Built and social environments and adiposity-related outcomes among youth in the quality cohort

Background: Paediatric obesity is a global public health concern. In order to identify potential population-based intervention and prevention strategies, environmental contexts are being investigated in relation to childhood obesity and antecedent behaviours, including physical activity (PA). However, to date, findings in the area have been inconsistent.   Purpose: The overarching goal of this thesis is to investigate the association between features of parks, school and neighbourhood environments in relation to adiposity-related outcomes. Specifically: 1) To group and characterize parks by their salient features and to determine if certain park “types” are associated with PA and adiposity outcomes; 2) To characterise schools by their predominant built and social environmental features for PA and to explore associations between school features and PA in cross-sectional and prospective analyses; 3) To determine if theoretically walkable features of the neighbourhood built environment are associated with 24-hour movement behaviours (sleep, sedentary behaviour, light physical activity (LPA), moderate-to-vigorous physical activity (MVPA)) in cross-sectional and prospective analyses.   Methods: Data were drawn from the QUALITY Cohort, a Quebec-based study of 630 children age 8-10 years at baseline with a parental history of obesity. Baseline park, residential and school environments of 512 participants living in the Montreal Metropolitan Area were characterised. Data included geographically linked census and administrative data and in-person observations. Questionnaires were completed by school principals or physical education teachers. PA was measured at baseline and follow up using self-reported questionnaires and by accelerometer. Sedentary time was measured at baseline and follow up using accelerometers while sleep time was calculated as the time the accelerometer was not worn. Body fat was measured using a DXA at baseline. Overweight and obesity was identified using body mass index computed from measured weight and height at baseline and follow up. Analyses included principal component analysis, cluster analysis, linear and logistic regression, generalized estimating equations and compositional data analysis.   Results: Findings point to specific features of parks, schools and theoretically walkable neighbourhood features that are associated with adiposity-related outcomes in the youth participants. Notably, certain types of parks that provide opportunities for unstructured play and a variety of physical activities are associated with self-reported PA while aesthetically pleasing parks are also associated with body fat. Schools that provide opportunities for unstructured play and that promote PA are associated with accelerometer measured PA, and the associations are different between boys and girls. Lastly, theoretically walkable neighbourhood features are associated with an increase in MVPA and a slight decrease in sleep, sedentary time and LPA over a 24-hour period among girls only.   Conclusion: This thesis contributes to the literature by considering three important contextual influences on children’s adiposity-related outcomes: parks, school and the residential environment. This is done by objectively characterizing these environments, by operationalising key characteristics of them, and by using innovative statistical approaches. Findings support the notion that obesity prevention and efforts to increase PA should include the consideration and modification of built and social environments and should target the multiple population-level factors that support healthy behaviours among children.

Keyphrases: QUALITY Study, Parks, Schools, Neighbourhood, Built environment, Physical activity, Body fat, Lifestyle behaviours, Obesity, Youth