Health-promoting environments for children and adolescents : built environment characteristics as resources for activity participation and well-being

Childhood and adolescence are important stages of life with long-lasting implications for both the health and well-being of individuals and society as a whole. Accordingly, health-promoting efforts aimed at supporting the everyday lives of children and adolescents represent a key priority for public health. In Norway, there has been increased attention paid to neighborhoods and local communities as crucial settings for such efforts, and health-promoting changes to the built environment are deemed a promising strategy. This doctoral thesis has examined neighborhood and local community built environment determinants and their potential to support participation in activities and strengthening the well-being of children and adolescents. Such knowledge can contribute to provide inputs for policy making, development and planning to achieve good health and well-being in the younger population. This thesis has brought together data from different sources using a pragmatic multi-methodology research strategy based on quantitatively driven approaches and geographic information systems (GIS) technology. Through a step-based research process, review designs were utilized together with a cross-sectional epidemiological design. The first review focused on methodological issues and involved identifying, systematizing and evaluating previously applied GIS-derived measures and operational definitions of the built environment characteristics and the spatial units of analysis. The second systematic review addressed the health-promoting potential of the built environment by synthesizing the existing empirical evidence of relations between the built environment and the participation in activities and well-being of children and adolescents. The cross-sectional studies were conducted within the Norwegian context. Data from 23 043 eight-year-olds in the Norwegian Mother and Child Cohort Study were linked to GIS-derived measures of population density, green spaces and facilities around the residential addresses of the study participants. Associations between these built characteristics and children’s participation in leisure-time physical activity (PA), organized activities and social activity with friends were investigated. Further, mediation analysis techniques were applied to examine whether these built environment characteristics were related to children’s subjective well-being and if participating in different leisure activities mediated any such associations. The methodological findings show numerous GIS-derived measures of diverse built environment characteristics for which consistency in operational definitions is very much needed. The empirical results suggested that the multifarious characteristics of built environments act as resources for participation in different activities, and could thereby contribute to strengthening well-being in childhood and adolescence. In particular, the synthesis of existing evidence showed that living in neighborhoods characterized by low traffic, proximate facilities, high walkability, more safety features and well-established infrastructure for walking and cycling likely promotes active travel and, to some extent, physical activity. Findings from the cross-sectional studies revealed that neighborhood green space was associated with more leisure-time PA among Norwegian 8-year-olds in both the summer and winter. The results also showed that more densely populated areas and more facilities, such as playgrounds/sports fields and schools, were associated with greater participation in organized and social activities. Further, positive indirect relations between the built environment characteristics and children’s moods and feelings, through greater participation in leisure activities, counteracted some of the negative direct associations observed between children’s emotional state and the determinants higher population density, access to a park, more playgrounds/sports fields. These findings from the Norwegian context underscore the role that the built environment may have in terms of enabling participation in a variety of leisure activities for children’s subjective well-being. This thesis concludes that although many methodological issues and knowledge gaps remain, planning for public health cannot wait. The best available evidence at this very moment suggests that children and adolescents who live in neighborhoods with versatile built resources and activity venues likely engage more in leisure activities that in the long run might contribute to strengthening their health and well-being. Accordingly, holistic approaches to public health within these everyday settings are essential. Different stakeholders, including policy makers, public health professionals and planners should acknowledge the multifaceted nature of determinants and appreciate that a variety of resources for health and well-being can be found within built environments