Mette Toftager

Health promoting outdoor environments - Associations between green space, and health, health-related quality of life and stress based on a Danish national representative survey

Aims: To investigate the associations between green space and health, health-related quality of life and stress, respectively. Methods: Data were derived from the 2005 Danish Health Interview Survey and are based on a region-stratified random sample of 21,832 adults. Data were collected via face-to-face interviews followed by a self-administered questionnaire, including the SF-36, which measures eight dimensions of health and the Perceived Stress Scale, which measures self-reported stress. A total of 11,238 respondents completed the interview and returned the questionnaire. Multiple logistic regression analyses were performed to investigate the association between distance to green space and self-perceived stress. Results: Danes living more than 1 km away from the nearest green space report poorer health and health-related quality of life, i.e. lower mean scores on all eight SF-36 dimensions of health than respondents living closer. Respondents living more than 1 km away from a green space have 1.42 higher odds of experiencing stress than do respondents living less than 300 m from a green space. Respondents not reporting stress are more likely to visit a green space than are respondents reporting stress. Reasons for visiting green spaces differ significantly depending on whether or not respondents experience stress. Respondents reporting stress are likely to use green spaces to reduce stress. Conclusions: An association between distance to a green space and health and health-related quality of life was found. Further, the results indicate awareness among Danes that green spaces may be of importance in managing stress and that green spaces may play an important role as health-promoting environments.

Correlates of Agreement between Accelerometry and Self-reported Physical Activity

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Activating schoolyards: study design of a quasi-experimental schoolyard intervention study

BackgroundThe aim of the Activating Schoolyards Study is to develop, implement, document and assess a comprehensive schoolyard intervention to promote physical activity (PA) during school recess for primary school children (grade 4-8). The intervention is designed to implement organizational and structural changes in the physical environment.MethodThe study builds on a quasi-experimental study design using a mixed method approach including: 1) an exploratory study aimed at providing input for the developing process; 2) an evaluation of the effect of the interventions using a combination of accelerometer, GPS and GIS; 3) a process evaluation facilitating the intervention development process and identifying barriers and facilitators in the implementation process; 4) a post-intervention end-user evaluation aimed at exploring who uses the schoolyards and how the schoolyards are used. The seven project schools (cases) were selected by means of an open competition and the interventions were developed using a participatory bottom-up approach.DiscussionThe participatory approach and case selection strategy make the study design novel. The use of a mixed methods design including qualitative as well as quantitative methods can be seen as a strength, as the different types of data complement each other and results of one part of the study informed the following parts. A unique aspect of our study is the use of accelerometers in combination with GPS and GIS in the effect evaluation to objectively determine where and how active the students are in the schoolyard, before and after the intervention. This provides a type of data that, to our knowledge, has not been used before in schoolyard interventions. Exploring the change in behavior in relation to specific intervention elements in the schoolyard will lead to recommendations for schools undergoing schoolyard renovations at some point in the future.

Schoolyard upgrade in a randomized controlled study design: how are school interventions associated with adolescents’ perception of opportunities and recess physical activity

Abstract School recess physical activity is important for adolescent s health and development, and several studies have established evidence based on cross-sectional studies that it is influenced by the environment in the schoolyard. The aim of this study was to investigate the effect and variation across schools of a school-based intervention on students perceived opportunities for physical activity in the schoolyard, and to evaluate if an improved collective perception of opportunities was followed by an increase in PA during recess for the 13–15 year-old students. The intervention components included schoolyard renovation; mandatory outdoor recess; and increased adult supervision and support. Students collective perceptions were evaluated by a newly developed Schoolyard index (SYi) with seven items, and physical activity was objectively measured with accelerometer. We found variations in the change of student perceptions across the intervention schools, and that a one unit increase in the Schoolyard index (SYi) led to a 12% increase in recess PA. This study shows that adolescent PA during recess can be increased through a multicomponent intervention. The prospect for making an impact is low and according to the process analysis dependent on direct involvement; active and supportive adults; and varied, connected and well located facilities.

Trends in social inequality in physical inactivity among Danish adolescents 1991–2014

The aim of this study was to investigate social inequality in physical inactivity among adolescents from 1991 to 2014 and to describe any changes in inequality during this period. The analyses were based on data from the Danish part of the HBSC study, which consists of seven comparable cross-sectional studies of nationally representative samples of 11–15-year old adolescents. The available data consisted of weekly time (hours) spent on vigorous physical activity and parental occupation from 30,974 participants. In summary, 8.0% of the adolescents reported to be physically inactive, i.e. spend zero hours of vigorous leisure time physical activity per week. The proportion of physically inactive adolescents was 5.4% in high social class and 7.8% and 10.8%, respectively, in middle and low social class. The absolute social inequality measured as prevalence difference between low and high social class did not change systematically across the observation period from 1991 to 2014. Compared to high social class, OR (95% CI) for physical inactivity was 1.48 (1.32–1.65) in middle social class and 2.18 (1.92–2.47) in lower social class. This relative social inequality was similar in the seven data collection waves (p=0.971). Although the gap in physical inactivity between social classes does not seem to be widening in Danish adolescents, there are still considerable differences in the activity levels between high, middle and low social class adolescents. Consequently, there is a need for a targeted physical activity intervention among adolescents from low (and middle) social class.

Effect of a school environment intervention on adolescent adiposity and physical fitness

The aim of this study was to evaluate the effect of an intervention targeting the physical and organizational school environment for noncurricular physical activity (SPACE) on adiposity, aerobic fitness, and musculo‐skeletal strength in Danish adolescents. The study used a cluster randomized controlled design. Fourteen schools and 1348 adolescents aged 11–14 years were included at baseline. Seven schools were randomized to the intervention, which was designed to change the organizational and physical environment of the school. The analysis revealed no significant differences between the adolescents in the intervention group compared to the comparison group after a 2‐year follow‐up. Adjusted for baseline, sex, age, and clustering within schools, the difference between the intervention schools compared to the comparison schools was 6 m in the shuttle run test [95% confidence interval (CI): −21; 33], 0.2 cm in waist circumference (95% CI: −2.6; 3.1), and −1.1 kg in handgrip strength (95% CI: −2.2; −0.1). The results did not provide evidence for the effect of the intervention on adiposity, aerobic fitness, or musculo‐skeletal strength in adolescents. Reasons for not finding an effect could be related to both the design and the implementation of the intervention.

Effect of a school environment intervention on adolescent adiposity and physical fitness: School environment intervention

The aim of this study was to evaluate the effect of an intervention targeting the physical and organizational school environment for noncurricular physical activity (SPACE) on adiposity, aerobic fitness, and musculo‐skeletal strength in Danish adolescents. The study used a cluster randomized controlled design. Fourteen schools and 1348 adolescents aged 11–14 years were included at baseline. Seven schools were randomized to the intervention, which was designed to change the organizational and physical environment of the school. The analysis revealed no significant differences between the adolescents in the intervention group compared to the comparison group after a 2‐year follow‐up. Adjusted for baseline, sex, age, and clustering within schools, the difference between the intervention schools compared to the comparison schools was 6 m in the shuttle run test [95% confidence interval (CI): −21; 33], 0.2 cm in waist circumference (95% CI: −2.6; 3.1), and −1.1 kg in handgrip strength (95% CI: −2.2; −0.1). The results did not provide evidence for the effect of the intervention on adiposity, aerobic fitness, or musculo‐skeletal strength in adolescents. Reasons for not finding an effect could be related to both the design and the implementation of the intervention.