Neighborhood environment and physical activity among Urban and Rural Schoolchildren in Taiwan
Introduction
There has been substantial scientific evidence indicating that physical activity produces a number of major health benefits for people of all ages (Sallis and Owen, 1999; Warburton et al., 2006). Advances in energy-saving technology and changing work patterns have at the same time resulted in a decrease in physical activity. In modern society, the adverse effects of an inactive lifestyle start in childhood. Results from studies on children's health and exercise behaviors (Biddle et al., 2004; Andersen et al., 2006) suggested that cardiovascular disease, hypertension, high total cholesterol, and obesity were linked to childhood unhealthy behavioral patterns such as high-fat diet and physical inactivity. The same pattern is true in Taiwan, where the chronic and degenerative diseases of middle and old age are believed to be related to unhealthy childhood behaviors (Taiwan Department of Health, 2006).
Although both lifestyle physical activity and structured exercise are promoted as beneficial to both individuals and society, the proportion of physically active people in Taiwan is relatively small. The prevalence of Taiwanese elementary school students engaged in regular exercise was 18.8% (Taiwan Sport Affairs Council, 2009), which does not compare favorably to their counterparts in other countries. For example, Troiano et al. (2008) found that 42% of American children exercised 60 minutes per day. Research into the factors that influence Taiwanese children's physical activity is important, so that those children who are physically inactive may be targeted for special interventions.
In order to develop effective intervention programs to promote physical activity among children, there is a need to identify variables that influence activity levels (Caspersen et al., 1998). Physical activity is a multifactorial behavior influenced by a set of variables ranging from intrapersonal and interpersonal factors to environmental factors; among these, environmental variables are particularly important. Considerable recent evidence documents a correlation between neighborhood environment and physical activity (Bogaert et al., 2003; Cunningham and Michael, 2004; Frank et al., 2003; Heath et al., 2006; Saelens et al., 2003). In a comprehensive literature review on the relationship between built environments and physical activity of children aged 3–18, Davison and Lawson (2006) found that physical activity was correlated to an area's public recreational infrastructure, such as access to recreational facilities and schools, the presence of sidewalks and controlled intersections, access to destinations and public transportation. By contrast, factors such as the number of roads to cross and high traffic density and traffic speed, as well as the prevalence of crime and area deprivation, were negatively correlated with children's physical activity. Humpel et al. (2002) identified 19 quantitative studies that assessed the relationship of physical activity with perceived and objectively determined physical environment attributes, and found that environmental attributes such as accessibility, opportunity, and aesthetic attributes had significant effect on physical activity levels. Similarly, Pikora et al. (2003) developed a framework of potential environmental influences on outdoor activities like walking and cycling based on policy literature and expert interview, to include four features: function, safety, aesthetics and destination. Environmental factors that support physical activity have been identified in Western society; however, few studies in Asian countries have explored this issue, especially in terms of children's physical activity.
Many experts have suggested that targeted intervention for specific subpopulations is needed to increase the overall physical activity of these groups. Thus, the examination of specific subpopulations within a socioecological framework is clearly warranted. Researchers (Pratt et al., 1999; Sallis et al., 2000) have pointed out that much additional work is needed on geographical differences as compared with other social factors such as gender, race and ethnicity in studies of physical activity. Findings from studies of urbanization and children's physical activity in the US and other areas are inconsistent and appear to vary across studies conducted in different regions (Damore, 2002; Loucaides et al., 2004; Joens-Matre et al., 2008; Sirard et al., 2005; Felton et al., 2002), and the potential impact of rural and urban residence should be subjected to more detailed study to design more effective programs. Therefore, the objectives of this study are (1) to examine differences between Taiwan urban and rural areas in physical activity levels of primary schoolchildren; (2) to compare differences in environmental attributes between the two areas; and (3) to explore the environmental determinants of physical activity by taking geographical differences into consideration. These findings could be used in the design of intervention programs aimed at raising children's physical activity levels.
Section snippets
Subjects
The sample consisted of 726 Taiwanese primary schoolchildren aged 11–12 and their caretakers, mostly parents or grandparents, who completed the daily teacher–parent communication log and had the children take it back to school the next day. Five hundred and twenty three students provided complete data for the analysis with a response rate of 72.0%. Children came from five urban schools (n=200) and five rural schools (n=323). The selection of schools was based on the diverse geographic areas of
Sociodemographic variables
The response rate of the sample was 72.2%. The average response rates of urban and rural areas were 70.3% and 74.2%, respectively. The minimum and maximum for the response rates for urban area schools were 60.6% and 88.5%, while for rural areas the rates were 67.0% and 78.5%. The final data analyzed consisted of 200 schoolchildren in 5 urban schools and 323 schoolchildren in 5 rural schools (total N=523). In comparing contextual characteristics (Table 1), urban schoolchildren were more likely
Discussion
The finding of a statistically significant difference in the amount and types of physical activity between urban and rural students indicates that residence plays a role in the physical activity of elementary school students. The urban students exercised more after school, during weekends and on holidays, and had a higher total amount of physical activity. Also, there was a difference in the types of physical activity students reported. The rural students bicycled and hiked more than urban
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