Brief report: The impact of the COVID-19 pandemic on health behaviors in adolescents with Autism Spectrum Disorder

BackgroundThere is concern that the COVID-19 pandemic may negatively affect health behaviors in youth, especially youth diagnosed with Autism Spectrum Disorder (ASD).ObjectiveThe purpose of this paper was to examine changes in physical activity, screen-time, and sleep in adolescents with ASD due to the COVID-19 pandemic.MethodsNine adolescents with ASD completed surveys measuring physical activity, screen-time, and sleep duration prior to and during the pandemic.ResultsA significant decrease in days of physical activity (4.17 vs 2.27; p = 0.0006), and a significant increase in hours of both weekday (3.69 vs 6.25; p = 0.007) and weekend screen-time (5.94 vs. 7.39; p = 0.004) was observed during the pandemic. No changes regarding sleep duration was observed.ConclusionsAlthough preliminary, results suggest that physical activity and screen-time may be negatively affected by the COVID-19 outbreak in youth with ASD. The development of interventions to promote health behaviors in ASD populations during long periods of less-structured time (quarantine) should be considered.     

Physical activity,body mass index,and health status among youth with severe visual impairments aged 13–17 years in the United States

Background

Limited population-based data is available in the United States (US) examining physical activity engagement, weight status, and health status among youth with visual impairments.

视力障碍青少年身体活动水平和久坐时间调查

了解中国视力障碍青少年日常身体活动模式和久坐行为时间,为指导学生科学合理安排作息时间提供参考.方法 采用加速度计对中国西部地区某特殊教育学校78名7~23岁视力障碍青少年的身体活动水平和模式进行测量.结果 男女生相比,男生身高略高、身体略重(t值分别为2.81,2.46,P值均<0.05).基于Puyan等加速度计切点值,学生平均每天进行轻度身体活动(light physical activity,LPA)时间为(285.18±47.29) min,中等强度身体活动(moderatephysical activity,MPA)时间为(141.92±57.63) min,高强度身体活动(vigorous PA,VPA)时间为(17.66± 14.83) min,中高强度身体活动(moderate-to-vigorous-intensity physical activity,MVPA)时间为(159.58±69.83) min,久坐时间为(988.38±110.18)min.98.7%的受试者达到了WHO关于青少年每天应至少进行60 min中等及以上强度的身体活动的推荐量.结论 中国西部地区特殊学校视障青少年每日进行促进身体健康的身体活动,身体活动水平达到且超过WHO身体活动推荐量.     

Environmental and social determinants of leisure-time physical activity in children with autism spectrum disorder

BackgroundIt is increasingly recognized that children's physical activity behaviors are shaped by neighborhood environment factors and their parent's support. However, these factors have been scarcely studied among children with autism spectrum disorder (ASD), a population at risk of inactivity.ObjectiveThis cross-sectional survey study was designed to examine how neighborhood environmental factors and parental support are related to physical activity levels of children with ASD. Also, this study examined if the relationship between the environment and physical activity is modified by demographic factors and COVID-19 related concerns.MethodsAn online survey was completed by parents of children with ASD aged 10–17 years. The questionnaire included items related to environmental factors (i.e., distance to school, distance to park, existence of sidewalks, walkability), parent support for physical activity (i.e., encouraging, watching, and providing transportation), child's physical activity, and demographic characteristics. The instrument also queried parental concerns about COVID-19 and their child's physical activity participation.ResultsThe results indicate that proximity to a local park and to school is positively associated with physical activity. Parent's encouraging behavior correlated with and predicted children's physical activity levels. Also, higher levels of COVID-19 related concerns among parents were related to decreased physical activity supporting behaviors.ConclusionsThis study demonstrated that the neighborhood environment, in particular the distance between home and parks and schools, and parent support behavior are influential factors that may shape physical activity behaviors for children with ASD.     

Correlates of obesity in adolescents with and without autism spectrum disorder: The 2017–2018 National Survey of Children's Health

BackgroundThe prevalence of autism spectrum disorder (ASD) and childhood obesity are increasing, and youth with ASD are at an increased risk of obesity compared to typically developing youth. Specific obesity risk factors in adolescents with ASD remain poorly understood.ObjectiveThis study examined correlates of obesity among adolescents with and without ASD using extant 2017–2018 National Survey of Children's Health (NSCH) data.MethodsThis cross-sectional study examined the co-occurrence of obesity among US adolescents with ASD aged 10–17 years compared to those without ASD, adjusting for sociodemographic characteristics, co-occurring conditions, and relevant covariates, using 2017–2018 NSCH data. Multiple logistic regression was used to compare the odds of obesity among children with mild ASD, moderate/severe ASD, and without ASD.ResultsOdds of obesity were higher in adolescents with ASD compared to adolescents without ASD (cOR 1.9, CI 1.3–2.7). In the adjusted model, the odds of obesity were not significantly higher in those with mild or moderate/severe ASD compared to those without ASD. Odds of obesity were higher for all adolescents who were Hispanic or Black, as well as those with lower household income or with one or more co-occurring conditions.ConclusionsThe association between obesity and ASD in this study highlights the need for greater attention to nutrition, physical activity, and co-occurring conditions among adolescents with ASD. Effective interventions to curtail the risks among racial/ethnic minority adolescents and adolescents with lower household income are needed. Further research is needed to examine additional factors associated with obesity in adolescents with ASD, including family, community, organizational, and policy factors.     

Peer Reviewed: School and Student Characteristics Associated With Screen-Time Sedentary Behavior Among Students in Grades 5-8, Ontario,Canada, 2007-2008

Introduction

We examined school and student characteristics associated with screen-time sedentary behavior.

Methods

We analyzed data collected from 2,449 students in grades 5 through 8 who attended 30 elementary schools in Ontario, Canada. We used multilevel logistic regression to examine the student- and school-level factors associated with moderate and high screen-time sedentary behavior.

Results

Moderate screen time did not vary significantly across schools. Student characteristics significantly associated with moderate screen time were sex, number of friends who are active, and parental encouragement of physical activity. High screen time did vary significantly across schools; school-level differences accounted for 12% of the variability in the odds of a student reporting high screen time. Students who attended a school in the more advanced phase of emphasizing participation in physical activity through school programs were less likely to report high screen time compared with students who attended schools in the earlier phase for this school-level indicator. Student characteristics significantly associated with high screen time were sex, parental encouragement of physical activity, parental support of physical activity, and race/ethnicity.

Conclusions

High levels of screen-time sedentary behavior are associated with both student characteristics and the characteristics of the school a student attends. Developing a better understanding of the school characteristics associated with sedentary behavior will be valuable for guiding the development of interventions to reduce sedentary behavior among youth populations.     

24-Hour Movement Behaviors and Internalizing and Externalizing Behaviors Among Youth

PurposeThe Canadian 24-Hour Movement Guidelines for Children and Youth (≥60 minutes of moderate-to-vigorous physical activity per day, ≤2 hours of recreational screen time per day, and 9–11 hours of sleep per night for 5–13 years old) are associated with better physical health, but less is known about how these behaviors are related to mental health. This study examined the association of meeting these guideline recommendations with internalizing and externalizing behaviors among youth.MethodsA large and broadly representative cross-sectional sample of 9- to 11-year-old U.S. youth (N = 11,875) from the Adolescent Brain and Cognitive Development study was analyzed. Internalizing and externalizing behaviors were measured using the Child Behaviour Checklist. Associations were examined using negative binomial regression adjusted for several confounders.ResultsCompared to meeting none of the recommendations, meeting recommendations for screen time and sleep but not physical activity was associated with a lower prevalence ratio of total, internalizing, and externalizing behaviors. Meeting two or all three recommendations was more strongly associated with these outcomes than meeting one recommendation or none. The prevalence ratio of the group meeting all three recommendations was .77 (95% confidence interval [CI]: .68–.86) for total problem scores, .78 (95% CI: .68–.89) for internalizing problem scores, and .79 (95% CI: .68–.91) for externalizing problem scores.ConclusionsMeeting the 24-hour movement guidelines was associated with a lower risk of internalizing and externalizing behaviors in youth. These associations were mainly explained by meeting the screen time and sleep duration recommendations.     

A Longitudinal Study of Youth Assets,Neighborhood Conditions,and Youth Sexual Behaviors

PurposeTo prospectively determine whether individual, family, and community assets help youth to delay initiation of sexual intercourse (ISI); and for youth who do initiate intercourse, to use birth control and avoid pregnancy. The potential influence of neighborhood conditions was also investigated.MethodsThe Youth Asset Study was a 4-year longitudinal study involving 1,089 youth (mean age = 14.2 years, standard deviation = 1.6; 53% female; 40% white, 28% Hispanic, 23% African American, 9% other race) and their parents. Participants were living in randomly selected census tracts. We accomplished recruitment via door-to-door canvassing. We interviewed one youth and one parent from each household annually. We assessed 17 youth assets (e.g., responsible choices, family communication) believed to influence behavior at multiple levels via in-person interviews methodology. Trained raters who conducted annual windshield tours assessed neighborhood conditions.ResultsCox proportional hazard or marginal logistic regression modeling indicated that 11 assets (e.g., family communication, school connectedness) were significantly associated with reduced risk for ISI; seven assets (e.g., educational aspirations for the future, responsible choices) were significantly associated with increased use of birth control at last sex; and 10 assets (e.g., family communication, school connectedness) were significantly associated with reduced risk for pregnancy. Total asset score was significantly associated with all three outcomes. Positive neighborhood conditions were significantly associated with increased birth control use, but not with ISI or pregnancy.ConclusionsProgramming to strengthen youth assets may be a promising strategy for reducing youth sexual risk behaviors.     

Suicidal ideation and self-harm behavior in a community sample of preadolescent youth: a case-control study

ObjectiveResearch has focused on understanding risk factors associated with suicidal ideation and self-harm behaviors in older youth, but less is known regarding these behaviors in preadolescents. We examined characteristics associated with suicidal ideation and self-harm behavior in youth aged 10–13 years.Design/MethodsA community sample of 387 youth was enrolled in a prospective study assessing precursors of risk behaviors. Twenty-three subjects endorsing items regarding suicidal ideation or self-harm behaviors (Achenbach's Youth Self-Report) (endorsers) were matched with 23 non-endorsers. Groups were compared on problem behaviors, impulsivity, neurocognitive function, risk behaviors, and other variables.ResultsEndorsers had higher levels of impulsivity, were more likely in borderline/clinical range on 5 of 8 Youth Self-Report Syndrome scales, and reported more risk taking. Endorsers and non-endorsers were similar in neurocognitive function. More non-endorsers were on stimulants, but groups were similar in parental monitoring and parental report of behavioral/emotional issues, socioeconomic status, and marital status.ConclusionIn this study, preadolescent endorsers report significantly more problem behaviors than non-endorsers. However, parental monitoring and parent report of problems were similar between groups. Given these findings, we suggest that at-risk youth may be underrecognized at young ages.     

The Health Indicators Associated With Screen-Based Sedentary Behavior Among Adolescent Girls: A Systematic Review

PurposeEvidence suggests sitting time is independently associated with a range of health issues in adults, yet the relationship between sedentary behavior and health indicators in young people is less clear. Age-related increases in sedentary behavior are well-documented; the behavioral patterns of adolescent girls are of particular concern. More than one third of adolescent girls’ sedentary behavior time is accumulated through use of recreational screen-based behaviors. The objective of this review was to investigate the association between recreational screen-based sedentary behavior and the physical, behavioral, and psychosocial health indicators for adolescent girls. A secondary objective was to identify studies that have adjusted sedentary behavior indicators for physical activity.MethodsA structured electronic search of all publication years (through December 2011) was conducted to identify studies in: CINAHL, Communications and Mass Media Complete, ERIC, MEDLINE with Full Text, PsycINFO, and SPORTDiscus with Full Text. Included publications were observational and interventional studies involving adolescent girls (12–18 years) that examined associations between screen-based, sedentary behavior and health indicators (physical, psychosocial, and/or behavioral). The search identified 33 studies that evaluated health indicators of screen-based sedentary behaviors among adolescent girls.ResultsStrong evidence for a positive association between screen-based sedentary behavior and weight status was found. A positive association was observed between screen-time and sleep problems, musculoskeletal pain and depression. Negative associations were identified between screen time and physical activity/fitness, screen time and psychological well-being, and screen time and social support. The relationship between screen-based sedentary behavior and diet quality was inconclusive. Less than half of the studies adjusted sedentary behavior indicators for physical activity.ConclusionsScreen-based sedentary behavior is associated with a range of adverse health consequences, but additional longitudinal studies are needed to better understand the health impacts. In addition, screen-time guidelines for youth should be regularly revised and updated to reflect rapid technological changes.     

Using a naturalistic ecological approach to examine the factors influencing youth physical activity across grades 7 to 12.

High levels of inactivity in youth have led researchers and practitioners to focus on identifying the factors that influence physical activity behaviors in young people. The present study employed a qualitative ecological framework to examine the intrapersonal, social, and environmental factors influencing youth physical activity. In grade-specific focus group settings, 160 youth in grades 7 through 12 (aged 12 to 18) were asked how they would increase the physical activity levels of youth their age. Participants identified eight factors that they felt should be addressed in programs and interventions designed to increase the physical activity behaviors of youth. These factors included the importance of fun, having the time to be physically active, the benefits of activity, being active with friends, the role of adults, and the importance of being able to access facilities in their neighborhood.     

Associations of children's perceived neighborhood environments with walking and physical activity

PURPOSE: To examine associations between children's perceptions of the neighborhood environment and walking and physical activity. DESIGN: Cross-sectional study of a school-based sample. SETTING: Elementary schools in Melbourne, Australia. SUBJECTS: 280 children aged 10 years (response rate 78%). MEASURES: A self-report survey assessed children's perceptions of the neighborhood physical and social environments and their weekly walking frequency. Physical activity was also objectively measured using accelerometers. RESULTS: Multiple linear regression analyses showed a positive association between walking frequency and the number of accessible destinations in the neighborhood among boys; having a neighborhood that was easy to walk/cycle around and perceiving lots of graffiti were positively associated with walking frequency among girls. Perceiving lots of litter and rubbish was positively associated with boys' overall physical activity, but no environmental variables were associated with girls' overall physical activity. CONCLUSION: Several different environmental factors were associated with walking and physical activity. Perceptions of the neighborhood environment were more strongly associated with girls' walking than with objectively-measured physical activity. Future studies should confirm these findings using objective measures and prospective study designs.     

Neighborhood,family and individual characteristics related to adolescent park-based physical activity

BackgroundLocal parks are an important community resource that may influence levels of physical activity among youth. However, few population-based studies have investigated park-based physical activity among youth.PurposeThis study examines sociodemographic, family, and neighborhood characteristics associated with park-based physical activity among adolescents.MethodsData were from the 2007 California Health Interview Survey (CHIS), a population-based survey of California households, and were analyzed in 2012–2013 and 2015. This study examined individual (age, gender, race/ethnicity, and nativity), family (household income, parental education, and nativity), and neighborhood characteristics (urbanicity, perceived park availability, perceived park safety, neighborhood income, and racial composition) associated with engaging in park-based physical activity among adolescents.ResultsIn California, 71% of adolescents reported being physically active the last time they visited a park. In adjusted multinomial logistic regression analyses, older adolescents and females were less likely to be physically active in parks. Adolescents with a park within walking distance of home and those with a safe park nearby were more likely to be physically active during a park visit.ConclusionsPark availability and perceptions of park safety are important predictors of engaging in park-based physical activity among adolescents. These findings provide information that can help inform interventions intended to increase physical activity among youth. Strategies that increase availability and safety of parks and other recreation spaces may be particularly effective.     

Unhealthy behaviors and psychosocial difficulties among overweight adolescents: the potential impact of familial factors.

PURPOSE: To compare overweight and non-overweight youth on a selection of self-reported eating, physical activity, dieting, educational, and emotional variables and identify familial factors that serve as protective forces against unhealthy behaviors and psychosocial difficulties among overweight adolescents. METHODS: Data were taken from a 1996 cross-sectional school-based survey of 9957 adolescents in grades 7, 9, and 11. Based on self-reported heights and weights, respondents were categorized as "overweight" (body mass index) > or =85th percentile or "non-overweight." Student's t-tests were used to compare the non-overweight and overweight sample on the self-reported health-related behaviors and psychosocial variables. Logistic and linear regressions were used to identify familial factors associated with a reduced risk of engaging in unhealthy behaviors and experiencing psychosocial distress. RESULTS: Overweight adolescents reported engaging in significantly more unhealthy behaviors and experiencing more psychosocial distress than their non-overweight peers. Among the overweight youth, higher levels of reported family connectedness and parental expectations and moderate levels of parental monitoring were associated with the lowest levels of unhealthy behaviors and psychosocial distress. CONCLUSIONS: Satisfying and developmentally appropriate parent-adolescent relationships are associated with reduced behavioral and psychosocial risk factors associated with overweight during adolescence.     

Crime and perceptions of safety in the home neighborhood are independently associated with physical activity among 11–15 year olds

ObjectiveTo determine whether perceptions of neighborhood safety and measures of neighborhood crime are independently associated within physical activity in youth.MethodsThe study sample consisted of 14,125 youths in grades 6–10 (ages 11–15) who participated in the nationally representative cross-sectional 2009/10 Canadian Health Behaviour in School-Aged Children Survey. Participants responded to four questions about how safe their home neighborhood is and reported whether or not they accumulated at least 4 h/week of physical activity in their free-time outside of school hours. Crimes against persons was assessed in 1 km radius buffers around participants' homes. Associations were assessed using logistic regression.ResultsAfter controlling for crime and relevant confounders, the relative odds of being physically active outside of school was 0.52 (95% CI: 0.44–0.62) in youth whose perceptions of neighborhood safety were in the lowest quintile. After controlling for perceptions of safety and relevant confounders, the relative odds of being physically active outside of school was 0.75 (0.60–0.95) in youth from neighborhoods with crimes against persons scores in the highest quintile.ConclusionsWithin this large sample of 11–15 year olds, perceptions and objective measures of neighborhood safety and crime were independently associated with physical activity in free-time outside of school.     

The Hispanic Community Children's Health Study/Study of Latino Youth (SOL Youth): design,objectives, and procedures

PurposeThis article describes the design and methodology of the Study of Latino Youth (SOL Youth) study, a multicenter study of Hispanic/Latino children living in the United States.MethodsParticipants are children aged 8–16 years whose parents/legal guardians participated in the Hispanic Community Health Study/Study of Latinos, a large community-based cohort study of Hispanic/Latino adults living in the United States.ResultsBetween 2012 and 2014, 1600 children recruited from four field centers (Bronx, Chicago, Miami, and San Diego) will undergo a 3.5-hour examination to collect biospecimens, obtain anthropometric measures, blood pressure, fitness level, dietary intake, and physical activity. Psychosocial and environmental characteristics are assessed by questionnaire. Primary study aims are to examine associations of youth's lifestyle behaviors and cardiometabolic risk factors with (1) youth's acculturation and parent-child differences in acculturation; (2) parenting strategies, family behaviors, and parental health behaviors; and (3) youth's psychosocial functioning.ConclusionsSOL Youth will determine the prevalence and distribution of obesity-promoting lifestyle behaviors, cardiometabolic risk profiles, and novel biomarkers associated with obesity and insulin resistance. This article describes the study methodology and considers advantages and limitations of embedding a cohort of children within a well-characterized cohort of adults.     

Associations between physical activity and other health behaviors in a representative sample of US adolescents.

OBJECTIVES: This study examined the associations between physical activity and other health behaviors in a representative sample of US adolescents. METHODS: In the 1990 Youth Risk Behavior Survey, 11631 high school students provided information on physical activity; diet; substance use; and other negative health behaviors. Logistic regression analyses examined associations between physical activity and other health behaviors in a subset of 2652 high-active and 1641 low-active students. RESULTS: Low activity was associated with cigarette smoking, marijuana use, lower fruit and vegetable consumption, greater television watching, failure to wear a seat belt, and low perception of academic performance. For consumption of fruit, television watching, and alcohol consumption, significant interactions were found with race/ethnicity or sex, suggesting that sociocultural factors may affect the relationships between physical activity and some health behaviors. CONCLUSIONS: Low physical activity was associated with several other negative health behaviors in teenagers. Future studies should examine whether interventions for increasing physical activity in youth can be effective in reducing negative health behaviors.     

Peer Reviewed: Effects of Perceived Neighborhood Characteristics and Use of Community Facilities on Physical Activity of Adults With and Without Disabilities

Introduction

Using data from the 2004 Texas Behavioral Risk Factor Surveillance System, we investigated whether the physical activity behaviors of people with disabilities are related to their perceptions of the characteristics of the built environment and whether this relationship differs from that of people without disabilities.

Methods

The research questions were, "Are perceived neighborhood characteristics and reported use of community facilities associated with reported leisure-time physical activity for adults aged 18 to 64 years with disabilities?"; "Are perceived neighborhood characteristics and reported use of community facilities associated with reported moderate to vigorous physical activity for adults with disabilities?"; and "To what extent do perceived neighborhood characteristics, reported use of community facilities, reported leisure-time physical activity, and reported moderate to vigorous physical activity differ between adults with disabilities and without disabilities?" We used logistic regression to analyze the responses.

Results

People with disabilities were less likely to engage in leisure-time physical activity and meet recommendations for physical activity than people without disabilities. Participation of people with disabilities in leisure-time physical activity had significant correlations with positive perceptions of neighbors, physical activity, trails, parks, playgrounds, or sports fields, and with their use of private or membership-only recreation facilities. The presence of sidewalks was significantly related to whether people with disabilities met recommended levels of physical activity.

Conclusion

Although people with disabilities engaged in less leisure-time physical activity and physical activity than people without disabilities, perceptions of the built environment and use of community facilities similarly affected people with and without disabilities.     

The influence of the social environment on youth smoking status

ObjectiveYouth smoking is complex with multilevel influences. While much is known about certain levels of influence on youth smoking, the lack of focus on institutional influences is notable. This study evaluated the effects of ambient smoking attitudes and behaviors in schools on individual youth smoking.MethodData from the 2012 Florida Youth Tobacco Survey (n = 67,460) were analyzed. Multinomial logistic regression was used to investigate individual and aggregated school-level factors that were associated with a youth being classified as a “susceptible nonsmoker” (SN) or “current smoker” (CS) relative to a “non-susceptible nonsmoker” (NN).ResultsThe aggregated percentage of regular smokers at a school, ambient school level positive smoking perceptions, and the standardized difference between individual and school-level positive smoking perceptions were statistically significant in the fully adjusted model. We also found an increased risk of being a SN relative to a NN for Hispanic youth. Moreover, our approach to modeling institutional-level factors raised the pseudo r-squared from 0.05 to 0.14.ConclusionThese findings suggest the importance of ambient smoking attitudes and behaviors on youth smoking. Prevention efforts affecting ambient smoking attitudes may be beneficial.