Using citizen science to understand the prerequisites for physical activity among adolescents in low socioeconomic status neighborhoods - The NESLA study

Highlights

• The study was a proof of concept study of a Swedish version of the app The Stanford Healthy Neighborhood Discovery Tool.

• The study identified facilitators and barriers in the way, of physical activity among adolescents in low SES neighborhoods.

• Green areas such as parks, playgrounds, and outdoor gyms were identified as key facilitators in the build environment.

• Poor lighting, walkability or bikeability in the neighborhoods were perceived as barriers in the build environment.

• Perceived lack of personal safety was mentioned frequently as a barrier in the social environment.

Abstract

Socioeconomic status (SES) as well as adolescents' perceptions of the neighborhood's built and social environments have been shown to influence adolescents' physical activity. Twenty-four adolescents from two low SES neighborhoods in Sweden participated as citizen scientists, using the Stanford Discovery Tool app on their phones to take photographs and record audio narratives of aspects of their neighborhood that they perceived facilitate or hinder their physical activity. The most frequently reported facilitators were ‘parks, playgrounds and outdoor gym’ as well as ‘amenities’ and ‘sport facilities’, whereas lack of or shortcomings regarding ‘bikeability and walkability’, ‘personal safety’ and ‘lighting’ were the most frequently reported barriers. The results will be used to inform local politicians and policy makers about new ways to improve physical activity among residents in Sweden's low SES neighborhoods. Also, this study shows that a Swedish version of the Discovery Tool app is acceptable and can generate useful information in the context of adolescents from disadvantaged neighborhoods.

Introduction

Physical inactivity is one of the leading causes of noncommunicable diseases (NCDs) and accounts for 3.2 million deaths per year globally. According to the World Health Organization, 25% of adults and over 80% of adolescents do not meet the recommended minimum levels for physical activity on a global level (WHO, 2018). Data on Swedish youths are consistent with the global average (Folkhälsomyndigheten, 2018). In a recent report published by the Public Health Agency of Sweden, only 14% of Swedish youths aged 11–15 years reach the recommended minimum levels for physical activity corresponding to 60 min of moderate to vigorous activity per day (Folkhälsomyndigheten, 2018). Insufficient physical activity during childhood and adolescence is associated with low levels of physical activity in adulthood (Telama, 2009; Hirvensalo and Lintunen, 2011), and is thus a predictor for long term adverse health effects including overweight, obesity, NCDs and premature death.

Age, gender, parental role modeling, ethnicity and socioeconomic status (SES) are important determinants of adolescents’ physical activity levels (Park and Kim, 2008; Sallis et al., 2000). Previous studies have shown that adolescents growing up with parents of low SES are less likely to be active in their leisure time, participate less in organized sport activities, and are more sedentary than adolescents with higher SES (Brodersen et al., 2007; Matias et al., 2018; Ottevaere et al., 2011; Molina-Garcia et al., 2017; Stalsberg and Pedersen, 2010; Gidlow et al., 2006; Centrum för idrottsforskning, 2017). In addition, adolescents with low SES have poorer overall health such as higher BMI z-scores and more mental health and physical health issues (Chung et al., 2016; Reiss, 2013, Quon and Mcgrath, 2014). A time-series analysis between years 2002–2010, including 34 countries and 492,788 youths, showed that health disparities between different SES groups increased over time (Elgar et al., 2015), and the trend seems to continue (Chung et al., 2016). In order to stem this rise, efforts need to be directed towards increasing health-enhancing physical activity for socioeconomically disadvantaged groups.

One way of doing this is to ensure that neighborhoods are built to encourage spontaneous as well as planned physical activity. The built environment impacts levels of physical activity, and access to green public spaces, walking and biking paths, and sport facilities are positively associated with physical activity in both youths and adults (Sallis et al., 2012, 2016; Mcgrath et al., 2015; Molina-Garcia et al., 2017; Smith et al., 2017; Althoff et al., 2017; Sundquist et al., 2011; Schipperijn et al., 2017, Physical Activity Guidelines Advisory Committee Scientific Report 2018.; Rundle et al., 2019). Rundle et al. (2019) found in a study conducted in the United States that higher neighborhood walkability scores were significantly associated with higher self-reported and objectively measured physical activity among adult participants. In contrast, the impacts of the social environment (i.e., crime/incivilities, perceptions of neighborhood safety, social cohesion, etc.) in relation to physical activity are not as well studied. Some studies also suggest that social support is a determinant of physical activity both for adults and adolescents (Sawyer et al., 2017; Mendonca et al., 2014), and parental perceptions of neighborhood safety influence adolescents’ physical activity levels (Esteban-Cornejo et al., 2016). However, inconsistent use of terminology, definitions and measurement of the social environment makes it challenging to compare studies (Kepper et al., 2019).

Considering the health disparities across different SES groups (Elgar et al., 2015; Chung et al., 2016), the built and social environments may be of greater importance in disadvantaged neighborhoods than in high SES neighborhoods. For instance, studies have shown that low SES neighborhoods in the United States and in Europe have lower walkability scores and less access to sport facilities and recreational opportunities compared to high SES areas (Sallis et al., 2012; Gordon-Larsen et al., 2006; Hoffimann et al., 2017; Schule et al., 2017). However, this is not the case for all cities, as some studies have found that disadvantaged neighborhoods or neighborhoods with low SES were more walkable than those with high SES in certain cities (Gullón et al., 2017; King and Clarke, 2014).

To date, a significant proportion of research on the built environment and physical activity has included objectively-measured data from geographical information systems (GIS) or global positioning systems (GPS) (Mcgrath et al., 2015, Molina-Garcia et al., 2017; Laxer and Janssen, 2013; Sundquist et al., 2011). While this research is important, it does not capture the residents’ views of their neighborhood built and social environments, which may be a better predictor of their level of physical activity than objective measurements (Hinckson et al., 2017; Scott et al., 2007). In addition, little is known about the built and social environments in relation to physical activity in a Swedish context.

In the present pilot study, citizen science methods are used to gain insights into what components of the built and social environments in low SES areas are perceived as barriers to or facilitators of physical activity by local adolescents. Citizen science is an increasingly popular method of engaging the general public in the scientific process (King et al., 2019). This “bottom-up” scientific approach has the dual advantage of empowering individuals by giving them the opportunity to affect communities, and offers scientists insights into issues that are important for residents (Den Broeder et al., 2018). While many forms of citizen science involve data collection by residents in order to inform formal research efforts, citizen science “by the people” engages community members in every step of the research process, from problem definition to data collection, analysis and interpretation of results, to using citizen-generated findings to advocate with local policy makers to advocate for change (King et al., 2016, 2020). Citizen science has previously been used to understand the prerequisites for physical activity among adolescents and older adults in low SES areas in the United States (Buman et al., 2013; Winter et al., 2016; King et al., 2016) and in a growing number of countries (King et al., 2020). However, this is the first study to use citizen science to study physical activity in relation to the built and social environments in low SES neighborhoods in a Swedish setting. This study serves as an initial proof of concept for the method in a new context among a small group of adolescents. In contrast to a number of prior studies that have used this method among youth, our study adds the social environment as one aspect of neighborhood assessment.