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Neighborhood determinants of self-efficacy, physical activity, and body weights among Canadian children
ARTICLE IN PRESS Health & Place 16 (2010) 567–572
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Health & Place journal homepage: www.elsevier.com/locate/healthplace
Neighborhood determinants of self-efficacy, physical activity, and body weights among Canadian children Z. Davidson, A. Simen-Kapeu, P.J. Veugelers n School of Public Health, University of Alberta, 650 University Terrace, 8303–112 Street, Edmonton, AB, Canada T6G 2T4
a r t i c l e in fo
abstract
Article history: Received 9 October 2009 Received in revised form 7 January 2010 Accepted 7 January 2010
Objective: To examine the presence and pathways of the influence of neighborhood characteristics on self-efficacy, physical activity (PA) and body weight among pre-adolescent children. Design: In 2008, we surveyed grade 5 students on self-efficacy, physical activity, neighborhood perception and measures of height and weight. We applied multilevel logistic regression methods and structural equation modeling to assess the presence and pathways of the influence of neighborhood characteristics on self-efficacy, PA and body weight. Participants: Of about 3421 grade 5 students from 148 randomly selected schools from across Alberta, Canada. Results: We identified neighborhood satisfaction and services as well as neighborhood sidewalks and parks as determinants of self-efficacy. Over and above various independent associations of neighborhood characteristics with self-efficacy, PA and body weight, self-efficacy exhibited a positive effect on PA and a negative effect on body weight. Conclusion: Both infrastructural investments such as in recreational facilities, sidewalks and parks, as well as health education to promote self-efficacy may increase PA and prevent overweight among children. & 2010 Elsevier Ltd. All rights reserved.
Keywords: Childhood obesity Physical activity Self-efficacy Neighborhood factors Public health Prevention
1. Introduction Overweight is an escalating public health problem, especially among children and youth (Belanger-Ducharme and Tremblay, 2005; Statistics Canada, 2002). The health consequences of overweight in terms of chronic diseases are well documented. For children and youth, overweight adds to this burden through negative effects on self-esteem and body-image (Austin et al., 2009; Erickson et al., 2009; Needham and Crosnoe, 2005; Wang and Veugelers, 2008). The decline in physical activity (PA) over the past decades is widely acknowledged as a contributor to the obesity epidemic (Tremblay and Williams, 2003). Various research efforts have revealed determinants of PA in an attempt to generate clues to boost PA and prevent overweight. Social-cognitive research has identified self-efficacy for PA, the confidence to be able to be physically active, as a strong determinant of PA among children, youth and adults (Binns et al., 2009; Fein et al., 2004; Pan et al., 2009; Ryan and Dzewaltowski, 2002; Shields et al., 2008; Trost et al., 1999). For example, the willingness to adopt an exercise program was found to be strongly influenced by an individual’s self-efficacy (Blanchard et al., 2007; Dutton et al., 2009). Good self-
efficacy for PA was further demonstrated to be negatively correlated with body weight (Dutton et al., 2009; Jaser et al., 2009). Other research efforts have identified the built environment as a key determinant of PA and body weight (Binns et al., 2009; Veugelers et al., 2008). Elements of the built environment including walkability, neighborhood safety, playgrounds and access to sport and recreational facilities have all been associated with PA and body weight among children, youth and adults. Research to date, however, has not clarified the pathways through which the built environment affects PA. Is it that elements of the built environment provide just the physical means to be physically active, is it that these elements affect individuals’ self-efficacy that then leads to more PA, or do both pathways exist? A better understanding of these pathways will allow public health decision makers to prioritize either infrastructural investments or health promotion targeting self-efficacy for PA. To further this, we here investigate the existence and pathways of the influence of neighborhood characteristics on self-efficacy and PA.
2. Methods 2.1. The Survey
n
Corresponding author. E-mail address: [email protected] (P.J. Veugelers).
1353-8292/$ - see front matter & 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.healthplace.2010.01.001
The Raising healthy Eating and Active Living Kids in Alberta (REAL Kids Alberta) survey aims to evaluate a comprehensive initiative by the Government of Alberta to promote healthy body
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weights among children and youth through surveys in 2008 and 2010. The present study reports on the 2008 observations. The survey employed a one-stage stratified random sampling design. The sampling frame includes all elementary schools in the province of Alberta with the exception of private schools (4.7% of all Alberta children attend such schools), francophone schools (0.6%), onreserve federal schools (2.0%), charter schools (1.7%) and colony schools (0.8%) (Alberta Education, 2006/2007). Schools were stratified into three geographies: (1) urban: Calgary and Edmonton; (2) towns: other municipalities with more than 40,000 residents; and (3) rural: municipalities with less than 40,000 residents. Schools were randomly selected within each of these strata to achieve a balanced number of students in each stratum. Of the 184 invited schools, 148 (80.4%) participated in the study. These schools were attended by 5594 grade 5 students who received an envelope with a parent consent form and survey to take home. Of the 3758 (67.2%) students that returned a completed consent form to school, 3645 (97.0%) had received parental consent to participate. Of these students, 3407 were present when research assistants visited the school to conduct the survey, 6 students declined to participate, and 20 absent students completed and mailed their surveys, resulting in 3421 participating students (61.2% of total grade 5 student population in those schools). These students completed a survey that included questions on self-efficacy and physical activity, and had their heights and weight measured.
2.2. Neighborhood factors The survey for parents included eight validated questions on the perception of their neighborhood. These are listed in Table 1. Using principal component analysis we reduced to these eight aspects to
three components: (1) neighborhood satisfaction and services; (2) neighborhood safety; and (3) neighborhood playgrounds and parks (see Table 1) which we described in detail elsewhere (Simen-Kapeu et al., 2009). 2.3. Self-efficacy The survey for students included four questions related to selfefficacy for PA. Specifically, these questioned students’ confidence to exercise: (1) when tired; (2) when there is a lot of homework; (3) with parents; and (4) most days of the week. These questions had demonstrated good internal consistency and test–retest reliability (Marcus, et al., 1992). The responses included the following statements: ‘‘not at all confident’’, ‘‘a little bit confident’’, ‘‘quite confident’’ and ‘‘very confident’’ and were assigned scores of 0 to 3 respectively. The scores of each of the four questions were then averaged. Students with scores of less than 1.5 were categorized as having ‘‘low self-efficacy’’, those with higher scores as ‘‘good self-efficacy’’. 2.4. Physical activity Parents and students responded to activity questions on: (a) travel to and from school; (b) time spent to get to and from school; (c) frequency of child’s activities outside of school hours; (d) activities at morning and lunch recess in the past seven days; and (e) frequency of involvement in sports and physical activities in the past seven days. These questions, totaling 29 items, were by large adopted from the Physical Activity Questionnaire for Children (PAQ-C) which has previously been validated and demonstrated high reliability (Crocker et al., 1997; Kowalski et al., 1997). The 29
Table 1 Descriptive characteristics by self-efficacy for physical activity of 3421 grade five students and their parents participating in the REAL Kids Alberta survey. Prevalence
Neighborhood satisfaction/services Like my neighborhood (Q1) Access to sport/recreation programs (Q7) Access to stores to purchase vegetables and fruits (Q8) Neighborhood safety Safe to play outside (Q2) Unsafe for my child due to traffic (Q5) Unsafe for my child due to crimes (Q6) Neighborhood sidewalks/parks Existence of good playgrounds/parks (Q3) Existence of sidewalks on most streets (Q4) Being physically active Body weight Overweight (including obese) Obese Gender Boys Girls Parental education Secondary graduation or less Postsecondary/college diploma University degree Household income r $50,000 $50,001–$75,000 $75,001–$100,000 4 $100,000 Geographic residency Urban Town Rural a
Prevalence among students by self-efficacy level
p Valuea
Low
Good
95.0 89.6 95.1
93.5 89.6 95.5
95.2 90.4 95.1
0.15 o 0.01 0.70
93.5 32.7 21.6
91.1 34.8 25.2
93.9 32.3 21.0
0.06 0.34 0.08
85.3 83.9 26.0
83.7 84.4 11.5
85.6 83.7 28.6
0.30 0.60 o 0.01
28.5 6.7
32.7 8.5
27.8 6.6
0.04 0.14
48.5 51.5
51.8 48.2
48.0 52.0
0.16
26.5 39.9 33.6
28.6 40.6 30.8
26.2 39.8 34.0
0.44
23.4 17.4 22.2 37.0
31.9 22.4 22.2 23.5
21.8 16.6 22.2 39.4
o 0.01
47.2 16.1 36.7
52.6 14.2 33.2
46.4 16.6 37.0
0.03
p Value of o 0.05 indicates a statistically significant difference between the prevalence among low and good self-efficacy for physical activity.
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items were the basis of a composite score ranging from 1 to 6. Participants with a score exceeding 3 were classified as ‘physically active’ (Crocker et al., 2009; Kowalski et al., 1997). 2.5. Height and weight REAL Kids Alberta research assistants visited schools to administer the questionnaires and to measure heights and weights. Specifically, standing height to the nearest 0.1 cm after students had removed their shoes and body weight to the nearest 0.1 kg on calibrated digital scales. Body mass index (BMI) was calculated by dividing weight (in kilograms) by height (in meters) squared. We applied the age and gender specific cut-offs by the International Obesity Task Force (IOTF) to categorize students as normal, overweight and obese (Cole et al., 2000). 2.6. Other factors The association between neighborhood factors and self-efficacy is influenced by various factors. We considered the following confounders: child’s gender, household income, parental education and whether they resided urban, in towns or rurally. Age was not considered as all participants were fifth graders who are primarily 10 to 11 years old. The questionnaire completed by parents provided information on household income (r$50,000; $50,001–$75,000; $75,001–$100,000 and 4$100,000) and parental education (secondary school or less, community college and graduate university). 2.7. Analytic approach We first applied multi-level logistic regression to assess the associations between neighborhood characteristics and selfefficacy. Multi-level regression methods accommodate clustering of student observation within that of their schools. These regression analyses were further adjusted for the confounding influence of gender, household income, parental education and place of residence. Missing values for income were treated as a separate covariate category. All analyses were weighted to account for the design effect. The above regression methods estimate associations of neighborhood characteristics and confounders with self-efficacy. However, like self-efficacy, neighborhood characteristics and confounders are also associated with PA and body weight. Such complex pathways are more appropriately analyzed with structural equation modeling (SEM), an analytic approach based on covariance matrices rather than individual observations (Hayduk, 1987). We considered a conceptual model in which self-efficacy affects PA and body weight, and in which PA affects body weight (Fig. 1). In this model, we considered neighborhood characteristics, gender, income, parental education and place of residence as exogenous concepts, each of which affecting each of the endogenous concepts (self-efficacy, PA and body weight) as depicted in Fig. 1. As SEM does not easily accommodate dichotomous endogenous concepts, we considered self-efficacy, PA and BMI as continuous entities (Hayduk, 1987). The w2 exactfit and degrees of freedom (df) were used to assess the goodnessof-fit of the SEM (Barrett, 2007). A model has a sufficient goodness-of-fit when the statistic reveals a p-value of more than 0.05. The critical ratio (t) values (tZ1.96 or p r0.05) were used to determine statistical significance of the associations between endogenous and exogenous concepts. The SEM was conducted using LISREL Version 8.80 and the remaining statistical analyses using STATA Version 10. This study, including data collection, and parental informed consent forms were approved by the Health Research Ethics Board of the University of Alberta.
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3. Results Table 1 displays descriptive statistics of the 3421 grade 5 students and their parents that participated in the 2008 REAL Kids Alberta survey. The prevalence for low self-efficacy for PA was
Neighborhood:
Self-efficacy
satisfaction/services safety sidewalks/parks Physical activity
gender parental education income residency
Body weight Fig. 1. Conceptual structural equation model of neighborhood characteristics in relation to self-efficacy, physical activity and body weight. In this hypothesized model is each of the exogenous concepts (neighborhood satisfaction/services, neighborhood safety, neighborhood sidewalks/parks, gender, parental education, income, place of residency) affecting each of the endogenous concepts (selfefficacy for physical activity, physical activity, and body weight). And, among the endogenous concepts, is self-efficacy affecting physical activity and body weight, and is physical activity affecting body weight? Table 2 Determinants of self-efficacy for physical activity among grade five students in Alberta. Self-efficacy for physical activity
Neighborhood satisfaction/services Low Middle High Neighborhood safety Low Middle High Neighborhood sidewalks/parks Low Middle High Gender Girls Boys Parental education Secondary graduation or less Postsecondary or college diploma University degree Household income r $50,000 $50,001–$75,000 $75,001–$100,000 4$100,000 Geographic residency Urban Town Rural
Univariate
Multivariate
OR
95% CI
OR
95% CI
1.00 1.34 2.13
1.03–1.74 1.64–2.78
1.00 1.30 1.98
0.97–1.74 1.43–2.75
1.00 1.12 1.06
0.86–1.46 0.79–1.40
1.00 0.94 0.78
0.72–1.23 0.58–1.04
1.00 1.26 1.35
0.95–1.68 1.00–1.84
1.00 1.35 1.16
0.98–1.85 0.81–1.66
1.00 0.85
0.69–1.06
1.00 0.84
0.67–1.06
1.00 1.04 1.18
0.79–1.37 0.88–1.59
1.00 0.95 0.99
0.71–1.26 0.73–1.35
0.42 0.45 0.61 1.00 1.00 1.32 1.30
0.31–0.56 0.33–0.63 0.42–0.88
0.97–1.80 0.97–1.75
0.48 0.53 0.61 1.00 1.00 1.25 1.37
0.34–0.67 0.37–0.77 0.41–0.91
0.95–1.67 0.98–1.91
OR: odds ratio; CI: confidence interval; multivariate odds ratios (OR) adjusted for all listed factors in the variables
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estimated to be 14.15%. The prevalence of low self-efficacy among students differed by parental perception of their neighborhoods. For example, 85.1% of parents of students reporting low selfefficacy perceived to have good access to sport and recreation programs. Among parents of students reporting good self-efficacy, this was 90.4% (Table 1). The prevalence of good self-efficacy was substantially higher among physically active students, and lower among overweight and obese students (Table 1). Relative to students whose parents perceived their neighborhoods as low in satisfaction and services, students whose parents indicated high satisfaction and services were 2.13 time more likely to report good self-efficacy for PA (Table 2). When considering the confounding effects of the factors listed in Table 2, the effect remained substantial (1.98) and statistically significant. Neighborhood safety and neighborhood sidewalks/parks did not exhibit statistically significant associations with self-efficacy, where income and place of residence did (Table 2). The conceptual model depicted in Fig. 1 yielded a good fit with the data: w2 =3.23, df=1, p value=0.07. With respect to the endogenous concepts, self-efficacy had a significant positive effect on PA whereby an increase of one unit of self-efficacy is associated with an increase of 0.280 (95% CI: 0.260, 0.300, p o0.01) units of physical activity on a scale of 0–6. Self-efficacy had a significant negative effect on body weight (coefficient: 0.170; 95% CI: 0.180, 0.160, po0.01), and PA had a significant negative effect on body weight (coefficient: 0.610 (95% CI: 0.791, 0.429, po0.01). The coefficients for the exogenous concepts are presented in Table 3. Consistent with the results of the multilevel regression analysis, neighborhood satisfaction/services were positively and statistically significantly associated self-efficacy (coefficient: 0.100; 95% CI: 0.080, 0.120, po0.01). Neighborhood satisfaction/services had also a statistically significant positive effect on the students’ PA. Neighborhood safety had a statistically significant negative relationship with body weight. Neighborhood sidewalks/parks had a statistically significant positive association with self-efficacy and
with PA, and a statistically significant negative association with body weight (Table 3). Further, income and place of residence revealed statistically significant associations with self-efficacy (Table 3).
4. Discussion This is the first study to describe the interrelationships of neighborhood characteristics with self-efficacy, PA and body weight. We observed that neighborhood satisfaction and services is an important determinant of self-efficacy. Our SEM confirmed this and also identified neighborhood sidewalks and parks as a determinant of self-efficacy. Over and above various independent associations of neighborhood characteristics with self-efficacy, PA and body weight, self-efficacy exhibited a positive effect on PA and a negative effect on body weight. Our observation that self-efficacy is a strong predicator of PA and body weight is consistent with findings from others among pre-adolescent children (Colella et al., 2009; Sharma et al., 2006; Trost et al., 1999). Likewise, our finding that various neighborhoods characteristics are associated with PA is consistent with findings from others in this age group (Binns et al., 2009; Epstein et al., 2006; Timperio et al., 2004; Veugelers et al., 2008). What the present study adds is that neighborhoods characteristics concurrently affect self-efficacy, which then affects PA, and PA directly. In other words, neighborhoods characteristics increase PA not only by providing the physical means for children to be physically active, but also in that they influence children’s selfefficacy that then leads to more PA. The presence of these dual pathways allows for two strategies to promote PA. Both infrastructural investments such as in recreational facilities, sidewalks and parks, as well as health education to promote self-efficacy will increase PA.
Table 3 Associations of neighborhood characteristics, gender, parental education, income, and place of residence with self-efficacy, physical activity and body weight among 3421 grade 5 students participating in the REAL Kids Alberta survey. Coefficient Neighborhood satisfaction/services Self-efficacy Physical activity Body weight Neighborhood safety Self-efficacy Physical activity Body weight Neighborhood sidewalks/parks Self-efficacy Physical activity Body weight Gender Self-efficacy Physical activity Body weight Parental education Self-efficacy Physical activity Body weight Income Self-efficacy Physical activity Body weight Place of residence Self-efficacy Physical activity Body weight
95% Confidence interval
p Value
o 0.01 o 0.01 0.147
0.100 0.030 0.130
0.080, 0.120 0.010, 0.050 0.290, 0.030
0.015 0.002 0.178
0.035, 0.005 0.018, 0.022 0.338, 0.018
0.28 0.85 0.03
0.030 0.032 0.261
0.010, 0.050 0.010, 0.050 0.421, 0.101
0.04 o 0.01 o 0.01
0.004 0.174 0.245
0.044, 0.036 0.174, 0.194 0.015, 0.505
0.84 o 0.01 0.05
0.007 0.014 0.218
0.013, 0.027 0.006, 0.034 0.378, -0.058
0.63 0.15 o 0.01
0.041 0.007 0.084
0.021, 0.061 0.013, 0.027 0.182, 0.014
o 0.01 0.18 0.08
0.038 0.040 0.310
0.018, 0.058 0.020, 0.060 0.150, 0.470
o 0.01 o 0.01 o 0.01
np Value of o 0.05 indicates a statistically significant coefficient. Proper model fit:
w2 goodness-of-fit: 3.23; df= 1; p value: 0.07.
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We observed a gradient whereby children from families with increasing household income levels reported higher self-efficacy. This seems consistent with the well established socioeconomic gradient in health. Apparently, financial and time pressures within lower income families provide barriers to children to be confident to engage in PA. We observed no statistical differences by gender with respect to self-efficacy. This seems consistent with a US based study showing no associations between self-competence and physical activity among pre-adolescents (Jambunathan and Hurlbut, 2000). However, studies in Belgium and Taiwan showed that boys were more confident, and a study in Germany showed that girls were more confident doing PA (Cardon et al., 2005; Wu et al., 2003; Lohaus et al., 2004). The discrepancy between studies underlines the context specific nature of relationships and the need to replicate this research in various settings to optimally inform public health decision makers. Our study, as did others (Colella et al., 2009; Sharma et al., 2006; Trost et al., 1999), demonstrated the importance of selfefficacy for PA consistent with the Bandura’s case ‘‘unless people believe they can produce desired effects by their actions, they have little incentive to act or to persevere in the face of difficulties’’ (Bandura, 2004, pp, 144). It is therefore essential to study determinants of self-efficacy. With more research identifying the importance of neighborhood factors, their role as determinants of self-efficacy is a logical step. We showed that where parents like their neighborhood and where they perceive to have good access to parks and recreational facilities, their children experienced better self-efficacy. Clearly, the perceptions of neighborhood are intertwined with the concept of social cohesion. Social cohesion of a community has also been reported to be positively related to the willingness of parents and children to take part in PA (Cradock et al., 2009). The strengths of this study are its population-based design with surveys for both parents and students, and the measurements of heights and weights. Limitations of the present study are related to the self-reported nature such as for self-efficacy, perceived neighborhood characteristics and PA. Objective characterizations of neighborhoods and PA may strengthen the research. In conclusion, the parent’s perceptions of neighborhood characteristics are positively associated with their children’s self-efficacy over and above their influence on PA and body weight. Self-efficacy is positively correlated with PA and negatively correlated with body weight. These findings suggest that both infrastructural investments such as in recreational facilities, sidewalks and parks, as well as health education to promote selfefficacy may increase PA and prevent overweight among children.
Acknowledgments We thank all of the grade 5 students, parents and schools for their participation in the REAL Kids Alberta evaluation. We thank all the research assistants and regional health promotion coordinators for the execution of the data collection, Dr. Stefan Kuhle and Connie Lu for the data management, validation and analytic support. This research was funded through a contract with Alberta Health and Wellness and through a Canada Research Chair in Population Health and Alberta Heritage Foundation for Medical Research Health Scholarship to Dr. Paul J. Veugelers. All interpretations and opinions in the present study are those of the authors. References Alberta Education, Student population by grade, school and authority, Alberta 2006/2007 school year : http://education.alberta.ca/apps/eireports/pdf_files/ eis1004_2007/eis1004_2007.pdf.(last accessed 15.05.2009).
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Austin, S.B., Haines, J., Veugelers, P.J., 2009. Body satisfaction and body weight: gender differences and sociodemographic determinant. BMC Public Health 9, 313. Bandura, A., 2004. Health promotion by social cognitive means. Health Education & Behavior 31, 143–164. Barrett, P., 2007. Structural equation modeling: adjusting fit model. Personality and Individual Differences 42, 815–824. Belanger-Ducharme, F., Tremblay, A., 2005. National prevalence of obesity—Prevalence of obesity in Canada. Obesity Reviews 6, 183–186. Binns, H.J., Forman, J.A., Karr, C.J., Osterhoudt, K., Paulson, J.A., Roberts, J.R., Sandel, M.T., Seltzer, J.M., Wright, R.O., 2009. The built environment: designing communities to promote physical activity in children. Pediatrics 123, 1591–1598. Blanchard, C.M., Fortier, M., Sweet, S., O’Sullivan, T., Hogg, W., Reid, R.D., Sigal, R.J., 2007. Explaining physical activity levels from a self-efficacy perspective: the Physical Activity Counseling trial. Annals of Behavioral Medicine 34, 323–328. Cardon, G., Phillippaerts, R., Lefevre, J., Matton, L., Wijndaele, K., Balduck, A.L., Bourdeaudhuij, I.D., 2005. Physical activity levels in 10-to-11 years olds: clustering of psychosocial correlates. Public Health Nutrition 8, 896–903. Cole, T.J., Bellizi, M.C., Flegal, K.M., Dietz, W.H., 2000. Establishing a standard definition for child overweight and obesity worldwide : international survey. BMJ 320, 1240–1243. Colella, D., Morano, M., Robazza, C., Bortoli, L., 2009. Body image, perceived physical ability, and motor performance in nonoverweight and overweight Italian children. Perceptual and Motor Skills 108, 209–218. Cradock, A.L., Kawachi, I., Colditz, G.A., Gortmaker, S.L., Buka, S.L., 2009. Neighborhood social cohesion and youth participation in physical activity in Chicago. Social Science & Medicine 68, 427–435. Crocker, P.R.E., Bailey, D.A., Faulkner, R.A., Kowalski, K.C., McGrath, R., 1997. Measuring general levels of physical activity: preliminary evidence for the Physical Activity Questionnaire for Older Children. Medicine and Science in Sports and Exercise 29, 1344–1349. Dutton, G.R., Tan, F., Provost, B.C., Sorenson, J.L., Allen, B., Smith, D., 2009. Relationship between self-efficacy and physical activity among patients with type 2 diabetes. Journal of Behavioral Medicine 32, 270–277. Epstein, L.H., Raja, S., Gold, S.S., Paluch, R.A., Pak, Y., Roemmich, J.N., 2006. Reducing sedentary behavior: the relationship between park area and the physical activity of youth. Psychological Science 17, 654–659. Erickson, S.J., Hahn-Smith, A., Smith, J.E., 2009. One step closer: understanding the complex relationship between weight and self-esteem in ethnically diverse preadolescent girls. Journal of Applied Developmental Psychology 30, 129–139. Fein, A.J., Plotnikoff, R.C., Wild, T.C., Spence, J.C., 2004. Perceived environment and physical activity in youth. International Journal of Behavioral Medicine 11, 135–142. Hayduk, L.A., 1987. Structural equation modeling with LISREL: essentials and advances. John Hopkins, Baltimore. Jambunathan, S., Hurlbut, N.L., 2000. Gender comparisons in the perception of selfcompetence among four-year-old children. Journal of Genetic Psychology 161, 469–477. Jaser, S.S., Holl, M.G., Jefferson, V., Grey, M., 2009. Correlates of depressive symptoms in urban youth at risk for Type 2 diabetes mellitus. Journal of School Health 79, 286–292. Kowalski, K.C., Crocker, P.R.E., Faulkner, R.A., 1997. Validation of the physical activity questionnaire for older children. Pediatric Exercise Science 9, 174–186. Lohaus, A., Klein-Hessling, J., Ball, J., Wild, M., 2004. The prediction of health-related behavior in elementary school children. Journal of Health Psychology 9, 375–379. Marcus, B.H., Selby, V.C., Niaura, R.S., Rossi, J.S., 1992. Self-efficacy and the stages of behavior change. Research Quarterly for Exercise and Sport 63, 60–66. Needham, B.L., Crosnoe, R., 2005. Overweight status and depressive symptoms during adolescence. Journal of Adolescent Health 36, 48–55. Pan, S.Y., Cameron, C., DesMeules, M., Morrison, H., Craig, C.L., & Jiang, X.H., 2009. Individual, social, environmental, and physical environment correlates with physical activity among Canadians: a cross-sectional study. BMC Public Health 9, article 21. Ryan, G.J., Dzewaltowski, D.A., 2002. Comparing the relationships between different types of self-efficacy and physical activity in youth. Health Education & Behavior 29, 491–504. Sharma, M., Wagner, D.I., Wilkerson, J., 2006. Predicting childhood obesity prevention behaviors using social cognitive theory. International Quarterly of Community Health Education 24, 191–203. Shields, C.A., Spink, K.S., Chad, K., Muhajarine, N., Humbert, L., Odnokon, P., 2008. Youth and adolescent physical activity lapsers—Examining self-efficacy as a mediator of the relationship between family social influence and physical activity. Journal of Health Psychology 12 1231-1130. Simen-Kapeu A., Kuhle S., Veugelers P.J. Geographic differences in childhood overweight, physical activity, nutrition and neighborhood facilities: implications for prevention. Canadian Journal of Public Health, in press. Statistics Canada, 2002. National longitudinal survey of children and youth: childhood obesity 1994 to 1999.The Daily (catalogue number 11-001-XIE); October 18: 6–7. Timperio, A., Crawford, D., Telford, A., Salmon, J., 2004. Perceptions about the local neighborhood and walking and cycling among children. Preventative Medicine 38, 39–47. Tremblay, M.S., Williams, J.D., 2003. Is the Canadian childhood obesity epidemic related to physical inactivity? International Journal of Obesity and Related Metabolic Disorders 27, 1100–1105.
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Trost, S.G., Pate, R.R., Ward, D.S., Saunders, R., Rinter, W., 1999. Correlates of objectivity measured physical activity in preadolescent youth. American Journal of Preventive Medicine 17, 120–126. Veugelers, P.J., Sithole, F., Zhang, S., Muhajarine, N., 2008. Neighborhood characteristics in relation to diet, physical activity and overweight of Canadian children. International Journal of Pediatric Obesity 3, 152–159.
Wang, F., Veugelers, P.J., 2008. Self-esteem and cognitive development in the era of the childhood obesity epidemic. Obesity Reviews 9, 615–623. Wu, T.Y., Pender, N., Noureddine, S., 2003. Gender differences in the psychosocial and cognitive correlates of physical activity among Taiwanese, adolescents: a structural equation modeling approach. International Journal of Behavioral Medicine 10, 93–105.
Contents lists available at ScienceDirect
Health & Place journal homepage: www.elsevier.com/locate/healthplace
Neighborhood determinants of self-efficacy, physical activity, and body weights among Canadian children Z. Davidson, A. Simen-Kapeu, P.J. Veugelers n School of Public Health, University of Alberta, 650 University Terrace, 8303–112 Street, Edmonton, AB, Canada T6G 2T4
a r t i c l e in fo
abstract
Article history: Received 9 October 2009 Received in revised form 7 January 2010 Accepted 7 January 2010
Objective: To examine the presence and pathways of the influence of neighborhood characteristics on self-efficacy, physical activity (PA) and body weight among pre-adolescent children. Design: In 2008, we surveyed grade 5 students on self-efficacy, physical activity, neighborhood perception and measures of height and weight. We applied multilevel logistic regression methods and structural equation modeling to assess the presence and pathways of the influence of neighborhood characteristics on self-efficacy, PA and body weight. Participants: Of about 3421 grade 5 students from 148 randomly selected schools from across Alberta, Canada. Results: We identified neighborhood satisfaction and services as well as neighborhood sidewalks and parks as determinants of self-efficacy. Over and above various independent associations of neighborhood characteristics with self-efficacy, PA and body weight, self-efficacy exhibited a positive effect on PA and a negative effect on body weight. Conclusion: Both infrastructural investments such as in recreational facilities, sidewalks and parks, as well as health education to promote self-efficacy may increase PA and prevent overweight among children. & 2010 Elsevier Ltd. All rights reserved.
Keywords: Childhood obesity Physical activity Self-efficacy Neighborhood factors Public health Prevention
1. Introduction Overweight is an escalating public health problem, especially among children and youth (Belanger-Ducharme and Tremblay, 2005; Statistics Canada, 2002). The health consequences of overweight in terms of chronic diseases are well documented. For children and youth, overweight adds to this burden through negative effects on self-esteem and body-image (Austin et al., 2009; Erickson et al., 2009; Needham and Crosnoe, 2005; Wang and Veugelers, 2008). The decline in physical activity (PA) over the past decades is widely acknowledged as a contributor to the obesity epidemic (Tremblay and Williams, 2003). Various research efforts have revealed determinants of PA in an attempt to generate clues to boost PA and prevent overweight. Social-cognitive research has identified self-efficacy for PA, the confidence to be able to be physically active, as a strong determinant of PA among children, youth and adults (Binns et al., 2009; Fein et al., 2004; Pan et al., 2009; Ryan and Dzewaltowski, 2002; Shields et al., 2008; Trost et al., 1999). For example, the willingness to adopt an exercise program was found to be strongly influenced by an individual’s self-efficacy (Blanchard et al., 2007; Dutton et al., 2009). Good self-
efficacy for PA was further demonstrated to be negatively correlated with body weight (Dutton et al., 2009; Jaser et al., 2009). Other research efforts have identified the built environment as a key determinant of PA and body weight (Binns et al., 2009; Veugelers et al., 2008). Elements of the built environment including walkability, neighborhood safety, playgrounds and access to sport and recreational facilities have all been associated with PA and body weight among children, youth and adults. Research to date, however, has not clarified the pathways through which the built environment affects PA. Is it that elements of the built environment provide just the physical means to be physically active, is it that these elements affect individuals’ self-efficacy that then leads to more PA, or do both pathways exist? A better understanding of these pathways will allow public health decision makers to prioritize either infrastructural investments or health promotion targeting self-efficacy for PA. To further this, we here investigate the existence and pathways of the influence of neighborhood characteristics on self-efficacy and PA.
2. Methods 2.1. The Survey
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Corresponding author. E-mail address: [email protected] (P.J. Veugelers).
1353-8292/$ - see front matter & 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.healthplace.2010.01.001
The Raising healthy Eating and Active Living Kids in Alberta (REAL Kids Alberta) survey aims to evaluate a comprehensive initiative by the Government of Alberta to promote healthy body
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weights among children and youth through surveys in 2008 and 2010. The present study reports on the 2008 observations. The survey employed a one-stage stratified random sampling design. The sampling frame includes all elementary schools in the province of Alberta with the exception of private schools (4.7% of all Alberta children attend such schools), francophone schools (0.6%), onreserve federal schools (2.0%), charter schools (1.7%) and colony schools (0.8%) (Alberta Education, 2006/2007). Schools were stratified into three geographies: (1) urban: Calgary and Edmonton; (2) towns: other municipalities with more than 40,000 residents; and (3) rural: municipalities with less than 40,000 residents. Schools were randomly selected within each of these strata to achieve a balanced number of students in each stratum. Of the 184 invited schools, 148 (80.4%) participated in the study. These schools were attended by 5594 grade 5 students who received an envelope with a parent consent form and survey to take home. Of the 3758 (67.2%) students that returned a completed consent form to school, 3645 (97.0%) had received parental consent to participate. Of these students, 3407 were present when research assistants visited the school to conduct the survey, 6 students declined to participate, and 20 absent students completed and mailed their surveys, resulting in 3421 participating students (61.2% of total grade 5 student population in those schools). These students completed a survey that included questions on self-efficacy and physical activity, and had their heights and weight measured.
2.2. Neighborhood factors The survey for parents included eight validated questions on the perception of their neighborhood. These are listed in Table 1. Using principal component analysis we reduced to these eight aspects to
three components: (1) neighborhood satisfaction and services; (2) neighborhood safety; and (3) neighborhood playgrounds and parks (see Table 1) which we described in detail elsewhere (Simen-Kapeu et al., 2009). 2.3. Self-efficacy The survey for students included four questions related to selfefficacy for PA. Specifically, these questioned students’ confidence to exercise: (1) when tired; (2) when there is a lot of homework; (3) with parents; and (4) most days of the week. These questions had demonstrated good internal consistency and test–retest reliability (Marcus, et al., 1992). The responses included the following statements: ‘‘not at all confident’’, ‘‘a little bit confident’’, ‘‘quite confident’’ and ‘‘very confident’’ and were assigned scores of 0 to 3 respectively. The scores of each of the four questions were then averaged. Students with scores of less than 1.5 were categorized as having ‘‘low self-efficacy’’, those with higher scores as ‘‘good self-efficacy’’. 2.4. Physical activity Parents and students responded to activity questions on: (a) travel to and from school; (b) time spent to get to and from school; (c) frequency of child’s activities outside of school hours; (d) activities at morning and lunch recess in the past seven days; and (e) frequency of involvement in sports and physical activities in the past seven days. These questions, totaling 29 items, were by large adopted from the Physical Activity Questionnaire for Children (PAQ-C) which has previously been validated and demonstrated high reliability (Crocker et al., 1997; Kowalski et al., 1997). The 29
Table 1 Descriptive characteristics by self-efficacy for physical activity of 3421 grade five students and their parents participating in the REAL Kids Alberta survey. Prevalence
Neighborhood satisfaction/services Like my neighborhood (Q1) Access to sport/recreation programs (Q7) Access to stores to purchase vegetables and fruits (Q8) Neighborhood safety Safe to play outside (Q2) Unsafe for my child due to traffic (Q5) Unsafe for my child due to crimes (Q6) Neighborhood sidewalks/parks Existence of good playgrounds/parks (Q3) Existence of sidewalks on most streets (Q4) Being physically active Body weight Overweight (including obese) Obese Gender Boys Girls Parental education Secondary graduation or less Postsecondary/college diploma University degree Household income r $50,000 $50,001–$75,000 $75,001–$100,000 4 $100,000 Geographic residency Urban Town Rural a
Prevalence among students by self-efficacy level
p Valuea
Low
Good
95.0 89.6 95.1
93.5 89.6 95.5
95.2 90.4 95.1
0.15 o 0.01 0.70
93.5 32.7 21.6
91.1 34.8 25.2
93.9 32.3 21.0
0.06 0.34 0.08
85.3 83.9 26.0
83.7 84.4 11.5
85.6 83.7 28.6
0.30 0.60 o 0.01
28.5 6.7
32.7 8.5
27.8 6.6
0.04 0.14
48.5 51.5
51.8 48.2
48.0 52.0
0.16
26.5 39.9 33.6
28.6 40.6 30.8
26.2 39.8 34.0
0.44
23.4 17.4 22.2 37.0
31.9 22.4 22.2 23.5
21.8 16.6 22.2 39.4
o 0.01
47.2 16.1 36.7
52.6 14.2 33.2
46.4 16.6 37.0
0.03
p Value of o 0.05 indicates a statistically significant difference between the prevalence among low and good self-efficacy for physical activity.
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items were the basis of a composite score ranging from 1 to 6. Participants with a score exceeding 3 were classified as ‘physically active’ (Crocker et al., 2009; Kowalski et al., 1997). 2.5. Height and weight REAL Kids Alberta research assistants visited schools to administer the questionnaires and to measure heights and weights. Specifically, standing height to the nearest 0.1 cm after students had removed their shoes and body weight to the nearest 0.1 kg on calibrated digital scales. Body mass index (BMI) was calculated by dividing weight (in kilograms) by height (in meters) squared. We applied the age and gender specific cut-offs by the International Obesity Task Force (IOTF) to categorize students as normal, overweight and obese (Cole et al., 2000). 2.6. Other factors The association between neighborhood factors and self-efficacy is influenced by various factors. We considered the following confounders: child’s gender, household income, parental education and whether they resided urban, in towns or rurally. Age was not considered as all participants were fifth graders who are primarily 10 to 11 years old. The questionnaire completed by parents provided information on household income (r$50,000; $50,001–$75,000; $75,001–$100,000 and 4$100,000) and parental education (secondary school or less, community college and graduate university). 2.7. Analytic approach We first applied multi-level logistic regression to assess the associations between neighborhood characteristics and selfefficacy. Multi-level regression methods accommodate clustering of student observation within that of their schools. These regression analyses were further adjusted for the confounding influence of gender, household income, parental education and place of residence. Missing values for income were treated as a separate covariate category. All analyses were weighted to account for the design effect. The above regression methods estimate associations of neighborhood characteristics and confounders with self-efficacy. However, like self-efficacy, neighborhood characteristics and confounders are also associated with PA and body weight. Such complex pathways are more appropriately analyzed with structural equation modeling (SEM), an analytic approach based on covariance matrices rather than individual observations (Hayduk, 1987). We considered a conceptual model in which self-efficacy affects PA and body weight, and in which PA affects body weight (Fig. 1). In this model, we considered neighborhood characteristics, gender, income, parental education and place of residence as exogenous concepts, each of which affecting each of the endogenous concepts (self-efficacy, PA and body weight) as depicted in Fig. 1. As SEM does not easily accommodate dichotomous endogenous concepts, we considered self-efficacy, PA and BMI as continuous entities (Hayduk, 1987). The w2 exactfit and degrees of freedom (df) were used to assess the goodnessof-fit of the SEM (Barrett, 2007). A model has a sufficient goodness-of-fit when the statistic reveals a p-value of more than 0.05. The critical ratio (t) values (tZ1.96 or p r0.05) were used to determine statistical significance of the associations between endogenous and exogenous concepts. The SEM was conducted using LISREL Version 8.80 and the remaining statistical analyses using STATA Version 10. This study, including data collection, and parental informed consent forms were approved by the Health Research Ethics Board of the University of Alberta.
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3. Results Table 1 displays descriptive statistics of the 3421 grade 5 students and their parents that participated in the 2008 REAL Kids Alberta survey. The prevalence for low self-efficacy for PA was
Neighborhood:
Self-efficacy
satisfaction/services safety sidewalks/parks Physical activity
gender parental education income residency
Body weight Fig. 1. Conceptual structural equation model of neighborhood characteristics in relation to self-efficacy, physical activity and body weight. In this hypothesized model is each of the exogenous concepts (neighborhood satisfaction/services, neighborhood safety, neighborhood sidewalks/parks, gender, parental education, income, place of residency) affecting each of the endogenous concepts (selfefficacy for physical activity, physical activity, and body weight). And, among the endogenous concepts, is self-efficacy affecting physical activity and body weight, and is physical activity affecting body weight? Table 2 Determinants of self-efficacy for physical activity among grade five students in Alberta. Self-efficacy for physical activity
Neighborhood satisfaction/services Low Middle High Neighborhood safety Low Middle High Neighborhood sidewalks/parks Low Middle High Gender Girls Boys Parental education Secondary graduation or less Postsecondary or college diploma University degree Household income r $50,000 $50,001–$75,000 $75,001–$100,000 4$100,000 Geographic residency Urban Town Rural
Univariate
Multivariate
OR
95% CI
OR
95% CI
1.00 1.34 2.13
1.03–1.74 1.64–2.78
1.00 1.30 1.98
0.97–1.74 1.43–2.75
1.00 1.12 1.06
0.86–1.46 0.79–1.40
1.00 0.94 0.78
0.72–1.23 0.58–1.04
1.00 1.26 1.35
0.95–1.68 1.00–1.84
1.00 1.35 1.16
0.98–1.85 0.81–1.66
1.00 0.85
0.69–1.06
1.00 0.84
0.67–1.06
1.00 1.04 1.18
0.79–1.37 0.88–1.59
1.00 0.95 0.99
0.71–1.26 0.73–1.35
0.42 0.45 0.61 1.00 1.00 1.32 1.30
0.31–0.56 0.33–0.63 0.42–0.88
0.97–1.80 0.97–1.75
0.48 0.53 0.61 1.00 1.00 1.25 1.37
0.34–0.67 0.37–0.77 0.41–0.91
0.95–1.67 0.98–1.91
OR: odds ratio; CI: confidence interval; multivariate odds ratios (OR) adjusted for all listed factors in the variables
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estimated to be 14.15%. The prevalence of low self-efficacy among students differed by parental perception of their neighborhoods. For example, 85.1% of parents of students reporting low selfefficacy perceived to have good access to sport and recreation programs. Among parents of students reporting good self-efficacy, this was 90.4% (Table 1). The prevalence of good self-efficacy was substantially higher among physically active students, and lower among overweight and obese students (Table 1). Relative to students whose parents perceived their neighborhoods as low in satisfaction and services, students whose parents indicated high satisfaction and services were 2.13 time more likely to report good self-efficacy for PA (Table 2). When considering the confounding effects of the factors listed in Table 2, the effect remained substantial (1.98) and statistically significant. Neighborhood safety and neighborhood sidewalks/parks did not exhibit statistically significant associations with self-efficacy, where income and place of residence did (Table 2). The conceptual model depicted in Fig. 1 yielded a good fit with the data: w2 =3.23, df=1, p value=0.07. With respect to the endogenous concepts, self-efficacy had a significant positive effect on PA whereby an increase of one unit of self-efficacy is associated with an increase of 0.280 (95% CI: 0.260, 0.300, p o0.01) units of physical activity on a scale of 0–6. Self-efficacy had a significant negative effect on body weight (coefficient: 0.170; 95% CI: 0.180, 0.160, po0.01), and PA had a significant negative effect on body weight (coefficient: 0.610 (95% CI: 0.791, 0.429, po0.01). The coefficients for the exogenous concepts are presented in Table 3. Consistent with the results of the multilevel regression analysis, neighborhood satisfaction/services were positively and statistically significantly associated self-efficacy (coefficient: 0.100; 95% CI: 0.080, 0.120, po0.01). Neighborhood satisfaction/services had also a statistically significant positive effect on the students’ PA. Neighborhood safety had a statistically significant negative relationship with body weight. Neighborhood sidewalks/parks had a statistically significant positive association with self-efficacy and
with PA, and a statistically significant negative association with body weight (Table 3). Further, income and place of residence revealed statistically significant associations with self-efficacy (Table 3).
4. Discussion This is the first study to describe the interrelationships of neighborhood characteristics with self-efficacy, PA and body weight. We observed that neighborhood satisfaction and services is an important determinant of self-efficacy. Our SEM confirmed this and also identified neighborhood sidewalks and parks as a determinant of self-efficacy. Over and above various independent associations of neighborhood characteristics with self-efficacy, PA and body weight, self-efficacy exhibited a positive effect on PA and a negative effect on body weight. Our observation that self-efficacy is a strong predicator of PA and body weight is consistent with findings from others among pre-adolescent children (Colella et al., 2009; Sharma et al., 2006; Trost et al., 1999). Likewise, our finding that various neighborhoods characteristics are associated with PA is consistent with findings from others in this age group (Binns et al., 2009; Epstein et al., 2006; Timperio et al., 2004; Veugelers et al., 2008). What the present study adds is that neighborhoods characteristics concurrently affect self-efficacy, which then affects PA, and PA directly. In other words, neighborhoods characteristics increase PA not only by providing the physical means for children to be physically active, but also in that they influence children’s selfefficacy that then leads to more PA. The presence of these dual pathways allows for two strategies to promote PA. Both infrastructural investments such as in recreational facilities, sidewalks and parks, as well as health education to promote self-efficacy will increase PA.
Table 3 Associations of neighborhood characteristics, gender, parental education, income, and place of residence with self-efficacy, physical activity and body weight among 3421 grade 5 students participating in the REAL Kids Alberta survey. Coefficient Neighborhood satisfaction/services Self-efficacy Physical activity Body weight Neighborhood safety Self-efficacy Physical activity Body weight Neighborhood sidewalks/parks Self-efficacy Physical activity Body weight Gender Self-efficacy Physical activity Body weight Parental education Self-efficacy Physical activity Body weight Income Self-efficacy Physical activity Body weight Place of residence Self-efficacy Physical activity Body weight
95% Confidence interval
p Value
o 0.01 o 0.01 0.147
0.100 0.030 0.130
0.080, 0.120 0.010, 0.050 0.290, 0.030
0.015 0.002 0.178
0.035, 0.005 0.018, 0.022 0.338, 0.018
0.28 0.85 0.03
0.030 0.032 0.261
0.010, 0.050 0.010, 0.050 0.421, 0.101
0.04 o 0.01 o 0.01
0.004 0.174 0.245
0.044, 0.036 0.174, 0.194 0.015, 0.505
0.84 o 0.01 0.05
0.007 0.014 0.218
0.013, 0.027 0.006, 0.034 0.378, -0.058
0.63 0.15 o 0.01
0.041 0.007 0.084
0.021, 0.061 0.013, 0.027 0.182, 0.014
o 0.01 0.18 0.08
0.038 0.040 0.310
0.018, 0.058 0.020, 0.060 0.150, 0.470
o 0.01 o 0.01 o 0.01
np Value of o 0.05 indicates a statistically significant coefficient. Proper model fit:
w2 goodness-of-fit: 3.23; df= 1; p value: 0.07.
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We observed a gradient whereby children from families with increasing household income levels reported higher self-efficacy. This seems consistent with the well established socioeconomic gradient in health. Apparently, financial and time pressures within lower income families provide barriers to children to be confident to engage in PA. We observed no statistical differences by gender with respect to self-efficacy. This seems consistent with a US based study showing no associations between self-competence and physical activity among pre-adolescents (Jambunathan and Hurlbut, 2000). However, studies in Belgium and Taiwan showed that boys were more confident, and a study in Germany showed that girls were more confident doing PA (Cardon et al., 2005; Wu et al., 2003; Lohaus et al., 2004). The discrepancy between studies underlines the context specific nature of relationships and the need to replicate this research in various settings to optimally inform public health decision makers. Our study, as did others (Colella et al., 2009; Sharma et al., 2006; Trost et al., 1999), demonstrated the importance of selfefficacy for PA consistent with the Bandura’s case ‘‘unless people believe they can produce desired effects by their actions, they have little incentive to act or to persevere in the face of difficulties’’ (Bandura, 2004, pp, 144). It is therefore essential to study determinants of self-efficacy. With more research identifying the importance of neighborhood factors, their role as determinants of self-efficacy is a logical step. We showed that where parents like their neighborhood and where they perceive to have good access to parks and recreational facilities, their children experienced better self-efficacy. Clearly, the perceptions of neighborhood are intertwined with the concept of social cohesion. Social cohesion of a community has also been reported to be positively related to the willingness of parents and children to take part in PA (Cradock et al., 2009). The strengths of this study are its population-based design with surveys for both parents and students, and the measurements of heights and weights. Limitations of the present study are related to the self-reported nature such as for self-efficacy, perceived neighborhood characteristics and PA. Objective characterizations of neighborhoods and PA may strengthen the research. In conclusion, the parent’s perceptions of neighborhood characteristics are positively associated with their children’s self-efficacy over and above their influence on PA and body weight. Self-efficacy is positively correlated with PA and negatively correlated with body weight. These findings suggest that both infrastructural investments such as in recreational facilities, sidewalks and parks, as well as health education to promote selfefficacy may increase PA and prevent overweight among children.
Acknowledgments We thank all of the grade 5 students, parents and schools for their participation in the REAL Kids Alberta evaluation. We thank all the research assistants and regional health promotion coordinators for the execution of the data collection, Dr. Stefan Kuhle and Connie Lu for the data management, validation and analytic support. This research was funded through a contract with Alberta Health and Wellness and through a Canada Research Chair in Population Health and Alberta Heritage Foundation for Medical Research Health Scholarship to Dr. Paul J. Veugelers. All interpretations and opinions in the present study are those of the authors. References Alberta Education, Student population by grade, school and authority, Alberta 2006/2007 school year : http://education.alberta.ca/apps/eireports/pdf_files/ eis1004_2007/eis1004_2007.pdf.(last accessed 15.05.2009).
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Austin, S.B., Haines, J., Veugelers, P.J., 2009. Body satisfaction and body weight: gender differences and sociodemographic determinant. BMC Public Health 9, 313. Bandura, A., 2004. Health promotion by social cognitive means. Health Education & Behavior 31, 143–164. Barrett, P., 2007. Structural equation modeling: adjusting fit model. Personality and Individual Differences 42, 815–824. Belanger-Ducharme, F., Tremblay, A., 2005. National prevalence of obesity—Prevalence of obesity in Canada. Obesity Reviews 6, 183–186. Binns, H.J., Forman, J.A., Karr, C.J., Osterhoudt, K., Paulson, J.A., Roberts, J.R., Sandel, M.T., Seltzer, J.M., Wright, R.O., 2009. The built environment: designing communities to promote physical activity in children. Pediatrics 123, 1591–1598. Blanchard, C.M., Fortier, M., Sweet, S., O’Sullivan, T., Hogg, W., Reid, R.D., Sigal, R.J., 2007. Explaining physical activity levels from a self-efficacy perspective: the Physical Activity Counseling trial. Annals of Behavioral Medicine 34, 323–328. Cardon, G., Phillippaerts, R., Lefevre, J., Matton, L., Wijndaele, K., Balduck, A.L., Bourdeaudhuij, I.D., 2005. Physical activity levels in 10-to-11 years olds: clustering of psychosocial correlates. Public Health Nutrition 8, 896–903. Cole, T.J., Bellizi, M.C., Flegal, K.M., Dietz, W.H., 2000. Establishing a standard definition for child overweight and obesity worldwide : international survey. BMJ 320, 1240–1243. Colella, D., Morano, M., Robazza, C., Bortoli, L., 2009. Body image, perceived physical ability, and motor performance in nonoverweight and overweight Italian children. Perceptual and Motor Skills 108, 209–218. Cradock, A.L., Kawachi, I., Colditz, G.A., Gortmaker, S.L., Buka, S.L., 2009. Neighborhood social cohesion and youth participation in physical activity in Chicago. Social Science & Medicine 68, 427–435. Crocker, P.R.E., Bailey, D.A., Faulkner, R.A., Kowalski, K.C., McGrath, R., 1997. Measuring general levels of physical activity: preliminary evidence for the Physical Activity Questionnaire for Older Children. Medicine and Science in Sports and Exercise 29, 1344–1349. Dutton, G.R., Tan, F., Provost, B.C., Sorenson, J.L., Allen, B., Smith, D., 2009. Relationship between self-efficacy and physical activity among patients with type 2 diabetes. Journal of Behavioral Medicine 32, 270–277. Epstein, L.H., Raja, S., Gold, S.S., Paluch, R.A., Pak, Y., Roemmich, J.N., 2006. Reducing sedentary behavior: the relationship between park area and the physical activity of youth. Psychological Science 17, 654–659. Erickson, S.J., Hahn-Smith, A., Smith, J.E., 2009. One step closer: understanding the complex relationship between weight and self-esteem in ethnically diverse preadolescent girls. Journal of Applied Developmental Psychology 30, 129–139. Fein, A.J., Plotnikoff, R.C., Wild, T.C., Spence, J.C., 2004. Perceived environment and physical activity in youth. International Journal of Behavioral Medicine 11, 135–142. Hayduk, L.A., 1987. Structural equation modeling with LISREL: essentials and advances. John Hopkins, Baltimore. Jambunathan, S., Hurlbut, N.L., 2000. Gender comparisons in the perception of selfcompetence among four-year-old children. Journal of Genetic Psychology 161, 469–477. Jaser, S.S., Holl, M.G., Jefferson, V., Grey, M., 2009. Correlates of depressive symptoms in urban youth at risk for Type 2 diabetes mellitus. Journal of School Health 79, 286–292. Kowalski, K.C., Crocker, P.R.E., Faulkner, R.A., 1997. Validation of the physical activity questionnaire for older children. Pediatric Exercise Science 9, 174–186. Lohaus, A., Klein-Hessling, J., Ball, J., Wild, M., 2004. The prediction of health-related behavior in elementary school children. Journal of Health Psychology 9, 375–379. Marcus, B.H., Selby, V.C., Niaura, R.S., Rossi, J.S., 1992. Self-efficacy and the stages of behavior change. Research Quarterly for Exercise and Sport 63, 60–66. Needham, B.L., Crosnoe, R., 2005. Overweight status and depressive symptoms during adolescence. Journal of Adolescent Health 36, 48–55. Pan, S.Y., Cameron, C., DesMeules, M., Morrison, H., Craig, C.L., & Jiang, X.H., 2009. Individual, social, environmental, and physical environment correlates with physical activity among Canadians: a cross-sectional study. BMC Public Health 9, article 21. Ryan, G.J., Dzewaltowski, D.A., 2002. Comparing the relationships between different types of self-efficacy and physical activity in youth. Health Education & Behavior 29, 491–504. Sharma, M., Wagner, D.I., Wilkerson, J., 2006. Predicting childhood obesity prevention behaviors using social cognitive theory. International Quarterly of Community Health Education 24, 191–203. Shields, C.A., Spink, K.S., Chad, K., Muhajarine, N., Humbert, L., Odnokon, P., 2008. Youth and adolescent physical activity lapsers—Examining self-efficacy as a mediator of the relationship between family social influence and physical activity. Journal of Health Psychology 12 1231-1130. Simen-Kapeu A., Kuhle S., Veugelers P.J. Geographic differences in childhood overweight, physical activity, nutrition and neighborhood facilities: implications for prevention. Canadian Journal of Public Health, in press. Statistics Canada, 2002. National longitudinal survey of children and youth: childhood obesity 1994 to 1999.The Daily (catalogue number 11-001-XIE); October 18: 6–7. Timperio, A., Crawford, D., Telford, A., Salmon, J., 2004. Perceptions about the local neighborhood and walking and cycling among children. Preventative Medicine 38, 39–47. Tremblay, M.S., Williams, J.D., 2003. Is the Canadian childhood obesity epidemic related to physical inactivity? International Journal of Obesity and Related Metabolic Disorders 27, 1100–1105.
ARTICLE IN PRESS 572
Z. Davidson et al. / Health & Place 16 (2010) 567–572
Trost, S.G., Pate, R.R., Ward, D.S., Saunders, R., Rinter, W., 1999. Correlates of objectivity measured physical activity in preadolescent youth. American Journal of Preventive Medicine 17, 120–126. Veugelers, P.J., Sithole, F., Zhang, S., Muhajarine, N., 2008. Neighborhood characteristics in relation to diet, physical activity and overweight of Canadian children. International Journal of Pediatric Obesity 3, 152–159.
Wang, F., Veugelers, P.J., 2008. Self-esteem and cognitive development in the era of the childhood obesity epidemic. Obesity Reviews 9, 615–623. Wu, T.Y., Pender, N., Noureddine, S., 2003. Gender differences in the psychosocial and cognitive correlates of physical activity among Taiwanese, adolescents: a structural equation modeling approach. International Journal of Behavioral Medicine 10, 93–105.