response relationship found only among males. CONCLUSIONS: Higher levels of positive mental health were associated with better odds of achieving WHO physical activity guidelines in a dose–response-manner. Prospective studies are needed to further elucidate the causal relationship between mental health and physical activity. Future interventions must pay attention to differential gender effects

Dynamic accuracy of GPS receivers for use in health research: a novel method to assess GPS accuracy in real-world settings

The emergence of portable global positioning system (GPS) receivers over the last 10 years has provided researchers with a means to objectively assess spatial position in free-living conditions. However, the use of GPS in free-living conditions is not without challenges and the aim of this study was to test the dynamic accuracy of a portable GPS device under real-world environmental conditions, for four modes of transport, and using three data collection intervals.We selected four routes on different bearings, passing through a variation of environmental conditions in the City of Copenhagen, Denmark, to test the dynamic accuracy of the Qstarz BT-Q1000XT GPS device. Each route consisted of a walk, bicycle and vehicle lane in each direction. The actual width of each walking, cycling and vehicle lane was digitized as accurately as possible using ultra-high-resolution aerial photographs as background. For each trip we calculated the percentage that actually fell within the lane polygon, and within the 2.5, 5 and 10 meter buffers respectively, as well as the mean and median error in meters.Our results showed that 49.6% of all ≈68,000 GPS points fell within 2.5 meters of the expected location, 78.7% fell within 10 meters and the median error was 2.9 m. The median error during walking trips was 3.9 m, 2.0 m for bicycle trips, 1.5 m for bus and 0.5 m for car. The different area types showed considerable variation in the median error: 0.7 m in open areas, 2.6 m in half-open areas and 5.2 m in urban canyons. The dynamic spatial accuracy of the tested device is not perfect, but we feel that it is within acceptable limits for larger population studies. Longer recording periods, for a larger population are likely to reduce the potentially negative effects of measurement inaccuracy. Furthermore, special care should be taken when the environment in which the study takes place could compromise the GPS signal.<br/

Intervention Activities Associated with the Implementation of a Comprehensive School Tobacco Policy at Danish Vocational Schools: A Repeated Cross-Sectional Study

School tobacco policies are often poorly implemented, which may explain their limited effectiveness. Further, constructs to measure implementation outcomes of school tobacco policies are missing. The Smoke-Free Vocational Schools intervention was designed to stimulate the implementation of a comprehensive school tobacco policy into routine practice. This study (1) developed implementation fidelity outcomes measures for the school tobacco policy and (2) examined associations between intervention activities and implementation fidelity at two time points. We applied a repeated cross-sectional survey study design across seven schools: the first time point was >5 months after the policy was established and the second time point > 14 months after policy establishment. The dependent/outcome variables were four binary fidelity domains as well as a total score across domains. A total of six intervention activities were measured among either students (e.g., new school-break facilities) or staff/managers (e.g., a joint workshop before policy implementation). Associations were analyzed separately for students and staff/managers using generalized linear mixed models, adjusted for confounders. A total of n = 2674 students and n = 871 staff/managers participated. The total implementation fidelity scores increased over time among both students and staff/managers. Three intervention activities were consistently associated with the total implementation fidelity score, including: new school-break facilities (BT1 = 0.08, 95% CI = 0.03; 0.12; BT2 = 0.07, 95% CI = 0.04–0.50), the joint workshop before policy implementation (BT1 = 0.13, 95% CI = 0.02; 0.25; BT2 = 0.13, 95% CI = 0.004; 0.24), and internalization of fixed procedures for enforcement (BT1 = 0.19, 95% CI = 0.13–0.26; BT2 = 0.16, 95% CI = 0.13–0.26). These findings can be applied by schools and other actors in practice. The developed implementation fidelity outcomes measures can be applied in future research on school tobacco policies

Attitudes towards implementing tobacco-free-schools in vocational schools in Denmark: an important health promotion setting in youth

Background The prevalence of daily smoking among youth at Danish vocational schools is 37 %, while the prevalence among high-school students is 12 %. Vocational schools are an important setting for health promotion to target inequality in health. Implementing Tobacco-Free-Schools (TFS) may reduce smoking among both students and staff. Smoking among students and staff has been found to be an important setting for socializing and bonding and the schools are reluctant to enforce TFS. The objective of this study was to investigate attitudes towards TFS among managers and staff across all Danish vocational schools, and determine characteristics of schools with a positive attitude towards TFS opposed to schools with a more negative attitude. Methods A total of 72 out of 87 (83%) vocational schools in Denmark participated in an electronic survey on health promotion activities and implementation capacity with a least one respondent. Overall a total of 185 respondents from management and 345 teaching staff participated (n=530). Data was analyzed in SPSS using univariate and multilevel modelling to detect differences between managers and staff in attitudes towards TFS and to identify characteristics of progressive TFS schools (28 schools) compared to non-progressive schools (44). Results Staff were more positive than managers towards future implementation of TFS (p< 0,05). Size of school (increasing size), gender (having a female manager), school type (health and teaching) and school health promotion profile (more initiatives and policies in general) were associated with being more positive towards TFS at the school level. Conclusions This study is one of the first to address attitudes towards TFS and characteristics of being a progressive TFS school in a national representative sample. Vocational schools are an important setting to target smoking among youth, and this study highlights the need to address implementation of TFS on multiple levels

Health Literacy is Associated with Health Behaviors in Students from Vocational Education and Training Schools: A Danish Population-Based Survey

Health literacy has been identified as an important and changeable intermediary determinant of health equity. Vocational education and training (VET) schools are a relevant setting for health behavior interventions seeking to diminish health inequities because many VET students come from low socio-economic status backgrounds. This study examines VET students&rsquo; health literacy and its association with health behavior based on a cross-sectional survey among 6119 students from 58 VET schools in Denmark in 2019. Two scales from the Health Literacy Questionnaire was used to assess domains of health literacy. Data were analyzed using Anova and logistic regression. The study population consisted of 43.4% female, and mean age was 24.2 years (range 15.8&ndash;64.0). The health literacy domain &lsquo;Actively managing my health&rsquo; mean was 2.51, SD 0.66, and &lsquo;Appraisal of health information&rsquo; mean was 2.37, SD 0.65. For both domains, being female, older age, attending the VET educational program Care-health-pedagogy, and higher self-rated health were associated with higher scale scores. In the adjusted analyses, lower scale scores were associated with less frequent breakfast, daily smoking, high-risk alcohol behavior and moderate-to-low physical activity. Our results show that low health literacy is associated with unhealthy behaviors in this population. Our results support and inform health literacy research and practice in educational institutions and services