Gendered relations? Associations between Swedish parents, siblings, and adolescents' time spent sedentary and physically active

IntroductionThe family is assumed to be fundamental in youth socialization processes and development, connected to social and cultural practices such as healthy lifestyles and physical activity. However, gender patterns in physical activity among adolescents and the structural drivers of gender inequality (e.g., parentage and siblingship) are poorly understood. The aim of this study was to explore further how gender structures relate to adolescents' time spent being sedentary and physically active, using contemporary gender theory.MethodsThis cross-sectional study involved 1,139 adolescents aged 13-14 and their parents, including 815 mothers and 572 fathers. Physical activity and time spent sedentary were assessed through accelerometry among adolescents and through a self-report questionnaire for parents validated against accelerometry.ResultsThe results showed significant relationships between mothers' moderate-to-vigorous physical activity (MVPA) and girls' MVPA on weekdays and weekends, and fathers' MVPA was significantly related to girls' MVPA on weekdays. Our results imply that the relationship between Swedish parents' and adolescent girls' physical activity in higher intensities are to some extent gendered practices. However, time spent sedentary does not seem to show any patterns of being performed according to binary ideas of gender. Further, our exploratory analyses suggest that these results somewhat intersect with parents' educational level and relate to intra-categorical aspects of doing gender. The results also indicate slight gendered patterns in the “doing” of brotherhood for time spent sedentary, however, for boys only on weekends.DiscussionThe study contributes to the understanding of gender norms as constraints and enablers for adolescents' participation in physical activity. The results can spur public health and physical activity research to apply a contemporary gender theory approach, and to expand the research agenda connected to what relates to gender inequalities in physical activity practices

Use of a Web-Based Dietary Assessment Tool (RiksmatenFlex) in Swedish Adolescents: Comparison and Validation Study

BACKGROUND: A Web-based dietary assessment tool-RiksmatenFlex-was developed for the national dietary survey of adolescents in Sweden. OBJECTIVE: This study aimed to describe the Web-based method RiksmatenFlex and to test the validity of the reported dietary intake by comparing dietary intake with 24-hour dietary recalls (recall interviews), estimated energy expenditure, and biomarkers. METHODS: Adolescents aged 11-12, 14-15, and 17-18 years were recruited through schools. In total, 78 students had complete dietary information and were included in the study. Diet was reported a few weeks apart with either RiksmatenFlexDiet (the day before and a random later day) or recall interviews (face-to-face, a random day later by phone) in a cross-over, randomized design. At a school visit, weight and height were measured and blood samples were drawn for biomarker analyses. Students wore an accelerometer for 7 days for physical activity measurements. Dietary intake captured by both dietary methods was compared, and energy intake captured by both methods was compared with the accelerometer-estimated energy expenditure (EEest). Intake of whole grain wheat and rye and fruit and vegetables by both methods was compared with alkylresorcinol and carotenoid concentrations in plasma, respectively. RESULTS: The mean of the reported energy intake was 8.92 (SD 2.77) MJ by RiksmatenFlexDiet and 8.04 (SD 2.67) MJ by the recall interviews (P=.01). Intake of fruit and vegetables was 224 (169) g and 227 (150) g, and whole grain wheat and rye intake was 12.4 (SD 13.2) g and 12.0 (SD 13.1) g, respectively; the intakes of fruit and vegetables as well as whole grain wheat and rye did not differ between methods. Intraclass correlation coefficients ranged from 0.57 for protein and carbohydrates to 0.23 for vegetables. Energy intake by RiksmatenFlexDiet was overreported by 8% (P=.03) but not by the recall interviews (P=.53) compared with EEest. The Spearman correlation coefficient between reported energy intake and EEest was 0.34 (P=.008) for RiksmatenFlexDiet and 0.16 (P=.21) for the recall interviews. Spearman correlation coefficient between whole grain wheat and rye and plasma total alkylresorcinol homologs was 0.36 (P=.002) for RiksmatenFlexDiet and 0.29 (P=.02) for the recall interviews. Spearman correlations between intake of fruit and vegetables and plasma carotenoids were weak for both dietary tools. The strongest correlations were observed between fruit and vegetable intake and lutein/zeaxanthin for RiksmatenFlexDiet (0.46; P<.001) and for recall interviews (0.28; P=.02). CONCLUSIONS: RiksmatenFlexDiet provides information on energy, fruit, vegetables, and whole grain wheat and rye intake, which is comparable with intake obtained from recall interviews in Swedish adolescents. The results are promising for cost-effective dietary data collection in upcoming national dietary surveys and other studies in Sweden. Future research should focus on how, and if, new technological solutions could reduce dietary reporting biases

A healthy school start - Parental support to promote healthy dietary habits and physical activity in children: Design and evaluation of a cluster-randomised intervention

<p>Abstract</p> <p>Background</p> <p>Childhood obesity is multi-factorial and determined to a large extent by dietary habits, physical activity and sedentary behaviours. Previous research has shown that school-based programmes are effective but that their effectiveness can be improved by including a parental component. At present, there is a lack of effective parental support programmes for improvement of diet and physical activity and prevention of obesity in children.</p> <p>Methods/Design</p> <p>This paper describes the rationale and design of a parental support programme to promote healthy dietary habits and physical activity in six-year-old children starting school. The study is performed in close collaboration with the school health care and is designed as a cluster-randomised controlled trial with a mixed methods approach. In total, 14 pre-school classes are included from a municipality in Stockholm county where there is large variation in socio-economic status between the families. The school classes are randomised to intervention (n = 7) and control (n = 7) groups including a total of 242 children. The intervention is based on social cognitive theory and consists of three main components: 1) a health information brochure; 2) two motivational interviewing sessions with the parents; and 3) teacher-led classroom activities with the children. The primary outcomes are physical activity in the children measured objectively by accelerometry, children's dietary and physical activity habits measured with a parent-proxy questionnaire and parents' self-efficacy measured by a questionnaire. Secondary outcomes are height, weight and waist circumference in the children. The duration of the intervention is six months and includes baseline, post intervention and six months follow-up measurements. Linear and logistic regression models will be used to analyse differences between intervention and control groups in the outcome variables. Mediator and moderator analysis will be performed. Participants will be interviewed.</p> <p>Discussion</p> <p>The results from this study will show if it is possible to promote a healthy lifestyle and a normal weight development among children from low-income districts with relatively limited efforts involving parents. Hopefully the study will provide new insights to the further development of effective programmes to prevent overweight and obesity in children.</p> <p>Trial registration</p> <p>ISRCTN: <a href="http://www.controlled-trials.com/ISRCTN32750699">ISRCTN32750699</a></p

Physical activity in 6-10 year old children : Variations over time, associations with metabolic risk factors and role in obesity prevention

Background and Aims: Childhood overweight and obesity are emerging health problems in all western countries and also in urban areas in developing countries. In Sweden, the prevalence of overweight and obesity has been rapidly increasing. The aim of this thesis was to assess the efficacy of a school-based intervention programme in reducing the prevalence of overweight in 6-10 year old children. Another aim was to examine the stability of physical activity (PA), and differences in PA patterns in relation to age and gender. Also, to study differences in metabolic risk between groups of normal weight and moderately overweight children and associations with PA and cardio-respiratory fitness (CRF). Material and Methods: 3135 boys and girls aged 6 to 10 years were included in the study. Ten schools were selected in Stockholm county area and randomised to intervention (n=5) and control (n=5) schools. Low fat dairy products and whole grain bread were promoted and all sweets and sweetened drinks were eliminated in intervention schools. PA was aimed to increase by 30 minutes per day during school time and sedentary behaviour restricted during after school care time. Eating habits at home were assessed by parental report. Eating attitudes were evaluated by self-report. PA was objectively measured during 7 days by accelerometry in 1293 children. Two sub-groups of children provided repeated measurements of physical activity. 68 children were selected based on their BMI and categorised into normal weight and overweight/obese. CRF was measured with a maximal ergometer cycle test and body composition with dual-energy x-ray absorptiometry (DXA). Oral glucose tolerance test was performed and triglycerides (TG) and HDL-cholesterol were measured from fasting blood samples. A metabolic risk score was computed and calculated as the mean of the standardised values of the outcome scores (i.e. insulin, glucose, TG, HDL and blood pressure). Results: The prevalence of overweight and obesity decreased by 3.2% (from 20.3 to 17.1) in intervention schools compared to an increase of 2.8% (from 16.1 to 18.9) in control schools (P<0.05). The results showed no difference between intervention and controls, after cluster adjustment, in the longitudinal analysis of BMI SDS changes. However, a larger proportion of the children who were initially overweight reached normal weight in the intervention group (14%) compared to the control group (7.5%) (P=0.017). PA did not differ between intervention and control schools after cluster adjustment. Eating habits at home were found to be healthier among families with children in intervention schools at the end of the intervention. There was no difference between children in intervention and control schools in selfreported eating attitudes. Mean daily PA differed significantly across age groups (P<0.001) and was significantly lower during weekends compared to weekdays in all age groups (P<0.001). This decline was similar across low, medium and highly active children. The difference in mean PA between boys and girls was highest during school time (P<0.001) and after school care time (P<0.001). Baseline physical activity was significantly correlated with physical activity at follow-up (r=0.59). There was a significant difference between normal weight and overweight children in clustered metabolic risk (P=0.03), insulin (AUC) (P=0.01), fasting insulin (P=0.003) and systolic blood pressure (P=0.02). PA and CRF did not differ significantly between groups. PA and CRF were negatively associated with insulin levels. Conclusions: A school-based intervention can reduce the prevalence of overweight and obesity in 6-10 year old children and may affect eating habits at home. The effect of the intervention was possibly due to its effect on healthy eating habits at school and at home rather than on increased levels of PA. The decline in PA in children may start already at the age of 6 years. The difference in PA levels between girls and boys is most pronounced during school time. PA levels are disproportionally low during weekends. Repeated measurements show that PA levels are fairly stable over time. Metabolic risk factors are elevated in moderately overweight pre-pubertal children compared with normal weight controls. This is not due to lower PA or CRF in the overweight group although PA and CRF were associated with lower insulin levels. This suggests a detrimental effect of a moderate excess of adiposity already at an early age

Associations between the School Environment and Physical Activity Pattern during School Time in Swedish Adolescents

Knowledge about associations between school-based initiatives and physical activity patterns is limited. The purpose of this paper was to examine associations between factors in the school environment, physical activity and sedentary time during school time. The cross-sectional study included 1139 adolescents aged 13–14 from 34 schools. Physical activity and sedentary time were measured using hip-worn accelerometers. Factors in the school environment included health policy, a mobile phone ban during breaks, organized physical activities during breaks and activity breaks during lessons reported by teachers. The frequency and duration of breaks and physical education (PE) lessons were collected from school schedules. The results showed significant associations between health policy (β = 3.87, 95% confidence interval (CI): 2.37, 5.23), the mobile phone ban (β = 2.51, 95% CI: 1.29, 3.94) and PE; total duration (β = 0.08, 95% CI: 0.05, 0.11), average duration (β = 0.08, 95% CI: 0.01, 0.13) and frequency (β = 1.73, 95% CI: 0.50, 3.04) and moderate-vigorous physical activity. There were negative associations between health policy (β = −6.41, 95% CI: −10.24, −2.67), the mobile phone ban (β = −3.75, 95% CI: −7.25, −0.77) and PE; total duration (β = −0.15, 95% CI: −0.23, −0.08) and average duration (β = −0.14, 95% CI: −0.27, −0.03) and time spent sedentary. Adolescents attending schools with health policies, mobile phone bans and more time for PE showed higher levels of physical activity and lower sedentary time

Sedentary activity bout length was associated with BMI and waist circumference in Swedish children aged 5-7 years.

AIM: This study examined the pattern of sedentary behaviour during the week and on weekends, and associations with health outcomes among children aged 5-7 years in Sweden. METHODS: This cross-sectional study used data from 342 children, many of whom had at least one parent born outside the Nordic region. Physical activity and sedentary time were measured by accelerometry. A sedentary bout was defined as 1-4 and 5-9 minutes. Diet, time in front of television or computer screen, sleep and physical activity behaviour were measured via parental reports, and anthropometric data by research staff. RESULTS: The number of sedentary bouts was higher on weekends than on weekdays. Compared to girls, boys had more 1-4 minute bouts on both weekdays and weekend days, and more 5-9 minute bouts on weekends. A higher number of 5-9 minute bouts was associated with a higher body mass index and waist circumference. CONCLUSION: This study showed an association between sedentary activity and weight status in children as young as 5-7 years. Reducing time, especially longer bouts, spent in sedentary activities may encourage healthy weight development in children

Associations between organised sports participation, general health, stress, screen-time and sleep duration in adolescents.

AIM: Physical activity patterns in adolescents have been associated with general health. Stress, screen-time and sleep are other factors associated with physical activity that influence health in adolescents. Physical activity accounts for several health benefits; however, the impact of organised sports participation to achieve the same health benefits are less explored. This study explored the associations of organised sports participation with general health, stress, screen-time and sleep-duration in adolescents. METHODS: For this cross-sectional study, data from 1139 adolescents (age 13-14 years) from 34 schools were analysed. Data were collected during autumn 2019. Data collection consisted of self-reported questionnaires and standard methods for height and weight measurements. RESULTS: Adolescents with organised sports participation ≥3 times/week were twice as likely to report better general health (OR: 2.11, CI: 1.45-3.07) and lower screen-time (OR: 1.98, CI: 1.43-2.74). Adolescents with organised sports participation ≥3 times/week were less likely to meet the recommended sleep-duration on weekdays (OR: 0.43, 95% CI: 0.29-0.65). CONCLUSIONS: Adolescents with frequent organised sports participation had better general health, lower amounts of screen-time and shorter sleep-duration on weekdays than those with no participation. Although the causal relationships remain unknown, these results can be relevant when developing strategies promoting physical activity and health in adolescents.Projektet samfinansieras av KK-stiftelsen, Coop AB, Skanska, IKEA, Generation Pep, Skandia och Konsumentföreningen Stockholm samt GIH.Fysisk aktivitet för främjande av hjärnhälsa bland skolungdomar, Hjärnhälsa i skolan

COVID-19 and unfavorable changes in mental health unrelated to changes in physical activity, sedentary time, and health behaviors among Swedish adolescents : A longitudinal study.

BACKGROUND: The COVID-19 pandemic has had major impact on the daily lives of adolescents. This study examined whether mental health outcomes had changed over the pandemic, and if such changes were related to changes in physical activity (PA), sedentary time, sleep, screen time, and participation in organized sports. MATERIALS AND METHODS: In this longitudinal study, data were collected in autumn 2019 with follow-up measurements in spring 2021. In total, 558 schools were invited and 34 schools around Stockholm with a variation in socioeconomic background were included. Physical activity and sedentary time were measured for seven consecutive days by accelerometry (Actigraph). Anxiety, health-related quality of life (HRQoL), psychosomatic health, stress, sleep duration, screen time, and organized sports participation were self-reported in questionnaires. Linear models were applied to estimate associations between changes in mental health outcomes and exposures. RESULTS: From the baseline sample of 1,139 participants, 585 (55% girls), mean (SD) age 14.9 (0.3) years, participated in the follow-up. Between 2019 and 2021, there was a decrease in HRQoL [mean difference -1.7 (-2.3, -1.2), p &lt; 0.001], increase in psychosomatic health problems [mean difference 1.8 (1.3, 2.3), p &lt; 0.001], and an increase in the number of participants with high stress [from 94 (28%) to 139 (42%), p &lt; 0.001]. Weekly light PA and sleep duration decreased and weekly sedentary time and screen time increased unrelated to changes in mental health outcomes. An increase in sleep duration during weekdays was significantly related to both a decrease in anxiety (B = -0.71, CI: -1.36, -0.06) and an increase in HRQoL (B = 1.00, CI: 0.51, 1.49). CONCLUSION: During the COVID-19 pandemic, mental health appears to have been impaired in Swedish adolescents, but unrelated to changes in PA, sedentary time, screen time, or participation in organized sports. However, increased sleep duration on weekdays was related to less anxiety and better HRQoL. The results may help policy makers and other stakeholders comprehend the differential effects of the COVID-19 pandemic on mental health outcomes and help guiding the planning of policy actions. TRIAL REGISTRATION: ISRCTN15689873.Projektet samfinansieras av KK-stiftelsen, COOP, Skandia, Skanska, IKEA, Generation PEP, Konsumentföreningen i Stockholm samt FolkhälsomyndighetenFysisk aktivitet för främjande av hjärnhälsa bland skolungdomar, Hjärnhälsa i skola

Adolescents' experiences of a school-based health promotion intervention in socioeconomically advantaged and disadvantaged areas in Sweden : a qualitative process evaluation study.

BACKGROUND: Adolescence is a transition period in which positive experiences of physical activity have the potential to last into later adulthood. These experiences are influenced by socioeconomic determinants, leading to health inequalities. This study aims to explore adolescents' experiences and participation in a multi-component school-based intervention in schools located in socioeconomically advantaged and disadvantaged areas in Sweden. METHODS: A qualitative design was used to evaluate how participants experienced the intervention. The intervention was a multi-component school-based intervention. It was conducted in six schools (four control and two intervention schools) with a total of 193 students and lasted one school year. It was teacher-led and consisted of three 60-minute group sessions per week: varied physical activities, homework support with activity breaks, and walks while listening to audiobooks. In total, 23 participant observations were conducted over eight months and 27 students participated in focus groups. A content analysis was conducted. RESULTS: The results describe a main category 'Engaging in activities depending on socioeconomic status' and three generic categories: 1. Variations in participation in PA together with classmates and teachers; 2. Variations in engagement in PA after school; and 3. Differences in time and place allocated to do homework and listen to audiobooks. These categories illustrate how participants looked forward to the physical activities but used the time spent during the walks and homework support differently depending on how busy they were after school. Frequently, those who were busiest after school were also those from the advantaged area, and those who had little to do after school were from the disadvantaged area. CONCLUSION: Socioeconomic factors influence participants' possibilities to engage in the intervention activities as well as how they use their time in the activities. This study showed that it is crucial to support adolescents' participation in physical activities by providing structure and engaging well-known teachers in the activities, especially in schools located in disadvantaged areas.Partners are IKEA, Kronprinsessparets stiftelse/Generation Pep, Storytel, SATS and Permobil.</p