Is the neighbourhood environment associated with indicators of health in children and adolescents? Developing and testing a new proof-of-concept Healthy Environments Index for Children in Taranaki, New Zealand

Geographic remoteness and socioeconomic disadvantage reduce the supportiveness of food and physical activity environments in Australia

The Australian and Canadian 24-hour movement guidelines for children and youth synthesized studies in English and French or other languages (if able to be translated with Google translate) and found very few studies published in English from Arabic countries that examined the relationship between objectively measured sedentary behaviour (SB), sleep and physical activity (PA) and health indicators in children aged 5–12 years. The purpose of this systematic review was to investigate the relationships between 24-hour movement behaviours and health indicators in school-aged children from Arab-speaking countries. Online databases MEDLINE, EMBASE, SPORTdiscus, CINAHL, PsycINFO and Scopus were searched for English, French and Arabic studies (written in English), while Saudi Digital Library, ArabBase, HumanIndex, KSUP, Pan-Arab Academic Journal, e-Marefa, Al Manhal eLibrary and Google Scholar were searched for Arabic studies. The Grading of Recommendations Assessment, Development and Evaluation framework was used to assess the risk of bias and the quality of evidence for each health indicator. A total of 16 studies, comprising 15,346 participants from nine countries were included. These studies were conducted between 2000 and 2019. In general, low levels of PA and sleep and high SB were unfavourably associated with adiposity outcomes, behavioural problems, depression and low self-esteem. Favourable associations were reported between sleep duration and adiposity outcomes. SB was favourably associated with adiposity outcomes, withdrawn behaviour, attention and externalizing problems. PA was favourably associated with improved self-esteem and adiposity outcomes. Further studies to address the inequality in the literature in the Arab-speaking countries to understand the role of 24-hour movement behaviours and its positive influence on health outcomes across childhood are urgently needed.

Objectives The aims of the present study were to: (1) describe the health status and health indicators for urban Aboriginal children (age 0-16 years) in south-east Sydney; and (2) evaluate the quality of routinely collected clinical data and its usefulness in monitoring local progress of health outcomes. Methods Aboriginal maternal and child health routine data, from multiple databases, for individuals accessing maternal and child health services between January 2007 and December 2012 were examined and compared with state and national health indicators. Results Reductions in maternal smoking, premature delivery and low birthweight delivery rates were achieved in some years, but no consistent trends emerged. Paediatric services had increased referrals each year. The most frequent diagnoses were nutritional problems, language delay or disorder and developmental delay or learning difficulties. Twenty per cent of children had a chronic medical condition requiring long-term follow-up. Aboriginal children were more likely to be discharged from hospital against medical advice than non-Aboriginal children. Routinely collected data did not include some information essential to monitor determinants of health and health outcomes. Conclusions Aboriginal children living in this urban setting had high levels of need. Routinely recorded data were suboptimal for monitoring local health status and needed to reflect national and state health indicators. Routinely collected data can identify service gaps and guide service development. What is known about this topic? Despite improvements in some areas, there continue to be significant gaps in maternal and child health outcomes between Aboriginal and non-Aboriginal Australians. These are poorly documented at a local service level. What does this paper add? Intensive, local services offered to Aboriginal women and children can result in rapid service engagement. Health service data routinely collected by local services can be used to demonstrate reductions in antenatal risk factors in pregnant Aboriginal women, even within the short time frame of 6 years. However, improvements in child health outcomes may require longer time frames. In this urban setting, the most frequent diagnoses in Aboriginal children attending the service were nutritional problems, language delay or disorder and developmental delay or learning difficulties. What are the implications for practitioners? Key information regarding determinants of health should be routinely monitored at a local level to understand local rates and health needs in addition to evaluating and quantifying the effectiveness of service delivery or health promotion activities.

Objective: This study examined the relationship between neighborhood food and physical activity environment, and obesity among elementary and junior high school students in Japan. Methods: The participants were fifth- to ninth-grade children (n=7277), who were attending municipal schools in Japan. Percent overweight (POW) was calculated using their age, gender, height, and weight, which were collected through a questionnaire. A POW of < 20% was considered non-obese, while ≥ 20% was considered obese. Furthermore, using a geographic information system, we investigated the density of convenience stores, fast-food stores, casual restaurants, supermarkets and department stores, parks, sports facilities, stations, and intersections in the school district. Additionally, from the census, we obtained information regarding the population density of the municipality where the participants’ schools were located. Multiple logistic regression analysis was used to examine the relationship between obesity and food environment (the food environment model), between obesity and physical activity environment (the physical activity environment model), and among obesity, food, and physical activity environment (the food and physical activity environment model). Results: In the food environment model and the food and physical activity environment model, the density of convenience stores showed a significant positive association. In the physical activity environment model, the density of stations showed a significant negative association. Conclusion: This study’s findings can contribute to the development of appropriate community interventions for improving children’s health in Japan and similar areas.

Purpose: Maternal and child healthcare play crucial role in reducing global mortality rates, with a significant impact on the overall burden of disease. The Sustainable Development Goal 3 aims to reduce the global maternal mortality ratio to less than 70 per 100,000 live births, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births by 2030. Sub-Saharan Africa, including Tanzania, carries a high burden of mortality rates and experiences a significant share of maternal and child deaths, exacerbating the global figures. The average prevalence of below 5 years mortality in SSA between 2010 and 2018 was 4.10% according to Ahinkorah (2021). Recognizing the severity of this issue, the government of Tanzania through the Development Agenda 2025, Draft health policy 2020 and the current Health Sector strategic plan 2021-2026 plans to reduce infant and maternal mortality rates through mother and child healthcare investment. The Health Sector Strategic Plan focuses on strengthening the health systems in the country and aims to sustain the achievements made in enhancing the health of reproductive, maternal, newborn, children, and adolescent populations. This study sought to assess the benefits of investing on mother and child healthcare in Tanzania. The study was guided by the investment commodity theory developed by the economist John Maynard Keynes in 1936. The study evaluated the current status of mother and child health indicators, the benefits of investing in mother and child health on overall health outcomes and identified the existing gaps and challenges in the provision, access and utilization of mother and child healthcare services in Tanzania.&#x0D; Methodology: The study was a desktop review-based study which relied on existing published information, data, and literature.&#x0D; Findings: The study found out that there have been improvements in certain areas of mother and child health indicators but maternal and child mortality rates remain high. Health interventions such as vaccination programs, improved access to healthcare services, and the use of maternal and child health insurance cards showed positive effects on reducing child mortality, improving child health outcomes, and enhancing maternal healthcare utilization. The significant gaps and challenges in the provision, access, and utilization of mother and child healthcare services include disparities in access to healthcare services based on factors such as education level and wealth status, inadequate healthcare infrastructure, long distances to health facilities, sociocultural barriers, and financial constraints.&#x0D; Unique contribution to theory, practice and policy: The study recommends strengthening of healthcare infrastructure, enhancing access to maternal and child healthcare services, especially for vulnerable populations, promoting health education and raising awareness about maternal and child healthcare practices, addressing the shortage of skilled healthcare professionals, improving data collection and use and monitoring of maternal and child health indicators, addressing socio-cultural barriers that hinder access and utilization of healthcare services and increasing investment in mother and child health care programs through allocate adequate resources.

Great variations exist in child health outcomes among states in the United States, with southern states consistently ranked among the lowest in the country. Investigation of the geographical distribution of children's health status and the regional factors contributing to these outcomes has been neglected. We attempted to identify the degree to which region of residence may be linked to health outcomes for children with the specific aim of determining whether living in the southern region of the United States is adversely associated with children's health status. A child health index (CHI) that ranked each state in the United States was computed by using state-specific composite scores generated from outcome measures for a number of indicators of child health. Five indicators for physical health were chosen (percent low birth weight infants, infant mortality rate, child death rate, teen death rate, and teen birth rates) based on their historic and routine use to define health outcomes in children. Indicators were calculated as rates or percentages. Standard scores were calculated for each state for each health indicator by subtracting the mean of the measures for all states from the observed measure for each state. Indicators related to social and economic status were considered to be variables that impact physical health, as opposed to indicators of physical health, and therefore were not used to generate the composite child health score. These variables were subsequently examined in this study as potential confounding variables. Mapping was used to redefine regional groupings of states, and parametric tests (2-sample t test, analysis of means, and analysis-of-variance F tests) were used to compare the means of the CHI scores for the regional groupings and test for statistical significance. Multiple-regression analysis computed the relationship of region, social and economic indicators, and race to the CHI. Simple linear-regression analyses were used to assess the individual effect of each indicator. A geographic region of contiguous states, characterized by their poor child health outcomes relative to other states and regions of the United States, exists within the "Deep South" (Mississippi, Louisiana, Arkansas, Tennessee, Alabama, Georgia, North Carolina, South Carolina, and Florida). This Deep-South region is statistically different in CHI scores from the US Census Bureau-defined grouping of states in the South. The mean of CHI scores for the Deep-South region was >1 SD below the mean of CHI scores for all states. In contrast, the CHI score means for each of the other 3 regions were all above the overall mean of CHI scores for all states. Regression analysis showed that living in the Deep-South region is a stronger predictor of poor child health outcomes than other consistently collected and reported variables commonly used to predict children's health. The findings of this study indicate that region of residence in the United States is statistically related to important measures of children's health and may be among the most powerful predictors of child health outcomes and disparities. This clarification of the poorer health status of children living in the Deep South through spatial analysis is an essential first step for developing a better understanding of variations in the health of children. Similar to early epidemiology work linking geographic boundaries to disease, discovering the mechanisms/pathways/causes by which region influences health outcomes is a critical step in addressing disparities and inequities in child health and one that is an important and fertile area for future research. The reasons for these disparities may be complex and synergistically related to various economic, political, social, cultural, and perhaps even environmental (physical) factors in the region. This research will require the use and development of new approaches and applications of spatial analysis to develop insights into the societal, environmental, and historical determinants of child health that have been neglected in previous child health outcomes and policy research. The public policy implications of the findings in this study are substantial. Few, if any, policies identify these children as a high-risk group on the basis of their region of residence. A better understanding of the depth and breadth of disparities in health, education, and other social outcomes among and within regions of the United States is necessary for the generation of policies that enable policy makers to address and mitigate the factors that influence these disparities. Defining and clarifying the regional boundaries is also necessary to better inform public policy decisions related to resource allocation and the prevention and/or mitigation of the effects of region on child health. The identification of the Deep South as a clearly defined subregion of the Census Bureau's regional definition of the South suggests the need to use more culturally and socially relevant boundaries than the Census Bureau regions when analyzing regional data for policy development.

The objective of this systematic review was to examine the relationships between objectively and subjectively measured sleep duration and various health indicators in children and youth aged 5-17 years. Online databases were searched in January 2015 with no date or study design limits. Included studies were peer-reviewed and met the a priori-determined population (apparently healthy children and youth aged 5-17 years), intervention/exposure/comparator (various sleep durations), and outcome (adiposity, emotional regulation, cognition/academic achievement, quality of life/well-being, harms/injuries, and cardiometabolic biomarkers) criteria. Because of high levels of heterogeneity across studies, narrative syntheses were employed. A total of 141 articles (110 unique samples), including 592 215 unique participants from 40 different countries, met inclusion criteria. Overall, longer sleep duration was associated with lower adiposity indicators, better emotional regulation, better academic achievement, and better quality of life/well-being. The evidence was mixed and/or limited for the association between sleep duration and cognition, harms/injuries, and cardiometabolic biomarkers. The quality of evidence ranged from very low to high across study designs and health indicators. In conclusion, we confirmed previous investigations showing that shorter sleep duration is associated with adverse physical and mental health outcomes. However, the available evidence relies heavily on cross-sectional studies using self-reported sleep. To better inform contemporary sleep recommendations, there is a need for sleep restriction/extension interventions that examine the changes in different outcome measures against various amounts of objectively measured sleep to have a better sense of dose-response relationships.

ABSTRACTAverage acceleration (AvAcc) and intensity gradient (IG) have been proposed as standardised metrics describing physical activity (PA) volume and intensity, respectively. We examined hypothesised between-group PA differences in AvAcc and IG, and their associations with health and well-being indicators in children. ActiGraph GT9X wrist accelerometers were worn for 24-h·d−1 over 7days by 145 children aged 9–10. Raw accelerations were averaged per 5-s epoch to represent AvAcc over 24-h. IG represented the relationship between log values for intensity and time. Moderate-to-vigorous PA (MVPA) was estimated using youth cutpoints. BMI z-scores, waist-to-height ratio (WHtR), peak oxygen uptake (VO2peak), Metabolic Syndrome risk (MetS score), and well-being were assessed cross-sectionally, and 8-weeks later. Hypothesised between-group differences were consistently observed for IG only (p < .001). AvAcc was strongly correlated with MVPA (r = 0.96), while moderate correlations were observed between IG and MVPA (r = 0.50) and AvAcc (r = 0.54). IG was significantly associated with health indicators, independent of AvAcc (p < .001). AvAcc was associated with well-being, independent of IG (p < .05). IG was significantly associated with WHtR (p < .01) and MetS score (p < .05) at 8-weeks follow-up. IG is sensitive as a gauge of PA intensity that is independent of total PA volume, and which relates to important health indicators in children.

There is no published data on quality of administrative data for various health indicators in Botswana, yet such data are used for policy making and future planning. This article reports on quality of data on child health and sexual and reproductive health (SRH) indicators in Botswana. The main objective of the study was to assess the quality of administrative data from Expanded Immunization Program (EPI) and condom use, Depo-Provera uptake and domiciliary care attendance in Botswana. This was a retrospective study entailing a review of data retrieved from district health records and District Health Information System (DHIS). A total of 30 clinics and health posts were randomly selected from two cities, a town and three rural villages which makes up 6 districts commonly denoted urban, semi-urban and rural respectively. Through a stratified random sampling health facilities were selected. EPI data (Penta 3- third dose of pentavalent vaccine and Measles vaccine) and SRH data (condom use, Depo-Provera uptake and Domiciliary care) were assessed for completeness, discrepancies and verification factor using WHO Routine data quality (RDQA) assessment tool. A verification score of less than 90%% was considered as underreporting while more than 110% is over reporting. However, the score which is within +-10% is acceptable, reliable and a good indicator of data quality and reporting system. About 56% (9/16) SRH indicators had a verification factor score outside the accepted range and 87% (13/15) discrepancy value outside the accepted range. For immunization, 10% (1/10) had a verification factor score outside the accepted range and 33% (3/9) had a discrepancy value outside the accepted range. The level of completeness was high for both Penta3 and Measles coverage and it was lowest for condom. Our findings highlight a poorer data quality for SRH indicators compared to child health indicators. A comprehensive program review drawing lessons from the child health indicators is required to improve the quality of administrative data in Botswana.

To evaluate the association of a combined measure of availability and use of facilities from the food environment and overweight (including obesity) among schoolchildren, while taking into account the physical activity and social-assistance environments. Cross-sectional study with a probabilistic sample of schoolchildren aged 7 to 14 years living in a southern Brazilian city (n = 2026). Multilevel analyses were performed with overweight as outcome and the food environment as main exposure. Models were adjusted for the physical activity and social-assistance environments, as well as individual and other residential neighborhood characteristics. Greater availability of restaurants around the home was associated with higher odds of overweight (odds ratio [OR] = 1.40; 95% CI = 1.06-1.85). Stronger associations were found for schoolchildren reporting to use restaurants (OR = 1.48; 95% CI = 1.15-1.90). This association remained significant after adjusting for the presence of other food retailers. Schoolchildren who had social-assistance facilities around their homes, but reported not to use them, showed consistently higher odds of being overweight (OR = 1.34; 95% CI = 1.01-1.78) as compared to schoolchildren who had these facilities near home and used them. The physical activity environment was not associated with the outcome. Availability and use of the food and social-assistance environments were significantly associated with overweight (including obesity) among the schoolchildren. Future research should consider the use of environmental facilities in combination to their geographical availability. Our results highlight the need for policies that limit the access to obesogenic food outlets by children and adolescents.

Associations between the built environment and body mass index in the Mexican American Mano A Mano Cohort

Objectives: To analyze the relationship between residential physical activity environment and food environment respectively and adolescent BMI level, the correlation between adolescent physical activity level and food intake behavior respectively and adolescent BMI level, as well as compare the difference of correlation between residential single physical activity environment or combined physical activity environment and adolescent BMI level, and the difference of correlation between food environment and adolescent BMI level. Methods: Based on the cross-sectional study design, a total of 1035 adolescents aged 11 to 17 years were surveyed in the urban area of Jinhua City. The final valid sample was 884 (including 411 males and 473 females) after screening, due to the methodological difficulties of the food intake frequency survey. The height and weight of the sample were measured, and the subjective perception evaluation of physical activity level, frequency of food intake, residential physical activity environment, and food environment were investigated. Results: (1) No significant difference exists in BMI between physical activity levels in the sample overall and among men, but a significant difference exists between physical activity levels among women (p&lt;0.05). A significant difference exists in BMI between the frequencies of non-healthy food intake in the overall sample (p&lt;0.05 or p&lt;0.01). After differentiating by gender, there were significant differences in BMI among different frequencies of fried food, puffed food, and carbonated beverage intake among men (p&lt;0.05 or p&lt;0.01), and among women for different frequencies of puffed food, sugary drinks, and carbonated beverages (p&lt;0.05 or p&lt;0.01). (2) All indicators of physical activity environment in the residence were correlated with the physical activity level of adolescents and were significant (p&lt;0.05 or p&lt;0.01). The physical activity level of females compared to males was correlated with the safety of physical activity facilities and other environmental indicators in and around the residence and was significant after differentiating by gender. (3) Binary Logistic Regression results showed that when the independent variable was the combination of "physical activity and frequency of food intake", fried food (OR=1.771, p&lt;0.05), puffed food (OR=1.762, p&lt;0.05), and carbonated beverage intake frequency (OR=2.082, p&lt;0.05) were risk factors for adolescent obesity. When the independent variable was a combination of "physical activity environment and food environment", fewer stray dogs roaming in and around the residence (OR=0.766, p&lt;0.05), better physical activity venues/facilities (OR=0.661, p&lt;0.05), and more free physical exercise areas (OR= 0.686, p &lt; 0.01) were protective factors for adolescent obesity. Conclusion: The overall physical activity level of adolescents in Jinhua urban area was low and the frequency of unhealthy food intake was high. The differences between groups with different unhealthy food intake frequencies were significant. There were significant correlations between physical activity environment and physical activity level of adolescents, and food environment and frequency of unhealthy food intake of adolescents. A better physical activity environment and food environment in and around the residence contributed to adolescents showing relatively lower BMI levels. Female adolescents need to pay more attention to the combined effect of "physical activity environment and food environment" in obesity prevention and control, compared with male adolescents.

The purpose of this systematic review was to determine how combinations of physical activity (PA), sedentary behaviour (SB), and sleep were associated with important health indicators in children and youth aged 5-17 years. Online databases (MEDLINE, EMBASE, SPORTdiscus, CINAHL, and PsycINFO) were searched for relevant studies examining the relationship between time spent engaging in different combinations of PA, SB, and sleep with the following health indicators: adiposity, cardiometabolic biomarkers, physical fitness, emotional regulation/psychological distress, behavioural conduct/pro-social behaviour, cognition, quality of life/well-being, injuries, bone density, motor skill development, and self-esteem. PA had to be objectively measured, while sleep and SB could be objectively or subjectively measured. The quality of research evidence and risk of bias for each health indicator and for each individual study was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. A total of 13 cross-sectional studies and a single prospective cohort study reporting data from 36 560 individual participants met the inclusion criteria. Children and youth with a combination of high PA/high sleep/low SB had more desirable measures of adiposity and cardiometabolic health compared with those with a combination of low PA/low sleep/high SB. Health benefits were also observed for those with a combination of high PA/high sleep (cardiometabolic health and adiposity) or high PA/low SB (cardiometabolic health, adiposity and fitness), compared with low PA/low sleep or low PA/high SB. Of the 3 movement behaviours, PA (especially moderate- to vigorous-intensity PA) was most consistently associated with desirable health indicators. Given the lack of randomized trials, the overall quality of the available evidence was low.

School Food and Physical Activity Environment: A Longitudinal Analysis of Four School Districts in New Jersey

Examining the Association between Intervention-Related Changes in Diet, Physical Activity, and Weight as Moderated by the Food and Physical Activity Environments among Rural, Southern Adults