Is Your Neighborhood Designed to Support Physical Activity? A Brief Streetscape Audit Tool

INTRODUCTION: Macro level built environment factors (eg, street connectivity, walkability) are correlated with physical activity. Less studied but more modifiable microscale elements of the environment (eg, crosswalks) may also affect physical activity, but short audit measures of microscale elements are needed to promote wider use. This study evaluated the relation of a 15-item neighborhood environment audit tool with a full version of the tool to assess neighborhood design on physical activity in 4 age groups. METHODS: From the 120-item Microscale Audit of Pedestrian Streetscapes (MAPS) measure of street design, sidewalks, and street crossings, we developed the 15-item version (MAPS-Mini) on the basis of associations with physical activity and attribute modifiability. As a sample of a likely walking route, MAPS-Mini was conducted on a 0.25-mile route from participant residences toward the nearest nonresidential destination for children (n = 758), adolescents (n = 897), younger adults (n = 1,655), and older adults (n = 367). Active transportation and leisure physical activity were measured with age-appropriate surveys, and accelerometers provided objective physical activity measures. Mixed-model regressions were conducted for each MAPS item and a total environment score, adjusted for demographics, participant clustering, and macrolevel walkability. RESULTS: Total scores of MAPS-Mini and the 120-item MAPS correlated at r = .85. Total microscale environment scores were significantly related to active transportation in all age groups. Items related to active transport in 3 age groups were presence of sidewalks, curb cuts, street lights, benches, and buffer between street and sidewalk. The total score was related to leisure physical activity and accelerometer measures only in children. CONCLUSION: The MAPS-Mini environment measure is short enough to be practical for use by community groups and planning agencies and is a valid substitute for the full version that is 8 times longer

Cross-sectional associations between high deprivation home and neighbourhood environments and health-related variables among Liverpool children

Objectives: (1) To investigate differences in health-related, home and neighbourhood environmental variables between Liverpool children living in areas of high deprivation (HD) and medium-to-high deprivation (MD) and (2) to assess associations between these perceived home and neighbourhood environments and health-related variables stratified by deprivation group. Design: Cross-sectional study. Setting: 10 Liverpool primary schools in 2014. Participants: 194 children aged 9–10 years. Main outcome measures: Health-related variables (self-reported physical activity (PA) (Physical Activity Questionnaire for Older Children, PAQ-C), cardiorespiratory fitness, body mass index (BMI) z-scores, waist circumference), home environment variables: (garden/backyard access, independent mobility, screen-based media restrictions, bedroom media) and neighbourhood walkability (Neighbourhood Environment Walkability Scale for Youth, NEWS-Y). Explanatory measures: Area deprivation. Results: There were significant differences between HD and MD children's BMI z-scores (p<0.01), waist circumference (p<0.001) and cardiorespiratory fitness (p<0.01). HD children had significantly higher bedroom media availability (p<0.05) and independent mobility scores than MD children (p<0.05). MD children had significantly higher residential density and neighbourhood aesthetics scores, and lower crime safety, pedestrian and road traffic safety scores than HD children, all of which indicated higher walkability (p<0.01). HD children's BMI z-scores (β=−0.29, p<0.01) and waist circumferences (β=−0.27, p<0.01) were inversely associated with neighbourhood aesthetics. HD children's PA was negatively associated with bedroom media (β=−0.24, p<0.01), and MD children's PA was positively associated with independent mobility (β=0.25, p<0.01). MD children's independent mobility was inversely associated with crime safety (β=−0.28, p<0.01) and neighbourhood aesthetics (β=−0.24, p<0.05). Conclusions: Children living in HD areas had the least favourable health-related variables and were exposed to home and neighbourhood environments that are unconducive to health-promoting behaviours. Less access to bedroom media equipment and greater independent mobility were strongly associated with higher PA in HD and MD children, respectively. Facilitating independent mobility and encouraging outdoor play may act as effective strategies to enhance PA levels and reduce sedentary time in primary school-aged children

Outdoor Education in Italian Kindergartens: How Teachers Perceive Child Developmental Trajectories

Outdoor Education (OE) refers to organized experiential education that takes place in the outdoor, characterized by action-centered and thematic learning processes. Literature shows how OE may have beneficial effects on different areas of child development, including cognitive abilities, social skills, and motor development. This relationship is not necessarily linear, but moderated by different variables. Until now, few studies have examined, using rigorous methods, the role of OE in children's development and studies of preschool aged children remain lacking. The current study aimed to explore teachers' perceptions of children's developmental trajectories over 2 school years, investigating whether teachers' perceptions differed between two kindergartens, one characterized by a consolidated OE approach and the other one characterized by a more traditional method of education. The sample was composed of 20 teachers, evaluating 93 children aged 3–5 (M = 46.95 months, SD = 6.73; 42 males): 13 teachers were from a traditional kindergarten (Traditional Group- TG) and evaluated 52 children; 7 teachers were from an OE kindergarten (Outdoor Group—OE) and observed 41 children. All the teachers completed the Kuno Beller Developmental Tables (Mantovani, 1995), in order to describe specific child developmental areas in 4 consecutive moments during 2 school years (T1-T2: January-May 2014; T3-T4: October 2014-May 2015). The 20 teachers also completed the “Outdoor Activities/Trips Diary,” an instrument created for this study to collect qualitative data on the characteristics of outdoor activities. Results showed that, in all the developmental areas, OE teachers perceived higher scores over time were found for the Outdoor Group compared to the Traditional one. Specifically, GLM ANOVAs Repeated Measures revealed a significant interaction of the 2 variables Time and Groups (p &lt; 0.001): contrast analyses showed that OE children, compared to the TG children, were perceived by their teachers with higher levels in all developmental areas at T1 and T2, but not at T3 and T4. The findings suggest that the OE activites, compared to indoor ones and according to teachers' perceptions, offer greater opportunities to promote the child's development at different levels, especially when children are younger. Future studies are recommended analyzing possible moderating variables and long term effects of OE

Beliefs About Medication and Uptake of Preventive Therapy in Women at Increased Risk of Breast Cancer: Results From a Multicenter Prospective Study

Introduction Uptake of preventive therapies for breast cancer is low. We examined whether women at increased risk of breast cancer can be categorized into groups with similar medication beliefs, and whether belief group membership was prospectively associated with uptake of preventive therapy. Patients and Methods Women (n = 732) attending an appointment to discuss breast cancer risk were approached; 408 (55.7%) completed the Beliefs About Medicines and the Perceived Sensitivity to Medicines questionnaires. Uptake of tamoxifen at 3 months was reported in 258 (63.2%). The optimal number of belief groups were identified using latent profile analysis. Results Uptake of tamoxifen was 14.7% (38/258). One in 5 women (19.4%; 78/402) reported a strong need for tamoxifen. The model fit statistics supported a 2-group model. Both groups held weak beliefs about their need for tamoxifen for current and future health. Group 2 (38%; 154/406 of the sample) reported stronger concerns about tamoxifen and medicines in general, and stronger perceived sensitivity to the negative effects of medicines compared with group 1 (62%; 252/406). Women with low necessity and lower concerns (group 1) were more likely to initiate tamoxifen (18.3%; 33/180) than those with low necessity and higher concerns (group 2) (6.4%; 5/78). After adjusting for demographic and clinical factors, the odds ratio was 3.37 (95% confidence interval, 1.08-10.51; P = .036). Conclusion Uptake of breast cancer preventive therapy was low. A subgroup of women reported low need for preventive therapy and strong medication concerns. These women were less likely to initiate tamoxifen. Medication beliefs are targets for supporting informed decision-making

The Implications of Neighborhood Crime and Parents' Perceptions of Crime on Children's Physical Activity and Resulting Health Outcomes and Health Care Use

Thesis (Ph.D.)--University of Washington, 2012Physical activity is a modifiable health behavior that can impact health outcomes. Chapter 2 examined children's baseline weight and physical activity and follow-up health care utilization and school absences. Meeting physical activity recommendations was negatively associated with overweight/obese status, and more overweight/obese children than healthy weight children had at least one health condition. Baseline physical activity and weight did not predict health care use or school absences at 2-year follow-up. Chapter 3 determined where children ages 6-11 were physically active using time-stamped accelerometer data and parent-reported place logs. Children spent most time and did most physical activity at home and school. Although neighborhood time was limited, this time was more proportionally active than time in other locations (e.g., 42.1% of time in neighborhood vs. 18.1% of time at home). Children with any neighborhood-based physical activity had higher average total physical activity. Chapter 4 evaluated how five crime measures were interrelated and which crime measures were related to children's total and neighborhood physical activity. We found positive correlations between parents' general crime & disorder perceptions and: neighborhood incivilities and stranger danger perceptions; parent-reported prior crime victimization and: neighborhood incivilities, general crime & disorder and stranger danger perceptions. Higher census block group-level police-reported crime was associated with less child total and neighborhood physical activity. Using 2003-2004 National Health and Nutrition Examination Survey cross-sectional data, Chapter 5 examined associations between physical activity and cardiorespiratory fitness and body adiposity. We also examined whether these relationships differed depending on how physical activity was measured: including 8-10 minute bouts or every minute. Positive associations between physical activity and cardiorespiratory fitness were found for boys 12-19 years and adults 20-49 years. Negative associations were found between physical activity and body adiposity for girls 12-19 years and adults 20-49 years. We found no significant differences between how physical activity was measured and its relationship with the two health outcomes. We demonstrated that meeting physical activity recommendations is significantly related to children's, adolescents', and adults' positive health outcomes. Furthermore, a child's neighborhood is a valid location for physical activity policy and interventions, and crime may be a worthwhile target

Children’s Objective Physical Activity by Location: Why the Neighborhood Matters

Knowledge of where children are active may lead to more informed policies about how and where to intervene and improve physical activity. This study examined where children aged 6–11 were physically active using time-stamped accelerometer data and parent-reported place logs and assessed the association of physical-activity location variation with demographic factors. Children spent most time and did most physical activity at home and school. Although neighborhood time was limited, this time was more proportionally active than time in other locations (e.g., active 42.1% of time in neighborhood vs. 18.1% of time at home). Children with any neighborhood-based physical activity had higher average total physical activity. Policies and environments that encourage children to spend time outdoors in their neighborhoods could result in higher overall physical activity

Neighborhood crime-related safety and its relation to children's physical activity

Crime is both a societal safety and public health issue. Examining different measures and aspects of crime-related safety and their correlations may provide insight into the unclear relationship between crime and children’s physical activity. We evaluated five neighborhood crime-related safety measures to determine how they were interrelated. We then explored which crime-related safety measures were associated with children’s total moderate-to-vigorous physical activity (MVPA) and MVPA in their neighborhoods. Significant positive correlations between observed neighborhood incivilities and parents’ perceptions of general crime and disorder were found (r = 0.30, p = 0.0002), as were associations between parents’ perceptions of general crime and disorder and perceptions of stranger danger (r = 0.30, p = 0.0002). Parent report of prior crime victimization in their neighborhood was associated with observed neighborhood incivilities (r = 0.22, p = 0.007) and their perceptions of both stranger danger (r = 0.24, p = 0.003) and general crime and disorder (r = 0.37, p  <  0.0001). After accounting for covariates, police-reported crime within the census block group in which children lived was associated with less physical activity, both total and in their neighborhood (beta = −0.09, p = 0.005, beta = −0.01, p = 0.02, respectively). Neighborhood-active children living in the lowest crime-quartile neighborhoods based on police reports had 40 min more of total MVPA on average compared to neighborhood-active children living in the highest crime-quartile neighborhoods. Findings suggest that police reports of neighborhood crime may be contributing to lower children’s physical activity

Children's objective physical activity by location: Why the neighborhood matters

Knowledge of where children are active may lead to more informed policies about how and where to intervene and improve physical activity. This study examined where children aged 6–11 were physically active using time-stamped accelerometer data and parent-reported place logs and assessed the association of physical-activity location variation with demographic factors. Children spent most time and did most physical activity at home and school. Although neighborhood time was limited, this time was more proportionally active than time in other locations (e.g., active 42.1% of time in neighborhood vs. 18.1% of time at home). Children with any neighborhood-based physical activity had higher average total physical activity. Policies and environments that encourage children to spend time outdoors in their neighborhoods could result in higher overall physical activity