Growing up in Scotland: overweight obesity and activity
Report describing the influences of parental factors and family and neighbourhood factors on childrens's weight and sedentary behayiour.
CHAPTER 4 PHYSICAL ACTIVITY AND SEDENTARY BEHAVIOUR
4.1 Key findings
- 15% of children exercised for less than the recommended level of 60 minutes daily, and 31% of children had 3 or more hours of screen time on a typical weekday.
- Children who were less physically active at age 6 were likely to have been less active when they were younger. Similarly, high sedentary behaviour as measured by screen time at age 6 reflected earlier high levels of screen use.
- However, it did not appear that high levels of screen time led to lower physical activity, or vice versa. The two behaviours appeared to have different sets of associated factors at age 6.
- Factors associated with low physical activity included winter season, child characteristics (being an only child, minority ethnic group), maternal characteristics (lower concern for and modelling of physical activity), neighbourhood characteristics (no swimming pool) and a less warm mother-child relationship.
- High screen time was more common in boys, in families with lower socio-economic status (low maternal education, mother smoking) and in neighbourhoods with poor quality local green spaces. High screen time was also associated with mothers' own screen use and a TV in the child's bedroom. General parenting was also involved, as screen use was greater in families where mothers did fewer activities with their children or had fewer rules for the child's behaviour.
- Being overweight or obese at age 4 was not a risk factor for either low physical actvity or high screen time at age 6.
4.2 Levels of physical activity and sedentary behaviour at age 6
According to mothers' reports, most children (85%) at age 6 met UK recommended targets for at least 60 minutes of moderate to vigorous physical activity every day (Table 4.1). 15% of the children were exercising for less than the recommended target . There was only a small increase in this figure (to 16%) when school-based activities were excluded. The proportion of children exercising for less than 60 minutes daily in the GUS data set was lower than found in the 2010 Scottish Health Survey ( SHeS). Taking school-based activity into account, the SHeS found that 27% of 5-7 year-olds exercised for less than the recommended amount. Excluding school-based actvities, this figure rose to 37% of 5-7 year olds (Marryat 2011) 13 .
There are no firm guidelines for sedentary behaviour in children, except that it should be limited. Most children (61%) watched TV and/or used a computer or games console for between 1 and 3 hours on a weekday, with just under a third using screens for 3 hours or more (Table 4.1). At the weekend, levels of children's screen use were higher, with around half the sample using screens for 3 hours or more on a Saturday. The SHeS did not have a measure of sedentary behaviour to compare with the GUS measure.
Table 4.1 Levels of physical activity and screen time in the age 6 sample
% | Bases | |||
---|---|---|---|---|
Wtd | Uwtd | |||
Physical activity including school-based activity | 60+ min on all 7 days | 86 | 2512 | 2581 |
30-59 min on all 7 days | 8 | 230 | 225 | |
Lower level of activity | 7 | 191 | 184 | |
Total | 100 | 2933 | 2990 | |
Physical activity excluding school-based activity | 60+ min on all 7 days | 83 | 2432 | 2497 |
30-59 min on all 7 days | 8 | 245 | 245 | |
Lower level of activity | 8 | 243 | 236 | |
Total | 100 | 2920 | 2978 | |
Weekday screen time | Under 1 hour | 8 | 190 | 212 |
1 hour to under 2 hours | 30 | 734 | 803 | |
2 hours to under 3 hours | 31 | 744 | 757 | |
3 hours plus | 31 | 763 | 698 | |
Total | 100 | 2431 | 2470 | |
Saturday screen time | Under 1 hour | 8 | 198 | 201 |
1 hour to under 2 hours | 16 | 394 | 421 | |
2 hours to under 3 hours | 24 | 575 | 608 | |
3 hours plus | 52 | 1248 | 1228 | |
Total | 100 | 2415 | 2458 |
Note: Due to rounding, percentages may not sum to 100.
4.3 Are sedentary behaviour and physical activity interrelated at age 6?
Children with higher levels of screen time were less likely to meet recommended targets for 60 minutes a day of moderate to vigorous physical activity at age 6 (see Figure 4.1 A and Figure 4.1 B). However, even among those children with screen time of 3 hours or more on a weekday, the majority (83%) still met the target.
Figure 4.1 Associations between weekday and Saturday screen time and physical activity level at age 6
A Weekday screen time
B Saturday screen time
4.4 Associations between activity levels and children's health
Physical activity did not vary systematically according to the child's general health (as reported by mothers at age 6), see Figure 4.2. However, children with poorer health had higher levels of screen time, see Figure 4.3.
Figure 4.2 Percentage of children with low (< 60 minutes daily) physical activity according to child's health at age 6
Figure 4.3 Percentage of children with high (3+ hours weekday) screen time according to their health at age 6
4.5 Associations between activity levels and season of the year
Children were physically active for longer periods in the second and third quarters of the year, when longer daylight hours permit more outdoor activity (Figure 4.4).
Use of screens showed less seasonal variation than physical activity, but was highest in the first, third and fourth quarters of the year (Figure 4.5). High screen time in the third quarter is likely to reflect increased leisure time during the school summer holidays in July and August.
Figure 4.4 Percentage of children with low (< 60 minutes daily) physical activity according to quarter of the year surveyed at age 6
Figure 4.5 Percentage of children with high (3+ hours weekday) screen time according to quarter of the year surveyed
4.6 Associations between age 6 activity levels and overweight or obesity
Current physical activity levels did not show clear associations with overweight or obesity at age 6 (Table 4.2). Further investigation with more sensitive measures (total minutes per week in all activities) also failed to find an association with overweight and obesity.
Screen time was not associated with overweight and obesity. Again, further investigation of weekend screen time allowing two further extended exposure categories of between 5 and 7 hours (13% of the sample) and 7 or more hours (5% of the sample) also failed to find an association with overweight and obesity.
Although there were no clear associations between either individual activity measure and overweight/obesity, it is possible that children who were less physically active AND used screens for long periods were most at risk. However, further investigation did not support the view that a combination of low activity and high sedentary behaviour, at age 6, is associated with greater risk of being overweight and/or obese (not shown here).
Table 4.2 Physical activity and sedentary behaviour at age 6: associations with age 6 overweight and obesity
% Overweight | % Obese | Bases | |||
---|---|---|---|---|---|
Wtd | Uwtd | ||||
Physical activity including school-based | 60+ min on all 7 days | 23 | 9 | 2512 | 2581 |
30-59 min on all 7 days | 20 | 7 | 230 | 225 | |
Lower level of activity | 20 | 9 | 191 | 184 | |
Physical activity excluding school-based | 60+ min on all 7 days | 23 | 9 | 2432 | 2497 |
30-59 min on all 7 days | 20 | 8 | 245 | 245 | |
Lower level of activity | 21 | 9 | 243 | 236 | |
Weekday screen time | Under 1 hour | 19 | 8 | 190 | 212 |
1 hour to under 2 hours | 19 | 7 | 734 | 803 | |
2 hours to under 3 hours | 24 | 9 | 744 | 757 | |
3 hours plus | 25 | 11 | 763 | 698 | |
Saturday screen time | Under 1 hour | 18 | 8 | 198 | 201 |
1 hour to under 2 hours | 23 | 8 | 394 | 421 | |
2 hours to under 3 hours | 20 | 9 | 575 | 608 | |
3 hours plus | 24 | 10 | 1248 | 1228 |
Note: No differences between groups were statistically significant. Note that associations are measured separately for each factor and do not control for other influences.
A recent UK study found that being overweight led to lower physical activity in children (Metcalf et al. 2011). We also explored whether overweight and obesity at age 4 was associated with later physical activity and sedentary behaviour at age 6. We did not find that children in the GUS sample who were overweight or obese at age 4 adopted different activity patterns from their healthy weight peer group two years later (not shown).
4.7 Exploration of factors associated with age 6 physical activity and sedentary behaviour
This analysis focused on two outcomes:
1. Low physical activity (defined as not meeting recommended guidelines of at least 60 minutes every day, including school-based activity) 14
2. High weekday sedentary behaviour of 3 hours or more screen time 15 .
Associations explored in this section do not take account of possible confounding influences (other factors that simultaneously may play a role).
4.7.1 Child and family characteristics associated with physical activity and sedentary behaviour
Girls and boys were equally likely to meet physical activity targets at age 6, but boys were more likely than girls to spend longer periods using screens. Lower levels of physical activity were seen in children from minority ethnic groups, but there were no ethnic differences in screen time. Children without any siblings had lower physical activity than those from larger families. There appeared to be a U-shaped relationship between the number of children in the family and screen use. The only child, and those in larger families had greater levels of screen time than children with one or two siblings (Table 4.3).
Table 4.3 Child and family characteristics associated with physical activity and sedentary behaviour at age 6
Not active for 60 mins/day (including school activity) | Screen time 3+hours weekday | ||||||||
---|---|---|---|---|---|---|---|---|---|
% | p | Bases | % | p | Bases | ||||
Wtd | Uwtd | Wtd | Uwtd | ||||||
Gender | Male | 14 | NS | 1500 | 1519 | 34 | ** | 1293 | 1306 |
Female | 14 | 1433 | 1471 | 28 | 1137 | 1164 | |||
Child's ethnic group | White | 14 | *** | 2812 | 2890 | 31 | NS | 2333 | 2390 |
Minority | 30 | 120 | 99 | 35 | 97 | 79 | |||
Children in household | One | 19 | * | 584 | 551 | 35 | * | 482 | 454 |
Two | 13 | 1537 | 1642 | 29 | 1293 | 1373 | |||
Three | 14 | 621 | 635 | 31 | 507 | 519 | |||
Four + | 12 | 192 | 162 | 39 | 148 | 124 | |||
Birth order | First born | 16 | * | 1471 | 1444 | 32 | NS | 1194 | 1162 |
Other children | 13 | 1462 | 1546 | 30 | 1236 | 1308 |
Notes: p=probability based on adjusted F where NS=not significant, † p<0.1, * p<0.05, ** p<0.01, *** p<0.001. Note that associations are measured separately for each factor and do not control for other influences.
4.7.2 Parental factors associated with physical activity and sedentary behaviour
Parental modelling
Parental modelling of specific behaviours appeared to be important. There were strong associations between mothers' physical activity at sweep 5 and children's physical activity at age 6. There were also strong associations between between mothers' screen time at sweep 5 and children's screen time at age 6 (Table 4.4). However, mothers' screen time did not predict children's physical activity, nor conversely did mothers' physical activity predict children's screen time.
Mothers' overweight or obesity at age 6 was not associated with children's physical activity or sedentary behaviour (not shown).
Table 4.4 Associations between parental modelling and children's physical activity and sedentary behaviour at age 6
Not active for 60 mins/day (including school activity) | Screen time 3+hours weekday | ||||||||
---|---|---|---|---|---|---|---|---|---|
% | p | Bases | % | p | Bases | ||||
Wtd | Uwtd | Wtd | Uwtd | ||||||
Mother's weekly physical activity sweep 5 (quintiles) | q1 - Bottom 20% | 21 | *** | 550 | 584 | 31 | NS | 462 | 484 |
q2 | 17 | 623 | 646 | 29 | 512 | 533 | |||
q3 | 11 | 452 | 478 | 28 | 369 | 391 | |||
q4 | 10 | 528 | 541 | 28 | 445 | 455 | |||
q5 - Top 20% | 9 | 574 | 552 | 35 | 472 | 448 | |||
Mother's weekly screen time sweep 5 (tertiles) | Low | 13 | NS | 926 | 1005 | 21 | *** | 724 | 784 |
Medium | 13 | 978 | 1021 | 27 | 818 | 856 | |||
High | 17 | 1027 | 961 | 43 | 885 | 827 |
Notes: p=probability based on adjusted F where NS=not significant, † p<0.1, * p<0.05, ** p<0.01, *** p<0.001. Note that associations are measured separately for each factor and do not control for other influences.
Health-related practices
Earlier measures of children's physical activity gathered at previous sweeps were associated with greater physical activity at age 6, but not with screen time at age 6. Frequency of visiting local green spaces (measured at age 6) was associated with both higher children's physical activity and reduced screen time (Table 4.5).
Children who had a TV in their bedroom at earlier sweeps and who spent a lot of time watching TV and/or playing with a computer or games console at earlier sweeps were more likely to use screens for 3 hours or more at age 6. However, there were no clear associations between earlier screen time and age 6 physical activity (Table 4.6).
Table 4.5 Associations between health practices related to active behaviour and children's physical activity and sedentary behaviour at age 6
Not active for 60 mins/day (including school activity) | Screen time 3+hours weekday | ||||||||
---|---|---|---|---|---|---|---|---|---|
% | p | Bases | % | p | Bases | ||||
Wtd | Uwtd | Wtd | Uwtd | ||||||
Weekly duration child's active behaviour (sweep 3) | Less than 1 hr | 41 | *** | 58 | 55 | 36 | NS | 46 | 44 |
1 to under 3 hrs | 25 | 251 | 253 | 35 | 211 | 209 | |||
3 to under 5 hrs | 21 | 544 | 537 | 36 | 454 | 445 | |||
5 to under 7 hrs | 15 | 604 | 620 | 29 | 505 | 519 | |||
7 hrs plus | 9 | 1446 | 1495 | 30 | 1191 | 1230 | |||
Physical activity level sweep 5 (quintiles) | q1 - Lowest 20% | 28 | *** | 60 1 | 593 | 35 | NS | 507 | 503 |
q2 | 19 | 557 | 565 | 33 | 462 | 467 | |||
q3 | 11 | 598 | 616 | 31 | 512 | 519 | |||
q4 | 8 | 592 | 606 | 27 | 476 | 490 | |||
q5 - Top 20% | 6 | 579 | 601 | 29 | 469 | 484 | |||
Frequency mother and child visit local green spaces/month (age 6) | Every day | 8 | *** | 488 | 522 | 27 | ** | 391 | 421 |
Several times a week | 12 | 747 | 784 | 30 | 615 | 644 | |||
Once a week | 16 | 569 | 578 | 30 | 478 | 482 | |||
Several times a month | 13 | 515 | 523 | 30 | 442 | 443 | |||
Once a month | 19 | 266 | 263 | 36 | 216 | 216 | |||
Less often | 22 | 217 | 200 | 40 | 179 | 163 | |||
Not at all | 27 | 130 | 119 | 45 | 109 | 100 |
Notes: p=probability based on adjusted F where NS=not significant, † p<0.1, * p<0.05, ** p<0.01, *** p<0.001. Note that associations are measured separately for each factor and do not control for other influences.
Table 4.6 Associations between earlier screen use and its related factors and children's physical activity and sedentary behaviour at age 6
Not active for 60 mins/day (including school activity) | Screen time 3+ hours weekday | ||||||||
---|---|---|---|---|---|---|---|---|---|
% | p | Bases | % | p | Bases | ||||
Wtd | Uwtd | Wtd | Uwtd | ||||||
TV in bedroom (sweep 5) | Yes | 14 | NS | 1511 | 1367 | 40 | *** | 1288 | 1169 |
No | 15 | 1413 | 1612 | 21 | 1136 | 1294 | |||
TV in bedroom (age 4) | Yes | 15 | NS | 1331 | 1179 | 41 | *** | 1118 | 996 |
No | 14 | 1572 | 1782 | 23 | 1293 | 1458 | |||
Hours watching TV on weekday (sweep 3) | None | 10 | NS | 15 | 18 | <1 | *** | 11 | 13 |
Up to 30 minutes | 14 | 299 | 311 | 23 | 229 | 236 | |||
30 minutes to 1 hour | 11 | 464 | 491 | 22 | 365 | 387 | |||
1 to 2 hours | 15 | 1015 | 1063 | 25 | 849 | 882 | |||
2 to 3 hours | 16 | 692 | 689 | 40 | 595 | 595 | |||
3 to 4 hours | 15 | 188 | 180 | 49 | 169 | 163 | |||
4 to 5 hours | 16 | 82 | 71 | 59 | 72 | 65 | |||
5 hours or more | 11 | 69 | 57 | 53 | 64 | 54 | |||
Hours watching TV on weekday (age 4) | None | 13 | NS | 152 | 165 | 17 | *** | 111 | 119 |
Up to 30 minutes | 11 | 78 | 84 | 11 | 59 | 63 | |||
30 minutes to 1 hour | 10 | 155 | 170 | 7 | 114 | 126 | |||
1 to 2 hours | 14 | 1120 | 1189 | 22 | 917 | 972 | |||
2 to 3 hours | 15 | 841 | 851 | 38 | 715 | 729 | |||
3 to 4 hours | 16 | 318 | 296 | 46 | 291 | 267 | |||
4 to 5 hours | 24 | 130 | 115 | 63 | 112 | 102 | |||
5 hours or more | 17 | 104 | 86 | 57 | 88 | 71 | |||
Screen time weekday (sweep 5) | Under 1 hour | 11 | NS | 279 | 314 | 7 | *** | 188 | 211 |
1 to under 2 hours | 14 | 875 | 955 | 14 | 684 | 746 | |||
2 to under 3 hours | 16 | 903 | 917 | 30 | 776 | 791 | |||
3 to under 5 hours | 15 | 691 | 656 | 50 | 618 | 590 | |||
5 hours or more | 11 | 157 | 125 | 65 | 145 | 116 |
Notes: p=probability based on adjusted F where NS=not significant, † p<0.1, * p<0.05, ** p<0.01, *** p<0.001. Note that associations are measured separately for each factor and do not control for other influences.
General patterns of parenting
Aspects of connection, control and conflict were each associated with screen time at age 6. Connection and conflict were associated with physical activity (Table 4.7).
Mothers who had a warm relationship with their child, who engaged in many joint activities and who experienced low levels of conflict were more likely to have physically active children with relatively low levels of screen use. In addition, mothers who had rules to guide their children's behaviour and a more organised home environment were less likely to have children who spent long periods watching TV or playing electronic games.
Parental supervision did not have a clear association with physical activity, although there was a trend for low supervision to be associated with higher levels of screen use.
Table 4.7 Associations between general patterns of parenting and children's physical activity and sedentary behaviour at age 6
Not active for 60 mins/day (including school activity) | Screen time 3+ hours weekday | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
% | p | Bases | % | p | Bases | |||||
Wtd | Uwtd | Wtd | Uwtd | |||||||
Connection | Pianta warmth (quartiles) a | q1 - low | 17 | ** | 730 | 686 | 38 | *** | 609 | 561 |
q2 and 3 | 16 | 871 | 896 | 33 | 725 | 743 | ||||
q4 - high | 12 | 1314 | 1392 | 26 | 1084 | 1154 | ||||
Mother-child joint activities (quartiles) | q1 - low | 16 | ** | 770 | 721 | 43 | *** | 620 | 579 | |
q2 | 20 | 291 | 290 | 29 | 248 | 247 | ||||
q3 | 15 | 1089 | 1109 | 30 | 900 | 910 | ||||
q4 - high | 10 | 783 | 870 | 23 | 663 | 734 | ||||
Control | Supervision (quintiles) a | q1 - low | 17 | NS | 568 | 534 | 36 | ? | 471 | 445 |
q2 | 14 | 921 | 906 | 31 | 758 | 741 | ||||
q3 and 4 | 14 | 1015 | 1065 | 31 | 853 | 897 | ||||
q5 - high | 12 | 430 | 485 | 26 | 348 | 387 | ||||
Number of rules (quintiles) a | q1 and q2 - low | 15 | NS | 1055 | 1017 | 40 | *** | 897 | 867 | |
q3 | 15 | 759 | 788 | 30 | 613 | 633 | ||||
q4 | 13 | 846 | 904 | 25 | 694 | 741 | ||||
q5 - high | 13 | 274 | 281 | 20 | 226 | 229 | ||||
Home chaos (quintiles) | q1 - low | 15 | NS | 766 | 820 | 26 | *** | 639 | 681 | |
q2 | 16 | 676 | 701 | 31 | 558 | 578 | ||||
q3 | 14 | 474 | 490 | 29 | 393 | 406 | ||||
q4 | 12 | 628 | 622 | 32 | 518 | 511 | ||||
q5 - high | 16 | 390 | 357 | 46 | 323 | 294 | ||||
Conflict | Pianta conflict (quintiles) | q1 - low | 13 | ** | 751 | 798 | 27 | *** | 634 | 668 |
q2 | 17 | 409 | 425 | 27 | 328 | 350 | ||||
q3 | 11 | 581 | 600 | 27 | 485 | 500 | ||||
q4 | 13 | 633 | 637 | 34 | 521 | 521 | ||||
q5 - high | 18 | 540 | 513 | 42 | 449 | 419 |
Notes: p=probability based on adjusted F where NS=not significant, † p<0.1, * p<0.05, ** p<0.01, *** p<0.001. Note that associations are measured separately for each factor and do not control for other influences. aDue to lack of subdivisions in measures, some percentiles are combined.
4.7.3 Distal family constraints on children's physical activity and sedentary behaviour
There appeared to be no clear social inequalities in the patterning of children's physical activity, according to the distal family constraints examined. There was a trend (bordering on statistical significance) for families on lower incomes and families where the mother had not worked to have lower physical activity levels.
In contrast, children's screen time varied strongly by factors at the family level. These suggest social inequalities in the patterning of children's sedentary behaviour. Children were more likely to use screens for 3 or more hours if their mother did not work, had a relatively low educational level, was a lone parent and had lower levels of household income. Children were also more likely to use screens for longer if their mother was in poor mental or physical health, or if their mother smoked when pregnant. However, mother's working hours were not clearly associated with greater screen use (Table 4.8).
Table 4.8 Family distal constraints associated with children's physical activity and sedentary behaviour at age 6
Not active for 60 mins/day (including school activity) | Screen time 3+ hours weekday | ||||||||
---|---|---|---|---|---|---|---|---|---|
% | p | Bases | % | p | Bases | ||||
Wtd | Uwtd | Wtd | Uwtd | ||||||
Maternal employment per week (sweep 5) | 35 hrs or more | 11 | NS | 446 | 498 | 25 | *** | 367 | 409 |
16 to less than 35 hrs | 14 | 1183 | 1271 | 27 | 994 | 1064 | |||
Less than 16 hrs | 14 | 307 | 351 | 24 | 251 | 284 | |||
Not working | 16 | 993 | 865 | 42 | 814 | 708 | |||
Mother's education | Up to Standard Grades or equivalent | 15 | NS | 1102 | 934 | 44 | *** | 923 | 782 |
Higher Grades or equivalent | 15 | 649 | 669 | 31 | 536 | 555 | |||
Upper level VQs ( e.g. HNC, HND) | 12 | 370 | 400 | 25 | 316 | 340 | |||
Degree or equivalent | 13 | 805 | 980 | 17 | 648 | 787 | |||
Biological father in household | No | 14 | NS | 849 | 639 | 43 | *** | 682 | 507 |
Yes | 14 | 2085 | 2351 | 27 | 1749 | 1963 | |||
Household income (quintiles) | Top 60% | 13 | ? | 1499 | 1784 | 21 | *** | 1242 | 1476 |
Bottom 40% | 15 | 1418 | 1192 | 40 | 1176 | 983 | |||
Mother's occupational class | Managerial and professional occupations | 13 | ? | 1066 | 1269 | 19 | *** | 872 | 1035 |
Intermediate occupations | 16 | 570 | 604 | 30 | 475 | 507 | |||
Small employers and own account workers | 12 | 118 | 134 | 24 | 97 | 110 | |||
Lower supervisory and technical occupations | 9 | 163 | 155 | 36 | 137 | 127 | |||
Semi-routine and routine occupations | 16 | 883 | 746 | 45 | 734 | 623 | |||
Never worked | 22 | 132 | 81 | 47 | 115 | 67 | |||
Mother's age at birth of first child | Under 20 | 15 | NS | 518 | 360 | 49 | *** | 431 | 298 |
20 to 29 | 15 | 1504 | 1496 | 31 | 1251 | 1242 | |||
30 to 39 | 14 | 885 | 1099 | 22 | 728 | 903 | |||
40 or over | 16 | 27 | 35 | 30 | 21 | 27 | |||
Mother's mental health | Poor | 16 | NS | 1001 | 987 | 35 | * | 842 | 823 |
Average | 14 | 944 | 997 | 29 | 769 | 815 | |||
Good | 13 | 979 | 1000 | 30 | 812 | 827 | |||
Mother's physical health | Poor | 15 | NS | 995 | 980 | 35 | * | 814 | 797 |
Average | 15 | 1003 | 1022 | 29 | 839 | 860 | |||
Good | 13 | 927 | 982 | 30 | 771 | 808 | |||
Mother's smoking in pregnancy | No | 14 | NS | 2221 | 2395 | 26 | *** | 1834 | 1968 |
Yes | 15 | 702 | 585 | 47 | 588 | 494 |
Notes: p=probability based on adjusted F where NS=not significant, † p<0.1, * p<0.05, ** p<0.01, *** p<0.001. Note that associations are measured separately for each factor and do not control for other influences.
4.7.4 Proximal family constraints
We explored two family level constraints that might affect how mothers managed their child's physical activity and sedentary behaviour. These were mothers' awareness of current guidelines ("target levels") for physical activity in children, and mothers' concerns about their child's weight.
Mothers' views on desirable amount of physical activity in children
At age 6, mothers were asked two questions about the desirable amount of physical activity for children:
- "How many days a week do you think children of [childname]'s age should do physical activity? Please include all moderate physical activity, including physical activity at school."
- "On each of the days someone of [childname]'s age does moderate physical activity, how many minutes a day should they do it for it to be good for their health?"
These questions were asked after questions on the child's actual physical activity had been completed. This helped to avoid the possibility of bias in the mothers' responses to the physical activity measures, after raising the issue of desirable levels of physical activity.
Although most (84%) mothers thought their children should take moderate to vigorous physical activity every day, many mothers (57%) did not think children needed to exercise for at least 60 minutes or more each day. 16
Views on desirable levels of physical activity were not associated with mothers' education or occupational class. Mothers who thought children should exercise for at least 60 minutes daily were likely to exercise more themselves, as measured at sweep 5. Mothers with an overweight child and who did not recognise the child's overweight were less likely to think at least an hour of daily physical activity was desirable.
Mothers' views were associated with whether their child met the physical activity target at age 6, but not with their child's sedentary behaviour (screen time):
- 9% of children failed the target when their mother thought at least 60 minutes daily was desirable, compared to 18% when mothers thought less activity was sufficient
- levels of screen time of 3 hours or more on a week day were almost identical whether mothers gave a 60-minute target level for physical activity (32%) or not (31%)
Mothers' concerns about their child's weight
At sweeps 4 and 6, mothers were asked: "How concerned are you about [childname]'s weight at the moment?" (with answers on a four-point scale of "not at all", "a little concerned", "quite concerned" and "very concerned"). Mothers were divided into those who were not at all concerned, and those who expressed some concern.
The GUS data do not appear to support the idea that mothers who are more concerned about a child's weight will encourage their child to exercise more and limit sedentary time watching television or using a computer.
There was no clear association between mothers' concern for their child's weight (measured at age 4 or age 6) and children's physical activity level at age 6. Mothers' concern was associated with greater sedentary behaviour: 42% of children with concerned mothers used screens for 3 or more hours, compared to 30% of children with unconcerned mothers ( p<0.001). A similar effect was seen with mother's concern measured at age 4. These findings suggest that the child's weight and/or sedentary behaviour may have led to mothers' concern, rather than mothers' concern succeeding in limiting the child's sedentary behaviour.
4.7.5 Distal neighbourhood constraints on children's physical activity and sedentary behaviour
Children had higher levels of screen use if they lived in an urban or small town setting rather than a rural setting, and if they lived in a deprived neighbourhood. However, meeting recommended physical activity levels was not clearly associated with these neighbourhood factors (Table 4.9).
Table 4.9 Distal neighbourhood constraints associated with children's physical activity and sedentary behaviour at age 6
Not active for 60 mins/day (including school activity) | Screen time 3+ hours weekday | ||||||||
---|---|---|---|---|---|---|---|---|---|
% | p | Bases | % | p | Bases | ||||
Wtd | Uwtd | Wtd | Uwtd | ||||||
Urban-rural | Urban | 15 | NS | 2027 | 1937 | 33 | * | 1693 | 1612 |
Small town | 12 | 370 | 407 | 33 | 307 | 339 | |||
Rural | 15 | 536 | 645 | 25 | 430 | 518 | |||
Area deprivation quintile | 1 - least deprived | 12 | NS | 576 | 697 | 20 | *** | 482 | 578 |
2 | 16 | 615 | 706 | 26 | 496 | 571 | |||
3 | 14 | 565 | 617 | 29 | 461 | 506 | |||
4 | 12 | 551 | 510 | 38 | 468 | 430 | |||
5 - most deprived | 17 | 627 | 459 | 43 | 524 | 384 |
Notes: p=probability based on adjusted F where NS=not significant, † p<0.1, * p<0.05, ** p<0.01, *** p<0.001. Note that associations are measured separately for each factor and do not control for other influences.
4.7.6 Proximal neighbourhood constraints on children's physical activity and sedentary behaviour
Social and physical aspects of the neighbourhood environment were explored in relation to children's physical activity and screen use at age 6.
Lower "child-friendliness", in terms of mothers' ratings at sweep 3 of the local social and physical environment for children, was associated with failing to meet the physical activity target and with greater screen time at age 6. However, child friendliness measured at age 6 did not show a clear asssociation with meeting the physical activity target at this age.
Some associations between access to local facilities and activity levels were found:
- access to a playground or park (sweep 2) and access to a pool at age 6 (but not sweep 2) were associated with age 6 physical activity
- access to a garden 17 was associated with lower screen time, but was not clearly associated with physical activity
Walking time to nearest green space (measured at age 6) was not associated either with physical activity or sedentary behaviour (not shown).
Greater screen time (but not physical activity) was also associated with a lower quality neighbourhood environment, in terms of:
- poorer quality of local green places
- concerns over safety of neighbourhood and local play areas
- greater levels of antisocial behaviour
Table 4.10 Proximal neighbourhood constraints associated with children's physical activity and sedentary behaviour at age 6
Not active for 60 mins/day (including school activity) | Screen time 3+ hours weekday | ||||||||
---|---|---|---|---|---|---|---|---|---|
% | p | Bases | % | p | Bases | ||||
Wtd | Uwtd | Wtd | Uwtd | ||||||
Garden (sweep 1) | Yes | 14 | NS | 2653 | 2767 | 30 | *** | 2194 | 2283 |
No | 18 | 280 | 223 | 44 | 237 | 187 | |||
Playground/park (sweep 2) | Not in area | 22 | * | 191 | 180 | 33 | NS | 155 | 148 |
In area | 14 | 2732 | 2802 | 31 | 2267 | 2316 | |||
Swimming pool locally (sweep 6) | Not in area | 18 | ** | 740 | 750 | 34 | NS | 617 | 625 |
In area | 13 | 2191 | 2238 | 31 | 1812 | 1844 | |||
Rating of local green places to walk/sit (sweep 6) | 1 - highest | 13 | NS | 1007 | 1139 | 23 | *** | 809 | 912 |
2 | 14 | 635 | 672 | 29 | 540 | 568 | |||
3 | 17 | 596 | 582 | 37 | 508 | 496 | |||
4 | 14 | 306 | 258 | 37 | 250 | 211 | |||
5 | 13 | 161 | 150 | 45 | 131 | 122 | |||
6 | 12 | 95 | 80 | 46 | 86 | 73 | |||
7 - lowest | 22 | 121 | 97 | 42 | 99 | 80 | |||
Rating of safe places for children to play locally (sweep 6) | 1 - highest | 12 | NS | 715 | 808 | 23 | *** | 566 | 636 |
2 | 16 | 641 | 695 | 26 | 534 | 579 | |||
3 | 15 | 674 | 684 | 33 | 576 | 581 | |||
4 | 14 | 379 | 344 | 40 | 333 | 301 | |||
5 | 11 | 210 | 182 | 39 | 169 | 150 | |||
6 | 16 | 136 | 121 | 43 | 120 | 105 | |||
7 - lowest | 21 | 166 | 144 | 40 | 126 | 111 | |||
Neighbourhood safety (sweep 3) | High | 14 | NS | 1885 | 2020 | 29 | *** | 1561 | 1663 |
Low | 16 | 1048 | 969 | 36 | 869 | 806 | |||
Neighbourhood safety (sweep 6) |
High | 14 | ? | 1470 | 1604 | 26 | *** | 1209 | 1315 |
Medium | 13 | 692 | 697 | 35 | 564 | 569 | |||
Low | 17 | 772 | 689 | 38 | 657 | 586 | |||
Safe public play areas locally (sweep 3) | Yes | 14 | NS | 2020 | 2180 | 27 | *** | 1655 | 1780 |
No | 16 | 885 | 783 | 40 | 751 | 667 | |||
Neighbourhood antisocial behaviour problems (age 6) | None | 15 | ? | 1501 | 1636 | 28 | *** | 1233 | 1343 |
1 | 11 | 625 | 640 | 29 | 518 | 531 | |||
2 | 17 | 295 | 296 | 37 | 245 | 244 | |||
3 | 19 | 197 | 183 | 43 | 174 | 159 | |||
4 or more | 12 | 312 | 233 | 41 | 258 | 191 | |||
Child friendly neighbourhood (sweep 3) | Good | 13 | * | 1100 | 1236 | 27 | *** | 906 | 1014 |
Average | 12 | 760 | 795 | 30 | 641 | 667 | |||
Poor | 17 | 1073 | 958 | 37 | 883 | 788 | |||
Child friendly neighbourhood (age 6) | Good | 14 | NS | 965 | 1082 | 26 | *** | 784 | 875 |
Average | 14 | 989 | 1042 | 31 | 846 | 888 | |||
Poor | 15 | 979 | 866 | 37 | 800 | 707 |
Notes: p=probability based on adjusted F where NS=not significant, † p<0.1, * p<0.05, ** p<0.01, *** p<0.001. Note that associations are measured separately for each factor and do not control for other influences. Bases: WTD = weighted, UWTD = unweighted.
4.8 Multivariate modelling of children's physical activity and sedentary behaviour at age 6
This section reports the main findings of multivariate analyses of children's low physical activity (below 60 minutes daily) and high sedentary behaviour (3 hours or more screen time on a weekday) at age 6.
Logistic regression models first investigated selected blocks of variables, before combining all factors in the final model. All models controlled for the child's gender, ethnic group, the number of children in the family, the child's general health and the season of the year when age 6 interviews took place. Detailed modelling results are provided in the Technical Appendix.
In the final model of physical activity, the following factors were significantly associated with the child exercising for less than 60 minutes daily:
- ethnic minority group
- being an only child
- winter season (October-March)
- no swimming pool in area
- mother's view that less than 60 minutes' daily physical activity was sufficient for children
- mother's lower level of physical activity
- less warmth in the mother-child relationship
In the final model of screen time, the following factors were significantly associated with the child using screens for three hours or more on a weekday:
- male gender
- low maternal education
- mother smoking in pregnancy
- poor quality local green spaces
- mother's greater screen time
- TV in the child's bedroom
- Fewer joint mother-child activities
- Fewer rules for the child's behaviour
These findings are summarised in Figure 4.6.
Figure 4.6 Summary of risk factors for children's low physical activity and high screen time at age 6: results of final multivariate modelling
Note: Dark shaded areas indicate associations with low physical activity and high screen time. Model adjusted for all factors together, see Technical Appendix for further details.
Parents who do not recognise that their child is overweight or obese are unlikely to help the child to lose weight. Research elsewhere has found that few parents seem to recognise overweight in their child (Parry et al. 2008; Jones et al. 2011a).
For the most part, this section focuses on the subgroup of GUS children who were defined as overweight or obese on the basis of their BMI at age 6. It explores the extent to which mothers recognised these children as overweight, and investigates factors associated with poor recognition and low levels of concern about children's overweight.
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