Teun Remmers

Investigating moderation between determinants of children's outside play | 77 One study specifically reported on the fairly minor influence of the perceived physical environment on outside play, and reported that the social environment overpowered the perceived physical environment in explaining outside play behavior (31). This is, to some extent, in line with the results of our study, which showed that the influence of the attractiveness of the neighborhood was attenuated when adjusted for parenting influences and social capital. In addition, previous research supports our finding that parental attitude is an important predictor of a higher amount of child outside play (33, 49). The evidence for the importance of social capital on child PA and especially outside play is scarce. It however seems plausible that social capital directly influences child outside play via the availability of more social contacts in the neighborhood, and indirectly influences child outside play by decreasing parental worries related to social safety (‘stranger danger’). Parental restriction of screen time was strongly associated with less outside play at age five and seven. This seems in contrast to one previous study that highlighted the importance of parental rules in regulation of outside play (31). However, in the present study these ‘rules’ have a restrictive character, which may be less suitable for promoting outside play than positively formulated, supportive rules. This resembles previous findings from the KOALA study that parental restriction of sedentary activities was related to more sedentary behavior, whereas parental promotion of PA was associated with more activity (42). This is also in line with studies regarding child feeding and snacking behavior, which showed that parental restriction of screen time was related with increased child snack consumption, energy intake and body weight (50, 51). In addition, personal factors such as PA enjoyment or peer support from other children may also exert great influence on child outside play, and perhaps even attenuate our associations of interest (4). Our findings regarding moderation of parenting influences and perceived physical environment in the regulation of outside play behavior are in line with the ecological perspective on energy balance related behaviors (52, 53) and PA specifically (54). However, we only found a limited number of relatively weak interactions. To date, studies on the moderating factors within the perceived physical environment regarding PA remain scarce (14). The few studies investigating these moderating factors are often incorporated within additional analyses of an intervention study, and mainly focused on socio- demographical factors (i.e. gender, age and race) (14, 55), which prohibits a valid comparison of our findings regarding the moderating influences of parenting influences and social capital with other studies. In line with recent advances in the field of parenting influences on child nutrition which reported upon moderations between general parenting style and specific parenting practices (56, 57), future studies are encouraged to focus on moderation among social environmental factors, and between the social and the (perceived) physical environment (14). In addition, attributes of the perceived physical environment may also interact with each other (e.g. relative accessibility of PA places may become less important if they are highly attractive). Based on recent work in the field of moderation of health behaviors, we suggest that social environmental factors (and especially parenting influences) act as a gatekeeper in the exposure of children to the