Parental perception of the neighborhood environment and health-related behaviors in Portuguese children: What has changed from 2009 vs. 2016

Introduction: Physical activity (PA) is beneficial for health. However, most children do not achieve the daily recommended PA levels. This study assesses changes in parental perception of the neighborhood environment from 2009 to 2016 across three Portuguese districts, and explores the associations between parental perception of the neighborhood environment and children's time in multiple health-related behaviors. Methods: We use two national cross-sectional surveys (2009 and 2016) on 3-10-year-old children. Parents reported children's time (min/day) in different activities (e.g., active transportation, indoor and outdoor play, sport participation, watching television, using computer, and using videogames) as well as perceptions of the neighborhood features. Analyses were stratified by year, and child's sex, age, family socioeconomic status, and district of residence were considered. Results: Neighborhood features were better rated in 2016 vs. 2009. Major improvements were found related with facilities to ride a bicycle and more sense of security, although some geographical differences were noted. Major time-consuming behaviors differed: in 2009, playing indoor was the most common behavior (124 min/day); in 2016, outdoor play was the activity that consumed more time (125 min/day). The linear regression supports that walkability and safety perceptions potentiate children's PA, while PA features associate with screen-time. Conclusions: National policies and investments may have promoted healthier neighborhoods. Findings can point to environmental actions’ priority (e.g., promote active transportation), but caution is needed since time devoted on health-related behaviors was poorly explained by the environment.