Educational differences in the validity of self-reported physical activity

BACKGROUND: The assessment of physical activity for surveillance or population based studies is usually done with self-report questionnaires. However, bias in self-reported physical activity may be greater in lower educated than in higher educated populations. The aim of the present study is to describe educational differences in the validity of self-reported physical activity. METHODS: We included 196 healthy adults (age 57 ± 15.4, of whom 17 % low, 24 % medium and 59 % high educated). Criterion validity of an adapted International Physical Activity Questionnaire was assessed against the ActiGraph GT3X+ accelerometer. RESULTS: While criterion validity of self-reported physical activity was low to moderate in the total sample (Spearman rho ranged from 0.16 to 0.27, depending on the variables used), the validity in lower educated respondents was poor (-0.07 to 0.05). CONCLUSIONS: The results confirm the hypothesis that self-report physical activity questionnaires are less valid in lower educated populations

Does the importance of dietary costs for fruit and vegetable intake vary by socioeconomic position?

Evidence suggests that diets meeting recommendations for fruit and vegetable (F&V) intake are more costly. Dietary costs may be a greater constraint on the diet quality of people of lower socioeconomic position (SEP). The aim of this study was to examine whether dietary costs are more strongly associated with F&V intake in lower-SEP groups than in higher-SEP groups. Data on individual participants' education and income were available from a population-based, cross-sectional study of 10 020 British adults. F&V intake and dietary costs (GBP/d) were derived from a semi-quantitative FFQ. Dietary cost estimates were based on UK food prices. General linear models were used to assess associations between SEP, quartiles of dietary costs and F&V intake. Effect modification of SEP gradients by dietary costs was examined with interaction terms. Analysis demonstrated that individuals with lowest quartile dietary costs, low income and low education consumed less F&V than individuals with higher dietary costs, high income and high education. Significant interaction between SEP and dietary costs indicated that the association between dietary costs and F&V intake was stronger for less-educated and lower-income groups. That is, socioeconomic differences in F&V intake were magnified among individuals who consumed lowest-cost diets. Such amplification of socioeconomic inequalities in diet among those consuming low-cost diets indicates the need to address food costs in strategies to promote healthy diets. In addition, the absence of socioeconomic inequalities for individuals with high dietary costs suggests that high dietary costs can compensate for lack of other material, or psychosocial resources.This work was undertaken by the Centre for Diet and Activity Research, a UK Clinical Research Collaboration Public Health Research Centre of Excellence. Funding from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, National Institute for Health Research, and Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged. Core MRC Epidemiology Unit support through programmes MC_UU_12015/1 and MC_UU_12015/5 is acknowledged. Funders had no role in the design, conduct, analysis, interpretation or publication of the manuscript.This is the final version of the article. It first appeared from Cambridge University Press via http://dx.doi.org/10.1017/S000711451500302

Individual and environmental correlates of objectively measured sedentary time in Dutch and Belgian adults

As the detrimental health effects of sedentary behaviour are well established, insight into the individual and environmental factors that influence adults' sedentary behaviour is needed. Most studies to date rely on self-reported measures of sedentary time. Therefore, the aim of the current study was to examine individual and environmental correlates of objectively measured sedentary time in Dutch and Belgian adults. Between March and August 2014, Belgian (n = 133) and Dutch (n = 223) adults, recruited as sub-sample of the SPOTLIGHT survey, wore an ActiGraph accelerometer to provide objectively measured sedentary and moderate to vigorous physical activity time. Participants completed a questionnaire assessing sociodemographic (country of residence, age, gender and educational level), lifestyle (sleep, smoking, sugar-containing beverage consumption, alcohol intake), health (body mass index, self-rated health), work (employment status and type of work), happiness, physical environmental (owning a car, number of screens, socioeconomic status and residential density) and social environmental factors (social network, social cohesion). Univariate and multivariable regression analyses showed that Belgian participants had a lower odds of being sedentary for at least 9 hours per day compared to Dutch participants. Women, older participants and those meeting the WHO recommendation for physical activity were also less likely to sit for 9 hours or more per day. Participants doing (heavy) manual work or being in education, homemaker, unemployed had lower odds of being sedentary for at least 9 hours per day compared to participants with a sitting job. Those with a higher self-reported social network also had lower odds for sedentary time. No associations between physical and other social environmental characteristics and sedentary time were found. Our findings add to the growing evidence of factors associated with prolonged sedentary time in adults. These findings may be used to inform the development of strategies and interventions aimed at reducing sedentary time, and to identify high risk groups

Objectively measured physical environmental neighbourhood factors are not associated with accelerometer-determined total sedentary time in adults

Background: The physical neighbourhood environment may influence adults' sedentary behaviour. Yet, most studies examining the association between the physical neighbourhood environment and sedentary behaviour rely on self-reported data of either the physical neighbourhood environment and/or sedentary behaviour. The aim of this study was to investigate the associations between objectively measured physical environmental neighbourhood factors and accelerometer-determined total sedentary time in adults. Methods: In total, 219 Dutch and 128 Belgian adults (mean age +/- SD: 55.8 +/- 15.4 years) were recruited between March and August 2014 as part of the European SPOTLIGHT project. Physical environmental neighbourhood factors, grouped into eight domains, i.e. walking, cycling, public transport, aesthetics, land use mix, grocery stores, food outlets and recreational facilities, were assessed using the SPOTLIGHT Virtual Audit Tool. Sedentary time was collected using ActiGraph GT3X+ accelerometers. General linear mixed models were conducted to examine associations between physical environmental neighbourhood factors and total sedentary time. Results: Participants were sedentary, on average, for 542.9 min/day (SD: 84.3), or 9.1 h/day. None of the examined physical environmental neighbourhood factors were significantly related to total sedentary time. Conclusions: Our findings do not support associations of objectively measured physical environmental neighbourhood factors with adults' objectively sedentary time in Dutch and Belgian adults. More research on sedentary behaviours in settings such as the home and work setting is needed to examine the influence of more specific physical environmental factors on these context-specific sedentary behaviours

Obesogenic environments: a systematic review of the association between the physical environment and adult weight status, the SPOTLIGHT project.

BACKGROUND: Understanding which physical environmental factors affect adult obesity, and how best to influence them, is important for public health and urban planning. Previous attempts to summarise the literature have not systematically assessed the methodological quality of included studies, or accounted for environmental differences between continents or the ways in which environmental characteristics were measured. METHODS: We have conducted an updated review of the scientific literature on associations of physical environmental factors with adult weight status, stratified by continent and mode of measurement, accompanied by a detailed risk-of-bias assessment. Five databases were systematically searched for studies published between 1995 and 2013. RESULTS: Two factors, urban sprawl and land use mix, were found consistently associated with weight status, although only in North America. CONCLUSIONS: With the exception of urban sprawl and land use mix in the US the results of the current review confirm that the available research does not allow robust identification of ways in which that physical environment influences adult weight status, even after taking into account methodological quality

Exploring the mediating role of energy balance-related behaviours in the association between sleep duration and obesity in European adults. The SPOTLIGHT project.

Sleep restriction is a risk factor for weight gain and obesity. Few studies have formally investigated the mediating role of energy balance-related behaviours in the sleep - obesity association. The aim of this study was to explore the mediating role of physical activity, sedentary behaviours and dietary habits in the association of sleep duration with obesity in adults in five European urban regions. Data on self-reported sleep duration, energy balance-related behaviours, height and weight and other covariates were collected between February and September 2014 from participants to the SPOTLIGHT survey (N=5900, mean age 52years). Participants were recruited from 60 urban neighbourhoods in Belgium, France, Hungary, the Netherlands and the United Kingdom. Multilevel logistic regression analyses were used to assess the associations of sleep duration, energy balance-related behaviours and obesity and mediating effects were calculated using MacKinnon's product-of-coefficients method. Results indicated that a 1h increase in sleeping time was associated with a 14% lower likelihood of being obese (OR=0.86, 95%CI=0.80; 0.93). Only work-related sedentary behaviour was identified as a statistically significant mediator in the association between sleep duration and obesity for the total sample, and youngest and oldest age group. We did not find evidence for a mediating role of dietary habits and physical activities

Obesity-related behaviours and BMI in five urban regions across Europe: sampling design and results from the SPOTLIGHT cross-sectional survey.

OBJECTIVES: To describe the design, methods and first results of a survey on obesity-related behaviours and body mass index (BMI) in adults living in neighbourhoods from five urban regions across Europe. DESIGN: A cross-sectional observational study in the framework of an European Union-funded project on obesogenic environments (SPOTLIGHT). SETTING: 60 urban neighbourhoods (12 per country) were randomly selected in large urban zones in Belgium, France, Hungary, the Netherlands and the UK, based on high or low values for median household income (socioeconomic status, SES) and residential area density. PARTICIPANTS: A total of 6037 adults (mean age 52 years, 56% female) participated in the online survey. OUTCOME MEASURES: Self-reported physical activity, sedentary behaviours, dietary habits and BMI. Other measures included general health; barriers and motivations for a healthy lifestyle, perceived social and physical environmental characteristics; the availability of transport modes and their use to specific destinations; self-defined neighbourhood boundaries and items related to residential selection. RESULTS: Across five countries, residents from low-SES neighbourhoods ate less fruit and vegetables, drank more sugary drinks and had a consistently higher BMI. SES differences in sedentary behaviours were observed in France, with residents from higher SES neighbourhoods reporting to sit more. Residents from low-density neighbourhoods were less physically active than those from high-density neighbourhoods; during leisure time and (most pronounced) for transport (except for Belgium). BMI differences by residential density were inconsistent across all countries. CONCLUSIONS: The SPOTLIGHT survey provides an original approach for investigating relations between environmental characteristics, obesity-related behaviours and obesity in Europe. First descriptive results indicate considerable differences in health behaviours and BMI between countries and neighbourhood types

Lack of interest in physical activity : individual and environmental attributes in adults across Europe : the SPOTLIGHT project

A considerable proportion of European adults report little or no interest in physical activity. Identifying individual-level and environmental-level characteristics of these individuals can help designing effective interventions and policies to promote physical activity. This cross-sectional study additionally explored associations between level of interest and physical activity, after controlling for other individual and environmental variables. Measures of objective and perceived features of the physical environment of residence, self-reported physical activity and other lifestyle behaviors, barriers towards physical activity, general health, and demographics were obtained from 5205 European adults participating in the 2014 online SPOTLIGHT survey. t-Tests, chi-square tests, and generalized estimating equations with negative binomial log-link function were conducted. Adults not interested in physical activity reported a higher BMI and a lower self-rated health, were less educated, and to a smaller extent female and less frequently employed. They were more prone to have less healthy eating habits, and to perceive more barriers towards physical activity. Only minor differences were observed in environmental attributes: the non-interested were slightly more likely to live in neighborhoods objectively characterized as less aesthetic and containing more destinations, and perceived as less functional, safe, and aesthetic. Even after controlling for other individual and environmental factors, interest in physical activity remained a significant correlate of physical activity, supporting the importance of this association. This study is among the first to describe characteristics of individuals with reduced interest in physical activity, suggesting that (lack of) interest is a robust correlate of physical activity in several personal and environmental conditions

The SPOTLIGHT virtual audit tool: a valid and reliable tool to assess obesogenic characteristics of the built environment.

BACKGROUND: A lack of physical activity and overconsumption of energy dense food is associated with overweight and obesity. The neighbourhood environment may stimulate or hinder the development and/or maintenance of a healthy lifestyle. To improve research on the obesogenicity of neighbourhood environments, reliable, valid and convenient assessment methods of potential obesogenic characteristics of neighbourhood environments are needed. This study examines the reliability and validity of the SPOTLIGHT-Virtual Audit Tool (S-VAT), which uses remote sensing techniques (Street View feature in Google Earth) for desk-based assessment of environmental obesogenicity. METHODS: A total of 128 street segments in four Dutch urban neighbourhoods - heterogeneous in socio-economic status and residential density - were assessed using the S-VAT. Environmental characteristics were categorised as walking related items, cycling related items, public transport, aesthetics, land use-mix, grocery stores, food outlets and physical activity facilities. To assess concordance of inter- and intra-observer reliability of the Street View feature in Google Earth, and validity scores with real life audits, percentage agreement and Cohen's Kappa (k) were calculated. RESULTS: Intra-observer reliability was high and ranged from 91.7% agreement (k = 0.654) to 100% agreement (k = 1.000) with an overall agreement of 96.4% (k = 0.848). Inter-observer reliability results ranged from substantial agreement 78.6% (k = 0.440) to high agreement, 99.2% (k = 0.579), with an overall agreement of 91.5% (k = 0.595). Criterion validity was substantial to high for most of the categories ranging from 87.3% agreement (k = 0.539) to 99.9% agreement (k = 0.887) with an overall score of 95.6% agreement (k = 0.747). CONCLUSION: These study results suggest that the S-VAT is a highly reliable and valid remote sensing tool to assess potential obesogenic environmental characteristics

Do poverty and wealth look the same the world over? A comparative study of 12 cities from five high-income countries using street images

Urbanization and inequalities are two of the major policy themes of our time, intersecting in large cities where social and economic inequalities are particularly pronounced. Large scale street-level images are a source of city-wide visual information and allow for comparative analyses of multiple cities. Computer vision methods based on deep learning applied to street images have been shown to successfully measure inequalities in socioeconomic and environmental features, yet existing work has been within specific geographies and have not looked at how visual environments compare across different cities and countries. In this study, we aim to apply existing methods to understand whether, and to what extent, poor and wealthy groups live in visually similar neighborhoods across cities and countries. We present novel insights on similarity of neighborhoods using street-level images and deep learning methods. We analyzed 7.2 million images from 12 cities in five high-income countries, home to more than 85 million people: Auckland (New Zealand), Sydney (Australia), Toronto and Vancouver (Canada), Atlanta, Boston, Chicago, Los Angeles, New York, San Francisco, and Washington D.C. (United States of America), and London (United Kingdom). Visual features associated with neighborhood disadvantage are more distinct and unique to each city than those associated with affluence. For example, from what is visible from street images, high density poor neighborhoods located near the city center (e.g., in London) are visually distinct from poor suburban neighborhoods characterized by lower density and lower accessibility (e.g., in Atlanta). This suggests that differences between two cities is also driven by historical factors, policies, and local geography. Our results also have implications for image-based measures of inequality in cities especially when trained on data from cities that are visually distinct from target cities. We showed that these are more prone to errors for disadvantaged areas especially when transferring across cities, suggesting more attention needs to be paid to improving methods for capturing heterogeneity in poor environment across cities around the world