The interplay between air pollution, built environment, and physical activity: perceptions of children and youth in rural and urban India

Abstract

The role of physical inactivity as a contributor to non-communicable diseases (NCDs) risk in children and youth is widely recognized. Air pollution and built environment can limit participation in physical activity and exacerbate NCD risk; however, the relationships between perceptions of air pollution, built environment, and health behaviors are not fully understood, particularly among children and youth in low and middle-income countries. Currently, there are no studies capturing how child and youth perceptions of air pollution and built environment influence physical activity in India, thus, this study investigates the association between perceived air pollution and built environmental factors on moderate-to-vigorous physical activity (MVPA) levels of children and youth in both rural and urban India. Online surveys captured MVPA, perception of air pollution and built environment factors, as well as relevant sociodemographic characteristics from parents and children aged 5 to 17 years in partnership with 41 schools across 28 urban and rural locations during the Coronavirus disease lockdowns in 2021. After adjusting for age, gender, and location, a significant association was found between the perception of air pollution and MVPA levels (β = -18.365, p < 0.001). Similarly, the perception of a high crime rate was associated with lower MVPA levels (β = -23.383, p = 0.002). Reporting the presence of zebra crossings and pedestrian signals or attractive natural sightings was associated with higher MVPA levels; however, this association varied across sociodemographic groups. These findings emphasize the importance of addressing air pollution and improving the built environment to facilitate outdoor active living, including active transportation — solutions that are particularly relevant not only for NCD risk mitigation, but also for climate change adaptation.