ACHPER Healthy Lifestyles Journal – 1
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. Built Environment – Child Physical Activity/Obesity,
2. Built Environment – Adult Physical Activity/Obesity,
3. Policy – Physical Activity/Obesity,
4. Social Environment – Child Physical Activity/Obesity,
5. Social Environment – Adult Physical Activity/Obesity,
6. Measurement,
7. Community Based Interventions – Physical Activity and Obesity,
8. 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: .
Papers that specifically report environmental correlates of physical activity behavior or obesity will be included in the online ALR literature database ().
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.
2008 Search Terms
|Physical Activity/Obesity terms (abstract only) |Environment terms (title or abstract) |
|non motorized OR NMT OR multimodal transportation OR active |environment OR environments OR environmental OR sprawl OR neighbourhood*|
|transport* OR driving OR active living OR inactivity OR inactive |OR neighborhood* OR recreation* OR metropolitan OR rural OR urban* OR |
|OR fit OR fitness OR body mass index OR BMI OR car OR cars OR |pedestrian OR pedestrians OR equipment OR geograph* OR aesthet* OR |
|automobile OR leisure OR television OR TV OR obese OR obesity OR |convenient OR convenience OR urban form OR destination* OR trail OR |
|weight OR overweight OR journey OR travel* OR walk OR walking OR |trails OR park OR parks OR path OR paths OR distance* OR density OR |
|cycle OR cycling OR bike OR bikers OR biking OR bicycle OR |access* OR planning OR location* OR feature* OR polic* OR facility OR |
|bicycling OR sedentary OR commuter* OR commuting OR exercise OR |facilities OR crime OR architecture OR building* OR transit OR street* |
|exercising OR exerciser* OR physical activity OR physically |OR stair* OR playground OR playgrounds OR urban design OR neighborhood |
|active OR play OR playground* OR playing OR vehicle OR obesogenic|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 rail-trail 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.
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
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=3.3-7.9), compared to native Dutch adolescents. A further distance from home to school was 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 cross-sectional 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 parent-reported 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 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-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.
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 program-based 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 pedometer-determined 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, 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 weekend-day steps during moderate rainfall (1.1-4.9 mm) for both sexes. Most effects of day length, wind speed, and hours of bright sunshine on step counts were trivial or unclear. Conclusions: Ambient temperature and rainfall have substantial effects on children's daily step counts and should therefore be considered when comparing physical activity across different locations or periods. Strategies to increase activity on cold or rainy days may also be appropriate.
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, open-ended 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. 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): 271-8.
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 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, por=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 socio-spatial disparity of obesity.
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 well-maintained 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.
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 ease of access to transit are modifiable neighborhood characteristics associated with self-reported 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.
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 self-reported. 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 (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 student-reported walkability around the student union. Methods: Students from ASU-Polytechnic (n = 20.33% male) and ASU-Tempe (n = 20, 60% male) recorded distance walked on campus and wore physical activity monitors for 5 days. Results: Polytechnic students spent an average of 36.9 minutes in moderate-to-vigorous physical activity each week; Tempe students spent 96.5 minutes (p /=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 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 race- and 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 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 supra-additive 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 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 pre-adult 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 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.
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.
Vrazel, J., R. P. Saunders, et al. (2008). "An overview and proposed framework of social-environmental 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 social-environmental 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.
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 objectively-assessed 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.
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 primary-aged 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 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 sex-adjusted 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, self-reported height was 0.88 cm greater than measured height, self-reported weight was 2.33 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). (2) Results from the test-retest reliability of the Chinese version of long self-administrated 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 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 activity-related 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 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.
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 self-assessment, 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.
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 African-American 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 school-based 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 multi-disciplinary 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 cost-effective, 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 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 multi-level 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.
De Cocker, K. A., I. M. De Bourdeaudhuij, et al. (2008). "The effect of a pedometer-based 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 (por= 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 non-drug-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.
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 3-5-year-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 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.
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 re-establishment 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 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. Twenty-one 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.
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 low-active ( 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.
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 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 school-based 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 DOiT-intervention 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.
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.
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-of-school 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, 12-month 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.
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 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 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.
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 10-12 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.
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 school-based 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.
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. 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: Self-enhancement 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 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 cut-offpoints. 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 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 socio-economic 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 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-y-olds: 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. 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: Cross-sectionally, 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%). After-school sites offered 4 different sessions per day (active recreation, academic time, nonactive recreation, and enrichment activities). Children were provided with a daily 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 non-cycling 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 ................
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