Richard G. Prins

Objective and perceived availability of physical activity opportunities: differences in associations with physical activity behavior among urban adolescents

BackgroundThis study examined the associations of the perceived and objective environment with adolescent engagement in sports activities and walking and cycling in leisure time. It also explored the degree of agreement between objective and perceived availability of physical activity (PA) facilities in neighborhoods.MethodsCross-sectional data on physical activity, the perceived availability of physical activity opportunities (perceived physical environment) was assessed through a questionnaire and the objective availability of PA opportunities (objective physical environment) was obtained through GIS data. The final sample included 654 adolescents with a mean age of 14.1 (SD = 1.2) years.ResultsPerceived availability of sports facilities and parks was significantly associated with engaging in sports (OR: 1.73; 95% CI: 1.16-2.56) and with walking and cycling in leisure time (OR: 1.66; 95% CI: 1.07-2.57) respectively. Agreement between objective and perceived environment was low to moderate with Kappa values ranging from -0.005 to 0.053.ConclusionThe perceived environment was the stronger correlate of PA behavior among adolescents. There were substantial differences between assessments of objective and perceived physical environment.

Longitudinal associations between cycling to school and weight status

OBJECTIVE The objective of the present study was to assess the longitudinal association between cycling to school and weight status in two cities where cycling to school is common - Kristiansand (Norway) and Rotterdam (The Netherlands). METHODS Data from two studies ENDORSE (Rotterdam) and YOUTH IN BALANCE (Kristiansand) were used. Both studies were longitudinal with two years between time (T) 1 and T2 measurements, and with mean age at T1 of 13.2 and 13.4 years, respectively. The sample was categorized into the following groups according to responses about main mode of commuting to school at the two time points: NO cycling, STARTED cycling, STOPPED cycling and CONTINUED cycling. Measured weight and height were obtained at both time points, and weight status (overweight vs. not overweight) was calculated using international classification criteria for BMI. The two datasets were analyzed separately and together. RESULTS In multilevel logistic regression models of the combined sample, adjusting for weight status at Time 1, those who stopped cycling had greater odds of being overweight at T2 (OR = 3.19; 95% CI = 1.41?7.24) while those continued cycling had lower odds of being overweight (OR = 0.44; 95% CI = 0.21?0.88), separately compared to the other three groups together. The same trend was observed in both study samples. CONCLUSIONS This study shows that there are longitudinal associations between cycling to school and weight status in two cities where cycling to school is common, implying that interventions aiming at reducing overweight/obesity among adolescents might consider the promotion of sustained cycling behaviour.

How many walking and cycling trips made by elderly are beyond commonly used buffer sizes: results from a GPS study.

In choosing appropriate buffer sizes to study environmental influences on physical activity, studies are hampered by insufficient insight into the distance elderly travel actively. This study aims at getting insight into the number of trips walked and cycled within various buffer sizes using GPS measures. Data were obtained from the Elderly And their Neighborhood study (Spijkenisse, the Netherlands (2011-2012)). Trip length and mode of transport were derived from the GPS data (N=120; total number of trips=337). Distance decay functions were fitted to estimate the percentage of trips to grocery stores within commonly used buffer sizes. Fifty percent of the trips walked had a distance of at least 729m; for trips cycled this was 1665m. Elderly aged under 75 years and those with functional limitations walked and cycled shorter distances than those over 75 years and those without functional limitations. Males cycled shorter distances than females. Distance decay functions may aid the selection of appropriate buffer sizes, which may be tailored to individual characteristics.

Are neighbourhood social capital and availability of sports facilities related to sports participation among Dutch adolescents

BackgroundThe aim of this study is to explore whether availability of sports facilities, parks, and neighbourhood social capital (NSC) and their interaction are associated with leisure time sports participation among Dutch adolescents.MethodsCross-sectional analyses were conducted on complete data from the last wave of the YouRAction evaluation trial. Adolescents (n = 852) completed a questionnaire asking for sports participation, perceived NSC and demographics. Ecometric methods were used to aggregate perceived NSC to zip code level. Availability of sports facilities and parks was assessed by means of geographic information systems within the zip-code area and within a 1600 meter buffer. Multilevel logistic regression analyses, with neighborhood and individual as levels, were conducted to examine associations between physical and social environmental factors and leisure time sports participation. Simple slopes analysis was conducted to decompose interaction effects.ResultsNSC was significantly associated with sports participation (OR: 3.51 (95%CI: 1.18;10.41)) after adjustment for potential confounders. Availability of sports facilities and availability of parks were not associated with sports participation. A significant interaction between NSC and density of parks within the neighbourhood area (OR: 1.22 (90%CI: 1.01;1.34)) was found. Decomposition of the interaction term showed that adolescents were most likely to engage in leisure time sports when both availability of parks and NSC were highest.ConclusionsThe results of this study indicate that leisure time sports participation is associated with levels of NSC, but not with availability of parks or sports facilities. In addition, NSC and availability of parks in the zip code area interacted in such a way that leisure time sports participation is most likely among adolescents living in zip code areas with higher levels of NSC, and higher availability of parks. Hence, availability of parks appears only to be important for leisure time sports participation when NSC is high.

Physical Activity in Non-Frail and Frail Older Adults

Introduction Physical activity (PA) is important for healthy ageing. Better insight into objectively measured PA levels in older adults is needed, since most previous studies employed self-report measures for PA assessment, which are associated with overestimation of PA. Aim This study aimed to provide insight in objectively measured indoor and outdoor PA of older adults, and in PA differences by frailty levels. Methods Data were collected among non-frail (N = 74) and frail (N = 10) subjects, aged 65 to 89 years. PA, measured for seven days with accelerometers and GPS-devices, was categorized into three levels of intensity (sedentary, light, and moderate-to-vigorous PA). Results Older adults spent most time in sedentary and light PA. Subjects spent 84.7%, 15.1% and 0.2% per day in sedentary, light and moderate-to-vigorous PA respectively. On average, older adults spent 9.8 (SD 23.7) minutes per week in moderate-to-vigorous activity, and 747.0 (SD 389.6) minutes per week in light activity. None of the subjects met the WHO recommendations of 150 weekly minutes of moderate-to-vigorous PA. Age-, sex- and health status-adjusted results revealed no differences in PA between non-frail and frail older adults. Subjects spent significantly more sedentary time at home, than not at home. Non-frail subjects spent significantly more time not at home during moderate-to-vigorous activities, than at home. Conclusions Objective assessment of PA in older adults revealed that most PA was of light intensity, and time spent in moderate-to-vigorous PA was very low. None of the older adults met the World Health Organization recommendations for PA. These levels of MVPA are much lower than generally reported based on self-reported PA. Future studies should employ objective methods, and age specific thresholds for healthy PA levels in older adults are needed. These results emphasize the need for effective strategies for healthy PA levels for the growing proportion of older adults.

Effectiveness of YouRAction, an Intervention to Promote Adolescent Physical Activity Using Personal and Environmental Feedback: A Cluster RCT

Background In this study the one and six months effects of the computer-tailored YouRAction (targeting individual level determinants) and YouRAction+e (targeting in addition perceived environmental determinants) on compliance with the moderate-to-vigorous physical activity (MVPA) guideline and weight status are examined. In addition the use and appreciation of both interventions are studied. Methods A three-armed cluster randomized trial was conducted in 2009–2010 with measurements at baseline, one and six months post intervention. School classes were assigned to one of the study arms (YouRaction, YouRAction+e and Generic Information (GI) control group). MVPA was derived from self-reports at baseline, one and six months post intervention. Body Mass Index and waist circumference were measured at baseline and six months post intervention in a random sub-sample of the population. Use of the interventions was measured by webserver logs and appreciation by self-reports. Multilevel regression analyses were conducted to study the effects of the intervention against the GI control group. ANOVAs and chi-square tests were used to describe differences in use and appreciation between study arms. Results There were no statistically significant intervention effects on compliance with the MVPA guideline, overweight or WC. Access to the full intervention was significantly lower for YouRAction (24.0%) and YouRAction+e (21.7%) compared to the GI (54.4%). Conclusion This study could not demonstrate that the YouRAction and YouRAction+e interventions were effective in promoting MVPA or improve anthropometric outcomes among adolescents, compared to generic information. Insufficient use and exposure to the intervention content may be an explanation for the lack of effects. Trial Registration TrialRegister.nl NTR1923

Systematic development of the YouRAction program, a computer-tailored physical activity promotion intervention for Dutch adolescents, targeting personal motivations and environmental opportunities

BackgroundIncreasing physical activity (PA) among adolescents is an important health promotion goal. PA has numerous positive health effects, but the majority of Dutch adolescents do not meet PA requirements. The present paper describes the systematic development of a theory-based computer-tailored intervention, YouRAction, which targets individual and environmental factors determining PA among adolescents.DesignThe intervention development was guided by the Intervention Mapping protocol, in order to define clear program objectives, theoretical methods and practical strategies, ensure systematic program planning and pilot-testing, and anticipate on implementation and evaluation. Two versions of YouRAction were developed: one that targets individual determinants and an extended version that also provides feedback on opportunities to be active in the neighbourhood. Key determinants that were targeted included: knowledge and awareness, attitudes, self-efficacy and subjective norms. The extended version also addressed perceived availability of neighbourhood PA facilities. Both versions aimed to increase levels of moderate-to-vigorous PA among adolescents. The intervention structure was based on self-regulation theory, comprising of five steps in the process of successful goal pursuit. Monitoring of PA behaviour and behavioural and normative feedback were used to increase awareness of PA behaviour; motivation was enhanced by targeting self-efficacy and attitudes, by means of various interactive strategies, such as web movies; the perceived environment was targeted by visualizing opportunities to be active in an interactive geographical map of the home environment; in the goal setting phase, the adolescents were guided in setting a goal and developing an action plan to achieve this goal; in the phase of active goal pursuit adolescents try to achieve their goal and in the evaluation phase the achievements are evaluated. Based on the results of the evaluation adolescents could revise their goal or choose another behaviour to focus on. The intervention is delivered in a classroom setting in three lessons. YouRAction will be evaluated in a cluster-randomized trial, with classes as unit of randomization. Evaluation will focus on PA outcomes, cognitive mediators/moderators and process measures.DiscussionThe planned development of YouRAction resulted in two computer-tailored interventions aimed at the promotion of PA in a Dutch secondary school setting.Trial registrationNTR1923

Socioeconomic Inequalities in Psychological Distress among Urban Adults: The Moderating Role of Neighborhood Social Cohesion

Background Various studies have reported socioeconomic inequalities in mental health among urban residents. This study aimed at investigating whether neighborhood social cohesion influences the associations between socio-economic factors and psychological distress. Methods Cross-sectional questionnaire study on a random sample of 18,173 residents aged 16 years and older from 211 neighborhoods in the four largest cities in the Netherlands. Psychological distress was the dependent variable (scale range 10–50). Neighborhood social cohesion was measured by five statements and aggregated to the neighborhood level using ecometrics methodology. Multilevel linear regression analyses were used to investigate cross-level interactions, adjusted for neighborhood deprivation, between individual characteristics and social cohesion with psychological distress. Results The mean level of psychological distress among urban residents was 17.2. Recipients of disability, social assistance or unemployment benefits reported higher psychological distress (β = 5.6, 95%CI 5.2 to 5.9) than those in paid employment. Persons with some or great financial difficulties reported higher psychological distress (β = 3.4, 95%CI 3.2 to 3.6) than those with little or no financial problems. Socio-demographic factors were also associated with psychological distress, albeit with much lower influence. Living in a neighborhood with high social cohesion instead of low social cohesion was associated with a lower psychological distress of 22% among recipients of disability, social assistance or unemployment benefits and of 13% among citizens with financial difficulties. Conclusions Residing in socially cohesive neighborhoods may reduce the influence of lack of paid employment and financial difficulties on psychological distress among urban adults. Urban policies aimed at improving neighborhood social cohesion may contribute to decreasing socio-economic inequalities in mental health.

Structural neighbourhood conditions, social cohesion and psychological distress in the Netherlands.

BACKGROUND Neighbourhood inequalities in psychological distress are well reported, but underlying mechanisms remain poorly understood. The main purposes of this study were to investigate associations between structural neighbourhood conditions and psychological distress, and to explore the potential mediating role of neighbourhood social cohesion. METHODS Cross-sectional questionnaire study on a random sample of 18,173 residents aged ≥ 16 years (response 49%) from the four largest cities in the Netherlands. Psychological distress was measured with the Kessler Psychological Distress Scale (K10). Structural environmental factors under study were neighbourhood socio-economic status (SES), neighbourhood green, urbanity and home maintenance. Neighbourhood social cohesion was measured by five statements and aggregated to the neighbourhood level by using ecometrics methodology. Multilevel linear regression analysis was used to investigate associations of neighbourhoods characteristics with psychological distress, adjusted for individual level characteristics. RESULTS High neighbourhood SES and neighbourhood social cohesion were associated with decreased psychological distress. Adjusted for individual level characteristics and neighbourhood SES, only neighbourhood social cohesion remained significantly associated with psychological distress. Neighbourhood social cohesion accounted for 38% of the differences in the association between neighbourhood SES and psychological distress. CONCLUSIONS High neighbourhood social cohesion is significantly associated with decreased psychological distress among residents of the four largest cities in the Netherlands. Reducing neighbourhood inequalities in psychological distress may require increasing social interactions among neighbourhood residents.

Neighborhood ethnic diversity and behavioral and emotional problems in 3 year olds: results from the Generation R Study.

Background Studies suggest that neighborhood ethnic diversity may be important when it comes to understanding ethnic inequalities in mental health. The primary aim of this study was to investigate whether neighborhood ethnic diversity moderated the association between the ethnic minority status and child behavioral and emotional problems. Methods We included 3076 preschoolers participating in the Generation R Study, a birth cohort study in Rotterdam, the Netherlands. At child age 3-years, parents completed the Child Behavior Checklist (CBCL/1,5-5). Individual-level data, assessed with questionnaires, was combined with neighborhood-level data. Multi-level logistic regression models predicted the Odds Ratios for the CBCL total problems score as a function of maternal ethnic background and neighborhood ethnic diversity, computed with the Racial Diversity Index and categorized into tertiles. Interaction on the additive scale was assessed using Relative Access Risk due to Interaction. Results Being from an ethnic minority was associated with child behavioral and emotional problems in unadjusted (OR 2.76, 95% CI 1.88–4.04) and adjusted models (OR 2.64, 95% CI 1.79–3.92). Residing in a high diversity neighborhood was associated with child behavioral and emotional problems in unadjusted (OR 2.03, 95% CI 1.13–3.64) but not in adjusted models (OR 0.89, 95% CI 0.51–1.57). When stratifying by the three levels of neighborhood ethnic diversity, ethnic inequalities in behavioral and emotional problems were greatest in low diversity neighborhoods (OR 5.24, 95%CI 2.47–11.14), smaller in high diversity neighborhoods (OR 3.15, 95% CI 1.66–5.99) and smallest in medium diversity neighborhoods (OR 1.59, 95% CI 0.90–2.82). Tests for interaction (when comparing medium to low diversity neighborhoods) trended towards negative on both the additive and multiplicative scale for the maternal-report (RERI: −3.22, 95% CI −0.70–0.59; Ratio of ORs: 0.30, 95% CI 0.12–0.76). Conclusion This study suggests that ethnic inequalities in child behavioral and emotional problems may be greatest in ethnically homogeneous neighborhoods.