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“Determinants of Change in Physical Activity in Children and Adolescents: A Systematic Review” (2011)

• Data are available on correlates of physical activity in children and adolescents, less is known about the determinants of change. This review aims to systematically review the published evidence regarding determinants of change in physical activity in children and adolescents.
• Prospective quantitative studies investigating change in physical activity in children and adolescents aged 4–18 years were identified from seven databases (to November 2010): PubMed, SCOPUS, PsycINFO, Ovid MEDLINE, SPORTDdiscus, Embase, and Web of Knowledge. Study inclusion, quality assessment, and data extraction were independently validated by two researchers. Semi-quantitative results were stratified by age (4–9 years, 10–13 years, and 14–18 years).
• Of the 46 studies that were included, 31 used self-reported physical activity; average methodologic quality was 3.2 (SD=1.2), scored 0–5. Of 62 potential determinants identified, 30 were studied more than three times and 14 reported consistent findings (66% of the reported associations were in the same direction). For children aged 4–9 years, girls reported larger declines than boys. Among those aged 10–13 years, higher levels of previous physical activity and self-efficacy resulted in smaller declines. Among adolescents (aged 14–18 years), higher perceived behavioral control, support for physical activity, and self-efficacy were associated with smaller declines in physical activity.
• Few of the variables studied were consistently associated with changes in physical activity, although some were similar to those identified in cross-sectional studies. The heterogeneity in study samples, exposure and outcome variables, and the reliance on self-reported physical activity limit conclusions and highlight the need for further research to inform development and targeting of interventions.

Craggs, C., Corder, K., van Sluijs, E.M., et al. (2011). Determinants of Change in Physical Activity in Children and Adolescents: A Systematic Review. American Journal of Preventive Medicine 40(6):645–658.

“Environmental Correlates of Physical Activity and Dietary Behaviors among Young People: A Systematic Review of Reviews” (2011)

• An extensive body of research exists on environmental influences on weight-related behaviors in young people. Existing reviews aimed to synthesize this body of work, but generally focused on specific samples, behaviors or environmental influences and integration of findings is lacking.
• The authors reviewed 18 reviews representing 671 unique studies, aiming to identify what environmental factors do and do not affect physical activity and dietary behaviors in children and adolescents. Eleven reviews focused exclusively on physical activity, six on diet, and one review focused on both physical activity and dietary behaviors with only small overlap in included studies.
• Physical activity was more consistently related to school and neighborhood characteristics than to interpersonal and societal environments. In contrast, interpersonal factors played a pronounced role in dietary behaviors; no school, neighborhood or societal factors were consistently related to dietary behaviors.
• This review of reviews adds to the literature by providing a comprehensive synthesis of factors related to physical activity and dietary behaviors that could be targeted in interventions. Moreover, by identifying factors that are unrelated to physical activity and dietary behaviors, this review may help to narrow the scope of future studies and environmental interventions.

de Vet, E., de Ridder, D.T., de Wit, J.B. (2011). Environmental Correlates of Physical Activity and Dietary Behaviors among Young People: A Systematic Review of Reviews. Obesity Reviews: An Official Journal of the International Association for the Study of Obesity 12(5):e130–142.

“Walking School Bus and Its Impact on BMI” (2011)

• Since 1970, obesity prevalence more than quadrupled in ages six to eleven. There are several pleas for research that would concurrently evaluate the threefold relationship between the built environment, children’s physical activity levels and impact on obesity. Having to pay for physical activity either monetarily or in lost leisure time is a recent phenomenon in society. Many people will not or cannot sacrifice time or money in order to purposely exercise, although society benefits with opportunities for physical activity within normal daily routines. For children, a normal daily routine is the trip to and from school.
• This study employed a quasi-experimental design of five Oklahoma schools with a Walking School Bus during school year 2009-2010. The study measured pre- and post-BMI in 1102 active commuters and controls ages five to twelve. A parent questionnaire evaluated dose response, confounders, and contributors or barriers to a child’s active commute.
• The provision of a chaperoned walk-to-school program in areas with lower walkability increased the percentage of children actively commuting to school to 39.8 percent, as compared to the national average of five to fourteen percent, p < 0.0005 (one-tailed)( SPSS Nonparametric Binomial), and decreased BMI, z = - 10.125, p < 0.0005 (two-tailed)( Wilcoxon Signed Rank). Sixty-six percent of obese students that actively commuted to school were no longer obese in post-testing. Forty-seven percent of overweight students that actively commuted to school were within the healthy weight category in post-testing. The number needed to treat was thirteen indicating that one case of obesity or overweight was prevented when thirteen students actively commuted to school. Walking School Bus participants walked 65% farther than students that walked without an adult chaperone.
• The provision of a chaperoned walk-to-school program was sufficient to overcome many barriers to the active commute to school such as disability, age, gender, distance and other environmental factors. The Walking School Bus significantly increased the percentage of children actively commuting to school and overweight and obesity significantly decreased in students that walked or biked to school.

Quarles, J. (2012). Walking school bus and its impact on BMI, Dissertation at the University of Oklahoma Health Sciences Center.

“Reduced Physical Activity Levels Associated with Obesity in Rural Hispanic Adolescent Females” (2011)

• The associations among physical activity (PA), screen behaviors (SB), and body mass in Hispanic adolescents in rural communities are not well defined.
• Surveys were used to collect self-reported data on time spent in PA and SB along with direct measurements of BMI and waist circumference from non-Hispanic white (312 males, 301 females) and Hispanic (671 males, 610 females) adolescents (13–17 years old).
• Regardless of ethnicity, females participated in less PA (in [PAi] or outside [PAo] of school) than males. Obese Hispanic males and females participated 20% and 31%, respectively, less in PA in school than their obese non-Hispanic white counterparts, and 17% and 37%, respectively, less in PA outside of school. Furthermore, obese Hispanic females participated 28% less in PA outside of school than normal-weight Hispanic females, suggesting that reduced PA levels, especially outside of school, may contribute to the development of obesity in this group. Males and females were over two-fold more likely to be obese when they participated in PAo for <1 hr/day, which further suggests the importance of PAo for the odds of developing obesity, and supports the national PA guidelines for this age group.
• The prevalence of overweight and obesity in Hispanics, especially females, is closely associated with reduced PA in and outside of school. The time spent on SB had no significant impact on the prevalence of overweight or obesity in non-Hispanics whites and Hispanics, suggesting that PA levels in this population may have a greater impact on body mass than SB; however, the causal relationships in this population warrant further investigation.

Rodriguez, R., S. E. Weffer, et al. (2011). "Reduced Physical Activity Levels Associated with Obesity in Rural Hispanic Adolescent Females." Childhood Obesity (Formerly Obesity and Weight Management) 7(3):194-205.

“The Role of School Physical Activity Programs in Child Body Mass Trajectory” (2011)

• This paper assesses the role of existing school physical activity programs for a national cohort from first grade to fifth grade.
• The authors analyzed a cohort from the Early Childhood Longitudinal Survey-Kindergarten Cohort which included 8246 children in 970 schools across the country.
• Growth curve models estimate the effect of physical education (PE) and recess on individual child body mass trajectories controlling for child and school characteristics. Hierarchical models allow for unobserved school and child effects.
• Among first graders, 7.0% met the National Association of Sport and Physical Education (NASPE) recommended time for PE and 70.7% met the recommended time for recess in the previous week. Boys experienced a greater increase in body mass than girls. Meeting the NASPE recommended time for recess was associated with a 0.74 unit decrease in BMI (body mass index) percentile for children overall. Meeting the NASPE recommendation for physical education was associated with 1.56 unit decrease in BMI percentile among boys but not girls.
• This study found evidence that meeting the national recommendations for PE and recess is effective in mitigating body mass increase among children.

Fernandes, M. and R. Sturm (2011). “The Role of School Physical Activity Programs in Child Body Mass Trajectory.” Journal of Physical Activity & Health 8(2): 174-181.

“Relationship between Active School Transport and Body Mass Index in Grades 4-to-6 Children” (2011)

• This study assessed the impact of active school transportation (AST) on average daily step counts, body mass index (BMI) and waist circumference in 315 children in Grades 4-6 who participated to Cycle 2 of the Canadian Assessment of Physical Literacy (CAPL) pilot testing.
• T-tests revealed a significant association between AST and lower BMI values (18.7 ± 3.3 vs. 19.9 ± 3.8 kg/m(2)). The active commuters accumulated an average of 662 more steps per day, and their waist circumference was lower by an average of 3.1 cm, but these differences were not statistically significant. ANCOVA analyses controlling for age and step counts, found trends toward lower BMI and waist circumference values among the active commuters.
• The study results suggest that AST may be a valid strategy to prevent childhood obesity; further research is needed to determine more precisely the impact of AST on body composition, and the direction of the relationship.

Larouche, R., M. Lloyd, et al. (2011). “Relationship Between Active School Transport and Body Mass Index in Grades 4-to-6 Children.” Pediatric Exercise Science 23(3):322-30.

“Longitudinal Changes in Active Transportation to School in Canadian Youth Aged 6 Through 16 Years” (2011)

• The objective of this study is to identify the sociodemographic predictors of active transportation to schools across time among school-aged children participating in the Canadian National Longitudinal Survey of Children and Youth (NLSCY).
• The sample included 7690 school-aged children attending public schools who were drawn from cycle 2 (1996 and 1997) of the Canadian NLSCY. Data were collected through interviews with the person most knowledgeable about the child. Parents were asked how their child usually gets to school. Responses were dichotomized into active (walking or bicycling) or inactive (school bus, public transit, is driven, or multiple) modes. Using 3 waves of data from the Canadian NLSCY (1996–2001), we estimated the effect of sociodemographic factors on the likelihood of active transportation to school across time using random-effects models.
• Longitudinal analyses indicated that as children aged, the likelihood of using active transportation to school increased, peaked at the age of 10 years, and then decreased. Urban settings (odds ratio [OR]: 3.66 [95% confidence interval (CI): 3.23–4.15]), households with inadequate income (OR: 1.21 [95% CI: 1.06–1.38]), living with 1 parent (OR: 1.46 [95% CI: 1.29–1.65]), and having an older sibling living at home (OR: 1.14 [95% CI: 1.04–1.25]) were significant predictors of active transportation to school at baseline and carried through across time.
• Understanding the factors that influence active transportation may support its adoption by children, which in turn may contribute to meeting physical activity guidelines.

Pabayo, R., L. Gauvin, et al. (2011). “Longitudinal Changes in Active Transportation to School in Canadian Youth Aged 6 Through 16 Years.” Pediatrics 128(2):e404-e413.

“Disconnections of African American Public Housing Residents: Connections to Physical Activity, Dietary Habits and Obesity” (2011)

• African American (AA) and low SES populations report poor health behaviors and outcomes. This study aimed to increase understanding of barriers to participating in healthful behaviors and programs in AA residents of public housing.
• Twenty two apparently healthy, AA residents (50% female, M = 43.9 years) completed in depth interviews, which were taped, transcribed and analyzed using a constant comparison approach.
• Residents demonstrated some awareness of health recommendations, but described limited adherence. Physical activity for recreation was reported as primarily for youth, with adults engaging in limited physical activity (primarily incidental to other activities).
• Barriers reported by residents were both personal and environmental. Few residents were aware of local neighborhood opportunities for physical activity or healthful eating.
• Future efforts should focus on increasing understanding of health promoting behaviors and awareness and efficacy of residents to connect with the resources of their surrounding communities.

Eugeni, M., M. Baxter, et al. (2011). "Disconnections of African American Public Housing Residents: Connections to Physical Activity, Dietary Habits and Obesity." American Journal of Community Psychology 47(3):264-276.

“The Walking School Bus and Children’s Physical Activity: A Pilot Cluster Randomized Controlled Trial” (2011)

• This study evaluates the impact of a walking school bus program on children’s rates of active commuting to school and physical activity.
• In this study, a pilot cluster randomized controlled trial is conducted among 4th-graders from 8 schools in Houston, Texas (N = 149). Random allocation to treatment or control conditions was at the school level. Study staff walked with children to and from school up to 5 days/week. Outcomes were measured the week before (time 1) and during weeks 4 and 5 of the intervention (time 2).
• The main outcome was the weekly rate of active commuting, and a secondary outcome was moderate-to-vigorous physical activity. Covariates included sociodemographics, distance from home to school, neighborhood safety, child BMI z-score, parent self-efficacy/outcome expectations, and child self-efficacy for active commuting. A mixed-model repeated measures regression accounted for clustering by school, and stepwise procedures with backward elimination of non-significant covariates were used to identify significant predictors.
• Intervention children increased active commuting (mean ± SD) from 23.8% ± 9.2% (time 1) to 54% ± 9.2% (time 2), whereas control subjects decreased from 40.2% ± 8.9% (time 1) to 32.6% ± 8.9% (time 2) (P < .0001). Intervention children increased their minutes of daily moderate-to-vigorous physical activity from 46.6 ± 4.5 (time 1) to 48.8 ± 4.5 (time 2), whereas control children decreased from 46.1 ± 4.3 (time 1) to 41.3 ± 4.3 (time 2) (P = .029).
• The program improved children’s active commuting to school and daily moderate-to-vigorous physical activity.

Mendoza, J. A., K. Watson, et al. (2011). "The Walking School Bus and Children’s Physical Activity: A Pilot Cluster Randomized Controlled Trial." Pediatrics.

“The Health Risks and Benefits of Cycling in Urban Environments Compared with Car Use: Health Impact Assessment Study” (2011)

• The purpose of this study is to estimate the risks and benefits to health of travel by bicycle, using a bicycle sharing scheme, compared with travel by car in an urban environment.
• This is a study of a public bicycle sharing initiative (Bicing) in Barcelona, Spain with 181,982 Bicing subscribers.
• The primary outcome measure was all cause mortality for the three domains of physical activity, air pollution (exposure to particulate matter <2.5 µm), and road traffic incidents. The secondary outcome was change in levels of carbon dioxide emissions.
• Compared with car users the estimated annual change in mortality of the Barcelona residents using Bicing (n=181 982) was 0.03 deaths from road traffic incidents and 0.13 deaths from air pollution. As a result of physical activity, 12.46 deaths were avoided (benefit:risk ratio 77). The annual number of deaths avoided was 12.28. As a result of journeys by Bicing, annual carbon dioxide emissions were reduced by an estimated 9 062 344 kg.
• Public bicycle sharing initiatives such as Bicing in Barcelona have greater benefits than risks to health and reduce carbon dioxide emissions.

Rojas-Rueda, D., A. de Nazelle, et al. (2011). "The Health Risks and Benefits of Cycling in Urban Environments Compared with Car Use: Health Impact Assessment Study." BMJ 343.

“Hawaii’s Opportunity for Active Living Advancement (HO‘ALA): Addressing Childhood Obesity through Safe Routes to School” (2011)

• Increasing active transportation to and from school may reduce childhood obesity rates in Hawaii. A community partnership was formed to address this issue in Hawaii’s Opportunity for Active Living Advancement (HO‘ÄLA), a quasi-experimental study of active transportation in Hawaii County.
• The purpose of this study was to determine baseline rates for active transportation rates to and from school and to track changes related to macro-level (statewide) policy, locally-based Safe Routes to School (SRTS) programs and bicycle and pedestrian planning initiatives expected to improve the safety, comfort and ease of walking and bicycling to and from school.
• Measures included parent surveys, student travel tallies, traffic counts and safety observations. Assessments of the walking and biking environment around each school were made using the Pedestrian Environment Data Scan. Complete Streets and SRTS policy implementation was tracked through the activities of a state transportation-led Task Force and an advocacy-led coalition, respectively. Planning initiatives were tracked through citizen-based advisory committees.
• Thirteen volunteer schools participated as the intervention (n=8) or comparison (n=5) schools. The majority of students were Asian, Native Hawaiian, and Pacific Islander in schools located in under-resourced communities.
• Overall, few children walked or biked to school. The majority of children were driven to and from school by their parents.
• With the influence of HO‘ÄLA staff members, two intervention schools were obligated SRTS project funding from the state, schools were identified as key areas in the pedestrian master plan, and one intervention school was slated for a bike plan priority project. As the SRTS programs are implemented in the next phase of the project, post-test data will be collected to ascertain if changes in active transportation rates occur.

Laura Dierenfield, B., D. A. Alexander, et al. (2011). "Hawaii’s Opportunity for Active Living Advancement (HO ‘ALA): Addressing Childhood Obesity through Safe Routes to School." HAWAII MEDICAL 70(7 Supplement 1):21.

“Gender Differences in Adolescent Travel to School: Exploring the Links with Physical Activity and Health” (2011)

• This paper investigates gender differences in the associations between adolescent mode choices and travel patterns for the trip to school and levels of physical activity.
• Analysis relies on cross-sectional data collected from adolescents (N = 269) in Baltimore City for a school-based recruitment study of physical activity and the built environment. Participants were recruited from two magnet high schools, comprising a predominantly African-American sample (67%) with geographically disperse home locations.
• Data analyzed here for each individual include (a) a web-based survey that collects background information, attitudes, perceptions, and recall behavior, (b) week-long physical activity data collected by accelerometers, (c) a week-long travel diary, (d) archived spatial data about the built environment around each student’s primary home address, and (e) height and weight measurements, used to calculate body mass index (BMI).
• Multinomial logit models of the primary mode to school were estimated separately for males and females.
• Results show key differences in the factors associated with their travel choices. Aggregate levels of physical activity during the weekday for transit commuters and auto commuters were compared for males and females. Results show significantly higher levels of physical activity for both male and female students who commute by transit, although male physical activity levels were higher on average.
• There were no significant differences in BMI between transit and auto commuters by gender, however.

Clifton, K. J., G. Akar, et al. (2011). "Gender Differences in Adolescent Travel to School: Exploring the Links with Physical Activity and Health." Transportation Research Board Special Report 2(46).

“The Relationship between Active Travel to School and Health-Related Fitness in Children and Adolescents: A Systematic Review” (2011)

• Active travel to school (ATS) has been identified as an important source of physical activity for youth. However, the relationship between ATS and health-related fitness (HRF) among youth remains unclear.
• A systematic search of seven electronic databases (EMBASE, OVID MEDLINE, PsycINFO, PubMed, Scopus, SPORTDiscus and TRIS on line) was conducted in December 2009 and studies published since 1980 were considered for inclusion.
• Twenty seven articles were identified that explored the relationship between ATS and the following aspects of HRF: weight status/body composition, cardiorespiratory fitness, muscular fitness and flexibility.
• Forty-eight percent of the studies that examined the relationship between ATS and weight status/body composition reported significant associations, this increased to 55% once poor quality studies were removed.
• The findings from five studies, including one longitudinal study, indicate that ATS is positively associated with cardiorespiratory fitness in youth. However, the evidence for the relationships between ATS and muscular fitness or flexibility is equivocal and limited by low study numbers.
• There is some evidence to suggest that ATS is associated with a healthier body composition and level of cardiorespiratory fitness among youth. Strategies to increase ATS are warranted and should be included in whole-of-school approaches to the promotion of physical activity.

Lubans, D. R., C. A. Boreham, et al. (2011). "The relationship between active travel to school and health-related fitness in children and adolescents: a systematic review." International Journal of Behavioral Nutrition and Physical Activity 8(1):5.

“A Cross-Sectional Study of the Individual, Social, and Built Environmental Correlates of Pedometer-Based Physical Activity among Elementary School Children” (2011)

• Children who participate in regular physical activity obtain health benefits. Preliminary pedometer-based cut-points representing sufficient levels of physical activity among youth have been established; however limited evidence regarding correlates of achieving these cut-points exists. The purpose of this study was to identify correlates of pedometer-based cut-points among elementary school-aged children.
• A cross-section of children in grades 5-7 (10-12 years of age) were randomly selected from the most (n = 13) and least (n = 12) ’walkable’ public elementary schools (Perth, Western Australia), stratified by socioeconomic status. Children (n = 1480; response rate = 56.6%) and parents (n = 1332; response rate = 88.8%) completed a survey, and steps were collected from children using pedometers. Pedometer data were categorized to reflect the sex-specific pedometer-based cut-points of ≥15000 steps/day for boys and ≥12000 steps/day for girls.
• Associations between socio-demographic characteristics, sedentary and active leisure-time behavior, independent mobility, active transportation and built environmental variables - collected from the child and parent surveys - and meeting pedometer-based cut-points were estimated (odds ratios: OR) using generalized estimating equations.
• Overall 927 children participated in all components of the study and provided complete data. On average, children took 11407 ± 3136 steps/day (boys: 12270 ± 3350 vs. girls: 10681 ± 2745 steps/day; p < 0.001) and 25.9% (boys: 19.1 vs. girls: 31.6%; p < 0.001) achieved the pedometer-based cut-points.
• After adjusting for all other variables and school clustering, meeting the pedometer-based cut-points was negatively associated (p < 0.05) with being male (OR = 0.42), parent self-reported number of different destinations in the neighborhood (OR 0.93), and a friend’s (OR 0.62) or relative’s (OR 0.44, boys only) house being at least a 10-minute walk from home. Achieving the pedometer-based cut-points was positively associated with participating in screen-time < 2 hours/day (OR 1.88), not being driven to school (OR 1.48), attending a school located in a high SES neighborhood (OR 1.33), the average number of steps among children within the respondent’s grade (for each 500 step/day increase: OR 1.29), and living further than a 10-minute walk from a relative’s house (OR 1.69, girls only).
• Comprehensive multi-level interventions that reduce screen-time, encourage active travel to/from school and foster a physically active classroom culture might encourage more physical activity among children.

McCormack, G. R., B. Giles-Corti, et al. (2011). "A cross-sectional study of the individual, social, and built environmental correlates of pedometer-based physical activity among elementary school children." International Journal of Behavioral Nutrition and Physical Activity 8(1):30.

“Parental Factors Associated with Walking to School and Participation in Organized Activities at Age 5: Analysis of the Millennium Cohort Study” (2011)

• Physical activity is associated with better health. Two sources of activity for children are walking to school and taking part in organized sports and activities. This study uses a large national cohort to examine factors associated with participation in these activities.
• The Millennium Cohort study contains 5 year follow-up of 17,561 singleton children recruited between 2000-2002 in the UK. All participants were interviewed in their own homes at 9 months, 3 years and 5 years follow-up and all measures were self reports. Logistic regression and likelihood ratio tests were used.
• Children are less likely to walk to school as income and parental education increase [Adjusted odds: 0.7 (95%CI: 0.6-0.8) for higher income/education compared to low income/no qualifications]. However, if the parent plays with the child in high income families the child is more likely to walk to school [Adjusted odds: 1.67 (95%CI: 1.3-2.1)]. Children taking part in organized activities are from higher income, higher education families, with a car, in a "good" area with non-working mothers. However, in low socio-economic families where the parent plays with the child the child is more likely to take part in organized activities [Adjusted odds: 2.0 (95% CI: 1.5-2.7)].
• Income is an important determinant of the type of activity available to children. Families that report good health behaviors (non-smoking, low TV viewing) and play with their children show higher levels of physical activity. Thus, parenting practice appears to have a strong impact on their child’s physical activity.

Brophy, S., R. Cooksey, et al. (2011). "Parental factors associated with walking to school and participation in organised activities at age 5: Analysis of the Millennium Cohort Study." BMC Public Health 11(1): 14.

“Longitudinal associations between cycling to school and weight status” (2011)

• The objective of the present study was to assess the longitudinal association between cycling to school and weight status in two cities where cycling to school is common – Kristiansand (Norway) and Rotterdam (The Netherlands).
• Data from two studies ENDORSE (Rotterdam) and YOUTH IN BALANCE (Kristiansand) were used. Both studies were longitudinal with two years between time (T) 1 and T2 measurements, and with mean age at T1 of 13.2 and 13.4 years, respectively. The sample was categorized into the following groups according to responses about main mode of commuting to school at the two time points: NO cycling, STARTED cycling, STOPPED cycling and CONTINUED cycling. Measured weight and height were obtained at both time points, and weight status (overweight vs. not overweight) was calculated using international classification criteria for BMI. The two datasets were analyzed separately and together.
• In multilevel logistic regression models of the combined sample, adjusting for weight status at Time 1, those who stopped cycling had greater odds of being overweight at T2 (OR = 3.19; 95% CI = 1.41–7.24) while those continued cycling had lower odds of being overweight (OR = 0.44; 95% CI = 0.21–0.88), separately compared to the other three groups together. The same trend was observed in both study samples.
• This study shows that there are longitudinal associations between cycling to school and weight status in two cities where cycling to school is common, implying that interventions aiming at reducing overweight/obesity among adolescents might consider the promotion of sustained cycling behavior.

Bere, E., A. Oenema, et al. (2011). "Longitudinal associations between cycling to school and weight status." International Journal of Pediatric Obesity (0): 1-6.

“Assessment of a school-based intervention in eating habits and physical activity in school children: the AVall study” (2011)

• Obesity has become a global public health problem, which also affects children. It has been proposed that the educational interventions during childhood could be a key strategy in the prevention of obesity.
• To evaluate the efficacy of an intervention on food habits and physical activity in school children.
• A 2-year cluster-randomized prospective study with two parallel arms was used to evaluate an intervention program in children in their first year of primary schooling (5–6 years of age) in schools in the city of Granollers. The intervention consisted of the promotion of healthy eating habits and physical activity by means of the educational methodology Investigation, Vision, Action and Change (IVAC). At the beginning and at the end of the study (2006 and 2008) the weight and height of each child was measured in situ, while the families were given a self-report physical activity questionnaire and the Krece Plus quick test.
• Two years after the beginning of the study, the body mass index of the children in the control group was 0.89 kg/m2 higher than that of the intervention schools. The intervention reduced by 62% the prevalence of overweight children. Similarly, the proportion of children that ate a second piece of fruit and took part in an after-school physical activity increased in the intervention group. In the control group, the weekly consumption of fish was reduced.
• The educational intervention in healthy eating habits and physical activity in the school could contribute to lessen the current increase in child obesity.

Llargues, E., R. Franco, et al. (2011). "Assessment of a school-based intervention in eating habits and physical activity in school children: the AVall study." Journal of Epidemiology and Community Health.

“Policies to Increase Physical Activity in Children and Youth” (2011)

• The World Health Organization (WHO) is encouraging countries to develop and implement policies aimed at increasing physical activity in children and adolescents.
• The purpose of this paper is twofold: (1) to identify the common existing international policies established to increase physical activity in children and adolescents; and (2) to examine the extent to which these policies are supported by solid scientific evidence.
• Existing policies as well as intervention studies for children and adolescents in Europe, America, Asia, and Oceania that were written in English and Chinese were identified via scientific databases, reference lists of articles, and existing archives and databases via non-electronic search. The policy areas found to be the most common were: (1) Physical Education in School; (2) Physical Activity-Related Health Education; (3) Community Environmental Support; (4) School Environmental Support; (5) Active Transport/Urban Design; and (6) Mass Media/Advertising Campaigns.
• For these policy areas, the intervention literature was reviewed and segmented into three domains: policy research (studies examining the relationship of policies to physical activity levels in young people), effectiveness studies (multi-site physical activity interventions), and efficacy studies (single site or local physical activity interventions).
• Effectiveness studies provided support for policies that focus on increasing Physical Education in School, improving School Environmental Support and Active Transport/Urban Design, and launching Mass Media/Advertising Campaigns designed to increase physical activity levels in children and adolescents.
• The results for Physical Activity-Related Health Education and Community Environmental Support were mixed, indicating that more research is needed to determine the effectiveness of physical activity policies in those areas.

Pate, R. R., J. L. Trilk, et al. (2011). "Policies to Increase Physical Activity in Children and Youth." Journal of Exercise Science & Fitness 9(1): 1-14.

“Engaging School Governance Leaders to Influence Physical Activity Policies” (2011)

• Most youth are not meeting physical activity guidelines, and schools are a key venue for providing physical activity. School districts can provide physical activity opportunities through the adoption, implementation, monitoring, and evaluation of policies.
• This paper reports results of a 2009 survey of California school governance leaders on the barriers and opportunities to providing school-based physical activity and strategies to promote adoption of evidence-based policies.
• California school board members (n = 339) completed an 83 item online survey about policy options, perceptions, and barriers to improving physical activity in schools.
• Board members’ highest rated barriers to providing physical activity were budget concerns, limited time in a school day, and competing priorities.
• The key policy opportunities to increase physical activity were improving the quantity and quality of physical education, integrating physical activity throughout the school day, supporting active transportation to/from school, providing access to physical activity facilities during nonschool hours, and integrating physical activity into before/after school programs.
• Survey findings were used to develop policy resources and trainings for school governance leaders that provide a comprehensive approach to improving physical activity in schools.

Cox, L, Berends, V., Sallis, JF, St. John, JM, Gonzalez, M, and Agron, P. "Engaging School Governance Leaders to Influence Physical Activity Policies." Journal of Physical Activity and Health. 8.1 (2011): S40-S48.

“A Systematic Review of Interventions for Promoting Active Transportation to School” (2011)

• The purpose of this paper is to review intervention studies related to active school transportation to guide future intervention research. A systematic review was conducted to identify intervention studies of active transportation to school published in the scientific literature through January 2010. Five electronic databases and a manual search were conducted. Detailed information was extracted, including a quantitative assessment comparing the effect sizes, and a qualitative assessment using an established evaluation tool.
• The study identified 14 interventions that focused on active transportation to school. These interventions mainly focused on primary school children in the United States, Australia, and the United Kingdom.
• The findings of this study include:
  • Existing interventions to promote active transportation to and from school are heterogeneous, due to the size, scope, and focus of the intervention and measurements.
  • Interventions with appropriate school, parent, and community involvement and that work toward a specific goal (i.e., increasing active transportation) seemed to be more effective than interventions that were broader in focus.
  • Intervention quality was often low as measured by the EPHPP tool.
  • Interventions evidenced a small but promising effectiveness in increasing active transportation to school.
• More research with higher quality study designs and measures should be conducted to further evaluate interventions and to determine the most successful strategies for increasing active transportation to school.

Chillón, P, Evenson, KR, Vaughn, A, and Ward, DS. "A Systematic Review of Interventions for Promoting Active Transportation to School." International Journal of Behavioral Nutrition and Physical Activity. 8.1 (2011): 10.

“Active Commuting to School and Association With Physical Activity and Adiposity Among US Youth” (2011)

• Walking or bicycling to school (ie, active commuting) has shown promise for improving physical activity and preventing obesity in youth. The objectives of this paper are to examine, among US youth, whether active commuting was inversely associated with adiposity and positively associated with moderate-to-vigorous physical activity (MVPA). This paper also examined whether MVPA mediated the relationships between active commuting and adiposity.
• Using data of participants aged 12 to 19 years from the US National Health and Nutrition Examination Survey 2003 to 2004 (n = 789 unweighted), we constructed multiple linear regression models that controlled for dietary energy intake and sociodemographics. The main exposure variable was active commuting.
• The outcomes were BMI z-score, waist circumference, skinfolds and objectively measured MVPA. The product-of-coefficients method was used to test for mediation.
• Active commuting was inversely associated with BMI z-score (β = –0.07, P = .046) and skinfolds (β = –0.06, P = .029), and positively associated with overall daily (β = 0.12, P = .024) and before- and after-school (β = 0.20, P < .001) MVPA.
• Greater before- and after-school MVPA explained part of the relationship between active commuting and waist circumference (Sobel z = –1.98, P = .048).
• Active commuting was associated with greater MVPA and lower measures of adiposity among US youth. Before- and after-school MVPA mediated the relationships between active commuting and waist circumference.

Mendoza, JA, Watson, K, Nguyen, N, Cerin, E, Baranowski, T, and Nicklas, TA. “Active Commuting to School and Association With Physical Activity and Adiposity Among US Youth.” Journal of Physical Activity and Health. 8.4 (2011): 488–495.

“A Physical and Social Contextual Influences on Children’s Leisure-Time Physical Activity: An Ecological Momentary Assessment Study.” (2011)

• This study used real-time electronic surveys delivered through mobile phones, known as Ecological Momentary Assessment (EMA), to determine whether level and experience of leisure-time physical activity differ across children’s physical and social contexts.
• Children participated in 4 days of EMA during nonschool time. Electronic surveys assessed primary activity (eg, active play/sports/exercise), physical location (eg, home, outdoors), social context (eg, friends, alone), current mood (positive and negative affect), and enjoyment. Responses were time-matched to the number of steps and minutes of moderate-to-vigorous physical activity (MVPA; measured by accelerometer) in the 30 minutes before each survey.
• Mean steps and MVPA were greater outdoors than at home or at someone else’s house. Steps were greater with multiple categories of company (eg, friends and family together) than with family members only or alone. Enjoyment was greater outdoors than at home or someone else’s house (all P < .05). Negative affect was greater when alone and with family only than friends only (all P < .05).
• Results describing the value of outdoor and social settings could inform context-specific interventions in this age group.

Dunton, Genevieve F., Liao, Yue, Intille, Stephen, Wolch, Jennifer, Pentz, Mary Ann. “A Physical and Social Contextual Influences on Children’s Leisure-Time Physical Activity: An Ecological Momentary Assessment Study.” Journal of Physical Activity and Health. 8.Suppl1 (2011): S103 – S108.

“A Comprehensive Multi-Level Approach for Passing Safe Routes to School and Complete Streets Policies in Hawaii” (2011)

• Policy changes are needed to reshape the built environment for active transportation.
• Using the social ecological model as a framework, the Healthy Hawaii Initiative worked with a contractor to develop a series of meetings, planning sessions, and workshops. Activities spanned 22 months between 2007 and 2009, and involved multiple stakeholders, including educational outreach for legislators and collaborative planning sessions with advocates.
• With the help of the contractor to initiate the process, Complete Streets and Safe Routes to School (SRTS) legislation were introduced January 2009. Advocacy groups monitored bill progress, testified at hearings, and assisted in rewording the bills. The SRTS statute required Hawaii DOT to administer the federal SRTS funds and the complete streets law tasked the state and county DOTs to adopt complete streets policies and review existing highway design standards and guidelines. Both bills were signed into law June 2009.
• Focusing efforts at multiple levels of the social ecological model involving champions and key stakeholders led to the successful passage of legislation supporting active transportation. Tracking policy implementation and evaluation over time will help determine actual impact on active transportation behaviors across Hawaii.

Heinrich, KM, Aki, NN, Hansen-Smith, H, Fenton, M, Maddock, JE. “A Comprehensive Multi-Level Approach for Passing Safe Routes to School and Complete Streets Policies in Hawaii” Journal of Physical Activity and Health. 8.Suppl1 (2011): S135-S140.

“School site and the potential to walk to school: The impact of street connectivity and traffic exposure in school neighborhoods” (2011)

• The impact of neighborhood walkability (based on street connectivity and traffic exposure) within 2 km of public primary schools on children regularly walking to school was examined. The most (n=13) and least walkable (n=12) schools were selected using a school-specific ‘walkability’ index and a cross sectional study undertaken of Year 5, 6 and 7 children (n=1480) and consenting parents (n=1332).
• After adjustment, regularly walking to school was higher in children attending schools in high walkable neighborhoods (i.e, high street connectivity and low traffic volume) (Odds ratio (OR) 3.63; 95% Confidence Interval (CI) 2.01–6.56), and less likely in neighborhoods with high connectivity but high traffic volume (OR 0.32; 95% CI 0.22–0.47).
• Connected street networks provide direct routes to school but when designed for heavy traffic, the potential for children to walk to school is reduced. This highlights the importance of carefully considering school siting and, particularly, street design in school neighborhoods.

Giles-Corti B, Wood G, Pikora T, Learnihan V, Bulsara M, Van Niel K, Timperio A, McCormack G, Villanueva K. Health Place.17.2 (2011): 545-50.

“Costs and Benefits of Bicycling Investments in Portland, Oregon” (2011)

• Promoting bicycling has great potential to increase overall physical activity; however, significant uncertainty exists with regard to the amount and effectiveness of investment needed for infrastructure.
• The objective of this study is to assess how costs of Portland’s past and planned investments in bicycling relate to health and other benefits.
• Costs of investment plans are compared with 2 types of monetized health benefits, health care cost savings and value of statistical life savings. Levels of bicycling are estimated using past trends, future mode share goals, and a traffic demand model.
• By 2040, investments in the range of $138 to $605 million will result in health care cost savings of $388 to $594 million, fuel savings of $143 to $218 million, and savings in value of statistical lives of $7 to $12 billion.
• The benefit-cost ratios for health care and fuel savings are between 3.8 and 1.2 to 1, and an order of magnitude larger when value of statistical lives is used.
• This first of its kind cost-benefit analysis of investments in bicycling in a US city shows that such efforts are cost-effective, even when only a limited selection of benefits is considered.

Gotschi, Thomas. “Costs and Benefits of Bicycling Investments in Portland, Oregon.” Journal of Physical Activity and Health. 8.Suppl1 (2011):S49-S58.

“Contributions of Built Environment to Childhood Obesity” (2011)

• As childhood obesity has reached epidemic proportions, it is critical to devise interventions that target the root causes of obesity and its risk factors. The two main components of childhood obesity are physical inactivity and improper nutrition, and it is becoming increasingly evident that the built environment can determine the level of exposure to these risk factors.
• Through a multidisciplinary literature review, the authors investigated the association between various built environment attributes and childhood obesity.
• They found that neighborhood features such as walkability/bikeability, mixed land use, accessible destinations, and transit increase resident physical activity; also that access to high-caloric foods and convenience stores increases risk of overweight and obesity, whereas the presence of neighborhood supermarkets and farmers’ markets is associated with lower childhood body mass index and overweight status.
• It is evident that a child’s built environment impacts his access to nutritious foods and physical activity. In order for children, as well as adults, to prevent onset of overweight or obesity, they need safe places to be active and local markets that offer affordable, healthy food options. Interventions that are designed to provide safe, walkable neighborhoods with access to necessary destinations will be effective in combating the epidemic of obesity.

Rahman, T, Cushing, RA, Jackson, RJ. Mt Sinai Journal of Medicine. 78 (2011):49–57.

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