Purpose: Although insufficient physical activity (PA), high sedentary behaviour (SB), and inadequate sleep are fairly common among children, little is known about these behaviours of immigrant children. This systematic review examined the prevalence of PA, SB, and sleep among immigrant children aged 5-17 years around the globe.

Methods: Four electronic databases were searched to retrieve the English language peer-reviewed original articles published between January 2000 and March 2019. Cross-sectional, cohort or longitudinal studies that reported on the prevalence of PA, SB, or sleep-related outcomes among immigrant children were included. Data were extracted independently by two reviewers.

Results: Of 2,724 retrieved articles, 55 were selected for full-text screening and 12 met the eligibility criteria. Included studies were from the USA (n=6), the Netherlands (3), Australia (1), Switzerland (1), and Sweden (1). Five studies were based on nationally representative samples. Five studies (42%) ranked as fair at the quality assessment and the remaining were ranked as poor. Over half the studies (n=7; 58%) assessed only PA, one reported only sleep, three reported both PA and SB, and one reported all three behaviours. While all studies included both male and female adolescents, only one reported gender-stratified prevalence. No study provided age-stratified results. Only one used device-based measure. Assessment of PA and SB varied greatly across the studies with differing definitions of PA/SB. Based on three US nationally (2) and state (1) representative studies, the prevalence of doing ≥20 minutes of PA on ≥3 days/wk ranged from 48-72%. One study reported that 9 in 10 participants had >2 hrs/day of television-time, and three studies reported an average sedentary time ranging from 1-3hrs/day. One study reported that 13% of immigrant children in the USA had inadequate sleep on <5 nights/wk.

Conclusions: Most of the studies on the prevalence of PA, SB, and sleep among immigrant children are derived from a few high-income countries. Future studies should include all three movement behaviours and use standard assessment tools and definitions.  

Purpose

Most studies on day-to-day patterns of physical activities and sedentary behaviour are based on adult populations of high socioeconomic status (SES) without differentiating between work and leisure. Consequently, little is known about domain-specific day-to-day patterns of physical behaviours and potential correlates of such patterns among low SES adults. Thus, we aimed to characterize the day-to-day pattern among low SES adults and to investigate the influence of day of the week and its interaction with workday, work duration and work physical behaviours on day-to-day leisure physical behaviours.

Method

This study included 1012 adults from typical low SES occupations (e.g. manufacturing, cleaning and transportation). The participants wore accelerometers for 1-5 days to measure daily physical behaviours at work and leisure, expressed as 3-part time-use compositions consisting of time spent 1) sedentary, 2) standing or 3) active (i.e. walking, stairclimbing or running). Multilevel linear log-ratio models were used to regress leisure time-use composition on (1) type of day, i.e., work/non-work, (2) day-of-week, (3) work duration, and (4) work time-use composition. Models were adjusted for sex, age, BMI and smoking-status.

Results

During leisure, sedentary time increased during the week (300 min/day on Monday, 307 min/day on Friday), while active time decreased (42 min/day on Monday, 38 min/day on Friday). At work, sedentary time decreased during the week (176 min/day on Monday, 167 min/day on Friday), while active time increased (83 min/day on Monday, 90 min/day on Friday). Leisure physical behaviours were associated with type of day (p < 0.005, more sedentary on work days vs. non-work days) and day-of-week (p < 0.005, more sedentary on Friday). There were no associations with work duration or work time-use composition.

Conclusion

Our findings suggest that low SES adults’ leisure time is more sedentary towards the end of the workweek, while their work time becomes more active. Leisure time was spent significantly more sedentary (and less active) on workdays compared to non-workdays, indicating that these workers might organize their day according to work obligations. Our findings highlight the need to differentiate between domain when investigating day-to-day physical behaviour patterns and its correlates among low SES adults.

Introduction: Evidence from longitudinal studies on the influence of neighbourhood disadvantage on cardiovascular disease (CVD) is limited. We investigated the prospective association of neighbourhood-level deprivation with CVD in older adults and whether physical activity (PA) mediated this association. 

Methods: Data comes from the HABITAT project, a multilevel longitudinal investigation of health and wellbeing in Brisbane. Data included 11,035 residents in 200 neighbourhoods in 2007, with follow-up data obtained in 2009, 2011, 2013 and 2016. Neighbourhood disadvantage was derived using a Census-based index and divided into quintiles. CVD was defined as reporting one or more medically diagnosed long-term conditions: coronary heart disease, high blood pressure/hypertension or any serious circulatory condition. PA was self-reported, and an overall measure of energy expenditure was derived by multiplying the time (minutes/week) spent in walking, moderate activity and vigorous activity by an intensity value, and summing the products. Hazard ratios were estimated using a multilevel mixed-effect parametric survival model, adjusting for age, sex, education, occupation, and household income. Those with pre-existing CVD at baseline were excluded from the analyses. The mediation effect of PA on CVD was examined using multilevel generalized structural equation modelling.

Results: There were a total of 20,018 observations at five-time points. Observations were clustered into three levels of year, individuals and HABITAT neighbourhoods. The risk of CVD was highest in the most disadvantaged neighbourhoods evidenced by higher hazard ratios (HR) (Q1: HR 1.56, 95% CI 1.24,1.90). HRs of CVD in Q1 were 1.22 (95% CI 1.01,1.47), 1.42 (95% CI 1.14,1.76), 1.38 (95%CI 1.11,1.72) after adjusting for education, occupation and household income, respectively. PA as a mediator had the strongest effect (both total and indirect p<0.001) on CVD among residents of the most disadvantaged neighbourhoods.

Conclusion: Neighbourhood disadvantage was associated with the incidence of CVD, and PA was a significant mediator of this relationship. Future research should investigate which neighbourhood-level features promote or inhibit PA in disadvantaged areas as the basis for policy initiatives to address inequities in CVD. 

Purpose: Cardiovascular disease (CVD) is a serious and prevalent health issue in aging populations. There can be wide geographic variations in CVD mortality. There are disparities in CVD mortality related to area-level socio-economic status (SES) disadvantage, which may be influenced by built-environment attributes. We examined relationships of objectively-assessed neighborhood walkability attributes with CVD mortality, in high, medium and low SES areas, using linking Japanese national data sets.

Methods: National data from the 1,824 municipalities across Japan were used. The outcome was mortality from CVD (the number of observed deaths from all types of CVD including acute myocardial infarction, heart failure, and cardiac arrhythmias and conduction disorders) for a five-year period (2008–2012) for each municipality. A standard national index of neighborhood deprivation was used as an indicator of municipality-level SES. A nationally-applicable walkability index (based on population density, road density and access to commercial areas) was derived using geographic information systems.

Results: Neighborhood walkability was significantly higher in higher SES municipalities than lower SES municipalities. Higher SES municipalities were also more populated, better connected, and had better access to commercial areas than lower SES municipalities. Compared to higher SES municipalities, relative rates [RR] for CVD mortality were significantly higher in medium SES municipalities (RR = 1.05, 95% CI: 1.04, 1.05) and in lower SES municipalities (RR = 1.09, 95% CI: 1.09, 1.10). There were walkability-related gradients in CVD mortality within the high and medium SES areas, and similar gradients for each of the three individual walkability components; however, walkability-related CVD mortality gradients were not apparent for lower SES municipalities.

Conclusions: Building on and expanding the known associations of socioeconomic disparities with CVD risk, we identified urban design attributes related to the geographic distribution of CVD mortality. CVD mortality rates varied not only by area-level socioeconomic status but also by walkability. In higher and medium SES municipalities, there are walkability-related gradients in CVD mortality, which were not apparent for the lower SES municipalities. Our findings provide a novel element of the evidence base needed to inform socially-and environmentally-focused approaches to CVD prevention in aging populations.

Purpose: We tested the hypothesis that lifetime discrimination mediates associations between perceived neighborhood social environment (PNSE) and TV viewing among African American (AA) adults. This study is innovative because it can shed new light on potential mechanisms linking neighborhood social environment to sedentary behavior.

Methods: Baseline data for 4,716 Jackson Heart Study (JHS) participants (mean age=55.1y), a large prospective cohort study of AAs in Jackson, Mississippi were used. One binary TV viewing outcome was created: ≥4 hours/day. PNSE variables included neighborhood violence, problems (higher value=more violence/problems), and social cohesion (higher value=more cohesion). Lifetime discrimination was based on a validated instrument about unfair treatment (workplace), summed to create a mediator. Covariates included demographics, health-related factors, and population density. Multivariable linear regression with bootstrap-generated 95% bias-corrected confidence intervals (BC CIs) was used to test for significant indirect mediation effects (determined by 95%BC CIs [not including one] for logistic regression (odds ratios; OR) adjusting for covariates. Significance of unstandardized coefficients was determined by 95%CIs (not including zero).

Results: Participants (37%) reported TV viewing≥4 hours/day. Neighborhood violence, problems, and social cohesion were indirectly related to TV viewing via lifetime discrimination (OR=1.03, 95%BC CI=1.00, 1.07; OR=1.03, 95%BC CI=0.99, 1.06 [marginal], and OR=0.98, 95%BC CI=0.94, 0.99, respectively). That is, lower neighborhood violence and problems (B=-0.41, 95%CI=-0.64, -0.18 and B=-0.36, 95%CI=-0.53, -0.20, respectively) and higher social cohesion (B=0.11, 95%CI=0.08, 0.53) were associated with higher lifetime discrimination. In turn, lifetime discrimination was inversely associated with TV viewing. No direct associations were observed. 

Conclusions: Each PNSE variable was indirectly associated with TV viewing via lifetime discrimination among JHS participants. Unexpected relationships between PNSE, lifetime discrimination, and TV viewing revealed when examining indirect associations warrant further investigation. Future research is needed to pinpoint effective community efforts to reduce discrimination and adverse neighborhood factors, and thereby decrease TV viewing and subsequent cardiovascular disease risk.

Purpose: Incentive-based programs are becoming increasingly popular to target physical inactivity and sedentary behaviours. However, little is known about the appeal of such programs among high-risk groups. The aim of this study was to qualitatively explore the appeal of incentive-based program components which aimed to increase physical activity and reduce sitting time in low socioeconomically positioned groups.
Method: Semi-structured interviews were conducted with participants (N=20) aged 40-65 years, who did not meet physical activity guidelines; reported sitting most of the day; and had an income below the Australian median. Interview schedule questions were guided by Adams et al. (2014) framework for documenting financial incentive interventions to change health behaviour. Interviews were transcribed and NVivo 10 utilised to conduct a thematic analysis.
Findings: Participants expressed interest in taking part in incentive programs that aimed to increase their physical activity and reduce their sitting time. Cash rewards and gift vouchers were the most desired incentive type, however most participants expressed the importance of individualising these rewards. The preferred incentive value was around AUD$10-20 a week. However, a few participants stated that the perceived social contact they might gain from involvement in the program was the strongest incentive. Participants expressed that these programs would be seen as more acceptable if funded by the government; however most believed this would not be possible. Alternative suggestions were for programs to be funded by sporting brands, supermarkets or health insurers who have a transparent partnership with the program. The importance of supplementing these programs with additional support elements was a strong theme. These included social platforms, links to credible educational health resources, transport services, carer services and activity self-monitoring technologies. When discussing ideal program duration most participants suggested that they would be willing to be involved long-term if the program met their needs and held their interest.
Conclusion: Incentive-based programs hold appeal for people with low incomes, particularly if they involve individualised rewards; and include additional components such as social contact and educational and behavioural support. Trialling the feasibility and effectiveness of such programs is an important future priority.