Correlates of socio-economic inequalities in women’s television viewing : a study of intrapersonal, social and environmental mediators

Introduction

Socio-economically disadvantaged women are at a greater risk of spending excess time engaged in television viewing, a behavior linked to several adverse health outcomes. However, the factors which explain socio-economic differences in television viewing are unknown. This study aimed to investigate the contribution of intrapersonal, social and environmental factors to mediating socio-economic (educational) inequalities in women's television viewing.
Methods

Cross-sectional data were provided by 1,554 women (aged 18-65) who participated in the 'Socio-economic Status and Activity in Women study' of 2004. Based on an ecological framework, women self-reported their socio-economic position (highest education level), television viewing, as well as a number of potential intrapersonal (enjoyment of television viewing, preference for leisure-time sedentary behavior, depression, stress, weight status), social (social participation, interpersonal trust, social cohesion, social support for physical activity from friends and from family) and physical activity environmental factors (safety, aesthetics, distance to places of interest, and distance to physical activity facilities).
Results

Multiple mediating analyses showed that two intrapersonal factors (enjoyment of television viewing and weight status) and two social factors (social cohesion and social support from friends for physical activity) partly explained the educational inequalities in women's television viewing. No physical activity environmental factors mediated educational variations in television viewing.
Conclusions

Acknowledging the cross-sectional nature of this study, these findings suggest that health promotion interventions aimed at reducing educational inequalities in television viewing should focus on intrapersonal and social strategies, particularly providing enjoyable alternatives to television viewing, weight-loss/management information, increasing social cohesion in the neighborhood and promoting friend support for activity.

Mediators of dietary patterns in an intervention to improve early childhood nutrition

This thesis assessed the effect of a novel health promotion intervention on early childhood nutrition. It found that improved maternal nutrition knowledge and reduced maternal use of rewards in child feeding were important contributors to improving child dietary patterns.

A systematic review of intervention effects on potential mediators of children's physical activity

Background : Many interventions aiming to increase children’s physical activity have been developed and implemented in a variety of settings, and these interventions have previously been reviewed; however the focus of these reviews tends to be on the intervention effects on physical activity outcomes without consideration of the reasons and pathways leading to intervention success or otherwise.

To systematically review the efficacy of physical activity interventions targeting 5-12 year old children on potential mediators and, where possible, to calculate the size of the intervention effect on the potential mediator.

Methods : A systematic search identified intervention studies that reported outcomes on potential mediators of physical activity among 5-12 year old children. Original research articles published between 1985 and April 2012 were reviewed.

Results : Eighteen potential mediators were identified from 31 studies. Positive effects on cognitive/psychological potential mediators were reported in 15 out of 31 studies. Positive effects on social environmental potential mediators were reported in three out of seven studies, and no effects on the physical environment were reported. Although no studies were identified that performed a mediating analysis, 33 positive intervention effects were found on targeted potential mediators (with effect sizes ranging from small to large) and 73% of the time a positive effect on the physical activity outcome was reported.

Conclusions : Many studies have reported null intervention effects on potential mediators of children’s physical activity; however, it is important that intervention studies statistically examine the mediating effects of interventions so the most effective strategies can be implemented in future programs.

Environmental perceptions as mediators of the relationship between the objective built environment and walking among socioeconomically disadvantaged women

Background
Women living in socio-economically disadvantaged neighbourhoods are at increased risk for physical inactivity and associated health outcomes and are difficult to reach through personally tailored interventions. Targeting the built environment may be an effective strategy in this population subgroup. The aim of this study was to examine the mediating role of environmental perceptions in the relationship between the objective environment and walking for transportation/recreation among women from socio-economically disadvantaged neighbourhoods.

Methods
Baseline data of the Resilience for Eating and Activity Despite Inequality (READI) study were used. In total, 4139 women (18–46 years) completed a postal survey assessing physical environmental perceptions (aesthetics, neighbourhood physical activity environment, personal safety, neighbourhood social cohesion), physical activity, and socio-demographics. Objectively-assessed data on street connectivity and density of destinations were collected using a Geographic Information System database and based on the objective z-scores, an objective destinations/connectivity score was calculated. This index was positively scored, with higher scores representing a more favourable environment. Two-level mixed models regression analyses were conducted and the MacKinnon product-of-coefficients test was used to examine the mediating effects.

Results
The destinations/connectivity score was positively associated with transport-related walking. The perceived physical activity environment mediated 6.1% of this positive association. The destinations/connectivity score was negatively associated with leisure-time walking. Negative perceptions of aesthetics, personal safety and social cohesion of the neighbourhood jointly mediated 24.1% of this negative association.

Conclusion
For women living in socio-economically disadvantaged neighbourhoods, environmental perceptions were important mediators of the relationship between the objective built environment and walking. To increase both transport-related and leisure-time walking, it is necessary to improve both objective walkability-related characteristics (street connectivity and proximity of destinations), and perceptions of personal safety, favourable aesthetics and neighbourhood social cohesion.

Mediators of the relationship between sedentary behavior and depressive symptoms amongst disadvantaged women

Statement of problem
Associations between sedentary behavior (e.g. time spent sitting watching TV/using the computer) and physical health have been well documented, however, studies are increasingly reporting a positive relationship between certain sedentary behaviors and poor mental health (e.g. depression). Little is known about the underlying factors that may explain the link between sedentary behavior and likelihood of depression. The purpose of this study was to investigate the contribution of selected intra-personal and social factors as potential mediators of the relationship between sedentary behavior and depressive symptoms among women from disadvantaged neighborhoods.
Method
Cross-sectional survey data were provided by 4065 women (aged 18–45) living in disadvantaged neighborhoods. Women self-reported their sedentary behavior (total sitting time and screen time), depressive symptoms (CES-D 10), as well as a number of intra-personal (leisure-time physical activity, diet quality, weight status) and social (social cohesion, interpersonal trust, club membership) factors.
Results
Mediating analyses, controlling for confounders, showed that women's leisure-time physical activity partly mediated the relationship between total sitting time and increased likelihood of depressive symptoms. Women's diet quality, and social cohesion partly mediated the relationship between screen time and increased likelihood of depressive symptoms.
Conclusions
Acknowledging the cross-sectional study design, findings suggest that there may be several factors that explain the increased likelihood of depressive symptoms associated with greater sedentary time. Although future studies should test the mediating relationships longitudinally, these findings may help inform interventions aimed at reducing the likelihood of depression in disadvantaged women with high sitting time.