Bijlage 2 - Onderzoek sociale leefomgeving kinderen in relatie tot gezonde levensstijl.pdf

Hereafter, appointments were made via e-mail with the parents. In total, five parents were interviewed, whose children go to four different schools and all live in different neighborhoods. See Table 1 for the description of the participants. Table 1. Description semi-structured interviews with parents Participant Gender

Age child

Gender child

Neighborhood

School

1

Male

7

Girl

De Dijk

Het Kompas

2

Female

10

Girl

Schrijversbuurt Het Kompas

12

Boy

Schrijversbuurt Special education

3

Female

12

Boy

Souburgh

Beukelmanschool

4

Female

4

Boy

Centrum

Beukelmanschool

6

Boy

Centrum

Beukelmanschool

4

Boy

Bloemenbuurt

t’ Nokkenwiel

5

Female

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Data collection As some people might not feel comfortable meeting in person due to the pandemic, the participants were offered the possibility of both an online and offline version of the interview. All participants chose to meet in person. On average the interviews lasted approximately 45 minutes, with some interviews being longer than others. The interview questions were made based on the questionnaire of the earlier mentioned dataset of the Kindmonitor, the website of JOGG, as well as the theoretical framework of this study. See Appendix 3 for an overview of the main interview questions. To provide sufficient space for in-depth and follow-up questions, the interviews took place in a semi-structured manner. Therefore, the content of the interviews differed slightly per interview, depending on the course of the interview. After the interviews were completed, they were transcribed, after which the recordings were deleted. The interviews took place from March-April 2022. Experts interviews Selection and recruitment After the interviews with the parents took place, the input that the parents provided seemed surprisingly positive. This could be due to participants answering in a socially desirable manner.

However, it also leads to the suspicion that it might be the case that mostly parents that are engaged with their child and their lifestyle tend to react to these types of invitations. Therefore, it is possible that these interviews largely include cases in which everything is going very well, but do not cover the more ‘problematic’ cases concerning lifestyles and social environments. Luckily, Alblasserdam knows multiple organizations and experts that are engaged with children and youths in Alblasserdam. Three organizations were chosen, which all in a very different way frequently interact with the target group. The first organization is ‘Jongerenwerk’, which aims to be present where children are and tries to support children by organizing fun activities but also activities surrounding prevention, for example concerning drug use. The second organization is the ‘ABC-team’, which organizes cultural and sportrelated activities for multiple age groups, including children aged 4-12. Lastly, two experts from the organization ‘Jeugdteams’ were interviewed together in the third and last interview. Their organization supports families that voluntarily ask for help by helping these families solve their problems or by referring them to other specialists. They were all interviewed as the expectation is that they have relevant experience with our target group, see Table 2 for an overview.

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Table 2. Description semi-structured interviews with experts Participant

Gender

Organization

1

Female

Jongerenwerk

2

Male

ABC-team

3

Female

Jeugdteams

4

Female

Jeugdteams

Data collection Firstly, the experts were asked if they were comfortable with an in-person interview. All participants agreed, however, due to the circumstances the first interview was changed to an online interview. In all three interviews, the same topics were discussed as in the interviews with the parents but this time from the perspective of the expert. Before the interview started the information letter and the informed consent, see Appendix 2, were discussed. The interviews were less structured than the interviews with the parents, as all experts had a different area of expertise. The interviews took approximately 45 minutes. The interviews took place from April – May 2022. Analyses All interviews were transcribed in Microsoft Word, after which they were analyzed in NVivo. During the analysis, the interviews were, first of all, openly coded through which patterns could be identified. Additionally, the transcripts were coded according to the relevant (sub)themes from the theoretical framework, namely healthy lifestyle, presence of peers, neighborhood, media education, and leisure. This in an attempt to make associations, both within and between different interviews. After both forms of coding, the codes were refined by categorizing codes into overarching categories, the corresponding code tree can be found in Appendix 9.

Reliability and validity There are many aspects that have been taken into account in order to guarantee the reliability and validity of the results of the interviews. This is important as it ensures that our measures are consistent and accurate. First of all, in advance of the interviews, the researcher made sure to establish the hypotheses, research questions, and a topic list with the main interview

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questions, in order to have a level of consistency throughout the interviews. This was done to increase the reliability of the interviews and to limit the potential subjectivity of the researcher. Furthermore, the questions are largely inspired by earlier published research, namely from the Kindmonitor 2017, in order to ensure validity. Additionally, the aspects included in the questionnaire concerned subjects that the participants are knowledgeable on. The probability of socially desirable answers was decreased as the participants were informed about the anonymity of the research, which increases the validity of this study. Lastly, to further increase the validity, experts’ opinions were included which ensured a better overall view of the situation in Alblasserdam. Ethical considerations Included in the e-mail asking to participate in this research is the information letter, which entails detailed information about potential participation in the form of an interview. In advance of the interviews, the information letter was again discussed after which the informed consent was discussed and signed. All participants agreed to participate in the interviews and the parents and the third and fourth experts also agreed to the recording of the interviews. The recordings were made using secured recording equipment borrowed from Utrecht University.

The recordings were, furthermore, anonymous as no personal information was mentioned during the interviews. After the interviews were transcribed, the recordings were deleted. The transcripts, furthermore, also did not include any personal information. All interviews were voluntary, participants could stop at any moment without having to explain themselves.

Results We will now turn to the results of this study. This will again be presented in two parts, first the quantitative results regarding the analysis of the dataset will be discussed. Afterward, the results of the interviews with the parents and experts will be presented.

Quantitative results In order to answer the hypotheses and thereby the research questions, multiple statistical analyses were run. As one of the aspects of a healthy lifestyle, having a set bedtime, is a binary variable, the analyses including this variable will be logistic regressions. The regression analyses for the consumption of water and sweet drinks will be linear regressions. Therefore, there are three statistical tests run per aspect of the social environment, one for

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each aspect of lifestyle. To prevent potential confounding effects the logistic and linear analyses are run with the control variables age, education of parents, gender, and parenting difficulty. The corresponding tables regarding the results of these analyses can be found in Appendix 4 to 7. Lastly, to test whether the found effects of these analyses hold when the other aspects of the social environment are included, three regression analyses are run including all aspects of the social environment and the control variables. This entails one logistic regression for bedtime, one linear regression for sweet drinks, and another linear regression for water consumption. The results of these analyses can be found in Table 4, and will be the guidelines for the discussion of the results. Compared to the individual analyses, only one significant association disappears when the other aspects of the social environments are added. This regards the relation between reading and bedtime, which will be discussed later on. State of the social environment and healthy lifestyles To investigate the current state of the social environments and healthy lifestyles of children, descriptive statistics were run, see Table 3.

Regarding the current state of healthy lifestyles of children, the data shows that 92% of children have a set bedtime, which indicates relatively consistent and thus healthy sleeping patterns. Furthermore, on average children score 4.71 out of 8 on how much water they consume. Regarding sweet drinks, children on average score 4.4 out of 8 on how few sweet drinks they consume. Therefore, although children do drink water, the drinking habits of children can certainly be healthier. Regarding the social environments of children aged 4-12, Table 3 also provides multiple insights. Starting off with leisure activities, 79% of children aged 4-12 play video games, and 21% use social media. Regarding how much children read for pleasure, children on average score a 2.34 out of 3, entailing that on average children read at least a few times a week, which is relatively positive. Regarding media education, 67% of the parents of children aged 4-12 have rules regarding screen time. Furthermore, parents on average score a 3.03 out of 4 on how heavily they supervise their child’s online behavior. Showing that media education is certainly present, although it could be more. Concerning neighborhoods, the neighborhoods are on average marked as 3.13 out of 4 regarding how child-friendly it is, showing that the average neighborhood is considered child-friendly.

Lastly, for the presence of peers, the average score is 2.49 out of 3, regarding how high the presence of peers is in the

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environment of a child, entailing that each child has a moderate or high degree of peers in its environment. Table 3. Descriptive Statistics N

Minimum

Maximum

Mean

Std. Deviation

Bedtime

3853

0.00

1.00

.92

.26

Water

3853

1.00

8.00

4.71

1.91

Sweet drinks

3853

1.00

8.00

4.40

1.65

Gaming

3853

0.00

1.00

0.21

.41

Reading

3853

1.00

3.00

2.34

.63

Social media

3853

0.00

1.00

0.79

.41

Rules

3853

0.00

1.00

0.67

.47

Supervision

3853

1.00

4.00

3.03

.58

Neighborhood

3853

1.00

4.00

3.13

.57

Presence of peers

3853

1.00

3.00

2.49

.72

Age

3853

4.00

11.00

8.08

-

Education parent

3853

1.00

3.00

2.00

-

Girl

3853

0.00

1.00

0.49

-

Parenting difficulty

3853

1.00

5.00

2.52

-

Healthy lifestyle

Leisure

Media education

Healthy lifestyle and presence of peers The results regarding the first hypothesis, which postulates that the presence of peers leads to less healthy drinking habits, are displayed in Table 4. First of all, Model 2 of Table 4 shows that the water consumption of a child is not significantly related to the presence of peers in the environment (B = .049, t(3852) = 1.094, p = .274). Model 3 shows that the presence of peers is significantly related to the consumption of sweet drinks for a child (B = -.079, t(3852) = 2.015, p <0.05). Meaning that a higher presence of peers leads to higher consumption of sweet drinks and thus less healthy drinking habits. Therefore, these analyses show that the presence of peers relates to the consumption of sweet drinks but it does not relate to water consumption. Therefore, the hypothesis regarding the negative impact of peers on drinking

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habits is only partially supported by the results of this study, only concerning the consumption of sweet drinks. Healthy lifestyle and neighborhood The second set of hypotheses, entailing that a child-friendly neighborhood leads to more healthy drinking habits and to more healthy sleeping habits was tested by logistic as well as linear regression analyses. The outcomes of these analyses are, again, displayed in Table 4. Model 1 shows that a child-friendly neighborhood does significantly relate to the bedtime of children (B(exp) = 1.241, p <0.05), meaning that children that live in a more child-friendly neighborhood have a 1.249 higher chance of having a set bedtime. Model 2 of Table 4 shows that a child-friendly neighborhood does not significantly relate to changes in the consumption of water in children (B = -.031, t(3852) = -.659, p = .510). When looking at the relation between the neighborhood and the consumption of sweet drinks, see Model 3, this relation is also not significant (B = -.020, t(3852) = -.485, p = .627). Entailing that again, a more childfriendly neighborhood does not correlate with healthy drinking habits. Returning to the hypotheses, for hypothesis 2a there is no effect of the neighborhood found on the consumption of water and sweet drinks. Therefore, this hypothesis cannot be confirmed.

As there is a significant positive effect found of the neighborhood on bedtime, hypothesis 2b is supported by our results. Healthy lifestyle and media education Concerning the third set of hypotheses, that state that media education leads to more healthy drinking habits and more healthy sleeping habits, these were also tested by logistic and linear regression analyses. See Table 4 for the results. As displayed in Model 1, rules about media use significantly and positively relate to the bedtime of children (B(exp) = 2.488, p <.001), meaning that children that have rules about media education have a 2.497 higher chance of a set bedtime. Furthermore, parental supervision also positively and significantly relates to the bedtime of children (B(exp) = 1.371, p <.01), entailing that this aspect relates to a 1.436 times higher chance of a set bedtime for children. Therefore, both aspects of media education, lead to more healthy sleeping habits, which supports hypothesis 3a. Model 2 of Table 4 shows the results regarding the consumption of water. It shows that both rules about social media and supervision significantly lead to healthier drinking habits (B = .256, t(3852) = 3.904, p <.001) and (B = .428, t(3852) = 7.766, p <.001), as they

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both have a positive relation with the consumption of water. Lastly, concerning the consumption of sweet drinks and media education, the outcomes of the analyses are displayed in Model 3. It shows that rules about media have a positive and very significant effect on the consumption of fewer sweet drinks (B = .286, t(3852) = 5.011, p <.001). The supervision of parents also very significantly and positively relates to consumption of sweet drinks (B = .391, t(3852) = 8.160, p <.001). Therefore, as the analyses show that both aspects of media education lead to healthier drinking habits, hypothesis 3b is supported by the results. Healthy lifestyle and leisure Lastly, the fourth set of hypotheses postulates that a healthier way of spending leisure relates to healthier sleeping- and drinking habits. These were once again tested by logistic and linear regression analyses, and the results can be found in Table 4. The logistic regression for bedtime did not show any significant effects for social media (B(exp) = 0.989, p = .947) and gaming (B(exp) = 1.228, p = .220). The analyses of Table 4 did also not find a significant relation between reading and bedtime (B(exp) = 1.153, p = .165). However, when the relation between leisure activities and bedtime is individually tested in a linear regression, see Appendix 7, a significant effect does show (B = .231, t(3852) = 4.633, p <.001).

This entails that reading relates to a 1.326 higher chance of a set bedtime. That this effect disappears when all other aspects of the social environment are added suggests that it might be that reading only has an effect on bedtime when the other aspects of the social environment are not present. Therefore, only the results regarding reading, to a certain degree, support hypothesis 4a, as the results show that under certain circumstances, reading does affect sleeping habits of children. The results regarding gaming and social media do not support hypothesis 4a. Regarding the relation between leisure and water consumption, see Model 2, the results show no significant relation between gaming and water consumption (B = .007, t(3852) = .096, p = .924) and between social media and water consumption (B = -.170. t(3852) = -2.022, p = .135). There is however a positive relation between reading and water consumption (B = .159, t(3852) = 3.176, p <.01), meaning that more reading associates with a higher water consumption. Lastly, for sweet drinks, see Model 3, the results show a positive relation with gaming (B = .348, t(3852) = 5.175, p <.001), meaning that playing video games is related with a higher consumption of sweet drinks.

Concerning the effect of both reading and social media on the consumption of sweet drinks, no correlation was found (B = -.006, t(3852) = -.146, p = .884) and (B = -.117, t(3852) = -1.598, p = .110). Regarding the relation

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between healthy ways of spending leisure and healthy drinking habits, there are mixed results, as not all expected associations were found. However, the effects that are found point to healthy leisure activities leading to healthy drinking habits, therefore, there is some support found for hypothesis 4b. As displayed in Table 4, the chosen control variables do significantly relate to the dependent variable in most analyses. This suggests that age, gender, parental education, and parenting difficulty do in fact relate to the lifestyles of children.

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Table 4. Regressions with healthy lifestyle as dependent variable and social environment and control variables as independent variables Model 1: Bedtime 1 B 95% CI for Odds ratio Lower Odds ratio Upper .032 [.090] .865 1.032 1.231 .216** [.094] 1.032 1.241 1.493

B .049 -.031

.912*** [.127]

1.939

2.488

3.192

.256***

Supervision Leisure

.315** [.111]

1.103

1.371

1.704

Gaming Reading

-.011 [.167] .142 [.103]

.713 .943

.989 1.153

Social media Age

.205 [.168] -.016 [.029]

.884 .921

Education parents Girl

-.028 [.090] .099 [.124]

Parenting difficulty Constant

.023 [.084] .020 [.682]

R2

.052

.051

N

3853

3853

Variable Presence of peers Neighborhood

Model 2: Water

Model 3: Sweet drinks

s.e. .045 .047

B -.079* -.020

s.e. .039 .041

.066

.286***

.057

.428***

.055

.391***

.048

1.372 1.409

.007 .159**

.077 .050

.348*** -.006

.067 .043

1.228 .984

1.705 1.051

-.170 .035*

.084 .016

-.117 .046**

.073 .014

.815 .858

.973 1.104

1.160 1.419

.345*** .180**

.044 .062

.143*** .143**

.038 .054

.867

1.023

1.208

-.164*** 2.322***

.041 .341

-.127*** 2.904***

.035 .297

Media education Rules

***p <.001, ** p <.01, *p <.05, two-tailed 1

The analyses including the variable bedtime are logistic regressions.

.045 3853

Qualitative results Interviews with parents In addition to the quantitative results, the analyses of the interviews with parents about the healthy lifestyle and social environments of their children can provide further insights into these topics. For an overview of the outcomes of the parental interviews, see Appendix 8. Healthy lifestyles With regards to the healthy lifestyles of their children, the outcomes of the interviews seem to be fairly positive. When asked to rate the lifestyles of their children, the parents of six children gave their child’s lifestyle a score of 8 out of 10 and one child got a 6 out of 10. These high rates were confirmed by the answers that the parents provided to the more indepth questions about the different aspects of a healthy lifestyle. Most parents seemed invested in making sure their children eat and drink healthy, sleep well, and exercise regularly. For example, one participant stated: ‘After school, I always freshly squeeze orange juice, so after school, they usually drink fresh orange juice.’ She also elaborated that she spends large amounts of money to buy fresh and healthy ingredients. What the parents also largely indicate is that healthy lifestyle choices, such as a healthy diet, are something children get used to.

This leads to children finding it normal to portray healthy habits, such as asking for a glass of water at a party instead of soda. One parent found his children even started eating vegetables because they felt like it: ‘Sometimes they have already eaten their 200 grams of vegetables before I’m awake.’. Another mother said that her son now asks to go to bed when he is tired, as he has grown to have a healthy relationship with sleeping. Most parents indicated that it might take some effort from the parents to get their child to have a healthy lifestyle, but that children easily take over the healthy habits. Social environment With regards to the social environment, the scores that parents gave their children regarding their social environment ranged between a 6 and a 9 out of 10, with an average of 7.7. Regarding the presence of peers in their children’s environment, all parents agreed that there are plenty of peers in the lives of their children. However, there were cases where children found it difficult to make friends. One participant stated about her son on the autistic spectrum: ‘Making friends is very complicated for him, but he also does not really feel the need to make friends.’ Regarding the neighborhood, all parents found their neighborhood safe

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and child-friendly to some degree, with some neighborhoods being safer than others. The biggest cause of unsafety that was mentioned several times was the traffic. One participant recalls: ‘This road is busy. The children play on the sidewalks, but the buses sometimes drive so fast, it is really dangerous.’ One aspect that all parents seem to view similarly is media education. All parents that were interviewed were involved in the media use of their child, and most had very clear and strict rules about technology use. In the cases where children had a mobile phone, the parents were closely monitoring it. One participant said: ‘We have connected our accounts to his account, so we can see exactly what he is watching. We are definitely aware of his online behavior.’. Concerning the way they are spending their leisure, six out of seven children included in this study seem to be doing well. Entailing that they barely play video games or use social media, but spent their time reading, playing outside, or going on day trips with their parents. However, for the seventh child, the situation is less healthy, partially as there are no fitting sports clubs for him because of his autism. His mother said: ‘A few years ago we had ‘JamaarIk’, which was a sports club for children with a stimulus processing disorder, where those children could do their thing. He really enjoyed going.

Unfortunately, it stopped, due to lack of volunteers.’ Lastly, in the interviews, the parents were asked whether they feel that some aspects of the social environment are more important than others. Two parents thought that there is no one aspect more important than the other, but ‘What is important, is that there is balance.’. Furthermore, two parents thought friends are the most important, and one parent argued that the neighborhood is the most important. Healthy lifestyle and social environment In three interviews, the question arose of whether there is a relation between a healthy lifestyle and the social environments of children. All three parents think that this is the case, and they all argued that they thought it was the environment that influenced the lifestyle. One mother said in this regard: ‘I think that your environment always influences the choices that you make. So there is definitely a relationship’. Role of the municipality All respondents were asked about the role of the municipality in improving the social environments of children. Two respondents indicated that they were very content with the involvement of the municipality, one said ‘The municipality is already involved in the aspects

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that are not going so well. I don’t think you can expect more from a government.’. The other three respondents all had one specific aspect in mind that they thought could be improved by the municipality of Alblasserdam. Namely, a sports club for children with disorders that make it hard to join regular sports clubs, fewer cars in residential areas, and the refurbishing of a local skate area for children. As the municipality of Alblasserdam is currently working hard to achieve a ‘Fit and green’ village for all residents, the interviews specifically included the question of whether participants felt like there is enough greenery in their neighborhoods. Of the five participants, four indicated that there is plenty of greenery in their neighborhoods. One even said: ‘Yes, there is enough greenery. To be honest, I wish they would trade some greenery for parking spaces, as we could use more of those.’. One participant, living very close to the center, said that some more greenery would be welcome, in the form of a grass field to play soccer and such. In three interviews, the parents were also asked whether the municipality has a role in promoting healthy lifestyles for children. Two parents felt like that is a difficult thing to do as lifestyles are something that is largely practiced within people’s homes.

The other respondent, however, said: ‘I don’t see anything wrong with pushing towards a healthy lifestyle in a friendly manner.’. Differences and similarities When comparing the outcomes of the five different interviews, a few things become apparent. First of all, the children that have trouble in one domain, tend to also have trouble in other domains. For example, a child that had trouble eating also had trouble with a healthy way of spending leisure and frequently exercising. Furthermore, it turned out that the two children that had significantly more trouble with achieving a healthy lifestyle and some aspects of the social environments were both children that were on the autism spectrum, to differing degrees. These were the children that got the lowest scores on the social environment, both around a 6, while the other children scored around an 8 or 9. Therefore, the biggest differences were between children with- and without special needs. Suggesting that children with special needs might have more difficulty with healthy habits and aspects of the social environment, and children without seem to do quite well regarding these aspects in Alblasserdam. For the children that do not have special needs, most outcomes were quite similar regarding healthy lifestyles, peers, media education, and leisure.

However, there were some differences in how their parents perceived their neighborhood.

Expert interviews Furthermore, the experts’ opinions can also provide insights from a different perspective compared to the parents which can help to answer the research questions. The outcomes from the interviews with the experts in the field will now be discussed. Healthy lifestyles Concerning healthy lifestyles, the outcomes of the expert interviews confirmed that children that are already suffering, for example, children living in poverty, also have trouble achieving healthy lifestyles. The first expert said in this regard: ‘It turns out that there are approximately 300 youths in Alblasserdam that are living on or under the poverty line, who are not playing sports in groups in an organized manner.’. The second expert mentioned another group that is having trouble, namely overweight children, which tend to attend fewer sport-related activities. However, the first two experts argue that the average child from Alblasserdam is doing fine in terms of a healthy lifestyle. The second expert also mentioned that quite a lot of children already drink lots of water, although there are still children that drink soft drinks. This was confirmed by the third interview, as the third and fourth experts also do not see anything remarkable regarding the lifestyles of children on average.

However, they doubt if they can provide a realistic picture as they have limited relevant knowledge on this topic. Social environments Regarding the aspects of the social environment, experts indicate more problems than the parents did. The first expert mentioned three problems, one being that due to the Covid pandemic children struggle with how to behave in groups. Furthermore, she notices that fewer children play outside, and thirdly there is a lot of traffic in Alblasserdam. The second expert also sees an increase in traffic, which prohibits children from playing outside for example as parents find it too dangerous for them to do so. Furthermore, he does not see aspects of the social environments that are structurally bad, but he does see that for children from certain disadvantaged groups there is a lot to gain. For example, for the earlier mentioned overweight children. The third and fourth experts have different expertise, as they only encounter children that need help, which comes with different experiences. They did confirm that children on the autism spectrum tend to struggle more with social contacts. Regarding leisure and neighborhood, they did not receive signals of trouble from parents. What they do get back

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from parents is troubles with media education and regulation, which accompanies children spending lots of time gaming or on social media. Greenery As Alblasserdam is very concerned with being ‘Fit and green’, the experts were also asked about greenery in Alblasserdam. In this regard, the first two experts agreed that there needs to be significantly more greenery in Alblasserdam. They also both acknowledged that this is hard to change as there is not much space left. However, the second expert provided a solution for this, as he said: ‘We should let nature do its thing. This enables children to create their own playgrounds. It is more fun and more challenging for children to play in trees and shrubs. We should just rearrange the greenery in the neighborhoods. That is what the children want.’ The third and fourth experts did not have any specific comments about the greenery in Alblasserdam. Role of the municipality Lastly, the experts all had something to say about the role of the municipality. The first expert indicated that the target group that the municipality should focus on is children living in poverty, especially concerning their opportunities of playing sports in an organized manner. She also mentioned that we have a responsibility for children that cannot keep up with the rest because they are autistic or do not get enough support from home.

The second expert felt that there are already a lot of activities organized for children, but argued that more organized activities after school could be beneficial for the children. For which, however, more manpower is needed. The third and fourth experts also had some ideas about the role of the municipality. Regarding what touches on the topics of this study, they mentioned the demand for activities for children with behavioral limitations. As a normal sports club does not fit them, they experience trouble finding appropriate leisure activities.

Conclusion This study aimed to answer the following three research questions: ‘To what extent are the social environments and lifestyles of children aged 4-12 in the Netherlands healthy?’, ‘To what extent does the social environment of children aged 4-12 in the Netherlands influence their lifestyles?’, and ‘Which aspects of the social environment are most important for achieving a healthy lifestyle for children aged 4-12?’. To answer these questions, four sets of hypotheses were formulated and tested using a quantitative dataset. Furthermore, qualitative

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interviews were conducted to further deepen the topics and provide additional insights and hereby strengthen the results. Regarding hypothesis 1, which postulates that the presence of peers correlates with less healthy drinking habits, the results partially support this hypothesis, as it was found that the presence of peers relates to increased consumption of sweet drinks. Peers do not influence water consumption. Therefore, only the results regarding sweet drinks are in line with social facilitation theory. The second set of hypotheses proclaims that a child-friendly neighborhood leads to healthier drinking habits and a set bedtime. The effect of the neighborhood was only found for bedtime, therefore only hypothesis 2b was confirmed, thereby also partially supporting ecological systems theory. Concerning the third set of hypotheses, the expectation was that the two forms of media education relate to healthy drinking- and sleeping patterns. The results show that rules and parental supervision relate to a higher chance of a set bedtime and also to healthier drinking patterns, meaning that there is support for hypotheses 3a and 3b. Lastly, the fourth set of hypotheses proclaims that healthier ways of spending leisure relate to healthier drinking patterns and sleeping patterns. The results indicate that reading, on its own, does associate with a higher chance of a set bedtime.

Furthermore, reading relates to higher consumption of water, and playing video games relates to higher consumption of sweet drinks. Implying that to a certain extent, healthier leisure activities associate with healthier sleeping and drinking habits, partially confirming hypotheses 4a and 4b. Concerning the current state of the social environments and lifestyles of children, the interviews with the parents and the experts revealed that the ‘average’ child from Alblasserdam is doing fine. This is confirmed by the descriptive statistics. However, certain groups of children need some extra help, such as children with autism, children in poverty, and overweight children, as their environments and lifestyles are less healthy, which makes them vulnerable in that sense. Furthermore, the statistical analyses show that all four aspects of the social environment influence at least one aspect of a healthy lifestyle. Therefore, the social environment and healthy lifestyles are certainly related, which the qualitative interviews confirmed. Regarding their impact, media education and leisure are the only aspects that influence all facets of a healthy lifestyle.

However, the interviews suggest that we need to focus on certain groups of children that are not doing well in multiple aspects of the social environment as well as concerning lifestyle, instead of focusing on certain aspects of the social environment. To conclude, this research shows that a healthy social environment can certainly contribute to a healthier lifestyle for children aged 4-12. This study also shows that although

40

the average state of the social environments and healthy lifestyles are sufficient, there are still areas that can be improved, which is especially the case for special needs children.

Discussion Looking back at the results of this study, most outcomes were in line with the formulated hypotheses, as all but one hypothesis were at least partially confirmed. This suggests that, overall, a healthy social environment for children is indeed related to healthier lifestyles for children. Only the presence of peers led to less healthy lifestyles in terms of drinking habits, which was in line with the expectations, which predicted that the presence of peers lead to fewer constraints and thus less healthy drinking habits. However, multiple other expected relations were not significant. The results show that there is no relation between a child-friendly neighborhood and the drinking habits of children. The reasoning behind the hypothesis is that a neighborhood can influence lifestyles through the resources they provide, such as the presence of healthy food shops. It might be the case that drinking behavior is separate from neighborhood influence as everyone has access to drinkable water at home. Furthermore, sweet drinks usually have a long shelf-life, meaning that quick access to (healthy) supermarkets might not be relevant. Additionally, there was no effect of peers on the consumption of water found, which was against the expectations.

A possible explanation could be that children usually consume water in settings where there are not many peers present, such as at home, and therefore it happens outside the influence of peers. Furthermore, for the association between leisure and aspects of a healthy lifestyle, gaming only relates to the consumption of sweet drinks, while reading leads to more water consumption and a set bedtime. The lack of relation between gaming and sleeping habits might be because playing video games for children aged 4-12 does not yet entail very long and intense sessions that influence how they sleep. For social media, there was no association with any of the aspects of lifestyle. This finding is unexpected as the reviewed literature strongly points towards a negative effect of social media on lifestyle. This result can possibly be explained by the fact that the children in this study are young, not yet teens, which might affect the way and the extent to which they use social media, which was not measured in this study. Implications This study has some scientific implications. Regarding the not yet largely explored relationship between social environments and lifestyles for children, this research shows that a

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healthy social environment clearly relates to a healthy lifestyle for children. Therefore, when trying to improve the lifestyles of children, the social environment is important to take into account. Furthermore, regarding the applied theories, this study shows support for the two ecological models and confirms that social facilitation theory can indeed be applied to children. Additionally, as this study shows no association between social media use and lifestyle choices, this suggests that the effects of media use might be different for children than for teens. It also suggests that when a child uses social media, it does not necessarily have negative consequences. Perhaps it depends more on how much time is spent using social media. In other words, this study provides insights into the effect of social media use on children.

Limitations Despite all efforts, there are some limitations to this study. One of them is the small sample size of the interviews, as only 5 parents are included in the parental interviews. Even though this has been tried to compensate by including experts’ opinions that have more of an overview of all children in Alblasserdam, it remains a threat to the external validity of the outcomes. Additionally, the four aspects used to conceptualize the social environment are only a part of the social environment of a child. It remains the question of what the effects of the other aspects of the social environment are, and thus what the effect of all aspects of the social environment together would be. Furthermore, the measures for lifestyle are also limited as they exclude important aspects, such as physical activity. Furthermore, this study uses samples from Zuid-Holland-Zuid and Alblasserdam, which is only a small part of the Netherlands. Therefore, these samples might not be as representative of the Netherlands as a whole or other countries. The last limitation is that the quantitative analyses could not control for the aspects that turned out to be relevant during the interviews, such as autism and the economic status of the parents. It cannot be ruled out that these factors influence the relationship between the social environment and a healthy lifestyle.

Suggestions for future research Furthermore, this study provides some suggestions for future research. The first suggestion is to conduct research specifically on vulnerable groups of children in society that struggle concerning their lifestyles and social environments, such as children with autism and children

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living in poverty. As the results suggest that these children are the ones that could use help, research should be conducted to investigate what can be done to improve the lifestyles and social environments of these children. Furthermore, to counter the limitation regarding the limited definition of the social environment as well as healthy lifestyles, a recommendation is to conduct a larger study including all aspects of a healthy lifestyle and all, or at least more, relevant aspects of a child’s social environment. Lastly, during the process of this study, there were multiple signals that Covid-19 harmed the social environments and lifestyles of children. The dataset of this research, however, is from before the pandemic, therefore, the quantitative analyses could not test those claims. As the Kindmonitor of 2022 came out in the meantime, it would be good to research the differences between the situation in 2017 and 2022. For example, in terms of how children behave in groups, but also how children spend their leisure time, to investigate potential differences.

Policy advice This thesis also aims to answer the policy question: ‘In which way can policy contribute to a healthy social environment and lifestyle for children aged 4-12 in the Netherlands?’. Hereby, the focus will be on the situation in Alblasserdam which is researched by the interviews with the parents and the experts. Based on these interviews, advice for the municipality of Alblasserdam is to target the social environments of children to try to improve them, as the current study shows that a healthy social environment is also associated with a healthier lifestyle. Additionally, lifestyles are something that is largely practiced at home, and therefore more difficult to change. To improve the social environments of children the focus should be on maintaining the current state of the social environments as well as on improving the social environments of vulnerable children. Hereby, collaborations with organizations such as JOGG that already focus on improving the social environments are valuable to maintain and perhaps even improve the average social environment. For the collaboration with JOGG, it is important to focus on all aspects of the social environment as they are all important, and all aspects approximately have the same amount of room for improvement.

However, to improve the social environment of vulnerable children, the insights and experiences of professionals should be taken into account.

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This study shows that vulnerable children struggle the most regarding leisure activities and contact with peers. For these children, the aspect of leisure entails reduced or lack of access to sports clubs due to lack of money or disorders such as autism which make it impossible to join regular clubs. Hereby, advice is to look into providing fitting exercise opportunities for children with physical or mental limitations, perhaps in collaboration with professionals, and focus on providing children in poverty opportunities to play sports in an organized manner. This will in turn increase opportunities for meeting peers, therefore also tackling this aspect. This advice strongly fits with Alblasserdam’s vision to be ‘Fit and green’, as increased opportunities to play sports for vulnerable groups make society more fit. Furthermore, although most parents are content with the amount of greenery, experts argue for more greenery in Alblasserdam, which also fits the vision of ‘Fit and green’. As there is not much space available, advice would be to look into refurbishing the available space. Hereby, one should think about planting more trees and shrubs instead of grass or pavement. Another possibility is to add more greenery such as trees and shrubs in the area of existing playgrounds to make children’s play more creative and challenging.

This can make Alblasserdam a more green environment and also encourage children to play, thereby increasing the health of children in terms of lifestyle. To conclude, overall the social environments and lifestyles of children in Alblasserdam are relatively healthy, although there is room for improvement. Nevertheless, it is essential to focus on the groups of vulnerable children that cannot join existing programs that aim to improve social environments and lifestyles.

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Appendices Appendix 1. Information letter Informatiebrief voor deelname aan sociaalwetenschappelijk onderzoek Voor: Ouders/verzorgers van kinderen 4, 6, 8, 10 of 12 jaar Betreft: Onderzoek naar de sociale leefomgeving & levensstijl van kinderen (4-12 jaar) Beste meneer/ mevrouw, Inleiding In het kader van het afstuderen voor mijn masteropleiding Sociologie loop ik momenteel stage bij de gemeente Alblasserdam. Als onderdeel van mijn stage schrijf ik mijn scriptie met allereerst als doel om de sociale leefomgeving van kinderen tussen de 4-12 jaar in Alblasserdam en heel Nederland in kaart te brengen. Daarnaast hoop ik de relatie tussen de sociale leefomgeving en een gezonde levensstijl voor kinderen te kunnen onderzoeken. De sociale leefomgeving kan gezien worden als het geheel van onder andere sociale, culturele en economische factoren die invloed hebben op het gedrag van mensen. Hieronder vallen heel veel aspecten, maar in dit onderzoek wordt er gekeken naar de aspecten leeftijdsgenootjes, vrije tijd besteding, sociale media, en de buurt. Op basis van de uitkomsten van mijn onderzoek hoop ik vervolgens beleidsadvies geven aan de gemeente Alblasserdam omtrent wat er gedaan kan worden om de sociale leefomgevingen van kinderen te verbeteren en de levensstijl van deze kinderen gezonder te maken. Via deze brief wil ik u uitnodigen om deel te nemen aan dit onderzoeksproject.

Opzet/ uitvoering van het onderzoek Voor mijn scriptie-onderzoek wil ik graag een aantal ouders van kinderen van 4, 6, 8, 10, en 12 jaar uit Alblasserdam interviewen over de sociale leefomgeving en levensstijl van hun kinderen. Dit zal gaan over een eenmalig interview van ongeveer een uur. Tijdens het interview zal ik een aantal vragen stellen over de volgende thema's: levensstijl, sociale media, leeftijdsgenootjes, buurt, en vrije tijd. Daarnaast zal ik ook wat overkoepelende vragen stellen over de sociale leefomgeving. Wat wordt er van u verwacht U zal eenmalig geïnterviewd worden. In dit interview wordt er enkel van u verwacht dat u de vragen, zover mogelijk, beantwoordt. Er is geen verdere voorbereiding nodig. Verder wil ik het interview graag opnemen, mits u daar toestemming voor geeft. Het doel hiervan is dat ik me tijdens het interview volledig kan richten op de vragen en het gesprek, wat lastig is als ik ook mee moet typen met het interview. Mocht u dit liever niet willen, dan hoeft het echter niet opgenomen te worden. Het interview zal plaatsvinden op een moment dat voor u uitkomt, online of fysiek. Vertrouwelijkheid van de gegevensverwerking Alle informatie die tijdens dit onderzoek wordt verzameld is geheim en zal vertrouwelijk worden behandeld. Alleen de onderzoekers kunnen de uitkomsten zien.

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Vrijwillige deelneming Deelname aan dit onderzoek is vrijwillig. Als u bepaalde vragen niet wilt beantwoorden bent u daar niet toe verplicht. U kunt uw deelname aan het onderzoek ook op elk moment beëindigen, zonder enige uitleg en zonder enige negatieve gevolgen. Als u de deelname beëindigt, zullen we de tot dan toe verzamelde gegevens gebruiken, tenzij u duidelijk aangeeft dat u dat niet wilt. Audio-opnamen In dit onderzoek wordt er, als u hiermee instemt, gebruik gemaakt van audio-opnamen. De opnamen worden gemaakt met een beveiligd opname apparaat. Nadat de audiodata zijn gemaakt worden ze direct op de beveiligde server van de faculteit opgeslagen. Vervolgens zullen de opnamen gelijk getranscribeerd worden, waarna de opnamen verwijderd zullen worden. De transcripten zullen daarnaast volledig anoniem zijn. Contact informatie:  Onderzoekers en contactpersoon Als u vragen of opmerkingen over het onderzoek heeft, kunt u contact opnemen met een van de onderzoekers, maar ook met Mathijs Kros (M.kros@uu.nl)  Klachtenfunctionaris Als u een officiële klacht heeft over het onderzoek, dan kunt u een mail sturen naar de klachtenfunctionaris via klachtenfunctionaris-fetcsocwet@uu.nl  Functionaris Gegevensbescherming: privacy@uu.nl Zie voor verder informatie over uw privacy rechten de informatie in de bijlage.

Mocht u na het lezen van deze informatiebrief besluiten deel te nemen aan het onderzoek, dan wil ik u vriendelijk verzoeken het bijgevoegde toestemmingsformulier te ondertekenen en aan de onderzoeker te overhandigen. Met vriendelijke groet, Jasmijn Koutstaal Jl.koutstaal@alblasserdam.nl Bijlagen: - Toestemmingsformulier

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Appendix 2. Informed consent TOESTEMMINGSFORMULIER Datum onderzoek: februari - juni 2022 Titel onderzoek: Sociale leefomgeving en levensstijl Naam onderzoeker: Jasmijn Koutstaal Hierbij verklaar ik de informatiebrief met betrekking tot onderzoek sociale leefomgeving en levensstijl gelezen te hebben. Ook kon ik vragen stellen. Mijn vragen zijn goed genoeg beantwoord. Ik had genoeg tijd om te beslissen of ik meedoe. Ik stem in met: 1) Deelname aan het onderzoek

ja/nee

2) Het maken van audio-opnamen

ja/nee

Ik weet dat meedoen vrijwillig is. Ook weet ik dat ik op ieder moment kan beslissen om toch niet mee te doen met het onderzoek en kan stoppen. Ik hoef dan niet te zeggen waarom ik wil stoppen. Ondertekening Datum: Handtekening: Naam:

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Appendix 3. Interview questions Interview-vragen sociale leefomgeving en gezonde levensstijl Introductie: - Voorstellen - Doel interview uitleggen - Toestemmingsverklaring bespreken + ondertekenen Achtergrond informatie: Vraag 1. Hoe oud is uw kind? In welke groep zit uw kind? …………………………………………………………………………………………………

Vraag 2. Wat is het geslacht van uw kind? …………………………………………………………………………………………………

Vraag 3. In welke buurt woont u? (evt. plus de wijk) …………………………………………………………………………………………………

Vraag 4. Op welke school zit uw kind? …………………………………………………………………………………………………

Vraag 5. Gaat uw kind naar een vorm van kinderopvang? Zo ja, welke vorm? …………………………………………………………………………………………………

Deelonderwerp 1: Gezonde levensstijl Vraag 1. Wat voor cijfer zou u de levensstijl van uw kind geven (1- heel ongezond, 10- heel gezond)? …………………………………………………………………………………………………