שנת סיום: 2023

כותרת עבודת הדוקטורט: Motivations for Active Travel Choices: Relationship of policy, environment, and psychosocial factors with walking, bicycling and e-bicycling among adolescents

מנחים: פרופ' אורנה בראון- אפל

Abstract

During the transitional period from childhood to adulthood, adolescents develop physically, psychologically and socially. At this stage in life, adoption of healthy behaviors is critical; acquiring positive habits and potentially long-term lifestyle choices. Regular participation in physical activity (PA) is associated with adolescent health and wellbeing; however, global levels of adolescent PA are low. Active travel (AT) incorporates PA into daily living with benefits for both individuals and the community.

The current study investigates different AT and PA behaviors in association with a variety of demographic, psychosocial, and environmental measures based on the framework of the social ecological model (SEM). The SEM assumes that health promotion and change is dependent on a multilevel approach that targets interpersonal, organizational, community, and public policy, as these are all different factors that stimulate positive change in individual and societal public health.

This PhD. Dissertation seeks to better understand the motivations for use of AT modes, including walking, bicycling and e-bicycling, by youth in Israel in association with the policy, environment, safety, and social norms. The study design utilized qualitative and quantitative methods to examine patterns of AT and PA among adolescents in Israel. Use of different research methods enhanced internal validity and provided a more comprehensive review in response to the research objectives.

Methods

The research framework included three distinct phases with tailored methods and processes: Phase 1 – Qualitative Interviews with Adolescent-Parent Dyads was conducted as a preliminary phase in order to refine the research objectives and the study design. The interviews were on the topics of active travel and physical activity, as well as related behaviors during the COVID-19 outbreak, lockdown and initial return to routine schedules (Manuscript 1).

Phase 2 – Secondary Analysis of Cross-Sectional Survey Data included an in-depth analysis of data from the Health Behaviour in School Age Children Study, conducted every four years in countries around the world including Israel. The 2018-2019 survey in Israel included an extended module focused on PA, including questions on active school travel (AST) and use of bicycles and e-bikes. (Manuscript 2).

Phase 3 – Cross-Sectional Survey Data Collection and Analysis was based on independent data collection with adolescents in Israel. The Study of Teen Active Travel (STAT) survey questionnaire is focused specifically on motivations for AT, self-reported AT, PA, sedentary behaviors, and perceptions of the local environment. The third phase of the study included a review of additional measures of environment and policy in line with the SEM. (Manuscript 4). The study incorporated an exploratory sequential mixed methods design and analysis based on Phases 1 and 3 of the study focused on the impact of peers and social media  (Manuscript 3).

Findings

The key finding of this study pertains to the cumulative and interrelated nature of adolescent AT and PA. Findings from STAT survey, which includes both leisure and school travel, reveal that adolescent AST is a predictor for active leisure travel (ALT) (Manuscript 4). Furthermore, adolescent AST and ALT are both associated with PA behaviors. We also find that many of the same measures and characteristics are related to both adolescent AT and PA (Manuscript 4). Similarly, findings from the HBSC analysis also point to an association between lower rates of AST and cycling and lower rates of adolescent PA (Manuscript 2). Another important finding of the study relates to high prevalence of adolescent AT in Israel as compared to findings cited for many other high-income countries. The majority of adolescents report frequent walking behaviors, 6-7 days a week, for both leisure and school (80.8%), 13.4% report frequent cycling and 5.5% report frequent e-cycling (Manuscript 4). We also find that 39.3% report 20 minutes or more of daily AST representing significant travel time (Manuscript 2).

Several key measures were identified that are associated with adolescent AT and PA; reflecting policy, community, interpersonal and personal levels of influence as delineated in the SEM. Throughout the different phases of the study, in both the qualitative and quantitative stages, similar threads emerge related to the different correlates of physically active adolescents in Israel. These include measures related to the environment such as urbanicity, distance to school, and supportive infrastructure (Manuscripts 1, 2, 4). Community, family and peer norms in association with adolescent AT were highlighted; joint AT and PA and social support encourage adolescent AT and PA, while joint sedentary or vehicle centric behaviors oppose adolescent AT and PA (Manuscripts 1, 2, 3, 4).

An original topic introduced in the current study relates to the contribution of social media platform (SMP) participation, messaging and message-sharing, to adolescent PA and AT. Several adolescents spoke about the use of SMP to promote joint PA and AT (Manuscript 1). Findings from the STAT survey confirm that the effects of SMP on these behaviors is relevant for a select group of adolescents (Manuscript 3). Moreover, findings of both regression and discriminant analyses highlight a consistent and strong role of SMP in association with adolescent AT and PA (Manuscript 4).

At the personal level several adolescent characteristics were associated with AT and PA. Of note are the effects of habits which was a strong predictor of adolescent AT (Manuscript 4). As well as sedentary behaviors, including an in-depth investigation of screen use and negative correlations of high rates of screen use with adolescent AT and PA (Manuscripts 2, 3, 4).

Research Contribution

This study seeks to contribute to the field of research on AT and health behaviors by identifying factors that predict the use of AT modes, prevalence of AT, differences across populations, and the association of AT with PA and other demographic, psychosocial and environmental characteristics in Israel. Inclusion of measures of environment, social norms, family norms, and SMP in single comprehensive regressions and discriminant analyses; pulled together the different facets of the SEM, making it possible to identify the strongest influences.

The findings contribute to research on the relationship between adolescent AT and PA. Within AT behaviors, we find that AST and ALT are associated, with AST serving as a predictor for leisure travel. Moreover, adolescent engagement in AST and ALT are both predictors for PA behaviors. This study focused on the different factors related to AT choices by adolescents in Israel including self-efficacy, environment, parental support and peer behaviors that were not studied previously in detail. The study was also unique in that e-bikes were added to the more traditional AT modes of walking and cycling and leisure trips were reviewed in addition to school routes. Innovative measures related to screentime, SMP and peer-to-peer communication were developed in the framework of the current research.

Practical Implications for Future Research

Although this study focused on AT and PA behaviors in Israel the methods and findings are relevant to research on this topic in other high-income countries.

To the best of our knowledge, this is the first in-depth study of adolescent AT to include e-cycling. With the increase of micromobility modes, it is recommended that additional modes of adolescent AT be further investigated as well as combinations of AT and public transport. Further research into these modes may include objective measurements of PA, such as accelerometer data, in order to gain a better understanding of the contribution of different AT modes to PA.

We identified association between AT, PA and SMP, an innovative contribution of this study. Further study of the role of SMP on these health behaviors is warranted. Longitudinal measurements would allow for an understanding of the long-term benefits of participation in SMP that encourage AT and PA as well as whether this type of influence carries over into young adulthood.

The findings regarding the association between adolescent AT and PA behaviors and the different spheres of influence support design of multilevel interventions that will target significant policy, community, interpersonal and personal measures. Future research may also include evaluation of programs and policies to promote AT and PA that include message delivery via SMP, highlight peer-to-peer communication, AT habits and emphasize parental support and joint parent-adolescent activities.

Conclusions

The majority of adolescents in high income countries have low levels of PA and are increasingly sedentary. Adoption of positive habits in childhood and adolescence increase likelihood of continued healthy behaviors into adulthood. Increased time in light-intensity activities may be important as a more feasible approach to increasing overall PA among adolescents, in particular for those who are less likely to meet the current guidelines. Furthermore, with the rise in urbanicity in Israel and worldwide there is an opportunity and necessity to move to active, micromobile and public travel modes. The findings of the current study regarding prevalence of adolescent AT and PA and key measures associated with these behaviors serves as a resource for future policy and programming.