Association of individual and neighbourhood socioeconomic status with physical activity and screen time in seventh-grade boys and girls in Berlin, Germany: a cross-sectional study.
ABSTRACT: OBJECTIVES:Few studies have explored the impact of neighbourhood socioeconomic status (SES) on health behaviours in youths in Germany. Our aim was to investigate the association of individual and neighbourhood SES with physical activity (PA) and screen time (ST) in students aged 12-13 years in Berlin. DESIGN:Cross-sectional study. SETTING:Secondary schools (high schools and integrated secondary schools) in Berlin, Germany. PARTICIPANTS:A total of 2586 students aged 12-13 years (seventh grade). MAIN OUTCOME MEASURES:Sociodemographics, anthropometric data and health behaviours were assessed by self-report during classes. Primary outcome was the association of individual and neighbourhood SES with meeting daily PA and exceeding daily ST recommendations. Students' characteristics were described with means or percentages. Comparisons were performed using generalised linear mixed model yielding ORs with 95% CIs. RESULTS:Mean (±SD) age was 12.5±0.5 years, 50.5% were girls and 34.1% had a migrant background. When adjusting for individual covariates, associations of low versus high individual SES were 0.85 (0.48; 1.52) for PA and 2.08 (1.26; 3.43) for ST. Associations of low versus high neighbourhood SES were 1.76 (1.12; 2.75) for PA and 1.54 (1.10; 2.17) for ST. After additional adjustment for school type and school neighbourhood SES, associations comparing low versus high individual and neighbourhood SES were attenuated for PA (individual SES 0.74 (0.41; 1.33) and neighbourhood SES 1.51 (0.93; 2.46)) and ST (individual SES 1.88 (1.12; 3.14) and neighbourhood SES 1.40(0.98; 2.00). CONCLUSIONS:Lower individual and neighbourhood SES were associated with higher ST. Lower neighbourhood but not individual SES was associated with higher PA. After consideration of school type and school neighbourhood SES associations were attenuated and became insignificant for the relationship between neighbourhood SES, PA and ST. Further research is warranted to unravel the complex relationships between individual SES, neighbourhood SES and school environment to develop more targeted health promotion strategies in the future.
Project description:Physical activity (PA) in youth tends to decline with increasing age, while sedentary behaviour including screen time (ST) increases. There are adolescents, however, whose PA and ST do not follow this pattern. The aim of this study is (i) to examine trajectories in PA and ST from grade 7-9 among students in Berlin, and (ii) to investigate the relationship of these trajectories with individual factors and school type. For the present analyses, changes in students' PA and ST across three time points from 7th to 9th grade were assessed via self-report questionnaires. Positive and negative trajectories were defined for both PA (positive: increasing or consistently high, negative: decreasing or consistently low) and ST (vice versa). Multivariable logistic regression analyses were performed to identify possible predictors of PA and ST trajectories. In total, 2122 students were included (50.2% girls, mean age 12.5 (standard deviation 0.7) years). Compared to grade 7, less students of grade 9 fulfilled PA and ST recommendations (PA: 9.4% vs. 13.2%; ST: 19.4% vs. 25.0%). The positive PA trajectory included 44% of all students (63% boys), while the positive ST trajectory included 21% of all students (30% boys). Being a boy was significantly associated with a positive PA trajectory, while being a girl, having a high socioeconomic status, and attending a high school, were significantly associated with a positive ST trajectory. Different PA and ST trajectories among adolescents should be taken into account when implementing prevention programs for this target group.
Project description:BACKGROUND:The US Centers for Disease Control and Prevention (CDC) promotes school-based strategies to increase physical activity (PA). Implementation feasibility and effect of these interventions on cardiovascular fitness (CVF) is unknown. METHODS:Forty-nine low-SES schools were randomly assigned to either (1) continue routine PA programs (N?=?24 schools, 2399 students) or (2) implement 4 CDC-based PA strategies (N?=?25 schools, 2495 students). CVF assessed by PACER (Progressive Aerobic Cardiovascular Endurance Run) was obtained at the beginning and end of the school year. A post-study questionnaire was administered at each school to assess adherence. RESULTS:Overall, PACER z-scores were not augmented by CDC-based PA strategies. In boys, PACER z-scores increased similarly in both intervention and control schools. In girls, increased mean PACER z-score was greater in control schools (p?<?.01). Fifty-two percent of intervention school's staff reported inability to implement or sustain 4 CDC-based PA strategies. CONCLUSIONS:Planned implementation of school-based CDC PA strategies did not increase CVF compared to routine PA programming. Lack of efficacy in girls suggests need for sex-specific targeted strategies. These findings highlight limited efficacy of CDC-based PA recommendations alone in low-SES schools. Schools may require additional support to successfully implement recommendations and meaningfully affect health outcomes.
Project description:INTRODUCTION:Researchers and policy-makers are interested in the influence that food retailing around schools may have on child obesity risk. Most previous research comes from North America, uses data aggregated at the school-level and focuses on associations between fast food outlets and school obesity rates. This study examines associations between food retailing and BMI among a large sample of primary school students in Berkshire, England. By controlling for individual, school and home characteristics and stratifying results across the primary school years, we aimed to identify if the food environment around schools had an effect on BMI, independent of socio-economic variables. METHODS:We measured the densities of fast food outlets and food stores found within schoolchildren's home and school environments using Geographic Information Systems (GIS) and data from local councils. We linked these data to measures from the 2010/11 National Child Measurement Programme and used a cross-classified multi-level approach to examine associations between food retailing and BMI z-scores. Analyses were stratified among Reception (aged 4-5) and Year 6 (aged 10-11) students to measure associations across the primary school years. RESULTS:Our multilevel model had three levels to account for individual (n = 16,956), home neighbourhood (n = 664) and school (n = 268) factors. After controlling for confounders, there were no significant associations between retailing near schools and student BMI, but significant positive associations between fast food outlets in home neighbourhood and BMI z-scores. Year 6 students living in areas with the highest density of fast food outlets had an average BMI z-score that was 0.12 (95% CI: 0.04, 0.20) higher than those living in areas with none. DISCUSSION:We found little evidence to suggest that food retailing around schools influences student BMI. There is some evidence to suggest that fast food outlet densities in a child's home neighbourhood may have an effect on BMI, particularly among girls, but more research is needed to inform effective policies targeting the effects of the retail environment on child obesity.
Project description:OBJECTIVES:Our first aim was to examine the main and interacting effects of accelerometer-based sedentary time (ST) and moderate-to-vigorous physical activity (MVPA) with BMI and the likelihood of being overweight/obese in Hong Kong and Ghent (Belgium) older adults. Second, we examined whether these main associations and interactions between MVPA and ST were moderated by socio-demographics (gender, education) and objective neighbourhood attributes supposed to be associated with healthy food intake (food outlet density, neighbourhood-level SES). Finally, we determined whether the associations and interactions were generalisable across study sites. METHODS:Data from the ALECS (Hong Kong) and BEPAS Seniors studies (Ghent), two comparable observational studies, were used. Older adults (n = 829, 65+) provided self-reported socio-demographic information and objective MVPA and ST data using Actigraph accelerometers. Annual household income data and GIS software were used to assess neighbourhood-level SES and food outlet density. Generalised additive mixed models were conducted in R. RESULTS:ST was linearly and positively related to both weight outcomes in the overall sample, while MVPA was not. The overall-sample analyses including the two-way interaction between MVPA and ST showed no interactions between these behaviours on weight outcomes. Three site-specific findings were identified, showing distinct associations in Hong Kong compared to Ghent. Study site moderated the interaction between ST and MVPA on both weight outcomes, the interaction between education and ST on both weight outcomes and the interaction between the number of food outlets and ST on being overweight/obese. CONCLUSIONS:The country-specific effects confirm the cultural dependency and complexity of the associations between PA, ST and weight outcomes. Future longitudinal international studies including older adults from multiple regions assessing PA, ST, weight outcomes and dietary intake should be encouraged. Such studies are needed to refine the recommendations regarding ST and PA in older adults in light of preventing overweight and obesity.
Project description:Schools are an important context to promote adolescent physical activity (PA). However, following ecologic frameworks, little is known about the influence of multiple school contextual levels - environment and policy - on adolescent PA. This study aimed to examine associations of school neighborhood environment factors and state laws with PA, and the moderating effects of school neighborhood socioeconomic status (SES) on these associations. Analyses used cross-sectional data from a national sample of middle (n?=?387) and high (n?=?591) school adolescents from the Family Life, Activity, Sun, Health, and Eating study conducted in 2014. Outcomes included self-report school-time PA and active transport to/from school (ATS), and estimated minutes/week of school-related moderate-to-vigorous PA (MVPA) and total MVPA. Separate regression models for middle and high school respondents examined state laws (school PA or physical education (PE) time requirements) and school neighborhood factors (density, age, and commute times), and their interactions with school neighborhood SES, in relation to each PA outcome, adjusting for socio-demographic and psychosocial factors. The high school models showed strong PE laws (B[SE]: 0.3[0.1], p?=?0.02) and any PA law (B[SE]: 0.3[0.1], p?=?0.0003) were related to higher school-time PA, and shorter school neighborhood commute times were related to lower ATS (OR [95% CI]: 0.4 [0.2-0.7]). We found similar associations with estimated school-related MVPA. The middle school models showed no significant state law or school neighborhood main effects. Interactions with school neighborhood SES were not significant. Our findings provide further support for state laws to promote PA in school regardless of school neighborhood SES.
Project description:School achievement gaps and school failure are problematic issues in Latin America, and are mainly explained by the socio-economic status (SES) of the students. What schools can do to improve school achievement and reduce school failure is a critical issue, both for school management and teacher training. In this study, we present the association of individual and school-related socio-emotional variables with school achievement and performance, controlling for the effects of SES. A probabilistic sample of 4,964 students, drawn from 191 schools enrolled in year 10 in urban areas of Chile, answered questionnaires assessing subjective wellbeing, social wellbeing in school, school climate, school social wellbeing and students' perceptions of teachers' wellbeing. Using structural equation modeling, and controlling for SES, we modeled subjective wellbeing as a mediator of the relationship between school-related variables, such as school climate and perception of teacher's wellbeing, and (a) school achievement, and (b) school performance. School achievement was computed as a product of (a) the probability of passing the school year, and (b) the percentage of yearly attendance at school. Data on school achievement was drawn from administrative registries from the Chilean Ministry of Education. School performance was computed as the estimated grade point average (GPA) at the end of the school year, based on the students' previous 5-year GPAs, and was also obtained through administrative data of the last 5 years. Findings reveal the mediating role of subjective wellbeing in the relationship between school-related evaluations (students' social wellbeing at school, their perception of teachers' wellbeing and school climate) and school achievement. For school achievement, two variables were mediated (students' social wellbeing at school and school climate). However, for school performance, no significant mediations were found. We conclude that, on the one hand, after controlling for SES, students' individual subjective wellbeing is associated with their achievement and performance in school. We discuss the importance of improving school experiences that may protect and promote students' subjective experience and school achievement and performance, and reduce the probability of school failure and dropout.
Project description:OBJECTIVES:To examine the relationship between school playground size and total physical activity (PA), fitness and fundamental movement skills (FMS) of primary school students. DESIGN:Cross-sectional ecological analysis. SETTING:43 primary schools in New South Wales, Australia. PARTICIPANTS:Data were from 5238 students, aged 5 to 12 years, participating in the Schools Physical Activity and Nutrition Survey. OUTCOME MEASURES:Self (for age ?11 years) and parent (for age <11 years) report of PA (meeting PA recommendations and number of days meeting recommendations), objectively measured FMS and cardiorespiratory and muscular fitness. RESULTS:Associations between playground space and measures of PA and fitness were mostly non-linear and moderated by loose equipment. Students in schools with no loose equipment showed a weak association between space and meeting PA recommendations (self-report). In schools with equipment, students' predicted probability of meeting PA recommendations increased sharply between 15?m2 and 25?m2 per student from 0.04 (95% CI: 0.01 to 0.08) to 0.30 (95% CI: 0.14 to 0.46), but at 30?m2 returned to levels comparable to students in schools with no equipment (0.18, 95%?CI: 0.07 to 0.28). For cardiorespiratory fitness, in schools with no loose equipment, probabilities for being in the healthy cardiovascular fitness zone varied between 0.66 and 0.77, showing no consistent trend. Students in schools with loose equipment had a predicted probability of being in the healthy fitness zone of 0.56 (95% CI: 0.41 to 0.71) at 15?m2 per student, which rose to 0.75 (95% CI: 0.63 to 0.86) at 20?m2 per student. There was no relationship between space and FMS. CONCLUSIONS:School space guidelines need to incorporate sufficient playground space for students. Our study provides evidence supporting better PA outcomes with increasing space up to 25?m2 per student, and access to loose equipment, however further research is required to determine precise thresholds for minimum space. Intersectoral planning and cooperation is required to meet the needs of growing school populations.
Project description:BACKGROUND: The Alberta Immunization Program offers a vaccine against the Human Papillomavirus (HPV) free of charge to all girls in Grades 5 and 9. The vaccine is provided in two different service delivery models depending upon the acceptance of the program by the local school board. Vaccinations may be provided "in-school" or in "community" through appointments at Public Health Clinics. The purpose of this study was to determine whether there was a difference in vaccine uptake in Calgary between the two service delivery models, "in-school" and "community", and to examine if socioeconomic status (SES) was a contributing factor. METHODS: Individual data from the Calgary Zone Public Health vaccination database for all grade 5 and 9 girls in Calgary for school years 2008-2011 were analyzed using descriptive statistics. These data included vaccination records for 35,592 girls. Logistic regression was used to examine the effect of delivery system and SES status on being vaccinated, controlling for school type. RESULTS: HPV vaccination completion rates were 75% (95% confidence interval = 74.7%, 75.8%) for girls with an "in-school" compared to 36% (95% confidence interval = 35.3%, 37.2%) for girls in schools with a "community" service delivery model. A girl's neighbourhood SES was related to the likelihood of being HPV vaccinated depending on the service delivery model available to her. For girls attending a Public school with an "in-school" delivery model, the proportion completing vaccination increased as SES decreased (high SES = 79%; medium SES = 79%; low SES = 83%; p-value<0.001). For girls attending Calgary Catholic School District schools with the "community" delivery model there was a decrease in immunization rates from high and mid to low SES (high SES = 41%; medium SES = 42%; low SES = 34%; p-value<0.001). These results show that those with lower SES were differentially disadvantaged by not having access to an "in-school" vaccination delivery model. CONCLUSION: Service delivery models make a difference in HPV vaccination completion rates and create inequities for health protection and disease prevention based on socioeconomic status.
Project description:BACKGROUND: Bullying and victimization are widespread phenomena in childhood and can have a serious impact on well-being. Children from families with a low socioeconomic background have an increased risk of this behaviour, but it is unknown whether socioeconomic status (SES) of school neighbourhoods is also related to bullying behaviour. Furthermore, as previous bullying research mainly focused on older children and adolescents, it remains unclear to what extent bullying and victimization affects the lives of younger children. The aim of this study is to examine the prevalence and socioeconomic disparities in bullying behaviour among young elementary school children. METHODS: The study was part of a population-based survey in the Netherlands. Teacher reports of bullying behaviour and indicators of SES of families and schools were available for 6379 children aged 5-6 years. RESULTS: One-third of the children were involved in bullying, most of them as bullies (17%) or bully-victims (13%), and less as pure victims (4%). All indicators of low family SES and poor school neighbourhood SES were associated with an increased risk of being a bully or bully-victim. Parental educational level was the only indicator of SES related with victimization. The influence of school neighbourhood SES on bullying attenuated to statistical non-significance once adjusted for family SES. CONCLUSIONS: Bullying and victimization are already common problems in early elementary school. Children from socioeconomically disadvantaged families, rather than children visiting schools in disadvantaged neighbourhoods, have a particularly high risk of involvement in bullying. These findings suggest the need of timely bullying preventions and interventions that should have a special focus on children of families with a low socioeconomic background. Future studies are necessary to evaluate the effectiveness of such programs.
Project description:OBJECTIVES:Social Cognitive Theory (SCT) has often been used as a guide to predict and modify physical activity (PA) behavior. We assessed the ability of commonly investigated SCT variables and perceived school environment variables to predict PA among elementary students. We also examined differences in influences between Hispanic and non-Hispanic students. DESIGN:This analysis used baseline data collected from eight schools who participated in a four-year study of a combined school-day curriculum and environmental intervention. METHODS:Data were collected from 393 students. A 3-step linear regression was used to measure associations between PA level, SCT variables (self-efficacy, social support, enjoyment), and perceived environment variables (schoolyard structures, condition, equipment/supervision). Logistic regression assessed associations between variables and whether students met PA recommendations. RESULTS:School and sex explained 6% of the moderate-to-vigorous PA models' variation. SCT variables explained an additional 15% of the models' variation, with much of the model's predictive ability coming from self-efficacy and social support. Sex was more strongly associated with PA level among Hispanic students, while self-efficacy was more strongly associated among non-Hispanic students. Perceived environment variables contributed little to the models. CONCLUSIONS:Our findings add to the literature on the influences of PA among elementary-aged students. The differences seen in the influence of sex and self-efficacy among non-Hispanic and Hispanic students suggests these are areas where PA interventions could be tailored to improve efficacy. Additional research is needed to understand if different measures of perceived environment or perceptions at different ages may better predict PA.