www.activelivingresearch.org
fax 619-260-1510
San Diego, California 92103 tel 619-260-5534
3900 Fifth Avenue, Suite 310
San Diego State University
James F. Sallis, Ph.D., Director
alr@projects.sdsu.edu
Carmen L. Cutter, MPH, Deputy Director
ccutter@projects.sdsu.edu
Introduction to the Active Living Research Reference List January – July 2008
The following pages are citations of studies of the relationships between the
environment, physical activity, and obesity published during the first half of 2008. We
have organized the publications into 9 categories to make them easier to review. The
categories are:
1.
2.
3.
4.
5.
6.
7.
8.
9.
Built Environment – Child Physical Activity/Obesity,
Built Environment – Adult Physical Activity/Obesity,
Policy – Physical Activity/Obesity,
Social, Cultural & Family Environments – Child Physical Activity/Obesity,
Social, Cultural & Family Environments – Adult Physical Activity/Obesity,
Measurement,
Community Based Interventions – Physical Activity and Obesity,
Childhood Obesity – General
Other
The searches were conducted using several databases and were designed to represent
the multiple disciplines in the active living research field. The number of citations
continues to grow, especially as there is an extraordinary amount of literature on built
environment and policy related to physical activity and obesity. Some citations do not
include a journal issue or page numbers; these are articles that are available online
ahead of print publication.
We have improved upon our search terms and hope that this list is inclusive. Please
send us relevant citations we have missed. Studies that focus on food environments will
be covered by the RWJF Healthy Eating Research program.
We will continue to publish twice yearly literature updates as the literature is expanding
so rapidly. The abstracts for the current 2008 update and the 2004-2007 abstracts can
be found at: http://activelivingresearch.org/resourcesearch/referencelist.
Papers that specifically report environmental correlates of physical activity behavior or
obesity will be included in the online ALR literature database
(http://www.activelivingresearch.org/resourcesearch/literaturedatabase).
If you have questions or comments please contact Chad Spoon at
cspoon@projects.sdsu.edu.
We would like acknowledgement the hard work of Ding Ding (Melody), Dori Rosenberg,
and the Active Living Research staff for searching several databases and compiling the
2008 reference list.
An Active Living program supported by The Robert Wood Johnson Foundation and administered by San Diego State
University.
Active Living Research Literature Summary 2008
Draft Published Nov. 2008
2008 Search Terms
Physical Activity/Obesity terms (abstract only)
non motorized OR NMT OR multimodal
transportation OR active transport* OR driving
OR active living OR inactivity OR inactive OR
fit OR fitness OR body mass index OR BMI OR
car OR cars OR automobile OR leisure OR
television OR TV OR obese OR obesity OR
weight OR overweight OR journey OR travel*
OR walk OR walking OR cycle OR cycling OR
bike OR bikers OR biking OR bicycle OR
bicycling OR sedentary OR commuter* OR
commuting OR exercise OR exercising OR
exerciser* OR physical activity OR physically
active OR play OR playground* OR playing OR
vehicle OR obesogenic
Environment terms (title or abstract)
environment OR environments OR environmental
OR sprawl OR neighbourhood* OR neighborhood*
OR recreation* OR metropolitan OR rural OR urban*
OR pedestrian OR pedestrians OR equipment OR
geograph* OR aesthet* OR convenient OR
convenience OR urban form OR destination* OR trail
OR trails OR park OR parks OR path OR paths OR
distance* OR density OR access* OR planning OR
location* OR feature* OR polic* OR facility OR
facilities OR crime OR architecture OR building* OR
transit OR street* OR stair* OR playground OR
playgrounds OR urban design OR neighborhood
development OR neighbourhood development OR
smart growth OR outdoor OR indoor OR connectivity
OR new urbanism OR healthy places OR healthy
communities OR greenway OR greenways OR railtrail OR home OR school OR schools OR land use
OR safe OR safety OR route OR routes OR
workplace OR community OR communities OR
attractive* OR green space* OR public space* OR
open space* OR place OR places OR site OR sites
OR siting OR greenery OR amenity OR amenities
OR attribute* OR walkable OR walkability OR
residential OR residence OR sidewalks OR
availability
Databases used in the literature searches included Pub Med, ISI Web of Science, Leisure and
Recreation Journals and other non-indexed journals.
For more specific information please contact Chad Spoon at cspoon@projects.sdsu.edu.
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Active Living Research Literature Summary 2008
Draft Published Nov. 2008
Journal Counts:
These may indicate journals more interested in built environment research where
you could send your manuscripts. Note that only journals with more than one
count were included.
Acta Paediatrica- 3
American Journal of Epidemiology- 3
American Journal of Health Promotion- 9
American Journal of Preventive Medicine- 28
Annals of Behavioral Medicine- 2
Applied Physiology Nutrition and Metabolism- 4
Archives of Diseases in Childhood- 5
Archives of Pediatrics and Adolescent Medicine- 3
BMC Public Health- 10
British Journal of Sports Medicine- 2
Canadian Journal of Public Health- 2
Child Care and Health Development- 4
Contemporary Clinical Trials- 2
East Mediterranean Health Journal- 2
Eating Behaviors- 2
Environment and Planning B- 3
Ethnicity and Disease- 2
European Journal of Clinical Nutrition- 2
Health and Place- 6
Health Education and Behavior- 2
Health Education Research- 6
Health Psychology- 2
IDEA Fitness Journal- 2
International Journal of Behavioral Nutrition and Physical Activity- 14
International Journal of Obesity- 5
International Journal of Pediatric Obesity- 8
The Journal of Physical Education, Recreation & Dance- 4
Journal of Adolescent Health- 6
Journal of American Dietetics Association- 6
Journal of Community Health - 2
Journal of Education Behavior-2
Journal of Epidemiology and Community Health- 6
Journal of Health Politics, Policy and Law- 6
Journal of Nutrition Education and Behavior- 4
Journal of Pediatrics and Child Health-2
Journal of Physical Activity and Health- 23
Journal of Public Health- 2
Journal of Public Health Management and Practice- 4
Journal of Rural Health- 3
Journal of School Health- 5
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Active Living Research Literature Summary 2008
Draft Published Nov. 2008
Journal of School Nursing- 2
Journal of Teaching in Physical Education- 3
Journal of Urban Health- 2
Leisure Sciences- 3
Medicine and Science in Sports and Exercise- 8
Nutrition Reviews-2
Obesity- 13
Obesity Reviews- 12
Pediatric Exercise Science- 3
Physiology & Behavior- 3
Preventing Chronic Disease- 5
Preventive Medicine- 17
Public Health- 3
Public Health Nutrition- 4
Research Quarterly For Exercise and Sport- 5
Rural and Remote Health- 2
Social Science and Medicine- 2
Transport Reviews- 2
Transportation- 4
Transportation Research- 4
Urban Studies- 2
4
Active Living Research Literature Summary 2008
Draft Published Nov. 2008
BUILT ENVIORNMENT -- CHILD PHYSICAL ACTIVITY/OBESITY
(2008). Examining Active Commuting to School. JOPERD: The Journal of Physical
Education, Recreation & Dance. 79, 4.
The article offers information on two studies in 2007 with regards to the status of active
commuting, such as by walking or by means of bicycles, to school. The first study,
published in the August 2007 American Journal of Preventive Medicine, surveys a
national sample of 7, 433 children, ages nine to 15 years in 2007, where in the result
showed that 47.9 percent of the 35 percent living within a mile of school actively
commutes at least one day per week. The second study, reported at the 54th Annual
Meeting of the American College of Sports Medicine, reveals that a study in Georgia
indicates that substantial physical barriers may inhibit students from walking to school.
(2008). Have playgrounds become boring? JOPERD: The Journal of Physical Education,
Recreation & Dance. 79, 11.
The article offers the contentions of various sports authorities which underscore the
steady decline in children's participation on play structures. One of them said that the
Consumer Product Safety Commission, as well as the American Society for Testing and
Materials, have put forward the standard of care within the playground field. One of them
said that playgrounds built after the 1980s are relatively safer as compared to those built
earlier. Another said that playgrounds still serve their purposes in child development.
K. N. Ahlport, L. Linnan, A. Vaughn, K. R. Evenson and D. S. Ward. (2008). Barriers to
and Facilitators of Walking and Bicycling to School: Formative Results From the NonMotorized Travel Study. Health Education & Behavior. 35, 221.
Barriers to and facilitators of walking and bicycling to school were explored through 12
focus groups made up of fourth- and fifth-grade students and their parents who lived near
their respective schools. The barriers and facilitators reported by parents and children
generally fell into one of three categories: intrapersonal and interpersonal characteristics
of parents and children, environmental characteristics of the neighborhood, and
environmental and policy characteristics of the school. Findings indicate that a supportive
environment is a necessary but insufficient condition to increase walking and biking to
school. Initiatives to increase active school travel may need to include multiple levels of
intervention to be effective.
M. Alm, N. Soroudi, J. Wylie-Rosett, C. R. Isasi, S. Suchday, J. Rieder and U. Khan.
(2008). A qualitative assessment of barriers and facilitators to achieving behavior goals
among obese inner-city adolescents in a weight management program. Diabetes
Educator. 34, 277-284.
Purpose The purpose of this study was (1) to examine the reasons for managing weight,
(2) to investigate the barriers and facilitators to achieving behavior goals, and (3) to
assess how a behavior coach affects the goal-setting process of obese inner-city
adolescents in a weight management program. Methods Obese adolescents participating
in a pilot study assessing the role of a behavior coach on successful weight management
(n = 18) were interviewed to identify barriers and facilitators to reaching behavior goals.
Data were analyzed using descriptive statistics and the constant comparative method of
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Active Living Research Literature Summary 2008
Draft Published Nov. 2008
qualitative analysis. Results In the rationale for weight control, adolescent girls and boys
reported a desire to improve physical appearance and physical conditioning, respectively.
Barriers to reaching physical activity goals among girls included unsafe neighborhoods
and a negative body image. Maintaining unrealistic behavior and weight goals hindered
satisfaction with behavior change and weight loss (in both genders. Overall, coaching
provided support that helped the obese teens feel more successful in the goal-setting
process and address issues related to their disruptive environments. Conclusions Diabetes
educators can include a behavior coach as part of a weight management program to help
teens set behavior goals and overcome barriers to reaching behavior goals.
S. H. Babey, T. A. Hastert, H. J. Yu and E. R. Brown. (2008). Physical activity among
adolescents - When do parks matter? American Journal Of Preventive Medicine. 34, 345348.
Background: The availability of places to engage in physical activity may influence
physical activity levels. This study examined whether the relationship between physical
activity and access to parks differs depending on adolescents' sociodemographic,
housing, and neighborhood characteristics. Methods: Data were analyzed from 4010
adolescents who responded to the 2003 California Health Inter-view Survey (CHIS).
Analyses were conducted in 2005-2006. Five sets of logistic regressions were conducted
to examine the relationship between physical activity and access to a safe park among
adolescents living in (1) urban versus rural areas; (2) apartment buildings versus houses,
(3) neighborhoods perceived as unsafe versus safe; (4) lower-versus higher-income
families; and (5) adolescents who were Latino, African American, Asian, or white.
Analyses also examined interactions between park access and these factors. Results:
Access to a safe park was positively associated with regular physical activity and
negatively associated with inactivity for adolescents in urban areas, but not rural areas.
Additionally, adolescents with access to a safe park were less likely to be inactive than
those without access among those living in (1) apartment buildings, (2) unsafe
neighborhoods, and (3) lower-income families. Park access was not associated with
regular physical activity for these groups. The association between park access and
physical activity varied by race/ethnicity. Conclusions: These findings suggest that the
relationship between physical activity and access to parks differs depending on
adolescents' sociodemographic, housing, and neighborhood characteristics, and that parks
may be particularly important for promoting physical activity among urban adolescents.
H. Baslington. (2008). School travel plans: Overcoming barriers to implementation.
Transport Reviews. 28, 239-258.
The number of primary school children travelling to school by car has almost doubled in
20 years. A governmental policy response is to introduce school travel plans. The paper
raises and discusses important issues identified during a literature review, documentary
analysis, and an empirical evaluation of school travel plans. These are: (1) barriers to
their implementation, extensiveness and longevity, and (2) the behavioural approach
which underpins school travel plan promotional literature. A comparative methods design
was used for the empirical evaluation that measured the effectiveness of the travel
initiatives operating at three schools. Quantitative and qualitative data were collected
using questionnaires and travel diaries (n = 555, ages 7-11 years) and interviews (22
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Active Living Research Literature Summary 2008
Draft Published Nov. 2008
parents, four key persons). The output measures were: 'levels of walking to and from
school' and 'awareness and attitudes' towards initiatives. In one of the schools a Walking
Bus scheme operated successfully. The findings from the research form the backdrop for
a discussion of potential measures to overcome the social, geographic, and financial
restrictions imposed on some schools. A recommendation is made regarding data
collection and the analysis of evaluation data. The general conclusion from the review is
that a wide variation in the effectiveness of travel initiatives can be expected.
M. W. Beets and J. T. Foley. (2008). Association of Father Involvement and
Neighborhood Quality with Kindergartners' Physical Activity: A Multilevel Structural
Equation Model. American Journal of Health Promotion. 22, 195.
Purpose. Examine the effects of father-child involvement and neighborhood
characteristics with young children's physical activity (PA) within a multilevel
framework. Design. Cross-sectional analysis of the Early Childhood Longitudinal
Study—Kindergarten Cohort 1998. Setting. Nationally representative sample. Subjects.
Data were available for 10,694 kindergartners (5-6 years; 5240 girls) living in 1053
neighborhoods. Measures. Parental report of child's PA level, father characteristics (e.g.,
time spent with child, age, education, socioeconomic status, hours worked), family time
spent doing sports/activities together, and neighborhood quality (e.g., safety, presence of
crime violence, garbage). Child weight status, motor skills, ethnicity, and television
viewing were used as covariates. Analysis. Multilevel structural equation modeling with
children nested within neighborhoods. Results. At the child level father-child time and
family time doing sports together were positively associated with children's PA. At the
neighborhood level parental perception of a neighborhood's safety for children to play
outside fully mediated the effect of neighborhood quality on children's PA. Overall
19.1% and 7.6% of the variance in PA was explained at the child and neighborhood
levels, respectively. Conclusions. Family-based interventions for PA should consider
father-child time, with this contributing to a child's overall PA level. Further,
neighborhood quality is an important predictor of PA only to the extent by which parents
perceive it to be unsafe for their child to play outdoors.
A. Beighle, B. Alderman, C. Morgan and G. L. Masurier. (2008). Seasonality in
children's pedometer-measured physical activity levels. Res Q Exerc Sport. 79, 256-260.
J. K. Bower, D. P. Hales, D. F. Tate, D. A. Rubin, S. E. Benjamin and D. S. Ward.
(2008). The childcare environment and children's physical activity. American Journal Of
Preventive Medicine. 34, 23-29.
Background: With increased numbers of children attending child care, this setting
presents an ideal opportunity to promote physical activity and the early development of
healthy behaviors. The purpose of this study was to examine the relationships between
the childcare environment and physical activity behavior of preschool children. Methods:
Aspects of the environment hypothesized to influence children's physical activity were
assessed in 20 childcare centers using the Environment and Policy Assessment and
Observation (EPAO) instrument. Physical activity behavior was assessed over 2 days
using direct observation. Results: Children in centers with supportive environments
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Active Living Research Literature Summary 2008
Draft Published Nov. 2008
achieved more moderate-to-vigorous physical activity (15% of observations vs 9%; effect
size [ESJ=1.17), spent less time in sedentary activities (50% vs 61%; ES=-1.52), and had
higher mean physical activity levels (2.68 vs 2.43; ES=1.41) compared to centers with
less supportive environments. Facets of the physical and social environment related to
physical activity behavior included active opportunities, portable play equipment, fixed
play equipment, sedentary environment, and physical activity training and education.
Conclusions: Previous research indicates that the childcare center that children attend
significantly affects physical activity behavior. The current findings extend this evidence
by identifying aspects of the childcare environment that relate to the physical activity
behavior of children. These factors should be considered when identifying determinants
of physical activity and designing interventions.
B. Bringolf-Isler, L. Grize, U. Mader, N. Ruch, F. H. Sennhauser and C. BraunFahrlander. (2008). Personal and environmental factors associated with active commuting
to school in Switzerland. Preventive Medicine. 46, 67-73.
Objective. To assess whether prevalence of active commuting and regular car trips to
school varies across communities and language regions in Switzerland and to determine
personal and environmental correlates. Methods. During the school year 2004/2005, 1345
parental questionnaires (response rate 65%) of children attending 1st, 4th and 8th grades
were completed, 1031 could be linked to a GIS environmental database. A Germanspeaking, a French-speaking and a bilingual study area were included. Usual mode of
transportation and frequency of regular car trips to school were assessed. Associations
with personal and environmental factors were evaluated with multivariate regression
models. Results. Seventy-eight percent of the children actively traveled to school. Twelve
percent were regularly driven at least once a week by car. Major road crossings and
distance were significantly related to usual mode of transportation, but not to regular car
trips. Age, daycare attendance, parental safety concerns, number of cars in the household
and belonging to French-speaking population were significantly associated with
increased regular car trips. Conclusion. Objective predictors are main deciding factors for
active commuting to school as main mode of transport whereas personal and lifestyle
factors are important factors associated with frequency of car use. Not only objective but
also differing cultural attitudes should be considered when promoting non-motorized
travel.
K. Butcher, J. F. Sallis, J. A. Mayer and S. Woodruff. (2008). Correlates of physical
activity guideline compliance for adolescents in 100 US cities. Journal Of Adolescent
Health. 42, 360-368.
Purpose: This study assessed the rates and correlates of adolescents' compliance with
national guidelines for physical activity. Methods: A cross-sectional phone survey of
adolescents and their parents was conducted in the 100 largest cities in the United States
in 2005. Adolescents ages 14-17 years (n = 6125) were asked how many days during the
previous week and during a typical week they were physically active for at least 60
minutes. Compliance was defined as 5 + days per week. Parents provided data on teen's
age and race/ethnicity, parental education level, annual household income, and region of
residence. Associations among these variables and compliance with physical activity
guidelines were examined. Results: Approximately 40% of the females and 57% of the
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Active Living Research Literature Summary 2008
Draft Published Nov. 2008
males complied with the national physical activity guidelines. Logistic regression
indicated that for both genders, compliance was significantly associated with having
higher household income and that, for females only, compliance declined significantly
with age. Region of residence did not predict compliance for either gender. Conclusion:
A majority of the girls and a large portion of the boys failed to meet the current
guidelines, thereby increasing their risks of multiple health problems. Targeting
intervention resources for low income teens and older adolescent teen girls is
recommended.
G. Cardon, E. Van Cauwenberghe, V. Labarque, L. Haerens and I. De Bourdeaudhuij.
(2008). The contribution of preschool playground factors in explaining children's
physical activity during recess. International Journal Of Behavioral Nutrition And
Physical Activity. 5,
Background: Low levels of physical activity are characteristic in preschoolers. To
effectively promote physical activity, it is necessary to understand factors that influence
young children's physical activity. The present study aimed to investigate how physical
activity levels are influenced by environmental factors during recess in preschool.
Methods: Preschool playground observations and pedometry during recess were carried
out in 39 randomly selected preschools (415 boys and 368 girls; 5.3 +/- 0.4 years old). In
order to examine the contribution of playground variables to physical activity levels,
taking adjustment for clustering of subjects within preschools into account, multilevel
analyses were conducted. Results: During recess boys took significantly more steps per
minute than girls (65 +/- 36 versus 54 +/- 28 steps/ min). In both genders higher step
counts per minute were significantly associated with less children per m(2) and with
shorter recess times. Only in boys a hard playground surface was a borderline significant
predictor for higher physical activity levels. In girls higher step counts were associated
with the presence of less supervising teachers. Playground markings, access to toys, the
number of playing or aiming equipment pieces and the presence of vegetation or height
differences were not significant physical activity predictors in both genders. Conclusion:
In preschool children physical activity during outdoor play is associated with modifiable
playground factors. Further study is recommended to evaluate if the provision of more
play space, the promotion of continued activity by supervisors and the modification of
playground characteristics can increase physical activity levels in preschoolers.
A. Carver, A. Timperio and D. Crawford. (2008). Playing it safe: The influence of
neighbourhood safety on children's physical activity - A review. Health & Place. 14, 217227.
Compared with previous generations, children spend less time playing outdoors and have
lower participation rates in active transport. Many studies have identified lack of
neighbourhood safety as a potential barrier to children's physical activity. This review
describes concerns regarding 'stranger danger' and road safety, and discusses empirical
studies that examine associations between neighbourhood safety and physical activity
among youth. Variability of perceptions of safety between parents and youth are
examined; 'social traps' are identified; and physical/social environmental interventions
aimed at improving neighbourhood safety are discussed. A research agenda is suggested
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Active Living Research Literature Summary 2008
Draft Published Nov. 2008
for further study of perceived and objective measures of neighbourhood safety and their
associations with children's physical activity.
A. Carver, A. Timperio and D. Crawford. (2008). Perceptions of Neighborhood Safety
and Physical Activity Among Youth: The CLAN Study. Journal of Physical Activity &
Health. 5, 430.
Background: The purpose of this study was to examine associations between perceptions
of neighborhood safety and physical activity among youth. Methods: We completed a
cross-sectional study of children age 8 to 9 years (n = 188) and adolescents age 13 to 15
years (n = 346) in areas of varying socioeconomic status in Melbourne, Australia. Parents
and adolescents completed questionnaires on perceptions of neighborhood safety. Scores
were computed for perceptions of road safety, incivilities, and personal safety of the child
or adolescent. Moderate-to-vigorous physical activity (MVPA) before or after school, on
evenings, and on weekends was recorded using accelerometers. Results: There were no
associations between parental perceptions of neighborhood safety and children's MVPA
outside school hours. Parental perception of personal safety was positively associated
with adolescent boys' MVPA after school. Adolescent girls' concern about road safety
was negatively associated with their MVPA during evenings and outside school hours.
Conclusion: Perceptions of neighborhood safety might influence physical activity among
youth in different ways according to age group and sex.
A. Carver, A. F. Timperio and D. A. Crawford. (2008). Neighborhood road environments
and physical activity among youth: The CLAN study. Journal Of Urban Health-Bulletin
Of The New York Academy Of Medicine. 85, 532-544.
We examined associations between objective measures of the local road environment and
physical activity (including active transport) among youth. There is little empirical
evidence of the impact of the road environment on physical activity among
children/adolescents in their neighborhoods. Most recent studies have examined
perceptions rather than objective measures of the road environment. This was a crosssectional study of children aged 8-9 years (n=188) and adolescents aged 13-15 years
(n=346) who were participants in the 3-year follow-up of the Children Living in Active
Neighborhoods (CLAN) longitudinal study in Melbourne, Australia. At baseline (2001),
they were recruited from 19 state primary schools in areas of varying socioeconomic
status across Melbourne. Habitual walking/cycling to local destinations was parentreported for children and self-reported for adolescents, while moderate-to-vigorous
physical activity (MVPA) outside school hours was recorded using accelerometers. Road
environment features in each participant's neighborhood (area of radius 800 m around the
home) were measured objectively using a geographical information system. Regression
analyses found no associations between road environment variables and children's
likelihood of making at least seven walking/cycling trips per week to neighborhood
destinations. Adolescent girls residing in neighborhoods with two to three
traffic/pedestrian lights were more likely to make seven or more walking/cycling trips per
week as those whose neighborhoods had fewer traffic lights (OR: 2.7; 95% CI: 1.2-6.2).
For adolescent boys, residing on a cul-de-sac, compared with a through road, was
associated with increases in MVPA of 9 min after school, 5 min in the evenings, and 22
min on weekend days. Speed humps were positively associated with adolescent boys'
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Active Living Research Literature Summary 2008
Draft Published Nov. 2008
MVPA during evenings. The road environment influences physical activity among youth
in different ways, according to age group, sex and type of physical activity.
J. L. Chen, V. Unnithan, C. Kennedy and C. H. Yeh. (2008). Correlates of physical
fitness and activity in Taiwanese children. International Nursing Review. 55, 81-88.
Aim: This cross-sectional study examined factors related to children's physical fitness
and activity levels in Taiwan. Methods: A total of 331 Taiwanese children, aged 7 and 8,
and their mothers participated in the study. Children performed physical fitness tests,
recorded their physical activities during two weekdays and completed self-esteem
questionnaires. Research assistants measured the children's body mass and stature.
Mothers completed demographic, parenting style and physical activity questionnaires.
Results: Attending urban school, lower body mass index (BMI), older age and better
muscular endurance contributed to the variance in better aerobic capacity, and attending
rural school and better aerobic capacity contributed to the variance in better muscular
endurance in boys. Attending urban school, lower BMI and better athletic competence
contributed to the variance in better aerobic capacity, and younger age, rural school and
higher household income contributed to the variance in better flexibility in girls.
Conclusion: Despite the limitations of the study, with many countries and regions,
including Taiwan, now emphasizing the importance of improving physical fitness and
activity in children, an intervention that is gender-, geographically, and developmentally
appropriate can improve the likelihood of successful physical fitness and activity
programmes.
D. Cohen, M. Scott, F. Z. Wang, T. L. McKenzie and D. Porter. (2008). School design
and physical activity among middle school girls. Journal of Physical Activity and Health.
5, 719-731.
D. Crawford, A. Timperio, K. Campbell, C. Hume, M. Jackson, A. Carver, K. Hesketh,
K. Ball and J. Salmon. (2008). Parent's views of the importance of making changes in
settings where children spend time to prevent obesity. Asia Pacific Journal Of Clinical
Nutrition. 17, 148-158.
Aim: To examine the kinds of changes parents would like to see in those settings where
children spend time (kindergartens and schools, child care centres and after-school care
facilities, and the local neighbourhood) in policies and practices that impact on children's
risk of obesity, and to establish whether parents might be willing to advocate for changes
in these settings. Materials and Methods: 175 parents from five randomly selected
primary schools and five randomly selected kindergartens located in suburbs of
metropolitan Melbourne completed a questionnaire in which they rated the importance of
a number of potential changes to promote healthy eating and increase physical activity in
their children. Results: Parents of children in kindergarten most commonly rated changes
to the eating environment as important. In contrast, parents of primary school children
believed changes related to both eating and physical activity in school were important.
Ninety-five per cent of parents of kindergarten children and 89% of parents of primary
school children believed it was possible for parents to bring about change to provide
more opportunities for their child to eat more healthily and be more physically active.
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One in four parents reported that they had thought about or had tried to bring about
changes in their community. Conclusions: The findings suggest that mobilising parents to
take an active role in advocating for change in those settings that have the potential to
shape their children's physical activity and eating behaviours may be feasible.
A. M. Davis, R. E. Boles, R. L. James, D. K. Sullivan, J. E. Donnelly, D. L. Swirczynski
and J. Goetz. (2008). Health behaviors and weight status among urban and rural children.
Rural Remote Health. 8, 810.
INTRODUCTION: Pediatric overweight is currently reaching epidemic proportions but
little information exists on differences in weight related behaviors between urban and
rural children. OBJECTIVE: To assess health behaviors and weight status among urban
and rural school-age children. METHODS: Fifth-grade children at two urban and two
rural schools were invited to participate in an assessment study of their health behaviors
and weight status. A total of 138 children (mean age = 10 years; % female = 54.6) chose
to participate. RESULTS: Children in rural and urban areas consumed equivalent calories
per day and calories from fat, but rural children ate more junk food and urban children
were more likely to skip breakfast. Urban children engaged in more metabolic equivalent
tasks and had slightly higher total sedentary activity than rural children. The BMI
percentile was equivalent across rural and urban children but rural children were more
often overweight and urban children were more often at risk for overweight.
CONCLUSIONS: Although some variables were equivalent across urban and rural
children, results indicate some key health behavior differences between groups. Results
should be interpreted with caution as the sample size was small and there were
demographic differences between urban and rural samples.
J. Duncan, W. Hopkins, G. Schofield and E. Duncan. (2008). Effects of weather on
pedometer-determined physical activity in children. Med Sci Sports Exerc. 40, 14321438.
The effects of weather conditions on children's physical activity have not been
well described. PURPOSE: To evaluate the effects of meteorological variables on
the number of pedometer steps accumulated by children. METHODS: Between August
and December 2004 (winter to summer), 1115 Auckland children (536 boys, 579
girls; aged 5-12 yr) from 27 socioeconomically and ethnically diverse schools
wore sealed multiday memory pedometers for five consecutive days (three weekdays
and two weekend days). Values of daily (7 a.m. to 7 p.m.) mean ambient
temperature, mean wind speed, precipitation, and duration of bright sunshine were
obtained from local meteorological stations. The independent effects of each of
these variables on step counts were estimated using composite mixed linear
models. Effects were standardized for interpretation of magnitudes. RESULTS:
Weekday and weekend-day step counts for boys were 16,100 +/- 5000 and 12,900+/5900 (mean +/- SD), whereas those for girls were 14,200 +/- 4200 and 11,300 +/4800. A 10 degrees C rise in mean ambient temperature was associated with a small
increase in weekday steps [1700; 90% confidence intervals (CI) +/-1300] and a
moderate increase in weekend-day steps (3400; 90% CI +/-1500) for boys, whereas
for girls the effects were small (2300; 90% CI +/-1000) and unclear (-300; 90% CI
+/-1200), respectively. There were substantial decreases in weekday and
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weekend-day steps during moderate rainfall (1.1-4.9 mm) for both sexes. Most
effects of day length, wind speed, and hours of bright sunshine on step counts
were trivial or unclear. CONCLUSIONS: Ambient temperature and rainfall have
substantial effects on children's daily step counts and should therefore be
considered when comparing physical activity across different locations or
periods. Strategies to increase activity on cold or rainy days may also be
appropriate.
J. Dwyer, L. Needham, J. R. Simpson and E. S. Heeney. (2008). Parents report
intrapersonal, interpersonal, and environmental barriers to supporting healthy eating and
physical activity among their preschoolers. Applied Physiology, Nutrition & Metabolism.
33, 338.
There is an increasing trend in childhood obesity in Canada and many preschool children
are overweight or obese. The objective of this study was to explore parents’ experiences
and challenges in supporting healthy eating and physical activity among their preschool
children. A qualitative descriptive study involving 5 focus groups was conducted. A
convenience sample of 39 parents from 3 childcare centres in Hamilton, Ontario,
participated. Parents were English speaking and had a child aged 2-5 years attending the
childcare centre for at least 3 months. The research team read transcripts of the audiotaped sessions and used a constant comparison approach to develop themes, which
involved coding comments by continually referring to previously coded comments for
comparison. The social ecological model was used to organize the themes into 3 higherlevel categories: (i) intrapersonal (individual): preschoolers’ preferences and health; (ii)
interpersonal (interactions): parents’ and others’ different views and practices, influence
of the childcare centre, parents’ lack of time, and family structure; and (iii) physical
environment: accessibility of healthy foods, preschoolers with special needs, media
influence, weather, lack of safety, and inaccessible resources. Parents perceived that there
are various intrapersonal, interpersonal, and environmental barriers to supporting healthy
eating and physical activity among their children. Program planners and health
professionals can consider these barriers when developing interventions to promote
healthy bodyweights among preschoolers
T. A. Farley, R. A. Meriwether, E. T. Baker, J. C. Rice and L. S. Webber. (2008). Where
Do the Children Play? The Influence of Playground Equipment on Physical Activity of
Children in Free Play. Journal of Physical Activity & Health. 5, 319.
Background: Promotion of physical activity in children depends on an understanding of
how children use play equipment. Methods: We conducted observations over 2 years of
children in 2nd through 8th grades in a schoolyard with 5 distinct play areas with
different amounts of play equipment. Results: Children were more likely to play in areas
with more installed play equipment, with densities of children in equipped areas 3.3 to
12.6 times higher than in an open grassy field. There were no significant differences by
play area in the percent of children who were physically active at all, but children were
more likely to be very active in areas with basketball goals and an installed play structure
than in an open field. Conclusions: Playground equipment appeared to have a strong
influence on where children played and a moderate influence on levels of activity. To
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maximize physical activity in children, playgrounds should be designed with ample and
diverse play equipment.
H. Forman, J. Kerr, G. J. Norman, B. E. Saelens, N. H. Durant, S. K. Harris and J. F.
Sallis. (2008). Reliability and validity of destination-specific barriers to walking and
cycling for youth. Preventive Medicine. 46, 311-316.
Objective. To investigate the psychometric properties of a new measure of barriers youth
encounter while walking to specific destinations and to validate the measure with selfreported walking to these destinations. Methods. In 2005 in Boston, Cincinnati and San
Diego, parents of youth (n = 289, aged 5-18) and adolescents (n = 189, aged 12-18)
completed surveys in a two-week test-retest study design. Seventeen items assessed
participant agreement with the influence of different barriers to walking or cycling to
three types of destinations: l) parks, 2) shops and restaurants and 3) school. Participants
also reported whether or not they walked or cycled to the destinations at least once a
week. Results. Principal components analysis identified three barrier subscales labeled
'environmental', 'psychosocial/planning', and 'safety', which were consistent across the
three destinations and two respondent groups. Internal consistency for the subscales was
good (alphas >.70) and two-week test-retest reliability was moderately high (ICCs.56.81) for both parents and adolescents for all destinations. Psychosocial and environmental
barriers were higher in adolescents who did not walk (p <.003). Parents of younger
children reported high environmental barriers. Conclusion. The three barrier subscales to
active commuting to multiple destinations demonstrated good reliability and some initial
evidence of validity.
S. A. Ham, S. Martin and I. I. I. H. W. Kohl. (2008). Changes in the Percentage of
Students Who Walk or Bike to School--United States, 1969 and 2001. Journal of Physical
Activity & Health. 5, 205.
Background: This report describes changes in the percentage of US students (age 5 to 18
years) who walked or bicycled to school and in the distance that they lived from or
traveled to their school in 1969 and 2001 and travel patterns in 2001. Methods: Data were
from the 1969 National Personal Transportation Survey report on school travel and the
2001 National Household Transportation Survey. Results: A smaller percentage of
students lived within 1 mile of school in 2001 than in 1969. The percentage of students
who walked or biked any distance decreased from 42.0% to 16.2%. Nearly half of
students used more than 1 travel mode or went to an additional destination en route
between home and school in 2001. Conclusion: Multidisciplinary efforts are needed to
increase the percentage of students who walk or bike to school, as well as decrease the
distances that students travel.
N. Harten, T. Olds and J. Dollman. (2008). The effects of gender, motor skills and play
area on the free play activities of 8-11 year old school children. Health Place. 14, 386-93.
Two studies were conducted to examine the interactions between gender, play area,
motor skills and free play activity in 8-11 year old school children. In both studies, boys
were more active than girls. In boys, but not in girls, energy expenditure was greater for
high-skill than for low-skill children (p = 0.0002), and increased as play area increased (p
= 0.01). These results suggest that motor skills and play space are important variables in
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determining the free play activity of boys, but not of girls. This may be related to widely
different play styles among boys and girls.
T. Hinkley, D. Crawford, J. Salmon, A. D. Okely and K. Hesketh. (2008). Preschool
children and physical activity - A review of correlates. American Journal Of Preventive
Medicine. 34, 435-441.
Background: Several reviews have summarized the research on correlates of older
children's and adolescents' physical activity behaviors, but none have been published on
preschool children. Over the past 27 years, a number of studies have investigated the
correlates of preschool children's physical activity behaviors. It is timely and necessary to
review the extant literature in this area. This paper reviews articles investigating
correlates of preschool children's physical activity behaviors published in peer-reviewed
journals between 1980 and March 2007. Methods: A literature search was conducted to
identify studies that investigated correlates of preschool children's physical activity. Data
were collected and analyzed in 2007. Results: Twenty-four articles were identified that
met the inclusion criteria. From those articles, 39 variables were identified across five
domains. Results showed that boys were more active than girls, that children with active
parents tended to be more active, and that children who spent more time outdoors were
more active than children who spent less time outdoors. Age and BMI were consistently
shown to have no association with preschool children's physical activity. Other variables
produced largely inconclusive results. Conclusions: The influences on the physical
activity behaviors of preschool children are multidimensional. Further research is
required to enhance an understanding of these influences.
N. L. Holt, J. C. Spence, Z. L. Sehn and N. Cutumisu. (2008). Neighborhood and
developmental differences in children's perceptions of opportunities for play and physical
activity. Health & Place. 14, 2-14.
The purposes of this study were to examine perceptions of places to play and be
physically active among children from two different urban neighborhoods, and evaluate
these perceptions for age-related developmental differences. One hundred and sixty-eight
children from grades K-6 (aged 6-12 years old) completed mental maps depicting places
where they could play and be physically active. The children were recruited from schools
in two neighborhoods-one a highwalkability (H-W) grid-style neighborhood, the other a
low-walkability (L-W) lollipop-style (i.e., cul-de-sacs) neighborhood. Analysis revealed
that children in the H-W neighborhood depicted more active transportation and less nonactive transportation than children in the L-W neighborhood. Children in the lowest
grades (K-2) in the L-W neighborhood depicted more play in the home/yard environment
than the oldest children, more good weather image events than children in Grades 3-6,
and less play outside the home/yard environment than children in Grades 3 and 4. In the
H-W neighborhood, the youngest children (K-2) depicted significantly less play in the
home/yard environment and less play outside the home/yard environment than older
children (Grades 3-6). Thus, both the type of urban neighborhood and children's age
moderated perceptions of places to play and be physically active.
M. L. Humbert, K. E. Chad, M. W. Bruner, K. S. Spink, N. Muhajarine, K. D. Anderson,
T. M. Girolami, P. Odnokon and C. R. Gryba. (2008). Using a Naturalistic Ecological
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Approach to Examine the Factors Influencing Youth Physical Activity Across Grades 7
to 12. Health Education & Behavior. 35, 158.
High levels of inactivity in youth have led researchers and practitioners to focus on
identifying the factors that influence physical activity behaviors in young people. The
present study employed a qualitative ecological framework to examine the intrapersonal,
social, and environmental factors influencing youth physical activity. In grade-specific
focus group settings, 160 youth in grades 7 through 12 (aged 12 to 18) were asked how
they would increase the physical activity levels of youth their age. Participants identified
eight factors that they felt should be addressed in programs and interventions designed to
increase the physical activity behaviors of youth. These factors included the importance
of fun, having the time to be physically active, the benefits of activity, being active with
friends, the role of adults, and the importance of being able to access facilities in their
neighborhood.
S. U. Jensen. (2008). How to obtain a healthy journey to school. Transportation Research
Part A-Policy And Practice. 42, 475-486.
Danish children walk and cycle a lot and at the same time have one of the best child road
safety records in the western part of world. Based on several studies, the paper describes
how Denmark has obtained a good child road safety and why Danish children choose to
walk and cycle. Child road safety has predominantly been improved due to higher seat
belt use and many implemented local safety measures such as campaigns and physical
safe routes to school projects. It is mostly safe routes to school projects that include speed
reducing measures and signalisation of junctions that are successful. The distance from
home to school is an important factor in children's transport mode choice. Since about
half of Danish children have less than 1.5 km to school the decentralised school structure
with many fairly small schools is an important reason to the many walking and bicycle
journeys. Road design and motorised traffic volumes do influence children's mode
choice, but to a rather limited extent.
R. R. Joens-Matre, G. J. Welk, M. A. Calabro, D. W. Russell, E. Nicklay and L. D.
Hensley. (2008). Rural-urban differences in physical activity, physical fitness, and
overweight prevalence of children. Journal Of Rural Health. 24, 49-54.
Context: The increasing prevalence of overweight in youth has been well chronicled, but
less is known about the unique patterns and risks that may exist in rural and urban
environments. A better understanding of possible rural-urban differences in physical
activity profiles may facilitate the development of more targeted physical activity
interventions. Methods: Participants (1,687 boys; 1,729 girls) were recruited from fourth,
fifth, and sixth grade classes in schools from urban areas, small cities, and rural areas.
Multilevel modeling analysis was used to examine rural-urban differences in physical
activity and prevalence of overweight. Physical activity was assessed by self-report and
body mass index was calculated from measured height and weight. Findings: Prevalence
of overweight was higher among rural children (25%; P <.001) than children from urban
areas (19%) and small cities (17%). Urban children were the least active overall (Cohens'
d = -0.4), particularly around lunchtime while at school (d = -0.9 to -1.1). Children from
small cities reported the highest levels of physical activity. Conclusions: The results of
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this study suggest there are rural-urban differences in children's prevalence of overweight
and physical activity even within a fairly homogenous Midwestern state.
J. A. Kahn, B. Huang, M. W. Gillman, A. E. Field, S. B. Austin, G. A. Colditz and A. L.
Frazier. (2008). Patterns and determinants of physical activity in US adolescents. Journal
Of Adolescent Health. 42, 369-377.
Purpose: The objectives of this study were to describe longitudinal trends in adolescent
physical activity in a sample of U.S. adolescents and to assess the effect of multiple
individual, parental, and environmental factors on initial level and rates of change in
adolescent physical activity. Methods: Study subjects were 12,812 boys and girls 10 to 18
years of age who were participating in the Growing Up Today Study and their mothers.
We used accelerated longitudinal analysis to describe trajectories of physical activity
from 1997-1999, and random effects linear mixed models to determine which factors
were independently associated with baseline physical activity and changes in physical
activity over time. Results: Mean hours of physical activity ranged from 7.3-11.6 hours
per week in boys and from 8.0-11.2 hours per week in girls. Physical activity was best
modeled as a quadratic function of age, increasing until early adolescence and declining
after age 13 in boys and girls. Multivariable modeling demonstrated that variables
associated with physical activity level at baseline in boys and girls were age, body mass
index, psychosocial variables, personal attitudes about body shape, perceived peer
attitudes about body shape/fitness, parental attitudes about physical activity, parental
physical activity, and environmental barriers to physical activity. Age was the only factor
that predicted change in physical activity over time. Conclusions: Interventions to
increase physical activity in adolescents should begin before adolescence. Interventions
may be more effective if they are multimodal and focus on modifiable individual,
parental, and environmental factors.
J. Kerr, G. J. Norman, J. F. Sallis and K. Patrick. (2008). Exercise Aids. Neighborhood
Safety, and Physical Activity in Adolescents and Parents. Medicine & Science in Sports
& Exercise. 40, 1244.
The article presents a study which investigates whether physical activity levels of parents
and their adolescent children were related to neighborhood safety and availability of
personal exercise aids designed to be used either at home or outdoors. It also investigates
the interaction between safety and home exercise aids, such that perceived neighborhood
safety or outdoor-use equipment with physical activity levels. The results show that the
number of home-use and outdoor-use exercise equipment was significantly related to
physical activity in adolescent girls. Also, parents living in neighborhoods perceived to
be safe benefit from having exercise aids that they can use outside.
P. L. Kristensen, L. Korsholm, N. C. Moller, N. Wedderkopp, L. B. Andersen and K.
Froberg. (2008). Sources of variation in habitual physical activity of children and
adolescents: the European youth heart study. Scandinavian Journal Of Medicine &
Science In Sports. 18, 298-308.
The present study examined the influence of gender, maturity state, seasonality, type of
measurement day and socioeconomic status (SES) on habitual physical activity in 8-10year-old children and 14-16-year-old adolescents (n=1318). Physical activity was
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assessed objectively by accelerometry. The results showed a significant effect of the type
of measurement day on physical activity with a general pattern of lower activity levels in
weekends compared with weekdays. Furthermore, higher physical activity levels were
observed during the months of spring/summer compared with the months of
autumn/winter for the 8-10-year-olds, whereas no significant effect of months was
observed for the 14-16-year-olds, possibly due to exam preparations and lack of physical
activity registration during the months of summer for this cohort. SES was unrelated to
physical activity in the 8-10-year-olds, whereas an inverse association was observed in
the 14-16-year-olds. However, a post hoc analysis provided strong evidence that this
latter result was biased by the accelerometers inability to pick up bicycling activities.
Finally, boys were more physically active compared with girls, and maturity state was
unrelated to physical activity. The results could prove useful for working out strategies to
prevent inactivity and for adjusting for temporal sources of variation in physical activity
in future studies.
C. Lazarou, D. B. Panagiotakos, G. Panayiotou and A. L. Matalas. (2008). Overweight
and obesity in preadolescent children and their parents in Cyprus: prevalence and
associated socio-demographic factors - the CYKIDS study. Obesity Reviews. 9, 185-193.
Obesity status differs by socio-demographic factors, but data for Cyprus are scarce. An
in-depth understanding of this relationship may be useful in designing public health
programmes. The objective of the present study is to estimate overweight and obesity
(OW/OB) prevalence among children and adults in Cyprus and identify related sociodemographic variables. National cross-sectional study of 1140 children (mean age 11 +/0.98 years) and their parents (mean age 42.5 +/- 5.8 years, total n = 1954). Obesity was
defined according to the World Health Organization classification for adults and
according to IOTF (International Obesity Task Force) criteria for children. Overweight
and obesity prevalence among girls was 18.3% and 2.9%, respectively, while in boys,
19.0% and 6.0%. Among parents, OW/OB prevalence was, respectively, women, 22.6%
and 5.8%; men, 47.1% and 14.1%. Logistic regression analysis in both children and
adults revealed that the most important socio-demographic predictors of obesity status are
factors of built environment. Higher prevalence of OW/OB was observed in adults living
in a house as opposed to an apartment, in older adults, in younger children, and in men,
irrespective of age. There is a severe obesity problem in the Cypriot population; almost
one in two adults and at least one in four preadolescent children are overweight or obese.
Prevalence of OW/OB was related to socio-demographic factors, especially among adults
and women.
M. Li, M. J. Dibley, D. Sibbritt and H. Yan. (2008). Factors associated with adolescents'
overweight and obesity at community, school and household levels in Xi'an City, China:
results of hierarchical analysis. European Journal Of Clinical Nutrition. 62, 635-643.
Objective: To identify personal and environmental factors associated with adolescent
overweight and obesity in Xi'an city, China. Subjects/Methods: A total of 1804
adolescents from 30 junior high schools in six districts in Xi'an City. Community, school,
household and individual characteristics were self reported by parents, school doctors and
students. Factors associated with adolescent overweight and obesity were identified using
a hierarchical logistic regression. Results: In all adolescents, after adjustment for age and
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gender, factors significantly associated with overweight and obesity were: living in urban
districts (odds ratio (OR): 4.0, 95% confidence interval (CI): 2.7 - 6.0); limited use of
school sports facilities (OR: 1.7, 95% CI: 1.1 - 2.6); wealthy households (OR: 1.7, 95%
CI: 1.1 - 2.6); parental restrictions on purchasing snacks (OR: 1.5, 95% CI: 1.03 - 2.0);
having an overweight/obese parent (OR: 1.8, 95% CI: 1.3 - 2.5); having soft drinks more
than four times per week (OR: 1.6, 95% CI: 1.02 - 2.5) and not fussy about foods (OR:
1.7, 95% CI: 1.2 - 2.2). Eating sweets was negatively associated with overweight/obesity
(OR: 0.6, 95% CI: 0.4 - 0.9). Separate gender analyses revealed that in boys, low physical
activity (OR: 2.0, 95% CI: 1.1 - 3.8) and higher energy intake (OR: 1.8, 95% CI: 1.1 2.9) were also associated with overweight/obesity. In girls, less school sports meetings
(OR: 2.3, 95% CI: 1.3 - 4.0); parental decisions about eating fast foods (OR: 1.8, 95% CI:
1.1 - 2.9) and availability of home video games (OR: 1.7, 95% CI: 1.1 - 2.5) were also
significant. Conclusions: Preventive strategies for adolescent overweight and obesity in
Xi'an should address the community and school environments to reinforce behavioral
change. Gender differences also need to be considered when planning interventions.
J. Mathieu. (2008). Safe play and its effect on childhood obesity. J Am Diet Assoc. 108,
774-5.
N. C. McDonald. (2008). Critical factors for active transportation to school among lowincome and minority students - Evidence from the 2001 national household travel survey.
American Journal Of Preventive Medicine. 34, 341-344.
Background: Walking to school may be an important source of daily physical activity in
children's lives, and government agencies are supporting programs to encourage walking
to school (e.g., Safe Routes to School and the CDC's KidsWalk programs). However,
little research has looked at differences in behavior across racial/ethnic and income
groups. Methods: This cross-sectional study used data from the 2001 National Household
Travel Survey to document rates of walking and biking to school among low-income and
minority youth in the U.S. (N= 14,553). Binary models of the decision to use active
transport to school were developed to simultaneously adjust for trip, individual,
household, and neighborhood correlates. All analyses were conducted in 2007. Results:
The data showed that low-income and minority groups, particularly blacks and Hispanics,
use active travel modes to get to school at much higher rates than whites or higherincome students. However, racial variation in travel patterns is removed by controlling
for household income, vehicle access, distance between home and school, and residential
density. Conclusions: Active transportation to school may be an important strategy to
increase and maintain physical activity levels for low-income and minority youth.
Current policy interventions such as Safe Routes to School have the opportunity to
provide benefits for low-income and minority students who are the most likely to walk to
school.
N. C. McDonald. (2008). Children's mode choice for the school trip: the role of distance
and school location in walking to school. Transportation. 35, 23-35.
Rising levels of childhood obesity in the United States and a 75% decline in the
proportion of children walking to school in the past 30 years have focused attention on
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school travel. This paper uses data from the US Department of Transportation's 2001
National Household Travel Survey to analyze the factors affecting mode choice for
elementary and middle school children. The analysis shows that walk travel time is the
most policy-relevant factor affecting the decision to walk to school with an estimated
direct elasticity of -0.75. If policymakers want to increase walking rates, these findings
suggest that current policies, such as Safe Routes to School, which do not affect the
spatial distribution of schools and residences will not be enough to change travel
behavior. The final part of the paper uses the mode choice model to test how a land use
strategy-community schools-might affect walking to school. The results show that
community schools have the potential to increase walking rates but would require large
changes from current land use, school, and transportation planning practices.
N. M. Nelson, E. Foley, D. J. O'Gorman, N. M. Moyna and C. B. Woods. (2008). Active
commuting to school: How far is too far? International Journal Of Behavioral Nutrition
And Physical Activity. 5,
Background: Walking and cycling to school provide a convenient opportunity to
incorporate physical activity into an adolescent's daily routine. School proximity to
residential homes has been identified as an important determinant of active commuting
among children. The purpose of this study is to identify if distance is a barrier to active
commuting among adolescents, and if there is a criterion distance above which
adolescents choose not to walk or cycle. Methods: Data was collected in 2003-05 from a
cross-sectional cohort of 15-17 yr old adolescents in 61 post primary schools in Ireland.
Participants self-reported distance, mode of transport to school and barriers to active
commuting. Trained researchers took physical measurements of height and weight. The
relation between mode of transport, gender and population density was examined.
Distance was entered into a bivariate logistic regression model to predict mode choice,
controlling for gender, population density socio-economic status and school clusters.
Results: Of the 4013 adolescents who participated (48.1% female, mean age 16.02 +/0.661), one third walked or cycled to school. A higher proportion of males than females
commuted actively (41.0 vs. 33.8%,chi(2) (1) = 22.21, p < 0.001, r = -0.074).
Adolescents living in more densely populated areas had greater odds of active commuting
than those in the most sparsely populated areas (chi(2) (df = 3) = 839.64, p < 0.001). In
each density category, active commuters travelled shorter distances to school. After
controlling for gender and population density, a 1-mile increase in distance decreased the
odds of active commuting by 71% (chi(2) (df = 1) = 2591.86, p < 0.001). The majority of
walkers lived within 1.5 miles and cyclists within 2.5 miles. Over 90% of adolescents
who perceived distance as a barrier to active commuting lived further than 2.5 miles from
school. Conclusion: Distance is an important perceived barrier to active commuting and a
predictor of mode choice among adolescents. Distances within 2.5 miles are achievable
for adolescent walkers and cyclists. Alternative strategies for increasing physical activity
are required for individuals living outside of this criterion.
J. R. Panter, A. P. Jones and E. M. F. van Sluijs. (2008). Environmental determinants of
active travel in youth: A review and framework for future research. International Journal
Of Behavioral Nutrition And Physical Activity. 5,
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Background: Many youth fail to meet the recommended guidelines for physical activity.
Walking and cycling, forms of active travel, have the potential to contribute significantly
towards overall physical activity levels. Recent research examining the associations
between physical activity and the environment has shown that environmental factors play
a role in determining behaviour in children and adolescents. However, links between the
environment and active travel have received less attention. Methods: Twenty four studies
were identified which examined the associations between the environment (perceived or
objectively measured) and active travel among youth aged 5-18 years. Findings were
categorised according to the location of the environmental measure examined; attributes
of the neighbourhood, destination and the route between home and destination. Results:
Results from the reviewed studies indicated that youth active travel is positively
associated with social interactions, facilities to assist active travel and urban form in the
neighbourhood as well as shorter route length and road safety en-route. A conceptual
framework is presented which highlights the associations between active travel
behaviours and environmental factors, drawing upon both existing and hypothesised
relationships. Conclusion: We provide a review of the available literature and present a
novel theoretical framework that integrates the environment into the wider decision
making process around travel choices for children and adolescents. Further work should
explore associations where gaps in understanding have been identified, and account for
the main moderators of behaviour so hypothesised associations can be confirmed.
R. R. Pate, N. Colabianchi, D. Porter, M. Almeida, F. Lobelo and M. Dowda. (2008).
Physical activity and neighborhood resources in high school girls. American Journal Of
Preventive Medicine. 34, 413-419.
Background: Physical activity behavior is influenced by a person's physical environment,
but few studies have used objective measures to study the influences of the physical
environment on physical activity behavior in youth. The purpose of this study was to
examine the relationship between selected neighborhood physical activity resources and
physical activity levels in high school girls. Methods: Participants were students in
schools that had participated in a large physical activity intervention trial. The 3-Day
Physical Activity Recall was completed by 1506 12th-grade girls. Data on physical
activity facilities and resources in the participating communities were collected using a
variety of methods. Physical activity resources within a 0.75-mile street-network buffer
around each girl's home were counted using ArcGIS, version 9.1. Mixed-model
regression models were used to determine if there was a relationship between three
physical activity variables and the number of physical activity resources within the 0.75mile buffer. Data were collected in 2002-2003 and analyzed in 2006-2007. Results: On
average, 3.5 physical activity resources (e.g., schools, parks, commercial facilities) were
located within the 0.75-mile street-network buffer. Thirty-six percent of the girls had no
physical activity resource within the buffer. When multiple physical activity resources
were considered, the number of commercial physical activity facilities was significantly
associated with reported vigorous physical activity, and the number of parks was
associated with total METs in white girls. Conclusions: Multiple physical activity
resources within a 0.75-mile street-network buffer around adolescent girls' homes are
associated physical activity in those girls. Several types of resources are associated with
vigorous physical activity and total activity in adolescent girls. Future studies should
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examine the temporal and causal relationships between the physical environment,
physical activity, and health outcomes related to physical activity.
A. V. Ries, J. Gittelsohn, C. C. Voorhees, K. M. Roche, K. J. Clifton and N. M. Astone.
(2008). The environment and urban adolescents' use of recreational facilities for physical
activity: a qualitative study. American Journal of Health Promotion. 23, 43-50.
A. V. Ries, C. C. Voorhees, J. Gittelsohn, K. M. Roche and N. M. Astone. (2008).
Adolescents' perceptions of environmental influences on physical activity. American
Journal Of Health Behavior. 32, 26-39.
Objectives: To examine African American adolescents' perceptions of environmental
influences on physical activity and identify physical activity promotion strategies.
Methods: Concept mapping with 50 adolescents was used to obtain cluster maps of
conceptual domains affecting physical activity. Results: Seven domains were identified,
including physical activity settings, social support, negative social influences, parental
control, negative environmental influences, transportation and technology issues, and
financial issues. Their relative importance to physical activity varied by gender.
Conclusions: This research identified salient environmental characteristics that can be
measured in future studies as well as strategies for increasing physical activity in urban
youths.
J. E. Robertson-Wilson, S. T. Leatherdale and S. L. Wong. (2008). Social-ecological
correlates of active commuting to school among high school students. Journal Of
Adolescent Health. 42, 486-495.
Purpose: It has been suggested that health benefits from physical activity may be accrued
through active commuting to school. Considering that active commuting is modifiable via
policy and that there is limited research examining active commuting among high school
students, this is a domain that warrants further investigation. The purpose of this study is
to explore the relationships between demographic, behavioral, social/psychological, and
environmental correlates of active commuting to school among a sample of high school
students. Methods: Students (N = 21,345) from 76 Ontario high schools (grades 9-12)
completed the School Health Action, Planning and Evaluation System Physical Activity
Module between 2005-2006. Demographic (gender, grade, body mass index), behavioral
(smoking status, physical activity, sedentary time), social/psychological (perceived
athletic ability, weight status, parental encouragement), and environmental (school
location, type, weather) predictors of active commuting (daily or mixed mode) were
assessed. Results: Only 42.5% of high school students reported actively commuting to
school. Students were less likely to actively commute to school if they were girls, in
grade 12, smoked daily, were low-moderate in physical activity, or attended a rural
school. Conclusions: Patterns of active commuting to school are influenced by multiple
factors, some of which are modifiable through intervention. This has important
implications for future school-based programming designed to enhance health and
physical activity of adolescents through using active modes of transportation to school.
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G. K. Singh, M. D. Kogan, M. Siahpush and P. C. van Dyck. (2008). Independent and
joint effects of socioeconomic, behavioral, and neighborhood characteristics on physical
inactivity and activity levels among US children and adolescents. Journal Of Community
Health. 33, 206-216.
This study examines the independent and joint associations between several
socioeconomic and behavioral characteristics and physical activity (PA) and inactivity
prevalence among 68,288 US children aged 6-17 years. The 2003 National Survey of
Children's Health was used to estimate PA prevalence. Multivariate logistic regression
was used to estimate odds of activity and inactivity and adjusted prevalence, while least
squares regression was used to model mean number of days of physical inactivity (PIA)
in past month. The prevalence of PA varied substantially by socioeconomic and
behavioral characteristics, with older, female, non-English speaking, and metropolitan
children and those with lower socioeconomic status (SES) and neighborhood social
capital having higher inactivity and lower activity levels. Children who watched
television <3 h/day had 60% higher adjusted odds of PIA and 30% lower odds of PA than
those who watched television < 3 h/day. Children experiencing inadequate sleep during
the entire week had 55% higher odds of PIA and 29% lower odds of PA than those who
experienced >= 5 nights of adequate sleep during the week. Children whose both parents
were physically inactive had 147% higher odds of PIA and 46% lower odds of PA than
children whose parents were both physically active. Differentials in PIA by ethnicity,
SES, television viewing, and parental inactivity were greater for younger than for older
children. Subgroups such as older, female adolescents, children from socially
disadvantaged households and neighborhoods, and those in metropolitan areas should be
targeted for the promotion of regular physical activity and reduced television viewing
time.
J. C. Spence, N. Cutumisu, J. Edwards and J. Evans. (2008). Influence of neighbourhood
design and access to facilities on overweight among preschool children. International
Journal Of Pediatric Obesity. 3, 109-116.
Objective. Studies of the role of the built environment in relation to obesity in young
children have reported inconsistent results. Methods. We explored the association of
objective measures of neighbourhood design (dwelling density, land use mix, intersection
density, availability of facilities) with the bodyweight status of 501 preschool children
(girls =262; boys = 239) residing in Edmonton, Canada. Results. Approximately 21 % of
the children were classified as overweight or at-risk of being overweight according to the
Centers for Disease Control (CDC) growth charts, while 15% of the children were
considered overweight or obese according to the International Obesity Task Force (IOTF)
criteria. Controlling for measures of physical activity, junk food consumption and
neighbourhood-level social class, significant interactions were found between sex of the
child and walkability of the neighbourhood (composite index of dwelling density, land
use mix, and intersection density) and sex of the child and intersection density regardless
of the bodyweight status criteria. The odds of girls being overweight or obese were lower
if they lived in walkable neighbourhoods (OR =0.78, 95%CI, 0.66-0.91 CDC; OR =0.73,
95%CI, 0.61-0.88 IOTF) with more intersections (OR =0.57, 95%CI, 0.39-0.86 CDC;
OR =0.48, 95%CI, 0.30-0.76 IOTF). No significant associations were observed for boys.
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Conclusion. Thus, aspects of the built environment may differentially influence the
bodyweight status of children depending upon sex.
N. J. Spurrier, A. A. Magarey, R. Golley, F. Curnow and M. G. Sawyer. (2008).
Relationships between the home environment and physical activity and dietary patterns
of preschool children: a cross-sectional study. International Journal Of Behavioral
Nutrition And Physical Activity. 5,
Objective: To assess relationships between characteristics of the home environment and
preschool children's physical activity and dietary patterns. Methods: Homes of 280
preschool children were visited and information obtained by direct observation and
parent interview regarding physical and nutritional characteristics of the home
environment. Children's physical activity, sedentary behaviour and dietary patterns were
measured using standardised parent-report questionnaires. Associations were analysed
using analysis of variance and correlation. Results: Parental physical activity (p = 0.030.008), size of backyard (p = 0.001) and amount of outdoor play equipment (p = 0.003)
were associated with more outdoor play. Fewer rules about television viewing (p < 0.001)
and presence of playstation (p = 0.02) were associated with more indoor sedentary time.
Higher fruit and vegetable intake was associated with restricting children's access to fruit
juice (p = 0.02) and restricting high fat/sugar snacks (p = 0.009). Lower intake of noncore foods was associated with restricting children's access to fruit juice (p = 0.007),
cordial/carbonated drinks (p < 0.001) and high fat/sugar snacks (p = 0.003). Lower fruit
and vegetable intake was associated with reminding child to 'eat up' (p = 0.007) and
offering food rewards to eat main meal (p = 0.04). Higher intake of non-core foods was
associated with giving food 'treats' (p = 0.03) and offering food rewards to eat main meal
(p = 0.04). The availability of food groups in the home was associated with children's
intake of these foods (fruit and vegetables, p < 0.001; fat in dairy, p = < 0.001; sweetened
beverages, p = 0.004 -< 0.001; non-core foods, p = 0.01 -< 0.001). Conclusion: Physical
attributes of the home environment and parental behaviours are associated with preschool
children's physical activity, sedentary behaviour and dietary patterns. Many of these
variables are modifiable and could be targeted in childhood obesity prevention and
management.
A. Timperio, J. Salmon, K. Ball, L. A. Baur, A. Telford, M. Jackson, L. Salmon and D.
Crawford. (2008). Family physical activity and sedentary environments and weight
change in children. International Journal Of Pediatric Obesity. 3, 160-167.
Objective. To examine associations between family physical activity and sedentary
environment and changes in body mass index (BMI) z-scores among 10-12-year-old
children over three years. Method. Design. Longitudinal (three-year follow-up). Subjects.
In total, 152 boys and 192 girls aged 10-12 years at baseline. Measurements. Measured
height and weight at baseline and follow-up (weight status, BMI z-scores); aspects of the
family physical activity and sedentary environment (parental and sibling modelling,
reinforcement, social support, family-related barriers, rules/restrictions, home physical
environment) measured with a questionnaire completed by parents at baseline. Results.
At baseline, 29.6% of boys and 21.9% of girls were overweight or obese, and mean
(standard deviation, SD) BMI z-scores were 0.44 (0.99) and 0.28 (0.89), respectively.
There was a significant change in BMI z-score among girls (mean change=0.19,
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SD=0.55, p < 0.001), but not boys. Among boys, the number of items at home able to be
used for sedentary behaviour (B=0.11, p=0.037) was associated with relatively greater
increases in BMI z-score. Among girls, sibling engagement in physical activity at least
three times/wk (B=-0.17, p=0.010) and the number of physical activity equipment items
at home (B=-0.05, p=0.018) were associated with relatively greater decreases in BMI zscore. Conclusion. Sibling physical activity and environmental stimuli for sedentary
behaviours and physical activity within the home may be important targets for prevention
of weight gain during the transition from childhood to adolescence.
G. F. Ulfarsson and V. N. Shankar. (2008). Children's travel to school: discrete choice
modeling of correlated motorized and nonmotorized transportation modes using
covariance heterogeneity. Environment And Planning B-Planning & Design. 35, 195206.
Children's school travel mode is changing, especially away from walking and bicycling
and towards private automobiles. Simultaneously we see warning signs from a public
health standpoint as children are becoming less active. It has been suggested that walking
and bicycling to or from school could help shift this trend, moving it towards greater
activity, and researchers are therefore exploring choices of school-trip mode in relation to
the pedestrian friendliness of the built environment. Mode-choice models are generally
framed as multinomial logit (MNL) models. However, the limitations of MNL models
can cause unrealistic effects when walking and bicycling are included with motorized
modes. In this paper the focus is on accounting for individual-specific heterogeneity,
since different children or families may have very different tastes or tolerances, such as
travel time, when it comes to choosing between driving a private automobile, taking the
school bus, bicycling, or walking to or from school. The results show that such
heterogeneity exists, and that it is more important for nonmotorized modes than for the
motorized modes. The results show that accounting for correlation across modes leads to
more realistic marginal rates of substitution (cross-elasticities) across modes-in particular,
an increase in the walking distance negatively affects the probability both of walking and
of bicycling.
K. van der Horst, A. Oenema, P. van de Looij-Jansen and J. Brug. (2008). The
ENDORSE study: Research into environmental determinants of obesity related behaviors
in Rotterdam schoolchildren. Bmc Public Health. 8,
Background: Children and adolescents are important target groups for prevention of
overweight and obesity as overweight is often developed early in life and tracks into
adulthood. Research into behaviors related to overweight (energy balance-related
behaviors) and the personal and environmental determinants of these behaviors is
fundamental to inform prevention interventions. In the Netherlands and in other countries
systematic research into environmental determinants of energy balance related behaviors
in younger adolescents is largely lacking. This protocol paper describes the design, the
components and the methods of the ENDORSE study (Environmental Determinants of
Obesity in Rotterdam SchoolchildrEn), that aims to identify important individual and
environmental determinants of behaviors related to overweight and obesity and the
interactions between these determinants among adolescents. Methods: The ENDORSE
study is a longitudinal study with a two-year follow-up of a cohort of adolescents aged
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12-15 years. Data will be collected at baseline (2005/2006) and at two years follow-up
(2007/2008). Outcome measures are body mass index (BMI), waist circumference, time
spent in physical activity and sedentary behaviors, and soft drink, snack and breakfast
consumption. The ENDORSE study consists of two phases, first employing qualitative
research methods to inform the development of a theoretical framework to examine
important energy balance related behaviors and their determinants, and to inform
questionnaire development. Subsequently, the hypothetical relationships between
behavioral determinants, energy balance related behaviors and BMI will be tested in a
quantitative study combining school-based surveys and measurements of
anthropometrical characteristics at baseline and two-year follow-up. Discussion: The
ENDORSE project is a comprehensive longitudinal study that enables investigation of
specific environmental and individual determinants of overweight and obesity among
younger adolescents. The project will result in specific recommendations for obesity
prevention interventions among younger adolescents.
P. Veugelers, F. Sithole, S. Zhang and N. Muhajarine. (2008). Neighborhood
characteristics in relation to diet, physical activity and overweight of Canadian children.
International Journal Of Pediatric Obesity. 3, 152-159.
Background. Neighborhood infrastructure may provide an important opportunity to
prevent overweight among children. In the present study we investigated whether access
to shops for modestly priced fresh produce, access to parks and playgrounds, access to
recreational facilities and neighborhood safety are related to children's diet, physical and
sedentary activities, and body weights. Methods. Data were obtained from the Children's
Lifestyle and School-performance Study, a survey including 5471 grade five students and
their parents in the province of Nova Scotia, Canada. Students completed the Harvard
Food Frequency Questionnaire and had their height and weight measured. Parents
completed questions on socio-economic background and how they perceived their
neighborhood. We applied multilevel regression methods to relate these neighborhood
characteristics with children's fruit and vegetable consumption, dietary fat intake, diet
quality, frequency of engaging in sports with and without a coach, screen time,
overweight and obesity. Results. Children in neighborhoods with greater perceived access
to shops had healthier diets and were less likely to be overweight or obese. Children in
neighborhoods with good access to playgrounds, parks and recreational facilities were
reportedly more active and were less likely to be overweight or obese, whereas children
in safe neighborhoods engaged more in unsupervised sports. Conclusions. The study
demonstrated associations between neighborhood characteristics, health behaviors and
childhood overweight. This contributes to the knowledge base that is still too narrow to
justify informed preventative public health policy. We advocate the evaluation of natural
experiments created by new policy that affect neighborhood infrastructures as the optimal
opportunity to enlarge this knowledge base.
L. M. Wen, D. Fry, C. Rissel, H. Dirkis, A. Balafas and D. Merom. (2008). Factors
associated with children being driven to school: implications for walk to school
programs. Health Education Research. 23, 325-334.
In this study, we examined factors associated with children being driven to school.
Participants were 1603 students (aged 9-11 years) and their parents from 24 public
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primary schools in inner western Sydney, Australia. Students recorded their modes of
travel to and from school for 5 days in a student survey. Parents recorded their
demographic data, their attitudes to travel, and their modes of travel to work, using a selfadministered survey. An analysis of the two linked data sets found that 41% of students
travelled by car to or from school for more than 5 trips per week. Almost a third (32%) of
students walked all the way. Only 1% of students rode a bike and 22% used more than
one mode of travel. Of those who were driven, 29% lived less than 1 km and a further
18% lived between 1 and 1.5 km from school. Factors associated with car travel (after
adjusting for other potential confounders) were mode of parents' travel to work, parent
attitudes, number of cars in the household, and distance from home to school. To be
effective, walk to school programs need to address the link between parent journey to
work and student journey to school.
A. K. Yarlagadda and S. Srinivasan. (2008). Modeling children's school travel mode and
parental escort decisions. Transportation. 35, 201-218.
Understanding of the activity-travel patterns of children is becoming increasingly
important to various policy makers. Further, there is also a growing recognition that intrahousehold interactions need to be explicitly accommodated in travel models for realistic
forecasts and policy evaluation. In the light of these issues, this paper contributes towards
an overall understanding of the school-travel behavior of children and the related
interdependencies among the travel patterns of parents and children. An econometric
model is formulated to simultaneously determine the choice of mode and the escorting
person for children's travel to and from school. The 2000 San Francisco Bay Area Travel
Survey (BATS) data are used in the model estimation process. Empirical results indicate
that the characteristics of child like age, gender, and ethnicity, and employment and work
flexibility characteristics of the parents have strong impacts on the mode choice
decisions. In addition, the impacts of some of these attributes on the choice of mode to
school are different from the corresponding impacts on the choice of mode from school.
The distance between home and school is found to strongly and negatively impact the
choice of walking to and from school, with the impact being stronger for walking to
school. Several land-use and built-environment variables were explored, but were found
not to be statistically significant predictors.
J. Yeung, S. Wearing and A. P. Hills. (2008). Child transport practices and perceived
barriers in active commuting to school. Transportation Research Part A-Policy And
Practice. 42, 895-900.
This study evaluated the transport practices of school children and perceived factors that
influenced parental decisions regarding their child's use of active transport to commute to
school. A self-administered parental questionnaire (n = 324) was used to determine the
transport practices of school children and factors that influence parental decisions
regarding their child's use of active transport to school. The relationship between
transportation modes (active vs. passive), distance and descriptive variables were
evaluated. Despite a median commuting distance of 2.5 km (0.1-28.0 km), only one-third
of school trips involved active transport. Children using active transport commuted
shorter distances (1.5 vs. 3.6 km), were older (10 vs. 8 years) and more likely to be male
than those using motorised transport (P < 0.05). While logistic regression revealed only
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commuting distance was significantly associated with an increased odds of active
transport (OR 0.29, 95% CI 0.17-0.48), the most frequently reported factors influencing
parental decisions regarding their child's use of active transport were: (1) the age of child;
(2) provision of safe walking paths; (3) adult supervision; (4) commuting distance, and
(5) child's fitness level. While the majority of these factors have been identified within
the literature, their validity has yet to be established.
J. Ziviani, D. Wadley, H. Ward, D. Macdonald, D. Jenkins and S. Rodger. (2008). A
place to play: Socioeconomic and spatial factors in children's physical activity. Australian
Occupational Therapy Journal. 55, 2-11.
Background and aims: Concerns about physical inactivity in children and growing levels
of obesity are expressed by politicians, health economists and those involved with the
health and well-being of children. As this has the potential to be a major health issue, the
aim of this investigation was to explore any contributing socioenvironmental
considerations. Methods and results: Census-matched survey data were analysed from
318 parents of 6- to 7-year-old children, revealing that family socioeconomic status
(SES) influenced the places where children engaged in physical activity. Children from
low SES backgrounds spent significantly more time playing close to their homes, and
their families were less able to afford access to commercial physical-activity facilities,
than those from middle and high SES families. Although neighbourhood-based activities
are generally associated with more spontaneous free play, such activities may not provide
the same opportunities for supervision and physical skill building available through
commercial-based activities. Conclusions: Given that access to 'enriching'
physicalactivity spaces may be limited by the capacity to pay, these findings have
implications for professionals such as occupational therapists who can take on a role in
advocating for equity in access and promotion of a more engaging urban design.
Dialogue with urban planners is central to this process.
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BUILT ENVIORNMENT -- ADULT PHYSICAL ACTIVITY/OBESITY
C. Arambepola, S. Allender, R. Ekanayake and D. Fernando. (2008). Urban living and
obesity: is it independent of its population and lifestyle characteristics? Tropical
Medicine & International Health. 13, 448-457.
Objectives Living in an urban area influences obesity. However, little is known about
whether this relationship is truly independent of, or merely mediated through, the
demographic, socio-economic and lifestyle characteristics of urban populations. We
aimed to identify and quantify the magnitude of this relationship in a Sri Lankan
population. Methods Cross-sectional study of adults aged 20-64 years representing the
urban (n = 770) and rural (n = 630) populations, in the district of Colombo in 2004.
Obesity was measured as a continuous variable using body mass index (BMI).
Demographic, socio-economic and lifestyle factors were assessed. Gender-specific
multivariable regression models were developed to quantify the independent effect of
urban/ rural living and other variables on increased BMI. Results The BMI (mean; 95%
confidence interval) differed significantly between urban (men: 23.3; 22.8-23.8; women:
24.2; 23.7-24.7) and rural (men: 22.3; 21.9-22.7; women: 23.2; 22.7-23.7) sectors (P <
0.01). The observed association remained stable independently of all other variables in
the regression models among both men (coefficient = 0.64) and women (coefficient =
0.95). These coefficients equated to 2.2 kg weight for the average man and 1.7 kg for the
average woman. Other independent associations of BMI were with income (coefficient =
1.74), marital status (1.48), meal size (1.53) and religion (1.20) among men, and with age
(0.87), marital status (2.25) and physical activity (0.96) among women. Conclusions
Urban living is associated with obesity independently of most other demographic, socioeconomic and lifestyle characteristics of the population. Targeting urban populations may
be useful for consideration when developing strategies to reduce the prevalence of
obesity.
S. A. Aytur, D. A. Rodriguez, K. R. Evenson, D. J. Catellier and W. D. Rosamond.
(2008). The sociodemographics of land use planning: Relationships to physical activity,
accessibility, and equity. Health & Place. 14, 367-385.
Little is known about relationships between attributes of land use plans and
sociodemographic variations in physical activity (PA). This study evaluates associations
between policy-relevant plan attributes, sociodemographic factors, and PA in North
Carolina. Results suggest that land use plans that included non-automobile transportation
improvements and more comprehensive policies to guide development were positively
associated with both leisure and transportation-related PA. However, residents of
counties with lower-income levels and higher proportions of non-white residents were
less likely to have attributes supportive of PA included in their plans. Implications for
transdisciplinary collaboration with respect to reducing health disparities are discussed.
H. M. Badland, G. M. Schofield and N. Garrett. (2008). Travel behavior and objectively
measured urban design variables: Associations for adults traveling to work. Health &
Place. 14, 85-95.
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Mixed land use, residential density, street connectivity, and commute distance have been
identified as potential variables affecting transport-related physical activity (TPA)
behaviors. In this Study, objectively measured urban design variables and TPA behaviors
for adults who commuted to an occupation (n = 364) were examined. Utilitarian walking
and cycling for other purposes were not investigated. Commute distance was negatively
associated with TPA behaviors. Logistic regression analysis identified respondents who
commuted through the most connected streets were more likely to engage in TPA modes
to access their occupation (OR = 6.9) when compared to those traveling along the least
connected. No other associations between TPA behaviors and urban variables were
shown. Improved street connectivity and reduced commute distances will likely support
TPA.
E. A. Baker, M. Schootman, C. Kelly and E. Barnidge. (2008). Do Recreational
Resources Contribute to Physical Activity? Journal of Physical Activity & Health. 5, 252.
Background: Previous research suggests that access to recreational resources might
influence physical activity. Little research, however, has looked at both access to and the
characteristics of recreational resources and physical activity. Methods: Access to
recreational resources was assessed by counting the number of recreational resources in
the geographic area. Resource characteristics were assessed through systematic
observation (audits) or telephone interview of each resource. Access and characteristics
in 2 counties in the St Louis, MO, metropolitan area with different prevalence rates of
physical activity were compared using the critical-ratio (Z) test with P value for the
difference between 2 independent proportions, given that the count and sample size were
used to assess differences in access to equipment and presence of physical disorder.
Financial accessibility was assessed for each facility. Results: Data indicated significant
differences in access and characteristics between the 2 areas that mimic differences in
levels of physical activity. Conclusion: Our findings suggest that both access to and
characteristics of recreational resources can contribute to differential rates of physical
activity.
J. Bjork, M. Albin, P. Grahn, H. Jacobsson, J. Ardo, J. Wadbro, P. O. Ostergren and E.
Skarback. (2008). Recreational values of the natural environment in relation to
neighbourhood satisfaction, physical activity, obesity and wellbeing. Journal Of
Epidemiology And Community Health. 62,
Objectives: The aim of this population-based study was to investigate associations
between recreational values of the close natural environment and neighbourhood
satisfaction, physical activity, obesity and wellbeing. Methods: Data from a large public
health survey distributed as a mailed questionnaire in suburban and rural areas of
southern Sweden were used (N = 24 819; 59% participation rate). Geocoded residential
addresses and the geographical information system technique were used to assess
objectively five recreational values of the close natural environment: serene, wild, lush,
spacious and culture. Results: On average, a citizen of the Scania region, inner city areas
excluded, only had access to 0.67 recreational values within 300 metres distance from
their residence. The number of recreational values near the residence was strongly
associated with neighbourhood satisfaction and physical activity. The effect on
satisfaction was especially marked among tenants and the presence of recreational values
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was associated with low or normal body mass index in this group. A less marked positive
association with vitality among women was observed. No evident effect on self-rated
health was detectable. Conclusions: Immediate access to natural environments with high
recreational values was rare in the study population and was distributed in an inequitable
manner. Moreover, such access was associated with a positive assessment of
neighbourhood satisfaction and time spent on physical activity, which can be expected to
reduce obesity and increase vitality by having a buffering effect on stress.
J. L. Black and J. Macinko. (2008). Neighborhoods and obesity. Nutrition Reviews. 66, 2.
This review critically summarizes the literature on neighborhood determinants of obesity
and proposes a conceptual framework to guide future inquiry. Thirty-seven studies met
all inclusion criteria and revealed that the influence of neighborhood-level factors appears
mixed. Neighborhood-level measures of economic resources were associated with obesity
in 15 studies, while the associations between neighborhood income inequality and racial
composition with obesity were mixed. Availability of healthy versus unhealthy food was
inconsistently related to obesity, while neighborhood features that discourage physical
activity were consistently associated with increased body mass index. Theoretical
explanations for neighborhood-obesity effects and recommendations for strengthening
the literature are presented.
M. G. Boarnet, M. Greenwald and T. E. McMillan. (2008). Walking, urban design, and
health - Toward a cost-benefit analysis framework. Journal Of Planning Education And
Research. 27, 341-358.
The authors examine the magnitude of health benefits from urban design characteristics
that are associated with increased walking. Using geocoded travel diary data front
Portland, Oregon, regression analyses give information on the magnitude and statistical
significance of the link between urban design variables and two-day walking distances.
From the coefficient point estimates, the authors link to the health literature to give
information on how many persons would realize health benefits, in the form of reductions
in mortality risk, from walking increases associated with urban design changes. Using a
cost-benefit analysis framework, they give monetized estimates of the health benefits of
various urban design changes. The article closes with Suggestions about how the
techniques developed can be applied to other cost-benefit analyses of the health benefits
of planning projects that are intended to increase walking.
T. D. Bodea, L. A. Garrow, M. D. Meyer and C. L. Ross. (2008). Explaining obesity with
urban form: a cautionary tale. Transportation. 35, 179-199.
In recent years, there has been a dramatic increase in studies exploring associations
between the built environment and obesity. Many studies have found that built
environment characteristics, such as high-density land developments, mixed-land uses,
and connected street networks, are associated with lower rates of obesity. However,
depending on the research field and the researcher, how one specifies the experimental
model and how sociodemographic characteristics of the population are defined and
included in the model has led to different policy conclusions and implications. This is not
a surprising observation; however, it is one that does seem to have been lost in current
discussions. This article highlights several data-processing, model-specification, and
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model-estimation factors that should be comprehensively considered in studies of the
built environment and obesity. Empirical results based on data from Atlanta, GA, USA,
illustrate that the association between the built environment and obesity is sensitive to
how age, income, and educational attainment are included in the model. Also, a detailed
examination of land-use-mix measures shows that it is difficult to create this measure and
that results are sensitive to the treatment of missing values. Models that distinguish
between overweight and obese individuals are shown to provide richer insights into the
associations among obesity, built environment, and sociodemographic characteristics for
the Atlanta area. The article concludes by offering modeling recommendations for future
studies.
A. L. Brown, A. J. Khattak and D. A. Rodriguez. (2008). Neighbourhood types, travel
and body mass: A study of new urbanist and suburban neighbourhoods in the US. Urban
Studies. 45, 963-988.
Using an ecological framework, this paper examines the body mass index (BMI),
physical activity and travel behaviour of household heads in a US new urbanist
neighbourhood relative to household heads of comparable conventional suburban US
neighbourhoods. Using a quasi-experimental design, a new urbanist neighbourhood and
five conventional suburban neighbourhoods were matched on age of development,
assessed property values and regional accessibility. Self-reported height, weight, physical
activity and travel behaviours were obtained from the household heads in each
neighbourhood type. No direct association was detected between neighbourhood type and
BMI. However, household heads of single-family dwellings in the new urbanist
neighbourhood have lower BMI partly due to the number of utilitarian trips made by
walking or bicycling. This relationship is independent of physical activity time. Although
small in magnitude, this association may have appreciable morbidity effects at the
population level.
E. Cerin and E. Leslie. (2008). How socio-economic status contributes to participation in
leisure-time physical activity. Social Science & Medicine. 66, 2596-2609.
The aim of this cross-sectional study was to identify individual, social, and environmental
contributors (mediators) to individual- and area-level differences in leisure-time physical
activity across socio-economic groups. A two-stage stratified sampling design was used
to recruit 20-65 year old adults (N = 2194) living in 154 census collection districts of
Adelaide, Australia (overall response rate: 12%). Participants completed two surveys six
months apart (response rate on the second survey: 83%). Individual-level socio-economic
status (SES) was assessed using self-report measures on educational attainment,
household income, and household size. Area-level SES was assessed using census data
on median household income and household size for each selected census district.
Bootstrap generalized linear models were used to examine associations between SES,
potential mediators, and leisure-time physical activity. The product-of-coefficient test
was used to estimate mediating effects. All SES measures were independently associated
with potential individual and social mediators of the SES-activity relationships.
Individual- and area-level income was also associated with perceived neighborhood
attributes. Self-efficacy and social support for physical activity explained virtually all of
the differences in physical activity across educational attainment groups. Physical
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barriers to walking and access to public open space contributed in part to the explanation
of differences in recreational walking across income groups. Yet, self-efficacy and social
support were the key mediators of the observed relationships between individual- and
area-level income and physical activity. This study suggests that in order to increase
physical activity participation in the more disadvantaged segments of the population,
comprehensive, multilevel interventions targeting activity-related attitudes and skills as
well as social and physical environments are needed.
E. Cerin, C. Vandelanotte, E. Leslie and D. Merom. (2008). Recreational facilities and
leisure-time physical activity: An analysis of moderators and self-efficacy as a mediator.
Health Psychol. 27, S126-35.
OBJECTIVE: To examine socio-demographic and psychosocial moderators, and selfefficacy as a mediator of the cross-sectional relationships between having access to
recreational facilities and leisure-time physical activity (LTPA); to investigate the extent
to which the environment-LTPA associations could be explained by self-selection to
neighborhoods. DESIGN: A two-stage stratified sampling design was used to recruit
2,650 adults (aged 20-65) from 32 urban communities varying in walkability and
socioeconomic status. Participants reported perceived access to facilities and home
equipment for LTPA, weekly minutes of LTPA, self-efficacy for and enjoyment of
LTPA, reasons for neighborhood selection, and socio-demographic characteristics.
MAIN OUTCOME MEASURES: Self-reported recreational walking and other forms of
moderate-to-vigorous LTPA expressed in MET-minutes. RESULTS: Specific types of
recreational facilities were independently associated with LTPA. Age, education, being
overweight/obese, reasons for neighborhood selection, enjoyment of, and self-efficacy for
LTPA moderated these relationships. Self-efficacy was not a significant mediator of these
cross-sectional associations. CONCLUSION: These findings have potentially significant
implications for the planning of environmental interventions aimed at increasing
population-level LTPA particularly in those who are less attitudinally inclined to being
physically active.
M. A. Colchero and D. Bishai. (2008). Effect of neighborhood exposures on changes in
weight among women in Cebu, Philippines (1983-2002). American Journal Of
Epidemiology. 167, 615-623.
The authors aimed to identify the contributions of community factors to weight change in
a cohort of women from Metropolitan Cebu, Philippines, between 1983 and 2002. The
authors created a three-level random-intercept model to see whether mean body mass
index (BMI; weight (kg)/height (m)(2)) varied by individual- and cluster-level variables
and identified community characteristics associated with changes in BMI among 2,952
nonpregnant women. The average BMI among women living in places with four public
amenities (telephones, electricity, mail delivery, and newspapers) was 0.16 kg/m(2) (95%
confidence interval: 0.07, 0.26) higher than that of women living in places with fewer
than three amenities. An increase in population density of 10,000 persons per km(2) was
associated with a BMI increase of 0.09 kg/m(2) (95% confidence interval: 0.05, 0.13). A
model with interactions revealed that the effect of population density increased
significantly over time. These findings confirm earlier observations that in low-income
countries, obesity starts among the wealthiest communities. Secondary and tertiary
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Active Living Research Literature Summary 2008
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prevention policies designed to reduce obesity should be implemented in the most
economically developed areas first. Primary prevention would be most needed in less
developed areas, where the obesity epidemic is just beginning.
C. Coutts. (2008). Greenway accessibility and physical-activity behavior. Environment
And Planning B-Planning & Design. 35, 552-563.
Public health initiatives have made important but relatively modest gains through
individual-level and nonecological health-promotion efforts aimed at increasing physical
activity. The previously overlooked built environment is now being considered as
facilitating or hindering one's ability to be active. The multiuse greenway is an example
of a facility that can support physical activity, but its level of use may be influenced by
the accessibility characteristics of the areas surrounding the greenway. In this study, an
unobtrusive methodology using GPS and GIS technology was employed to test whether
two variables used to measure accessibility, proximity (population density) and
opportunities (land-use mixture), predicted the use of greenway segments. The results
presented here allow us to confirm that smaller walking and bicycling scales of analysis
are better predictors of physical-activity behavior. The results also suggest that solely
bringing environmental support for physical activity closer to concentrated areas of
population does not necessarily equate to more use. It is important that areas with
increased population density have correspondingly increased levels of land-use mixture if
increasing physical activity is the goal.
B. de Geus, I. De Bourdeaudhuij, C. Jannes and R. Meeusen. (2008). Psychosocial and
environmental factors associated with cycling for transport among a working population.
Health Education Research. 23, 697-708.
The aim of this study was to examine psychosocial and environmental predictors of
cycling for transportation. A sample of 343 Flemish adults (43% men) living at maximum
10 km from their workplace was surveyed. Self-report measures of cycling, demographic
variables, psychosocial variables, self-efficacy, perceived benefits and barriers and
environmental attributes (destination, traffic variables and facilities at the workplace) of
cycling for transport were obtained by means of a mailing questionnaire. Modeling and
social support by accompanying, external self-efficacy, ecological-economic awareness
and lack of time and interest were positively associated with the likelihood of cycling for
transport and varied in importance between cyclists and non-cyclists. Cyclists estimate
the time to destination shorter than non-cyclists and indicate to have more facilities for
cyclists at the workplace. The results suggest that when people live in a setting with
adequate bicycle infrastructure, individual determinants (psychosocial, self-efficacy,
perceived benefits and barriers) outperform the role of environmental determinants in this
sample. Promotion campaigns aimed at increasing cycling for transportation should focus
on creating social support by encouraging cycling with partners, increasing self-efficacy,
raising ecological and economic awareness, decreasing lack of time and interest barriers
and providing facilities for cyclists at the workplace.
G. E. Duncan, J. Goldberg, C. Noonan, A. V. Moudon, P. Hurvitz and D. Buchwald.
(2008). Unique environmental effects on physical activity participation: a twin study.
PLoS ONE. 3, e2019.
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BACKGROUND: The health benefits of regular physical activity are well established.
However, the relative contribution of heritable and environmental factors to physical
activity participation remains controversial. Using a cut-point of 60 minutes of total
activity per week, data from the GenomEUtwin project revealed consistent genetic
influence on physical activity participation in 37,051 twin pairs from seven countries. We
hypothesized that the heritability of physical activity participation would be attenuated
using the CDC/ACSM recommended minimum threshold of 150 minutes of moderate
intensity activity per week. METHODS: Data were obtained from 1,389 twin pairs from
the community-based University of Washington Twin Registry. Twin similarity in
physical activity participation using both cut-points was analyzed using tetrachoric
correlations and structural equation modeling in all same-sex pairs. RESULTS:
Correlations were higher in monozygotic (r(MZ) = 0.43, 95% CI = 0.33-0.54) than
dizygotic pairs (r(DZ) = 0.30, 95% CI = 0.12-0.47) using the 60 minute cut-point.
However, differences were attenuated using the 150 minute standard (r(MZ) = 0.30, 95%
CI = 0.20-0.40; r(DZ) = 0.25, 95% CI = 0.07-0.42). Using the lower cut-point, the best
fitting model of twin resemblance only included additive genetics and unique
environment, with a heritability of 45%. In contrast, using the higher threshold, the best
fitting model included the common and unique environment, with the unique
environment contributing 72% of the variance. CONCLUSION: Unique environment
factors provide the strongest influence on physical activity participation at levels
recommended for health benefits.
M. Z. Dunn. (2008). Psychosocial mediators of a walking intervention among African
American women. Journal Of Transcultural Nursing. 19, 40-46.
Many Americans are sedentary and would reduce their disease risk if they increased their
levels of physical activity to 30 minutes of moderate activity most days of the week. This
descriptive exploratory study addresses how to maximize adherence to a physical activity
prescription. A sample of 14 older African American women enrolled in a walking
intervention study participated in three focus-group discussions of barriers to and
facilitators of walking. Focus groups were audiotaped, transcribed, and examined by
three nurse researchers using analytic induction, content analysis, and grounded theory
techniques. Women who participated in the focus-group discussions identified lack of
family support, perceived or real family obligations, personal health status, and
neighborhood safety as factors influencing adherence to physical activity. A necessary
component of successful walking maintenance was the confidence and support of the
woman's family. The most compelling reason for continued walking in this group was to
help others.
J. Eid, H. G. Overman, D. Puga and M. A. Turner. (2008). Fat city: Questioning the
relationship between urban sprawl and obesity. Journal Of Urban Economics. 63, 385404.
We study the relationship between urban sprawl and obesity. Using data that tracks
individuals over time, we find no evidence that urban sprawl causes obesity. We show
that previous findings of a positive relationship most likely reflect a failure to properly
control for the fact the individuals who are more likely to be obese choose to live in more
sprawling neighborhoods. Our results indicate that current interest in changing the built
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environment to counter the rise in obesity is misguided. (C) 2008 Elsevier Inc. All rights
reserved.
F. F. Eves, R. S. W. Masters, A. McManus, M. Leung, P. Wong and M. J. White. (2008).
Contextual Barriers to Lifestyle Physical Activity Interventions in Hong Kong. Medicine
& Science in Sports & Exercise. 40, 965.
The article reports on the studies which examine the contextual barriers to lifestyle
physical activity interventions in Hong Kong, China. According to the authors of the
study, pedestrians on a mass transit escalator system and in an air conditioned shopping
mall were encouraged to take the stairs for their cardiovascular health by point-of-choice
prompts. The results of the study showed that the active transport of walking on the mass
transit system was reduced at higher rates of humidity and temperature, with steeper
slopes for the effects of climate variables in men than in women.
M. F. Floyd, J. O. Spengler, J. E. Maddock, P. H. Gobster and L. Suau. (2008).
Environmental and Social Correlates of Physical Activity in Neighborhood Parks: An
Observational Study in Tampa and Chicago. Leisure Sciences. 30, 360.
This study used observational methods to examine physical activity (PA) and selected
correlates in 28 parks in Tampa, Florida, and Chicago, Illinois. We observed 9,454 park
users within predetermined activity zones and coded their activity as sedentary, walking
(i.e., moderate intensity), or vigorous PA. In Tampa, higher temperature, unorganized
activity, lower amounts of shade, lower neighborhood income, Hispanic neighborhood
ethnicity, male gender and child age group were significantly associated with walking.
Vigorous activity was not associated with income and ethnicity. Morning hours,
unorganized activity, lower neighborhood income and African American neighborhood
ethnicity were associated with walking in Chicago. Vigorous activity was associated with
children, lower neighborhood income and African American ethnicity. Findings from this
study can inform policy decisions and future research directions.
M. F. Floyd, J. O. Spengler, J. E. Maddock, P. H. Gobster and L. J. Suau. (2008). Parkbased physical activity in diverse communities of two US cities - An observational study.
American Journal Of Preventive Medicine. 34, 299-305.
Background: Systematic study of human behavior in public parks and specific activity
settings can inform policy to promote physical activity in diverse communities. Methods:
Direct observation was used to assess physical activity in public parks in Tampa FL (n=
10) and Chicago IL (n= 18). Parks were selected from census tracts with high
concentrations of white, African-American, and Hispanic populations. Representation
from low- and high-income census tracts was also achieved. Physical activity was
measured by a modified version of the System for Observing Play and Leisure Activity in
Youth (SOPLAY). Activity codes from SOPLAY were transformed to energy
expenditure per person (kcal/kg/min). Results: Seventy percent of Tampa and 51% of
Chicago park users were observed engaged in sedentary behavior. In both cities, children
were more likely than adults to be observed in walking or vigorous activity. In Tampa,
parks located in neighborhoods with the highest concentration of Hispanic residents were
associated with greatest levels of energy expenditure. In Chicago, parks in neighborhoods
with the highest concentration of African Americans showed the highest energy
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expenditure per person. Gender was associated with physical activity only in Tampa
parks. Energy expenditure also varied by activity areas. Conclusions: More than one half
of park users in both cities engaged in sedentary behavior. While differences in parkbased physical activity by neighborhood income and racial/ethnic composition were
observed, these differences can more likely be attributed to the types of designated
activity areas that support physical activity. The study findings suggest that specific
configurations of park environments can enhance physical activity in parks.
J. Garrard, G. Rose and S. K. Lo. (2008). Promoting transportation cycling for women:
The role of bicycle infrastructure. Preventive Medicine. 46, 55-59.
Objective. Females are substantially less likely than males to cycle for transport in
countries with low bicycle transport mode share. We investigated whether female
commuter cyclists were more likely to use bicycle routes that provide separation from
motor vehicle traffic. Methods. Census of cyclists observed at 15 locations (including offroad bicycle paths, on-road lanes and roads with no bicycle facilities) within a 7.4 kin
radius of the central business district (CBD) of Melbourne, Australia, during peak
commuting times in February 2004. Results. 6589 cyclists were observed, comprising
5229 males (79.4%) and 1360 females (20.6%). After adjustment for distance of the
bicycle facility from the CBD, females showed a preference for using off-road paths
rather than roads with no bicycle facilities (odds ratio [OR]=1.43, 95% confidence
interval [CI]: 1.12, 1.83), or roads with on-road bicycle lanes (OR=1.34, 95% CI: 1.03,
1.75). Conclusions. Consistent with gender differences in risk aversion, female commuter
cyclists preferred to use routes with maximum separation from motorized traffic.
Improved cycling infrastructure in the form of bicycle paths and lanes that provide a high
degree of separation from motor traffic is likely to be important for increasing
transportation cycling amongst under-represented population groups such as women.
T. L. Gary, M. M. Safford, R. B. Gerzoff, S. L. Ettner, A. J. Karter, G. L. Beckles and A.
F. Brown. (2008). Perception of neighborhood problems, health behaviors, and diabetes
outcomes among adults with diabetes in managed care: the Translating Research Into
Action for Diabetes (TRIAD) study. Diabetes Care. 31, 273-8.
OBJECTIVE: Recent data suggest that residential environment may influence health
behaviors and outcomes. We assessed whether perception of neighborhood problems was
associated with diabetes behaviors and outcomes. RESEARCH DESIGN AND
METHODS: This cross-sectional analysis included 7,830 diabetic adults enrolled in
Translating Research Into Action for Diabetes, a study of diabetes care and outcomes in
managed care settings. Perception of neighborhood problems was measured using a
summary score of participants' ratings of crime, trash, litter, lighting at night, and access
to exercise facilities, transportation, and supermarkets. Outcomes included health
behaviors and clinical outcomes. Hierarchical regression models were used to account for
clustering of patients within neighborhoods and to adjust for objective neighborhood
socioeconomic status (percentage living in poverty) and potential individual-level
confounders (age, sex, race/ethnicity, education, income, comorbidity index, and duration
of diabetes). RESULTS: After adjustment, residents of neighborhoods in the lowest
tertile (most perceived problems) reported higher rates of current smoking (15 vs. 11%)
than those in the highest tertile and had slightly lower participation in any weekly
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physical activity (95 vs. 96%). In addition, their blood pressure control was worse (25 vs.
31% <130/80 mmHg), and their Short Form 12 scores were slightly lower (44 vs. 46
units for emotional well-being and 43 vs. 44 units for physical well-being); all P < 0.01.
CONCLUSIONS: Neighborhood problems were most strongly associated with more
smoking and higher blood pressure, both of which have significant implications for
cardiovascular risk. Potential mechanisms that explain these associations should be
further explored in longitudinal studies.
L. Gauvin, M. Riva, T. Barnett, L. Richard, C. L. Craig, M. L. Spivock, S. Laforest, S.
Laberge, M. C. Fournel, H. Gagnon and S. Gagne. (2008). Association between
neighborhood active living potential and walking. American Journal Of Epidemiology.
167, 944-953.
This paper examines the association between neighborhood active living potential and
walking among middle-aged and older adults. A sample of 2,614 (61.1% women) persons
aged 45 years or older and living in one of 112 census tracts in Montreal, Canada, were
recruited between February and May of 2005 to participate in a 20-minute telephone
survey. Data were linked to observational data on neighborhood active living potential in
the 112 census tracts and analyzed through multilevel modeling. Greater density of
destinations in the census tract was associated with greater likelihoods of walking for any
reason at least 5 days per week for at least 30 minutes (odds ratio = 1.53, 95% confidence
interval: 1.21, 1.94). Associations were attenuated but remained statistically significant
after controlling for socioeconomic, health, lifestyle, and other physical activity
characteristics. Sensitivity analyses showed that associations were robust across smaller
and larger volumes of walking. No associations were found between dimensions of
neighborhood active living potential and walking for recreational reasons. The authors
conclude that a larger number and variety of neighborhood destinations in one's
residential environment are associated with more walking and possibly more utilitarian
walking among middle-aged or older adults.
Z. Guo and J. Ferreira. (2008). Pedestrian environments, transit path choice, and transfer
penalties: understanding land-use impacts on transit travel. Environment And Planning
B-Planning & Design. 35, 461-479.
This paper investigates the impact of pedestrian environments on walking behavior, and
the related choice of travel path for transit riders. Activity logs from trip surveys
combined with transit-route and land-use information are used to fit discrete-choice
models of how riders choose among multiple paths to downtown destinations. The work
illustrates (1) how the quality of pedestrian environments along transit egress paths
affects transfers inside a transit system, and (2) how the impedance of transferring affects
egress walking path choices. The use of GIS techniques for path-based spatial analysis is
key to understanding the impact of pedestrian environments on walking behavior at the
street level. The results show that desirable pedestrian environments encourage transit
riders to choose paths that are 'friendlier', even if they involve more walking after leaving
transit. Policy implications for land-use planning and transit service planning are
discussed.
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S. L. Handy, X. Y. Cao and P. L. Mokhtarian. (2008). The causal influence of
neighborhood design on physical activity within the neighborhood: Evidence from
Northern California. American Journal Of Health Promotion. 22, 350-358.
Purpose. Test for a causal relationship between neighborhood design. and physical
activity within the neighborhood by controlling for self-selection. Design. Cross-sectional
and quasi-longitudinal analyses of residents of selected neighborhoods. Setting. Eight
Northern California neighborhoods. Subjects. Random sample of 1682 adults stratified by
movers (moved within 1 year) and nonmovers (moved > 1 year ago) responding to selfadministered mail surveys (24.7% response rate). Measures. Self-reported number of
days in last 7 days of moderate to vigorous physical activity somewhere in the
neighborhood and self-reported change in physical activity in the neighborhood from
prior to moving (for movers) or from 1 year ago (for nonmovers). Analysis. Zero-inflated
Poisson regression for cross-sectional analysis (n = 1497); ordered, probit model for
quasi-longitudinal analysis (n = 1352). Results. After we controlled for physical activity
attitudes and neighborhood preferences, selected neighborhood design characteristics
were associated with physical activity within the neighborhood and changes in selected
neighborhood design characteristics were associated with changes in physical activity
within the neighborhood. Conclusions. Both cross-sectional and quasi-longitudinal
analyses provided evidence of a causal impact of neighborhood design. Improving
physical activity options, aesthetic qualities, and social environment may increase
physical activity. Critical limitations included self-report measures of physical activity,
lack of measures of duration and intensity of neighborhood physical activity, lack of
measures of total physical activity, and limited measures of preferences related to
physical activity.
S. S. Hawkins, L. J. Griffiths, T. J. Cole, C. Dezateux and C. Law. (2008). Regional
differences in overweight: an effect of people or place? Archives Of Disease In
Childhood. 93, 407-413.
Objective: To examine UK country and English regional differences in childhood
overweight (including obesity) at 3 years and determine whether any differences persist
after adjustment for individual risk factors. Design: Nationally representative prospective
study. Setting: England, Wales, Scotland and Northern Ireland. Participants: 13 194
singleton children from the UK Millennium Cohort Study with height and weight data at
age 3 years. Main outcome measure: Overweight (including obesity) was defined
according to the International Obesity TaskForce cut-offs for body mass index, which are
age and sex specific. Results: At 3 years of age, 23% (3102) of children were overweight
or obese. In univariable analyses, children from Northern Ireland (odds ratio 1.30, 95%
confidence interval 1.14 to 1.48) and Wales (1.26, 1.11 to 1.44) were more likely to be
overweight than children from England. There were no differences in overweight
between children from Scotland and England. Within England, children from the East
(0.71, 0.57 to 0.88) and South East regions (0.82, 0.68 to 0.99) were less likely to be
overweight than children from London. There were no differences in overweight between
children from other English regions and children from London. These differences were
maintained after adjustment for individual socio-demographic characteristics and other
risk factors for overweight. Conclusions: UK country and English regional differences in
early childhood overweight are independent of individual risk factors. This suggests a
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role for policies to support environmental changes that remove barriers to physical
activity or healthy eating in young children.
K. M. Heinrich, E. L. Rebecca, G. R. Regan, J. Y. Reese-Smith, H. H. Howard, C. K.
Haddock, W. S. C. Poston and J. S. Ahluwalia. (2008). How Does the Built Environment
Relate to Body Mass Index and Obesity Prevalence Among Public Housing Residents?
American Journal of Health Promotion. 22, 187.
Purpose. This study examined associations of environmental variables with obesity
prevalence and individual body mass index (BMI) among impoverished residents of
public housing developments. Design. Cross-sectional data were drawn from two studies
in the same Midwestern metropolitan area of participants within neighborhoods. Setting.
Pathways to Health interviewed housing development residents and Understanding
Neighborhood Determinants of Obesity assessed built environment factors in the
surrounding neighborhoods (i.e., 800-m radius from center of housing development).
Subjects. Four hundred twenty-one residents participated (mean age = 43.8 years; 72.0%
women, 59.6% high school degree, 79.6% African-American). Fifty-five physical activity
resources were identified and assessed. Measures. Demographics and measured weights
and heights were obtained for participants. The Physical Activity Resource Assessment
measured the type, accessibility, features, amenities, qualities, and incivilities of
neighborhood physical activity resources. Neighborhood street connectivity was also
measured. Results. Average age-adjusted BMI was 31.4 (SD = 1.3), with 45% of
residents obese. High negative correlations were found between BMI and street
connectivity (p =.05) and between obesity prevalence and resource accessibility (p =.09),
number of amenities (p =.04), and amenity quality (p =.04). Higher resource accessibility,
feature quality, number of amenities, and fewer incivilities per resource accounted for 71
% of obesity variance (p <.05). Male gender and higher feature quality, F(11, 407)37.19
and 12.66, p <.001, predicted lower BMI among residents. Conclusion. Supportive
neighborhood environments were related to lower obesity prevalence and lower BMI
among residents.
M. Hillsdon, D. A. Lawlor, S. Ebrahim and J. N. Morris. (2008). Physical activity in
older women: associations with area deprivation and with socioeconomic position over
the life course: observations in the British Women's Heart and Health Study. Journal Of
Epidemiology And Community Health. 62, 344-350.
Objective: To assess the association between residential area-level deprivation, individual
life-course socioeconomic position and adult levels of physical activity in older British
women. Methods: A cross-sectional study of 4286 British women aged 60-79 years at
baseline, who were randomly selected from general practitioner lists in 23 British towns
between April 1999 and March 2001 (the British Women's Heart and Health Study).
Results: All three of childhood socioeconomic position, adult socioeconomic position and
area of residence (in adulthood) deprivation were independently (of each other and
potential confounders) associated with physical activity. There was a cumulative effect of
life-course socioeconomic position on physical activity, with the proportion who
undertook no moderate or vigorous activity per week increasing linearly with each
additional indicator of life-course socioeconomic position (p < 0.001 for linear trend).
Conclusion: Adverse socioeconomic position across the life-course is associated with an
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Active Living Research Literature Summary 2008
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increased cumulative risk of low physical activity in older women. Reducing
socioeconomic inequalities across the life course would thus be expected to improve
levels of physical activity and the associated health benefits in later life.
C. E. Joshu, T. K. Boehmer, R. C. Brownson and R. Ewing. (2008). Personal,
neighbourhood and urban factors associated with obesity in the United States. Journal Of
Epidemiology And Community Health. 62, 202-208.
Introduction: Growing evidence suggests the built environment impacts obesity within
urban areas; however, little research has investigated these relationships across levels of
urbanisation in diverse and representative populations. This study aimed to determine
whether personal and neighbourhood barriers differ by the level of urbanisation and the
relative importance of personal barriers, neighbourhood barriers and land-use
development patterns measured by a county-level sprawl index. Methods: Populationbased, cross-sectional telephone survey data were collected on 1818 United States adults
of diverse ethnicity and income level. Primary analyses were stratified by the level of
urbanisation at the county level (large metropolitan, small metropolitan, non-metro,
rural). Associations between obesity and neighbourhood and personal barriers were
estimated with logistic regression, controlling for demographic variables. Within
metropolitan areas, the association between body mass index (BMI) and county-level
sprawl was estimated using hierarchical linear modelling, controlling for individual-level
neighbourhood and personal barriers and demographic variables and then assessing crosslevel interaction. Results: The prevalence of neighbourhood, but not personal, barriers
differed widely across levels of urbanisation. Specific neighbourhood (eg traffic,
unattended dogs) and personal (eg time, injury) barriers differentially correlated with
obesity across strata. The impact of sprawl on BMI (B = -0.005) was consistent with
previous findings; standardised coefficients indicate that personal (beta = 0.10) and
neighbourhood (beta = 0.05) barriers had a stronger association than sprawl (beta =
20.02). Furthermore, the effect of sprawl on BMI increased by -0.006 with each
additional personal barrier. Conclusions: Future intervention planning and policy
development should consider that personal barriers and built environment characteristics
may interact with each other and influence obesity differently across urbanisation levels.
A. Kaczynski, L. Potwarka and B. Saelens. (2008). Association of park size, distance,
and features with physical activity in
neighborhood parks. Am J Public Health. 98, 1451-1456.
OBJECTIVES: We studied whether park size, number of features in the park, and
distance to a park from participants' homes were related to a park being used for
physical activity. METHODS: We collected observational data on 28 specific
features from 33 parks. Adult residents in surrounding areas (n=380) completed
7-day physical activity logs that included the location of their activities. We
used logistic regression to examine the relative importance of park size,
features, and distance to participants' homes in predicting whether a park was
used for physical activity, with control for perceived neighborhood safety and
aesthetics. RESULTS: Parks with more features were more likely to be used for
physical activity; size and distance were not significant predictors. Park
facilities were more important than were park amenities. Of the park facilities,
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trails had the strongest relationship with park use for physical activity.
CONCLUSIONS: Specific park features may have significant implications for
park-based physical activity. Future research should explore these factors in
diverse neighborhoods and diverse parks among both younger and older populations.
A. T. Kaczynski and K. A. Henderson. (2008). Parks and Recreation Settings and Active
Living: A Review of Associations With Physical Activity Function and Intensity. Journal
of Physical Activity & Health. 5, 619.
Background: The purpose of this study was to review reported associations between
parks and recreation settings (PRSs) as features of the built environment and various
functions and intensities of physical activity (PA). Methods: By searching 4 major
databases for the years 1998 to 2005, 50 articles were uncovered that reported
quantitative relationships between PRSs and PA. Results: Most articles showed some
significant positive relationships between PRSs and PA. PRSs were more likely to be
positively associated with PA for exercise or utilitarian functions than for recreational
PA. Mixed results were observed for the associations between PRSs and both moderate
and vigorous PA, but PRSs were commonly associated with walking. Conclusions: The
studies indicated links between PRSs and PA and provided evidence for the contributions
parks and recreation makes as part of the "health care" system within communities.
Because of the ubiquity of PRSs and their potential contributions to active living, these
relationships merit further exploration.
R. Kelishadi, S. Alikhani, A. Delavari, F. Alaedini, A. Safaie and E. Hojatzadeh. (2008).
Obesity and associated lifestyle behaviours in Iran: findings from the First National Noncommunicable Disease Risk Factor Surveillance Survey. Public Health Nutrition. 11,
246-251.
Objective: To assess the national prevalence of overweight and obesity, as well as some
associated lifestyle behaviours, for the first time in Iran. Design and Settings: This
population-based Study was performed in early 2005 as part of the World Health
Organization (WHO) STEPwise approach to non-communicable diseases' risk factor
surveillance. Dietary and physical activity habits were assessed by WHO questionnaires.
Subjects: The study population comprised 89 532 subjects aged over 15 years living in
the 28 provinces of Iran. Results: Overall, 50.4% (n = 45 113) of the participants were
male and 64.6% (n = 57 866) were from the urban areas. The national estimates of
overweight, obesity and morbid obesity were 28.6%, 10.8% and 3.4%, respectively. Body
mass index (BMI) >= 25 kg m(-2) in men, women, urban residents and rural residents,
were found in 37%, 48% 46.7% and 35.5%, respectively. Abdominal obesity was present
in 43.4% of women, 9.7% of men, 28.5% of the urban residents and 23% of the rural
residents. Overweight as well as generalised and abdominal obesity were more prevalent
in the 45-64-year age group. Although there was no significant difference in frequency of
consumption of the food groups in subjects with different BMI categories, various kinds
of physical activities showed a steady decline with increasing BMI. Conclusions: The
findings of the present study provide alarming evidence for health professionals and
policy makers about the very high prevalence of generalised and abdominal obesity in
Iran. The unhealthy lifestyle habits, notably sedentary lifestyles in our community, are
the major contributing factors for this emerging public health problem.
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A. D. A. M. Kemperman and H. J. P. Timmermans. (2008). Influence of SocioDemographics and Residential Environment on Leisure Activity Participation. Leisure
Sciences. 30, 306.
Participating in leisure activities provides important benefits for all people. However,
there is a substantial reduction of (green) leisure opportunities in cities, and the green
spaces that are available often are poorly accessible. The purpose of this study is to
analyze the diversity of participation in various types of leisure activities and to
determine the relationship between leisure activity participation and characteristics of the
residential environment depending on socio-demographic characteristics. Diary data from
803 respondents living in the Eindhoven region in the Netherlands were used. Four
segments were identified that differ regarding their leisure activity participation, and a
modest impact of green space accessibility was found.
A. C. King, W. A. Satariano, J. Marti and W. Zhu. (2008). Multilevel Modeling of
Walking Behavior: Advances in Understanding the Interactions of People, Place, and
Time. Medicine & Science in Sports & Exercise. 40, S584.
The article assesses the impact of multilevel modeling of walking on personal, social,
cultural or environmental behaviors. Advances in the application and understanding of
this framework through the inclusion of previously ignored dimensions are discussed.
State-of-the-art statistical method and computer technologies are applied to determine the
complex relationship between multiple levels of impact and walking behavior. A
research-practice agenda is recommended to establish better coordination of the
simulation and scientific investigations.
D. King. (2008). Neighborhood and individual factors in activity in older adults: results
from the neighborhood and senior health study. J Aging Phys Act. 16, 144-70.
This study examined whether features of the built environment and residents' perceptions
of neighborhood walkability, safety, and social cohesion were associated with selfreported physical activity (PA) and community-based activity among a sample of 190
older adults (mean age 74) residing in 8 Denver neighborhoods. Neighborhood walking
audits were conducted to assess walkability and social capital. In multilevel analyses, a
few walkability variables including curb cuts, crosswalks, and density of retail predicted
greater frequency of walking for errands (p <.05), but mean frequency of walking for
errands for this sample was low (<1/wk). Contrary to expectations, total PA and
community-based activity were highest in neighborhoods with fewer walkability
variables but higher respondent perceptions of safety and social cohesion (p <.01). For
seniors, the importance of characteristics of the built environment in promoting PA and
general activity engagement might be secondary to attributes of the social environment
that promote safety and social cohesion.
C. E. Kirchner, E. G. Gerber and B. C. Smith. (2008). Designed to deter. Community
barriers to physical activity for people with visual or motor impairments. Am J Prev Med.
34, 349-52.
BACKGROUND: People with disabilities are more likely to be obese, in poor health, and
get less physical activity than the general population. However, research on community
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factors for physical activity has generally either excluded most people with disabilities, or
overlooked relevant factors of community accessibility. This exploratory study
investigated environmental factors affecting people with motor impairments and people
with visual impairments in urban neighborhoods. METHODS: Quantitative and
qualitative methods were used with a nonrandom sample (n=134) of users of four types
of assistive mobility technologies: guide dogs, long canes, and motorized and manual
wheelchairs. From July 2005 to August 2006, the sample participated in two telephone
surveys. Between the surveys, a stratified random subsample (n =32) engaged in an
ethnographic phase of observation and interviews. RESULTS: Most participants in all
groups using assistive mobility technologies rated their neighborhoods as accessible,
although they also reported many specific barriers. Users of assistive mobility
technologies differed in the amount of reported physical activity and on specific barriers.
Problems with sidewalk pavement and puddles/poor drainage were the most frequently
mentioned environmental barriers, by 90% and 80%, respectively. Users of assistive
mobility technologies were more similar on main strategies for dealing with barriers. All
groups reported having to plan routes for outings, to alter planned routes, to go more
slowly than planned, or to wait for a different time. CONCLUSIONS: Despite legislative
requirements for accommodation, people with disabilities face barriers to physical
activity, both in the built and social environments. Determined people with disabilities
were able to overcome barriers, but required additional expenditure of resources to do so.
Community design that can include people with disabilities requires detailed
understanding of barriers specific both to types of impairments and to different types of
assistive mobility technologies.
F. Z. Li, P. A. Harmer, B. J. Cardinal, M. Bosworth, A. Acock, D. Johnson-Shelton and J.
M. Moore. (2008). Built environment, adiposity, and physical activity in adults aged 5075. American Journal Of Preventive Medicine. 35, 38-46.
Background: Few studies have investigated the built environment and its association with
health-especially excess adiposity-and physical activity in the immediate pre-Baby
Boom/early-Baby Boom generations, soon to be the dominant demographic in the U.S.
The purpose of this study was to examine this relationship. Methods: This study used a
cross-sectional, multilevel design with neighborhoods as the primary sampling unit
(PSU). Residents (N = 1221; aged 50-75) were recruited from 120 neighborhoods in
Portland OR. The independent variables at the PSU level involved GIS-derived measures
of land-use mix, distribution of fast-food outlets, street connectivity, access to public
transportation, and green and open spaces. Dependent variables included resident-level
measures of excess adiposity (BMI >= 25), three walking activities, and physical activity.
Data were collected in 2006-2007 and analyzed in 2007. Results: Each unit (i.e., 10%)
increase in land-use mix was associated with a 25% reduction in the prevalence of
overweight/obesity. However, a 1-SD increase in the density of fast-food outlets was
associated with a 7% increase in overweight/obesity. Higher mixed-use land was
positively associated with all three types of walking activities and the meeting of physical
activity recommendations. Neighborhoods with high street connectivity, high density of
public transit stations, and green and open spaces were related in varying degrees to
walking and the meeting of physical activity recommendations. The analyses adjusted for
neighborhood- and resident-level sociodemographic characteristics. Conclusions:
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Findings suggest the need for public health and city planning officials to address
modifiable neighborhood-level, built-environment characteristics to create more livable
residential communities aimed at both addressing factors that may influence unhealthy
eating and promoting active, healthy lifestyles in this rapidly growing population.
G. S. Lovasi, A. V. Moudon, A. L. Pearson, P. M. Hurvitz, E. B. Larson, D. S. Siscovick,
E. M. Berke, T. Lumley and B. M. Psaty. (2008). Using built environment characteristics
to predict walking for exercise. Int J Health Geogr. 7, 10.
BACKGROUND: Environments conducive to walking may help people avoid sedentary
lifestyles and associated diseases. Recent studies developed walkability models
combining several built environment characteristics to optimally predict walking.
Developing and testing such models with the same data could lead to overestimating
one's ability to predict walking in an independent sample of the population. More
accurate estimates of model fit can be obtained by splitting a single study population into
training and validation sets (holdout approach) or through developing and evaluating
models in different populations. We used these two approaches to test whether built
environment characteristics near the home predict walking for exercise. Study
participants lived in western Washington State and were adult members of a health
maintenance organization. The physical activity data used in this study were collected by
telephone interview and were selected for their relevance to cardiovascular disease. In
order to limit confounding by prior health conditions, the sample was restricted to
participants in good self-reported health and without a documented history of
cardiovascular disease. RESULTS: For 1,608 participants meeting the inclusion criteria,
the mean age was 64 years, 90 percent were white, 37 percent had a college degree, and
62 percent of participants reported that they walked for exercise. Single built
environment characteristics, such as residential density or connectivity, did not
significantly predict walking for exercise. Regression models using multiple built
environment characteristics to predict walking were not successful at predicting walking
for exercise in an independent population sample. In the validation set, none of the
logistic models had a C-statistic confidence interval excluding the null value of 0.5, and
none of the linear models explained more than one percent of the variance in time spent
walking for exercise. We did not detect significant differences in walking for exercise
among census areas or postal codes, which were used as proxies for neighborhoods.
CONCLUSION: None of the built environment characteristics significantly predicted
walking for exercise, nor did combinations of these characteristics predict walking for
exercise when tested using a holdout approach. These results reflect a lack of
neighborhood-level variation in walking for exercise for the population studied.
J. Maas, R. A. Verheij, P. Spreeuwenberg and P. P. Groenewegen. (2008). Physical
activity as a possible mechanism behind the relationship between green space and health:
A multilevel analysis. Bmc Public Health. 8,
Background: The aim of this study was to investigate whether physical activity (in
general, and more specifically, walking and cycling during leisure time and for
commuting purposes, sports and gardening) is an underlying mechanism in the
relationship between the amount of green space in people's direct living environment and
self-perceived health. To study this, we first investigated whether the amount of green
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space in the living environment is related to the level of physical activity. When an
association between green space and physical activity was found, we analysed whether
this could explain the relationship between green space and health. Methods: The study
includes 4.899 Dutch people who were interviewed about physical activity, selfperceived health and demographic and socioeconomic background. The amount of green
space within a one-kilometre and a three-kilometre radius around the postal code
coordinates was calculated for each individual. Multivariate multilevel analyses and
multilevel logistic regression analyses were performed at two levels and with controls for
socio-demographic characteristics and urbanicity. Results: No relationship was found
between the amount of green space in the living environment and whether or not people
meet the Dutch public health recommendations for physical activity, sports and walking
for commuting purposes. People with more green space in their living environment
walked and cycled less often and fewer minutes during leisure time; people with more
green space garden more often and spend more time on gardening. Furthermore, if people
cycle for commuting purposes they spend more time on this if they live in a greener
living environment. Whether or not people garden, the time spent on gardening and time
spent on cycling for commuting purposes did not explain the relationship between green
space and health. Conclusion: Our study indicates that the amount of green space in the
living environment is scarcely related to the level of physical activity. Furthermore, the
amount of physical activity undertaken in greener living environments does not explain
the relationship between green space and health.
G. R. McCormack, B. Giles-Corti and M. Bulsara. (2008). The relationship between
destination proximity, destination mix and physical activity behaviors. Preventive
Medicine. 46, 33-40.
Background. The presence and mix of destinations is an important aspect of the built
environment that may encourage or discourage physical activity. This study examined the
association between the proximity and mix of neighbourhood destinations and physical
activity. Methods. Secondary analysis was undertaken on physical activity data from
Western Australian adults (n=1394). These data were linked with geographical
information systems (GIs) data including the presence and the mix of destinations located
within 400 and 1500 in from respondents' homes. Associations with walking for transport
and recreation and vigorous physical activity were examined. Results. Access to post
boxes, bus stops, convenience stores, newsagencies, shopping malls, and transit stations
within 400 in (OR 1.63-5.00) and schools, transit stations, newsagencies, convenience
stores and shopping malls within 1500 in (OR 1.75-2.38) was associated with
participation in regular transport-related walking. A dose-response relationship between
the mix of destinations and walking for transport was also found. Each additional
destination within 400 and 1500 in resulted in an additional 12 and 11 min/fortnight spent
walking for transport, respectively. Conclusion. Proximity and mix of destinations
appears strongly associated with walking for transport, but not walking for recreation or
vigorous activity. Increasing the diversity of destinations may contribute to adults doing
more transport-related walking and achieving recommended levels of physical activity.
R. Miles. (2008). Neighborhood disorder, perceived safety, and readiness to encourage
use of local playgrounds. American Journal Of Preventive Medicine. 34, 275-281.
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Background: Knowledge of the association between the neighborhood physical
environment and adults' readiness to encourage children's use of local playgrounds, and
the extent to which perceived safety acts as a mediator, can inform efforts to increase
children's physical activity. Methods: Data were obtained from seven European cities
based on a cross-sectional household survey conducted between 2001 and 2002. The
sample included 2123 household informants (from a total of 2782 households) with a
median age of 48 years; 65% were women, 66% were married, and 33% had achieved a
secondary education. Indicators of local neighborhood physical disorder (litter, graffiti,
lack of greenery), traffic volume, and land use were directly observed by trained
surveyors. Perceived safety, encouragement of playground use, and physical activity
levels were assessed with self-reported measures. Analyses were conducted in 2007.
Results: Respondents in neighborhoods showing signs of low or moderate physical
disorder compared to high physical disorder had slightly over twice the odds of
encouraging children to use local playgrounds (p < 0.01). The percentage of the effect of
neighborhood physical disorder accounted for by perceived safety was between 15% and
20%. Neighborhood physical disorder was associated only, vith adults' occasional
involvement in sports or exercise and only among women (p < 0.05); perceived safety
was not significantly associated with physical activity for either men or women.
Conclusions: Neighborhood physical environments and perceived safety influence adults'
readiness to encourage children's physical activity and women's occasional involvement
in sports or exercise. Health promotion strategies designed to upgrade the environments
near where children live and to address parental safety concerns merit further exploration.
R. Miles, L. B. Panton, M. Jang and E. M. Haymes. (2008). Residential context, walking
and obesity: Two African-American neighborhoods compared. Health & Place. 14, 275286.
We compare walking and obesity rates in two African-American neighborhoods that are
similar in urban form but different in level of neighborhood disadvantage. We find higher
rates of utilitarian walking in the neighborhood with higher density and disadvantage and
more destinations within walking distance. However levels of leisure walking and
physical activity were not higher, and rates of obesity were not lower in the non-poor
neighborhood with better maintenance, more sidewalks and recreational facilities.
Different types of barriers to physical activity reported in the two neighborhoods and the
high rates of overweight and obesity in both may explain the findings.
P. L. Mokhtarian and X. Y. Cao. (2008). Examining the impacts of residential selfselection on travel behavior: A focus on methodologies. Transportation Research Part BMethodological. 42, 204-228.
Numerous studies have found that suburban residents drive more and walk less than
residents in traditional neighborhoods. What is less well understood is the extent to which
the observed patterns of travel behavior can be attributed to the residential built
environment itself, as opposed to the prior self-selection of residents into a built
environment that is consistent with their predispositions toward certain travel modes and
land use configurations. To date, most studies addressing this attitudinal self-selection
issue fall into seven categories: direct questioning, statistical control, instrumental
variables models, sample selection models, joint discrete choice models, structural
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equations models, and longitudinal designs. This paper reviews and evaluates these
alternative approaches with respect to this particular application (a companion paper
focuses on the empirical findings of 28 studies using these approaches). We identify
some advantages and disadvantages of each approach, and note the difficulties in actually
quantifying the absolute and/or relative extent of the true influence of the built
environment on travel behavior. Although time and resource limitations are recognized,
we recommend usage of longitudinal structural equations modeling with control groups, a
design which is strong with respect to all causality requisites.
J. B. Moore. (2008). The built environment and physical activity: influencing physical
activity through healthy design. J Public Health Manag Pract. 14, 209-10.
L. V. Moore, A. V. Diez Roux, K. R. Evenson, A. P. McGinn and S. J. Brines. (2008).
Availability of recreational resources in minority and low socioeconomic status areas.
Am J Prev Med. 34, 16-22.
BACKGROUND: Differences in availability of recreational resources may contribute to
racial and socioeconomic status (SES) disparities in physical activity. Variations in the
location and density of recreational resources were examined by SES and racial
composition of neighborhoods. METHODS: Densities of resources available in
recreational facilities and parks were estimated for census tracts between April 2003 and
June 2004 in North Carolina, New York, and Maryland using kernel estimation. The
probability of not having a facility or park was modeled by tract racial composition and
SES, adjusting for population and area, using binomial regression in 2006. Mean
densities of tract resources were modeled by SES and racial composition using linear
regression. RESULTS: Minority neighborhoods were significantly more likely than white
neighborhoods not to have recreational facilities (relative probability [RP]=3.27 [95%
CI=2.11-5.07] and 8.60 [95% CI=4.48-16.51], for black and Hispanic neighborhoods,
respectively). Low-income neighborhoods were 4.5 times more likely to not have
facilities than high-income areas (95% CI=2.87-7.12). Parks were more equitably
distributed. Most resources located in recreational facilities required a fee and were less
dense in minority and low-income areas. Those located inside parks were usually free to
use, sports-related, and denser in poor and minority neighborhoods. CONCLUSIONS:
Recreational facilities and the resources they offer are not equitably distributed. The
presence of parks in poor and minority areas suggest that improving the types and quality
of resources in parks could be an important strategy to increase physical activity and
reduce racial/ethnic and socioeconomic disparities.
K. S. Morris, E. McAuley and R. W. Motl. (2008). Self-efficacy and environmental
correlates of physical activity among older women and women with multiple sclerosis.
Health Education Research. 23, 744-752.
Physical inactivity is a major health problem in the United States, particularly in elderly
and disabled populations. Little research exists examining the relationships between
aspects of the built environment and physical activity in older adults and individuals with
multiple sclerosis (MS). We adopted a social cognitive perspective to examine the
independent roles of perceptions of the environmental, self-efficacy and functional
limitations in understanding physical activity levels among elderly women and women
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with MS. Older women (n = 136) and women diagnosed with MS (n = 173) were
recruited to participate in separate cross-sectional studies. Individuals completed a battery
of questionnaires and wore an activity monitor for 7 days. All measures were issued and
collected through the mail with the use of self-addressed, pre-paid envelopes. Initial
correlational analyses indicated that self-efficacy, functional limitations and
environmental perceptions were significantly related to physical activity. Among older
women, self-efficacy, functional limitations and street connectivity demonstrated
independent contributions to physical activity behavior. Only self-efficacy and functional
limitations demonstrated significant associations among women with MS. The
prospective contributions of the environment and individual factors to changes in
physical activity need to be determined.
K. S. Morris, E. McAuley and R. W. Motl. (2008). Neighborhood satisfaction, functional
limitations, and self-efficacy influences on physical activity in older women.
International Journal Of Behavioral Nutrition And Physical Activity. 5,
Background: Perceptions of one's environment and functional status have been linked to
physical activity in older adults. However, little is known about these associations over
time, and even less about the possible mediators of this relationship. We examined the
roles played by neighborhood satisfaction, functional limitations, self-efficacy, and
physical activity in a sample of older women over a 6-month period. Methods:
Participants (N = 137, M age = 69.6 years) completed measures of neighborhood
satisfaction, functional limitations, self-efficacy, and physical activity at baseline and
again 6 months later. Results: Analyses indicated that changes in neighborhood
satisfaction and functional limitations had direct effects on residual changes in selfefficacy, and changes in self-efficacy were associated with changes in physical activity at
6 months. Conclusion: Our findings support a social cognitive model of physical activity
in which neighborhood satisfaction and functional status effects on physical activity are
in part mediated by intermediate individual outcomes such as self-efficacy. Additionally,
these findings lend support to the position that individual perceptions of both the
environment and functional status can have prospective effects on self-efficacy
cognitions and ultimately, physical activity behavior.
M. S. Mujahid, A. V. D. Roux, M. W. Shen, D. Gowda, B. Sanchez, S. Shea, D. R.
Jacobs and S. A. Jackson. (2008). Relation between neighborhood environments and
obesity in the multi-ethnic study of atherosclerosis. American Journal Of Epidemiology.
167, 1349-1357.
This study investigated associations between neighborhood physical and social
environments and body mass index in 2,865 participants of the Multi-Ethnic Study of
Atherosclerosis (MESA) aged 45-84 years and residing in Maryland, New York, and
North Carolina. Neighborhood (census tract) environments were measured in non-MESA
participants residing in MESA neighborhoods (2000-2002). The neighborhood physical
environment score combined measures of a better walking environment and greater
availability of healthy foods. The neighborhood social environment score combined
measures of greater aesthetic quality, safety, and social cohesion and less violent crime.
Marginal maximum likelihood was used to estimate associations between neighborhood
environments and body mass index (kg/m(2)) before and after adjustment for individual-
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level covariates. MESA residents of neighborhoods with better physical environments
had lower body mass index (mean difference per standard deviation higher neighborhood
measure = -2.38 (95% confidence interval (CI): -3.38, -1.38) kg/m(2) for women and 1.20 (95% CI: -1.84, -0.57) kg/m(2) for men), independent of age, race/ethnicity,
education, and income. Attenuation of these associations after adjustment for diet and
physical activity suggests a mediating role of these behaviors. In men, the mean body
mass index was higher in areas with better social environments (mean difference = 0.52
(95% CI: 0.07, 0.97) kg/m(2)). Improvement in the neighborhood physical environment
should be considered for its contribution to reducing obesity.
M. Neovius and F. Rasmussen. (2008). Place of residence and obesity in 1,578,694
young Swedish men between 1969 and 2005. Obesity (Silver Spring). 16, 671-6.
OBJECTIVE: To compare prevalence of overweight and obesity in young adult men
from rural areas with those from urban areas of Sweden over three decades. METHODS
AND PROCEDURES: Eighty-two percent of the Swedish male population at military
conscription age between 1969 and 2005 (n = 1,578,694; 18.3 +/- 0.4 years) was grouped
by urban, semiurban, and rural place of residence. BMI was calculated from measured
height and weight. Comparisons were made with and without adjustments for parental
education, socioeconomic position (SEP), and intelligence quotient (IQ). RESULTS:
During the study period, the prevalence of obesity more than quintupled from 0.9-5.1%,
while overweight tripled from 7.1-20.5% (P < 0.0001). An urban-rural gradient was
observed within all socioeconomic and education strata. After adjustment for SEP, IQ,
parental education level, and testing year, the odds ratios (ORs) were 1.28 (1.23-1.34)
and 1.20 (1.18-1.22) for obesity and overweight, respectively, in a rural compared to an
urban area. The corresponding ORs for semiurban place of residence were 1.16 (1.131.19) and 1.11 (1.10-1.12), respectively. Significant effect modification by time was seen,
with evidence of an increasing gradient until the early 1990s (P < 0.001). DISCUSSION:
A strong and persisting gradient of increasing overweight and obesity from urban to rural
areas was observed that could not be explained by individual or family-related factors
such as IQ, parental education level, or SEP. These results indicate the presence of strong
environmental or contextual obesogenic factors affecting the energy balance of people in
rural areas more negatively than those in urban communities.
J. Panter, A. Jones and M. Hillsdon. (2008). Equity of access to physical activity facilities
in an English city. Preventive Medicine. 46, 303-307.
Objective. To examine associations between household income, access to sports facilities
and gyms, and physical activity in an English city. Method. A cross sectional
geographical study was conducted in six neighbourhoods in the city of Norwich in
August and September 2004. Participants were (n = 401) adults who received, completed,
and returned questionnaires. Road distances to facilities were calculated using
Geographical Information System. Results. For all facility types except gyms, mean
income was lowest amongst those living farthest away. Compared to those with the
lowest incomes, the most affluent participants lived on average just over 0.5 km closer to
a facility of any type, 1 km closer to a sports facility but 900 m farther from a gym (all p
< 0.001). In general, those living farther from facilities reported that they were less active
although they did not tend to report a desire to exercise more. Conclusion. People in low
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income households, who are more likely to adopt low levels of activity, are least well
served by affordable facilities that would enable them to become more active. If the
British Government is to meet targets for improving levels of physical activity, it may
need to consider how market forces might be creating an inequitable distribution of
facility provision.
Y. Park, K. M. Neckerman, J. Quinn, C. Weiss and A. Rundle. (2008). Place of birth,
duration of residence, neighborhood immigrant composition and body mass index in New
York City. International Journal Of Behavioral Nutrition And Physical Activity. 5,
Background: Past research has suggested that changes in culture explain the substantial
weight gain seen in many immigrant groups with length of residence in the U. S. and
across generations of residence in the U. S. However, it has been theorized that those
settling in immigrant and co-ethnic neighborhoods may be buffered against this
acculturative process and will be more likely to maintain home country dietary and
physical activity patterns. To investigate this theory we incorporated measures of
neighborhood immigrant composition into analyses of individual's body mass index
(BMI) and generation of immigration and duration of residence in the U. S. Methods:
Multilevel analyses were performed using objectively measured height and weight and
survey data on diet and physical activity from a sample of 13,011 residents of New York
City. Census data were used to calculate the proportion of foreign-born residents and
extent of household linguistic isolation in a 1/2 mile radial buffer around the subject's
home. Results: Foreign birth was associated with a significantly lower BMI (-1.09 BMI
units, P < 0.001). This association was weakest among Asians (-0.66 BMI units, P =
0.08) and strongest among Black-Caribbeans (-1.41 BMI units, P = 0.07). After
controlling for individual level variables, neighborhood proportion foreign-born was not
associated with BMI, but increasing neighborhood linguistic isolation was inversely
associated with BMI among Hispanics (-2.97 BMI units, P = 0.03). Furthermore among
Hispanics, the association between foreign birth and BMI was stronger in low linguistic
isolation neighborhoods (-1.36 BMI units, P < 0.0001) as compared to in high linguistic
isolation levels (-0.42 BMI units, P = 0.79). Increasing duration of residence in the U. S.
was significantly associated with higher BMI overall and among Hispanics. Conclusion:
The analyses suggest that acculturation is associated with weight gain, and that
neighborhood characteristics are only associated with BMI among Hispanics. However,
we suggest that changes in body size currently interpreted as post-migration effects of
acculturation to U. S. norms may in fact reflect changes in norms that are taking place
internationally.
C. G. Roman and A. Chalfin. (2008). Year of walking outdoors - A multilevel Ecologic
analysis of crime and disorder. American Journal Of Preventive Medicine. 34, 306-312.
Background: Although a number of studies have tested ecologic models that postulate
relationships among social networks, the built environment, and active living, few
neighborhood-based studies have considered the role of crime and violence. This study
investigates the degree to which individual-level demographic characteristics and
neighborhood-level physical and social characteristics are associated with increased fear
of crime. Methods: Data were analyzed in 2007 from a 2005 survey of 901 randomly
selected individuals living in 55 neighborhoods in Washington DC. Multilevel ordered
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logit regression was used to examine associations between individual-level and
neighborhood-level characteristics and how often fear of crime prevents a respondent
from walking outdoors. Results: Age and female gender were associated with an increase
in fear; the percentage of a resident's life spent in the same neighborhood was associated
with a decrease in fear. Results of cross-level interactions showed that at the
neighborhood level, women were more fearful than men in neighborhoods without
violence, but that the difference in fear between men and women shrinks as neighborhood
violence increases. Collective efficacy was found to increase fear among black
respondents and had no effect on fear among nonblack respondents. Conclusions: If the
study of neighborhoods and active living is to progress and contribute to both etiologic
understanding and policy formation, it is essential that theoretical and empirical models
consider the impact of violence and fear on walking. Efforts to increase active living in
urban neighborhoods that do not account for the impact of crime and fear may fall short
of their intended outcomes.
B. E. Saelens and S. L. Handy. (2008). Built Environment Correlates of Walking: A
Review. Medicine & Science in Sports & Exercise. 40, S550.
The article examines the evidence on the built environment correlates with walking. It
cites that there has been an increase in empirical investigation into the relations between
built environment and physical activity. According to the article, practitioners need an
understanding of the specific characteristics of the built environment that correlate most
strongly with walking to create places that facilitate and encourage walking. Moreover,
research on the characteristics of the built environment with walking is discussed.
R. Santos, P. Silva, P. Santos, J. C. Ribeiro and J. Mota. (2008). Physical activity and
perceived environmental attributes in a sample of Portuguese adults: Results from the
Azorean Physical Activity and Health Study. Preventive Medicine. 47, 83-88.
Objectives. The aim of the present study was to determine whether the relation of
perceived neighbourhood attributes to reported Physical Activity (PA) levels in Azorean
adults varied by gender and body mass index (BMI). Methods. 7330 adult participants
(4104 women), aged 38.1 +/- 93 years, from the 2004 Azorean Physical Activity and
Health Study. They answered the Environmental Module and the short version of the
International Physical Activity Questionnaire (IPAQ). Height and weight were selfreported. Results. After adjustments for age, BMI, education level and island of
residence, the dimension Infrastructures, Access to destinations, Social environment and
Aesthetics was positively associated with moderate PA level and Health-Enhancing
Physical Activity (HEPA) level, only in women. When participants were categorized by
BMI status, the same dimension was a significant predictor for moderate PA level in
normal weight men and women, and for HEPA level only in overweight/obese women,
after controlling for age, education level and island of residence. Conclusions. The
dimension Infrastructures, Access to destinations, Social environment and Aesthetics was
predictors of higher PA levels in Azorean adults. Targeted programs for Azoreans to
increase PA levels should consider that this set of environmental features seem to act
synergistically and are positively associated with PA.
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K. A. Shores and S. T. West. (2008). The relationship between built park environments
and physical activity in four park locations. J Public Health Manag Pract. 14, e9-16.
Despite widespread knowledge that physical activity is a valuable mechanism for
preventing many lifestyle diseases, data from the 2001 Behavioral Risk Factor
Surveillance System indicate that less than half of the US population met activity
recommendations established by the Centers for Disease Control and Prevention. To
increase physical activity levels, community officials around the United States have
identified public parks as a convenient, low-cost resource to enable active living.
However, the amenities of the built park environment that best facilitate active park visits
are unknown. The current article describes the relationship of micro-level environmental
components and park visitors' physical activity. Using the System for Observing Play and
Recreation in Communities, park visitation patterns are documented and described
according to user demographics. Broadly, visitors who were observed in park
environments, which contained playgrounds, sport courts, and paths, were significantly
more active than visitors in settings without these features. Furthermore, six types of built
features were able to explain 58% of the variance in observed activity intensity among
park visitors. Findings suggest that built features that support physical activity across the
life span (paths and courts in particular) may be considered by community leaders
seeking relatively low-cost mechanisms to promote physical activity among residents.
S. B. Sisson, J. J. McClain and C. Tudor-Locke. (2008). Campus Walkability,
Pedometer-Determined Steps, and Moderate-to-Vigorous Physical Activity: A
Comparison of 2 University Campuses. Journal of American College Health. 56, 585.
Objective and Participants: At 2 Arizona State University (ASU) campuses, the authors
measured student activity and distance walked on campus, as well as student-reported
walkability around the student union. Methods: Students from ASU-Polytechnic (n = 20,
33% male) and ASU-Tempe (n = 20, 60% male) recorded distance walked on campus
and wore physical activity monitors for 5 days. Results: Polytechnic students spent an
average of 36.9 minutes in moderate-to-vigorous physical activity each week; Tempe
students spent 69.5 minutes (p <.001). At Polytechnic, students walked an average of
7,674 steps per weekday; at Tempe, 11,294 steps (p =.003). Female students at
Polytechnic walked an average of 1.3 km/d; at Tempe, 4.3 km/d (p <.001). At
Polytechnic, men walked an average of 1.4 km/d; at Tempe, 3.1 km/d (p =.03). Tempe
students rated campus walk-ability as very good, whereas Polytechnic students rated it
fair (p <.001). Conclusions: Students at both campuses met activity recommendations;
noted differences may be attributed to the built environment's contribution to walkability.
S. B. Sisson and C. Tudor-Locke. (2008). Comparison of cyclists' and motorists'
utilitarian physical activity at an urban university. Preventive Medicine. 46, 77-79.
Objective. Preliminary comparison of cyclists and motorists on: (1) distance lived from
campus and, (2) the impact of transportation mode on physical activity. Methods. A
purposive sample of students (n=50; cyclists=26, motorists=24) living <5 miles from
Arizona State University campus wore an accelerometer and completed a travel log for
two on-campus days during fall 2005-spring 2006. Residence distance to campus was
calculated by geocoded addresses (n=45; cyclists=23 vs. motorists=22). Final outcome
variables were: distance lived from campus, accelerometer time moderate-to-vigorous
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physical activity, steps/day, total time moderate-to-vigorous physical activity (logged
minutes cycling+accelerometer-derived moderate-to-vigorous physical activity), and
minutes total active commuting (logged walking+cycling). Results. Groups were
significantly different for: distance lived from campus (cyclists=0.6+/-0.6 vs.
motorists=2.0+/-1.1 miles;p<0.000); steps/day (cyclists=11,051+/-4295 vs.
motorists=9174+/-3319; p=0.046); total time moderate-to-vigorous physical activity
(cyclists=85.7+/-37.0 vs. motorists=50.3+/-23.8 minutes; p<0.001); minutes in motorized
transport (cyclists=24.9+/-27.5 vs. motorists=61.6+/-32.9; p<0.001); and total active
transport (cyclists=59.4+/-32.4 vs. motorists=29.5+/-20.0;p<0.001). Conclusion. Among
students living within 5 miles of campus, cyclists lived relatively closer to campus,
accumulated more minutes of physical activity, and spent more time in active
transportation than students who used motorized means.
K. R. Smith, B. B. Brown, I. Yamada, L. Kowaleski-Jones, C. D. Zick and J. X. Fan.
(2008). Walkability and body mess index: Density, design, and new diversity measures.
American Journal of Preventive Medicine. 35, 237-244.
M. Spivock, L. Gauvin, M. Riva and J. M. Brodeur. (2008). Promoting active living
among people with physical disabilities evidence for neighborhood-level buoys. Am J
Prev Med. 34, 291-8.
BACKGROUND: People with physical disabilities are more likely to be sedentary than
the general population, possibly because they have an accrued sensitivity to
environmental features. OBJECTIVES: This paper describes the relationship between
neighborhood-level active living buoys and the active living practices of adults with
physical disabilities living in a large urban area. METHODS: A sample of 205 people
with physical disabilities was recruited via a local rehabilitation center and its adapted
fitness center. Telephone interviews were administered by senior occupational therapy
students. The interview included a modified version of the Physical Activity and
Disability Survey, a validated instrument that includes questions on physical activity,
active transportation, and other activities of daily living. Individuals were geocoded
within their census tract of residence (n=114) using their postal codes. Data on
neighborhood active living potential were gleaned from systematic social observation.
RESULTS: Multilevel logistic regression analyses showed that the association between
the presence of environmental buoys and leisure activity was significant (OR=4.0, 95%
CI=1.1-13.8) despite adjustments for individual difference variables while the association
with active transportation became nonsignificant (OR=2.9, 95% CI=0.7-7.7) following
adjustment for these variables. CONCLUSIONS: People with physical disabilities who
live in neighborhoods with more environmental buoys are more likely to report
involvement in leisure-time physical activity.
T. Sugiyama, E. Leslie, B. Giles-Corti and N. Owen. (2008). Associations of
neighbourhood greenness with physical and mental health: do walking, social coherence
and local social interaction explain the relationships? Journal Of Epidemiology And
Community Health. 62,
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Background: Studies have shown associations between health indices and access to
"green'' environments but the underlying mechanisms of this association are not clear.
Objectives: To examine associations of perceived neighbourhood "greenness'' with
perceived physical and mental health and to investigate whether walking and social
factors account for the relationships. Methods: A mailed survey collected the following
data from adults (n = 1895) in Adelaide, Australia: physical and mental health scores (12item short-form health survey); perceived neighbourhood greenness; walking for
recreation and for transport; social coherence; local social interaction and
sociodemographic variables. Results: After adjusting for sociodemographic variables,
those who perceived their neighbourhood as highly green had 1.37 and 1.60 times higher
odds of better physical and mental health, respectively, compared with those who
perceived the lowest greenness. Perceived greenness was also correlated with recreational
walking and social factors. When walking for recreation and social factors were added to
the regression models, recreational walking was a significant predictor of physical health;
however, the association between greenness and physical health became non-significant.
Recreational walking and social coherence were associated with mental health and the
relationship between greenness and mental health remained significant. Conclusions:
Perceived neighbourhood greenness was more strongly associated with mental health
than it was with physical health. Recreational walking seemed to explain the link between
greenness and physical health, whereas the relationship between greenness and mental
health was only partly accounted for by recreational walking and social coherence. The
restorative effects of natural environments may be involved in the residual association of
this latter relationship.
R. R. Suminski, K. M. Heinrich, W. S. C. Poston, M. Hyder and S. Pyle. (2008).
Characteristics of urban Sidewalks/Streets and objectively measured physical activity.
Journal Of Urban Health-Bulletin Of The New York Academy Of Medicine. 85, 178190.
Several studies have found significant relationships between environmental
characteristics (e.g., number of destinations, aesthetics) and physical activity. While a
few of these studies verified that the physical activities assessed were performed in the
environments examined, none have done this in an urban, neighborhood setting. This
information will help efforts to inform policy decisions regarding the design of more
"physically active" communities. Fourteen environmental characteristics of 60, 305-mlong segments, located in an urban, residential setting, were directly measured using
standardized procedures. The number of individuals walking, jogging, and biking in the
segments was assessed using an observation technique. The segments were
heterogeneous with regards to several of the environmental characteristics. A total of 473
individuals were seen walking, bicycling, or jogging in the segments during 3,600 min of
observation (60 min/segment). Of the 473 seen, 315 were walking, 116 bicycling, and 42
jogging. A greater number of individuals were seen walking in segments with more
traffic, sidewalk defects, graffiti, and litter and less desirable property aesthetics. Only
one environmental characteristic was associated with bicycling and none were
significantly related with jogging. This study provides further evidence that
environmental characteristics and walking are related. It also adds new information
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regarding the importance of scale (e.g., micro, macro) and how some environmental
characteristics of urban, residential sidewalks and streets relate to physical activity.
L. M. Taylor, E. Leslie, R. C. Plotnikoff, N. Owen and J. C. Spence. (2008). Associations
of perceived community environmental attributes with walking in a population-based
sample of adults with type 2 diabetes. Ann Behav Med. 35, 170-8.
BACKGROUND: No studies have yet examined the associations of physical
environmental attributes specifically with walking in adults with type 2 diabetes.
PURPOSE: The purpose of this study was to examine associations of perceived
community physical environmental attributes with walking for transport and for
recreation among adults living with type 2 diabetes. METHODS: Participants were 771
adults with type 2 diabetes who completed a self-administered survey on perceived
community physical environmental attributes and walking behaviors. RESULTS: Based
on a criterion of a minimum of 120-min/week, some 29% were sufficiently active
through walking for transport and 33% through walking for recreation. Significantly
higher proportions of those actively walking for transport and for recreation had shops or
places to buy things close by (67.8% and 60.9%); lived within a 15-min walk to a transit
stop (70.6% and 71.0%); did not have dead-end streets close by (77.7% and 79.8%);
reported interesting things to look at (84.8% and 84.4%); and lived close to low-cost
recreation facilities (81.3% and 78.8%). In addition, those actively walking for transport
reported living in a community with intersections close to each other (75.6%) and with
sidewalks on their streets (88.1%). When these variables were entered simultaneously
into logistic regression models, living close by to shops was positively related to walking
for transport (OR = 1.92, 99% CI = 1.11-3.32). CONCLUSIONS: Consistent with
findings from studies of healthy adult populations, positive perceptions of community
environmental attributes are associated with walking for transport among adults with type
2 diabetes. The now-strong public health case for environmental innovations to promote
more walking for transport is further reinforced by the potential to benefit those living
with diabetes.
M. J. van der Meer. (2008). The sociospatial diversity in the leisure activities of older
people in the Netherlands. Journal Of Aging Studies. 22, 1-12.
Leisure activities afford an important way for old people to continue to take part in
society and have a positive effect on personal wellbeing. The types and number of leisure
activities in which older people participate are highly diverse. This diversity is associated
not only with personal characteristics, but also with those of the environment in which
old people live. Using cross sectional data selected in 2002-2003, differences are
presented between regions, cities and villages, and between prosperous and deprived
neighbourhoods. The characteristics of the region and of the urban or rural environment
show a clear relationship wit the intrinsic orientation in leisure. The diversity is smallest
among older adults who live in deprived neighbourhoods and among the very old. They
take part in fewer activities (contraction), which leads to a more similar activity pattern in
and around the home (convergence).
C. Vaughan, A. Kilkkinen, B. Philpot, J. Brooks, A. Schoo, T. Laatikainen, A. Chapman,
E. D. Janus and J. A. Dunbar. (2008). Physical activity behaviours of adults in the
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Greater Green Triangle region of rural Australia. Australian Journal Of Rural Health. 16,
92-99.
Objective: To assess physical activity (PA) behaviours of adults in rural Australia.
Design and setting: Three cross-sectional surveys in the Greater Green Triangle area
covering the south-east of South Australia (Limestone Coast), and south-west
(Corangamite Shire) and north-west (Wimmera) of Victoria during 2004-2006.
Participants: A total of 1546 persons, aged 2574 years, randomly selected from the
electoral roll. Main outcome measures: Overall PA, leisure-time PA, occupational PA,
active commuting and moderate-to-vigorous PA. Results: Approximately 80% of
participants, more women than men, engaged in 30 minutes or more of daily PA. Only
30% (95% CI 26.3, 33.0) of men and 21% (95% CI 18.3, 23.9) of women did moderateto-vigorous PA for at least 20-30 minutes four or more times a week. In leisure time,
most participants were moderately active; almost one-fifth were inactive and another fifth
highly active. Two-thirds of men engaged in high-level occupational PA, compared with
one-sixth of women. Only 30% of participants actively commuted to work. There was a
tendency for a positive association between income level and leisure-time PA.
Conclusions: One-fifth of adults in rural Australia were inactive. While there was a high
prevalence of participants who engaged in daily PA, few did so at moderate-to-vigorous
intensity to achieve health benefits. As occupational PA is difficult to change,
improvements in levels of PA are more likely during leisure-time and for some people by
engaging in commuting PA.
N. M. Wells and Y. Z. Yang. (2008). Neighborhood design and walking - A quasiexperimental longitudinal study. American Journal Of Preventive Medicine. 34, 313-319.
Background: Few studies have employed longitudinal data to examine associations
between the physical environment and walking. Methods: Using cross-sectional (n=70)
and longitudinal (n=32) data (collected 2003-2006), associations of neighborhood design
and demographics with walking were examined. Participants were low-income, primarily
African-American women in the southeastern U.S. Through a natural experiment, some
women relocated to neo-traditional communities (experimental group) and others moved
to conventional suburban neighborhoods (control group). Results: Post-move crosssectional comparisons indicated that women in neo-traditional neighborhoods did not, on
average, walk more than women in suburban neighborhoods. Race and household size
were significant predictors of physical activity. Additionally, using longitudinal data, this
study controlled for the effects of pre-move walking and demographics. Analyses
examined the effects of environmental factors (e.g., density, land-use mix, street-network
patterns) on post-move walking. Women who moved to places with fewer culs-de-sac, on
average, walked more. Unexpectedly, increases in land-use mix were associated with less
walking. Conclusions: Results suggest that neo-traditional neighborhood features alone
(e.g., sidewalks, front porches, small set-back distances) may not be enough to affect
walking; however, changes in street patterns may play a role.
G. C. W. Wendel-Vos, C. van Hooijdonk, D. Uitenbroek, C. Agyemang, E. M. Lindeman
and M. Droomers. (2008). Environmental attributes related to walking and bicycling at
the individual and contextual level. Journal Of Epidemiology And Community Health.
62, 689-694.
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Objective: The aim of the present paper was to give insight into the practical
consequences of using either single-level or multilevel regression analyses on data from
research on environmental determinants of physical activity. Methods: For this purpose,
results from single-level and multilevel regression analyses on comparable attributes of
the environment were compared using a combination of individual and aggregated data,
merged at the neighbourhood level. Results: Using only individual level data, applying
multilevel instead of single-level analyses did not substantially influence the results.
However, ignoring the multilevel structure of our data by applying single-level in stead of
multilevel analyses resulted in statistically significant associations for all the
environmental attributes under study. Moreover, using information on environmental
attributes at both the individual and the contextual level to adjust associations at one level
for the other level showed that associated environmental attributes tend to be associated
either at the individual or at the contextual level. Conclusions: These results stress the
importance for reviews and meta-analyses of recording type of measurement and type of
analytical strategy used and incorporating them in the review process. Using advanced
multilevel designs will still only partly solve the methodological issues involved in
studying environmental attributes associated with physical activity, but it will help in
disentangling this complex relationship. Therefore, it is recommended that, whenever
there is a presumably relevant grouping (context; eg neighbourhoods) in a study, a
multilevel approach should at least be considered.
D. E. Whaley and P. P. Haley. (2008). Creating Community, Assessing Need: Preparing
for a Community Physical Activity Intervention. Research Quarterly for Exercise &
Sport. 79, 245.
This paper describes the preliminary steps needed to begin a community physical activity
intervention in a rural context, including forming a community coalition and assessing
values, beliefs, and knowledge about physical activity. A random mail survey (N = 171)
indicated relatively high activity rates, and perceived barriers consistent with the
literature (time, program convenience, safety issues). Perceived benefits included
improving/sustaining health and looking better/improving appearance. Five focus groups
added additional barriers (e.g., physical isolation, lack of transportation). Residents were
unaware of many existing services and indicated a desire for more walking trails, healthrelated activities, and low-cost exercise facilities. The discussion focuses on the
importance of establishing a community coalition and implications for future program
development and research.
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POLICY – CHILD AND ADULT PHYSICAL ACTIVITY/OBESITY
(2008). Active living in diverse and disadvantaged communities. Proceedings of the
Fourth Annual Active Living Research Conference. February 22-24, 2007. Coronado,
California, USA. Am J Prev Med. 34, 271-372.
(2008). Practicing What We Preach: A Look at Healthy Active Living Policy and
Practice in Canadian Pediatric Hospitals. Clinical Journal of Sport Medicine. 18, 187.
An abstract of the article "Practicing What We Preach: A Look at Healthy Active Living
Policy and Practice in Canadian Pediatric Hospitals," by Ziad Solh, Jennica L. Plan,
Kristi B. Adamo, Erin Boyd, Elaine Orrbine and Elizabeth Cummings is presented.
S. Adler, N. Dobson, K. P. Fox and L. Weigand. (2008). Advocating for active living on
the rural-urban fringe: A case study of planning in the Portland, Oregon, metropolitan
area. Journal Of Health Politics Policy And Law. 33, 525-558.
This case study is about the politics of incorporating active-living elements into a concept
plan for a new community of about 68,000 people on the edge of the Portland, Oregon,
metropolitan area. Development on the rural-urban fringe is ongoing in metropolitan
areas around the United States. In this article, we evaluate the product of the conceptplanning process from the standpoint of the extent to which environmental elements
conducive to active living were included. We also analyze four issues in which
challenges to the incorporation of active-living features surfaced: choices related to
transportation facilities, the design and location of retail stores, the location of schools
and parks, and the location of a new town center. Overall, the Damascus/Boring Concept
Plan positions the area well to promote active living. Analyses of the challenges that
emerged yielded lessons for advocates regarding ways to deal with conflicts between
facilitating active living and local economic development and related tax-base concerns
and between active-living elements and school-district planning autonomy as well as the
need for advocates to have the capacity to present alternatives to the usual financial and
design approaches taken by private- and public-sector investors.
S. Ahrentzen. (2008). Sustaining active-living communities over the decades: Lessons
from a 1930s greenbelt town. Journal Of Health Politics Policy And Law. 33, 429-453.
Greendale, Wisconsin, was intentionally created with many of the design and planning
principles that active-living advocates promote today. This case study examines the
processes behind sustaining these particular planning and design principles over time in
light of economic and regional challenges that have faced not just Greendale but most
town centers over the last fifty years. Despite these challenges, the walkable nature of
Greendale's center remains strong today, in terms of both activity and community
identity. While many circumstances are specific to this particular town, useful lessons can
be drawn for those new urbanist (NU) communities being developed in greenfields and
suburbs today, many of which are strikingly similar to Greendale - relatively small, low
density, and located within metropolitan areas. Greendale's success resulted from (1)
attending to the retail/commercial product mix; (2) attracting nonresidents to use the
community's retail and public space; and (3) capitalizing on community investment not
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simply from residents' organizing efforts but, more important in this case, from corporate
community involvement by a Greendale business firm whose interests and values
coincided with those of the community.
S. A. Aytur, D. A. Rodriguez, K. R. Evenson and D. J. Catellier. (2008). Urban
containment policies and physical activity: A time-series analysis of metropolitan areas,
1990-2002. American Journal Of Preventive Medicine. 34, 320-332.
Background: Urban containment policies attempt to manage the location, character, and
timing of growth to support a variety of goals such as compact development, preservation
of greenspace, and efficient use of infrastructure. Despite prior research evaluating the
effects of urban containment policies on land use, housing, and transportation outcomes,
the public health implications of these policies remain unexplored. This ecologic study
examines relationships among urban containment policies, state adoption of
growthmanagement legislation, and population levels of leisure and transportation-related
physical activity in 63 large metropolitan statistical areas from 1990 to 2002. Methods:
Multiple data sources were combined, including surveys of urban containment policies,
the Behavioral Risk Factor Surveillance System, the U.S. Census of Population, the
National Resources Inventory, and the Texas Transportation Institute Urban Mobility
Study. Mixed models were used to examine whether urban containment policies and state
adoption of growth-management legislation were associated with population levels of
leisure-time physical activity (LTPA) and walking/bicycling to work over time. Results:
Strong urban containment policies were associated with higher population levels of
LTPA and walking/bicycling to work during the study period. Additionally, residents of
states with legislation mandating urban growth boundaries reported significantly more
minutes of LTPA/week compared to residents of states without such policies. Weak
urban containment policies showed inconsistent relationships with physical activity.
Conclusions: This study provides preliminary evidence that strong urban containment
policies are associated with higher population levels of LTPA and active commuting.
Future research should examine potential synergies among state, metropolitan, and local
policy processes that may strengthen these relationships.
A. Baumann, M. Hunsberger, J. Blythe and M. Crea. (2008). Sustainability of the
workforce: government policies and the rural fit. Health Policy. 85, 372-9.
OBJECTIVES: Critical workforce issues among health care workers have raised public
concerns about the ability of health care systems to provide adequate service. Services,
however, are influenced by geographical and social factors. One important source of
variation is rurality. This study evaluated the perception of the applicability of health
human resource policies for rural areas. METHODS: An exploratory design was used.
Twenty-one nurse administrators and 44 staff nurses from a sampling of 19 rural health
care settings were interviewed. Hospitals with less than 100 beds were targeted.
RESULTS: The government policies most frequently mentioned by study participants
were the goal of 70% full-time employment, the new graduate policy and the late career
initiative. Each presented challenges to managers attempting implementation. Urban bias
is apparent in health care policy including health human resource policies. Little data is
available about rural health care workers because health care statistics tend to be reported
regionally. CONCLUSION: Rural institutions have difficulty accessing government
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funding intended to build sustainable workforces. Policies meant to be broadly
implemented across jurisdictions may not fit the needs of rural institutions and their
clients. Health care databases should include a rural variable to enhance understanding
about this population.
W. Bemelmans, P. van Baal, W. Wendel-Vos, J. Schuit, E. Feskens, A. Ament and R.
Hoogenveen. (2008). The costs, effects and cost-effectiveness of counteracting
overweight on a population level. A scientific base for policy targets for the Dutch
national plan for action. Prev Med. 46, 127-32.
OBJECTIVES: To gain insight in realistic policy targets for overweight at a population
level and the accompanying costs. Therefore, the effect on overweight prevalence was
estimated of large scale implementation of a community intervention (applied to 90% of
general population) and an intensive lifestyle program (applied to 10% of overweight
adults), and costs and cost-effectiveness were assessed. METHODS: Costs and effects
were based on two Dutch projects and verified by similar international projects. A
markov-type simulation model estimated long-term health benefits, health care costs and
cost-effectiveness. RESULTS: Combined implementation of the interventions--at the
above mentioned scale--reduces prevalence rates of overweight by approximately 3
percentage points and of physical inactivity by 2 percentage points after 5 years, at a cost
of 7 euros per adult capita per year. The cost-effectiveness ratio of combined
implementation amounts to euro 6000 per life-year gained and euro 5700 per QALY
gained (including costs of unrelated diseases in life years gained). Sensitivity analyses
showed that these ratios are quite robust. CONCLUSIONS: A realistic policy target is a
decrease in overweight prevalence of three percentage points, compared to a situation
with no interventions. In reality, large scale implementation of the interventions may not
counteract the expected upward trends in The Netherlands completely. Nonetheless,
implementation of the interventions is cost-effective.
S. E. Benjamin, A. Cradock, E. M. Walker, M. Slining and M. W. Gillman. (2008).
Obesity prevention in child care: A review of US state regulations. Bmc Public Health. 8,
Objective: To describe and contrast individual state nutrition and physical activity
regulations related to childhood obesity for child care centers and family child care
homes in the United States. Methods: We conducted a review of regulations for child
care facilities for all 50 states and the District of Columbia. We examined state
regulations and recorded key nutrition and physical activity items that may contribute to
childhood obesity. Items included in this review were: 1) Water is freely available; 2)
Sugar-sweetened beverages are limited; 3) Foods of low nutritional value are limited; 4)
Children are not forced to eat; 5) Food is not used as a reward; 6) Support is provided for
breastfeeding and provision of breast milk; 7) Screen time is limited; and 8) Physical
activity is required daily. Results: Considerable variation exists among state nutrition and
physical activity regulations related to obesity. Tennessee had six of the eight regulations
for child care centers, and Delaware, Georgia, Indiana, and Nevada had five of the eight
regulations. Conversely, the District of Columbia, Idaho, Nebraska and Washington had
none of the eight regulations. For family child care homes, Georgia and Nevada had five
of the eight regulations; Arizona, Mississippi, North Carolina, Oregon, Tennessee, Texas,
Vermont, and West Virginia had four of the eight regulations. California, the District of
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Columbia, Idaho, Iowa, Kansas, and Nebraska did not have any of the regulations related
to obesity for family child care homes. Conclusion: Many states lack specific nutrition
and physical activity regulations related to childhood obesity for child care facilities. If
widely implemented, enhancing state regulations could help address the obesity epidemic
in young children in the United States.
T. K. Boehmer, D. A. Luke, D. L. Haire-Joshu, H. S. Bates and R. C. Brownson. (2008).
Preventing childhood obesity through state policy. Predictors of bill enactment. Am J
Prev Med. 34, 333-40.
BACKGROUND: To address the epidemic of childhood obesity, health professionals are
examining policies that address obesogenic environments; however, there has been little
systematic examination of state legislative efforts in childhood obesity prevention. Using
a policy research framework, this study sought to identify factors that predict successful
enactment of childhood obesity prevention in all 50 states. METHODS: A legislative
scan of bills introduced during 2003-2005 in all 50 states identified 717 bills related to
childhood obesity prevention. Multilevel logistic regression modeling was performed in
2006 to identify bill-level (procedure, composition, and content) and state-level
(sociodemographic, political, economic, and industrial) factors associated with bill
enactment. RESULTS: Seventeen percent of bills were enacted. Bill-level factors
associated with increased likelihood of enactment included having more than one
sponsor; bipartisan sponsorship; introduction in the state senate; budget proposals; and
content areas related to safe routes to school, walking/biking trails, model school policies,
statewide initiatives, and task forces and studies. State-level political factors, including 2year legislative session and Democratic control of both chambers, increased enactment.
An indicator of state socioeconomic status was inversely associated with bill enactment;
economic and industrial variables were not significantly related to bill enactment.
CONCLUSIONS: In general, bill-level factors were more influential in their effect on
policy enactment than state-level factors. This study provides policymakers, practitioners,
and advocacy groups with strategies to develop more politically feasible childhood
obesity prevention policies, including the identification of several modifiable bill
characteristics that might improve bill enactment.
L. D. Brown and M. K. Kraft. (2008). Active living as an institutional challenge: Lessons
from the Robert Wood Johnson Foundation's "Celebrate Fitness" program. Journal Of
Health Politics Policy And Law. 33, 497-523.
Native American youth suffer disproportionately from a range of adverse health
conditions. Empowering youth leaders to work on community-based solutions has proved
effective in reducing tobacco use and gun violence and is now emerging as a promising
approach to improving fitness and health. This article, based on direct observation and
interviews with key informants, examines the implementation of a Robert Wood Johnson
Foundation - funded project that gave tribal youth councils minigrants to design and run
diverse projects that encourage physical activity in their communities. The article
highlights the institutional challenges that confront health-promotion strategies for
disadvantaged populations. Unless they take proper account of organizational, political,
environmental, and cultural forces, funders' interventions have limited chances for
success and sustainability.
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R. C. Brownson, C. M. Kelly, A. A. Eyler, C. Carnoske, L. Grost, S. L. Handy, J. E.
Maddock, D. Pluto, B. A. Ritacco, J. F. Sallis and T. L. Schmid. (2008). Environmental
and Policy Approaches for Promoting Physical Activity in the United States: A Research
Agenda. Journal of Physical Activity & Health. 5, 488.
Background: Environmental and policy approaches are promising strategies to raise
population-wide rates of physical activity; yet, little attention has been paid to the
development and prioritization of a research agenda on these topics that will have
relevance for both researchers and practitioners. Methods: Using input from hundreds of
researchers and practitioners, a research agenda was developed for promoting physical
activity through environmental and policy interventions. Concept mapping was used to
develop the agenda. Results: Among those who brainstormed ideas, 42% were
researchers and 33% were practitioners. The data formed a concept map with 9 distinct
clusters. Based on ratings by both researchers and practitioners, the policy research
cluster on city planning and design emerged as the most important, with economic
evaluation second. Conclusions: Our research agenda sets the stage for new inquiries to
better understand the environmental and policy influences on physical activity.
J. Cawley and L. Feng. (2008). Correlates of State Legislative Action to Prevent
Childhood Obesity. Obesity (19307381). 16, 162.
The article discusses a study which aims to determine the factors associated with state
legislatures to prevent childhood obesity in the U.S. Based on the results, the trend
toward the introduction of bills and enactment of laws to address childhood obesity
occurred from 2003 to 2005. The results also showed that states with Democratic
governors and state legislatures not controlled by Republicans are associated with greater
policy actions against obesity.
J. C. Cogan, J. P. Smith and M. D. Maine. (2008). The risks of a quick fix: a case against
mandatory body mass index reporting laws. Eat Disord. 16, 2-13.
As the United States addresses obesity, a number of state legislatures are considering
laws that require schools to track and report students' body mass index (BMI), a
measurement of body weight (weight/height2). This article describes the state level
activity on mandatory BMI reporting, offers numerous arguments against this practice,
and suggests an alternative approach to promoting health in youth. Mandatory BMI
reporting laws place a new and inappropriate responsibility on the schools. Proponents of
such laws imply that BMI reporting will have positive outcomes, yet there is virtually no
independent research to support this assumption. The authors argue that these laws could
do significant harm, including an increased risk for children to develop eating disorder
symptoms.
D. Cohen, A. Sehgal, S. Williamson, D. Golinelli, T. L. McKenzie, P. Capone-Newton
and N. Lurie. (2008). Impact of a new bicycle path on physical activity. Prev Med. 46,
80-1.
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R. D. Edwards. (2008). Public transit, obesity, and medical costs: assessing the
magnitudes. Prev Med. 46, 14-21.
OBJECTIVE: This paper assesses the potential benefits of increased walking and reduced
obesity associated with taking public transit in terms of dollars of medical costs saved
and disability avoided. METHODS: I conduct a new analysis of a nationally
representative U.S. transportation survey to gauge the net increase in walking associated
with public transit usage. I translate minutes spent walking into energy expenditures and
reductions in obesity prevalence, estimating the present value of costs and disability that
may be avoided. RESULTS: Taking public transit is associated with walking 8.3 more
minutes per day on average, or an additional 25.7-39.0 kcal. Hill et al. [Hill, J.O., Wyatt,
H.R., Reed, G.W., Peters, J.C., 2003. Obesity and the environment: Where do we go from
here? Science 299 (5608), 853-855] estimate that an increase in net expenditure of 100
kcal/day can stop the increase in obesity in 90% of the population. Additional walking
associated with public transit could save $5500 per person in present value by reducing
obesity-related medical costs. Savings in quality-adjusted life years could be even higher.
CONCLUSIONS: While no silver bullet, walking associated with public transit can have
a substantial impact on obesity, costs, and well-being. Further research is warranted on
the net impact of transit usage on all behaviors, including caloric intake and other types
of exercise, and on whether policies can promote transit usage at acceptable cost.
M. F. Floyd, C. J. Crespo and J. F. Sallis. (2008). Active living research in diverse and
disadvantaged communities stimulating dialogue and policy solutions. Am J Prev Med.
34, 271-4.
G. D. Foster, S. Sherman, K. E. Borradaile, K. M. Grundy, S. S. Vander Veur, J.
Nachmani, A. Karpyn, S. Kumanyika and J. Shults. (2008). A policy-based school
intervention to prevent overweight and obesity. Pediatrics. 121, e794-802.
BACKGROUND: The prevalence and seriousness of childhood obesity has prompted
calls for broad public health solutions that reach beyond clinic settings. Schools are ideal
settings for population-based interventions to address obesity. OBJECTIVE: The purpose
of this work was to examine the effects of a multicomponent, School Nutrition Policy
Initiative on the prevention of overweight (85.0th to 94.9th percentile) and obesity (>
95.0th percentile) among children in grades 4 through 6 over a 2-year period.
METHODS: Participants were 1349 students in grades 4 through 6 from 10 schools in a
US city in the Mid-Atlantic region with > or = 50% of students eligible for free or
reduced-price meals. Schools were matched on school size and type of food service and
randomly assigned to intervention or control. Students were assessed at baseline and
again after 2 years. The School Nutrition Policy Initiative included the following
components: school self-assessment, nutrition education, nutrition policy, social
marketing, and parent outreach. RESULTS: The incidences of overweight and obesity
after 2 years were primary outcomes. The prevalence and remission of overweight and
obesity, BMI z score, total energy and fat intake, fruit and vegetable consumption, body
dissatisfaction, and hours of activity and inactivity were secondary outcomes. The
intervention resulted in a 50% reduction in the incidence of overweight. Significantly
fewer children in the intervention schools (7.5%) than in the control schools (14.9%)
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became overweight after 2 years. The prevalence of overweight was lower in the
intervention schools. No differences were observed in the incidence or prevalence of
obesity or in the remission of overweight or obesity at 2 years. CONCLUSION: A
multicomponent school-based intervention can be effective in preventing the
development of overweight among children in grades 4 through 6 in urban public schools
with a high proportion of children eligible for free and reduced-priced school meals.
B. Giles-Corti, M. Knuiman, A. Timperio, K. Van Niel, T. J. Pikora, F. C. L. Bull, T.
Shilton and M. Bulsara. (2008). Evaluation of the implementation of a state government
community design policy aimed at increasing local walking: Design issues and baseline
results from RESIDE, Perth Western Australia. Preventive Medicine. 46, 46-54.
Objectives. To describe the design and baseline results of an evaluation of the Western
Australian government's pedestrian-friendly subdivision design code (Liveable
Neighborhood (LN) Guidelines). Methods. Baseline results (2003-2005) from a
longitudinal study of people (n=1813) moving into new housing developments: 18
Liveable, 11 Hybrid and 45 Conventional (i.e., LDs, HDs and CDs respectively) are
presented including usual recreational and transport-related walking undertaken within
and outside the neighborhood, and 7-day pedometer steps. Results. At baseline, more
participants walked for recreation and transport within the neighborhood (52.6%; 36.1%
respectively), than outside the neighborhood (17.7%; 13.2% respectively). Notably, only
20% of average total duration of walking (128.4 min/week (SD159.8)) was transport
related and within the neighborhood. There were few differences between the groups'
demographic, psychosocial and perceived neighborhood environmental characteristics,
pedometer steps, or the type, amount and location of self-reported walking (p>0.05).
However, asked what factors influenced their choice of housing development, more
participants moving into LDs reported aspects of their new neighborhood's walkability as
important (p<0.05). Conclusions. The baseline results underscore the desirability of
incorporating behavior and context-specific measures and value of longitudinal designs to
enable changes in behavior, attitudes, and urban form to be monitored, while adjusting
for baseline residential location preferences.
R. Hanson and G. Young. (2008). Active living and biking: Tracing the evolution of a
biking system in Arlington, Virginia. Journal Of Health Politics Policy And Law. 33,
387-406.
In Arlington, Virginia, a steady evolutionary change in biking policy during the last three
decades has yielded some of the nation's best biking assets. It has a comprehensive, wellconnected, highly integrated, well-mapped, and well-signed system of shared-use paved
trails, bike lanes, bike routes, and other biking assets, such as workplace showers.
Understanding the conditions that led to Arlington's current biking system can provide
lessons in the strategy and tactics of active-living politics. One potentially effective
political strategy that was successful in Arlington is for activists to pressure elected
officials to select professional managers who see bikeways as crucial to the overall
transportation system. Then it is important to formalize the government-citizen
relationship through an advisory panel. Also, in Arlington, the incremental creation of
biking assets helped create demand for more and better facilities. In turn, this created
political support for expanding and upgrading. Finally, Arlington used potentially
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negative circumstances (e. g., the building of highway corridors, the introduction of the
Metro) as opportunities to change the built environment in ways that have encouraged
more active living.
J. Harrington, S. Friel, C. Thunhurst, A. Kirby and B. McElroy. (2008). Obesogenic
island: the financial burden of private transport on low-income households. Journal Of
Public Health. 30, 38-44.
Background The physical and social environment influences access to a healthy lifestyle,
of which transport is one determining factor. This paper estimates the cost of transport on
the island of Ireland. Methods Budget standards were developed on the basis of costs of
baskets of core goods and services required for daily living. The transport budget was
based on the needs of an urban living family. Financial capacity of the family relative to
transport basket costs was determined. Results Transport costs vary depending on family
type and car ownership. The motoring costs for a family with two unemployed adults,
with a weekly financial capacity of 388.28(sic) and 427.70(sic), respectively, for the
Republic of Ireland and Northern Ireland, amount to 94.78(sic) and 74.68(sic),
representing 18 and 10% of the family's weekly income. Conclusion The prohibitive
costs of private transport present an opportunity for policy makers to consider creating
supportive environments incorporating the more cost-effective and environmentally
friendly options of public transport. Without such measures, dependence on private
transport will exacerbate the incidence of food poverty and the health inequalities
consequent upon it.
L. A. Hearn, M. R. Miller and R. Campbell-Pope. (2008). Review of evidence to guide
primary health care policy and practice to prevent childhood obesity. Med J Aust. 188,
S87-91.
OBJECTIVES: To identify key barriers to effective engagement of primary health care
(PHC) providers and families in promoting healthy weight among children aged 2-6
years, and to examine promising interventions to identify policy goals to overcome these
barriers. METHODS: We conducted a literature review of published and unpublished
articles from January 1990 to February 2006 using keywords relating to childhood
obesity, risk factors, prevention, populations and primary care provider interventions,
constraints and models. We identified barriers to engagement by PHC providers.
Appraisal of "promise" was based on best available evidence and consideration of
strengths and weaknesses of interventions in specific contexts and settings. RESULTS:
Of 982 interventions aimed at the primary prevention of overweight and obesity among
children, few related to 2-6-year-olds, with only 45 interventions meeting the inclusion
criteria and 11 ranking highly on key criteria. Areas of weakness were low-level
engagement by PHC providers, focus on single risk factors rather than a
multidimensional approach, and lack of a population focus. A range of administrative,
attitudinal, knowledge, skills and training issues were identified as barriers to effective
engagement of different PHC providers with parents and other early childhood service
providers. CONCLUSIONS: Engagement of PHC providers in prevention of childhood
obesity requires a systematic approach involving practice protocols, assessment tools,
client support material and referral pathways, as well as adequate training and sufficient
staff for implementation. A more comprehensive approach could be promoted by
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increased collaboration, agreed role delineation, consistent public health messages and
better coordination between PHC providers and other service providers, facilitated at
service policy and administration level.
K. M. Heinrich, C. B. Johnson, Y. Jokura, B. Nett and J. E. Maddock. (2008). A survey
of policies and local ordinances supporting physical activity in Hawaii counties. Prev
Chronic Dis. 5, A19.
BACKGROUND: Features of the built environment that influence physical activity
behavior characterize Active Community Environments. CONTEXT: Whether Active
Community Environments policies exist in the state of Hawaii's four counties is
unknown. The purpose of this study was to provide a baseline assessment of these
policies in Hawaii. METHODS: A survey assessing policies in six domains (i.e.,
sidewalks, bike lanes, greenways, recreational facilities, commercial buildings, and
shared-use paths) was completed by employees of Hawaii planning departments.
CONSEQUENCES: Honolulu County had the most policies (n = 13), followed by Maui
County (n = 6), Kauai County (n = 2), and Hawaii County (n = 1). Written policies were
most prevalent in Honolulu County (n = 15), followed by Kauai County (n = 14), Hawaii
County, (n = 4), and Maui County (n = 3). Sidewalk policies were reported for Honolulu
County, Maui County (no written policies were found for Maui County), and Kauai
County. Bike lane and greenway policies were found for Honolulu County (reported and
written) and Kauai County (written). Recreation facility and pedestrian shared-use path
policies existed for all counties, although only Honolulu and Kauai counties had written
policies for commercial buildings (Maui County reported having policies). Few policies
directly addressed physical activity promotion. INTERPRETATION: The most populous
county, Honolulu, had the most policies in place, although discrepancies existed between
reported and written policies. This baseline measure of physical activity-related policies
will help focus efforts of county coalitions to increase opportunities for physical activity.
Additional policies should be tracked with population behavior surveillance.
W. P. T. James. (2008). The fundamental drivers of the obesity epidemic. Obesity
Reviews. 9, 6-13.
Most policy makers do not yet understand that the obesity epidemic is a normal
population response to the dramatic reduction in the demand for physical activity and the
major changes in the food supply of countries over the last 40 years. A national focus on
individual behaviour reflects a failure to confront the facts. Thus, the changes in food
supply and physical environment are socioeconomically driven, and the health sector
simply picks up the consequences. Urbanization alone in China has reduced daily energy
expenditure by about 300-400 kcal d(-1) and cycling/bussing or going to work by car
determines another variation of 200 kcal d(-1). Thus, energy demands may have dropped
with additional TV/media, mechanization and computerized changes by 400-800 kcal d(1), so weight gain and obesity are inevitable for most or all the population. Food intake
should have fallen substantially despite the community's focus on the value of food after
all the food crises of the past. Yet, Chinese fat and sugar intakes are escalating, and these
policy-mediated features are amplified by the primeval biological drive for those
commodities with specialized taste buds for fatty acids, meat, sugar and salt. Yet,
traditionally, Chinese diets had negligible sugar, and 25-year-old data show that the
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optimum diet for Chinese contains 15% fat. Policies relating to food imports, agriculture,
food quality standards, appropriate food traffic light labelling, price adjustments and
controlled access to unhealthy foods are all within the grasp of the Chinese government.
China has traditionally been far more responsive to the value of policies which limit
inequalities and establish standards of care than many western governments, who have
yet to recognize that the individualistic free-market approach to obesity prevention is
guaranteed to fail. China could therefore lead the way: if it follows western approaches,
the health and economic burden will become unsustainable.
S. K. Kumanyika. (2008). Global calorie counting: a fitting exercise for obese societies.
Annu Rev Public Health. 29, 297-302.
Implementation of strategies to address obesity on a global scale has not yet begun in
earnest. One key issue is uncertainty about the relative importance of taking aggressive
action on the food vs. physical activity side of the energy balance equation, recognizing
that interventions in both areas are critical. Using data on obesity prevalence, food
availability, and selected economic and sociodemographic indicators from member
countries of the Organization for Economic Cooperation and Development, an article in
this volume of the Annual Review of Public Health provides estimates and projections to
help resolve this uncertainty. The analyses presented support the authors' hypothesis that
most of the recent rise in obesity is attributable to excess caloric intake. The implication
that policies to curb overconsumption might include deliberate changes in the price
structure of the food supply should stimulate debate about our current agricultural and
trade paradigms, particularly because any such global policies would also affect the
developing world.
J. M. Lee. (2008). Why young adults hold the key to assessing the obesity epidemic in
children. Archives Of Pediatrics & Adolescent Medicine. 162, 682-687.
Despite significant increases in prevalence rates of childhood obesity in the United States
during the past 2 decades, rates of type 2 diabetes mellitus among children at the
population level have not followed a similar trajectory as those in adults. In this review,
hypotheses for the contrasting findings in children compared with adults are explored, as
are possible links between the trends in childhood obesity rates and increases in type 2
diabetes among young adults in the United States. This review concludes with
observations about the profound policy implications from current patterns of type 2
diabetes among youth and particularly young adults and a proposed research agenda
regarding childhood obesity and type 2 diabetes risk over the life course.
K. M. Leyden, B. Reger-Nash, A. Bauman and T. Bias. (2008). Changing the Hearts and
Minds of Policy Makers: An Exploratory Study Associated With the West Virginia
Walks Campaign. American Journal of Health Promotion. 22, 204.
Purpose. To pilot test whether West Virginia Walks changed local policy makers'
awareness of walking-related issues. Design. A quasi-experimental design with
preintervention and postintervention mail surveys. Setting. Morgantown, WV
(intervention community), and Huntington, WV (comparison community). Subjects. One
hundred thirty-three and 134 public officials in Morgantown and 120 and 116 public
officials in Huntington at baseline and at follow-up, respectively. Intervention. An 8-
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week mass media social ecological campaign designed to encourage moderate-intensity
walking among insufficiently active persons aged 40 to 65 years. Measures. Policy
makers listed three problems they believed needed to be addressed in their community.
They then rated the severity of several problems that many communities face using a
Likert scale, with 1 representing "not a problem" and 5 representing "an extremely
important problem." Analysis. Independent sample t-tests were used to examine
differences in mean responses at baseline and at follow-up. Results. Statistically
significant increases in the perceived importance of walking-related issues were observed
among policy makers in Morgantown but not in the comparison community.
Conclusions. Integrated communitywide health promotion campaigns designed to
influence the public can also affect the perceptions of policy makers. Future research
should examine this linkage and determine whether resource allocation and policy
changes follow such interventions.
R. Lopez, R. Campbell and J. Jennings. (2008). The Boston Schoolyard Initiative: A
public-private partnership for rebuilding urban play spaces. Journal Of Health Politics
Policy And Law. 33, 617-638.
The Boston Schoolyard Initiative (BSI) is a policy effort to rebuild school yards in
Boston through innovative citywide public-private partnerships. At the center of the
initiative is a commitment to engage multiple stakeholders and utilize a bottom-up
planning process to encourage meaningful change. Based on a case study of BSI, this
article develops a framework to understand and analyze how different school and
neighborhood sectors can partner to benefit neighborhood communities and utilize the
built environment to encourage more active living and active learning. The article
contributes to a literature that focuses on the effects of school yards and the role of
physically active environments on learning. It expands on this literature by looking at the
school-yard initiative as a way to build and expand relationships between teachers,
parents, and the community at large. Finally, the study shows that even older schools in
inner-city neighborhoods, previously considered blights, can be turned into community,
educational, and political assets.
J. R. Morrow, J. E. Fulton, N. D. Brener and H. W. Kohl. (2008). Prevalence and
correlates of physical fitness testing in US schools-2000. Research Quarterly For
Exercise And Sport. 79, 141-148.
Because of the perceived lack of youth physical fitness and/or concerns for increased
obesity, physical education teachers are interested in youth fitness and physical activity
levels. Statewide mandates are being developed that require school-based teachers to
complete physical fitness testing. Data from the nationally representative School Health
Policies and Programs Study 2000 were analyzed to investigate the prevalence of fitness
testing and the professional characteristics of fitness test users. Data: were collected with
teachers of either randomly selected classes in elementary schools and randomly selected
required physical education courses in middle/junior high and senior high schools (N =
1,564). The prevalence of fitness test use is 65% across all school levels. Variables
associated with physical fitness test usage., were professionally oriented. Results showed
that teachers in secondary schools (odds ratio [OR] = 2.25, 95% confidence interval [CI]
= 1.18-4.27), those with degrees in physical education/kinesiology-related disciplines
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(OR = 2.01, 95% CI = 1.11-3.63), and those who had completed staff development on
physical fitness testing (OR = 3.22, 95% CI = 1.86-5.60) were more likely than
respondents without these characteristics to engage in physical fitness testing. Results
changed little when separate analyses were conducted for classes/courses in districts
requiring versus not requiring fitness testing. Financial variables, including fitnessoriented facilities available, metropolitan location, and discretionary expenditures per
student, were not associated with fitness test use. Results provided national prevalence of
school-based physical fitness testing use in the U. S. and conveyed information about
those who currently use physical fitness tests.
D. Penney. (2008). Playing a political game and playing for position: Policy and
curriculum development in health and physical education. European Physical Education
Review. 14, 33.
This paper addresses prospective policy relationships between health and physical
education (HPE) and contemporary education policies. It specifically explores the
opportunities and challenges that contemporary education discourses present for policy
and curriculum development in HPE. Contemporary education discourses of lifelong
learning, learning communities, personalized learning, inclusivity and excellence are
critically analysed in relation to policy and curriculum development in HPE. It is
contended that these discourses present a potentially strong focus for advocacy and that
their adoption may be an astute political move for HPE. Recent curriculum development
in senior physical education in Western Australia is used to illustrate the scope for the
discourses to be embedded in curricula and for HPE to thereby be seen to firmly connect
with key education agendas.
J. Pucher and R. Buehler. (2008). Making cycling irresistible: Lessons from the
Netherlands, Denmark and Germany. Transport Reviews. 28, 495-528.
This article shows how the Netherlands, Denmark and Germany have made bicycling a
safe, convenient and practical way to get around their cities. The analysis relies on
national aggregate data as well as case studies of large and small cities in each country.
The key to achieving high levels of cycling appears to be the provision of separate
cycling facilities along heavily travelled roads and at intersections, combined with traffic
calming of most residential neighbourhoods. Extensive cycling rights of way in the
Netherlands, Denmark and Germany are complemented by ample bike parking, full
integration with public transport, comprehensive traffic education and training of both
cyclists and motorists, and a wide range of promotional events intended to generate
enthusiasm and wide public support for cycling. In addition to their many pro-bike
policies and programmes, the Netherlands, Denmark and Germany make driving
expensive as well as inconvenient in central cities through a host of taxes and restrictions
on car ownership, use and parking. Moreover, strict land-use policies foster compact,
mixed-use developments that generate shorter and thus more bikeable trips. It is the
coordinated implementation of this multi-faceted, mutually reinforcing set of policies that
best explains the success of these three countries in promoting cycling. For comparison,
the article portrays the marginal status of cycling in the UK and the USA, where only
about 1% of trips are by bike.
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J. A. Rye, N. O'Hara Tompkins, R. Eck and W. A. Neal. (2008). Promoting youth
physical activity and healthy weight through schools. W V Med J. 104, 12-5.
The prevalence of overweight in youth has increased three- to four-fold in the United
States since the 1960s. The school environment can play prominently in the mitigation of
this epidemic by increasing physical activity opportunities/ levels, decreasing the
availability of food/ beverage with added sugar, and enhancing students' scientific
understandings about energy balance. The potential to increase energy expenditure goes
beyond the school day to include safe routes for walking and biking to school (active
transport) as well as the availability of school facilities as a community resource for
physical activity outside of school hours. However, school consolidation and siting
decisions have profound effects on active transport as well as the school as a community
resource. Teachers and adolescents should not be overlooked as important partners in
conceiving and carrying out programming that seeks to increase physical activity levels
in youth and the broader community. As leaders and health care providers in their
communities, physicians are postured to be effective advocates of, and to leverage in
their own practice, school-based policies and practices towards promoting healthy weight
in youth.
T. J. Ryley. (2008). The propensity for motorists to walk for short trips: Evidence from
West Edinburgh. Transportation Research Part A-Policy And Practice. 42, 620-628.
The trade-offs individuals make between the motor car and walking for short trips are
investigated, using data from a West Edinburgh household survey. Propensity to walk
discrete choice models are estimated from a stated preference experiment within the
survey questionnaire. This includes segmented models using socio-economic, spatial and
attitudinal variables. The relative importance of the three attributes of journey time, petrol
cost and parking cost are examined; value of time estimates are also generated. With all
other factors remaining constant, for short trips motorists are more likely to walk in
response to an increase in parking costs than a rise in petrol prices. The use of parking as
a transport policy tool is discussed. (c) 2008 Elsevier Ltd. All rights reserved.
D. Salvesen, K. R. Evenson, D. A. Rodriguez and A. Brown. (2008). Factors influencing
implementation of local policies to promote physical activity: A case study of
Montgomery County, Maryland. Journal Of Public Health Management And Practice. 14,
280-288.
Policy interventions such as zoning ordinances, school facility siting guidelines, capital
improvement programs, and park master plans hold particular promise for promoting
physical activity, especially at the local level. Despite increasing attention to the
relationship between built environment characteristics and physical activity, there is a
paucity of research on the extent to which local policies can promote or hinder physical
activity. Furthermore, the impact of local policies on physical activity should depend on
how effectively the policies are implemented. Based on the policy implementation
literature and using Montgomery County, Maryland, as a case study, this study identifies
factors related to the successful implementation of local policies hypothesized to
influence physical activity. For our study, we conducted an extensive policy review and
17 in-depth interviews with 26 individuals. The interviews were transcribed, coded, and
analyzed to identify the relevant factors that affect policy implementation. Our findings
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suggest that knowledge and awareness, commitment and capacity, intergovernmental
coordination, the presence of an advocate or champion, and conflict influence physical
activity policy implementation at the local level. Those trying to increase physical
activity through policy could focus on these implementation features to help make policy
implementation more successful.
J. Schilling and S. D. Keyes. (2008). The promise of Wisconsin's 1999 comprehensive
planning law: Land-use policy reforms to support active living. Journal Of Health Politics
Policy And Law. 33, 455-496.
Weaving together the disciplines of planning and policy change with the emerging
research of active living, this article explores the competing interests and underlying
political forces behind the design and passage of Wisconsin's Comprehensive Planning
Law of 1999. While Wisconsin's law remains a work in progress, it illustrates the
contemporary policy battles over land use and smart growth and the resurgence of the
property-rights movement. It further highlights the influence of smart-growth coalitions
and policy networks on planning reform. The authors suggest that planning practitioners
and active-living proponents can adapt and transfer these policy lessons from Wisconsin
to address the complex relationships of the built environment, physical activity, and the
nation's current obesity problem through state and local planning reforms.
D. Siegel. (2008). Policies and Opportunities for Physical Activity in Middle Schools.
JOPERD: The Journal of Physical Education, Recreation & Dance. 79, 8.
The article presents a study on policies and opportunities for physical activity in middle
schools. It states that various interventions have been proposed to increase children's
participation in physical activity. In this activity, school principals, department heads for
physical education and health, and leaders of school-grounded physical activity programs
from 36 schools participating in the Trial of Activity for Adolescent Girls (TAAG) were
asked to determine the level of support for physical activity in their schools. The study
identified that none of the schools received a perfect score for support of physical
activity.
P. J. Spilchak, E. Denney-Wilson, L. King and L. A. Baur. (2008). Tertiary paediatric
obesity services in Australia. J Paediatr Child Health. 44, 243-7.
AIM: To examine the nature and availability of paediatric obesity services in tertiary care
settings across the states/territories of Australia. METHODS: Surveys were sent to all
clinicians identified as offering obesity services to children and adolescents. Respondents
were asked to identify other service providers in their area, who were also asked to
complete the survey. RESULTS: Sixteen clinicians responded to the survey, from 20
requests. The clinicians who responded identified nine services in three of the eight
states/territories of Australia. Existing services are limited to children and adolescents
with severe obesity, with an average of 12 new referrals per service each month and an
average waiting time of 5 months for an appointment. Most services involve a
multidisciplinary approach, although the mix of staff varies considerably and emphasises
nutrition rather than physical activity approaches. CONCLUSIONS: Despite the public
attention devoted to paediatric obesity, tertiary services in Australia are inadequate to
meet the increasing incidence and prevalence of this complex condition. The
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development of tertiary services as part of service delivery arrangements for paediatric
obesity and its associated morbidities must become a priority within the health system.
J. W. Yang. (2008). Policy implications of excess commuting: Examining the impacts of
changes in US metropolitan spatial structure. Urban Studies. 45, 391-405.
This article examines how changes in US metropolitan spatial structure lead to an
increase in measurable excess commuting and a decrease in measurable transport-land
use connections. Using Boston and Atlanta as two comparative regions, this research
computes excess commuting with three-decade census data and then examines excess
commuting in relation to the changes in metropolitan spatial structure. Empirical results
suggest that the transport-land use connection appears weaker over the decades as the
dispersion of jobs changes the dynamics of commuting and the selection of residential
location follows patterns of average job location rather than that of the closest available
job location. This decreasing transport-land use connection points to a spatial structure
effect apart from individual preferences. It also suggests an alternative view of excess
commuting for metropolitan transport policy-making.
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SOCIAL, CULTURAL & FAMILY ENVIORNMENT -- CHILD PHYSICAL
ACTIVITY/OBESITY
(2008). Minority children in a low socioeconomic environment found to have increased
rates of being overweight.Ethnicity & Disease. 18, 110.
The article reports on the results of a study conducted in school-based centers in New
York City to determine the prevalence and characteristics of childhood obesity. It was
found that minority children in a low socioneconomic environment have increased rates
of being overweight. It states that more research is needed to found out what causes
overweight in minority children and to assess the effectiveness of school-based
prevention programs.
H. Amigo, P. Bustos, M. Erazo, P. Cumsille and C. Silva. (2007). [Determinant factors of
excess of weight in school children: a multilevel study]. Rev Med Chil. 135, 1510-8.
BACKGROUND: Rates of obesity reach high levels in Chile, with geographic, social and
school variations. AIM: To identify factors at two levels associated with excessive weight
in school children: child-family characteristics and school-neighborhood. MATERIAL
AND METHODS: Using a cross-sectional and multi-step design, seven counties with the
highest prevalence of obesity were identified, and schools were randomly chosen from
within the 1st, 3 and 5 quintiles of the school strata (same level of obesity prevalence).
Within each school, twelve 2nd grade children were randomly chosen (n =42 schools and
504 students). Nutritional status, food intake, eating habits and physical activity were
measured. Socio demographic, economic characteristics and nutritional status of the
parents were assessed. Home size and facilities for children physical activities were
assessed, as well as school infrastructure and management. Results: Most of the
explained variance (97%) in the Body Mass Index (BMI) was due to individual-level
factors: sedentary children behaviour (JS coefficient 1.6, standard error (SE) 0.052),
maternal obesity (ss 0.94; SE 0.25), paternal obesity (ss 0.83; SE 0.28) and hours
watching television (ss 0.789, SE 0.297). The same risk factors were predictive of
obesity: child sedentary behaviours odds ratio (OR): 3-98, 95%) confidence interval (CI):
2.44-6.48, maternal obesity (OR 1.91, CI 1.21-3-02) and being woman (OR 1.75, CI
1.01-2.76). CONCLUSIONS: BMI and obesity are associated with children behaviour or
biological and cultural conditions of their families and not with school characteristics.
D. R. Bassett Jr. (2008). Physical activity of Canadian and American children: a focus on
youth in Amish, Mennonite, and modern cultures. Applied Physiology, Nutrition &
Metabolism. 33, 831.
K. W. Bauer, M. C. Nelson, K. N. Boutelle and D. Neumark-Sztainer. (2008). Parental
influences on adolescents' physical activity and sedentary behavior: longitudinal findings
from Project EAT-II. International Journal Of Behavioral Nutrition And Physical
Activity. 5,
Background: The long- term role that parental encouragement and attitudes about fitness
and exercise play in adolescents' physical activity and sedentary behavior habits remains
unclear. This paper aims to longitudinally examine how parental encouragement to be
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physically active and parental concern about staying fit are associated with adolescents'
physical activity and sedentary behavior habits five years later. Methods: Project EAT- II
adolescent and young adult participants (1130 male, 1386 female) completed surveys
while in middle school or high school (1998 - 1999), and again 5 years later. Participants
were asked whether their mother and father encourage them to be physically active and
care about staying fit and exercising. Adolescent moderate and vigorous physical activity
(MVPA) and TV/ video watching (hours/ week) were assessed. Linear regression models
adjusted for socio- demographic characteristics and baseline behavior were used to
examine the association of Time 1 parental factors with behavioral outcomes among
adolescents and young adults five years later (Time 2). Results: After adjustment for
socio- demographic characteristics and baseline MVPA, adolescent- reported maternal
and paternal encouragement to be active, and paternal care for fitness, were positively
associated with weekly hours of MVPA after five years in young adult males (p for trend
<=.01). The positive relationship between maternal encouragement and MVPA
approached significance among high- school aged females (p for trend =.06), and paternal
encouragement was positively related to MVPA among high-school aged males (p for
trend =.02). While maternal encouragement to be active was associated with decreased
TV/ video time among younger females (p for trend =.02), other parental factors were not
associated with lower TV/ video time among the other groups. Conclusion: Parental
encouragement to be active was associated with increased physical activity among males
and younger females 5 years later. Younger adolescents appear to be especially
influenced by their same- sex parent. These findings suggest that encouragement may be
more influential than parental concern for fitness on adolescents' physical activity habits.
Further research is needed to determine how parents can help adolescents decrease
sedentary behavior time.
H. S. Brown, A. Perez, G. G. Mirchandani, D. M. Hoelscher and S. H. Kelder. (2008).
Crime rates and sedentary behavior among 4(th) grade Texas school children.
International Journal Of Behavioral Nutrition And Physical Activity. 5,
Introduction: Although per capita crime has generally fallen over the period which
coincides with the obesity epidemic, it has not fallen uniformly across communities. It
also has not fallen enough to allay fears on the part of parents. Over the past 30 years,
technological changes have made the indoor alternatives to playing outside, where
children are more vulnerable to criminal activity, more enjoyable (cable TV, video
games, and the internet) and comfortable (the spread of air conditioning to low income
neighborhoods). We determined whether indoor sedentary behavior patterns are
associated with community crime statistics. 4(th) graders in the U. S. are typically 9 or 10
years old. Methods: We used data from the 2004-2005 Texas School Physical Activity
and Nutrition (SPAN) survey linked with U.S. Department of Justice, Office of Justice
Programs, Bureau of Justice Statistics data for the years 2000 through 2005 and Texas
State data on sexual offenders. The probability-based sample included a total of 7,907
children in grade four. Multistage probability sampling weights were used. The
dependent variables included were hours of TV watching, video game playing, computer
use and total indoor sedentary behavior after school. Incremental Relative Rates were
computed for community crime rates including robberies, all violent crimes, murders,
assaults, property crimes, rapes, burglaries, larcenies and motor vehicle thefts as well as
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for sexual offenders living in the neighborhood. The neighborhood refers to the areas
where the students at each school live. In the case of sexual offenders, sexual offenders
per capita are estimated using the per capita rate in the zip code of the school attended; all
other crime statistics are estimated by the crimes per capita in the police department
jurisdiction covering the school attended. After controlling for sex, age, and AfricanAmerican and Hispanic, cross-sectional associations were determined using multivariate
Poisson regression. Results: 4(th) grade boys were more likely to play video games in
communities with increased per 100 population rates of larceny and burglary as well as in
communities with increased per capita sexual offenders; 4(th) grade girls were more
likely to watch television in communities with increased per capita sexual offenders.
While 4(th) grade girls were more likely to watch TV in communities with increased per
capita sex offenders, they were less likely to use computers. Per capita sexual offenders
were negatively related to computer use amongst 4(th) grade girls. Conclusion: By
combining community crime and cross-sectional individual level data on indoor
sedentary behavior, we found that there is an association between community crimes/sex
offender rates and certain types of indoor sedentary behavior. The development of
technologies in recent decades which makes supervising children easier indoors, where
children are much less vulnerable to crime, may be contributing to the epidemic of
childhood obesity.
B. C. Chow, T. L. McKenzie and L. Louie. (2008). Children's Physical Activity and
Environmental Influences During Elementary School Physical Education. Journal of
Teaching in Physical Education. 27, 38.
Physical activity (PA) during physical education is important for health purposes and for
developing physical fitness and movement skills. To examine PA levels and how PA was
influenced by environmental and instructor-related characteristics, we assessed children's
activity during 368 lessons taught by 105 physical education specialists in 42 randomly
selected schools in Hong Kong. Trained observers used SOFIT in randomly selected
classes, grades 4-6, during three climatic seasons. Results indicated children's PA levels
met the U.S. Healthy People 2010 objective of 50% engagement time and were higher
than comparable U.S. populations. Multiple regression analyses revealed that
temperature, teacher behavior, and two lesson characteristics (subject matter and mode of
delivery) were significantly associated with the PA levels. Most of these factors are
modifiable, and changes could improve the quantity and intensity of children's PA.
T. Cochrane and R. C. Davey. (2008). Increasing uptake of physical activity: a social
ecological approach. J R Soc Health. 128, 31-40.
AIMS: Increasing population physical activity (PA) is a public health priority. An
approach to increasing PA in an urban community, based on the social ecology model, is
presented and evaluated. METHODS: A quasi-experimental (non-equivalent control
group) design was chosen to test whether this approach can increase, significantly, the
population proportion that is physically active. Two deprived inner-city electoral ward
areas of Sheffield, UK, with similar socio-demographic and health profiles were selected.
Implementation was carried out in five phases over 21 months: preparation and piloting,
initial survey estimates, community awareness campaign, PA intervention and evaluation.
Impact was evaluated by recording uptake and attendance at all sessions, and using a
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post-intervention postal survey. At follow-up, questionnaires were sent to 2500 randomly
selected addresses in both areas, which assessed changes in PA, health and PA
participation over the last year. RESULTS: A pilot baseline survey confirmed similar
proportions taking some form of PA on most days: intervention 36% (25-47), control
33% (21-45). At follow-up, 38 different activity groups were in place and 1275
individuals had attended at least one activity. Satisfactorily completed responses were
received from 1532 (31%), 55% (846) intervention, 45% (686) control. Relative to the
control, the intervention sample demonstrated trends towards: being more physically
active compared with one year ago, greater readiness to take up PA, better general health
and improved health compared with one year ago (p < or = 0.001). Further, 30.6%
(intervention) vs 18.3% (control) reported an increase in PA compared with one year ago,
while 13.7% (intervention) vs 24.5% (control) reported no intention to exercise. These
differences in proportions translated to an overall effect size estimate of 0.23 for the
intervention. Relative to those whose PA had remained the same, intervention area
residents were more likely to report being more active (odds ratio (95% confidence
interval) = 1.79 (1.38-2.32), p < 60; 0.001). CONCLUSION: These results suggest that,
even within one of the most deprived inner-city areas in the UK, a community-based
social ecological approach can positively change PA behaviour and attitudes.
L. Coleman, L. Cox and D. Roker. (2008). Girls and young women's participation in
physical activity: psychological and social influences. Health Education Research. 23,
633-647.
The importance of increasing young women's level of physical activity is recognized as a
priority within the United Kingdom and other Westernized nations. This study, conducted
in two distinct geographical locations in the United Kingdom, explores the leading
influences upon levels of physical activity participation among 75 young women aged
15-19. Through in-depth interviews, this study explores the influence of psychological
and social influences, by examining contrasting accounts from those young women who
'always' and 'never' participate in sport or physical activity. The main differences lie with
the always participates, relative to the never participates, reporting more positive images
of 'sport', positive perceptions of their own ability, low self-consciousness, firm
motivations and personal choice to engage in activities and the supporting influence of
their friends and family. The study also notes the detrimental impact of life transitions
such as moving from college to full-time employment. Further case study analyses reveal
the friendship group as the primary influence over all other factors considered. The
research concludes by summarizing the influences on physical activity participation that
are pertinent to this age group, highlights theoretical implications, suggests possible
intervention strategies and reports areas of further investigation that are required.
M. Grieser, D. Neumark-Sztainer, B. I. Saksvig, J. S. Lee, G. M. Felton and M. Y. Kubik.
(2008). Black, Hispanic, and white girls' perceptions of environmental and social support
and enjoyment of physical activity. Journal Of School Health. 78, 314-320.
BACKGROUND: This study examines the differences among black, Hispanic, and white
adolescent girls in their perceptions surrounding physical activity (PA), including support
within the school climate, friend and family social support, and personal enjoyment.
METHODS: Participants included 1466 sixth-grade girls from 36 middle schools across
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the United States. Participants were 20% black, 21% Hispanic, 47% white, and 12% of
other or mixed races. Multivariate analyses were performed on each scale, adjusting for
body mass index and free and reduced-price lunch status. RESULTS: Results showed
racial differences on several variables. Black girls, compared with white girls, perceived
significantly lower PA enjoyment (p <.001) and teacher support for PA (p =.004).
Hispanic girls experienced less PA enjoyment (p =.003) and perceived less support for
PA from boys (p =.001) and their families (p =.008) than white girls. Black girls reported
significantly higher levels of physical education (PE) enjoyment than did white girls (p
=.003). CONCLUSIONS: Differences in perceived PA support and enjoyment across
race raise questions about why these differences exist and how best to address disparities
within interventions.
K. Hamilton and K. M. White. (2008). Extending the theory of planned behavior: The
role of self and social influences in predicting adolescent regular moderateto-vigorous
physical activity. Journal Of Sport & Exercise Psychology. 30, 56-74.
The current study aimed to test the validity of an extended theory of planned behavior
model (TPB; Ajzen, 1991), incorporating additional self and social influences, for
predicting adolescent moderate-to-vigorous physical activity. Participants (N = 423)
completed an initial questionnaire that assessed the standard TPB constructs of attitude,
subjective norm, and perceived behavioral control, as well as past behavior, self-identity,
and the additional social influence variables of group norms, family social support,
friends' social support, and social provisions. One week after completion of the main
questionnaire, participants completed a follow-up questionnaire that assessed selfreported physical activity during the previous week. The standard TPB variables-past
behavior, self-identity, and group norms, but not social support influences-predicted
intentions, with intention, past behavior, and self-identity predicting behavior. Overall,
the results provide support for an extended version of the TPB incorporating self-identity
and those social influences linked explicitly to membership of a behaviorally relevant
reference group.
L. L. Hardy, A. D. Okely, T. A. Dobbins and M. L. Booth. (2008). Physical activity
among adolescents in New South Wales (Australia): 1997 and 2004. Medicine And
Science In Sports And Exercise. 40, 835-841.
Purpose: To examine secular trends, seasonal and socioeconomic differences in physical
activity participation among Australian adolescents in 1997 and 2004. Methods: Repeat
cross-sectional school survey, conducted in 1997 and 2004. School students were
randomly selected from grades 8 and 10 in New South Wales Australia (1997, N = 2026;
2004 N = 1771). Time spent in moderate-to-vigorous physical activity (MVPA) was
assessed by self-reported participation in organized and nonorganized physical activity
separately for summer and winter by sex, grade, and socioeconomic status (SES).
Results: Between survey periods, the proportion of students reporting >= 60 min.d (-) (1)
of MVPA increased, except among grade 10 boys during winter. MVPA (min.d (- 1))
increased among all groups during summer school terms, During winter school terms,
MVPA was relatively stable between surveys for grade 8 students but inconsistent among
grade 10 students. Organized MVPA increased among all groups in both summer (19 - 49
min.d (- 1)) and winter (7 - 21 min.d (- 1)) school terms. Participation in nonorganized
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MVPA increased only during summer school terms (4 - 32 min.d (- 1)) and decreased
during winter school terms (7 - 17 min.d (- 1)). MVPA increased consistently among
students in the high-SES group compared with other SES groups, independent of season,
and in some cases MVPA decreased in low-SES groups during winter school terms.
Conclusion: Overall, the patterns of change were similar for boys and girls, with
substantial increases in summer school terms and insubstantial changes during winter
school terms (with the exception of a decrease among grade 10 boys). There was a direct
association between change in participation in MVPA and SES, indicating that
interventions are required to focus on the needs of less-advantaged students.
S. S. Hawkins, T. J. Cole and C. Law. (2008). Maternal employment and early childhood
overweight: findings from the UK Millennium Cohort Study. Int J Obes (Lond). 32, 30-8.
BACKGROUND: In most developed countries, maternal employment has increased
rapidly. Changing patterns of family life have been suggested to be contributing to the
rising prevalence of childhood obesity. OBJECTIVES: Our primary objective was to
examine the relationship between maternal and partner employment and overweight in
children aged 3 years. Our secondary objective was to investigate factors related to early
childhood overweight only among mothers in employment. DESIGN: Cohort study.
SUBJECTS: A total of 13 113 singleton children aged 3 years in the Millennium Cohort
Study, born between 2000 and 2002 in the United Kingdom, who had complete
height/weight data and parental employment histories. MEASUREMENTS: Parents were
interviewed when the child was aged 9 months and 3 years, and the child's height and
weight were measured at 3 years. Overweight (including obesity) was defined by the
International Obesity Task Force cut-offs. RESULTS: A total of 23% (3085) of children
were overweight at 3 years. Any maternal employment after the child's birth was
associated with early childhood overweight (odds ratio (OR) [95% confidence interval
(CI)]; 1.14 [1.00, 1.29]), after adjustment for potential confounding and mediating
factors. Children were more likely to be overweight for every 10 h a mother worked per
week (OR [95% CI]; 1.10 [1.04, 1.17]), after adjustment. An interaction with household
income revealed that this relationship was only significant for children from households
with an annual income of pound33 000 ($57 750) or higher. There was no evidence for
an association between early childhood overweight and whether or for how many hours
the partner worked, or with mothers' or partners' duration of employment. These
relationships were also evident among mothers in employment. Independent risk factors
for early childhood overweight were consistent with the published literature.
CONCLUSIONS: Long hours of maternal employment, rather than lack of money may
impede young children's access to healthy foods and physical activity. Policies
supporting work-life balance may help parents reduce potential barriers.
K. Hesketh, M. Graham and E. Waters. (2008). Children's After-School Activity:
Associations With Weight Status and Family Circumstance. Pediatric Exercise Science.
20, 84.
This study investigated children's after-school activity and associations with body mass
index (BMI) and family circumstance. One thousand two hundred thirty-four parents and
854 children (age 8-13 years) completed activity diaries for the 2 hours after school.
Parents reported children as more active than children reported themselves. Boys were
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reported to be more active than girls. Activity levels were generally not associated with
BMI or family circumstance with the exception of cultural background. Parent-reported
mean child METs were higher for mothers born in Australia (3.3 vs. 3.0; p =.02). Childreported mean METs were higher for fathers born in Australia (2.9 vs. 2.6; p =.04) and
where English was their main language (2.9 vs. 2.3, p =.003).
L. Humenikova and G. E. Gates. (2008). Social and Physical Environmental Factors and
Child Overweight in a Sample of American and Czech School-aged Children: A Pilot
Study. Journal of Nutrition Education & Behavior. 40, 251.
Objective: To compare environmental factors that influence body mass index for age
(BMI-for-age) between a sample of American and Czech school-aged children. Design:
Pilot study. A parent questionnaire and school visits were used to collect data from
parents and children. Setting: Public schools in 1 American and 2 Czech cities.
Participants: Forty-five American and 97 Czech 4th-through 6th-graders and their
parents. Variables Measured: Parenting style, food socialization and preparation
practices, healthful food availability, and children's BMI-for-age were measured.
Analysis: Factors from the parental scales were derived using factor analysis.
Independent t tests compared environmental factors between American and Czech
families. A regression model was used to identify environmental variables associated
with BMI-for-age. Results: American parents used authoritative parenting style and
positive food socialization practices more often than Czech parents (P <.001).
Availability of healthful food and parental involvement in food preparation were higher
(P <.001) in Czech households. Positive encouraging socialization practices, less frequent
use of negative explanations, and a greater availability of vegetables were associated with
lower BMI-for-age in the Czech sample of children. Conclusions and Implications: A
future study should focus on identifying environmental factors that influence children's
BMI-for-age with a large sample of Czech and American parents and their school-aged
children.
M. Jackson, D. Crawford, K. Campbell and J. Salmon. (2008). Areparental concerns
about children's inactivity warranted, and are they associated with a supportive home
environment? Research Quarterly for Exercise and Sport. 79, 274-282.
C. Y. Ji. (2008). The prevalence of childhood overweight/obesity and the epidemic
changes in 1985-2000 for Chinese school-age children and adolescents. Obesity Reviews.
9, 78-81.
This paper describes the nationwide prevalence of childhood overweight/obesity in
Chinese urban population. Data sets of boys and girls aged 7-18 yrs were collected from
the series of Chinese national surveillance on students' constitution and health between
1985 and 2000 were divided into five socioeconomic groups, while WGOC BMIreference was used as definitions of overweight and obesity. In 2000, the prevalence of
childhood obesity/overweight in the coastal big cities, followed by that of the coastal
middle/small cities, had reached the average level of the developed countries. The
prevalence of obesity was low in most of the inland cities at an early stage of epidemic
overweight. The epidemic manifested a gradient distribution in groups, which was
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closely related to socioeconomic status of the populations. A dramatic and steady
increasing trend was witnessed among all sex-age subgroups in these urban groups, and
the increments in obesity/overweight are exceptionally high in recent 5 years, and the
prospect of epidemic obesity in China is in no way optimistic. Preventive program should
be focused on the improvement of the balance between caloric intake and energy
expenditure, and interventions aimed at changing children's life styles.
K. A. King, J. L. Tergerson and B. R. Wilson. (2008). Effect of Social Support on
Adolescents' Perceptions of and Engagement in Physical Activity. Journal of Physical
Activity & Health. 5, 374.
Background: Social support can influence physical activity among some individuals. This
study examined the effect that social support has on adolescents' physical activity and
their perceived barriers and benefits to exercising. Methods: A survey was completed by
adolescents (N = 535) at 2 single-sex (1 male, 1 female) high schools in Ohio. Results:
Adolescents who received parental encouragement to exercise and who had an exercising
friend engaged in significantly more days of physical activity in the past week than did
their counterparts. Perceived benefits of physical activity differed significantly based on
whether the respondent received parental encouragement and had a friend who exercised.
Social support for physical activity significantly affected adolescents' perceptions of and
engagement in physical activity. Conclusions: Parents should encourage their children to
become physically active and partner with peers when exercising.
S. T. Leatherdale and S. L. Wong. (2008). Modifiable characteristics associated with
sedentary behaviours among youth. International Journal Of Pediatric Obesity. 3, 93-101.
Objective. Childhood overweight and obesity is a major public health issue. A better
understanding of factors associated with sedentary behaviours would provide valuable
insight for tailoring interventions to prevent or reduce overweight among youth.
Methods. Data were collected from 25 416 grade 9 to 12 students attending 76 secondary
schools in Ontario, Canada, using the Physical Activity Module of the School Health
Action, Planning and Evaluation System (SHAPES). Sex specific multivariate logistic
regression analyses were then used to examine how physical activity, BMI, social
influences, and smoking behaviour were associated with screen time, time spent reading,
and time spent on homework. Results. The average screen time per day was 2.7 (+/-1.7)
hours, yet 48.1 % of students reported spending less than one hour reading per week and
30.2% spent less than an hour of time on homework per week. Among males, being
underweight (<= 5% percentile BMI, adjusted for age and sex) was associated with more
screen time (OR 1.23, 95%CI 1.01-1.50) and time spent reading (OR 1.19, 95%CI 1.001.43), whereas being at risk of overweight (>= 85% percentile BMI, adjusted for age and
sex) was associated with less time spent on homework (OR 0.75, 95%CI 0.65-0.85).
Conversely, among females, being at risk of overweight was associated with more screen
time (OR 1.24, 95%CI 1.10-1.41), and time spent reading (OR 1.19, 95%CI 1.05-1.35).
Aside from BMI, other factors associated with sedentary behaviours included physical
activity, parental encouragement and support for physical activity, close friend physical
activity behaviour, and smoking status. Discussion. We found that students are highly
involved in screen-based sedentary behaviours, but spend a limited time on more
productive sedentary behaviours, like reading and homework. Developing a better
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understanding of sedentary behaviours is critical for preventing and reducing obesity
among youth populations.
M. N. Lutfiyya, R. Garcia, C. M. Dankwa, T. Young and M. S. Lipsky. (2008).
Overweight and obese prevalence rates in African American and Hispanic children: An
analysis of data from the 2003-2004 National Survey of Children's Health. Journal Of
The American Board Of Family Medicine. 21, 191-199.
Background: The prevalence of overweight and obesity was examined in AfricanAmerican and Hispanic children compared with white children. Methods: Multivariate
analyses were performed on cross-sectional data from the National Survey of Children's
Health collected in 2003 to 2004. Results: Analyses found that overweight children were
more likely to be African American and Hispanic than white, be male, live in households
with incomes below 150% of the Federal poverty level, watch television 3 or more hours
daily, and not have received preventive care in the past 12 months. Overweight children
were less likely to get minimum levels of moderate physical activity or have participated
on a sports team. Conclusions: Poverty impacts childhood body mass index in at least 2
specific ways: unsafe neighborhoods and the cost and accessibility of healthy foods in
low income communities. Addressing these issues require the concerted efforts of policy
makers. The same is true for resolving the issues of children not receiving preventive
care. Increasing the number of well child check-ups mandated by the government and
required by school systems may be a beneficial policy. Furthermore, policymakers
concerned with issues of childhood obesity may pursue the creation of school-based
health clinics in schools where at least 50% of the student body live in households with
incomes < 150% of the Federal poverty level.
T. L. MaKenzie, B. Baquero, N. C. Crespo, E. M. Arredondo, N. R. Campbell and J. P.
Elder. (2008). Environmental correlates of physical activity in Mexican American
children at home. Journal of Physical Activity and Health. 5,
H. Margellos-Anast, A. M. Shah and S. Whitman. (2008). Prevalence of obesity among
children in six Chicago communities: Findings from a health survey. Public Health
Reports. 123, 117-125.
Objectives. We analyzed data from a community health survey to assess levels of obesity
and overweight among children in some Chicago communities compared with national
U.S. estimates. Methods. Data came from the Sinai Improving Community Health
Survey, which was conducted via face-to-face interviews with people living in six
racially and ethnically diverse Chicago communities during 2002 and 2003. A stratified,
three-stage probability study design was employed to obtain a representative sample from
each community. Height and weight data reported by the primary caretakers of 501
randomly selected children aged 2-12 years were used to determine age- and genderspecific body mass index (BMI), which was then used to classify weight status (obese >=
95th percentile for age and gender). Results. Compared with 16.8% for the U.S., the
prevalence of obesity was 11.8% in a non-Hispanic white community on Chicago's north
side, 34.0% in a Mexican American community on the west side, and 56.4% in a nonHispanic black community on the south side. Conclusions. Surveillance of the childhood
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obesity epidemic at the local level is limited. Findings describe the extent of disparities in
childhood overweight and obesity within one city and how local-level data can shape new
initiatives for improved health, one community at a time.
T. L. McKenzie, B. Baquero, N. C. Crespo, E. M. Arredondo, N. R. Campbell and J. P.
Elder. (2008). Environmental Correlates of Physical Activity in Mexican American
Children at Home. Journal of Physical Activity & Health. 5, 579.
Background: Understanding home environments might shed light on factors contributing
to reduced physical activity (PA) in children, particularly minorities. Few studies have
used microlevel observations to simultaneously assess children's PA and associated
conditions in homes. Methods: Trained observers assessed PA and associated physical
and social environmental variables in the homes of 139 Mexican American children (69
boys, 70 girls; mean age = 6 years) after school. Results: Children spent most time
indoors (77%) and being sedentary (74%). Reduced PA was associated with viewing
media, being indoors, and parents being present. Increased PA was associated with
prompts for PA and other children being present. PA prompts differed by child gender
and location and prompter age status. Conclusions: Children are frequently sedentary at
home. Microlevel observations showed PA is associated with potentially modifiable
social and physical factors, including spending time outdoors. Studies to determine
whether interventions on these correlates can improve children's PA are needed.
A. M. McMinn, E. M. F. van Sluijs, N. Wedderkopp, K. Froberg and S. J. Griffin. (2008).
Sociocultural correlates of physical activity in children and adolescents: Findings from
the Danish arm of the European Youth Heart Study. Pediatric Exercise Science. 20, 319332.
J. Mota, P. Silva, L. Aires, M. P. Santos, J. Oliveira and J. C. Ribeiro. (2008). Differences
in School-Day Patterns of Daily Physical Activity in Girls According to Level of
Physical Activity. Journal of Physical Activity & Health. 5, S90.
Background: The purpose of this study was to examine whether there are differences in
physical activity (PA) during specific periods of the day among active and less-active
girls. Methods: The sample comprised 54 girls age 10 to 15 years. PA was assessed by
accelerometry. Girls were grouped as less active, active, and highly active. Results: Total
minutes of moderate-to-vigorous physical activity (MVPA) was significantly higher in
more-active girls than in their less-active peers (113 and 72 min/d, respectively). The
most-active groups were significantly more engaged in MVPA during the outside-ofschool period than were less-active girls. Highly active girls spent a significantly higher
amount of their MVPA time outside of school than did the less-active group, which spent
a significantly higher proportion of MVPA time during late afternoon. Conclusion:
Outside-of-school PA is a key point for MVPA engagement. Particularly for the lessactive girls, however, schools might provide additional PA.
J. A. O'Dea. (2008). Gender, ethnicity, culture and social class influences on childhood
obesity among Australian schoolchildren: implications for treatment, prevention and
community education. Health Soc Care Community. 16, 282-90.
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The aim of the study was to explore the associations between obesity, weight perceptions
and gender, ethnicity, culture and social class in a large national study of Australian
school children. Primary and high schools (N = 47) were recruited from every state and
territory of Australia and included 7889 children from government, private and Catholic
schools (82% response rate) in August-November, 2006. The socioeconomic status (SES)
of schools was based on a government survey of total family income. A questionnaire
completed by students, measured demographic details of gender, age, weight perceptions
and ethnic/cultural background. Height and weight were measured by trained research
assistants. Outcome measures included body mass index (BMI), prevalence of obesity,
overweight, weight perceptions. Prevalence of obesity was 6.4% of males and 5.6% of
females in primary school students (P = 0.34). More high school males were obese than
females (7.7% vs. 5.7%, P = 0.001). Obesity was more prevalent among students from
Pacific Islander backgrounds. Adolescents who were most likely to be obese were boys
and girls of low SES or Pacific Islander or Middle Eastern/Arabic background. The least
likely to be obese were Anglo/Caucasian or Asian students and in particular, the girls.
Obese female adolescents from Aboriginal, Middle Eastern/Arabic and Pacific Islander
backgrounds were less likely than their Caucasian or Asian peers to perceive themselves
as 'too fat'.Those working in clinical, community or educational settings with young
people and in particular, obese young people, should be aware that obesity is likely to be
more prevalent, more culturally acceptable and perhaps more desirable among children
and teens from low SES communities and/or Middle Eastern and Pacific Islander
backgrounds. Health and social work professionals should be careful not to exaggerate
the risks of overweight or obesity or inadvertently create weight concerns among young
people. The different body image perceptions identified in this study should be taken into
account when planning clinical, community or preventive initiatives among children or
adolescents from varying ethnic groups.
L. N. Oliver and M. V. Hayes. (2008). Effects of neighbourhood income on reported
body mass index: an eight year longitudinal study of Canadian children. BMC Public
Health. 8, 16.
BACKGROUND: This study investigates the effects of neighbourhood income on
children's Body Mass Index (BMI) from childhood (ages 2-3) to early adolescence (ages
10-11) using longitudinal data. METHODS: Five cycles of data from the Canadian
National Longitudinal Survey of Children and Youth are analyzed for a sub-sample of
children (n = 2152) aged 2-3 at baseline (1994) and assessed at two year intervals to
2002. Body mass index percentiles are based on height/weight estimates reported by
proxy respondents (child's person most knowledgeable). Family and neighbourhood
factors were assessed at baseline. The prevalence of neighbourhood low income was
obtained from the 1996 Census and divided into three categories from 'most poor' to 'least
poor'. Longitudinal modelling techniques were applied to the data. RESULTS: After
controlling for individual/family factors (age, sex, income, education, family structure)
living in the 'most poor' neighbourhood was associated with increasing BMI percentile
(1.46, 95% CI 0.16 to 2.75) over time compared to a 'middle' income neighbourhood.
Living in an urban (vs. rural) neighbourhood was associated with a decreased BMI
percentile (-3.57, 95% CI -6.38 to -0.76) across all time periods. CONCLUSION: These
findings provide evidence that effects of neighbourhood disadvantage on children's BMI
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occur between childhood and early adolescence and suggest that policies should target
the conditions of childhood, including the neighbourhood environment.
D. L. Patterson and H. Van Der Mars. (2008). Distant interactions and their effects on
children's physical activity levels. Physical Education & Sport Pedagogy. 13, 277.
Background: It has been observed that physical activity patterns of health-related
behavior are established in childhood and may continue into adulthood. Recent findings
showing a relationship between the onset of chronic diseases and sedentary lifestyles
support the importance of examining Moderate to Vigorous Physical Activity (MVPA).
One instructional strategy that has been shown to correlate with higher physical activity
levels in students at elementary school levels is the promotion of physical activity by
teachers through verbal prompts, encouragement, and feedback. Purpose: To determine
the functional relationship between distant interactions (a component of active
monitoring where verbal interaction is given across the teaching environment) by
physical education teachers and elementary students' MVPA levels during the physical
fitness segment of their physical education class. Participants and setting: Five classes
between Grades 3 and 5 (age range 8-10) and two elementary physical education teachers
were observed for this study over 23-25 class sessions. Only the fitness segments were
observed for this study. Intervention: Following a baseline phase, two conditions
implemented and repeated across multiple class sessions. Condition C-IA (close
interaction) consisted of the teachers only actively supervising those students in their
immediate area (except for possible safety issues). During Condition D-IA (distant
interaction) teachers also supervised actively, but only targeted their interactions to those
students at fitness stations farthest removed from where they themselves were located.
Research design: A reversal design using a baseline condition and two treatments, close
interaction (C-IA) and distant interaction (D-IA) was implemented to demonstrate this
relationship. Data collection: A modified System for Observing Fitness Instruction Time
(SOFIT) and 'live' momentary time sampling along with videotape recordings were used
to measure students' MVPA.
K. L. Procter, G. P. Clarke, J. K. Ransley and J. Cade. (2008). Micro-level analysis of
childhood obesity, diet, physical activity, residential socioeconomic and social capital
variables: where are the obesogenic environments in Leeds? Area. 40, 323.
This paper describes global (whole of Leeds) and local (super output area) analyses of the
relationship between childhood obesity and many ‘obesogenic environment’
variables, such as deprivation, urbanisation, access to local amenities, and perceived local
safety, as well as dietary and physical activity behaviours. The analyses identify the
covariates with the strongest relationships with obesity, and highlight variation in these
relationships across Leeds, thus identifying ‘at-risk’ populations. This paper seeks
to demonstrate the importance of analysis at the micro-level in order to provide health
planners with additional information with which to tailor interventions and health policies
to prevent childhood obesity.
A. M. N. Renzaho, B. Swinburn and C. Burns. (2008). Maintenance of traditional cultural
orientation is associated with lower rates of obesity and sedentary behaviours among
African migrant children to Australia. International Journal Of Obesity. 32, 594-600.
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Background: Migrants from developing to developed countries rapidly develop more
obesity than the host population. While the effects of socio- economic status on obesity
are well established, the influence of cultural factors, including acculturation, is not
known. Objective: To examine the association between acculturation and obesity and its
risk factors among African migrant children in Australia. Design and participants: A
cross- sectional study using a non- probability sample of 3- to 12- year- old sub- Saharan
African migrant children. A bidimensional model of strength of affiliation with African
and Australian cultures was used to divide the sample into four cultural orientations:
traditional (African), assimilated (Australian), integrated (both) and marginalized
(neither). Main outcome measures: Body mass index (BMI), leisure- time physical
activity (PA) and sedentary behaviours (SBs) and energy density of food. Results: In all,
18.4% (95% confidence interval (CI): 14 - 23%) were overweight and 8.6% (95% CI: 6 12%) were obese. After adjustment for confounders, integrated (beta= 1.1; P<0.05) and
marginalized (beta= 1.4; P<0.01) children had higher BMI than traditional children.
However, integrated children had significantly higher time engaged in both PA (beta=
46.9, P<0.01) and SBs (beta= 43.0, P<0.05) than their traditional counterparts. In
comparison with traditional children, assimilated children were more sedentary (beta<
57.5, P<0.01) while marginalization was associated with increased consumption of
energy- dense foods (beta= 42.0, P<0.05). Conclusions: Maintenance of traditional
orientation was associated with lower rates of obesity and SBs. Health promotion
programs and frameworks need to be rooted in traditional values and habits to maintain
and reinforce traditional dietary and PA habits, as well as identify the marginalized
clusters and address their needs.
R. R. Rosenkranz and D. A. Dzewaltowski. (2008). Model of the home food environment
pertaining to childhood obesity. Nutr Rev. 66, 123-40.
The home food environment can be conceptualized as overlapping interactive domains
composed of built and natural, sociocultural, political and economic, micro-level and
macro-level environments. Each type and level of environment uniquely contributes
influence through a mosaic of determinants depicting the home food environment as a
major setting for shaping child dietary behavior and the development of obesity. Obesity
is a multifactorial problem, and the home food environmental aspects described here
represent a substantial part of the full environmental context in which a child grows,
develops, eats, and behaves. The present review includes selected literature relevant to
the home food environment's influence on obesity with the aim of presenting an
ecologically informed model for future research and intervention in the home food
environment.
A. M. Sanigorski, A. C. Bell, P. J. Kremer, R. Cuttler and B. A. Swinburn. (2008).
Reducing unhealthy weight gain in children through community capacity-building:
results of a quasi-experimental intervention program, Be Active Eat Well. International
Journal Of Obesity. 32, 1060-1067.
Background: Be Active Eat Well (BAEW)was a multifaceted community capacitybuilding program promoting healthy eating and physical activity for children (aged 4-12
years) in the Australian town of Colac. Objective: To evaluate the effects of BAEW on
reducing children's unhealthy weight gain. Methods: BAEW had a quasi-experimental,
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longitudinal design with anthropometric and demographic data collected on Colac
children in four preschools and six primary schools at baseline (2003, n = 1001, response
rate: 58%) and follow-up (2006, n =839, follow-up rate: 84%). The comparison sample
was a stratified random selection of preschools (n 4) and primary schools (n 12) from the
rest of the Barwon South Western region of Victoria, with baseline assessment in 20032004 (n = 1183, response rate: 44%) and follow-up in 2006 (n = 979, follow-up rate:
83%). Results: Colac children had significantly lower increases in body weight (mean: 0.92 kg, 95% CI: -1.74 to -0.11), waist (-3.14 cm, -5.07 to -1.22), waist/height (-0.02, 0.03 to -0.004), and body mass index z-score (-0.11, -0.21 to -0.01) than comparison
children, adjusted for baseline variable, age, height, gender, duration between
measurements and clustering by school. In Colac, the anthropometric changes were not
related to four indicators of socioeconomic status (SES), whereas in the comparison
group 19/20 such analyses showed significantly greater gains in anthropometry in
children from lower SES families. Changes in underweight and attempted weight loss
were no different between the groups. Conclusions: Building community capacity to
promote healthy eating and physical activity appears to be a safe and effective way to
reduce unhealthy weight gain in children without increasing health inequalities.
N. E. I. Smith, R. E. Rhodes, P.-J. Naylor and H. A. McKay. (2008). Exploring
Moderators of the Relationship Between Physical Activity Behaviors and Television
Viewing in Elementary School Children. American Journal of Health Promotion. 22, 231.
Purpose. Previous research suggests that there is limited evidence to support a negative
association, between physical activity (PA) behaviors and television (TV) viewing time
in children. The purpose of this study was to extend the research involving PA-TV
viewing relationships and to explore potential moderators, including gender ethnicity,
weekday/ weekend behaviors, structured/unstructured activities, and seasonal variability.
Design. A 9-month longitudinal design, across one school year with assessments every 3
months. Setting. Elementary schools in tile Vancouver and Richmond districts of British
Columbia, Canada. Subjects. Subjects (N = 344; 47% female) were 9- to 11-year-old
children who participated in a school-based PA initiative from September 2003 to June
2004. Intervention. Not applicable. Measures. Assessments of PA were measured using
the Physical Activity Questionnaire for Children. TV viewing time and structured PA
were measured using a self-report questionnaire. Analysis. Basic descriptives, Pearson r
bivariate correlations and moderated multiple regressions with mean centered variables.
Results. No significant interaction effects were found for any of the proposed moderators.
Null bivariate correlations are supportive of findings in previous literature. conclusions.
Our results with not find support for PA-TV viewing relations, regardless of gender;
ethnicity, structured PA, and seasonal variability. PA interventions aimed at modifying
sedentary behaviors, such as TV viewing, may not be warranted.
H. P. van der Ploeg, D. Merom, G. Corpuz and A. E. Bauman. (2008). Trends in
Australian children traveling to school 1971-2003: Burning petrol or carbohydrates?
Preventive Medicine. 46, 60-62.
Objective. To determine how Australian children traveled to and from school between
1971 and 2003. Methods. The 1971 (n=4284), 1981 (n=4936), 1991 (n=662) and 19992003 (n=816) Household Travel Surveys from the New South Wales Government
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Department of Planning were used to determine the mode of transport kids (5-14 years)
took to and from school in the area of Sydney (Australia). Results. The results showed
that the percentage of children aged 5-9 that walked to school was 57.7, 44.5, 35.3 and
25.5 in 1971, 1981, 1991 and 1999-2003, respectively. The percentage of children aged
5-9 that were driven to school by car in the four surveys was 22.8, 37.3, 53.9 and 66.6,
respectively. The results for children aged 10-14 were similar, walking decreased from
44.2% to 21.1% and car use increased from 12.2% to 47.8% over the study period.
Similar results were found for travel from school and there were no major differences
between boys and girls. Conclusion. Between 1971 and 2003, Australian children's mode
of travel to and from school has markedly shifted from active (walking) to inactive (car)
modes.
D. Vissers, N. Devoogdt, N. Gebruers, I. Mertens, S. Truijen and L. Van Gaal. (2008).
Overweight in Adolescents: Differences per Type of Education. Does One Size Fit All?
Journal of Nutrition Education & Behavior. 40, 65.
Objective: To assess the lifestyle and prevalence of overweight among 16- to 18-year-old
adolescents attending 4 different types of secondary education (SE). Design: Crosssectional school-based survey. Participants: A community sample of 994 adolescents
(body mass index [BMI]: 15-43 kg/m²). Variables Measured: Overweight and obesity
were assessed by BMI. Health-related quality of life (HRQL) was assessed using the 36item short-form (SF-36) questionnaire. The Dutch eating behavior questionnaire was
administered. Lifestyle was assessed using the Baecke questionnaire and self-reported
activities. Analysis: Prevalence of overweight, HRQL and lifestyle were assessed per
type of education. Gender differences and differences between BMI-categories were
analyzed. Results: Students in Vocational SE were significantly more likely to be
overweight (18%) or obese (7.5%) compared to students in other types of SE (chi square27.0, P <.001). HRQL was significantly lower among obese girls compared to
overweight (P =.009) or normal weight girls (P <.01). Obese and overweight adolescents
scored higher in restrained eating than their normal weight peers (P <.001) but lower in
externally induced eating (P =.001). Conclusions and Implications: Lifestyle and
prevalence of overweight and obesity seems to differ between different types of
education. This could be of importance when making health policy decisions. Health
programs should focus on types of education with the highest prevalence of overweight
and obesity and should be tailor-made to the specific needs of the targeted type of
education.
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SOCIAL, CULTURAL & FAMILY ENVIORNMENT -- ADULT PHYSICAL
ACTIVITY/OBESITY
A. Batnitzky. (2008). Obesity and household roles: gender and social class in Morocco.
Sociol Health Illn. 30, 445-62.
Often referred to as the developing world's new burden of disease, obesity constitutes a
major and growing health epidemic in Morocco, in particular for women (22% of women
versus 8% of men). Through an analysis of qualitative data, I demonstrate how gender
roles influence obesity risk in the Moroccan context. Current social and economic
theories, including the nutrition transition theory, are inadequate in explaining the
persistent gender differentials in health status across time and place. I suggest that
Moroccan women's higher prevalence of obesity is predominantly the outcome of
different risks acquired from their distinct roles. In the Moroccan context, we can gain
insight into how men and women divide household labour and how the overall nonegalitarian nature of social roles may deleteriously affect women's health. I hypothesise
that marital status, age and socioeconomic status determine Moroccan women's
household roles and help to explain why women are more likely to be obese than men.
The main findings support this hypothesis and demonstrate the interactive relationship
between culture and structure in influencing obesity risk.
L. N. Burgoyne, C. Woods, R. Coleman and I. J. Perry. (2008). Neighbourhood
perceptions of physical activity: a qualitative study. Bmc Public Health. 8,
Background: Effective promotion of physical activity in low income communities is
essential given the high prevalence of inactivity in this sector. Methods: This study
explored determinants of engaging in physical activity in two Irish city based
neighbourhoods using a series of six focus groups and twenty five interviews with adult
residents. Data were analysed using constant comparison methods with a grounded theory
approach. Results: Study findings centred on the concept of 'community contentment'.
Physical activity was related to the degree of contentment/comfort within the 'self' and
how the 'self' interacts within the neighbourhood. Contemporary focus on outer bodily
appearance and pressure to comply with societal expectations influenced participants'
sense of confidence and competence. Social interaction, involvement, and provision of
adequate social supports were viewed as positive and motivating. However normative
expectations appeared to affect participants' ability to engage in physical activity, which
may reflect the 'close knit' culture of the study neighbourhoods. Access to suitable local
facilities and amenities such as structured and pleasant walking routes was regarded as
essential. Indeed participants considered walking to be their preferred form of physical
activity which may relate to the minimal skill requirement, ease of access and low
financial costs incurred. Conclusion: In the context of physical activity, health promoters
need to be conscious of the difficulties that individuals feel in relation to bodily
appearance and the pressure to comply with societal standards. This may be particularly
relevant in low income settings where insufficient allocation of resources and social
supports means that individuals have less opportunity to attend to physical activity than
individuals living in higher income settings.
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M. W. Chang, S. Nitzke, E. Guilford, C. H. Adair and D. L. Hazard. (2008). Motivators
and barriers to healthful eating and physical activity among low-income overweight and
obese mothers. Journal Of The American Dietetic Association. 108, 1023-1028.
Low-income women who are overweight and obese are at high risk for long-term
retention of weight gain during pregnancy, in part because they may have poor diets and
inadequate physical activity, both of which may be exacerbated by stressful situations.
This study identified motivators and barriers to healthful eating and physical activity
among low-income overweight and obese non-Hispanic black and non-Hispanic white
mothers. Qualitative data were collected via eight focus group interviews. Eighty lowincome overweight and obese non-Hispanic black (n=41) and non-Hispanic white (n=39)
mothers, age 18 to 35 years, were recruited from the Special Supplemental Nutrition
Program for Women, Infants, and Children sites in six counties in Michigan. Personal
appearance, fit in clothes, inability to play with their children, and social support were
motivating factors for healthful eating and physical activity. Stressful experiences
triggered emotional eating and reduced participants' ability to practice these behaviors.
Other factors-for example, wanting quick weightloss results-made it difficult for these
mothers to follow recommended healthful lifestyle practices. Nutrition educators can
address these concerns by including information about ways to deal with stress and
emotional eating and emphasizing the benefits of healthful eating and physical activity in
their program plans.
H. Cutt, B. Giles-Corti, M. Knuiman, A. Timperio and F. Bull. (2008). Understanding
Dog Owners' Increased Levels of Physical Activity: Results From RESIDE. American
Journal of Public Health. 98, 66.
We examined the influence of dog ownership on physical activity, independent of
demographic, intrapersonal, and perceived environmental factors, in a cross-sectional
survey of 1813 adults. Although only 23% of the dog owners walked their dogs 5 or more
times per week, the adjusted odds of achieving sufficient physical activity and walking
were 57% to 77% higher among dog owners compared with those not owning dogs
(P<.05). Dog ownership was independently associated with physical activity and
walking. Actively encouraging more dog walking may increase community physical
activity levels. (Am J Public Health. 2008; 98: 66-69. doi: 10. 2105/AJPH. 2006. 103499)
H. E. Cutt, M. W. Knuiman and B. Giles-Corti. (2008). Does getting a dog increase
recreational walking? International Journal Of Behavioral Nutrition And Physical
Activity. 5,
Background: This study examines changes in socio-demographic, environmental and
intrapersonal factors associated with dog acquisition in non-dog owners at baseline to 12months follow-up and the effect of dog acquisition on minutes per week of recreational
walking. Methods: RESIDE study participants completed self-administered
questionnaires (baseline and 12-months follow-up) measuring physical activity, dog
ownership, dog walking behavior as well as environmental, intrapersonal and sociodemographic factors. Analysis was restricted to 'Continuing non-owners' (i.e., nonowners at both baseline and follow-up; n = 681) and 'New dog owners' (i.e., non-owners
who acquired a dog by follow-up; n = 92). Results: Overall, 12% of baseline non-owners
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had acquired a dog at follow-up. Dog acquisition was associated with working and
having children at home. Those who changed from single to couple marital status were
also more likely to acquire a dog. The increase in minutes of walking for recreation
within the neighborhood from baseline to follow-up was 48 minutes/week for new dog
owners compared with 12 minutes/week for continuing non-owners (p < 0.05). After
adjusting for baseline variables the effect of dog acquisition on the increase in minutes of
recreational walking within the neighborhood was 31 minutes (95% CI: 7.39, 54.22; p <
0.01). However, this reduced to 22 minutes (95% CI: -1.53, 45.42; p > 0.05) after further
adjustment for change in baseline to follow-up variables. Increase in intention to walk
was the main factor contributing to attenuation of the effect of dog acquisition on
recreational walking. Conclusion: This study used a large representative sample of nonowners to examine the relationship between dog acquisition and recreational walking and
provides evidence to suggest that dog acquisition leads to an increase in walking. The
most likely mechanism through which dog acquisition facilitates increased physical
activity is through behavioral intention via the dog's positive effect on owner's cognitive
beliefs about walking, and through the provision of motivation and social support for
walking. The results suggest that behavioral intention mediates the relationship between
dog acquisition and walking and that dogs may have a significant role in the maintenance
of owner walking behavior.
G. M. Fletcher, T. K. Behrens and L. Domina. (2008). Barriers and Enabling Factors for
Work- Site Physical Activity Programs: A Qualitative Examination. Journal of Physical
Activity & Health. 5, 418.
Background: Work sites offer a productive setting for physical activity (PA) promoting
interventions. Still, PA participation remains low. Thus, the purpose of this study was to
examine the reasoning behind commonly reported barriers and enabling factors to
participation in PA programs in a work-site setting. Methods: Employees from a large
city government were recruited to participate in focus groups, stratified by white- and
blue-collar occupations. Responses from open-ended questions about factors influencing
participation in PA programs were audio recorded and transcribed verbatim. Resulting
data were analyzed with open and axial coding. Results: The sample consisted of 60
employees composing 9 focus groups. Although time was the most common barrier
between both groups, white-collars workers responded that scheduling and work conflicts
were the most common barrier concerning time. Blue-collar workers indicated shift work
as their most common barrier. In addition, health was a significant enabling factor for
both occupational categories. White-collar workers were much more concerned with
appearances and were more highly motivated by weight loss and the hopefulness of quick
results than were blue-collar workers. Conclusions: These findings are important in the
understanding of PA as it relates to the reasoning behind participation in work-site
programs in regard to occupational status.
A. Heraclides, D. Witte and E. J. Brunner. (2008). The association between father's social
class and adult obesity is not explained by educational attainment and an unhealthy
lifestyle in adulthood. European Journal Of Epidemiology. 23, 573-579.
Objectives: To investigate the effect of father's social class on central and general obesity
in adulthood. To test the role of educational attainment and adult health behaviours as
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mediators in this association. Methods: BMI, Waist-hip-ratio, smoking status, alcohol
consumption, leisure-time physical activity and dietary intake (semi-quantitative foodfrequency questionnaire) were assessed at phase 5 (1997-1998) of the Whitehall II cohort
study. We used retrospective data on educational attainment and father's social class. Our
study sample was 4598 participants (3364 men, 1234 women) aged 44-69, with a valid
obesity measure and information on father's social class and educational attainment.
Results: Father's social class was inversely associated with adult life central (Waist-hipratio) and general (BMI) obesity in women but not in men. For example, mean BMI
difference between the highest and lowest childhood social class was 2.04 kg/m(2) (95%
confidence intervals: 0.90; 3.18). These associations remained robust to adjustment for
adult life socioeconomic position. Adjusting for educational attainment resulted in a
reduction of 10-15% in the difference in mean obesity measures between lowest and
highest father's social class. In our fully adjusted model, adult life health behaviours did
not provide further attenuation of the effect of father's social class on adult obesity.
Conclusion: We provide evidence for an independent effect of father's social class on
adult central and general obesity in women, which is not explained by educational
attainment and an unhealthy lifestyle in adulthood. Policies aiming at reducing
inequalities in obesity should tackle the problem of social inequality early in life.
B. Hickerson, A. Moore, L. Oakleaf, M. Edwards, P. A. James, J. Swanson and A. H.
Karla. (2008). The Role of a Senior Center in Promoting Physical Activity for Older
Adults. Journal of Park & Recreation Administration. 26, 22.
The health of citizens in communities is a paramount concern of parks and recreation
professionals. Although opportunities for physical activity have been ubiquitous in public
recreation programs, their potential is more important today than ever before for all ages,
including older adults. The purpose of this paper is to explore the roles of a community
senior center (CSC) in promoting physical activity among older adults. People are living
longer, and the number of older people is growing rapidly. Therefore, examining how
physical activity can be facilitated has implications that can lead to healthier older adults
and communities. Health and well-being are influenced by multiple facets within the
individual as well as in physical and social environments. Health behaviors such as
physical activity are influenced not only by motivations but also by the structures,
opportunities, and policies that exist in communities. We conducted research for this case
study over a period of three months in the spring of 2007. Data were gathered through the
triangulation of field observations, focus groups, and in-depth interviews. The focus was
not on the CSC in general but specifically on the programs that facilitated physical
activity, which were defined as activities that involved large muscle movement. Four
major themes related to physical activity participation at the CSC emerged from the
analysis: organizational resources, personal capital, relational capital and social structure,
and physical activity and enjoyment. The idea of capital as the sum of assets that make a
phenomenon work was a way to examine how these themes could be theorized to
understand the possible role of a senior center in facilitating physical activity for and with
older adults. This study further confirms for managers the importance of a social
ecological approach to health promotion through parks and recreation. Although most
recreation programs are based on the idea that many factors can.
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C. B. Kamphuis, F. J. Van Lenthe, K. Giskes, M. Huisman, J. Brug and J. P.
Mackenbach. (2008). Socioeconomic status, environmental and individual factors, and
sports participation. Med Sci Sports Exerc. 40, 71-81.
PURPOSE: To examine the contribution of neighborhood, household, and individual
factors to socioeconomic inequalities in sports participation in a multilevel design.
METHODS: Data were obtained by a large-scale postal survey among a stratified sample
of the adult population (age 25-75 yr) of Eindhoven (the fifth-largest city of the
Netherlands) and surrounding areas, residing in 213 neighborhoods (N = 4785; response
rate 64.4%). Multilevel logistic regression analyses were performed with sports
participation as a binary outcome (no vs yes); that is, respondents not doing any
moderate- or high-intensity sports at least once a week were classified as nonparticipants.
RESULTS: Unfavorable perceived neighborhood factors (e.g., feeling unsafe, small
social network), household factors (material and social deprivation), and individual
physical activity cognitions (e.g., negative outcome expectancies, low self-efficacy) were
significantly associated with doing no sports and were reported more frequently among
lower socioeconomic groups. Taking these factors into account reduced the odds ratios of
doing no sports among the lowest educational group by 57%, from 3.99 (95% CI, 2.995.31) to 2.29 (95% CI, 1.70-3.07), and among the lowest income group by 67%, from
3.02 (95% CI, 2.36-3.86) to 1.66 (95% CI, 1.22-2.27). CONCLUSIONS: A combination
of neighborhood, household, and individual factors can explain socioeconomic
inequalities in sports participation to a large extent. Interventions and policies should
focus on all three groups of factors simultaneously to yield a maximal reduction of
socioeconomic inequalities in sports participation.
C. Lu, J. Sylvestre, N. Melnychuk and J. Li. (2008). East meets West: ChineseCanadians' perspectives on health and fitness. Can J Public Health. 99, 22-5.
BACKGROUND: Chinese-Canadians comprise one of Canada's largest and fastestgrowing ethnocultural groups. This exploratory qualitative study examined how ChineseCanadians' views of health and fitness, and their understanding of mainstream Western
health care and fitness programs, influence their health behaviours, health beliefs, and use
of health care services. This issue is explored against the backdrop of immigration and
processes of integration to understand how this immigrant population reconciles
conceptions of health acquired in their originating cultures with their experiences in
Western society. METHODS: Semi-structured interviews were conducted with 10 firstgeneration Chinese-Canadians to elicit their views and experiences with the concepts of
health and fitness. Interview transcripts were analyzed using an inductive analytic
approach involving constant comparison of emerging themes to the data. RESULTS: The
analysis revealed that participants had integrated some Canadian health and fitness
practices in their daily lives, particularly in their diet and use of health care services.
Nonetheless, Chinese-Canadians retained their view of the superiority of Eastern
conceptions of health and health practices. Both positive and negative changes in their
health practices attributed to their immigration experiences. INTERPRETATION: The
integration of some Western health and fitness practices does not appear to be based on
changes in values and beliefs. The evolution and pattern of Chinese-Canadians' practice
of health and fitness is complex over the course of immigration and acculturation. The
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findings of this study suggest the importance of attending to actual practices as a way of
understanding how immigration may affect health behaviour and health status.
F. I. Matheson, R. Moineddin and R. H. Glazier. (2008). The weight of place: a
multilevel analysis of gender, neighborhood material deprivation, and body mass index
among Canadian adults. Soc Sci Med. 66, 675-90.
This study examined the impact of neighborhood material deprivation on gender
differences in body mass index (BMI) for urban Canadians. Data from a national health
survey of adults (Canadian Community Health Survey Cycles 1.1/2.1) were combined
with census tract-level neighborhood data from the 2001 census. Using multilevel
analysis we found that living in neighborhoods with higher material deprivation was
associated with higher BMI. Compared to women living in the most affluent
neighborhoods, women living in the most deprived neighborhoods had a BMI score 1.8
points higher. For women 1.65 m in height (5'4'' inches), this translated into a 4.8 kg or
11 lb difference. For men, living in affluent neighborhoods was associated with higher
BMI (7 lb) relative to men living in deprived neighborhoods. The relative disadvantage
for men living in pockets of affluence and women living in pockets of poverty persisted
after adjusting for age, married and visible minority status, educational level, selfperceived stress, sense of belonging, and lifestyle factors, including smoking, exercise,
diet, and chronic health conditions. The implication of these disparate findings for men
and women is that interventions that lead to healthy weight control may need to be
gender responsive. Our findings also suggest that what we traditionally have thought to
be triggering factors for weight gain and maintenance of unhealthy BMI-lifestyle and
behavioral factors-are not sufficient explanations. Indeed, these factors account for only a
portion of the explanation of why neighborhood stress is associated with BMI. Cultural
attitudes about the body that pressure women to meet the thin ideal which can lead to an
unhealthy cycle of dieting and, subsequent weight gain, and the general acceptability of
the heavier male need to be challenged. Education and intervention within a public health
framework remain important targets for producing healthy weight.
N. C. McDonald. (2008). The effect of objectively measured crime on walking in
minority adults. American Journal Of Health Promotion. 22, 433-436.
Purpose. Evaluate the relationship between neighborhood crime and the amount of daily
walking by minority adults. Design. This was a cross-sectional study of minority adult
walking behavior and crime. Setting. Oakland, California was chosen as the study area
because of the substantial spatial variation in levels of criminal activity combined with
detailed, information on walking trips. Participants. The study was restricted to minority
adults who responded to the 2000 Bay Area Travel Survey and lived in Oakland,
California (n = 359). Method. Data on leisure and utilitarian walking were collected
through the 2000 Bay Area Travel Survey and combined with crime data from the
Oakland Police Department. A negative binomial model was used to test if violent,
Property, or quality of life crimes had significant associations with daily minutes walked,
controlling for individual and neighborhood covariates. Results. The model showed a
significant negative association between violent crime and minutes walked per day (b = .07; p =.016). Neither property nor quality of life crimes were correlated with amount of
walking. Conclusions. Reductions in violent crime may increase opportunities for
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minority residents in urban areas to participate in physical activity such as walking,
thereby providing another reason to pursue anticrime measures. Urban designers' efforts
to increase physical activity by improving neighborhood walkability may consider violent
crime prevention in their designs.
N. C. McDonald. (2008). The effect of objectively measured crime on walking in
minority adults. American Journal of Health Promotion. 22, 433-436.
A. P. McGinn, K. R. Evenson, A. H. Herring, S. L. Huston and D. A. Rodriguez. (2008).
The Association of Perceived and Objectively Measured Crime With Physical Activity:
A Cross-Sectional Analysis. Journal of Physical Activity & Health. 5, 117.
Background: Crime is one aspect of the environment that can act as a barrier to physical
activity. The goals of this study were to (1) compare measures of perceived crime with
observed crime and (2) examine the association between the independent and combined
effects of objective and perceived crime on physical activity. Methods: Perceived crime
and physical activity were assessed in 1659 persons via telephone survey. Crime was
objectively measured in a subset of 303 survey participants. Results: For all types of
crime, there was low agreement between objective and perceived measures. Both
perceived and objectively measured crime were independently associated with leisure
activities. Conclusions: This study suggests that perceptions and objective measures of
crime are both important correlates of leisure physical activity. Evaluating both measures
is necessary when examining the relationship between crime and physical activity to
develop interventions that will most influence leisure physical activity levels.
W. K. Mummery, W. Lauder, G. Schofield and C. Caperchione. (2008). Associations
between physical inactivity and a measure of social capital in a sample of Queensland
adults. Journal Of Science And Medicine In Sport. 11, 308-315.
How social capital is related to an increasingly important disease risk-physical inactivity
has not yet been investigated. In the present study the associations between social capital
and physical inactivity were investigated in a sample of Queensland (Australia) adults.
Data was collected from 1278 persons by means of a computer-assisted-telephoneinterview survey. The association between the social capital variables and physical
inactivity was studied using logistical regression. Multivariate analysis adjusted for the
effects of selected socio-demographic factors in the investigation of the association
between physical inactivity and quartile groupings of social capital scores. Physical
inactivity was negatively associated with the measure of social capital. Individuals in the
top two quartiles of social capital were significantly less likely to be physically inactive
than those in the two lowest quartiles. In summary, low social capital was associated with
physical inactivity. The results offer implications for health promotion programs aimed at
increasing levels of physical activity at the community or population level.
L. M. Neufeld, S. Hernandez-Cordero, L. C. Fernald and U. Ramakrishnan. (2008).
Overweight and obesity doubled over a 6-year period in young women living in poverty
in Mexico. Obesity (Silver Spring). 16, 714-7.
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OBJECTIVE: To document the changes in BMI and the prevalence of overweight and
obesity in young women living in poverty in a semi-urban community in Mexico.
METHODS AND PROCEDURES: Women who had previously participated in a
longitudinal research study (1997-2000) were re-assessed in 2005. Anthropometric
measurements were obtained using standard procedures, and socio-demographic
questionnaires were administered. Total and annual rate of change in BMI and change in
the prevalence of overweight and obesity (BMI > or = 25.0 and > or =30.0) were
estimated. RESULTS: Mean age in 2005 was 30.0 +/- 5.7 years (n = 683) and time
between recruitment and follow-up was 6.4 +/- 1.0 years. Mean change in BMI was +3.6
+/- 2.7 (range -8.2 to +14.6). In 2005, 500 (73.2%) women were overweight, up from 263
(38.5%) in the original assessment. The prevalence of obesity tripled over the follow-up
period (from 9.8% to 30.3%). The mean annual rate of change in BMI was +0.6 (+/-0.4).
After adjustment for age and parity at baseline, an annual rate of change of BMI above
the sample median (>0.5) was associated with lower levels of formal education.
DISCUSSION: The annual increase in the prevalence of overweight and obesity in this
sample is double that which was reported at a national level in Mexico. An understanding
of the determinants of this rapid increase among the women living in poverty in Mexico
is urgently needed.
M. H. Ochner, F. R. Salvail, E. S. Ford and U. Ajani. (2008). Obesity and self-reported
general health, Hawaii BRFSS: Are polynesians at higher risk? Obesity. 16, 923-926.
objective: This study compared the relationship between fair/poor general health status
among overweight and obese Polynesians with that among other overweight and obese
persons in Hawaii. Methods and Procedures: Data were pooled from the 1998-2003
Hawaii Behavioral Risk Factor Surveillance System (BRFSS) and logistic regression
used to examine the predictors of fair/poor health status. Results: Polynesians were
significantly more likely to be obese than non-Polynesians; overweight Polynesians were
more likely than other overweight individuals to report fair/poor health status. After
adjusting for confounders, among Polynesians, being obese was no longer associated
with fair/poor health. Non-Polynesians who were obese (odds ratio 1.9; 95% confidence
interval: 1.4-2.6), older, less educated, smokers, diabetic, hypertensive, and physically
inactive were more likely to report fair/ poor health. Discussion: Although Polynesians
were significantly more obese than the rest of the Hawaii population, their weight was
not independently associated with their odds for fair/ poor health as it was with nonPolynesians. The difference may be that, for Polynesians, hypertension and diabetes
overrode the effect of obesity on general health status or this group maintains different
cultural perceptions of body size. Regardless, these findings show a major health risk
among Polynesians and suggest the need for culturally specific health interventions.
E. Regidor, J. L. Gutierrez-Fisac, E. Ronda, M. E. Calle, D. Martinez and V. Dominguez.
(2008). Impact of cumulative area-based adverse socioeconomic environment on body
mass index and overweight. Journal Of Epidemiology And Community Health. 62, 231238.
Objective: Although the relationship between area socioeconomic environment and
obesity is known, previous research has measured area socioeconomic environment at
only one point in time. This study evaluates the relationship of cumulative area-based
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adverse socioeconomic environment with body mass index (BMI) and overweight.
Design: Cross-sectional study. Setting: Spain. Participants: 17 917 subjects in 2001. Main
outcome measure: Information from 1980, 1990 and 2000 was used for the percentage of
the population with low educational achievement, gross domestic product per capita
(GDPpc), and Gini coefficient to estimate BMI and prevalence of overweight by the
number of times each province had an adverse exposure to each of these measures of
socioeconomic environment. Results: After adjusting for individual variables and sports
facilities in the area, the difference in BMI in residents of provinces with the highest
percentage of population with low educational achievement in 1980, 1990 and 2000,
compared with residents of provinces with no history of adverse socioeconomic
environment based on this indicator, was 0.61 kg/m(2), whereas the prevalence of
overweight was 1.46 times higher. Similar results were obtained for residents of
provinces with cumulative low GDPpc versus residents of provinces that had never had
low GDPpc. Neither BMI nor overweight were associated with cumulative income
inequality based on the Gini coefficient. Conclusion: Cumulative adverse socioeconomic
environment based on indicators of educational level or wealth, but not of income
inequality, is positively associated with BMI and overweight. This association is not
explained by individual characteristics or by the availability of sports facilities.
C. G. Roman and A. Chalfin. (2008). Fear of walking outdoors. A multilevel ecologic
analysis of crime and disorder. Am J Prev Med. 34, 306-12.
BACKGROUND: Although a number of studies have tested ecologic models that
postulate relationships among social networks, the built environment, and active living,
few neighborhood-based studies have considered the role of crime and violence. This
study investigates the degree to which individual-level demographic characteristics and
neighborhood-level physical and social characteristics are associated with increased fear
of crime. METHODS: Data were analyzed in 2007 from a 2005 survey of 901 randomly
selected individuals living in 55 neighborhoods in Washington DC. Multilevel ordered
logit regression was used to examine associations between individual-level and
neighborhood-level characteristics and how often fear of crime prevents a respondent
from walking outdoors. RESULTS: Age and female gender were associated with an
increase in fear; the percentage of a resident's life spent in the same neighborhood was
associated with a decrease in fear. Results of cross-level interactions showed that at the
neighborhood level, women were more fearful than men in neighborhoods without
violence, but that the difference in fear between men and women shrinks as neighborhood
violence increases. Collective efficacy was found to increase fear among black
respondents and had no effect on fear among nonblack respondents. CONCLUSIONS: If
the study of neighborhoods and active living is to progress and contribute to both
etiologic understanding and policy formation, it is essential that theoretical and empirical
models consider the impact of violence and fear on walking. Efforts to increase active
living in urban neighborhoods that do not account for the impact of crime and fear may
fall short of their intended outcomes.
C. N. Sawchuk, A. Bogart, S. Charles, J. Goldberg, R. Forquera, P. Roy-Byrne and D.
Buchwald. (2008). Education is associated with physical activity among American Indian
elders. American Indian And Alaska Native Mental Health Research. 15, 1-17.
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Although educational attainment and physical activity levels tend to be positively
associated in majority populations, this relationship has not been investigated in
American Indian and Alaska Native (Al/AN) elders. This study examined the association
between education and physical activity among Al/AN elders (N = 107) using self-report
and behavioral outcomes. Regression models showed that higher education was
significantly associated with total caloric expenditure for moderate-intensity physical
activities and distance traveled during a 6-minute walk test of fitness. Additional research
is needed to understand modifiable personal, social, and environmental physical activity
barriers in these populations.
M. H. Shishehbor, P. Gordon-Larsen, C. I. Kiefe and D. Litaker. (2008). Association of
neighborhood socioeconomic status with physical fitness in healthy young adults: The
Coronary Artery Risk Development in Young Adults (CARDIA) study. American Heart
Journal. 155, 699-705.
Background Impaired physical fitness, a contributor to obesity and cardiovascular
disease, has been associated with both an individual's socioeconomic status (SES) and
with residence in disadvantaged neighborhoods. The aim of the study was to examine the
extent to which neighborhood socioeconomic status (SES) is associated with impaired
fitness, independent of clinical characteristics and individual-level SES. Methods Two
thousand five hundred five participants 25 to 42 years old examined in the CARDIA
study from 1992 to 1993 underwent symptom-limited exercise stress testing. Physical
fitness was considered impaired if metabolic equivalents were in the lowest sex-specific
quintile. Neighborhood SES was determined for each census tract using 1990 census
data. Generalized estimating equations assessed the association between neighborhood
SES and physical fitness, before and after adjustments for individual SES,
sociodemographic, and clinical characteristics, and accounted for clustering within
census tracts. Results Individuals in disadvantaged neighborhoods had lower educational
attainment and income, and were more likely unemployed, black, and uninsured. The
odds ratio (95% CI) for impaired physical fitness in the lowest vs highest tertile of
neighborhood SES was 5.8 (3.7-7.3). These became 3.9 (2.7-5:7) after adjusting for
individuals' educational attainment, personal income, employment status, and ability to
pay for basic needs; and 1.9 (1.2-2.9) after additional adjustment for other
sociodemographic and clinical factors. Conclusions Features of one's neighborhood of
residence are relevant to cardiovascular health. A health policy perspective that looks
beyond an individual's characteristics may therefore be useful in identifying more
effective interventions to reduce the prevalence of low physical fitness and its
consequences in young adults.
K. Y. Wolin and G. G. Bennett. (2008). Interrelations of socioeconomic position and
occupational and leisure-time physical activity in the National Health and Nutrition
Examination Survey. J Phys Act Health. 5, 229-41.
BACKGROUND: The interrelations between various physical activity domains have
received little empirical attention in the United States. Of particular interest, given the
potential applicability to traditionally underserved communities, is the nature of the
association between occupational physical activity (OPA) and leisure-time physical
activity (LTPA). METHODS: 5448 adult men and women who participated in NHANES
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1999-2000 were included in analyses. Linear regression was used to examine the
bivariate and multivariable associations of OPA and education with LTPA. Generalized
logit models were used to examine the association of education with OPA. RESULTS:
We found no association between education and LTPA. OPA was significantly positively
associated with LTPA (P <.001). The association between OPA and LTPA was not
strongest among those with low education and held only for men in gender-stratified
analysis. Education was inversely associated with OPA (P <.001) in multivariable
analysis. CONCLUSIONS: Our findings lend preliminary support to the hypothesis that
OPA is an important determinant of LTPA, particularly in men. This provides additional
support to calls for assessment of OPA, particularly among individuals of low social
class.
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MESUREMENT
A. L. Bedimo-Rung, J. L. Thomson, A. J. Mowen, J. Gustat, B. J. Tompkins, P. K.
Strikmiller and M. S. Sothern. (2008). The condition of neighborhood parks following
Hurricane Katrina: development of a Post-Hurricane Assessment instrument. J Phys Act
Health. 5, 45-57.
BACKGROUND: Parks provide environments for physical activity, yet little is known
about how natural disasters affect them or how these disasters alter physical activity. Our
objectives were to (1) describe the development of an instrument to assess park
conditions following a hurricane and (2) document the conditions of New Orleans' parks
3 and 6 months after Hurricane Katrina. METHODS: A Post-Hurricane Assessment
(PHA) instrument was developed and implemented in 54 parks 3 and 6 months posthurricane. RESULTS: Summary scores of the Park Damage Index and the Neighborhood
Damage Index showed improvement between 3 and 6 months of data collection. Parks
and neighborhoods most affected by the hurricane were located in the most- and leastaffluent areas of the city. CONCLUSION: The PHA proved to be a promising tool for
assessing park conditions in a timely manner following a natural disaster and allowed for
the creation of summary damage scores to correlate to community changes.
J. E. Boone, P. Gordon-Larsen, J. D. Stewart and B. M. Popkin. (2008). Validation of a
GIS facilities database: quantification and implications of error. Ann Epidemiol. 18, 3717.
PURPOSE: To validate a commercial database of community-level physical activity
facilities that can be used in future research examining associations between access to
physical activity facilities and individual-level physical activity and obesity. METHODS:
Physical activity facility characteristics and locations obtained from a commercial
database were compared to a field census conducted in 80 census block groups within
two U.S. communities. Agreement statistics, agreement of administratively defined
neighborhoods, and distance between locations were used to quantify count, attribute, and
positional error. RESULTS: There was moderate agreement (concordance: nonurban:
0.39; urban: 0.46) of presence of any physical activity facility and poor to moderate
agreement (kappa range: 0.14 to 0.76) of physical activity facility type. The mean
Euclidean distance between commercial database versus field census locations was 757
and 35 m in the nonurban and urban communities, respectively. However, 94% and 100%
of nonurban and urban physical activity facilities, respectively, fell into the same 5-digit
ZIP code, dropping to 92% and 98% in the same block group and 71% along the same
street. CONCLUSIONS: Our findings suggest that the commercial database of physical
activity facilities may contain appreciable error, but patterns of error suggest that built
environment-health associations are likely biased downward.
M. J. Bryant, D. S. Ward, D. Hales, A. Vaughn, R. G. Tabak and J. Stevens. (2008).
Reliability and validity of the Healthy Home Survey: A tool to measure factors within
homes hypothesized to relate to overweight in children. International Journal Of
Behavioral Nutrition And Physical Activity. 5,
Background: The contribution of the environment to the obesity epidemic is well
recognized. Parents have control over their home environment and can, therefore, support
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healthy dietary and activity habits in their children by manipulating factors such as access
to energy-dense foods, availability of physical activity equipment, and restricting screen
time. This paper describes the development of the Healthy Home Survey and its
reliability and validity. The Healthy Home Survey was designed to assess characteristics
of the home environment that are hypothesized to influence healthy weight behaviors in
children including diet and physical activity. Methods: We recruited 85 families with at
least one child between 3-8 years. The Healthy Home Survey was administered to parents
via telephone and repeated in a random sample of 45 families after 7 days. In-home
observations were performed within 14 days of the first Healthy Home Survey interview.
Percent agreement, Kappa statistics, Intra-class correlation coefficients and sensitivity
analyses were used to evaluate reliability and validity evidence. Results: Reliability and
validity estimates for the Healthy Home Survey were varied, but generally high (0.221.00 and 0.07-0.96 respectively), with lower scores noted for perishable foods and policy
items. Lower scores were likely related to actual change in the perishable foods present
and the subjective nature or clarity of policy questions and response categories.
Conclusion: Initial testing demonstrated that the Healthy Home Survey is a feasible,
reliable, and valid assessment of the home environment; however, it has also highlighted
areas that need improvement. The Healthy Home Survey will be useful in future research
exploring the relationship between the home environment and child weight.
M. W. Chang, R. Brown and S. Nitzke. (2008). Scale development: factors affecting diet,
exercise, and stress management (FADESM). BMC Public Health. 8, 76.
BACKGROUND: The objective of this study was to develop scales measuring personal
and environmental factors that affect dietary fat intake behavior, physical activity, and
stress management in low-income mothers. METHODS: FADESM (factors affecting
diet, exercise, and stress management) scales were developed using the Social Cognitive
Theory to measure personal (outcome expectancies, self-efficacy, emotional coping
response) and environmental (physical environment, social environment, situation)
factors affecting dietary fat intake behavior, physical activity, and stress management.
Low-income African American and white mothers were recruited from the Special
Supplemental Nutrition Program for Women, Infants, and Children in three counties in
Michigan. In Phase one, 45 mothers completed individual cognitive interviews. Content
analyses were performed. In Phase two, items modified from the cognitive interviews
were administered to 216 mothers. Factor analysis and multiple indicators/multiple
causes were performed. RESULTS: Results of cognitive interviews were used to revise
items for the instrument that was tested in Phase two. The factor solution revealed 19
dimensions to measure personal and environmental factors affecting dietary fat intake
behavior (three dimensions), physical activity (eight dimensions), and stress management
(eight dimensions). Results of multiple indicators/multiple causes model showed scale
invariance. Of 19 dimensions, 15 had Cronbach alpha between 0.76 and 0.94 and four
were between 0.66 and 0.69. All dimensions had composite construct reliability scores
between 0.74 to 0.97 and satisfactory construct and discriminant validities.
CONCLUSION: The theory-based FADESM scales have documented good validity and
reliability for measuring factors affecting dietary fat intake behavior, physical activity,
and stress management in low-income women. Results of this study support the use of
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these scales with low-income African American and white mothers in community
settings.
G. K. W. Chin, K. P. Van Niel, B. Giles-Corti and M. Knuiman. (2008). Accessibility
and connectivity in physical activity studies: The impact of missing pedestrian data.
Preventive Medicine. 46, 41-45.
Objective. One important characteristic in physical activity research into the built
environment is network connectivity, usually calculated using street networks. However,
a true pedestrian network may have very different connectivity than a street network.
This study, conducted in 2004, examines the difference in walkability analyses when
street networks versus pedestrian networks are used for four metropolitan suburbs in
Perth, Western Australia. Methods. A street network of Perth was used to represent the
current standard of data for walkability analyses. Aerial photography from 2003 was used
to create a pedestrian network, which incorporated pedestrian footpaths into the street
network. The street and pedestrian networks were compared using three measures of
connectivity: Pedsheds, link node ratio and pedestrian route directness. Results. A
comparison of the results using street versus pedestrian networks showed very different
outcomes for conventional neighbourhood designs. Connectivity measures for
conventional neighbourhoods improved up to 120% with the addition of pedestrian
networks, although traditional neighbourhoods still had slightly better connectivity values
overall. Conclusion. The true pedestrian network increases the connectivity of a
neighbourhood and may have significant impact on these measures, especially in
neighbourhoods with conventional street designs. It is critical that future studies
incorporate pedestrian networks into their analyses.
H. E. Cutt, B. Giles-Corti, M. W. Knulman and T. J. Pikora. (2008). Physical activity
behavior of dog owners: development and reliability of the Dogs and Physical Activity
(DAPA) tool. J Phys Act Health. 5 Suppl 1, S73-89.
BACKGROUND: This study aimed to develop a reliable instrument, the Dogs and
Physical Activity (DAPA) tool, for measuring important attributes and scales relating to
the dog-walking behavior of dog owners. METHODS: Items measuring dog-specific
individual, social environmental, physical environmental, and policy-related factors that
affect dog owners' walking with their dogs were assessed for test-retest reliability. Factor
analysis was undertaken to demonstrate that the collection of test items had underlying
constructs consistent with the theoretical framework. RESULTS: DAPA-tool items had
test-retest reliability scores >.7, indicating a high level of stability. Distinct general and
dog-specific constructs of subscales measuring dog-supportive features of parks, barriers
to dog walking, and behavioral beliefs about the outcomes of regular dog walking were
demonstrated through factor analysis. CONCLUSIONS: The DAPA tool is the first
comprehensive, reliable tool for measuring important attributes and scales relating to dog
owners' physical activity and the context-specific factors that affect owners' walking with
their dogs.
D. M. DeJoy, M. G. Wilson, R. Z. Goetzel, R. J. Ozminkowski, S. H. Wang, K. M.
Baker, H. M. Bowen and K. J. Tully. (2008). Development of the Environmental
Assessment Tool (EAT) to measure organizational physical and social support for
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worksite obesity prevention programs. Journal Of Occupational And Environmental
Medicine. 50, 126-137.
Objective: To describe the development, reliability, and validity of the Environmental
Assessment Tool (EAT) for assessing worksite physical and social environmental support
for obesity prevention. Methods: The EAT was developed using a multistep process.
Inter-rater reliability was estimated via Kappa and other measures. Concurrent and
predictive validity were estimated using site-level correlations and person-level multiple
regression analyses comparing EAT scores and employee absenteeism and health care
expenditures. Results: Results show high inter-rater reliability and concurrent validity for
many measures and predictive validity for absenteeism expenditures. Conclusions: The
primary use of the FAT is as a physical and social environment assessment tool for
worksite obesity prevention efforts. It can be used as a reliable and valid means to
estimate relationships between environmental interventions and absenteeism and medical
expenditures, provided those expenditures are for the same year that the EAT is
administered.
C. D. Economos, J. M. Sacheck, K. Kwan Ho Chui, L. Irizzary, J. Guillemont, J. J.
Collins and R. R. Hyatt. (2008). School-based behavioral assessment tools are reliable
and valid for measurement of fruit and vegetable intake, physical activity, and television
viewing in young children. J Am Diet Assoc. 108, 695-701.
Interventions aiming to modify the dietary and physical activity behaviors of young
children require precise and accurate measurement tools. As part of a larger communitybased project, three school-based questionnaires were developed to assess (a) fruit and
vegetable intake, (b) physical activity and television (TV) viewing, and (c) perceived
parental support for diet and physical activity. Test-retest reliability was performed on all
questionnaires and validity was measured for fruit and vegetable intake, physical activity,
and TV viewing. Eighty-four school children (8.3+/-1.1 years) were studied. Test-retest
reliability was performed by administering questionnaires twice, 1 to 2 hours apart.
Validity of the fruit and vegetable questionnaire was measured by direct observation,
while the physical activity and TV questionnaire was validated by a parent phone
interview. All three questionnaires yielded excellent test-retest reliability (P<0.001). The
majority of fruit and vegetable questions and the questions regarding specific physical
activities and TV viewing were valid. Low validity scores were found for questions on
watching TV during breakfast or dinner. These questionnaires are reliable and valid tools
to assess fruit and vegetable intake, physical activity, and TV viewing behaviors in early
elementary school-aged children. Methods for assessment of children's TV viewing
during meals should be further investigated because of parent-child discrepancies.
H. E. Erwin. (2008). Test-Retest Reliability of a Preadolescent Environmental Access to
Physical Activity Questionnaire. Journal of Physical Activity & Health. 5, S62.
Background: Physical activity behavior is an important aspect of overall health, and it is
important to understand determinants of physical activity in order for children to
accumulate the recommended levels. The ecological-systems theory describes the
relationship between individuals and their contexts, suggesting that environment affects
physical activity behaviors. Researchers should measure children's access to physical
activity to determine environmental influences. At the time of data collection, however,
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no reliable questionnaires had been created for measuring children's access to physical
activity. Methods: Students from grades 4 and 5 completed a physical activity
environmental-access questionnaire on 2 occasions, approximately 7 to 10 days apart.
Results: The questionnaire appeared appropriate for children age 9 to 12. The lowest
reliability was found with items located in the school environment. Conclusions: This
questionnaire is a suitable tool for examining children's physical activity supports and
inhibitors.
K. R. Evenson, B. Neelon, S. C. Ball, A. Vaughn and D. S. Ward. (2008). Validity and
Reliability of a School Travel Survey. Journal of Physical Activity & Health. 5, S1.
Background: Despite the growing interest in active (ie, nonmotorized) travel to and from
school, few studies have explored the measurement properties to assess active travel. We
evaluated the criterion validity and test-retest reliability of a questionnaire with a sample
of young schoolchildren to assess travel to and from school, including mode, travel
companion, and destination after school. Methods: To assess test-retest reliability, 54
children age 8 to 11 years completed a travel survey on 2 consecutive school days. To
assess criterion validity, 28 children age 8 to 10 years and their parents completed a travel
survey on 5 consecutive weekdays. Results: Test-retest reliability of all questions
indicated substantial agreement. The questions on mode of transport, where you will go
after school, and how you will get there also displayed substantial agreement between
parental and child reports. Conclusions: For this population, a questionnaire completed
by school-age children to assess travel to and from school, including mode, travel
companion, and destination after school, was reliably collected and indicated validity for
most items when compared with parental reports.
M. L. Gattshall, J. A. Shoup, J. A. Marshall, L. A. Crane and P. A. Estabrooks. (2008).
Validation of a survey instrument to assess home environments for physical activity and
healthy eating in overweight children. International Journal Of Behavioral Nutrition And
Physical Activity. 5,
Background: Few measures exist to measure the overall home environment for its ability
to support physical activity (PA) and healthy eating in overweight children. The purpose
of this study was to develop and test the reliability and validity of such a measure.
Methods: The Home Environment Survey (HES) was developed to reflect availability,
accessibility, parental role modelling, and parental policies related to PA resources, fruits
and vegetables (F&V), and sugar sweetened drinks and snacks (SS). Parents of
overweight children (n = 219) completed the HES and concurrent behavioural
assessments. Children completed the Block Kids survey and wore an accelerometer for
one week. A subset of parents (n = 156) completed the HES a second time to determine
test-retest reliability. Finally, 41 parent dyads living in the same home (n = 41) completed
the survey to determine inter-rater reliability. Initial psychometric analyses were
completed to trim items from the measure based on lack of variability in responses,
moderate or higher item to scale correlation, or contribution to strong internal
consistency. Inter-rater and test-retest reliability were completed using intraclass
correlation coefficients. Validity was assessed using Pearson correlations between the
HES scores and child and parent nutrition and PA. Results: Eight items were removed
and acceptable internal consistency was documented for all scales (alpha =.66-84) with
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the exception of the F&V accessibility. The F&V accessibility was reduced to a single
item because the other two items did not meet reliability standards. Test-retest reliability
was high (r >.75) for all scales. Inter-rater reliability varied across scales (r =.22-.89). PA
accessibility, parent role modelling, and parental policies were all related significantly to
child (r =.14-.21) and parent (r =.15-.31) PA. Similarly, availability of F&V and SS,
parental role modelling, and parental policies were related to child (r =.14-36) and parent
(r =.15-26) eating habits. Conclusion: The HES shows promise as a potentially valid and
reliable assessment of the physical and social home environment related to a child's
physical activity and eating habits.
G. R. McCormack, E. Cerin, E. Leslie, L. Du Toit and N. Owen. (2008). Objective versus
perceived walking distances to destinations - Correspondence and predictive validity.
Environment And Behavior. 40, 401-425.
Judgments concerning features of environments do not always correspond accurately
with objective measures of those same features. Moreover, perceived and objectively
assessed environmental attributes, including proximity of destinations, may influence
walking behavior in different ways. This study compares perceived and objectively
assessed distance to several different destinations and examines whether correspondence
between objective and perceived distance is influenced by age, gender, neighborhood
walkability, and walking behavior. Distances to most destinations close to home are
overestimated, whereas distances to those farther away are underestimated. Perceived and
objective distances to certain types of destinations are differentially associated with
walking behavior. Perceived environmental attributes do not consistently reflect
objectively assessed attributes, and both appear to have differential effects on physical
activity behavior.
J. L. Nasar. (2008). Assessing perceptions of environments for active living. American
Journal Of Preventive Medicine. 34, 357-363.
Background: Substantial research has been done on the relationship of physical
environments to active living, much of it using observational measures of physical
properties. Although this research is important, it produces an incomplete picture.
Perceptions of environmental factors may affect physical activity. There is particular
value in learning about people's perceptions of environmental factors that are associated
with increased or decreased likelihood of physical activity. Methods: The present paper
surveys and evaluates various options for measuring perceptions of specific environments
and alternatives for study designs and methods. Referring to the relevant studies and
concepts in environmental psychology, environmental perception, and related disciplines,
it identifies and evaluates the measurement methods. Results: The measurement of
environmental perceptions must take into consideration the selection of respondents,
measurement of environmental variables, sampling and mode of presentation of the
environmental stimuli, and response measures. Conclusions: Research can build on
current knowledge of environmental perception to explore measures and methods of
particular relevance to understanding people's likelihood of using places for physical
activity.
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D. Ogilvie, R. Mitchell, N. Mutrie, M. Petticrew and S. Platt. (2008). Perceived
characteristics of the environment associated with active travel: development and testing
of a new scale. International Journal Of Behavioral Nutrition And Physical Activity. 5,
Background: Environmental characteristics may be associated with patterns of physical
activity. However, the development of instruments to measure perceived characteristics
of the local environment is still at a comparatively early stage, and published instruments
are not necessarily suitable for application in all settings. We therefore developed and
established the test-retest reliability of a new scale for use in a study of the correlates of
active travel and overall physical activity in deprived urban neighbourhoods in Glasgow,
Scotland. Methods: We developed and piloted a 14-item scale based on seven constructs
identified from the literature (aesthetics, green space, access to amenities, convenience of
routes, traffic, road safety and personal safety). We administered the scale to all
participants in a random postal survey (n = 1322) and readministered the scale to a subset
of original respondents (n = 125) six months later. We used principal components
analysis and Varimax rotation to identify three principal components (factors) and
derived summary scores for subscales based on these factors. We examined the internal
consistency of these subscales using Cronbach's alpha and examined the test-retest
reliability of the individual items, the subscale summary scores and an overall summary
neighbourhood score using a combination of correlation coefficients and Cohen's kappa
with and without weighting. Results: Public transport and proximity to shops were the
items most likely to be rated positively, whereas traffic volume, traffic noise and road
safety for cyclists were most likely to be rated negatively. Three principal components 'safe and pleasant surroundings', 'low traffic' and 'convenience for walking' - together
explained 45% of the total variance. The test-retest reliability of individual items was
comparable with that of items in other published scales (intraclass correlation coefficients
(ICCs) 0.34-0.70; weighted Cohen's kappa 0.24-0.59). The overall summary
neighbourhood score had acceptable internal consistency (Cronbach's alpha 0.72) and
test-retest reliability (ICC 0.73). Conclusion: This new scale contributes to the
development of a growing set of tools for investigating the role of perceived
environmental characteristics in explaining or mediating patterns of active travel and
physical activity.
H. M. Seagle, J. B. Moore and K. D. DuBose. (2008). An assessment of the walkability
of two school neighborhoods in Greenville, North Carolina. J Public Health Manag Pract.
14, e1-8.
Walking to school provides the opportunity for increasing physical activity and for
improving weight status in youth. Social ecological theory recognizes the link between
supportive built environments and increased walking. To promote walking to school as a
way to increase physical activity in youth, it is important to begin by assessing the
presence and quality of sidewalks in school neighborhoods and then to advocate for
improvements. The purpose of this study is to demonstrate the assessment of the
walkability of two school neighborhood areas, using an evaluation process, which is
designed for use by lay community members, that produces maps to disseminate the
assessment findings to decision makers. A validated and reliable audit instrument was
used to assess the walkability of 114 road segments in the immediately adjacent student
enrollment areas surrounding two elementary schools. Ten variables characterizing the
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transportation and pedestrian environment were measured and used to calculate a
walkability score for each road segment. Color-coded maps of the walkability scores for
each road segment were created to display the patterns of walkability. Sidewalks were
absent in 67 percent and 75 percent of the road segments surrounding the two schools,
respectively. The maps reveal that the very few suitable roads for walking are isolated by
networks of streets with no sidewalks.
J. R. Sirard, M. C. Nelson, M. A. Pereira and L. A. Lytle. (2008). Validity and reliability
of a home environment inventory for physical activity and media equipment.
International Journal Of Behavioral Nutrition And Physical Activity. 5,
Background: Little is known about how the home environmental supports physical
activity and screen media usage. The purpose of this study was to develop and test the
reliability and validity of a self-report instrument to comprehensively reflect the
availability and accessibility of physical activity and screen media equipment in the home
environment. Methods: Ten families participated in the initial field testing to provide
feedback for instrument development. Thirty one adult participants, each of whom had at
least one child 10 -17 years old, completed two Physical Activity and Media Inventory
(PAMI) instruments. The first PAMI was completed simultaneously, but independently,
with a research assistant to assess validity. A second PAMI was completed by the
participant one week later to assess reliability. Results: The adult participants were
mostly mothers/ female guardians, mean age 38 +/- 7.2 years, mostly Caucasian (52%),
college educated (65%), living in single family homes (74%). Test-retest reliability was
acceptable to strong for all summary variables (physical activity equipment, ICC = 0.76
to 0.99; media equipment, ICC = 0.72 to 0.96). For validation, reports from participants
and research assistants were strongly correlated (physical activity, 0.67 - 0.98; media,
0.79 - 0.96). Compared to participants, research assistants reported a greater percentage
of physical activity equipment as "in plain view and easy to get to" and a smaller
percentage of items as "put away and difficult to get to". Conclusion: Our results indicate
strong evidence for the reliability and validity of the variables calculated from the PAMI.
This self report inventory may be useful in assessing the availability of physical activity
and screen media equipment in the home environment and could be used in conjunction
with other home assessment tools (food availability, parenting styles and feeding
practices) to identify obesogenic home environments.
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COMMUNITY INTERVENTIONS–PHYSICAL ACTIVITY/ OBESITY
D. A. Abood, D. R. Black and D. C. Coster. (2008). Evaluation of a school-based teen
obesity prevention minimal intervention. J Nutr Educ Behav. 40, 168-74.
OBJECTIVE: A school-based nutrition education minimal intervention (MI) was
evaluated. DESIGN: The design was experimental, with random assignment at the
school level. SETTING: Seven schools were randomly assigned as experimental, and
7 as delayed-treatment. PARTICIPANTS: The experimental group included 551
teens, and the delayed treatment group included 329 teens. INTERVENTION: The
minimal intervention was Present and Prevent, a commercially available PowerPoint
program presented in two 30-minute time slots over 1 week. MAIN OUTCOME
MEASURES: The dependent variables were nutrition knowledge, attitudes, peer and
family influences, behavioral intentions, and program satisfaction. The independent
variable was group assignment. ANALYSES: A matched-pairs and 2-sample t test
were used respectively to assess within-group and between-group changes.
RESULTS: Significant experimental posttest improvements occurred in the
following: knowledge (P <.001); intention to maintain a healthy body weight because
of importance to friends (P <.001); and intention to eat fewer fried foods, eat fewer
sweets, look more at food labels, and limit TV watching (all P <.001). Program
satisfaction measures were significantly associated with each of the healthy weight
maintenance behavioral intentions. CONCLUSIONS AND IMPLICATIONS: The MI
teen obesity prevention program made an impact on nutrition knowledge and positive
behavioral intentions in only 2 classroom sessions and was well received by
participants.
R. E. Andersen, A. E. Bauman, S. C. Franckowiak, S. M. Reilley and A. L. Marshall.
(2008). Promting health professionals to be activity role models- Motivating stairs use
at the 2001 ACSM Scientific Meeting. Journal of Physical Activity and Health. 5,
607-618.
O. Batik, E. A. Phelan, J. A. Walwick, G. Wang and J. P. LoGerfo. (2008).
Translating a community-based motivational support program to increase physical
activity among older adults with diabetes at community clinics: a pilot study of
Physical Activity for a Lifetime of Success (PALS). Prev Chronic Dis. 5, A18.
BACKGROUND: Regular physical activity is an important goal for elders with
chronic health conditions. CONTEXT: This report describes Physical Activity for a
Lifetime of Success (PALS), an attempt to translate a motivational support program
for physical activity, Active Choices, for use by a group of diverse, low-income,
community-dwelling elders with diabetes. METHODS: PALS linked physical activity
assessment and brief counseling by primary care providers with a structured referral
to a community-based motivational telephone support program delivered by older
adult volunteers. People with diabetes aged 65 years or older who were receiving care
at two community clinics were randomized to receive either immediate or delayed
intervention. The main intended outcome measure was physical activity level; the
secondary outcome measure was mean hemoglobin A1c. CONSEQUENCES: One-
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third of those offered referral to the PALS program in the clinic setting declined.
Another 44% subsequently declined enrollment or were unreachable by the support
center. Only 14 (21%) of those offered referral enrolled in the program. Among these
14, the percentage who were sufficiently active was higher at follow-up than at
enrollment, though not significantly so. Using an intent-to-treat analysis, which
included all randomized clinic patients, we found no significant change in mean
hemoglobin A1c for the intervention group compared with controls.
INTERPRETATION: A community-based referral and support program to increase
physical activity among elderly, ethnically diverse, low-income people with diabetes,
many of whom are not English-speaking, may be thwarted by unforeseen barriers.
Those who enroll and participate in the PALS program appear to increase their level
of physical activity.
M. Blackstone and J. Callahan. (2008). An unsteady walk in the park. Pediatr Emerg
Care. 24, 193-5.
R. A. Carels, K. Konrad, K. M. Young, L. A. Darby, C. Coit, A. M. Clayton and C.
K. Oemig. (2008). Taking control of your personal eating and exercise environment:
a weight maintenance program. Eat Behav. 9, 228-37.
The current investigation examined the impact of a weight maintenance intervention
(MI) designed to empower people to create a personal healthy food and physical
activity environment on weight loss treatment outcomes. It was hypothesized that
behavioral weight loss program (BWLP) participants who received an additional MI
would evidence superior weight loss maintenance compared to participants who
received a BWLP alone (no contact [NC]). Fifty-one obese adults were randomly
assigned to participate in a 16-week weight loss intervention followed by NC or a 6week MI. Thirty-eight participants completed the six-month follow-up. Body weight,
percent body fat, cardiorespiratory fitness, self-reported physical activity, and selfreported diet (i.e., calories, percent daily intake of fat, protein, and carbohydrates)
were assessed. Participants significantly decreased their weight, increased physical
activity/fitness, and improved dietary intake (ps<.05). MI participants had
significantly greater weight loss maintenance than NC participants (ps<.05). Helping
obese individuals to modify their personal eating and physical activity environment in
order to reduce exposure to "obesogenic" cues may contribute to long-term weight
loss maintenance.
K. D. DuBose, M. S. Mayo, C. A. Gibson, J. L. Green, J. O. Hill, D. J. Jacobsen, B.
K. Smith, D. K. Sullivan, R. A. Washburn and J. E. Donnelly. (2008). Physical
activity across the curriculum (PAAC): rationale and design. Contemp Clin Trials. 29,
83-93.
BACKGROUND: Over the years schools have reduced physical education and recess
time in favor of more academic instruction. Due to the drastic rise in obesity levels
among children, some states have begun to mandate minimum amounts of physical
activity (PA) that school children receive, causing schools to find alternative methods
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for increasing PA levels. Physical Activity Across the Curriculum (PAAC) is a 3-year
randomized clinical trial incorporating moderate-intensity PA in elementary schools
to reduce childhood obesity. This paper describes the rational, design, and methods of
the PAAC intervention study. METHODS: Twenty-two elementary schools were
randomized to either a control or intervention condition. In schools randomized to the
intervention condition (PAAC), regular classroom teachers were taught how to
incorporate PA into standard academic lessons. Teachers were asked to accumulate
90-100 min/week of PAAC each week through out the 3-year study period. Schools
randomized to the control group did not alter their teaching methods. Direct
observation of PA levels in the classroom was collected weekly. Height and weight
was measured twice a year to calculate BMI. RESULTS: Two years of the
intervention have been completed and only one school has left the study. The
remaining 21 schools are participating in the final intervention year.
CONCLUSIONS: The results from the PAAC intervention may provide schools with
an alternative method to increase PA levels in children and reduce childhood obesity.
J. C. Eisenmann, D. A. Gentile, G. J. Welk, R. Callahan, S. Strickland, M. Walsh and
D. A. Walsh. (2008). SWITCH: rationale, design, and implementation of a
community, school, and family-based intervention to modify behaviors related to
childhood obesity. Bmc Public Health. 8,
Background: Although several previous projects have attempted to address the issue
of child obesity through school-based interventions, the overall effectiveness of
school-based programs on health-related outcomes in youth has been poor. Thus, it
has been suggested that multi-level interventions that aim to influence healthy
lifestyle behaviors at the community, school and family levels may prove more
successful in the prevention of childhood obesity. Methods/Design: This paper
describes the rationale, design, and implementation of a community, school-, and
family-based intervention aimed at modifying key behaviors (physical activity, screen
time (Internet, television, video games), and nutrition) related to childhood obesity
among third through fifth graders in two mid-western cities. The intervention
involves a randomized study of 10 schools (5 intervention and 5 control schools). The
intervention is being conducted during the duration of the academic year approximately 9 months - and includes baseline and post-intervention measurements
of physical activity, dietary intake, screen time and body composition. Discussion:
We hope this report will be useful to researchers, public health professionals, and
school administrators and health professionals (nurses and physical/health educators)
seeking to develop similar prevention programs. It is obvious that more collaborative,
inter-disciplinary, multi-level work is needed before a proven, effective intervention
package to modify behaviors related to childhood obesity can be generally
recommended. It is our hope that SWITCH is a step in that direction. Trial
Registration: ClinicalTrials. gov NCT00685555.
P. A. Estabrooks, M. Bradshaw, D. A. Dzewaltowski and R. L. Smith-Ray. (2008).
Determining the impact of walk kansas: Applying a team-building approach to
community physical activity promotion. Annals of Behavioral Medicine. 36, 1-12.
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S. J. Fairclough, G. Stratton and Z. H. Butcher. (2008). Promoting health-enhancing
physical activity in the primary school: a pilot evaluation of the BASH health-related
exercise initiative. Health Education Research. 23, 576-581.
The 'Be Active Stay Healthy' (BASH) health-related exercise (HRE) programme was
delivered to Year 5 students (age 9-10 years) in two primary schools situated in the
same area of a northwest England town. BASH aims to improve students'
participation in and knowledge of HRE through structured physical activities. Fiftyfive students completed pre- and post-programme HRE knowledge and understanding
questionnaires. Moderate to vigorous physical activity (MVPA) levels of 13 students
were assessed using accelerometers during two contrasting lessons focusing on
optimal activity levels (active) and cognitive learning (cognitive). Mean percentage of
correct questionnaire answers improved from 60.8 to 83.8% (P = 0.0001, effect size
(ES) = 1.44), and questionnaire performance was significantly better among students
in one of the schools (P = 0.017, ES = 0.72). Boys engaged in MVPA for 11% more
time than girls during the active lessons (P = 0.0006, ES = 1.21) but MVPA during
cognitive lessons was similar. The BASH programme has potential to use structured
physical activity as a medium to enhance students' HRE knowledge, particularly in
relation to the fundamental understanding of healthy and active lifestyles. HRE
knowledge may differ between schools, even when they are similarly sized and
located, with analogous student catchment areas. Recommendations for the future
delivery and evaluation of the programme are made.
C. Graf, B. Koch, G. Falkowski, S. Jouck, H. Christ, K. Staudenmaier, W. Tokarski,
A. Gerber, H.-G. Predel and S. Dordel. (2008). School-based prevention: Effects on
obesity and physical performance after 4 years. Journal of Sports Sciences. 26, 987.
Juvenile obesity is increasing worldwide. Preventive strategies are warranted. The
school-based Children's Health Interventional Trial (the CHILT Project) combines
health education and physical activity for children. The effect on obesity and physical
performance was studied after four years in 12 primary schools compared with five
control schools. Anthropometric data were recorded. Physical performance was
measured by a coordination test for children (balancing backwards, one-legged
obstacle jumping, lateral jumping, sideways movements) and a 6-min run
(endurance). No difference in the prevalence and incidence of overweight and obesity
was found between the intervention and control schools before and after the
intervention. Remission of overweight was higher in the intervention schools (23.2
vs. 19.2%), but not significant. An increase in coordination related to lateral jumping
and balancing backwards was apparent in the intervention schools (30.6, s = 10.8 vs.
26.1, s = 10.8, P = 0.005; 21.8, s = 11.8 vs. 19.4, s = 11.7, P = 0.007), and the
increase in endurance performance tended to be higher in intervention schools (100.8,
s = 122.7 vs. 92.8, s = 126.0, P = 0.055), adjusted for age, sex, baseline test result,
and body mass index at final examination. Therefore, preventive intervention in
primary school offers the possibility to improve physical performance in children.
The prevalence and incidence of obesity were not affected.
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B. Gutin, Z. Yin, M. Johnson and P. Barbeau. (2008). Preliminary findings of the
effect of a 3-year after-school physical activity intervention on fitness and body fat:
the Medical College of Georgia Fitkid Project. Int J Pediatr Obes. 3 Suppl 1, 3-9.
OBJECTIVE: To evaluate the effect of a 3-year after-school physical activity (PA)
intervention on aerobic fitness and percent body fat (%BF). METHODS: In total, 18
schools were randomized into intervention or control arms. Measurements were made
at the beginning and end of the third, fourth and fifth grades. Fitness was measured
with heart rate response to a bench-stepping task.%BF and bone density were
measured with dual-energy x-ray absorptiometry. The intervention included 40 min
of academic enrichment activities, during which healthy snacks were provided, and
80 min of moderate-to-vigorous PA (MVPA). RESULTS: Data analyses were
performed on 206 youths who remained in the same schools for the 3-year period,
who were measured at all six time points and, for the intervention group, who
attended at least 40% of the sessions in each of the 3 years. The group by time
interactions were significant for fitness (p < 0.01) and %BF (p < 0.05). Children in
intervention schools improved in fitness and %BF during the school years and
returned to levels similar to those in control schools during the summers. Over the six
measurement points, the intervention group increased more than the control group in
bone density (p < 0.01), fat-free soft tissue (p < 0.01), weight (p < 0.01), height (p <
0.01), and body mass index (p < 0.05). CONCLUSIONS: An after-school program
focusing on MVPA had a beneficial effect on fitness and body composition. During
the summers, the beneficial effect of the previous year's participation on fitness and
%BF was lost. This highlights the importance of year-round programs to promote
healthy growth in youths.
L. Haerens, E. Cerin, L. Maes, G. Cardon, B. Deforche and I. De Bourdeaudhuij.
(2008). Explaining the effect of a 1-year intervention promoting physical activity in
middle schools: a mediation analysis. Public Health Nutr. 11, 501-12.
OBJECTIVE: The aim of the present study was to examine the mediation effects of
changes in psychosocial determinants of physical activity (attitude, social support,
self-efficacy, perceived benefits and barriers) on changes in physical activity.
DESIGN: One-year intervention study with baseline and 1-year post measures of
physical activity habits and psychosocial correlates. SETTING: Fifteen middle
schools. SUBJECTS: Boys and girls (n = 2840) aged 11-15 years completed the
validated questionnaires during class hours. RESULTS: The product-of-coefficients
test was used to asses the mediating effects. Self-efficacy for physical activity at
school was found to be the only significant mediator of physical activity change.
Specifically, self-efficacy for physical activity at school partly mediated the effect of
the intervention on total and school-related physical activity change in the
intervention group with parental support (P < 0.05). None of the other potential
mediators, attitudes, social support, perceived benefits and perceived barriers, seemed
to have had a positive effect. Even a suppressor effect was found for attitudes. Given
that the effects of self-efficacy and attitudes were of opposite direction, the total
mediated/suppressed effects of the intervention were not statistically significant.
CONCLUSIONS: Positive changes in total and school-related physical activity in
adolescents could be partly explained by increases in self-efficacy for physical
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activity at school through a physical activity intervention in middle schools with
parental support. However, the suppressor effect of attitudes decreased this effect. As
this is one of the first true mediation analyses in this age group, further research is
needed to replicate the importance of these mediators.
J. Henaghan, N. McWhannell, L. Foweather, N. T. Cable, A. M. Batterham, G.
Stratton and K. P. George. (2008). The Effect of Structured Exercise Classes and a
Lifestyle Intervention on Cardiovascular Risk Factors in Primary Schoolchildren: An
Exploratory Trial (The A-CLASS Project). Pediatric Exercise Science. 20, 169.
This exploratory trial evaluates the effect of a structured exercise (STEX) or lifestyle
intervention (PASS) program upon cardiovascular (CV) disease risk factors in
children. Sixty-one schoolchildren were randomly assigned by school to an
intervention or control (CON) condition. The effect of the STEX (compared with
CON) was a mean benefit of -0.018 mm for average maximum carotid intimamedia
thickness. The PASS intervention did not result in clinically important effects, and no
other substantial changes were observed. Relatively high probability of clinically
beneficial effects of the STEX intervention suggests that a larger, definitive
randomized trial with longer follow-up is warranted. ABSTRACT FROM AUTHOR
C. M. Hoehner, J. Soares, D. P. Perez, I. C. Ribeiro, C. E. Joshu, M. Pratt, B. D.
Legetic, D. C. Malta, V. R. Matsudo, L. R. Ramos, E. J. Simoes and R. C. Brownson.
(2008). Physical activity interventions in Latin America - A systematic review.
American Journal Of Preventive Medicine. 34, 224-233.
Background: Recommendations for physical activity in the Guide to Community
Preventive Services (the Community Guide) have not been systematically examined
or applied in developing countries such as those in Latin America. The aim of this
systematic review was to assess the current evidence base concerning interventions to
increase physical activity in Latin America using a modified Community Guide
process and to develop evidence-based recommendations for physical activity
interventions. Methods: In 2006, a literature review of both peer-reviewed and nonpeer-reviewed literature in Portuguese, Spanish, and English was carried out to
identify physical activity interventions conducted in community settings in Latin
America. Intervention studies were identified by searching ten databases using 16
search terms related to physical activity, fitness, health promotion, and community
interventions. All intervention studies related to physical activity were summarized
into tables. Six reviewers independently classified the intervention studies by the
categories used in the Community Guide and screened the studies for inclusion in a
systematic abstraction process to assess the strength of the evidence. Five trained
researchers conducted the abstractions. Results: The literature search identified 903
peer-reviewed articles and 142 Brazilian theses related to physical activity, of which
19 were selected for full abstraction. Only for school-based physical education classes
was the strength of the evidence from Latin America sufficient to support a practice
recommendation. Conclusions: This systematic review highlights the need for
rigorous evaluation of promising interventions to increase physical activity in Latin
America. Implementation and maintenance of school physical education programs
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and policies should be strongly encouraged to promote the health of Latin American
children.
J. M. Jancey, A. H. Lee, P. A. Howat, A. Clarke, K. Wang and T. Shilton. (2008).
The effectiveness of a physical activity intervention for seniors. American Journal Of
Health Promotion. 22, 318-321.
Purpose. To determine whether a tailored, 6-month, neighborhood-based, physical
activity intervention for people aged 65 to 74 years could increase their total physical
activity levels and to identify factors associated with physical activity times. Design.
A longitudinal, prospective, intervention study. Setting. Perth, Western Australia.
Subjects. A total of 573 older adults, recruited from 30 intervention (n = 260) and 30
control (n 313) neighborhoods. Initial response rates were 74% (260/352) in the
intervention group and 82% (313/382) in the control group, which provided the 5 73
adults for participation in the study. A total of 413 participants (177 and 236 in the
intervention and control groups, respectively) completed the program. Intervention. A
neighborhood-based physical activity intervention. Measures. A self-reported
questionnaire administered, at three time points. Physical activity levels were
measured using the International Physical Activity Questionnaire. Personal and
demographic information, including perceived financial. struggle and proximity to
friends, were collected. Analysis. Descriptive statistics, repeated measures analysis of
variance, and generalized estimating equations (GEE). Results. The intervention
resulted in a significant increase in total average physical activity times of 2.25 hours
per week (p <.001). The GEE analysis confirmed significant increases in physical
activity from baseline to midpoint (p =.002) and to postintervention (p =.031).
Perception of financial struggle (p =.020) was positively associated with physical
activity time spent by participants, whereas having no friends or acquaintances living
nearly (p =.037) had a significant negative correlation. The main limitation of this
study was the restricted duration of the intervention. Conclusion. The program was
successful in increasing weekly mean time for physical activity in seniors and in
identifying factors that affect their commitment to physical activities.
R. R. Kipping, C. Payne and D. A. Lawlor. (2008). Randomised controlled trial
adapting US school obesity prevention to England. Archives Of Disease In
Childhood. 93, 469-473.
Objectives: To determine whether a school obesity prevention project developed in
the United States can be adapted for use in England. Methods: A pilot cluster
randomised controlled trial and interviews with teachers were carried out in 19
primary schools in South West England. Participants included 679 children in year 5
(age 9-10). Baseline and follow-up assessments were completed for 323 children
(screen viewing) and 472 children (body mass index). Sixteen lessons on healthy
eating, physical activity and reducing TV viewing were taught over 5 months by
teachers. Main outcome measures were hours of screen activities, body mass index,
mode of transport to school and teachers' views of the intervention. Results: Children
from intervention schools spent less time on screen-viewing activities after the
intervention but these differences were imprecisely estimated: mean difference in
minutes spent on screen viewing at the end of the intervention (intervention schools
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minus control schools) adjusted for baseline levels and clustering within schools was
-11.6 (95% CI -42.7 to 19.4) for a week day and was -15.4 (95% CI -57.5 to 26.8) for
a Saturday. There was no difference in mean body mass index or the odds of obesity.
Conclusions: It is feasible to transfer this US school-based intervention to UK
schools, and it may be effective in reducing the time children spend on screen-based
activities. The study has provided information for a full-scale trial, which would
require 50 schools (similar to 1250 pupils) to detect effects on screen viewing and
body mass index over 2 years of follow-up.
A. Lara, A. K. Yancey, R. Tapia-Conye, Y. Flores, P. Kuri-Morales, R. Mistry, E.
Subirats and W. J. McCarthy. (2008). Pausa para tu Salud: reduction of weight and
waistlines by integrating exercise breaks into workplace organizational routine. Prev
Chronic Dis. 5, A12.
INTRODUCTION: Proactive worksite strategies that change the physical or
sociocultural environment(s) to incorporate obligatory physical activity may be
necessary to engage sedentary people. This study describes implementation and
evaluation of an intervention, Pausa para tu Salud (Pause for Your Health), that
integrated a brief period of group exercise into the workday. METHODS: An
uncontrolled pretest-post-test study design tested the effects of integrating daily 10minute exercise breaks during paid work time during January 2003 through January
2004. A total of 335 Mexican Ministry of Health office workers provided baseline
data as a part of routine annual clinical screening examinations. RESULTS: Baseline
mean body mass index and waist circumferences were 27.8 kg/m(2) and 87.6 cm for
women and 26.6 kg/m(2) and 89.7 cm for men. Complete data were available for 271
(80.9%) employees at 1-year follow-up. Two-tailed, paired t-test comparisons were
used. Body mass index decreased by 0.32 kg/m(2) (P =.05), and waist circumference
by 1.6 cm (P =.0009) overall. The body mass index decrease, however, was
significant only for men (-0.43 kg/m(2), P =.03). Multivariate analyses revealed a
significant decrease in diastolic blood pressure among women (z = -2.04, P =.042).
CONCLUSION: The intervention was associated with significant improvements in
both measures of body composition. Substantive health and organizational benefits
may result from integrating brief periods of physical activity into the workday if these
findings are replicated in randomized controlled trials in other worksites.
A. Liu, X. Hu, G. Ma, Z. Cui, Y. Pan, S. Chang, W. Zhao and C. Chen. (2008).
Evaluation of a classroom-based physical activity promoting programme. Obesity
Reviews. 9, 130-134.
The purpose of the present study was to evaluate the effect of the Happy 10
programme on the promotion of physical activity, physical growth and development
of primary school students, and on obesity control and prevention. Two similar
primary schools from one district of Beijing, China were selected, one as an
intervention school and the other as a control school. A Happy 10 programme was
implemented at least once every school day in the intervention school for two
semesters, whereas no intervention was adopted in the control school. The
information on energy expenditure and duration of physical activity was collected by
a validated 7-day physical activity questionnaire. Height and weight were measured
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by the trained investigators following standardized procedure. Energy expenditure
and intensity of each Happy 10 session were measured by a physical activity monitor.
The average energy expenditure and duration of total physical activity per day among
students in the intervention school increased significantly from 15.0 to 18.2 kcal kg(1) and 2.8 to 3.3 h, respectively, whereas the figures significantly decreased in the
control school. There was a significant difference in change of weight and body mass
index between girls in the intervention and control school (2.4 kg vs. 4.6 kg; 0.47 kg
m(-2) vs. 0.66 kg m(-2)). The prevalence of overweight and obesity in the
intervention school decreased by 0.4-5.6%, as compared with the increase by 0.64.5% in the control school. The average energy expenditure and intensity per 10-min
session ranged from 25.0 to 35.1 kcal and from 4.8 to 6.2 kcal kg(-1) h(-1),
respectively, in grades 1-5. The Happy 10 programme provides a useful strategy to
promote physical activity among school children, and also plays a positive role in
building up physical growth and development of girls.
P. J. Naylor, H. M. Macdonald, D. E. R. Warburton, K. E. Reed and H. A. McKay.
(2008). An active school model to promote physical activity in elementary schools:
Action schools! BC. British Journal Of Sports Medicine. 42,
Objective: To assess the impact of an active school model on children's physical
activity (PA). Design: 16-month cluster randomised controlled trial. Setting: 10
elementary schools in Greater Vancouver, BC. Participants: 515 children aged 9-11
years. Intervention: Action Schools! BC (AS! BC) is an active school model that
provided schools with training and resources to increase children's PA. Schools
implemented AS! BC with support from either external liaisons (liaison schools, LS;
four schools) or internal champions (champion schools, CS; three schools). Outcomes
were compared with usual practice (UP) schools (three schools). Main outcome
measurements: PA was measured four times during the study using pedometers (step
count, steps/day). Results: Boys in the LS group took 1175 more steps per day, on
average, than boys in the UP group (95% CI: 97 to 2253). Boys in the CS group also
tended to have a higher step count than boys in the UP group (+ 804 steps/day; 95%
CI: 2341 to 1949). There was no difference in girls' step counts across groups.
Conclusions: The positive effect of the AS! BC model on boys' PA is important in
light of the current global trend of decreased PA.
J. O'Connor, K. Steinbeck, A. Hill, M. Booth, M. Kohn, S. Shah and L. Baur. (2008).
Evaluation of a community-based weight management program for overweight and
obese adolescents: The Loozit study. Nutrition & Dietetics. 65, 121.
Aim: To evaluate a community-based weight management program for overweight
and obese adolescents aged 13–16 years. Methods: The present study was a groupbased intervention over five months conducted in Australian community health
centres. Program evaluation questionnaires were completed by adolescents and their
parents. Seven semi-structured group sessions were held for adolescents: weekly for
four weeks and then at two, four and five months. The program sessions focused on
healthy eating, increasing physical activity, decreasing sedentary behaviour and
increasing self-esteem. Adolescents' anthropometry, blood pressure and fasting blood
biochemistry were measured. Adolescents completed validated questionnaires on diet,
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physical activity and self-esteem. Results: Twenty-two overweight and obese
adolescents were recruited with a median body mass index (BMI) z-score 2.30.
Recruitment strategies were identified and a high retention rate (91%) was achieved.
The program was well received by adolescents. Parents reported their adolescents
were making healthier food choices and increasing physical activity. At treatment end
there were clinically significant improvements in self-perception scores for physical
appearance and romantic appeal (P < 0.05), waist circumference (median 100.1 cm vs
97.1 cm; P < 0.0001) and HDL cholesterol (median 1.10 mmol/L vs 1.20 mmol/L; P
= 0.02), but not BMI or BMI z-score. Conclusions: The Loozit weight management
intervention is one of the first to involve adolescents in the evaluation of the program
and to operate at a sustainable intensity in an accessible community setting. The
present study provides valuable insights into the elements of a program that is
acceptable to adolescents.
R. R. Pate and J. R. O'Neill. (2008). Summary of the American Heart Association
scientific statement: promoting physical activity in children and youth: a leadership
role for schools. J Cardiovasc Nurs. 23, 44-9.
Schools have long played an important role in providing students with healthful
physical activity. However, the decline in population-level physical activity suggests
that schools should play an even greater role in providing and promoting physical
activity. Recently, the American Heart Association issued a set of recommendations
that, if implemented, would position schools as leaders in helping children and youth
become more physically active. This article summarizes an American Heart
Association scientific statement on physical activity and the schools that was recently
developed by the Association's Council on Nutrition, Physical Activity, and
Metabolism in collaboration with the Council on Cardiovascular Disease in the
Young and the Council on Cardiovascular Nursing.
J. A. Perman, T. L. Young, E. Stines, J. Hamon, L. M. Turner and M. G. Rowe.
(2008). A community-driven obesity prevention and intervention in an elementary
school. J Ky Med Assoc. 106, 104-8.
In partnership with community agencies and organizations, University of Kentucky
College of Medicine (UKCOM) launched an after-school program focusing on
creating healthy, active lifestyles for students at a Lexington elementary school.
Chosen for the underserved population of children it cares for, the school exhibits all
of the national risk factors for obesity: low-income families (57% of annual
household incomes less than $10,000); minority population (80% of the children
African-American or Hispanic); and located in an unsafe neighborhood for outdoor
physical activity. These demographics resulted in a school population that had body
mass index (BMI) demographics of 48.8% overweight (BMI >85%), including 30.7%
obese (BMI >95%), in contrast with the national average of 16% obese. METHODS:
Targeting the school's children with a BMI >85th percentile, an after-school program
was created. The students met twice a week for 90-minute sessions of fun physical
activities, proper nutritional information, as well as small group sessions with
pediatric psychiatry residents focusing on good choices and proper motivations in
life. Universal school interventions were also instituted in an attempt to reach the
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entire school population. RESULTS: Initial findings after the first year of the
program indicated a slowing in the average rate of weight gain by the targeted
population. While the results, compared to accessible data in a school population with
similar demographics, did not reach statistical significance, the trends were in the
desired direction. A statistically significant difference (p=0.027) was observed in
mean BMI percentile for the universal school population versus the comparison
school. CONCLUSION: School-based prevention and intervention conducted by a
coalition of community agencies and organizations is a promising and cost-effective
approach to curtailing childhood obesity.
K. E. Reed, D. E. R. Warburton, H. M. Macdonald, P. J. Naylor and H. A. McKay.
(2008). Action Schools! BC: A school-based physical activity intervention designed
to decrease cardiovascular disease risk factors in children. Preventive Medicine. 46,
525-531.
Objective. Our primary objective was to determine whether a novel 'active school'
model - Action Schools! BC - improved the cardiovascular disease (CVD) risk profile
in elementary-school children. Our secondary objective was to determine the
percentage of children with elevated CVD risk factors. Methods. We undertook a
cluster-randomized controlled school-based trial with 8 elementary schools across I
school year, in British Columbia, Canada, beginning in 2003. Boys and girls (n=268,
age 9-11 years) were randomly assigned (by school) to usual practice (UP, 2 schools)
or intervention (INT, 6 schools) groups. We assessed change between groups in
cardiovascular fitness (20-m Shuttle Run), blood pressure (BP), and body mass index
(BMI, wt/ht(2)). We evaluated total cholesterol (TC), total: high-density cholesterol
(TC:HDL-C), low-density lipoprotein, apolipoprotein B, C-reactive protein and
fibrinogen on a subset of volunteers (n=77). Results. INT children had a 20% greater
increase in fitness and a 5.7% smaller increase in BP compared with children
attending UP schools (P<0.05). Forty five percent of children had at least one
elevated risk factor (fitness, BP or BMI) at baseline. There were no significant
differences between groups for change in BMI or in any of the blood variables.
Conclusion. Action Schools! BC was an effective school-based physical activity
model for improving the CVD risk profile of elementary-school children. Our multicomponent intervention exposed children to fitness enhancing physical activity. It
may be important for education stakeholders to adequately resource the delivery of
the active school models if cardiovascular health benefits are to be achieved on a
population basis.
J. Rice, D. Thombs, R. Leach and R. Rehm. (2008). Successes and barriers for a
youth weight-management program. Clin Pediatr (Phila). 47, 143-7.
A patient recruiting process was developed for a youth weight-management program
in a metropolitan area, and the clinical effects of the program on overweight and
obese children aged 7 to 17 years old were assessed. During the 12-month effort, 68
overweight children were enrolled. The program included exercise, nutrition
coaching, and behavior change counseling. Clinical outcomes were measured. Patient
recruiting methods were monitored and included working with physicians and schools
and marketing to consumers. Program adherence was 71% attendance, 5%
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noncompliance, and 5% drop out rates. Clinical outcomes were excellent: 68% of
participants lowered their body mass index by an average of 2.5% (mean, 24 weeks).
The program was clinically successful, but patient recruitment initiatives were
unsuccessful and the program was discontinued. Parents were the largest obstacle to
patient recruiting efforts. For children's weight-management programs to be
commercially viable, new models of patient recruiting and promotion of parental
acceptance are needed.
F. T. Shaya, D. Flores, C. M. Gbarayor and J. Wang. (2008). School-Based Obesity
Interventions: A Literature Review. Journal of School Health. 78, 189.
Background: Childhood obesity is an impending epidemic. This article is an overview
of different interventions conducted in school settings so as to guide efforts for an
effective management of obesity in children, thus minimizing the risk of adult obesity
and related cardiovascular risk. Methods: PubMed and OVID Medline databases were
searched for school-based obesity interventions with anthropometric measures in
children and adolescents between the ages of 7 and 19 years from June 1986 to June
2006. Studies were reviewed by duration, type of intervention, and defined qualitative
and quantitative measures, resulting in a yield of 51 intervention studies. Results: The
interventions ranged from 4 weeks in length to as long as 8 continuing years. In total,
15 of the intervention studies exclusively utilized physical activity programs, 16
studies exclusively utilized educational models and behavior modification strategies,
and 20 studies utilized both. In addition, 31 studies utilized exclusively quantitative
variables like body mass indices and waist-to-hip ratios to measure the efficacy of the
intervention programs, and another 20 studies utilized a combination of quantitative
and qualitative measures that included self-reported physical activity and attitude
toward physical activity and the tested knowledge of nutrition, cardiovascular health,
and physical fitness. A total of 40 studies achieved positive statistically significant
results between the baseline and the follow-up quantitative measurements.
Conclusions: No persistence of positive results in reducing obesity in school-age
children has been observed. Studies employing long-term follow-up of quantitative
and qualitative measurements of short-term interventions in particular are warranted.
W. G. Thompson, R. C. Foster, D. S. Eide and J. A. Levine. (2008). Feasibility of a
walking workstation to increase daily walking. Br J Sports Med. 42, 225-8;
discussion 228.
OBJECTIVE: The number of calories expended in the workplace has declined
significantly in the past 75 years. A walking workstation that allows workers to walk
while they work has the potential to increase caloric expenditure. We evaluated
whether employees can and will use walking workstations while performing their
jobs. METHODS AND PROCEDURES: We studied nurses, clinical assistants,
secretaries and appointment secretaries using the StepWatch Activity Monitor System
(which accurately measures steps taken at slow speeds) while performing their job
functions in their usual fashion and while using the walking workstation. RESULTS:
Subjects increased the number of steps taken during the workday by 2000 steps per
day (p<0.05). This was equivalent to an increase in caloric expenditure of 100
kcal/day. Subjects reported that they enjoyed using the workstation, that it could be
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used in the actual work arena and that, if available, they would use it. DISCUSSION:
Walking workstations have the potential for promoting physical activity and
facilitating weight loss. Several subjects in this study expended more than 200 extra
calories daily using such a system. Further trials are indicated.
D. S. Ward, S. E. Benjamin, A. S. Ammerman, S. C. Ball, B. H. Neelon and S. I.
Bangdiwala. (2008). Nutrition and physical activity in child care: results from an
environmental intervention. American Journal of Preventive Medicine. 35, 352-356.
L. S. Webber, D. J. Catellier, L. A. Lytle, D. M. Murray, C. A. Pratt, D. R. Young, J.
P. Elder, T. G. Lohman, J. Stevens, J. B. Jobe and R. R. Pate. (2008). Promoting
physical activity in middle school girls - Trial of activity for adolescent girls.
American Journal Of Preventive Medicine. 34, 173-184.
Background: Physical activity is important for weight control and good health;
however, activity levels decline in the adolescent years, particularly in girls. Design:
Group randomized controlled trial. Setting/participants: Middle school girls with
English-speaking skills and no conditions to prevent participation in physical activity
in 36 schools in six geographically diverse areas of the United States. Random, crosssectional samples were drawn within schools: 6th graders in 2003 (n=1721) and 8th
graders in 2005 (n=3504) and 2006 (n=3502). Intervention: A 2-year study-directed
intervention (fall 2003 to spring 2005) targeted schools, community agencies, and
girls to increase opportunities, support, and incentives for increased physical activity.
Components included programs linking schools and community agencies, physical
education, health education, and social marketing. A third-year intervention used
school and community personnel to direct intervention activities. Main outcome
measures: The primary outcome, daily MET-weighted minutes of moderate-tovigorous physical activity (MET-weighted MVPA), was assessed using
accelerometry. Percent body fat was assessed using anthropometry. Results: After the
staff-directed intervention (pre-stated primary outcome), there were no differences
(mean=-0.4, 95% CI=-8.2 to 7.4) in adjusted MET-weighted MVPA between 8thgrade girls in schools assigned to intervention or control. Following the Program
Champion-directed intervention, girls in intervention schools were more physically
active than girls in control schools (mean difference 10.9 MET-weighted minutes of
MVPA, 95% CI=0.52-21.2). This difference is about 1.6 minutes of daily MVPA or
80 kcal per week. There were no differences in fitness or percent body fat at either
8th-grade timepoint. Conclusion: A school-based, community-linked intervention
modestly improved physical activity in girls. Trial Registration: NCT00006409.
J. Wolman, E. Skelly, M. Kolotourou, M. Lawson and P. Sacher. (2008). Tackling
toddler obesity through a pilot community-based family intervention. Community
Pract. 81, 28-31.
The lack of effective child obesity intervention and intervention prevention
programmes is an increasing concern for public health professionals. Since eating and
physical activity habits become established in the early years, these efforts should
start as early as possible. A pilot programme, Fighting Fit Tots, was developed within
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a local Sure Start area. It consiste, of 11 weekly parent and toddler physical activity
sessions, followed by a parent/carer healthy lifestyle workshop. Fighting Fit Tots was
modelled on The MEND Programme, a successful community-based obesity
intervention for school-aged children. Toddle recruitment criteria were based on the
children's age, body mass index and parental obesity status. It was noticed that uptake
and attendance were unsatisfac tory due to poor parental perception of child weight
status, commitment issues, and limited staff capacity for outreach work. Therefore,
the group was extended to all families with a toddler and this proved more
successful.The pilot was a promising experience, an more community practitioners
should be encourager to adopt and improve a public health approach to obesity
prevention in the early years.
H. R. Wyatt, B. T. Jortberg, C. Babbel, S. Garner, F. Dong, G. K. Grunwald and J. O.
Hill. (2008). Weight loss in a community initiative that promotes decreased energy
intake and increased physical activity and dairy consumption: Calcium Weighs-In. J
Phys Act Health. 5, 28-44.
BACKGROUND: This project addresses the need to identify feasible, effective
weight-management programs that can be implemented within communities. The
controversial role of dairy products in weight-management programs is also explored.
METHODS: The "Calcium Weighs-In" weight-loss program placed equal emphasis
on diet and physical activity and was delivered within a community intervention to
promote dairy consumption in Calcium, New York. One hundred ninety-nine adults
in Calcium, NY, participated in the weight-loss program. Weight loss, increase in
dairy intake, increase in steps, decrease in blood pressure, decrease in waist
circumference, and decrease in body mass index (BMI) were examined. RESULTS:
The mean weight loss for 116 subjects who completed the program was 6.0 +/- 4.2 kg
(mean +/- SD, P <.0001) with a percent weight change of 6.4% +/- 4.2% (P <.0001).
An increase of 3582 +/- 4070 steps (P <.0001), as well as an increase of 0.8 +/- 1.2
dairy servings (P <.0001) was seen. Higher average dairy consumption was
associated with greater weight loss and a greater decrease in waist circumference.
CONCLUSION: The results show that effective weight-management programs can
be implemented within communities. The results are also consistent with
recommendations to include low-fat dairy products and a physical activity component
in weight-management programs.
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CHILDHOOD OBESITY—GENERAL
(2008). Large-Scale Childhood Obesity Prevention Efforts. IDEA Fitness Journal. 5, 62.
This article offers an overview of organizations and coalitions that introduce childhood
obesity prevention efforts in the U.S. Action for Health Kids is a national nonprofit
organization devoted to optimizing school-based efforts to address childhood obesity.
The Alliance for a Healthier Generation created the Healthy Schools Program to improve
school nutrition and physical activity. The Food Trust works on initiatives to expand food
access, education and marketing campaigns aimed at improving health.
(2008). Childhood Obesity in a South Florida Elementary School. Journal of School
Health. 78, 243.
A letter to the editor is presented in response to a study about childhood obesity in the
Miami-Dade County Public Schools in Miami-Dade County, Florida.
L. S. Adair. (2008). Child and adolescent obesity: epidemiology and developmental
perspectives. Physiol Behav. 94, 8-16.
From infancy through adolescence, more and more children are becoming overweight.
National prevalence data show that more than 17% of youth have a body mass index
(BMI) above the 95th percentile of the US age and sex-specific reference. Particularly
alarming are rates in children as young as 2 years of age, and among minority children.
Periods of heightened vulnerability to weight gain have been identified, and research
supports the notion that obesity has its origins in early life. This paper focuses on
susceptibility to increased adiposity during the prenatal period, infancy, mid-childhood
and adolescence, and how factors operating in each of these periods influence risk of
becoming overweight. Prenatal exposure to over or undernutrition, rapid growth in early
infancy, an early adiposity rebound in childhood, and early pubertal development have all
been implicated in the development of obesity. The persistence of obesity from young
ages emphasizes the importance of understanding growth trajectories, and of developing
prevention strategies to overcome strong influences of obesigenic environments at young
ages.
A. K. Adams, H. Harvey and D. Brown. (2008). Constructs of Health and Environment
Inform Child Obesity Prevention in American Indian Communities. Obesity (19307381).
16, 311.
The article describes a qualitative research project designed to identify parental
perceptions regarding children's health that might either enable or limit healthy behaviors
related to obesity. In this study, focus group sessions were conducted to explore parental
perspectives on children's health, diet and physical activity in American Indian (AI)
populations.
A. Albertini, A. Tripodi, A. Fabbri, M. Mattioli, G. Cavrini, R. Cecchetti, E. Dalle
Donne, C. Cortesi, S. De Giorgi, V. Contarini, L. Andreotti, B. Veronesi, I. Stefanelli and
E. Di Martino. (2008). Prevalence of obesity in 6- and 9-year-old children living in
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Central-North Italy. Analysis of determinants and indicators of risk of overweight. Obes
Rev. 9, 4-10.
The objective of our article is to survey the prevalence of overweight and obesity among
6- and 9-year-old children in Emilia-Romagna, a region of Central-North Italy, and to
study the eating habits and behaviours of these children and their families. During 2003
and 2005, we analysed a stratified sample of the general population of children attending
pre-school (2681 children aged 6 years) and primary school (2955 children aged 9 years).
Their height and weight were measured by healthcare workers. In the 6-year-old children,
information concerning their eating habits was collected by means of a questionnaire
completed by their parents. The prevalence of overweight was 16.5% in 6-year-old
children and 20.6% in 9-year-old children. The increase of overweight from 6- to 9-yearold children was observed in males (13.5% in 6-year-old/21.3% in 9-year-old boys), but
not in females. The prevalence of obesity was 8.9% in children aged 6 years and 9.0% in
those aged 9 years, and it was higher in comparison with Italian surveys carried out in
1993 and in 2001: 7.5% in 6-year-old and 7.8% in 9-year-old children in 1993, and 6.6%
in 6-year-old and 7.2% in 9-year-old children in 2001. In pre-school children, overweight
and obesity were closely influenced by the education level, occupation and nutritional
status of the parents.
A. N. Al-Isa and L. Thalib. (2008). Body mass index of Kuwaiti adolescents aged 10-14
years: reference percentiles and curves. East Mediterr Health J. 14, 333-43.
The aim of this population-based study was to develop body mass index (BMI) reference
standards for Kuwaiti adolescents for use in Kuwait and other Gulf countries. All
available intermediate school students aged 10-14 years (32 624 males and 30 209
females) were measured for weight and height. Polynomial regression smoothing
techniques were used to obtain the best-fitting curves for BMI percentiles. The BMI of
boys at lower centiles and ages was almost always higher than girls. At higher centiles,
the BMI of girls was almost always higher than boys. The data were compared with the
United States National Center for Health Statistics standards and data from Saudi Arabian
and Iranian adolescents.
C. J. Apfelbacher, J. Cairns, T. Bruckner, M. Mohrenschlager, H. Behrendt, J. Ring and
U. Kramer. (2008). Prevalence of overweight and obesity in East and West German
children in the decade after reunification: population-based series of cross-sectional
studies. J Epidemiol Community Health. 62, 125-30.
OBJECTIVE: To analyse time trends in overweight and obesity from 1991 to 2000 in
samples of German children and to test the hypothesis of a trend difference between the
samples from East and West Germany during this time period. DESIGN: Repeated crosssectional studies using data of 35,434 five to seven-year-old children from school entry
examinations in several rural and urban areas in East and West Germany (between 1991
and 2000). The main outcome measures were overweight and obesity. Weight and height
were measured and body mass index was calculated. International cut-off points were
used to classify overweight and obesity. RESULTS: From 1991 to 2000, the prevalence
of overweight increased from 10.0% to 17.5% in the East and from 14.8% to 22.2% in
the West. The prevalence of obesity increased from 2.1% to 5.7% in the East and from
3.6% to 7.6% in the West. All increases were significant. There was no evidence of a
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trend difference between the East and the West German samples. CONCLUSIONS:
Unlike in other countries in transition, prevalences of childhood overweight and obesity
were increasing in samples of East German children after reunification in 1990, possibly
as a result of the rapid adoption of a western lifestyle in the East. Although prevalences
were generally higher in the West German samples, there was no evidence that the
increase was levelling off in the West. Overall, trends were similar in the East and West
German samples.
C. J. Apfelbacher, A. Loerbroks, J. Cairns, H. Behrendt, J. Ring and U. Kramer. (2008).
Predictors of overweight and obesity in five to seven-year-old children in Germany:
Results from cross-sectional studies. Bmc Public Health. 8,
Background: Childhood obesity is a serious public health problem and epidemiological
studies are important to identify predictive factors. It is the aim of this study to analyse
factors associated with overweight/obesity in samples of German children. Methods:
35,434 five to seven year-old children (50.9% boys) participated in cross-sectional
studies between 1991 and 2000 in several rural and urban areas in East and West
Germany. Weight and height were measured and body mass index was calculated.
International cut-off points, recommended by the International Obesity Task Force, were
used to classify childhood overweight and obesity. Predictive modelling was employed to
analyse independently associated factors, using logistic regression to adjust for
confounding. Results: 15.5% were overweight, and 4.3% were obese. Female sex, other
than German nationality, smoking in the living place and increasing birth weight were
found to increase the odds of overweight and obesity, while increasing educational level,
living space > 75 m(2) and breastfeeding for more than three months were inversely
associated. Conclusion: The findings add to the evidence informing public health action,
both through health promotion strategies (promoting breastfeeding, tackling smoking)
and wider societal change management (addressing children from migrant families and
families with low educational level).
A. C. Benson, M. E. Torode and M. A. Fiatarone Singh. (2008). Effects of resistance
training on metabolic fitness in children and adolescents: a systematic review. Obes Rev.
9, 43-66.
The majority of resistance training (RT) research with children to date has focused on
pre-adolescents and the safety and efficacy of this type of training rather than the
potential metabolic health benefits. Our objectives, using computerized databases, were
(i) to systematically review studies utilizing RT interventions with children and
adolescents <18 years; (ii) to investigate the metabolic health outcomes (adiposity, lipids,
insulin, glucose) associated with RT; (iii) to provide recommendations for future
investigations. A total of 12 studies met the review criteria. There is only a small amount
of evidence that children and adolescents may derive metabolic health-related adaptations
from supervised RT. However, methodological limitations within the body of this
literature make it difficult to determine the optimal RT prescription for metabolic fitness
in children and adolescents, and the extent and duration of such benefits. More robustly
designed single modality randomized controlled trials utilizing standardized reporting
and precise outcome assessments are required to determine the extent of health outcomes
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attributable solely to RT and to enable the development of evidence-based obesity
prevention and treatment strategies in this cohort.
A. Berghofer, T. Pischon, T. Reinhold, C. M. Apovian, A. M. Sharma and S. N. Willich.
(2008). Obesity prevalence from a European perspective: a systematic review. Bmc
Public Health. 8,
Background: Obesity has been recognised as an important contributing factor in the
development of various diseases, but comparative data on this condition are limited. We
therefore aimed to identify and discuss current epidemiological data on the prevalence of
obesity in European countries. Methods: We identified relevant published studies by
means of a MEDLINE search (1990-2008) supplemented by information obtained from
regulatory agencies. We only included surveys that used direct measures of weight and
height and were representative of each country's overall population. Results: In Europe,
the prevalence of obesity (body mass index >= 30 kg/m(2)) in men ranged from 4.0% to
28.3% and in women from 6.2% to 36.5%. We observed considerable geographic
variation, with prevalence rates in Central, Eastern, and Southern Europe being higher
than those in Western and Northern Europe. Conclusion: In Europe, obesity has reached
epidemic proportions. The data presented in our review emphasise the need for effective
therapeutic and preventive strategies.
J. Bocarro, M. A. Kanters, J. Casper and S. Forrester. (2008). School Physical Education,
Extracurricular Sports, and Lifelong Active Living. Journal of Teaching in Physical
Education. 27, 155.
The purpose of this article is to examine the role of school-based extracurricular
initiatives in facilitating immediate and long-term positive impact on physical activity,
healthy behavior, and obesity in children. A critique of the role of various sports-related
initiatives that have been developed to address the obesity epidemic currently facing
children within the United States is provided, with a specific emphasis on intramural
sports as a preferred mechanism to encourage long-term involvement in sport and
physically active pursuits. The article presents support for the notion that a physical
education curriculum that includes intramurals before, during, and after school can help
children learn the skills to enjoy participation in a variety of sports designed to facilitate
lifelong active living.
M. M. Boere-Boonekamp, M. P. L'Hoir, M. Beltman, J. Bruil, N. Dijkstra and A. C.
Engelberts. (2008). [Overweight and obesity in preschool children (0-4 years): behaviour
and views of parents]. Ned Tijdschr Geneeskd. 152, 324-30.
OBJECTIVE: Description of unhealthy behaviour and views regarding nutrition, physical
exercise and education in families with young children, in relation to specific groups with
a high risk of overweight. DESIGN: Cross-sectional study. METHOD: In wellbaby
clinics for infants and toddlers in various sites in The Netherlands 534 parents were
requested to fill in questionnaires on nutrition, physical exercise and education. Enquiry
into background characteristics took place and several hypotheses were tested. Using a
bivariate and multivariate analysis each hypothesis was examined with regard to linkage
of the answers to specific high-risk groups. RESULTS: 73% (390 parents) responded.
Overweight was found in 15% of the 2-4-year-olds, this included 3.7% with obesity.
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Relatively often, parents held views and showed behaviour characteristic of an unhealthy
lifestyle for young children. For example, approximately 1 out of 7 families was not used
to having breakfast. 43% of the respondents considered sweetened milk products
approprite substitutes for milk and 39% of the children always had soft drinks at their
disposal. One fifth of the parents indicated that they did not have enough time to go out
with their child. Approximately 1 out of 10 toddlers aged 2-4 years had a TV in their own
room; 22% were allowed to determine whether they wanted to watch TV or not and 9%
were allowed to decide how long they watched. Such specific high-risk behaviour was
seen in particular in families with non-western mothers, mothers with a low level of
education or mothers living on social security. Regular use of child care or a nursery
seemed to have some protective effect. CONCLUSION: In families with children aged 04 years, behaviour patterns related to overweight at a later age were frequently observed.
In view of the increased incidence of overweight and obesity in young children, initiation
of research aimed at optimisation of education is warranted, which should include special
attention for the behaviour of parents with regard to 5 spearheads: breast-feeding, more
outside play and more physical exercise, a regular wholesome breakfast, less
consumption of sweetened drinks and less TV and computer use. Implementation of
interventions in young age groups is able to prevent the development of unhealthy
lifestyle and childrearing styles.
J. E. Boyington, L. Carter-Edwards, M. Piehl, J. Hutson, D. Langdon and S. McManus.
(2008). Cultural attitudes toward weight, diet, and physical activity among overweight
African American girls. Prev Chronic Dis. 5, A36.
INTRODUCTION: The growing epidemic of childhood obesity has led to an increasing
focus on strategies for prevention. However, little is known about attitudes and
perceptions toward weight, diet, and physical activity among American youth, and
particularly among young African American females. This pilot study sought to
qualitatively explore cultural attitudes and perceptions toward body image, food, and
physical activity among a sample of overweight African American girls. METHODS: We
recruited 12 overweight girls, aged 12 to 18 years, from a hospital-based pediatric
diabetes screening and prevention program. Five semistructured group interviews were
conducted to explore attitudes on weight, diet, and physical activity. Sessions averaged 1
hour and were conducted by trained interviewers. Data were transcribed and evaluated
for content and relevant themes. RESULTS: The following themes emerged: weight and
body size preferences were primarily determined by the individual and her immediate
social circle and were less influenced by opinions of those outside of the social circle;
food choices depended on texture, taste, appearance, and context more than on nutritional
value; engagement in recreational physical activity was influenced by time constraints
from school and extracurricular activities and by neighborhood safety; participation in
structured exercise was limited because of the cost and time related to maintenance of
personal aesthetics (hair and nails); and celebrities were not perceived as role models for
diet and physical activity habits. CONCLUSION: In this sample of girls, the findings
imply that perceptions of weight and healthy lifestyle behaviors are largely determined by
environmental and personal influences. These factors should be considered in the
development of healthy-weight interventions for African American girls.
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M. Bronikowski, M. González-Gross, K. Kleiner, E. Knisel, I. Martinková, A. Stache,
A. Kantanista, D. C. a. Lòpez and A. Konlechner. (2008). PHYSICAL ACTIVITY,
OBESITY AND HEALTH PROGRAMS IN SELECTED EUROPEAN COUNTRIES.
Studies in Physical Culture & Tourism. 15, 9.
One of the main health-related problems Europe is facing today is the increasing
prevalence of obesity in all age groups, especially in youth. According to the
International Obesity Task Force (2004) 155 million school-age children and adolescents
worldwide show symptoms of obesity or overweight. Obese children are less confident,
have lower self-esteem and engagement rate both in and after school physical activity.
This is becoming a huge and very costly economic and social problem as well. Positive
changes will require modification of the physical education curriculum, especially its
contents and teachers' approach. Specially designed programs are required.
HEALTH(A)WARE (128737-CP-1-2006-1-DE-Comenius-C2) is a project funded by the
European Commission in the Socrates-Comenius Program to enable experimental health
teaching within and across school courses. Cross-curricular instruction of knowledge and
skills may help pupils in the process of lifelong learning, and hopefully may be
implemented in the curricula of European schools. ABSTRACT FROM AUTHOR
H. Brunt, N. Lester, G. Davies and R. Williams. (2008). Childhood overweight and
obesity: is the gap closing the wrong way? Journal Of Public Health. 30, 145-152.
Background Obesity is a significant public health issue. Obese children have an increased
risk of developing chronic adult diseases. Knowledge of socio-economic distribution
trends in childhood overweight/obesity is limited. Methods Body mass indices for 3-yearold children resident in three South Wales localities from 1995 to 2005 were derived
from the National Community Child Health Database (NCCHD) and examined in
relation to residence lower super output area (LSOA) Townsend Material Deprivation
Score. Results Over 11 years, 53-69% of children had height/weight measurements
recorded (with little difference observed across deprivation fifths). Amalgamating the
data for all 11 years showed no significant association of prevalence with LSOA socioeconomic status. Annual trends varied substantially: the most deprived fifth had the
lowest proportion on five, and the highest on six, occasions. Linear regression analysis
suggested a greater rate of increase of overweight/obesity in children from most-deprived
LSOA areas compared with those from least deprived areas (not statistically significant).
Conclusions Socio-economic difference in overweight/obesity prevalence lessened
between 1995 and 2005. Despite annual variation, this apparent closing of the gap has
been the result of an increase in overweight/obesity prevalence in children from the most
deprived areas who, initially, had a lower prevalence compared with children from least
deprived areas, but by 2005, had overtaken them.
G. M. Budd and L. L. Hayman. (2008). Addressing the childhood obesity crisis - A call
to action. Mcn-The American Journal Of Maternal-Child Nursing. 33, 111-118.
The prevalence of childhood obesity is increasing in the United States and globally.
Associated with numerous comorbid conditions, childhood obesity is also recognized as a
risk factor for multiple chronic conditions and premature mortality in adult life. Children
and adolescents, particularly those from ethnic minorities and rural low income
populations, bear an excess burden of obesity and its attendant comorbidities. A major
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contributor to childhood obesity is a physical and social environment that promote's
foods high in fat and calories and minimizes the opportunities for physical activity.
Despite the strong environmental influences that encourage overeating and sedentary
behavior, weight maintenance is viewed as a personal responsibility. Addressing the
obesity crisis requires a paradigm shift away from blaming individuals for the lack of
willpower to control their eating and physical activity to one of recognizing the "toxic" or
"obesigenic" environment as a primary determinant. This article addresses the obesity
crisis from individual, family, local community, and public policy perspectives. Emphasis
is placed on the role of nurses and nursing, acting to promote change with individuals and
families and acting as advocates for multilevel policy initiatives, in reversing the
epidemic and improving the health of future generations.
G. Bukara-Radujkovic and D. Zdravkovic. (2008). [Determinants of body mass index in
children and adolescents]. Srp Arh Celok Lek. 136, 22-7.
INTRODUCTION: Body Mass Index (BMI) in boys and girls is predicted by parental
BMI, age and occupation. OBJECTIVE: Correlation of BMI among children and
adolescents in Banjaluka region (Bosnia and Herzegovina) and parental age, BMI,
parents'educational level and occupation, as well as the number of family members were
investigated as the possible determinants of overweight and obesity in childhood.
METHOD: The study included 1204 children and adolescents (578 males, 626 females),
6-17 years old from primary and secondary schools in the Banjaluka region. BMI was
calculated from height and weight using the standard formula. Each subject along with
his parents answered the questionnaire that contained information about parents' height
and weight, educational level and occupation, as well as the number of family members.
RESULTS: In all studied children, the prevalence of overweight was 12.2% and of
obesity 6.1%. Strong positive correlation was found between parental BMI and age (older
than 40 years) in males and females (p<0.001), while parental higher BMI and higher
educational level had positive correlation only in males (p<0.001).The number of family
members showed negative correlation with overweight/obesity only in females.
CONCLUSION: The prevalence of overweight and obesity in children's population in the
Banjaluka region is 12.2% and 6.1%, respectively. There is a positive correlation of
overweight and obesity in children with parental overweight and obesity, as well as older
age, and parental higher educational level.
D. L. Burnet, A. J. Plaut, K. Ossowski, A. Ahmad, M. T. Quinn, S. Radovick, R.
Gorawara-Bhat and M. H. Chin. (2008). Community and family perspectives on
addressing overweight in urban, African-American youth. Journal Of General Internal
Medicine. 23, 175-179.
OBJECTIVE: To assess weight-related beliefs and concerns of overweight urban,
African-American children, their parents, and community leaders before developing a
family-based intervention to reduce childhood overweight and diabetes risk. DESIGN:
We conducted 13 focus groups with overweight children and their parents and eight
semistructured interviews with community leaders. PARTICIPANTS AND SETTING:
Focus group participants (N = 67) from Chicago's South Side were recruited through
flyers in community sites. Interview participants (N = 9) were recruited to sample
perspectives from health, fitness, education, civics, and faith leaders. RESULTS:
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Community leaders felt awareness was higher for acute health conditions than for
obesity. Parents were concerned about their children's health, but felt stressed by
competing priorities and constrained by lack of knowledge, parenting skills, time, and
financial resources. Parents defined overweight in functional terms, whereas children
relied upon physical appearances. Children perceived negative social consequences of
overweight. Parents and children expressed interest in family-based interventions to
improve nutrition and physical activity and offered suggestions for making programs
interesting. CONCLUSIONS: This study provides insights into the perspectives of urban,
African-American overweight children, their parents, and community leaders regarding
nutrition and physical activity. The specific beliefs of these respondents can become
potential leverage points in interventions.
S. Byrne, M. Wake, D. Blumberg and M. Dibley. (2008). Identifying priority areas for
longitudinal research in childhood obesity: Delphi technique survey. International Journal
Of Pediatric Obesity. 3, 120-122.
In 2005, the Australian Child and Adolescent Obesity Research Network (ACAORN)
addressed the question, "What childhood and adolescent obesity research questions
remain to be addressed through longitudinal research?" Using the Delphi Technique,
ACAORN members individually generated then refined and prioritised a set of research
ideas. When delegates to a national child obesity symposium repeated the final
(prioritisation) step, a strong concordance in rankings was evident. The highest-priority
questions related to modifiable environmental risk/protective factors; parental and family
factors; longitudinal relationships between development of obesity and physical, social
and mental health; predisposing prenatal and early childhood patterns of growth and
nutrition; identification of stronger early markers of later chronic disease risk; and better
understanding of the natural course of overweight in childhood. These prioritised
research questions could be proactively provided to funding bodies, quoted to support
research applications, and used to stimulate secondary data analysis and collaborations
between research groups.
P. D. B. Campagnolo, M. R. Vitolo, C. M. Gama and A. T. Stein. (2008). Prevalence of
overweight and associated factors in southern Brazilian adolescents. Public Health. 122,
509-515.
Objective: The aim of this study was to determine the prevalence of overweight in
adolescents in a southern Brazilian city, and ascertain gender differences and association
with socio-economic and demographic conditions, family factors and individual
behaviours. Methods: Cross-sectional population-based study with random cluster
sampling of households, including 722 adolescents (10-19 years), from a city in southern
Brazil. Body mass index (BMI) was calculated based on the National Center for Health
and Statistics reference curve, defining overweight as BMI >= 85th percentile. Results:
Prevalence of overweight was 17% in girls and 19% in boys. In multivariate Poisson
regression, chronic illness in parent(s) and household of up to four people were
associated with overweight in boys, whereas low fibre intake, more hours spent watching
television and regular exercise were associated with overweight in girls. Conclusion: The
prevalence of overweight in Brazilian adolescents is high, with gender differences in
associated factors. Health workers in schools and public health services should be aware
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of these differences in order to improve preventive and therapeutic strategies in this age
group.
G. M. Cardon and I. M. M. D. Bourdeaudhuij. (2008). Are preschool children active
enough? Objectively measured physical activity levels. 79, 326-332.
C. Chan. (2008). Childhood obesity and adverse health effects in Hong Kong. Obesity
Reviews. 9, 87-90.
Hong Kong soon became aware of the importance of ensuring the optimum growth of
their children with growth standards for Hong Kong being set out in 1962. By 1972 it
was already clear that childhood obesity was emerging as a problem and increasing in
prevalence and by 1987 an international workshop on nutrition, held in Hong Kong, was
being alerted to this issue. Then 10 years later obesity featured as a major issue in the
programme of the Asian Congress of Pediatrics with the local contributors highlighting
the evidence already available in Hong Kong of the wide range of metabolic,
cardiovascular, physical and psychological complications of obesity in the local
community. The school health service was given a prominent role and there are now
guidelines not only in relation to the standards of school lunches but also for the need to
enhance the physical activity of children and involve a new educational community wide
approach as part of a major co-coordinated effort within Hong Kong. Professional and
community workers together with the government now have a comprehensive
determination to tackle the challenge of obesity prevention. So Hong Kong intends to
play a major role in the international response to the formation of the Global Alliance for
the prevention of obesity and its associated chronic diseases.
C. Chang, W. Liu, X. Zhao, S. Li and C. Yu. (2008). Effect of supervised exercise
intervention on metabolic risk factors and physical fitness in Chinese obese children in
early puberty. Obes Rev. 9 Suppl 1, 135-41.
The aim of this paper was to study the effect of long-term supervised exercise-induced
weight maintenance on metabolic risk factors and physical fitness in obese children in
early puberty. A total of 49 obese children aged 12-14 years were divided into control
and exercise groups. The children in the exercise group accepted exercise intervention
supervised by a professional sports teacher for 9 of the 12 months. All participants in
both groups received health education once every 3 months. Anthropometry and fasting
serum lipids, glucose, insulin and homeostatic model assessment for insulin resistance
(HOMA-IR) were measured at months 0, 3, 9, 12 of the intervention. Physical fitness was
determined before and after intervention. After the intervention (i) BMI was reduced by
0.6 (P < 0.05) in the exercise group, but increased by 0.5 (P < 0.05) in the control group,
compared with the pre-intervention level at the end of 9-month intervention; (ii)
Triglyceride levels in the exercise group significantly decreased by 23.1% by 3 months (P
< 0.05), and by 30.2% after 9 months (P < 0.05), but increased by 50% (P < 0.05) in the
control group; high density lipoprotein-cholesterol (HDL-C) decreased more by 35% (P <
0.05) in the controls than in the exercise group (P < 0.05); (iii) Fasting serum glucose,
insulin level and HOMA-IR decreased, respectively, by 23.1%, 36.6% and 48.5% in the
exercise group at 9 months (P < 0.05), whereas glucose levels increased by 10.9% (P <
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0.05) in the control group; (iv) Exercise performance, such as upper- and lower-limb
strength, flexibility and endurance, were enhanced by 17.9%, 12.3%, 22.3% and 20.4%
(P < 0.01), respectively and (v) At 12 months, i.e. 3 months after terminating the
supervised exercise, serum triglycerides, glucose, insulin and HOMA-IR level all
returned to the pre-intervention level. Supervised decrement exercise can effectively slow
the progress of obesity, improve insulin sensitivity and metabolic risk factors, but once
the supervised exercise is stopped, the health benefits weaken or vanish. The key to
helping these obese children is for them to cultivate good exercise habits which are
sustained throughout their lives.
V. J. Cleland, T. Dwyer and A. J. Venn. (2008). Physical activity and healthy weight
maintenance from childhood to adulthood. Obesity. 16, 1427-1433.
The objective of this study was to determine whether change in physical activity was
associated with maintaining a healthy weight from childhood to adulthood. This
prospective cohort study examined 1,594 young Australian adults (48.9% female) aged
27-36 years who were first examined at age 9-15 years as part of a national health and
fitness survey. BMI was calculated from measured height and weight, and physical
activity was self-reported at both time points; pedometers were also used at follow-up.
Change in physical activity was characterized by calculating the difference between
baseline and follow-up z-scores. Change scores were categorized as decreasing (large,
moderate), stable, or increasing (large, moderate). Healthy weight was defined in
childhood as a BMI less than international overweight cutoff points, and in adulthood as
BMI< 25 kg/m(2). Healthy weight maintainers were healthy weight at both time points.
Compared with those who demonstrated large relative decreases in physical activity,
females in all other groups were 25-37% more likely to be healthy weight maintainers,
although associations differed according to the physical activity measure used at followup and few reached statistical significance. Although younger males whose relative
physical activity moderately or largely increased were 27-34% more likely to be healthy
weight maintainers than those whose relative physical activity largely decreased,
differences were not statistically significant. In conclusion, relatively increasing and
stable physical activity from childhood to adulthood was only weakly associated with
healthy weight maintenance. Examining personal, social, and environmental factors
associated with healthy weight maintenance will be an important next step in
understanding why some groups avoid becoming overweight.
A. E. Collins, B. Pakiz and C. L. Rock. (2008). Factors associated with obesity in
Indonesian adolescents. International Journal Of Pediatric Obesity. 3, 58-64.
Objective. To investigate adolescent eating, activity, and behavioral patterns, and
attitudes and their associations with obesity in selected communities in Indonesia.
Design. A cross-sectional questionnaire and physical measurement-based study in three
communities of varying modernization levels in Indonesia (Yogyakarta, Kuta, and
Jakarta). Subjects. 1758 middle school students (aged 12-15 years) recruited at six
different schools: one public and one private school in each of the three target
communities. Measurements. The questionnaire collected data on demographic
characteristics (age, gender, ethnicity, estimated household income); fast food eating
habits (frequency, types of food/restaurant, general beliefs about fast foods),television,
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computer, and Play Station usage; physical activity (hrs/wk of participation in physical
activity, transportation means for attending school); and eating habits (frequency of
consuming selected foods and beverages). Student's height and weights were obtained,
body mass index BMI: weight [kg]/height [m(2)]) was calculated, and obesity was
defined as >= 95%, using the BMI-for-age cut-offs from the Centers for Disease Control
and Prevention (CDC) charts. Results. Chi-square analysis revealed associations between
obesity and community setting, family income, use of a computer or Play Station, type of
transportation to school, and beliefs about fast foods (P < 0.01). According to the logistic
regression analysis, adolescents from families with incomes over Rp 2 mil were three
times as likely to be obese (95% CI 1.9, 4.9) and boys were 2.6 times more likely to be
obese (95% CI 1.5, 4.5). Conclusion. Greater likelihood of obesity among Indonesian
adolescents who spend greater amounts of time using a computer or Play Station suggests
that such sedentary activities may be replacing physical activity, promoting an energy
imbalance, and subsequently, an increased risk for obesity.
M. A. Cortina, K. Kahn, M. Fazel, T. Hlungwani, S. Tollman, A. Bhana, D. ProthrowStith and A. Stein. (2008). School-based interventions can play a critical role in
enhancing children's development and health in the developing world. Child Care Health
Dev. 34, 1-3.
D. A. Dennison, Z. Yin, D. Kibbe, S. Burns and F. Trowbridge. (2008). Training health
care professionals to manage overweight adolescents: experience in rural Georgia
communities. J Rural Health. 24, 55-9.
CONTEXT: The obesity epidemic threatens the present and future health of adolescents
in the United States. Yet, health care providers lack specific training for pediatric obesity
assessment and management. PURPOSE: This study examined the adherence of rural
Georgia primary care practitioners to an overweight adolescent management protocol.
The study also documented the prevalence of obesity-associated physiological and
behavioral risk factors among overweight adolescent patients. METHODS: Ten rural
clinics (58 providers) were recruited and received a 90-minute adolescent overweight
assessment and management training session. Select biochemical, dietary, physical
activity, and physical inactivity behaviors were assessed in overweight adolescent
patients. Medical charts were abstracted to assess practitioner compliance with an
overweight assessment protocol and patient adherence to a 16-week follow-up visit.
FINDINGS: Providers were receptive to training and complied with the recommended
protocol. Eighty-five overweight adolescents were assessed, but only 49 (57%)
completed the scheduled 16-week follow-up visit. Physical, biochemical, and behavioral
assessments revealed that 13%-27% of the participants had abnormal levels of lipids,
fasting glucose, and glucose/insulin ratio, and 80.5% had waist circumferences above the
90th percentile. CONCLUSIONS: Practitioners complied with the assessment and
follow-up protocol, leading to the discovery of previously unrecognized risk factors in
many overweight adolescent patients. Lack of patient adherence to follow-up was the
greatest limiting factor for obesity management. Further efforts are needed to implement
and evaluate training to improve the management of adolescent overweight, especially in
rural communities.
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P. P. DiNapoli and J. B. Lewis. (2008). Understanding school-age obesity: through
participatory action research. MCN Am J Matern Child Nurs. 33, 104-10.
PURPOSE: This study aimed to assess current levels of overweight (obesity) and fitness
among school students using objective data. METHODS: School-based action research
teams were recruited statewide by the New Hampshire Healthy Schools Coalition, the
state team of the National Action for Healthy Kids Coalition. Action teams consisted of a
physical education teacher, a school nurse, and a school administrator. Data were
collected from 6,511 student participants aged 6 to 14 years, which was a representative
cross-section from New Hampshire school districts. Key variables of interest in the study
were body mass index, and ability to pass five fitness tests using FITNESSGRAM.
Pearson's correlation was used to assess the relationships among body mass index, age,
gender, and the percent of students that passed FITNESSGRAM tests. RESULTS: The
ability of participants to pass the FITNESSGRAM tests declined markedly with age and
differed between boys and girls, although the healthy fitness zones for any particular test
was lower for girls. Body mass index was significantly negatively correlated with
performance on all tests. Age was also statistically negatively correlated with
performance on all tests; the relationship between gender and performance on the tests
was less striking. CLINICAL IMPLICATIONS: Results reflected an increase in the
prevalence of overweight school children, even in New Hampshire, which is purported to
be one of the healthiest states in the nation. Results offered evidence that body mass
index is a valid proxy measure for fitness levels and that fitness programs are necessary
to effectively combat the obesity epidemic. Evidence-based changes need to be
implemented to address obesity-related factors in schools, because children spend many
of their waking hours in that setting. Physical activity during recess and physical
education classes could help to increase energy expenditure and develop sound minds and
bodies. Schools should consider the development of school-based wellness teams to
advise and advocate improved school-based wellness policies. School nurses can take an
active part in these initiatives.
M. M. Driskell, S. Dyment, L. Mauriello, P. Castle and K. Sherman. (2008).
Relationships among multiple behaviors for childhood and adolescent obesity prevention.
Prev Med. 46, 209-15.
BACKGROUND: Curbing the epidemic of childhood and adolescent obesity requires
impacting multiple behaviors. This article examines the interrelationships of physical
activity, fruit and vegetable consumption, and limiting television time among elementary,
middle, and high school students. METHODS: Nationwide samples of students in grades
4 through 12 (n=4091) completed self-administered questionnaires assessing
Transtheoretical Model constructs and behavioral indicators for physical activity, fruit
and vegetable consumption, and limiting television time. Analyses were conducted to
compare the prevalence of students at-risk for the target behaviors across the age groups
and to examine the interrelationships of the target behavior risks. RESULTS: Across the
three age groups, physical activity and fruit and vegetable consumption declined, while
limiting TV time increased. In addition, high school students had the greater number of
behavioral risks. Across all three samples, being at-risk for one behavior almost always
significantly increased the odds of being at-risk for another behavior. CONCLUSION:
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The findings of this study provide further evidence for the need for early promotion of
healthy lifestyle behaviors. The relationships among the target behaviors in three samples
strongly support a multiple behavior approach for obesity prevention. Transtheoretical
Model-based tailored interventions are currently being used to change multiple behaviors
without overwhelming students.
S. A. Dugan. (2008). Exercise for preventing childhood obesity. Phys Med Rehabil Clin
N Am. 19, 205-16, vii.
Childhood obesity is a key public health issue in the United States and around the globe
in developed and developing countries. Obese children are at increased risk of acute
medical illnesses and chronic diseases-in particular, osteoarthritis, diabetes mellitus, and
cardiovascular disease, which can lead to poor quality of life; increased personal and
financial burden to individuals, families, and society; and shortened lifespan. Physical
inactivity and sedentary lifestyle are associated with being overweight in children and
adults. Thus it is imperative to consider exercise and physical activity as a means to
prevent and combat the childhood obesity epidemic. Familiarity with definitions of
weight status in children and health outcomes like metabolic syndrome is crucial in
understanding the literature on childhood obesity. Exercise and physical activity play a
role in weight from the prenatal through adolescent time frame. A child's family and
community impact access to adequate physical activity, and further study of these
upstream issues is warranted. Recommended levels of physical activity for childhood
obesity prevention are being developed.
M. J. Edmonds, K. J. Ferreira, E. A. Nikiforuk, A. K. Finnie, S. H. Leavey, A. M.
Duncan and J. A. Randall Simpson. (2008). Body weight and percent body fat increase
during the transition from high school to university in females. J Am Diet Assoc. 108,
1033-7.
A critical period for weight gain may occur during the transition from high school to
university. This descriptive, noncontrolled cohort study of 116 healthy females examined
the effect of this transition over three study visits in first year university. The main
outcome measure was body weight; others were height, body composition, waist
circumference, dietary intake, and participation in physical and sedentary activities.
Difference among study visits was determined by repeated measures analysis of variance;
multiple regression examined changes in energy intake and physical and sedentary
activities as predictors of final weight. Weight increased (P<0.001) by 2.4 kg (61.4 to
63.8 kg) during the entire course of the study. Other increases (P<0.001) included: body
mass index (calculated as kg/m(2)), 22.3 to 23.1; percent body fat, 23.8% to 25.6%; and
waist circumference, 76.9 to 79.4 cm. Dietary energy intake did not increase; vigorous
physical, but not strength building, activities increased; television use decreased; and
computer use increased (P<0.03 for all): however, these changes were not predictive of
final weight. A change (decrease) in moderate physical activity was, however, an
important predictor of final weight. Females making the transition to university gained
2.4 kg; weight gain during this formative period may be modified by lifestyle activities.
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J. E. Eichner, W. E. Moore, G. Perveen, C. E. Kobza, K. E. Abbott and A. L. Stephens.
(2008). Overweight and Obesity in an Ethnically Diverse Rural School District: The
Healthy Kids Project. Obesity (19307381). 16, 501.
The article discusses a study which aimed to describe the prevalence of overweight and
obesity in a racially mixed rural area where Native American, Hispanic, African
American, and white children reside. In this study, the body mass index (BMI) was
calculated and the International Obesity Task Force reference was used to classify
children into BMI categories.
J. C. Eisenmann, R. T. Bartee, D. T. Smith, G. J. Welk and Q. Fu. (2008). Combined
influence of physical activity and television viewing on the risk of overweight in US
youth. International Journal Of Obesity. 32, 613-618.
Objective: The purpose of this study was to examine the combined influence of physical
activity (PA) and television viewing (TV) on the risk of overweight in US youth ages 14 18 years. Research design and methods: Cross- sectional data from a nationally
representative sample of approximately 13 600 US high school students participating in
the 2001 Centers for Disease Control and Prevention Youth Risk Behavior Survey
(YRBS) were examined. Participants were cross- tabulated into nine PA - TV groups
according to the level of moderate (MPA) or vigorous PA (VPA) (low: <= 2 days per
week; moderate: 3 - 5 days per week; high: 6 - 7 days per week) and TV (low: <= 1 h per
day; moderate: 2 - 3 h per day; high: >= 4 h per day). The referent group was the low TV/
high PA group. The body mass index was used to determine overweight and obesity
based on the International Obesity Task Force reference values. Logistic regression was
used to examine the influence of TV and PA on the odds of overweight in boys and girls,
while controlling for age and ethnicity. Results: Boys and girls watching low levels of
TV did not have increased odds of overweight regardless of PA level with the exception
of girls with low TV/ low VPA (odds ratio (OR) 1.48). Girls who watched moderate and
high levels of TV had increased odds of overweight at any level of MPA or VPA (OR
1.24 - 3.11). In girls, the odds of overweight increased in a graded manner across PA
levels for both the moderate and high levels of TV. Girls with high TV/ low VPA had the
highest odds of overweight (OR 3.11). In general, most of the associations were stronger
in girls compared to boys. Conclusion: The results highlight the importance of
considering both PA and TV as risk factors for overweight in adolescents.
A. Eyler, J. Baldwin, C. Carnoske, J. Nickelson, P. Troped, L. Steinman, D. Pluto, J. Litt,
K. Evenson, J. Terpstra, R. Brownson and T. Schmid. (2008). Parental Involvement in
Active Transport to School Initiatives: A Multi-Site Case Study. American Journal of
Health Education. 39, 138.
The article explores the parental perception and participation in active transportation to
and from school (ATS) initiatives. A study was conducted which involved sixty-nine key
informants, including 10 parents, that were interviewed at nine different elementary
schools. Results showed that parental support was a significant component for ATS
success, that the roles of parents varied, and that parents participated in ATS for a
particular reason. Thus, it is concluded that parents can be essential resources in school
ATS programs, their level of participation can differ from coordinating a program to lead
a walking group, and that participation among parents can promote a successful initiative.
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N. J. Farpour-Lambert, A. Nydegger, S. Kriemler, D. L'Allemand and J. J. Puder. (2008).
[How to treat childhood obesity? Importance of primary prevention]. Rev Med Suisse. 4,
533-6.
The prevalence of childhood obesity increases dramatically. First signs of cardiovascular
diseases and type 2 diabetes appear early in life. The treatment of childhood obesity aims
at weight maintenance during growth, normalization of body mass index at long-term and
prevention of complications. The family based behavioural therapy is a promising
approach. It provides simultaneous treatment for the overweight parent and child in order
to modify the family environment, to provide role models and support for child behaviour
changes. However, this requires group leaders and multiple counselors to meet with
families. The treatment should be initiated as soon as possible, as its efficacy is reduced
after the onset of puberty. Early preventive interventions that aim to modify both
individual's behaviours and the environment are needed.
R. J. Ferreira and P. M. Marques-Vidal. (2008). Prevalence and determinants of obesity
in children in public schools of Sintra, Portugal. Obesity (Silver Spring). 16, 497-500.
OBJECTIVE: To assess the prevalence of and the factors related to overweight and
obesity in a sample of children from the region of Sintra, Portugal. METHODS AND
PROCEDURES: Cross-sectional study, stratified for freguesia with random selection of
schools. Height, weight, triceps skinfold, upper arm and waist circumferences were
measured, and overweight/obesity defined according to international criteria. Breastfeeding, number of daily meals and parents' height and weight data were also collected.
RESULTS: One thousand two hundred and twenty-five children aged 6-10 years were
assessed. Overall prevalence of overweight and obesity was 35.6% (23% overweight and
12.6% obesity). Overweight or obese children had higher triceps skinfold, upper arm
circumference, arm muscle area, and waist circumference than their normal weight
counterparts (P < 0.001). On multivariate analysis, relatively to a child without obese
progenitors, a child with one obese progenitor had an obesity risk multiplied by 2.78
(95% confidence interval (CI): 1.76-4.38), while a child with two obese progenitors had a
risk multiplied by 6.47 (95% CI: 5.59-16.19). Conversely, being picky was significantly
related with a smaller risk of obesity: for boys, odds ratio (OR) = 0.15 (95% CI: 0.040.63); for girls, OR = 0.19 (95% CI: 0.06-0.64). Finally, no relationships were found
between obesity, birth weight, birth height or breast-feeding. DISCUSSION: Prevalence
of overweight and obesity are elevated among children of the Sintra region in Portugal
compared to most other regions of Europe. The relationship with the parents' nutritional
state stresses the need to target families for preventing obesity.
V. Floriani and C. Kennedy. (2008). Promotion of physical activity in children. Curr
Opin Pediatr. 20, 90-5.
PURPOSE OF REVIEW: Promotion of physical activity continues to be recommended
as an essential component of obesity treatment and prevention interventions. This review
explores recent updates in the area of physical activity promotion and its impact on the
physical and mental health consequences of childhood obesity. RECENT FINDINGS:
Despite the availability of opportunities for physical activity in the school environment,
namely recess and physical education classes, students do not appear to be meeting
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activity recommendations at school alone. Access to neighborhood parks may increase
levels of physical activity and reduce time spent in sedentary behaviors at home. Less
time spent watching television and in other sedentary behaviors such as playing
videogames may contribute to higher rates of physical activity. Frequency of physical
activity also appears to be related to improved mental health status, although the direction
of this relationship warrants further exploration. SUMMARY: Physical activity is an
evidence-based intervention that offers benefits to both physical and mental health.
Pediatric health care providers are encouraged to engage in discussions with patients and
families on the topic of physical activity and to assist them in finding ways to incorporate
activity into daily life.
D. Fussenegger, A. Pietrobelli and K. Widhalm. (2008). Childhood obesity: political
developments in Europe and related perspectives for future action on prevention. Obesity
Reviews. 9, 76-82.
The dramatically increasing prevalence of obesity, especially among children, has
become a major public health problem in Europe. In reaction to this alarming trend, a
series of initiatives and actions has been launched in recent years. As the potential impact
of these activities is widely unknown so far, we underline the need for adequate
evaluation of these measures. The aim of this paper is to report the latest developments in
the fight against obesity at different political levels across Europe, with special attention
to the major results of the recent World Health Organization European Ministerial
Conference on Counteracting Obesity. In accordance with the main principles of the
European Charter on Counteracting Obesity adopted at the meeting, immediate action
should be taken now by implementing the few available schemes with proven
effectiveness. Finally, given the lack of appropriate evaluation, we consider it particularly
important to establish national research centres to collect country-specific data that are to
be evaluated together by a central European administration department. Based on the
results of such a comprehensive data pool, concrete strategies could be developed for
future policy building.
P. S. Gaskin, H. Broome, C. Alert and H. Fraser. (2008). Misperceptions, inactivity and
maternal factors may drive obesity among Barbadian adolescents. Public Health Nutr. 11,
41-8.
OBJECTIVES: To describe (1) the prevalence of overweight and obesity and their
association with physical activity; (2) the effect of different cut-off points for body mass
index (BMI) on weight status categorisation; and (3) associations of weight status with
perceptions of body size, health and diet quality. DESIGN: A cross-sectional study.
SETTING: Secondary schools in Barbados. SUBJECTS: A cohort of 400 schoolchildren,
11-16 years old, selected to study physical education practices. RESULTS: Prevalence of
overweight (15% boys; 17% girls) and obesity (7% boys; 12% girls) was high. Maternal
obesity, as defined by the International Obesity Task Force (IOTF) BMI cut-off points,
predicted weight status such that reporting an obese mother increased the odds of being
overweight by 5.25 (95% confidence interval: 2.44, 11.31). Physical activity was
inversely associated with weight status; however levels were low. Recreational physical
activity was not associated with weight status in either category. Overweight subjects
tended to misclassify themselves as normal weight and those who misclassified perceived
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themselves to be of similar health status to normal-weight subjects. The National Center
for Health Statistics and IOTF BMI cut-off points produced different estimates of
overweight and obesity. CONCLUSIONS: Our findings suggest that inadequate physical
activity and ignorance related to food and appropriate body size are promoting high
levels of adiposity with a strong contribution from maternal obesity, which may be
explained by perinatal and other intergenerational effects acting on both sexes.
Prevalence studies and local proxy tools for adiposity assessment are needed.
G. S. Goldfield, R. Mallory, D. Prud'homme and K. B. Adamo. (2008). Gender
Differences in Response to a Physical Activity Intervention in Overweight and Obese
Children. Journal of Physical Activity & Health. 5, 592.
Background: This study evaluated the effects of gender on response to a behavioral
intervention that rewarded increases in physical activity (PA) with increases in access to
TV viewing. Methods: We performed a secondary analysis of a clinical trial that
randomized 30 overweight or obese, 8- to 12-year-old children to an intervention (8 boys,
6 girls) or control (7 boys, 9 girls) group. Participants wore accelerometers every day for
8 weeks and attended biweekly meetings to download the activity monitors. For the
intervention group, accumulating 400 counts of PA on accelerometers earned 1 hour of
TV time, which was controlled by a Token TV electronic device. Controls wore activity
monitors but had free access to TV. Results: Compared with girls, boys in the
intervention group exhibited greater increases in overall daily PA counts (110% versus
40%, P <.05) and minutes per day of moderate-to-vigorous physical activity (MVPA;
+18.1 versus +2.7, P <.05). Neither boys nor girls in the control group showed significant
changes in overall PA or intensity of PA. Conclusion: Wearing an accelerometer in
combination with rewarding PA with TV might be a more effective intervention for
increasing overall PA and time spent in MVPA in overweight and obese boys than it is
for overweight or obese girls.
C. Gundersen, B. J. Lohman, J. C. Eisenmann, S. Garasky and S. D. Stewart. (2008).
Child-specific food insecurity and overweight are not associated in a sample of 10- to 15year-old low-income youth. J Nutr. 138, 371-8.
In the United States, 17% of children and adolescents are overweight and 20% live in a
food insecure household. Previous studies examining the association between household
food insecurity and overweight among children have been inconclusive but are limited
insofar as they did not assess child-specific measures of food insecurity and overweight.
In response, this study examined the association between food insecurity and child
overweight status when these variables were measured for the same child using
information on children (n = 1031) aged 10-15 y from the Three-City Study.
Approximately 8% of the children were food insecure, whereas 50% were either at risk of
overweight or overweight. Bivariate analyses indicated that there were no significant
differences in the prevalence of at risk of overweight and overweight between food
secure and food insecure children. Gender, race, and income showed similar patterns.
Results from logistic regression analyses also indicated that the likelihood of being
overweight or at risk of overweight was not significantly different for food secure and
food insecure children. Although child-specific food insecurity was not associated with
overweight in this sample of low-income children, food insecurity and overweight coexist
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among these low-income children, because approximately 25% of the food insecure
children were overweight. Additional research is needed to explore the potential
relationships between food insecurity and overweight and to better inform policy that
attempts to address these issues among low-income households with children.
S. Harding, A. Teyhan, M. J. Maynard and J. K. Cruickshank. (2008). Ethnic differences
in overweight and obesity in early adolescence in the MRC DASH study: the role of
adolescent and parental lifestyle. Int J Epidemiol. 37, 162-72.
BACKGROUND: Ethnicity is a consistent correlate of excess weight in youth. We
examine the influence of lifestyles on ethnic differences in excess weight in early
adolescence in the UK. METHOD: Data were collected from 6599 pupils, aged 11-13
years in 51 schools, on dietary practices and physical activity, parental smoking and
overweight, and on overweight and obesity (using International Obesity Task Force
criteria). RESULTS: Skipping breakfast [girls odds ratio (OR) 1.74, 95% confidence
interval (CI) 1.30-2.34; boys OR 2.06; CI 1.57-2.70], maternal smoking (girls OR 2.04,
CI 1.49-2.79; boys OR 1.63, CI 1.21-2.21) and maternal overweight (girls OR 2.01, CI
1.29-3.13; boys OR 2.47, CI 1.63-3.73) were associated with obesity. Skipping breakfast,
more common among girls, was associated with other poor dietary practices. Compared
with White UK peers, Black Caribbeans (girls OR 1.62, CI 1.24-2.12; boys OR 1.49, CI
1.15-1.95) and Black Africans (girls OR 1.96, CI 1.52-2.53; boys OR 2.50, CI 1.92-3.27)
were more likely to skip breakfast and engage in other poor dietary practices, and Indians
were least likely. White Other boys reported more maternal smoking (OR 1.37, CI 1.031.82). All these reports were more common among those born in the UK than those born
elsewhere. Black Caribbean girls were more likely to be overweight (OR 1.38, CI 1.021.87) and obese (OR 1.65, CI 1.05-2.58), Black African girls to be overweight (OR 1.35,
CI 1.02-1.79) and White Other boys to be overweight (OR 1.37, CI 1.00-1.88) and obese
(OR 1.86, CI 1.15-3.00). Adverse dietary habits and being born in the UK contributed to
these patterns. CONCLUSION: These findings signal a potential exacerbating effect on
ethnic differences in obesity if adverse dietary habits persist. Combined adolescent and
parent-focused interventions should be considered.
W. W. Ho, R. E. Adams, J. A. Boscarino and D. Laraque. (2008). The prevalence and
characteristics of childhood overweight in a multiethnic, school-based health setting.
Ethn Dis. 18, 98-103.
OBJECTIVE: The prevalence and correlates of overweight and the risk of overweight in
minority children attending urban school-based health centers remains poorly
characterized. The purpose of our study was to examine the prevalence and
characteristics of overweight and at risk for overweight in low socioeconomic status
minority children enrolled in East Harlem school-based health centers in New York City.
DESIGN: A retrospective cross-sectional study during the period of September 2002 to
August 2003. SETTING: Four Pediatric School-based Health Centers in East Harlem.
PARTICIPANTS: Children and adolescents, aged 5 to 18 years. MAIN OUTCOME
MEASURES: We examined presence of overweight or the risk of overweight based on
body mass index (BMI) percentile and other clinical characteristics. Bivariate and
multivariate analyses were performed to assess the relationship between demographics
and clinical characteristics with overweight and the risk of overweight. RESULTS: Of
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the 491 children enrolled, 45.8% were either overweight or at risk for overweight, with
the highest risk observed in Hispanic/Latino children. This latter relation remained
significant after adjusting for age, sex, and birthweight status. In addition, high screening
office blood pressure was related to overweight status and higher BMI percentile.
CONCLUSIONS: A large proportion of minorities, especially Hispanic/Latino children,
attending school-based health centers in an urban community sample, are overweight or
at risk for overweight. Elevated screening blood pressure was also a common comorbidity. Further research should determine the predictors and correlates of overweight,
and effective targeted school-based interventions should be tested in this high-risk
population.
A. I. Ibrahim, Z. M. Hawamdeh, J. T. Al-Smadi and B. A. Ammari. (2008). Prevalence of
overweight and obesity in urban and semi-urban Jordanian children aged 3-6 years. Child
Care Health And Development. 34, 464-469.
Objectives To show the prevalence of overweight and obesity among the Jordanian urban
and semi-urban children; to compare their body mass index (BMI) with the international
standards of BMI. Methods We measured 1695 healthy children (842 boys and 853 girls)
between 3 and 6 years for height, weight and mid upper arm circumference. BMI was
calculated and transformed into percentiles. Children were divided into boys and girls.
Results The mean and SD values of BMI observed in our study were 16.69 +/- 4.9
kg/m(2) for boys and 16.82 +/- 4.77 kg/m(2) for girls aged 3-6 years. The prevalence of
obesity and overweight among boys was 20.8% and 3.8% respectively and among girls
was 19.1% and 7.2% respectively. In total, 48.0% of boys and 38.1% of girls were of
healthy weight. Conclusions The mean BMI observed in our study's children aged 3-6
years was higher than the expected 50th percentile of the (World Health
Organization/Centers for Disease Control and Prevention) reference values for a similar
age range but, it was equivalent to the 75th percentile values. Obesity was more frequent
than overweight among boys and girls aged 3-6 years.
D. Ilardi. (2008). Obesity wars continue. Home-based pediatric weight management.
School Nurse News. 25, 22-4.
There is a growing demand for pediatric weight management programs that can be
adminisetred at home. School staff, including school nurses and food service staff, are
frustrated by the pressure of handling these problems exclusively in the school; parents
who want to exercise successful influence over their child's food choices are at a loss for
answers. A pilot study of the SUCCESS AT HOME Program indicated that children
made significant improvements in a number of health-related areas (weight, body-mass
index, body circumference measures, flexibility) after nine months of using the program.
Overall, parents were highly satisfied with the program and saw significant
improvements in the physical health and psychological well-being of their children.
E. Isganaitis and L. L. Levitsky. (2008). Preventing childhood obesity: can we do it? Curr
Opin Endocrinol Diabetes Obes. 15, 1-8.
PURPOSE OF REVIEW: This review critically examines recent publications on
prevention of childhood obesity and places these publications within a biologic,
epidemiologic, public health, and policy context. It should help practitioners advocate
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effective preventive strategies and develop effective plans of action for research and
policy. RECENT FINDINGS: Risk factors for childhood obesity include low
socioeconomic status, maternal obesity, rapid infancy weight gain, and decreased
physical activity. Changes in food availability and activity levels during the past 30 years
are well documented. Obesity prevention programs have had limited success but they
demonstrate that changes in school and community environments can decrease childhood
weight gain. Legislative approaches to the obesity epidemic have not led to changes in
governmental agricultural policy or in the food and marketing industry. SUMMARY:
Obesity in childhood is a major public health problem and contributes to significant
morbidity in adulthood. It is the natural biologic outcome of an unprecedented increase of
food availability and intake, coupled with decreased energy output. Present obesity
prevention measures have been small scale and timid. Public policy measures to address
the obesity epidemic have not yet been sufficiently strong to be effective. Suggestions are
made to intensify public education and change national behaviors.
T. H. Jafar, Z. Qadri, M. Islam, J. Hatcher, Z. A. Bhutta and N. Chaturvedi. (2008). Rise
in childhood obesity with persistently high rates of undernutrition among urban schoolaged Indo-Asian children. Arch Dis Child. 93, 373-8.
BACKGROUND: Childhood obesity is an emerging global public health challenge.
Evidence for the transition in nutrition in Indo-Asian developing countries is lacking. We
conducted these analyses to determine the trends in nutritional status of school-aged
children in urban Pakistan. METHODS: Data on the nutritional status of children aged 5
to 14 years from two independent population-based representative surveys, the urban
component of the National Health Survey of Pakistan (NHSP; 1990-1994) and the
Karachi survey (2004-2005), were analysed. Using normative data from children in the
United States as the reference, trends for age- and gender-standardised prevalence (95%
CI) of underweight (more than 2 SD below the weight-for-age reference), stunted (more
than 2 SD below the height-for-age reference) and overweight and obese (body mass
index (BMI) 85(th) percentile or greater) children were compared for the two surveys.
The association between physical activity and being overweight or obese was analysed in
the Karachi survey using logistical regression analysis. RESULTS: 2074 children were
included in the urban NHSP and 1675 in the Karachi survey. The prevalence of
underweight children was 29.7% versus 27.3% (p = 0.12), stunting was 16.7% versus
14.3% (p = 0.05), and prevalence of overweight and obese children was 3.0 versus 5.7
(p<0.001) in the NHSP and Karachi surveys, respectively. Physical activity was inversely
correlated with being overweight or obese (odds ratio, 95% CI, 0.51, 0.32-0.80 for those
who engaged in more than 30 minutes of physical activity versus those engaged in less
than 30 minutes' activity). CONCLUSIONS: Our study highlights the challenge faced by
Pakistani school-aged children. There has been a rapid rise in the number of overweight
and obese children despite a persistently high burden of undernutrition. Focus on
prevention of obesity in children must include strategies for promoting physical activity.
D. M. Janicke, B. J. Sallinen, M. G. Perri, L. D. Lutes, J. H. Silverstein, M. G. Huerta and
L. A. Guion. (2008). Sensible treatment of obesity in rural youth (STORY): design and
methods. Contemp Clin Trials. 29, 270-80.
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Project STORY is a 3-arm, randomized, planning and feasibility study assessing the
effectiveness of two behavioral weight management interventions in an important and atrisk population, overweight children and their parents in medically underserved rural
counties. Participants will include 90 parent-child dyads from rural counties in north
central Florida. Families will be randomized to one of three conditions: (a) a FamilyBased Behavioral Group Intervention, (b) a Parent-Only Behavioral Group Intervention,
and (c) a waitlist control condition. Child and parent participants will be assessed at
baseline (month 0), post-treatment (month 4) and follow-up (month 10). Assessment and
intervention sessions will be held at Cooperative Extension offices within each local
participating county. The primary outcome measure is change in child body mass index
(BMI) z-score. Additional key outcome measures include child dietary intake, physical
activity, self-esteem, body image, and parent BMI. The goals of the study are to (a)
assess the feasibility of recruitment in rural settings, (b) develop and evaluate training
protocol for group leaders, (c) determine strategies to increase adherence to monitoring
and goal setting protocol, (d) evaluate strategies for participant retention, (e) assess the
relative cost-effectiveness of the interventions, (f) assess the acceptability of the
intervention to families and Cooperative Extension administrators and personnel, and (g)
if successful, estimate the sample size needed for a full-scale trial. This research has
potential implications for medically underserved rural communities with limited
resources and preventive health care services. If successful, a Parent-Only intervention
program may provide a cost-effective and practical intervention for families in
underserved rural communities.
M. Julia, M. M. van Weissenbruch, E. P. Prawirohartono, A. Surjono and H. A.
Delemarre-van de Waal. (2008). Tracking for underweight, overweight and obesity from
childhood to adolescence: a 5-year follow-up study in urban Indonesian children. Horm
Res. 69, 301-6.
AIMS: To assess tracking of body mass index (BMI) of urban Indonesian children from
childhood to adolescence and to compare the prevalence of underweight, overweight and
obesity in 6- to 8-year-old children from two surveys: years 1999 and 2004. METHODS:
A longitudinal study assessing BMI tracking of 308 urban children followed from age 6-8
to 11-13 years and two cross-sectional surveys comparing the prevalence of underweight,
overweight and obesity in 6- to 8-year-old children: year 1999 (n = 1,524) and 2004 (n =
510). RESULTS: Childhood BMI determined 52.3% variation of later BMI. After 5.1
(0.6) years the prevalence of overweight and obesity increased from 4.2 and 1.9% in
childhood to 8.8 and 3.2% in adolescence. The prevalence of underweight decreased
from 27.3 to 18.8%. All obese children remained obese, 84.6% overweight children
stayed overweight, 56.0% underweight children remained underweight. In cross-sectional
comparison the prevalence of overweight and obesity raised from 5.3 to 8.6% and from
2.7 to 3.7%, respectively. The prevalence of underweight remained constant.
CONCLUSIONS: The prevalence of overweight and obesity increases as children grow
into adolescence. Overweight or obese children are more likely to remain overweight or
obese. Cross-sectional comparison shows, while the prevalence of underweight stays
constant, the prevalence of overweight and obesity increases.
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P. T. Katzmarzyk, L. A. Baur, S. N. Blair, E. V. Lambert, J. M. Oppert and C. Riddoch.
(2008). International conference on physical activity and obesity in children: summary
statement and recommendations. Applied Physiology Nutrition And MetabolismPhysiologie Appliquee Nutrition Et Metabolisme. 33, 371-388.
The increasing prevalence of obesity among the world's children and youth was the
impetus for an international conference convened in Toronto, Canada, to examine issues
related to physical activity and obesity in children (24-27 June 2007). The goal of the
conference was to assimilate, interpret, and share scientific evidence with key
stakeholders to develop recommendations concerning effective physical activity policies
and programs to address obesity in children. The conference was attended by
approximately 1000 delegates from 33 countries who gathered to listen to the invited
speakers and to share information on promising practices related to the promotion of
physical activity with the aim of reducing the burden of obesity in children. The major
topics addressed at the conference included the biological and behavioural causes of
obesity, current and past levels of physical activity and sedentarism in children, the role
of the social, family, and built environments in addressing the physical activity deficit,
and the role of legislation and industry in promoting physical activity. Promising physical
activity interventions among children were presented, and important research, policy, and
practice recommendations to address the issue of physical inactivity and obesity were
provided.
R. Kelishadi, G. Ardalan, R. Gheiratmand, R. Majdzadeh, M. Hosseini, M. M. Gouya, E.
M. Razaghi, A. Delavari, M. Motaghian, H. Barekati, M. S. Mahmoud-Arabi and K.
Lock. (2008). Thinness, overweight and obesity in a national sample of Iranian children
and adolescents: CASPIAN Study. Child Care Health Dev. 34, 44-54.
BACKGROUND: This study was conducted to assess the national prevalence of different
grades of nutritional status (underweight, normal weight, overweight and obesity) among
Iranian school-students and to compare the prevalence of overweight and obesity using
three different sets of criteria. METHODS: This cross-sectional national survey was
conducted on a representative sample of 21 111 school students including 10 253 boys
(48.6%) and 10 858 girls (51.4%) aged 6-18 years, selected by multistage random cluster
sampling from urban (84.6%) and rural (15.4%) areas of 23 provinces in Iran The
percentage of subjects in the corresponding body mass index (BMI) categories of the
Centers of Disease Control and Prevention (CDC), the International Obesity Task Force
(IOTF) and the obtained national percentiles were assessed and compared. RESULTS:
There was no gender differences in BMI, but was higher in boys living in urban than in
rural areas (18.4 +/- 3.88 vs. 17.86 +/- 3.66 kg/m(2) respectively, P < 0.05). The
prevalence of underweight was 13.9% (8.1% of boys and 5.7% of girls) according to the
CDC percentiles, and 5% (2.6% of boys and 2.4% of girls) according to the obtained
percentiles. According to the CDC, IOTF and national cut-offs, the prevalence of
overweight was 8.82%, 11.3% and 10.1% respectively; and the prevalence of obesity was
4.5%, 2.9% and 4.79% respectively. The prevalence of overweight was highest (10.98%)
in the 12-year-old group and that of obesity (7.81%) in the 6-year-old group. The kappa
correlation coefficient was 0.71 between the CDC and IOTF criteria, 0.64 between IOTF
and national cut-offs, and 0.77 between CDC and national cut-offs. CONCLUSIONS:
The findings of this study warrant the necessity of paying special attention to monitoring
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of the time trends in child obesity based on uniform definitions, as well as to design
programmes to prevent and control associated factors.
T. Kidd, E. Johannes, L. Simonson and D. Medeiros. (2008). KNACK Online: an
evidence-based Web site developed to address adolescent obesity. J Nutr Educ Behav.
40, 189-90.
E. G. Klein, L. A. Lytle and V. Chen. (2008). Social ecological predictors of the
transition to overweight in youth: results from the Teens Eating for Energy and Nutrition
at Schools (TEENS) study. J Am Diet Assoc. 108, 1163-9.
OBJECTIVE: To explore the social ecological predictors of the transition to overweight
in youth, as shown in results from the Teens Eating for Energy and Nutrition at Schools
study. DESIGN: Longitudinal data from a school-based intervention trial.
PARTICIPANTS: Adolescents who were involved in the Teens Eating for Energy and
Nutrition at Schools intervention study who reported a healthful weight at baseline in
1998 (n=1,728). MAIN OUTCOME MEASURE: Transition to overweight status (body
mass index > or =85th percentile) at follow-up in eighth grade. STATISTICAL
ANALYSIS: Generalized linear mixed model regression. RESULTS: Factors in the
social, environmental, individual, and behavioral domains had significant unadjusted
relationships with a transition to overweight status. In the multivariate analysis,
adolescents who perceived themselves to be overweight at baseline were 2.3 times more
likely to be overweight at follow-up compared to those with a normal weight selfperception. Compared to nondieters, current dieters were 2.6 times more likely to be
overweight at follow-up, and boys were nearly three times more likely to transition to
overweight status at follow-up compared with girls. CONCLUSIONS: Individual factors,
primarily related to a self-perception of being overweight, were the strongest predictors
of transitioning to overweight as adolescents progressed from seventh through eighth
grade. A better understanding of the relationship between weight concern and transition
to overweight is needed.
L. M. Klesges, D. A. Dzewaltowski and R. E. Glasgow. (2008). Review of external
validity reporting in childhood obesity prevention research. Am J Prev Med. 34, 216-23.
BACKGROUND: The translation and dissemination of prevention intervention evidence
into practice is needed to address significant public health issues such as childhood
obesity. Increased attention to and reporting of external validity information in research
publications would allow for better understanding of generalizability issues relevant to
successful translation. To demonstrate this potential, recent reports of childhood obesity
prevention interventions were evaluated on the extent to which external validity
dimensions were reported. METHODS: Childhood obesity prevention studies that were
controlled, long-term research trials published between 1980 and 2004 that reported a
behavioral target of physical activity and/or healthy eating along with at least one
anthropometric outcome were identified in 2005. Studies were summarized between 2005
and 2006 using review criteria developed by Green and Glasgow in 2006. RESULTS:
Nineteen publications met selection criteria. In general, all studies lacked full reporting
on potential generalizability and dissemination elements. Median reporting over all
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elements was 34.5%; the mode was 0% with a range of 0% to 100%. Most infrequent
were reports of setting level selection criteria and representativeness, characteristics
regarding intervention staff, implementation of intervention content, costs, and program
sustainability. CONCLUSIONS: The evidence base for future prevention interventions
can be improved by enhancing the reporting of contextual and generalizability elements
central to translational research. Such efforts face practical hurdles but could provide
additional explanation for variability in intervention outcomes, insights into successful
adaptations of interventions, and help guide policy decisions.
G. T. Ko, R. Ozaki, G. W. Wong, A. P. Kong, W. Y. So, P. C. Tong, M. H. Chan, C. S.
Ho, C. W. Lam and J. C. Chan. (2008). The problem of obesity among adolescents in
Hong Kong: a comparison using various diagnostic criteria. BMC Pediatr. 8, 10.
BACKGROUND: Obesity is now a global epidemic. In this study, we aimed to assess the
rates of obesity using several major diagnostic criteria in Chinese school adolescents in
Hong Kong. METHODS: This is a cross-sectional study. Using a computer-generated
coding system, we randomly selected schools from different geographical regions in
Hong Kong to obtain a representative sample. Subjects aged 11-18 years of age were
randomly selected from different class of the schools. Their rates of obesity according to
four different international and local criteria were compared [International Obesity Task
Force (IOTF) 2000 criterion; the Group of China Obesity Task Force (COTF) 2004
criterion; Centers for Disease Control and Prevention (CDC) 2000 Growth Charts and the
Hong Kong Growth Survey (HKGS) charts in 1993]. RESULTS: Of the 2098 adolescents
[982 (46.8%) boys and 1116 (53.2%) girls], the mean age (+/- SD) was 15.1 +/- 1.8 years
(range: 11-18 years; median: 15.0 years). The crude rates of obesity were similar based
on IOTF, COTF or CDC criteria (boys: 3.9-6.0%, girls: 1.8-3.7%), however, the rate
increased to 11-27% if the HKGS charts were used. Obesity rate varied markedly
according to age. It decreased from 8-10% among those aged 12-13 years to 2-4% among
those aged 17-18 years. CONCLUSION: The prevalence of obesity in Hong Kong
adolescents using various diagnostic criteria were similar except for the 1993 HKGS
criteria, which gave an exceeding high figure. Using the IOTF, COTF or CDC criteria,
the adolescent obesity in Hong Kong varied from 1.8% to 6.0%.
J. A. Kropski, P. H. Keckley and G. L. Jensen. (2008). School-based Obesity Prevention
Programs: An Evidence-based Review. Obesity (19307381). 16, 1009.
The article reviews fourteen studies on the effectiveness of school-based programs for
reducing childhood overweight or obesity. These studies were published in 1990. Twelve
studies indicated significant improvement in at least one measure of dietary intake,
physical activity, and/or sedentary behavior.
T. Kubo, M. Furujo, Y. Ueda, K. Imai, K. Tsukahara, H. Morita, K. Ogura, T. Kimura, J.
Shimizu, S. Fukuhara, T. Koyama, T. Kanadani and H. Shiraga. (2008). Predicting
obesity in early adulthood in Japanese women. J Paediatr Child Health. 44, 33-7.
AIM: We analysed the body measurements of Japanese women to determine which
factors may forecast adult obesity and also performed a comparative study of the utility
of body mass index (BMI), which is used widely in Western Europe, and percentage of
overweight, which is used in Japan. METHODS: Subjects included 244 Japanese women
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who were born between 1983 and 1986. Using a questionnaire, we investigated
anthropometric values from birth to present and parents' present anthropometric data, and
analysed factors that correlate with current BMI data. RESULTS: (i) BMI after 10 years
of age and BMI increase between ages 7 and 8 years correlated with BMI in adulthood.
The carrying over rate of overweight increased with age. Meanwhile, percentage of
overweight after 13 years onwards correlated with BMI in adulthood. (ii) Adult BMI
positively correlated to both parents' BMI. CONCLUSIONS: (i) For a Japanese woman,
BMI in childhood is a good indicator of young adult BMI, and has the possibility of
becoming an important parameter to monitor obesity progression. (ii) Therefore, attempts
to control obesity in elementary school girls are necessary. (iii) Parents' weights may
potentially influence obesity in adulthood; however, further examination of other
confounding factors is necessary.
S. K. Kumanyika. (2008). Environmental influences on childhood obesity: Ethnic and
cultural influences in context. Physiology & Behavior. 94, 61-70.
Ethnicity is associated with differences in food-related beliefs, preferences, and
behaviors, and cultural influences may contribute to the higher than average risk of
obesity among children and youth in U.S. ethnic minority populations. However, cultural
attitudes and beliefs are not the only potential source of ethnic variation in childhood
obesity prevalence and should not be studied in isolation. Demographic, socio-structural,
and environmental variables must also be considered. Available evidence indicates ethnic
differences along several pathways that may increase risks of obesity development during
gestation, infancy, childhood and adolescence. These include above-average prevalence
of obesity in adult females and of maternal diabetes during pregnancy, parental attitudes
and practices that may lead to overfeeding children, above-average levels of consumption
of certain high calorie foods and beverages, and inadequate physical activity.
Environments with lower than average neighborhood availability of healthful foods and
higher than average availability of fast food restaurants, along with exposure to ethnically
targeted food marketing may contribute to reliance on high calorie foods and beverages,
and these foods may be socially and culturally valued. Attitudes about and environmental
contexts for physical activity are also relevant. Increasingly, it is acknowledged that
individual behaviors and lifestyles, e.g. food choices or child feeding practices, are
responsive to the ecological contexts in which they are practiced. Focusing attention on
the fluid interactions of cultural influences with contextual factors, of recognized
importance for the study of childhood undernutrition, can also lead to further
understanding of how to address ethnic disparities in childhood obesity. (C) 2007
Elsevier Inc. All rights reserved.
B. Landsberg, S. Plachta-Danielzik, D. Much, M. Johannsen, D. Lange and M. J. Muller.
(2008). Associations between active commuting to school, fat mass and lifestyle factors
in adolescents: the Kiel Obesity Prevention Study (KOPS). European Journal Of Clinical
Nutrition. 62, 739-747.
Objective: To examine possible associations between active commuting (walking or
cycling) to school, parameters of adiposity and lifestyle factors in 14-year-old adolescents
of the Kiel Obesity Prevention Study. Subjects: A total of 626 14-year-old adolescents.
Methods: Measured body mass index (BMI), fat mass (FM), distance to school as well as
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self-reported modes and duration of commuting to school, time spent in structured and
unstructured physical activities (PAs), media use, nutrition, alcohol consumption and
smoking. Results: Parameters of adiposity did not differ between different commuting
modes after stratifying by gender. Active commuters reported higher overall PA, which
was caused by commuting activity and time spent in unstructured PA in girls and just by
commuting activity in boys. In active commuters, 28.4% of overall PA was explained by
commuting activity. Additionally, TV viewing was lower in active commuters.
Compared to their inactively commuting counterparts, actively commuting boys were
less likely to smoke. After controlling for potential confounders the interaction term
'active commuting by distance to school' and 'time spent in structured PA' were
independent predictors of FM, whereas active commuting by itself showed no effect.
Conclusion: The present data suggest that active commuting to school per se does not
affect FM or BMI until considering distance to school. Increasing walking or cycling
distance results in decreasing FM. However, the everyday need to get to and from school
may enhance adolescents' overall PA.
K. L. Larson and C. McQuiston. (2008). Walking out of one culture into another: health
concerns of early adolescent Latinos. J Sch Nurs. 24, 88-94.
Adolescence is considered a critical life transition that can lead to heightened
vulnerability. Acculturation takes on increased importance during this period. The
purpose of this study was to explore the relationship between acculturation and perceived
health concerns of early adolescent Latinos in rural North Carolina. A qualitative
descriptive design using gender-specific focus groups was conducted in the summer of
2001. Twenty-six Latino adolescents, predominantly from Mexico, participated in one of
four focus groups. Acculturation was assessed using the Short Acculturation Scale (Marin
& Marin, 1991). The most prevalent health concern of the girls was unsolicited physical
contact and aggressive male behavior. Boys expressed concerns about stress related to
financial worries and drinking alcohol. A better understanding of where Latino
adolescents are located in the acculturation process can assist school nurses in developing
targeted school-based prevention programs that focus on building specific skills for
Latino girls and boys.
K. Laurson, J. C. Eisenmann and S. Moore. (2008). Lack of association between
television viewing, soft drinks, physical activity and body mass index in children. Acta
Paediatrica. 97, 795-800.
Objective: To examine the cross-sectional and longitudinal associations of physical
activity, screen time and dietary habits on the body mass index (BMI) of children.
Methods: A cohort of 122 girls and 146 boys (age at entry 10 years) from three rural
states in the western USA was studied over an 18-month period. Subjects were measured
for height and weight. Habitual physical activity, screen time (television viewing, video
games and computer use) and dietary variables were assessed by a questionnaire. Crosssectional and longitudinal analyses were conducted to examine the associations between
physical activity, screen time and diet with BMI at baseline and follow-up and change in
BMI. Results: At baseline, approximately 10% of boys and girls were obese and 17.8%
of boys and 14.8% of girls were overweight. BMI showed a high degree of stability for
boys and girls (r = 0.90), whereas physical activity, screen time and dietary habits
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showed moderate stability (r = 0.31-0.50) across the 18-month period. Cross-sectional
and longitudinal correlations between physical activity, screen time, diet and BMI were
low and non-significant (r < 0.15). The regression models explained between 8% and
22% of the variance in the change in BMI; however, none of the predictor variables were
statistically significant. Conclusion: Physical activity, screen time and dietary habits were
not significantly related to the BMI in cross-sectional or longitudinal analyses. Further
research is warranted to better understand the complex, multifactorial phenotype of the
BMI in growing and maturing children.
S. A. Lee, W. Q. Wen, W. H. Xu, W. Zheng, H. L. Li, G. Yang, Y. B. Xiang and X. O.
Shu. (2008). Prevalence of obesity and correlations with lifestyle and dietary factors in
Chinese men. Obesity. 16, 1440-1447.
Objective: To estimate the age-adjusted prevalence of general and centralized obesity
among Chinese men living in urban Shanghai. Methods and Procedures: A crosssectional study was conducted in 61,582 Chinese men aged 40-75. BMI (kg/m(2)) was
used to measure overweight (23 <= BMI < 27.4) and obesity (BMI >= 27.5) based on the
World Health Organization (WHO) recommended criteria for Asians. Waist-to-hip ratio
(WHR) was used to measure moderate (75th <= WHR < 90th percentile) and severe
(WHR >= 90th percentile) centralized obesity. Results: The average MI and WHR were
23.7 kg/m(2) and 0.90, respectively. The prevalence of overweight was 48.6% and
obesity was 10.5%. The prevalence of general and centralized obesity was higher in men
with high income or who were retired, tea drinkers, or nonusers of ginseng than their
counterparts. Men with high education had a higher prevalence of overweight and
centralized obesity, but had a lower prevalence of obesity and severe centralized obesity
compared to those with less education. Current smokers or alcohol drinkers had a lower
prevalence of general obesity but higher prevalence of centralized obesity than
nonsmokers or nondrinkers of alcohol. Ex-smokers and ex-alcohol drinkers had a higher
prevalence of general and centralized obesity compared to nonsmokers and nondrinkers
of alcohol. Prevalence of obesity was associated with high energy intake and less daily
physical activity. Discussion: The prevalence of obesity among Chinese men in urban
Shanghai was lower than that observed in Western countries but higher than that in other
Asian countries, and the prevalence of general and centralized obesity differed by
demographic, lifestyle, and dietary factors.
N. Leigh-Hunt and M. Rudolf. (2008). A review of local practice regarding investigations
in children attending obesity clinics and a comparison of the results with other studies.
Child Care Health Dev. 34, 55-8.
BACKGROUND: Obese children are at high risk of developing co-morbidities, with a
prevalence of abnormal tests ranging from 30 to 58%. Recent guidance recommends that
all children with a body mass index (BMI) above the 95th centile be investigated. This
study aimed to determine the prevalence of abnormal results in an urban paediatric
population and to compare local practice against these recommendations. METHODS:
Patient records of children attending either a community or hospital-based obesity clinic
were analysed retrospectively to obtain anthropometric data and laboratory results; from
this, the frequency of investigation and the prevalence of abnormal results were
calculated. Investigations considered were alanine aminotransferase, thyroid-stimulating
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hormone (TSH), and fasting glucose, insulin and lipid profiles. RESULTS: One hundred
thirty-six children (75 girls, 61 boys) were identified, with mean BMI z-score of 3.27 and
mean age of 11.4 years (range 1.4-20.4). Children with BMI z-score >3 were more likely
to be investigated, but otherwise, the frequency was similar for both sex and age. The
prevalence of abnormal results was liver function tests, 14.3%; TSH, 0.0%; glucose,
0.0%; insulin, 31.6%; triglycerides, 10.0%; cholesterol, 15.6%. The sample size was
small, but there did not appear to be a significant difference in the percentage abnormal
results found for sex, age, or BMI z-score. CONCLUSION: The prevalence of abnormal
results was less than that identified in another UK study carried out in a tertiary centre,
suggesting that the true population-based prevalence is lower than believed. This might
be especially so because fewer tests were performed in these clinics than currently
recommended and children at highest risk were more likely to be investigated. Therefore,
further research is indicated to determine the true figure as well as to identify risk factors
for co-morbidity, before costly recommendations to test all children with a BMI above
the 95th centile are implemented.
R. S. Levine, R. G. Feltbower, A. M. Connor, M. Robinson and M. C. J. Rudolf. (2008).
Monitoring trends in childhood obesity: A simple school-based model. Public Health.
122, 255-260.
Background: The UK Government has set a target of halting the rise in childhood obesity
by 2010. However, at the time the target was set, no monitoring process existed. The
English Department of Health has now issued guidelines to primary care trusts for the
annual weighing and measuring of all children on entry to primary school and in year 6.
Aim: Development of an inexpensive school-based monitoring scheme for trends in
childhood obesity suitable for national implementation. Method: The methodology was
developed in 10 pilot schools in 2004 and implemented in 25 primary schools and three
secondary schools in 2005. Specialty trained healthcare support workers (HCSWs)
recorded height and weight measurements of primary school children in reception and
year 4, and secondary school children in year 8 (aged 5, 8 and 13 years, respectively, on
average). The ethnic and socio-economic profile of the sample was compared with census
data, and the levels of obesity were calculated using standard age cut-offs. Results: While
monitoring in primary schools was achieved with no evidence of disruption to the schools
or distress to the subjects, monitoring in secondary schools was deemed to be impractical.
Cost analysis indicated an estimated cost of less than (sic)1.50 per primary school child
measured. Conclusions: The model provides a viable means of monitoring childhood
obesity trends. Monitoring should be confined to primary schools and should be
conducted by specially trained HCSWs rather than school nurses. (C) 2007 The Royal
Institute of Public Health. Published by Elsevier Ltd. All rights reserved.
Y. Li, X. Yang, F. Zhai, J. Piao, W. Zhao, J. Zhang and G. Ma. (2008). Childhood
obesity and its health consequence in China. Obes Rev. 9 Suppl 1, 82-6.
Analyses of data from the representative 2002 National Nutrition and Health Survey were
used to assess the likelihood of metabolic complications of overweight and obesity in
Chinese children aged 7-17 years. Chinese criteria for body mass index classification
were used for overweight and obesity with the 75th percentile US adolescent values for
waist circumferences and all the metabolic criteria for blood pressure, lipids, fasting
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glucose established for US adolescents. Diabetes in 7-12-year-olds was 0.2% and 0.4% in
children aged 12-18 years. Prevalences of dyslipidaemia (61.9%), hypertriglyceridaemia
(18.2%) and low high-density lipoprotein cholesterol (56.1%) were high and 16.0% of
15-18 years had hypertension. The overall prevalence of the metabolic syndrome was
3.3% with more than half the children having at least one metabolic abnormality and
19.8% having at least two. All the metabolic parameters were significantly elevated in the
overweight and obese children except high-density lipoprotein cholesterol. These data
emphasize the marked sensitivity of Chinese children to the metabolic complications of
overweight and obesity and amplify the need for early preventive measures.
C. A. Loucaides and R. Jago. (2008). Differences in physical activity by gender, weight
status and travel mode to school in Cypriot children. Preventive Medicine. 47, 107-111.
Objective. More information about children's physical activity during different periods of
the day is needed. The purpose of this study was to describe children's physical activity
during the segmented school day and examine potential differences during different
periods of the day across gender, travel mode to school and weight status. Methods.
School children (N=247) wore pedometers for four consecutive school days and recorded
their steps during the before school period, the 20-min school break, the whole school
period, the after school period and for the whole day. Children also reported how they
traveled to school. Data were collected in Cyprus, in January/February of 2007. Results.
T-tests indicated that boys took significantly higher steps than girls throughout all the
segments of the day (p<0.001) and children who walked to school exhibited higher step
counts during the before school period (p<0.001), the after school period (p<0.01), and
the whole day (p<0.01) in comparison to children who used motorized transport. A threeway ANOVA revealed significant two-way interactions between weight status and travel
mode to school. Conclusion. Results suggest that there is a need to promote physical
activity among children, especially among girls. Promoting active transport to school
may further enhance the effectiveness of intervention programs. (C) 2008 Elsevier Inc.
All rights reserved.
A. A. Mahfouz, I. Abdelmoneim, M. Y. Khan, A. A. Daffalla, M. M. Diab, K. S. AlGelban and H. Moussa. (2008). Obesity and related behaviors among adolescent school
boys in Abha City, Southwestern Saudi Arabia. Journal Of Tropical Pediatrics. 54, 120124.
Using stratified sampling technique 2696 adolescent school boys (aged 11-19 years) in
Abha City, Southwestern Saudi Arabia were interviewed and examined for weight and
height using standardized techniques. The overall prevalence of obesity and overweight
in the present study amounted to 16. Using logistic regression analysis, lack of exercise
practice in the previous week in general [aOR = 1.352, 95 confidence interval (CI) =
1.0661.941] or in the class (aOR = 1.446, 95 CI = 1.0831.931) were significantly
associated with obesity. The present study showed that obesity among adolescent school
boys in Abha City is a public health problem. There is a need for a national program in
the country to prevent and control obesity among adolescents. The program should
incorporate: dietary management of obesity, promotion of physical activity, health
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education campaigns and consideration of the possibility of providing facilities for
practicing physical activity and exercise in the community.
R. M. Malina, M. E. P. a. Reyes, S. K. Tan and B. B. Little. (2008). Physical activity in
youth from a subsistence agriculture community in the Valley of Oaxaca, southern
Mexico. Applied Physiology, Nutrition & Metabolism. 33, 819.
Observations of activities of contemporary subsistence agricultural communities may
provide insights into the lifestyle of youth of 2 to 3 generations ago. The purpose of this
study was to document age- and sex-associated variation in household activities and daily
steps walking to school of youth 9-17 years in an indigenous subsistence agricultural
community in Oaxaca, southern Mexico. Activities during leisure were also considered.
A cross-sectional survey of a rural Zapotec-speaking community was undertaken, and
respondents included 118 boys and 152 girls, aged 8.7-17.9 years. Household and leisure
activities were documented by questionnaire and subsequent interview. Household
activities were classified by estimated intensity for before and after school and on the
weekend, and an estimate of METS per day accumulated while doing chores was derived.
Number of steps from home to school was estimated. Contingency table analysis and
MANCOVA controlling for age was used to evaluate results. Household activities tended
to cluster at light and moderate intensities in girls and at moderate to moderate-tovigorous intensities in boys. Estimated METS per day in ~2 h of chores differed
significantly by sex. Secondary school girls expended significantly more METS per day
in chores than primary school girls, but there was no difference by school level in boys.
The daily round trip from home to school was ~2400 steps for primary students and
~2700 and ~3100 steps for secondary boys and girls, respectively. Television viewing
and participation in sports were major leisure activities for boys and girls. Daily
household chores, walking, and leisure activities suggest moderately active and
moderately-to-vigorously active lifestyles in girls and boys, respectively, in this
indigenous subsistence agricultural community.
J. J. Martin, N. McCaughtry and B. Shen. (2008). Predicting physical activity in Arab
American school children. Journal Of Teaching In Physical Education. 27, 205-219.
Theoretically grounded research on the determinants of Arab American children's
physical activity is virtually nonexistent. Thus, the purpose of our investigation was to
evaluate the ability of the theory of planned behavior (TPB) and social cognitive theory
(SCT) to predictArab American children's moderate-to-vigorous physical activity
(MVPA). Children (N = 348, ages 10-14) completed questionnaires assessing the TPB
and SCT constructs as well as MVPA. Using multiple regression analyses we were able
to account for 9% of the variance in MVPA. Based on standardized beta-weights,
variance accounted for, and the significance of F change, we concluded that SCT
variables were better predictors of MVPA compared with the TPB constructs. In
particular, barrier self-efficacy was the most critical variable within SCT and supports the
potentially valuable role that efficacy cognitions play in promoting MVPA in Arab
American children.
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J. J. D. Martin, L. S. Hernandez, M. G. Gonzalez, C. P. Mendez, C. R. Galan and S. M.
Guerrero. (2008). Trends in childhood and adolescent obesity prevalence in Oviedo
(Asturias, Spain) 1992-2006. Acta Paediatrica. 97, 955-958.
Aim: To analyse obesity and overweight prevalence trend in Oviedo (Spain) during the
last 14 years. Patients and Methods: Two cross-sectional studies were conducted in the
same five public schools of the urban area of Oviedo in 1992 and 2004-06. One thousand
one hundred sixty-five children and young adults between the age of 6 and 17 years were
studied in 1992 and 1312 in 2004-06. Obesity and overweight were defined according to
the International Obesity Task Force cut-off values. Results: Body mass index (BMI)
values (20.5 +/- 3.6 vs. 20.1 +/- 3.3 p = 0.02) and obesity prevalence (6.3% vs. 4.5% p <
0.05) were significantly higher in the 2004-06 cohort, while overweight prevalence
showed a non-significant increase. Obesity prevalence increased in both sexes in the 611-year group. In adolescent females, a four-fold increase was observed, from 0.9% in
1992 (95% CI: -0.1 to 1.9) to 3.8% in 2004-06 (95% CI: 1.8-6). A slight non-significant
decrease was observed in adolescent males (6.6% in 1992 to 5.8% in 2004-06).
Conclusion: Obesity and overweight are increasing in children and adolescents in Oviedo
at a level similar to that observed in studies conducted in developed countries. This
obesity epidemic is becoming an important public health issue.
A. E. Matthews. (2008). 'Children and obesity: a pan-European project examining the
role of food marketing'. Eur J Public Health. 18, 7-11.
BACKGROUND: Rising levels of obesity in school-age children across Europe are
causing increasing concern. The 'Children, Obesity and associated avoidable Chronic
Diseases' project sought to examine the effects of promotion within food marketing,
given the influential role it plays in children's diets. METHOD: A questionnaire and datacollection protocol was designed for the national co-ordinators, facilitating standardized
responses. Co-ordinators collected data from within 20 European Union countries
relating to food promotion to children. RESULTS: Results showed that unhealthy foods
such as savoury snacks and confectionary were the most commonly marketed and
consumed by children across all countries. Television was found to be the prime
promotional medium, with in-school and internet marketing seen as growth areas. Media
literacy programmes designed specifically to counterbalance the effects of food
marketing to children were reported by only a few of the 20 countries. An ineffective and
incoherent pattern of regulation was observed across the countries as few governments
imposed tough restrictions with most preferring to persuade industry to voluntarily act
with responsibly. Most health, consumer and public interest groups supported food
marketing restrictions whilst industry and media groups advocated self-regulation.
CONCLUSION: Recommendations include the amendment of the European Union's
Television Without Frontiers Directive to ban all TV advertising of unhealthy food to
children, the adoption of a commonly agreed European Union definition of an 'unhealthy'
food, and the establishment of a mechanism for pan-European monitoring of the nature
and extent of food marketing to children and its regulation.
W. Maziak, K. D. Ward and M. B. Stockton. (2008). Childhood obesity: are we missing
the big picture? Obesity Reviews. 9, 35-42.
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Childhood obesity is increasing worldwide, raising alarm about future trends of
cardiovascular disease, diabetes and cancer. This article discusses what may underlie our
failure to respond effectively to the obesity epidemic, and presents a wider perspective
for future research and public health agendas. So far targeting individual-level
determinants and clinical aspects of childhood obesity has produced limited success.
There is growing interest in understanding the wider determinants of obesity such as the
built environment (e.g. walkability), social interactions, food marketing and prices, but
much needs to be learned. Particularly, we need to identify distal modifiable factors with
multiple potential that would make them attractive for people and policymakers alike. For
example, walking-biking-friendly cities can reduce obesity as well as energy cosumption,
air pollution and traffic delays. Such agenda needs to be driven by strong evidence from
research involving multi-level influences on behaviour, as well as the study of wider
politico-economic trends affecting people's choices. This article highlights available
evidence and arguments for research and policy needed to curb the obesity epidemic. The
upstream approach underlying these arguments aims to make healthy choices not only the
most rational, but also the most feasible and affordable.
W. J. McCarthy, A. K. Yancey, J. M. Siegel, W. K. Wong, A. Ward, J. Leslie and E.
Gonzalez. (2008). Correlation of obesity with elevated blood pressure among
racial/ethnic minority children in two Los Angeles middle schools. Prev Chronic Dis. 5,
A46.
INTRODUCTION: To identify anthropometric and fitness correlates of elevated blood
pressure, serum cholesterol, and glycated hemoglobin, we examined anthropometric and
physiologic biomarkers among racial/ethnic minority children aged 11 to 13 years in two
urban Los Angeles middle schools. We explored the potential for using obesity or fitness
level as screening variables for cardiovascular disease risk factors in these students.
METHODS: During regularly scheduled physical education classes, we collected data on
demographic characteristics, height, weight, blood pressure, nonfasting total serum
cholesterol, glycated hemoglobin, time to run/walk 1 mile, and a range of self-reported
behaviors. A total of 199 sixth-graders (121 Latinos, 78 African Americans) participated
in the study. RESULTS: Bivariate analyses indicated that 48.6% of sixth-graders were of
desirable weight, 17.5% were overweight, 29.9% were at risk for overweight, and 4.0%
were underweight. Higher weight was associated with higher levels of serum cholesterol,
systolic blood pressure, and diastolic blood pressure (P values for all associations <.02)
but not with glycated hemoglobin. Multivariate analyses maintained the findings with
regard to blood pressure but not serum cholesterol. CONCLUSION: Overweight status
could be a screening variable for identifying youth at risk for high blood pressure.
Obesity prevention and intervention programs and policies need to target low-income
racial/ethnic minority children. Assessment of hypertension status also seems warranted
in low-income racial/ethnic minority sixth-graders, as does early intervention for children
at high risk.
H. McKay and E. Smith. (2008). Commentary: Winning the Battle Against Childhood
Physical Inactivity: The Key to Bone Strength? Journal of Bone & Mineral Research. 23,
980.
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The article focuses on the effect inactivity has on bone strength in children and in adults.
It states that randomized controlled trials showed increased bone accrual in girls and boys
who participated in a 10-to 12-minute moderate impact circuit training program, and
similar increases in other trails of children participating in impact exercise programs.
T. L. McKenzie and D. Kahan. (2008). Physical activity, public health, and elementary
schools. Elementary School Journal. 108, 171-180.
Physical inactivity is a serious public health problem that is associated with numerous
preventable diseases. Public health concerns, particularly those related to the increased
prevalence of overweight, obesity, and diabetes, call for schools to become proactive in
the promotion of healthy, physically active lifestyles. This article begins by
differentiating physical activity from associated concepts (e. g., physical education,
physical fitness) and then summarizes the literature related to the importance of physical
activity for children and the need for its promotion in elementary schools. We describe
numerous opportunities for children to accrue physical activity in elementary schools (e.
g., physical education classes, program integration with other subject areas, recess,
extracurricular programs, and active transport to school) and provide recommendations
for sound educational practice.
J. M. Mellor, R. B. Rapoport and D. Maliniak. (2008). The impact of child obesity on
active parental consent in school-based survey research on healthy eating and physical
activity. Evaluation Review. 32, 298-312.
Previous studies have shown that active consent procedures result in sampling bias in
surveys dealing with adolescent risk behaviors such as cigarette smoking and illicit drug
use. To examine sampling bias from active consent procedures when the survey topic
pertains to childhood obesity and associated health behaviors, the authors pair data
obtained from both active and passive consent procedures. The authors find that parents
of children who are overweight or at risk for being overweight are significantly less likely
to give active consent. In addition, parents of children enrolled in lower grades are more
reluctant to consent to participate.
D. Menschik, S. Ahmed, M. H. Alexander and R. W. Blum. (2008). Adolescent physical
activities as predictors of young adult weight. Arch Pediatr Adolesc Med. 162, 29-33.
OBJECTIVE: To examine the relationship between increased physical activity in
adolescence and adult weight status. DESIGN: Cohort study based on data from the
National Longitudinal Study of Adolescent Health. SETTING: In-home interviews.
PARTICIPANTS: A total of 3345 adolescents in grades 8 to 12 with body mass index
(calculated as weight in kilograms divided by height in meters squared) data available at
baseline and 5 years later. Main Exposures Days per week of curricular and
extracurricular physical activity. MAIN OUTCOME MEASURE: Overweight status
(body mass index > or =25) 5 years after baseline. RESULTS: Increasing participation in
certain extracurricular physical activities and physical education decreased the likelihood
of young adulthood overweight. Regarding extracurricular physical activities, the
likelihood of being an overweight adult was reduced most (ie, 48%) by performing
certain wheel-related activities (ie, rollerblading, roller skating, skateboarding, or
bicycling) more than 4 times per week. Each weekday that adolescents participated in
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physical education decreased the odds of being an overweight adult by 5%, with
participation in all 5 weekdays of physical education decreasing the odds by 28%. In
general, physical activity predicted normal-weight maintenance better than weight loss.
CONCLUSION: These data underscore the important role that school-based and
extracurricular physical activity play in reducing the likelihood of transitioning to
overweight as young adults.
B. G. Meriaux, A. L. Hellstrom and S. Marild. (2008). Identification and follow-up of
obesity in ten-year-old school children. Int J Pediatr Obes. 3, 102-8.
OBJECTIVE: Growth surveillance of children in school health services is a routine in
Sweden. We describe the effect at follow-up of an overt identification of obesity in
school children. METHODS: Follow-up data were collected in two populations of tenyear-old children with obesity. Children in the study group belonged to a cohort born in
1990. Here the presence of obesity had been identified at the routine growth screening,
and intervention activities against obesity had been actively offered. Controls belonged to
a cohort born in 1989. RESULTS: Of the 176 children with obesity, 91 were in the study
group (41 girls) and 85 (44 girls) in the control group. No differences were found
between the groups in age, gender or body mass index at baseline. At follow-up, after one
to two years, children in the study group had a modest but significantly more pronounced
decrease in the relative body mass index, compared with controls. The mean difference
between the populations in body mass index standard deviation score (z-score) after
adjustment for baseline body mass index and follow-up time was -0.14 (95% confidence
interval: -0.25 to -0.02; P=0.027). Socioeconomic status, gender, follow-up time and
group were independent predictors for change in body mass index z-score.
CONCLUSIONS: To identify children with obesity in a routine school health survey may
be a crucial initial step in the management of childhood obesity.
M. L. Mietus-Snyder and R. H. Lustig. (2008). Childhood obesity: Adrift in the "Limbic
Triangle". Annual Review Of Medicine. 59, 147-162.
The prevalence and severity of childhood obesity have increased steadily over the post
three decades. The human species evolved to rigorously defend its lower limit for weight
and adiposity but is tolerant of the upper limit, which, until recent times, was rarely
approached. Neuroendocrine mechanisms within the limbic core of the brain prevent
starvation (ventromedial hypothalamus), heighten reward (ventral tegmental area and
nucleus accumbens), and attenuate stress (amygdala), in order to promote food-seeking
and ingestive behavior and to conserve energy output. In a stressful modern environment
with ready access to calorie-dense, highly palatable foods and limited venues for activity,
normal, reflexive responsiveness to these three drives makes weight gain all but
inevitable. The obesity that ensues often engenders insulin resistance, which undermines
the ability of normal hunger and satiety signals to accurately modulate energy intake
versus expenditure. Obesity interventions that rely on cognitive information alone cannot
free children from this "limbic triangle." Integrated multidisciplinary family- and
community-based education, effective stress reduction, and a societal commitment to
alter the food and built environments are all necessary components to battle the global
obesity epidemic.
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F. Moola, G. E. Faulkner, J. A. Kirsh and J. Kilburn. (2008). Physical activity and sport
participation in youth with congenital heart disease: perceptions of children and parents.
Adapt Phys Activ Q. 25, 49-70.
This study explored perceptions toward physical activity and sport in the lives of youth
with congenital heart disease. Thirteen cardiac participants were interviewed in the
presence of their parents, and a process of inductive analysis was conducted. Sport was
not considered a valued pursuit despite the belief that it is essential for the attainment of
good health. Low-self efficacy and fatigue were influenced by covert fears and exclusion
and further decreased the value ascribed to sport and physical activity. Nontraditional
activities, support from others, and perceptions of mastery played a crucial role in
enabling participation and facilitated the journey toward recovery. Findings are discussed
within the context of self-efficacy theory and may inform the design of safe and
enjoyable physical activity opportunities for this population.
L. A. Moreno, M. Gonzalez-Gross, M. Kersting, D. Molnar, S. de Henauw, L. Beghin,
M. Sjostrom, M. Hagstromer, Y. Manios, C. C. Gilbert, F. B. Ortega, J. Dallongeville, D.
Arcella, J. Warnberg, M. Hallberg, H. Fredriksson, L. Maes, K. Widhalm, A. G. Kafatos
and A. Marcos. (2008). Assessing, understanding and modifying nutritional status, eating
habits and physical activity in European adolescents: the HELENA (Healthy Lifestyle in
Europe by Nutrition in Adolescence) Study. Public Health Nutr. 11, 288-99.
OBJECTIVES: To identify the main knowledge gaps and to propose research lines that
will be developed within the European Union-funded 'Healthy Lifestyle in Europe by
Nutrition in Adolescence' (HELENA) project, concerning the nutritional status, physical
fitness and physical activity of adolescents in Europe. DESIGN: Review of the currently
existing literature. RESULTS: The main gaps identified were: lack of harmonised and
comparable data on food intake; lack of understanding regarding the role of eating
attitudes, food choices and food preferences; lack of harmonised and comparable data on
levels and patterns of physical activity and physical fitness; lack of comparable data
about obesity prevalence and body composition; lack of comparable data about
micronutrient and immunological status; and lack of effective intervention methodologies
for healthier lifestyles. CONCLUSIONS: The HELENA Study Group should develop,
test and describe harmonised and state-of-the-art methods to assess the nutritional status
and lifestyle of adolescents across Europe; develop and evaluate an intervention on eating
habits and physical activity; and develop and test new healthy food products attractive for
European adolescents.
N. D. Muth. (2008). Preventing Childhood Obesity. IDEA Fitness Journal. 5, 58.
The article looks at the efforts to overcome childhood obesity in the U.S. Prevalence of
obesity increased from 5% in the 1960s to 17% in 2004. The Office of the Surgeon
General launched the Childhood Overweight and Obesity Prevention Initiative to
coordinate and expand programs for preventing obesity. A fitness facility was introduced
by Overtime Fitness Inc. founders to address the special interests and needs of teens.
Highlights of the report "Progress in Preventing Childhood Obesity: How Do We
Measure Up?" are presented.
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P. R. Nader, R. H. Bradley, R. M. Houts, S. L. McRitchie and M. O'Brien. (2008).
Moderate-to-vigorous physical activity from ages 9 to 15 years. Jama-Journal Of The
American Medical Association. 300, 295-305.
Context Decreased physical activity plays a critical role in the increase in childhood
obesity. Although at least 60 minutes per day of moderate- to- vigorous physical activity
(MVPA) is recommended, few longitudinal studies have determined the recent patterns
of physical activity of youth. Objective To determine the patterns and determinants of
MVPA of youth followed from ages 9 to 15 years. Design, Setting, and Participants
Longitudinal descriptive analyses of the 1032 participants in the 1991- 2007 National
Institute of Child Health and Human Development Study of Early Child Care and Youth
Development birth cohort from 10 study sites who had accelerometer- determined
minutes of MVPA at ages 9 (year 2000), 11 (2002), 12 (2003), and 15 (2006) years.
Participants included boys (517 [50.1%]) and girls (515 [49.9%]); 76.6% white (n= 791);
and 24.5% (n= 231) lived in low- income families. Main Outcome Measure Mean MVPA
minutes per day, determined by 4 to 7 days of monitored activity. Results At age 9 years,
children engaged in MVPA approximately 3 hours per day on both weekends and
weekdays. Weekday MVPA decreased by 38 minutes per year, while weekend MVPA
decreased by 41 minutes per year. By age 15 years, adolescents were only engaging in
MVPA for 49 minutes per weekday and 35 minutes per weekend day. Boys were more
active than girls, spending 18 and 13 more minutes per day in MVPA on the weekdays
and weekends, respectively. The rate of decrease in MVPA was the same for boys and
girls. The estimated age at which girls crossed below the recommended 60 minutes of
MVPA per day was approximately 13.1 years for weekday activity compared with boys
at 14.7 years, and for weekend activity, girls crossed below the recommended 60 minutes
of MVPA at 12.6 years compared with boys at 13.4 years. Conclusion In this study
cohort, measured physical activity decreased significantly between ages 9 and 15 years.
M. S. Nanney, C. Bohner and M. Friedrichs. (2008). Poverty-related factors associated
with obesity prevention policies in Utah secondary schools. J Am Diet Assoc. 108, 12105.
To address the childhood obesity epidemic, numerous national agencies have outlined
specific school policy recommendations for nutrition and physical activity. The extent to
which current policies differ by socioeconomic status and geographic location is yet to be
determined. This cross-sectional study examined select school nutrition and physical
activity policies by markers for poverty among 209 middle and high schools in Utah
(82% response rate). The results show that students' opportunities to establish healthful
dietary and physical activity patterns differed by economic circumstances and geographic
location. Schools with the highest percentage of free and reduced-price lunch enrollment
and schools in rural areas were both less likely to offer a variety of healthful foods
outside of the school meal program (ie, competitive foods and drinks) and intramural
activities or physical activity clubs. Schools with highest free and reduced-price lunch
enrollment were more likely to allow the purchase of unhealthful snacks during
lunchtimes than schools with low enrollment (28.4% vs 7.6%, P=0.01). Schools in rural
communities were less likely to promote walking and bicycling to school compared with
other locations (47.4% rural vs 67.1% urban and 63.6% suburban, P=0.06). Current
school policies related to nutrition and physical activity may not be conducive to
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reducing the childhood overweight problem among children attending schools in areas
with increased risk factors due to poverty or rural location in Utah.
A. Nash, D. Secker, M. Corey, M. Dunn and D. L. O'Connor. (2008). Field testing of the
2006 World Health Organization growth charts from birth to 2 years: assessment of
hospital undernutrition and overnutrition rates and the usefulness of BMI. JPEN J
Parenter Enteral Nutr. 32, 145-53.
BACKGROUND: The World Health Organization (WHO) recently released a growth
standard, a first attempt at describing how children should grow in an ideal environment.
These charts introduce body mass index (BMI)-for-age percentiles for children younger
than 2 years. Adopting the WHO standard may affect the number of children screened to
require follow-up; hence, field testing needs to be completed in a tertiary care center
where the incidence of suboptimal nutrition is high. The objectives of this study were to
quantify differences between the new WHO and 2000 Centers for Disease Control and
Prevention (CDC) growth charts for children younger than 2 years. The
interchangeability of the WHO weight-for-length and WHO BMI percentiles was also
assessed. METHODS: Percentile scores were computed for children younger than 2 years
(n = 547) admitted to a pediatric tertiary health care center in Toronto, Canada.
RESULTS: The WHO standard identified more children younger than 2 years as at risk
of overweight/obesity compared with the CDC reference (21.0% vs 16.6%, >or=85th
weight-for-length percentile) and fewer children as wasted (18.6% vs 23.0%, <5th
weight-for-length percentile). The WHO BMI-for-age and WHO weight-for-length
percentiles were highly correlated (r2 = 0.83) but not interchangeable. For approximately
9% of all children, and approximately 16% of those aged <or=6 months, BMI-for-age
and weight-for-length percentiles differed by >25 percentile points. CONCLUSIONS:
These data describe for the first time the magnitude of differences in the number of
children screened as undernourished (4.4% decrease) or overnourished (4.4% increase)
with adoption of the WHO standard in a tertiary care setting. Furthermore, the WHO's
BMI-for-age and weight-for-length percentiles for children younger than 2 years are
correlated but are not interchangeable.
L. Nhantumbo, J. Maia, S. Saranga and A. Prista. (2008). [Physical activity among
children and adolescents in a rural community in Mozambique: effects of age, sex, and
nutritional status]. Rev Panam Salud Publica. 23, 171-8.
OBJECTIVE: To determine the association between physical activity levels of children
and adolescents of a rural community in Mozambique and their age, sex, and nutritional
status. METHOD: The sample comprised 845 boys and girls from 7-16 years of age.
Weight and height were measured, while physical activity level was determined using a
questionnaire developed and validated for the population of Mozambique. Nutritional
status was determined according to criteria recommended by the World Health
Organization. Analysis of variance (ANOVA) and analysis of covariance (ANCOVA)
were used to test the interaction between age and sex and between nutritional groups,
respectively. RESULTS: Age and sex significantly influenced all types of activities
except walking, for which the effect of sex was not significant (F = 0.4, P = 0.517). Girls
were more active than boys. Age and sex were significantly associated only in relation to
household chores (F = 1.933, P = 0.044) and sports (F = 2.32, P =0.014). In boys, only
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the total activity coefficient was different among nutritional groups (F = 3.44, P = 0.017),
with boys of normal weight presenting a higher level of activity as compared to boys with
low height or both low weight and height. In girls, significant differences were observed
only in relation to household chores (F = 2.65, P = 0.049), with girls of normal and low
weight differing from the other nutritional groups and those with low height differing
from girls low in both weight and height. CONCLUSIONS: The results suggest that in
rural Mozambique, deficits in height, weight, or both did not limit the physical activity
levels of children and adolescents.
S. B. Nye. (2008). A Physical Activity Program for Elementary Schools. JOPERD: The
Journal of Physical Education, Recreation & Dance. 79, 36.
The article presents an outline of the process on how to create a developmentally
appropriate physical activity program in elementary schools. It is stated that the National
Association for Sport and Physical Education (NASPE) has recommended that
elementary school children should receive quality physical education instruction for a
minimum of 150 minutes in a week. NASPE has further recommended guidelines for the
physical activity of children ages five through twelve. Accordingly, activity sessions
should last at least 15 minutes that include a range of age-appropriate fitness activities,
incorporate positive role models, and encourage students to make their own pace or
intensity while engaging in activities.
A. D. Okely, M. L. Booth, L. Hardy, T. Dobbins and E. Denney-Wilson. (2008). Changes
in physical activity participation from 1985 to 2004 in a statewide survey of Australian
adolescents. Arch Pediatr Adolesc Med. 162, 176-80.
OBJECTIVE: To examine changes in physical activity during a 19-year period between 2
representative cohorts of adolescents from New South Wales, Australia. DESIGN:
Repeat cross-sectional study. SETTING: Randomly selected secondary schools from
New South Wales, the most populous state in Australia. PARTICIPANTS: One thousand
fifty-five adolescents surveyed in May through October 1985 (with the Australian Health
and Fitness Survey) and 1226 adolescents surveyed in March through April 2004 (with
the New South Wales Schools Physical Activity and Nutrition Survey). Participants were
aged 12 to 15 years. MAIN OUTCOME MEASURES: The proportion meeting current
guidelines for physical activity (60 min/d of moderate to vigorous physical activity) and
time spent in moderate to vigorous physical activity assessed by self-reported
participation in physical activity using the same questionnaire at both time points.
RESULTS: All of the age and sex groups reported increases in both the prevalence of
physical activity (mean increase range, 11.7%-20.0%) and in the minutes per week spent
in moderate to vigorous physical activity (median increase range, 135-175 minutes).
These findings remained the same after additional adjustment for age, socioeconomic
status, and cultural background. CONCLUSIONS: Physical activity participation has
considerably increased during the past 19 years among adolescents in the state of New
South Wales, Australia. These findings provide important information about trends in
compliance with physical activity recommendations and in time spent in physical
activity. They could help to explain what aspects may need to be promoted to maximize
the role of physical activity in reducing the high and increasing rates of child and
adolescent obesity.
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F. B. Ortega, J. R. Ruiz, M. J. Castillo and M. Sjostrom. (2008). Physical fitness in
childhood and adolescence: a powerful marker of health. Int J Obes (Lond). 32, 1-11.
This review aims to summarize the latest developments with regard to physical fitness
and several health outcomes in young people. The literature reviewed suggests that (1)
cardiorespiratory fitness levels are associated with total and abdominal adiposity; (2) both
cardiorespiratory and muscular fitness are shown to be associated with established and
emerging cardiovascular disease risk factors; (3) improvements in muscular fitness and
speed/agility, rather than cardiorespiratory fitness, seem to have a positive effect on
skeletal health; (4) both cardiorespiratory and muscular fitness enhancements are
recommended in pediatric cancer patients/survivors in order to attenuate fatigue and
improve their quality of life; and (5) improvements in cardiorespiratory fitness have
positive effects on depression, anxiety, mood status and self-esteem, and seem also to be
associated with a higher academic performance. In conclusion, health promotion policies
and physical activity programs should be designed to improve cardiorespiratory fitness,
but also two other physical fitness components such us muscular fitness and
speed/agility. Schools may play an important role by identifying children with low
physical fitness and by promoting positive health behaviors such as encouraging children
to be active, with special emphasis on the intensity of the activity.
R. R. Pate, K. McIver, M. Dowda, W. H. Brown and C. Addy. (2008). Directly observed
physical activity levels in preschool children. Journal Of School Health. 78, 438-444.
BACKGROUND: Millions of young children attend preschools and other structured
child development programs, but little is known about their physical activity levels while
in those settings. The purpose of this study was to describe the physical activity levels
and demographic and school-related correlates of physical activity in children attending
preschools, using a direct observation measurement system. METHODS: The
Observational System for Recording Physical Activity in Children-Preschool Version
was used to measure physical activity levels and related factors in four hundred ninetythree 3- to 5-year-old children in 24 preschools. A minimum of six hundred 30-second
observation intervals were recorded for each child. Physical (height/weight) and
demographic data also were collected. RESULTS: Children engaged in moderate-tovigorous physical activity (MVPA) during less than 3% of the observation intervals and
were sedentary during more than 80% of the observation intervals. Boys were more likely
than girls to engage in MVPA (p =.01), and 3-year-old boys were more active than 4- and
5-year-old boys (p =.01). The preschool that a child attended explained 27% of the
variance in activity levels. CONCLUSIONS: The study indicates that young children are
physically inactive during most of their time in preschool. The preschool that a child
attended was a stronger predictor of physical activity level than any other factor
examined. Additional research is needed to identify the characteristics of preschools in
which children are more active.
S. Peter, L. Biro, A. Nemeth and M. Antal. (2008). [Association between birth weight
and childhood obesity in a Budapest metropolitan survey]. Orv Hetil. 149, 407-10.
INTRODUCTION: According to epidemiological investigations, association between
birth weight and overweight and obesity in childhood/adolescence is ambiguous. AIM:
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The purpose of the study was to investigate the association between birth weight and
overweight and obesity in childhood and adolescence. METHODS: Birth and actual
anthropometric data of school children and secondary school students from metropolitan
schools were analyzed. Overweight/obesity were established by standardized (sex, age)
body mass index, and obesity also by body fat percent. RESULTS: Data of 1,334, 7- to
19-year-old children and adolescents (725 boys and 609 girls) were evaluated. Prevalence
of overweight/obesity was similar in the case of persons with low (19.36%) and normal
birth weight (18.96%), while in the case of persons with high birth weight this rate was
25.98%. Based on body fat percent, the prevalence of obesity in the latter group was also
higher than in groups with low and normal birth weight (18.11% vs. 12.89% and
12.66%). CONCLUSIONS: Among macrosomic babies the rate of overweight and
obesity is higher than among normal or low-birth-weight babies, particularly in
childhood.
P. Pliner and T. Saunders. (2008). Vulnerability to freshman weight gain as a function of
dietary restraint and residence. Physiol Behav. 93, 76-82.
Although many studies have found that students gain weight during their first year at
college, many others have not. Participants in the present study were classified according
to their scores on the Herman/Polivy Restraint Scale and their place of residence-at home
or on campus. Body weight was assessed early in the academic year and five months
later. At the same sessions participants completed a questionnaire pertaining to their
eating habits prior to beginning college (first session) and since coming to college
(second session). Overall weight gain was 1.5 kg; those most likely to gain weight were
restrained eaters living on campus, who gained an average of 4.1 kg. In addition, changes
in eating habits were a significant independent predictor of weight gain.
M. L. Potestio, L. McLaren, A. Robinson Vollman and P. K. Doyle-Baker. (2008).
Childhood obesity: perceptions held by the public in Calgary, Canada. Can J Public
Health. 99, 86-90.
OBJECTIVE: To investigate the perceptions about causes and prevention of childhood
obesity held by the adult public in Calgary, Canada. DESIGN: Using a cross-sectional
survey design, adults were recruited from a shopping mall located in a region of Calgary,
Alberta characterized by mixed ethnic and socio-economic residents. SUBJECTS: 264
adults in Calgary, Canada. MEASUREMENTS: Participants completed a selfadministered questionnaire that involved rating the importance of 25 potential causes of
obesity and 13 potential preventive measures, using a four-point Likert scale anchored by
"not important" and "very important". Demographic information including age, sex,
educational level, parental status, and self-reported weight and height was also collected.
RESULTS: Principal components analysis of questionnaire items revealed five "cause"
factors ('parental responsibility', 'over-consumption and media promotion of unhealthy
foods', 'misuse/overuse of modern technology', 'children's lack of knowledge and
motivation', 'physical activity environment') and two "prevention" factors ('healthy
public/private policy and targeted intervention', and 'media campaigns and compulsory
physical education'). Tests for group differences revealed that women ranked 'overconsumption of unhealthy foods and media influence' and 'physical activity environment'
as more important causes of childhood obesity than men. Additionally, persons classified
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as obese ranked 'misuse/overuse of modern technology' and 'healthy public/private policy
and targeted intervention' as more important than those persons classified as
under/normal weight. CONCLUSION: By providing a snapshot of views held by the
public regarding childhood obesity in this large Canadian city, this study offers
preliminary guidance about publicly acceptable intervention strategies for use by health
promotion researchers and policy-makers.
J. J. Puder and S. Kriemler. (2008). [Can we stop the epidemic of childhood obesity?].
Praxis (Bern 1994). 97, 17-23.
Childhood obesity influences body weight in the adult and is intrinsically associated with
multiple co-morbidities. In the past 20 years, the prevalence of overweight and obese
school children in Switzerland has increased by three to six-fold. One out of every four to
five children is overweight or obese. Thus, primary prevention is absolutely essential.
Excess weight results from a positive energy balance. According to the current literature,
changes in the quantity and quality of nutrition, a reduction in physical activity, an
increase in sedentary lifestyles, including media consumption, as well as a reduction of
sleep time are the most important external factors that promote the development of
childhood obesity after infancy. Hereby, the intrauterine milieu and genetic factors also
play a role. The obesity epidemic particularly affects children born to overweight parents,
children with low socio-economic status, and migrants. Randomized, controlled studies
aimed at medium to long-term (> or =1 year) reductions in BMI or fat tissue have mainly
been school-based and sometimes involved the family as well. Unfortunately, these
studies only produced unanimously negative or modest results. We believe that
successful and sustainable prevention must contain 3 elements: (1) A relatively intensive
and sustained modification of the individual's behavior that appropriately accounts for the
multifactorial causes of childhood obesity. (2) A concurrent adaptation of external
conditions that enable behavioral modifications. (3) Incorporation of socio-economic and
political aspects.
O. Receveur, K. Morou, K. Gray-Donald and A. C. Macaulay. (2008). Consumption of
key food items is associated with excess weight among elementary-school-aged children
in a Canadian first nations community. J Am Diet Assoc. 108, 362-6.
The present analyses aim to identify differences in selected dimensions of diet quality
and quantity across body mass index (BMI) categories for Mohawk children in grades 4
through 6 so as to enhance ongoing community intervention strategies within the
Kahnawake School Diabetes Prevention Project (KSDPP). Using 24-hour recalls
(n=444), no observable differences in energy intake, percent fat, energy density, or diet
diversity across BMI categories were observed. Using a new method, we compared the
frequency of use and the amounts consumed for only the most-frequently consumed food
items across BMI categories. Compared to normal-weight children, and after adjusting
for age, children "at risk of overweight" consume potato chips more frequently (P=0.017)
and crackers less frequently (P=0.153), while overweight children consumed larger
portions of french fries (P=0.027). We conclude that, in this group of children,
consuming slightly more french fries or potato chips than what is already consumed by
normal-weight children appears to compromise diet quality as far as overweight is
concerned.
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J. P. Rey-Lopez, G. Vicente-Rodriguez, M. Biosca and L. A. Moreno. (2008). Sedentary
behaviour and obesity development in children and adolescents. Nutrition Metabolism
And Cardiovascular Diseases. 18, 242-251.
Sedentary lifestyle patterns in children and adolescents, i.e. playing digital games, using
computers and especially watching television, have been associated with obesity.
However, not all sedentary behaviour has shown the same relevance to, and relationship
with, obesity. Therefore, we conducted a review including published studies found in
PubMed and other medical journals, dated between January 1990 and April 2007. The
ages of the children and adolescents who were the object of the study ranged between 2
and 18 years. For the purpose of this paper, we selected cross-sectional, longitudinal and
intervention studies. Sufficient evidence exists to recommend setting a limit to the time
spent watching TV, especially for younger children. However, video games and
computers do not represent such a high risk compared to watching TV, when they do not
replace physical activity too much. In fact, there is no evidence to suggest that sedentary
behaviour displaces physical activity levels. Mechanisms that explain the link between
sedentariness and obesity are also discussed. Finally, future studies should take into
account important mediators such as socioeconomic status and family structure. (C) 2007
Elsevier B.V. All rights reserved.
J. A. Rimmer and J. L. Rowland. (2008). Physical activity for youth with disabilities: a
critical need in an underserved population. Dev Neurorehabil. 11, 141-8.
The recommended amount of daily physical activity for youth is 60 minutes a day, most
days of the week. Youth with disabilities are not achieving this target and are
significantly less active and more obese than their non-disabled peers. The combination
of the health risks associated with physical inactivity and obesity presents a serious health
concern in this population. While there is a small amount of research on interventions
aimed at improving fitness among youth with disabilities, the majority of these studies
were conducted in clinical settings where most or all of the common barriers to
participation were eliminated (e.g. transportation, lack of knowledgeable staff, adaptation
of programmes and/or facilities to child's needs). One of the most important challenges
for paediatric rehabilitation and healthcare professionals is finding ways to increase
physical activity and fitness among youth with disabilities in community-based settings.
The use of information technology (IT) to customize physical activity programmes for
youth with disabilities offers a promising approach to addressing this important health
issue in the future.
P. B. Rukavina and W. Li. (2008). School physical activity interventions: do not forget
about obesity bias. Obesity Reviews. 9, 67-75.
Obesity bias is the tendency to negatively judge an overweight or obese individual based
on assumed and/or false character traits, such as being physically unattractive,
incompetent, lazy and lacking self-discipline. Obesity biases, such as teasing or weight
criticism during physical activity (PA), can be psychologically or emotionally damaging
for overweight children and adolescents. Ultimately, the effects students experience over
time may create a psychological barrier and students can become resistant to schools'
health and PA interventions that promote lifestyle changes. Fortunately, the
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psychological effects of obesity bias are mediated by social buffers and coping
mechanisms. Several PA-related researchers have proposed strategic intervention
components, but no studies have been completed in PA settings. The purpose of this
review was to discuss the nature and different types of obesity bias in PA settings. Major
theoretical frameworks of the aetiology and change mechanisms of obesity biases from
the psychological literature were reviewed and direct applications for strategic
component interventions were made for PA settings. Because of the pervasiveness and
entrenchment of obesity bias, it is obvious that multiple theoretical frameworks need to
be considered and even combined to create safe and caring school PA environments for
students.
C. M. Sabiston and P. R. E. Crocker. (2008). Examining an integrative model of physical
activity and healthy eating self-perceptions and Behaviors among adolescents. Journal Of
Adolescent Health. 42, 64-72.
Purpose: This study tested a comprehensive model of physical activity and healthy eating
behavior. Methods: A sample of older adolescents (boys n = 206, girls n = 326)
volunteered to complete a scientifically supported questionnaire assessing physical
activity and healthy eating perceptions of competence, values, and behaviors once during
class time. Results: Confirmatory factor analysis suggested the data fit the model well.
Tests of group differences supported factorial invariance, and revealed higher physical
activity perceptions of competence, value, and behavior as well as lower healthy diet
value and behavior for adolescent boys compared with girls. Perceptions of competence
for healthy diet were also higher among boys. Path modeling demonstrated a good model
fit, whereby behavior-specific perceptions of competence and values were significant
correlates of physical activity for the total sample and subsamples of boys and girls (R2=.41-.53). Perceptions of competence and values were also significant correlates of
healthy diet for the total sample (R-2=.34) and boys (R-2=.42). Subjective values were
significant correlates of healthy diet for girls (R-2=.30). Structural invariance suggested
that the models were not significantly different for adolescent boys and girls.
Conclusions: These results demonstrate the saliency of the comprehensive model in
understanding physical activity and healthy eating behaviors among older adolescents.
Further tests of the model are needed to advance theory exploring both physical activity
and healthy eating behaviors, and to inform intervention strategies targeting adolescent
health.
S. J. Salvy, E. Kieffer and L. H. Epstein. (2008). Effects of social context on overweight
and normal-weight children's food selection. Eat Behav. 9, 190-6.
Although most eating occurs in a social context, the impact of peer influence on child
food consumption and selection of healthy and unhealthy snacks has not been the object
of systematic experimental study. The present experiment assessed the effects of peer
interaction on energy intake and food choices in 18 overweight and 21 non-overweight
youth. Participants had access to high and low-calorie food items and were provided with
several games as alternatives to eating. On one occasion, participants were tested alone
and on another occasion they were tested in dyads with an unfamiliar peer. Consistent
with previous results, we found that overweight children ate substantially more when
alone than when in the presence of a peer and also more when alone than the lean
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children in the same condition. Non-overweight youths' food intake was unaffected by
the social context. Findings also indicated that the best predictor of whether participants
consumed healthy snack foods was if the other youth in the dyad also consumed healthy
snack foods. These findings suggest that the presence of peers can influence overweight
children's energy intake and also influence healthier food selection in both overweight
and non-overweight children.
I. N. Sener, R. B. Copperman, R. M. Pendyala and C. R. Bhat. (2008). An analysis of
children's leisure activity engagement: examining the day of week, location, physical
activity level, and fixity dimensions. Transportation. 35, 673-696.
This paper presents a detailed analysis of discretionary leisure activity engagement by
children. Children's leisure activity engagement is of much interest to transportation
professionals from an activity-based travel demand modeling perspective, to child
development professionals from a sociological perspective, and to health professionals
from an active lifestyle perspective that can help prevent obesity and other medical
ailments from an early age. Using data from the 2002 Child Development Supplement of
the Panel Study of Income Dynamics, this paper presents a detailed analysis of children's
discretionary activity engagement by day of week (weekend versus weekday), location
(in-home versus out-of-home), type of activity (physically active versus passive), and
nature of activity (structured versus unstructured). A mixed multiple discrete-continuous
extreme value model formulation is adopted to account for the fact that children may
participate in multiple activities and allocate positive time duration to each of the
activities chosen. It is found that children participate at the highest rate and for the
longest duration in passive unstructured leisure activities inside the home. Children in
households with parents who are employed, higher income, or higher education were
found to participate in structured outdoor activities at higher rates. The child activity
modeling framework and methodology presented in this paper lends itself for
incorporation into larger activity-based travel model systems where it is imperative that
children's activity-travel patterns be explicitly modeled-both from a child health and wellbeing policy perspective and from a travel forecasting perspective.
M. Share and M. Strain. (2008). Making schools and young people responsible: a critical
analysis of Ireland's obesity strategy. Health & Social Care In The Community. 16, 234243.
Worldwide reports of an obesity 'epidemic' prompted the Irish government to appoint a
multidisciplinary Taskforce, whose report was published in May 2005. This paper
critically analyses the report and its recommendations for reducing health risks among
families, children and young people. Using a Foucauldian perspective, we question the
report's individualizing focus and support for a strategy which responsibilises schools,
families and young people and relies on individuals to do 'the right thing'. Specifically,
we examine the Taskforce recommendations for the education sector, and identify their
dependence upon a discourse of governmentality, under categories of individualization,
responsibilization and freedom of choice, participation and techniques for management of
the self. We conclude that the report fails to address the multi-faceted and complex nature
of obesity, and obscures the social, economic and material realities of the lives of pupils
and schools.
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E. Simsek, S. Akpinar, T. Bahcebasi, D. A. Senses and K. Kocabay. (2008). The
prevalence of overweight and obese children aged 6-17 years in the West Black Sea
region of Turkey. International Journal Of Clinical Practice. 62, 1033-1038.
Objective: To assess the prevalence of overweight and obese Turkish children. Design:
Cross-sectional study in school children. Subjects: A total of 6924 children (3281 boys
and 3643 girls) aged 6-17 years from the West Black Sea region of Turkey.
Measurements: Overweight and obese were defined using international age- and sexspecific cutoff points for body mass index. The data were analysed by age, sex, residence
and socioeconomic level. Results: The overall prevalence of overweight and obesity was
10.3% and 6.1% respectively. The overall prevalence of obesity in boys and girls was
7.0% and 5.4%, respectively, and the difference was significant (chi(2) = 8, p = 0.004).
The prevalence of obesity in urban and rural areas was 7.7% and 3.9%, respectively, and
the difference was significant (chi(2) = 40, p < 0.001). The prevalence of overweight
boys and girls in urban areas was 11.6% and 13.2%, respectively, but the difference was
not significant (chi(2) = 2, p > 0.05). However, the prevalence of overweight boys and
girls in rural areas was 4.8% and 9.4%, respectively, and the difference was significant
(chi(2) = 25, p < 0.001). Although the prevalence of obesity differed significantly
between boys and girls in urban children (chi(2) = 13, p < 0.001), no significant
difference was detected in the prevalence between boys and girls from rural areas (chi(2)
= 0.4, p > 0.5). The prevalence of obesity was significantly higher in private schools than
in public schools (chi(2) = 48, p < 0.0001). The prevalence of overweight and obese
Turkish children aged 6-17 years is considerably lower than in most European countries.
The children in urban settings and higher socioeconomic groups had a higher prevalence
of overweight and obesity. The Westernisation of the behaviour patterns of children and
living in an urban setting in a developing country are risk factors for obesity.
G. K. Singh, M. D. Kogan and P. C. van Dyck. (2008). A multilevel analysis of state and
regional disparities in childhood and adolescent obesity in the United States. Journal Of
Community Health. 33, 90-102.
This study examines state- and regional disparities in obesity prevalence among 46,707
US children and adolescents aged 10-17 years before and after adjusting for individual
socioeconomic and behavioral characteristics and area deprivation measures. The 2003
National Survey of Children's Health was used to calculate obesity prevalence in nine
geographic regions and in the 50 states and the District of Columbia (DC). Logistic
regression was used to estimate odds of obesity and adjusted prevalence. OLS regression
was used to determine the amount of variance explained by income inequality, poverty,
and violent crime rates. The prevalence of childhood obesity varied substantially across
geographic areas, with the Southcentral regions of the US having the highest prevalence
(>= 18%) and the Mountain region the lowest prevalence (11.4%). Children in West
Virginia, Kentucky, Texas, Tennessee, and North Carolina (adjusted prevalence > 18.3%)
had over twice the odds of being obese than their Utah counterparts (adjusted prevalence
= 10.4%). Geographic disparities in obesity were similar for male and female children.
Individual characteristics such as race/ethnicity, household socioeconomic status,
neighborhood social capital, television viewing, recreational computer use, and physical
activity accounted for 55% of the state and 25% of the regional disparities in obesity.
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Area poverty rates accounted for an additional 18% of the state variance in adjusted
obesity prevalence. Although individual and area level socioeconomic factors are
important predictors, substantial geographic disparities in childhood and adolescent
obesity remain. Prevention efforts targeting individual risk factors as well as contextual
social and environmental factors may reduce geographic disparities in childhood and
adolescent obesity.
A. Sjoberg, L. Lissner, K. Albertsson-Wikland and S. Marild. (2008). Recent
anthropometric trends among Swedish school children: evidence for decreasing
prevalence of overweight in girls. Acta Paediatr. 97, 118-23.
AIM: To assess the recent prevalence of overweight and obesity in 10 year old children
in Goteborg, Sweden. METHODS: Cross-sectional data on weight and height from
school health examinations, including fourth grade children, born in 1974 (n=4126), 1990
(n=4683) and 1994 (n=4193) and measured in academic years 1984/1985, 2000/2001 and
2004/2005, were used. Weight classification was based on age- and sex-specific body
mass index cutoff values. The two latest cohorts were classified according to socioeconomic areas. RESULTS: Between 2000/2001 and 2004/2005, the prevalence of
overweight plus obesity in girls decreased from 19.6% to 15.9% (p<0.01). Prevalence of
obesity was 3.0% and 2.5% (nonsignificant), respectively. In boys, all differences
between the corresponding cohorts were nonsignificant: 17.1% versus 17.6% were
overweight (including obese) and 2.9% versus 2.8% were obese. In 1984/1985,
prevalence of overweight plus obesity was only 8.6% among girls and 7.2% among boys,
while 0.8% and 0.7% were classified as obese, respectively. The socio-economic gradient
in overweight prevalence remained, particularly in girls. CONCLUSIONS: This study
suggests that the obesity epidemic in 10-11 year olds may be easing off in urban Sweden,
and possibly reversing among girls. Even if future monitoring confirms these findings,
much health promoting work still remains since the power of the 'obesogenic
environment' will probably continue to be strong.
D. T. Smith, M. J. Vendela, R. T. Bartee and L. J. Carr. (2008). Body mass index in rural
first grade schoolchildren: progressive increase in boys. J Rural Health. 24, 40-8.
CONTEXT: Childhood overweight is a global health problem. Monitoring of childhood
body mass index (BMI) may help identify critical time periods during which excess body
weight is accumulated. PURPOSE: To examine changes in mean BMI and the prevalence
of at-risk-for overweight in repeated cross-sectional samples of rural first grade
schoolchildren between 1999 and 2004. METHODS: BMI was determined in 479 first
graders from a rural Wyoming school district. BMI and gender-specific BMI-for-age
percentiles were determined and evaluated over the 6 years. Children were also classified
as normal or at-risk-for overweight according to CDC classification procedures.
FINDINGS: From 1999 to 2004, there was a significant increase in the average BMI of
first graders, 15.8+/-2.2 kg/m2 versus 16.8+/-2.2 kg/m2, respectively (P<.05). First grade
boys had a progressive increase in BMI from 1999 to 2004 (15.6+/-2.2 kg/m2 compared
to 17.3+/-2.2 kg/m2, respectively), but no change was evident for first grade girls. There
was an approximate 4-fold increase in the percentage of rural first grade boys classified
as at-risk-for overweight between 1999 and 2004. CONCLUSIONS: A progressive
increase in the BMI and the significant increase in prevalence of at-risk-for overweight in
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rural first grade boys highlight the need for future gender and age group-specific
investigations. Focus should be given to primary prevention programs targeting
potentially vulnerable time periods when excess weight gain may be occurring.
A. C. Sollerhed, E. Apitzsch, L. Rastam and G. Ejlertsson. (2008). Factors associated
with young children's self-perceived physical competence and self-reported physical
activity. Health Education Research. 23, 125-136.
The aim of this study was to identify factors associated with self-reported physical
activity (PA), self-perceived physical fitness and competence in physical education (PE)
among young children. The study included physical tests, anthropometric measures and a
questionnaire. The study group comprised 206 children (114 boys and 92 girls, aged 8-12
years). Positive Odds Ratio was used in the logistic regression analyses. High level of
self-reported PA was associated with membership of sport clubs and high self-perceived
physical fitness. Variables associated with high self-perceived competence in PE were
low age, high physical performance, living with both parents, high self-perceived
physical fitness, male gender and enjoying PE. Variables associated with high selfperceived physical fitness were low age, high performance in endurance running, high
self-reported PA, positive self-perceived body function and high self-perceived
competence in PE. Correlations between children's self-perceived competence in PE and
actual measured physical performance, between the self-perceived fitness and endurance
performance and between self-reported PA and physical performance could be seen as a
form of concurrent validity. One implication of the study for practitioners might be that
children's own perceptions of their physical competence and activity levels could be used
to roughly identify groups of children who are at risk of remaining physically inactive
and therefore more prone to be unhealthy.
S. A. Stoddard, M. Y. Kubik and C. Skay. (2008). Is school-based height and weight
screening of elementary students private and reliable? J Sch Nurs. 24, 43-8.
The Institute of Medicine recommends school-based body mass index (BMI) screening as
an obesity prevention strategy. While school nurses have provided height/weight
screening for years, little has been published describing measurement reliability or
process. This study evaluated the reliability of height/weight measures collected by
school nurses and the privacy of the measurement process. Interrater reliability for
height/weight measures was computed on 70 elementary students, comparing
measurements collected by a trained researcher to those collected by 7 school nurses.
Students arrived in small groups to private measurement spaces. Height agreement was
80% for younger and 85% for older students. Agreement for weight was 97% and 100%,
respectively. Reliability for weight was very good. Reliability for height was good, but
results suggest careful attention to the collection process is required. Nurses may benefit
from regular training on measurement procedures. The results of this study suggest that
school nurses provide BMI screening that is private and reliable.
S. D. Stovitz, J. B. Schwimmer, H. Martinez and M. T. Story. (2008). Pediatric obesity:
the unique issues in Latino-American male youth. Am J Prev Med. 34, 153-60.
Pediatric obesity in the United States has been steadily rising over the past few decades,
and it is a clear risk factor for adult obesity and obesity-related morbidity and mortality.
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A review of the literature from three major national databases reveals that the prevalence
rates of obesity within Latino male children and adolescents is, in general, higher than
other major gender-ethnic groups. Additionally, obese Latino male youth seem to be
especially prone to a variety of obesity-related morbidities. Given the rising percentage of
Latinos among our nation's youth, there is an urgency to develop and implement clinical
and community research strategies to prevent and treat obesity within this high-risk
gender-ethnic group. This article reviews the prevalence of pediatric obesity within the
three largest databases in the U.S. with Latino representation. The paper then discusses
unique issues in the etiology and ramifications of obesity within young Latino-American
boys, reviews the few intervention studies that focus on Latino youth, and discusses
potential strategies for further research.
S. D. Stovitz, L. M. Steffen and A. Boostrom. (2008). Participation in physical activity
among normal- and overweight Hispanic and non-Hispanic white adolescents. Journal Of
School Health. 78, 19-25.
BACKGROUND: The purpose of this study was to determine the relation between
weight status and participation in physical activity (PA) among Hispanic and nonHispanic white (NHW) adolescent boys and girls. METHODS: In this cross-sectional
study, height and weight were measured and a modified 2001 Youth Risk Behavior
Survey was administered to 1302 Hispanic and NHW adolescents, aged 14-17 years,
attending high school in Nueces County, Texas. Linear regression analysis was used to
assess the relation between weight status (normal weight or "at risk for overweight and
overweight" [AR&O]) and PA, including moderate PA, vigorous PA, strength training,
participation in team sports, and TV viewing, according to gender and ethnicity.
RESULTS: Thirty-eight percent of adolescents were AR&O, including 32% and 48% of
Hispanic girls and boys, respectively, and 22% and 35% of NHW girls and boys,
respectively. As expected, boys reported participating in more PAs than girls. Compared
with NHW girls, both normal weight and AR&O Hispanic girls reported significantly
fewer bouts of moderate activity, less involvement in team sports, and more time
watching TV. Normal weight boys reported participating in significantly more vigorous
activity than those who were AR&O. Hispanic boys reported more strength training than
NHWs; however, they watched significantly more hours of TV than NHW boys.
CONCLUSIONS: Hispanic and NHW high school students reported participation in
different PAs; this information may be useful for planning health and physical education
curriculum.
H. N. Sweeting. (2008). Gendered dimensions of obesity in childhood and adolescence.
Nutr J. 7, 1.
BACKGROUND: The literature on childhood and adolescent obesity is vast. In addition
to producing a general overview, this paper aims to highlight gender differences or
similarities, an area which has tended not to be the principal focus of this literature.
METHODS: Databases were searched using the terms 'obesity' and 'child', 'adolescent',
'teenager', 'youth', 'young people', 'sex', 'gender', 'masculine', 'feminine', 'male', 'female',
'boy' and 'girl' (or variations on these terms). In order to limit the potential literature, the
main focus is on other reviews, both general and relating to specific aspects of obesity.
RESULTS: The findings of genetic studies are similar for males and females, and
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differences in obesity rates as defined by body mass index are generally small and
inconsistent. However, differences between males and females due to biology are evident
in the patterning of body fat, the fat levels at which health risks become apparent, levels
of resting energy expenditure and energy requirements, ability to engage in certain
physical activities and the consequences of obesity for the female reproductive system.
Differences due to society or culture include food choices and dietary concerns, overall
physical activity levels, body satisfaction and the long-term psychosocial consequences
of childhood and adolescent obesity. CONCLUSION: This review suggests differences
between males and females in exposure and vulnerability to obesogenic environments,
the consequences of child and adolescent obesity, and responses to interventions for the
condition. A clearer focus on gender differences is required among both researchers and
policy makers within this field.
A. Z. Taha. (2008). Self-reported knowledge and pattern of physical activity among
school students in Al Khobar, Saudi Arabia. East Mediterr Health J. 14, 344-55.
The aim of this cross-sectional study was to determine the self-reported knowledge and
pattern of physical activity among a sample of 1240 male and 1331 female intermediate
and secondary school students in Al-Khobar city, Saudi Arabia. The majority of male and
female students knew that physical activity is protective against diseases in general
(92.9% and 91.8% respectively) and in the prevention of obesity (69.4% and 78.5%) but
had poor knowledge about the role of physical activity in the prevention of diabetes
mellitus and hypertension. Significantly more male students than female students
practised physical activity 3+ times per week (45.6% versus 33.7%). Age and the
knowledge that exercise protects from obesity were the main determinants of the practice
of physical activity among male students.
S. G. Trost, R. R. Rosenkranz and D. Dzewaltowski. (2008). Physical Activity Levels
among Children Attending After-School Programs. Medicine & Science in Sports &
Exercise. 40, 622.
The article presents a study that examines physical activity (PA) levels of children
attending after-school programs and evaluates after-school PA differences in groups
defined by sex and weight status. The researchers uploaded stored activity counts to a
customized data-reduction program to determine minutes of sedentary (SED), light
(LPA), moderate (MPA), vigorous (VPA) and moderate-to-vigorous (MVPA)physical
activity. It found that boys exhibited higher levels of MPA, VPA and MVPA and lower
levels of SED and LPA than girls. It concludes that after-school programs are important
contributor to the PA of attending children and ample room for improvement exists by
making better use of existing time devoted to PA.
F. Trudeau and R. J. Shephard. (2008). Physical education, school physical activity,
school sports and academic performance. International Journal Of Behavioral Nutrition
And Physical Activity. 5,
Background: The purpose of this paper is to review relationships of academic
performance and some of its determinants to participation in school-based physical
activities, including physical education (PE), free school physical activity (PA) and
school sports. Methods: Linkages between academic achievement and involvement in PE,
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school PA and sport programmes have been examined, based on a systematic review of
currently available literature, including a comprehensive search of MEDLINE (1966 to
2007), PSYCHINFO (1974 to 2007), SCHOLAR.GOOGLE.COM, and ERIC databases.
Results: Quasi-experimental data indicate that allocating up to an additional hour per day
of curricular time to PA programmes does not affect the academic performance of
primary school students negatively, even though the time allocated to other subjects
usually shows a corresponding reduction. An additional curricular emphasis on PE may
result in small absolute gains in grade point average (GPA), and such findings strongly
suggest a relative increase in performance per unit of academic teaching time. Further,
the overwhelmingly majority of such programmes have demonstrated an improvement in
some measures of physical fitness (PF). Cross-sectional observations show a positive
association between academic performance and PA, but PF does not seem to show such
an association. PA has positive influences on concentration, memory and classroom
behaviour. Data from quasi-experimental studies find support in mechanistic experiments
on cognitive function, pointing to a positive relationship between PA and intellectual
performance. Conclusion: Given competent providers, PA can be added to the school
curriculum by taking time from other subjects without risk of hindering student academic
achievement. On the other hand, adding time to "academic" or "curricular" subjects by
taking time from physical education programmes does not enhance grades in these
subjects and may be detrimental to health.
M. D. Tsiros, N. Sinn, A. M. Coates, P. R. Howe and J. D. Buckley. (2008). Treatment of
adolescent overweight and obesity. Eur J Pediatr. 167, 9-16.
Adolescence is a vulnerable period for the development of obesity, and adolescent weight
tracks strongly into adulthood. Previous reviews of treatment strategies have failed to
discriminate between adolescents and children, thereby, disregarding the uniqueness of
this population. Hence, this review aims to summarise the evidence for treatment
approaches for adolescent obesity. Pubmed, OVID, EBSCOhost and Google Scholar
were searched for randomised controlled trials, meta-analyses and systematic reviews
testing treatments for overweight/obese adolescents (aged 12-19 years), published from
1982-2006 in English. Eligible studies had to assess either weight, percentage
overweight, body mass index (BMI) or body fat. Thirty-four randomised controlled trials
were eligible. The results of this review indicate that the safety and efficacy of surgical
and pharmacotherapy treatments for adolescent obesity is uncertain. Diet and physical
activity approaches may improve obese status in the short term. However, obesity
interventions appear more effective when strategies are combined, rather than when used
in isolation. Psychological interventions, such as behavioural and cognitive behavioural
therapy, show promise in achieving the necessary lifestyle changes for obesity reduction;
however, long-term follow-up studies are needed. There were multiple limitations in
appraising the literature. Inconsistent definitions of overweight/obesity make
comparisons between studies difficult. Many studies have not used direct adiposity
measures, have failed to assess pubertal status or have not used an exclusive adolescent
sample. We conclude that, despite these limitations, current evidence indicates that
behavioural and cognitive behavioural strategies combined with diet and physical activity
approaches may assist in reducing adolescent obesity,although long-term follow-up
studies are needed.
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C. Tudor-Locke, B. E. Ainsworth and B. M. Popkin. (2008). Patterns of physical activity
and overweight among 7-13-year-old Russian children: A 7-year nationally
representative monitoring study. Research Quarterly For Exercise And Sport. 79, 10-17.
This is a repeated cross-sectional study of overweight and physical activity (PA) and
inactivity patterns of successive samples of 7-13-year-old Russian children who were
surveyed six times between 1995 and 2002 as part of the Russian Longitudinal
Monitoring Survey. This analysis focused on moderate/vigorous (MOD/VIG) PA (e.g.,
active commuting to school, during school MOD/VIG PA as part of physical education
classes, and/or before/after school MOD/VIG PA) and inactivity patterns (e.g., television
viewing habits) obtained through parent proxy-reports of 3,50 7 boys (M age = 10.1
years, SD = 2.0, body mass index = 17.5 kg/m(2), SD = 3.0) and 3,273 girls (M age =
10.1 years, SD = 2.0; body mass index = 17.2 kg/m(2), SD = 3. 0). Time spent in
MOD/VIG PA appears to be on the rise, while the proportion of those actively
commuting to school is decreasing, especially among girls.
G. Turconi, M. Guarcello, L. Maccarini, F. Cignoli, S. Setti, R. Bazzano and C. Roggi.
(2008). Eating habits and behaviors, physical activity, nutritional and food safety
knowledge and beliefs in an adolescent Italian population. J Am Coll Nutr. 27, 31-43.
OBJECTIVE: The present study evaluates eating habits and behaviors, and nutritional
and food safety knowledge of a group of Italian adolescents. DESIGN: A dietary
questionnaire previously constructed and tested was self-administered during school time.
Each section was evaluated using a separate score. SETTING: The study was carried out
as a part of a nutritional surveillance project in the Aosta Valley Region, Northern Italy.
SUBJECTS: Five hundred and thirty-two adolescent subjects, aged 15.4 +/- 0.7 years,
attending the second year of secondary schools participated in the study. MEASURES:
We evaluated eating habits, physical activity, meaning of healthy and unhealthy dietary
habits and food, self-efficacy, barriers affecting healthy food choices, nutritional and food
safety, weight, height, Body Mass Index (BMI). RESULTS: Only 37.0% of the sample
have satisfactory eating habits; 18.5% have a very active lifestyle; only 8.6% have quite
good nutritional knowledge, 2.4% have satisfactory food safety knowledge, although
43.7% have good hygiene practices. CONCLUSIONS: The results point out unhealthy
behaviors influencing adolescents' eating habits and suggest which of these must be
considered in order to develop tailored nutrition interventions, improving adolescents'
consciousness aimed at adopting a healthy lifestyle.
M. Wake, P. Hardy, M. G. Sawyer and J. B. Carlin. (2008). Comorbities of
overweight/obesity in Australian preschoolers: a cross-sectional population study.
Archives Of Disease In Childhood. 93, 502-507.
Objective: To determine relationships between body mass index (BMI) status and
indicators of health and morbidity in a nationally-representative population sample of
preschool children. Methods: Data from the 4-5-year-old cohort in the first wave (2004)
of the Longitudinal Study of Australian Children were studied. Main outcome measures
were: measured child BMI, categorised as non-overweight, overweight and obese using
International Obesity TaskForce cutpoints; parent-reported child global health, healthrelated quality of life, mental health problems, asthma, sleep problems, injuries, special
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health care needs, and level of parental concern about the child's weight. Regression
methods were used to assess associations with child's BMI status, adjusted for sociodemographic factors. Results: BMI was available for 4934 (99%) children; 756 (15.3%)
were overweight and 258 (5.2%) obese. Compared to non-overweight children, parents of
overweight and obese children reported a higher prevalence of special health care needs
(adj OR 1.72, 95% CI 1.20 to 2.46), but other health outcomes were similar. Parental
concern about the child's weight was low among the overweight (14.4%) and nonoverweight (17.8%) children, but rose to 52.7% in the obese. However, parental concern
was unrelated to any of the specific health problems studied. Conclusions: Despite a high
prevalence of overweight/obesity, parents of overweight and obese children reported
relatively few additional health burdens over and above those of the non-overweight
preschoolers. These findings may shed light on the disparity between strong public
concern and parents' expressed lack of concern about overweight/obesity in their own
children around the time of school entry.
J. Wardle, S. Carnell, C. M. Haworth and R. Plomin. (2008). Evidence for a strong
genetic influence on childhood adiposity despite the force of the obesogenic environment.
Am J Clin Nutr. 87, 398-404.
BACKGROUND: Body mass index (BMI) has been shown to be highly heritable, but
most studies were carried out in cohorts born before the onset of the "obesity epidemic."
OBJECTIVE: We aimed to quantify genetic and environmental influences on BMI and
central adiposity in children growing up during a time of dramatic rises in pediatric
obesity. DESIGN: We carried out twin analyses of BMI and waist circumference (WC) in
a UK sample of 5092 twin pairs aged 8-11 y. Quantitative genetic model-fitting was used
for the univariate analyses, and bivariate quantitative genetic model-fitting was used for
the analysis of covariance between BMI and WC. RESULTS: Quantitative genetic
model-fitting confirmed substantial heritability for BMI and WC (77% for both).
Bivariate genetic analyses showed that, although the genetic influence on WC was
largely common to BMI (60%), there was also a significant independent genetic effect
(40%). For both BMI and WC, there was a very modest shared-environment effect, and
the remaining environmental variance was unshared. CONCLUSIONS: Genetic
influences on BMI and abdominal adiposity are high in children born since the onset of
the pediatric obesity epidemic. Most of the genetic effect on abdominal adiposity is
common to BMI, but 40% is attributable to independent genetic influences.
Environmental effects are small and are divided approximately equally between shared
and non-shared effects. Targeting the family may be vital for obesity prevention in the
earliest years, but longer-term weight control will require a combination of individual
engagement and society-wide efforts to modify the environment, especially for children
at high genetic risk.
G. J. Welk. (2008). The Role of Physical Activity Assessments for School-Based
Physical Activity Promotion. Measurement in Physical Education & Exercise Science.
12, 184.
The emphasis in public health on lifestyle physical activity in recent years has focused
attention on the promotion of lifetime physical activity as the primary objective of
physical education. If used properly, physical activity and physical fitness assessments
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can enhance individual promotion of physical activity and also provide valuable outcome
measures to facilitate home and community support for physical education. This article
describes the importance of comprehensive evaluation of physical education and
emphasizes the importance of including assessments of both physical activity and
physical fitness for promoting physical activity. Effective evaluation practices are needed
to optimize the effectiveness of physical education programming.
D. S. West, J. M. Raczynski, M. M. Phillips, Z. Bursac, C. Heath Gauss and B. E.
Montgomery. (2008). Parental recognition of overweight in school-age children. Obesity
(Silver Spring). 16, 630-6.
OBJECTIVE: Examine the accuracy of parental weight perceptions of overweight
children before and after the implementation of childhood obesity legislation that
included BMI screening and feedback. METHODS AND PROCEDURES: Statewide
telephone surveys of parents of overweight (BMI > or = 85th percentile) Arkansas public
school children before (n = 1,551; 15% African American) and after (n = 2,508; 15%
African American) policy implementation were examined for correspondence between
parental perception of child's weight and objective classification. RESULTS: Most (60%)
parents of overweight children underestimated weight at baseline. Parents of younger
children were significantly more likely to underestimate (65%) than parents of
adolescents (51%). Overweight parents were not more likely to underestimate, nor was
inaccuracy associated with parental education or socioeconomic status. AfricanAmerican parents were twice as likely to underestimate as whites. One year after BMI
screening and feedback was implemented, the accuracy of classification of overweight
children improved (53% underestimation). African-American parents had significantly
greater improvements than white parents (P < 0.0001). DISCUSSION: Parental
recognition of childhood overweight may be improved with BMI screening and feedback,
and African-American parents may specifically benefit. Nonetheless, underestimation of
overweight is common and may have implications for public health interventions.
R. P. Wildman, D. F. Gu, P. Muntner, X. Q. Wu, K. Reynolds, X. F. Duan, C. S. Chen,
G. Y. Huang, L. A. Bazzano and J. He. (2008). Trends in overweight and obesity in
Chinese adults: Between 1991 and 1999-2000. Obesity. 16, 1448-1453.
Objective: The aim of this study was to evaluate trends in BMI and the prevalence of
overweight (BMI >= 25 kg/m(2)) and obesity (BMI = 30 kg/m(2)) between 1991 and
1999-2000 among Chinese adults. Methods and Procedures: In this study, two
population-based samples of Chinese adults aged between 45 and 79 years (n = 7,858
during each period), and comparable in the distributions of age, gender, degree of
urbanization, and region (North/South) were used. Height and weight were measured
using identical procedures at each period, and BMI was calculated as weight (in
kilogram) divided by height (in square meter). Results: From 1991 to 1999-2000, the
mean BMI increased from 21.8 to 23.4 kg/m(2) among men and from 21.8 to 23.5
kg/m(2) among women (each P < 0.001). Among men, the prevalence of overweight and
obesity increased from 9.6 and 0.6%, respectively, in 1991 to 20.0 and 3.0%,
respectively, in 1999-2000 (each P < 0.001). Among women, the prevalence of
overweight and obesity increased from 14.5 and 1.8%, respectively, in 1991 to 26.5 and
5.2%, respectively, in 1999-2000 (each P < 0.001). The prevalence of overweight and
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obesity increased in all age groups, in rural and urban areas, and in North and South
China, with greater relative increases in obesity among older age groups, South China,
and rural areas (P interaction < 0.05). Discussion: Overweight and obesity increased
tremendously during the 1990s in China. These data underscore the need for national
programs in weight maintenance and reduction, to prevent obesity-related outcomes in
China.
K. J. Williams, C. A. Taylor, K. N. Wolf, R. F. Lawson and R. Crespo. (2008). Cultural
perceptions of healthy weight in rural Appalachian youth. Rural Remote Health. 8, 932.
INTRODUCTION: Rates of overweight among US children have been rising over the
past three decades. Changes in lifestyle behaviors, including dietary and physical activity
habits, have been examined thoroughly to identify correlates of weight status in children.
Youth in rural US Appalachia are at a disproportionately greater risk for obesity and
related health complications. Inadequate physical activity and poor dietary habits are two
primary causes of obesity that have been noted in West Virginia adolescents. Few
existing data describes the decisional balance in performing lifestyle behaviors, nor the
perceptions of these youth regarding their beliefs about weight. The purpose of this study
was to identify the perceptions of a healthy weight in rural Appalachian adolescents.
METHODS: Ninth grade students were recruited from classroom presentations in four
high schools throughout West Virginia. Interested parent-caregiver pairs returned forms
to indicate interest in participation. Separate focus group interviews were conducted
concurrently with adolescent and parents or caregivers to identify the cultural perceptions
of a healthy weight. Questions were developed using grounded theory to explore how a
healthy weight was defined, what factors dictate body weight, the perceived severity of
the obesity issue, and the social or health ramifications of the condition. Verbatim
transcripts were analyzed to identify dominant themes, and content analysis provided text
segments to describe the themes. This article describes the data obtained from the
adolescent focus groups. RESULTS: When asked what defined a healthy weight, the
adolescents who participated in the focus groups placed great value on physical
appearance and social acceptability. Students believed there was a particular number,
either an absolute weight or body mass index value that determined a healthy weight.
These numbers were usually conveyed by a physician; however, there was also a general
acceptance of being 'thick' or a reliance on 'feeling healthy' as a determinant of
maintaining a healthy weight. Despite these beliefs, many teens had unrealistic and
unhealthy perceptions of weight. Female participants were more concerned with weight
than males, some to the point of obsession. Both males and females expressed a social
stigma associated with overweight. Issues of guilt and diminished self-esteem were
prevalent. When asked about the extensiveness of the problem of childhood overweight,
the students indicated that a degree of familiarity with being overweight has developed
and 'you just get used to [seeing] it.' Because of the rising rates of chronic disease in this
region, a fear was evident in these youth about the increased risk of developing these
conditions in those who are overweight. Experiences with family members with diabetes
and cardiovascular disease fueled these concerns, which instilled a fear of becoming
overweight in many of the students. Many perceptions of healthy weight and appropriate
body size were shaped by the media and entertainment industry. Additionally, some
participants admitted to performing unsafe practices to reduce body mass, such as very
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low calorie diets or fasting. CONCLUSIONS: Youth in rural Appalachia present similar
perceptions about weight as other children; however, differences in perceived healthy
lifestyle habits and a general acceptance of a higher average body weight present
additional challenges to addressing the increasing problem of child overweight. Despite
the relative isolation of many of these communities, the media has a profound impact on
weight valuation that has been intertwined with school-based health education and
cultural values of health. These data will provide valuable information for the
development of obesity prevention programs in rural Appalachia.
C.-Z. Wojtek, Z. Weimo, T. Bazzarre, D. Castelli, K. Graber and A. Woods. (2008). "We
Move Kids"-The Consensus Report from the Roundtable to Examine Strategies for
Promoting Walking in the School Environment. Medicine & Science in Sports &
Exercise. 40, S603.
The article highlights the roundtable discussion of public health professionals related to
the factors of childhood physical activity and patterns of engagement on October 15,
2005 in the U.S. The discussion aimed to identify practical and effective strategies for
increasing physical activity and walking in school setting. Topics include promotion of
physical activity, barriers for promotion of activity and integration of activity with other
health behaviors. Strategies on how students, teachers, school administrators, parents and
community could the address the barriers are presented.
K. Yuasa, M. Sei, E. Takeda, A. A. Ewis, H. Munakata, C. Onishi and Y. Nakahori.
(2008). Effects of lifestyle habits and eating meals together with the family on the
prevalence of obesity among school children in Tokushima, Japan: a cross-sectional
questionnaire-based survey. J Med Invest. 55, 71-7.
Obesity in children has become a major global public health concern. The prevention of
obesity must start from early childhood in order to establish sound lifestyle habits and
promote healthy adulthood. In this study, we evaluated factors associated with the
prevention of obesity and the development of healthy lifestyle habits in children. A crosssectional, questionnaire-based survey was performed in elementary and junior high
school students in Tokushima Prefecture, Japan, during the summer of 2004. The
questionnaire consisted of 30 items such as physique, sleep, eating habits, diet, exercise,
free time, and attending after-school lessons. Our study revealed that eating meals as a
family every day is associated with a lower rate of obesity as well as getting good
lifestyle habits such as eating balanced meals and getting enough sleep. Of the 3,291
students who responded to the questionnaire, 2,688 (81.7%) reported that they eat meals
with their family every day. The percentage of students who eat meals with their family
every day decreased with increasing school grade, with the lowest percent in the junior
high school students. However, the results regarding female junior high school students
revealed a marked association between eating meals with the family every day and good
lifestyle habits. We recommend that parents and school teaching staff encourage the
establishment of sound, healthy lifestyle habits in children from early childhood as an
effective measure for the prevention of obesity.
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X. G. Zhang, Z. Q. Sun, X. Z. Zhang, L. Q. Zheng, S. S. Liu, C. L. Xu, J. J. Li, F. F.
Zhao, J. Li, D. Y. Hu and Y. X. Sun. (2008). Prevalence and associated factors of
overweight and obesity in a chinese rural population. Obesity. 16, 168-171.
Background: Overweight and obesity are now considered as a serious health problem,
and a very important risk factor for many diseases. Objective: This study was designed to
investigate the epidemiologic features of overweight and obesity among rural adults in
China. Method and Procedures: A cross-sectional survey was conducted during 20042005, using a multistage cluster sampling method to select a representative sample in
Fuxin county, Liaoning province, China. A total of 29,970 adults, aged >= 35 years, were
examined. At baseline, lifestyle and other factors were obtained. Overweight and obesity
were defined according to the classification by the World Health Organization. Results:
Overall, the prevalence of overweight was 18.6%; 15.1% in men and 22.1% in women.
The prevalence of obesity was 1.7%; 1.2% in men and 2.2% in women. Multivariable
logistic regression revealed certain risk factors of obesity that included being a women,
Mongolian nationality and education status of over junior high school level. Moderate
physical activity alone was shown as protective factor. Discussion: Although the
prevalence of obesity was low, overweight was relatively high in the Chinese rural
population, especially in adult women. Gender, diet, physical activity, education levels,
and ethnicity were associated with the prevalence of these health conditions.
J. Ziviani, D. Macdonald, H. Ward, D. Jenkins and S. Rodger. (2008). Physical Activity
of Young Children: A Two-Year Follow-Up. Physical & Occupational Therapy in
Pediatrics. 28, 25.
Inadequate physical activity in children is a major health concern. The purpose of this
study was to examine changes in physical activity of boys and girls, between 6-8 and 810 years of age and how activity patterns correlated with selected family, child, and
environment factors. The sample included 59 children without motor delays (26 boys and
23 girls) between 8 and 10 years of age. Twenty-two of the children participated in a
previous study at 6-8 years of age. Parents completed a questionnaire on their children's
non-physical and physical activities. Children wore a pedometer during two weekdays
and two weekend days. The results indicate that girls spent more time on homework and
reading and on crafts and indoor play than boys. Girls spent more time on musical and
cultural activities and boys spent more time on screen-based activities at 8-10 years of
age. Children spent significantly less time on physical activity at 8-10 years of age. Boys
took more steps per day than girls on weekends. The average number of steps taken per
weekday increased for boys, but not girls, at 8-10 years of age. There was an inverse
relationship between body mass index and number of steps taken per day (weekdays r = .28; weekend r = -.32). Socioeconomic status was associated with the number of steps
taken by children on weekends (r =.34). The results have implications for physical
activities for girls and school and community programs for children.
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OTHER CATEGORY
S. Alhassan, J. R. Sirard, T. R. Spencer, A. Varady and T. N. Robinson. (2008).
Estimating Physical Activity From Incomplete Accelerometer Data in Field Studies.
Journal of Physical Activity & Health. 5, S112.
Background: The purpose of this study was to develop a data-driven approach for
analyzing incomplete accelerometer data from field-base studies. Methods: Multiple days
of accelerometer data from the Stanford Girls health Enrichment Multi-site Studies (N =
294 African American girls) were summed across each minute of each day to produce a
composite weekday and weekend day. Composite method estimates of physical activity
were compared with those derived from methods typically described in the literature
(comparison methods). Results: The composite method retained 99.7% and 100% of
participants in weekday and weekend-day analysis, respectively, versus 84.7% to 94.2%
and 28.6% to 99.0% for the comparison methods. Average wearing times for the
composite method for weekday and weekend day were 99.6% and 98.6%, respectively,
91.7% to 93.9% and 82.3% to 95.4% for the comparison methods. Composite-method
physical activity estimates were similar to comparison-methods estimates. Conclusion:
The composite method used more available accelerometer data than standard approaches,
reducing the need to exclude periods within a day, entire days, and participants from
analysis.
A. A. Beaton and D. C. Funk. (2008). An evaluation of theoretical frameworks for
studying physically active leisure. Leisure Sciences. 30, 53-70.
Recent reviews demonstrate participation in active recreation and the development of an
active lifestyle is important to a broad spectrum of society. Reviews further highlight the
presence of an underdeveloped knowledge base for active leisure. Theory development is
required to guide researchers, practitioners, and policy makers. Specifically, evaluating
the theoretical frameworks applied to active recreation is needed to foster collaboration
and enhance the research-practice relation as well as to allow for rigorous testing and
evaluation of theories, policies, programs, and interventions. Our paper responds to this
call by developing five criteria to assess a selection of theoretical frameworks. The
assessment demonstrates the limitations and advantages of various frameworks. Five
propositions are presented to illustrate future theory development.
L. M. Candib, M. Silva, S. B. Cashman, D. Ellstrom and K. Mallett. (2008). Creating
open access to exercise for low-income patients through a community collaboration for
quality improvement: if you build it, they will come. J Ambul Care Manage. 31, 142-50.
Community health centers face the need for safe, accessible, and affordable exercise for
low-income patients to implement self-management strategies. This study reports on one
federally qualified health center's experience developing a partnership with a local
YWCA to offer open access to patients for physical activity. Over a 24-month period,
1060 adult patients made at least 1 visit to the YWCA, logging a total of 14,276 visits.
Among the exercisers, 112 had diabetes and made 3225 visits. Frequent users (> or =24
visits), had an HbAlc reduction of 1% (P =.02). Community health centers can
collaborate with local exercise facilities to ensure that patients have opportunities to
pursue healthier lifestyles.
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G. R. Flores. (2008). Active living in Latino communities. Am J Prev Med. 34, 369-70.
B. Hutto, P. A. Sharpe, M. L. Granner, C. L. Addy and S. Hooker. (2008). The Effect of
Question Order on Reporting Physical Activity and Walking Behavior. Journal of
Physical Activity & Health. 5, S16.
Background: Question order might affect self-reported regular physical activity (PA)
measured with items from the Behavioral RiskFactor Surveillance System (BRFSS) PA
module. Methods: A telephone survey was conducted using 2 forms (N = 1004, N = 212)
with varying PA question order. The standard form presented moderate- PA, vigorousPA, and walking questions, in that order, whereas the alternate form presented walking
questions, followed by moderate-PA, and then vigorous-PA questions. Weighted,
adjusted rates of vigorous PA, walking, meeting the Centers for Disease Control and
Prevention (CDC) recommendation for moderate or vigorous PA, and moderate PA from
each form were compared. Results: Vigorous PA and walking were similar regardless of
question order. Meeting the CDC recommendation for moderate or vigorous PA was
reported less often with the alternate form among 18- to 34-year-olds. Less moderate PA
was reported with the alternate form overall and among 18- to 34-year-olds, women,
whites, and those with a high school education or less. Conclusion: Estimating PA and
walking across sociodemographic strata with differing patterns of PA requires asking
moderate-PA and vigorous-PA questions before walking questions. Asking walking
questions first might lead to bias, especially for moderate PA. Walking, added to a survey
with BRFSS moderate and vigorous PA items, should be placed after moderate and
vigorous PA. Walking questions first may cause bias, especially for moderate PA.
H. J. Moore, L. J. Ells, S. A. McLure, S. Crooks, D. Cumbor, C. D. Summerbell and A.
M. Batterham. (2008). The development and evaluation of a novel computer program to
assess previous-day dietary and physical activity behaviours in school children: the
Synchronised Nutrition and Activity Program (SNAP). Br J Nutr. 99, 1266-74.
Self-report recall questionnaires used to measure physical activity and dietary intake in
children can be labour intensive and monotonous and tend to focus on either dietary
intake or physical activity. The web-based software, Synchronised Nutrition and Activity
Program (SNAP), was developed to produce a novel, simple, quick and engaging method
of assessing energy balance-related behaviours at a population level, combining
principles from new and existing 24 h recall methodologies, set within a user-friendly
interface. Dietary intake was measured using counts for twenty-one food groups and
physical activity levels were measured in min of moderate to vigorous physical activity
(MVPA). A combination of the mean difference between methods, type II regression and
non-parametric limits of agreement techniques were used to examine the accuracy and
precision of SNAP. Method comparison analyses demonstrated a good agreement for
both dietary intake and physical activity behaviours. For dietary variables, accuracy of
SNAP (mean difference) was within +/- 1 count for the majority of food groups. The
proportion of the sample with between-method agreement within +/- 1 count ranged from
0.40 to 0.99. For min of MVPA, there was no substantial fixed or proportional bias, and a
mean difference between methods (SNAP - accelerometry) of -9 min. SNAP provides a
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quick, accurate, low-burden, cost-effective and engaging method of assessing energy
balance behaviours at a population level. Tools such as SNAP, which exploit the
popularity, privacy and engagement of the computer interface, and linkages with other
datasets, could make a substantial contribution to future public health monitoring and
research.
A. Pirasteh, A. Hidarnia, A. Asghari, S. Faghihzadeh and F. Ghofranipour. (2008).
Development and validation of psychosocial determinants measures of physical activity
among Iranian adolescent girls. Bmc Public Health. 8,
Background: The present study aimed at assessing the psychometric properties of
psychosocial determinants of physical activity-related measures in Iranian adolescent
girls. Methods: Several measures of psychosocial determinants of physical activity were
translated from English into Persian using the back-translation technique. These
translated measures were administered to 512 ninth and tenth-grade Iranian high school
students. Results: The results of a series of factor analysis showed that the self-efficacy
scale contained a single factor, the social support scale contained two factors: family
support and friend support, the physical activity 'pros & cons' scale contained two factors:
physical activity pros scale and physical activity cons scale, the change strategies scale
contained a single factor, the environment scale also contained a single factor.
Chronbach's alphas, mean inter-item correlations and test-retest coefficients showed that
these solutions were reliable. Conclusions: These preliminary results provide support for
using the mentioned scales to measure psychosocial determinants of physical activity in
Iranian adolescent girls.
J. J. Reilly, V. Penpraze, J. Hislop, G. Davies, S. Grant and J. Y. Paton. (2008). Objective
measurement of physical activity and sedentary behaviour: review with new data.
Archives Of Disease In Childhood. 93, 614-619.
Objective methods are being used increasingly for the quantification of the amount of
physical activity, intensity of physical activity and amount of sedentary behaviour in
children. The accelerometer is currently the objective method of choice. In this review we
address the advantages of objective measurement compared with more traditional
subjective methods, notably the avoidance of bias, greater confidence in the amount of
activity and sedentary behaviour measured, and improved ability to relate variation in
physical activity and sedentary behaviour to variation in health outcomes. We also
consider unresolved practical issues in paediatric accelerometry by critically reviewing
the existing evidence and by providing new evidence.
J. F. Sallis. (2008). Angels in the details: comment on "The relationship between
destination proximity, destination mix and physical activity behaviors". Prev Med. 46, 67.
F. J. van Lenthe, S. P. Kremers and J. Brug. (2008). Exploring environmental
determinants of physical activity--the road to the future is always under construction.
Public Health. 122, 329; author reply 330.
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S. E. Wiehe, S. C. Hoch, G. C. Liu, A. E. Carroll, J. S. Wilson and J. D. Fortenberry.
(2008). Adolescent travel patterns: Pilot data indicating distance from home varies by
time of day and day of week. Journal Of Adolescent Health. 42, 418-420.
We conducted a pilot study using new technology to track adolescent "place." Using
Global Positioning System (GPS)-enabled cell phones, we recruited and tracked 15
female adolescents for a 1-week period. Distance away from home was greatest in the
evenings on weekends or holidays. The greatest percentage of time spent more than 1
kilometer away from home was also during these times. Such GPS technology holds
promise for future adolescent health research in allowing more specific and dynamic
measurement of where adolescents spend time. (c) 2008 Society for Adolescent
Medicine. All rights reserved.
D. K. Wilson. (2008). Commentary for Health Psychology special issue: theoretical
advances in diet and physical activity interventions. Health Psychol. 27, S1-2.
This issue of Health Psychology includes original contributions for advancing research
on theoretical issues such as mediation and moderation effects in promoting healthy diet
and physical activity behavior change. This special issue was developed to highlight
some of the fundamental issues from a biological, cognitive, social, and environmental
perspective for understanding the impact of intervention effects on behavior change
processes and ultimate health. Given the increasing prevalence of health-related
problems, such as the increasing prevalence of obesity and diabetes in the United States,
the perspective presented in this issue should be very useful to researchers, scientists,
scholars, and a wide range of health professionals who hope to curb these critical public
health problems.
N. Yphantides. (2008). For parents. Community solutions to childhood obesity. Diabetes
Self Manag. 25, 60, 62-4.
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