Purpose: This cross-sectional study used data from the 2018-2019 National Survey of Children's Health to examine the association between metropolitan statistical area (MSA) status and sports ...participation among American youth ages 6-17. Methods: Weighted prevalence statistics were computed for sports participation by MSA status (non-MSA, MSA), overall and by child sex and age. Modified Poisson regression was used to estimate prevalence ratios (PR) for non-MSA versus MSA youth, before and after adjusting for special health-care needs, race/ethnicity, household income, parent education, and family structure. Results: The final sample included 30,029 youth M
age
= 11.6 years (SD = 0.4), 51.4% female, 49.0% White. About 56% participated in sports in the past year. Sports participation was significantly higher among females versus males 59.1% (95% CI: 57.4%-60.7%) versus 52.1% (95% CI: 50.4%-53.8%), p < .001. Among ages 6-11, those in non-MSAs (versus MSAs) were less likely to participate in sports PR 0.92 (95% CI: 0.86-0.99), p = .033, which was non-significant after adjustment. In adjusted models, youth ages 12-17 in non-MSAs (versus in MSAs) were more likely to participate in sports overall aPR 1.07 (95% CI: 1.00-1.15), p = .042 and among males aPR 1.12 (95% CI: 1.01-1.23), p = .026. Conclusion: The relationship between MSA status and sports participation may be largely driven by factors that affect youth's ability to participate in sports. Sports participation was higher among females versus males overall. In the models adjusted for demographics, non-MSA youth ages 12-17 were more likely to participate, particularly males. Efforts promoting youth sports should consider differences in socio-demographic factors between MSA versus non-MSA areas to help increase participation.
The purpose of this study was to investigate the effects of a walking school bus intervention on children's active commuting to school.
We conducted a randomized controlled trial (RCT) in Houston, ...Texas (Year 1) and Seattle, Washington (Years 2-4) from 2012 to 2016. The study had a two-arm, cluster randomized design comparing the intervention (walking school bus and education materials) to the control (education materials) over one school year October/November - May/June). Twenty-two schools that served lower income families participated. Outcomes included percentage of days students' active commuting to school (primary, measured via survey) and moderate-to-vigorous physical activity (MVPA, measured via accelerometry). Follow-up took place in May or June. We used linear mixed-effects models to estimate the association between the intervention and outcomes of interest.
Total sample was 418 students M
=9.2 (SD = 0.9) years; 46% female, 197 (47%) in the intervention group. The intervention group showed a significant increase compared with the control group over time in percentage of days active commuting (β = 9.04; 95% CI: 1.10, 16.98; p = 0.015) and MVPA minutes/day (β = 4.31; 95% CI: 0.70, 7.91; p = 0.02).
These findings support implementation of walking school bus programs that are inclusive of school-age children from lower income families to support active commuting to school and improve physical activity.
This RCT is registered at clinicaltrials.gov (NCT01626807).
Abstract
Background
The COVID-19 pandemic presented novel barriers to youth physical activity engagement. Identifying what resources parents and children are interested in receiving can support ...efforts to mitigate the negative impact of the pandemic on youth physical activity behavior. This study aimed to identify physical activity-related information needs during the COVID-19 pandemic among a nationally representative sample of American parents of children 6–10 years-old and parent-child dyads of children 11–17 years-old.
Methods
A cross-sectional survey was conducted by a market research company in October–November 2020. Parents and children were asked about their interest in specific types of information about helping their family and themselves, respectively, be active (Yes/No). Weighted percentages were calculated for reported information needs and compared using two-sample test of proportions.
Results
Final analytic sample was 1000 parents (55.4% female; 74.7% White; 74.0% non-Hispanic); 500 children 11–17 years-old (52.1% male; 77.6% White). Over 40% of participants were interested in information about being active during COVID-19. Parents were more likely to be interested in information if they always (versus never) worked from home 53.3% (95% CI: 43.3–63.0%) versus 22.0% (95% CI: 14.9–31.3%),
p
< 0.001; had children attending school remotely versus in-person 47.3% (95% CI:40.2–54.5%) versus 27.5% (95% CI: 19.6–37.1%),
p
< 0.001; and lived in a big city versus a rural area 66.5% (95% CI:54.5–76.7%) versus 34.1% (95% CI: 22.8–47.6%),
p <
0.001. Children most interested were those who did not have resources for online activity engagement and those worried about their safety or getting infected with COVID-19. Children were also more likely to be interested if their parents worked full-time versus not working 48.6% (95% CI:41.7–55.6%) versus 31.5% (95% CI: 24.1–39.9%),
p
< 0.001, and lived in a big city versus a rural area 57.2% (95% CI:45.3–68.3%) versus 27.8% (95% CI:17.8–40.7%),
p <
0.001.
Conclusions
Families are interested in physical activity resources, particularly those whose daily routines and opportunities for physical activity may have been most significantly impacted by the pandemic. This includes parents who always worked from home or whose children attended school remotely. Identifying felt needs is an important step in developing tailored interventions that aim to effectively and sustainably support families in promoting physical activity.
Importance Children’s physical activity and screen time are likely suboptimal during the COVID-19 pandemic, which may influence their current and future mental health. Objective To describe the ...association of physical activity and screen time with mental health among US children during the pandemic. Design, Setting, and Participants This cross-sectional survey was conducted from October 22 to November 2, 2020, among 547 parents of children aged 6 to 10 years and 535 parent-child dyads with children and adolescents (hereinafter referred to as children) aged 11 to 17 years and matched down to 500 children per cohort using US Census–based sampling frames. Children aged 11 to 17 years self-reported physical activity, screen time, and mental health, and their parents reported other measures. Parents of children aged 6 to 10 years reported all measures. All 1000 cases were further weighted to a sampling frame corresponding to US parents with children aged 6 to 17 years using propensity scores. Exposures Child physical activity, screen time, COVID-19 stressors, and demographics. Main Outcomes and Measures Mental health using the Strengths and Difficulties Questionnaire for total difficulties and externalizing and internalizing symptoms. Results Among the 1000 children included in the analysis (mean SD age, 10.8 3.5 years; 517 52.6% boys; 293 31.6% American Indian/Alaska Native, Asian, or Black individuals or individuals of other race; and 233 27.8% Hispanic/Latino individuals), 195 (20.9%) reported at least 60 minutes of physical activity every day. Children reported a mean (SD) of 3.9 (2.2) d/wk with at least 60 minutes of physical activity and 4.4 (2.5) h/d of recreational screen time. COVID-19 stressors were significantly associated with higher total difficulties for both younger (β coefficient, 0.6; 95% CI, 0.3-0.9) and older (β coefficient, 0.4; 95% CI, 0.0-0.7) groups. After accounting for COVID-19 stressors, engaging in 7 d/wk (vs 0) of physical activity was associated with fewer externalizing symptoms in younger children (β coefficient, −2.0; 95% CI, −3.4 to −0.6). For older children, engaging in 1 to 6 and 7 d/wk (vs 0) of physical activity was associated with lower total difficulties (β coefficients, −3.5 95% CI, −5.3 to −1.8 and −3.6 95% CI, −5.8 to −1.4, respectively), fewer externalizing symptoms (β coefficients, −1.5 95% CI, −2.5 to −0.4 and −1.3 95% CI, −2.6 to 0, respectively), and fewer internalizing symptoms (β coefficients, −2.1 95% CI, −3.0 to −1.1 and −2.3 95% CI, −3.5 to −1.1, respectively). More screen time was correlated with higher total difficulties among younger (β coefficient, 0.3; 95% CI, 0.1-0.5) and older (β coefficient, 0.4; 95% CI, 0.2-0.6) children. There were no significant differences by sex. Conclusions and Relevance In this cross-sectional survey study, more physical activity and less screen time were associated with better mental health for children, accounting for pandemic stressors. Children engaged in suboptimal amounts of physical activity and screen time, making this a potentially important target for intervention.
Schools are central to providing opportunities for youth physical activity (PA), however such opportunities were limited during the COVID-19 pandemic. Identifying feasible, acceptable, and effective ...approaches for school-based PA promotion amid pandemic-related barriers can inform resource allocation efforts in future circumstances necessitating remote instruction. The aims of this study were to: (1) describe the pragmatic, stakeholder-engaged and theory-informed approach employed to adapt one school's PA promotion efforts to pandemic restrictions, leading to the creation of at-home "play kits" for students, and (2) assess the feasibility, acceptability, and preliminary effectiveness of this intervention.
Intervention activities occurred in one middle school (enrollment: 847) located in a Federal Opportunity Zone in the Seattle, WA area, with control data from a nearby middle school (enrollment: 640). Students at the intervention school were eligible to receive a play kit during the quarter they were enrolled in physical education (PE) class. Student surveys were completed across the school year (n = 1076), with a primary outcome of days/week that the student engaged in ≥ 60 min of PA. Qualitative interviews (n = 25) were conducted with students, staff, parents, and community partners, and focused on play kit acceptability and feasibility.
During remote learning play kits were received by 58% of eligible students. Among students at the intervention school only, students actively enrolled in PE (versus not enrolled) reported significantly more days with ≥ 60 min of PA in the previous week, however the comparison between schools was not statistically significant. In qualitative interviews, most students reported the play kit motivated them to participate in PA, gave them activity ideas, and made virtual PE more enjoyable. Student-reported barriers to using play kits included space (indoors and outdoors), requirements to be quiet at home, necessary but unavailable adult supervision, lack of companions to play outdoors, and inclement weather.
A pre-existing community organization-school partnership lent itself to a rapid response to meet student needs at a time when school staff and resources were highly constrained. The intervention developed through this collaborative response-play kits-has potential to support middle school PA during future pandemics or other conditions that necessitate remote schooling, however modifications to the intervention concept and implementation strategy may be needed to improve reach and effectiveness.
This study aimed to examine the relation between learning mode with sport participation and compare participation prevalence in different settings by learning mode among United States adolescents ...during the COVID-19 pandemic. A cross-sectional, national survey was conducted by a market research company (December 2021-January 2022) among parents whose child participated in sports pre-pandemic. Parents were asked about their child’s learning mode (in-person, online, hybrid); sports participation (yes/no) during the pandemic; and participation setting (school, community, club/elite). Weighted logistic regression models examined the relation between learning mode with sport participation. Weighted prevalence estimates of participation setting were compared by learning mode. Among youth included in the analysis (n = 500; Meanage = 14.0 years), 71.0% played sports during the pandemic. Learning mode was significantly associated with participating (versus not participating) among adolescents attending school online (aOR = 0.09; 95% CI: 0.04–0.18) and in a hybrid modality (aOR = 0.30; 95% CI: 0.15–0.58) versus those attending in-person. Those attending school online (versus in-person or hybrid) had significantly lower participation prevalence in community, school, and club/elite sports. Findings may reflect parents opting out of in-person activities or schools canceling organized sport opportunities. To inform engagement strategies, research is needed to understand reasons for declined participation and extent to which participation resumed.
This study aimed to identify barriers and facilitators to comprehensive, school-based physical activity (PA) promotion among adolescents prior to and during the coronavirus disease of 2019 (COVID-19) ...pandemic, considering the perspectives of students, parents, and school staff. Data were collected from 2020 to 2021 using semi-structured individual interviews with students (n = 15), parents (n = 20), and school staff (n = 8) at a Title I middle school (i.e. high percentage of students from low-income families). Two theoretical frameworks guided analysis: the Comprehensive School Physical Activity Program framework and Bronfenbrenner's ecological systems theory. Using an iteratively developed codebook, data were coded, thematically analyzed, and synthesized. PA barriers and facilitators were present throughout the school day, at home, and in the community. Key determinants included pandemic-induced challenges (e.g. COVID-19 exposure); neighborhood characteristics/weather (e.g. neighborhood safety); school-family communication/collaboration; implementation climate (i.e. school staff's support for programming); time, spatial, and monetary resources (e.g. funding); staffing capacity/continuity and school champions; staffing creativity and adaptability; PA opportunities before, during, and after school; and child's motivation/engagement. Efforts to improve school-based PA programs, irrespective of pandemic conditions, should include strategies that address factors at the community, school, family and individual levels. School-family communication/collaboration, school staff programming support, and PA opportunities throughout the day can help promote comprehensive, school-based PA.
Few U.S. adolescents meet physical activity guidelines. Although several neighborhood characteristics influence physical activity, the role of food-related features as potential drivers of adolescent ...physical activity remains understudied. Using representative U.S. data, authors examined the effect of the neighborhood food environment on adolescents’ out-of-school physical activity.
The Family Life, Activity, Sun, Health, and Eating (FLASHE) study was conducted in 2014. Secondary data analysis occurred in 2018. Multinomial logistic regression models examined associations between neighborhood availability of (1) convenience store; (2) supermarket; (3) farmer's market; (4) fast food; (5) non–fast food restaurant and adolescent out-of-school physical activity (tertile-based, low as referent). An additional association between a total aggregate neighborhood food environment score was assessed.
Final analytic sample was 1,384 adolescents (mean age=14.5 years, SD=1.6). Controlling for free/reduced-price lunch, age, sex, race/ethnicity, and neighborhood physical activity and social environments, the aggregate food environment score was significantly associated with high physical activity (versus low tertile; OR=1.2, 95% CI=1.1, 1.3). Most individual categories of food retail outlets were significantly and directly associated with out-of-school moderate- to vigorous-intensity physical activity in the single food environment variable models. However, when fully adjusting for all food retail outlet categories plus confounders, they were no longer significant.
The availability of a diverse combination of retail food destinations within walking distance from home may provide opportunities for adolescents to achieve more physical activity, likely because of transport-based physical activity. Pending future research, these findings suggest that the role of the food environment on health extends beyond its influence on dietary behaviors to other health behaviors like physical activity.
The prevalence and attributable risk of disease due to physical inactivity require it to be made a public health priority. Public health planning allows for prioritization and resource allocation, ...particularly at the state and local levels. The extent to which state planning efforts for physical activity exist in the United States is unknown. The purpose of this paper is to describe the scope in which physical activity is incorporated in state-level public health plans in the United States, with an emphasis on alignment with the national guidelines and the National Physical Activity Plan. A standardized internet search audit was developed and conducted for each of 50 US states and the District of Columbia between May 2017 and January 2018 to determine the prevalence and characteristics of health planning documents that include physical activity. Data abstracted for analysis used a standardized search protocol that included the components of the Physical Activity Guidelines for Americans and the US National Physical Activity Plan. Results found that most states had between 4 and 6 chronic disease prevention and control plans that mention physical activity; however, it was inconsistently aligned with recommendations from both the Guidelines and the National Plan. Only 2 states had stand-alone public health planning documents explicitly dedicated to physical activity promotion. No state planning documents addressed children and adolescents, adults, and older adults simultaneously. To be maximally effective, state public health planning for physical activity should be made a priority and these efforts should align as much as possible with current guidance from the Physical Activity Guidelines for Americans and the US National Physical Activity Plan.
Abstract
Objective
Research has demonstrated associations between parental depression (PD) and negative psychological outcomes among their children. However, little is known about the pathways ...through which lifetime parent traumatic events (PTEs) influence their adolescents’ internalizing symptoms. Our study examined whether PD mediates the association between PTE and adolescent depressive and anxious symptoms among youth with persistent postconcussive symptoms (PPCS).
Methods
We used baseline data from a randomized effectiveness trial of collaborative care for treatment of persistent postconcussive symptoms among sports-injured adolescents aged 11–18 years. Parent–adolescent dyads were recruited from pediatric clinics throughout western Washington. Eligible adolescents had three or more PPCS that lasted for at least 1 month but <9 months and spoke English. Of 1,870 potentially eligible adolescents, 1,480 (79%) were excluded for not meeting the inclusion criteria. Of the eligible 390 adolescents, 189 (49%) declined to participate/consent. Participants included 200 parent–adolescent dyads (adolescent Mage = 14.7 years, SD = 1.7). Parent respondents were mostly female (83%) and mothers (81%). Adolescents reported on their depressive (Patient Health Questionnaire-9; PHQ-9) and anxious symptoms (Revised Child Anxiety and Depression Scale-Short Version anxiety subscale) and parents reported on their depressive symptoms (M = 3.7, SD = 3.7; PHQ-9).
Results
Mediation analyses revealed two (out of four) significant indirect effects of PTE on both adolescent and parent report of depressive symptoms, but not anxiety.
Conclusions
This study elucidates one pathway (PD) through which PTE history influences adolescent depressive symptoms, supporting a two-generation approach to pediatric patient care for youth experiencing PPCS.
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