Teun Remmers

70 | Chapter 5 understanding the mechanisms that underlie outside play. Based on results from other studies, some variables are of special interest. First, as young children’s exposure to the neighborhood are considered relatively dependent on their parents, factors such as negative parental attitudes, worry or restrictions may attenuate the relationship between the perceived physical environment and outside play (14, 32, 33). Second, factors such as social capital in the neighborhood may strengthen the perceived physical environment – outside play relationship. Neighborhoods with high social capital may be able to reinforce social norms about the plural benefits of PA, and via these social norms – may have increased perceived safety in places where children are likely to regularly participate in outside play (34, 35). In addition, parents experiencing social cohesion may grant their child more autonomy in following up on their needs to play outside. Consequently, the present study addresses the question to what extent the factors of the social environment – expressed as parenting influences and social capital – moderate the relationship between the parent-perceived physical environment and outside play in five and seven year-old children. Methods Study design and participants This study is embedded in the KOALA Birth Cohort Study that follows a group of (originally) 2834 children of healthy pregnant women from the general population who participated in an ongoing prospective cohort study on pregnancy-related pelvic girdle pain. The study addresses two major themes; allergy / asthma, and growth / development. Children are located mainly in the south of the Netherlands, in municipalities of various sizes, including a variety of spatial settings (36). From the total KOALA-cohort ( N =2834), 1875 parents provided information on their child’s outside play around five years, and 1525 reported on their child’s outside play around age seven years. As the perceived physical environment may not be longer valid for the second measurement when participants have moved, we omitted participants’ measurements at follow up when moved home between baseline and follow-up (n=208, 13.6%). Consequently, follow-up of outside play was available for 1317 participants. All parents gave written informed consent. The present study was approved by the Medical Ethics Committee of Maastricht University Medical Center+. Measurements Perceived physical environment Around child age of five years, parents completed a 48 items questionnaire assessing characteristics of the neighborhood environment. Perceived social as well as physical aspects of the environment were assessed through self-completed questionnaires. The construction of the questionnaire was based on the Neighborhood Environment