Background
Regular physical activity is associated with numerous health benefits among young children [
1] and their parents [
2]. For example, physical activity is positively associated with motor skill development and psychosocial health and negatively associated with adiposity and cardio-metabolic risk factors among 0- to 4-year-olds [
1]. Similarly, a dose–response relationship between physical activity, several chronic conditions (e.g., cardiovascular disease, type 2 diabetes) and all-cause mortality has been observed among adults [
2]. Conversely, excessive screen time (e.g., television, video/computer games) is associated with poorer health outcomes across the lifespan, such as obesity among young children [
3] and adults [
4] as well as impaired psychosocial and cognitive development among young children [
3]. Furthermore, physical activity and screen time habits formed at an early age may track overtime [
5,
6]. Therefore, early childhood is a critical period for establishing healthy habits for both current and later health. Active parents can serve as important role models for their children while maximizing their own health [
7].
Despite the known benefits of a healthy active lifestyle, a large proportion of young Canadian children and their parents are not meeting recommended levels [
8,
9]. For instance, national surveillance data indicate that only 15% of Canadian 3- to 4-year-olds meet both the physical activity and sedentary behavior guidelines [
8]. In addition, only 43% of 0- to 4-year olds from Kingston, Canada meet the screen time recommendations that are part of the Canadian Sedentary Behavior Guidelines for the Early Years [
10]. Similarly, only 8% of mothers and 10% of Canadian fathers with children <6 years old met recommendations of 150 minutes per week of moderate-to-vigorous intensity physical activity [
9]. In fact, Canadian mothers and fathers with a child <6 years old are the only group of parents less likely (odds ratio = 0.31 for mothers; odds ratio = 0.34 for fathers) to meet physical activity recommendations when compared with adults with no dependent children [
9]. While sedentary behavior guidelines do not currently exist for adults, data from various population-base studies indicate that two-thirds of adults accumulate more than 2 hours per day of recreational screen time [
11].
To develop evidence-based interventions to promote healthy active lifestyles in young children and their parents, a greater understanding is needed of the correlates of physical activity and screen time in these dyads. Features of the physical environment in neighborhoods where families live have the potential to encourage or discourage the physical activity and screen time behaviors of young children and their parents [
12]. There are a growing number of studies examining the relationship between the physical environment and adult’s physical activity [
12‐
15]. To date, findings have been relatively inconsistent but a recent review indicates availability/connectivity of trails and accessibility/convenience of recreation facilities show promise [
13]. However, it is unclear if features of the physical environment have similar or different influences on parents with young children, given the unique time and energy demands of child care. Furthermore, little is known regarding the influence of the physical environment on the physical activity of young children [
16] and on the screen time of young children and their parents [
17‐
19].
To our knowledge no study has examined the influence of features of the physical environment on physical activity and screen time of young child–parent dyads. While it is clear young children have little autonomy from their parents [
20], it is unclear whether features of the physical environment have similar or different influences on behaviors in these different age groups. This has important implications on the strategies used in future interventions and public health initiatives aiming to promote a healthy active lifestyle in young children and their parents.
Using previous qualitative and quantitative research, Pikora and colleagues have developed a conceptual framework for examining the influence of the neighborhood physical environment on physical activity [
14]. The framework includes function (i.e., walking surface, streets, traffic, permeability), safety (i.e., personal, traffic), aesthetic (i.e., streetscape, views), and destination (i.e., facilities) physical environment features [
14]. The purpose of this study was to use this framework as a guide to examine the associations between several features of the physical environment with physical activity and screen time among young children (≤5 years old) and their parents after taking into account several socio-demographic factors.
Results
A total of 62 participants were excluded because they were missing the birth date or sex of the child or physical activity data. Another 15 participants were excluded because they lived in rural neighborhoods where Google Earth Street View was not available. Finally, a further 212 participants were excluded because they lived outside of the 45 Kingston neighborhoods where extensive GIS data was not available. In total, 511 child–parent dyads from 37 neighborhoods were included in the analyses. There were no significant differences in the physical activity and screen time variables between excluded and included participants.
Participant characteristics of the 511 children and parents are in Table
1. Approximately 55% of the children were male, 4% were less than <1 years old, 61% were aged 1–3 years, and 35% were aged 4–5 years. Children participated in a median of 57 min/day of screen time and 23 min/day of physical activity. Parents participated in a median of 81 min/day of screen time, light physical activity 4 times/week, moderate physical activity 2 times/week, and strenuous physical activity 1 time/week. Characteristics of the 37 neighborhoods are in Table
2. Of note, median income was $72,217, a median 62% of roads had sidewalks, and a median 50% and 6% of total land area was residential area and parks/sports fields, respectively.
Table 1
Individual-level characteristics
Child sex (%) | |
Male | 55.2 |
Female | 44.8 |
Parent sex (%) | |
Male | 8.6 |
Female | 91.4 |
Child age (%) | |
Infants (< 1 years old) | 4.3 |
Toddlers (1–3 years old) | 60.5 |
Preschoolers (4–5 years old) | 35.2 |
Child care status | |
Yes | 83.8 |
No | 16.2 |
Family structure (%) | |
Two-parent home | 70.8 |
Single-parent home | 29.2 |
Parental Education (%) | |
Elementary (Grades 1–8) | 1.2 |
High school (Grades 9–12) | 14.1 |
Community/technical college | 32.1 |
University bachelor degree | 26.2 |
University graduate degree | 26.4 |
Distance to closest park (km) | 0.2 (0.1, 0.4) |
Yard space at home (m2) | 467 (288, 885) |
Child physical activity (min/day) | 22.8 (13.0, 30.0) |
Child screen time (min/day) | 57.4 (28.4, 106.6) |
Parent physical activity | |
Light (times/week) | 4 (2, 7) |
Moderate (times/week) | 2 (0, 4) |
Strenuous (times/week) | 1 (0, 3) |
Parent screen time (min/day) | 81.4 (42.9, 137.1) |
Table 2
Neighborhood-level characteristics
Neighborhood SES | |
Education (% < high school) | 7.3 (5.2, 13.8) |
Average income ($ CAD) | 72,217 (53,806, 90,488) |
Unemployment (%) | 3.9 (2.8, 7.7) |
Walkability | |
Average block length (km) | 0.3 (0.3, 0.4) |
Connected intersection ratio (% of true intersections) | 80.4 (76.6, 85.7) |
Intersection density (N per km2) | 35.5 (11.4, 42.4) |
Residential area (% of land area) | 50.4 (20.5, 74.8) |
Sidewalks (% of roads with sidewalks) | 61.5 (44.1, 78.1) |
Road speed (% roads <61 km/h) | 99.7 (84.2, 100.0) |
Streetscape | |
Conditions of buildings/grounds (1–4 point scale) | 2.0 (2.0, 2.1) |
Graffiti (1–4 point scale) | 1.0 (1.0, 1.2) |
Litter (1–5 point scale) | 1.9 (1.5, 2.3) |
Outdoor play/activity space | |
Cul-de-sac density (N per km2) | 6.5 (3.1, 9.0) |
Open wooded area (% of land area) | 2.3 (0, 12.8) |
Parks/sports fields (% of land area) | 6.2 (2.8, 8.3) |
Recreation facilities (N per km2) | 0.4 (0, 1.6) |
The associations between physical environment and socio-demographic variables with the child and parent physical activity levels are in Table
3. In the multivariate model, none of the physical environment variables were associated with physical activity in the children or parents. However, associations were observed with socio-demographic factors. For children, not attending child care was associated with lower physical activity levels while being older and having a higher family SES was associated with higher physical activity levels. For parents, being female was associated with lower physical activity levels.
Table 3
The relationship between individual- and neighborhood-level variables and physical activity
Child physical activity†
| | |
Socio-demographic
| | |
Child age (months) |
0.02 (0.02, 0.03)*
|
0.02 (0.02, 0.03)*
|
Child sex | -0.10 (-0.35, 0.15) | - |
Child care status |
-0.71 (-1.05, -0.38)*
|
-0.34 (-0.68, -0.00)*
|
Family structure | -0.16 (-0.48, 0.16) | - |
Parental education |
0.19 (0.07, 0.31)*
|
0.14 (0.02, 0.26)*
|
Neighborhood SES (z-score) |
0.21 (-0.07, 0.35)*
| 0.09 (-0.06, 0.23) |
Functional
| | |
Walkability (z-score) | -0.09 (-0.27, 0.09) | - |
Safety
| | |
Road speed (%) | -0.34 (-0.90, 0.21) | - |
Aesthetic
| | |
Streetscape (z-score) | 0.05 (-0.10, 0.21) | - |
Destination
| | |
Outdoor play/activity space (z-score) | -0.08 (-0.25, 0.09) | - |
Recreation facilities (N per km2) | -0.01 (-0.07, 0.06) | - |
Distance to closest park (km) | 0.01 (-0.01, 0.02) | - |
Yard space at home (100 m2) | -0.01 (-0.01, 0.00) | - |
Parent physical activity†
| | |
Socio-demographic
| | |
Child age (months) |
0.03 (0.02, 0.03)*
| 0.00 (-0.01, 0.02) |
Child sex | -0.34 (-0.82, 0.16) |
-
|
Parent sex |
-1.35 (0.49, 2.25)*
|
-1.35 (0.49, 2.21)*
|
Child care status | 0.33 (-0.43, 0.88) |
-
|
Family structure | 0.14 (-0.48, 0.76) | - |
Parental education | -0.17 (-0.40, 0.06) | - |
Neighborhood SES (z-score) | -0.11 (-0.34, 0.13) | - |
Functional
| | |
Walkability (z-score) | 0.18 (-0.09, 0.45) |
-
|
Safety
| | |
Road speed (%) | 0.05 (-0.78, 0.88) | - |
Aesthetic
| | |
Streetscape (z-score) | -0.13 (-0.34, 0.09) | - |
Destination
| | |
Outdoor play/activity space (z-score) | 0.03 (-0.22, 0.27) |
-
|
Recreation facilities (N per km2) | 0.06 (-0.05, 0.17) |
-
|
Distance to closest park (km) | -0.01 (-0.04, 0.03) | - |
Yard space at home (100 m2) | -0.00 (-0.02, 0.01) | - |
The associations between physical environment and socio-demographic variables with child and parent screen time levels are in Table
4. In the multivariate model, none of the physical environment variables were associated with screen time in children. However, being older was associated with higher levels of screen time and having higher family and neighborhood SES were associated with lower levels of screen time. For parents, higher outdoor play/activity space (e.g., parks, wooded areas) was associated with higher screen time levels and having a higher neighborhood SES was associated with lower screen time levels.
Table 4
The relationship between individual- and neighborhood-level variables and screen time
Child screen time†
| | |
Socio-demographic
| | |
Child age (months) |
0.10 (0.08, 0.11)*
|
0.10 (0.08, 0.11)*
|
Child sex |
-0.76 (-1.39, -0.13)*
| -0.44 (-0.99, 0.12) |
Child care status | -0.43 (-1.30, 0.43) | - |
Family structure | 0.22 (-0.49, 0.93) | - |
Parental education |
-0.80 (-1.10, -0.51)*
|
-0.76 (-1.03, -0.48)*
|
Neighborhood SES (z-score) |
-0.42 (-0.73, -0.12)*
|
-0.39 (-0.67, -0.11)*
|
Functional
| | |
Walkability (z-score) | 0.01 (-0.38, 0.41) | - |
Safety
| | |
Road speed (%) | 0.63 (-0.59, 1.86) | - |
Aesthetic
| | |
Streetscape (z-score) | -0.00 (-0.32, 0.32) | - |
Destination
| | |
Outdoor play/activity space (z-score) | 0.04 (-0.32, 0.40) | - |
Recreation facilities (N per km2) | 0.02 (-0.13, 0.17) | - |
Distance to closest park (km) | -0.04 (-0.09, 0.01) |
-
|
Yard space at home (100 m2) | 0.02 (-0.002, 0.03) |
-
|
Parent screen time†
| | |
Socio-demographic
| | |
Child age (months) | 0.01 (-0.01, 0.03) | - |
Child sex | 0.27 (-0.34, 0.91) | - |
Parent sex | 0.69 (-0.45, 1.83) | - |
Child care status | 0.66 (-0.22, 1.53) | - |
Family structure | -0.02 (-0.85, 0.81) | - |
Parental education | -0.30 (-0.62, 0.01) |
-
|
Neighborhood SES (z-score) |
-0.65 (-0.96, -0.34)*
|
-0.59 (-0.89, -0.28)*
|
Functional
| | |
Walkability (z-score) | 0.04 (-0.02, 0.83) |
-
|
Safety
| | |
Road speed (%) | 1.27 (-0.03, 2.58) |
-
|
Aesthetic
| | |
Streetscape (z-score) | 0.05 (-0.31, 0.42) |
-
|
Destination
| | |
Outdoor play/activity space (z-score) |
0.47 (0.10, 0.85)*
|
0.38 (0.06, 0.70)*
|
Recreation facilities (N per km2) | 0.14 (-0.02, 0.30) |
-
|
Distance to closest park (km) | -0.03 (-0.08, 0.02) | - |
Yard space at home (100 m2) | 0.01 (-0.01, 0.03) | - |
Discussion
This study examined independent associations between features of the physical environment on physical activity and screen time among a sample of children ≤5 years old and their parents. Only one independent association was observed with the physical environment features and the association was in the opposite direction to what was expected. Specifically, higher outdoor play/activity space was associated with a higher screen time levels in parents. For physical activity, child age, child care status, and family SES were independent correlates for children while sex was an independent correlate for parents. For screen time, child age and family SES were independent correlates for children while neighborhood SES was an independent correlate for parents.
There is a growing body of literature examining the influence of several physical environment variables on physical activity among adults [
13,
15,
25,
38]. Pikora and colleagues developed a conceptual framework that categorizes the different physical environment variables into four main features (function, safety, aesthetic, destination). A narrative review identified positive associations between availability, accessibility and convenience of destinations, functionality of the neighborhood, and aesthetics with adult physical activity [
25]. However, a recent systematic review only identified consistent associations with a few physical environment variables [
13]. More specifically, connectivity of trails was identified as a consistent predictor of active commuting and accessibility/convenience of recreation facilities and availability of trails were identified as possible predictors of moderate-to vigorous-intensity physical activity among adults [
13]. In line with the present study, inconsistent or null associations were observed for a number of other variables (e.g., availability of sidewalks, traffic volume, street lights, hills) [
13]. Less research has examined the relationship between the physical environment and physical activity among young children. A recent narrative literature review reported that time spent outdoors/in play spaces is the only feature of the physical environment that is consistently associated with physical activity within pre-school children (aged 2–5 years) [
16].
While some associations have been observed between the physical environment and adult physical activity, it is important to note that the present study focused on a sub-group of adults who have young children. This sub-group has been found to be less physically active compared to adults without young children [
9,
39,
40]. Additional physical activity barriers experienced by parents with young children, such as the time and energy demands of child care, may explain this trend [
9,
39]. Thus, in comparison to the general adult population, the physical environment may be less important compared to other correlates of physical activity participation (e.g., access to social support) [
39].
In comparison to physical activity, little is known about the relationship between the physical environment and screen time among young children or adults [
17,
18]. For example, no physical environment predictors of screen time were identified in two recent reviews among young children [
18,
19]. One of the few studies to examine this relationship in adults found neighborhood walkability was negatively associated with television viewing among women but not men in a small sample of Australian adults [
17]. Conversely, outdoor play/activity space was positively associated with screen time among parents in the present study. It is unclear why more outdoor play/activity space in a neighborhood would be related to more screen time in adults. Perhaps this neighborhood feature is not relevant in providing alternative screen time activities to parents.
While the physical environment had little influence on physical activity and screen time behaviors of young children and their parents in the present study, several socio-demographic factors were of importance. Many of the associations observed were consistent with previous findings in the literature. For instance, sex (being female) was reported as a consistent negative correlate of physical activity in a systematic review among adults [
41]. Similarly, two recent reviews identified age as a consistent positive correlate and SES as a consistent negative correlate of screen time in young children [
18,
19]. Furthermore, a negative relationship was observed between neighborhood SES and screen time in another large sample of young Canadian children [
42]. The findings of this study suggest that socio-demographic factors, including social environment factors, may be stronger correlates of physical activity and screen time behaviors of young children and their parents compared to features of the physical environment. To our knowledge this is the first study to examine these associations in young child–parent dyads. Therefore, due to the overall dearth of information, future research is needed to confirm and build upon these findings.
Study strengths include the objective measures of the environment and the large sample size, which allowed for the examination of multiple environment measures. A main limitation is the cross-sectional design, which limits the assessment of causality. Further, the physical activity and screen time measures were either self- or parent-reported. While subjective measures have frequently been used in the environment and physical activity literature [
13], the information bias associated with these measures may result in an underestimation of the true associations [
43]. Additionally, the sample was not representative due to the low response rate and the fact that the main source of recruitment was licensed child care centers. Only 15% of young children in the health region attend these centres [
44], and their high attendance cost is a likely barrier. Therefore, caution should be taken when generalizing the findings due to the relatively high socioeconomic status of our sample.
Acknowledgements
The authors are grateful to all the parents and children who took part in the study. The authors would like to thank their partners from Kingston, Frontenac, Lennox, and Addington Public Health, Mary Jane Gordon, Connie Wowk, and Alison Bradshaw for their assistance with the logistical planning of the study. We would also like to thank Greg Pickett for helping to obtain the neighborhood measures as well as Hoda Gharib for her help with data collection and entry. VC was supported by a CIHR - Frederick Banting and Charles Best Doctoral Award. IJ was supported by a Canada Research Chair. This research was supported by funds received through IJ’s Canada Research Chair award.
Competing interest
The authors declare that they have no competing interests.
Authors’ contributions
VC assisted with the design of the study, collected the questionnaire data, led the statistical analysis, and wrote the initial draft of the manuscript. AR collected the environment data and revised the manuscript for important intellectual content. IJ assisted with the design of the study, provided insight and guidance on the statistical analysis, and revised the manuscript for important intellectual content. All authors approved the final version of the manuscript.