Health promotion interventions in social economy companies in Flanders (Belgium)

Background

Disadvantaged groups are often not reached by mainstream health promotion interventions. Implementing health promotion (HP) interventions in social economy companies, can be an opportunity to reach those people. The implementation of these interventions in social economy companies was studied. Factors that could be related to the implementation of HP and being supportive towards implementation in the future, were investigated.

Methods

An online, quantitative survey was sent to all 148 sheltered and social workshops in Flanders. In the questionnaire, the status of HP interventions and characteristics of the workshop were explored. Personal factors (such as attitudes towards HP, behavioural control, social norms and moral responsibility) were asked to the person responsible for implementation of HP interventions. Univariate and multivariate logistic regressions were performed.

Results

Respondents of 88 workshops completed the questionnaire. Almost 60 % of the workshops implemented environmental or policy interventions. Having a positive attitude towards HP, being more morally responsible, and having the subjective norm that employees are positive towards health promotion at work, were related to being more supportive towards the implementation of HP in the univariate analyses. Only attitude stayed significantly related to being more supportive towards the implementation of HP in the multivariate analyses.

Conclusions

Sheltered and social workshops are open to HP interventions, but more can be done to optimize the implementation. To persuade persons responsible for the implementation of HP to invest more in HP, changing attitudes concerning the benefits of health promotion for the employee and the company, is an important strategy.

Perceived environmental correlates of cycling for transport among adults in five regions of Europe

Regular cycling for transport is an important potential contributor to daily physical activity among adults. Characteristics of the physical environment are likely to influence cycling for transport. The current study investigated associations between perceived physical environmental neighbourhood factors and adults' cycling for transport across five urban regions across Europe, and whether such associations were moderated by age, gender, education and urban region. A total of 4,612 adults from five European regions provided information about their transport-related cycling and their neighbourhood physical environmental perceptions in an online survey. Hurdle models adjusted for the clustering within neighbourhoods were performed to estimate associations between perceived physical environmental neighbourhood factors and odds of engaging in cycling for transport and minutes of cycling for transport per week. Inhabitants of neighbourhoods that were perceived to be polluted, having better street connectivity, having lower traffic speed levels and being less pleasant to walk or cycle in had higher levels of cycling for transport. Moderation analyses revealed only one interaction effect by gender. This study indicates that cycling for transport is associated with a number of perceived physical environmental neighbourhood factors across five urban regions across Europe. Our results indicated that the majority of the outcomes identified were valid for all subgroups of age, gender, education and across regions in the countries included in the study.

Neighborhood walkability and health outcomes among older adults: The mediating role of physical activity

We examined the mediating role of physical activity on the relationships of walkability with Flemish older adults' health outcomes. In low income neighborhoods, residents of high walkable neighborhoods had a 1.5 kg/m(2) lower BMI than low walkable residents. Of this difference 0.3 kg/m(2) (19%) and 0.2 kg/m(2) (12%) were explained through walking for transport and MVPA, respectively. Similar findings were observed for waist circumference. Walkability did not relate to functional performance or quality of life. Walkable neighborhoods may benefit older adults' health, especially in low income neighborhoods. More research in other contexts is warranted to confirm current findings.

Creating Cycling-Friendly Environments for Children: Which Micro-Scale Factors Are Most Important? An Experimental Study Using Manipulated Photographs

BACKGROUND

Increasing participation in transportation cycling represents a useful strategy for increasing children's physical activity levels. Knowledge on how to design environments to encourage adoption and maintenance of transportation cycling is limited and relies mainly on observational studies. The current study experimentally investigates the relative importance of micro-scale environmental factors for children's transportation cycling, as these micro-scale factors are easier to change within an existing neighborhood compared to macro-scale environmental factors (i.e. connectivity, land-use mix, …).

METHODS

Researchers recruited children and their parents (n = 1232) via 45 randomly selected schools across Flanders and completed an online questionnaire which consisted of 1) demographic questions; and 2) a choice-based conjoint (CBC) task. During this task, participants chose between two photographs which we had experimentally manipulated in seven micro-scale environmental factors: type of cycle path; evenness of cycle path; traffic speed; traffic density; presence of speed bumps; environmental maintenance; and vegetation. Participants indicated which route they preferred to (let their child) cycle along. To find the relative importance of these micro-scale environmental factors, we conducted Hierarchical Bayes analyses.

RESULTS

Type of cycle path emerged as the most important factor by far among both children and their parents, followed by traffic density and maintenance, and evenness of the cycle path among children. Among parents, speed limits and maintenance emerged as second most important, followed by evenness of the cycle path, and traffic density.

CONCLUSION

Findings indicate that improvements in micro-scale environmental factors might be effective for increasing children's transportation cycling, since they increase the perceived supportiveness of the physical environment for transportation cycling. Investments in creating a clearly designated space for the young cyclist, separated from motorized traffic, appears to be the most effective way to increase perceived supportiveness. Future research should confirm our laboratory findings with experimental on-site research.

Longitudinal study on the association between three dietary indices, anthropometric parameters and blood lipids

BACKGROUND

From a health promotion perspective, the use of dietary indices is preferred above single nutrients and foods to evaluate diet quality. Longitudinal research about the association between dietary indices and respectively anthropometric parameters and blood lipids is lacking. The aim of this study was to investigate the longitudinal association between three dietary indices (Healthy Eating Index-2010 (HEI), Mediterranean Diet Score (MDS) and Diet Quality Index (DQI)) and respectively anthropometric parameters and blood lipids.

METHODS

A three day diet record was completed by 373 men and 197 women in 2002-2004 and 2012-2014. HEI, MDS and DQI were calculated. Waist circumference (WC) and Body Mass Index (BMI) were used as anthropometric parameters. A linear regression analysis was performed to investigate associations between changes in dietary indices and changes in respectively anthropometric parameters and blood lipids, adjusted for potential confounders.

RESULTS

Only in men an increase in all three dietary indices was associated with a decrease in WC and BMI in the non-adjusted analysis and for HEI and DQI also in the adjusted analysis. No longitudinal associations were found between dietary indices and blood lipids both in men and women.

CONCLUSIONS

Only few associations were found between dietary indices and anthropometric parameters, whilst no associations were found with blood lipids. An increase in dietary indices was associated with an improvement in anthropometric parameters only in men. As this is the first study investigating associations between changes in dietary indices and changes in respectively anthropometric parameters and blood lipids, further research is needed to evaluate these possible associations.

Correlates of University Students' Soft and Energy Drink Consumption According to Gender and Residency

This study assessed personal and environmental correlates of Belgian university students' soft and energy drink consumption and investigated whether these associations were moderated by gender or residency. Four hundred twenty-five university students completed a self-reported on-line questionnaire assessing socio-demographics, health status, soft and energy drink consumption, as well as personal and environmental factors related to soft and energy drink consumption. Multiple linear regression analyses were conducted. Students believing soft drink intake should be minimized (individual subjective norm), finding it less difficult to avoid soft drinks (perceived behavioral control), being convinced they could avoid soft drinks in different situations (self-efficacy), having family and friends who rarely consume soft drinks (modelling), and having stricter family rules about soft drink intake were less likely to consume soft drinks. Students showing stronger behavioral control, having stricter family rules about energy drink intake, and reporting lower energy drink availability were less likely to consume energy drinks. Gender and residency moderated several associations between psychosocial constructs and consumption. Future research should investigate whether interventions focusing on the above personal and environmental correlates can indeed improve university students' beverage choices.

Diurnal Patterns and Correlates of Older Adults' Sedentary Behavior

INTRODUCTION

Insights into the diurnal patterns of sedentary behavior and the identification of subgroups that are at increased risk for engaging in high levels of sedentary behavior are needed to inform potential interventions for reducing older adults' sedentary time. Therefore, we examined the diurnal patterns and sociodemographic correlates of older adults' sedentary behavior(s).

METHODS

Stratified cluster sampling was used to recruit 508 non-institutionalized Belgian older adults (≥ 65 years). Morning, afternoon, evening and total sedentary time was assessed objectively using accelerometers. Specific sedentary behaviors, total sitting time and sociodemographic attributes were assessed using an interviewer-administered questionnaire.

RESULTS

Participants self-reported a median of 475 (Q1-Q3 = 383-599) minutes/day of total sitting time and they accumulated a mean of 580 ± 98 minutes/day of accelerometer-derived sedentary time. Sedentary time was lowest during the morning and highest during the evening. Older participants were as sedentary as younger participants during the evening, but they were more sedentary during daytime. Compared to married participants, widowers were more sedentary during daytime. Younger participants (< 75 years), men and the higher educated were more likely to engage in (high levels of) sitting while driving a car and using the computer. Those with tertiary education viewed 29% and 22% minutes/day less television compared to those with primary or secondary education, respectively. Older participants accumulated 35 sedentary minutes/day more than did younger participants and men accumulated 32 sedentary minutes/day more than did women.

CONCLUSION

These findings highlight diurnal variations and potential opportunities to tailor approaches to reducing sedentary time for subgroups of the older adult population.

IPAQ interview version: convergent validity with accelerometers and comparison of physical activity and sedentary time levels with the self-administered version

AIM

This study aimed to assess convergent validity of International Physical Activity Questionnaire (IPAQ) interview (long form, last seven days), and to examine differences in reported physical activity and sedentary time between the self-administered and interview versions of the long IPAQ (last seven days); and whether these differences depend on gender, age, educational level and weight status.

METHODS

In total, 542 Belgian adults (45.3% male, 43.8±12.1 years) completed the IPAQ self-administered version. Data of these adults were compared with data of 542 adults (45.2% male, 43.5±12.3 years) who completed the IPAQ interview version and wore an accelerometer for seven consecutive days. Samples were matched on gender, age, education, neighborhood characteristics and time of data collection.

RESULTS

Convergent validity of the IPAQ interview version was moderate for total physical activity (Spearman ρ=0.37, P<0.001) and high for sedentary time (Spearman ρ=0.67; P<0.001). Bland-Altman plots showed that systematic and proportional biases were present for total physical activity; for sedentary time only systematic bias was present. Adults who completed the self-administered IPAQ reported higher means for most types of physical activity and less sedentary time than those who completed the IPAQ interview version. Differences between the two IPAQ versions were larger in males, lower-educated, older and overweight/obese adults.

CONCLUSION

Convergent validity of assessing total physical activity using IPAQ interview was similar to previous studies examining validity of the IPAQ, but stronger results were found for sedentary time. In general, and especially in males, lower-educated, older and overweight/obese adults, the use of the IPAQ interview version assessed by trained researchers, should be recommended to collect self-reported data on physical activity and sedentary time.

The association between the parental perception of the physical neighborhood environment and children's location-specific physical activity

Background

The relationship between children’s physical neighborhood environment and their physical activity, has been largely investigated. However in recent reviews, only a few significant and consistent direct associations between children’s physical neighborhood environment and their physical activity were found. This is possibly due to the fact that the location where children’s physical activity took place, is insufficiently specified. Therefore, this study aimed to investigate the association between parental perceived neighborhood characteristics and children’s physical activity in clearly defined environments.

Methods

Children (9–12 years; n = 606) wore an Actigraph accelerometer for 7 days. Parents completed the parental version of the Neighborhood Environmental Walkability Scale questionnaire and reported on children’s physical activity in specific locations: physical activity in nearby streets and on sidewalks, physical activity in public recreation spaces and physical activity in the garden. Multilevel logistic regression analyses were conducted in MLwiN 2.30.

Results

Children were more likely to be active in nearby streets and on sidewalks, if their parents perceived lower street connectivity (OR = 0.479; 95 % CI = 0.33 and 0.70), higher land use mix accessibility (OR = 1.704; 95 % CI = 1.25 and 2.33) and more crime safety (OR = 1.879; 95 % CI = 1.29 and 2.74). Children whose parents perceived higher presence of recreation facilities (OR = 1.618; CI = 1.23; 2.12) were more likely to be active in public recreation spaces. No environmental neighborhood variables were related to physical activity in the garden and overall moderate- to vigorous-intensity physical activity.

Conclusions

The parental perceived physical neighborhood environment relates differently to physical activity in different locations. In order to develop effective interventions, it seems promising to further investigate the association between location-specific physical activity and specific neighborhood environmental correlates.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-1937-5) contains supplementary material, which is available to authorized users.

Multidisciplinary residential treatment can improve perceptual-motor function in obese children

AIM

This study evaluated the effects of a 10-month multidisciplinary residential treatment programme on the perceptual-motor function of obese children and compared them to children with a healthy weight.

METHODS

We studied 26 obese Belgian children (10 girls and 16 boys) with a mean age of 10.1 years (±1.4 years), who followed a residential treatment programme consisting of moderate dietary restriction, psychological support and physical activity. The results were compared with 26 healthy weight children matched for age and gender. The anthropometrics and performance of both groups were assessed on two occasions, 10 months apart, based on simple and choice reaction time tasks and a tracking task using a stylus and tablet. Time by body mass index group interactions were investigated using repeated measure ANCOVAs, with age included as a covariate.

RESULTS

No significant interaction effect occurred in either task. In contrast, the obese participants showed a significant improvement in tracking performance over time during the stylus and tablet tests, demonstrating mean deviation from the ideal curve. No difference in performance between baseline and follow-up was observed in the healthy weight controls.

CONCLUSION

Taking part in a multidisciplinary residential treatment programme improved the perceptual-motor function of obese children.

Do psychosocial factors moderate the association between objective neighborhood walkability and older adults' physical activity?

This study investigated moderating effects of psychosocial factors on the association between walkability and physical activity (PA) in 433 Belgian older adults. Furthermore, main effects of psychosocial factors on PA were determined. No moderating effects were observed for the associations between walkability and transport walking, or moderate-to-vigorous PA (MVPA). Walkability was positively associated with recreational walking in those with high self-efficacy. Regarding main effects, benefits and social norm were positively associated with recreational walking. Benefits were positively and barriers were negatively associated with MVPA. There were no significant main effects for transport walking. The overall lack of moderation suggests that environmental interventions might enhance all older adults' transport walking and MVPA. Recreational walking might be enhanced by simultaneously targeting self-efficacy and neighborhood environmental factors.

Assessing cycling-friendly environments for children: are micro-environmental factors equally important across different street settings?

Background

As physical activity levels decrease as children age, sustainable and accessible forms of physical activity are needed from a young age. Transportation cycling is one such physical activity and has been associated with many benefits. The aims of the study were to identify whether manipulating micro-environmental factors (e.g. speed limits, evenness of cycle path) within a photographed street influences the perceived supportiveness for transportation cycling; and whether changing these micro-environmental factors has the same effect across different street settings.

Methods

We recruited 305 fifth and sixth grade children and their parents from twelve randomly selected primary schools in Flanders, Belgium. They completed a web-based questionnaire including 12 choice-based conjoint tasks, in which they had to choose between two possible routes depicted on manipulated photographs, which the child would cycle along. The routes differed in four attributes: general street setting (enclosed, half open, open), evenness of cycle path (very uneven, moderately uneven, even), speed limit (70 km/h, 50 km/h, 30 km/h) and degree of separation between a cycle path and motorised traffic (no separation, curb, hedge). Hierarchical Bayes analyses revealed the relative importance of each micro-environmental attribute across the three street settings.

Results

For each attribute, children and their parents chose routes that had the best alternative (i.e. open street setting, even cycle path, 30 km/h, a hedge separating the cycle path from motorised traffic). The evenness of the cycle path and lower speed limit had the largest effect for the children, while the degree of separation and lower speed limit had the largest effect for their parents. Interactions between micro-scale and macro-scale factors revealed differences in the magnitude but not direction of their effects on route choice. The results held across the different kinds of street settings tested.

Conclusions

Improving micro-scale attributes may increase the supportiveness of a street for children’s transportation cycling. We call for on-site research to test effects of changes in micro-environmental attributes on transportation cycling among children.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-015-0216-2) contains supplementary material, which is available to authorized users.

Assessment of physical activity in older Belgian adults: validity and reliability of an adapted interview version of the long International Physical Activity Questionnaire (IPAQ-L)

BACKGROUND

Adequate monitoring of older adults' physical activity (PA) is essential to develop effective health promotion programs. The present study examined criterion validity and test-retest reliability of the long International Physical Activity Questionnaire (IPAQ-L), adapted for Belgian, community-dwelling older adults (65 y and older).

METHODS

Participants (n = 434) completed the last seven days version of IPAQ-L, modified for the Belgian population of community-dwelling older adults. This elderly-adapted version of IPAQ-L combined vigorous and moderate activities, and questions on gait speed and recreational cycling were added. Furthermore, participants wore an ActiGraph GT3X(+) accelerometer for at least five days. Criterion validity was determined by comparing self-reported weekly minutes of moderate-to-vigorous physical activity (MVPA) and weekly minutes of total PA with accelerometer data, defined by two different cut points (Freedson vs. Copeland). To examine test-retest reliability, a subsample of 29 participants completed IPAQ-L for a second time within a ten day interval.

RESULTS

IPAQ-L showed moderate criterion validity for measuring weekly minutes of MVPA and total PA (Spearman's ρ range 0.33-0.40). However, plots on agreement between self-reported and accelerometer PA showed a systematic over-reporting of IPAQ-L for MVPA. In contrast, plots indicated that IPAQ-L under-estimated levels of total PA, however, this under-estimation of total PA was substantially lower than the observed over-reporting of MVPA. Test-retest reliability was moderate-to-good for work-related PA, domestic PA, MVPA and total PA (ICC range 0.52-0.81), but poorer for transportation and recreational PA (ICC 0.44 and 0.43, respectively).

CONCLUSIONS

Criterion validity results suggest that IPAQ-L is more valid to measure older adults' weekly minutes of total PA than weekly MVPA minutes. Moreover, results might imply that content validity of IPAQ-L can be improved if specific light-intensity PA items are incorporated into IPAQ-L. Test-retest reliability of IPAQ-L was moderate to good, except for weekly minutes of transportation and recreational PA, probably due to week-to-week variability of these behaviors.

Park proximity, quality and recreational physical activity among mid-older aged adults: moderating effects of individual factors and area of residence

Background

The transition from active employment to retirement is a potentially critical period for promoting maintenance or development of recreational physical activity in older age. Park proximity and quality might be important correlates of recreational physical activity in this age group. However, research on park-physical activity relationships among mid-older aged adults is limited and inconclusive. Furthermore, while knowledge of individual moderators of park-physical activity relationships is crucial for tailoring interventions, this knowledge is also limited. We investigated relationships between perceived park proximity, park quality and recreational physical activity among mid-older aged adults. Additionally, we examined the potential moderating effects of gender, education level, retirement status, functional limitations and area of residence on these relationships.

Methods

Self-reported data on demographics, functional limitations, park proximity, park quality, recreational walking and other recreational moderate- to vigorous-intensity physical activity (MVPA) were collected among 2700 Australian adults (57–67 years) in 2012. Objective information on area of residence was collected. To examine associations of park-related variables with recreational walking and other recreational MVPA, zero-inflated negative binomial (ZINB) regression models were used.

Results

Park proximity significantly interacted with retirement status; non-retired participants who reported living near a park were more likely to participate in recreational walking, whereas no relationship was observed in retired participants. Among those who walked for recreation, higher park quality was related to more weekly minutes of recreational walking. No significant relationships with other recreational MVPA and no moderating effects of gender, education level, functional limitations and area of residence were observed.

Conclusions

Parks may stimulate engagement in recreational walking among non-retirees and more walking among those who already walk. Future research should investigate which environmental factors relate to engagement in recreational walking among retirees and examine whether improvements in park quality actually lead to increases in mid-older aged adults’ recreational walking.

Attentional distraction during exercise in overweight and normal-weight boys

The purpose of this study was to investigate the effect of attentional distraction on field running distance and activity intensity during an exercise session in normal-weight and overweight youngsters and to investigate potential mediators. Fifty-three 12–14 yr-old boys participated twice in a 12-min running test and a 20-min exercise session, once with attentional distraction (by listerning to music) and once without distraction (counterbalanced randomised controlled design). At the end of the endurance test running distance was recorded. During the exercise session activity intensity was assessed by accelerometers. After each experiment, rate of perceived exertion (RPE) was estimated and seven questions were asked about how participants experienced the experiment. Both overweight and normal-weight boys ran further during the running test with music (p < 0.05) and this effect was mediated by a decrease in feelings of annoyance. During the exercise session with music, both overweight and normal-weight boys exercised less at low and high intensity and more at moderate and very high intensity (p < 0.01) and this effect was mediated by a decrease in RPE. We can conclude that attentional distraction has a positive effect on running distance on a field endurance test and on activity intensity during an exercise session through different mechanisms in both overweight and normal-weight boys.

Psychosocial moderators of associations between life events and changes in physical activity after leaving high school

OBJECTIVES

To examine 1) associations between life events and changes in leisure-time physical activity (LTPA) in school leavers and 2) whether these associations are moderated by psychosocial factors.

METHODS

Final year students (n=440) from high schools in rural Western Australia completed annual telephone interviews on three occasions; baseline (T1), one-year follow-up (T2; n=440) and two-year follow-up (T3; n=374). LTPA was measured using the Minnesota Leisure-time Physical Activity Questionnaire. Life events included moving out of home, working full-time and studying full-time. Psychosocial factors included enjoyment, self-efficacy, outcome expectations, club membership, and support from family and friends. Mixed linear regression models examined the effect of life events on changes in LTPA from T1 to T2 and T1 to T3.

RESULTS

A decline in LTPA across all time points was observed. Those who continued full-time education had a smaller LTPA decline than those who did not. Those who were not a member of a sporting club at T1 had greater LTPA decline if they worked full-time at T2.

CONCLUSIONS

There is a need for interventions to prevent declines in LTPA among school leavers, especially those who do not enter tertiary education. Encouraging sporting club membership during high school might be important.

Determinants of physical activity and sedentary behaviour in university students: a qualitative study using focus group discussions

Background

College or university is a critical period regarding unhealthy changes in energy related behaviours in students. The first objective of this explorative study was to identify determinants of physical activity and sedentary behaviour in Belgian university students. Secondly, we aimed to collect ideas and recommendations to increase physical activity and decrease sedentary behaviours in university students.

Methods

Using a semi-structured question guide, seven focus group discussions were conducted consisting of 17 male and 29 female university students from a variety of study disciplines, with a mean age of 20.7 ± 1.6 yrs. Using Nvivo9, an inductive thematic approach was used for data analysis.

Results

Students reported that both physical and sedentary activities were influenced by individual factors (e.g. perceived enjoyment, self-discipline, time and convenience), their social networks (e.g. (lack of) parental control, modelling, social support), physical environment (e.g. availability and accessibility, travel time/distance, prices), and macro environment (e.g. media and advertising). Furthermore, the relationships between determinants and university students’ physical activity and sedentary behaviour seemed to be moderated by university characteristics, such as residency, university lifestyle, exams and academic pressure. Recommendations for future physical activity interventions include improving information strategies regarding on-campus sports activities, cheaper and/or more flexible sports subscriptions and formulas, including ‘sports time’ into the curricula, and providing university bicycles around campus. Students also believed that increasing students’ physical activity might decrease their sedentary behaviour at the same time.

Conclusions

The recommendations and ideas discussed in this study may facilitate the development of effective and tailored (multilevel) intervention programs aiming to increase physical activity and decrease sedentary behaviours in university students.

Changes in weight, physical activity, sedentary behaviour and dietary intake during the transition to higher education: a prospective study

Background

The transition to higher education involves a significant life change and might be accompanied with less healthy behaviours. However, the only longitudinal study that spanned the period from high school to college/university was limited to self-reported weight. Other studies assessed objective weight, but only at the start of the first semester at college/university and used retrospective questionnaires to asses health behaviours in high school. This study investigated changes in objectively assessed weight and prospective health behaviours during the transition from high school to college/university in Belgian students and examined which health behaviour changes were related to weight change.

Methods

A sample of 291 students was followed from the final year of high school until the second year of college/university. Body mass index (BMI) and waist circumference were measured objectively. Physical activity, sedentary behaviours and dietary intake were estimated using validated questionnaires. In order to study changes in BMI and health behaviours, 2 × 2 (time × gender) Repeated Measures ANOVA analyses were conducted. A stepwise multiple regression analysis was executed to investigate the association between changes in health behaviours and BMI changes, and the moderating effect of gender.

Results

On average students gained 2.7 kg with a greater increase in boys (boys: 4.2 kg, girls: 1.9 kg). Active transportation and sport participation decreased. Some sedentary behaviours (watching TV/DVD, playing computer games) decreased, while others (internet use, studying) increased. Consumption of different foods decreased, while alcohol consumption increased. A higher decrease in sport participation, a higher increase in internet use and a lower increase in studying were related to a greater increase in BMI. An increase in alcohol consumption only contributed to weight gain in boys, whereas a decrease in fruit/vegetable intake only contributed to weight gain in girls.

Conclusion

We can conclude that the transition to higher education is an at risk period for weight gain and unfavourable changes in health behaviours. Interventions to prevent weight gain in college/university students should therefore already start in high school with a somewhat different focus in boys versus girls.

Does parental accompaniment when walking or cycling moderate the association between physical neighbourhood environment and active transport among 10-12 year olds?

OBJECTIVES

To assess whether associations between neighbourhood environmental features and frequency of children's active trips per week are moderated by frequency of parental accompaniment when walking/cycling.

DESIGN

Cross-sectional survey

METHODS

Children aged 10-12 years (n=677) were recruited from 19 schools in Melbourne, Australia. Parents reported the number of walking/cycling trips/week usually made by their child to eight local destinations. Environmental variables (i.e. number of cul-de-sacs, intersections, public open spaces (POS) defined as reserves or parks, sport and recreation POS, sport options, population density, length of busy roads and length of walking/cycling tracks) within an 800m buffer around participants' homes were objectively assessed with a Geographic Information System. Associations between neighbourhood features and frequency of active trips were assessed using multilevel linear regressions. Moderating effects of regular parental accompaniment when walking/cycling were examined.

RESULTS

Parental co-participation in walking and cycling was positively associated with frequency of overall walking/cycling trips. Number of intersections, sport and recreation POS, sport options and population density were positively associated with walking/cycling trips. Only one significant interaction was found; a positive association was found between intersection density and walking/cycling trips among children whose parents did not cycle with them while it was not associated among others.

CONCLUSIONS

Building supporting and safe neighbourhood environments is needed to support children's active travel behaviours to improve real and perceived safety concerns and provide relevant infrastructure and destinations, regardless of whether or not parents accompany children during walking and cycling. Although little evidence of moderation was found, future research should include co-participation in a broader range of walking behaviours.

Critical environmental factors for transportation cycling in children: a qualitative study using bike-along interviews

BACKGROUND

Environmental factors are found to influence transport-related physical activity, but have rarely been studied in relation with cycling for transport to various destinations in 10-12 yr old children. The current qualitative study used 'bike-along interviews' with children and parents to allow discussion of detailed environmental factors that may influence children's cycling for transport, while cycling in the participant's neighborhood.

METHODS

Purposeful convenience sampling was used to recruit 35 children and one of their parents residing in (semi-) urban areas. Bike-along interviews were conducted to and from a randomly chosen destination (e.g. library) within a 15 minutes' cycle trip in the participant's neighborhood. Participants wore a GoPro camera to objectively assess environmental elements, which were subsequently discussed with participants. Content analysis and arising themes were derived using a grounded theory approach.

RESULTS

The discussed environmental factors were categorized under traffic, urban design, cycling facilities, road design, facilities at destination, aesthetics, topography, weather, social control, stranger danger and familiar environment. Across these categories many environmental factors were (in)directly linked to road safety. This was illustrated by detailed discussions of the children's visibility, familiarity with specific traffic situations, and degree of separation, width and legibility of cycle facilities.

CONCLUSION

Road safety is of major concern in this 10-12 yr old study population. Bike-along interviews were able to identify new, detailed and context-specific physical environmental factors which could inform policy makers to promote children's cycling for transport. However, future studies should investigate whether hypothetical changes to such micro environmental features influence perceptions of safety and if this in turn could lead to changes in children's cycling for transport.

Cross-sectional study on the relationship between the Mediterranean Diet Score and blood lipids

BACKGROUND

Blood lipids are cardiovascular health indicators. High LDL cholesterol values and/or high total cholesterol (TC)/HDL cholesterol ratios are positively related with cardiovascular mortality. Evidence suggests that a Mediterranean diet can reduce the incidence of cardiovascular diseases. Adherence to the Mediterranean diet is often measured by the Mediterranean Diet Score (MDS). However, the association between the Mediterranean diet and blood lipid profiles seems still inconclusive. The aim of this study was to investigate the relationship between the MDS, its different components and blood lipid profiles.

METHODS

A sample of 506 women and 707 men (aged 18-75 years) was recruited. Three-day diet records were used to calculate the MDS. Blood samples were analyzed for serum TC, LDL and HDL cholesterol. ANOVA was used to analyze blood lipids across the MDS tertiles. A multivariate linear regression analysis was performed to investigate the associations between the MDS, its components and blood lipids, adjusted for several confounders. All analyses were stratified by gender.

RESULTS

Few gender-specific associations were found between the MDS, its components and blood lipids. Only in men, the total MDS was negatively related with LDL cholesterol and the ratio TC/HDL cholesterol while positively with HDL cholesterol. In women, respectively two (MUFA/SFA and cereals) and in men three (fruits & nuts, meat and alcohol) of the nine MDS components were related with blood lipids.

CONCLUSIONS

Analyses investigating the relationship between the MDS, its components and blood lipid profiles indicate only limited influence of the Mediterranean diet on blood lipids. More associations were detected in men compared to women.

The association between objective walkability, neighborhood socio-economic status, and physical activity in Belgian children

Background

Objective walkability is an important correlate of adults’ physical activity. Studies investigating the relation between walkability and children’s physical activity are scarce. However, in order to develop effective environmental interventions, a profound investigation of this relation is needed in all age groups. The aim of this study was to investigate the association between objective walkability and different domains of children’s physical activity, and to investigate the moderating effect of neighborhood socio-economic status in this relation.

Methods

Data were collected between December 2011 and May 2013 as part of the Belgian Environmental Physical Activity Study in children. Children (9–12 years old; n = 606) were recruited from 18 elementary schools in Ghent (Belgium). Children together with one of their parents completed the Flemish Physical Activity Questionnaire and wore an accelerometer for 7 consecutive days. Children’s neighborhood walkability was calculated using geographical information systems. Multilevel cross-classified modeling was used to determine the relationship between children’s PA and objectively measured walkability and the moderating effect of neighborhood SES in this relation.

Results

In low SES neighborhoods walkability was positively related to walking for transportation during leisure time (β = 0.381 ± 0.124; 95% CI = 0.138, 0.624) and was negatively related to sports during leisure time (β = −0.245 ± 0.121; 95% CI = −0.482, −0.008). In high socio-economic status neighborhoods, walkability was unrelated to children’s physical activity. No relations of neighborhood walkability and neighborhood socio-economic status with cycling during leisure time, active commuting to school and objectively measured moderate- to vigorous-intensity physical activity were found.

Conclusions

No univocal relation between neighborhood walkability and physical activity was found in 9–12 year old children. Results from international adult studies cannot be generalized to children. There is a need in future research to determine the key environmental correlates of children’s physical activity.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-014-0104-1) contains supplementary material, which is available to authorized users.

The effect of changing micro-scale physical environmental factors on an environment's invitingness for transportation cycling in adults: an exploratory study using manipulated photographs

Previous studies have shown convincing evidence for positive relationships between transportation cycling in adults and macro-scale physical environmental factors. In contrast, relationships are less consistent for more changeable, micro-scale environmental factors. The majority of existing studies used observational study designs, which cannot determine causality. The present mixed-methods study used manipulated photographs to determine causal relationships between micro-scale environmental factors and the environment’s invitingness for transportation cycling. Further, interactions among environmental factors and moderating effects of gender, age and educational level were investigated. For this study, panoramic photograph of a street was manipulated on eight environmental factors: traffic, speed bump, general upkeep, evenness of the cycle path, vegetation, separation of motorized traffic, separation with sidewalk and cycle path width. Sixty-six middle-aged adults participated in the study and sorted the manipulated panoramic photographs from least to most inviting to cycle for transportation. Participants also provided qualitative data on how they sorted the streets. Multilevel cross-classified modelling was used to analyse the relationships between the environmental manipulations and the invitingness-scores. The qualitative data were deductively categorized according to the environmental factors. All environmental factors, except for separation with sidewalk, proved to have a significant main effect on the invitingness-score for transportation cycling. Cycle path evenness appeared to have the strongest effect on the invitingness. This effect was even stronger in an environment with good compared to poorly overall upkeep. Another significant interaction effect showed that the invitingness decreased when both separations along the cycle path were present compared to only a separation with traffic. No moderating effects of the demographic factors on these relationships were found. Qualitative data confirmed the observed quantitative relationships and added depth and understanding. Current study shows that the use of manipulated photographs can be an effective way to examine environment-physical activity relationships. Our findings indicate that evenness of the cycle path may be a crucial environmental factor when aiming to increase a street’s invitingness for transportation cycling among middle-aged adults. The findings of our exploratory study could be used to develop an environmental intervention to determine if our findings are applicable to real changes in cycling behavior.

Older adults' reporting of specific sedentary behaviors: validity and reliability

Background

Previous questionnaires targeting older adults’ sedentary time have underestimated total sedentary time, possibly by not including all relevant specific sedentary behaviors. The current study aimed to investigate the criterion validity and test-retest reliability of a new questionnaire assessing a comprehensive set of sedentary behaviors. Additionally, we examined whether the criterion validity of the questionnaire differed according to age, gender and educational level.

Methods

A sample of home-dwelling Belgian older adults (>64 years, n = 508) completed a newly-developed questionnaire assessing twelve specific sedentary behaviors and wore an accelerometer for seven consecutive days as criterion measure. A subsample (n = 28) completed the questionnaire a second time to examine test-retest reliability. Data collection occurred between September 2010 and October 2012.

Results

Correlational analyses examining self-reported total sitting time and accelerometer-derived sedentary time yielded a Spearman’s ρ of 0.30. Using the Bland-Altman regression procedure, self-reported total sitting time underestimated accelerometer-derived sedentary time by -82 minutes/day for a participant with an average level of sedentary time (539 minutes/day). Corresponding 95% limits of agreement were wide (-364, 200 minutes/day). Better, but still not ideal, validity findings were observed in the younger, male and tertiary-educated subgroups. Acceptable test-retest reliability (ICC > 0.70) was found for total sitting time, TV viewing, computer use, and driving a car.

Conclusion

Validity for older adults’ self-reported total sitting time against accelerometer-derived sedentary time was not strong, but comparable to previous studies. However, underestimation of total sedentary time was lower compared to previous studies, possibly explained by the inclusion of additional specific sedentary behaviors. Further research is needed to develop self-report tools and objective criterion measures that accurately measure engagement in (specific) sedentary behavior(s) among different subgroups of the older population.

Understanding the relationships between the physical environment and physical activity in older adults: a systematic review of qualitative studies

BACKGROUND

While physical activity (PA) provides many physical, social, and mental health benefits for older adults, they are the least physically active age group. Ecological models highlight the importance of the physical environment in promoting PA. However, results of previous quantitative research revealed inconsistencies in environmental correlates of older adults' PA that may be explained by methodological issues. Qualitative studies can inform and complement quantitative research on environment-PA relationships by providing insight into how and why the environment influences participants' PA behaviors. The current study aimed to provide a systematic review of qualitative studies exploring the potential impact of the physical environment on older adults' PA behaviors.

METHODS

A systematic search was conducted in databases of various disciplines, including: health, architecture and urban planning, transportation, and interdisciplinary databases. From 3,047 articles identified in the physical activity, initial search, 31 articles published from 1996 to 2012 met all inclusion criteria. An inductive content analysis was performed on the extracted findings to identify emerging environmental elements related to older adults' PA. The identified environmental elements were then grouped by study methodologies [indoor interviews (individual or focus groups) vs spatial methods (photo-voice, observations, walk-along interviews)].

RESULTS

This review provides detailed information about environmental factors that potentially influence older adults' PA behaviors. These factors were categorized into five themes: pedestrian infrastructure, safety, access to amenities, aesthetics, and environmental conditions. Environmental factors especially relevant to older adults (i.e., access to facilities, green open spaces and rest areas) tended to emerge more frequently in studies that combined interviews with spatial qualitative methods.

CONCLUSIONS

Findings showed that qualitative research can provide in-depth information on environmental elements that influence older adults' PA. Future qualitative studies on the physical environment and older adults' PA would benefit from combining interviews with more spatially-oriented methods. Multidisciplinary mixed-methods studies are recommended to establish quantitative relationships complemented with in-depth qualitative information.

Understanding the relationships between the physical environment and physical activity in older adults: a systematic review of qualitative studies

BACKGROUND

While physical activity (PA) provides many physical, social, and mental health benefits for older adults, they are the least physically active age group. Ecological models highlight the importance of the physical environment in promoting PA. However, results of previous quantitative research revealed inconsistencies in environmental correlates of older adults' PA that may be explained by methodological issues. Qualitative studies can inform and complement quantitative research on environment-PA relationships by providing insight into how and why the environment influences participants' PA behaviors. The current study aimed to provide a systematic review of qualitative studies exploring the potential impact of the physical environment on older adults' PA behaviors.

METHODS

A systematic search was conducted in databases of various disciplines, including: health, architecture and urban planning, transportation, and interdisciplinary databases. From 3,047 articles identified in the physical activity, initial search, 31 articles published from 1996 to 2012 met all inclusion criteria. An inductive content analysis was performed on the extracted findings to identify emerging environmental elements related to older adults' PA. The identified environmental elements were then grouped by study methodologies [indoor interviews (individual or focus groups) vs spatial methods (photo-voice, observations, walk-along interviews)].

RESULTS

This review provides detailed information about environmental factors that potentially influence older adults' PA behaviors. These factors were categorized into five themes: pedestrian infrastructure, safety, access to amenities, aesthetics, and environmental conditions. Environmental factors especially relevant to older adults (i.e., access to facilities, green open spaces and rest areas) tended to emerge more frequently in studies that combined interviews with spatial qualitative methods.

CONCLUSIONS

Findings showed that qualitative research can provide in-depth information on environmental elements that influence older adults' PA. Future qualitative studies on the physical environment and older adults' PA would benefit from combining interviews with more spatially-oriented methods. Multidisciplinary mixed-methods studies are recommended to establish quantitative relationships complemented with in-depth qualitative information.

Validity of the Omron pedometer and the actigraph step count function in preschoolers

OBJECTIVES

To validate the GT1M actigraph accelerometer step count function, and the Omron Walking Style Pro pedometer against accelerometer-based activity counts, and to compare pedometer-based and accelerometer-based steps in preschoolers.

DESIGN

A sample of 41 preschoolers (21 boys, mean age 5.43±0.63 years) from one preschool in Flanders, Belgium, was included in data analysis.

METHODS

Accelerometer-based and pedometer-based steps were simultaneously collected in this Flemish sample of preschool children. Preschoolers wore two motion sensors (accelerometer and pedometer) for four consecutive days. Pearson correlations were calculated to compare accelerometer activity counts with accelerometer-based steps, accelerometer activity counts with pedometer-based steps and accelerometer-based steps with pedometer-based steps. Bland-Altman analysis was carried out to investigate the agreement between the pedometer-based and the accelerometer-based steps.

RESULTS

Accelerometer-based steps correlated moderately high with accelerometer activity counts per hour (r=0.77) and per day (r=0.82). Pedometer-based steps correlated moderately high with accelerometer activity counts per hour (r=0.65) and per day (r=0.64). High correlations were revealed between steps from both devices (hourly: r=0.92; daily: r=0.89). The Bland-Altman analysis showed a bias of 221.81 (±1679.78) and the limits of agreement ranged from -3070.57 to 3514.18 steps per day.

CONCLUSIONS

Both the accelerometer-based as pedometer-based step counts are valid estimates of preschoolers' physical activity levels during free-living activities based on group estimates. High agreement between both step counts justifies combining and comparing pedometer- and accelerometer-based step counts.

A longitudinal study of gross motor coordination and weight status in children

OBJECTIVE

This longitudinal study investigated the interrelationship between children's weight status and level of gross motor coordination over time, taking baseline physical activity (PA) into account as a possible mediator.

METHODS

Baseline measurements were collected in 2517 children (5-13 years, 52.8% boys), including (1) body height and weight to calculate body mass index (BMI) z-scores, (2) gross motor coordination using the Körperkoordinationstest für Kinder (KTK), (3) total PA estimated by a questionnaire. At follow-up, 754 participants (7-13 years, 50.8% boys) underwent anthropometric and KTK assessments again. Two hypothesized partial mediation models (i.e., KTK ↔ PA ↔ BMI z-score) were examined by multiple linear mixed models.

RESULTS

A lower performance on the KTK at baseline significantly predicted an increase in BMI z-score (B = -0.003, P = 0.027). Conversely, a higher baseline BMI z-score also predicted a decrease in KTK performance (B = -1.792, P < 0.001). Since total PA at baseline was not significantly related to initial KTK performance (B = 1.628, P = 0.134) nor BMI z-score (B = 25.312, P = 0.130), its mediating effect was not further explored.

CONCLUSIONS

Our results strongly suggest that children's weight status negatively influences future level of gross motor coordination, and vice versa. Prevention and intervention initiatives should consider this reciprocal causal relationship across developmental time.

Associations between different types of physical activity and teachers' perceived mental, physical, and work-related health

BACKGROUND

The teaching profession is characterized by high levels of stress and physical complaints, which might be improved through regular participation in physical activity (PA). However, the effect of PA on mental and physical health is not always consistent and depends on the type of PA performed. The aim of this study was to examine the mental, physical, and work-related health of Flemish secondary school teachers and identify the impact on those health variables by demographic and teaching-related factors and various types of PA.

METHODS

This study included an online survey conducted across a representative sample of secondary school teachers (n = 1066, average age 40 years; 68 percent female). Level of PA and sitting time were estimated using the International Physical Activity Questionnaire, and perceived mental health and physical health were estimated using the Short Form 36. Work-related factors such as job satisfaction, occupational stress, and absenteeism were also collected. T-tests, ANOVAs, and linear regression analyses were performed.

RESULTS

Flemish secondary school teachers have poorer perceived mental and physical health than a general healthy population. This difference is particularly evident among female teachers, who reported lower perceived health, more occupational stress, and more absent days compared to their male colleagues. Higher participation in leisure-time PA was associated with a more positive perceived health. In contrast, higher levels of occupational PA and sitting time had a negative impact on perceived health. Total amount of PA, total amount of moderate-to-vigorous PA, transportation-related PA, and PA at home were not associated to teachers' perceived health.

CONCLUSION

Because secondary school teachers' levels of perceived health are low, they are an important target group for interventions aiming to improve health. Only leisure-time PA was associated with more positive perceived health. This finding may indicate that teachers performing more exercise during leisure time, or in a more autonomous way, may be more resistant to physical and mental health problems. Future research should verify whether promoting leisure-time PA among teachers has the potential to improve their mental and physical health, and counteract the negative associations between teachers' health and their occupational PA.

Perception of built environmental factors and physical activity among adolescents in Nigeria

BACKGROUND

Understanding environmental factors related to adolescents' physical activity can inform intervention for obesity control and prevention, but virtually no study has been conducted in the African region, where adolescents' physical inactivity and chronic diseases rates are rising. This study assessed associations between perceived built environmental variables and adolescents' physical activity (active transportation to school and leisure-time moderate-to- vigorous physical activity), and the moderating effects of neighborhood-level income on association between environmental variables and physical activity among Nigerian boys and girls.

METHODS

Participants were 1006 adolescents (12-19 years, 50.4% girls) randomly selected from 11 secondary schools in Maiduguri city, Nigeria. Physical activity and perceptions of environmental characteristics were assessed by validated self-report questionnaires. Separate gender-based, hierarchical multiple moderated linear regression analyses were used to examine the direct associations between the environmental perceptions and physical activity variables (active transportation and leisure-time MVPA; dependent variables), as well as the moderating effects of neighborhood-level income.

RESULTS

Only in boys were direct associations and interaction effect of neighborhood-level income found. Access to destinations was positively associated with active transportation to school (β = 0.18; CI = 0.67, 2.24); while residential density (β = 0.10; CI = 0.01, 1.74) and availability/quality of infrastructures (β = 0.14; CI = 0.49, 2.68) were positively associated with leisure-time MVPA. Also, neighborhood-level income moderated the association between perceived safety and leisure-time MVPA, with more perceived safety related to less MVPA (β = -0.16; CI = -0.01, -0.70) in boys living in high SES neighborhood but marginally related to more MVPA (β = 0.11; CI = -0.04, 2.88, p = 0.06) in boys living in low SES neighborhood.

CONCLUSIONS

Few environmental attributes were associated with adolescents' physical activity in Nigeria. Future studies are needed to determine the multidimensional correlates of physical activity that may be relevant for both adolescents' boys and girls in Nigeria.

Changes in physical activity during the transition from primary to secondary school in Belgian children: what is the role of the school environment?

BACKGROUND

Key life periods have been associated with changes in physical activity (PA). This study investigated (1) how PA changes when primary school children transfer to secondary school, (2) if school environmental characteristics differ between primary and secondary schools and (3) if changes in school environmental characteristics can predict changes in PA in Belgian schoolchildren. Moderating effects of gender and the baseline level of PA were investigated for the first and third research question.

METHODS

In total, 736 children (10-13 years) of the last year of primary school participated in the first phase of this longitudinal study. Two years later, 502 of these children (68.2%) agreed to participate in the second phase. Accelerometers, pedometers and the Flemish Physical Activity Questionnaire were used to measure PA. School environmental characteristics were reported by the school principals. Cross-classified regression models were conducted to analyze the data.

RESULTS

Self-reported active transport to school and accelerometer weekday moderate to vigorous PA (MVPA) increased after the transition to secondary school while self-reported extracurricular PA and total PA decreased. Pedometer weekday step counts decreased, but this decrease was only apparent among those who achieved the PA guidelines in primary school.Secondary schools scored higher on the school environmental characteristics: provision of sports and PA during lunch break, active schoolyards and playgrounds and health education policy but lower on sports and PA after-school than primary schools. Changes in the school environmental characteristics: active commuting to school, active schoolyards and playgrounds and health education policy resulted in changes in self-reported extracurricular PA, total PA , pedometer/accelerometer determined step counts and accelerometer determined MVPA. Moderating effects were found for baseline PA and gender.

CONCLUSION

PA changed after the transition to secondary school. In general, secondary schools seem more likely to foster strategies to promote PA during school hours than primary schools who seem more likely to foster strategies to promote PA after school. Changes in school environmental characteristics may contribute to changes in PA. Thus, if confirmed in future studies, efforts are needed to implement these components in schools as early as possible to positively affect the change in PA.

Traditional and cyberbullying victimization as correlates of psychosocial distress and barriers to a healthy lifestyle among severely obese adolescents--a matched case-control study on prevalence and results from a cross-sectional study

Background

Obese youth are at increased risk for peer victimization, which may heighten their risk of psychosocial problems and physical activity avoidance, and lower the effectiveness of professional and lifestyle weight-loss initiatives. Little is known about obese adolescents’ risk for victimization from cyber-bullying and how this relates to psychosocial functioning and healthy lifestyle barriers. The purpose of the study was to assess traditional and cyber-victimization among adolescents with severe obesity and its relation to psychosocial distress and barriers to healthy lifestyles.

Methods

A sample of 102 obese adolescents (mean age = 15.32 ±1.71) in residential treatment was matched with 102 normal-weight youngsters from the Health Behavior in School-aged Children (HBSC) study (mean age = 15.30 ±1.73).

Results

Adolescents with obesity were significantly more often cyber-victimized than normal-weight peers. Obese youth victimized by traditional bullying experienced lower quality of life, lower motivation for physical activity and higher avoidance and emotional coping towards healthy lifestyles than those non-victimized. Obese cyber-victims experienced significantly higher suicidal ideation.

Conclusions

Traditional and cyber-victimization may hinder treatment effectiveness and healthy lifestyle change in adolescents with obesity. Health professionals should pro-actively address peer victimization and psychosocial functioning during multidisciplinary obesity treatment. Schools could contribute to a better physical and psychosocial health of obese youth by implementing multi-behavioral health-promotion programs.

Determinants of eating behaviour in university students: a qualitative study using focus group discussions

Background

College or university is a critical period regarding unhealthy changes in eating behaviours in students. Therefore, the purpose of this study was to explore which factors influence Belgian (European) university students’ eating behaviour, using a qualitative research design. Furthermore, we aimed to collect ideas and recommendations in order to facilitate the development of effective and tailored intervention programs aiming to improve healthy eating behaviours in university students.

Methods

Using a semi-structured question guide, five focus group discussions have been conducted consisting of 14 male and 21 female university students from a variety of study disciplines, with a mean age of 20.6 ± 1.7 yrs. Using Nvivo9, an inductive thematic approach was used for data analysis.

Results

After the transition from secondary school to university, when independency increases, students are continuously challenged to make healthful food choices. Students reported to be influenced by individual factors (e.g. taste preferences, self-discipline, time and convenience), their social networks (e.g. (lack of) parental control, friends and peers), physical environment (e.g. availability and accessibility, appeal and prices of food products), and macro environment (e.g. media and advertising). Furthermore, the relationships between determinants and university students’ eating behaviour seemed to be moderated by university characteristics, such as residency, student societies, university lifestyle and exams. Recommendations for university administrators and researchers include providing information and advice to enhance healthy food choices and preparation (e.g. via social media), enhancing self-discipline and self-control, developing time management skills, enhancing social support, and modifying the subjective as well as the objective campus food environment by e.g. making healthy foods price-beneficial and by providing vending machines with more healthy products.

Conclusions

This is the first European study examining perceived determinants of eating behaviour in university students and collecting ideas and recommendations for healthy eating interventions in a university specific setting. University characteristics (residency, exams, etc.) influence the relationships between individual as well as social environmental determinants and university students’ eating behaviour, and should therefore be taken into account when designing effective and tailored multilevel intervention programs aiming to improve healthy eating behaviours in university students.

Weight, socio-demographics, and health behaviour related correlates of academic performance in first year university students

Background

This study aimed to examine differences in socio-demographics and health behaviour between Belgian first year university students who attended all final course exams and those who did not. Secondly, this study aimed to identify weight and health behaviour related correlates of academic performance in those students who attended all course exams.

Methods

Anthropometrics of 101 first year university students were measured at both the beginning of the first (T1) and second (T2) semester of the academic year. An on-line health behaviour questionnaire was filled out at T2. As a measure of academic performance student end-of-year Grade Point Averages (GPA) were obtained from the university’s registration office. Independent samples t-tests and chi²-tests were executed to compare students who attended all course exams during the first year of university and students who did not carry through. Uni- and multivariate linear regression analyses were conducted to identify correlates of academic performance in students who attended all course exams during the first year of university.

Results

Students who did not attend all course exams were predominantly male, showed higher increases in waist circumference during the first semester and consumed more French fries than those who attended all final course exams. Being male, lower secondary school grades, increases in weight, Body Mass Index and waist circumference over the first semester, more gaming on weekdays, being on a diet, eating at the student restaurant more frequently, higher soda and French fries consumption, and higher frequency of alcohol use predicted lower GPA’s in first year university students. When controlled for each other, being on a diet and higher frequency of alcohol use remained significant in the multivariate regression model, with frequency of alcohol use being the strongest correlate of GPA.

Conclusions

This study, conducted in Belgian first year university students, showed that academic performance is associated with a wide range of weight and health related behaviours. Future studies should investigate whether interventions aiming at promoting healthy behaviours among students could also have a positive impact on academic performance.

Fine and gross motor skills differ between healthy-weight and obese children

Within the obesity literature, focus is put on the link between weight status and gross motor skills. However, research on fine motor skills in the obese (OB) childhood population is limited. Therefore, the present study focused on possible weight related differences in gross as well as fine motor skill tasks. Thirty-four OB children (12 ♀ and 22 ♂, aged 7-13 years) were recruited prior to participating in a multidisciplinary treatment program at the Zeepreventorium (De Haan, Belgium). Additionally, a control group of 34 age and gender-matched healthy-weight (HW) children was included in the study. Anthropometric measures were recorded and gross and fine motor skills were assessed using the Bruininks-Oseretsky Test of Motor Proficiency, second edition (BOT-2). Results were analyzed by independent samples t-tests, multivariate analysis of variance, and a chi-squared test. Being OB was detrimental for all subtests evaluating gross motor skill performance (i.e., upper-limb coordination, bilateral coordination, balance, running speed and agility, and strength). Furthermore, OB children performed worse in fine motor precision and a manual dexterity task, when compared to their HW peers. No group differences existed for the fine motor integration task. Our study provides evidence that lower motor competence in OB children is not limited to gross motor skills alone; OB children are also affected by fine motor skill problems. Further investigation is warranted to provide possible explanations for these differences. It is tentatively suggested that OB children experience difficulties with the integration and processing of sensory information. Future research is needed to explore whether this assumption is correct and what the underlying mechanism(s) could be.

A comparative study of performance in simple and choice reaction time tasks between obese and healthy-weight children

This study investigated weight status related differences in executive functions and movement execution to determine whether or not childhood obesity is associated with impaired perceptual-motor function. Nineteen obese (OB) children (10 ♂ and 9 ♀, aged 6-12 years) and nineteen gender and age matched healthy-weight (HW) peers performed two computer-based reaction time tasks. For both the simple and four choice reaction time (SRT/CRT) task condition, absolute mean reaction time (RT) and movement time (MT) were determined and expressed as a percentage of total response time (RsT). During the SRT task, OB children were intrinsically slower than their HW peers as reflected by a significantly higher absolute RT, MT and RsT. In the CRT task, however, between-group differences were only present for RT and RsT, whereas absolute MT was comparable among OB and HW participants. As a result, the relative temporal structure of RsT significantly differed between BMI groups, with a greater RT percentage among the OB children. During the CRT condition, OB children probably await final decision-making with regard to the execution of their response movement, which then no longer needs to be adjusted. Our results therefore indicate the use of a more conservative strategy within the OB group, suggesting that childhood obesity is associated with impaired perceptual-motor function. Besides the widely accepted mechanical explanation, a better understanding of the mechanisms underlying OB children's motor incompetence is needed to set up appropriate interventions to tackle this deficit and indirectly address associated health-related problems.

Behavioral Mediators of the Association between Neighborhood Environment and Weight Status in Nigerian Adults

Purpose.

Neighborhood built environments are related to obesity and physical activity (PA), but inconsistently to sedentary behaviors. This study investigated the mediating effects of PA and sedentary time on the associations of neighborhood environmental factors and body mass index (BMI) among Nigerian adults.

Design.

The study design was cross-sectional.

Setting.

The study setting was metropolitan Maiduguri, Nigeria.

Subjects.

Nigerian adults (n = 1411) were randomly selected from diverse neighborhoods and had complete data (43.1% women, 33.8% overweight or obese).

Measures.

PA, sedentary time, and 16 perceived neighborhood environmental factors were measured using Nigerian adaptations of validated international questionnaires. Outcomes were measured BMI and interviewer-led self-reports of moderate to vigorous PA, walking, total PA, and sitting time.

Analysis.

The product-of-coefficient test using generalized linear models was used to assess the mediating effects of outcomes on the associations between environmental factors and BMI.

Results.

Walking and total PA significantly mediated the association between BMI and perception of higher residential density (αβ = –.025 and –.037, respectively), absence of garbage (αβ = –.046 and –.076, respectively), and more safety from crime at night (αβ = –.044 and –.083, respectively). In addition, walking, moderate to vigorous PA, and total PA significantly mediated the association between BMI and perception of better aesthetics (αβ = –.035, –.022, and –.071, respectively). Sedentary time was not a significant mediator of any associations between environmental factors and BMI.

Conclusion.

The association of several neighborhood environmental variables with BMI was partially mediated by PA in Nigerian adults. Including questions on specific types of sedentary behaviors in future prospective studies may improve understanding of the relative influence of sedentary behavior and physical activity on obesity control and prevention among sub-Saharan African adults.

Older adults' transportation walking: a cross-sectional study on the cumulative influence of physical environmental factors

Background

The physical environment may play a crucial role in promoting older adults’ walking for transportation. However, previous studies on relationships between the physical environment and older adults’ physical activity behaviors have reported inconsistent findings. A possible explanation for these inconsistencies is the focus upon studying environmental factors separately rather than simultaneously. The current study aimed to investigate the cumulative influence of perceived favorable environmental factors on older adults’ walking for transportation. Additionally, the moderating effect of perceived distance to destinations on this relationship was studied.

Methods

The sample was comprised of 50,685 non-institutionalized older adults residing in Flanders (Belgium). Cross-sectional data on demographics, environmental perceptions and frequency of walking for transportation were collected by self-administered questionnaires in the period 2004-2010. Perceived distance to destinations was categorized into short, medium, and large distance to destinations. An environmental index (=a sum of favorable environmental factors, ranging from 0 to 7) was constructed to investigate the cumulative influence of favorable environmental factors. Multilevel logistic regression analyses were applied to predict probabilities of daily walking for transportation.

Results

For short distance to destinations, probability of daily walking for transportation was significantly higher when seven compared to three, four or five favorable environmental factors were present. For medium distance to destinations, probabilities significantly increased for an increase from zero to four favorable environmental factors. For large distance to destinations, no relationship between the environmental index and walking for transportation was observed.

Conclusions

Our findings suggest that the presence of multiple favorable environmental factors can motivate older adults to walk medium distances to facilities. Future research should focus upon the relationship between older adults’ physical activity and multiple environmental factors simultaneously instead of separately.

The relationship between changes in steps/day and health outcomes after a pedometer-based physical activity intervention with telephone support in type 2 diabetes patients

The study aim was to investigate the health effects of a pedometer-based behavioural modification program in type 2 diabetes patients and to examine the relationship between changes in steps/day (baseline-post and baseline-follow up) and health outcomes. Ninety-two type 2 diabetes patients (69% male, mean age: 62 ± 9 years and mean BMI: 30.0 ± 2.5 kg/m(2)) were recruited and randomly assigned to an intervention or control group. The intervention consisted of one face-to-face session, pedometer use and seven telephone calls. Selection criteria included 35-75 years, 25-35 kg/m(2) and ≤12% HbA1c (108 mmol/mol). Outcome measures were assessed at baseline, post and follow up, and included systolic blood pressure, waist circumference, body mass index, glucose control (HbA1c and fasting glucose), triglycerides, total, HDL and LDL cholesterol and steps/day. The results showed no significant short- or intermediate-term differences in health outcomes between the control and intervention group. However, a threshold was identified, as HbA1c improved significantly in those who increased ≥4000 steps/day between baseline- and post-measurements (n = 18). This threshold was not applicable to any other health outcome. Hence, although the intervention successfully increased steps/day, no direct effect on health outcomes was identified. However, an increase of ≥4000 steps/day seemed a threshold to have a positive impact on HbA1c.

Associations of neighborhood characteristics with active park use: an observational study in two cities in the USA and Belgium

BACKGROUND

Public parks can be an important setting for physical activity promotion, but to increase park use and the activity levels of park users, the crucial attributes related to active park use need to be defined. Not only user characteristics and structural park attributes, but also characteristics of the surrounding neighborhood are important to examine. Furthermore, internationally comparable studies are needed, to find out if similar intervention strategies might be effective worldwide. The main aim of this study was to examine whether the overall number of park visitors and their activity levels depend on study site, neighborhood walkability and neighborhood income.

METHODS

Data were collected in 20 parks in Ghent, Belgium and San Diego, USA. Two trained observers systematically coded park characteristics using the Environmental Assessment of Public Recreation Spaces (EAPRS) tool, and park user characteristics using the System for Observing Play and recreation in Communities (SOPARC) tool. Multilevel multiple regression models were conducted in MLwiN 2.25.

RESULTS

In San Diego parks, activity levels of park visitors and number of vigorously active visitors were higher than in Ghent, while the number of visitors walking and the overall number of park visitors were lower. Neighborhood walkability was positively associated with the overall number of visitors, the number of visitors walking, number of sedentary visitors and mean activity levels of visitors. Neighborhood income was positively associated with the overall number of visitors, but negatively with the number of visitors being vigorously active.

CONCLUSIONS

Neighborhood characteristics are important to explain park use. Neighborhood walkability-related attributes should be taken into account when promoting the use of existing parks or creating new parks. Because no strong differences were found between parks in high- and low-income neighborhoods, it seems that promoting park use might be a promising strategy to increase physical activity in low-income populations, known to be at higher risk for overweight and obesity.

Physical Environmental Attributes and Active Transportation in Belgium: What about Adults and Adolescents Living in the Same Neighborhoods?

Purpose.

To examine if adults and adolescents living in the same high- and low-walkable neighborhoods have different environmental perceptions and if this is reflected in distinct associations between environmental perceptions and active transportation.

Design.

Cross-sectional study with observational design.

Setting.

In Ghent, 24 neighborhoods were selected, stratified on objectively assessed walkability, and matched on neighborhood income. This resulted in four walkability/income quadrants, each consisting of six neighborhoods.

Subjects.

Living in the 24 neighborhoods were 1166 adults (20–65 years, 52.1% women) and 477 adolescents (13–15 years, 49.7% girls).

Measures.

All participants completed a sociodemographic questionnaire, the International (adults) or Flemish (adolescents) Physical Activity Questionnaire and the Neighborhood Environmental Walkability Scale.

Analysis.

Multilevel (two-level: participant-neighborhood) moderated regression models, using MLwiN 2.23.

Results.

Both adults and adolescents living in objectively high-walkable neighborhoods perceived their environment as more activity friendly than their low-walkable neighborhoods counterparts (11 out of 13 main effects walkability: p < .05). However, perceived residential density (p < .05), land use mix (p < .01), safety for cycling (p < .05), and perceived walkability (p < .001) were associated with active transportation only in adults.

Conclusion.

Different environmental intervention strategies are probably needed to increase active transportation in Belgian adults and adolescents living in the same neighborhoods. In adults, changing objective or perceived environmental characteristics might be effective, whereas in adolescents, the current environmental focus should be changed towards multidimensional research.

Factors influencing mode of transport in older adolescents: a qualitative study

Background

Since a decline in activity levels occurs in adolescence, active transport could be important to increase daily physical activity in older adolescents (17–18 years). To promote active transport, it is necessary to be aware of the barriers and facilitators of this type of transport, but also of other transport modes. This study sought to uncover the factors influencing the choice of transport mode for short distance travel to various destinations in older adolescents using focus groups.

Methods

Thirty-two focus group volunteers (mean age of 17 ± 1.2 years) were recruited from the two final years of the secondary school in Antwerp (Belgium). Five focus groups were conducted (five to eight participants/group). Content analysis was performed using NVivo 9 software (QSR International). Grounded theory was used to derive categories and subcategories.

Results

Data were categorized in three main themes with several subcategories: personal factors (high autonomy, low costs and health), social factors (good social support) and physical environmental factors (short travel time, good access to transport modes and to facilities, good weather, an adapted built environment, perceived safety and ecology).

Conclusions

For older adolescents, the interplay between short travel time, high autonomy, good social support, low costs, good access to transport modes and facilities, and good weather was important for choosing active transport over other transport forms for travelling short distances to various destinations. Other well-known factors such as safety, ecology and health seemed not to have a big influence on their transport mode choice.

Physical activity and beverage consumption in preschoolers: focus groups with parents and teachers

BACKGROUND

Qualitative research is a method in which new ideas and strategies can be discovered. This qualitative study aimed to investigate parents' and teachers' opinions on physical activity and beverage consumption of preschool children. Through separate, independent focus groups, they expressed their perceptions on children's current physical activity and beverage consumption levels, factors that influence and enhance these behaviours, and anticipated barriers to making changes.

METHODS

Multi-cultural and multi-geographical focus groups were carried out in six European countries (Belgium, Bulgaria, Germany, Greece, Poland and Spain). In total, twenty-four focus groups with 122 parents and eighteen focus groups with 87 teachers were conducted between October 2010 and January 2011. Based on a semi-structured interview guide, questions on preschoolers' physical activity (opinions on preschoolers' physical activity, how to increase physical activity, facilitators and barriers of physical activity) and beverage consumption (rules and policies, factors influencing promotion of healthy drinking, recommendations for future intervention development) were asked. The information was analyzed using qualitative data analysis software (NVivo8).

RESULTS

The focus group results indicated misperceptions of caregivers on preschoolers' physical activity and beverage consumption levels. Caregivers perceived preschoolers as sufficiently active; they argue that children need to learn to sit still in preparation for primary school. At most preschools, children can drink only water. In some preschools sugar-sweetened beverages like chocolate milk or fruit juices, are also allowed. It was mentioned that sugar-sweetened beverages can be healthy due to mineral and vitamin content, although according to parents their daily intake is limited. These opinions resulted in low perceived needs to change behaviours.

CONCLUSIONS

Although previous research shows need of change in obesity-related behaviours, the participants in the current study didn't perceive such. The awareness of parents and teachers needs to be raised concerning their shared responsibility about healthy behaviours in preschoolers. Providing preschool teachers with ready-to-use classroom material will encourage them to change physical activity and beverage consumption, and to implement related activities in the classroom. Involvement in activities that their children perform at preschool will motivate parents to extend these behaviours to the home environment.