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Are Perceived Neighborhood Hazards a Barrier to Physical Activity in Children?
Andrea J. Romero, PhD;
Thomas N. Robinson, MD, MPH;
Helena C. Kraemer, PhD;
Sarah J. Erickson, PhD;
K. Farish Haydel, BA;
Fernando Mendoza, MD;
Joel D. Killen, PhD
Arch Pediatr Adolesc Med. 2001;155:1143-1148.
ABSTRACT
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Background We hypothesized that children's perceptions of more neighborhood hazards
would be associated with less physical activity, less aerobic fitness, and
a higher body mass index.
Objective To examine the association between a hazardous neighborhood context
and physical activity in children.
Methods Fourth-grade students (n = 796) of diverse ethnic and economic backgrounds
completed measures of neighborhood hazards, self-reported physical activity,
physical fitness, height, and weight. Parents (n = 518) completed telephone
interviews and provided data on their education level and occupation.
Results As expected, children from families of lower socioeconomic status perceived
significantly more neighborhood hazards. Contrary to our hypothesis, the perception
of more hazards was significantly associated with more reported physical activity.
This finding was not explained by school heterogeneity, alteration of the
hazards measure, or differences in socioeconomic status.
Conclusion To further examine the relationship between neighborhood hazards and
physical activity, we suggest that future studies include assessments of sedentary
behavior, parental fear of violence, parental regulation of children's leisure
activities, and cost and quality of available play areas and organized sports.
INTRODUCTION
LOWER socioeconomic status (SES) is associated with lower levels of
physical activity, more television viewing, and an increased amount of body
fat in children and adolescents.1, 2, 3, 4
In part, this association may be due to the comparatively hazardous physical
environment in which many lower-income families live.2, 5, 6, 7
For example, hazards that might serve as barriers to physical activity and
general health include lack of recreational facilities or athletic programs
and the presence of crime, gangs, traffic, drugs, noise, or prejudice.8, 9, 10, 11 In
our study we explore the subjective perception of neighborhood hazards that
might pose barriers to physical activity in a sample of children.
Higher levels of neighborhood hazards have been linked to reports of
less physical activity in 2 studies of middle-class adults of primarily European
American descent.10, 11 However,
few studies have explored the relationship between physical environmental
factors and physical fitness in children. One study of chronically ill children
reported that activity patterns were directly related to child and parent
perceptions of neighborhood safety.9 The generalizability
of this study is unclear. Parents of chronically ill children may be more
attuned to environmental dangers and may be more likely to limit their children's
opportunities for physical activity.
Despite the potential for increased hazards in communities of low SES,
the association between neighborhood hazards and physical activity among healthy
children has not been examined. We looked for evidence of this relationship
in a sample of children with diverse ethnic and economic backgrounds. We hypothesized
that children who perceived more neighborhood hazards would be less physically
active, less physically fit, and have a higher body mass index (BMI).
PARTICIPANTS AND METHODS
All fourth-grade students (N = 845) enrolled in 8 northern California
elementary schools were eligible to participate in the study. Of the total
eligible children, 796 (94%) participated. A passive-consent procedure was
used; 12 parents refused to allow their children to participate, and other
eligible children not included were absent or unavailable on assessment days.
Parent or guardian telephone interviews were attempted for all eligible children,
and 518 parents or guardians completed interviews. The study was approved
by the Stanford University Committee for the Protection of Human Subjects
in Research, Stanford, Calif.
PROCEDURE
Assessments were carried out by trained project staff. To ensure confidentiality,
students were assigned a special identification number that was used for tracking.
Each survey contained 2 cover sheets, the first including a printed label
with the student's name and identification number and the second including
a label containing only the identification number. Data collectors removed
and destroyed the first cover sheet when they collected the survey. Children
completed questionnaires during a regular class period. The survey was read
aloud to the entire class and took approximately 45 minutes to complete. Surveys
were prepared with facing pages written in English and Spanish or English
and Vietnamese. Children were given the option to have the survey read aloud
to them in English, Spanish, or Vietnamese; 88% of the children completed
the survey in English, 9% in Spanish, and 3% in Vietnamese. All physical measures
of participating children were obtained at stations set up in the classroom
or at a nearby outdoor area.
All parent interviews were conducted on the telephone by trained project
staff. The primary target adult in the household was the mother. Most interviews
required 10 to 15 minutes for completion. Parent interviews were conducted
in English (33.6%), Spanish (43.9%), and Vietnamese (22.5%). Active consent
was obtained by telephone and recorded. All parent and child assessments were
completed within the same 2-month period.
MEASURES
Demographics
Children self-reported their sex and date of birth. School district
data provided pan-ethnic labels for all children, such as Latino, that combined
several specific ethnic groups within 1 larger grouping. Parents reported
their own sex and specific ethnic label.
Socioeconomic Status
Parents self-reported education levels and occupations for themselves
and another parent or guardian living in the house. In this sample, parent
occupation was chosen as an indicator of SES instead of parent education level
or a combination of the two. Parent education level was not used as an indicator
of SES because of the high percentage of immigrants in the sample, who may
have been educated in another country but whose income in the United States
may not reflect their education level. The higher occupation level was chosen
if more than 1 parent or guardian occupation was reported. Parent occupation
was coded into the 7 Hollingshead12 categories
and then dichotomized into lower (1-4) and higher (5-9) SES levels based on
the midpoint of the scale.
Child Acculturation
Child acculturation was determined based on language preference for
English or another language when at home, with friends, and when watching
television. These items were adapted from the language use subscale of the
Bidimensional Acculturation Scale for Hispanics.13
We acknowledge that the acculturation process is more complex than what language
use can represent; however, measurement of acculturation based on language
has become a common shorthand method that typically accounts for more than
half the variance of acculturation measures. Language use has been found to
be the primary determinant of acculturation. English usage and other language
usage items were averaged separately, and midpoint cutoff scores were used
to dichotomize these measures into high and low categories. Four acculturation
categories, as described by Cuéllar et al,14
were determined based on the following combinations: traditional (high use
of another language/low English use), marginalized (low use of another language/low
English use), assimilated (high English use/low use of another language),
and bicultural (high use of another language/high English use).
Neighborhood Hazards
Children's perceived neighborhood hazards were assessed with 8 self-reported
items based on a 3-point Likert-type scale: 1 indicated "not a problem," 2
indicated "a little problem," and 3 indicated "a big problem." This scale
was adapted from the Hazards Scale developed by Aneshensel and Sucoff.8 All of the items used the beginning phrase "How much
of a problem is . . . ?" The 8 items included the following neighborhood hazards:
traffic, trash and litter, crime, too much noise, gangs, lack of access to
parks, prejudice, and drugs. All 8 items were summed for a total score with
a possible range of 8 to 24, with a higher score indicating the perception
of more neighborhood hazards. Questions were chosen to reflect dangers that
would be most relevant to a younger population and to outdoor physical activity.
The original scale has previously demonstrated significant associations with
lower SES and a variety of measures of mental well-being.8
In our sample, the internal consistency of this scale was found to be 
= .76.
Self-reported Physical Activity
Self-reported physical activity was assessed with a modified version
of the Self-administered Physical Activity Checklist (SAPAC) developed by
Sallis et al15 for the National Heart, Lung,
and Blood Institute's Child and Adolescent Trial for Cardiovascular Health
project. The SAPAC has been demonstrated to be a reliable and comprehensive
measure of physical activity in children. In the original SAPAC, children
reported the number of minutes they participated in 21 common physical activities
before, during, and after school on the previous day. Because of pretesting,
we modified the SAPAC to include only after-school activities, added 2 more
common activities (for a total of 23), and simplified the response to be a
forced choice of "none," "less than 10 minutes," or "more than 10 minutes."
Children reported their previous day's physical activity on 2 different days,
and these 2 reports were averaged. These simplified response options have
previously resulted in a high percentage of agreement (86%) with direct observation
ratings of children's physical activity.16
Physical Fitness
The maximal multistage 20-m shuttle run test of physical fitness was
used to assess cardiorespiratory fitness.17, 18
In varied samples of children and adolescents, this test has been found to
be a valid measure of fitness compared with maximum oxygen consumption as
measured by treadmill testing (r = 0.69-0.87), and
is sensitive to change.19, 20, 21, 22, 23
Height, Weight, and BMI
Standing height was measured to the nearest millimeter using a portable
direct-reading stadiometer. Students were measured with their shoes removed
and with the body positioned so that the head, heels, and buttocks were against
the vertical support of the stadiometer. The head was aligned so that the
auditory canal and the lower rim of the orbit were in a horizontal plane.
Two measures of height were obtained, and the average was used in the data
analyses.
Body weight was determined to the nearest 0.1 kg using digital scales,
with the subjects wearing light indoor clothing without shoes or coats. Two
measures of weight were obtained, and the average was used in the data analyses.
Body mass index was computed from the formula kg/m2, which
is generally considered to be the preferred index of relative body weight
as a reflection of adiposity.24, 25
RESULTS
DESCRIPTIVES AND ANALYSIS OF VARIANCE
Sample characteristics are shown in Table 1 and Table 2
for children and parents, respectively. The mean ± SD age of participating
fourth-grade children was 9.0 ± 0.37 years. Differences between the
sexes were found for the measure of physical fitness (t234 = - 4.18; P<.001);
boys ran more laps than girls (mean ± SD, 17.61 ± 11.20 laps
and 14.66 ± 7.58 laps, respectively). There were no significant differences
between boys and girls for the perception of neighborhood hazards, self-reported
physical activity, height, weight, or BMI.
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Table 1. Sample Characteristics of Children
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Table 2. Sample Characteristics of Parents*
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One-way analysis of variance was conducted to examine differences by
child acculturation, SES level, and ethnicity. There were no significant differences
in neighborhood hazards, reported physical activity, or physical fitness by
child acculturation level. There were no significant differences in physical
fitness or reported physical activity by SES level, but there were significant
differences in neighborhood hazards by this measure (F1398 = 4.26; P = .04). Children of lower SES reported more neighborhood
hazards (mean ± SD, 13.51 ± 3.83) than children of higher SES
(mean ± SD, 12.73 ± 3.48).
There were no significant ethnic differences in perceptions of neighborhood
hazards. There were significant ethnic differences for reported physical activity
levels (F4697 = 5.04; P<.001) and physical
fitness (F4719 = 3.26; P = .01). Latinos
reported significantly higher rates of physical activity than Asians (mean
± SD, 8.67 ± 4.61 and 7.19 ± 4.39, respectively), and
Latinos ran significantly more total laps than Asians (mean ± SD, 17.21
± 10.65 laps and 14.45 ± 7.36 laps, respectively).
CORRELATIONS
Spearman correlations among study variables are presented in Table 3. As expected, children of lower
SES reported more neighborhood hazards. Contrary to our hypothesis, the perception
of more neighborhood hazards was positively correlated with reported physical
activity. Although there was a slight positive association between self-reported
physical activity and BMI, amount of body fat as measured by BMI was significantly
negatively associated with physical fitness.
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Table 3. Spearman Correlation Coefficients*
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Did School Effects Mask the True Association?
Children in the same school are more likely to live in similar neighborhoods.
Therefore, we conducted analyses to examine whether school effects masked
an association between neighborhood hazards and physical activity. First,
1-way analysis of variance and  2 tests were conducted to examine
differences in means for variables of interest by school. There were no significant
differences by school for perception of neighborhood hazards, self-reported
physical activity, or physical fitness. School differences were found for
ethnicity (214 = 85.84; P<.001),
SES level (27 = 46.35; P<.001),
and BMI (F7737 = 2.58; R2 =
0.02; P = .01). Additionally, we investigated intraclass
correlations with physical activity using mixed models with compound symmetry
as the covariance structure. All intraclass correlations were close to 0;
thus, the original Spearman correlations are reported.
Second, a test was conducted to determine homogeneity between schools
and the correlations between neighborhood hazards and physical activity, physical
fitness, and BMI. Results indicated no significant heterogeneity between schools
(P>.05 for all tests). This test was conducted for
Spearman correlations between neighborhood hazards and physical activity (pooled r = 0.14), neighborhood hazards and physical fitness (pooled r = - 0.01), and neighborhood hazards and BMI (pooled r = - 0.01), which are nearly identical with those
in Table 3.
Correlations by SES
Neighborhood hazards and SES were negatively correlated (r = - 0.13; P = .01) (Table 3). Therefore, all further correlations were conducted separately
by lower and higher SES levels (Table 4). For both SES levels, physical fitness and BMI were inversely
correlated, as expected. There was no significant association between neighborhood
hazards and reported physical activity or neighborhood hazards and physical
fitness for the lower SES group. A significant but low negative correlation
was found for neighborhood hazards and BMI for children of lower SES; a higher
BMI was associated with the perception of fewer neighborhood hazards. For
children of higher SES, the perception of more neighborhood hazards was associated
with more reported physical activity. Neighborhood hazards were not significantly
associated with physical fitness or BMI for children of higher SES.
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Table 4. Spearman Correlation Coefficients by Parent Occupation Level*
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COMMENT
Although children from families of lower SES reported more neighborhood
hazards than their peers of higher SES, the hypothesis that the perception
of more hazards would be associated with lower levels of physical activity
and fitness was not supported. Indeed, several of our findings contradicted
study hypotheses. Among children of lower SES, those with the perception of
more neighborhood hazards had significantly lower levels of body fat. Among
children of higher SES, those with the perception of more neighborhood hazards
reported higher levels of physical activity.
Several caveats must be considered when interpreting the results of
this study. First, the measure of neighborhood hazards used in this study
may have lacked sensitivity because it did not directly assess the degree
to which children perceived that the hazard was a barrier to their engaging
in physical activity. Additionally, the measure did not assess perceived fear
of the hazard; rather, participants rated the degree to which each potential
hazard was a problem. Thus, whereas children may perceive that drug dealers
in their neighborhood are problematic, they may not feel that such a problem
poses a direct barrier to playing outdoors. This perception may vary by SES.
Second, the neighborhood hazards scale consisted of 8 potential barriers
to physical activity, ranging from crime to noise. Other potential barriers
to physical activity may exist in neighborhoods of lower SES that are not
included in the 8-item scale. For example, researchers have discussed the
effects of larger sociocultural issues on the health habits of lower-income
families.26 It may be fruitful to assess competing
time demands faced by lower-income children, such as baby-sitting or other
family responsibilities. Moreover, the instrument did not include questions
about the cost and quality of available locations for physical activity or
organized sports. Future studies exploring the relationship between environmental
barriers and physical activity in neighborhoods of lower SES should include
assessments of cost and quality of accessible facilities for physical activity
or organized teams.
Third, parents' perceptions of neighborhood hazards may affect the regulation
of their children's opportunities for physical activity. This may explain
the finding that children with higher BMI scores were more likely to perceive
fewer neighborhood hazards; these children may not be as aware of neighborhood
problems as their more active counterparts because of parental regulation
of activity. Parents' perceptions of neighborhood hazards should be assessed
when the relationship between perceived neighborhood hazards and a healthful
lifestyle is studied in young children.
Fourth, the assessment of physical activity in children is difficult
at best. The fact that the self-reporting of physical activity was not significantly
correlated with physical fitness, whereas physical fitness and BMI were highly
correlated, suggests that the self-report measure may contain significant
measurement error. Problems with self-reported physical activity measures
have been amply documented. Previous research has found poor to moderate correlation
between self-reports of physical activity and accelerometer data in children.27 In reviews of the literature, the validity of self-report
measures for children varies widely.28, 29
It is possible that a demand bias exists in these measures; children are aware
that they should be exercising more, and heavier children may be even more
aware of this fact. The 1-day recall format, used here in the modified SAPAC,
has typically demonstrated the highest correlations with direct observations.
However, our results suggest that the instrument may be problematic for many
assessment situations.
Our findings are not consistent with other research reports in this
area,10, 11 but our sample demographics
were also different from those of previous studies. Whereas we did not find
any ethnic differences in perception of hazards, children of lower SES reported
more hazards than those of higher SES. Moreover, the significant relationships
between hazards and physical fitness variables were different by SES level
of children. Although there is not enough information in our study to interpret
the meaning behind these differences, it appears that the relationship between
SES and hazards is more complex than initially proposed.
In summary, this study provides no evidence to support the common assertion
that children from neighborhoods of lower SES do not engage in physical activity
or are any less physically fit because of neighborhood dangers such as crime
or gangs. Although our findings show that children in neighborhoods of lower
SES are more likely to perceive environmental dangers, these hazards do not
appear to present direct barriers to their engaging in physical activity.
Children from lower-income homes have been found to have higher rates of sedentary
behavior and television watching, which may provide more insight into the
link between lower income and low physical activity. We suggest that future
studies in this area examine other potential barriers to physical activity
for lower-income children by including assessments of sedentary behavior,
parental fear of violence, parental regulation of children's leisure activities,
and the cost and quality of available locations for physical activity and
organized sports.
AUTHOR INFORMATION
Accepted for publication April 26, 2001.
Funding for this research was provided by grant RO1 CA68082 from the
National Cancer Institute, Bethesda, Md.
What This Study Adds
Research has reported that less physical activity is associated with
higher levels of neighborhood hazards in populations of middle-class adults
of European descent. Despite the potential for increased hazards in communities
of low SES, the association between neighborhood hazards and physical activity
in children has not been examined.
Children of lower SES report higher levels of neighborhood hazards.
However, contrary to previous research, more hazards were associated with
more physical activity in our results. This finding was not further explained
by school or SES heterogeneity. The implication is that the relationship between
neighborhood context and physical activity is complex, and future studies
should include assessments of sedentary behavior, parental fear of violence,
parental regulation of children's leisure activities, cost and quality of
play areas, and availability of organized sports.
From the Mexican American Studies and Research Center, University of Arizona (Dr Romero); Stanford Center
for Research in Disease Prevention (Ms Haydel and Dr Killen), the
Division of General Pediatrics, Department of Pediatrics (Drs Robinson
and Mendoza), and the Department of Psychiatry and Behavioral Sciences
(Dr Kraemer), Stanford University, Stanford, Calif; and the Department
of Psychology, University of New Mexico (Dr Erickson), Albuquerque.
Corresponding author and reprints: Andrea Romero, Mexican American
Studies and Research Center, University of Arizona, Economics Bldg, Rm 208,
Tucson, AZ 85721 (e-mail: romeroa{at}u.arizona.edu).
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