The geospatial and conceptual configuration of the natural environment impacts the association with health outcomes and behavior in children and adolescents.

BACKGROUND Studies investigating associations between natural environments and health outcomes or health behaviors in children and adolescents yielded heterogenous results to date. This may be the result of different geospatial configurations of the natural environment and confounding characteristics of the study population. Thus, we investigated how the relationship between the natural environment and mental health, muscular fitness, and physical activity varies depending on the geospatial configuration of nature and children's and adolescents' characteristics. METHODS Data were derived from the German Motorik-Modul (MoMo) cohort study (2018-2020) that investigates physical activity, muscular fitness, and health parameters in a national sample of children and adolescents (N = 2843) between four and 17 years (Mage = 10.46 ± 3.49 years; 48.3% girls). Mental health was assessed via questionnaire, muscular fitness via standing long jump, and physical activity with 7-day accelerometer measurement. Using geographic information systems, land cover, and land use data, three different nature definitions were applied. Both circular buffers (100-1000 m) and street-network buffers (1000-5000 m) were created for each of the nature definitions. Associations were explored with linear regression models, and interaction analysis was used to investigate how those relationships vary by gender, age, and socio-economic status. RESULTS The relationship between the three outcomes and the natural environment varied considerably depending on the nature definition, buffer size, and buffer type, as well as socio-demographic characteristics. Specifically, when comparing youth with a high socio-economic status to those with a medium socio-economic status, smaller circular buffer distances were related to less physical activity, but larger street-network buffer distances were related to greater mental health problems. Distinct relationships also occurred for youth with low socio-economic status in those relationships, with the pattern being less clear. CONCLUSIONS For future health research studies that investigate the role of the natural environment, we argue for the development of an a-priori model that integrates both geospatial considerations (nature definition, buffer type, and buffer size) and conceptual considerations (health outcome/behavior, sample characteristics) based on potentially underlying mechanisms that link the natural environment and the health outcome or behavior under investigation to theoretically underpin the geospatial configuration of the natural environment

The geospatial and conceptual configuration of the natural environment impacts the association with health outcomes and behavior in children and adolescents

Background Studies investigating associations between natural environments and health outcomes or health behaviors in children and adolescents yielded heterogenous results to date. This may be the result of different geospatial configurations of the natural environment and confounding characteristics of the study population. Thus, we investigated how the relationship between the natural environment and mental health, muscular fitness, and physical activity varies depending on the geospatial configuration of nature and children’s and adolescents’ characteristics. Methods Data were derived from the German Motorik-Modul (MoMo) cohort study (2018–2020) that investigates physical activity, muscular fitness, and health parameters in a national sample of children and adolescents (N = 2843) between four and 17 years (Mage = 10.46 ± 3.49 years; 48.3% girls). Mental health was assessed via questionnaire, muscular fitness via standing long jump, and physical activity with 7-day accelerometer measurement. Using geographic information systems, land cover, and land use data, three different nature definitions were applied. Both circular buffers (100–1000 m) and street-network buffers (1000–5000 m) were created for each of the nature definitions. Associations were explored with linear regression models, and interaction analysis was used to investigate how those relationships vary by gender, age, and socio-economic status. Results The relationship between the three outcomes and the natural environment varied considerably depending on the nature definition, buffer size, and buffer type, as well as socio-demographic characteristics. Specifically, when comparing youth with a high socio-economic status to those with a medium socio-economic status, smaller circular buffer distances were related to less physical activity, but larger street-network buffer distances were related to greater mental health problems. Distinct relationships also occurred for youth with low socio-economic status in those relationships, with the pattern being less clear. Conclusions For future health research studies that investigate the role of the natural environment, we argue for the development of an a-priori model that integrates both geospatial considerations (nature definition, buffer type, and buffer size) and conceptual considerations (health outcome/behavior, sample characteristics) based on potentially underlying mechanisms that link the natural environment and the health outcome or behavior under investigation to theoretically underpin the geospatial configuration of the natural environment

Children and adolescents do not compensate for physical activity but do compensate for sedentary behavior [Kinder und Jugendliche kompensieren nicht für körperliche Aktivität, jedoch für sitzendes Verhalten]

Little is known about behavioral transfer and compensation within and between moderate-to-vigorous physical activity (MVPA) and sedentary behavior. Thus, taking a within-person perspective, this study investigated across 1 week whether (a) children and adolescents compensate for increased MVPA and sedentary behavior with less of the respective behavior the next day and (b) transfer and compensation occur between these behaviors within 1 day and across 2 days. We obtained data from 2676 participants (6–17 years) of the national Motorik-Modul (MoMo) study in Germany. Participants wore an ActiGraph accelerometer (Pensacola, FL, USA) for 7 days. We analyzed within- and between-day associations using hierarchical linear modeling. If youth engaged in 2 h more sedentary behavior than typical on any given day, they engaged in 37.20 min less MVPA the same day (B = −0.31, p < 0.001) as well as in 4.80 min more MVPA (B = 0.04, p < 0.001) and 7.20 min less sedentary behavior (B = −0.06, p < 0.001) the next day. If youth engaged in 1 h more MVPA than typical on any given day, they engaged in 97.80 min less sedentary behavior the same day (B = −1.63, p < 0.001) and in 5.40 min less sedentary behavior the next day (B = −0.09, p < 0.001). No association with next-day MVPA was observed. Our results indicate that children do not compensate for enhanced MVPA but transfer to less sedentary behavior, while more sedentary behavior is compensated with less sedentary behavior and more MVPA the next day. This provides essential information for the design of intervention studies to tackle physical inactivity and sedentary behavior

Exploratory Determined Correlates of Physical Activity in Children and Adolescents: The MoMo Study

Background: Physical activity is an important contributor to reducing the risk for a variety of diseases. Understanding why people are physically active contributes to evidence-based planning of public health interventions because successful actions will target factors known to be related to physical activity (PA). Therefore the aim of this study is to identify the most meaningful correlates of PA in children and adolescents using a large, representative data set. Methods: Among n = 3539 (1801 boys) 6 to 17-year-old participants of the German representative Motorik-Modul baseline study (2003–2006) a total of 1154 different demographic, psychological, behavioral, biological, social and environmental factors were ranked according to their power of predicting PA using least absolute shrinkage and selection operator (LASSO) regressions. Results: A total of 18 (in girls) and 19 (in boys) important PA predictors from different, personal, social and environmental factors have been identified and ranked by LASSO. Peer modeling and physical self-concept were identified as the strongest correlates of PA in both boys and girls. Conclusions: The results confirm that PA interventions must target changes in different categories of PA correlates, but we suggest to focus particularly on the social environment and physical self-concept for interventions targeting children and adolescents in Germany nowadays. We also strongly recommend to repeatedly track correlates of PA, at least every 10 years, from representative samples in order to tailor contemporary PA interventions

Measurement of Physical Activity and Sedentary Behavior by Accelerometry Among a Nationwide Sample from the KiGGS and MoMo Study: Study Protocol

Background: Currently, no nationwide objective physical activity data exists for children and adolescents living in Germany. The German Health Interview and Examination Survey for Children and Adolescents (KiGGS) and the Motorik-Modul study (MoMo) is a national cohort study that has incorporated accelerometers in its most recent data collection wave (wave 2, since 2014). This wave 2 marks the first nationwide collection of objective data on the physical activity of children and adolescents living in Germany. Objective: The purpose of this protocol is to describe the methods used in the KiGGS and MoMo study to capture the intensity, frequency, and duration of physical activity with accelerometers. Methods: Participants (N=11,003, aged 6 to 31 years) were instructed to wear an ActiGraph GT3X+ or wGT3X-BT accelerometer laterally on the right hip. Accelerometers were worn on consecutive days during waking hours, including at least 4 valid weekdays and 1 weekend day (wear time >8 hours) in the evaluation. A nonwear time protocol was also implemented. Results: Data collection was completed by October 2017. Data harmonization took place in 2018. The first accelerometer results from this wave were published in 2019, and detailed analyses are ready to be submitted in 2020. Conclusions: This study protocol provides an overview of technical details and basic choices when using accelerometers in large-scale epidemiological studies. At the same time, the restrictions imposed by the specified filters and the evaluation routines must be taken into account

Associations between green space availability and youth’s physical activity in urban and rural areas across Germany

Green space may be an important physical activity facilitator for children and adolescents. However, to date, most studies focused on urban green space, and few studies investigated associations between green space and physical activity across urban and rural areas, which was the goal of this study. Data were obtained from a German cohort study, including 1,211 youth aged 6–17 years. Residential green space was assessed within a 1000 m street-network buffer using land cover and land use data and divided into quartiles, urbanicity using the European Urbanization Degree, and moderate-to-vigorous physical activity (MVPA) using accelerometers. Associations were investigated via linear regression analysis stratified by urbanicity degree, controlling for relevant confounders. We found that in rural areas, compared to youth in the bottom green quartile, those within the middle (2nd) and upper (3rd) green quartiles engaged in less MVPA. This relationship was not observed for youth in towns and cities. Interactions occurred between green space and socio-demographic characteristics for children and adolescents in cities: Compared to the bottom green quartile, boys or younger children within the middle green quartile engaged in more MVPA. However, socially disadvantaged children and adolescents in cities engaged in less MVPA in the upper compared to the bottom green quartile. Our results show that associations between green space and MVPA do not only differ between urban and rural areas but also among youth sub-populations. These findings are important to consider for planning policies to create inclusive active living environments across urban and rural areas

Physical Activity and Recurrent Pain in Children and Adolescents in Germany—Results from the MoMo Study

Recurrent pain can be a significant disruption in the activities of daily life, and is not only a health problem in adults but also in children and adolescents. This study analyzed the prevalence of recurrent pain in the current sample (n = 1516; 11–17 years (mean$_{age}$ = 14.4 ± 2.0 years); 50.8% female) of a nationwide study in Germany, evaluated the association of participants’ device-based physical activity (PA) with the prevalence of recurrent pain, and assessed whether children and adolescents who reported pain for the last three months accumulated less PA than those who did not. A higher prevalence was found in girls for recurrent headaches (42.2% vs. 28.7%), abdominal pain (28.2% vs. 20.1%), and back pain (26.9% vs. 19.5%). We found higher odds for recurrent headaches in girls (OR = 1.54) and in participants that did not reach at least 60 min of moderate to vigorous PA (MVPA) per day (OR = 2.06). Girls who reported recurrent headaches accumulated 4.7 min less MVPA per day than those without. The prevalence of pain remains at a high level in the German youth and underscores the need for interventions to improve the health situations of children and adolescents

Testing the Weiss-Harter-Model in a prospective study design: the importance of perceived social support for youth physical activity = Überprüfung des Weiss-Harter-Modells in einem prospektiven Studiendesign: Die Relevanz der wahrgenommenen sozialen Unterstützung für die körperliche Aktivität von Kindern und Jugendlichen

To counteract low physical activity levels in children and adolescents, it is crucial to understand the relevant psychological processes that can promote physical activity in this age group. The Weiss-Harter model focuses on self-esteem as a central construct for physical activity promotion in youth, which mediates the effects of perceived competence and perceived social support on enjoyment and physical activity. However, in two cross-sectional studies, an adapted model was found to have a better model fit in which perceived social support has additional direct effects on physical activity and enjoyment. The purpose of the present study was to compare the original Weiss-Harter model and the adapted model in a prospective study design. Data were based on two assessment waves of the German Motorik-Modul-Study involving 1107 participants (603 female) with a mean age of 13.98 years (SD = 2.03). Participants filled out questionnaires on perceived competence, perceived social support, self-esteem, enjoyment, and moderate-vigorous physical activity (MVPA) during the first assessment. MVPA was again assessed about five years later allowing to test whether the models could predict (1) future MVPA and (2) the difference of MVPA from the first to the second assessment. For both research questions, the original Weiss-Harter model (Model 1a: χ2 = 812.44; df = 95; p < 0.01; CFI = 0.905; RMSEA = 0.083; Model 2a: χ2 = 755.29; df = 95; p < 0.01; CFI = 0.910; RMSEA = 0.079) had a worse fit than the adapted model (Model 1b: χ2 = 512.19; df = 93; p < 0.01; CFI = 0.943; RMSEA = 0.065; Model 2b: χ2 = 513.25; df = 93; p < 0.01; CFI = 0.943; RMSEA = 0.064). The results of this study highlight the role of perceived social support for youth MVPA

Walking and non-motorized vehicle use in adolescents: the role of neighborhood environment perceptions across urbanization levels

Promoting active travel is key to achieving the sustainable development goals of sustainable communities, climate action, and health and well-being. Walking and non-motorized vehicle use (e.g., cycling, longboarding) are influenced by the perceptions of the neighborhood environment. However, most evidence is limited to studies conducted in urban areas. This study aims to assess the relationship between perceived environment and walking as well as non-motorized vehicle use stratified across different levels of urbanicity in adolescents in Germany. Cross-sectional data of 3976 adolescents aged 11–17 (51% female) from the nationwide Motorik-Modul Longitudinal Study in Germany were used. Age, gender, socioeconomic status, neighborhood environment perceptions, duration of walking, and non-motorized vehicle use were assessed via questionnaire. Separate cumulative link mixed models were calculated to analyze the relationships between environment perceptions and walking as well as non-motorized vehicle use across rural areas, small towns, medium-sized towns, and cities. The presence of public sports facilities was related to both walking and non-motorized vehicle use across urbanicity levels. Relationships with other aspects of the perceived environment, such as traffic safety concerns and walking or cycling infrastructure, were more context-specific meaning that associations differed based on active travel mode and urbanicity level. Additionally, non-motorized vehicle use differed considerably across sample points. To conclude, when creating active and sustainable environments for active travel, it is crucial to target specific travel modes and take the urbanicity and regional context into account