Positive HABITATS for physical activity: Examining use of parks and its contribution to physical activity levels in mid-to older-aged adults

Studies of parks and physical activity rarely identify the actual spaces participants use. Using data from the HABITAT project, a longitudinal cohort of mid-to older-aged (40–70 years) respondents (n = 11,036) living in Brisbane Australia, this study examined (1) the demographic characteristics of users and non-users of parks; (2) the park used and the characteristics and features of the most popular reported spaces; and (3) the level of physical activity undertaken in the reported parks and whether users had higher total physical activity levels than non-users. Park use was significantly higher (p < 0.01) among dog walkers, couples (over 40) living with children, and those living in least disadvantaged areas. Regular park use was significantly higher among users of larger-sized neighbourhood and district-catchment parks. Park users were 35% more likely to meet the physical activity guidelines (OR = 1.35, 95%CI 1.21–1.50, p < 0.001) compared with those who indicated they did nto regularly use a park. The size of the park used was positively associated with participation in physical activity. Users of larger-sized parks spent more time doing vigorous activity and engaged in more activity sessions than non-users. Future data obtained from large populations, including spatial examination of the actual parks used and their characteristics, are essential to facilitate planning for park provision, optimising the use of these spaces for recreation and physical activity by mid-to older-aged adults, and creating healthy communities.     

Associations between physical activity,sedentary time and social-emotional functioning in young children

BackgroundThis study preliminarily examined the relationship between physical activity, sedentary time, and social emotional functioning in children aged 4–6 years.MethodsEighty children attending kindergarden classes in Ottawa, Canada wore Actical accelerometers for 1-week to directly assess their physical activity and sedentary time. Physical activity was quantified as minutes per day in light intensity or moderate intensity, and steps per day, while sedentary time was quantified as minutes per day. Social emotional functioning attributes were assessed by teachers using the Devereux Students Strengths Assessment.ResultsAfter controlling for age, sex, household-income and school clustering using multilevel regression models, steps per day were positively associated with social awareness β = 1.537, CI = 0.115–2.959) self-awareness (β = 1.285, CI = 0.014–2.555), relationship skills (β = 1.729, CI = 0.238–3.219), personal responsibilities (β = 1.689, CI = 0.101–3.276), and optimistic thinking (β = 1.091, CI = 0.251–2.157). Moderate physical activity was positively associated with relationship skills (β = 1.598, CI = 0.065–3.131) and optimistic thinking (β = 1.515, CI = 0.069–2.234). Time spent in light physical activity and sedentary time were not associated with social emotional functioning indicators.ConclusionsPhysical activity as measured by steps per day and time spent in moderate physical activity was associated with better social emotional functioning. Future research is needed to verify these preliminary findings and determine the directionality of relationships observed, and experimental studies are needed to determine whether promoting either increased steps per day or intensity of physical activity can improve social emotional functioning in the early years.     

Prevalence and risk factors of the co-occurrence of physical frailty and cognitive impairment in Chinese community-dwelling older adults

This cross-sectional study aimed to determine the prevalence of the co-occurrence of physical frailty and cognitive impairment and to identify its associated demographic, psychosocial and behavioural factors. Participants were recruited from 32 neighbourhoods using multistage sampling method in Xuhui District, Shanghai, China. A total of 1585 older adults were included who lived in community, were 75 years or older and without a clinical diagnosis of dementia. Based on the presences of frailty (using the modified frailty phenotype criteria) and/or cognitive impairment (using Chinese version Mini-Mental Status Examination stratified by educational level), the participants were classified into four groups: normal, cognitive impairment alone, frailty alone and co-occurrence. Multinomial logistic regression analyses were conducted to identify the demographic, psychosocial (depression, social participation and social support) and behavioural (sedentary lifestyle and sleep problems) characteristics associated with the co-occurrence of physical frailty and cognitive impairment. The prevalence of frailty alone, cognitive impairment alone and the co-occurrence of physical frailty and cognitive impairment in the study sample were 7%, 26.94% and 7.19% respectively. The results of multinomial logistic regression show the following characteristics significantly associated with the co-occurrence of physical frailty and cognitive impairment: advanced age (81–85 years old, Odds Ratio, OR = 1.99, 95% CI = 1.10–3.59; 86 years or older, OR = 6.43, 95% CI = 3.66–11.29), number of co-morbidities (OR = 1.34, 95% CI = 1.01–1.77), depression (OR = 3.88, 95% CI = 2.39–6.29), social participation (OR = 0.61, 95% CI = 0.39–0.96), sedentary lifestyle (OR = 2.69, 95% CI = 1.66–4.34) and sleep problems (insomnia occasionally, OR = 1.84, 95% CI = 1.07–3.17; insomnia every day, OR = 2.38, 95% CI = 1.33–4.26). The co-occurrence of physical frailty and cognitive impairment is a prevalent health issue in oldest old community-dwelling older adults. Advanced age, co-morbidity, depression, sedentary lifestyle and sleep problems are risk factors for cognitive frailty while good social participation may have a protective effect on it.     

Physical Activity is Associated With Fewer Subjective Cognitive Complaints in 47 Low- and Middle-Income Countries

ObjectivesTo determine the association between physical activity (PA) and subjective cognitive complaints (SCCs), and the influential factors in this association.DesignCross-sectional study.Setting and ParticipantsCommunity-based data of the World Health Survey, which included 248,504 individuals from 47 low- and middle-income countries (LMICs), were analyzed [mean age = 38.6 (standard deviation 16.1) years; 50.7% female].MethodsPA was assessed with the International Physical Activity Questionnaire. Participants were grouped into those who meet (high PA) the 150 minutes of moderate-to-vigorous intensity PA per week recommendation, and those who do not (low PA). Two questions on subjective memory and learning complaints in the past 30 days were used (scales ranged from 1 to 5, with higher scores representing more severe SCC). Multivariable ordinal logistic regression and mediation analyses were performed.ResultsOverall, after adjusting for sociodemographic and a wide range of behavioral, psychological, and physical factors, low PA was associated with a higher risk for having more severe subjective memory complaints [odds ratio (OR) = 1.10, 95% confidence interval (CI) = 1.04-1.23] and learning complaints (OR = 1.18, 95% CI = 1.12-1.26). Significant associations were only observed among the middle-aged (45-64 years; learning complaints OR = 1.19, 95% CI = 1.06-1.33) and older populations (≥65 years; memory complaints OR = 1.31, 95% CI = 1.15-1.49, and learning complaints OR = 1.41, 95% CI = 1.24-1.60). Chronic physical conditions, sleep problems, depression, and anxiety explained between 7.7% and 29.4% of the PA-SCC association among those aged ≥45 years.Conclusions and ImplicationsLow PA was associated with increased odds for more severe SCCs in middle-aged and older adults in LMICs. Given the particularly rapid increase in dementia in LMICs, more longitudinal research is warranted from this setting to understand the utility of PA promotion in the prevention of cognitive impairment.     

Lifetime total physical activity and prostate cancer risk: a population-based case–control study in Sweden

The etiologic role of physical activity in prostate cancer development is unclear. We assessed the association between lifetime total physical activity and prostate cancer risk in a Swedish population-based case–control study comprising 1,449 incident prostate cancer cases and 1,118 unaffected population controls. Information regarding physical activity was obtained via a self-administered questionnaire assessing occupational, household, and recreational activity separately at various ages throughout an individual’s lifetime. Clinical data (TNM-classification, Gleason sum and PSA) was obtained from linkage to the National Prostate Cancer Registry. Overall, we observed no association between lifetime total physical activity and prostate cancer risk (odds ratio [OR] = 1.04, 95% confidence interval [CI] = 0.77–1.41 for ≥49.7 vs. <41.9 metabolic equivalent-hours per day). There was a significantly increased risk of prostate cancer in the most active men compared with the least active men in household (OR = 1.44, 95% CI = 1.08–1.92) and recreational physical activity (OR = 1.56, 95% CI = 1.16–2.10). Comparing the most active with the least active men, total physical activity was not associated with either localized disease (OR = 0.95, 95% CI = 0.67–1.34) or advanced disease (OR = 1.19, 95% CI = 0.83–1.71). These findings do not support the hypothesis that physical activity uniformly protects against prostate cancer development.     

The risk factors for hospital re‐admission in medical patients in Singapore

Unplanned hospital re‐admissions are common, expensive and often unpreventable in the community. The study aimed to identify risk factors associated with unplanned hospital re‐admission in Singapore. In a cross‐sectional survey, 1509 patients admitted to the medical wards of a large acute hospital in Singapore during 2010 were recruited (78.8% response rate), data being collected using a structured questionnaire based on the Andersen behavioural model underlying healthcare use. The dependent variable was re‐admission within 28 days, with independent variables in the four areas of predisposing characteristics, needs, enabling resources and health behaviour. Hierarchical logistic regression was used to evaluate the risk factors associated with unplanned hospital re‐admission. There were 222 inpatients re‐admitted (14.7%) within 28 days and the final model showed that patients who were unemployed (OR = 1.5; 95% CI = 1.1–2.1) and had chronic obstructive pulmonary disease (OR = 2.0; 95% CI = 1.1–3.7) with abnormal respiratory patterns (OR = 1.6; 95% CI = 1.1–2.2) were more likely to be re‐admitted. Less likely to be re‐admitted were patients doing regular daily activities (OR = 0.7; 95% CI = 0.5–0.9), those assisted by a social worker (OR = 0.3; 95% CI = 0.2–0.6), those referred to other health professionals when sick (OR = 0.6; 95% CI = 0.4–0.7) and those who had received health education programmes before discharge in the previous admission (OR = 0.7; 95% CI = 0.4–0.9). Unplanned re‐admissions are a concern to healthcare providers because this suggests that patients are discharged with unresolved problems that reflect ineffective care in hospital. This study provides evidence to prompt more effective discharge educational care programmes that incorporate patients' enabling and need outcomes, thereby reducing re‐admission rates. Community‐based healthcare should play an important role in reducing patients' re‐admission rates.     

Dieting to Lose Weight and Occurrence of Neural Tube Defects in Offspring of Mexican–American Women

Lowered maternal weight gain and reduction in early pregnancy have been associated with risk of neural tube defects (NTDs) in offspring. We examined the association of self-reported maternal dieting behaviors on the occurrence of NTDs. We conducted a population based case–control study among Mexican–American women who were residents of the 14 Texas counties bordering Mexico. Case women had an NTD-affected pregnancy identified at birth or prenatally and had deliveries during the years 1995–2000. Control women were those who delivered live born infants without an apparent congenital malformation, randomly selected and frequency-matched to cases by year and facility. One hundred eighty-four case women and 225 control women were asked in person about the use of nutritional supplements, dieting to lose weight, and type of weight reduction supplements used during the 3 months before conception. Women who reported being on a diet to lose weight during the 3 months before conception had an NTD odds ratio (OR) of 1.9 (95% confidence interval (CI) = 1.1, 3.3) compared with those not reporting being on a diet. Neither consuming vitamin drinks (OR = 1.2) nor using diet pills (OR = 1.6) during the 3 months before conception had ORs that were different from the null, when compared to women not reporting those behaviors. The risk effect for dieting did not differ markedly among normal or underweight (OR = 2.0, 95% CI = 0.7, 5.6), overweight (OR = 1.9, 95% CI = 0.7, 5.0), or obese women (OR = 1.5, 95% CI = 0.6, 4.0). No effect was seen among dieting women who were consuming at least 1.0 mg/day of folate (OR = 1.1, CI = 0.3, 4.5). Maternal dieting prior to conception may increase the risk of NTDs in offspring.     

Psychosocial Correlates of Overweight or Obese Status in Latino Adults with Coronary Artery Disease

This study evaluated the psychosocial correlates of being overweight or obese among US born and immigrant Latino adults. Depressive symptoms were measured with the Center for Epidemiological Studies Depression Scale (CES-D10). Of the 177 participants, 64% were either overweight or obese, of which, 51% also had comorbid depressive symptoms. On bivariate analyses, these participants were younger (OR = 2.4, 95% CI = 1.5–5.2), female (OR = 2.5, 95% CI = 1.3–4.6), US born (OR = 6, 95% CI = 1.3–9.0), more likely to have lived in the US 15 or more years (OR = 2.6, 95% CI 1.3–5.1), reported fair or poor health, (OR = 3.8, 95% CI = 1.8–8.0), and were more likely to perceive greater stress (OR = 7.8, 95% CI = 3.4–18.0). On multivariate analysis, only perceived stress remained significant (OR = 6.5, 95% CI = 2.7–15.6). This suggests that interventions designed to reduce the epidemic of overweight and obesity in Latino adults may also need to address their psychosocial health.     

Is park visitation associated with leisure-time and transportation physical activity?

Objective

The aim of this study was to examine whether frequency of park visitation was associated with time spent in various domains of physical activity among adults living in a disadvantaged neighbourhood of Victoria, Australia.

Methods

In 2009, participants (n = 319) self-reported park visitation and physical activity including: walking and cycling for transport, leisure-time walking, leisure-time moderate- to vigorous-intensity physical activity, and total physical activity.

Results

The mean number of park visits per week was 3.3 (SD = 3.8). Park visitation was associated with greater odds of engaging in high (as compared to low) amounts of transportation physical activity, leisure-time walking, leisure-time moderate- to vigorous-intensity physical activity (MVPA) and total physical activity. Each additional park visit per week was associated with 23% greater odds of being in the high category for transportation physical activity, 26% greater odds of engaging in high amounts of leisure-time walking, 11% greater odds of engaging in MVPA, and 40% greater odds of high total physical activity.

Conclusions

Acknowledging the cross-sectional study design, the findings suggest that park visitation may be an important predictor and/or destination for transportation and leisure-time walking and physical activity. Findings highlight the potentially important role of parks for physical activity.     

Inequalities in the long-term impact of the economic recession on preventive healthcare use and health-related lifestyle in Spain (2006–2017)

Study of the long-term impact of economic recession on lifestyle according to socioeconomic groups is scarce. This study examines health-related lifestyle and preventive medical attendance in different socioeconomic groups in the Spanish adult population (18–64 years of age) before, during and after an economic recession. Data were collected from three waves of the Spanish National Health Survey (2006, 2012 and 2017). Self-perceived health, health-related lifestyle and common preventive medical attendance were evaluated by means of multivariate logistic models. The increase in good self-perceived health in 2006–2012 was 7.1%, 6.9% and 8.3% for the high, middle and low group, respectively, and 5.2%, 5.9% and 7.9% for the high, middle and low group, respectively, in 2006–2017. In 2006–2012 and 2006–2017, the gap increased between people of the high and low groups in smoking prevalence (2.8%–4.7%), physical activity (2.0%–4.0%), daily fruit (1.0%–6.3%) and vegetable intake (2.5%–6.1%). The probability of women´s gynaecological attendance increased statistically significant for cytology in three groups in 2006–2012 and 2006–2017 (OR = 1.35, 95% CI = 1.08–1.67; OR = 1.42, 95% CI = 1.18–1.7; OR = 1.34, 95% CI = 1.21–1.47 for the high, middle and low groups, respectively, in 2006–2012 and OR = 1.34, 95% CI = 1.08–1.67; OR = 1.62, 95% CI = 1.35–1.95; OR = 1.51, 95% CI = 1.37–1.66 for the high, middle and low groups, respectively, in 2006–2017), but not for mammography. This study reveals long-term socioeconomic inequalities in lifestyle behaviours after the economic recession. Health policies must be emphasised in these population subgroups and in more disadvantaged populations.     

Association between perceived urban built environment attributes and leisure-time physical activity among adults in Hangzhou,China

BackgroundNeighborhood built environment may influence residents' physical activity, which in turn, affects their health. This study aimed to determine the associations between perceived built environment and leisure-time physical activity in Hangzhou, China.Methods1440 participants aged 25–59 were randomly selected from 30 neighborhoods in three types of administrative planning units in Hangzhou. International Physical Activity Questionnaire long form and NEWS-A were used to obtain individual-level data. The China Urban Built Environment Scan Tool was used to objectively assess the neighborhood-level built environment. Multi-level regression was used to explore the relationship between perceived built environment variables and leisure-time physical activities. Data was collected in Hangzhou from June to December in 2012, and was analyzed in May 2013.ResultsSignificant difference between neighborhood random variations in physical activity was identified (P = 0.0134); neighborhood-level differences accounted for 3.0% of the variability in leisure-time physical activity. Male residents who perceived higher scores on access to physical activity destinations reported more involvement in leisure-time physical activity. Higher scores on perception of esthetic quality, and lower on residential density were associated with more time in leisure-time walking in women.ConclusionsThe present study demonstrated that perceived urban built environment attributes significantly correlate with leisure-time physical activity in Hangzhou, China.     

Cross-sectional associations between sitting at work and psychological distress: Reducing sitting time may benefit mental health

ProblemEvidence is emerging of adverse associations between prolonged sitting at work and physical health, yet little is known about occupational sitting and mental health. This study examined associations between occupational sitting and psychological distress in employed adults, independent of leisure-time physical activity.MethodsA survey of 3367 state government employees (mean age 46.2 years, 71.9% women) was conducted in Tasmania, Australia, during 2010 as part of an evaluation of workplace health and wellbeing programs. The Kessler Psychological Distress Scale (K10) was used to measure psychological distress, and participants reported time spent sitting at work on a typical day. Physical activity was assessed using the International Physical Activity Questionnaire (IPAQ). Ratios of prevalence (PR) for categories of psychological distress were estimated by log multinomial regression separately for men and women, and with adjustment for age, marital status, effort-reward imbalance and leisure-time physical activity.ResultsAverage reported occupational sitting time was 4.8 (Standard Deviation SD = 2.5) hours for men and 4.2 (SD = 2.7) hours for women. Compared to those sitting at work less than 3 h/day, men sitting more than 6 h/day had increased prevalence of moderate psychological distress (adjusted PR = 1.90, 95%CI 1.22, 2.95), and women sitting more than 6 h/day had an increased prevalence of moderate (adjusted PR = 1.25, 95%CI 1.05, 1.49) and high (adjusted PR = 1.76, 95%CI 1.25, 2.47) distress.ConclusionThe current study found an association between occupational sitting and intermediate levels of psychological distress, independent of leisure-time physical activity. Reducing occupational sitting time may have mental health benefits.     

Risk Factors for Sub-Clinical and Major Postpartum Depression Among a Community Cohort of Canadian Women

Objectives To identify prenatal and perinatal factors that predict women at risk of sub-clinical and major postpartum depression among a cohort of low medical risk pregnant women in Canada. Methods Data from 1,403 women who completed a randomized controlled trial of supplementary support during pregnancy was analyzed to identify risk factors for sub-clinical and major postpartum depression. The Edinburgh Postnatal Depression Scale (EPDS), completed at eight weeks postpartum, was used to classify each woman’s depression symptom severity. Demographic, obstetric, behavioral risk, mental health and psychosocial factors were considered. Multiple logistic regression analyses were used to identify risk factors most predictive of sub-clinical and major postpartum depression. Results After adjustment for other covariates, variables that increased the risk of sub-clinical postpartum depression included a history of depression (OR = 2.27, CI = 1.42–3.63), anxiety symptoms during pregnancy (OR = 2.12, CI = 1.09–4.11), being born outside Canada (OR = 1.87, CI = 1.17–3.00), and low parenting self-efficacy (OR = 1.65, CI = 1.06–2.55). Variables that increased the risk of major postpartum depression included a history of depression (OR = 2.78, CI = 1.56–4.97), being born outside Canada (OR = 2.97, CI = 1.70–5.17), depressive symptoms during pregnancy (OR = 2.83, CI = 1.29–6.19) and not breastfeeding at eight weeks postpartum (OR = 2.12, CI = 1.21–3.70). Conclusions A history of depression and being born outside Canada predicted women who were at an increased risk of sub-clinical and major postpartum depression. The remaining risk factors specific to sub-clinical and major postpartum depression suggest some differences between women vulnerable to sub-clinical compared to major depressive symptoms in the postpartum period, which may have implications for targeted screening and intervention strategies.     

Patterns of use of a maternal mental health service in a low‐resource antenatal setting in South Africa

The prevalence of perinatal common mental disorders in South Africa is high, yet little is known about mental health service use among pregnant and postnatal women. This paper reports on pregnant women's patterns of use of a counselling service at a primary level obstetric facility in Cape Town, South Africa, between January 2010 and December 2011. It investigates whether these are associated with demographics, severity and risk of depressive symptoms. Participants (N = 3311) were screened for psychological distress using the Edinburgh Postnatal Depression Scale (EPDS) at their first antenatal visit. Risk factors for antenatal depression were assessed using a 11‐item checklist. Questionnaires were self‐administered, but some participants required assistance. Participants scoring positive (≥13) on the EPDS were offered referral to on‐site, individual counselling, and assigned to one of three groups according to their service use: declined referral; accepted referral and attended counselling sessions; and accepted referral but defaulted all appointments. Consent to participate was received by 3437 (96.4%) participants who were offered screening, of which 627 (18.9%) screened positive on the EPDS. Of these, 363 (57.9%) attended counselling. Both bivariate analyses and regression analyses revealed that age and risk factor assessment score were associated with screening positive on the EPDS. Odds ratios (OR) for accepting counselling were OR = 0.94 (95% CI = 0.92–0.97) for gestation, OR = 1.27 (95% CI = 1.15–1.39) for EPDS score and OR = 0.48 (95% CI = 0.23–0.99) for reporting three or more risk factors. OR for attending counselling were, for age: OR = 1.06 (95% CI = 1.00–1.12) and for reporting three or more risk factors: OR = 0.60 (95% CI = 0.37–0.97). While the majority of women with psychological distress accessed the counselling service provided, strategies to increase service use of younger pregnant women specifically are required.     

Attitudes of parents towards influenza vaccine in the Eastern Mediterranean Region: A multilevel analysis

BackgroundSeasonal influenza vaccines (SIVs) can protect against influenza and substantially reduce the risk of influenza-related hospitalizations and fatalities in children. This study aimed to assess parental attitudes towards SIVs in the Eastern Mediterranean region (EMR).MethodsThrough an anonymous online survey conducted in 19 countries in the EMR, parents or caregivers over 18 years who had at least one child above 6 months filled out the Parent Attitudes about Childhood Vaccines questionnaire. As data had two levels; country and individual factors, we utilized multilevel binary logistic regression models.ResultsIn total, 6992 respondents filled out the questionnaire. Of them, 47.4 % were residents of middle-income countries, 72.4 % of the mothers were between 26 and 45 years old, 56.5 % had at least a university degree, and approximately 51.6 % were unemployed. Nearly 50.8 % of the respondents were hesitant to vaccinate their children against seasonal influenza. Parental attitudes towards seasonal influenza vaccination differed significantly between countries, p < 0.001. The main predictors of parental seasonal influenza vaccine hesitancy (VH) were parents vaccination (odds ratio (OR) = 0.42, 95 % CI = 0.32–0.55, p < 0.001)), the mother's education if mother educated vs. who did not receive any education (OR ranged from 0.48 to 0.64, p < 0.05), living in low-income countries (OR = 0.52, 95 % CI = 0.35–0.77, p < 0.01), mountain residence (0.69, 95 % CI = 0.49–0.99, p < 0.05), health workers as a source of information (OR = 0.70, 95 % CI = 0.58–0.85, p < 0.001), children vaccination against COVID-19 (OR = 0.52, 95 % CI = 0.41–0.65, p < 0.001), not receiving routine vaccinations (OR = 1.93, 95 % CI = 1.09–3.44, p = 0.025), and if parents respondents could not remember whether their child had suffered from seasonal influenza in the previous year (OR = 1.57, 95 % CI = 1.33–1.84, p < 0.001).ConclusionA high seasonal influenza VH rate was found in the EMR. Health authorities should implement different interventions targeting the identified modifiable risk factor to increase vaccine uptake among children, especially those at risk of complication from seasonal influenza infection.     

Associations of park features with park use and park-based physical activity in an urban environment in Asia: A cross-sectional study

Park use is associated with health, yet our understanding of park features related to their use is limited. Singapore's parks were audited for 30 micro-features, then geospatial analysis characterized micro-features scores for parks nearest to participants' homes. Adults (3,435) reported their park use and park-based physical activity. Using linear regression models, we found living near a park with higher micro-features scores was associated with more time in parks and park-based physical activity. Specific micro-features were associated with more park time (wildlife areas, water features, forested areas, unpaved trails (2–2.6 h/month, p < 0.05)) and with physical activity in parks (water features, forested areas, large playground, open green spaces (1.8–2.2 h/month, p < 0.05)). These findings could inform parks planning to support population-health.