Article

Environmental and school influences on physical activity in South Asian children from low socio-economic backgrounds: A qualitative study

Journal of Child Health Care 2015, Vol. 19(3) 345–358 ª The Author(s) 2013 Reprints and permission: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1367493513508845 chc.sagepub.com

Emma Lisa Jane Eyre, Michael J Duncan, Samantha L Birch and Val Cox Coventry University, UK

Abstract South Asian (SA) children are less active but have enhanced metabolic risk factors. Physical activity (PA) is a modifiable risk factor for metabolic disease. Evidence suggests that environmental factors and socio-economic status influence PA behaviour. The purpose of this study was to understand PA environments, barriers and facilitators of PA in deprived environments for children from SA backgrounds. Focus groups were conducted with 5 groups of children aged 7–9 years (n ¼ 33; male ¼ 16, female ¼ 17; SA ¼ 17, White ¼ 8 and Black ¼ 8) from two schools in deprived wards of Coventry, England. Thematic analysis was used to identify key themes and subthemes across all transcripts. From the results, emergent themes included school and home environment, outdoor activity, equipment, weather, parental constraints and safety. Ethnic differences were apparent for sources of beliefs and knowledge and religious practice as constraints for PA. The findings suggest that school provides a good foundation for PA attitude, knowledge and behaviour, especially for SA children. To increase PA, multi-component interventions are needed, which focus on changing the home environment (i.e. junk food and media time), encouraging outdoors activity, changing perceptions of safety and weather conditions, which provide parental constraints for children. Interventions also need to be considerate to religious practices that might constrain time. Keywords Built environment, children, physical activity, school, South Asian, thematic analysis

Corresponding author: Emma Lisa Jane Eyre, Coventry University, Priory Street, Coventry, CV1 5FB, UK. Email: [email protected]

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Introduction Children should engage in 60 minutes of moderate to vigorous physical activity (MVPA) daily for health benefits (WHO, 2010). However, only 64% of UK children meet these guidelines (Owen et al., 2009). This is important because habitual physical activity (PA) is associated with a range of health benefits in children, including cardiovascular/metabolic health, psychological well-being and bone growth (Brage et al., 2004; Janssen and Leblanc, 2010; Katzmarzyk et al., 1998). Studies have also shown that being active as a child increases the likelihood of becoming an active adult (Malina, 1996; Rowland, 1996). Of particular concern in the UK is the low level of engagement in MVPA amongst South Asian (SA) children (54% SA vs. 70% White and 69% Black) (Owen et al., 2009). SA adults have increased risk of type 2 diabetes and cardiovascular disease (Balarajan, 1996; Bhopal et al., 1993; Williams et al., 2011), which emerges in childhood (Berenson et al., 1998; Ehtisthan et al., 2000; Whincup et al., 2002, 2007). Differences in metabolic profiles are seen in SA children as young as 8 years (Bavdekar et al., 1999; Whincup et al., 2007), and studies have concluded that cardiometabolic risk factors track from childhood to adulthood (Bao et al., 1994; Chen et al., 2005; Raitakari et al., 2003). Understanding barriers to PA in SA children is thus useful for both child and adult health. There are a number of factors that determine PA behaviours, these include physiological, psychological/individual, social, demographic and environmental (Giles-Corti et al., 2011). A wealth of studies have concluded that environmental factors affect PA behaviour, specifically relating to features and design of the environment such as the availability of open spaces, walkability, facilities and proximity (Almanza et al., 2012; Frank et al., 2005; Giles-Corti et al., 2011; Kaczynski et al., 2008; Lachowycz and Jones, 2011; McCormack et al., 2004; Rodrı´quez and Vogtica, 2009; Timperio et al., 2008). The environment is likely to significantly impact PA in SA populations who cluster in deprived inner city areas, based on employment opportunities or entering into the housing system (McGarrigle and Kearns, 2009; Singh and Tatla, 2006) and thus more likely to be of lower socioeconomic status (SES). SES affects objectively measured PA in children (Duncan et al., 2008, 2012), and people from SA backgrounds are the most socio-economically deprived (Jayaweera et al., 2007; Williams et al., 2009). This is important because studies suggest that living in deprived neighbourhoods is associated with reduced PA (Griew et al., 2010; Pabayo et al., 2011; Spengler et al., 2011). Children from low SES suffer from multiple and accumulative experiences of deprivation including increased traffic volume, pollution and poor housing and residential conditions and thus have less opportunity for PA (Bolte et al., 2010). However, there appears to be no research on the combined effects of ethnicity and SES on PA. In previous studies, the focus has been on quantitative assessment of PA in specific locations or using global positioning system technology to map PA patterns (McCormack et al., 2004). Whilst this is useful, it is also important to understand the lived experiences of people’s interaction with the environment in relation to PA and to understand socio-economic and environmental influences. To date, only one article has considered the interactions of young adults with the environment (16– 20 years) from a qualitative perspective (Lake and Townsend, 2012). The authors concluded that qualitative approaches provide useful insight into understanding the impact of the built environment on PA. However, no research has explored environmental experiences on PA in a paediatric population. This would prove useful to understand why many children do not meet PA guidelines, why this adherence is lower in specific ethnic groups and to inform policy and future intervention planning aimed at increasing PA levels. The aim of the study is to explore environmental

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Table 1. Sampling quota for focus-group interviews. School 1: most deprived ward

School 2: second most deprived ward

Group 1 3 Boys; 3 girls All SA aged 8 years (year 4) Group 2 2 Boys; 2 girls All SA aged 7 years (year 3)

Group 3 4 Boys; 4 girls Mixed ethnic groups aged 8 years (year 4) Group 4 4 Boys; 4 girls Mixed ethnic group children aged 8 years (year 3) Group 5 3 Boys; 4 girls Mixed ethnic group children aged 7–8 years

SA: South Asian.

influences on PA from a qualitative perspective in children with a specific focus on ethnic differences in low SES areas.

Method Participants Following informed consent, primary school children (7–9 years) from the two most deprived wards of Coventry participated in the study (N ¼ 33 children, male ¼ 16, female ¼ 17; SA ¼ 17, White ¼ 8 and Black ¼ 8). The 4th school in a cluster of 6 schools was selected from Foleshill and St Michaels wards. Every sixth child that met the sampling quota (Table 1) was then invited to take part in the study. The study period took place between March 2012 and April 2012, and the ethical approval was obtained from Coventry University Ethics Committee. Homogenous focus group 1 and 2 interviews took place with SA children, enabling them to share their unique cultural experience with those they have things in common with (King and Horrock, 2010). For focus groups 3 to 5, ethnicity and gender were both heterogeneous, which enabled ethnic variations to be explored. It was hoped that using both these methods would provide a wide range of variation in factors as well exploring more in-depth information with an SA subgroup. Focus group consisted of four to eight children (slightly larger in heterogeneous groups to allow for both ethnic and gender experiences). These meet the requirements, which suggest a group should include from four to eight participants (King and Horrocks, 2010). Focus groups were continued until the point of redundancy, in which no new themes emerged and were chosen as they provide a more naturalistic data collection method compared to interviews or questionnaires. They also allow respondents to build upon the responses of other group members and the relatively free flow of talk can provide an excellent opportunity for hearing the language and experiences of the respondents (Wilkinson, 2004). Four main topic areas were used for questioning, that is, knowledge and beliefs about PA, key sources of knowledge and beliefs about PA, PA patterns and barriers and facilitators to PA. These were topic areas used by Rai and Finch (1997) to question SA, Black and White adult’s attitudes towards PA. Questions were openended to gain depth in responses.

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The interviews were conducted in a familiar setting to the child (rainbow room) during school time, as familiar settings are described as beneficial in providing a degree of comfort for such data collection methods (King and Horrocks, 2010). The interviews took 40–60 minutes per group; this was equivalent to a school lesson and was kept short in order to prevent the children becoming bored and losing concentration.

Analysis of qualitative data Focus groups were digitally recorded (Olympus VN-750, Tokyo, Japan), anonymised and transcribed. The transcripts were verified by a facilitator. Data from the focus-group interviews were analysed using thematic analysis following guidelines proposed by Braun and Clarke (2006) and, in this way, sought to describe patterns within the sample. Thematic analysis is a widely used mechanism to identify, analyse and explore patterns within qualitative data (Braun and Clarke, 2006). There were no disagreements between the three separate analyses.

Results The quotes are referenced as school followed by focus group number and a summary of the findings can be found in Table 2.

Knowledge and beliefs about PA There appeared to be no ethnic differences in knowledge and beliefs about what PA was and the benefits of PA between SA versus White and Black children.

What is PA? Regardless of their ethnic background, children had a good knowledge of PA. The emerging themes related to movement, exercise, the use of energy and specific activities that are commonly related to the structured activities like sport or physical education (PE). Children reported ‘you are moving your body and your heart starts beating’ (S1, G3) and ‘it is where you use like energy’ (S1, G2).

What are the benefits of PA? A number of benefits from PA were described, which can be broadly themed under psychological and physiological (Table 2). Psychological benefits included ‘being happy’, ‘enjoyable’, ‘relaxed’, ‘excited’ and ‘feeling healthy’. In addition, learning skills and becoming competent at skills made the children happy and provided intrinsic rewards. The children reported physiological benefits of PA such as muscle or bone growth. For health and fitness, children understood the long-term benefits of PA to make you ‘fit’ and keep you healthy (dental health and weight management). Finally, children reported the physiological responses that they feel when engaging in PA such as ‘after I have finished my exercise I feel like I have just run away from a monster . . . because I can feel my heart beating really fast’ (S2, G3).

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Footballer Athlete

Book website PE teacher

‘ME’ TV

Family

‘my dad sometimes teaches me to do star jumps and lifts’ (S2, G3) ‘my dad because he was running around the whole park by our house and he got me to do it with my bike’ (S2, G2), ‘my dad because we go to the park’ (S2, G2) ‘my mum because she is a member so she can tell me what is good and bad’ (S2, G2). I did it myself . . . I just do it by myself then I don’t have to get moaned at by my mum when I do it wrong’ (S2, G2). ‘ . . . I saw this exercise programme it was called keeping your arms, your bum, your hips healthy . . . .it showed you how you keep your bum and your legs fit. It was to keep the muscles on your bum’ (S2, G3)) ‘erm I have a book and it is called ‘keeping fit and healthy’ (S2, G3) ‘ . . . and sometimes I go on a website called Olympic exercise’ (S2, G3)’ ‘ [PE teachers name] . . . make sure that you are good . . . make sure that we enjoy them . . . at lunch we play a skipping game and [teachers name] helps me to skip, he holds the rope’ (S1, G1,). ‘Wayne Rooney, he plays football, so I play football just like him’ (S1, G2) ‘miss my role model is Usain Bolt . . . because he is like me, running faster’ (S2, G2).

‘I do exercise because it makes me feel healthy’ (S2, G2). ‘when it was our sports day I was exercising every day and i had a race and I was first and I had a gold medal. miss it makes me feel the champion . . . . my heart was beating really fast’ (S2, G2). Happy ‘exercise makes me happy because when I exercise I get more good like basketball’ (S2, G1). Enjoyable ‘it is fun and we have really fun activities to do’(S1, G1) ‘all of the games and the extensions that we do like the warm ups and the little things’(S1, G1) Muscle and bone Growth/ ‘you should do exercise because it makes your Bones strong and its good for you and will make you stronger’ strength (S2, G1). Muscle and bone Growth/ ‘I think PA is good because like [child’s name]said when you are older you tend to have more, you can move your strength for adult health back a bit more than just sitting down on the couch feeling old’ (S2, G2). Health and fitness ‘Fit’ ‘I think PA is good for you because you get fit and if you want to get fitter then you have to Exercise more to so you can get more fitter’ (S2, G2). Prevent disease ‘it stops you getting cancer. diseases and diabetes’ (S2, G2), Dental health ‘because if I am not healthy then it will make my teeth fall out’ (S1, G2). Weight Management ‘if you didn’t do exercise then you would end up being fat’ (S2, G1). Skill ‘I think you should exercise because if you don’t do more exercise then like somebody kick this ball in the air you wont kick it up very far because you don’t do much exercise’ (S2, G1). Teacher ‘yeah he runs these clubs’ ‘[teachers name] does all these activities’ (S1, G1).

Feel healthy Intrinsic rewards

PA: physical activity; TV: television; PE: physical education.

Role models

Key sources of belief media

Psychological

Psychological

Benefits of PA

Table 2. Sources and knowledge of PA.

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Key sources and beliefs about PA In regard to key sources of beliefs about PA, there appeared to be an ethnic difference. Children from SA backgrounds reported that the school and specifically the PE teacher played a major role in educating about the benefits of keeping healthy, organising and introducing children to a range of activities. For other ethnic groups, family (granddad, dad and mum) was a key influence for demonstrating, encouraging and taking them to an activity environment. Media also influenced the behaviour and beliefs of children. None of the children from SA backgrounds reported parental influence on their activity engagement or beliefs about PA. Ethnic differences were also found for role models. SA children’s role models were their class teachers and most commonly the PE teacher, whereas other ethnic groups reported sporting stars from football or athletics as role models.

Factors affecting PA engagement An outline of the barriers and facilitators to PA can be found in Table 3, which is divided into two broad areas of general and environmental.

Environmental facilitators There were no ethnic differences in preference for PA. The majority of children reported that they preferred playing outside, which included the park/playground, green space/garden or the street/car park. This was because playing outside gave them more space and fresh air and enabled the children to keep cool. A few children reported a preference for activities indoors. These included sports/recreational facilities, home or school. Having space and equipment to do activities was important and feelings of safety were particularly associated with the school environments. When the children were asked when they were more active, the most common answer related to the school environment, which was mostly related to the playground and PE. Again, no ethnic differences were observed here.

Environmental barriers Religious practice was the only barrier reported in SA children. Having to attend mosque was a barrier because it limited the time available for other activities. All other experiences of environmental barriers were similar in all ethnic groups. Media influences (television (TV), play station and laptop) and the weather (rain and wind) were the most common barriers to outdoor PAs. Children also shared experiences of parents’ concerns regarding the weather. It was clear that some children were allowed to play out regardless of the conditions; but for other children, the rain, sun and cold meant and the parents stopped them from going outdoors. In addition, the weather causing indoor play at school was also seen as a barrier to PA because ‘when we have indoor play there is nowhere to exercise’ (S2, G2). Barriers also related to local parks. Children reported that they have parks near them but shared concerns about the parks’ aesthetics, safety and age appropriateness of the equipment. Children reported ‘I’ve got one by me but people leave injections on the stairs so I just stay outside the house’ (S2, G2) and ‘when I go on the monkey bars my feet touch the floor so I cant really go on anything . . . it is too small for me’ (S1, G1). Parental constraints were also a factor, they enabled or prevented the children from doing activities such as playing out because of their own safety

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Facilitators

PA: physical activity; PE: physical education.

Time Proximity ‘If you go in the car then you are early and you won’t be late’ (S1, G2), ‘I walk because I live really close’ (S1, G2), Weather ‘If the sun is shining then I will walk but if it raining then my mum will give me a lift to school’ (S2, G2) ‘I get a taxi when it is really cold or I will walk in sometimes. My coat does have a hood but it doesn’t stay up so that is why I get a taxi’ (S2, G2).

Travel to school

Junk food Outside environments (grass, playground and back garden) ‘When I was doing my exercise . . . my mum came back from shopping . . . and put some junk food on the ‘I prefer outside because you get more air, you get more space and you spread out more to do activities’ table and then I had it’ (S2, G2). (S2, G2). ‘I prefer outside because when I am inside I get really hot but when I am outside I feel cool’ (S1, G2). Weather Space ‘when it is windy . . . .like really windy I can’t go in the car park because I might hurt myself’ (S1, G1). ‘I like to do it in my house because we have a big massive space and it is where my mum, dad and me do gym ‘the rain stops me from playing outside . . . . because it is too wet’ (S2, G3). and sometimes I like to put the music on and do my gym’ (S2, G3). Religious practice School environment ‘I go mosque so I have no time really’ (S1, G1) and ‘I have to go mosque and I will get told off so I have to ‘because in school we can do, we can go in the adventure playground and there is more things to play with’ mosque, which stops me from doing my swimming’ (S2, G2). (S2, G1) ‘in PE because we do lots of sports, we do it for a long time. It makes you active. And I do sometimes play football at home’ (S1, G1). Media ‘What stops me from doing my exercise is my game because I always watch the TV and play on my laptop’ (‘Because if you get hurt then someone will help you’ (S2, G1)). (S2, G1). Social Equipment ‘I have no one to play with’ (S1, G2) ‘I play in my garden and outside, I have lots of stuff in the garden that I can play with’ (S1, G2). Inappropriate equipment Proximity (‘when I go on the monkey bars my feet touch the floor so I cant really go on anything . . . . . . it is too small for ‘next to my house . . . there is a big park there and I play with my bike there once a week’ (S1, G1). me’) (S1, G1) Safety of local activity spaces Parental non-constraints ‘I’ve got one by me but people leave injections on the stairs so I just stay outside the house’ (S2, G2) ‘I’m allowed out in the rain’ (S2, G1) Aesthetics of local activity spaces ‘there is a park, like I told you before when I went it was proper trampy but now it is a bit better’ (S1, G1).

Environment

Parental constraints ‘She said that I will get ill and then you will miss too many days off school and you wouldn’t get a good school report’ (S1, G1). my mum said If you want to stay outside, stay outside and play for a few minutes but I can’t go back inside . . . only for a drink . . . then my mum will say you have to stay inside’ (S1, G1). Lack of skill ‘football . . . because people always tackled me and they always tripped me over’ (S2, G1)

General

Barriers

Table 3. Barriers and facilitators to PA.

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concerns (‘sometimes my mum doesn’t let me out, we use to play with these children but their house got robbed so we couldn’t play out anymore’, S1, G2).

Travel to school No ethnic differences were found for travel behaviour. The mode of travel choice was determined by proximity, time and the weather.

Other barriers to PA All children, regardless of ethnic background, shared common experiences of junk food (fat snacks, i.e. chocolate, crisps and ice cream) at home, which was a distraction from PA. This related to parents offering them junk food whilst doing PA. Homework, siblings and other children’s poor behaviour were also identified. References were made to past negative experiences that affected their current activity engagement. One child reported that there was a lack of variety. ‘I stopped swimming because you just have to swim every time and not do different things’ (S2, G1). Lack of skills or competence was a barrier to activity. Parents’ constraints were also drawn upon. For one child, they became too good so the parents wanted them to try other activities. For another child, the mother’s lack of ability to swim and needing the child’s assistance hindered their own ability to swim.

Discussion The purpose of this study was to qualitatively explore environmental influences on PA from a child’s perspective with a specific focus on ethnic differences in low SES areas. The results highlight that there are some ethnic differences for environmental influences on PA and that SES may be more important. In the few ethnic differences that were found, religion (attending mosque) was a barrier to PA in SA children. This comment is specific to the Islamic community, hence shows some heterogeneity in SA children’s experience of barriers to PA. In the present study, ‘mosque’ was identified as a time constraint because children reported that parents prioritise mosque over PA. The Birmingham Healthy Eating and Active Lifestyle for Children Study (BEACHeS) has also suggested that children in Islamic communities spend a significant amount of time at their place of worship (mosque). They report that children attend mosque daily after school and during weekends, which limits the time available for PA, food preparation and also the travel time to school or home (Pallan et al., 2012). It is clear from this study and the BEACHeS (Pallan et al., 2012) that for intervention planning, research needs to understand religious practices more effectively. Providing more after-school clubs is unlikely to increase PA because of daily religious practices as mosque attendance has been reported to clash with after-school intervention times, resulting in non-attendance (Rudolf et al., 2006). Clearly, the role of religious practices needs to be considered when designing ethnic-focused interventions. Ethnic differences were also apparent for sources of knowledge and beliefs about PA. School and specifically the PE teacher were the main and only influence on knowledge and beliefs for SA children. The school teachers, especially the PE teacher, were also named as their only role model for PA, playing a vital part in providing a role model for the children to aspire to. For other ethnic groups, school and parents were the main influences on knowledge and beliefs about PA, and role models were described as sporting stars, highlighting the role of the media. Parental influences,

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role modelling and the importance of school for encouraging healthy behaviours and habits have been described in previous research (Finn et al., 2002; Kamtsios and Digelidis, 2008), but this study is the first to explore and report ethnic differences. The findings that the PE teacher was an important influence on PA in SA children but not for other ethnic groups might relate in part to differences in terms of PE delivery between schools. In school 1, all the children interviewed were SA, and PE was taught by a school-based teacher employed specifically to teach PE. In school 2, PE was delivered by an outside organisation that only came in to teach PE. The effect of this on the results from this present study is unknown. However, the thematic analysis did indicate that specialised PE teachers play a crucial role on PA behaviours and attitudes especially in SA communities, where this person appears to be the main source of knowledge, beliefs and engagement. The importance of school PE on attitudes and beliefs as well as current and future PA is well documented (Ferguson et al., 2009), and as such, the results of the present study are supportive of this prior work. Despite having different sources of information for knowledge and beliefs between SA and other ethnic groups, it was apparent that all influences played a vital role in providing a source for knowledge and beliefs about PA. They provided a range of opportunities and encouragement for children to be active. As a result of this input, the children demonstrated a good understanding of what PA is and showed knowledge of the importance of PA on physiological, psychological and skill development. In addition, they were able to identify some understanding of how the benefits of PA translate to adult health. These results are therefore consistent with Fishbein and Ajzen’s (1975) theory of planned behaviour that highlights the importance of the influence of believing that PA will have positive benefits of determining PA behaviour. Furthermore, irrespective of different sources of information, the children’s understanding of PA did not differ by ethnic background. The children’s understanding of PA related to structured activities such as sports activities or PE lessons are arguably described as exercise. This is surprising because the nature of children’s activity patterns is described as intermittent and transitory (Baquet et al., 2007), which is more akin to play activities. However, play was only briefly mentioned. Walking to school is also a common activity for children but was not mentioned by children in the current sample. These findings are consistent with recent research (Beets et al., 2011). SA and other ethnic groups reported similarly that they were most active when they were at school, affirming its importance as an environmental correlate of children’s PA behaviour. Likewise, they felt that the home environments were a barrier to PA because they provided increased availability of junk food and media entertainment opportunities. All children reported how their parents would offer junk food to them at times when they were engaged in home PA. In addition, TV, play station and computers were reported as barriers to PA. This is consistent with meta-analytical data that confirmed that TV viewing and video computer use is positively associated with body fatness and negatively associated with PA (Marshall et al., 2004). It has also been suggested that lower income households have greater access to media devices that provided increased opportunity for sedentary behaviour and less for PA (Tandon et al., 2012). The current sample was drawn from the two most deprived wards in the city of Coventry, and so the role of media devices and access to them may be particular to low SES groups. This comment is however speculative and future research should endeavour to explore this issue further. Interventions at the home environment in which parental restrictions are made on media entertainment and junk food might therefore provide more opportunities to be active. Prior work by Beets et al. (2011) has supported the importance of improving the home environment to decrease physical inactivity.

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There were three main themes that were related to PA and the environment in this study. Arguably these appeared to be pre-affected more by SES than ethnicity. These included equipment or space, safety and parental constraints. Equipment was identified as an important facilitator or barrier to activities both inside and outside. This is not necessarily a novel finding as prior research has highlighted the importance of school facilities and unfixed equipment on increasing PA during school break times (Ridgers et al., 2012) and the availability of recreational space or public open spaces such as parks, playgrounds, playing fields or courts is associated with PA (Chomitz et al., 2011; Duncan et al., 2012; Loureiro et al., 2010; Nielsen et al., 2010; Veitch et al., 2010). In this study, the children preferred to play outside, and it was a time when they perceived themselves to be most active. Researchers have confirmed that children are most active in outdoor environments (Cleland et al., 2008; Dunton et al., 2011; Jones et al., 2009; Perry et al., 2011). A review also concluded that the health benefits of PA are greater outdoors (McCurdy et al., 2010). However, there is no prior research highlighting why outdoor space is perceived to be better. The findings from this study suggest this is because they have more ‘space’ and ‘fresh air’. Safety was noted as a common barrier to PA outdoors, which is related to feelings of getting lost, feelings of crime in the neighbourhood and sharing experiences of drugs and violence within park settings. Children’s concerns regarding their safety in relation to crime and danger are already known (Loureiro et al., 2010) and neighbourhood satisfaction is described as a moderator of PA (Carson and Spence, 2010). It is likely that children’s fears of danger and safety are influenced by parents’ own beliefs and perceptions, and it was identified that parents constrained children’s behaviour of ‘playing out’ in relation to their own safety concerns, consistent with previous research (Veitch et al., 2010). This is important because children of concerned parents are less active (Jackson et al., 2008), and the perceived absence of having safe places to play is also associated with obesity (Robinson et al., 2012). Parents also constrained children’s PA behaviours in relation to the weather. Children shared experiences of not being allowed out if it was too windy or wet, which would also restrict play in indoor settings. This is consistent with reports linking weather conditions to PA behaviour (Rich et al. (2012). Consideration of specific weather conditions does not seem to have been explored. The weather also restricted school PA and resulted in ‘indoor play’. The children would comment that there was not enough space to play indoors. This may restrict the amount of activity that children can engage in. The results of the current study support the assertion that children are not autonomous in their decisions, and parental constraints limit being physically active (Panter et al., 2010). The children in the current study were also relatively young (seven–nine years); and it is not known whether children are aware of all features of their neighbourhood, which affect their behaviour at this age. Additional interviews with parents and community leaders might explore these issues with more detail in relation to children’s behaviour and also parents’ constraints. Finally, the social component to PA was important for engaging in activity and also promoting PA. Children reported that they like to engage in activities with people including friends, family or teachers. These findings are consistent with the findings from previous studies that have found that PA in children takes place most commonly with friends and family (Beets et al., 2011; Dunton et al., 2011). It can be suggested that social component to PA is an important mechanism, which should be considered in intervention planning. There are some limitations to this study. The study examined two schools within two geographical areas, which makes it difficult to generalise to other built environments. It is also difficult to separate what is socio-economic or an environmental influence within this study because

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children in deprived areas are likely to have different environmental influences based on SES. It would have been useful to compare different ethnic groups such as Black and other ethnic minority groups. However, a large sample of these ethnic groups was not available in the electoral wards of interest. Despite this, this study is the first to consider ethnicity, socio-economic and environmental influences on PA in children. The nature of the focus group data has enabled a unique and rich depth of information to be obtained in relation to children’s attitudes, beliefs and experiences.

Conclusion The major novel finding of this study is that the time available for PA in SA children is reduced by religious practices (i.e. attending mosque). In addition, the school and specifically the PE teacher are important and are the major influences for knowledge and beliefs, providing opportunity, encouragement, role modelling and engagement in PA. Therefore, the school environment provides an important foundation for PA in primary school children from SA backgrounds. However, there are a range of other environmental influences that appear to relate to SES rather than ethnicity. For instance, the school is important on PA beliefs and behaviours, but a supportive home environment is needed to sustain PA. In order to improve the home environment (e.g. junk food and media influences), perceptions relating to the environment (e.g. safety issues and weather), which limit behaviour need to be challenged and changed in both children and parents. Further research needs to confirm parental perceptions that may constraint their child’s PA. Building social networks for PA outside play/PAs and being considerate to religious practice in South Asia is also important for increasing engagement in PA and should be considered when targeting interventions to increase children’s PA and PA environments. Funding This research received no specific grant from any funding agency in the public, commercial or nonprofitable sectors. References Almanza E, Jerrett M, Dunton G, et al. (2012) A study of community design, greenness, and PA in children using satellite, GPS and accelerometer data. Health Place 18(1): 46–54. Balarajan R (1996) Ethnicity and variations in mortality from coronary heart disease. Health Trends 28: 45–51. Bao W, Srinivasan SR, Wattigney WA, et al. (1994) Persistence of multiple cardiovascular risk clustering related to syndrome X from childhood to young adulthood. The Bogalusa heart study. Archives of Internal Medicine 154: 1842–1847. Baquet G, Stratton G, Van Praagh E, et al. (2007) Improving physical activity assessment in prepubertal children with high-frequency accelerometer monitoring: A methological issue. Preventive Medicine 44(2): 143–147. Bavdekar A, Yajnik CS, Fall CH, et al. (1999) Insulin resistance syndrome in 8-year-old Indian children: Small at birth, big at 8 years, or both? Diabetes 48: 2422–2429. Beets MW, Banda JA, Erwin HE, et al. (2011) A pictorial view of physical activity socialisation of young adolescents outside of school. Research Quarterly for Exercise Sport 28(4): 760–778. Berenson GS, Srinivasan SR, Bao W, et al. (1998) Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. New England Journal of Medicine 338: 1650–1656.

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Environmental and school influences on physical activity in South Asian children from low socio-economic backgrounds: A qualitative study.

South Asian (SA) children are less active but have enhanced metabolic risk factors. Physical activity (PA) is a modifiable risk factor for metabolic d...
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