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 Jul. – Dec. 2008
The following pages are citations of studies of the relationships between the
environment, physical activity, and obesity published during the second half of 2008.
We have organized the publications into 8 categories to make them easier to review.
The categories are:
1.
2.
3.
4.
5.
6.
7.
8.
Built Environment – Child Physical Activity/Obesity,
Built Environment – Adult Physical Activity/Obesity,
Policy – Physical Activity/Obesity,
Social Environment – Child Physical Activity/Obesity,
Social Environment – Adult Physical Activity/Obesity,
Measurement,
Community Based Interventions – Physical Activity and Obesity,
Childhood Obesity – General
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), Erin Merz 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 Aug. 2009
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
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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.
American Journal of Health Behavior- 3
American Journal of Health Promotion- 2
American Journal of Preventive Medicine- 4
American Journal of Public Health-6
Annals of Behavioral Medicine- 2
BMC Public Health- 7
British Journal of Sports Medicine- 5
Canadian Journal of Public Health- 3
Contemporary Clinical Trials- 2
Health and Place- 9
Health Education Research- 9
Health promotion International -2
Health Promotion Journal of Australia -3
Health Promotion Practice -2
International Journal of Behavioral Nutrition and Physical Activity- 8
International Journal of Obesity- 3
International Journal of Pediatric Obesity- 3
Journal of American College Health-2
Journal of Community Health - 2
Journal of Health Economics - 2
Journal of Pediatrics Psychology-2
Journal of Physical Activity and Health- 6
Journal of Public Health- 2
Journal of Science and Medicine in Sport- 4
Journal of Transportation Geography- 2
Journal of Urban Health- 2
Leisure Sciences- 3
Medicine and Science in Sports and Exercise- 8
Obesity- 3
Obesity Reviews- 3
Preventing Chronic Disease- 6
Preventive Medicine- 21
Research in Nursing and Health- 2
Public Health Nutrition- 5
Social Science and Medicine- 4
Transportation Research- 2
Western Journal of Nursing Research- 2
3
Active Living Research Literature Summary 2008
Draft Published Aug. 2009
2008 July-Dec. Abstract List
Built Environment and Physical Activity/Obesity (Youth)
Bell, J. F., J. S. Wilson, et al. (2008). "Neighborhood Greenness and 2-Year Changes in
Body Mass Index of Children and Youth." American Journal Of Preventive Medicine
35(6): 547-553.
Background: Available Studies of the built environment and the BMI of children
and Youth suggest a contemporaneous association with neighborhood greenness in
neighborhoods with high population density. The Current study tests whether greenness
and residential density are independently associated with 2-year changes in the BMI of
children and youth. Methods: The sample included children and youth aged 3-16 years
who lived at the same address for 24 consecutive months and received well-child care
from a Marion County IN clinic network within the years 1996-2002 (n=3831). Multiple
linear regression was used to examine associations among age- and gender-specific BMI
z-scores in Year 2, residential density, and a satellite-derived measure of greenness,
controlling for baseline BMI z-scores and other covariates. Logistic regression was used
to model associations between all indicator of BMI 7 score increase from baseline to
Time 2 and the above-mentioned predictors. Results: Higher greenness was significantly
associated with lower BMI z-scores at Time 2 regardless of residential density
characteristics. Higher residential density was not associated with Time 2 BMI z-scores
in models regardless of greenness. Higher greenness was also associated with lower odds
of children's and youth's increasing their BMI 7 scores over 2 years (OR=0.87; 95%
CI=0.79, 0.97). Conclusions: Greenness may present a target for environmental
approaches to preventing child obesity. Children and youth living in greener
neighborhoods had lower BMI z-scores at Time 2, presumably due to increased physical
activity or time spent outdoors. Conceptualizations of walkability from adult studies,
based solely on residential density, may not be relevant to children and Youth in urban
environments.
Bere, E., K. van der Horst, et al. (2008). "Socio-demographic factors as correlates of
active commuting to school in Rotterdam, the Netherlands." Preventive Medicine 47(4):
412-416.
Objective. Report frequencies of adolescents' active commuting to school in an
inner city environment in the Netherlands, and to explore potential socio-demographic
correlates of active commuting to school. Methods. Cross-sectional data were obtained
from the ENDORSE study (2005-2006) including 1361 adolescents (response=82%),
aged 12-15 from 16 schools in Rotterdam. Socio-demographic variables were assessed by
questionnaire. height and weight were measured and distance to school was calculated
based on route planner information. Multilevel logistic regressions were performed to
analyze the data. Results. The proportions of participants categorized as walkers, cyclists,
non-active commuters were 12%, 35% and 34% respectively. With cyclists as the
reference category, adolescents of non-Western ethnic background were more likely to be
walkers (OR=4.1; 95% CI=2.1-8.2) and non-active commuters (OR=5.1; 95% CI=3.37.9), compared to native Dutch adolescents. A further distance from home to school was
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Active Living Research Literature Summary 2008
Draft Published Aug. 2009
inversely associated with being a walker (OR=0.22; 95% CI=0.17-0.29) and being a
cyclist (OR=0.83; 95% CI=0.79-0.86) and positively associated with being a non-active
commuter (OR=1.2; 95% CI=1.16-1.23). Conclusion. Almost 50% of the adolescents
reported to actively commute to school on most school days, and mode of commuting
was associated with ethnicity and distance. Further research is needed to examine main
barriers to active commuting among adolescents from non-Western ethnic background.
(C) 2008 Elsevier Inc.
Carver, A., A. F. Timperio, et al. (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(4): 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'
MVPA during evenings. The road environment influences physical activity among youth
in different ways, according to age group, sex and type of physical activity.
Cohen, D., M. Scott, et al. (2008). "School design and physical activity among middle
school girls." J Phys Act Health 5(5): 719-31.
Building design and grounds might contribute to physical activity, and youth
spend much of their daylight hours at school. We examined the associations among
school building footprints, the size of school grounds, and in-school physical activity of
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Active Living Research Literature Summary 2008
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1566 sixth-grade girls from medium to large middle schools enrolled in the Trial of
Activity for Adolescent Girls (TAAG). The school building footprint and the number of
active outdoor amenities were associated with physical activity among adolescent girls.
On average, the school footprint size accounted for 4% of all light physical activity and
16% of all MET-weight moderate-to-vigorous physical activity (MW-MVPA) during
school hours. Active outdoor amenities accounted for 29% of all MW-MVPA during
school. School design appears to be associated with physical activity, but it is likely that
programming (eg, physical education, intramurals, club sports), social factors, and school
siting are more important determinants of total physical activity.
Cohen, D. A. (2008). "Obesity and the built environment: changes in environmental cues
cause energy imbalances." Int J Obes (Lond) 32 Suppl 7: S137-42.
The past 30 years have seen dramatic changes in the food and physical activity
environments, both of which contribute to the changes in human behavior that could
explain obesity. This paper reviews documented changes in the food environment,
changes in the physical activity environment and the mechanisms through which people
respond to these environments, often without conscious awareness or control. The most
important environmental changes have been increases in food accessibility, food salience
and decreases in the cost of food. The increases in food marketing and advertising create
food cues that artificially stimulate people to feel hungry. The existence of a metabolic
pathway that allows excess energy to be stored as fat suggests that people were designed
to overeat. Many internal mechanisms favor neurophysiologic responses to food cues that
result in overconsumption. External cues, such as food abundance, food variety and food
novelty, cause people to override internal signals of satiety. Other factors, such as
conditioning and priming, tie food to other desirable outcomes, and thus increase the
frequency that hunger is stimulated by environmental cues. People's natural response to
the environmental cues are colored by framing, and judgments are flawed and biased
depending on how information is presented. People lack insight into how the food
environment affects them, and subsequently are unable to change the factors that are
responsible for excessive energy consumption. Understanding the causal pathway for
overconsumption will be necessary to interrupt the mechanisms that lead to obesity.
Colabianchi, N., A. E. Kinsella, et al. (2009). "Utilization and physical activity levels at
renovated and unrenovated school playgrounds." Prev Med 48(2):140-143.
OBJECTIVE: This study examined utilization and physical activity levels at
renovated compared to unrenovated school playgrounds. METHODS: Ten unrenovated
and ten renovated school playgrounds (renovated at least a year prior) in Cleveland, OH
were matched on school and neighborhood characteristics. Using direct observation
(SOPLAY), the number of persons attending each playground and their physical activity
levels were recorded using separate counts for girls, boys, men and women. Each school
was observed ten times for 90 min each time outside of school hours in 2005. Paired t-
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Active Living Research Literature Summary 2008
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tests, Wilcoxon Signed Ranks tests, and regression analyses were completed to examine
differences across school pairs. RESULTS: More persons overall including adults and
children utilized the renovated playgrounds compared to the unrenovated playgrounds.
The proportion moderately-to-vigorously active was not different between renovated and
unrenovated playgrounds although the proportion of children, in particular boys, who
were vigorously active was greater at the renovated playgrounds. Although utilization
was higher at the renovated playgrounds, absolute utilization was low across all
playgrounds. CONCLUSIONS: This study suggests that playgrounds renovations may
have the potential to increase the number of children utilizing the playground outside of
school hours and may increase the proportion of children, especially boys, who are
vigorously active.
Crawford, D., A. Timperio, et al. (2008). "Do features of public open spaces vary
according to neighbourhood socio-economic status?" Health Place 14(4): 889-93.
This study examined the relations between neighbourhood socio-economic status
and features of public open spaces (POS) hypothesised to influence children's physical
activity. Data were from the first follow-up of the Children Living in Active
Neighbourhoods (CLAN) Study, which involved 540 families of 5-6 and 10-12-year-old
children in Melbourne, Australia. The Socio-Economic Index for Areas Index (SEIFA) of
Relative Socio-economic Advantage/Disadvantage was used to assign a socioeconomic
index score to each child's neighbourhood, based on postcode. Participant addresses were
geocoded using a Geographic Information System. The Open Space 2002 spatial data set
was used to identify all POS within an 800 m radius of each participant's home. The
features of each of these POS (1497) were audited. Variability of POS features was
examined across quintiles of neighbourhood SEIFA. Compared with POS in lower
socioeconomic neighbourhoods, POS in the highest socioeconomic neighbourhoods had
more amenities (e.g. picnic tables and drink fountains) and were more likely to have trees
that provided shade, a water feature (e.g. pond, creek), walking and cycling paths,
lighting, signage regarding dog access and signage restricting other activities. There were
no differences across neighbourhoods in the number of playgrounds or the number of
recreation facilities (e.g. number of sports catered for on courts and ovals, the presence of
other facilities such as athletics tracks, skateboarding facility and swimming pool). This
study suggests that POS in high socioeconomic neighbourhoods possess more features
that are likely to promote physical activity amongst children.
Cutumisu, N. and J. C. Spence (2009). "Exploring associations between urban
environments and children's physical activity: Making the case for space syntax." J Sci
Med Sport 12(5):537-538.
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Active Living Research Literature Summary 2008
Draft Published Aug. 2009
Davison, K. K., J. L. Werder, et al. (2008). "Children's active commuting to school:
current knowledge and future directions." Prev Chronic Dis 5(3): A100.
INTRODUCTION: Driven largely by international declines in rates of walking
and bicycling to school and the noted health benefits of physical activity for children,
research on children's active commuting to school has expanded rapidly during the past 5
years. We summarize research on predictors and health consequences of active
commuting to school and outline and evaluate programs specific to children's walking
and bicycling to school. METHODS: Literature on children's active commuting to school
published before June 2007 was compiled by searching PubMed, PsycINFO, and the
National Transportation Library databases; conducting Internet searches on programbased activities; and reviewing relevant transportation journals published during the last 4
years. RESULTS: Children who walk or bicycle to school have higher daily levels of
physical activity and better cardiovascular fitness than do children who do not actively
commute to school. A wide range of predictors of children's active commuting behaviors
was identified, including demographic factors, individual and family factors, school
factors (including the immediate area surrounding schools), and social and physical
environmental factors. Safe Routes to School and the Walking School Bus are 2 public
health efforts that promote walking and bicycling to school. Although evaluations of
these programs are limited, evidence exists that these activities are viewed positively by
key stakeholders and have positive effects on children's active commuting to school.
CONCLUSION: Future efforts to promote walking and bicycling to school will be
facilitated by building on current research, combining the strengths of scientific rigor
with the predesign and postdesign provided by intervention activities, and disseminating
results broadly and rapidly.
Duncan, J. S., W. G. Hopkins, et al. (2008). "Effects of weather on pedometerdetermined physical activity in children." Medicine And Science In Sports And Exercise
40(8): 1432-1438.
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,
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Active Living Research Literature Summary 2008
Draft Published Aug. 2009
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 weekendday 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.
Dyment, J. E. and A. C. Bell (2008). "Grounds for movement: green school grounds as
sites for promoting physical activity." Health Education Research 23(6): 952-962.
An environmental factor of particular importance to children's physical activity
levels appears to be the presence of parks and open space. Thus, in promoting children's
health, school grounds merit consideration as a potential setting for intervention. This
paper explores how 'green' school grounds, which contain a greater diversity of
landscaping and design features, affect the quantity and quality of physical activity
among elementary school children. Teachers, parents and administrators associated with
59 schools across Canada completed questionnaires (n = 105). Analysis reveals that
through greening, school grounds diversify the play repertoire, creating opportunities for
boys and girls of all ages, interests and abilities to be more physically active.
Complementing the rule-bound, competitive games supported by asphalt and turf playing
fields, green school grounds invite children to jump, climb, dig, lift, rake, build, role play
and generally get moving in ways that nurture all aspects of their health and
development. Of particular significance is the potential to encourage moderate and light
levels of physical activity by increasing the range of enjoyable, non-competitive, openended forms of play at school. Seen in this light, green school grounds stand to be an
important intervention to be included in school health promotion initiatives.
Eyler, A. A., R. C. Brownson, et al. (2008). "Policies related to active transport to and
from school: a multisite case study." Health Education Research 23(6): 963-975.
Active transportation to and from school (ATS) is a viable strategy to help
increase physical activity among youth. ATS can be challenging because initiatives
require transdisciplinary collaboration, are influenced by the built environment and are
affected by numerous policies. The purpose of this study is to identify policies and
factors that influence ATS initiatives. Nine elementary schools in seven states
participated in this case study. Sixty-nine stakeholders were interviewed. The interviews
were transcribed, coded and analyzed using a master thematic codebook. This study
identified two distinct aspects of policies: 'influential factors' which are factors that might
impact policies related to ATS and 'policy actions' which are policies reported by people
involved in ATS initiatives that directly affected their success. Influential factors
included sidewalks, crosswalks/crossing guards, funding, personal safety concerns,
advocacy group involvement and others. Policy actions included policies on school speed
zone, drop-off, no-transport zones, school siting, school start/dismissal time and school
choice. Despite the diversity of the schools studied, similarities included influence of
built environment, safety concerns, funding and transdisciplinary collaboration.
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Active Living Research Literature Summary 2008
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Stakeholders need to work together to stimulate action and ensure successful initiatives.
Influential factors appear to be important to this process.
Foster, S. and B. Giles-Corti (2008). "The built environment, neighborhood crime and
constrained physical activity: An exploration of inconsistent findings." Preventive
Medicine 47(3): 241-251.
Objectives. Personal safety is commonly cited in qualitative research as a barrier
to local walking, yet the relationship between safety and constrained physical activity has
received mixed support in quantitative studies. This paper reviews the quantitative
evidence to date, seeking to explain the inconsistencies, and offers recommendations for
future research. Methods. A social-ecological framework was adopted to explore the
evidence linking crime-related safety, and factors that influence real and perceived safety,
with constrained physical activity. Results. Perceived safety tends to affect the physical
activity of groups already known to exhibit greater anxiety about crime: and some
elements of the built environment that influence safety appear to constrain physical
activity. However the evidence is somewhat inconsistent, and this may be partly
attributed to measurement limitations. Many studies employ generic safety measures that
make implicit references to crime or use composite variables that lack specificity.
Physical activity outcomes also require consideration, as only activities occurring locally
outdoors are likely to be affected by neighborhood crime. Conclusions. Further research
is required to tease out associations between real and perceived crime-related safety and
physical activity, ideally employing behaviour and crime-specific measures, and
addressing the moderating role of the social and built environments. (c) 2008 Elsevier
Inc. All rights reserved.
Franzini, L., M. N. Elliott, et al. (2009). "Influences of physical and social neighborhood
environments on children's physical activity and obesity." Am J Public Health 99(2): 2718.
OBJECTIVES: We investigated the association between physical and social
neighborhood environments and fifth-grade students' physical activity and obesity.
METHODS: We collected data on 650 children and their primary caregivers during phase
1 of Healthy Passages, a multisite, community-based, cross-sectional study of health risk
behaviors and health outcomes in children. We conducted independent systematic
neighborhood observations to measure neighborhood physical characteristics, and we
analyzed survey data on social processes. We modeled children's physical activity and
obesity status with structural equation models that included latent variables for the
physical and social environments. RESULTS: After we controlled for children's
sociodemographic factors, we found that a favorable social environment was positively
associated with several measures of physical activity and that physical activity was
negatively associated with obesity in these children. Physical environment was not
significantly associated with physical activity. CONCLUSIONS: Our findings suggest
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that neighborhood social factors as well as the physical environment should be
considered in the development of health policy and interventions to reduce childhood
obesity.
Grafova, I. B. (2008). "Overweight children: assessing the contribution of the built
environment." Prev Med 47(3): 304-8.
OBJECTIVE: To examine the relationship between the built environment and
overweight status in children. METHODS: Analyses were based on 2482 children aged
5-18 and their primary care givers who participated in the second wave of the Child
Development Supplement (CDS-II) of the Panel Study of Income Dynamics (PSID).
CDS-II is a nationally representative survey that was administered in October 2002-May
2003. A number of built environment characteristics were examined: population density,
alpha index of connectivity, urban design, pedestrian fatality from motor vehicle crashes,
restaurant density, and grocery store and convenience store densities. Also, interviewer's
observations on neighborhood physical disorder, such as the condition and upkeep of the
buildings and street surface on the block were analyzed. RESULTS: Living in a
neighborhood with higher convenience store density (OR=1.3, p<0.05) and living in a
neighborhood built after 1969 (OR=1.9, p<0.01) is associated with a higher probability of
being overweight for children and adolescents. Living in the neighborhood where no
physical disorder (OR=0.5, p<0.01) is observed is associated with a decreased likelihood
of being overweight. CONCLUSIONS: The results of this study emphasize a particular
importance of the built environment of the neighborhood for weight status of children
and adolescents.
Grow, H. M., B. E. Saelens, et al. (2008). "Where Are Youth Active? Roles of Proximity,
Active Transport, and Built Environment." Medicine And Science In Sports And
Exercise 40(12): 2071-2079.
Purpose: This study examined factors related to two sources of physical activity
for youth: active use of recreation sites and active transport to recreation sites. Methods:
Parents of children (n = 87) and matched pairs of parents and adolescents (n = 124 pairs)
in three US cities reported on Youths' active use of, proximity to, and walking/biking to
12 recreation sites and on neighborhood walkability and safety. Multivariate regression
models evaluated factors associated with youths' frequent site use and active transport to
sites. Results: Proximity to the site was associated with frequent use of large parks and
public open space. Walking/biking to the site was associated with frequent use of most
sites (indoor recreation sites, small and large parks, basketball courts, walking/running
tracks, school recreation sites, playgrounds, and public open space). After controlling for
proximity and demographic factors, active transport to sites remained significantly
associated (P < 0.05) with frequent use of four sites for children (indoor recreation,
walking/running tracks, school recreation facilities, and public open space) and all but
three sites for adolescents (indoor recreation, playfields/courts, and beach/lake/rivers).
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Adolescents' active transport to more sites was most positively related to higher
perceived traffic safety and to better pedestrian infrastructure and was negatively related
to crime threat. Adolescents with driver's licenses walked/biked to recreation sites less
often. Conclusions: Active transport was strongly associated with the use of multiple
recreation sites by children and adolescents, even when accounting for proximity and
demographic factors. Adolescents living in neighborhoods with better traffic safety
walked/biked to more recreation sites for physical activity. Findings support the need for
built environments and transportation policies that facilitate safe, active transport to
recreation sites for youth physical activity.
Harten, N., T. Olds, et al. (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(3): 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 determining the free play activity of boys, but not of girls. This may be
related to widely different play styles among boys and girls.
Haug, E., T. Torsheim, et al. (2008). "The characteristics of the outdoor school
environment associated with physical activity." Health Educ Res.
The school is an important setting for physical activity. The purpose of the present
study was to examine the association between physical environmental characteristics and
participation in daily physical activity during school breaks. Data from 130 schools and
16 471 students (Grades 4-10) in Norway were obtained in 2004 through selfadministered questionnaires to principals and students. Multilevel logistic regression
models revealed that boys at secondary level with a larger number of outdoor facilities at
school had 2.69 times [95% confidence interval (CI) = 1.21-5.98] and girls 2.90 times
(95% CI = 1.32-6.37) higher odds of being physically active compared with students in
schools with fewer facilities. Boys at secondary level with areas for hopscotch/skipping
rope had 2.53 times (95% CI = 1.55-4.13), with a soccer field 1.68 times (95% CI = 1.152.45), with playground equipment 1.66 times (95% CI = 1.16-2.37) and with a sledding
hill 1.70 times (95% CI = 1.23-2.35) higher odds to be physically active compared with
students in schools without these facilities. A sledding hill was also associated with girls'
physical activity participation in secondary school (odds ratio = 1.58, 95% CI = 1.112.24). Outdoor facilities in secondary schools are associated with students' daily physical
activity participation during school breaks. Therefore, improving the outdoor
environment should be considered in physical activity promotion school programs in
secondary schools.
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Haug, E., T. Torsheim, et al. (2008). "Physical environmental characteristics and
individual interests as correlates of physical activity in Norwegian secondary schools:
The health behaviour in school-aged children study." International Journal Of Behavioral
Nutrition And Physical Activity 5.
Background: The school has been identified as a key arena for physical activity
promotion for young people. Effective change of physical activity behaviour requires
identification of consistent and modifiable correlates. The study explores students'
interests in school physical activity and facilities in the school environment and examines
their associations with students' participation in physical activity during recess and their
cross-level interaction effect. Methods: This cross-sectional study was based on a
national representative sample of Norwegian secondary schools and grade 8 students who
participated in the Health Behaviour in School-aged Children (HBSC) 2005/06 study.
The final sample comprised 68 schools and 1347 students. Physical environment
characteristics were assessed through questionnaires completed by the principals, and
students' physical activity and interests in physical activity were assessed through student
self-completion questionnaires. Results: Most students were interested in more
opportunities for physical activity in school. Multilevel logistic regression models
demonstrated that students attending schools with many facilities had 4.49 times (95%
Confidence Interval (CI) = 1.93-10.44) higher odds of being physically active compared
to students in schools with fewer facilities when adjusting for socio-economic status, sex
and interests in school physical activity. Also open fields (Odds Ratio (OR) = 4.31, 95%
CI = 1.65-11.28), outdoor obstacle course (OR = 1.78, 95% CI = 1.32-2.40), playground
equipment (OR = 1.73, 95% CI = 1.24-2.42) and room with cardio and weightlifting
equipment (OR = 1.58, 95% CI = 1.18-2.10) were associated with increased participation
in physical activity. Both students' overall interests and the physical facilitation of the
school environment significantly contributed to the prediction of recess physical activity.
The interaction term demonstrated that students' interests might moderate the effect of
facilities on recess physical activity. Conclusion: The findings support the use of an
ecological approach and multilevel analyses in the investigation of correlates of physical
activity that allows for a broader understanding of the influence of and interaction
between factors at multiple levels on physical activity behaviour. In the promotion of
physical activity in lower secondary schools, the study suggests that programmes should
include a focus on environmental facilitation and incorporate strategies to increase
students' interests for school physical activity.
Hawkins, S. S., A. Pearce, et al. (2008). "Perceived and objective measures of the
neighbourhood environment and overweight in preschool children and their mothers." Int
J Pediatr Obes: 1-10.
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Objectives. The primary aim was to examine the relationships between perceived
and objective measures of the neighbourhood environment, measured in late infancy, and
subsequent overweight (including obesity) in 3-year-old children and their mothers. The
secondary aim was to assess whether moving residence confounded these relationships.
Methods. We analysed data on 8 154 children and their mothers from the UK Millennium
Cohort Study who had participated since birth and were living in England. At the first
contact (late infancy), mothers reported their perceptions of their neighbourhood
environment, and objective measures of the neighbourhood environment were obtained
by linking national deprivation data to each child's postcode. We conducted logistic and
multilevel regression analyses to examine perceived and objective measures of the
neighbourhood environment, respectively, and overweight at the second contact (3 years)
in children and their mothers. All analyses were adjusted for moving residence. Results.
There were few consistent patterns between measures of the neighbourhood environment
(perceived or objective) and early childhood overweight. However, mothers' risk of
overweight increased with increasingly poor neighbourhood conditions (perceived) or
residence in areas of increasing deprivation (objective), after adjustment for individual
socio-demographic factors. All relationships were maintained after adjustment for
moving residence. Conclusions. While area-level factors have limited influence on the
development of overweight in preschool children, they are likely to affect overweight in
their mothers. Policies need to address both individual and environmental factors to
tackle obesity and its determinants across the life course.
Kerr, J., G. J. Norman, et al. (2008). "Exercise AIDS, neighborhood safety, and physical
activity in adolescents and parents." Med Sci Sports Exerc 40(7): 1244-8.
PURPOSE: To investigate the relationships among exercise aids available at
home, physical activity, and perceived neighborhood safety. METHODS: Physical
activity was assessed using the 7-d recall interview for adolescents (n = 878) and the
International Physical Activity Questionnaire for parents (n = 853). Parents reported
exercise aids such as fitness equipment, running shoes, and dogs in their household using
a 16-item checklist and perceptions of neighborhood safety using the Neighborhood
Environment Walkability Scale. Physical activity scores were dichotomized to represent
meeting weekly guidelines for children (300 min) and adults (150 min). Logistic
regression analyses investigated the interaction between exercise equipment and
neighborhood safety in relation to the two physical activity outcomes, controlling for
participant demographics. RESULTS: The number of home-use (OR = 1.27) and
outdoor-use (OR = 1.24) exercise aids was significantly related to physical activity in
adolescent girls but not boys. An interaction effect indicated that the relationship between
home-use exercise equipment and physical activity levels was specific for girls in
neighborhoods perceived as less-safe (OR = 4.40), rather than those perceived as safe
(OR = 1.07, P < 0.01). In the parent sample, home-use (OR = 1.24) and outdoor use (OR
= 1.16) exercise aids were significantly related to physical activity levels. An interaction
between outdoor exercise aids and safety indicated that the effect was specific to parents
who lived in neighborhoods perceived as safe (OR = 2.43) compared to those perceived
as less-safe (OR = 0.91, P < 0.01). CONCLUSION: Girls living in neighborhoods their
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parents perceive to be less-safe may benefit from having exercise equipment they can use
in the home. Parents living in neighborhoods perceived to be safe may benefit from
having exercise aids that they can use outside.
Lanningham-Foster, L., R. C. Foster, et al. (2008). "Changing the school environment to
increase physical activity in children." Obesity (Silver Spring) 16(8): 1849-53.
We examined the hypothesis that elementary school-age children will be more
physically active while attending school in a novel, activity-permissive school
environment compared to their traditional school environment. Twenty-four children
were monitored with a single-triaxial accelerometer worn on the thigh. The students
attended school in three different environments: traditional school with chairs and desks,
an activity-permissive environment, and finally their traditional school with desks which
encouraged standing. Data from the school children were compared with another group
of age-matched children (n = 16) whose physical activity was monitored during summer
vacation. When children attended school in their traditional environment, they moved an
average (mean +/- s.d.) of 71 +/- 0.4 m/s(2). When the children attended school in the
activity-permissive environment, they moved an average of 115 +/- 3 m/s(2). The
children moved 71 +/- 0.7 m/s(2) while attending the traditional school with standing
desks. Children moved significantly more while attending school in the activitypermissive environment compared to the amount that they moved in either of the
traditional school environments (P < 0.0001 for both). Comparing children's activity
while they were on summer vacation (113 +/- 8 m/s(2)) to school-bound children in their
traditional environment showed significantly more activity for the children on summer
vacation (P < 0.0001). The school children in the activity-permissive environment were
as active as children on summer vacation. Children will move more in an activitypermissive environment. Strategies to increase the activity of school children may
involve re-designing the school itself.
Larsen, K., J. Gilliland, et al. (2008). "The Influence of the Physical Environment and
Sociodemographic Characteristics on Children's Mode of Travel to and From School."
Am J Public Health.
Objectives. We examined whether certain characteristics of the social and
physical environment influence a child's mode of travel between home and school.
Methods. Students aged 11 to 13 years from 21 schools throughout London, Ontario,
answered questions from a travel behavior survey. A geographic information system
linked survey responses for 614 students who lived within 1 mile of school to data on
social and physical characteristics of environments around the home and school. Logistic
regression analysis was used to test the influence of environmental factors on mode of
travel (motorized vs "active") to and from school. Results. Over 62% of students walked
or biked to school, and 72% from school to home. The likelihood of walking or biking to
school was positively associated with shorter trips, male gender, higher land use mix, and
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presence of street trees. Active travel from school to home was also associated with lower
residential densities and lower neighborhood incomes. Conclusions. Our findings
demonstrate that active travel is associated with environmental characteristics and
suggest that school planners should consider these factors when siting schools in order to
promote increased physical activity among students.
Lee, S. M., C. Tudor-Locke, et al. (2008). "Application of a walking suitability
assessment to the immediate built environment surrounding elementary schools." Health
Promot Pract 9(3): 246-52.
This study examines the usefulness of applying a walking suitability assessment
to a specific geographic area surrounding elementary schools. Streets within a 0.25-mile
radius were measured to create a summary walking suitability score for seven schools
from high-busing strata and seven from low-busing strata. Summary walking suitability
scores were calculated for each school. A Mann-Whitney U test was conducted to
determine any differences in scores between the high- and low-busing schools. The
median walking suitability score was 3.7 (a good rating); the 25th percentile score was
2.9 (very good), and the 75th was 22.3 (poor). No statistical differences existed between
busing strata. Walking suitability is an important consideration when examining the
feasibility of walk-to-school programs within school settings; however, it might not be
the main factor limiting children's active commuting to school. Several aspects of the
environment were captured that researchers, practitioners, school personnel, and
transportation experts may deem useful.
Leoni, E., P. Beltrami, et al. (2008). "Survey on sports practice and physical activity of
primary school children living in the area of Bologna Local Health Unit in relation with
some individual and environmental variables." Ann Ig 20(5): 441-53.
A randomized stratified sample of 522 children attending the third class of
primary schools within the area of Bologna Local Health Unit was analysed for physical
activity and sports practice. Information about the children's habits and availability of
facilities for physical and sports activities were collected by means of structured
questionnaires completed by children (507 respondents), parents (491), reference teachers
for physical education (26) and class teachers (46) during the school year 2006-07. At the
same time, the children's heights and weights were measured in order to calculate BMI
values. Regular sports activity is practised by 80.1% of children (males: 82.4%, females:
77.6%), with significant diferences between genders only in children with at least one
non-Italian parent (M>F, p < 0.05); the practice of sports is influenced by the area of
residence (metropolitan > plain and hills, p < 0.05) and nationality (Italians > nonItalians, p < 0.01). Children with at least one actively sports practising parent are
involved more frequently in sports activities (p < 0.001). In free time, sedentary activities
are prevalent for both sports-practising children and not. However children not involved
in regular sports activities tend to practise outdoor physical activities with a frequency
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significantly higher than children involved in sports (17.3% vs 10.4% of respondents).
The percentage of completely sedentary children, who stated that they practise neither
sports nor physical activity in their free time, is 7.3% (metropolitan area: 4.5%, hills:
8.7%, plain: 10.6%). The prevalence of overweight is 24.4%, of obesity 9.7%, with a
better distribution of BMI values in the metropolitan area where there is the highest
occurrence of positive conditions and behaviours: availability of sports facilities, the
highest prevalence of sports practice, and the lowest prevalence of completely sedentary
children.
Liu, J., K. J. Bennett, et al. (2008). "Urban-rural differences in overweight status and
physical inactivity among US children aged 10-17 years." J Rural Health 24(4): 407-15.
CONTEXT: Few studies have examined the prevalence of overweight status and
physical inactivity among children and adolescents living in rural America. PURPOSE:
We examined urban and rural differences in the prevalence of overweight status and
physical inactivity among US children. METHODS: Data were drawn from the 2003
National Survey of Children's Health, restricted to children aged 10-17 (unweighted N =
47,757). Overweight status was defined as the gender- and age-specific body mass index
(BMI) values at or above the 95th percentile. Physical inactivity was defined using
parentally reported moderate-to-vigorous intensity leisure-time physical activity lasting
for at least 20 minutes/d on less than three days in the past week. The 2003 Urban
Influence Codes were used to define rurality. Multiple logistic regression models were
used to examine urban/rural differences in overweight status and physical inactivity after
adjusting for potential confounders. FINDINGS: Overweight status was more prevalent
among rural (16.5%) than urban children (14.3%). After adjusting for covariates
including physical activity, rural children had higher odds of being overweight than urban
children (OR: 1.13; 95% CI: 1.01-1.25). Minorities, children from families with lower
socioeconomic status, and children living in the South experienced higher odds of being
overweight. More urban children (29.1%) were physically inactive than rural children
(25.2%) and this pattern remained after adjusting for covariates (OR: 0.79; 95% CI: 0.730.86). CONCLUSIONS: The higher prevalence of overweight among rural children,
despite modestly higher physical activity levels, calls for further research into effective
intervention programs specifically tailored for rural children.
Martin, J. J. and N. McCaughtry (2008). "Using Social Cognitive Theory to Predict
Physical Activity in Inner-City African American School Children." Journal of Sport &
Exercise Psychology 30(4): 378.
Researchers using social cognitive theory and employing built environment
constructs to predict physical activity (PA) in inner-city African American children is
quite limited. Thus, the purpose of our investigation was to evaluate the ability of
important social cognitive variables (e.g., self-efficacy) and built environment constructs
(e.g., neighborhood hazards) to predict African American children's PA. Children (N =
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331, ages 10-14) completed questionnaires assessing social cognitive theory constructs
and PA. Using multiple regression analyses we were able to account for 19% of the
variance in PA. Based on standardized beta weights, the best predictors of PA were time
spent outside and social support derived from friends. These findings illuminate the
valuable role of PA support from peers, as well as the simple act of going outside for
inner-city African American children. ABSTRACT FROM AUTHOR
McClafferty, H. (2008). "Interactions between environmental health and pediatric
obesity." Explore (NY) 4(5): 328-32.
Muller, S., S. Tscharaktschiew, et al. (2008). "Travel-to-school mode choice modelling
and patterns of school choice in urban areas." Journal Of Transport Geography 16(5):
342-357.
Because of declining enrollment and school closures in some German regions
students have to choose a certain school location from a reduced set of schools. For the
analysis of adverse effects of school closures on transport mode choice the patterns of
school choice are specified first. It seems that proximity and the profile offered
(languages as a core for example) are adequate factors. Second, the travelto-school mode
choice are modelled using a multinornial logit approach, since students might switch
from low cost transport modes (cycling for instance) to modes with remarkably higher
costs (public transport for instance). Here, the most influencing factors are distance, car
availability and weather. Furthermore, these findings are incorporated into a case study to
quantify the effects of a modal-shift (switch from one transport mode to another). For this
analysis a comprehensive survey was undertaken and a method of data disaggregation
and geocoding is presented. (c) 2007 Elsevier Ltd. All rights reserved.
Ozdemir, A. and O. Yilmaz (2008). "Assessment of outdoor school environments and
physical activity in Ankara's primary schools." Journal Of Environmental Psychology
28(3): 287-300.
Outdoor school environments are sites for play and physical activity for many
children, and shortcomings within these environments are considered significant factors
that contribute to children's inactive lifestyles and high levels of childhood obesity. This
study explores the associations between the physical characteristics of schoolyards and
the physical activity of third and fourth year Students ill five Turkish primary schools.
Data were collected through multiple methods, including behavior mapping of student
activities during recess, physical assessments of schoolyards, and interviews with
students, teachers and administrations. The findings show similarities in the landscape
features and physical qualities of schoolyards, particularly in the types of play and
activities in which students engage. Results indicated that active Students who walk to
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and from schools have lower body mass index (BMI) values than passive students, and
students in schools with larger yards have lower BMI values. Most of the Students prefer
spacious and vegetated yards. A major concern is the crowdedness of the yards during
recess that limit children's activity. Schoolyards with advanced landscape features are
preferred more, and this in turn affects students' positive satisfaction. Outdoor school
environments have a correlation to health outcomes and should be designed to promote
more activity. Improving the physical and landscape qualities of the public schoolyards
Should be the primary concern of the designers in order to increase awareness of natural
environment and more important, increase the health of children. (C) 2008 Elsevier Ltd.
All rights reserved.
Panter, J. R., A. P. Jones, et al. (2008). "Environmental determinants of active travel in
youth: A review and framework for future research." International Journal Of Behavioral
Nutrition And Physical Activity 5.
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.
Pate, R. R., K. McIver, et al. (2008). "Directly Observed Physical Activity Levels in
Preschool Children." Journal of School Health 78(8): 438.
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 ninety-three 3- to 5-
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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-to-vigorous 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.
Pearce, A., C. Kirk, et al. (2009). "Gaining children's perspectives: A multiple method
approach to explore environmental influences on healthy eating and physical activity."
Health Place 15(2): 614-21.
In order to inform local action for health improvement, this pilot study used
multiple methods to explore children's perspectives of environmental influences on their
eating and physical activity. Thirty-nine children aged 9-11 years from a North London
local authority took photos, drew maps, and attended focus groups. We found that the
approach engaged children and that each of the methods returned useful, complementary
information. The results highlighted a number of areas for local policymakers and
practitioners to consider when developing work to prevent childhood obesity. We
conclude that these methods of gaining children's views should be further developed and
tested.
Potwarka, L. R., A. T. Kaczynski, et al. (2008). "Places to play: Association of park
space and facilities with healthy weight status among children." Journal Of Community
Health 33(5): 344-350.
The purpose of this study was to examine how healthy weight status among youth
was related to (i) three proximity-based park variables: number of parks within 1 km of
home, total area of parkland within 1 km, and distance to the closest park from home, and
(ii) the availability of 13 specific park facilities within 1 km of the home. Data were
collected from parents of children living in four neighborhoods of a medium-sized
Canadian city. Logistic regression analyses revealed that none of the three proximitybased park variables was significantly associated with healthy weight status among
children in the sample. However, when availability of the 13 park facilities was
examined, children with a park playground within 1 km were almost five times more
likely to be classified as being of a healthy weight rather then at risk or overweight
compared to those children without playgrounds in nearby parks. Results suggest that
availability of certain park facilities may play a more important role in promoting
physical activity and healthy weight status among children than availability of park space
in general. Implications for park design are discussed.
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Santos, M. P., A. S. Page, et al. (2009). "Perceptions of the built environment in relation
to physical activity in Portuguese adolescents." Health Place 15(2): 548-52.
In this study, we investigated the association between perceptions of the built
environment and physical activity among Portuguese boys and girls. Participants were
1124 adolescents (592 girls and 532 boys) 12- to 18-years-old. Physical activity and
perceptions of environmental characteristics were assessed by self-report questionnaires.
Significantly more girls (p<0.01) were classified as low-active (61.5%) compared to boys
(22.9%). Logistic regression analyses (adjusted for age) showed a significant association
between girl's physical activity and availability of free- or low-cost recreational facilities
in the neighbourhood (OR=1.44; 95% CI 0.99-2.11). Among boys, the presence of people
being active in the neighbourhood was associated with higher levels of physical activity
(OR=1.59; 95% CI 1.05-2.40). Perceptions of some aspects of neighbourhood
environment may relate differently to participation in physical activity for boys compared
to girls.
Springer, A. E., D. M. Hoelscher, et al. (2009). "Prevalence of physical activity and
sedentary behaviors by metropolitan status in 4th-, 8th-, and 11th-grade students in
Texas, 2004-2005." Prev Chronic Dis 6(1): A21.
INTRODUCTION: Research on geographic differences in children's physical
activity (PA) engagement is limited. This study examined the prevalence of PA and
sedentary behaviors in a probability sample of children in the 4th (mean age, 9.7 years; n
= 7,907), 8th (mean age, 13.7 years; n = 8,827), and 11th (mean age 16.9 years; n =
6,456) grades by urban, suburban, and rural location in Texas. METHODS: Using data
from the 2004-2005 School Physical Activity and Nutrition (SPAN) study, we conducted
logistic regression analyses stratified by sex to assess associations of 6 PA indicators and
2 sedentary behavior indicators with metropolitan status. RESULTS: Urban 8th- and
11th-grade students reported the lowest prevalence of PA. Suburban or rural schools were
significantly more likely than their urban counterparts to report higher school-based
sports team participation in 8th graders (P =.001); higher vigorous PA (P =.01) and
strengthening exercise (P =.01) in 11th-grade boys; and higher physical education
attendance in 4th (P <.01) and 11th graders (P =.05). Sports team (P =.04) and other
organized PA participation (P =.04) in urban 4th-grade girls and vigorous PA in urban
8th-grade boys (P =.04) were the only behaviors for which a significantly higher
prevalence was reported compared with nonurban counterparts. We observed few
significant geographic differences in prevalence of television watching and video game
playing. CONCLUSION: Several significant differences in PA behaviors were found by
metropolitan status in this sample of public school students in Texas. Research is needed
on availability of PA opportunities and PA barriers by metropolitan status to better
understand the lower prevalence estimates reported in older urban children.
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Timperio, A., B. Giles-Corti, et al. (2008). "Features of public open spaces and physical
activity among children: findings from the CLAN study." Prev Med 47(5): 514-8.
OBJECTIVE: To examine associations between features of public open spaces,
and children's physical activity. PARTICIPANTS: 163 children aged 8-9 years and 334
adolescents aged 13-15 years from Melbourne, Australia participated in 2004.
METHODS: A Geographic Information System was used to identify all public open
spaces (POS) within 800 m of participants' homes and their closest POS. The features of
all POS identified were audited in 2004/5. Accelerometers measured moderate-tovigorous physical activity (MVPA) after school and on weekends. Linear regression
analyses examined associations between features of the closest POS and participants'
MVPA. RESULTS: Most participants had a POS within 800 m of their home. The
presence of playgrounds was positively associated with younger boys' weekend MVPA
(B=24.9 min/day; p< or =0.05), and lighting along paths was inversely associated with
weekend MVPA (B=-54.9 min/day; p< or =0.05). The number of recreational facilities
was inversely associated with younger girls' MVPA after school (B=-2.6 min/day; p< or
=0.05) and on the weekend (B=-8.7 min/day; p< or =0.05). The presence of trees
providing shade (5.8 min/day, p< or =0.01) and signage regarding dogs (B=6.8 min/day,
p< or =0.05) were positively associated with adolescent girls' MVPA after school.
CONCLUSION: Certain features of POS were associated with participants' MVPA,
although mixed associations were evident. Further research is required to clarify these
complex relationships.
Timperio, A., J. Salmon, et al. (2008). "Family physical activity and sedentary
environments and weight change in children." International Journal Of Pediatric Obesity
3(3): 160-167.
Objective. To examine associations between family physical activity and
sedentary environment and changes in body mass index (BMI) z-scores among 10-12year-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, 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 z-score. 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.
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Tucker, P., J. D. Irwin, et al. (2009). "Environmental influences on physical activity
levels in youth." Health Place 15(1): 357-63.
This study assessed the amount of physical activity engaged in by youth aged 1113, in relation to: (1) the presence of neighborhood recreational opportunities, objectively
measured within a geographic information system; and (2) parents' perceptions of
recreation opportunities in their neighborhoods. Students in grade 7 and 8 (n=811) in 21
elementary schools throughout London, Ontario completed the adapted Previous Day
Physical Activity Recall and a questionnaire assessing environmental influences in the
home and school neighborhoods. Parents/guardians of participants also completed a
questionnaire eliciting demographic information and perceptions of the neighborhood
environment. On average, students engaged in 159.9 min/day of physical activity. Both
subjective and objective measures of recreational opportunities were associated positively
with physical activity (p<0.05). Greater access to recreational opportunities seem
essential to facilitate youths' healthy levels of physical activity.
Veitch, J., J. Salmon, et al. (2008). "Children's active free play in local neighborhoods: a
behavioral mapping study." Health Education Research 23(5): 870-879.
Many Australian children are more sedentary than they should be, and almost one
in five are currently overweight or obese. Some children may face difficulties finding
opportunities to be active, having poor access to safe public open spaces or having low
independent mobility limiting their access to places to play. This study aimed to examine
children's access to places in their neighborhood for active free play and how these vary
by age, sex and socioeconomic status (SES). Behavioral maps of the local neighborhood
were completed by children (8-12 years) from five primary schools across different areas
of Melbourne. Children living in low SES outer-urban neighborhoods had to travel
greater distances to access local parks compared with those in inner-urban mid and high
SES areas. One-third (32%) of children reported an independent mobility range of < 100
m from home. In conclusion, for some children opportunities to engage in active free play
in the local neighborhood may be limited due to lack of parks in close proximity to home
and restricted independent mobility. It is important to collaborate with local governments,
urban planners and community groups to improve access to neighborhood parks and to
promote a sense of neighborhood safety.
Yeung, J., S. Wearing, et al. (2008). "Child transport practices and perceived barriers in
active commuting to school." Transportation Research Part A-Policy And Practice 42(6):
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
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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 onethird 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
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. (C) 2008 Published by Elsevier Ltd.
Zhu, X. M., B. Arch, et al. (2008). "Personal, Social, and Environmental Correlates of
Walking to School Behaviors: Case Study in Austin, Texas." Thescientificworldjournal
8: 859-872.
Walking is an affordable and environmentally clean mode of transportation that
can bring additional benefits as healthy physical activity. This cross-sectional study
examines the prevalence and correlates of walking to or from school in eight elementary
schools in Austin, Texas, which have high percentages of low-income, Hispanic students.
A survey of 1,281 parents was conducted, including questions about personal, social, and
environmental factors that may influence their decisions on the children's school
transportation. Binary logistic regressions were used to estimate the odds of choosing
walking as the children's typical school travel mode. The results showed that walking was
a typical mode for 28 and 34% of trips to and from school, respectively, and mostly
accompanied by an adult. Parents' education level, family's car ownership, children's and
parents' personal barriers, and having the school bus service reduced the likelihood of
walking, while positive peer influences encouraged walking. Among the physical
environmental factors, living close to school was the strongest positive predictor; safety
concerns and the presence of highway or freeway en route were negative correlates. We
concluded that the location of school is a key, as it determines the travel distance and the
presence of highway or freeway en route. In addition to environmental improvements,
educational and other assistance programs are needed for both parents and children to
overcome their personal barriers and safety concerns. Health and disparity issues require
further attention, as many underprivileged children have no other means of school
transportation but walking in unsafe and poor environments.
Built Environment and Physical Activity/Obesity (Adults)
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Aytur, S. A., D. A. Rodriguez, et al. (2008). "The sociodemographics of land use
planning: relationships to physical activity, accessibility, and equity." Health Place 14(3):
367-85.
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.
Badland, H. M., M. J. Duncan, et al. (2008). "Travel perceptions, behaviors, and
environment by degree of urbanization." Preventive Medicine 47(3): 265-269.
Objectives. This study examines how engagement in transport-related physical
activity (TPA), perceptions of the commute route, actual travel distance, and perceptions
of travel distance vary by degree of urbanization in rural and remote areas of Central
Queensland, Australia. Method. A random, cross-sectional sample of 1230 adults aged 18
years and over residing in rural and remote Central Queensland were surveyed by
telephone in October-November 2006. Engagement in and attitudes towards TPA,
perceptions of the commute route, actual travel distances, and perceived appropriate
travel distances for TPA were assessed. Result. For this study 765 adults were eligible for
the analysis as they traveled to an occupation. Overall, 86% of the sample commuted to
their occupation by motorized modes, 71% of individuals recognized 5 km or less as an
appropriate distance to travel via TPA modes, and 45% of respondents reported travel
distances less than five kilometers (km) to reach their workplace. Participants from small
rural and remote settings more frequently traveled greater than 20 kin to reach their
occupation, reported fewer sidewalks and shops, and less heavy traffic enroute compared
to respondents in large rural settings. Conclusion. Infrastructure for, and participation in
TPA varies according to degree of urbanization. Future work in this area should target the
substantial population that recognizes they could engage in TPA. As such, increasing
TPA participation in these settings likely requires a cultural shift and infrastructure
improvements. (c) 2008 Elsevier Inc. All rights reserved.
Bamana, A., S. Tessier, et al. (2008). "Association of perceived environment with
meeting public health recommendations for physical activity in seven European
countries." Journal Of Public Health 30(3): 274-281.
Background This study investigates the association of perceived environment and
meeting the current public health recommendations (PHRs) for physical activity (PA) and
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examines the role of body mass index (BMI) in this relation. Methods A total of 4231
subjects (>= 18 years), from seven European countries, were involved in a cross-sectional
survey. PA was measured by the International PA Questionnaire, and specific questions
about perceived environment for PA were added. Results Adults with high personal
motivation were more likely to meet PHRs for PA than those without motivation (odds
ratio [OR] 1.79; 95% confidence interval [CI] 1.50-2.14). Participants perceiving high
social support from work or school were more likely to meet PHRs for PA than those
without this support (OR 1.60; 95% CI 1.30-2.00). Likewise, those with perceived
opportunities for PA were more likely to meet PHRs than those without this perception
(OR 1.23; 95% CI 1.02-1.50)- BMI had no effect on meeting PHRs for PA. Conclusion
The study shows a relation between personal motivation and some aspects of social and
physical environment in meeting current PHRs for PA. Future research involving an
objective environment to meet PHRs for PA should be undertaken to validate these
findings.
Choi, J., J. Wilbur, et al. (2008). "Correlates of leisure-time physical activity in Korean
immigrant women." West J Nurs Res 30(5): 620-38.
This study describes the physical activity behavior of Korean immigrant women
and examines the relationships among leisure-time physical activity (LTPA) behavior,
background, and intrapersonal correlates of behavior in Korean immigrant women in the
United States using a cross-sectional survey design. A convenience sample of
Midwestern Korean immigrant women completed the long form of the International
Physical Activity Questionnaire in Korean. Among the participants, 78% were physically
active, meeting the Healthy People 2010 goal for physical activity when all physical
activity behaviors were considered, whereas 23% met the goal when only LTPA was
considered. Women who were older, did not have a child younger than 5, used
environmental resources for physical activity, had lower depressive symptoms, and had
higher confidence for overcoming exercise barriers were spent more time in LTPA.
Accommodating those with young children, enhancing environmental resource use, and
improving exercise self-efficacy are important considerations for interventions aimed at
increasing LTPA in Korean immigrant women.
Cleland, V. J., K. Ball, et al. (2008). "Personal, social and environmental correlates of
resilience to physical inactivity among women from socio-economically disadvantaged
backgrounds." Health Educ Res.
While sex and socio-economic disparities in physical activity have been well
documented, not all disadvantaged women are inactive. This study aimed to examine
correlates of achieving recommended levels of physical activity among women of low
socio-economic position. In 2005, a population-based sample of 291 women with low
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educational attainment provided survey data on leisure time physical activity (LTPA).
Participants reported potential personal (enjoyment and self-efficacy; barriers; intentions;
guilt and priorities; routines and scheduling; occupational physical activity; television
viewing), social (support from family/friends; social participation; sport/recreation club
membership; dog ownership) and environmental (aesthetics; safety; local access;
footpaths; interesting walks; busy roads to cross; heavy traffic) correlates of physical
activity. Nearly 40% of participants achieved recommended LTPA (150 min week(-1)).
Multivariable analyses revealed that higher levels of self-efficacy for walking [prevalence
ratio (PR) 2.05, 95% confidence interval (CI) 1.19-3.53], higher enjoyment of walking
(PR 1.48, 95% CI 1.04-2.12), greater intentions to be active (PR 1.97, 95% CI 1.12-3.45)
and having set routines for physical activity (PR 1.91, 95% CI 1.18-3.09) were
significantly associated with achieving recommended LTPA. Personal factors were the
characteristics most strongly associated with achieving recommended levels of LTPA
among women from socio-economically disadvantaged backgrounds.
Cleland, V. J., A. Timperio, et al. (2008). "Are perceptions of the physical and social
environment associated with mothers' walking for leisure and for transport? A
longitudinal study." Prev Med 47(2): 188-93.
OBJECTIVE: The role local neighbourhood environments play in influencing
purpose-specific walking behaviors has not been well-explored in prospective studies.
This study aimed to cross-sectionally and prospectively examine whether local physical
and social environments were associated with mothers' walking for leisure and for
transport. METHODS: In 2004, 357 mothers from Melbourne, Australia, provided
information on their local physical and social neighbourhood environments, and in 2004
and 2006 reported weekly time spent walking for leisure and for transport. Environmental
predictors of high levels of walking and increases in walking were examined using log
binomial regression. RESULTS: Public transport accessibility and trusting many people
in the neighbourhood were predictive of increases in walking for leisure, while
connectivity, pedestrian crossings, a local traffic speed were predictive of increases in
transport-related walking. Satisfaction with local facilities was associated with increasing
both types of walking, and the social environment was important for maintaining high
levels of both leisure- and transport-related walking. CONCLUSION: The findings
provide evidence of a longitudinal relationship between physical and social environments
and walking behaviors amongst mothers. Enhancing satisfaction with local facilities and
giving consideration to 'walkability', safety and public transport accessibility during
environment planning processes may help mothers to increase walking.
Cole, R., E. Leslie, et al. (2008). "Motivational readiness for active commuting by
university students: incentives and barriers." Health Promot J Austr 19(3): 210-5.
ISSUE ADDRESSED: Walking for transport can contribute significantly to
health-enhancing physical activity. We examined the associations of stages of
motivational readiness for active transport with perceived barriers and incentives to
walking to and from university among students. METHODS: Mail-back surveys were
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completed by 781 students in a regional university in south-east Queensland. They
identified one of eight options on motivational readiness for active commuting, which
were then classified as: pre-contemplation; contemplation-preparation; or, actionmaintenance. Open-ended questions were used to identify relevant barriers and
incentives. Logistic regressions were used to examine the barriers and incentives that
distinguished between those at different stages of motivational readiness. RESULTS:
Barriers most frequently reported were long travel distances, inconvenience and time
constraints. Incentives most frequently reported were shorter travel distance, having more
time, supportive infrastructure and better security. Those not considering active
commuting (pre-contemplation) were significantly more likely to report shorter travel
distance as an incentive compared to those in contemplation-preparation. Those in
contemplation-preparation were significantly more likely to report lack of motivation,
inadequate infrastructure, shorter travel distance and inconvenience as barriers; and,
having more time, supportive infrastructure, social support and incentive programs as
encouragement. CONCLUSIONS: Different barriers and incentives to walking to or from
university exist for students in the different stages of motivational readiness for active
commuting. Interventions targeted specifically to stage of motivational readiness may be
potentially helpful in increasing activity levels, through active transport.
Coleman, K. J., D. E. Rosenberg, et al. (2008). "Physical activity, weight status, and
neighborhood characteristics of dog walkers." Preventive Medicine 47(3): 309-312.
Objective. This study examined how demographics, physical activity, weight
status, and neighborhood characteristics varied among households with and without dogs.
Method. Participants aged 20 to 65 years (n=2199, 52% male, 75% white, mean age=45)
were recruited from 32 neighborhoods in the Seattle, WA and Baltimore, MD regions
during 2002-2005. Dog ownership, dog walking, education, height, weight, and family
income were self-reported. Minutes of moderate to vigorous physical activity (MVPA)
were measured objectively by 7-day accelerometry. Results. Dog walking was associated
with a higher proportion of participants who met national recommendations for MVPA
(53%) when compared to those who had but did not walk their dog (33%) and to non-dog
owners (46%). There were significantly fewer obese dog walkers (17%) when compared
to both owners who did not walk their dogs (28%) and non-owners (22%). Dog owners
who walked their dogs were more likely to live in high-walkable neighborhoods when
compared to dog owners who did not walk their dogs. Conclusion. Dog walking may
promote physical activity and contribute to weight control. Dog walking appears to be a
mechanism by which residents of high-walkable neighborhoods obtain their physical
activity. (C) 2008 Elsevier Inc. All rights reserved.
Cronan, M. K., K. J. Shinew, et al. (2008). "Physical activity patterns and preferences
among latinos in different types of public parks." J Phys Act Health 5(6): 894-908.
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BACKGROUND: Centers for Disease Control (CDC) data suggest that Latinos
are less likely to be physically active and more likely to be overweight and suffer from
resulting complications than are Whites and that within the Latino population, Latina
women are especially at risk. Therefore, promoting physical activity among Latinos, and
understanding gender participation patterns within that population, is particularly
important. One strategy for encouraging physical activity is to promote active uses of
public parks. METHODS: A national, multiyear, multisite study funded by the USDA
Forest Service sought to understand use of public parks by Latinos and Latinas in Los
Angeles, Minneapolis, and Chicago. RESULTS: More than 50% of our sample visited
parks to engage in physical activity, and in part, activity choice was related to gender.
Furthermore, nearly half of all respondents walked to city park sites, whereas few or none
walked to state or regional park sites. CONCLUSIONS: Our data suggest that Latinos are
using some parks repeatedly and, in the case of city parks, are using them for physical as
well as social activity. Therefore, we suggest specific ways that parks could be managed
to encourage more physical activity while taking into account gender variations.
de Geus, B., I. De Bourdeaudhuij, et al. (2008). "Psychosocial and environmental factors
associated with cycling for transport among a working population." Health Educ Res
23(4): 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, ecologicaleconomic awareness and lack of time and interest were positively associated with the
likelihood of cycling for transport and varied in importance between cyclists and noncyclists. 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.
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Floyd, M. F., J. O. Spengler, et al. (2008). "Environmental and Social Correlates of
Physical Activity in Neighborhood Parks: An Observational Study in Tampa and
Chicago." Leisure Sciences 30(4): 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.
ABSTRACT FROM AUTHOR
Forsyth, A., M. Hearst, et al. (2008). "Design and destinations: Factors influencing
walking and total physical activity." Urban Studies 45(9): 1973-1996.
Do people walk more, or less, depending on the physical character of their
residential areas rather than merely their individual characteristics? This paper reports
findings for the Twin Cities, Minnesota, about how walking and total physical activity
are affected by street pattern, 'pedestrian-oriented' infrastructure and amenities, and
mixed use or destinations-in shorthand, design and destinations. The effects of density are
dealt with in less depth. Like earlier studies, it finds that walking for specific purposes
(i.e. travel or leisure) varies in relation to the physical characteristics of places. However,
this study using multiple measures of overall walking and physical activity suggests that
socially similar people do the same total amount of physical activity in different kinds of
places and that level of activity is, on average, low.
Frank, L. D., J. Kerr, et al. (2008). "A hierarchy of sociodemographic and environmental
correlates of walking and obesity." Preventive Medicine 47(2): 172-178.
Objectives. Initial studies demonstrate the need for further investigation of how
the association of built environment with physical activity and BMI may differ by
sociodemographic subgroups. The aim of this study was to use a novel statistical
technique to identify possible subgroups. Methods. Data from the 2002 Strategies for
Metro Atlanta's Regional Transportation and Air Quality (SMARTRAQ) study were
analyzed to explore relationships between measures of residential density, street
connectivity, land use mix, and sociodemographic characteristics of individuals in
predicting walking, overweight and obesity status. Chi-squared Automatic interaction
Detector (CHAID) analyses were used to partition the population into subgroups
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(N=13,065). Results. Subgroups, were more likely to walk if they lived in neighborhoods
with greater residential density, greater street connectivity and greater land use mix. A
similar relationship was seen in men for the outcomes of obesity and overweight. Male
residents of more walkable neighborhoods were less likely to be obese or overweight. In
contrast, features of walkability were related to higher rates of obesity and overweight in
women and non whites. Conclusions. These analyses reveal that gender and ethnic
subgroups display substantially different weight outcomes across different levels of
walkability. In contrast, walking was consistently higher for all groups in the more
walkable neighborhoods. This information can contribute to better targeting of
interventions, and calls for more detailed investigadion of the moderators that affect
weight and physical activity across subgroups. This information supports a more efficient
use of scarce resources to promote physical activity and healthy body weight. (C) 2008
Published by Elsevier Inc.
Garden, F. L. and B. B. Jalaludin (2009). "Impact of urban sprawl on overweight,
obesity, and physical activity in sydney, australia." J Urban Health 86(1): 19-30.
Obesity and inadequate physical activity are major risk factors for many diseases.
The built environment plays an important role in influencing participation in physical
activity. We aimed to determine whether urban sprawl in Sydney, Australia is associated
with overweight/obesity and levels of physical activity. We used a cross-sectional
multilevel study design to relate urban sprawl (based on population density) measured at
an area level to overweight/obesity and levels of physical activity measured at an
individual level whilst controlling for individual and area level covariates in metropolitan
Sydney. Individual level data were obtained from the 2002 and 2003 New South Wales
Population Health Survey. We had information on 7,290 respondents. The mean
population density was 2,168 persons per square kilometer (standard deviation = 1,741,
range = 218-7,045). After controlling for individual and area level covariates, for an
inter-quartile increase in sprawl, the odds of being overweight was 1.26 (95% CI = 1.101.44), the odds of being obese was 1.47 (95% CI = 1.24-1.75), the odds of inadequate
physical activity was 1.38 (95% CI = 1.21-1.57), and the odds of not spending any time
walking during the past week was 1.58 (95% CI = 1.28-1.93). Living in more sprawling
suburbs increases the risk of overweight/obesity and inadequate physical activity despite
the relatively low levels of urban sprawl in metropolitan Sydney. Modifications to the
urban environment to increase physical activity may be worthwhile.
Grafova, I. B., V. A. Freedman, et al. (2008). "Neighborhoods and obesity in later life."
Am J Public Health 98(11): 2065-71.
OBJECTIVES: We examined the influence of neighborhood environment on the
weight status of adults 55 years and older. METHODS: We conducted a 2-level logistic
regression analysis of data from the 2002 wave of the Health and Retirement Study. We
included 8 neighborhood scales: economic advantage, economic disadvantage, air
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pollution, crime and segregation, street connectivity, density, immigrant concentration,
and residential stability. RESULTS: When we controlled for individual- and family-level
confounders, living in a neighborhood with a high level of economic advantage was
associated with a lower likelihood of being obese for both men (odds ratio [OR] = 0.86;
95% confidence interval [CI] = 0.80, 0.94) and women (OR = 0.83; 95% CI = 0.77,
0.89). Men living in areas with a high concentration of immigrants and women living in
areas of high residential stability were more likely to be obese. Women living in areas of
high street connectivity were less likely to be overweight or obese. CONCLUSIONS:
The mechanisms by which neighborhood environment and weight status are linked in
later life differ by gender, with economic and social environment aspects being important
for men and built environment aspects being salient for women.
Kaczynski, A. T. and K. A. Henderson (2008). "Parks and recreation settings and active
living: a review of associations with physical activity function and intensity." J Phys Act
Health 5(4): 619-32.
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.
Kaczynski, A. T., L. R. Potwarka, et al. (2008). "Association of park size, distance, and
features with physical activity in neighborhood parks." Am J Public Health 98(8): 14516.
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.
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Park facilities were more important than were park amenities. Of the park facilities, 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.
Kamphuis, C. B., K. Giskes, et al. (2008). "Area variation in recreational cycling in
Melbourne: a compositional or contextual effect?" J Epidemiol Community Health
62(10): 890-8.
OBJECTIVE: To examine whether compositional and/or contextual area
characteristics are associated with area socioeconomic inequalities and between-area
differences in recreational cycling. SETTING: The city of Melbourne, Australia.
PARTICIPANTS: 2349 men and women residing in 50 areas (58.7% response rate).
MAIN OUTCOME MEASURE: Cycling for recreational purposes (at least once a month
vs never). DESIGN: In a cross-sectional survey participants reported their frequency of
recreational cycling. Objective area characteristics were collected for their residential
area by environmental audits or calculated with Geographic Information Systems
software. Multilevel logistic regression models were performed to examine associations
between recreational cycling, area socioeconomic level, compositional characteristics
(age, sex, education, occupation) and area characteristics (design, safety, destinations or
aesthetics). RESULTS: After adjustment for compositional characteristics, residents of
deprived areas were less likely to cycle for recreation (OR 0.66; 95% CI 0.43 to 1.00),
and significant between-area differences in recreational cycling were found (median odds
ratio 1.48 (95% credibility interval 1.24 to 1.78). Aesthetic characteristics tended to be
worse in deprived areas and were the only group of area characteristics that explained
some of the area deprivation differences. Safety characteristics explained the largest
proportion of between-area variation in recreational cycling. CONCLUSION: Creating
supportive environments with respect to safety and aesthetic area characteristics may
decrease between-area differences and area deprivation inequalities in recreational
cycling, respectively.
Kemperman, A. and H. J. P. Timmermans (2008). "Influence of socio-demographics and
residential environment on leisure activity participation." Leisure Sciences 30(4): 306324.
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
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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.
King, A. C., W. A. Satariano, et al. (2008). "Multilevel modeling of walking behavior:
advances in understanding the interactions of people, place, and time." Med Sci Sports
Exerc 40(7 Suppl): S584-93.
It has become increasingly clear that the influences on walking as well as other
forms of regular physical activity are complex and require an increased understanding of
factors across multiple levels of influence. Ecological frameworks have provided the field
with a heuristic means of capturing potential impacts on behavior across diverse domains,
including personal, behavioral, social or cultural, and environmental. We discuss
advances in both understanding and applying this framework through the inclusion of
previously ignored dimensions of impact (e.g., time), the application of state-of-the-art
statistical methods for understanding interactions among multiple domains (e.g., signal
detection), and the development of computer technologies (e.g., agent-based modeling)
aimed at simulating the complex relationships between multiple levels of impact and
walking behavior. We conclude with suggestions for future research in this emerging
field.
Lee, C. and A. V. Moudon (2008). "Neighbourhood design and physical activity."
Building Research And Information 36(5): 395-411.
Health problems related to physical inactivity have become a global health
challenge affecting people from the full spectrum of income, age, and ethnicity. This
paper examines if neighbourhood environments are associated with physical activity,
especially walking and cycling. It analyses 608 respondent survey data from Washington
State in the US and Geographic Information System-derived measures of the
neighbourhood environment. Respondents reported traffic volume to be the most
significant barrier, and good lighting to be the most important facilitator of walking and
cycling. Utilitarian destinations, such as grocery stores, restaurants, retail stores and
convenience stores, were significant correlates of walking and moderate-intensity
physical activities, while housing type, sports facility and transportation infrastructure
were correlated with vigorous physical activities. Active people rated higher for their
neighbourhood attributes including safety, visual quality, knowing neighbours, seeing
many other people walking and cycling, and the availability of sports facilities, parks, and
bike racks. Simple interventions such as street lighting, pavements/sidewalks, street trees,
benches, bike lanes or trails, bike racks, and traffic-calming devices appeared to hold
some promise in promoting physical activities in neighbourhoods. Long-term solutions
should include strategies to enhance overall aesthetics, safety, accessibility, street
connectivity, and social interactions among neighbours.
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Li, F., P. A. Harmer, et al. (2008). "Built environment, adiposity, and physical activity in
adults aged 50-75." Am J Prev Med 35(1): 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 GISderived 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>or=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: 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.
Lin, J. and L. Long (2008). "What neighborhood are you in? Empirical findings of
relationships between household travel and neighborhood characteristics." Transportation
35(6): 739-758.
In recent years, there have been studies of the influence of neighborhood or built
environment characteristics on residential location choice and household travel behavior.
Interestingly, there is no uniform definition of neighborhood in the literature and the
definition is often vague. This paper presents an alternative way of defining
neighborhood and neighborhood type, which involves innovative usage of public data
sources. Furthermore, the paper investigates the interaction between neighborhood
environment and household travel in the US. A neighborhood here is spatially identical to
a census tract. A neighborhood type identifies a group of neighborhoods with similar
neighborhood socio-economic, demographic, and land use characteristics. This is
accomplished by performing log-likelihood clustering on the Census Transportation
Planning Package (CTPP) 2000 data. Five household travel measures, i.e., number of
trips per household, mode share, average travel distance and time per trip, and vehicle
miles of travel (VMT), are then compared across the resulting 10 neighborhood types,
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using the 2001 National Household Travel Survey (NHTS) household and trip files. It is
found that household life cycle status and residential location are not independent. Transit
availability at place of residence tends to increase the transit mode share regardless of
household automobile ownership and income level, and job-housing trade-offs are
evident when mobility is not of concern. The study also reveals racial preference in
residential location and contrasting travel characteristics among ethnic groups.
Liang, H., K. Tomey, et al. (2008). "Objective Measures of Neighborhood Environment
and Self-Reported Physical Activity in Spinal Cord Injured Men." Archives of Physical
Medicine & Rehabilitation 89(8): 1468.
Abstract: Liang H, Tomey K, Chen D, Savar NL, Rimmer JH, Braunschweig CL.
Objective measures of neighborhood environment and self-reported physical activity in
spinal cord injured men. Objectives: To assess the relationship between objective
neighborhood environment and self-reported physical activity (PA) and between PA and
obesity-related risk factors in people with spinal cord injury (SCI). Design: A crosssectional study. Setting: Urban university. Participants: Men with SCI (N=131), 20 to 59
years old, at least 1 year postinjury and using wheelchair for mobility most of the time.
Interventions: Not applicable. Main Outcome Measures: Metabolic syndrome (abdominal
obesity, elevated blood pressure, glucose, triglycerides, and low-high density lipoprotein
cholesterol) and high C-reactive protein (CRP), as well as total PA metabolic equivalent
score. Results: Lower PA was associated with higher prevalence rate for elevated
triglycerides, metabolic syndrome, and high CRP. Compared with those in low PA tertile,
those in high PA tertile had significantly lower odds for elevated triglycerides (odds ratio
[OR]=.19; 95% confidence interval [CI].04–.80), metabolic syndrome (OR=.15; 95%
CI.03–.66) and high CRP (OR=.17; 95% CI.04–.71) while adjusting for relevant
factors. In crude analysis, lower PA was associated with neighborhood environmental
characteristics including shorter distance to nearest transit stops, smaller mean block area,
greater number of transit stops, high vacant housing, and higher neighborhood crime rate.
In multivariate analysis higher total crime was the only risk factor significantly associated
with lower PA level. Those living in higher crime rate neighborhoods had 86% lower
odds of having greater than median PA level (OR=.14; 95% CI.04–.49) than their
counterparts. Conclusions: In men with SCI, lower PA is independently associated with
having elevated triglycerides, metabolic syndrome, and high CRP. Copyright 2008
Elsevier
Lopez, I. A., C. A. Bryant, et al. (2008). "Influences on physical activity participation
among Latinas: an ecological perspective." Am J Health Behav 32(6): 627-39.
OBJECTIVES: To explore intrapersonal, social environmental, and physical
environmental influences that promote or impede total physical activity (TPA) among
Latinas in Lee County, Florida. METHODS: In-depth interviews (n=41) and face-to-face
surveys (n=358). RESULTS: Women who worked outside the home, had positive
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attitudes about activity, perceived themselves to have access to activity facilities, and
perceived their neighborhood to be safe reported higher TPA. Women who had more
education and whose health information source was radio had lower TPA.
CONCLUSIONS: Intrapersonal and environmental factors influence TPA levels among
Latinas. Segmenting Latina groups using these factors may promote more involvement in
physical activity through targeted programs and messages.
Lovasi, G. S., A. V. Moudon, et al. (2008). "Using built environment characteristics to
predict walking for exercise." International Journal Of Health Geographics 7.
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 Cstatistic 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.
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Maas, J., R. A. Verheij, et al. (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
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.
Mau, M. K., K. N. Wong, et al. (2008). "Environmental factors of obesity in communities
with native Hawaiians." Hawaii Med J 67(9): 233-6.
OBJECTIVE: To compare the fast food outlets and exercise resources across 3
communities with varying percentages of Native Hawaiians (NH) and to correlate these
findings with obesity prevalence. METHODS: Data on all food and exercise resources
were collected from January through July 2006 within a 1-mile radius in 3 distinct
communities (site A = higher % NH to site C = lower % NH). Comparisons between
communities were analyzed in 2007 using Fisher's Exact and ANOVA. RESULTS:
Trends in obesity prevalence paralleled the percentage of NHs. After adjusting for
population size, site B had a greater number of fast food outlets (p < 0.001) than site A or
C, and more exercise facilities compared to site A (p = 0.05). Availability of fast food
outlets was significantly greater at site A compared to site C (p = 0.03). Usage of exercise
facilities was not significantly different between sites although exercise resources were in
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'poorer' condition at site A compared to site B or C (p < or = 0.05). DISCUSSION:
Results confirm the increased frequency of obesogenic environmental factors and their
correlation with obesity trends across 3 distinct NH communities. These results suggest
that environmental factors may offer another means for reducing obesity disparities in
minority communities.
Morris, K. S., E. McAuley, et al. (2008). "Self-efficacy and environmental correlates of
physical activity among older women and women with multiple sclerosis." Health Educ
Res 23(4): 744-52.
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 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.
Nagel, C. L., N. E. Carlson, et al. (2008). "The relation between neighborhood built
environment and walking activity among older adults." Am J Epidemiol 168(4): 461-8.
The association of neighborhood built environment with walking activity has
received growing attention, although most studies have relied upon subjective measures
of the built environment and few have examined the relation between built environment
and walking among older adults. This 2001 study examined the relation between
objectively measured characteristics of the local neighborhood and walking activity
among a sample of 546 community-dwelling older adults in Portland, Oregon. A
geographic information system was used to derive measures of the built environment
within a quarter-mile (0.4 km) and half-mile (0.8 km) radius around each participant's
residence. Multilevel regression analysis was used to examine the association of built
environment with walking behavior. No association between built environment and the
likelihood of walking or not walking was observed in this cohort of older adults.
However, among those participants who reported some degree of walking activity,
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average time spent walking per week was significantly associated with amount of
automobile traffic and number of commercial establishments in their local neighborhood.
These findings suggest that built environment may not play a significant role in whether
older adults walk, but, among those who do walk, it is associated with increased levels of
activity.
Ntandou, G., H. Delisle, et al. (2008). "Physical activity and socioeconomic status
explain rural-urban differences in obesity: A cross-sectional study in Benin (West
Africa)." Ecology Of Food And Nutrition 47(4): 313-337.
To explore the relationships between obesity, socioeconomic status (SES), and
physical activity (PA), we conducted a study with 341 subjects of a medium-size city of
Benin and its semi-rural outskirts. PA was appraised with 24-hour recalls and SES, with a
questionnaire. The overall prevalence of obesity (body mass index [BMI] >= 30),
abdominal obesity (waist circumference) and elevated percent of body fat (%BF) were
10.6%, 23.8% and 20.2%, respectively. However, 14.6% were underweight (BMI 18.5).
Overweight (BMI >= 25) was significantly higher in urban than rural areas and in women
than men. SES and PA were independently associated with obesity indicators, while
urbanization variables were not.
Ogilvie, D., R. Mitchell, et al. (2008). "Personal and environmental correlates of active
travel and physical activity in a deprived urban population." International Journal Of
Behavioral Nutrition And Physical Activity 5.
Background: Environmental characteristics may be associated with patterns of
physical activity in general or with particular types of physical activity such as active
travel (walking or cycling for transport). However, most studies in this field have been
conducted in North America and Australia, and hypotheses about putative correlates
should be tested in a wider range of sociospatial contexts. We therefore examined the
contribution of putative personal and environmental correlates of active travel and overall
physical activity in deprived urban neighbourhoods in Glasgow, Scotland as part of the
baseline for a longitudinal study of the effects of opening a new urban motorway
(freeway). Methods: We conducted a postal survey of a random sample of residents (n =
1322), collecting data on socioeconomic status, perceptions of the local environment,
travel behaviour, physical activity and general health and wellbeing using a new 14-item
neighbourhood rating scale, a travel diary, the short form of the International Physical
Activity Questionnaire (IPAQ) and the SF-8. We analysed the correlates of active travel
and overall physical activity using multivariate logistic regression, first building models
using personal (individual and household) explanatory variables and then adding
environmental variables. Results: Active travel was associated with being younger, living
in owner-occupied accommodation, not having to travel a long distance to work and not
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having access to a car, whereas overall physical activity was associated with living in
social rented accommodation and not being overweight. After adjusting for personal
characteristics, neither perceptions of the local environment nor the objective proximity
of respondents' homes to motorway or major road infrastructure explained much of the
variance in active travel or overall physical activity, although we did identify a significant
positive association between active travel and perceived proximity to shops. Conclusion:
Apart from access to local amenities, environmental characteristics may have limited
influence on active travel in deprived urban populations characterised by a low level of
car ownership, in which people may have less capacity for making discretionary travel
choices than the populations studied in most published research on the environmental
correlates of physical activity.
Ouedraogo, H. Z., F. Fournet, et al. (2008). "Socio-spatial disparities of obesity among
adults in the urban setting of Ouagadougou, Burkina Faso." Public Health Nutr 11(12):
1280-7.
OBJECTIVES: To document the prevalence and the socio-spatial variations of
obesity and to identify individual and household characteristics, lifestyles and dietary
practices contributing to obesity and its socio-spatial distribution. DESIGN: Populationbased cross-sectional survey. We selected 1,570 households from four strata
characterised as unstructured and low building-density (ULBD), unstructured and high
building-density (UHBD), structured and low building-density (SLBD) and structured
and high building-density (SHBD) areas. Structured areas are those that were allotted by
the township authority (cadastral services), with public services; unstructured areas refer
to those developed with no cadastral organisation. SETTING: Ouagadougou, the capital
city of Burkina Faso. SUBJECTS: BMI was calculated in 2022 adults aged 35 years and
above who were classified as obese when their BMI was >or=30 kg/m2. Obesity was
investigated in relation to household and individual characteristics, lifestyles and dietary
practices; adjusted odds ratios with 95 % confidence intervals were derived from a
logistic regression model. RESULTS: The overall prevalence of obesity was 14.7 %
(males 5.5 % and females 21.9 %). Age, gender, household equipment index, usual
transport with motor vehicles and micronutrient-rich food consumption were associated
with obesity. After adjustment for these factors, obesity remained associated with the area
of residence: residents from SHBD areas were more likely to be obese than those from
ULBD areas (OR = 1.41; 95 % CI 2.59,4.76). CONCLUSIONS: Obesity in
Ouagadougou is a preoccupant problem that calls for more consideration. Thorough
investigation is needed to assess the environmental factors that contribute to the sociospatial disparity of obesity.
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Panter, J. R. and A. P. Jones (2008). "Associations between physical activity, perceptions
of the neighbourhood environment and access to facilities in an English city." Soc Sci
Med 67(11): 1917-23.
This article explores the environmental influences on physical activity in an
English city. The cross-sectional design of this study allowed us to determine whether
perceptions of the local environment and access to facilities were associated with activity
in a sample of urban residents (n=401). Logistic regression analysis revealed that
respondents who rated their neighbourhood as being of high walkability also tended to
report higher levels of overall physical activity. Neighbourhood perceptions were also
associated with higher reporting of aerobic activity and walking, although these
observations did not reach statistical significance. There is a need for further studies to
clarify the respective roles that social and environmental factors play in determining
observed variations in physical activity.
Pescatello, L. S., M. Alonso, et al. (2008). "Determinants of physical activity among a
convenience sample of Puerto Rican women residing in the Northeastern United States."
J Strength Cond Res 22(5): 1515-21.
The research examining determinants of physical activity among Hispanics
focuses on Mexican Americans, although Puerto Ricans are the second largest Hispanic
subgroup in the United States. The purpose of this study was to explore factors
influencing physical activity among Puerto Rican women in the urban northeastern
United States. Two bilingual female investigators administered the Women and Physical
Activity Survey by telephone to a convenience sample of Puerto Rican women (n = 28).
Women were categorized as physically active if they performed moderate-intensity
physical activity for at least 30 minutes a day at least 5 days a week or vigorous-intensity
physical activity for at least 20 minutes a day at least 3 days a week. Women not meeting
these criteria were classified as physically inactive. Chi-squared testing revealed whether
the physically active and inactive women differed among physical activity determinants.
Respondents had a mean age of 36 years and were predominately college-educated (64%)
and physically active (68%). More physically active women (90%) had an annual income
of more than $35,000 than did the inactive women (10%) (p < 0.05). More physically
active women belonged to community groups (42% versus 0%), lived in communities
where people exercise (95% versus 11%), and felt their community was good for their
family (100% versus 67%) than did the inactive women, respectively (p < 0.05). The
physically active women reported the presence of exercise facilities (p = 0.084) and wellmaintained sidewalks (p = 0.087) to be more important for exercise accessibility than did
the inactive women. Annual income, sense of community, and exercise accessibility were
the most important physical activity determinants in this convenience sample of Puerto
Rican women. Factors influencing the physical activity levels of Puerto Rican women
should continue to be explored so that targeted, culturally appropriate strategies can be
developed to promote physically activity in this population.
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Pucher, J. and R. Buehler (2008). "Making cycling irresistible: Lessons from the
Netherlands, Denmark and Germany." Transport Reviews 28(4): 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.
Rodriguez, D. A., S. Aytur, et al. (2008). "Relation of modifiable neighborhood attributes
to walking." Preventive Medicine 47(3): 260-264.
Background. There is a paucity of research examining associations between
walking and environmental attributes that are more modifiable in the short term, such as
car parking availability, access to transit, neighborhood traffic. walkways and trails, and
sidewalks. Methods. Adults were recruited between April 2004 and September 2006 in
the Minneapolis-St Paul metropolitan area and in Montgomery County, Maryland using
similar research designs in the two locations. Self-reported and objective environmental
measures were calculated for participants' neighborhoods. Self-reported physical activity
was collected through the long form of the International Physical Activity Questionnaire
(IPAQ-LF). Generalized estimating equations were used to examine adjusted associations
between environmental measures and transport and overall walking. Results. Participants
(n = 887) averaged 47 years of age (SD = 13.65) and reported 67 min/week (SD =
121.21) of transport walking and 159 min/week (SD = 187.85) of non-occupational
walking. Perceived car parking difficulty was positively related to higher levels of
transport walking (OR 1.41, 95%CI: 1.18, 1.69) and overall walking (OR 1.18, 95%Cl:
1.02,137). Self-reported ease of walking to a transit stop was negatively associated with
transport walking (OR 0.86, 95%CI: 0.76, 0.97), but this relationship was moderated by
perceived access to destinations. Walking to transit also was related to non-occupational
walking (OR 0.85, 95%CI: 0.73. 0.99). Conclusions. Parking difficulty and perceived
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ease of access to transit are modifiable neighborhood characteristics associated with selfreported walking. (C) 2008 Elsevier Inc. All rights reserved.
Rundle, A., S. Field, et al. (2008). "Personal and neighborhood socioeconomic status and
indices of neighborhood walk-ability predict body mass index in New York City." Soc
Sci Med 67(12): 1951-8.
Past research has observed inverse associations between neighborhood and
personal level measures of socioeconomic status and body mass index (BMI), but has not
assessed how personal and neighborhood-level measures might interact together to
predict BMI. Using a sample of 13,102 adult residents of New York City who
participated in a health survey, cross-sectional multi-level analyses assessed whether
personal income, education and Zip code-level poverty rates were associated with BMI.
Demographic, income, education and objectively measured height and weight data were
collected in the survey and poverty rates and the proportion of Black and Hispanic
residents in the subject's Zip code were retrieved from the 2000 Census. Zip code-level
population density and land use mix, indices of neighborhood walk-ability which are
often higher in lower income neighborhoods and are associated with lower BMI, were
also measured. After controlling for individual and Zip code-level demographic
characteristics, increasing income was associated with lower BMI in women but not in
men, and college and graduate level education was associated with lower BMI in both
men and women. After control for income and individual and Zip code-level
demographic characteristics, higher Zip code poverty rate was unassociated with BMI.
However, as expected, indices of neighborhood walk-ability acted as substantial inverse
confounders in the relationship between Zip code poverty rate and BMI. After further
adjustment for indices of neighborhood walk-ability, Zip code poverty rate became
significantly, and positively associated with BMI in women. Among women, the inverse
association between income and BMI was significantly stronger in richer compared to
poorer Zip codes. In men and women, the association between college and graduate
education and lower BMI was significantly stronger in richer versus poorer Zip codes.
These analyses suggest that neighborhood socioeconomic context influences how
personal socioeconomic status interact in predicting boby size.
Saelens, B. E. 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.
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Santos, R., P. Silva, et al. (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(1): 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. (C) 2008 Elsevier Inc. All rights
reserved.
Scarborough, P. and S. Allender (2008). "The North-South gap in overweight and obesity
in England." British Journal Of Nutrition 100(3): 677-684.
Regional differences in overweight and obesity levels in England have mirrored
those of CVD, with higher levels in the North. It is unclear whether the increase in the
prevalence of overweight and obesity over the last 15 years has been consistent in
different regions of the country. BMI data from each of the health surveys for England
conducted between 1993 and 2004 were analysed. Annual grouped estimates of the
prevalence of overweight (BMI >= 25 kg/m(2)) and obesity (BMI >= 30 kg/m(2)) for the
North and the South of England were produced by appropriately combining regional
administrative authorities. Logistic regression analyses were performed to assess the
independence of the geographical effect after adjustment for age and social class. The
prevalence of both overweight and obesity in women has risen more quickly in the North
than in the South between 1993 and 2004, leading to a widening of inequalities. The
prevalence of both overweight and obesity ill women in the South has remained
reasonably stable since 1997. The prevalence rates of both conditions in men have risen
in parallel in the North and the South between 1993 and 2004 by approximately 8 %. The
OR for obesity for young women increased between 1993/98 and 1998/2004 from 1.07
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(1.00, 1.14) to 1.21 (1.13, 1.30). Widening geographical inequalities in overweight and
obesity rates in women could lead to widening inequalities in cardiovascular and other
diseases.
Schwetschenau, H. M., W. H. O'Brien, et al. (2008). "Barriers to physical activity in an
on-site corporate fitness center." J Occup Health Psychol 13(4): 371-80.
Many corporations provide employees the option of participating in on-site fitness
centers, but utilization rates are low. Perceived barriers to physical activity have been
established as important correlates of physical activity, and recent research indicates that
barriers may vary across settings. Work-site fitness centers may present unique barriers to
participation, but there are currently no standardized measures that assess such barriers.
Eighty-eight employees of a midwestern corporation completed a survey designed to
identify and evaluate the extent to which barriers influence participation in an on-site
corporate fitness center. Regression analyses revealed that external environmental
barriers (e.g., inadequate exercise facilities) significantly accounted for not joining the
fitness center, and for decreased duration of visits to the facility among members. Internal
barriers (e.g., feeling embarrassed to exercise around coworkers) significantly accounted
for frequency of fitness center visits among members. This corporate specific measure
may lead to more effective interventions aimed to increase use of on-site corporate fitness
centers.
Sharpe, P. A., M. L. Granner, et al. (2008). "Correlates of physical activity among
African American and white women." Am J Health Behav 32(6): 701-13.
OBJECTIVE: To compare potential correlates of physical activity between
African American and white women. METHODS: A random-digit-dialed telephone
survey was conducted in central South Carolina. Bivariate and multivariate analyses
focused on women aged 18+ (N = 1176). RESULTS: African American women reported
greater maintenance of sidewalks and public parks than did white women, who reported
higher physical activity, exercise self-efficacy, access to indoor walking facilities, and
knowledge of mapped-out walking routes. Exercise self-efficacy was the only significant
correlate of physical activity among both African American and white women.
CONCLUSIONS: Self-efficacy was a robust cross-sectional correlate of physical activity
in women.
Sisson, S. B., J. J. McClain, et al. (2008). "Campus walkability, pedometer-determined
steps, and moderate-to-vigorous physical activity: A comparison of 2 university
campuses." Journal Of American College Health 56(5): 585-592.
Objective and Participants: At 2 Arizona State University (ASU) campuses, the
authors measured student activity and distance walked on campus, as well as student46
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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 96.5 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, 43 km/d; at Tempe, 3.1 km/d (p
=.03). Tempe students rated campus walkability 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.
Smith, K. R., B. B. Brown, et al. (2008). "Walkability and body mass index - Density,
design, and new diversity measures." American Journal Of Preventive Medicine 35(3):
237-244.
Background: Rising rates of overweight and obesity in the U.S. have increased
interest in community designs that encourage healthy weight. This study relates
neighborhood walkability-density, pedestrian-friendly design, and two novel 1 measures
of land-use diversity-to residents' excess weight. Methods: Walkable-environment
measures include two established predictors-higher density and pedestrian-friendly
design (intersections within 0.25 mile of each address)- and two new census-based, landuse diversity measures: the proportion of residents walking to work and the median age
of housing. In 2006, weight, height, age, and address data from 453, 927 Salt Lake
County driver licenses for persons aged 25-64 years were linked to 2000 Census and GIS
street-network information that was analyzed in 2007-2008. Linear regressions of BMI
and logistic regressions of overweight and obesity include controls for individual-level
age and neighborhood-level racial/ethnic composition, median age of residents, and
median family income. Results: Increasing levels of walkability decrease the risks of
excess weight. Approximately doubling the proportion of neighborhood residents
walking to work decreases art individual's risk of obesity by almost. 10%. Adding a
decade to the average age of neighborhood housing decreases women's risk of obesity by
about, 8% and men's by 13%. Population density is unrelated to weight in four of six
models, and inconsistently related to weight measures in two models. Pedestrian-friendly
street networks are unrelated to BMI bill. related to lower risks of overweight and obesity
in three of four models. Conclusions: Walkability indicators, particularly the two landuse diversity measures, are important predictors of body weight. Driver licenses should
be considered as a source of data for community studies of BMI, as they, provide
extensive coverage at low cost.
Titze, S., W. J. Stronegger, et al. (2008). "Association of built-environment, socialenvironment and personal factors with bicycling as a mode of transportation among
Austrian city dwellers." Prev Med 47(3): 252-9.
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OBJECTIVE: To determine the association of built-environment, socialenvironment, and personal-level factors with bicycling for transportation, among adult
city dwellers. METHOD: Survey of a representative sample of 1000 inhabitants of the
city of Graz, Austria, using a computer-assisted telephone interview addressing cycling
behavior and associated personal, social and environmental factors. RESULTS: The
prevalence of biking for transportation was 22.5%. After adjustment for gender, age,
education, physical activity level and distance from home to destination, cycling was
positively associated with the presence of bike lane connectivity (OR=2.09) and social
support/modeling (OR=1.62), and negatively associated with the perceived barriers of
"physical discomfort" (OR=0.49) and "an impractical transport mode" (OR=0.50).
Analysis of interactions indicated that the effect of the perceived benefit of "rapidity" was
stronger in physically active persons than inactive individuals, and the effect of the
perceived barrier of "an impractical mode of transportation" was stronger among women
than men. CONCLUSION: In addition to cycling-related social support and perceived
benefits and barriers, bike lane connectivity may be an important determinant of cycling
as a means of transportation among adult city dwellers.
Velasquez, K. S., C. K. Holahan, et al. (2009). "Relationship of perceived environmental
characteristics to leisure-time physical activity and meeting recommendations for
physical activity in Texas." Prev Chronic Dis 6(1): A24.
INTRODUCTION: We investigated the relationship of perceived environmental
characteristics to self-reported physical activity in Texas adults using 2004 Behavioral
Risk Factor Surveillance System data. METHODS: The 2 research questions were, "Are
perceived neighborhood characteristics and reported use of facilities associated with selfreported leisure-time physical activity for male and female Texas residents aged 18 to 64
years?" and "Are perceived neighborhood characteristics and reported use of facilities
related to meeting recommendations for moderate to vigorous physical activity for Texas
men and women aged 18 to 64 years?" Descriptive statistics and multiple logistic
regression were used for the analyses. RESULTS: Multiple logistic regression analyses
controlling for sociodemographic factors showed that for women, perceptions of
neighbors being physically active, pleasantness of the neighborhood, lighting, safety, and
feelings of neighbor trustworthiness were associated with leisure-time physical activity.
Several of these variables were also related to meeting recommendations for physical
activity. Reports of use of several types of neighborhood facilities were related to men's
and women's leisure-time physical activity and with meeting recommendations for
physical activity for women. CONCLUSION: Perceptions of neighborhood
characteristics and reported use of facilities were related to physical activity and to
meeting recommendations for physical activity, with stronger associations for women
than for men. Interventions to increase levels of physical activity among Texans should
be informed by multilevel assessments including environmental characteristics and by
attention to important subpopulations.
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Wiggs, I., R. C. Brownson, et al. (2008). "If you build it, they will come: lessons from
developing walking trails in rural Missouri." Health Promot Pract 9(4): 387-94.
Given the high rates of sedentary behaviors, attempts to increase physical activity
have incorporated individual and, more recently, policy and environmental approaches
for promotion of activity. This article presents a summary of the approaches being used
by the Ozark Heart Health Coalitions in developing walking trails in rural Missouri. In
summarizing these approaches the authors describe 10 lessons with the aim of
articulating the process and, thereby, increasing interest and capacity in development of
walking trails. Qualitative and quantitative data were used to show burden and priorities
and build support with numerous stakeholders. Stakeholders were engaged to identify
common objectives, obtain land and funding, and determine trail size, materials, and time
needed for construction. Implementation activities focused on trail maintenance and
addition of amenities (e.g., playgrounds, benches). In the area of evaluation, they collect
data via interviews with walkers on trails and community telephone surveys.
Williams, D. M., B. A. Lewis, et al. (2008). "Comparing Psychosocial Predictors of
Physical Activity Adoption and Maintenance." Annals Of Behavioral Medicine 36(2):
186-194.
Most health behavior models do not distinguish between determinants of behavior
adoption and maintenance. This study compared psychosocial predictors of physical
activity (PA) adoption and predictors of PA maintenance among 205 initially sedentary
adults enrolled in a home-based PA promotion trial. Psychosocial variables were
measured at 6 months (at which point 107 participants remained inactive and 98
participants adopted regular PA) and used to predict 12-month PA status (an indicator of
PA adoption among those inactive at 6 months and an indicator of PA maintenance
among those active at 6 months). Six-month PA status moderated the relationships
between 6-month measures of home access to PA equipment (p=.049), self-efficacy
(p=.086), and perceived satisfaction (p=.062) and 12-month PA status. Simple effects
analyses revealed that home access to PA equipment was predictive of PA adoption
(OR=1.73; 95% CI: 1.05, 2.85), but not PA maintenance (OR=0.88; 95% CI: 0.58, 1.35),
whereas self-efficacy and perceived satisfaction were predictive of PA maintenance
(OR=2.65; 95% CI: 1.55, 4.52; OR=1.95; 95% CI: 0.93, 4.06), but not PA adoption
(OR=1.50; 95% CI: 0.87, 2.57; OR=0.82, CI: 0.44, 1.52). Results suggest that these
psychosocial variables may operate differently in predicting PA adoption versus
maintenance.
Witten, K., R. Hiscock, et al. (2008). "Neighbourhood access to open spaces and the
physical activity of residents: a national study." Prev Med 47(3): 299-303.
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OBJECTIVE: Increasing population levels of physical activity is high on the
health agenda in many countries. There is some evidence that neighbourhood access to
public open space can increase physical activity by providing easier and more direct
access to opportunities for exercise. This national study examines the relationship
between travel time access to parks and beaches, BMI and physical activity in New
Zealand neighbourhoods. METHODS: Access to parks and beaches, measured in minutes
taken by a car, was calculated for 38,350 neighbourhoods nationally using Geographic
Information Systems. Multilevel regression analyses were used to establish the
significance of access to these recreational amenities as a predictor of BMI, and levels of
physical activity and sedentary behaviour in the 12,529 participants, living in 1178
neighbourhoods, of the New Zealand Health Survey 2002/3. RESULTS: Neighbourhood
access to parks was not associated with BMI, sedentary behaviour or physical activity,
after controlling for individual-level socio-economic variables, and neighbourhood-level
deprivation and urban/rural status. There was some evidence of a relationship between
beach access and BMI and physical activity in the expected direction. CONCLUSIONS:
This study found little evidence of an association between locational access to open
spaces and physical activity.
Yadav, K. and A. Krishnan (2008). "Changing patterns of diet, physical activity and
obesity among urban, rural and slum populations in north India." Obesity Reviews 9(5):
400-408.
Rapid urbanization and accompanying lifestyle changes in India lead to transition
in non-communicable disease risk factors. A survey was done in urban, urban slum and
rural population of Haryana, India, in a sample of 4129 men and 3852 women using
WHO STEPS questionnaire. A very high proportion of all the three populations reported
inadequate intake of fruits and vegetables. Rural men reported five times physical activity
as compared with urban and urban slum men and rural women reported seven times
physical activity as compared with women in the other two settings. Mean body mass
index (BMI) was highest among urban men (22.8 kg m(-2)) followed by urban slum (21.0
kg m(-2)) and rural men (20.6 kg m(-2)) (P-value < 0.01). Similar trend was seen for
women but at a higher level than men. Prevalence of obesity (BMI >= 30 kg m(-2)) was
highest for urban population (male = 5.5%, female = 12.6%) followed by urban slum
(male = 1.9%, female = 7.2%) and rural populations (male = 1.6%, female = 3.8%).
Urbanization increases the prevalence of the studied non-communicable disease risk
factors, with women showing a greater increase as compared with men. Noncommunicable disease control strategy needs to address urbanization and warrants gender
sensitive strategies specifically targeting women.
Policy and Physical Activity/Obesity
(2008). "Public policy and physical activity in U.S. schools." Active Living 17(4): 13.
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Several excerpts from a letter by Sheila Franklin, director of the U.S. National
Coalition for Promoting Physical Activity, are presented.
Boyle, S. E., G. L. Jones, et al. (2008). "Physical activity among adolescents and barriers
to delivering physical education in Cornwall and Lancashire, UK: A qualitative study of
heads of PE and heads of schools." Bmc Public Health 8.
Background: Recent initiatives have been introduced by the UK government into
secondary schools to increase pupils' access to physical activity (PA). Despite this, not
enough is known about pupils' levels of physical activity or whether the delivery of these
initiatives in schools facilitates or creates a barrier for pupils' PA. The aim of this study
was to gain an understanding of adolescents PA levels from the perspective of those
responsible for delivering physical education (PE) in schools; heads of PE (HOPE) and
heads of school (HS). Methods: Seventeen semi-structured qualitative interviews were
carried out with a snowball sample of HOPE and HS in schools in the Northwest and
Southwest of England. Thematic data analysis using NVIVO was used to identify
emergent themes. Results: 17 core themes were generated, 12 of which confirmed the
findings from similar research. However, five themes relating to 'ethos of
performance/elitism', 'lower fitness leads to lower ability', 'undervaluing activities within
PE dept' or school as a whole', 'role of the school' and 'PE department doing all it can'
offer valuable new insight into the factors which may encourage or prevent PA inside or
outside the curriculum. Conclusion: Despite many positive perceptions of the delivery of
PE in schools, it is evident that barriers still exist within that delivery which discourages
physical activity. More research is needed to particularly address the complex issues of
elitism and the ethos of PA in schools.
Gladwin, C. P., J. Church, et al. (2008). "Public policy processes and getting physical
activity into Alberta's urban schools." Can J Public Health 99(4): 332-8.
OBJECTIVES: Public policies impact the amount of physical activity (PA) that
children receive at school. These policies are of interest because overweight and obesity
among Canadian children have grown at significant rates, and increasing PA among
children is one way to reverse this trend. This research investigates the public policy
processes that have resulted in Alberta's education system adopting in-school daily
physical activity (DPA) and not supporting walk-to-school (WTS) initiatives.
METHODS: Using the policy process described by Kingdon and others as a conceptual
framework, this research reviews literature and documents on public policy relating to
PA in schools and interviews key individuals (N = 20) to identify the policy-related
facilitators and barriers in Alberta, Canada to increasing PA in school-aged children.
RESULTS: DPA was mandated because Kingdon's three policy streams (problem,
solution and politics) became joined or linked. DPA was the most viable solution because
literature supports and teachers believe in the educational benefits of PA. As well, a
physician with personal beliefs about the benefits of PA became the minister of education
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and coupled the solution with the political stream through his ministerial power. Reasons
that WTS programs have not become school or health policy include advocacy led by
politically weak organizations, lack of a supportive policy entrepreneur and poor saliency
among educators. CONCLUSIONS: This research illuminates the inner workings of the
policy process shaping PA in schools, identifying the unseen forces of the policy process
that move issues forward. The findings provide valuable insight for building other
healthy public policies.
Jaime, P. C. and K. Lock (2009). "Do school based food and nutrition policies improve
diet and reduce obesity?" Prev Med 48(1): 45-53.
OBJECTIVE: To review the effectiveness of school food and nutrition policies
world wide in improving the school food environment, student's dietary intake, and
decreasing overweight and obesity. METHODS: Systematic review of published and
unpublished literature up to November 2007 of three categories of nutrition policy;
nutrition guidelines, regulation of food and/or beverage availability, and price
interventions applied in preschools, primary and secondary schools. RESULTS: 18
studies met the inclusion criteria. Most evidence of effectiveness was found for the
impact of both nutrition guidelines and price interventions on intake and availability of
food and drinks, with less conclusive research on product regulation. Despite the
introduction of school food policies worldwide few large scale or national policies have
been evaluated, and all included studies were from the USA and Europe.
CONCLUSION: Some current school policies have been effective in improving the food
environment and dietary intake in schools, but there is little evaluation of their impact on
BMI. As schools have been proposed worldwide as a major setting for tackling childhood
obesity it is essential that future policy evaluations measure the long term effectiveness of
a range of school food policies in tackling both dietary intake and overweight and
obesity.
Jurg, M. E., J. S. De Meij, et al. (2008). "Using health promotion outcomes in formative
evaluation studies to predict success factors in interventions: an application to an
intervention for promoting physical activity in Dutch children (JUMP-in)." Health
Promot Int 23(3): 231-9.
JUMP-in is a systematically developed intervention aimed at promoting physical
activity among primary school children. It is a joint project involving different authorities
and entails six school-based programme components. Measuring effects of such an
intervention is a complex challenge. A common problem is the lack of valid instruments
to measure physical activity and its determinants. In addition, it usually takes years to
find improvements in physical activity and related constructs like weight and fitness, or
even in causal factors. For this reason different authors advocate for the establishment of
'health promotion outcomes'; (i) health literacy, (ii) social action and influence and (iii)
healthy public policy and organizational practice. It is presumed that these health
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promotion outcomes lead to changes in determinants, behaviour and finally in health.
Insight in these health promotion outcomes and information about input and through-put
are important in discussing the impact and output. The formative evaluation study of the
JUMP-in pilot shows the health promotion outcomes of the intervention. The health
promotion outcomes 'social action and influence' and 'healthy public policy and
organizational practices' were found to be positive. By measuring the presence of the
conditions to achieve 'health literacy', it became clear that more attention must be paid to
implementation in the future. Based on the health promotion outcomes, we expect that
JUMP-in will be an effective intervention in the future.
Kumanyika, S. K., E. Obarzanek, et al. (2008). "Population-based prevention of obesity:
the need for comprehensive promotion of healthful eating, physical activity, and energy
balance: a scientific statement from American Heart Association Council on
Epidemiology and Prevention, Interdisciplinary Committee for Prevention (formerly the
expert panel on population and prevention science)." Circulation 118(4): 428-64.
Obesity is a major influence on the development and course of cardiovascular
diseases and affects physical and social functioning and quality of life. The importance of
effective interventions to reduce obesity and related health risks has increased in recent
decades because the number of adults and children who are obese has reached epidemic
proportions. To prevent the development of overweight and obesity throughout the life
course, population-based strategies that improve social and physical environmental
contexts for healthful eating and physical activity are essential. Population-based
approaches to obesity prevention are complementary to clinical preventive strategies and
also to treatment programs for those who are already obese. This American Heart
Association scientific statement aims: 1) to raise awareness of the importance of
undertaking population-based initiatives specifically geared to the prevention of excess
weight gain in adults and children; 2) to describe considerations for undertaking obesity
prevention overall and in key risk subgroups; 3) to differentiate environmental and policy
approaches to obesity prevention from those used in clinical prevention and obesity
treatment; 4) to identify potential targets of environmental and policy change using an
ecological model that includes multiple layers of influences on eating and physical
activity across multiple societal sectors; and 5) to highlight the spectrum of potentially
relevant interventions and the nature of evidence needed to inform population-based
approaches. The evidence-based experience for population-wide approaches to obesity
prevention is highlighted.
Maddock, J., L. B. Choy, et al. (2008). "Increasing access to places for physical activity
through a joint use agreement: a case study in urban Honolulu." Prev Chronic Dis 5(3):
A91.
BACKGROUND: To increase levels of physical activity (PA), interventions that
create or enhance access to places for PA are recommended. Establishing a joint use
agreement is one way to increase access to existing PA and recreational facilities. The
purpose of this article is to present a case study of In-Motion, a pilot joint use agreement
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project at one urban high school in Honolulu, Hawaii. CONTEXT: Residents of urban
Honolulu are underserved by the amount of parkland and recreational facilities available
for their use. The Honolulu County Department of Parks and Recreation sought to
implement a joint use agreement to use the facilities of one urban high school for a
recreational program. The high school selected for the pilot project has a student
population primarily from low-income and ethnic minority backgrounds. METHODS: An
assessment of the potential of 7 urban high schools to implement a joint use agreement
was conducted to select the pilot site. In-Motion developed and implemented a joint use
agreement. PA preferences of students, staff, and community members were assessed to
guide recreational program offerings. Various recreational classes were offered free to the
school community. CONSEQUENCES: Several barriers to implementing the joint use
agreement and recreational program were encountered. However, participants were
satisfied with the recreational classes they attended and said that the In-Motion program
helped them to engage in more PA. Program awareness by high school students and staff
was high. INTERPRETATION: In-Motion has successfully modeled a pilot joint use
agreement and provided new opportunities for PA to the high school's students, teachers,
and staff, and to community residents.
Musingarimi, P. (2009). "Obesity in the UK: A review and comparative analysis of
policies within the devolved administrations." Health Policy 91(1):10-16.
In the United Kingdom obesity is a significant public problem and the formulation
and implementation of policies to address it are primarily the responsibility of the
devolved administrations. Containing populations which are broadly similar, albeit with
regional differences, devolution allows for the exploration of the obesity policy directions
the different UK countries have taken; thus providing opportunities for policy learning
and comparison. A review and analysis of policy responses in the devolved
administrations reveals differences in the strategic approaches to tackling obesity with
England having recently introduced a population-wide strategy in contrast to the other
countries. Further, policies to address obesity in England and Northern Ireland are being
target driven in contrast to Scotland and Wales. In all the countries, the focus on obesity
has been on addressing childhood obesity with Scotland having taken the lead on setting
nutritional standards for school meals and the other countries subsequently following.
While devolution has provided scope for the variation in responses to address the obesity
epidemic in the UK, it is still too early to determine the impact of the different strategic
approaches being used to tackling it.
Ramanathan, S., K. R. Allison, et al. (2008). "Challenges in assessing the implementation
and effectiveness of physical activity and nutrition policy interventions as natural
experiments." Health Promot Int 23(3): 290-7.
The Ontario (Canada) government has instituted a policy requiring elementary
schools to offer at least 20 min of daily physical activity for students in Grades 1-8 and
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replace non-nutritious vending machine foods with healthier choices. These policy
interventions represent 'natural experiments' offering unique opportunities for conducting
research and evaluation. The use of natural experiments to contribute evidence on the
effectiveness of policy interventions is identified as an underused tool for public health
[Tudor-Locke, C., Ainsworth, B. E. and Popkin, B. M. (2001) Active commuting to
school: an overlooked source of children's physical activity? Sports Medicine, 31, 309313; Petticrew, M., Cummins, S., Ferrell, C., Findlay, A., Higgins, C., Hoy, C. et al.
(2005) Natural experiments: an underused tool for public health? Public Health, 119,
751-757]. To date, some Canadian school-based food and nutrition policies are being
monitored, but their impact on child and youth obesity is unknown [Canadian Institute for
Health Information. (2006) Improving the Health of Canadians: Promoting Healthy
Weights, Ottawa, ON]. There are a number of challenges to the evaluation of policy
interventions as natural experiments. Often, there are little or no baseline data available to
use as the basis for assessing change. Government policies that result in the adoption of
particular approaches across large jurisdictions, such as provinces, may result in wide
variation in the design and implementation of interventions. Thus, in some cases, natural
experiments may be at risk of having low potential to be adequately evaluated on key
outcomes. In this paper, we discuss the context of these challenges in relation to the
Ontario government school physical activity and nutrition policies.
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Social Environment and Physical Activity/Obesity (Youth)
Ahn, M. K., H. S. Juon, et al. (2008). "Association of race/ethnicity, socioeconomic
status, acculturation, and environmental factors with risk of overweight among
adolescents in California, 2003." Prev Chronic Dis 5(3): A75.
INTRODUCTION: Little has been published about racial/ethnic differences in the
prevalence of overweight among adolescents that accounts in detail for socioeconomic
status, acculturation, and behavioral and environmental factors. Increased understanding
of factors associated with overweight can provide a rational basis for developing
interventions to address the obesity epidemic in the United States. METHODS: Using a
cross-sectional analysis of data from adolescents who participated in the California
Health Interview Survey 2003, we estimated the prevalence of overweight and at risk of
overweight, combined as a single measure (AROW, body mass index > or =85th
percentile). We used logistic regression models to examine associations between AROW
and risk factors. RESULTS: Twenty-nine percent of California adolescents were AROW.
The prevalence of AROW differed significantly by sex and race. Boys were more likely
than girls to be AROW (33% vs 25%). American Indians/Pacific Islanders/others (39%)
were at highest risk, followed by Hispanics (37%), blacks (35%), whites (23%), and
Asians (15%). For boys, older age, Hispanic or American Indian/Pacific Islander/other
race/ethnicity, lower education of parents, and longer residence in the United States were
significantly associated with AROW. For girls, Hispanic or black race/ethnicity, lower
education of parents, and poor dietary habits were significantly associated with AROW.
CONCLUSION: The high prevalence of AROW among California adolescents in most
racial/ethnic groups indicates the need for culturally specific and appropriate
interventions to prevent and treat overweight.
Alam, A. A. (2008). "Obesity among female school children in North West Riyadh in
relation to affluent lifestyle." Saudi Medical Journal 29(8): 1139-1144.
Objectives: To estimate the prevalence of obesity among elementary school
female students and to identify some obesity-associated risk factors. Methods: This crosssectional study surveyed healthy female school students (grades 4-6) during 2006-2007.
Four private schools in North West Riyadh, Kingdom of Saudi Arabia were selected
where the majority of high income families enrolled their daughters. One thousand and
two hundred students were included. A pre-designed validated questionnaire was used for
data collection. Weights and heights were measured, and the body mass index (BMI) was
calculated. Students were categorized into "obese" and "non-obese" according to BMI by
age scale. Results: A total of 1072 students participated in the study with a response rate
of 89.3%. Obesity was prevalent among 14.9% of students. We observed that the
proportion of "obese" students inversely increased by age and schooling grade (p<0.001).
Ninety-five percent of the students living in villas or big houses were obese.
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Approximately 89.2% admitted that they are performing some exercises; however, 13.8%
of them were obese. Consuming fast food and soft drinks were common practiced among
obese students. Watching television on daily basis was prevalent among 97.5% of obese
students. Conclusions: The existence of obesity promoting factors, calls for integrating
interventions at family and school level to match changes in social and cultural context.
Awareness is needed to enhance healthy lifestyle.
Beck, L. F. and A. I. Greenspan (2008). "Why don't more children walk to school?"
Journal Of Safety Research 39(5): 449-452.
Chang, H. W. and H. L. Chang (2008). "Students' Perceptions of Difficulties in Cycling
to School in Urban and Suburban Taiwan." Transportation Research Record(2060): 123130.
Previous research has identified the importance of cycling training programs and
examined the relationship between cycling attitudes and the behavior of cyclists; another
important factor that needs further research is obstacles to cycling in cities. This study
investigates cycling difficulties confronted by Taiwanese students in the Hsin-Chu
technopolis while riding their bikes to and from school. For an empirical perspective, a
questionnaire was designed to collect data related to perceptions of cycling difficulties
and to provide a descriptive analysis of students and their parents. Data were collected
from samples in urban and suburban environments. The Rasch model was applied to
analyze the cycling abilities of the students as well as their perceptions of cycling
difficulty. Findings indicate that boys have better cycling abilities than girls, urban
students have better abilities than suburban students, ability parallels age (older students
have better cycling ability), and parents' attitudes toward cycling to school parallel their
children's abilities (parents of students with better cycling ability are less concerned).
Various impediments to cycling are identified and, based on students' perceptions, levels
of difficulty are assigned. Implications of the results are discussed, and recommendations
are offered, so as to facilitate matching bicycle use with Taiwan's status as a worldwide
leader in bicycle manufacturing.
Coleman, L., L. Cox, et al. (2008). "Girls and young women's participation in physical
activity: psychological and social influences." Health Education Research 23(4): 633647.
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
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differences lie with the always participates, relative to the never participates, reporting
more positive images of 'sport', positive perceptions of their own ability, low selfconsciousness, 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.
Cradock, A. L., I. Kawachi, et al. (2009). "Neighborhood social cohesion and youth
participation in physical activity in Chicago." Soc Sci Med 68(3): 427-35.
Many young people do not meet recommended levels of participation in physical
activity. Neighborhoods may play a role in supporting healthy behavior via social and
physical environmental features. We examine whether neighborhood-levels of social
cohesion, range of youth services and educational attainment were associated with
participation in recreational programs and general physical activity among young people.
Hierarchical regression analyses were carried out using data from 680 young people (ages
11-15 years at baseline) participating in the Project on Human Development in Chicago
Neighborhoods. The participants' primary caregiver reported recreational program
participation at baseline and self-reported general physical activity were assessed at
follow-up 2-3 years later. Neighborhood-level characteristics were obtained from census
data and via a community survey. Neighborhood social cohesion was inversely associated
with participation in recreational programs at baseline, controlling for availability of
neighborhood services for youth, neighborhood education status, race/ethnicity,
individual-level parental education, overweight status, sex, and age. Residing in an area
with greater social cohesion was directly associated with frequency of reported general
physical activity, independent of previously reported participation in recreational
programs and other neighborhood and individual-level covariates. The present findings
suggest that neighborhood social cohesion influences participation in physical activity.
Dieu, H. T., M. J. Dibley, et al. (2008). "Trends in overweight and obesity in pre-school
children in urban areas of Ho Chi Minh City, Vietnam, from 2002 to 2005." Public
Health Nutr: 1-8.
OBJECTIVE: To assess the trends in overweight and obesity in pre-school
children in urban areas of Ho Chi Minh City (HCMC), Vietnam, over the period 2002 to
2005. DESIGN: Two cross-sectional studies were conducted in 2002 and 2005.
Multistage cluster sampling was used in both surveys to select the subjects.
Sociodemographic information was collected using a self-administered questionnaire
given to parents in 2002 and using an interview-administered questionnaire to parents in
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2005. Weight and height were measured using the same standard methods in both
surveys. BMI (kg/m2) was calculated and overweight/obesity was defined using the ageand sex-specific BMI cut-off points proposed by the International Obesity
Taskforce.Subjects and settingChildren aged 4 to 5 years, attending pre-schools in urban
areas of HCMC, Vietnam, in 2002 (n 492) and 2005 (n 670). RESULTS: The prevalence
of overweight and obesity almost doubled from 2002 to 2005 (21.4 % and 36.8 %,
respectively). The increase was more evident in less wealthy districts than in wealthy
districts. The proportion of boys classified as obese in 2005 (22.5 %) was three times that
in 2002 (6.9 %).ConclusionThe prevalence of overweight and obesity has increased
rapidly in children aged 4 to 5 years in urban areas, and especially in less wealthy
districts, over a 3-year period. These results signal an urgent need for prevention
programmes to control and reverse this rapid upward trend in overweight and obesity in
young children in HCMC.
Dishman, R. K., R. P. Saunders, et al. (2008). "Self-Efficacy Moderates the Relation
Between Declines in Physical Activity and Perceived Social Support in High School
Girls." J Pediatr Psychol.
OBJECTIVE: To test whether self-efficacy for overcoming barriers to physical
activity has direct, indirect (i.e., mediated), or moderating relations with naturally
occurring change in perceived social support and declines in physical activity during high
school. METHODS: Latent growth modeling was used with measures completed in the
8th, 9th, and 12th grades by a cohort of 195 Black and White girls. RESULTS: Selfefficacy was stable and moderated the relation between changes in physical activity and
perceived social support. Girls who maintained a perception of strong social support had
less of a decline in physical activity if they also had high self-efficacy. However, girls
having high self-efficacy had a greater decline in physical activity if they perceived
declines in social support. CONCLUSIONS: Randomized controlled trials of physical
activity interventions based on social cognitive theory should consider that the influence
of girls' perceptions of social support on their physical activity may differ according to
their efficacy beliefs about barriers to physical activity.
Dwyer, G. M., J. Higgs, et al. (2008). "What do parents and preschool staff tell us about
young children's physical activity: a qualitative study." Int J Behav Nutr Phys Act 5: 66.
ABSTRACT: BACKGROUND: Physical activity and small screen recreation are
two modifiable behaviours associated with childhood obesity and the development of
chronic health problems. Parents and preschool staff shape behaviour habits in young
children. The aims of this qualitative study were to explore the attitudes, values,
knowledge and understanding of parents and carers of preschool-age children in relation
to physical activity and small screen recreation and to identify influences upon these
behaviours. METHODS: This research involved a focus group study with parents and
carers of the target population. A purposive sample of 39 participants (22 parents, 17
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carers) participated in 9 focus groups. Participants were drawn from three populations of
interest: those from lower socioeconomic status, and Middle-Eastern and Chinese
communities in the Sydney (Australia) metropolitan region. RESULTS: All participants
understood the value of physical activity and the impact of excessive small screen
recreation but were unfamiliar with national guidelines for these behaviours. Participants
described the nature and activity patterns of young children; however, the concept of
activity 'intensity' in this age group was not a meaningful term. Factors which influenced
young children's physical activity behaviour included the child's personality, the physical
activity facilities available, and the perceived safety of their community. Factors
facilitating physical activity included a child's preference for being active, positive parent
or peer modelling, access to safe play areas, organised activities, preschool programs and
a sense of social connectedness. Barriers to physical activity included safety concerns
exacerbated by negative media stories, time restraints, financial constraints, cultural
values favouring educational achievement, and safety regulations about equipment design
and use within the preschool environment. Parents considered that young children are
naturally 'programmed' to be active, and that society 'de-programs' this behaviour. Staff
expressed concern that free, creative active play was being lost and that alternate
activities were increasingly sedentary. CONCLUSION: The findings support the
relevance of the socioecological model of behavioural influences to young children's
physical activity. In this age group, efforts may best be directed at emphasising national
guidelines for small screen recreation and educating families and carers about the
importance of creative, free play to reinforce the child's inherent nature to be active.
Dwyer, J., L. Needham, et al. (2008). "Parents report intrapersonal, interpersonal, and
environmental barriers to supporting healthy eating and physical activity among their
preschoolers." Applied Physiology Nutrition And Metabolism-Physiologie Appliquee
Nutrition Et Metabolisme 33(2): 338-346.
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 audio-taped 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
higher-level 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
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and health professionals can consider these barriers when developing interventions to
promote healthy bodyweights among preschoolers.
Dzewaltowski, D. A., G. J. Ryan, et al. (2008). "Parental bonding may moderate the
relationship between parent physical activity and youth physical activity after school."
Psychology Of Sport And Exercise 9(6): 848-854.
Objectives: The processes and conditions through which parents may influence
children's physical activity have not been identified. This study tested the hypothesis that
bonding with parents would moderate the relationships between parental physical activity
and youth physical activity. Design: A cross-sectional preliminary study. Methods: A
total of 57 sixth and seventh grade students completed a survey that assessed bonding
with parents and parental physical activity. Then, oil 3 days, they reported their moderate
and vigorous physical activity using the Previous Day Physical Activity Recall. Results:
Hierarchical multiple regression analyses showed a moderation effect such that the
interaction between bonding with parents and parental physical activity significantly
predicted youth physical activity after controlling for their main effects. Conclusion: This
preliminary study suggests that interventions targeting parents as the route to increasing
physical activity may need to target both increasing, parental physical activity and the
parent-child bond. (C) 2008 Elsevier Ltd. All rights reserved.
Eime, R. M., W. R. Payne, et al. (2008). "Transition in participation in sport and
unstructured physical activity for rural living adolescent girls." Health Educ Res.
Physical activity (PA) is important for lifelong health; however, participation is
lower in rural compared with metropolitan areas and declines during adolescence,
particularly for girls. It is likely that this decline is related to the number of life transitions
that occur during adolescence. This qualitative study examined the views of active rural
living girls regarding the factors affecting their sport and PA participation, using the
socioecological model. Twenty-seven girls aged 16-17 from four schools participated in
semi-structured focus group discussions. Content and thematic analysis was conducted
from verbatim transcripts using NVivo. The girls enjoyed involvement in community
club sport with friends and they reported living in communities where participation in
sport was a major form of social interaction. However, the desire to succeed
educationally was a critical factor affecting their participation in sport and PA and
influenced their movement from structured club sport to more flexible, but socially
isolated individual activities. It is recommended that future longitudinal research should
track rural living adolescent females as they complete secondary school, in order to better
understand the influence of educational priorities upon sport and PA participation and to
identify practical strategies for both schools and community organizations to foster
continuing participation throughout this crucial period of life transition.
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Friedman, L. S., E. M. Lukyanova, et al. (2008). "Social-environmental factors associated
with elevated body mass index in a Ukrainian cohort of children." Int J Pediatr Obes: 110.
Background. While obesity is a growing epidemic in most developed countries,
we still lack information on countries in economic transition. In this study, we evaluate
the built environment, activity levels, economic status and dietary patterns associated
with body mass index (BMI) greater than or equal to the 85th percentile among 3-yearold Ukrainian children living through the downturn in the economy during the mid1990s. Methods. We evaluated 883 3-year-old children from the Ukraine ELSPAC
cohort. Principal components analysis was used as a data reduction tool for dietary, built
environment and activity variables. We evaluated predictors of elevated BMI (>/=85th
percentile) using a multivariable logistic regression model. Results. The final
multivariable model showed that for every kilogram increase in the mother's weight,
there was a corresponding 2% increase in risk of a child having a BMI >/=85th percentile
(OR =1.02; 95% CI: 1.00-1.04). A higher social class and a friendly neighborhood were
associated with higher BMI, whereas infrequent outings to places that require spending
money was associated with lower BMI. Except for meat consumption, none of the dietary
variables were associated with elevated BMI. Discussion. The picture in the Ukraine
during the 1990s, a period of economic hardship, revealed that variables associated with
higher standards of living were predictive of elevated BMI: higher social class, meat
consumption and friendly neighborhoods. Variables associated with economic isolation
were predictive of a lower risk of elevated BMI.
Gesell, S. B., E. B. Reynolds, et al. (2008). "Social influences on self-reported physical
activity in overweight Latino children." Clinical Pediatrics 47(8): 797-802.
Psychosocial variables influence physical activity for different age groups, sex,
and ethnic groups. However, little is known about their influence on physical activity in
preadolescent Latino children. The authors examined how a) confidence in one's ability
to be physically active (self-efficacy); b) ideas about the consequences of being
physically active (beliefs), and c) the influences of family and friends on physical activity
(Social influences) effect physical activity levels in overweight (body mass index >=
85%) Latino preadolescent children. One hundred and fourteen preadolescents
participated in a larger intervention designed to improve healthy life styles for Latino
families. The authors report baseline data collected at a community-based primary care
clinic. Multivariate regression analyses showed that only social influences significantly
predicted (P <.01) the metabolic equivalent adjusted self-reported baseline physical
activity Prevention and intervention strategies that augment Social influences on physical
activity are likely to result in more physical activity and improved health in these
children.
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Haworth, C. M., R. Plomin, et al. (2008). "Childhood obesity: genetic and environmental
overlap with normal-range BMI." Obesity (Silver Spring) 16(7): 1585-90.
OBJECTIVE: To understand the overlap between the etiology of obesity and
normal variation in BMI in children. METHODS AND PROCEDURES: Height and
weight data were available from a large UK representative sample of twins: 2,342 samesex pairs at 7 years and 3,526 same-sex pairs at 10 years. The twin method and modelfitting techniques were used to estimate genetic and environmental contributions to BMI.
DeFries-Fulker (DF) extremes analysis was used to investigate genetic and environmental
influences on the mean difference between obese and normal-weight children. Obesity
was classified using the International Obesity Task Force (IOTF) criteria. RESULTS: At
both ages, BMI and obesity were highly heritable (0.60-0.74) and only modestly
influenced by shared environmental factors (0.12-0.22). Extremes analyses indicated that
genetic and environmental influences on obesity are quantitatively and qualitatively
similar to those operating across the range of BMI. DISCUSSION: Obesity is the extreme
of the same genetic and environmental factors responsible for variation throughout the
distribution of BMI. This finding implies that genes that influence obesity will also be
associated with BMI in the normal range, and similar environmental influences will
affect BMI in the clinical and normal range. Knowing that obesity is influenced by the
same genetic and environmental factors that affect weight at all levels has implications
for investigating the mechanisms for weight gain and developing interventions for weight
control.
Hume, C., M. Jorna, et al. (2008). "Are children's perceptions of neighbourhood social
environments associated with their walking and physical activity?" J Sci Med Sport.
This study aimed to examine cross-sectional associations between neighbourhood
social environmental factors and physical activity (PA) among Australian primary school
children. Baseline data from a large-scale trial among 957 children (48% boys) aged 9-12
years were utilised. Children self-reported their perceptions of the neighbourhood social
environment including social networks (e.g. there are lots of other children around to play
with), and social capital (e.g. there are lots of people in my area I could go to if I need
help). Children also self-reported their weekly walking frequency and PA from which
average daily moderate to vigorous PA (MVPA) was calculated. Linear regression
analyses examined these associations. Boys performed 17min/day more MVPA than girls
(p<0.01), and girls performed one extra trip/week than boys (p<0.001). Children's
perceptions of social capital (p<0.0001) and social networks (p<0.01) were both
positively associated with MVPA and social capital was positively associated with
walking frequency (p<0.05). These associations were not moderated by the child's sex.
These findings suggest that children who had positive perceptions of neighbourhood
social capital and social networks in the neighbourhood, tended to be more physically
active. Longitudinal and experimental studies are required to further test the influence of
these factors among children.
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Humenikova, L. and G. E. Gates (2008). "Social and physical environmental factors and
child overweight in a sample of American and Czech school-aged children: A pillot
study." Journal Of Nutrition Education And Behavior 40(4): 251-257.
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 I American and 2 Czech cities.
Participants: Forty-five American and 97 Czech 4(th)- through 6(th)-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.
Humenikova Shriver, L. and G. Gates (2008). "A cross-cultural comparison of dietary
intakes and physical activity between American and Czech school-aged children." Public
Health Nutr: 1-5.
OBJECTIVE: The prevalence of child overweight in the Czech Republic is
substantially lower than that in the USA. The objective of the present pilot study was to
explore dietary intakes, frequency of dining in fast-food establishments, and the amount
and intensity of physical activity between a sample of American and Czech children.
DESIGN: A cross-sectional correlational pilot study. SETTING: Four public schools in
the USA and four public schools in the Czech Republic. SUBJECTS: Ninety-five Czech
and forty-four American 4-6th graders from urban public schools participated in the
study. Dietary intake and number of fast-food visits were evaluated using two multiplepass 24 h recalls. Physical activity was measured using the modified Self-Administered
Physical Activity Checklist. RESULTS: American children (mean age 10.8 (se 0.2)
years) consumed more energy and fat, less fruits and vegetables, more soft drinks, and
visited fast-food establishments more often than Czech children (mean age 11.0 (se 0.1)
years). Although no differences were found in vigorous activity by nationality, Czech
children spent significantly more time in moderate physical activities than American
children. CONCLUSIONS: Despite the influx of some negative Western dietary trends
into the country, Czech children had a healthier diet and were more physically active than
American children. Further research is warranted to determine whether the same
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differences in dietary intakes, physical activity and fast-food visits exist between
nationally representative samples of American and Czech children.
Jackson, M., D. Crawford, et al. (2008). "Are parental concerns about children's inactivity
warranted, and are they associated with a supportive home environment?" Res Q Exerc
Sport 79(3): 274-82.
This paper explores parental concern about children's activity levels and whether
parents who are concerned about their child's activity provide a supportive environment.
A sample of 615 parents of 5-6-year-old children and 947 parents of 10-12-year-old
children completed a questionnaire. Just over 50% of parents reported they were
concerned their child was not getting enough activity. Children of concerned parents
were less active than those whose parents were not concerned. These findings suggest
that parents who are concerned about their child's physical activity levels provided a less
supportive environment for physical activity than parents who are not concerned. The
challenge for public health will be to harness parental concerns and translate them into
action.
Jago, R., A. Page, et al. (2008). "Screen-viewing and the home TV environment: the
European Youth Heart Study." Prev Med 47(5): 525-9.
OBJECTIVE: Examine if home environmental factors are associated with screenviewing. METHODS: Data are for 2670, 3rd and 9th grade participants in Denmark,
Portugal, Estonia and Norway collected between 1997 and 2000. Outcomes were
spending >2 h after-school watching television (TV) and >1 h per day playing computer
games. Child Autonomy and the home TV Environment were exposures. RESULTS:
Each unit increase in Child Autonomy was associated with 9% increase in risk of
watching more than 2 h of TV per day after school and a 19% increase in risk of spending
more than an hour per day playing computer games. TV Environment was associated
with a 31% per unit increase in risk of watching >2 h of TV after school and 11%
increase in risk of spending >1 h playing computer games. CONCLUSIONS: A family
environment in which after-school TV viewing is part of the home culture and homes
where children have more autonomy over their own behavior are associated with an
increased risk of watching >2 h of TV per day after school and spending more >1 h per
day playing computer games. The home screen-viewing environment and Child
Autonomy may be malleable targets for changing screen-viewing.
Ji, C. Y. and T. O. Cheng (2009). "Epidemic increase in overweight and obesity in
Chinese children from 1985 to 2005." Int J Cardiol 132(1): 1-10.
This study tracks the temporal changes in prevalence of childhood and adolescent
overweight and obesity in different regions of China from 1985 to 2005. Using a series
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data of the Chinese National Survey on Students Constitution and Health, we compared
the temporal changes over a 20-year period of the prevalence of overweight and obesity
among ten regions in China for school-aged children between 7 and 18 years of age.
Large disparities in the temporal changes of obesity prevalence exist in different regions
of China. North coastal residents, especially those of the upper socioeconomic status, had
the earliest and largest increase in prevalence. Similar increases then followed
successively in other regions of upper, moderate and low socioeconomic status, and
finally in the affluent rural regions. No significant increase was found in the developing
rural areas. Regions where the obesity epidemic occurred late also began to show rather
rapid increases in prevalence in recent years. In 2005, the national estimates indicated
that 7.73% of Chinese youth are overweight and 3.71% of them are obese, representing
an estimated 21.37 million Chinese children (13.43 million boys and 7.94 million girls).
Klein, E. G., L. A. Lytle, et al. (2008). "Social ecological predictors of the transition to
overweight in youth: Results from the Teens Eating for Energy and Nutrition at Schools
(TEENS) study." Journal Of The American Dietetic Association 108(7): 1163-1169.
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 >=
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 self-perception. Compared to non-dieters, 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.
Lindsay, A. C., K. M. Sussner, et al. (2009). "Influence of social context on eating,
physical activity, and sedentary behaviors of latina mothers and their preschool-age
children." Health Educ Behav 36(1): 81-96.
As more U.S. children grow up in Latino families, understanding how social
class, culture, and environment influence feeding practices is key to preventing obesity.
The authors conducted six focus groups and 20 in-depth interviews among immigrant,
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low-income Latina mothers in the Northeast United States and classified 17 emergent
themes from content analysis according to ecologic frameworks for behavior change.
Respondents related environmental influences to child feeding, diet, and activity, namely,
supermarket proximity, food cost, access to recreational facilities, neighborhood safety,
and weather. Television watching was seen as integral to family life, including watching
during meals and using TV as babysitter and tool to learn English. Participation in the
WIC program helped families address food insecurity, and child care provided healthy
eating and physical activity opportunities. Health promotion efforts addressing obesity
trends in Latino children must account for organizational and environmental influences
on the day-to-day social context of young immigrant families.
Mazur, A., K. Klimek, et al. (2008). "Risk factors for obesity development in school
children from south-eastern Poland." Ann Agric Environ Med 15(2): 281-5.
The aim of the study was to determine socio-economic and parental factors
affecting odds for development of obesity in school-age children from south-eastern
Poland (SEP). 2,182 boys and 2,066 girls from randomly selected elementary schools in
SEP were involved in this study. The mean age of the girls was 10.4 years (SD 2.4, range
6.7-14.9). The mean age of the boys was 10.5 years (SD 2.3, range 6.9-14.9). 167 boys
(7.7 %, 95 % CI: 6.6-8.8 %) and 208 girls (10.1 %, 95 % CI: 8.8-11.4 %) were obese.
The difference in prevalence of obesity between genders was statistically significant.
Socioeconomic risk factors (RF) were different from those in Western Europe or the
United States. A small number of siblings was RF for obesity. Intact family had a
protective effect. No correlation was found between child's obesity and parental
education, income per capita or mother working outside the home. Parental obesity was
RF for the obesity in children. High BMI at birth was an RF for obesity. A distinct
pattern of socio-economic RF underlines the importance of population specific
epidemiological studies. Defining RF in a specific region provides information to design
specific preventive strategies.
McDermott, R. J., J. Nickelson, et al. (2009). "A community-school district-university
partnership for assessing physical activity of tweens." Prev Chronic Dis 6(1): A15.
INTRODUCTION: Obesity among youth is related to a decline in physical
activity, and data on physical activity levels among children in elementary and middle
schools are limited. METHODS: We leveraged a community-school district-university
partnership in Sarasota County, Florida, in May of 2005 to assess physical activity levels
among tweens (youth aged 9-13 years) and to measure the relationship between tweens'
awareness of the Centers for Disease Control and Prevention's VERB program and
participation in physical activity, using a minimally obtrusive survey. After surveying
participating schools (4 elementary schools and 3 middle schools), we obtained 1,407
responses from children in grades 5 through 7. RESULTS: In all, 83.1% of students met
the federal recommendation for daily participation in vigorous-intensity physical activity
(VPA), and 58.6% had tried a new game or sport within the previous 2 months. Mean
number of days in the previous week engaging in VPA was significantly higher (P <
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.001) for boys (5.22) than for girls (4.35). Mean number of days engaging in VPA in the
previous week was significantly higher (P = .006) among 6th-grade students (4.93) than
7th-grade students (4.54), but no consistent decline through the grade levels occurred.
Activity was significantly correlated with the number of friends reported as playing a
game or sport daily (r = .369, P < .001). Most students (88.8%) reported having seen,
read, or heard messages or ads about VERB, a tween-centric national social marketing
campaign promoting physical activity and participation in new games and sports.
CONCLUSION: Although participation in VPA was high, girls reported significantly
fewer days spent engaged in VPA than did boys. We found a modest association between
engaging in VPA and having active friends. Capitalizing on leadership from multiple
community-based organizations to monitor youth physical activity may inspire
implementation of strategies for motivating youth to try new games and sports that they
can sustain through the adolescent years and beyond.
McDonald, N. C. (2008). "Household interactions and children's school travel: the effect
of parental work patterns on walking and biking to school." Journal Of Transport
Geography 16(5): 324-331.
This study evaluates how household interactions affect walking and biking to
school. The cross-sectional research design uses a representative sample of trips to school
by US youth (n = 8231) to test how parental employment status and commute patterns
affect nonmotorized travel. Results from a binary logit model show that young children
(5-14) with mothers who commute to work in tile morning are less likely to walk or bike
to school after controlling for individual, household, and neighborhood factors.
Policymakers may therefore want to create programs that allow parents to share
chaperoning responsibilities for the school trip to address parental time constraints. (c)
2008 Elsevier Ltd. All rights reserved.
McKenzie, T. L., B. Baquero, et al. (2008). "Environmental correlates of physical activity
in Mexican American children at home." J Phys Act Health 5(4): 579-91.
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.
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Robbins, L. B., M. Stommel, et al. (2008). "Social support for physical activity of middle
school students." Public Health Nurs 25(5): 451-60.
OBJECTIVE: To explore gender and age differences in social support and their
relationship with physical activity. DESIGN AND SAMPLE: This cross-sectional study
with enhanced reliability due to repeated measures involved 105 boys and 101 girls.
MEASUREMENTS: Information on sources and forms of social support, as well as
physical activity, was obtained from students, who completed the same questionnaire
twice, 2 weeks apart. RESULTS: Boys, compared with girls, were more likely to name
fathers and less likely to identify sisters. Compared with older boys, older girls were less
likely to identify fathers. Older girls were less likely than both younger girls and older
boys to name brothers. Students who identified fathers reported more minutes and days of
physical activity and had a stronger physical activity self-definition than those who did
not name fathers. Students who selected peers and sisters had more minutes of physical
activity and a stronger physical activity self-definition, respectively, than those who did
not name peers and sisters. Transportation and encouragement were related to physical
activity. CONCLUSIONS: Gender differences in social support are not uniform across
age groups. Awareness of these differences can inform the development of appropriate
physical activity programs.
Robbins, L. B., A. Sikorskii, et al. (2008). "Gender comparisons of perceived benefits of
and barriers to physical activity in middle school youth." Res Nurs Health.
Perceived benefits of and barriers to physical activity (PA) reported by 206
middle school boys and girls in a survey were compared. Only "take care of myself, stay
in shape, and be healthier" emerged as a greater benefit for girls than boys. Among
students not on a sports team, boys reported fewer barriers than girls. Among those
selecting an active pursuit, boys perceived more barriers than girls. When controlling for
sports team participation and perceived benefits and barriers, boys reported more minutes
of vigorous PA than girls. As boys and girls reported relatively similar benefits of and
barriers to PA, nurse counseling with both groups can focus on the same information.
Effort is particularly needed to increase PA among girls. (c) 2008 Wiley Periodicals, Inc.
Sagatun, A., E. Kolle, et al. (2008). "Three-year follow-up of physical activity in
Norwegian youth from two ethnic groups: associations with socio-demographic factors."
BMC Public Health 8(1): 419.
ABSTRACT: BACKGROUND: More research on factors associated with
physical activity and the decline in participation during adolescence is needed. In this
paper, we investigate the levels, change, and stability of physical activity during the late
teens among ethnic Norwegians and ethnic minorities, and we examine the associations
between physical activity and socio-demographic factors. METHODS: The baseline (T1)
of this longitudinal study included 10th graders who participated in the youth part of the
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Oslo Health Study, which was carried out in schools in 2000-2001. The follow-up (T2) in
2003-2004 was conducted partly at school and partly by mail. A total of 2489 (1112 boys
and 1377 girls) participated both at baseline and at follow-up. Physical activity level was
measured by a question on weekly hours of physical activity outside of school. Sociodemographic variables were collected by questionnaire and from data obtained from
Statistics Norway. Analysis of variance was used to study the level of and changes (T1 to
T2) in physical activity, and the associations between physical activity and sociodemographic factors. Stability in physical activity was defined as the percentage of
students reporting the same physical activity both times. RESULTS: Boys were more
active than girls at age 15 and 18 years, independent of ethnic background. Among girls,
ethnic Norwegians were more active than ethnic minorities. Hours per week spent on
physical activity declined in all groups during the follow-up period. Few associations
were found between physical activity and socio-demographic factors in both crosssectional and longitudinal data. Among the ethnic minority girls, 65% reported being
physically active 0-2 hours per week at baseline, and 82% of these girls reported the same
level at follow up. CONCLUSIONS: The association between physical activity and
ethnicity at age 15 years remained the same during the follow-up. Few associations were
found between physical activity and socio-demographic variables. A large proportion of
ethnic minority girls reported a persistently low physical activity level, and this low
participation rate may need special attention.
Salvy, S. J., J. N. Roemmich, et al. (2008). "Effect of Peers and Friends on Youth
Physical Activity and Motivation to be Physically Active." J Pediatr Psychol 34(2):217225.
OBJECTIVE: To test whether the presence of a peer or a friend increases the
motivation to be physically active in overweight and non-overweight youth in a
laboratory setting. METHODS: Youth motivation to be physically active as a function of
the social context was measured using a computerized relative reinforcing value task to
earn points exchangeable for physical and/or sedentary activities. RESULTS: The
presence of a friend (p<.001) increased youth's; motivation to be physically active. The
presence of a peer increased overweight youth's; motivation to be physically active,
whereas this was not the case for lean youth (p=.47). Participants biked a greater distance
in the presence of a friend than when alone (p<.001). Overweight youth biked a greater
distance in the presence of a peer than when alone, while this was not the case for lean
youth (p=.23). CONCLUSIONS: Friendships may increase youth's; motivation to engage
in physical activity and promote greater physical activity in non-overweight and
overweight youth.
Simsek, E., S. Akpinar, et al. (2008). "The prevalence of overweight and obese children
aged 6-17 years in the West Black Sea region of Turkey." Int J Clin Pract 62(7): 1033-8.
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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.
Singh, G. K., M. D. Kogan, et al. (2008). "Racial/ethnic, socioeconomic, and behavioral
determinants of childhood and adolescent obesity in the United States: analyzing
independent and joint associations." Ann Epidemiol 18(9): 682-95.
PURPOSE: This study examines independent and joint associations between
several socioeconomic, demographic, and behavioral characteristics and obesity
prevalence among 46,707 children aged 10-17 years in the United States. METHODS:
The 2003 National Survey of Children's Health was used to calculate obesity prevalence.
Logistic regression was used to estimate odds of obesity and adjusted prevalence.
RESULTS: Ethnic minority status, non-metropolitan residence, lower socioeconomic
status (SES) and social capital, higher television viewing, and higher physical inactivity
levels were all independently associated with higher obesity prevalence. Adjusted obesity
prevalence varied by age, gender, race/ethnicity, and SES. Compared with affluent white
children, the odds of obesity were 2.7, 1.9 and 3.2 times higher for the poor Hispanic,
white, and black children, respectively. Hispanic, white, and black children watching
television 3 hours or more per day had 1.8, 1.9, and 2.5 times higher odds of obesity than
white children who watched television less than 1 hour/day, respectively. Poor children
with a sedentary lifestyle had 3.7 times higher odds of obesity than their active, affluent
counterparts (adjusted prevalence, 19.8% vs. 6.7%). CONCLUSIONS: Race/ethnicity,
SES, and behavioral factors are independently related to childhood and adolescent
obesity. Joint effects by gender, race/ethnicity, and SES indicate the potential for
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considerable reduction in the existing disparities in childhood obesity in the United
States.
Sutherland, R., M. Finch, et al. (2008). "Higher prevalence of childhood overweight and
obesity in association with gender and socioeconomic status in the Hunter region of New
South Wales." Nutrition & Dietetics 65(3): 192-197.
Objective: To determine the prevalence of overweight and obesity in primary
school-aged children in the Hunter region and examine associations with gender, age,
socioeconomic status (SES) and geographical location. Design: Cross-sectional survey of
a stratified sample of randomly selected government primary schools in the Hunter region
with SES defined by Socio-Economic Index For Areas index and geographical location
based on school education areas. Subjects: A total of 2224 out of 5206 (42.7%) primary
school children from randomly selected government primary schools representing year 1
to year 6 (x = 9.61 +/- 1.7). Setting: Sixteen government primary schools in the Hunter
Region of New South Wales. Main outcome measures: Overweight and obesity were
assessed using the international body mass index cut points, standardised for both age and
gender as defined by Cole. Data analyses: Chi square (alpha = 0.05) was used to compare
prevalence across categories of gender, age, SES or geographical location. Results: Of
the 2224 children who had their height and weight measured, 28.35% (n = 606) were
either overweight (n = 415, 19.3%) or obese (n = 191, 9.06%). Significant differences in
the prevalence of combined overweight and obesity were observed between children
residing in high and low socioeconomic areas, by ages and between boys and girls.
Conclusion or application: The prevalence of childhood obesity is high and appears more
prevalent in girls, in children residing in low-income areas and at specific ages.
Determinants of the observed differences will need to be investigated in order to address
the higher prevalence of childhood obesity in high-risk population groups.
Timperio, A., J. Salmon, et al. (2008). "Is dog ownership or dog walking associated with
weight status in children and their parents?" Health Promotion Journal Of Australia
19(1): 60-63.
Issue addressed: Several studies have shown that clog owners do more physical
activity than non-owners; however, associations with weight Status are unknown. This
study examined associations between clog ownership, frequency of dog walking and
weight status among children and their parents. Methods: Height and weight were
measured for 281 children aged 5-6 years and 864 children aged 10-12 years. One parent
reported their own and their partner's height and weight (n = 1,1108), clog ownership,
usual frequency their child walks a clog, and usual frequency of walking the clog as a
family. Logistic regression analyses were adjusted for sex (children only), physical
activity, education, neighbourhood SES, parental weight status (children only) and
clustering by school. Results: Dog ownership ranged from 45-57% in the two age groups.
Nearly one in four 5-6 year-olds and 37% of 10-12 year-olds walked a clog at least
once/week. Weekly clog walking as a family was reported by 24-28% of respondents.
The odds of being overweight or obese were lower among younger children who owned a
dog (OR=0.5, 95% Cl 0.3-0.8) and higher among mothers whose family walked the clog
together (OR = 1.3, 95% Cl 1.0-1.7). Conclusions: Dog ownership may offer some
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protection from overweight among young children. It is important that families with a
clog are encouraged to walk or play with it regularly. Associations with weight status
may depend on the type of clog owned, length of ownership and the nature of walks or
interaction.
Trogdon, J. G., J. Nonnemaker, et al. (2008). "Peer effects in adolescent overweight." J
Health Econ 27(5): 1388-99.
This study is the first to estimate peer effects for adolescent weight. We use data
from the National Longitudinal Study of Adolescent Health (Add Health) and define peer
groups using nominated friends within schools. Endogenous peer groups are accounted
for using a combination of school fixed effects, instrumental variables, and alternative
definitions of peers (i.e., grade-level peers). Mean peer weight is correlated with
adolescent weight, even after controlling endogenous peer groups. The impact of peer
weight is larger among females and adolescents with high body mass index. The results
are consistent with social multipliers for adolescent overweight policies.
Tsai, A. C. and Y. R. Lin (2008). "Sex and ethnic disparities in weight and height among
children of transnational couples, aborigines, and Han Chinese in Taiwan." Nutr Res
28(10): 664-70.
In this study, we examined sex and ethnic disparities in growth and body mass
index (BMI) status among schoolchildren of transnational families, the aborigines and
Han Taiwanese in Nantou, Taiwan. We tested the hypothesis that cultural and social
factors of the transnational couples could impact the growth status of their children. The
study also determined the factors associated with the growth status of schoolchildren. A
total of 1674 school age children in the county were cluster sampled, and their weight and
height data were statistically analyzed by 1-way analysis of variance, chi(2) test, and
linear regression analysis according to sex, ethnicity, and residential locations. The
institutional review board of Asia University, Taiwan, ROC, approved the study protocol.
Results showed that aboriginal boys were significantly shorter in stature than sons of the
transnational couples and Han Taiwanese. However, weight and BMI were not different
among the 3 groups. Daughters of the transnational couples were significantly shorter and
lighter, whereas the aboriginal girls were shorter but not lighter and had significantly
greater BMI compared with their Han Taiwanese counterparts. Regression analysis
revealed significant associations of weight and BMI with sex and ethnicity. Results
suggest that culture plays a role in sex disparity. Ethnic and sex disparities in growth
status exist in Taiwan. Aboriginal boys and girls are shorter but not lighter compared
with their Han Taiwanese counterparts, whereas daughters but not sons of transnational
couples are shorter and lighter compared with Han Taiwanese counterparts. These
findings are useful information for the educators and healthcare policy makers for
improving diet and health.
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van Sluijs, E. M., A. Page, et al. (2008). "Behavioural and social correlates of sedentary
time in young people." Br J Sports Med.
OBJECTIVE: To identify behavioural and social correlates of objectivelymeasured sedentary time in young people. DESIGN: Cross-sectional analysis of data
from the European Youth Heart Study (EYHS). SETTING: Schools in Denmark, Estonia,
Portugal and Norway. PARTICIPANTS: Invited using a two-stage cluster sampling
procedure. Analyses include 2107 children (9-10 years) and adolescents (14-15 years).
Assessment of independent variables: Seven behavioral and 15 social variables assessed
by parental and computerized child questionnaires. MAIN OUTCOME MEASURE:
Sedentary activity as assessed by accelerometry (10-minute blocks at <200
counts/minute). Analyses were stratified by country and interactions with grade and
gender were investigated. RESULTS: Adolescents were more sedentary than children
(335.4 (SD: 90.4) vs. 217.2 (SD: 75.6) minutes/day, p<0.001). Patterns of associations
differed across countries. High computer use and no television viewing before school in
Norway, and being sedentary during school-breaks in Estonia were positively associated
with sedentary time. No behavioural variables were associated with sedentary time in the
Danish and Portuguese models. Socioeconomic position was positively associated with
sedentary time in Portugal and Estonia, father inverted exclamation mark|s body mass
index negatively in the Estonian model. Norwegian participants with a games console at
home and Portuguese participants with a television in their bedroom were more
sedentary. CONCLUSIONS: A single strategy aimed at reducing sedentary behaviour is
unlikely to be effective across Europe as the target populations and behaviours of focus
differ between countries. Targeting high socioeconomic groups in Portugal and Estonia
or focusing on reducing computer use in Norway might be effective intervention
strategies to reduce overall sedentary time.
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Social Environment and Physical Activity/Obesity (Adults)
Ackerson, L. K., I. Kawachi, et al. (2008). "Geography of underweight and overweight
among women in India: A multilevel analysis of 3204 neighborhoods in 26 states."
Economics & Human Biology 6(2): 264-280.
We investigated the geographic distribution and the relationship with
neighborhood wealth of underweight and overweight in India. Using multilevel modeling
techniques, we calculated state-specific smoothed shrunken state residuals of overweight
and underweight, neighborhood and state variation of nutritional status, and the
relationships between neighborhood wealth and nutritional status of 76,681 women living
in 3204 neighborhoods in 26 Indian states. We found a substantial variation in
overweight and underweight at the neighborhood and state levels, net of what could be
attributed to individual-level factors. Neighborhood wealth was associated with increased
levels of overweight and decreased levels of underweight, and was found to modify the
relationship between personal living standard and nutritional status. These findings
suggest that interventions to address, the double burden of undernutrition and
overnutrition in India must take into account state and neighborhood characteristics in
order to be successful. (C) 2008 Elsevier B.V. All rights reserved.
Annear, M. J., G. Cushman, et al. (2009). "Leisure time physical activity differences
among older adults from diverse socioeconomic neighborhoods." Health Place 15(2):
482-90.
This paper examines how neighborhood deprivation potentially affects older
adults' participation in leisure time physical activity (LTPA). Recall surveys and semistructured interviews were conducted with 63 elderly residents of high- and lowdeprivation neighborhoods in Christchurch, New Zealand. Results showed that residing
in a neighborhood of high socioeconomic deprivation was potentially associated with
significantly lower levels of neighborhood-based LTPA and that this effect appeared to
be partly mediated by deleterious physical and social environmental conditions. These
results suggest that strategies to promote increased participation in LTPA among older
adults may need to consider intervening in the physical and social environment in highly
deprived neighborhoods.
Casey, A. A., M. Elliott, et al. (2008). "Impact of the food environment and physical
activity environment on behaviors and weight status in rural U.S. communities." Prev
Med 47(6): 600-4.
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OBJECTIVE: To examine the association between weight status and
characteristics of the food and physical activity environments among adults in rural U.S.
communities. METHOD: Cross-sectional telephone survey data from rural residents were
used to examine the association between obesity (body mass index [BMI] >30 kg/m(2))
and perceived access to produce and low-fat foods, frequency and location of food
shopping and restaurant dining, and environmental factors that support physical activity.
Data were collected from July to September 2005 in Missouri, Arkansas, and Tennessee.
Logistic regression models (N=826) adjusted for age, education and gender comparing
normal weight to obese respondents. RESULTS: Eating out frequently, specifically at
buffets, cafeterias, and fast food restaurants was associated with higher rates of obesity.
Perceiving the community as unpleasant for physical activity was also associated with
obesity. CONCLUSION: Adults in rural communities were less likely to be obese when
perceived food and physical activity environments supported healthier behaviors.
Additional environmental and behavioral factors relevant to rural adults should be
examined in under-studied rural U.S. populations.
Cohen-Cole, E. and J. M. Fletcher (2008). "Is obesity contagious? Social networks vs.
environmental factors in the obesity epidemic." J Health Econ 27(5): 1382-7.
This note's aim is to investigate the sensitivity of Christakis and Fowler's claim
[Christakis, N., Fowler, J., 2007. The spread of obesity in a large social network over 32
years. The New England Journal of Medicine 357, 370-379] that obesity has spread
through social networks. It is well known in the economics literature that failure to
include contextual effects can lead to spurious inference on "social network effects." We
replicate the NEJM results using their specification and a complementary dataset. We
find that point estimates of the "social network effect" are reduced and become
statistically indistinguishable from zero once standard econometric techniques are
implemented. We further note the presence of estimation bias resulting from use of an
incorrectly specified dynamic model.
Drewnowski, A., C. Rehm, et al. (2009). "Poverty and childhood overweight in
California Assembly districts." Health Place 15(2): 631-5.
OBJECTIVES: The goal of the present study was to determine the association
between childhood overweight and area-based socioeconomic indicators in California
Assembly districts. DESIGN: A cross-sectional ecologic study. PARTICIPANTS:
California public school students. MAIN EXPOSURE: Poverty and demographic data for
California Assembly districts were based on the 2000 Census and obtained from the
UCLA Center for Health Policy Research. OUTCOME MEASURES: Overall and raceand ethnicity-specific rates of childhood overweight for California Assembly districts
(n=80) were based on the 2004 statewide Fitnessgram evaluation of California public
school students. RESULTS: Poverty was significantly associated with childhood
overweight in California Assembly districts. At the Assembly district scale, childhood
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overweight was significantly associated with percent residents below poverty for the
entire population (r=0.82), and with the race/ethnicity-specific overweight prevalence for
African-American (r=0.43), Latino (r=0.61) and White (r=0.54) populations. There was
also evidence that childhood overweight in California Assembly districts was spatially
clustered. Linear regression models confirmed that percent of residents below poverty
was an independent predictor of a higher prevalence of childhood overweight for the
entire population. The results of race/ethnicity-specific models confirmed that the
association between area poverty and childhood overweight was not explained by
differences in the risk of overweight among specific race/ethnicity groups.
CONCLUSIONS: Area-based measures of socioeconomic status can be used to identify
problem areas and can be used for optimal targeting of public health prevention and
intervention efforts.
Kanu, M., E. Baker, et al. (2008). "Exploring associations between church-based social
support and physical activity." J Phys Act Health 5(4): 504-15.
OBJECTIVE: This study tested associations between church-based instrumental
and informational social support and meeting physical activity guidelines. METHODS:
Cross-sectional data were analyzed for 1625 rural residents using logistic regression.
RESULTS: Associations were found between instrumental social support and performing
some amount of physical activity but not between the 2 forms of support and meeting
physical activity guidelines. CONCLUSION: Instrumental social support might help
initiation of physical activity. Given that 54.1% of US adults get no leisure-time physical
activity at the recommended minimum level, instrumental social support might be
important in considering physical activity programs.
Kavikondala, S., C. M. Schooling, et al. (2009). "Pathways to obesity in a developing
population: The Guangzhou Biobank Cohort Study." Int J Epidemiol 38(1): 72-82.
BACKGROUND: 'Environmental mismatch' may contribute to obesity in rapidly
developing societies, because poor early life conditions could increase the risk of obesity
in a subsequently more socio-economically developed environment. In a recently
developing population (from southern China) we examined the association of life-course
socio-economic position (SEP) with obesity. METHODS: In a cross-sectional study of
9998 adults from the Guangzhou Biobank Cohort Study (phase 2) examined in 2005-06,
we used multivariable linear regression to assess the association of SEP at three life
stages (proxied by parental possessions, education and longest held occupation) with
obesity [body mass index (BMI) and waist-hip ratio (WHR)] in men and women.
RESULTS: There was no evidence that socio-economic position trajectory had supraadditive effects on BMI or WHR. Instead in women, higher SEP at any life stage usually
contributed to lower BMI and WHR; e.g. women with higher early adult SEP had lower
BMI [-0.45; 95% confidence interval (CI) -0.71 to -0.19) and WHR (-0.02; 95% CI -0.02
to -0.012]. In contrast, in men, higher childhood SEP was associated with higher BMI
(0.53; 95% CI 0.18 to 0.88) and WHR (0.01; 95% CI 0.003 to 0.02) as was high late
adulthood SEP with BMI (0.36; 95% CI 0.07 to 0.64). CONCLUSIONS: This study
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provides little support for environmental mismatch over the life course increasing obesity
in this rapidly transitioning southern Chinese population. However, our findings highlight
different effects of the epidemiologic transition in men and women, perhaps with preadult exposures as a critical window for sex-specific effects.
Mavoa, H. M. and M. McCabe (2008). "Sociocultural factors relating to Tongans' and
Indigenous Fijians' patterns of eating, physical activity and body size." Asia Pacific
Journal Of Clinical Nutrition 17(3): 375-384.
This paper reviews literature between 1974 and 2007 that addresses the impact of
sociocultural factors on reported patterns of eating, physical activity (activity) and body
size of Tongans and indigenous Fijians (Fijians) in their countries of origin. There have
been changes in diet (more imported and fewer traditional foods), activity (reduced,
especially in urban settings), residence (rural-urban shift) and body size (increased
obesity and at a younger age). The prevalence of overweight/obesity in Tongans and
Fijians has increased rapidly over the last two decades and remains among the highest in
the world (>80% in Tonga; >40% in Fiji), with more females reported to be obese than
males. The few studies that investigated sociocultural influences on patterns of eating,
activity and/or body size in this population have examined the impact of hierarchical
organisation, rank and status (sex, seniority), values (respect, care, co-operation) and/or
role expectations. It is important to examine how sociocultural factors influence eating,
activity and body size in order to i) establish factors that promote or protect against
obesity, ii) inform culturally-appropriate interventions to promote healthy lifestyles and
body size, and iii) halt the obesity epidemic, especially in cultural groups with a high
prevalence of obesity. There is an urgent need for more systematic investigations of key
sociocultural factors, whilst taking into account the complex interplay between
sociocultural factors, behaviours and other influences (historical; socioeconomic; policy;
external global influences; physical environment).
McDonald, N. C. (2008). "The effect of objectively measured crime on walking in
minority adults." Am J Health Promot 22(6): 433-6.
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
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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 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.
McLaren, L. and J. Godley (2009). "Social Class and BMI Among Canadian Adults: A
Focus on Occupational Prestige." Obesity (Silver Spring) 17(2): 290-9.
The objective was to examine BMI of working-age Canadian adults in relation to
occupational prestige, adjusting for other aspects of social class including household
income and respondent's education. We analyzed data from 49,252 adults (age 25-64)
from Cycle 2.1 of the Canadian Community Health Survey, a cross-sectional self-report
survey conducted in 2003. Multiple linear regression was used to examine the relation
between BMI and occupational prestige, adjusting for other sociodemographic variables.
For women, higher ranking occupations showed lower average BMI relative to the lowest
ranking occupations, but this effect was largely eliminated when adjusting for education.
For men, occupation effects endured in adjusted models and we detected some evidence
of a pattern whereby men in occupations characterized by management/supervisory
responsibilities were heavier than those in the lowest ranking occupations (i.e., elemental
sales and service). Results are interpreted in light of the symbolic value of body size in
western culture, which differs for men and women. Men in positions of
management/supervision may benefit from the physical dominance conveyed by a larger
body size, and thus occupational prestige rankings may help us to understand the gender
differences in the patterning of BMI by different indicators of social class.Obesity (2009)
17 2, 290-299. doi:10.1038/oby.2008.539.
Neighbors, C. J., D. X. Marquez, et al. (2008). "Leisure-time physical activity disparities
among Hispanic subgroups in the United States." American Journal Of Public Health
98(8): 1460-1464.
Studies of leisure-time physical activity disparities for Hispanic individuals have
not adjusted for sociodemographic confounds or accounted for variation by country of
origin. We used the National Health Interview Survey to compare leisure-time physical
activity among Hispanic and non-Hispanic White persons. All Hispanic subgroups were
less active than were non-Hispanic White people, yet significant heterogeneity existed
among Hispanic persons. Sociodemographic factors partly accounted for disparities
among men; disparities among women persisted despite multivariate adjustments.
Interventions must attend to these underserved yet varied subcommunities.
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Plonczynski, D. J., J. Wilbur, et al. (2008). "Lifestyle physical activity of older rural
women." Res Nurs Health 31(5): 501-13.
The purpose of this study was to describe and examine the lifestyle physical
activity behaviors (household, leisure, occupational) of older rural women. Background
characteristics included demographics, environment, social support, and health.
Intrapersonal characteristics included motivation and self-efficacy. The majority of the
women's energy expenditure was in the household dimension. Social support was
positively associated with household activities. A higher level of leisure physical activity
was associated with living within the two small cities and reporting lower levels of health
and lower motivation. This research highlights the importance of household physical
activity and the contribution of social support for household physical activity, both of
which may be important in developing interventions to promote physical activity in older
rural women.
Sturm, R. (2008). "Stemming the global obesity epidemic: what can we learn from data
about social and economic trends?" Public Health 122(8): 739-46.
Although the policy debate is only slowly moving away from the focus on
individual-level psychological and social factors, the research community has largely
recognized that changes in dietary and physical activity patterns are driven by changes in
the environment and by the incentives that people face. Many factors have been
suggested as causes of the 'obesity epidemic'. Putting a multitude of isolated data points
into a coherent picture is a challenging, but necessary, task to assess whether proposed
solutions are promising or likely to lead down a blind alley. Conventional wisdom is an
unreliable guide and some widely held beliefs are incorrect. Can one distinguish between
important and less important behavioural changes and relate them to environmental
incentives? People face trade-offs in allocating their scarce resources of time and money
to best achieve their goals, including health. Studying what people are doing with their
time and money is a good start towards understanding how economic incentives have
altered energy intake and energy expenditure in a way that has led to weight gain. A
challenging task for policy will be finding the right levers. Both economic and public
health/medical perspectives play an important role in the policy process, but often
approach policy questions in an incompatible way. Economics and public health
perspectives can complement each other, but harnessing any synergy requires an
understanding of the other perspective. Arguably the most effective community
intervention would be multi-faceted and would include several goals about diet and
physical activity. In practice, however, it appears that much more effort is devoted to
promoting increased fruit/vegetable consumption, and exhorting individuals to increase
physical activity than to environmental intervention that would make it easier for people
to reduce energy intake and sedentary entertainment. Politically, it may often be more
expedient to promote an increase than a decrease, but it may be far less effective.
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Vrazel, J., R. P. Saunders, et al. (2008). "An overview and proposed framework of socialenvironmental influences on the physical-activity behavior of women." Am J Health
Promot 23(1): 2-12.
OBJECTIVE: The primary purposes of this review were to identify key socialenvironmental influences on the physical-activity behavior of women and to propose an
organizing framework of these influences in the social environment. DATA SOURCES:
Computerized searches of MEDLINE, Science Direct, and CINAHL were conducted to
identify relevant research. Study Inclusion and Exclusion Criteria. Studies were included
if they used a sample of adult women or included gender-specific analysis, identified or
measured some aspect of the social environment in relation to physical activity, and were
published in English within the last two decades. DATA EXTRACTION: Characteristics
of study design, sample population, and identified social-environmental variables were
extracted. DATA SYNTHESIS: Through an iterative review of the data by several
researchers, common influences and themes were identified and organized into a social
environment framework, which included the following components: social support/social
networks, life transitions/ multiple roles, and cultural standards/gender role expectations.
RESULTS: Women are exposed to societal messages that indicate physical activity is not
a priority and may be inappropriate; they may also lack the social support necessary to
adopt and maintain physical activity. CONCLUSIONS: This review reveals the complex
range of factors in the social environment that influence women, and it provides support
for the importance of the social environment on physical-activity behavior in women. A
social-environmental framework related to Bronfenbrenner's social ecological model is
proposed along with recommended strategies to apply in interventions targeting women.
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Measurement
Ball, K., R. W. Jeffery, et al. (2008). "Mismatch between perceived and objective
measures of physical activity environments." Prev Med 47(3): 294-8.
OBJECTIVES: This study investigated the correspondence between measures of
physical activity facilities obtained through self-report and objective audits; and
identified the socio-demographic, cognitive and behavioral characteristics of those who
perceive their physical activity environment to be less supportive than objective measures
indicate. METHODS: Self-report surveys were completed by 1540 women recruited from
45 neighborhoods in Melbourne, Australia. Women reported perceived access to physical
activity facilities within 2 km from home, and also socio-demographic, cognitive and
behavioral factors. Objective data on physical activity facilities within a 2 km pedestrian
catchment area around women's homes were sourced. RESULTS: There was relatively
poor agreement between measures of access to physical activity facilities obtained via
self-report and objective assessment. Mismatch between perceived and objectivelyassessed environments was more common amongst younger and older women, and
women of low income, with low self-efficacy for physical activity, who were less active,
who reported using fewer facilities and who had lived in the neighborhood for less than 2
years. CONCLUSIONS: Future studies of environmental determinants of physical
activity should consider incorporating objective indices of access to facilities, or
accounting for the systematic bias that may result from relying on self-report perceptions
as an indicator of the actual physical activity environment.
Bassett, D. R., Jr., M. T. Mahar, et al. (2008). "Walking and measurement." Med Sci
Sports Exerc 40(7 Suppl): S529-36.
Walking is an important form of physical activity. It is practiced by people of
nearly all ages, throughout the world. Walking is an integral part of life, and there is
accumulating evidence that it is essential to good health. There are many ways to
measure walking including pedometers, accelerometers, trail counters, direct observation,
physical activity questionnaires, and transportation surveys. When measuring walking,
researchers must be prepared to demonstrate the validity of their instruments. A paradigm
for validation in walking research consists of accumulating evidence at three levels or
stages. First, the definitional stage involves investigation of prior theory and empirical
evidence to describe the nature of walking. The confirmatory stage involves
investigations that either confirm or disconfirm the definition of walking. The highest
level of validation is at the theory-testing stage, where we examine theories of how
walking is related to other constructs, including the outcomes and the determinants of
walking. It is important that validation research in the latter two stages (confirmatory
research and theory-testing research) is built on directly relevant research at the earlier
stages. The articles presented at the conference on "Walking for Health: Measurement
and Research Issues and Challenges" suggest future research directions that will increase
our knowledge of walking and health outcomes and provide new approaches to get
people walking.
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Brown, B. B. and C. M. Werner (2008). "Using accelerometer feedback to identify
walking destinations, activity overestimates, and stealth exercise in obese and nonobese
individuals." J Phys Act Health 5(6): 882-93.
BACKGROUND: Accelerometer output feedback might enable assessment of
recall biases for moderate bouts by obese and nonobese individuals; accelerometry might
also help residents recall destinations for moderate-intensity walking bouts. METHODS:
Adult residents' 1-week accelerometer-measured physical activity and obesity status were
measured before and after a new rail stop opened (n = 51 Time 1; n = 47 Time 2).
Participants recalled the week's walking bouts, described them as brisk (moderate) or not,
and reported a rail stop destination or not. RESULTS: At the end of the week, we
provided accelerometry output to residents as a prompt. Recall of activity intensity was
accurate for about 60% of bouts. Nonobese participants had more moderate bouts and
more "stealth exercise" --moderate bouts recalled as not brisk--than did obese individuals.
Obese participants had more overestimates--recalling light bouts as brisk walks--than did
nonobese individuals. Compared with unprompted recall, accelerometry-prompted recalls
allowed residents to describe where significantly more moderate bouts of activity
occurred. CONCLUSION: Coupling accelerometry feedback with self-report improves
research by measuring the duration, intensity, and destination of walking bouts. Recall
errors and different patterns of errors by obese and nonobese individuals underscore the
importance of validation by accelerometry.
Duncan, J. S., H. M. Badland, et al. (2008). "Combining GPS with heart rate monitoring
to measure physical activity in children: A feasibility study." J Sci Med Sport.
The recent development of global positioning system (GPS) receivers with
integrated heart rate (HR) monitoring has provided a new method for estimating the
energy expenditure associated with children's movement. The purpose of this feasibility
study was to trial a combination of GPS surveillance and HR monitoring in 39 primaryaged children from New Zealand. Spatial location and HR data were recorded during a
school lunch break using an integrated GPS/HR receiver (1Hz). Children averaged a total
distance of 1.10+/-0.56km at speeds ranging from 0 to 18.6kmh(-1). Activity patterns
were characterised by short bursts of moderate to high speeds followed by longer periods
of slow speeds. In addition, boys averaged higher speeds than girls (1.77+/-0.62kmh(-1)
and 1.36+/-0.50kmh(-1), respectively; p=0.003). The percentage of time spent at 0kmh(1) (stationary) ranged from 0.1% to 21.3% with a mean of 6.4+/-4.6%. These data
suggest that while children were relatively active during the lunch period, they spent a
substantial portion of time engaged in slow or stationary physical activities. Furthermore,
associations between HR, average speed, and stationary time demonstrated that children
who moved at faster speeds expended more energy than those who moved at slower
speeds. We conclude that the combined approach of GPS and HR monitoring is a
promising new method for investigating children's play-related energy expenditure. There
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is also scope to integrate GPS data with geographic information systems to examine
where children play and accumulate physical activity.
Egeland, G. M., D. Denomme, et al. (2008). "Concurrent validity of the International
Physical Activity Questionnaire (IPAQ) in an liyiyiu Aschii (Cree) community." Can J
Public Health 99(4): 307-10.
BACKGROUND: Culturally acceptable and validated instruments for assessing
physical activity among Indigenous Peoples are lacking. Given the current trends in
obesity, health behaviour surveillance tools are needed to evaluate trends and to
determine the effectiveness of health promotion efforts aimed at curbing the obesity
epidemic. OBJECTIVE: To evaluate whether the International Physical Activity
Questionnaire (IPAQ) scores correlate with anthropometric indices in an liyiyiu Aschii
community (Cree Territory of northern Quebec, Canada). METHODS: A cross-sectional
study was carried out in a Cree community as part of a larger research effort entitled,
"Nituuchischaayihitaau Aschii: A Multi-Community Environment-and-Health
Longitudinal Study in liyiyiu Aschii". Randomly selected adult participants (n = 161)
underwent an anthropometric assessment and answered the IPAQ which was
administered by bilingual research assistants. Concurrent validity of the IPAQ was
evaluated by the extent to which the physical activity scores were related to
anthropometric measures. RESULTS: Significant inverse correlations were observed
between the IPAQ Total MET score and % body fat (r = -.19, p < or = 0.01) and the
IPAQ Vigorous MET score and % body fat (r = -.26, p < or = 0.001), but not for waist
circumference or BMI. Walkers (6-7 days/wk for > or = 60 minutes/day), however, had a
waist circumference that was, on average, 5 cm smaller than non-walkers in age- and sexadjusted linear regression analyses (beta = -4.97; SE = 2.5; p < or = 0.05).
DISCUSSION: The results indicate that the IPAQ holds promise as a culturally adaptable
questionnaire for the liyiyiuch. However, modifications will help improve its
acceptability for community members.
Elgar, F. J. and J. M. Stewart (2008). "Validity of self-report screening for overweight
and obesity. Evidence from the Canadian Community Health Survey." Can J Public
Health 99(5): 423-7.
OBJECTIVE: Community health surveys often collect self-report data on body
height and weight for the purposes of calculating the Body Mass Index (BMI) and
identifying cases of overweight and obesity. The aim of the study was to test the validity
of this method and to describe age and gender trends in self-report bias in height, weight,
and BMI. METHODS: This population survey included 4,615 adolescents and adults
from across Canada who were interviewed and then measured in their homes.
Overweight and obesity were identified using self-reports and cut points in BMI.
RESULTS: Self-reports correlated highly with body measurements but on average, selfreported height was 0.88 cm greater than measured height, self-reported weight was 2.33
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kg less than measured weight, and BMI derived from self-reports was 1.16 lower than
BMI derived from measurements. Consequently, self-reports yielded lower rates of
overweight (31.87%) and obesity (15.32%) than measurements (33.67% and 22.92%,
respectively). The magnitude and variability of self-report bias in BMI were related to
female gender, older age, and the presence of overweight or obesity. DISCUSSION:
Comparison of self-reported and measured height and weight indicated that most survey
respondents under-reported weight and over-reported height. Intentional or not, these
biases were compounded in the BMI formula and affected the accuracy of self-reports as
a tool for identifying weight problems. Self-reports may be easier to collect than body
measurements but should not be used exclusively as an obesity surveillance tool.
Freedson, P. S., K. Brendley, et al. (2008). "New Techniques and Issues in Assessing
Walking Behavior and Its Contexts." Medicine & Science in Sports & Exercise 40: S574.
The article discusses the metabolic responses to walking by identifying the
economy of walking during different locomotion velocities. It examines gender, weight
status and growth effects on metabolic responses. It also analyzes the use of technology
in the assessment of walking patterns and behavior in the community. Self-report
methods used to assess walking behavior as well as the strengths and weaknesses of these
methods are illustrated. Furthermore, ways of measuring the walkability of the
community to understand the influence of the built environment on walking behavior are
provided.
Jia, Y. J., L. Z. Xu, et al. (2008). "[Reliability and validity regarding the Chinese version
of the International Physical Activity Questionnaires (long self-administrated format) on
women in Chengdu, China.]." Zhonghua Liu Xing Bing Xue Za Zhi 29(11): 1078-82.
OBJECTIVE: To test the reliability and validity of International Physical Activity
Questionnaires (long self-administrated format) (IPAQ), Chinese version on women of
12 - 44 years old, in Chengdu city. METHODS: Clustered sampling was used, according
to the age distribution of investigated population. One community, one university and
two middle schools (including one high school and one junior high school) in Chengdu
were selected. The reliability study was conducted in a 28-day period. Participants were
contacted three times within 28 days (on the 1(st), the 8(th) and the 28(th) day
respectively). In the validity study, participants completed the same questionnaire and
Bouchard physical activity diary (PA diary) each day for seven days between visit 1 and
visit 2 before comparing the IPAQ's result with Bouchard physical activity diary's for
validity study. Pearson or Spearman' correlation coefficients were calculated for validity
and interclass correlation coefficients for reliability according to date distribution.
RESULTS: (1) One hundred and eighty six participants were recruited for the reliability
study. All of them completed the first questionnaire with 143 (76.88%) and 172 (92.50%)
finished the second and third questionnaires. One hundred and fifty eight participants
were recruited in the validity study. Qualified questionnaire accounted for 90.59% (143).
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(2) Results from the test-retest reliability of the Chinese version of long selfadministrated format (IPAQ) showed: the ICC after one week ranged from 0.7373 to
0.972 (mean: 0.870) which were higher than those interval's reliability [ICC = 0.472 0.948 for three weeks interval (mean: 0.721), and 0.473 - 0.925 for four weeks interval
(mean: 0.696)]. The ICCs of three weeks interval and four weeks interval were not
significantly different. ICCs for vigorous physical activity and leisure time physical
activity were the best. (3) The validity for different intensity, total physical activity and
sitting time showed the correlation coefficients between IPAQ and PA diary ranged from
0.445 to 0.696, with correlation for vigorous physical activity the best (r = 0.696).
CONCLUSION: IPAQ-C seemed a reliable and validated measure of physical activity
for 12 - 44 year-old women in Chengdu city.
Kavanagh, J. J. and H. B. Menz (2008). "Accelerometry: A technique for quantifying
movement patterns during walking." Gait & Posture 28(1): 1.
Abstract: The popularity of using accelerometer-based systems to quantify human
movement patterns has increased in recent years for clinicians and researchers alike. The
benefits of using accelerometers compared to more traditional gait analysis instruments
include low cost; testing is not restricted to a laboratory environment; accelerometers are
small, therefore walking is relatively unrestricted; and direct measurement of 3D
accelerations eliminate errors associated with differentiating displacement and velocity
data. However, accelerometry is not without its disadvantages, an issue which is scarcely
reported in gait analysis literature. This paper reviews the use of accelerometer
technology to investigate gait-related movement patterns, and addresses issues of
acceleration measurement important for experimental design. An overview of
accelerometer mechanics is provided before illustrating specific experimental conditions
necessary to ensure the accuracy of gait-related acceleration measurement. A literature
review is presented on how accelerometry has been used to examine basic temporospatial
gait parameters, shock attenuation, and segmental accelerations of the body during
walking. The output of accelerometers attached to the upper body has provided useful
insights into the motor control of normal walking, age-related differences in dynamic
postural control, and gait patterns in people with movement disorders. Copyright 2008
Elsevier
Lachat, C. K., R. Verstraeten, et al. (2008). "Validity of two physical activity
questionnaires (IPAQ and PAQA) for Vietnamese adolescents in rural and urban areas."
Int J Behav Nutr Phys Act 5: 37.
ABSTRACT: BACKGROUND: Although physical activity is recognised to be an
important determinant of health and nutritional status, few instruments have been
developed to assess physical activity in developing countries. The aim of this study was
to compare the validity of the short form of the International Physical Activity
Questionnaire (IPAQ) and a locally adapted version of the Physical Activity
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Questionnaire for Adolescents (PAQA) for use in school going adolescents in rural and
urban areas in Vietnam. METHODS: Sixteen year old adolescents from rural areas (n =
137) and urban areas (n = 90) completed the questionnaires in 2006. Test-retest reliability
was assessed by comparing registrations after 2 weeks. Criterion validity was assessed by
comparison with 7 days continuous accelerometer logging. Validity of the two methods
was assessed using Spearman correlation coefficient, intra class correlation coefficients
(ICC) and Kappa statistics. RESULTS: Reliability of both questionnaires was poor for
both the IPAQ (ICC = 0.37) and the PAQA (ICC = 0.40). Criterion validity of both
questionnaires was acceptable and similar for the IPAQ (rho = 0.21) and the PAQA (rho
= 0.27) but a significantly lower validity was observed in rural areas. Both forms poorly
estimated time spent on light, moderate and vigorous physical activity. Agreement of
both questionnaires to classify individuals was also low but the IPAQ performed better
than the PAQA. CONCLUSION: Both questionnaires have a similar and overall poor
validity to be used as a population instrument in Vietnam. Low reliability and
classification properties in rural areas call for further research for specific use in such
settings.
Paquet, C., M. Daniel, et al. (2008). "Field validation of listings of food stores and
commercial physical activity establishments from secondary data." Int J Behav Nutr Phys
Act 5: 58.
ABSTRACT: BACKGROUND: Food- and activity-related establishments are
increasingly viewed as neighbourhood resources that potentially condition health-related
behaviour. The primary objective of the current study was to establish, using ground
truthing (on-site verification), the validity of measures of availability of food stores and
physical activity establishments that were obtained from commercial database and
Internet searches. A secondary objective was to examine differences in validity results
according to neighbourhood characteristics and commercial establishment categories.
METHODS: Lists of food stores and physical activity-related establishments in 12 census
tracts within the Montreal metropolitan region were compiled using a commercial
database (n = 171 establishments) and Internet search engines (n = 123 establishments).
Ground truthing through field observations was performed to assess the presence of listed
establishments and identify those absent. Percentage agreement, sensitivity (proportion of
establishments found in the field that were listed), and positive predictive value
(proportion of listed establishments found in the field) were calculated and contrasted
according to data sources, census tracts characteristics, and establishment categories.
RESULTS: Agreement with field observations was good (0.73) for the commercial list,
and moderate (0.60) for the Internet-based list. The commercial list was superior to the
Internet-based list for correctly listing establishments present in the field (sensitivity), but
slightly inferior in terms of the likelihood that a listed establishment was present in the
field (positive predictive value). Agreement was higher for food stores than for activityrelated establishments. CONCLUSION: Commercial data sources may provide a valid
alternative to field observations and could prove a valuable tool in the evaluation of
commercial environments relevant to eating behaviour. In contrast, this study did not find
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strong evidence in support of commercial and Internet data sources to represent
neighbourhood opportunities for active lifestyle.
Procter, K. L., M. C. Rudolf, et al. (2008). "Measuring the school impact on child
obesity." Social Science & Medicine 67(2): 341-349.
This article explores the impact that schools have on their pupils' obesity and so
identify those where targeted input is most needed. A modelling process was developed
using data that had been collected over 2 years on a socio-economically and ethnically
representative sample of 2367 school pupils aged 5 and 9 years old attending 35 Leeds
primary schools. The three steps in the model involved calculating the "Observed" level
of obesity for each school using mean body mass index standard deviation (BMI SDS);
adjusting this using ethnicity and census-derived deprivation data to calculate the
"Expected" level; and calculating the "Value Added" by each school from differences in
obesity at school entry and transfer. We found there was significant variance between the
schools in terms of mean BMI SDS (range -0.07 to +0.78). Residential deprivation score
and ethnicity accounted for only a small proportion of the variation. Expected levels of
obesity therefore differed little from the Observed, but the Value Added step produced
very different rankings. As such, there is variation between schools in terms of their
levels of obesity. Our modelling process allowed us to identify schools whose levels
differed from that expected given the socio-demographic make up of the pupils attending.
The Value Added step suggests that there may be a significant school effect. If this is
validated in extended studies, the methodology could allow for exploration of
mechanisms contributing to the school effect, and identify schools with the highest
unexpected prevalence. Resources could then be targeted towards those schools in
greatest need. (C) 2008 Elsevier Ltd. All rights reserved..
Suminski, R. R., J. Fritzsinger, et al. (2008). "Observing physical activity in suburbs."
Health & Place 14(4): 894-899.
This study examined the reliability of the block walk method (BWM) for
observing physical activity on suburban sidewalks/streets. Trained observers
simultaneously walked 40 sidewalk/street segments each 1525 m in length at a pace of
30.5 m/min while recording the number of individuals walking/bicycling/jogging and the
address where the activity occurred. An activity was observed at 2.9% of the 1020
addresses walked passed. In all 41 individuals were seen walking, 4 jogging, and 3
bicycling during 400 observation minutes. Agreements were 80%, 90%, and 86.7% for
address, activity type, and number of individuals. The BWM is reliable for assessing
activity on suburban sidewalks/streets. (C) 2008 Elsevier Ltd. All rights reserved.
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Ward, D., D. Hales, et al. (2008). "An instrument to assess the obesogenic environment
of child care Centers." American Journal Of Health Behavior 32(4): 380-386.
Objectives: To describe protocol and interobserver agreements of an instrument to
evaluate nutrition and physical activity environments at child care. Methods:
Interobserver data were collected from 9 child care centers, through direct observation
and document review (17 observer pairs). Results: Mean agreement between observer
pairs was 87.26% and 79.29% for the observation and document review, respectively.
Items with lower agreement were primarily staff behavior, counting across the day/week,
and policy classifications. Conclusions: Although some revisions are required, the
interobserver agreement for the environment and policy assessment and observation
(EPAO instrument) appears to be quite good for assessing the nutrition and physical
activity environment of child care centers.
Ward, D. S., S. E. Benjamin, et al. (2008). "Nutrition and physical activity in child care Results from an environmental intervention." American Journal Of Preventive Medicine
35(4): 352-356.
Background: With evidence of increased levels of obesity in younger children, the
child-care setting is an important intervention target. Few environmental interventions
exist, and none target both diet and physical activity. The Nutrition and Physical Activity
Self-Assessment for Child Care (NAP SACC) intervention was developed to fill this
research and practice gap. Design: Randomized controlled. Setting/participants: Health
professionals (child-care health consultants) serving child-care centers in North Carolina
were recruited (n=30), randomly assigned into intervention or delayed-intervention
control groups, and trained to implement the NAP SACC program. Up to three child-care
centers were recruited (n=84) from each consultant's existing caseload. Intervention:
Implemented in 2005, the NAP SACC intervention includes an environmental selfassessment, selection of areas for change, continuing education workshops, targeted
technical assistance, and re-evaluation. Implementation occurred over a 6-month period.
Main outcome measures: An observational instrument, Environment and Policy
Assessment and Observation (EPAO), provided objective evidence of intervention impact
and was completed by trained research staff blinded to study assignment. Data were
collected in 2005 and 2006. Statistical analyses were conducted in 2006. Results:
Intention-to-treat analysis results were nonsignificant. Exploratory analyses using only
centers that completed most of the NAP SACC program suggest an intervention effect.
Conclusions: Factors in the intervention design, the fidelity of implementation, the
selection of outcome measure, or a combination of these may have contributed to the lack
of intervention effect observed. Because of this study's use of existing public health
infrastructure and its potential for implementation, future studies should address
strategies for improving effectiveness.
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Community Intervention
Annesi, J. J., J. C. Moore, et al. (2008). "Correlates of changes in voluntary physical
activity associated with the Youth Fit For Life (TM) intervention during after-school
care." Psychological Reports 102(3): 911-919.
Overweight in youth is increasing and physical inactivity has been implicated as a
causal factor, An after-school care intervention, Youth Fit For Life (TM), has been
associated with significant improvements in physiological factors and frequency of
moderate-to-vigorous physical activity Voluntarily completed outside of structured
settings. Correlates of the observed changes in physical activity amounts were, however,
unknown. A multiple regression equation with simultaneous entry of sex, age, race, initial
Body Mass Index, and initial frequency of voluntary physical activity as predictor
variables for changes in physical activity was Calculated on Euro-American and AfricanAmerican participants ages 8 to 12 years (N=217). A statistically significant 16% of the
variance in changes in frequency of voluntary physical activity over 12 wk. was
accounted for, with only voluntary physical activity at baseline and age making
significant, unique contributions. For participants either overweight or at risk for
overweight (n=72), the changes in physical activity significantly correlated with changes
in Body Mass Index. Implications of findings to maximize treatment effects on voluntary
physical activity were suggested.
Carlson, J. J., J. C. Eisenmann, et al. (2008). "(S)Partners for Heart Health: a schoolbased program for enhancing physical activity and nutrition to promote cardiovascular
health in 5th grade students." BMC Public Health 8: 420.
BACKGROUND: The American Heart Association Position Statement on
Cardiovascular Health Promotion in Public Schools encourages school-based
interventions for the primary prevention of cardiovascular disease (CVD) through risk
factor prevention or reduction in children with an emphasis on creating an environment
that promotes healthy food choices and physical activity (PA). In an effort to address
issues related to CVD risk factors including obesity in Michigan children, a multidisciplinary team of Michigan State University (MSU) faculty, clinicians, and health
profession students was formed to "(S)partner" with elementary school physical
education (PE) teachers and MSU Extension staff to develop and implement a costeffective, sustainable program aimed at CVD risk factor prevention and management for
5th grade students. This (S)partnership is intended to augment and improve the existing
5th grade PE, health and nutrition curriculum by achieving the following aims: 1)
improve the students' knowledge, attitudes and confidence about nutrition, PA and heart
health; 2) increase the number of students achieving national recommendations for PA
and nutrition; and 3) increase the number of students with a desirable CVD risk factor
status based on national pediatric guidelines. Secondary aims include promoting school
staff and parental support for heart health to help children achieve their goals and to
provide experiential learning and service for MSU health profession students for
academic credit. METHODS/DESIGN: This pilot effectiveness study was approved by
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the MSU IRB. At the beginning and the end of the school year students undergo a CVD
risk factor assessment conducted by MSU medical students and graduate students. Key
intervention components include eight lesson plans (conducted bi-monthly) designed to
promote heart healthy nutrition and PA behaviors conducted by PE teachers with
assistance from MSU undergraduate dietetic and kinesiology students (Spartners). The
final 10 minutes of each lesson, MSU Spartners conduct small breakout/discussion
groups with the 5th grade students. Additionally, each Spartner case manages/mentors
two to three 5th grade students using a web-based goal setting and tracking protocol
throughout the school year. DISCUSSION: This paper describes the rationale,
development, and methods of the Spartners for Heart Health program. This is a multilevel intervention designed to promote heart healthy behaviors and prevent or manage
CVD risk factors in children. We believe this will be a viable sustainable intervention
that can be disseminated and adopted by other institutions with minimal cost by engaging
college students as an integral part of the measurement and intervention teams.
Davey, R. C., T. Cochrane, et al. (2008). "Design of a pragmatic cluster randomised
controlled trial: ecological approach to increasing physical activity in an urban
community." Contemp Clin Trials 29(5): 774-82.
This study was set up to test an ecological intervention using a pragmatic cluster
randomised controlled design (RCT) aimed at increasing physical activity (PA) within
the community in a deprived inner-city area in the UK. The research will provide a
detailed mapping (using Graphical Information Systems GIS) of the environment at
lower super output area (SOA) level in Stoke-on-Trent (SoT) and will evaluate the
relationship between the environment, PA behaviour, health and healthcare utilisation.
The environmental mapping will aggregate data from a wide range of available
databases, augmented by local data gathering and validation, to produce a comprehensive
geo-coded map of 10 SOAs (covering a population ~15,000). GIS will be used to derive
indices through which to evaluate the relationship between environmental characteristics
and levels of physical activity and health, using Hierarchical Linear Modelling (HLM).
Environmental indices used will include: proximity of PA spaces and facilities, street
connectivity, land use mix, population density, mass transport provision, traffic, safety,
crime, proximity of food outlets and shops, "Walkability Index", weather and indices of
multiple deprivation (IMD). The areas for mapping, baseline assessment and intervention
will be considered in two parts, a) community-based and b) schools-based. The
effectiveness of the community-based intervention will be assessed by an independent
panel survey conducted at baseline and at 2 years follow-up, with an expected 10%
increase in the proportion of the population more active in the intervention arm.
Effectiveness of the schools-based intervention will be designed to detect an increase of
~15 min/day in school children's moderate to vigorous PA (MVPA). Resource use, cost,
willingness to pay and incidental consequences data will be collected alongside the
community-based intervention to enable economic modelling from health and social care,
societal, other public service and participant perspectives. Findings from the project will
inform public policy for increasing population PA and improving neighbourhoods and
urban design.
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De Cocker, K. A., I. M. De Bourdeaudhuij, et al. (2008). "The effect of a pedometerbased physical activity intervention on sitting time." Prev Med 47(2): 179-81.
OBJECTIVE: To assess whether the "10,000 Steps Ghent" intervention had any
effect on self-reported sitting time. METHODS: A multi-strategy community-based
intervention was implemented in 2005 to promote physical activity (PA) to adults living
in Ghent, Belgium. In 2005, 648 randomly selected participants (aged 25 to 75) from the
intervention community Ghent and 592 from a comparison community, completed the
International Physical Activity Questionnaire (IPAQ) and a pedometer log. Of these, 440
intervention participants and 426 comparison participants completed the follow-up
measurements in 2006. RESULTS: A decrease of 12 min in total daily sitting time was
found in the intervention community, compared with an increase of 18 min/day in the
comparison community (F=9.5, p=0.002). The effect was seen for both weekday
(p=0.044) and weekend day (p<0.001) sitting times. In the intervention community, total
daily sitting time decreased more in the participants who increased their step counts (-18
min/day; t=2.5; p=0.012), than in those who did not (no change; t=0.8, ns).
CONCLUSIONS: After 1 year of intervention, total, weekday, and weekend day sitting
times were reduced in the intervention community, while sitting time increased in the
comparison community.
Estabrooks, P. A., M. Bradshaw, et al. (2008). "Determining the impact of Walk Kansas:
Applying a team-building approach to community physical activity promotion." Annals
Of Behavioral Medicine 36(1): 1-12.
Background Research and practice partnerships have the potential to enhance the
translation of research findings into practice. Purpose This paper describes such a
partnership in the development of Walk Kansas (WK) and highlights individual and
organizational level outcomes. Method Phase 1 examined: (a) the reach of WK, (b)
physical activity changes, and (c) maintenance of physical activity changes 6 months
after the program was completed. Phase 2 explored WK adoption and sustainability over
5 years. Results WK attracted a large number of participants who were more likely to be
female, more active, and older than the adult population within the counties where they
resided. Inactive or insufficiently active participants at baseline experienced significant
increases in both moderate (p < 0.001) and vigorous (p < 0.001) physical activity. A
random selection of participants who were assessed 6 months post-program did not
demonstrate a significant decrease in moderate or vigorous activity between program
completion and 6-month follow-up. The number of counties adopting the program
increased across years, peaking at 97 in 2006 and demonstrated the sustainability of the
WK over 5 years. Conclusions WK is effective, has a broad reach, and enables
participants to maintain increased activity. It also shows promise for broad adoption and
sustainability.
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Ferney, S. L., A. L. Marshall, et al. (2008). "Randomized trial of a neighborhood
environment-focused physical activity website intervention." Prev Med.
OBJECTIVE: To evaluate the use of a local neighborhood environment-focused
physical activity website and its effects on walking and overall physical activity in
middle-aged adults. METHOD: One-hundred and six (72% women) inactive adults aged
52+/-4.6 years were randomly allocated to receive access to a neighborhood
environment-focused website, (Neighborhood group, n=52) or a motivationalinformation website (Comparison group n=54). Participants also received eleven emails
over the 26 weeks. Study outcomes were objectively-monitored website use, and selfreported total walking (min/wk), total physical activity (min/wk) and neighborhood
walking (min/wk) collected at baseline, 12 and 26 weeks. The study was conducted
between August 2005 and February 2006 in Brisbane, Australia. RESULTS: Website use
was significantly greater among Neighborhood participants (p=0.01). Statistically
significant increases in walking and total physical activity were observed in both groups.
There was also a statistically significant interaction effect for total physical activity, with
Neighborhood group participants maintaining more of their initial increase in physical
activity at week-26 (p<0.05). Further, those in the Neighborhood group who used the
website more often reported significantly more walking along the community trail at
week-26 (p=0.05) compared with those who did not. CONCLUSIONS: A local
neighborhood-environment focused physical activity website was more effective at
engaging participants than a motivational-information website. Moreover, its use resulted
in meaningful increases in physical activity relative to the comparison website.
Ford, M. A. and D. Torok (2008). "Motivational signage increases physical activity on a
college campus." Journal Of American College Health 57(2): 242-244.
Objective: The authors evaluated whether motivational signage influenced rates
of stair use relative to elevator use on a college campus. Participants: In March and April
2004, the authors observed students, faculty, staff, and any visitors accessing a college
campus building. Methods: During Phase I, the authors monitored ascending stair and
elevator use at the same time each weekday (Monday-Friday). During Phase II, the
authors placed motivational signs encouraging stair use at the bottom of the stairs and
outside and inside the elevators. During the third week (Phase III), the authors removed
the signs. Results: The authors observed 18,389 ascending trips during the 3 weeks of the
study. Motivational signs significantly contributed to an 18.6% increase in stair use in the
second week, which was maintained in the following week. Conclusions: The signage
intervention successfully enhanced physical activity on a college campus by providing
educational health tips that may have served as motivation to choose the stairs.
Gao, Y., S. Griffiths, et al. (2008). "Community-based interventions to reduce overweight
and obesity in China: a systematic review of the Chinese and English literature." J Public
Health (Oxf) 30(4): 436-48.
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BACKGROUND: Overweight and obesity pose a challenge to public health in
China. According to Chinese definition, 303 million Chinese are overweight (body mass
index, BMI >or= 24 kg m(-2)). Among them, 73 million are clinically obese (BMI >or=
28 kg m(-2)). In line with the global trend, the rate of obesity in China continues to
increase, with associated morbidity and mortality. This study was to identify
interventions, which are effective in Mainland Chinese society. METHODS: All nondrug-controlled interventions (>or=3 months) in Mainland China, which used
anthropometric outcome measures, were selected from three Chinese and nine
international electronic databases (before May 2006) and included in this systematic
review. RESULTS: A total of 20 studies met the selection criteria and were included in
the review. Among them only one was published in an international journal. Most studies
combined at least physical activity, dietary intervention and health education. Seventeen
studies (85%) reported significant effects in anthropometric measurement outcomes.
CONCLUSIONS: Comprehensive interventions with at least physical activity, dietary
intervention and health education may be effective in reducing obesity in Chinese
children. The role of grandparents as carers in the one-child society is worth considering
further. Current evidence of effective interventions for adults is limited. Publication bias
in Chinese databases should be taken into account.
Gibson, C. A., B. K. Smith, et al. (2008). "Physical activity across the curriculum: year
one process evaluation results." International Journal Of Behavioral Nutrition And
Physical Activity 5.
Background: Physical Activity Across the Curriculum (PAAC) is a 3-year
elementary school-based intervention to determine if increased amounts of moderate
intensity physical activity performed in the classroom will diminish gains in body mass
index (BMI). It is a cluster-randomized, controlled trial, involving 4905 children (2505
intervention, 2400 control). Methods: We collected both qualitative and quantitative
process evaluation data from 24 schools (14 intervention and 10 control), which included
tracking teacher training issues, challenges and barriers to effective implementation of
PAAC lessons, initial and continual use of program specified activities, and potential
competing factors, which might contaminate or lessen program effects. Results: Overall
teacher attendance at training sessions showed exceptional reach. Teachers incorporated
active lessons on most days, resulting in significantly greater student physical activity
levels compared to controls (p < 0.0001). Enjoyment ratings for classroom-based lessons
were also higher for intervention students. Competing factors, which might influence
program results, were not carried out at intervention or control schools or were judged to
be minimal. Conclusion: In the first year of the PAAC intervention, process evaluation
results were instrumental in identifying successes and challenges faced by teachers when
trying to modify existing academic lessons to incorporate physical activity.
Graf, C., B. Koch, et al. (2008). "School-based prevention: Effects on obesity and
physical performance after 4 years." Journal of Sports Sciences 26(10): 987.
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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. ABSTRACT FROM
AUTHOR
Hannon, J. C. and B. B. Brown (2008). "Increasing preschoolers' physical activity
intensities: An activity-friendly preschool playground intervention." Preventive Medicine
46(6): 532-536.
Objective. The purpose of this study was to see if portable play equipment added
to a preschool playground resulted in higher intensities of physical activity among 3-5year-old children. Methods. Activity-friendly equipment was added to an outdoor
preschool playground. Accelerometry-measured intensities of 15-s epochs of physical
activity were tracked for 5 pre-intervention and 5 post-intervention days during outdoor
play. Data were collected during fall 2005 in Salt Lake City for 64 preschoolers aged 3,
4, and 5 years. Results. After the intervention, both male and female 3- to 5-year-olds
significantly decreased sedentary behavior and significantly increased light, moderate,
and vigorous physical activity as measured by accelerometry. Conclusions. Results
suggest simple interventions, requiring little teacher training, can yield increases in
healthy physical activity. (C) 2008 Elsevier Inc. All rights reserved.
Heelan, K. A., S. A. Unruh, et al. (2008). "Walking to School: Taking Research to
Practice." JOPERD: The Journal of Physical Education, Recreation & Dance 79(6): 36.
The article reports on a study that determines barriers to active commuting to and
from school, as well as the results of the Walking School Bus program at elementary
schools in Nebraska. It mentions that barriers for active commuting to and from school
include distance from school, traffic-related dangers, weather, time and convenience. It
also develops the Walking School Bus program wherein college students escorted
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neighborhood children to and from school in the morning and afternoon. It also finds out
from parents that their children enjoyed participating in the Walking School Bus program
and that the program increased child physical activity levels.
Honas, J. J., R. A. Washburn, et al. (2008). "Energy expenditure of the physical activity
across the curriculum intervention." Medicine And Science In Sports And Exercise 40(8):
1501-1505.
Physical activity is frequently a component of interventions designed to diminish
weight gain in children. It is essential to determine whether the energy expenditure (EE)
elicited by these interventions is sufficient to reduce the rate of weight gain. Purpose: To
quantify the EE of the Physical Activity across the Curriculum (PAAC) intervention.
This intervention involved two 10-min physically active academic lessons per day, taught
by classroom teachers. Methods: We assessed EE of PAAC in 19 males and 19 females
using both an indirect calorimeter (IC) (COSMED K4b(2)) and an accelerometer
(ActiGraph) (AC). Independent t-tests were used to evaluate gender differences.
Dependent t-tests were used to examine the difference between EE assessed by IC and
AC. The agreement between EE measured by IC and estimated by AC was evaluated
using a Bland-Altman plot. A Pearson correlation between EE measured by IC and
estimated by AC was calculated. Results: There were no significant gender differences
for age, BMI, or EE; therefore, analyses by gender were not performed. The mean EE
measured by IC was 3.1 +/- 1.0 kcal.min(-1) (3.4 METs). Mean EE estimated by AC (1.8
+/- 0.9 kcal.min(-1)) was significantly lower (P < 0.05) than EE measured by IC (mean
underestimation = 1.3 kcal.min(-1)). The Bland-Altman plot suggested increased
underestimation with increased levels of EE. The 95% limits of agreement were large (2.8 to +0.3 kcal.min(-1)). The correlation between EE measured by IC and estimated by
AC was r = 0.68 (P < 0.001). Conclusion: PAAC elicited a level of EE that may prevent
excessive weight gain in children. AC significantly underestimated the EE of PAAC
lessons and may not provide useful EE estimates in this context.
Hudson, C. E. (2008). "An integrative review of obesity prevention in African American
children." Issues Compr Pediatr Nurs 31(4): 147-70.
The obesity epidemic disproportionately affects African American children ages 2
to 18 years of age. The author performed an integrative review of the literature pertaining
to African American childhood obesity prevention. The 28 research articles that met the
inclusion criteria for this integrative review were primarily comprised of descriptive
studies, targeted primarily middle-school children and only six were intervention studies.
Most intervention studies were pilot studies, had insufficient power related to small
sample size, and had short-term interventions and no follow-up. These studies are
promising as they test innovative and cultural specific interventions targeting children's
lifestyle behaviors aimed at reducing obesity among African Americans.
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Jansen, W., H. Raat, et al. (2008). "A school-based intervention to reduce overweight and
inactivity in children aged 6-12 years: study design of a randomized controlled trial."
Bmc Public Health 8.
Background: Effective interventions to prevent overweight and obesity in children
are urgently needed especially in inner-city neighbourhoods where prevalence of
overweight and inactivity among primary school children is high. A school based
intervention was developed aiming at the reduction of overweight and inactivity in these
children by addressing both behavioural and environmental determinants.
Methods/design: The main components of the intervention (Lekker Fit!) are the reestablishment of a professional physical education teacher; three (instead of two) PE
classes per week; additional sport and play activities outside school hours; fitness testing;
classroom education on healthy nutrition, active living and healthy lifestyle choices; and
the involvement of parents. The effectiveness of the intervention is evaluated through a
cluster randomized controlled trial in 20 primary schools among grades 3 through 8 (6-12
year olds). Primary outcome measures are BMI, waist circumference and fitness.
Secondary outcome measures are assessed in a subgroup of grade 6-8 pupils (9-12 year
olds) through classroom questionnaires and constitute of nutrition and physical activity
behaviours and behavioural determinants. Multilevel regression analyses are used to
study differences in outcomes between children in the intervention schools and in control
schools, taking clustering of children within schools into account. Discussion:
Hypotheses are that the intervention results in a lower prevalence of children being
overweight and an improved mean fitness score, in comparison with a control group
where the intervention is not implemented. The results of our study will contribute to the
discussion on the role of physical education and physical activity in the school
curriculum. Trial registration: [ISRCTN84383524].
Kamath, C. C., K. S. Vickers, et al. (2008). "Behavioral Interventions to Prevent
Childhood Obesity: A Systematic Review and Metaanalyses of Randomized Trials."
Journal Of Clinical Endocrinology & Metabolism 93(12): 4606-4615.
Context: The efficacy of lifestyle interventions to encourage healthy lifestyle
behaviors to prevent pediatric obesity remains unclear. Objective: Our objective was to
summarize evidence on the efficacy of interventions aimed at changing lifestyle
behaviors (increased physical activity, decreased sedentary activity, increased healthy
dietary habits, and decreased unhealthy dietary habits) to prevent obesity. Data Sources:
Data sources included librarian-designed searches of nine electronic databases, references
from included studies and reviews (from inception until February 2006), and content
expert recommendations. Study Selection: Eligible studies were randomized trials
enrolling children and adolescents assessing the impact of interventions on both lifestyle
behaviors and body mass index (BMI). Data Extraction: Two reviewers independently
abstracted data on methodological quality, study characteristics, intervention
components, and treatment effects. Data Analysis: We conducted random-effects
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metaanalyses, quantified inconsistency using I-2, and conducted planned subgroup
analyses for each examined outcome. Data Synthesis: Regarding target behaviors, the
pooled effect size for physical activity (22 comparisons; n = 9891 participants) was 0.12
[95% confidence interval (CI) = 0.04-0.20; I-2 = 63%], for sedentary activity (14
comparisons; n = 3003) was -0.29, (CI = -0.35 to -0.22; I-2 = 0%), for healthy dietary
habits (14 comparisons, n = 5468) was 0.00 (CI = -0.20; 0.20; I-2 = 83%), and for
unhealthy dietary habits (23 comparisons, n = 9578) was -0.20 (CI = -0.31 to -0.09; I-2 =
34%). The effect of these interventions on BMI (43 comparisons, n = 32,003) was trivial
(-0.02; CI = -0.06-0.02; I-2 = 17%) compared with control. Trials with interventions
lasting more than 6 months (vs. shorter trials) and trials with postintervention outcomes
(vs. in-treatment outcomes) yielded marginally larger effects. Conclusion: Pediatric
obesity prevention programs caused small changes in target behaviors and no significant
effect on BMI compared with control. Trials evaluating promising interventions lapplied
over a long period, using responsive outcomes, with longer measurement timeframes are
urgently needed. (J Clin Endocrinol Metab 93: 4606-4615, 2008)
Katz, D. L., M. O'Connell, et al. (2008). "Strategies for the prevention and control of
obesity in the school setting: systematic review and meta-analysis." Int J Obes (Lond)
32(12): 1780-9.
OBJECTIVE: To determine the effectiveness of school-based strategies for
obesity prevention and control using methods of systematic review and meta-analysis.
METHODS: Peer-reviewed studies published between 1966 and October 2004 were
considered for review. Studies meeting eligibility criteria were published in English,
targeted children aged 3-18 in a school setting, reported weight-related outcomes,
included a control measurement and had at least a 6-month follow-up period. Studies
employed interventions related to nutrition, physical activity, reduction in television
viewing or combinations thereof. Weight related data were analyzed using RevMan
software. RESULTS: Sixty-four studies were considered for inclusion. Fourteen did not
meet inclusion criteria; 29 were excluded due to poor methodological quality. Twentyone papers describing 19 studies were included in the systematic review and 8 of these
were included in the meta-analysis. Nutrition and physical activity interventions resulted
in significant reductions in body weight compared with control ((standardized mean
difference, SMD=-0.29, 95% confidence interval (CI)=-0.45 to -0.14), random effects
model). Parental or family involvement of nutrition and physical activity interventions
also induced weight reduction ((SMD=-0.20, 95%CI=-0.41 to 0.00), random effects
model). CONCLUSION: Combination nutrition and physical activity interventions are
effective at achieving weight reduction in school settings. Several promising strategies
for addressing obesity in the school setting are suggested, and warrant replication and
further testing.
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Li, M., S. Li, et al. (2008). "A systematic review of school-based intervention studies for
the prevention or reduction of excess weight among Chinese children and adolescents."
Obes Rev 9(6): 548-59.
The aim of this paper was to conduct a systematic review of intervention studies
in China aimed at the prevention or control of excess weight gain among children and
adolescents. Two Chinese databases (The China Full Text Database and Wanfang
Database) and two English databases (Medline and Meditext) were searched with
keywords for intervention studies published between 1990 and 2006. Data were extracted
on aspects of study quality, methodology and effectiveness of interventions. Quality
assessment was conducted using a previously established assessment tool. Twenty-two
studies were included, of which 17 were conducted among overweight and/or obese
children and/or adolescents. Interventions strategies varied across studies but the majority
focused on improving the level of knowledge, physical activity levels and/or diet of
overweight children and adolescents. Most studies reported a beneficial effect of the
intervention with one or more of the study outcomes, but all of the studies had serious, or
moderate, methodological weaknesses. None of the trials identified by this systematic
review demonstrated convincing evidence of the efficacy of any single intervention for
the prevention of overweight and obesity in children and adolescents from Mainland
China. Future intervention trials should address the methodological weaknesses identified
in this review.
Lubans, D. and P. Morgan (2008). "Impact of an extra-curricular school sport programme
on determinants of objectively measured physical activity among adolescents." Health
Education Journal 67(4): 305-320.
Objective The purpose of this study was to identify potential determinants of
objectively measured physical activity in the Learning to Enjoy Activity with Friends (
LEAF) study. Design This study involved a quasi-experimental design and students (N =
116) were assigned to an intervention group (n = 50) or a comparison group ( n = 66) for
a period of eight weeks. Setting Three secondary schools ( grades 7-12) in New South
Wales ( NSW), Australia were involved in the study. Method At baseline and
immediately following the intervention, students wore pedometers for four consecutive
days and completed questionnaires assessing potential determinants of physical activity.
At baseline, participants were classified using existing step recommendations, as lowactive ( girls < 11,000, boys < 13,000) or active ( girls >= 11,000, boys >= 13,000) and
the effects of the intervention on potential determinants were assessed using these
subgroups. Subgroups were compared at baseline using independent samples t-tests and
intervention effects were compared at post-test using linear regression ( controlling for
baseline measures). Results Although the intervention had a statistically significant effect
on physical activity among individuals classified as low-active at baseline, the
intervention did not impact upon potential determinants of physical activity. Conclusion
Short-term changes in physical activity identified in the LEAF intervention were not
mediated by changes in hypothesized determinants.
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Mummery, W. K. and W. J. Brown (2009). "Whole of community physical activity
interventions: easier said than done." Br J Sports Med 43(1): 39-43.
OBJECTIVES: To reflect on whole community intervention approaches to
promoting physical activity, using experiences from the 10,000 Steps Rockhampton
project. DESIGN: Many studies are quasi-experimental with single site intervention and
comparison communities. SETTING AND PARTICIPANTS: Whole communities.
INTERVENTION: Coordinated multiple strategies designed to address individual,
interpersonal and environmental determinants of physical activity. MAIN OUTCOME
MEASURE: Physical activity RESULTS: There are many challenges to conducting
whole community interventions. Developing community partnerships and coalitions,
reaching socially disadvantaged groups, and developing effective evaluation methods are
identified as specific concerns. CONCLUSIONS: Despite the challenges, the whole
community approach still offers tremendous potential for developing the social and
cultural change which will be required for sustained improvements in population physical
activity.
Pate, R. R. and J. R. O'Neill (2009). "After-school interventions to increase physical
activity among youth." Br J Sports Med 43(1): 14-8.
Most children and adolescents do not meet the recommended 60 minutes or more
of moderate to vigorous physical activity per day. One attractive approach to increasing
physical activity in young people is providing activity through structured after-school
programmes. This paper provides a review of the scientific literature on the effects of
after-school programmes on physical activity in children and adolescents. After-school
physical activity interventions provided mixed results; some increased children's physical
activity, others did not. Although after-school programmes have the potential to help
children and adolescents engage in regular, enjoyable physical activity, the research on
these programmes is limited and, in some cases, methodologically weak. Additional,
well-controlled studies are needed to identify the components of after-school programmes
that promote physical activity and to determine the level of activity that can be attained
when children and adolescents participate in these programmes.
Patterson, D. L. and H. Van Der Mars (2008). "Distant interactions and their effects on
children's physical activity levels." Physical Education & Sport Pedagogy 13(3): 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
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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... ABSTRACT FROM AUTHOR
Paw, M., A. S. Singh, et al. (2008). "Why did soft drink consumption decrease but screen
time not? Mediating mechanisms in a school-based obesity prevention program."
International Journal Of Behavioral Nutrition And Physical Activity 5.
Objectives: This paper aims to identify the mediating mechanisms of a schoolbased obesity prevention program (DOiT). Methods: The DOiT-program was
implemented in Dutch prevocational secondary schools and evaluated using a controlled,
cluster-randomised trial (September 2003 to May 2004). We examined mediators of
effects regarding (1) consumption of sugar containing beverages (SCB); (2) consumption
of high caloric snacks; (3) screen-viewing behaviour; and (4) active commuting to
school. To improve these behaviours the DOiT-program tried to influence the following
potentially mediating variables: attitude, subjective norm, perceived behavioural control,
and habit-strength. Results: Both in boys (n = 418) and girls (n = 436) the DOiTintervention reduced SCB consumption (between group difference in boys = -303.5
ml/day, 95% CI: -502.4;-104.5, between group difference in girls = -222.3 ml/day, 95%
CI: -371.3;-73.2). The intervention did not affect the other examined behaviours. In girls,
no intervention effect on hypothetical mediators was found nor evidence of any
mediating mechanisms. Boys in intervention schools improved their attitude towards
decreasing SCB consumption, while this behaviour became less of a habit. Indeed,
attitude and habit strength were significant mediators of the DOiT-intervention's effect
(4.5 and 3.8%, respectively) on SCB consumption among boys. Conclusion: Our findings
imply that interventions aimed at EBRB-change should be gender-specific. Future studies
aimed at reducing SCB consumption among boys should target attitude and habit strength
as mediating mechanisms. Our study did not resolve the mediating mechanisms in girls.
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Richards, E., M. Riner, et al. (2008). "A Social Ecological Approach of Community
Efforts to Promote Physical Activity and Weight Management." Journal Of Community
Health Nursing 25(4): 179-192.
Obesity and physical inactivity are major public health problems in the United
States. Campus-Community partnerships have the potential to address the community
health and quality of life issues at the local level. The purposes of this study were: (a) to
identify groups who are at risk for being overweight and physically inactive; (b) to
identify a relationship between broad social ecological layers and weight and exercise
levels; and (c) to identify community features that are associated with weight and
exercise levels. Interventions for physical activity and weight reduction should consider
the social ecological framework, including environmental and social influences.
Romon, M., A. Lommez, et al. (2008). "Downward trends in the prevalence of childhood
overweight in the setting of 12-year school- and community-based programmes." Public
Health Nutr: 1-8.
OBJECTIVE: A school-based nutrition information programme was initiated in
1992 in two towns in northern France (Fleurbaix and Laventie, FL) and was followed by
a number of community-based interventions. We took the opportunity to measure the
outcomes in terms of childhood obesity and overweight over the next 12 years. DESIGN:
Repeated, cross-sectional, school-based survey. For the school years beginning in 1992,
2000, 2002, 2003 and 2004, the height and weight of all 5- to 12-year-old children
attending school were measured in FL. In 2004, the same assessments were made in two
comparison towns with similar socio-economic characteristics but no intervention.
SETTING: Fleurbaix and Laventie (intervention towns), Bois-Grenier and Violaines
(comparison towns), northern France. SUBJECTS: In 2002, 2003 and 2004, respectively
515, 592 and 633 children were measured in FL (participation rate of 95-98 % of all
eligible individuals); in the comparison towns, 349 children were measured in the 2004
school year (98 % of the towns' school population). RESULTS: After an initial increase,
trends in mean BMI and prevalence of overweight started to reverse. Compared with
2002, the age-adjusted OR for overweight in FL was significantly lower in 2003 and
2004 (but for girls only). In the 2004 school year, the overweight prevalence was
significantly lower in FL (8.8 %) than in the comparison towns (17.8 %, P <
0.0001).ConclusionThese data suggest that, over a long period of time, interventions
targeting a variety of population groups can have synergistic effects on overweight
prevalence. This gives hope that it is possible to reverse trends towards increasing
overweight by actions at the community level.
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Rowlands, A. V., D. W. Esliger, et al. (2008). "Physical activity content of Motive8 PE
compared to primary school PE lessons in the context of children's overall daily activity
levels." Journal Of Exercise Science & Fitness 6(1): 26-33.
Motive8 is a health and fitness company that provides in-school PE/sport
provision. The primary aim of this study was to assess the quantity and quality of
physical activity during Motive8 PE lessons compared to PE lessons taught by the school
PE specialist. A secondary aim was to assess whether PE lessons impact on daily activity
levels. Physical activity was measured for 2 weeks in 19 children, aged 10-11 years,
using accelerometry. In week 1, half of the children undertook a normal week of lessons,
including two School PE lessons (football-based and dance-based); the other half also
followed their normal timetable, except that Motive8 led their PE lessons. In week 2, this
was reversed. Motive8 classes provided 20.5 +/- 3.8 minutes of moderate and 7.9 +/- 2.6
minutes of vigorous activity This was greater than the 15.9 +/- 6.1 minutes of moderate
and 5.1 +/- 3.8 minutes of vigorous activity experienced in the School PE lessons (p <
0.005). Seventy-five percent of children achieved 22 minutes of moderate to vigorous
activity in Motive8 PE lessons, compared with the 9 minutes of moderate to vigorous
activity achieved by 75% of children in School PE classes. Days containing football
classes contained fewer minutes of moderate activity than days containing dance classes
or no PE (football, 46.4 +/- 14.6 minutes; dance, 51.8 +/- 15.4 minutes; no PE, 50.7 +/10.5 minutes; p < 0.05). In conclusion, physical activity during Motive8 lessons was
more consistent between children than in School PE lessons, reflecting increased physical
activity in the least active children. PE lessons had little impact on overall daily physical
activity.
Sangster, J., P. Eccleston, et al. (2008). "Improving children's physical activity in out-ofschool hours care settings." Health Promotion Journal Of Australia 19(1): 16-21.
Issues addressed: Improving children's opportunities for and participation in
physical activity at out-of-school hours (OOSH) care. Methods: A needs assessment, 12month implementation and evaluation were conducted. Strategies included feedback and
support to improve physical activity programs and policies; staff training; resource
distribution; and grants to disadvantaged services. Strategies were developed in
partnership with an advisory committee from the OOSH sector. Physical activity policies,
the types of after-school activities offered and children's participation in these activities
were evaluated before and after implementation. Results: Statistically significant
improvements were seen in the proportion of moderate or vigorous activities
programmed each week. Children's participation showed a significant shift from lower to
higher-intensity activities. Improvements were also seen in the number of services with
planned physical activity programs and physical activity policies. Conclusion: The
OOSH sector is an effective setting for promoting children's physical activity.
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Sanigorski, A. M., A. C. Bell, et al. (2008). "Reducing unhealthy weight gain in children
through community capacity-building: results of a quasi-experimental intervention
program, Be Active Eat Well." Int J Obes (Lond) 32(7): 1060-7.
BACKGROUND: Be Active Eat Well (BAEW) was a multifaceted community
capacity-building 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, 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 2003-2004 (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.
Schmidt, M., S. Absalah, et al. (2008). "Which factors engage women in deprived
neighbourhoods to participate in exercise referral schemes?" BMC Public Health 8: 371.
BACKGROUND: Exercise referral schemes (ERS) have become a popular way
of promoting physical activity. The aim of these schemes is to encourage high risk
patients to exercise. In evaluating these schemes, little attention has been paid to lower
socio-economic groups in a multi-ethnic urban setting. This study aimed to explore the
socio-demographic and psychosocial characteristics of female participants in ERS located
in deprived neighbourhoods. The second aim was to determine which elements of the
intervention make it appealing to participate in the scheme. METHODS: A mixed
method approach was utilized, combining a cross-sectional descriptive study and a
qualitative component. In the quantitative part of the study, all female participants (n =
523) filled out a registration form containing questions about socio-demographic and
psychosocial characteristics. Height and weight were also measured. In the qualitative
part of the study, 38 of these 523 participants were interviewed. RESULTS: The majority
of the participants had a migrant background, a low level of education, no paid job and a
high body mass index. Although most participants were living sedentary lives, at intake
they were quite motivated to start exercising. The ERS appealed to them because of its
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specific elements: facilitating role of the health professional, supportive environment,
financial incentive, supervision and neighbourhood setting. CONCLUSION: This study
supports the idea that ERS interventions appeal to women from lower socio-economic
groups, including ethnic minorities. The ERS seems to meet their contextual, economic
and cultural needs. Since the elements that enabled the women to start exercising are
specific to this ERS, we should become aware of whether this population continues to
exercise after the end of the scheme.
Sharma, M. (2008). "Physical activity interventions in Hispanic American girls and
women." Obes Rev 9(6): 560-71.
The purpose of this article was to review physical activity interventions done with
Hispanic American girls and women that were published between 1994 and 2007, and
suggest ways of enhancing these interventions. A total of 12 such interventions were
found. Majority of the interventions focused on both physical activity and nutrition
behaviours. Only half of the interventions were based on a behavioural theory. Social
cognitive theory was the most popular theory, which was operationalized by four
interventions. The interventions ranged from 3 weeks to 2 years in duration. The impact
was not necessarily linked to the length of the intervention. The most popular physical
activity that was promoted was walking, which was utilized by four interventions. Most
of the interventions utilized a classroom format for imparting instruction in being
physically active. All the interventions utilized individual-level behaviour change as an
approach, and none tried to address broader policy and environmental-level changes.
Process evaluation was done by very few interventions and must be done more
systematically. In terms of the impact, half of the interventions were successful in
influencing the outcomes. Recommendations for enhancing the effectiveness of physical
activity interventions in Hispanic American girls and women are presented.
Simoes, E. J., P. Hallal, et al. (2009). "Effects of a community-based, professionally
supervised intervention on physical activity levels among residents of Recife, Brazil."
Am J Public Health 99(1): 68-75.
OBJECTIVES: We evaluated the effects of a community-based intervention, the
Academia da Cidade program (ACP), on increasing leisure-time physical activity among
residents of Recife, Brazil. METHODS: We used the International Physical Activity
Questionnaire to assess leisure-time physical activity and transport physical activity (i.e.,
activities involved in traveling from place to place) levels in a random sample of 2047
Recife residents surveyed in 2007. We also examined factors related to exposure to ACP
(participation in the intervention, residing near an intervention site, hearing about or
seeing intervention activities). We estimated prevalence odds ratios (ORs) of moderate to
high leisure-time and transport physical activity levels via intervention exposures
adjusted for sociodemographic, health, and environmental variables. RESULTS:
Prevalence ORs for moderate to high levels of leisure-time physical activity were higher
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among former (prevalence OR=2.0; 95% confidence interval [CI]=1.0, 3.9) and current
(prevalence OR=11.3; 95% CI=3.5, 35.9) intervention participants and those who had
heard about or seen an intervention activity (prevalence OR=1.8; 95% CI=1.3, 2.5).
Transport physical activity levels were inversely associated with residing near an ACP
site. CONCLUSIONS: The ACP program appears to be an effective public health
strategy to increase population-level physical activity in urban developing settings.
Sugden, J. A., F. F. Sniehotta, et al. (2008). "The feasibility of using pedometers and
brief advice to increase activity in sedentary older women--a pilot study." BMC Health
Serv Res 8: 169.
BACKGROUND: People over the age of 70 carry the greatest burden of chronic
disease, disability and health care use. Participation in physical activity is crucial for
health, and walking accounts for much of the physical activity undertaken by sedentary
individuals. Pedometers are a useful motivational tool to encourage increased walking
and they are cheap and easy to use. The aim of this pilot study was to evaluate the
feasibility of the use of pedometers plus a theory-based intervention to assist sedentary
older women to accumulate increasing amounts of physical activity, mainly through
walking. METHODS: Female participants over the age of 70 were recruited from
primary care and randomised to receive either pedometer plus a theory-based intervention
or a theory-based intervention alone. The theory-based intervention consisted of
motivational techniques, goal-setting, barrier identification and self-monitoring with
pedometers and daily diaries. The pedometer group were further randomised to one of
three target groups: a 10%, 15% or 20% monthly increase in step count to assess the
achievability and acceptability of a range of targets. The primary outcome was change in
daily activity levels measured by accelerometry. Secondary outcome measures were
lower limb function, health related quality of life, anxiety and depression. RESULTS: 54
participants were recruited into the study, with an average age of 76. There were 9 drop
outs, 45 completing the study. All participants in the pedometer group found the
pedometers easy to use and there was good compliance with diary keeping (96% in the
pedometer group and 83% in the theory-based intervention alone group). There was a
strong correlation (0.78) between accelerometry and pedometer step counts i.e. indicating
that walking was the main physical activity amongst participants. There was a greater
increase in activity (accelerometry) amongst those in the 20% target pedometer group
compared to the other groups, although not reaching statistical significance (p = 0.192).
CONCLUSION: We have demonstrated that it is feasible to use pedometers and provide
theory-based advice to community dwelling sedentary older women to increase physical
activity levels and a larger study is planned to investigate this further.
van Sluijs, E. M., A. M. McMinn, et al. (2008). "Effectiveness of interventions to
promote physical activity in children and adolescents: systematic review of controlled
trials." Br J Sports Med 42(8): 653-7.
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OBJECTIVE: To review the published literature on the effectiveness of
interventions to promote physical activity in children and adolescents. DESIGN:
Systematic review. DATA SOURCES: Literature search using PubMed, SCOPUS,
Psychlit, Ovid Medline, Sportdiscus, and Embase up to December 2006. REVIEW
METHODS: Two independent reviewers assessed studies against the following inclusion
criteria: controlled trial, comparison of intervention to promote physical activity with no
intervention control condition, participants younger than 18 years, and reported statistical
analyses of a physical activity outcome measure. Levels of evidence, accounting for
methodological quality, were assessed for three types of intervention, five settings, and
three target populations. RESULTS: The literature search identified 57 studies: 33 aimed
at children and 24 at adolescents. Twenty four studies were of high methodological
quality, including 13 studies in children. Interventions that were found to be effective
achieved increases ranging from an additional 2.6 minutes of physical education related
physical activity to 283 minutes per week of overall physical activity. Among children,
limited evidence for an effect was found for interventions targeting children from low
socioeconomic populations, and environmental interventions. Strong evidence was found
that school based interventions with involvement of the family or community and
multicomponent interventions can increase physical activity in adolescents.
CONCLUSION: Some evidence was found for potentially effective strategies to increase
children's levels of physical activity. For adolescents, multicomponent interventions and
interventions that included both school and family or community involvement have the
potential to make important differences to levels of physical activity and should be
promoted. A lack of high quality evaluations hampers conclusions concerning
effectiveness, especially among children.
Wen, L. M., D. Fry, et al. (2008). "Increasing active travel to school: are we on the right
track? A cluster randomised controlled trial from Sydney, Australia." Prev Med 47(6):
612-8.
OBJECTIVE: To evaluate the effectiveness of a program to increase walking to
and from school. DESIGN: A cluster randomised controlled trial. SETTING: 24 primary
public schools in inner west Sydney, Australia. PARTICIPANTS: 1996 students aged 1012 years and their parents. INTERVENTION: A two-year multi-component program
included classroom activities, development of school Travel Access Guides, parent
newsletters and improving environments with local councils. MEASURES: Two
measures were used: a survey completed by students on how they travelled to and from
school over five days, and a survey completed by their parents on how their child
travelled to and from school in a usual week. RESULTS: The percentage of students who
walked to and from school increased in both the intervention and control schools. Data
from parent surveys found that 28.8% of students in the intervention group increased
their walking, compared with 19% in the control group (a net increase of 9.8%, p=0.05).
However this effect was not evident in the student data. CONCLUSION: The study
produced a mixed result, with a high variation in travel patterns from school to school.
Intervention research should address the complexity of multiple factors influencing
student travel to school with a focus on changing local environments and parents' travel
to work.
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Williamson, D. A., C. M. Champagne, et al. (2008). "Louisiana (LA) Health: design and
methods for a childhood obesity prevention program in rural schools." Contemp Clin
Trials 29(5): 783-95.
There is a worldwide epidemic of obesity with far-reaching consequences for the
health of our nation. Prevention of obesity, especially in children, has been deemed by
public health policy makers to be one of the most important objectives for our country.
This prevention project, called Louisiana (LA) Health, will test whether modification of
environmental and behavioral factors can prevent inappropriate weight gain in children
from rural parishes of Louisiana who are enrolled in the fourth to sixth grades during
Year 1. The primary aim of the LA Health project is to test the efficacy of two schoolbased approaches for obesity prevention: primary prevention alone and a combination of
primary and secondary prevention which will be compared to a no-intervention control
group using a cluster randomization research design, with 17 school clusters randomly
assigned to the three treatment arms. The study will span 3 years and will provide critical
tests of strategies that: 1) modify the child's environment as a primary prevention strategy
and 2) provide health behavior modification via classroom instruction and internet
counseling as a secondary prevention strategy. The study will also recruit a similar
sample of students to measure changes in body weight relative to height, gender, and age
over the same three-year period.
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Childhood obesity—General
Aggarwal, T., R. C. Bhatia, et al. (2008). "Prevalence of obesity and overweight in
affluent adolescents from Ludhiana, Punjab." Indian Pediatrics 45(6): 500-502.
The objective was to study the prevalence of obesity among adolescents in public
schools of Ludhiana, catering to the affluent segment of population. We selected 1000
students from these schools by random, purposive sampling. Their anthropometry was
taken. Students also filled-up a prevalidated questionnaire regarding dietary habits and
lifestyle. Overweight/Obesity was defined using age and sex specific Body mass index
(BMI) cut off points. Incidence of obesity was 3.4% and overweight was 12.7%. A
significantly greater number of boys (15%) were overweight as compared to girls (10%).
Atkin, A. J., T. Gorely, et al. (2008). "Critical Hours: Physical Activity and Sedentary
Behavior of Adolescents After School." Pediatric Exercise Science 20(4): 446-456.
The present Study examined physical activity and sedentary behavior patterns of
adolescents between 15.30h and 18.30h. The sample for this Study is 1,484 (boys: n = 56
1: girls: n = 923). Boys and girls reported 21 and 19 min of physical activity and 24 and
26 min of homework respectively during this period. Technology-based sedentary
behavior (TV viewing. computer and video game use) was significantly higher in boys
than girls (boys = 50 mins: girls = 35 mins: p < .05). The most prevalent behaviors after
school are technology-based sedentary behavior, homework and physical activity. During
these hours, engagement in physical activity does not appear to displace time spent doing
homework.
Baig, F., M. A. Hameed, et al. (2009). "Association between active commuting to school,
weight and physical activity status in ethnically diverse adolescents predominately living
in deprived communities." Public Health 123(1): 39-41.
Bailis, D. S., J. G. Chipperfield, et al. (2008). "Exploring the Commonalities Between
Adaptive Resources and Self-Enhancement in Older Adults' Comparative Judgments of
Physical Activity." J Aging Health.
OBJECTIVE: This study examines the extent to which optimism, control beliefs
and motivation, and downward social comparison contribute independently to the
maintenance of older adults' positive self-evaluations in a functional domain. METHOD:
Adaptive resources/strategies and life satisfaction were measured in personal interviews
with 164 community-dwelling older adults. Participants judged their physical activity
compared with the average person of their age and wore an accelerometer for 24 hours.
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Commonality analysis was used to estimate unique versus shared effects of the
resource/strategy variables on a residual measure of self-enhancement, obtained by
adjusting the comparative judgments for participants' age and objectively measured
physical activity. RESULTS: Self-enhancement was positively related to life satisfaction.
Perceived control and optimism had shared positive effects on self-enhancement, whereas
downward social comparison had a unique positive effect. DISCUSSION: Selfenhancement of physical activity plays a part in at least two adaptive profiles with
implications for older adults' well-being and health.
Bell, A. C., A. Simmons, et al. (2008). "Preventing childhood obesity: the sentinel site for
obesity prevention in Victoria, Australia." Health Promot Int 23(4): 328-36.
In spite of greater awareness of the need for action to reduce obesity, the evidence
on sustainable community approaches to prevent childhood and adolescent obesity is
surprisingly sparse. This paper describes the design and methodological components of
the Sentinel Site for Obesity Prevention, a demonstration site in the Barwon-South West
region of Victoria, Australia, that aims to build the programs, skills and evidence
necessary to attenuate and eventually reverse the obesity epidemic in children and
adolescents. The Sentinel Site for Obesity Prevention is based on a partnership between
the region's university (Deakin University) and its health, education and local
government agencies. The three basic foundations of the Sentinel Site are: multi-strategy,
multi-setting interventions; building community capacity; and undertaking program
evaluations and population monitoring. Three intervention projects have been supported
that cover different age groups (preschool: 2-5 years, primary school: 5-12 years,
secondary school: 13-17 years), but that have many characteristics in common including:
community participation and ownership of the project; an intervention duration of at least
3 years; and full evaluations with impact (behaviours) and outcome measures
(anthropometry) compared with regionally representative comparison populations. We
recommend the Sentinel Site approach to others for successfully building evidence for
childhood obesity prevention and stimulating action on reducing the epidemic.
Biddle, S. J., T. Gorely, et al. (2008). "The prevalence of sedentary behavior and physical
activity in leisure time: A study of Scottish adolescents using ecological momentary
assessment." Prev Med.
OBJECTIVE: To report time and prevalence of leisure time sedentary and active
behaviors in adolescents. METHOD: Cross-sectional, stratified, random sample from
schools in 14 districts in Scotland, 2002-03, using ecological momentary assessment
(n=385 boys, 606 girls; mean age 14.1 years; range 12.6-16.7 years). This is a method of
capturing current behavioral episodes. We used 15 min time intervals. RESULTS:
Television viewing occupied the most leisure time. The five most time consuming
sedentary activities occupied 228 min per weekday and 396 min per weekend day for
boys, and 244 min per weekday and 400 min per weekend day for girls, with TV
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occupying one-third to one-half of this time. In contrast, 62 min was occupied by active
transport and sports/exercise per weekday and 91 min per weekend day for boys, with 55
min per weekday and 47 min per weekend day for girls. A minority watched more than 4
h of TV per day, with more at weekends. Other main sedentary behaviors for boys were
homework, playing computer/video games, and motorised transport and, for girls,
homework, motorised transport, and sitting and talking. CONCLUSION: Scottish
adolescents engage in a variety of sedentary and active behaviors. Research into
sedentary behavior must assess multiple behaviors and not rely solely on TV viewing.
Boone-Heinonen, J., P. Gordon-Larsen, et al. (2008). "Obesogenic clusters:
multidimensional adolescent obesity-related behaviors in the U.S." Ann Behav Med
36(3): 217-30.
BACKGROUND: Diet, physical activity, and psychosocial factors are
independent and potentially interactive obesity determinants, but few studies have
explored complex behavior patterns. PURPOSE: The purpose of this study is to examine
obesity-related behavior patterning and identify high-risk adolescent groups. METHODS:
Cluster analysis identified groups with shared behavior patterns in the National
Longitudinal Study of Adolescent Health (1995 and 1996, ages 11-21; N = 9,251).
Descriptive and multivariate regression analyses compared sociodemographics and
prevalent and incident obesity across clusters. RESULTS: Seven and six clusters in males
and females, respectively, represented behavior patterns such as School Clubs & Sports,
Sedentary Behaviors, Dieters, and Junk Food & Low Activity. Sociodemographics varied
across clusters. Compared to School Clubs & Sports clusters, adjusted odds of prevalent
and incident obesity were higher for most clusters in females but not males.
CONCLUSIONS: Cluster analysis identified several obesogenic behavior patterns,
highlighting areas for future research and potential avenues for interventions that target
broad lifestyle factors.
Cairella, G., L. Casagni, et al. (2008). "[Overweight and obesity in Italian children aged
6-11 years]." Ann Ig 20(4): 315-27.
The objective of this study is to obtain reliable data from recent surveys carried
out in Italy on the prevalence of overweight (OW) and obesity (OB) in children. We
searched in MEDLINE/PubMed, Google and Google Scholar and we included the
surveys that fulfilled the following criteria: English or Italian language, time period
January 2000-April 2008, target of 6-11 years; BMI evaluated according to IOFT cutoffpoints. Search terms included overweight, obesity, children, Italy, associated with
AND/OR. 41 studies have been selected; the percentage of OW varied between 14.7%
and 31.3% and OB between 4.3% and 27.3%. In girls, OW values ranged from 11.5% to
34.7% and in boys from 12.6% to 30.1%; in girls, the percentage of OB varied between
4.7% and 29.2%, in boys between 4.4% and 25.8%. There were some variations in the
prevalence of OW and OB among diferent regions. The highest values were in Central
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and Southern Italy, except for Sardinia, where the values were similar to that of Northern
Italy. Beyond BMI, the most frequently collected variables were dietary pattern, physical
activity, and lifestyle. School is the main site of investigation; third grades (8-9 years) is
the most studied age group. The urgency to develop actions to contrast obesity in
childhood is confirmed by the prevalence values observed in the Italian regions.
Cardoso, H. and C. Padez (2008). "Changes in height, weight, BMI and in the prevalence
of obesity among 9-to 11-year-old affluent Portuguese schoolboys, between 1960 and
2000." Annals Of Human Biology 35(6): 624-638.
Background: There is a lack of detailed series of growth data that can be used to
analyse secular trends in growth and obesity of Portuguese children. Aim: The purpose of
this study was to examine the secular trend in height, weight, BMI and in the prevalence
of obesity (including overweight), during the last four decades, in a sample of high socioeconomic status Portuguese boys. Subjects and methods: All candidates (9-11 years) to a
military boarding school (Colegio Militar) in Lisbon, Portugal, examined between 1962
and 2006 were the subjects of this study. Records of height and weight measured during
medical examination were obtained (n=3176). Body mass index (kg m-2) (BMI) was
calculated and the International Obesity Taskforce (IOTF) cut-offs were used to define
overweight and obesity. Results: The data obtained provide evidence for accelerating
rates of overweight and obesity in affluent Portuguese boys, concomitant with a greater
secular increase in mean weight, compared to that of height. Obesity (including
overweight) more than doubled in the group of 9-year-olds (highest prevalence of 47.3%
in 2000) and tripled in the group of 10- and 11-year-olds with greatest changes occurring
between 1990 and 2000. Conclusion: The results suggest that a high family income does
not necessarily translate into more informed choices about healthy foods and lifestyles,
with a strong influence in the prevalence of obesity. This pattern of association between
socio-economic status and obesity may reflect a late socio-economic transition of
Portugal, compared to that of other high-income countries.
Carnell, S. and J. Wardle (2008). "Appetite and adiposity in children: evidence for a
behavioral susceptibility theory of obesity." American Journal Of Clinical Nutrition
88(1): 22-29.
Background: Pressures from the "obesogenic" environment are driving up obesity
rates, but adiposity still varies widely within the population. Appetitive characteristics
could underlie differences in susceptibility to the environment. Objective: We examined
associations between adiposity and 2 appetitive traits: satiety responsiveness and food
cue responsiveness in children. Design: Parents of 2 groups of children, 8-11-y-olds (n =
10 364) from a population-based twin cohort and 3-5-y-olds (n = 572) from a community
sample, completed the Child Eating Behavior Questionnaire. Adiposity was indexed with
body mass index (BMI; in kg/m(2)) SD scores. For the 8-11-y-olds, waist circumference
was also recorded and used to derive waist SD scores. Results: In both samples, higher
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BMI SD scores were associated with lower satiety responsiveness (8-11-y-olds: r = -0.22;
3-5-y-olds: r = -0.19; P < 0.001) and higher food cue responsiveness (r = 0.18 and 0.18; P
< 0.001). In the twin sample, waist SD scores were associated with satiety responsiveness
(r = -0.23, P < 0.001) and food cue responsiveness (r = 0.20, P < 0.001). By analyzing the
data by weight categories, children in higher weight and waist categories had lower
satiety responsiveness and higher responsiveness to food cues in both samples (8-11-yolds: both P < 0.00 1; 3-5-y-olds: both P < 0.05), but the effect was more strongly linear
in the older children. All associations remained significant, controlling for child age and
sex and parental education and BMI. Conclusions: Associations between appetite and
adiposity are consistent with a behavioral susceptibility model of obesity. Assessing
appetite in childhood could help identify higher-risk children while they are still at a
healthy weight, enabling targeted interventions to prevent obesity.
Cawley, J. (2008). "Contingent valuation analysis of willingness to pay to reduce
childhood obesity." Economics & Human Biology 6(2): 281-292.
Several recent surveys have asked Americans whether they support policies to
reduce childhood obesity. There is reason for skepticism of such surveys because people
are not confronted with the tax costs of such policies when they are asked whether they
support them. This paper uses contingent valuation (CV), a method frequently used to
estimate people's willingness to pay (WTP) for goods or services not transacted in
markets, applied to unique survey data from New York State to estimate the willingness
to pay to reduce childhood obesity. The willingness to pay data correlate in predictable
ways with respondent characteristics. The mean WTP for a 50% reduction in childhood
obesity is $46.41 (95% Cl: $33.45, $59.15), which implies a total WTP by New York
State residents of $690.6 million (95% Cl: $497.7, $880.15), which is less than that
implied by previous surveys that did not use CV methods but greater than current
spending on policies to reduce childhood obesity and greater than the estimated savings
in external costs. The findings provide policymakers with useful information about
taxpayers' support for, and preferred budget for, anti-obesity policies. (C) 2008 Elsevier
B.V. All rights reserved.
Chen, L. J., K. R. Fox, et al. (2008). "Body shape dissatisfaction and obesity among
Taiwanese adolescents." Asia Pacific Journal Of Clinical Nutrition 17(3): 457-460.
Purpose: The purpose of this study was to estimate the level of body shape
dissatisfaction among a large sample of adolescent boys and girls within different weight
categories. Methods: A total sample of 883 adolescents aged 12 to 16 was included from
junior high schools in Taipei County, Taiwan. The Contour Drawing Rating Scale was
used to assess body shape dissatisfaction. Results: Body shape dissatisfaction is prevalent
in Taiwanese adolescents, particularly for girls. This is linked to degree of overweight in
both boys and girls but is also prevalent in girls who are not overweight or obese. Girls
and boys clearly aspire to thinness but some boys would also prefer to be larger.
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Conclusions: This study extends our understanding of body shape dissatisfaction and its
relationship with weight status in eastern cultures such as Taiwan.
Cleland, V., D. Crawford, et al. (2008). "A prospective examination of children's time
spent outdoors, objectively measured physical activity and overweight." Int J Obes
(Lond) 32(11): 1685-93.
OBJECTIVE: This study aimed to determine whether time spent outdoors was
associated with objectively measured physical activity, body mass index (BMI) z-score
and overweight in elementary-school aged children, cross-sectionally and prospectively
over 3 years. METHODS: Three-year cohort study with data collected during 2001 and
2004. Nineteen randomly selected state elementary schools across Melbourne, Australia.
One hundred and eighty eight 5-6-year-old and 360 10-12-year-old children. Baseline
parent reports of children's time spent outdoors during warmer and cooler months, on
weekdays and weekends. At baseline and follow-up, children's moderate and vigorous
physical activity (MVPA) was objectively assessed by accelerometry, and BMI z-score
and overweight was calculated from measured height and weight. RESULTS: Crosssectionally, each additional hour outdoors on weekdays and weekend days during the
cooler months was associated with an extra 27 min week(-1) MVPA among older girls,
and with an extra 20 min week(-1) MVPA among older boys. Longitudinally, more time
outdoors on weekends predicted higher MVPA on weekends among older girls and boys
(5 min week(-1)). The prevalence of overweight among older children at follow-up was
27-41% lower among those spending more time outdoors at baseline. CONCLUSION:
Encouraging 10-12-year-old children to spend more time outdoors may be an effective
strategy for increasing physical activity and preventing increases in overweight and
obesity. Intervention research investigating the effect of increasing time outdoors on
children's physical activity and overweight is warranted.
Coleman, K. J., K. S. Geller, et al. (2008). "Physical Activity and Healthy Eating in the
After-School Environment." Journal Of School Health 78(12): 633-640.
No research to date has extensively described moderate and vigorous physical
activity (MVPA) and healthful eating (HE) opportunities in the after-school environment.
The current study described the quality of the after-school environment for its impact on
children's MVPA and HE. An alliance of 7 elementary schools and Boys and Girls Clubs
who worked with the Cooperative Extension Service in Lawrence, KS, was selected to
participate in a larger intervention study. After-school settings were observed for
information regarding session type, session context, leader behavior, physical activity,
and snack quality using validated instruments such as the System for Observing Fitness
Instruction Time. Data presented are baseline measures for all sites. Participating children
(n = 144) were primarily non-Hispanic white (60%) and in fourth grade (69%). Afterschool sites offered 4 different sessions per day (active recreation, academic time,
nonactive recreation, and enrichment activities). Children were provided with a daily
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snack. On 36% of the days observed, this snack included fruit, fruit juice, or vegetables.
There was significantly more time spent in MVPA during free play sessions (69%)
compared to organized adult-led sessions (51%). There was also significantly more
discouragement of physical activity during organized adult-led sessions (29%) as
compared to the free play sessions (6%). The quality of after-school programs can be
improved by providing fruits and vegetables as snacks; offering more free play activities;
training the after-school staff in simple, structured games for use in a variety of indoor
and outdoor settings; and training after-school staff to promote and model MVPA and HE
in and out of the after-school setting.
Cooper, A. R., N. Wedderkopp, et al. (2008). "Longitudinal associations of cycling to
school with adolescent fitness." Prev Med 47(3): 324-8.
OBJECTIVE: To investigate whether change in transport to school from noncycling to cycling was associated with change in cardio-respiratory fitness (CRF) over a
six-year follow-up. METHODS: Participants were 384 children (9.7 (0.5) years) who
participated in the Danish arm of the European Youth Heart Study in 1997 and who were
followed up 6 years later. CRF was assessed by a maximal cycle ergometer test and travel
to school was investigated by questionnaire at both time points. Linear regression models
were used to investigate associations between CRF and change in mode of travel to
school between baseline and follow-up. RESULTS: Higher CRF was significantly
associated with cycling to school in children and adolescents of both sexes. Longitudinal
regression models showed that a change in travel mode from non-cycling to cycling was
a significant predictor of CRF at follow-up (P<0.001) after adjustment for potential
confounders. Participants who did not cycle to school at baseline, but who had changed to
cycling at follow-up, were significantly fitter (0.33 W kg(-1)) than those who did not
cycle to school at either time point (P=0.001), a difference of 9%. CONCLUSION:
Cycling to school may contribute to higher cardiovascular fitness in young people.
Davis, A. M., R. L. James, et al. (2008). "Pediatric obesity attitudes, services, and
information among rural parents: a qualitative study." Obesity (Silver Spring) 16(9):
2133-40.
The objective of this study was to learn more about the attitudes concerning
pediatric obesity among rural parents, the barriers these parents face in trying to help
their children attain a healthy weight status, and the pediatric weight loss services
currently available in small rural communities. A series of eight qualitative focus groups
were conducted with 21 parents of overweight rural children in third through fifth grade.
Eight saturated themes resulted indicating that parents (i) believe overweight children are
lazy, (ii) are concerned about the weight of their children, (iii) believe that some
individuals will be overweight no matter what they do, and (iv) have tried a variety of
techniques to help their children lose weight. Barriers to helping their children lose
weight unique to their rural status included lack of weight loss resources in their
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community, lack of exercise facilities, and lack of low-fat or low-calorie options in
grocery stores. Rural families of overweight children encounter many barriers to healthier
living, some of which are unique to their rural status.
Dencker, M., O. Thorsson, et al. (2008). "Daily physical activity related to aerobic fitness
and body fat in an urban sample of children." Scandinavian Journal Of Medicine &
Science In Sports 18(6): 728-735.
This study evaluates associations between objectively measured daily physical
activity vs aerobic fitness and body fat in children aged 8-11 years. A cross-sectional
study of 225 children aged 7.9-11.1 years was performed. Abdominal fat mass (AFM)
and total body fat (TBF) were quantified by dual-energy x-ray absorptiometry. TBF was
calculated as percentage of total body mass (BF%). Body fat distribution was calculated
as AFM/TBF. Aerobic fitness was measured by indirect calorimetry during a maximal
cycle ergometer exercise test. Daily physical activity was assessed by accelerometers for
4 days and daily accumulation of moderate-to-vigorous and vigorous activity was
calculated. Significant relationships (P < 0.05) existed for vigorous activity vs ln BF%
(r=-0.40), ln AFM (r=-0.35), TBF/AFM (r=-0.22) and aerobic fitness (r=0.38), whereas
moderate-to-vigorous activity displayed weaker relationships (-0.22, -0.18, -0.12 NS, and
0.25). Multiple regression analyses with inclusion of possible confounders concluded that
vigorous activity was independently related to aerobic fitness and ln BF% or ln AFM.
Moderate-to-vigorous activity was only independently related to aerobic fitness. In this
population, low daily accumulation of vigorous activity was, already in children aged 811 years, associated with more body fat and lower aerobic fitness. A similar relation was
not found for daily accumulation of moderate-to-vigorous activity.
Deshpande, A. D., E. A. Dodson, et al. (2008). "Physical Activity and Diabetes:
Opportunities for Prevention Through Policy." Physical Therapy 88(11): 1425-1435.
Over the past decade, the prevalence of type 2 diabetes mellitus has reached
epidemic levels in the United States and other developed countries. With a concomitant
rise in obesity levels in the United States and advances in the treatment of diabetes and its
complications, the prevalence of diabetes is expected to continue to rise through the year
2050. Despite strong evidence that regular physical activity can prevent or delay the onset
of diabetes, too many Americans are not meeting the recommended levels of regular
physical activity. Although most physical activity interventions to date have been focused
on characteristics of the individual, more-recent studies have considered how changing
characteristics of the social and physical environment in which people live may
ultimately have a greater impact on increasing population levels of physical activity.
Policy interventions are a way to make sustainable changes in the physical environment
of a community and thus provide support for other intrapersonal and interpersonal
behavioral change interventions. Policy changes also can affect the social norms that
shape behavior. The purposes of this perspective article are: (1) to describe the rationale
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for population approaches to primary prevention of type 2 diabetes, (2) to discuss how
policy interventions can increase physical activity levels within populations, and (3) to
provide recommendations for the role of physical therapists in interventions that can
increase the level of physical activity in communities. Public health approaches to curb
the diabetes epidemic are urgently needed. Policy interventions to increase population
levels of physical activity show promise for diabetes prevention. Physical therapists are
uniquely suited to influence primary prevention efforts for diabetes.
Fagan, H. B., J. Diamond, et al. (2008). "Perception, Intention, and Action in Adolescent
Obesity." Journal Of The American Board Of Family Medicine 21(6): 555-561.
Background: Insight into adolescents' weight-loss behavior is needed. Methods:
Survey data were obtained from overweight and obese adolescents in the Youth Risk
Behavioral Survey (YRBS) in Delaware. Cross tabulations were used to determine the
frequency of accurate perception, recent action, and current intention regarding weight
loss. Multivariable analysis identified factors associated with recent action to lose weight.
Results: From 2728 records, 482 overweight adolescents and 398 obese adolescents were
identified. Most obese (83%) and overweight (79%) adolescents reported recent action to
lose weight. Most obese (75%) and overweight (65%) adolescents intended to lose
weight. Obese and overweight adolescents who reported a current intention to lose
weight were more likely to have taken recent action to lose weight (odds ratio [OR], 11.6
and 6.6, respectively). Conclusions: The percentage of obese and overweight adolescents
who have an accurate perception of weight, intend to lose weight, and have taken recent
action to lose weight suggests that this group is highly engaged in weight-related
behavior change. Compared with their obese peers, overweight adolescents seem less
engaged in weight change behavior. There is a strong association in both groups between
intention and recent action, and this association indicates that obese and overweight
adolescents are highly motivated to change their weight. (J Am Board Fam Med 2008;
21: 555-61.)
Faulkner, G. E., R. N. Buliung, et al. (2009). "Active school transport, physical activity
levels and body weight of children and youth: a systematic review." Prev Med 48(1): 3-8.
OBJECTIVES: Active school transport (AST) may be an important source of
children's physical activity (PA). Innovative solutions that increase PA time for children,
without putting added pressure on the school curriculum, merit consideration. Before
implementing such solutions, it is important to demonstrate that active school transport is
associated with health-related outcomes. METHODS: Following a standardized protocol,
we conducted a systematic review of published research to address this question and
explore whether children who actively commute to school also have a healthier body
weight. Online searches of 5 electronic databases were conducted. Potential studies were
screened on the basis of objective measures of physical activity. RESULTS: Thirteen
studies were included in this review. Nine studies demonstrated that children who
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actively commute to school accumulate significantly more PA and two studies reported
that they expended significantly more kilocalories per day. Where studies examined body
weight (n=10), only one reported active commuters having a lower body weight.
CONCLUSIONS: These studies demonstrate that active school commuters tend to be
more physically active overall than passive commuters. However, evidence for the
impact of AST in promoting healthy body weights for children and youth is not
compelling.
Fernandes, R. A., J. Casonatto, et al. (2008). "[Risk of overweight in adolescents from
different socioeconomic levels]." Rev Assoc Med Bras 54(4): 334-8.
BACKGROUND: To analyze the association between risk factors and presence of
overweight in adolescents from different socioeconomic levels. METHODS: A crosssection analysis with 888 youths recruited from both genders with ages ranging from 11
to 17 years was carried out. The body mass index was calculated through body mass and
height values, and was used as the overweight indicator. Physical activity, food intake,
and socioeconomic levels (high and low) were obtained by questionnaires. Data were
analyzed by chi-square test and binary logistic regression. RESULTS: For adolescents in
the lower socioeconomic level, both inadequate food intake (Odds Ratio [OR]= 4.59) and
parent overweight (OR= 5.33) were associated to overweight. Among adolescents in the
higher socioeconomic level, maternal education (OR= 0.57), study in private school
(OR= 3.04), and parent overweight (OR= 3.47) were associated to development of
overweight. CONCLUSION: In both socioeconomic levels, parent overweight was an
important risk factor associated with overweight. The other risk factors were different
among the socioeconomic levels.
Foley, L., H. Prapavessis, et al. (2008). "Predicting physical activity intention and
behavior in school-age children." Pediatric Exercise Science 20(3): 342-356.
Two studies were conducted to predict physical activity in school-aged children.
Study I tested the utility of an integrated model in predicting physical activity (PA)
intention and behavior-the theory of planned behavior (TPB) and self-efficacy theory. Six
hundred and forty-five New Zealand children (aged 11-13 years) completed measures
corresponding to the integrated model and a self-reported measure of PA one week later.
Perceived behavioral control (PBC) and subjective norm were the two strongest
predictors of intentions. Task efficacy and barrier efficacy were the two strongest
predictors of PA. A second study (Study 2) was conducted to determine whether the selfefficacy measures could discriminate objectively measured PA levels. Sixty-seven
Canadian children (aged 11-13 years) completed task and barrier self-efficacy measures.
The following week, children classified as 'high' (n = 11) and 'lower' (n = 7) for both task
and barrier efficacy wore an Actical(R) monitor for seven consecutive days to provide
activity-related energy expenditure (AEE) data. Results showed that children with high
efficacy expended significantly greater AEE than their lower efficacious counterparts.
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Findings from these two studies provide support for the use of self-efficacy interventions
as a potentially useful means of increasing PA levels among school-aged children.
Gidlow, C., T. Cochrane, et al. (2008). "In-school and out-of-school physical activity in
primary and secondary school children." Journal Of Sports Sciences 26(13): 1411-1419.
The aim of this study was to compare in-school and out-of-school physical
activity within a representative sample. Socio-demographic, physical activity, and
anthropometric data were collected from a random sample of children (250 boys, 253
girls) aged 3-16 years attending nine primary and two secondary schools. Actigraph
GT1M accelerometers, worn for seven days, were used to estimate physical activity
levels for in-school (typically 09.00-15.00h), out-of-school (weekday), and weekend
periods. Physical activity as accelerometer counts per minute were lower in school versus
out of school overall (in school: 437.2172.9; out of school: 575.5202.8; P0.001),
especially in secondary school pupils (secondary: 321.6127.5; primary: 579.2216.3;
P0.001). Minutes of moderate-to-vigorous physical activity accumulated in school
accounted for 29.49.8% of total weekly moderate-to-vigorous physical activity overall
but varied by sector (preschool: 37.46.2%; primary: 33.68.1%; secondary: 23.09.3%;
F=114.3, P0.001). Approximately half of the children with the lowest in-school activity
compensated out of school during the week (47.4%) and about one-third at the weekend
(30.0%). Overall, physical activity during the school day appears to be lower than that
out of school, especially in secondary school children, who accumulate a lower
proportion of their total weekly moderate-to-vigorous physical activity at school than
younger children. As low in-school activity was compensated for beyond the school
setting by less than half of children, promoting physical activity within the school day is
important, especially in secondary schools.
Hudson, C. E. (2008). "Being overweight and obese: Black children ages 2-5 years."
Abnf J 19(3): 89-91.
Obesity in children is a significant public health concern. The prevalence of
obesity in Black preschoolers (ages 2-5 years) is slightly higher than in whites. However,
by age 6, Black children experience higher obesity prevalence. The consequences to
health throughout childhood and into adulthood have both medical and economic cost to
individuals and society. Factors associated with obesity in preschool children are lifestyle
behaviors such as diet, level of activity, culture, environment, and parental perceptions.
Programs should target young Black children and their families to reduce the incidence of
obesity and promoting healthy behaviors could aid in eliminating health disparities and
improving quality of life. Nurses need to provide comprehensive culturally appropriate
strategies at community and individual/family levels to prevent overweight and obesity in
children.
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Hulley, A., N. Bentley, et al. (2008). "Active and passive commuting to school:
influences on affect in primary school children." Res Q Exerc Sport 79(4): 525-34.
Active commuting among school children is being encouraged for physical and
environmental reasons, but little is known about its influence on affect. The aim of this
study was to test the hypothesis that children who walk further to school experience
increased arousal and affective valence compared with children who walk a short
distance. This was assessed with the children's feeling scale (CFS) and children's felt
arousal scale (CFAS). Distance walked to school and affective change between home and
school were assessed over a 2-week period in 99 children between 5 and 10 years of age.
Home to school differences in CFS and CFAS scores were compared in children who
walked a short (100-300 m); medium (301-500 m), and long distance (over 500 m).
Although differences were not always statistically significant, there was evidence that the
children who walked further reported a greater increase in their CFAS scores between
home and school (average eta2 = .08, range: .01-.15) and, to a lesser extent, in their CFS
scores (eta2 = .04, range: .002-.06). Further research is needed to explore whether there is
an optimum walking distance and the contribution of other factors, especially social
contacts during commuting, the environment, and the weather.
Ivanova, L., P. Dimitrov, et al. (2008). "Prevalence of obesity and overweight among
urban adults in Bulgaria." Public Health Nutr 11(12): 1407-10.
OBJECTIVE: The prevalence of obesity is increasing in transitional countries, but
extensive data on some countries, such as Bulgaria, are still lacking. Therefore, the
objective of the present study was to estimate the prevalence of overweight and obesity,
relative to gender and income, among adults in Sofia, Bulgaria. DESIGN: Cross-sectional
survey to collect data on diet, health, BMI and income using a brief questionnaire on diet
and income. Data were analysed using analysis of covariance to determine differences
within and between income and gender groups. SETTING: Sofia, Bulgaria. SUBJECTS:
Adults living in the city of Sofia, Bulgaria. RESULTS: For adults 30-60 years of age,
35.1 % were overweight and 6.2 % were obese. The proportion of overweight and obesity
was higher among men than women (44.8 % v. 32.4 % and 6.0 % v. 4.7 %, respectively).
With respect to income, BMI decreased as income increased. For men, BMI was highest
for the lowest and highest income groups, whereas for women lower income was
associated with a higher BMI. CONCLUSION: The prevalence of overweight and
obesity appears to be an emerging problem in some sectors of Bulgarian society, based
on our data from the largest urban area of the country. These data provide new
information on the divergence in health and disease risk in a country that is still
economically challenged and may be facing the nutrition transition.
Ji, C. Y. and T. J. Chen (2008). "Secular changes in stature and body mass index for
Chinese youth in sixteen major cities, 1950s-2005." American Journal Of Human
Biology 20(5): 530-537.
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Evidence shows a secular trend in physical growth in China in recent years. We
analyze the secular trend of stature and body mass index (BMI) for the period 1950s2005 to provide biological evidence for policy-makers to identify measures for improving
Chinese children's health. Data come from the historical records in 1950s and the
successive cycles of the Chinese National Survey on Student's Constitution and Health.
Subjects were 7- to 18-year-old youth from 16 cities. Sex-age differences in mean stature
and BMI values, between the surveys were analyzed, and the increments per decade were
compared. An overall positive secular trend was found in 1950s-2005. Mean stature of
the 18-year olds increased from 166.6 to 173.4 cm for males and from 155.8 to 161.2 cm
for females, yielding rates of 1.3 and 1.1 cm/decade; the overall increments of BMI
values were 2.6 for males and 1.8 for females, yielding rates of 0.8 and 0.6/decade,
respectively. The most significant changes occurred during puberty. The overall positive
secular trend is closely associated with the socioeconomic progress and the improvement
of livelihood. Strong evidence suggests that in China this trend will be continued for
many years. Further studies are needed to explore how to ensure healthy changes for
poorer rural youth. Effective preventive strategies and measures should be taken to
prevent the progressive increase in the prevalence of childhood obesity accompanying
this trend.
Ji, C. Y. and T. O. Cheng (2008). "Prevalence and geographic distribution of childhood
obesity in China in 2005." Int J Cardiol 131(1): 1-8.
China now joins the world epidemic of childhood obesity. Because of the large
disparity of environmental conditions across various sub-populations, accurate
prevalence of obesity/overweight cannot be estimated by population-based approaches.
Using a resident-based targeted approach, we determined the geographical distribution of
childhood obesity in China and analyzed the specific factors related to the increasing
prevalence of obesity in each of its ten regions. An alarming increase in the prevalence of
obesity has spread all over China, except for the poverty western rural areas. In 2005, the
prevalence of combined childhood overweight and obesity in China reached 32.5% for
males and 17.6% for females in the northern coastal big cities, suggesting that the obesity
prevalence in some urban Chinese populations has approached that of the developed
countries. The prevalence of obesity in the affluent rural sub-populations first exceeded
that in some urban populations; then, as they learned their lessons and revised their
lifestyles, the prevalence declined to a lower level approaching that of the transitional
societies of other countries. The geographical distribution of obesity prevalence in China
is mainly caused by the large disparity in the socioeconomic status related to dietary and
lifestyle changes in modern China. Multiple and integrated interventions are urgently
needed to halt the epidemic of childhood obesity by tackling its basic causes such as fast
food, automobiles, television and lack of exercise. The differing prevalences in different
regions of China offer an opportunity to reverse this alarming, growing epidemic of
childhood obesity in the world's most populous country.
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Ji, C. Y. and T. O. Cheng (2009). "Epidemic increase in overweight and obesity in
Chinese children from 1985 to 2005." Int J Cardiol 132(1): 1-10.
This study tracks the temporal changes in prevalence of childhood and adolescent
overweight and obesity in different regions of China from 1985 to 2005. Using a series
data of the Chinese National Survey on Students Constitution and Health, we compared
the temporal changes over a 20-year period of the prevalence of overweight and obesity
among ten regions in China for school-aged children between 7 and 18 years of age.
Large disparities in the temporal changes of obesity prevalence exist in different regions
of China. North coastal residents, especially those of the upper socioeconomic status, had
the earliest and largest increase in prevalence. Similar increases then followed
successively in other regions of upper, moderate and low socioeconomic status, and
finally in the affluent rural regions. No significant increase was found in the developing
rural areas. Regions where the obesity epidemic occurred late also began to show rather
rapid increases in prevalence in recent years. In 2005, the national estimates indicated
that 7.73% of Chinese youth are overweight and 3.71% of them are obese, representing
an estimated 21.37 million Chinese children (13.43 million boys and 7.94 million girls).
Kamtsios, S. and N. Digelidis (2008). "Physical activity levels, exercise attitudes, selfperceptions and BMI type of 11 to 12-year-old children." J Child Health Care 12(3): 23240.
This study examined elementary school pupils with different body mass index
(BMI) as to attitudes towards exercise, self-perception, lesson satisfaction in physical
education and participation in physical activity. Seven hundred and seventy-five pupils
participated in this study, aged 11-12 years. The study was conducted through
questionnaires. Students were divided according to their BMI: normal, overweight and
obese. Two-way analysis of variance was used, with gender and BMI type as independent
variables. The results revealed that when compared to students with a normal BMI, the
obese and overweight students had lower scores in lesson satisfaction, negative views of
their body and reduced levels of physical activity. Also, the results showed that the obese
and overweight students adopted more sedentary daily habits, such as many hours of TV
watching and PC usage. The results of this study imply the need for necessary school
interventions in order to encourage healthier behaviours and habits.
Katzmarzyk, P. T., L. A. Baur, et al. (2008). "International conference on physical
activity and obesity in children: summary statement and recommendations." Applied
Physiology Nutrition And Metabolism-Physiologie Appliquee Nutrition Et Metabolisme
33(2): 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
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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.
Kral, T. V. E., A. J. Stunkard, et al. (2008). "Beverage consumption born at different risk
of patterns of children obesity." Obesity 16(8): 1802-1808.
Background: Increased intake of sugar-sweetened beverages and fruit juice has
been associated with overweight in children. Objective: This study prospectively assessed
beverage consumption patterns and their relationship with weight status in a cohort of
children born at different risk for obesity. Methods and Procedures: Participants were
children born at low risk (n = 27) or high risk (n = 22) for obesity based on maternal
prepregnancy BMI (kg/m(2)). Daily beverage consumption was generated from 3-day
food records from children aged 3-6 years and coded into seven beverage categories
(milk, fruit juice, fruit drinks, caloric and noncaloric soda, soft drinks including and
excluding fruit juice). Child anthropometric measures were assessed yearly. Results:
High-risk children consumed a greater percentage of daily calories from beverages at age
3, more fruit juice at ages 3 and 4, more soft drinks (including fruit juice) at ages 3-5, and
more soda at age 6 compared to low-risk children. Longitudinal analyses showed that a
greater 3-year increase in soda intake was associated with an increased change in waist
circumference, whereas a greater increase in milk intake was associated with a reduced
change in waist circumference. There was no significant association between change in
intake from any of the beverage categories and change in BMI z-score across analyses.
Discussion: Children's familial predisposition to obesity may differentially affect their
beverage consumption patterns. Future research should examine the extent to which
dietary factors may play a role in pediatric body fat deposition over time.
Kumar, H. N. H., P. Mohanan, et al. (2008). "Prevalence of overweight and obesity
among pre-school children in semi urban South India." Indian Pediatrics 45(6): 497-499.
This study was conducted to ascertain the prevalence of overweight and obesity in
425 pre-school children (2 to 5 years) using the new Child Growth Standards released by
the World Health Organization. Overweight and obesity were defined as body mass index
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(BMI) > 85th and 95th percentiles for that age and sex, respectively. The prevalence of
overweight and obesity was 4.5% and 1.4%, respectively.
Kurokawa, N., K. Nakai, et al. (2008). "Trends in growth status among schoolchildren in
Sendai, Japan, 1994-2003: leveling-off of mean body height and weight." Tohoku J Exp
Med 216(4): 371-5.
Secular changes in growth have been well documented in various world
populations, with secular increase especially noticeable in the developed countries.
Accordingly, we have been monitoring the secular changes in growth status among the
6th year children in primary schools (6thPS, 11-12 years old) and 3rd year children in
junior high schools (3rdJHS, 14-15 years old) in the city of Sendai since 1934. After
World War II, both primary school children and junior high school students showed
marked increases in height and weight up to the early 1970s. Acceleration and the
subsequent reduction in the degree of acceleration in growth were observed in 1965-1974
and 1975-1984, respectively, and were followed by reacceleration in 1985-1994. The aim
of this study was to assess the growth changes among Sendai schoolchildren in 19942003. The period between 1994 and 1999 was characterized by positive trends both in
height and weight among schoolchildren. However, the degree of the increases in height
and weight was diminished between 1999 and 2003. The linear regression analysis
revealed the significant increases in mean weight during the 10-year study period in
6thPS boys and 3rdJHS boys and girls. In contrast, there was no significant increase in
mean height in any group. These findings suggest the leveling-off of the mean body
height and weight among schoolchildren in Sendai at the end of the 20th century.
Additional study is needed to examine possible explanations and consequences of these
secular trends.
Lagiou, A. and M. Parava (2008). "Correlates of childhood obesity in Athens, Greece."
Public Health Nutr 11(9): 940-5.
OBJECTIVE: Childhood obesity is a growing public health problem. We have
examined the association between sociodemographic profile and eating and physical
activity patterns with overweight among primary-school students in Athens, Greece.
DESIGN: Cross-sectional study. SETTING: Eleven primary schools in the greater
Athens area, Greece. SUBJECTS: A total of 633 children aged 10-12 years (50 % boys,
50 % girls) were interviewed in person during spring 2003. Multivariate logistic
regression was used to investigate the association between eating and physical activity
patterns and overweight (> or =85th sex- and age-specific BMI centile). Results are
presented as odds ratios and 95 % confidence intervals. RESULTS: Overweight was
more common among girls than among boys (OR=1.73; 95% CI 1.11, 2.69) and
substantially less common among children born outside Greece (OR=0.46; CI 0.22,
0.95). Reported physical activity (per 1.5 h per day) was unrelated to overweight
(OR=0.97; CI 0.85, 1.12) but patent physical inactivity, operationalised as time spent
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watching television or working/playing with the computer (per 1.5 h per day) was a
highly significant predictor of overweight (OR=1.20; CI 1.05, 1.36). Composition of diet
was unrelated to overweight but the daily number of eating occasions, controlling for
total energy intake, was significantly inversely associated with overweight (OR=0.61; CI
0.48, 0.76). CONCLUSIONS: The principal factor underlying overweight among
children in Athens appears to be the extended inactivity imposed by modern childhood
lifestyles. An intriguing finding is that spreading a given energy intake over several
eating occasions was inversely associated with the likelihood of childhood obesity.
Laurson, K. R., J. C. Eisenmann, et al. (2008). "Combined influence of physical activity
and screen time recommendations on childhood overweight." Journal Of Pediatrics
153(2): 209-214.
Objectives To examine the combined influence of physical activity and screen
time (television and video games) on the odds of being overweight and to evaluate the
utility of current public policy recommendations. Study design Physical activity was
assessed by a pedometer and screen time was assessed by survey in a sample of 709
children age 7 to 12 years. The percentage of subjects meeting current physical activity
and screen time recommendations was calculated. Cross-tabulated physical activityscreen time groups were formed depending on whether or not the children were meeting
current recommendations. Logistic regression was used to examine the influence of
physical activity and screen time on the odds of being overweight. Results Children
meeting physical activity and screen time recommendations were the least likely to be
overweight. Approximately 10% of the boys and 20% of the girls meeting both
recommendations were overweight, compared with 35% to 40% of those who did not
meet either recommendation. Screen time and physical activity appeared to be equivalent
risk factors for boys, even though physical activity in girls was more strongly associated
with body mass index. Conclusions Children not meeting the physical activity or screen
time recommendations were 3 to 4 times more likely to be overweight than those
complying with both recommendations.
Lee, M. C., M. R. Orenstein, et al. (2008). "Systematic review of active commuting to
school and childrens physical activity and weight." J Phys Act Health 5(6): 930-49.
BACKGROUND: The recent decline in children's active commuting (walking or
biking) to school has become an important public health issue. Recent programs have
promoted the positive effects of active commuting on physical activity (PA) and
overweight. However, the evidence supporting such interventions among schoolchildren
has not been previously evaluated. METHODS: This article presents the results of a
systematic review of the association between active commuting to school and outcomes
of PA, weight, and obesity in children. RESULTS: We found 32 studies that assessed the
association between active commuting to school and PA or weight in children. Most
studies assessing PA outcomes found a positive association between active commuting
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and overall PA levels. However, almost all studies were cross-sectional in design and did
not indicate whether active commuting leads to increased PA or whether active children
are simply more likely to walk. Only 3 of 18 studies examining weight found consistent
results, suggesting that there might be no association between active commuting and
reduced weight or body mass index. CONCLUSION: Although there are consistent
findings from cross-sectional studies associating active commuting with increased total
PA, interventional studies are needed to help determine causation.
Loucaides, C. A. and R. Jago (2008). "Differences in physical activity by gender, weight
status and travel mode to school in Cypriot children." Prev Med 47(1): 107-11.
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 three-way 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.
Mackett, R. L. and J. Paskins (2008). "Children's physical activity: The contribution of
playing and walking." Children & Society 22(5): 345-357.
This paper draws on research in which 200 children were fitted with motion
sensors and asked to keep travel and activity diaries. The findings show that walking and
playing away from home can contribute significantly to children's volume of physical
activity, with consequent implications for their health. Not only do both playing and
walking provide high levels of physical activity, they are linked to other behaviours
which further augment the level of physical activity. Children who walk rather than use
the car tend to be generally more active than other children, and children tend to be more
active when they are out of their homes than when they are in them. The findings are
placed in the context of other research about children's travel and physical activity, and
conclusions drawn about the need to reverse current trends in children's patterns of travel
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and physical activity. (C) 2007 The Author(s). Journal compilation (C) 2007 National
Children's Bureau.
Maher, E. J., G. H. Li, et al. (2008). "Preschool child care participation and obesity at the
start of kindergarten." Pediatrics 122(2): 322-330.
OBJECTIVE. We examined the association between type of child care,
participation in different types of child care in the year before kindergarten and the
likelihood of obesity at the start of kindergarten. METHODS. Using a nationally
representative sample of 15 691 first-time kindergartners from the Early Childhood
Longitudinal Study-Kindergarten Cohort, we used logistic regression to estimate the
relationship between type of primary child care arrangement and children's likelihood of
being obese at the start of kindergarten. Our models controlled for family and child
characteristics associated with obesity and choice of child care. To examine differential
effects of child care participation for groups at high risk for obesity, we tested
interactions between children's ethnicity and income with primary type of child care.
RESULTS. At the start of kindergarten, 12% of the children were obese. Without
controlling for other characteristics of children and families, children not in child care
were significantly less likely and children in family, friend, and neighbor care were
significantly more likely to be obese than children in other primary child care
arrangements. White children were significantly less likely and Latino children more
likely to be obese than children of other ethnic groups. After controlling for relevant child
and family characteristics, children in family, friend, and neighbor care and non-Latino
children in Head Start were more likely to be obese than children not in child care. For
Latino children, however, participation in some types of nonparental child care had
protective effects on their likelihood of being obese. CONCLUSIONS. Primary type of
child care is associated with children's obesity. For Latino children, who are at a greater
risk of being obese, participation in nonparental child care seems to have a protective
effect. These results suggest that child care settings may be an important site for policy
intervention during a crucial developmental period. Efforts to help family, friend, and
neighbor caregivers support children's physical health may be warranted.
Malina, R. M., M. E. P. a. Reyes, et al. (2008). "Physical activity in youth from a
subsistence agriculture community in the Valley of Oaxaca, southern Mexico." Applied
Physiology, Nutrition & Metabolism 33(4): 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.
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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-to-vigorous 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. L’observation des activités des
communautés agricoles contemporaines travaillant à des fins de subsistance peut
nous donner une image du... ABSTRACT FROM AUTHOR
Martinez, S. M., G. X. Ayala, et al. (2008). "Active transportation and acculturation
among Latino children in San Diego County." Prev Med 47(3): 313-8.
OBJECTIVES: To examine multiple measures of acculturation and their
association with walking to school in a large population-based sample in San Diego,
California. METHODS: The sample consisted of predominantly Latino children and their
parents (n=812) who participated in a study to maintain healthy weights from
kindergarten through 2nd grade (2004-2007). Acculturation and walking/driving to and
from school were assessed through parent-proxy surveys. RESULTS: Children of
foreign-born child-parent dyads walked to school more frequently than their counterparts
(F=7.71, df=5, 732, p<.001). Similarly, parents who reported living in the U.S. for less
than or equal to 12 years reported more walking to school by their children compared
with parents living in the U.S. for more than 12 years (F=10.82, df=4, 737, p<.001).
Finally, English-speaking females walked to school more frequently than Spanishspeaking and bilingual females. CONCLUSION: This study explores Latino children's
walking to and from school using four measures of acculturation. In this cross-sectional
study, being less acculturated was associated with more walking to school among
children living in South San Diego County.
Muth, N. D. (2008). "Preventing Childhood Obesity." IDEA Fitness Journal 5(7): 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
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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.
Nader, P. R., R. H. Bradley, et al. (2008). "Moderate-to-vigorous physical activity from
ages 9 to 15 years." Jama 300(3): 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.
Neovius, M. and F. Rasmussen (2008). "Evaluation of BMI-based classification of
adolescent overweight and obesity: choice of percentage body fat cutoffs exerts a large
influence. The COMPASS study." Eur J Clin Nutr 62(10): 1201-7.
OBJECTIVE: To determine the impact of commonly used body fat percentage
(%BF) references when evaluating the sensitivity, specificity and misclassifications of
body mass index (BMI) for obesity screening in adolescence. SUBJECTS/METHODS: A
community-based sample of 3334 adolescents aged 15.2+/-0.6 years was studied. Weight,
height and %BF were measured. Sensitivity, specificity, predictive values and type and
extent of misclassifications were calculated. True-positive subjects for overweight and
obesity were defined by recently published paediatric %BF cutoffs, 85th and 95th
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percentiles from the present study population, and an older %BF reference. RESULTS:
Regardless of %BF reference used, specificities were high (>0.98 for obesity and >0.90
for overweight) in both sexes, with values for overweight consistently higher for girls
(P<0.05). Sensitivities were much lower, with boys ranging from 0.52 to 0.74 for
overweight, and 0.24 to 0.43 for obesity. Corresponding sensitivities for girls were 0.420.66 and 0.22-0.46. Large discrepancies were seen in total number of misclassifications,
with published references resulting in twice as many misclassified for overweight (620,
514 vs 362) when compared to the cutoffs from the study population. For obesity, the
difference was even greater (367 vs 133). CONCLUSIONS: No matter which %BF
reference used, specificity of BMI was high, and sensitivity low for both sexes.
Population percentiles resulted in somewhat lower specificity but much higher
sensitivity, and many more correctly classified compared to when cutoffs from the
literature were used. The choice of %BF reference in evaluations of BMI-based
classification systems has a large impact on the outcome. Sensitivity analyses are
therefore warranted.
Oulamara, H., A. Nacer Agli, et al. (2008). "Changes in the prevalence of overweight,
obesity and thinness in Algerian children between 2001 and 2006." Int J Pediatr Obes: 13.
Annual cross-sectional studies were performed between 2001 and 2006 in Algeria
in order to evaluate the nutritional status and determine the changes in prevalence of
categories of nutritional status, according to the International Obesity Task Force (IOTF)
criteria for overweight and obesity and Cole's criteria for thinness. A total of 19263
children aged 6 to 10 years originating from three economically different areas were
enrolled in the study. The overall prevalence of thinness decreased from 34.3% (95% CI:
32.4-36.2) to 24.5% (95% CI: 22.6-26.4) (p<0.0001). Overweight, including obesity,
increased from 6.8% (95% CI: 5.7-7.8) to 9.5% (95% CI: 8.2-10.8) (p=0.001) mainly due
to overweight excluding obesity. Children in urban areas showed the most marked
decrease in thinness and increase in overweight as opposed to those from rural areas
where overweight and obesity remained stable over time.
Ozturk, A., M. M. Mazicioglu, et al. (2008). "Reference Body Mass Index Curves for
Turkish Children 6 to 18 Years of Age." Journal Of Pediatric Endocrinology &
Metabolism 21(9): 827-836.
Aim: To determine reference body mass index (BMI) curves for Turkish children
6 to 18 years old and to compare with BMI in other countries. Methods: A cross-sectional
study conducted in Kayseri, Turkey. A total of 5,727 children (2,942 girls, 2,785 boys)
aged between 6 and 18 years were selected to construct a reference curve using LMS
method. Results: BMI age reference charts of Turkish children were constructed. The
50(th) percentile curve of Turkish girls is lower than Italian and Turkish girls in The
Netherlands but higher than Iranian girls. The 50(th) percentile curve of Turkish boys is
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lower than Italian and Turkish boys in The Netherlands and similar to Iranian boys after
13 years of age. Conclusion: BMI references of Turkish children are lower than in South
East Europe, UK and North American populations, but higher than in Central European
and Scandinavian countries.
Pearce, A., R. Jenkins, et al. (2008). "An evaluation of UK secondary data sources for the
study of childhood obesity, physical activity and diet." Child Care Health And
Development 34(6): 701-709.
Background This study assesses the potential of secondary datasets for measuring
recent and future trends in childhood obesity, physical activity and diet in the UK, at
national, regional and sub-regional levels, and in relation to inequalities. Methods
Relevant datasets were identified using online searches; they were excluded if they had
low sample sizes, were assembled prior to 1990 or on only one occasion, were not
potentially accessible, or were limited to a specific population. Remaining datasets were
assessed according to content, sampling frame and size, timing and ability to be used to
assess inequalities and regional trends. Results A total of 96 datasets were identified, but
only 11 had the potential to be used to assess trends. Eight of these contained data on
physical activity, 8 on diet and 3 on obesity. The period over which trends might be
assessed varied from 2 years to over 10, with over half of the datasets expected to
continue data collection into the future. Most had the potential to be used to assess
inequalities and also regional and sub-regional level trends, albeit with relatively small
sample sizes. There were some limitations to the datasets, such as non-objective measures
of diet and physical activity and, in some, low response rates, which would require
further consideration when utilizing individual datasets. Conclusions Awareness of the
potential of secondary datasets for monitoring trends in childhood obesity should be
raised, alongside the financial and intellectual capacity to enhance and exploit them.
Raudsepp, L., I. Neissaar, et al. (2008). "Longitudinal Stability of Sedentary Behaviors
and Physical Activity During Early Adolescence." Pediatric Exercise Science 20(3): 251.
The purpose of this study was to examine the stability of sedentary behaviors and
physical activity in Estonian school children aged 11-12 year at the beginning of the
study. In addition, the consequence of changes in sedentary behaviors on a change in
physical activity was investigated. Adolescents (N = 345) completed the 3-Day Physical
Activity Recall on four occasions over a 22-month period. Results indicated the
curvilinear changes in sedentary behaviors and physical activity across time. There was a
significant decrease in physical activity and an increase in sedentary behaviors across
three years. Stability coefficients indicated a moderate differential stability of the
sedentary behaviors (ranged from 0.31 to 0.64) and physical activity (ranged from 0.36 to
0.59) during early adolescence. Latent growth modeling indicated that increase in
sedentary behaviors across a 22-month period was inversely associated with a change in
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physical activity. Interventions targeted at "high-risk" groups to reduce sedentary
behaviors during early adolescence are encouraged.
Savva, S. C., M. J. Tornaritis, et al. (2008). "Prevalence of overweight and obesity among
11-year-old children in Cyprus, 1997-2003." International Journal Of Pediatric Obesity
3(3): 186-192.
Objectives. To report 5-year changes in the prevalence of overweight and obesity
in 11-year-old children in Cyprus. Methods. This was a school-based study performed in
Cyprus. A total of 14 090 11-year-old children (males: 51.2%), who had been examined
in the 1997-8 and 2002-3 school years, were included in the study. The International
Obesity Task Force (IOTF) cut-offs were used to define overweight and obese subjects,
and logistic regression models were used to estimate 5-year trends. Results. The overall
prevalence of overweight children was slightly higher in the second period but this
change was not statistically significant. There was only a significant increase in
overweight boys in rural areas; odds ratio (OR) (95% confidence interval [CI]) for the 5year period was 1.33 (1.10, 1.62; p = 0.004). The overall relative increase in obesity was
17.9% and the OR (95% CI) was 1.22 (1.07, 1.38; p = 0.003). Although the prevalence of
obesity was higher in males in both periods, the relative increase was substantially higher
in females, 29.6% vs. 11.4%. The relative increase was also higher in rural (35.9%)
compared with urban areas (8.7%); ORs (95% CI) 1.46 (1.17, 1.81) vs. 1.10 (0.94, 1.29),
respectively. Conclusions. This is the first report documenting increasing rates of obesity
among school-aged children in Cyprus. Females and children living in rural areas
experienced the most striking increases. The prevalence of overweight increased only in
males living in rural areas.
Sirard, J. R., M. Y. Kubik, et al. (2008). "Objectively Measured Physical Activity in
Urban Alternative High School Students." Medicine And Science In Sports And Exercise
40(12): 2088-2095.
Introduction: Alternative high school (AHS) students are an underserved
population of youth at greater risk for poor health behaviors and outcomes. Little is
known about their physical activity patterns. Purpose: The purpose of this study was to
describe 1) physical activity levels of students attending alternative high schools (AHS)
in St. Paul/Minneapolis, MN, and 2) compliance with wearing a physical activity
accelerometer. Methods: Sixty-five students (59% male, 65% <18 yr old, 51% African
American, 17% Caucasian, 32% mixed and other) wore an accelerometer during all
waking hours for 7 d as part of the baseline assessment for a school-based physical
activity and dietary behavior intervention. Accelerometer data were reduced to summary
variables using a custom software program. Compliance with wearing the accelerometer
was assessed by the number of days with >= 10 h of data. Accelerometer counts per
minute and minutes spent in moderate-to-vigorous physical activity (MVPA) were
calculated. Results: Students averaged 323 +/- 143.0 counts.min(-1) and 51 +/- 25.5
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min.d(-1) of MVPA. Minutes of MVPA.d(-1) were greater on weekdays compared with
the weekend (52 +/- 27.3 vs 43 +/- 39.7 min.d(-1), respectively; P = 0.05). However,
students wore the accelerometer less on the weekends (weekdays 17.2 +/- 3.0, weekend =
14.9 +/- 6.8 h.d(-1)) Expressing minutes of MVPA as a percentage of the number of
minutes of available data. students spent approximately 5% of their time in MVPA on
weekdays and weekends. Forty-five percent of students had 7 d of data, 51% had 4-6 d,
and 5% had fewer than 4 d. On average, students wore the accelerometer for 17 +/- 3.2
h.d(-1) (range = 12.0-23.8 h.d(-1)). Conclusion: Compliance was high (95% of students
provided at least 4 d of data), and physical activity was relatively low representing a
vulnerable population in need of further study and intervention.
Smith, D. T., R. T. Bartee, et al. (2009). "Prevalence of overweight and influence of outof-school seasonal periods on body mass index among American Indian schoolchildren."
Prev Chronic Dis 6(1): A20.
INTRODUCTION: The prevalence of overweight and obesity among American
Indian youth may be 2 to 3 times higher than the national average. Whether weight gain
during discrete out-of-school periods is occurring and contributing to the prevalence of
overweight and obesity in this population is unknown. METHODS: We obtained
repeated cross-sectional body mass index (BMI) samples from third-, fourth-, fifth-,
seventh-, and eighth-grade boys and girls who reside on the Wind River Indian
Reservation in central Wyoming. We collected measures at the beginning of 2 school
years (N = 251), during 2 holiday breaks (N = 226), and during 1 summer recess (N =
141). We determined prevalence of normal weight and overweight among participants by
grade level, and we calculated paired comparisons of BMI, BMI z score, and weight
status during the holiday breaks and summer recess. RESULTS: Combined prevalence of
at risk for overweight and overweight was 62.0% for boys and 56.6% for girls. For fifthgrade girls, significant increases in BMI (P = .01) and z score (P < .001) occurred over
the holiday break. BMI increased significantly over the summer among third- and fifthgrade girls and among fourth-grade boys, but changes in z scores were nonsignificant.
We observed an increase in weight status by out-of-school time in BMI (P < .001) for
schoolchildren at or above the 85th BMI percentile over the summer recess, but
corresponding z scores did not change. CONCLUSION: Prevalence of overweight among
American Indian schoolchildren was higher than national estimates and higher than the
prevalence in other similarly aged American Indian youth. Increases in BMI during outof-school periods are likely due to normal growth, except among fifth-grade girls.
So, H. K., E. A. S. Nelson, et al. (2008). "Secular changes in height, weight and body
mass index in Hong Kong Children." Bmc Public Health 8.
Background: Large population growth surveys of children and adolescents aged 6
to 18 y were undertaken in Hong Kong in 1963 and 1993. The global epidemic of obesity
is a major public health concern. To monitor the impact of this epidemic in Hong Kong
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children and to identify secular changes in growth, a further growth survey was
undertaken in 2005/6. Methods: Cross-sectional height and weight measurements of
14,842 children and adolescents aged 6 to 18 y from Hong Kong's 18 districts were
obtained during the 2005/6 school year. Percentile curves were constructed using LMS
method and sex-specific percentile values of weight-forage, height-for-age, and BMI-forage were compared with those data from 1963 and 1993. Results: Secular changes in
height, weight and BMI were noted between 1963 and 1993 and between 1993 and
2005/6. In the latter period, greater changes were observed at younger ages, and
particularly in boys. On an annual basis, the 1993-2005/6 changes were less than those
during 1963-1993. Using the International Obesity Task Force cut-offs, 16.7% of
children were overweight or obese in 2005/6, which was a 5.1% increase since 1993.
Conclusion: These data provide policy-makers with further evidence of the secular
changes in child growth and the increasing obesity epidemic among Hong Kong children.
van Sluijs, E. M., P. M. Skidmore, et al. (2008). "Physical activity and dietary behaviour
in a population-based sample of British 10-year old children: the SPEEDY study (Sport,
Physical activity and Eating behaviour: environmental Determinants in Young people)."
BMC Public Health 8: 388.
BACKGROUND: The SPEEDY study was set up to quantify levels of physical
activity (PA) and dietary habits and the association with potential correlates in 9-10 year
old British school children. We present here the analyses of the PA, dietary and
anthropometry data. METHODS: In a cross-sectional study of 2064 children (926 boys,
1138 girls) in Norfolk, England, we collected anthropometry data at school using
standardised procedures. Body mass index (BMI) was used to define obesity status. PA
was assessed with the Actigraph accelerometer over 7 days. A cut-off of > or = 2000
activity counts was used to define minutes of moderate-to-vigorous PA (MVPA). Dietary
habits were assessed using the Health Behaviour in School Children food questionnaire.
Weight status was defined using published international cut-offs (Cole, 2000).
Differences between groups were assessed using independent t-tests for continuous data
and chi-squared tests for categorical data. RESULTS: Valid PA data (>500 minutes per
day on > or = 3 days) was available for 1888 children. Mean (+/- SD) activity counts per
minute among boys and girls were 716.5 +/- 220.2 and 635.6 +/- 210.6, respectively (p <
0.001). Boys spent an average of 84.1 +/- 25.9 minutes in MVPA per day compared to
66.1 +/- 20.8 among girls (p < 0.001), with an average of 69.1% of children accumulating
60 minutes each day. The proportion of children classified as overweight and obese was
15.0% and 4.1% for boys and 19.3% and 6.6% for girls, respectively (p = 0.001). Daily
consumption of at least one portion of fruit and of vegetables was 56.8% and 49.9%
respectively, with higher daily consumption in girls than boys and in children from higher
socioeconomic backgrounds. CONCLUSION: Results indicate that almost 70% of
children meet national PA guidelines, indicating that a prevention of decline, rather than
increasing physical activity levels, might be an appropriate intervention target. Promotion
of daily fruit and vegetable intake in this age group is also warranted, possibly focussing
on children from lower socioeconomic backgrounds.
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Vicente-Rodriguez, G., J. P. Rey-Lopez, et al. (2008). "Television watching, videogames,
and excess of body fat in Spanish adolescents: The AVENA study." Nutrition 24(7-8):
654-662.
Objective: We assessed the individual association of sedentary behaviors with the
risk of overweight and excess body fat (overfat) in adolescents. Methods: A
representative sample (1960 subjects, 1012 males, age 13-18.5 y) of Spanish adolescents
was studied within the framework of the Alimentacion y Valoracion del Estado
Nutricional de los Adolescentes (AVENA) study. Television (TV) watching, videogame
and computer usage, doing homework, and the way students got to school, physical
activity, and socioeconomic status were analyzed. Anthropometrics were measured to
describe overweight (International Obesity Task Force cutoffs for body mass index) and
overfat (body fat percentage >85th percentile). Results: When all subjects were
considered as an entire group, the overweight risk increased by 15.8% (P < 0.05) per
increasing hour of TV watching. The overweight risks decreased by 32.5% in females,
22% per increasing year of age, and 12.5% by increasing socioeconomic status by I U (all
Ps < 0.05). The obesity risks decreased with age by 17.8% per year in males and 27.1%
in females (both Ps < 0.05). The overfat risks increased by 26.8% and 9.4% per
increasing hour of TV and weekend videogame usage, respectively (both Ps < 0.05). In
males, the overfat risk increased by 21.5% per increasing hour in weekend videogame
usage (P < 0.05). Each hour of TV use increased the overfat risks by 22% in males and
28.3% in females (both Ps < 0.05). Conclusions: Time spent watching TV increased the
risk of overweight and obesity in Spanish adolescents, but the effect was influenced by
age, sex, and socioeconomic status. Moreover, an excess of body fat was more directly
explained by the time spent watching TV and playing videogames during the weekend.
(C) 2008 Elsevier Inc. All rights reserved.
Vuorela, N., M. T. Saha, et al. (2009). "Prevalence of overweight and obesity in 5- and
12-year-old Finnish children in 1986 and 2006." Acta Paediatr 98(3): 507-12.
OBJECTIVE: To investigate the prevalence and the trends of overweight and
obesity in Finnish 5- and 12-year-old children in 1986 and 2006. DESIGN: Retrospective
cross-sectional study. Subjects and methods: Anthropometric data were collected
retrospectively from health examinations in Tampere and in three rural municipalities.
The size of the 5- and 12-year-old cohorts were 2108 in 1986 and 4013 in 2006,
respectively. The body mass index (BMI) was calculated. Overweight and obesity was
estimated using the International Obesity Task Force cutoff values (ISO BMI).
RESULTS: The prevalence of overweight (ISO BMI >25) and obesity (ISO BMI >30) in
5-year-old boys in 2006 was 9.8% and 2.5% and in girls 17.7% and 2.5%, respectively.
At the age of 12 years, the corresponding figures in boys were 23.6% and 4.7% and in
girls 19.1% and 3.2%. Between 1986 and 2006, the prevalence of overweight in 12-yearold children had increased 1.8 fold in boys (p < 0.001) and 1.5 fold in girls (p = 0.008).
Overweight was significantly more common in rural than in urban areas.
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CONCLUSION: During the last 20 years the prevalence of overweight has markedly
increased in 12-year-old Finnish children, but remained nearly unchanged in 5-year-old
children.
Williamson, D. A., C. M. Champagne, et al. (2008). "Increased obesity in children living
in rural communities of Louisiana." Int J Pediatr Obes: 1-6.
Objective. Rates of obesity among children have been rising in recent years.
Information on the prevalence of obesity in children living in rural communities is
needed. We report the prevalence of overweight and obesity in children enrolled in
grades 4 to 6 who live in rural areas of Louisiana, USA. Methods and Procedures. These
data were collected as baseline assessment for the Louisiana (LA) Health project. Height,
weight, and estimates of body fat (using body impedance analysis) were collected on 2
709 children. Average age was 10.5 years and the sample composition was 57.3% girls,
61.7% African-American, 36.0% Caucasian, and 2.3% other minority. A majority of
children (77%) met the criterion for poverty status. Results. The distribution of body
mass index (BMI) percentile was highly skewed toward obesity. The most frequent BMI
percentile scores were 98(th) and 99(th) percentile. Using Centers for Disease Control
and Prevention (CDC) norms, the overall prevalence of obesity was 27.4%, and for
overweight was 45.1%, of which 17.7% were between the 85(th) and 95(th) percentile.
The prevalence of childhood overweight and obesity were much higher than the national
norm and this increased prevalence was observed in both genders and in Caucasian and
African-American children. Discussion. The prevalence of childhood overweight and
obesity was found to be much higher in rural and primarily poor (77%) children living in
Louisiana when compared with national norms. This observation suggests that rural
children from Louisiana may be experiencing an epidemic of obesity that exceeds
national prevalence estimates.
Wong, S. L. and S. T. Leatherdale (2009). "Association between sedentary behavior,
physical activity, and obesity: inactivity among active kids." Prev Chronic Dis 6(1): A26.
INTRODUCTION: Sedentary behavior and physical activity are not mutually
exclusive behaviors. The relative risk of overweight for adolescents who are highly
sedentary and highly physically active is unclear. A better understanding of the
relationship between sedentary behaviors, physical activity, and body mass index (BMI)
would provide insight for developing interventions to prevent or reduce overweight.
METHODS: Using the physical activity module of the School Health Action, Planning
and Evaluation System (SHAPES), we collected data from 25,060 students in grades 9
through 12 from 76 secondary schools in Ontario, Canada. Sex-specific logistic
regression analyses were performed to examine how BMI, weight perceptions, social
influences, team sports participation, and smoking behavior were associated with being
1) high active-high sedentary, 2) low active-low sedentary, and 3) low active-high
sedentary. RESULTS: Low active-high sedentary boys were more likely to be overweight
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than high active-low sedentary boys (adjusted odds ratio [AOR], 1.60; 95% confidence
interval [CI], 1.01-2.58). When compared with high active-low sedentary girls, girls who
were low active-high sedentary (OR, 2.24; 95% CI, 1.23-4.09) or high active-high
sedentary (OR, 1.91; 95% CI, 1.01-3.61) were more likely to be overweight.
CONCLUSION: Sedentary behavior may moderate the relationship between physical
activity and overweight. Developing a better understanding of sedentary behavior in
relation to physical activity and overweight is critical for preventing and reducing
overweight among youth.
Zhang, C. X., Y. M. Chen, et al. (2008). "Energy expenditure and energy intake in 10-12
years obese and non-obese Chinese children in a Guangzhou boarding school." Asia
Pacific Journal Of Clinical Nutrition 17(2): 235-242.
Objective: The objective of this study was to observe the variation of energy
intake and energy expenditure in the obese Chinese children. Methods: Basic metabolic
rate was measured by using open-circuit indirect calorimetry in 54 obese children and 60
non-obese children aged 10-12 years in a full-time boarding school in Guangzhou suburb,
China. Total energy expenditure was estimated by using a factorial method. Dietary
intake was surveyed by the weighed inventory method. Physical activity was determined
using a 2-day activity diary. Results: Univariate analysis showed that basic metabolic rate
was significantly higher (p<0.05) in obese children than in non-obese ones, but the
significant difference disappeared after controlling for fat free mass and fat mass. Energy
intake and total energy expenditure were significantly higher (p<0.05) in obese than in
non-obese children. Obese children spent more time in sleeping and light physical
activity, but less time in moderate physical activity and vigorous physical activity than
non-obese children (p<0.05). Conclusions: Compared to non-obese children, both energy
intake and expenditure were higher in obese Chinese children. It appears that an area for
preventive strategies may be to encourage increased physical activity expenditure in this
age group.
Zhang, L., P. J. Fos, et al. (2008). "Body mass index and health related quality of life in
elementary school children: a pilot study." Health And Quality Of Life Outcomes 6.
Background: We investigated the relationship between Body Mass Index (BMI)
and health-related quality of life (HRQOL) indicated by baseline health status in
elementary school children. Methods: Data were obtained via parents whose children
enrolled in an elementary school, kindergarten to fourth grade, in southern Mississippi in
spring 2004. Parents completed the SF-10 for Children (TM), a brief 10-item
questionnaire designed to measure children's HRQOL on a voluntary basis. Results: A
total of 279 parents completed the questionnaires for their children. On average, physical
and psychosocial summary scores, major indicators for HRQOL, were significantly
higher among the elementary school children in our study relative to those from U. S.
children overall (p < 0.0001 and p = 0.0007, respectively). Males tended to have better
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physical functioning than their female classmates, whereas females had better
psychosocial health. Overall, except for third graders, the physical summary scores
increased as grade level increased. The means for psychosocial score fluctuated without a
clear pattern over the five grade levels. High level of BMI was significantly associated
with children's physical summary scores below 50, a norm used for U. S. children (p =
0.003). Gender and grade were not significant predictors of children's physical and
psychosocial scores. Discussion: This study can be used as baseline information to track
changes over time, in BMI and health status among the elementary school children. In
addition, this study can be used to investigate relationships between BMI, health status,
intellectual ability, and performance in school. Conclusion: The findings suggest that
programs designed to encourage children to lose weight in a healthy manner, thus
reducing their BMI, could improve the physical and psychosocial health, and
subsequently increase HRQOL.
Zhang, Y. X. and S. R. Wang (2008). "Distribution of body mass index and the
prevalence changes of overweight and obesity among adolescents in Shandong, China
from 1985 to 2005." Ann Hum Biol 35(5): 547-55.
BACKGROUND: There is strong evidence of a positive secular trend in physical
growth and body mass index (BMI) in most of the world over the last 20 years. However,
no studies on this trend have been reported in Shandong Province, China. AIM: The
present study assessed the secular trend in BMI in Shandong Province during the past 20
years and the prevalence of overweight and obesity among adolescents. SUBJECTS
AND METHODS: The BMI of adolescents aged 7-18 was calculated using data from
three national surveys on students' constitution and health carried out by the government
in 1985, 1995 and 2005 in Shandong Province, China. The distribution of BMI was
reported, and the prevalence of overweight and obesity were obtained according to the
screening criteria of overweight and obesity for Chinese students using BMI. Results: In
the past 20 years, the P(50) (percentile 50) of BMI increased rapidly. The average
increments of BMI were 2.05 kg m(-2) (Urban male), 1.08 kg m(-2) (Urban female), 1.11
kg m(-2) (Rural male) and 0.57 kg m(-2) (Rural female). The prevalence of overweight
and obesity increased rapidly: for overweight from 3.08% (Urban male), 2.67% (Urban
female), 0.74% (Rural male) and 1.50% (Rural female) in 1985 to 17.52% (Urban male),
10.56% (Urban female), 11.06% (Rural male) and 7.01% (Rural female) in 2005; and for
obesity from 0.52% (Urban male), 0.36% (Urban female), 0.03% (Rural male) and 0.11%
(Rural female) in 1985 to 14.50% (Urban male), 6.79% (Urban female), 7.11% (Rural
male) and 4.71% (Rural female) in 2005. CONCLUSION: The average value of BMI has
increased over time; overweight and obesity among adolescents has become a serious
public health problem. Comprehensive evidence-based strategies of intervention should
be introduced, including periodic monitoring.
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