Socioeconomic position, built environment and physical activity among children and adolescents: a systematic review of mediating and moderating effects

Abstract

Background Physical activity behaviors among children and adolescents are socioeconomically patterned. Understanding if, and how, the built environment contributes to socioeconomic inequalities in physical activity and for whom built environments are most important, can lead to the identification of intervention entry points to reduce inequalities in physical activity. Objective To summarize the existing evidence among children and adolescents on (a) whether the built environment mediates the association between socioeconomic position and physical activity and (b) whether socioeconomic position moderates the association between the built environment and physical activity. Methods A systematic literature search was conducted using PubMed, Embase, PsycINFO and Web of Science. Two independent reviewers screened articles for eligibility, extracted information from included studies and assessed risk of bias with the Quality Assessment Tool for Observational Cohort and Cross-Sectional studies. We performed a narrative evidence synthesis considering the totality of the evidence and by study characteristics such as geographic region, age group, and exposure-outcome assessment methodology. The reporting was conducted in agreement with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Results A total of 28 papers were included. In general, the studies were of low methodological quality. There was no evidence to support that the built environment functions as a mediator in the relationship between socioeconomic position and physical activity. We observed inconclusive moderation patterns with five studies reporting stronger associations between features of the built environment and physical activity among high socioeconomic positioned youths. Seven studies reported stronger associations among low socioeconomic positioned youth and fourteen studies reported no difference in associations. We observed different moderation patterns across geographical regions (Europe vs. US) indicating that, in Europe, having a walkable neighborhood is important for low socioeconomic positioned youth only. No differences in moderation patterns were observed for younger vs. older children or activity domains. Conclusion Current evidence does not support a strong interplay between built environment and socioeconomic position on physical activity in youth. However, given the low quality of the evidence, firm conclusions cannot be made, and additional high-quality research is likely to have substantial impact on the evidence base.

Comparison of children’s physical activity profiles before and after COVID-19 lockdowns: A latent profile analysis

“…Previous research has suggested that reasons why girls may be less active than boys include lack of role models, desire for more choice and issues around body image [49], and it is possible that these have become more pronounced after lockdowns. Similarly, reasons for socioeconomic gaps include the physical environment, parental education, financial resources and accessibility [50][51][52]. While the first two factors are unlikely to have changed over the time scale of this study, both cost and accessibility, for example impacted by the COVID-19 pandemic and/or rising cost of living, could potentially explain the widening gaps, especially with the observed stronger reliance on structured activities.…”

Neighbourhood characteristics and socioeconomic inequalities in child mental health: cross-sectional and longitudinal findings from the Growing Up in Ireland Study

“…To date, there is a dearth of evidence on the extent to which a wide range of neighbourhood characteristics may in part explain socioeconomic inequalities in child mental health. Previous studies mostly examined neighbourhood characteristics (e.g., built environments) as an effect modifier of the association between SES and health (Andersen et al, 2022;Rigolon et al, 2021), and did not explore their relative contributions to the development of socioeconomic inequalities in health. One previous study, using nationally representative data from a UK birth cohort, found that caregiver-reported neighbourhood problems and safety explained 17% of the association between family SES and socioemotional behavioural problems at age 14 (Straatmann et al, 2019).…”