ACHPER Healthy Lifestyles Journal – 1

g r o . h c r a e s e r g n i v i l e James F. Sallis, Ph.D., Director v i t [email protected] c a . Carmen L. Cutter, MPH, Deputy Director w [email protected] w w

0 Introduction to the Active Living Research Reference List Jul. – Dec. 2008 1 5 1 -

0 The following pages are citations of studies of the relationships between the 6

2 environment, physical activity, and obesity published during the second half of 2008. - 9

1 We have organized the publications into 8 categories to make them easier to review. 6 The categories are: x a f

1. Built Environment – Child Physical Activity/Obesity, 4 3

5 2. Built Environment – Adult Physical Activity/Obesity, 5 - 3. Policy – Physical Activity/Obesity, 0 6

2 4. Social Environment – Child Physical Activity/Obesity, -

9 5. Social Environment – Adult Physical Activity/Obesity, 1 6

6. Measurement, l e t

7. Community Based Interventions – Physical Activity and Obesity,

3 8. Childhood Obesity – General 0 1 2 9 a i

n The searches were conducted using several databases and were designed to represent r o

f the multiple disciplines in the active living research field. The number of citations i l a continues to grow, especially as there is an extraordinary amount of literature on built C

, environment and policy related to physical activity and obesity. Some citations do not o g include a journal issue or page numbers; these are articles that are available online e i ahead of print publication. D n a S

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 0

1 be covered by the RWJF Healthy Eating Research program. 3 e t i u We will continue to publish twice yearly literature updates as the literature is expanding S

, so rapidly. The abstracts for the current 2008 update and the 2004-2007 abstracts can e u be found at: http://activelivingresearch.org/resourcesearch/referencelist. n e v A

Papers that specifically report environmental correlates of physical activity behavior or h t f obesity will be included in the online ALR literature database i F (http://www.activelivingresearch.org/resourcesearch/literaturedatabase). 0 0 9 3

If you have questions or comments please contact Chad Spoon at

[email protected]. y t i s r e We would like acknowledgement the hard work of Ding Ding (Melody), Erin Merz and the v i

n Active Living Research staff for searching several databases and compiling the 2008 U reference list. e t a t S An Active Living program supported by The Robert Wood Johnson Foundation and administered by o g San Diego State University. e i D n a S Active Living Research Literature Summary 2008 Draft Published Aug. 2009

2008 Search Terms

Physical Activity/Obesity terms (abstract only) Environment terms (title or abstract) non motorized OR NMT OR multimodal environment OR environments OR environmental transportation OR active transport* OR driving OR sprawl OR neighbourhood* OR neighborhood* OR active living OR inactivity OR inactive OR OR recreation* OR metropolitan OR rural OR urban* fit OR fitness OR body mass index OR BMI OR OR pedestrian OR pedestrians OR equipment OR car OR cars OR automobile OR leisure OR geograph* OR aesthet* OR convenient OR television OR TV OR obese OR obesity OR convenience OR urban form OR destination* OR trail weight OR overweight OR journey OR travel* OR trails OR park OR parks OR path OR paths OR OR walk OR walking OR cycle OR cycling OR distance* OR density OR access* OR planning OR bike OR bikers OR biking OR bicycle OR location* OR feature* OR polic* OR facility OR bicycling OR sedentary OR commuter* OR facilities OR crime OR architecture OR building* OR commuting OR exercise OR exercising OR transit OR street* OR stair* OR playground OR exerciser* OR physical activity OR physically playgrounds OR urban design OR neighborhood active OR play OR playground* OR playing OR development OR neighbourhood development OR vehicle OR obesogenic 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 [email protected].

2 Active Living Research Literature Summary 2008 Draft Published Aug. 2009

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

4 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 inversely associated with being a walker (OR=0.22; 95% CI=0.17-0.29) and being a cyclist (OR=0.83; 95% CI=0.79-0.86) and positively associated with being a non-active commuter (OR=1.2; 95% CI=1.16-1.23). Conclusion. Almost 50% of the adolescents reported to actively commute to school on most school days, and mode of commuting was associated with ethnicity and distance. Further research is needed to examine main barriers to active commuting among adolescents from non-Western ethnic background. (C) 2008 Elsevier Inc.

Carver, A., A. F. Timperio, et al. (2008). "Neighborhood road environments and physical activity among youth: The CLAN study." Journal Of Urban Health-Bulletin Of The New York Academy Of Medicine 85(4): 532-544.

We examined associations between objective measures of the local road environment and physical activity (including active transport) among youth. There is little empirical evidence of the impact of the road environment on physical activity among children/adolescents in their neighborhoods. Most recent studies have examined perceptions rather than objective measures of the road environment. This was a 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-

6 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 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,

8 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 whereas for girls the effects were small (2300; 90% CI +/- 1000) and unclear (-300; 90% CI +/- 1200), respectively. There were substantial decreases in weekday and 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

10 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 that neighborhood social factors as well as the physical environment should be considered in the development of health policy and interventions to reduce childhood obesity.

Grafova, I. B. (2008). "Overweight children: assessing the contribution of the built environment." Prev Med 47(3): 304-8.

OBJECTIVE: To examine the relationship between the built environment and overweight status in children. METHODS: Analyses were based on 2482 children aged 5-18 and their primary care givers who participated in the second wave of the Child Development Supplement (CDS-II) of the Panel Study of Income Dynamics (PSID). CDS-II is a nationally representative survey that was administered in October 2002-May 2003. A number of built environment characteristics were examined: population density, alpha index of connectivity, urban design, pedestrian fatality from motor vehicle crashes, restaurant density, and grocery store and convenience store densities. Also, interviewer's observations on neighborhood physical disorder, such as the condition and upkeep of the buildings and street surface on the block were analyzed. RESULTS: Living in a neighborhood with higher convenience store density (OR=1.3, p<0.05) and living in a neighborhood built after 1969 (OR=1.9, p<0.01) is associated with a higher probability of being overweight for children and adolescents. Living in the neighborhood where no physical disorder (OR=0.5, p<0.01) is observed is associated with a decreased likelihood of being overweight. CONCLUSIONS: The results of this study emphasize a particular importance of the built environment of the neighborhood for weight status of children and adolescents.

Grow, H. M., B. E. Saelens, et al. (2008). "Where Are Youth Active? Roles of Proximity, Active Transport, and Built Environment." Medicine And Science In Sports And Exercise 40(12): 2071-2079.

Purpose: This study examined factors related to two sources of physical activity for youth: active use of recreation sites and active transport to recreation sites. Methods: Parents of children (n = 87) and matched pairs of parents and adolescents (n = 124 pairs) in three US cities reported on Youths' active use of, proximity to, and walking/biking to 12 recreation sites and on neighborhood walkability and safety. Multivariate regression models evaluated factors associated with youths' frequent site use and active transport to sites. Results: Proximity to the site was associated with frequent use of large parks and public open space. Walking/biking to the site was associated with frequent use of most sites (indoor recreation sites, small and large parks, basketball courts, walking/running tracks, school recreation sites, playgrounds, and public open space). After controlling for proximity and demographic factors, active transport to sites remained significantly associated (P < 0.05) with frequent use of four sites for children (indoor recreation, walking/running tracks, school recreation facilities, and public open space) and all but three sites for adolescents (indoor recreation, playfields/courts, and beach/lake/rivers).

Adolescents' active transport to more sites was most positively related to higher perceived traffic safety and to better pedestrian infrastructure and was negatively related to crime threat. Adolescents with driver's licenses walked/biked to recreation sites less often. Conclusions: Active transport was strongly associated with the use of multiple recreation sites by children and adolescents, even when accounting for proximity and demographic factors. Adolescents living in neighborhoods with better traffic safety walked/biked to more recreation sites for physical activity. Findings support the need for built environments and transportation policies that facilitate safe, active transport to recreation sites for youth physical activity.

Harten, N., T. Olds, et al. (2008). "The effects of gender, motor skills and play area on the free play activities of 8-11 year old school children." Health Place 14(3): 386-93.

Two studies were conducted to examine the interactions between gender, play area, motor skills and free play activity in 8-11 year old school children. In both studies, boys were more active than girls. In boys, but not in girls, energy expenditure was greater for high-skill than for low-skill children (p = 0.0002), and increased as play area increased (p = 0.01). These results suggest that motor skills and play space are important variables in determining the free play activity of boys, but not of girls. This may be related to widely different play styles among boys and girls.

Haug, E., T. Torsheim, et al. (2008). "The characteristics of the outdoor school environment associated with physical activity." Health Educ Res.

The school is an important setting for physical activity. The purpose of the present study was to examine the association between physical environmental characteristics and participation in daily physical activity during school breaks. Data from 130 schools and 16 471 students (Grades 4-10) in Norway were obtained in 2004 through self- administered questionnaires to principals and students. Multilevel logistic regression models revealed that boys at secondary level with a larger number of outdoor facilities at school had 2.69 times [95% confidence interval (CI) = 1.21-5.98] and girls 2.90 times (95% CI = 1.32-6.37) higher odds of being physically active compared with students in schools with fewer facilities. Boys at secondary level with areas for hopscotch/skipping rope had 2.53 times (95% CI = 1.55-4.13), with a soccer field 1.68 times (95% CI = 1.15- 2.45), with playground equipment 1.66 times (95% CI = 1.16-2.37) and with a sledding hill 1.70 times (95% CI = 1.23-2.35) higher odds to be physically active compared with students in schools without these facilities. A sledding hill was also associated with girls' physical activity participation in secondary school (odds ratio = 1.58, 95% CI = 1.11- 2.24). Outdoor facilities in secondary schools are associated with students' daily physical activity participation during school breaks. Therefore, improving the outdoor environment should be considered in physical activity promotion school programs in secondary schools.

Haug, E., T. Torsheim, et al. (2008). "Physical environmental characteristics and individual interests as correlates of physical activity in Norwegian secondary schools: The health behaviour in school-aged children study." International Journal Of Behavioral Nutrition And Physical Activity 5.

Background: The school has been identified as a key arena for physical activity promotion for young people. Effective change of physical activity behaviour requires identification of consistent and modifiable correlates. The study explores students' interests in school physical activity and facilities in the school environment and examines their associations with students' participation in physical activity during recess and their cross-level interaction effect. Methods: This cross-sectional study was based on a national representative sample of Norwegian secondary schools and grade 8 students who participated in the Health Behaviour in School-aged Children (HBSC) 2005/06 study. The final sample comprised 68 schools and 1347 students. Physical environment characteristics were assessed through questionnaires completed by the principals, and students' physical activity and interests in physical activity were assessed through student self-completion questionnaires. Results: Most students were interested in more opportunities for physical activity in school. Multilevel logistic regression models demonstrated that students attending schools with many facilities had 4.49 times (95% Confidence Interval (CI) = 1.93-10.44) higher odds of being physically active compared to students in schools with fewer facilities when adjusting for socio-economic status, sex and interests in school physical activity. Also open fields (Odds Ratio (OR) = 4.31, 95% CI = 1.65-11.28), outdoor obstacle course (OR = 1.78, 95% CI = 1.32-2.40), playground equipment (OR = 1.73, 95% CI = 1.24-2.42) and room with cardio and weightlifting equipment (OR = 1.58, 95% CI = 1.18-2.10) were associated with increased participation in physical activity. Both students' overall interests and the physical facilitation of the school environment significantly contributed to the prediction of recess physical activity. The interaction term demonstrated that students' interests might moderate the effect of facilities on recess physical activity. Conclusion: The findings support the use of an ecological approach and multilevel analyses in the investigation of correlates of physical activity that allows for a broader understanding of the influence of and interaction between factors at multiple levels on physical activity behaviour. In the promotion of physical activity in lower secondary schools, the study suggests that programmes should include a focus on environmental facilitation and incorporate strategies to increase students' interests for school physical activity.

Hawkins, S. S., A. Pearce, et al. (2008). "Perceived and objective measures of the neighbourhood environment and overweight in preschool children and their mothers." Int J Pediatr Obes: 1-10.

Objectives. The primary aim was to examine the relationships between perceived and objective measures of the neighbourhood environment, measured in late infancy, and subsequent overweight (including obesity) in 3-year-old children and their mothers. The secondary aim was to assess whether moving residence confounded these relationships. Methods. We analysed data on 8 154 children and their mothers from the UK Millennium Cohort Study who had participated since birth and were living in England. At the first contact (late infancy), mothers reported their perceptions of their neighbourhood environment, and objective measures of the neighbourhood environment were obtained by linking national deprivation data to each child's postcode. We conducted logistic and multilevel regression analyses to examine perceived and objective measures of the neighbourhood environment, respectively, and overweight at the second contact (3 years) in children and their mothers. All analyses were adjusted for moving residence. Results. There were few consistent patterns between measures of the neighbourhood environment (perceived or objective) and early childhood overweight. However, mothers' risk of overweight increased with increasingly poor neighbourhood conditions (perceived) or residence in areas of increasing deprivation (objective), after adjustment for individual socio-demographic factors. All relationships were maintained after adjustment for moving residence. Conclusions. While area-level factors have limited influence on the development of overweight in preschool children, they are likely to affect overweight in their mothers. Policies need to address both individual and environmental factors to tackle obesity and its determinants across the life course.

Kerr, J., G. J. Norman, et al. (2008). "Exercise AIDS, neighborhood safety, and physical activity in adolescents and parents." Med Sci Sports Exerc 40(7): 1244-8.

PURPOSE: To investigate the relationships among exercise aids available at home, physical activity, and perceived neighborhood safety. METHODS: Physical activity was assessed using the 7-d recall interview for adolescents (n = 878) and the International Physical Activity Questionnaire for parents (n = 853). Parents reported exercise aids such as fitness equipment, running shoes, and dogs in their household using a 16-item checklist and perceptions of neighborhood safety using the Neighborhood Environment Walkability Scale. Physical activity scores were dichotomized to represent meeting weekly guidelines for children (300 min) and adults (150 min). Logistic regression analyses investigated the interaction between exercise equipment and neighborhood safety in relation to the two physical activity outcomes, controlling for participant demographics. RESULTS: The number of home-use (OR = 1.27) and outdoor-use (OR = 1.24) exercise aids was significantly related to physical activity in adolescent girls but not boys. An interaction effect indicated that the relationship between home-use exercise equipment and physical activity levels was specific for girls in neighborhoods perceived as less-safe (OR = 4.40), rather than those perceived as safe (OR = 1.07, P < 0.01). In the parent sample, home-use (OR = 1.24) and outdoor use (OR = 1.16) exercise aids were significantly related to physical activity levels. An interaction between outdoor exercise aids and safety indicated that the effect was specific to parents who lived in neighborhoods perceived as safe (OR = 2.43) compared to those perceived as less-safe (OR = 0.91, P < 0.01). CONCLUSION: Girls living in neighborhoods their

14 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 parents perceive to be less-safe may benefit from having exercise equipment they can use in the home. Parents living in neighborhoods perceived to be safe may benefit from having exercise aids that they can use outside.

Lanningham-Foster, L., R. C. Foster, et al. (2008). "Changing the school environment to increase physical activity in children." Obesity (Silver Spring) 16(8): 1849-53.

We examined the hypothesis that elementary school-age children will be more physically active while attending school in a novel, activity-permissive school environment compared to their traditional school environment. Twenty-four children were monitored with a single-triaxial accelerometer worn on the thigh. The students attended school in three different environments: traditional school with chairs and desks, an activity-permissive environment, and finally their traditional school with desks which encouraged standing. Data from the school children were compared with another group of age-matched children (n = 16) whose physical activity was monitored during summer vacation. When children attended school in their traditional environment, they moved an average (mean +/- s.d.) of 71 +/- 0.4 m/s(2). When the children attended school in the activity-permissive environment, they moved an average of 115 +/- 3 m/s(2). The children moved 71 +/- 0.7 m/s(2) while attending the traditional school with standing desks. Children moved significantly more while attending school in the activity- permissive environment compared to the amount that they moved in either of the traditional school environments (P < 0.0001 for both). Comparing children's activity while they were on summer vacation (113 +/- 8 m/s(2)) to school-bound children in their traditional environment showed significantly more activity for the children on summer vacation (P < 0.0001). The school children in the activity-permissive environment were as active as children on summer vacation. Children will move more in an activity- permissive environment. Strategies to increase the activity of school children may involve re-designing the school itself.

Larsen, K., J. Gilliland, et al. (2008). "The Influence of the Physical Environment and Sociodemographic Characteristics on Children's Mode of Travel to and From School." Am J Public Health.

Objectives. We examined whether certain characteristics of the social and physical environment influence a child's mode of travel between home and school. Methods. Students aged 11 to 13 years from 21 schools throughout London, Ontario, answered questions from a travel behavior survey. A geographic information system linked survey responses for 614 students who lived within 1 mile of school to data on social and physical characteristics of environments around the home and school. Logistic regression analysis was used to test the influence of environmental factors on mode of travel (motorized vs "active") to and from school. Results. Over 62% of students walked or biked to school, and 72% from school to home. The likelihood of walking or biking to school was positively associated with shorter trips, male gender, higher land use mix, and

15 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 presence of street trees. Active travel from school to home was also associated with lower residential densities and lower neighborhood incomes. Conclusions. Our findings demonstrate that active travel is associated with environmental characteristics and suggest that school planners should consider these factors when siting schools in order to promote increased physical activity among students.

Lee, S. M., C. Tudor-Locke, et al. (2008). "Application of a walking suitability assessment to the immediate built environment surrounding elementary schools." Health Promot Pract 9(3): 246-52.

This study examines the usefulness of applying a walking suitability assessment to a specific geographic area surrounding elementary schools. Streets within a 0.25-mile radius were measured to create a summary walking suitability score for seven schools from high-busing strata and seven from low-busing strata. Summary walking suitability scores were calculated for each school. A Mann-Whitney U test was conducted to determine any differences in scores between the high- and low-busing schools. The median walking suitability score was 3.7 (a good rating); the 25th percentile score was 2.9 (very good), and the 75th was 22.3 (poor). No statistical differences existed between busing strata. Walking suitability is an important consideration when examining the feasibility of walk-to-school programs within school settings; however, it might not be the main factor limiting children's active commuting to school. Several aspects of the environment were captured that researchers, practitioners, school personnel, and transportation experts may deem useful.

Leoni, E., P. Beltrami, et al. (2008). "Survey on sports practice and physical activity of primary school children living in the area of Bologna Local Health Unit in relation with some individual and environmental variables." Ann Ig 20(5): 441-53.

A randomized stratified sample of 522 children attending the third class of primary schools within the area of Bologna Local Health Unit was analysed for physical activity and sports practice. Information about the children's habits and availability of facilities for physical and sports activities were collected by means of structured questionnaires completed by children (507 respondents), parents (491), reference teachers for physical education (26) and class teachers (46) during the school year 2006-07. At the same time, the children's heights and weights were measured in order to calculate BMI values. Regular sports activity is practised by 80.1% of children (males: 82.4%, females: 77.6%), with significant diferences between genders only in children with at least one non-Italian parent (M>F, p < 0.05); the practice of sports is influenced by the area of residence (metropolitan > plain and hills, p < 0.05) and nationality (Italians > non- Italians, p < 0.01). Children with at least one actively sports practising parent are involved more frequently in sports activities (p < 0.001). In free time, sedentary activities are prevalent for both sports-practising children and not. However children not involved in regular sports activities tend to practise outdoor physical activities with a frequency

16 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 significantly higher than children involved in sports (17.3% vs 10.4% of respondents). The percentage of completely sedentary children, who stated that they practise neither sports nor physical activity in their free time, is 7.3% (metropolitan area: 4.5%, hills: 8.7%, plain: 10.6%). The prevalence of overweight is 24.4%, of obesity 9.7%, with a better distribution of BMI values in the metropolitan area where there is the highest occurrence of positive conditions and behaviours: availability of sports facilities, the highest prevalence of sports practice, and the lowest prevalence of completely sedentary children.

Liu, J., K. J. Bennett, et al. (2008). "Urban-rural differences in overweight status and physical inactivity among US children aged 10-17 years." J Rural Health 24(4): 407-15.

CONTEXT: Few studies have examined the prevalence of overweight status and physical inactivity among children and adolescents living in rural America. PURPOSE: We examined urban and rural differences in the prevalence of overweight status and physical inactivity among US children. METHODS: Data were drawn from the 2003 National Survey of Children's Health, restricted to children aged 10-17 (unweighted N = 47,757). Overweight status was defined as the gender- and age-specific body mass index (BMI) values at or above the 95th percentile. Physical inactivity was defined using parentally reported moderate-to-vigorous intensity leisure-time physical activity lasting for at least 20 minutes/d on less than three days in the past week. The 2003 Urban Influence Codes were used to define rurality. Multiple logistic regression models were used to examine urban/rural differences in overweight status and physical inactivity after adjusting for potential confounders. FINDINGS: Overweight status was more prevalent among rural (16.5%) than urban children (14.3%). After adjusting for covariates including physical activity, rural children had higher odds of being overweight than urban children (OR: 1.13; 95% CI: 1.01-1.25). Minorities, children from families with lower socioeconomic status, and children living in the South experienced higher odds of being overweight. More urban children (29.1%) were physically inactive than rural children (25.2%) and this pattern remained after adjusting for covariates (OR: 0.79; 95% CI: 0.73- 0.86). CONCLUSIONS: The higher prevalence of overweight among rural children, despite modestly higher physical activity levels, calls for further research into effective intervention programs specifically tailored for rural children.

Martin, J. J. and N. McCaughtry (2008). "Using Social Cognitive Theory to Predict Physical Activity in Inner-City African American School Children." Journal of Sport & Exercise Psychology 30(4): 378.

Researchers using social cognitive theory and employing built environment constructs to predict physical activity (PA) in inner-city African American children is quite limited. Thus, the purpose of our investigation was to evaluate the ability of important social cognitive variables (e.g., self-efficacy) and built environment constructs (e.g., neighborhood hazards) to predict African American children's PA. Children (N =

331, ages 10-14) completed questionnaires assessing social cognitive theory constructs and PA. Using multiple regression analyses we were able to account for 19% of the variance in PA. Based on standardized beta weights, the best predictors of PA were time spent outside and social support derived from friends. These findings illuminate the valuable role of PA support from peers, as well as the simple act of going outside for inner-city African American children. ABSTRACT FROM AUTHOR

McClafferty, H. (2008). "Interactions between environmental health and pediatric obesity." Explore (NY) 4(5): 328-32.

Muller, S., S. Tscharaktschiew, et al. (2008). "Travel-to-school mode choice modelling and patterns of school choice in urban areas." Journal Of Transport Geography 16(5): 342-357.

Because of declining enrollment and school closures in some German regions students have to choose a certain school location from a reduced set of schools. For the analysis of adverse effects of school closures on transport mode choice the patterns of school choice are specified first. It seems that proximity and the profile offered (languages as a core for example) are adequate factors. Second, the travelto-school mode choice are modelled using a multinornial logit approach, since students might switch from low cost transport modes (cycling for instance) to modes with remarkably higher costs (public transport for instance). Here, the most influencing factors are distance, car availability and weather. Furthermore, these findings are incorporated into a case study to quantify the effects of a modal-shift (switch from one transport mode to another). For this analysis a comprehensive survey was undertaken and a method of data disaggregation and geocoding is presented. (c) 2007 Elsevier Ltd. All rights reserved.

Ozdemir, A. and O. Yilmaz (2008). "Assessment of outdoor school environments and physical activity in Ankara's primary schools." Journal Of Environmental Psychology 28(3): 287-300.

Outdoor school environments are sites for play and physical activity for many children, and shortcomings within these environments are considered significant factors that contribute to children's inactive lifestyles and high levels of childhood obesity. This study explores the associations between the physical characteristics of schoolyards and the physical activity of third and fourth year Students ill five Turkish primary schools. Data were collected through multiple methods, including behavior mapping of student activities during recess, physical assessments of schoolyards, and interviews with students, teachers and administrations. The findings show similarities in the landscape features and physical qualities of schoolyards, particularly in the types of play and activities in which students engage. Results indicated that active Students who walk to

18 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 and from schools have lower body mass index (BMI) values than passive students, and students in schools with larger yards have lower BMI values. Most of the Students prefer spacious and vegetated yards. A major concern is the crowdedness of the yards during recess that limit children's activity. Schoolyards with advanced landscape features are preferred more, and this in turn affects students' positive satisfaction. Outdoor school environments have a correlation to health outcomes and should be designed to promote more activity. Improving the physical and landscape qualities of the public schoolyards Should be the primary concern of the designers in order to increase awareness of natural environment and more important, increase the health of children. (C) 2008 Elsevier Ltd. All rights reserved.

Panter, J. R., A. P. Jones, et al. (2008). "Environmental determinants of active travel in youth: A review and framework for future research." International Journal Of Behavioral Nutrition And Physical Activity 5.

Background: Many youth fail to meet the recommended guidelines for physical activity. Walking and cycling, forms of active travel, have the potential to contribute significantly towards overall physical activity levels. Recent research examining the associations between physical activity and the environment has shown that environmental factors play a role in determining behaviour in children and adolescents. However, links between the environment and active travel have received less attention. Methods: Twenty four studies were identified which examined the associations between the environment (perceived or objectively measured) and active travel among youth aged 5-18 years. Findings were categorised according to the location of the environmental measure examined; attributes of the neighbourhood, destination and the route between home and destination. Results: Results from the reviewed studies indicated that youth active travel is positively associated with social interactions, facilities to assist active travel and urban form in the neighbourhood as well as shorter route length and road safety en-route. A conceptual framework is presented which highlights the associations between active travel behaviours and environmental factors, drawing upon both existing and hypothesised relationships. Conclusion: We provide a review of the available literature and present a novel theoretical framework that integrates the environment into the wider decision making process around travel choices for children and adolescents. Further work should explore associations where gaps in understanding have been identified, and account for the main moderators of behaviour so hypothesised associations can be confirmed.

Pate, R. R., K. McIver, et al. (2008). "Directly Observed Physical Activity Levels in Preschool Children." Journal of School Health 78(8): 438.

Background: Millions of young children attend preschools and other structured child development programs, but little is known about their physical activity levels while in those settings. The purpose of this study was to describe the physical activity levels and demographic and school-related correlates of physical activity in children attending preschools, using a direct observation measurement system. Methods: The Observational System for Recording Physical Activity in Children-Preschool Version was used to measure physical activity levels and related factors in four hundred ninety-three 3- to 5-

19 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 year-old children in 24 preschools. A minimum of six hundred 30-second observation intervals were recorded for each child. Physical (height/weight) and demographic data also were collected. Results: Children engaged in moderate-to-vigorous physical activity (MVPA) during less than 3% of the observation intervals and were sedentary during more than 80% of the observation intervals. Boys were more likely than girls to engage in MVPA (p =.01), and 3-year-old boys were more active than 4- and 5-year-old boys (p =.01). The preschool that a child attended explained 27% of the variance in activity levels. Conclusions: The study indicates that young children are physically inactive during most of their time in preschool. The preschool that a child attended was a stronger predictor of physical activity level than any other factor examined. Additional research is needed to identify the characteristics of preschools in which children are more active.

Pearce, A., C. Kirk, et al. (2009). "Gaining children's perspectives: A multiple method approach to explore environmental influences on healthy eating and physical activity." Health Place 15(2): 614-21.

In order to inform local action for health improvement, this pilot study used multiple methods to explore children's perspectives of environmental influences on their eating and physical activity. Thirty-nine children aged 9-11 years from a North London local authority took photos, drew maps, and attended focus groups. We found that the approach engaged children and that each of the methods returned useful, complementary information. The results highlighted a number of areas for local policymakers and practitioners to consider when developing work to prevent childhood obesity. We conclude that these methods of gaining children's views should be further developed and tested.

Potwarka, L. R., A. T. Kaczynski, et al. (2008). "Places to play: Association of park space and facilities with healthy weight status among children." Journal Of Community Health 33(5): 344-350.

The purpose of this study was to examine how healthy weight status among youth was related to (i) three proximity-based park variables: number of parks within 1 km of home, total area of parkland within 1 km, and distance to the closest park from home, and (ii) the availability of 13 specific park facilities within 1 km of the home. Data were collected from parents of children living in four neighborhoods of a medium-sized Canadian city. Logistic regression analyses revealed that none of the three proximity- based park variables was significantly associated with healthy weight status among children in the sample. However, when availability of the 13 park facilities was examined, children with a park playground within 1 km were almost five times more likely to be classified as being of a healthy weight rather then at risk or overweight compared to those children without playgrounds in nearby parks. Results suggest that availability of certain park facilities may play a more important role in promoting physical activity and healthy weight status among children than availability of park space in general. Implications for park design are discussed.

Santos, M. P., A. S. Page, et al. (2009). "Perceptions of the built environment in relation to physical activity in Portuguese adolescents." Health Place 15(2): 548-52.

In this study, we investigated the association between perceptions of the built environment and physical activity among Portuguese boys and girls. Participants were 1124 adolescents (592 girls and 532 boys) 12- to 18-years-old. Physical activity and perceptions of environmental characteristics were assessed by self-report questionnaires. Significantly more girls (p<0.01) were classified as low-active (61.5%) compared to boys (22.9%). Logistic regression analyses (adjusted for age) showed a significant association between girl's physical activity and availability of free- or low-cost recreational facilities in the neighbourhood (OR=1.44; 95% CI 0.99-2.11). Among boys, the presence of people being active in the neighbourhood was associated with higher levels of physical activity (OR=1.59; 95% CI 1.05-2.40). Perceptions of some aspects of neighbourhood environment may relate differently to participation in physical activity for boys compared to girls.

Springer, A. E., D. M. Hoelscher, et al. (2009). "Prevalence of physical activity and sedentary behaviors by metropolitan status in 4th-, 8th-, and 11th-grade students in Texas, 2004-2005." Prev Chronic Dis 6(1): A21.

INTRODUCTION: Research on geographic differences in children's physical activity (PA) engagement is limited. This study examined the prevalence of PA and sedentary behaviors in a probability sample of children in the 4th (mean age, 9.7 years; n = 7,907), 8th (mean age, 13.7 years; n = 8,827), and 11th (mean age 16.9 years; n = 6,456) grades by urban, suburban, and rural location in Texas. METHODS: Using data from the 2004-2005 School Physical Activity and Nutrition (SPAN) study, we conducted logistic regression analyses stratified by sex to assess associations of 6 PA indicators and 2 sedentary behavior indicators with metropolitan status. RESULTS: Urban 8th- and 11th-grade students reported the lowest prevalence of PA. Suburban or rural schools were significantly more likely than their urban counterparts to report higher school-based sports team participation in 8th graders (P =.001); higher vigorous PA (P =.01) and strengthening exercise (P =.01) in 11th-grade boys; and higher physical education attendance in 4th (P <.01) and 11th graders (P =.05). Sports team (P =.04) and other organized PA participation (P =.04) in urban 4th-grade girls and vigorous PA in urban 8th-grade boys (P =.04) were the only behaviors for which a significantly higher prevalence was reported compared with nonurban counterparts. We observed few significant geographic differences in prevalence of television watching and video game playing. CONCLUSION: Several significant differences in PA behaviors were found by metropolitan status in this sample of public school students in Texas. Research is needed on availability of PA opportunities and PA barriers by metropolitan status to better understand the lower prevalence estimates reported in older urban children.

Timperio, A., B. Giles-Corti, et al. (2008). "Features of public open spaces and physical activity among children: findings from the CLAN study." Prev Med 47(5): 514-8.

OBJECTIVE: To examine associations between features of public open spaces, and children's physical activity. PARTICIPANTS: 163 children aged 8-9 years and 334 adolescents aged 13-15 years from Melbourne, Australia participated in 2004. METHODS: A Geographic Information System was used to identify all public open spaces (POS) within 800 m of participants' homes and their closest POS. The features of all POS identified were audited in 2004/5. Accelerometers measured moderate-to- vigorous physical activity (MVPA) after school and on weekends. Linear regression analyses examined associations between features of the closest POS and participants' MVPA. RESULTS: Most participants had a POS within 800 m of their home. The presence of playgrounds was positively associated with younger boys' weekend MVPA (B=24.9 min/day; p< or =0.05), and lighting along paths was inversely associated with weekend MVPA (B=-54.9 min/day; p< or =0.05). The number of recreational facilities was inversely associated with younger girls' MVPA after school (B=-2.6 min/day; p< or =0.05) and on the weekend (B=-8.7 min/day; p< or =0.05). The presence of trees providing shade (5.8 min/day, p< or =0.01) and signage regarding dogs (B=6.8 min/day, p< or =0.05) were positively associated with adolescent girls' MVPA after school. CONCLUSION: Certain features of POS were associated with participants' MVPA, although mixed associations were evident. Further research is required to clarify these complex relationships.

Timperio, A., J. Salmon, et al. (2008). "Family physical activity and sedentary environments and weight change in children." International Journal Of Pediatric Obesity 3(3): 160-167.

Objective. To examine associations between family physical activity and sedentary environment and changes in body mass index (BMI) z-scores among 10-12- year-old children over three years. Method. Design. Longitudinal (three-year follow-up). Subjects. In total, 152 boys and 192 girls aged 10-12 years at baseline. Measurements. Measured height and weight at baseline and follow-up (weight status, BMI z-scores); aspects of the family physical activity and sedentary environment (parental and sibling modelling, reinforcement, social support, family-related barriers, rules/restrictions, home physical environment) measured with a questionnaire completed by parents at baseline. Results. At baseline, 29.6% of boys and 21.9% of girls were overweight or obese, and mean (standard deviation, SD) BMI z-scores were 0.44 (0.99) and 0.28 (0.89), respectively. There was a significant change in BMI z-score among girls (mean change=0.19, SD=0.55, p < 0.001), but not boys. Among boys, the number of items at home able to be used for sedentary behaviour (B=0.11, p=0.037) was associated with relatively greater increases in BMI z-score. Among girls, sibling engagement in physical activity at least three times/wk (B=-0.17, p=0.010) and the number of physical activity equipment items at home (B=-0.05, p=0.018) were associated with relatively greater decreases in BMI z-score. Conclusion. Sibling physical activity and environmental stimuli for sedentary behaviours and physical activity within the home may be important targets for prevention of weight gain during the transition from childhood to adolescence.

Tucker, P., J. D. Irwin, et al. (2009). "Environmental influences on physical activity levels in youth." Health Place 15(1): 357-63.

This study assessed the amount of physical activity engaged in by youth aged 11- 13, in relation to: (1) the presence of neighborhood recreational opportunities, objectively measured within a geographic information system; and (2) parents' perceptions of recreation opportunities in their neighborhoods. Students in grade 7 and 8 (n=811) in 21 elementary schools throughout London, Ontario completed the adapted Previous Day Physical Activity Recall and a questionnaire assessing environmental influences in the home and school neighborhoods. Parents/guardians of participants also completed a questionnaire eliciting demographic information and perceptions of the neighborhood environment. On average, students engaged in 159.9 min/day of physical activity. Both subjective and objective measures of recreational opportunities were associated positively with physical activity (p<0.05). Greater access to recreational opportunities seem essential to facilitate youths' healthy levels of physical activity.

Veitch, J., J. Salmon, et al. (2008). "Children's active free play in local neighborhoods: a behavioral mapping study." Health Education Research 23(5): 870-879.

Many Australian children are more sedentary than they should be, and almost one in five are currently overweight or obese. Some children may face difficulties finding opportunities to be active, having poor access to safe public open spaces or having low independent mobility limiting their access to places to play. This study aimed to examine children's access to places in their neighborhood for active free play and how these vary by age, sex and socioeconomic status (SES). Behavioral maps of the local neighborhood were completed by children (8-12 years) from five primary schools across different areas of Melbourne. Children living in low SES outer-urban neighborhoods had to travel greater distances to access local parks compared with those in inner-urban mid and high SES areas. One-third (32%) of children reported an independent mobility range of < 100 m from home. In conclusion, for some children opportunities to engage in active free play in the local neighborhood may be limited due to lack of parks in close proximity to home and restricted independent mobility. It is important to collaborate with local governments, urban planners and community groups to improve access to neighborhood parks and to promote a sense of neighborhood safety.

Yeung, J., S. Wearing, et al. (2008). "Child transport practices and perceived barriers in active commuting to school." Transportation Research Part A-Policy And Practice 42(6): 895-900.

This study evaluated the transport practices of school children and perceived factors that influenced parental decisions regarding their child's use of active transport to

23 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 commute to school. A self-administered parental questionnaire (n = 324) was used to determine the transport practices of school children and factors that influence parental decisions regarding their child's use of active transport to school. The relationship between transportation modes (active vs. passive), distance and descriptive variables were evaluated. Despite a median commuting distance of 2.5 km (0.1-28.0 km), only one- third of school trips involved active transport. Children using active transport commuted shorter distances (1.5 vs. 3.6 km), were older (10 vs. 8 years) and more likely to be male than those using motorised transport (P < 0.05). While logistic regression revealed only commuting distance was significantly associated with an increased odds of active transport (OR 0.29, 95% CI 0.17-0.48), the most frequently reported factors influencing parental decisions regarding their child's use of active transport were: (1) the age of child; (2) provision of safe walking paths; (3) adult supervision; (4) commuting distance, and (5) child's fitness level. While the majority of these factors have been identified within the literature, their validity has yet to be established. (C) 2008 Published by Elsevier Ltd.

Zhu, X. M., B. Arch, et al. (2008). "Personal, Social, and Environmental Correlates of Walking to School Behaviors: Case Study in Austin, Texas." Thescientificworldjournal 8: 859-872.

Walking is an affordable and environmentally clean mode of transportation that can bring additional benefits as healthy physical activity. This cross-sectional study examines the prevalence and correlates of walking to or from school in eight elementary schools in Austin, Texas, which have high percentages of low-income, Hispanic students. A survey of 1,281 parents was conducted, including questions about personal, social, and environmental factors that may influence their decisions on the children's school transportation. Binary logistic regressions were used to estimate the odds of choosing walking as the children's typical school travel mode. The results showed that walking was a typical mode for 28 and 34% of trips to and from school, respectively, and mostly accompanied by an adult. Parents' education level, family's car ownership, children's and parents' personal barriers, and having the school bus service reduced the likelihood of walking, while positive peer influences encouraged walking. Among the physical environmental factors, living close to school was the strongest positive predictor; safety concerns and the presence of highway or freeway en route were negative correlates. We concluded that the location of school is a key, as it determines the travel distance and the presence of highway or freeway en route. In addition to environmental improvements, educational and other assistance programs are needed for both parents and children to overcome their personal barriers and safety concerns. Health and disparity issues require further attention, as many underprivileged children have no other means of school transportation but walking in unsafe and poor environments.

Built Environment and Physical Activity/Obesity (Adults)

Aytur, S. A., D. A. Rodriguez, et al. (2008). "The sociodemographics of land use planning: relationships to physical activity, accessibility, and equity." Health Place 14(3): 367-85.

Little is known about relationships between attributes of land use plans and sociodemographic variations in physical activity (PA). This study evaluates associations between policy-relevant plan attributes, sociodemographic factors, and PA in North Carolina. Results suggest that land use plans that included non-automobile transportation improvements and more comprehensive policies to guide development were positively associated with both leisure and transportation-related PA. However, residents of counties with lower-income levels and higher proportions of non-white residents were less likely to have attributes supportive of PA included in their plans. Implications for transdisciplinary collaboration with respect to reducing health disparities are discussed.

Badland, H. M., M. J. Duncan, et al. (2008). "Travel perceptions, behaviors, and environment by degree of urbanization." Preventive Medicine 47(3): 265-269.

Objectives. This study examines how engagement in transport-related physical activity (TPA), perceptions of the commute route, actual travel distance, and perceptions of travel distance vary by degree of urbanization in rural and remote areas of Central Queensland, Australia. Method. A random, cross-sectional sample of 1230 adults aged 18 years and over residing in rural and remote Central Queensland were surveyed by telephone in October-November 2006. Engagement in and attitudes towards TPA, perceptions of the commute route, actual travel distances, and perceived appropriate travel distances for TPA were assessed. Result. For this study 765 adults were eligible for the analysis as they traveled to an occupation. Overall, 86% of the sample commuted to their occupation by motorized modes, 71% of individuals recognized 5 km or less as an appropriate distance to travel via TPA modes, and 45% of respondents reported travel distances less than five kilometers (km) to reach their workplace. Participants from small rural and remote settings more frequently traveled greater than 20 kin to reach their occupation, reported fewer sidewalks and shops, and less heavy traffic enroute compared to respondents in large rural settings. Conclusion. Infrastructure for, and participation in TPA varies according to degree of urbanization. Future work in this area should target the substantial population that recognizes they could engage in TPA. As such, increasing TPA participation in these settings likely requires a cultural shift and infrastructure improvements. (c) 2008 Elsevier Inc. All rights reserved.

Bamana, A., S. Tessier, et al. (2008). "Association of perceived environment with meeting public health recommendations for physical activity in seven European countries." Journal Of Public Health 30(3): 274-281.

Background This study investigates the association of perceived environment and meeting the current public health recommendations (PHRs) for physical activity (PA) and

25 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 examines the role of body mass index (BMI) in this relation. Methods A total of 4231 subjects (>= 18 years), from seven European countries, were involved in a cross-sectional survey. PA was measured by the International PA Questionnaire, and specific questions about perceived environment for PA were added. Results Adults with high personal motivation were more likely to meet PHRs for PA than those without motivation (odds ratio [OR] 1.79; 95% confidence interval [CI] 1.50-2.14). Participants perceiving high social support from work or school were more likely to meet PHRs for PA than those without this support (OR 1.60; 95% CI 1.30-2.00). Likewise, those with perceived opportunities for PA were more likely to meet PHRs than those without this perception (OR 1.23; 95% CI 1.02-1.50)- BMI had no effect on meeting PHRs for PA. Conclusion The study shows a relation between personal motivation and some aspects of social and physical environment in meeting current PHRs for PA. Future research involving an objective environment to meet PHRs for PA should be undertaken to validate these findings.

Choi, J., J. Wilbur, et al. (2008). "Correlates of leisure-time physical activity in Korean immigrant women." West J Nurs Res 30(5): 620-38.

This study describes the physical activity behavior of Korean immigrant women and examines the relationships among leisure-time physical activity (LTPA) behavior, background, and intrapersonal correlates of behavior in Korean immigrant women in the United States using a cross-sectional survey design. A convenience sample of Midwestern Korean immigrant women completed the long form of the International Physical Activity Questionnaire in Korean. Among the participants, 78% were physically active, meeting the Healthy People 2010 goal for physical activity when all physical activity behaviors were considered, whereas 23% met the goal when only LTPA was considered. Women who were older, did not have a child younger than 5, used environmental resources for physical activity, had lower depressive symptoms, and had higher confidence for overcoming exercise barriers were spent more time in LTPA. Accommodating those with young children, enhancing environmental resource use, and improving exercise self-efficacy are important considerations for interventions aimed at increasing LTPA in Korean immigrant women.

Cleland, V. J., K. Ball, et al. (2008). "Personal, social and environmental correlates of resilience to physical inactivity among women from socio-economically disadvantaged backgrounds." Health Educ Res.

While sex and socio-economic disparities in physical activity have been well documented, not all disadvantaged women are inactive. This study aimed to examine correlates of achieving recommended levels of physical activity among women of low socio-economic position. In 2005, a population-based sample of 291 women with low

26 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 educational attainment provided survey data on leisure time physical activity (LTPA). Participants reported potential personal (enjoyment and self-efficacy; barriers; intentions; guilt and priorities; routines and scheduling; occupational physical activity; television viewing), social (support from family/friends; social participation; sport/recreation club membership; dog ownership) and environmental (aesthetics; safety; local access; footpaths; interesting walks; busy roads to cross; heavy traffic) correlates of physical activity. Nearly 40% of participants achieved recommended LTPA (150 min week(-1)). Multivariable analyses revealed that higher levels of self-efficacy for walking [prevalence ratio (PR) 2.05, 95% confidence interval (CI) 1.19-3.53], higher enjoyment of walking (PR 1.48, 95% CI 1.04-2.12), greater intentions to be active (PR 1.97, 95% CI 1.12-3.45) and having set routines for physical activity (PR 1.91, 95% CI 1.18-3.09) were significantly associated with achieving recommended LTPA. Personal factors were the characteristics most strongly associated with achieving recommended levels of LTPA among women from socio-economically disadvantaged backgrounds.

Cleland, V. J., A. Timperio, et al. (2008). "Are perceptions of the physical and social environment associated with mothers' walking for leisure and for transport? A longitudinal study." Prev Med 47(2): 188-93.

OBJECTIVE: The role local neighbourhood environments play in influencing purpose-specific walking behaviors has not been well-explored in prospective studies. This study aimed to cross-sectionally and prospectively examine whether local physical and social environments were associated with mothers' walking for leisure and for transport. METHODS: In 2004, 357 mothers from Melbourne, Australia, provided information on their local physical and social neighbourhood environments, and in 2004 and 2006 reported weekly time spent walking for leisure and for transport. Environmental predictors of high levels of walking and increases in walking were examined using log binomial regression. RESULTS: Public transport accessibility and trusting many people in the neighbourhood were predictive of increases in walking for leisure, while connectivity, pedestrian crossings, a local traffic speed were predictive of increases in transport-related walking. Satisfaction with local facilities was associated with increasing both types of walking, and the social environment was important for maintaining high levels of both leisure- and transport-related walking. CONCLUSION: The findings provide evidence of a longitudinal relationship between physical and social environments and walking behaviors amongst mothers. Enhancing satisfaction with local facilities and giving consideration to 'walkability', safety and public transport accessibility during environment planning processes may help mothers to increase walking.

Cole, R., E. Leslie, et al. (2008). "Motivational readiness for active commuting by university students: incentives and barriers." Health Promot J Austr 19(3): 210-5.

ISSUE ADDRESSED: Walking for transport can contribute significantly to health-enhancing physical activity. We examined the associations of stages of motivational readiness for active transport with perceived barriers and incentives to walking to and from university among students. METHODS: Mail-back surveys were

27 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 completed by 781 students in a regional university in south-east Queensland. They identified one of eight options on motivational readiness for active commuting, which were then classified as: pre-contemplation; contemplation-preparation; or, action- maintenance. Open-ended questions were used to identify relevant barriers and incentives. Logistic regressions were used to examine the barriers and incentives that distinguished between those at different stages of motivational readiness. RESULTS: Barriers most frequently reported were long travel distances, inconvenience and time constraints. Incentives most frequently reported were shorter travel distance, having more time, supportive infrastructure and better security. Those not considering active commuting (pre-contemplation) were significantly more likely to report shorter travel distance as an incentive compared to those in contemplation-preparation. Those in contemplation-preparation were significantly more likely to report lack of motivation, inadequate infrastructure, shorter travel distance and inconvenience as barriers; and, having more time, supportive infrastructure, social support and incentive programs as encouragement. CONCLUSIONS: Different barriers and incentives to walking to or from university exist for students in the different stages of motivational readiness for active commuting. Interventions targeted specifically to stage of motivational readiness may be potentially helpful in increasing activity levels, through active transport.

Coleman, K. J., D. E. Rosenberg, et al. (2008). "Physical activity, weight status, and neighborhood characteristics of dog walkers." Preventive Medicine 47(3): 309-312.

Objective. This study examined how demographics, physical activity, weight status, and neighborhood characteristics varied among households with and without dogs. Method. Participants aged 20 to 65 years (n=2199, 52% male, 75% white, mean age=45) were recruited from 32 neighborhoods in the Seattle, WA and Baltimore, MD regions during 2002-2005. Dog ownership, dog walking, education, height, weight, and family income were self-reported. Minutes of moderate to vigorous physical activity (MVPA) were measured objectively by 7-day accelerometry. Results. Dog walking was associated with a higher proportion of participants who met national recommendations for MVPA (53%) when compared to those who had but did not walk their dog (33%) and to non-dog owners (46%). There were significantly fewer obese dog walkers (17%) when compared to both owners who did not walk their dogs (28%) and non-owners (22%). Dog owners who walked their dogs were more likely to live in high-walkable neighborhoods when compared to dog owners who did not walk their dogs. Conclusion. Dog walking may promote physical activity and contribute to weight control. Dog walking appears to be a mechanism by which residents of high-walkable neighborhoods obtain their physical activity. (C) 2008 Elsevier Inc. All rights reserved.

Cronan, M. K., K. J. Shinew, et al. (2008). "Physical activity patterns and preferences among latinos in different types of public parks." J Phys Act Health 5(6): 894-908.

BACKGROUND: Centers for Disease Control (CDC) data suggest that Latinos are less likely to be physically active and more likely to be overweight and suffer from resulting complications than are Whites and that within the Latino population, Latina women are especially at risk. Therefore, promoting physical activity among Latinos, and understanding gender participation patterns within that population, is particularly important. One strategy for encouraging physical activity is to promote active uses of public parks. METHODS: A national, multiyear, multisite study funded by the USDA Forest Service sought to understand use of public parks by Latinos and Latinas in Los Angeles, Minneapolis, and Chicago. RESULTS: More than 50% of our sample visited parks to engage in physical activity, and in part, activity choice was related to gender. Furthermore, nearly half of all respondents walked to city park sites, whereas few or none walked to state or regional park sites. CONCLUSIONS: Our data suggest that Latinos are using some parks repeatedly and, in the case of city parks, are using them for physical as well as social activity. Therefore, we suggest specific ways that parks could be managed to encourage more physical activity while taking into account gender variations.

de Geus, B., I. De Bourdeaudhuij, et al. (2008). "Psychosocial and environmental factors associated with cycling for transport among a working population." Health Educ Res 23(4): 697-708.

The aim of this study was to examine psychosocial and environmental predictors of cycling for transportation. A sample of 343 Flemish adults (43% men) living at maximum 10 km from their workplace was surveyed. Self-report measures of cycling, demographic variables, psychosocial variables, self-efficacy, perceived benefits and barriers and environmental attributes (destination, traffic variables and facilities at the workplace) of cycling for transport were obtained by means of a mailing questionnaire. Modeling and social support by accompanying, external self-efficacy, ecological- economic awareness and lack of time and interest were positively associated with the likelihood of cycling for transport and varied in importance between cyclists and non- cyclists. Cyclists estimate the time to destination shorter than non-cyclists and indicate to have more facilities for cyclists at the workplace. The results suggest that when people live in a setting with adequate bicycle infrastructure, individual determinants (psychosocial, self-efficacy, perceived benefits and barriers) outperform the role of environmental determinants in this sample. Promotion campaigns aimed at increasing cycling for transportation should focus on creating social support by encouraging cycling with partners, increasing self-efficacy, raising ecological and economic awareness, decreasing lack of time and interest barriers and providing facilities for cyclists at the workplace.

Floyd, M. F., J. O. Spengler, et al. (2008). "Environmental and Social Correlates of Physical Activity in Neighborhood Parks: An Observational Study in Tampa and Chicago." Leisure Sciences 30(4): 360.

This study used observational methods to examine physical activity (PA) and selected correlates in 28 parks in Tampa, Florida, and Chicago, Illinois. We observed 9,454 park users within predetermined activity zones and coded their activity as sedentary, walking (i.e., moderate intensity), or vigorous PA. In Tampa, higher temperature, unorganized activity, lower amounts of shade, lower neighborhood income, Hispanic neighborhood ethnicity, male gender and child age group were significantly associated with walking. Vigorous activity was not associated with income and ethnicity. Morning hours, unorganized activity, lower neighborhood income and African American neighborhood ethnicity were associated with walking in Chicago. Vigorous activity was associated with children, lower neighborhood income and African American ethnicity. Findings from this study can inform policy decisions and future research directions. ABSTRACT FROM AUTHOR

Forsyth, A., M. Hearst, et al. (2008). "Design and destinations: Factors influencing walking and total physical activity." Urban Studies 45(9): 1973-1996.

Do people walk more, or less, depending on the physical character of their residential areas rather than merely their individual characteristics? This paper reports findings for the Twin Cities, Minnesota, about how walking and total physical activity are affected by street pattern, 'pedestrian-oriented' infrastructure and amenities, and mixed use or destinations-in shorthand, design and destinations. The effects of density are dealt with in less depth. Like earlier studies, it finds that walking for specific purposes (i.e. travel or leisure) varies in relation to the physical characteristics of places. However, this study using multiple measures of overall walking and physical activity suggests that socially similar people do the same total amount of physical activity in different kinds of places and that level of activity is, on average, low.

Frank, L. D., J. Kerr, et al. (2008). "A hierarchy of sociodemographic and environmental correlates of walking and obesity." Preventive Medicine 47(2): 172-178.

Objectives. Initial studies demonstrate the need for further investigation of how the association of built environment with physical activity and BMI may differ by sociodemographic subgroups. The aim of this study was to use a novel statistical technique to identify possible subgroups. Methods. Data from the 2002 Strategies for Metro Atlanta's Regional Transportation and Air Quality (SMARTRAQ) study were analyzed to explore relationships between measures of residential density, street connectivity, land use mix, and sociodemographic characteristics of individuals in predicting walking, overweight and obesity status. Chi-squared Automatic interaction Detector (CHAID) analyses were used to partition the population into subgroups

(N=13,065). Results. Subgroups, were more likely to walk if they lived in neighborhoods with greater residential density, greater street connectivity and greater land use mix. A similar relationship was seen in men for the outcomes of obesity and overweight. Male residents of more walkable neighborhoods were less likely to be obese or overweight. In contrast, features of walkability were related to higher rates of obesity and overweight in women and non whites. Conclusions. These analyses reveal that gender and ethnic subgroups display substantially different weight outcomes across different levels of walkability. In contrast, walking was consistently higher for all groups in the more walkable neighborhoods. This information can contribute to better targeting of interventions, and calls for more detailed investigadion of the moderators that affect weight and physical activity across subgroups. This information supports a more efficient use of scarce resources to promote physical activity and healthy body weight. (C) 2008 Published by Elsevier Inc.

Garden, F. L. and B. B. Jalaludin (2009). "Impact of urban sprawl on overweight, obesity, and physical activity in sydney, australia." J Urban Health 86(1): 19-30.

Obesity and inadequate physical activity are major risk factors for many diseases. The built environment plays an important role in influencing participation in physical activity. We aimed to determine whether urban sprawl in Sydney, Australia is associated with overweight/obesity and levels of physical activity. We used a cross-sectional multilevel study design to relate urban sprawl (based on population density) measured at an area level to overweight/obesity and levels of physical activity measured at an individual level whilst controlling for individual and area level covariates in metropolitan Sydney. Individual level data were obtained from the 2002 and 2003 New South Wales Population Health Survey. We had information on 7,290 respondents. The mean population density was 2,168 persons per square kilometer (standard deviation = 1,741, range = 218-7,045). After controlling for individual and area level covariates, for an inter-quartile increase in sprawl, the odds of being overweight was 1.26 (95% CI = 1.10- 1.44), the odds of being obese was 1.47 (95% CI = 1.24-1.75), the odds of inadequate physical activity was 1.38 (95% CI = 1.21-1.57), and the odds of not spending any time walking during the past week was 1.58 (95% CI = 1.28-1.93). Living in more sprawling suburbs increases the risk of overweight/obesity and inadequate physical activity despite the relatively low levels of urban sprawl in metropolitan Sydney. Modifications to the urban environment to increase physical activity may be worthwhile.

Grafova, I. B., V. A. Freedman, et al. (2008). "Neighborhoods and obesity in later life." Am J Public Health 98(11): 2065-71.

OBJECTIVES: We examined the influence of neighborhood environment on the weight status of adults 55 years and older. METHODS: We conducted a 2-level logistic regression analysis of data from the 2002 wave of the Health and Retirement Study. We included 8 neighborhood scales: economic advantage, economic disadvantage, air

31 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 pollution, crime and segregation, street connectivity, density, immigrant concentration, and residential stability. RESULTS: When we controlled for individual- and family-level confounders, living in a neighborhood with a high level of economic advantage was associated with a lower likelihood of being obese for both men (odds ratio [OR] = 0.86; 95% confidence interval [CI] = 0.80, 0.94) and women (OR = 0.83; 95% CI = 0.77, 0.89). Men living in areas with a high concentration of immigrants and women living in areas of high residential stability were more likely to be obese. Women living in areas of high street connectivity were less likely to be overweight or obese. CONCLUSIONS: The mechanisms by which neighborhood environment and weight status are linked in later life differ by gender, with economic and social environment aspects being important for men and built environment aspects being salient for women.

Kaczynski, A. T. and K. A. Henderson (2008). "Parks and recreation settings and active living: a review of associations with physical activity function and intensity." J Phys Act Health 5(4): 619-32.

BACKGROUND: The purpose of this study was to review reported associations between parks and recreation settings (PRSs) as features of the built environment and various functions and intensities of physical activity (PA). METHODS: By searching 4 major databases for the years 1998 to 2005, 50 articles were uncovered that reported quantitative relationships between PRSs and PA. RESULTS: Most articles showed some significant positive relationships between PRSs and PA. PRSs were more likely to be positively associated with PA for exercise or utilitarian functions than for recreational PA. Mixed results were observed for the associations between PRSs and both moderate and vigorous PA, but PRSs were commonly associated with walking. CONCLUSIONS: The studies indicated links between PRSs and PA and provided evidence for the contributions parks and recreation makes as part of the "health care" system within communities. Because of the ubiquity of PRSs and their potential contributions to active living, these relationships merit further exploration.

Kaczynski, A. T., L. R. Potwarka, et al. (2008). "Association of park size, distance, and features with physical activity in neighborhood parks." Am J Public Health 98(8): 1451- 6.

OBJECTIVES: We studied whether park size, number of features in the park, and distance to a park from participants' homes were related to a park being used for physical activity. METHODS: We collected observational data on 28 specific features from 33 parks. Adult residents in surrounding areas (n=380) completed 7-day physical activity logs that included the location of their activities. We used logistic regression to examine the relative importance of park size, features, and distance to participants' homes in predicting whether a park was used for physical activity, with control for perceived neighborhood safety and aesthetics. RESULTS: Parks with more features were more likely to be used for physical activity; size and distance were not significant predictors.

Park facilities were more important than were park amenities. Of the park facilities, trails had the strongest relationship with park use for physical activity. CONCLUSIONS: Specific park features may have significant implications for park-based physical activity. Future research should explore these factors in diverse neighborhoods and diverse parks among both younger and older populations.

Kamphuis, C. B., K. Giskes, et al. (2008). "Area variation in recreational cycling in Melbourne: a compositional or contextual effect?" J Epidemiol Community Health 62(10): 890-8.

OBJECTIVE: To examine whether compositional and/or contextual area characteristics are associated with area socioeconomic inequalities and between-area differences in recreational cycling. SETTING: The city of Melbourne, Australia. PARTICIPANTS: 2349 men and women residing in 50 areas (58.7% response rate). MAIN OUTCOME MEASURE: Cycling for recreational purposes (at least once a month vs never). DESIGN: In a cross-sectional survey participants reported their frequency of recreational cycling. Objective area characteristics were collected for their residential area by environmental audits or calculated with Geographic Information Systems software. Multilevel logistic regression models were performed to examine associations between recreational cycling, area socioeconomic level, compositional characteristics (age, sex, education, occupation) and area characteristics (design, safety, destinations or aesthetics). RESULTS: After adjustment for compositional characteristics, residents of deprived areas were less likely to cycle for recreation (OR 0.66; 95% CI 0.43 to 1.00), and significant between-area differences in recreational cycling were found (median odds ratio 1.48 (95% credibility interval 1.24 to 1.78). Aesthetic characteristics tended to be worse in deprived areas and were the only group of area characteristics that explained some of the area deprivation differences. Safety characteristics explained the largest proportion of between-area variation in recreational cycling. CONCLUSION: Creating supportive environments with respect to safety and aesthetic area characteristics may decrease between-area differences and area deprivation inequalities in recreational cycling, respectively.

Kemperman, A. and H. J. P. Timmermans (2008). "Influence of socio-demographics and residential environment on leisure activity participation." Leisure Sciences 30(4): 306- 324.

Participating in leisure activities provides important benefits for all people. However, there is a substantial reduction of (green) leisure opportunities in cities, and the green spaces that are available often are poorly accessible. The purpose of this study is to analyze the diversity of participation in various types of leisure activities and to determine the relationship between leisure activity participation and characteristics of the

33 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 residential environment depending on socio-demographic characteristics. Diary data from 803 respondents living in the Eindhoven region in the Netherlands were used. Four segments were identified that differ regarding their leisure activity participation, and a modest impact of green space accessibility was found.

King, A. C., W. A. Satariano, et al. (2008). "Multilevel modeling of walking behavior: advances in understanding the interactions of people, place, and time." Med Sci Sports Exerc 40(7 Suppl): S584-93.

It has become increasingly clear that the influences on walking as well as other forms of regular physical activity are complex and require an increased understanding of factors across multiple levels of influence. Ecological frameworks have provided the field with a heuristic means of capturing potential impacts on behavior across diverse domains, including personal, behavioral, social or cultural, and environmental. We discuss advances in both understanding and applying this framework through the inclusion of previously ignored dimensions of impact (e.g., time), the application of state-of-the-art statistical methods for understanding interactions among multiple domains (e.g., signal detection), and the development of computer technologies (e.g., agent-based modeling) aimed at simulating the complex relationships between multiple levels of impact and walking behavior. We conclude with suggestions for future research in this emerging field.

Lee, C. and A. V. Moudon (2008). "Neighbourhood design and physical activity." Building Research And Information 36(5): 395-411.

Health problems related to physical inactivity have become a global health challenge affecting people from the full spectrum of income, age, and ethnicity. This paper examines if neighbourhood environments are associated with physical activity, especially walking and cycling. It analyses 608 respondent survey data from Washington State in the US and Geographic Information System-derived measures of the neighbourhood environment. Respondents reported traffic volume to be the most significant barrier, and good lighting to be the most important facilitator of walking and cycling. Utilitarian destinations, such as grocery stores, restaurants, retail stores and convenience stores, were significant correlates of walking and moderate-intensity physical activities, while housing type, sports facility and transportation infrastructure were correlated with vigorous physical activities. Active people rated higher for their neighbourhood attributes including safety, visual quality, knowing neighbours, seeing many other people walking and cycling, and the availability of sports facilities, parks, and bike racks. Simple interventions such as street lighting, pavements/sidewalks, street trees, benches, bike lanes or trails, bike racks, and traffic-calming devices appeared to hold some promise in promoting physical activities in neighbourhoods. Long-term solutions should include strategies to enhance overall aesthetics, safety, accessibility, street connectivity, and social interactions among neighbours.

Li, F., P. A. Harmer, et al. (2008). "Built environment, adiposity, and physical activity in adults aged 50-75." Am J Prev Med 35(1): 38-46.

BACKGROUND: Few studies have investigated the built environment and its association with health-especially excess adiposity-and physical activity in the immediate pre-Baby Boom/early-Baby Boom generations, soon to be the dominant demographic in the U.S. The purpose of this study was to examine this relationship. METHODS: This study used a cross-sectional, multilevel design with neighborhoods as the primary sampling unit (PSU). Residents (N=1221; aged 50-75) were recruited from 120 neighborhoods in Portland OR. The independent variables at the PSU level involved GIS- derived measures of land-use mix, distribution of fast-food outlets, street connectivity, access to public transportation, and green and open spaces. Dependent variables included resident-level measures of excess adiposity (BMI>or=25), three walking activities, and physical activity. Data were collected in 2006-2007 and analyzed in 2007. RESULTS: Each unit (i.e., 10%) increase in land-use mix was associated with a 25% reduction in the prevalence of overweight/obesity. However, a 1-SD increase in the density of fast-food outlets was associated with a 7% increase in overweight/obesity. Higher mixed-use land was positively associated with all three types of walking activities and the meeting of physical activity recommendations. Neighborhoods with high street connectivity, high density of public transit stations, and green and open spaces were related in varying degrees to walking and the meeting of physical activity recommendations. The analyses adjusted for neighborhood- and resident-level sociodemographic characteristics. CONCLUSIONS: Findings suggest the need for public health and city planning officials to address modifiable neighborhood-level, built-environment characteristics to create more livable residential communities aimed at both addressing factors that may influence unhealthy eating and promoting active, healthy lifestyles in this rapidly growing population.

Lin, J. and L. Long (2008). "What neighborhood are you in? Empirical findings of relationships between household travel and neighborhood characteristics." Transportation 35(6): 739-758.

In recent years, there have been studies of the influence of neighborhood or built environment characteristics on residential location choice and household travel behavior. Interestingly, there is no uniform definition of neighborhood in the literature and the definition is often vague. This paper presents an alternative way of defining neighborhood and neighborhood type, which involves innovative usage of public data sources. Furthermore, the paper investigates the interaction between neighborhood environment and household travel in the US. A neighborhood here is spatially identical to a census tract. A neighborhood type identifies a group of neighborhoods with similar neighborhood socio-economic, demographic, and land use characteristics. This is accomplished by performing log-likelihood clustering on the Census Transportation Planning Package (CTPP) 2000 data. Five household travel measures, i.e., number of trips per household, mode share, average travel distance and time per trip, and vehicle miles of travel (VMT), are then compared across the resulting 10 neighborhood types,

35 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 using the 2001 National Household Travel Survey (NHTS) household and trip files. It is found that household life cycle status and residential location are not independent. Transit availability at place of residence tends to increase the transit mode share regardless of household automobile ownership and income level, and job-housing trade-offs are evident when mobility is not of concern. The study also reveals racial preference in residential location and contrasting travel characteristics among ethnic groups.

Liang, H., K. Tomey, et al. (2008). "Objective Measures of Neighborhood Environment and Self-Reported Physical Activity in Spinal Cord Injured Men." Archives of Physical Medicine & Rehabilitation 89(8): 1468.

Abstract: Liang H, Tomey K, Chen D, Savar NL, Rimmer JH, Braunschweig CL. Objective measures of neighborhood environment and self-reported physical activity in spinal cord injured men. Objectives: To assess the relationship between objective neighborhood environment and self-reported physical activity (PA) and between PA and obesity-related risk factors in people with spinal cord injury (SCI). Design: A cross- sectional study. Setting: Urban university. Participants: Men with SCI (N=131), 20 to 59 years old, at least 1 year postinjury and using wheelchair for mobility most of the time. Interventions: Not applicable. Main Outcome Measures: Metabolic syndrome (abdominal obesity, elevated blood pressure, glucose, triglycerides, and low-high density lipoprotein cholesterol) and high C-reactive protein (CRP), as well as total PA metabolic equivalent score. Results: Lower PA was associated with higher prevalence rate for elevated triglycerides, metabolic syndrome, and high CRP. Compared with those in low PA tertile, those in high PA tertile had significantly lower odds for elevated triglycerides (odds ratio [OR]=.19; 95% confidence interval [CI].04â€“.80), metabolic syndrome (OR=.15; 95% CI.03â€“.66) and high CRP (OR=.17; 95% CI.04â€“.71) while adjusting for relevant factors. In crude analysis, lower PA was associated with neighborhood environmental characteristics including shorter distance to nearest transit stops, smaller mean block area, greater number of transit stops, high vacant housing, and higher neighborhood crime rate. In multivariate analysis higher total crime was the only risk factor significantly associated with lower PA level. Those living in higher crime rate neighborhoods had 86% lower odds of having greater than median PA level (OR=.14; 95% CI.04â€“.49) than their counterparts. Conclusions: In men with SCI, lower PA is independently associated with having elevated triglycerides, metabolic syndrome, and high CRP. Copyright 2008 Elsevier

Lopez, I. A., C. A. Bryant, et al. (2008). "Influences on physical activity participation among Latinas: an ecological perspective." Am J Health Behav 32(6): 627-39.

OBJECTIVES: To explore intrapersonal, social environmental, and physical environmental influences that promote or impede total physical activity (TPA) among Latinas in Lee County, Florida. METHODS: In-depth interviews (n=41) and face-to-face surveys (n=358). RESULTS: Women who worked outside the home, had positive

36 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 attitudes about activity, perceived themselves to have access to activity facilities, and perceived their neighborhood to be safe reported higher TPA. Women who had more education and whose health information source was radio had lower TPA. CONCLUSIONS: Intrapersonal and environmental factors influence TPA levels among Latinas. Segmenting Latina groups using these factors may promote more involvement in physical activity through targeted programs and messages.

Lovasi, G. S., A. V. Moudon, et al. (2008). "Using built environment characteristics to predict walking for exercise." International Journal Of Health Geographics 7.

Background: Environments conducive to walking may help people avoid sedentary lifestyles and associated diseases. Recent studies developed walkability models combining several built environment characteristics to optimally predict walking. Developing and testing such models with the same data could lead to overestimating one's ability to predict walking in an independent sample of the population. More accurate estimates of model fit can be obtained by splitting a single study population into training and validation sets (holdout approach) or through developing and evaluating models in different populations. We used these two approaches to test whether built environment characteristics near the home predict walking for exercise. Study participants lived in western Washington State and were adult members of a health maintenance organization. The physical activity data used in this study were collected by telephone interview and were selected for their relevance to cardiovascular disease. In order to limit confounding by prior health conditions, the sample was restricted to participants in good self- reported health and without a documented history of cardiovascular disease. Results: For 1,608 participants meeting the inclusion criteria, the mean age was 64 years, 90 percent were white, 37 percent had a college degree, and 62 percent of participants reported that they walked for exercise. Single built environment characteristics, such as residential density or connectivity, did not significantly predict walking for exercise. Regression models using multiple built environment characteristics to predict walking were not successful at predicting walking for exercise in an independent population sample. In the validation set, none of the logistic models had a C- statistic confidence interval excluding the null value of 0.5, and none of the linear models explained more than one percent of the variance in time spent walking for exercise. We did not detect significant differences in walking for exercise among census areas or postal codes, which were used as proxies for neighborhoods. Conclusion: None of the built environment characteristics significantly predicted walking for exercise, nor did combinations of these characteristics predict walking for exercise when tested using a holdout approach. These results reflect a lack of neighborhood- level variation in walking for exercise for the population studied.

Maas, J., R. A. Verheij, et al. (2008). "Physical activity as a possible mechanism behind the relationship between green space and health: A multilevel analysis." Bmc Public Health 8.

Background: The aim of this study was to investigate whether physical activity (in general, and more specifically, walking and cycling during leisure time and for commuting purposes, sports and gardening) is an underlying mechanism in the relationship between the amount of green space in people's direct living environment and self-perceived health. To study this, we first investigated whether the amount of green space in the living environment is related to the level of physical activity. When an association between green space and physical activity was found, we analysed whether this could explain the relationship between green space and health. Methods: The study includes 4.899 Dutch people who were interviewed about physical activity, self- perceived health and demographic and socioeconomic background. The amount of green space within a one-kilometre and a three-kilometre radius around the postal code coordinates was calculated for each individual. Multivariate multilevel analyses and multilevel logistic regression analyses were performed at two levels and with controls for socio-demographic characteristics and urbanicity. Results: No relationship was found between the amount of green space in the living environment and whether or not people meet the Dutch public health recommendations for physical activity, sports and walking for commuting purposes. People with more green space in their living environment walked and cycled less often and fewer minutes during leisure time; people with more green space garden more often and spend more time on gardening. Furthermore, if people cycle for commuting purposes they spend more time on this if they live in a greener living environment. Whether or not people garden, the time spent on gardening and time spent on cycling for commuting purposes did not explain the relationship between green space and health. Conclusion: Our study indicates that the amount of green space in the living environment is scarcely related to the level of physical activity. Furthermore, the amount of physical activity undertaken in greener living environments does not explain the relationship between green space and health.

Mau, M. K., K. N. Wong, et al. (2008). "Environmental factors of obesity in communities with native Hawaiians." Hawaii Med J 67(9): 233-6.

OBJECTIVE: To compare the fast food outlets and exercise resources across 3 communities with varying percentages of Native Hawaiians (NH) and to correlate these findings with obesity prevalence. METHODS: Data on all food and exercise resources were collected from January through July 2006 within a 1-mile radius in 3 distinct communities (site A = higher % NH to site C = lower % NH). Comparisons between communities were analyzed in 2007 using Fisher's Exact and ANOVA. RESULTS: Trends in obesity prevalence paralleled the percentage of NHs. After adjusting for population size, site B had a greater number of fast food outlets (p < 0.001) than site A or C, and more exercise facilities compared to site A (p = 0.05). Availability of fast food outlets was significantly greater at site A compared to site C (p = 0.03). Usage of exercise facilities was not significantly different between sites although exercise resources were in

'poorer' condition at site A compared to site B or C (p < or = 0.05). DISCUSSION: Results confirm the increased frequency of obesogenic environmental factors and their correlation with obesity trends across 3 distinct NH communities. These results suggest that environmental factors may offer another means for reducing obesity disparities in minority communities.

Morris, K. S., E. McAuley, et al. (2008). "Self-efficacy and environmental correlates of physical activity among older women and women with multiple sclerosis." Health Educ Res 23(4): 744-52.

Physical inactivity is a major health problem in the United States, particularly in elderly and disabled populations. Little research exists examining the relationships between aspects of the built environment and physical activity in older adults and individuals with multiple sclerosis (MS). We adopted a social cognitive perspective to examine the independent roles of perceptions of the environmental, self-efficacy and functional limitations in understanding physical activity levels among elderly women and women with MS. Older women (n=136) and women diagnosed with MS (n=173) were recruited to participate in separate cross-sectional studies. Individuals completed a battery of questionnaires and wore an activity monitor for 7 days. All measures were issued and collected through the mail with the use of self-addressed, pre-paid envelopes. Initial correlational analyses indicated that self-efficacy, functional limitations and environmental perceptions were significantly related to physical activity. Among older women, self-efficacy, functional limitations and street connectivity demonstrated independent contributions to physical activity behavior. Only self-efficacy and functional limitations demonstrated significant associations among women with MS. The prospective contributions of the environment and individual factors to changes in physical activity need to be determined.

Nagel, C. L., N. E. Carlson, et al. (2008). "The relation between neighborhood built environment and walking activity among older adults." Am J Epidemiol 168(4): 461-8.

The association of neighborhood built environment with walking activity has received growing attention, although most studies have relied upon subjective measures of the built environment and few have examined the relation between built environment and walking among older adults. This 2001 study examined the relation between objectively measured characteristics of the local neighborhood and walking activity among a sample of 546 community-dwelling older adults in Portland, Oregon. A geographic information system was used to derive measures of the built environment within a quarter-mile (0.4 km) and half-mile (0.8 km) radius around each participant's residence. Multilevel regression analysis was used to examine the association of built environment with walking behavior. No association between built environment and the likelihood of walking or not walking was observed in this cohort of older adults. However, among those participants who reported some degree of walking activity,

39 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 average time spent walking per week was significantly associated with amount of automobile traffic and number of commercial establishments in their local neighborhood. These findings suggest that built environment may not play a significant role in whether older adults walk, but, among those who do walk, it is associated with increased levels of activity.

Ntandou, G., H. Delisle, et al. (2008). "Physical activity and socioeconomic status explain rural-urban differences in obesity: A cross-sectional study in Benin (West Africa)." Ecology Of Food And Nutrition 47(4): 313-337.

To explore the relationships between obesity, socioeconomic status (SES), and physical activity (PA), we conducted a study with 341 subjects of a medium-size city of Benin and its semi-rural outskirts. PA was appraised with 24-hour recalls and SES, with a questionnaire. The overall prevalence of obesity (body mass index [BMI] >= 30), abdominal obesity (waist circumference) and elevated percent of body fat (%BF) were 10.6%, 23.8% and 20.2%, respectively. However, 14.6% were underweight (BMI 18.5). Overweight (BMI >= 25) was significantly higher in urban than rural areas and in women than men. SES and PA were independently associated with obesity indicators, while urbanization variables were not.

Ogilvie, D., R. Mitchell, et al. (2008). "Personal and environmental correlates of active travel and physical activity in a deprived urban population." International Journal Of Behavioral Nutrition And Physical Activity 5.

Background: Environmental characteristics may be associated with patterns of physical activity in general or with particular types of physical activity such as active travel (walking or cycling for transport). However, most studies in this field have been conducted in North America and Australia, and hypotheses about putative correlates should be tested in a wider range of sociospatial contexts. We therefore examined the contribution of putative personal and environmental correlates of active travel and overall physical activity in deprived urban neighbourhoods in Glasgow, Scotland as part of the baseline for a longitudinal study of the effects of opening a new urban motorway (freeway). Methods: We conducted a postal survey of a random sample of residents (n = 1322), collecting data on socioeconomic status, perceptions of the local environment, travel behaviour, physical activity and general health and wellbeing using a new 14-item neighbourhood rating scale, a travel diary, the short form of the International Physical Activity Questionnaire (IPAQ) and the SF-8. We analysed the correlates of active travel and overall physical activity using multivariate logistic regression, first building models using personal (individual and household) explanatory variables and then adding environmental variables. Results: Active travel was associated with being younger, living in owner-occupied accommodation, not having to travel a long distance to work and not

40 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 having access to a car, whereas overall physical activity was associated with living in social rented accommodation and not being overweight. After adjusting for personal characteristics, neither perceptions of the local environment nor the objective proximity of respondents' homes to motorway or major road infrastructure explained much of the variance in active travel or overall physical activity, although we did identify a significant positive association between active travel and perceived proximity to shops. Conclusion: Apart from access to local amenities, environmental characteristics may have limited influence on active travel in deprived urban populations characterised by a low level of car ownership, in which people may have less capacity for making discretionary travel choices than the populations studied in most published research on the environmental correlates of physical activity.

Ouedraogo, H. Z., F. Fournet, et al. (2008). "Socio-spatial disparities of obesity among adults in the urban setting of Ouagadougou, Burkina Faso." Public Health Nutr 11(12): 1280-7.

OBJECTIVES: To document the prevalence and the socio-spatial variations of obesity and to identify individual and household characteristics, lifestyles and dietary practices contributing to obesity and its socio-spatial distribution. DESIGN: Population- based cross-sectional survey. We selected 1,570 households from four strata characterised as unstructured and low building-density (ULBD), unstructured and high building-density (UHBD), structured and low building-density (SLBD) and structured and high building-density (SHBD) areas. Structured areas are those that were allotted by the township authority (cadastral services), with public services; unstructured areas refer to those developed with no cadastral organisation. SETTING: Ouagadougou, the capital city of Burkina Faso. SUBJECTS: BMI was calculated in 2022 adults aged 35 years and above who were classified as obese when their BMI was >or=30 kg/m2. Obesity was investigated in relation to household and individual characteristics, lifestyles and dietary practices; adjusted odds ratios with 95 % confidence intervals were derived from a logistic regression model. RESULTS: The overall prevalence of obesity was 14.7 % (males 5.5 % and females 21.9 %). Age, gender, household equipment index, usual transport with motor vehicles and micronutrient-rich food consumption were associated with obesity. After adjustment for these factors, obesity remained associated with the area of residence: residents from SHBD areas were more likely to be obese than those from ULBD areas (OR = 1.41; 95 % CI 2.59,4.76). CONCLUSIONS: Obesity in Ouagadougou is a preoccupant problem that calls for more consideration. Thorough investigation is needed to assess the environmental factors that contribute to the 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

43 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 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-

46 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 reported walkability around the student union. Methods: Students from ASU-Polytechnic (n = 20.33% male) and ASU-Tempe (n = 20, 60% male) recorded distance walked on campus and wore physical activity monitors for 5 days. Results: Polytechnic students spent an average of 36.9 minutes in moderate-to-vigorous physical activity each week; Tempe students spent 96.5 minutes (p <.001). At Polytechnic, students walked an average of 7.674 steps per weekday; at Tempe, 11.294 steps (p =.003). Female students at Polytechnic walked an average of 1.3 km/d; at Tempe, 43 km/d; at Tempe, 3.1 km/d (p =.03). Tempe students rated campus walkability as very good, whereas Polytechnic students rated it fair (p <.001). Conclusions: Students at both campuses met activity recommendations; noted differences may be attributed to the built environment's contribution to walkability.

Smith, K. R., B. B. Brown, et al. (2008). "Walkability and body mass index - Density, design, and new diversity measures." American Journal Of Preventive Medicine 35(3): 237-244.

Background: Rising rates of overweight and obesity in the U.S. have increased interest in community designs that encourage healthy weight. This study relates neighborhood walkability-density, pedestrian-friendly design, and two novel 1 measures of land-use diversity-to residents' excess weight. Methods: Walkable-environment measures include two established predictors-higher density and pedestrian-friendly design (intersections within 0.25 mile of each address)- and two new census-based, land- use diversity measures: the proportion of residents walking to work and the median age of housing. In 2006, weight, height, age, and address data from 453, 927 Salt Lake County driver licenses for persons aged 25-64 years were linked to 2000 Census and GIS street-network information that was analyzed in 2007-2008. Linear regressions of BMI and logistic regressions of overweight and obesity include controls for individual-level age and neighborhood-level racial/ethnic composition, median age of residents, and median family income. Results: Increasing levels of walkability decrease the risks of excess weight. Approximately doubling the proportion of neighborhood residents walking to work decreases art individual's risk of obesity by almost. 10%. Adding a decade to the average age of neighborhood housing decreases women's risk of obesity by about, 8% and men's by 13%. Population density is unrelated to weight in four of six models, and inconsistently related to weight measures in two models. Pedestrian-friendly street networks are unrelated to BMI bill. related to lower risks of overweight and obesity in three of four models. Conclusions: Walkability indicators, particularly the two land- use diversity measures, are important predictors of body weight. Driver licenses should be considered as a source of data for community studies of BMI, as they, provide extensive coverage at low cost.

Titze, S., W. J. Stronegger, et al. (2008). "Association of built-environment, social- environment and personal factors with bicycling as a mode of transportation among Austrian city dwellers." Prev Med 47(3): 252-9.

OBJECTIVE: To determine the association of built-environment, social- environment, and personal-level factors with bicycling for transportation, among adult city dwellers. METHOD: Survey of a representative sample of 1000 inhabitants of the city of Graz, Austria, using a computer-assisted telephone interview addressing cycling behavior and associated personal, social and environmental factors. RESULTS: The prevalence of biking for transportation was 22.5%. After adjustment for gender, age, education, physical activity level and distance from home to destination, cycling was positively associated with the presence of bike lane connectivity (OR=2.09) and social support/modeling (OR=1.62), and negatively associated with the perceived barriers of "physical discomfort" (OR=0.49) and "an impractical transport mode" (OR=0.50). Analysis of interactions indicated that the effect of the perceived benefit of "rapidity" was stronger in physically active persons than inactive individuals, and the effect of the perceived barrier of "an impractical mode of transportation" was stronger among women than men. CONCLUSION: In addition to cycling-related social support and perceived benefits and barriers, bike lane connectivity may be an important determinant of cycling as a means of transportation among adult city dwellers.

Velasquez, K. S., C. K. Holahan, et al. (2009). "Relationship of perceived environmental characteristics to leisure-time physical activity and meeting recommendations for physical activity in Texas." Prev Chronic Dis 6(1): A24.

INTRODUCTION: We investigated the relationship of perceived environmental characteristics to self-reported physical activity in Texas adults using 2004 Behavioral Risk Factor Surveillance System data. METHODS: The 2 research questions were, "Are perceived neighborhood characteristics and reported use of facilities associated with self- reported leisure-time physical activity for male and female Texas residents aged 18 to 64 years?" and "Are perceived neighborhood characteristics and reported use of facilities related to meeting recommendations for moderate to vigorous physical activity for Texas men and women aged 18 to 64 years?" Descriptive statistics and multiple logistic regression were used for the analyses. RESULTS: Multiple logistic regression analyses controlling for sociodemographic factors showed that for women, perceptions of neighbors being physically active, pleasantness of the neighborhood, lighting, safety, and feelings of neighbor trustworthiness were associated with leisure-time physical activity. Several of these variables were also related to meeting recommendations for physical activity. Reports of use of several types of neighborhood facilities were related to men's and women's leisure-time physical activity and with meeting recommendations for physical activity for women. CONCLUSION: Perceptions of neighborhood characteristics and reported use of facilities were related to physical activity and to meeting recommendations for physical activity, with stronger associations for women than for men. Interventions to increase levels of physical activity among Texans should be informed by multilevel assessments including environmental characteristics and by attention to important subpopulations.

Wiggs, I., R. C. Brownson, et al. (2008). "If you build it, they will come: lessons from developing walking trails in rural Missouri." Health Promot Pract 9(4): 387-94.

Given the high rates of sedentary behaviors, attempts to increase physical activity have incorporated individual and, more recently, policy and environmental approaches for promotion of activity. This article presents a summary of the approaches being used by the Ozark Heart Health Coalitions in developing walking trails in rural Missouri. In summarizing these approaches the authors describe 10 lessons with the aim of articulating the process and, thereby, increasing interest and capacity in development of walking trails. Qualitative and quantitative data were used to show burden and priorities and build support with numerous stakeholders. Stakeholders were engaged to identify common objectives, obtain land and funding, and determine trail size, materials, and time needed for construction. Implementation activities focused on trail maintenance and addition of amenities (e.g., playgrounds, benches). In the area of evaluation, they collect data via interviews with walkers on trails and community telephone surveys.

Williams, D. M., B. A. Lewis, et al. (2008). "Comparing Psychosocial Predictors of Physical Activity Adoption and Maintenance." Annals Of Behavioral Medicine 36(2): 186-194.

Most health behavior models do not distinguish between determinants of behavior adoption and maintenance. This study compared psychosocial predictors of physical activity (PA) adoption and predictors of PA maintenance among 205 initially sedentary adults enrolled in a home-based PA promotion trial. Psychosocial variables were measured at 6 months (at which point 107 participants remained inactive and 98 participants adopted regular PA) and used to predict 12-month PA status (an indicator of PA adoption among those inactive at 6 months and an indicator of PA maintenance among those active at 6 months). Six-month PA status moderated the relationships between 6-month measures of home access to PA equipment (p=.049), self-efficacy (p=.086), and perceived satisfaction (p=.062) and 12-month PA status. Simple effects analyses revealed that home access to PA equipment was predictive of PA adoption (OR=1.73; 95% CI: 1.05, 2.85), but not PA maintenance (OR=0.88; 95% CI: 0.58, 1.35), whereas self-efficacy and perceived satisfaction were predictive of PA maintenance (OR=2.65; 95% CI: 1.55, 4.52; OR=1.95; 95% CI: 0.93, 4.06), but not PA adoption (OR=1.50; 95% CI: 0.87, 2.57; OR=0.82, CI: 0.44, 1.52). Results suggest that these psychosocial variables may operate differently in predicting PA adoption versus maintenance.

Witten, K., R. Hiscock, et al. (2008). "Neighbourhood access to open spaces and the physical activity of residents: a national study." Prev Med 47(3): 299-303.

OBJECTIVE: Increasing population levels of physical activity is high on the health agenda in many countries. There is some evidence that neighbourhood access to public open space can increase physical activity by providing easier and more direct access to opportunities for exercise. This national study examines the relationship between travel time access to parks and beaches, BMI and physical activity in New Zealand neighbourhoods. METHODS: Access to parks and beaches, measured in minutes taken by a car, was calculated for 38,350 neighbourhoods nationally using Geographic Information Systems. Multilevel regression analyses were used to establish the significance of access to these recreational amenities as a predictor of BMI, and levels of physical activity and sedentary behaviour in the 12,529 participants, living in 1178 neighbourhoods, of the New Zealand Health Survey 2002/3. RESULTS: Neighbourhood access to parks was not associated with BMI, sedentary behaviour or physical activity, after controlling for individual-level socio-economic variables, and neighbourhood-level deprivation and urban/rural status. There was some evidence of a relationship between beach access and BMI and physical activity in the expected direction. CONCLUSIONS: This study found little evidence of an association between locational access to open spaces and physical activity.

Yadav, K. and A. Krishnan (2008). "Changing patterns of diet, physical activity and obesity among urban, rural and slum populations in north India." Obesity Reviews 9(5): 400-408.

Rapid urbanization and accompanying lifestyle changes in India lead to transition in non-communicable disease risk factors. A survey was done in urban, urban slum and rural population of Haryana, India, in a sample of 4129 men and 3852 women using WHO STEPS questionnaire. A very high proportion of all the three populations reported inadequate intake of fruits and vegetables. Rural men reported five times physical activity as compared with urban and urban slum men and rural women reported seven times physical activity as compared with women in the other two settings. Mean body mass index (BMI) was highest among urban men (22.8 kg m(-2)) followed by urban slum (21.0 kg m(-2)) and rural men (20.6 kg m(-2)) (P-value < 0.01). Similar trend was seen for women but at a higher level than men. Prevalence of obesity (BMI >= 30 kg m(-2)) was highest for urban population (male = 5.5%, female = 12.6%) followed by urban slum (male = 1.9%, female = 7.2%) and rural populations (male = 1.6%, female = 3.8%). Urbanization increases the prevalence of the studied non-communicable disease risk factors, with women showing a greater increase as compared with men. Non- communicable disease control strategy needs to address urbanization and warrants gender sensitive strategies specifically targeting women.

Policy and Physical Activity/Obesity

(2008). "Public policy and physical activity in U.S. schools." Active Living 17(4): 13.

Several excerpts from a letter by Sheila Franklin, director of the U.S. National Coalition for Promoting Physical Activity, are presented.

Boyle, S. E., G. L. Jones, et al. (2008). "Physical activity among adolescents and barriers to delivering physical education in Cornwall and Lancashire, UK: A qualitative study of heads of PE and heads of schools." Bmc Public Health 8.

Background: Recent initiatives have been introduced by the UK government into secondary schools to increase pupils' access to physical activity (PA). Despite this, not enough is known about pupils' levels of physical activity or whether the delivery of these initiatives in schools facilitates or creates a barrier for pupils' PA. The aim of this study was to gain an understanding of adolescents PA levels from the perspective of those responsible for delivering physical education (PE) in schools; heads of PE (HOPE) and heads of school (HS). Methods: Seventeen semi-structured qualitative interviews were carried out with a snowball sample of HOPE and HS in schools in the Northwest and Southwest of England. Thematic data analysis using NVIVO was used to identify emergent themes. Results: 17 core themes were generated, 12 of which confirmed the findings from similar research. However, five themes relating to 'ethos of performance/elitism', 'lower fitness leads to lower ability', 'undervaluing activities within PE dept' or school as a whole', 'role of the school' and 'PE department doing all it can' offer valuable new insight into the factors which may encourage or prevent PA inside or outside the curriculum. Conclusion: Despite many positive perceptions of the delivery of PE in schools, it is evident that barriers still exist within that delivery which discourages physical activity. More research is needed to particularly address the complex issues of elitism and the ethos of PA in schools.

Gladwin, C. P., J. Church, et al. (2008). "Public policy processes and getting physical activity into Alberta's urban schools." Can J Public Health 99(4): 332-8.

OBJECTIVES: Public policies impact the amount of physical activity (PA) that children receive at school. These policies are of interest because overweight and obesity among Canadian children have grown at significant rates, and increasing PA among children is one way to reverse this trend. This research investigates the public policy processes that have resulted in Alberta's education system adopting in-school daily physical activity (DPA) and not supporting walk-to-school (WTS) initiatives. METHODS: Using the policy process described by Kingdon and others as a conceptual framework, this research reviews literature and documents on public policy relating to PA in schools and interviews key individuals (N = 20) to identify the policy-related facilitators and barriers in Alberta, Canada to increasing PA in school-aged children. RESULTS: DPA was mandated because Kingdon's three policy streams (problem, solution and politics) became joined or linked. DPA was the most viable solution because literature supports and teachers believe in the educational benefits of PA. As well, a physician with personal beliefs about the benefits of PA became the minister of education

51 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 and coupled the solution with the political stream through his ministerial power. Reasons that WTS programs have not become school or health policy include advocacy led by politically weak organizations, lack of a supportive policy entrepreneur and poor saliency among educators. CONCLUSIONS: This research illuminates the inner workings of the policy process shaping PA in schools, identifying the unseen forces of the policy process that move issues forward. The findings provide valuable insight for building other healthy public policies.

Jaime, P. C. and K. Lock (2009). "Do school based food and nutrition policies improve diet and reduce obesity?" Prev Med 48(1): 45-53.

OBJECTIVE: To review the effectiveness of school food and nutrition policies world wide in improving the school food environment, student's dietary intake, and decreasing overweight and obesity. METHODS: Systematic review of published and unpublished literature up to November 2007 of three categories of nutrition policy; nutrition guidelines, regulation of food and/or beverage availability, and price interventions applied in preschools, primary and secondary schools. RESULTS: 18 studies met the inclusion criteria. Most evidence of effectiveness was found for the impact of both nutrition guidelines and price interventions on intake and availability of food and drinks, with less conclusive research on product regulation. Despite the introduction of school food policies worldwide few large scale or national policies have been evaluated, and all included studies were from the USA and Europe. CONCLUSION: Some current school policies have been effective in improving the food environment and dietary intake in schools, but there is little evaluation of their impact on BMI. As schools have been proposed worldwide as a major setting for tackling childhood obesity it is essential that future policy evaluations measure the long term effectiveness of a range of school food policies in tackling both dietary intake and overweight and obesity.

Jurg, M. E., J. S. De Meij, et al. (2008). "Using health promotion outcomes in formative evaluation studies to predict success factors in interventions: an application to an intervention for promoting physical activity in Dutch children (JUMP-in)." Health Promot Int 23(3): 231-9.

JUMP-in is a systematically developed intervention aimed at promoting physical activity among primary school children. It is a joint project involving different authorities and entails six school-based programme components. Measuring effects of such an intervention is a complex challenge. A common problem is the lack of valid instruments to measure physical activity and its determinants. In addition, it usually takes years to find improvements in physical activity and related constructs like weight and fitness, or even in causal factors. For this reason different authors advocate for the establishment of 'health promotion outcomes'; (i) health literacy, (ii) social action and influence and (iii) healthy public policy and organizational practice. It is presumed that these health

52 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 promotion outcomes lead to changes in determinants, behaviour and finally in health. Insight in these health promotion outcomes and information about input and through-put are important in discussing the impact and output. The formative evaluation study of the JUMP-in pilot shows the health promotion outcomes of the intervention. The health promotion outcomes 'social action and influence' and 'healthy public policy and organizational practices' were found to be positive. By measuring the presence of the conditions to achieve 'health literacy', it became clear that more attention must be paid to implementation in the future. Based on the health promotion outcomes, we expect that JUMP-in will be an effective intervention in the future.

Kumanyika, S. K., E. Obarzanek, et al. (2008). "Population-based prevention of obesity: the need for comprehensive promotion of healthful eating, physical activity, and energy balance: a scientific statement from American Heart Association Council on Epidemiology and Prevention, Interdisciplinary Committee for Prevention (formerly the expert panel on population and prevention science)." Circulation 118(4): 428-64.

Obesity is a major influence on the development and course of cardiovascular diseases and affects physical and social functioning and quality of life. The importance of effective interventions to reduce obesity and related health risks has increased in recent decades because the number of adults and children who are obese has reached epidemic proportions. To prevent the development of overweight and obesity throughout the life course, population-based strategies that improve social and physical environmental contexts for healthful eating and physical activity are essential. Population-based approaches to obesity prevention are complementary to clinical preventive strategies and also to treatment programs for those who are already obese. This American Heart Association scientific statement aims: 1) to raise awareness of the importance of undertaking population-based initiatives specifically geared to the prevention of excess weight gain in adults and children; 2) to describe considerations for undertaking obesity prevention overall and in key risk subgroups; 3) to differentiate environmental and policy approaches to obesity prevention from those used in clinical prevention and obesity treatment; 4) to identify potential targets of environmental and policy change using an ecological model that includes multiple layers of influences on eating and physical activity across multiple societal sectors; and 5) to highlight the spectrum of potentially relevant interventions and the nature of evidence needed to inform population-based approaches. The evidence-based experience for population-wide approaches to obesity prevention is highlighted.

Maddock, J., L. B. Choy, et al. (2008). "Increasing access to places for physical activity through a joint use agreement: a case study in urban Honolulu." Prev Chronic Dis 5(3): A91.

BACKGROUND: To increase levels of physical activity (PA), interventions that create or enhance access to places for PA are recommended. Establishing a joint use agreement is one way to increase access to existing PA and recreational facilities. The purpose of this article is to present a case study of In-Motion, a pilot joint use agreement

53 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 project at one urban high school in Honolulu, Hawaii. CONTEXT: Residents of urban Honolulu are underserved by the amount of parkland and recreational facilities available for their use. The Honolulu County Department of Parks and Recreation sought to implement a joint use agreement to use the facilities of one urban high school for a recreational program. The high school selected for the pilot project has a student population primarily from low-income and ethnic minority backgrounds. METHODS: An assessment of the potential of 7 urban high schools to implement a joint use agreement was conducted to select the pilot site. In-Motion developed and implemented a joint use agreement. PA preferences of students, staff, and community members were assessed to guide recreational program offerings. Various recreational classes were offered free to the school community. CONSEQUENCES: Several barriers to implementing the joint use agreement and recreational program were encountered. However, participants were satisfied with the recreational classes they attended and said that the In-Motion program helped them to engage in more PA. Program awareness by high school students and staff was high. INTERPRETATION: In-Motion has successfully modeled a pilot joint use agreement and provided new opportunities for PA to the high school's students, teachers, and staff, and to community residents.

Musingarimi, P. (2009). "Obesity in the UK: A review and comparative analysis of policies within the devolved administrations." Health Policy 91(1):10-16.

In the United Kingdom obesity is a significant public problem and the formulation and implementation of policies to address it are primarily the responsibility of the devolved administrations. Containing populations which are broadly similar, albeit with regional differences, devolution allows for the exploration of the obesity policy directions the different UK countries have taken; thus providing opportunities for policy learning and comparison. A review and analysis of policy responses in the devolved administrations reveals differences in the strategic approaches to tackling obesity with England having recently introduced a population-wide strategy in contrast to the other countries. Further, policies to address obesity in England and Northern Ireland are being target driven in contrast to Scotland and Wales. In all the countries, the focus on obesity has been on addressing childhood obesity with Scotland having taken the lead on setting nutritional standards for school meals and the other countries subsequently following. While devolution has provided scope for the variation in responses to address the obesity epidemic in the UK, it is still too early to determine the impact of the different strategic approaches being used to tackling it.

Ramanathan, S., K. R. Allison, et al. (2008). "Challenges in assessing the implementation and effectiveness of physical activity and nutrition policy interventions as natural experiments." Health Promot Int 23(3): 290-7.

The Ontario (Canada) government has instituted a policy requiring elementary schools to offer at least 20 min of daily physical activity for students in Grades 1-8 and

54 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 replace non-nutritious vending machine foods with healthier choices. These policy interventions represent 'natural experiments' offering unique opportunities for conducting research and evaluation. The use of natural experiments to contribute evidence on the effectiveness of policy interventions is identified as an underused tool for public health [Tudor-Locke, C., Ainsworth, B. E. and Popkin, B. M. (2001) Active commuting to school: an overlooked source of children's physical activity? Sports Medicine, 31, 309- 313; Petticrew, M., Cummins, S., Ferrell, C., Findlay, A., Higgins, C., Hoy, C. et al. (2005) Natural experiments: an underused tool for public health? Public Health, 119, 751-757]. To date, some Canadian school-based food and nutrition policies are being monitored, but their impact on child and youth obesity is unknown [Canadian Institute for Health Information. (2006) Improving the Health of Canadians: Promoting Healthy Weights, Ottawa, ON]. There are a number of challenges to the evaluation of policy interventions as natural experiments. Often, there are little or no baseline data available to use as the basis for assessing change. Government policies that result in the adoption of particular approaches across large jurisdictions, such as provinces, may result in wide variation in the design and implementation of interventions. Thus, in some cases, natural experiments may be at risk of having low potential to be adequately evaluated on key outcomes. In this paper, we discuss the context of these challenges in relation to the Ontario government school physical activity and nutrition policies.

Social Environment and Physical Activity/Obesity (Youth)

Ahn, M. K., H. S. Juon, et al. (2008). "Association of race/ethnicity, socioeconomic status, acculturation, and environmental factors with risk of overweight among adolescents in California, 2003." Prev Chronic Dis 5(3): A75.

INTRODUCTION: Little has been published about racial/ethnic differences in the prevalence of overweight among adolescents that accounts in detail for socioeconomic status, acculturation, and behavioral and environmental factors. Increased understanding of factors associated with overweight can provide a rational basis for developing interventions to address the obesity epidemic in the United States. METHODS: Using a cross-sectional analysis of data from adolescents who participated in the California Health Interview Survey 2003, we estimated the prevalence of overweight and at risk of overweight, combined as a single measure (AROW, body mass index > or =85th percentile). We used logistic regression models to examine associations between AROW and risk factors. RESULTS: Twenty-nine percent of California adolescents were AROW. The prevalence of AROW differed significantly by sex and race. Boys were more likely than girls to be AROW (33% vs 25%). American Indians/Pacific Islanders/others (39%) were at highest risk, followed by Hispanics (37%), blacks (35%), whites (23%), and Asians (15%). For boys, older age, Hispanic or American Indian/Pacific Islander/other race/ethnicity, lower education of parents, and longer residence in the United States were significantly associated with AROW. For girls, Hispanic or black race/ethnicity, lower education of parents, and poor dietary habits were significantly associated with AROW. CONCLUSION: The high prevalence of AROW among California adolescents in most racial/ethnic groups indicates the need for culturally specific and appropriate interventions to prevent and treat overweight.

Alam, A. A. (2008). "Obesity among female school children in North West Riyadh in relation to affluent lifestyle." Saudi Medical Journal 29(8): 1139-1144.

Objectives: To estimate the prevalence of obesity among elementary school female students and to identify some obesity-associated risk factors. Methods: This cross- sectional study surveyed healthy female school students (grades 4-6) during 2006-2007. Four private schools in North West Riyadh, Kingdom of Saudi Arabia were selected where the majority of high income families enrolled their daughters. One thousand and two hundred students were included. A pre-designed validated questionnaire was used for data collection. Weights and heights were measured, and the body mass index (BMI) was calculated. Students were categorized into "obese" and "non-obese" according to BMI by age scale. Results: A total of 1072 students participated in the study with a response rate of 89.3%. Obesity was prevalent among 14.9% of students. We observed that the proportion of "obese" students inversely increased by age and schooling grade (p<0.001). Ninety-five percent of the students living in villas or big houses were obese.

Approximately 89.2% admitted that they are performing some exercises; however, 13.8% of them were obese. Consuming fast food and soft drinks were common practiced among obese students. Watching television on daily basis was prevalent among 97.5% of obese students. Conclusions: The existence of obesity promoting factors, calls for integrating interventions at family and school level to match changes in social and cultural context. Awareness is needed to enhance healthy lifestyle.

Beck, L. F. and A. I. Greenspan (2008). "Why don't more children walk to school?" Journal Of Safety Research 39(5): 449-452.

Chang, H. W. and H. L. Chang (2008). "Students' Perceptions of Difficulties in Cycling to School in Urban and Suburban Taiwan." Transportation Research Record(2060): 123- 130.

Previous research has identified the importance of cycling training programs and examined the relationship between cycling attitudes and the behavior of cyclists; another important factor that needs further research is obstacles to cycling in cities. This study investigates cycling difficulties confronted by Taiwanese students in the Hsin-Chu technopolis while riding their bikes to and from school. For an empirical perspective, a questionnaire was designed to collect data related to perceptions of cycling difficulties and to provide a descriptive analysis of students and their parents. Data were collected from samples in urban and suburban environments. The Rasch model was applied to analyze the cycling abilities of the students as well as their perceptions of cycling difficulty. Findings indicate that boys have better cycling abilities than girls, urban students have better abilities than suburban students, ability parallels age (older students have better cycling ability), and parents' attitudes toward cycling to school parallel their children's abilities (parents of students with better cycling ability are less concerned). Various impediments to cycling are identified and, based on students' perceptions, levels of difficulty are assigned. Implications of the results are discussed, and recommendations are offered, so as to facilitate matching bicycle use with Taiwan's status as a worldwide leader in bicycle manufacturing.

Coleman, L., L. Cox, et al. (2008). "Girls and young women's participation in physical activity: psychological and social influences." Health Education Research 23(4): 633- 647.

The importance of increasing young women's level of physical activity is recognized as a priority within the United Kingdom and other Westernized nations. This study, conducted in two distinct geographical locations in the United Kingdom, explores the leading influences upon levels of physical activity participation among 75 young women aged 15-19. Through in-depth interviews, this study explores the influence of psychological and social influences, by examining contrasting accounts from those young women who 'always' and 'never' participate in sport or physical activity. The main

57 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 differences lie with the always participates, relative to the never participates, reporting more positive images of 'sport', positive perceptions of their own ability, low self- consciousness, firm motivations and personal choice to engage in activities and the supporting influence of their friends and family. The study also notes the detrimental impact of life transitions such as moving from college to full-time employment. Further case study analyses reveal the friendship group as the primary influence over all other factors considered. The research concludes by summarizing the influences on physical activity participation that are pertinent to this age group, highlights theoretical implications, suggests possible intervention strategies and reports areas of further investigation that are required.

Cradock, A. L., I. Kawachi, et al. (2009). "Neighborhood social cohesion and youth participation in physical activity in Chicago." Soc Sci Med 68(3): 427-35.

Many young people do not meet recommended levels of participation in physical activity. Neighborhoods may play a role in supporting healthy behavior via social and physical environmental features. We examine whether neighborhood-levels of social cohesion, range of youth services and educational attainment were associated with participation in recreational programs and general physical activity among young people. Hierarchical regression analyses were carried out using data from 680 young people (ages 11-15 years at baseline) participating in the Project on Human Development in Chicago Neighborhoods. The participants' primary caregiver reported recreational program participation at baseline and self-reported general physical activity were assessed at follow-up 2-3 years later. Neighborhood-level characteristics were obtained from census data and via a community survey. Neighborhood social cohesion was inversely associated with participation in recreational programs at baseline, controlling for availability of neighborhood services for youth, neighborhood education status, race/ethnicity, individual-level parental education, overweight status, sex, and age. Residing in an area with greater social cohesion was directly associated with frequency of reported general physical activity, independent of previously reported participation in recreational programs and other neighborhood and individual-level covariates. The present findings suggest that neighborhood social cohesion influences participation in physical activity.

Dieu, H. T., M. J. Dibley, et al. (2008). "Trends in overweight and obesity in pre-school children in urban areas of Ho Chi Minh City, Vietnam, from 2002 to 2005." Public Health Nutr: 1-8.

OBJECTIVE: To assess the trends in overweight and obesity in pre-school children in urban areas of Ho Chi Minh City (HCMC), Vietnam, over the period 2002 to 2005. DESIGN: Two cross-sectional studies were conducted in 2002 and 2005. Multistage cluster sampling was used in both surveys to select the subjects. Sociodemographic information was collected using a self-administered questionnaire given to parents in 2002 and using an interview-administered questionnaire to parents in

2005. Weight and height were measured using the same standard methods in both surveys. BMI (kg/m2) was calculated and overweight/obesity was defined using the age- and sex-specific BMI cut-off points proposed by the International Obesity Taskforce.Subjects and settingChildren aged 4 to 5 years, attending pre-schools in urban areas of HCMC, Vietnam, in 2002 (n 492) and 2005 (n 670). RESULTS: The prevalence of overweight and obesity almost doubled from 2002 to 2005 (21.4 % and 36.8 %, respectively). The increase was more evident in less wealthy districts than in wealthy districts. The proportion of boys classified as obese in 2005 (22.5 %) was three times that in 2002 (6.9 %).ConclusionThe prevalence of overweight and obesity has increased rapidly in children aged 4 to 5 years in urban areas, and especially in less wealthy districts, over a 3-year period. These results signal an urgent need for prevention programmes to control and reverse this rapid upward trend in overweight and obesity in young children in HCMC.

Dishman, R. K., R. P. Saunders, et al. (2008). "Self-Efficacy Moderates the Relation Between Declines in Physical Activity and Perceived Social Support in High School Girls." J Pediatr Psychol.

OBJECTIVE: To test whether self-efficacy for overcoming barriers to physical activity has direct, indirect (i.e., mediated), or moderating relations with naturally occurring change in perceived social support and declines in physical activity during high school. METHODS: Latent growth modeling was used with measures completed in the 8th, 9th, and 12th grades by a cohort of 195 Black and White girls. RESULTS: Self- efficacy was stable and moderated the relation between changes in physical activity and perceived social support. Girls who maintained a perception of strong social support had less of a decline in physical activity if they also had high self-efficacy. However, girls having high self-efficacy had a greater decline in physical activity if they perceived declines in social support. CONCLUSIONS: Randomized controlled trials of physical activity interventions based on social cognitive theory should consider that the influence of girls' perceptions of social support on their physical activity may differ according to their efficacy beliefs about barriers to physical activity.

Dwyer, G. M., J. Higgs, et al. (2008). "What do parents and preschool staff tell us about young children's physical activity: a qualitative study." Int J Behav Nutr Phys Act 5: 66.

ABSTRACT: BACKGROUND: Physical activity and small screen recreation are two modifiable behaviours associated with childhood obesity and the development of chronic health problems. Parents and preschool staff shape behaviour habits in young children. The aims of this qualitative study were to explore the attitudes, values, knowledge and understanding of parents and carers of preschool-age children in relation to physical activity and small screen recreation and to identify influences upon these behaviours. METHODS: This research involved a focus group study with parents and carers of the target population. A purposive sample of 39 participants (22 parents, 17

59 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 carers) participated in 9 focus groups. Participants were drawn from three populations of interest: those from lower socioeconomic status, and Middle-Eastern and Chinese communities in the Sydney (Australia) metropolitan region. RESULTS: All participants understood the value of physical activity and the impact of excessive small screen recreation but were unfamiliar with national guidelines for these behaviours. Participants described the nature and activity patterns of young children; however, the concept of activity 'intensity' in this age group was not a meaningful term. Factors which influenced young children's physical activity behaviour included the child's personality, the physical activity facilities available, and the perceived safety of their community. Factors facilitating physical activity included a child's preference for being active, positive parent or peer modelling, access to safe play areas, organised activities, preschool programs and a sense of social connectedness. Barriers to physical activity included safety concerns exacerbated by negative media stories, time restraints, financial constraints, cultural values favouring educational achievement, and safety regulations about equipment design and use within the preschool environment. Parents considered that young children are naturally 'programmed' to be active, and that society 'de-programs' this behaviour. Staff expressed concern that free, creative active play was being lost and that alternate activities were increasingly sedentary. CONCLUSION: The findings support the relevance of the socioecological model of behavioural influences to young children's physical activity. In this age group, efforts may best be directed at emphasising national guidelines for small screen recreation and educating families and carers about the importance of creative, free play to reinforce the child's inherent nature to be active.

Dwyer, J., L. Needham, et al. (2008). "Parents report intrapersonal, interpersonal, and environmental barriers to supporting healthy eating and physical activity among their preschoolers." Applied Physiology Nutrition And Metabolism-Physiologie Appliquee Nutrition Et Metabolisme 33(2): 338-346.

There is an increasing trend in childhood obesity in Canada and many preschool children are overweight or obese. The objective of this study was to explore parents' experiences and challenges in supporting healthy eating and physical activity among their preschool children. A qualitative descriptive study involving 5 focus groups was conducted. A convenience sample of 39 parents from 3 childcare centres in Hamilton, Ontario, participated. Parents were English speaking and had a child aged 2-5 years attending the childcare centre for at least 3 months. The research team read transcripts of the audio-taped sessions and used a constant comparison approach to develop themes, which involved coding comments by continually referring to previously coded comments for comparison. The social ecological model was used to organize the themes into 3 higher-level categories: (i) intrapersonal (individual): preschoolers' preferences and health; (ii) interpersonal (interactions): parents' and others' different views and practices, influence of the childcare centre, parents' lack of time, and family structure; and (iii) physical environment: accessibility of healthy foods, preschoolers with special needs, media influence, weather, lack of safety, and inaccessible resources. Parents perceived that there are various intrapersonal, interpersonal, and environmental barriers to supporting healthy eating and physical activity among their children. Program planners

60 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 and health professionals can consider these barriers when developing interventions to promote healthy bodyweights among preschoolers.

Dzewaltowski, D. A., G. J. Ryan, et al. (2008). "Parental bonding may moderate the relationship between parent physical activity and youth physical activity after school." Psychology Of Sport And Exercise 9(6): 848-854.

Objectives: The processes and conditions through which parents may influence children's physical activity have not been identified. This study tested the hypothesis that bonding with parents would moderate the relationships between parental physical activity and youth physical activity. Design: A cross-sectional preliminary study. Methods: A total of 57 sixth and seventh grade students completed a survey that assessed bonding with parents and parental physical activity. Then, oil 3 days, they reported their moderate and vigorous physical activity using the Previous Day Physical Activity Recall. Results: Hierarchical multiple regression analyses showed a moderation effect such that the interaction between bonding with parents and parental physical activity significantly predicted youth physical activity after controlling for their main effects. Conclusion: This preliminary study suggests that interventions targeting parents as the route to increasing physical activity may need to target both increasing, parental physical activity and the parent-child bond. (C) 2008 Elsevier Ltd. All rights reserved.

Eime, R. M., W. R. Payne, et al. (2008). "Transition in participation in sport and unstructured physical activity for rural living adolescent girls." Health Educ Res.

Physical activity (PA) is important for lifelong health; however, participation is lower in rural compared with metropolitan areas and declines during adolescence, particularly for girls. It is likely that this decline is related to the number of life transitions that occur during adolescence. This qualitative study examined the views of active rural living girls regarding the factors affecting their sport and PA participation, using the socioecological model. Twenty-seven girls aged 16-17 from four schools participated in semi-structured focus group discussions. Content and thematic analysis was conducted from verbatim transcripts using NVivo. The girls enjoyed involvement in community club sport with friends and they reported living in communities where participation in sport was a major form of social interaction. However, the desire to succeed educationally was a critical factor affecting their participation in sport and PA and influenced their movement from structured club sport to more flexible, but socially isolated individual activities. It is recommended that future longitudinal research should track rural living adolescent females as they complete secondary school, in order to better understand the influence of educational priorities upon sport and PA participation and to identify practical strategies for both schools and community organizations to foster continuing participation throughout this crucial period of life transition.

Friedman, L. S., E. M. Lukyanova, et al. (2008). "Social-environmental factors associated with elevated body mass index in a Ukrainian cohort of children." Int J Pediatr Obes: 1- 10.

Background. While obesity is a growing epidemic in most developed countries, we still lack information on countries in economic transition. In this study, we evaluate the built environment, activity levels, economic status and dietary patterns associated with body mass index (BMI) greater than or equal to the 85th percentile among 3-year- old Ukrainian children living through the downturn in the economy during the mid- 1990s. Methods. We evaluated 883 3-year-old children from the Ukraine ELSPAC cohort. Principal components analysis was used as a data reduction tool for dietary, built environment and activity variables. We evaluated predictors of elevated BMI (>/=85th percentile) using a multivariable logistic regression model. Results. The final multivariable model showed that for every kilogram increase in the mother's weight, there was a corresponding 2% increase in risk of a child having a BMI >/=85th percentile (OR =1.02; 95% CI: 1.00-1.04). A higher social class and a friendly neighborhood were associated with higher BMI, whereas infrequent outings to places that require spending money was associated with lower BMI. Except for meat consumption, none of the dietary variables were associated with elevated BMI. Discussion. The picture in the Ukraine during the 1990s, a period of economic hardship, revealed that variables associated with higher standards of living were predictive of elevated BMI: higher social class, meat consumption and friendly neighborhoods. Variables associated with economic isolation were predictive of a lower risk of elevated BMI.

Gesell, S. B., E. B. Reynolds, et al. (2008). "Social influences on self-reported physical activity in overweight Latino children." Clinical Pediatrics 47(8): 797-802.

Psychosocial variables influence physical activity for different age groups, sex, and ethnic groups. However, little is known about their influence on physical activity in preadolescent Latino children. The authors examined how a) confidence in one's ability to be physically active (self-efficacy); b) ideas about the consequences of being physically active (beliefs), and c) the influences of family and friends on physical activity (Social influences) effect physical activity levels in overweight (body mass index >= 85%) Latino preadolescent children. One hundred and fourteen preadolescents participated in a larger intervention designed to improve healthy life styles for Latino families. The authors report baseline data collected at a community-based primary care clinic. Multivariate regression analyses showed that only social influences significantly predicted (P <.01) the metabolic equivalent adjusted self-reported baseline physical activity Prevention and intervention strategies that augment Social influences on physical activity are likely to result in more physical activity and improved health in these children.

Haworth, C. M., R. Plomin, et al. (2008). "Childhood obesity: genetic and environmental overlap with normal-range BMI." Obesity (Silver Spring) 16(7): 1585-90.

OBJECTIVE: To understand the overlap between the etiology of obesity and normal variation in BMI in children. METHODS AND PROCEDURES: Height and weight data were available from a large UK representative sample of twins: 2,342 same- sex pairs at 7 years and 3,526 same-sex pairs at 10 years. The twin method and model- fitting techniques were used to estimate genetic and environmental contributions to BMI. DeFries-Fulker (DF) extremes analysis was used to investigate genetic and environmental influences on the mean difference between obese and normal-weight children. Obesity was classified using the International Obesity Task Force (IOTF) criteria. RESULTS: At both ages, BMI and obesity were highly heritable (0.60-0.74) and only modestly influenced by shared environmental factors (0.12-0.22). Extremes analyses indicated that genetic and environmental influences on obesity are quantitatively and qualitatively similar to those operating across the range of BMI. DISCUSSION: Obesity is the extreme of the same genetic and environmental factors responsible for variation throughout the distribution of BMI. This finding implies that genes that influence obesity will also be associated with BMI in the normal range, and similar environmental influences will affect BMI in the clinical and normal range. Knowing that obesity is influenced by the same genetic and environmental factors that affect weight at all levels has implications for investigating the mechanisms for weight gain and developing interventions for weight control.

Hume, C., M. Jorna, et al. (2008). "Are children's perceptions of neighbourhood social environments associated with their walking and physical activity?" J Sci Med Sport.

This study aimed to examine cross-sectional associations between neighbourhood social environmental factors and physical activity (PA) among Australian primary school children. Baseline data from a large-scale trial among 957 children (48% boys) aged 9-12 years were utilised. Children self-reported their perceptions of the neighbourhood social environment including social networks (e.g. there are lots of other children around to play with), and social capital (e.g. there are lots of people in my area I could go to if I need help). Children also self-reported their weekly walking frequency and PA from which average daily moderate to vigorous PA (MVPA) was calculated. Linear regression analyses examined these associations. Boys performed 17min/day more MVPA than girls (p<0.01), and girls performed one extra trip/week than boys (p<0.001). Children's perceptions of social capital (p<0.0001) and social networks (p<0.01) were both positively associated with MVPA and social capital was positively associated with walking frequency (p<0.05). These associations were not moderated by the child's sex. These findings suggest that children who had positive perceptions of neighbourhood social capital and social networks in the neighbourhood, tended to be more physically active. Longitudinal and experimental studies are required to further test the influence of these factors among children.

Humenikova, L. and G. E. Gates (2008). "Social and physical environmental factors and child overweight in a sample of American and Czech school-aged children: A pillot study." Journal Of Nutrition Education And Behavior 40(4): 251-257.

objective: To compare environmental factors that influence body mass index for age (BMI-for-age) between a sample of American and Czech school-aged children. Design: Pilot study. A parent questionnaire and school visits were used to collect data from parents and children. Setting: Public schools in I American and 2 Czech cities. Participants: Forty-five American and 97 Czech 4(th)- through 6(th)-graders and their parents. Variables Measured: Parenting style, food socialization and preparation practices, healthful food availability, and children's BMI-for-age were measured. Analysis: Factors from the parental scales were derived using factor analysis. Independent t tests compared environmental factors between American and Czech families. A regression model was used to identify environmental variables associated with BMI-for-age. Results: American parents used authoritative parenting style and positive food socialization practices more often than Czech parents (P <.001). Availability of healthful food and parental involvement in food preparation were higher (P <.001) in Czech households. Positive encouraging socialization practices, less frequent use of negative explanations, and a greater availability of vegetables were associated with lower BMI-for-age in the Czech sample of children. Conclusions and implications: A future study should focus on identifying environmental factors that influence children's BMI-for-age with a large sample of Czech and American parents and their school-aged children.

Humenikova Shriver, L. and G. Gates (2008). "A cross-cultural comparison of dietary intakes and physical activity between American and Czech school-aged children." Public Health Nutr: 1-5.

OBJECTIVE: The prevalence of child overweight in the Czech Republic is substantially lower than that in the USA. The objective of the present pilot study was to explore dietary intakes, frequency of dining in fast-food establishments, and the amount and intensity of physical activity between a sample of American and Czech children. DESIGN: A cross-sectional correlational pilot study. SETTING: Four public schools in the USA and four public schools in the Czech Republic. SUBJECTS: Ninety-five Czech and forty-four American 4-6th graders from urban public schools participated in the study. Dietary intake and number of fast-food visits were evaluated using two multiple- pass 24 h recalls. Physical activity was measured using the modified Self-Administered Physical Activity Checklist. RESULTS: American children (mean age 10.8 (se 0.2) years) consumed more energy and fat, less fruits and vegetables, more soft drinks, and visited fast-food establishments more often than Czech children (mean age 11.0 (se 0.1) years). Although no differences were found in vigorous activity by nationality, Czech children spent significantly more time in moderate physical activities than American children. CONCLUSIONS: Despite the influx of some negative Western dietary trends into the country, Czech children had a healthier diet and were more physically active than American children. Further research is warranted to determine whether the same

64 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 differences in dietary intakes, physical activity and fast-food visits exist between nationally representative samples of American and Czech children.

Jackson, M., D. Crawford, et al. (2008). "Are parental concerns about children's inactivity warranted, and are they associated with a supportive home environment?" Res Q Exerc Sport 79(3): 274-82.

This paper explores parental concern about children's activity levels and whether parents who are concerned about their child's activity provide a supportive environment. A sample of 615 parents of 5-6-year-old children and 947 parents of 10-12-year-old children completed a questionnaire. Just over 50% of parents reported they were concerned their child was not getting enough activity. Children of concerned parents were less active than those whose parents were not concerned. These findings suggest that parents who are concerned about their child's physical activity levels provided a less supportive environment for physical activity than parents who are not concerned. The challenge for public health will be to harness parental concerns and translate them into action.

Jago, R., A. Page, et al. (2008). "Screen-viewing and the home TV environment: the European Youth Heart Study." Prev Med 47(5): 525-9.

OBJECTIVE: Examine if home environmental factors are associated with screen- viewing. METHODS: Data are for 2670, 3rd and 9th grade participants in Denmark, Portugal, Estonia and Norway collected between 1997 and 2000. Outcomes were spending >2 h after-school watching television (TV) and >1 h per day playing computer games. Child Autonomy and the home TV Environment were exposures. RESULTS: Each unit increase in Child Autonomy was associated with 9% increase in risk of watching more than 2 h of TV per day after school and a 19% increase in risk of spending more than an hour per day playing computer games. TV Environment was associated with a 31% per unit increase in risk of watching >2 h of TV after school and 11% increase in risk of spending >1 h playing computer games. CONCLUSIONS: A family environment in which after-school TV viewing is part of the home culture and homes where children have more autonomy over their own behavior are associated with an increased risk of watching >2 h of TV per day after school and spending more >1 h per day playing computer games. The home screen-viewing environment and Child Autonomy may be malleable targets for changing screen-viewing.

Ji, C. Y. and T. O. Cheng (2009). "Epidemic increase in overweight and obesity in Chinese children from 1985 to 2005." Int J Cardiol 132(1): 1-10.

This study tracks the temporal changes in prevalence of childhood and adolescent overweight and obesity in different regions of China from 1985 to 2005. Using a series

65 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 data of the Chinese National Survey on Students Constitution and Health, we compared the temporal changes over a 20-year period of the prevalence of overweight and obesity among ten regions in China for school-aged children between 7 and 18 years of age. Large disparities in the temporal changes of obesity prevalence exist in different regions of China. North coastal residents, especially those of the upper socioeconomic status, had the earliest and largest increase in prevalence. Similar increases then followed successively in other regions of upper, moderate and low socioeconomic status, and finally in the affluent rural regions. No significant increase was found in the developing rural areas. Regions where the obesity epidemic occurred late also began to show rather rapid increases in prevalence in recent years. In 2005, the national estimates indicated that 7.73% of Chinese youth are overweight and 3.71% of them are obese, representing an estimated 21.37 million Chinese children (13.43 million boys and 7.94 million girls).

Klein, E. G., L. A. Lytle, et al. (2008). "Social ecological predictors of the transition to overweight in youth: Results from the Teens Eating for Energy and Nutrition at Schools (TEENS) study." Journal Of The American Dietetic Association 108(7): 1163-1169.

Objective To explore the social ecological predictors of the transition to overweight in youth, as shown in results from the Teens Eating for Energy and Nutrition at Schools study. Design Longitudinal data from a school-based intervention trial. Participants Adolescents who were involved in the Teens Eating for Energy and Nutrition at Schools intervention study who reported a healthful weight at baseline in 1998 (n=1,728). Main outcome measure Transition to overweight status (body mass index >= 85th percentile) at follow-up in eighth grade. Statistical analysis Generalized linear mixed model regression. Results Factors in the social, environmental, individual, and behavioral domains had significant unadjusted relationships with a transition to overweight status. In the multivariate analysis, adolescents who perceived themselves to be overweight at baseline were 2.3 times more likely to be overweight at follow-up compared to those with a normal weight self-perception. Compared to non-dieters, current dieters were 2.6 times more likely to be overweight at follow-up, and boys were nearly three times more likely to transition to overweight status at follow-up compared with girls. Conclusions Individual factors, primarily related to a self-perception of being overweight, were the strongest predictors of transitioning to overweight as adolescents progressed from seventh through eighth grade. A better understanding of the relationship between weight concern and transition to overweight is needed.

Lindsay, A. C., K. M. Sussner, et al. (2009). "Influence of social context on eating, physical activity, and sedentary behaviors of latina mothers and their preschool-age children." Health Educ Behav 36(1): 81-96.

As more U.S. children grow up in Latino families, understanding how social class, culture, and environment influence feeding practices is key to preventing obesity. The authors conducted six focus groups and 20 in-depth interviews among immigrant,

66 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 low-income Latina mothers in the Northeast United States and classified 17 emergent themes from content analysis according to ecologic frameworks for behavior change. Respondents related environmental influences to child feeding, diet, and activity, namely, supermarket proximity, food cost, access to recreational facilities, neighborhood safety, and weather. Television watching was seen as integral to family life, including watching during meals and using TV as babysitter and tool to learn English. Participation in the WIC program helped families address food insecurity, and child care provided healthy eating and physical activity opportunities. Health promotion efforts addressing obesity trends in Latino children must account for organizational and environmental influences on the day-to-day social context of young immigrant families.

Mazur, A., K. Klimek, et al. (2008). "Risk factors for obesity development in school children from south-eastern Poland." Ann Agric Environ Med 15(2): 281-5.

The aim of the study was to determine socio-economic and parental factors affecting odds for development of obesity in school-age children from south-eastern Poland (SEP). 2,182 boys and 2,066 girls from randomly selected elementary schools in SEP were involved in this study. The mean age of the girls was 10.4 years (SD 2.4, range 6.7-14.9). The mean age of the boys was 10.5 years (SD 2.3, range 6.9-14.9). 167 boys (7.7 %, 95 % CI: 6.6-8.8 %) and 208 girls (10.1 %, 95 % CI: 8.8-11.4 %) were obese. The difference in prevalence of obesity between genders was statistically significant. Socioeconomic risk factors (RF) were different from those in Western Europe or the United States. A small number of siblings was RF for obesity. Intact family had a protective effect. No correlation was found between child's obesity and parental education, income per capita or mother working outside the home. Parental obesity was RF for the obesity in children. High BMI at birth was an RF for obesity. A distinct pattern of socio-economic RF underlines the importance of population specific epidemiological studies. Defining RF in a specific region provides information to design specific preventive strategies.

McDermott, R. J., J. Nickelson, et al. (2009). "A community-school district-university partnership for assessing physical activity of tweens." Prev Chronic Dis 6(1): A15.

INTRODUCTION: Obesity among youth is related to a decline in physical activity, and data on physical activity levels among children in elementary and middle schools are limited. METHODS: We leveraged a community-school district-university partnership in Sarasota County, Florida, in May of 2005 to assess physical activity levels among tweens (youth aged 9-13 years) and to measure the relationship between tweens' awareness of the Centers for Disease Control and Prevention's VERB program and participation in physical activity, using a minimally obtrusive survey. After surveying participating schools (4 elementary schools and 3 middle schools), we obtained 1,407 responses from children in grades 5 through 7. RESULTS: In all, 83.1% of students met the federal recommendation for daily participation in vigorous-intensity physical activity (VPA), and 58.6% had tried a new game or sport within the previous 2 months. Mean number of days in the previous week engaging in VPA was significantly higher (P < .

001) for boys (5.22) than for girls (4.35). Mean number of days engaging in VPA in the previous week was significantly higher (P = .006) among 6th-grade students (4.93) than 7th-grade students (4.54), but no consistent decline through the grade levels occurred. Activity was significantly correlated with the number of friends reported as playing a game or sport daily (r = .369, P < .001). Most students (88.8%) reported having seen, read, or heard messages or ads about VERB, a tween-centric national social marketing campaign promoting physical activity and participation in new games and sports. CONCLUSION: Although participation in VPA was high, girls reported significantly fewer days spent engaged in VPA than did boys. We found a modest association between engaging in VPA and having active friends. Capitalizing on leadership from multiple community-based organizations to monitor youth physical activity may inspire implementation of strategies for motivating youth to try new games and sports that they can sustain through the adolescent years and beyond.

McDonald, N. C. (2008). "Household interactions and children's school travel: the effect of parental work patterns on walking and biking to school." Journal Of Transport Geography 16(5): 324-331.

This study evaluates how household interactions affect walking and biking to school. The cross-sectional research design uses a representative sample of trips to school by US youth (n = 8231) to test how parental employment status and commute patterns affect nonmotorized travel. Results from a binary logit model show that young children (5-14) with mothers who commute to work in tile morning are less likely to walk or bike to school after controlling for individual, household, and neighborhood factors. Policymakers may therefore want to create programs that allow parents to share chaperoning responsibilities for the school trip to address parental time constraints. (c) 2008 Elsevier Ltd. All rights reserved.

McKenzie, T. L., B. Baquero, et al. (2008). "Environmental correlates of physical activity in Mexican American children at home." J Phys Act Health 5(4): 579-91.

BACKGROUND: Understanding home environments might shed light on factors contributing to reduced physical activity (PA) in children, particularly minorities. Few studies have used microlevel observations to simultaneously assess children's PA and associated conditions in homes. METHODS: Trained observers assessed PA and associated physical and social environmental variables in the homes of 139 Mexican American children (69 boys, 70 girls; mean age = 6 years) after school. RESULTS: Children spent most time indoors (77%) and being sedentary (74%). Reduced PA was associated with viewing media, being indoors, and parents being present. Increased PA was associated with prompts for PA and other children being present. PA prompts differed by child gender and location and prompter age status. CONCLUSIONS: Children are frequently sedentary at home. Microlevel observations showed PA is associated with potentially modifiable social and physical factors, including spending time outdoors. Studies to determine whether interventions on these correlates can improve children's PA are needed.

Robbins, L. B., M. Stommel, et al. (2008). "Social support for physical activity of middle school students." Public Health Nurs 25(5): 451-60.

OBJECTIVE: To explore gender and age differences in social support and their relationship with physical activity. DESIGN AND SAMPLE: This cross-sectional study with enhanced reliability due to repeated measures involved 105 boys and 101 girls. MEASUREMENTS: Information on sources and forms of social support, as well as physical activity, was obtained from students, who completed the same questionnaire twice, 2 weeks apart. RESULTS: Boys, compared with girls, were more likely to name fathers and less likely to identify sisters. Compared with older boys, older girls were less likely to identify fathers. Older girls were less likely than both younger girls and older boys to name brothers. Students who identified fathers reported more minutes and days of physical activity and had a stronger physical activity self-definition than those who did not name fathers. Students who selected peers and sisters had more minutes of physical activity and a stronger physical activity self-definition, respectively, than those who did not name peers and sisters. Transportation and encouragement were related to physical activity. CONCLUSIONS: Gender differences in social support are not uniform across age groups. Awareness of these differences can inform the development of appropriate physical activity programs.

Robbins, L. B., A. Sikorskii, et al. (2008). "Gender comparisons of perceived benefits of and barriers to physical activity in middle school youth." Res Nurs Health.

Perceived benefits of and barriers to physical activity (PA) reported by 206 middle school boys and girls in a survey were compared. Only "take care of myself, stay in shape, and be healthier" emerged as a greater benefit for girls than boys. Among students not on a sports team, boys reported fewer barriers than girls. Among those selecting an active pursuit, boys perceived more barriers than girls. When controlling for sports team participation and perceived benefits and barriers, boys reported more minutes of vigorous PA than girls. As boys and girls reported relatively similar benefits of and barriers to PA, nurse counseling with both groups can focus on the same information. Effort is particularly needed to increase PA among girls. (c) 2008 Wiley Periodicals, Inc.

Sagatun, A., E. Kolle, et al. (2008). "Three-year follow-up of physical activity in Norwegian youth from two ethnic groups: associations with socio-demographic factors." BMC Public Health 8(1): 419.

ABSTRACT: BACKGROUND: More research on factors associated with physical activity and the decline in participation during adolescence is needed. In this paper, we investigate the levels, change, and stability of physical activity during the late teens among ethnic Norwegians and ethnic minorities, and we examine the associations between physical activity and socio-demographic factors. METHODS: The baseline (T1) of this longitudinal study included 10th graders who participated in the youth part of the

Oslo Health Study, which was carried out in schools in 2000-2001. The follow-up (T2) in 2003-2004 was conducted partly at school and partly by mail. A total of 2489 (1112 boys and 1377 girls) participated both at baseline and at follow-up. Physical activity level was measured by a question on weekly hours of physical activity outside of school. Socio- demographic variables were collected by questionnaire and from data obtained from Statistics Norway. Analysis of variance was used to study the level of and changes (T1 to T2) in physical activity, and the associations between physical activity and sociodemographic factors. Stability in physical activity was defined as the percentage of students reporting the same physical activity both times. RESULTS: Boys were more active than girls at age 15 and 18 years, independent of ethnic background. Among girls, ethnic Norwegians were more active than ethnic minorities. Hours per week spent on physical activity declined in all groups during the follow-up period. Few associations were found between physical activity and socio-demographic factors in both cross- sectional and longitudinal data. Among the ethnic minority girls, 65% reported being physically active 0-2 hours per week at baseline, and 82% of these girls reported the same level at follow up. CONCLUSIONS: The association between physical activity and ethnicity at age 15 years remained the same during the follow-up. Few associations were found between physical activity and socio-demographic variables. A large proportion of ethnic minority girls reported a persistently low physical activity level, and this low participation rate may need special attention.

Salvy, S. J., J. N. Roemmich, et al. (2008). "Effect of Peers and Friends on Youth Physical Activity and Motivation to be Physically Active." J Pediatr Psychol 34(2):217- 225.

OBJECTIVE: To test whether the presence of a peer or a friend increases the motivation to be physically active in overweight and non-overweight youth in a laboratory setting. METHODS: Youth motivation to be physically active as a function of the social context was measured using a computerized relative reinforcing value task to earn points exchangeable for physical and/or sedentary activities. RESULTS: The presence of a friend (p<.001) increased youth's; motivation to be physically active. The presence of a peer increased overweight youth's; motivation to be physically active, whereas this was not the case for lean youth (p=.47). Participants biked a greater distance in the presence of a friend than when alone (p<.001). Overweight youth biked a greater distance in the presence of a peer than when alone, while this was not the case for lean youth (p=.23). CONCLUSIONS: Friendships may increase youth's; motivation to engage in physical activity and promote greater physical activity in non-overweight and overweight youth.

Simsek, E., S. Akpinar, et al. (2008). "The prevalence of overweight and obese children aged 6-17 years in the West Black Sea region of Turkey." Int J Clin Pract 62(7): 1033-8.

OBJECTIVE: To assess the prevalence of overweight and obese Turkish children. Design: Cross-sectional study in school children. SUBJECTS: A total of 6924 children (3281 boys and 3643 girls) aged 6-17 years from the West Black Sea region of Turkey. Measurements: Overweight and obese were defined using international age- and sex- specific cutoff points for body mass index. The data were analysed by age, sex, residence and socioeconomic level. RESULTS: The overall prevalence of overweight and obesity was 10.3% and 6.1% respectively. The overall prevalence of obesity in boys and girls was 7.0% and 5.4%, respectively, and the difference was significant (chi(2) = 8, p = 0.004). The prevalence of obesity in urban and rural areas was 7.7% and 3.9%, respectively, and the difference was significant (chi(2) = 40, p < 0.001). The prevalence of overweight boys and girls in urban areas was 11.6% and 13.2%, respectively, but the difference was not significant (chi(2) = 2, p > 0.05). However, the prevalence of overweight boys and girls in rural areas was 4.8% and 9.4%, respectively, and the difference was significant (chi(2) = 25, p < 0.001). Although the prevalence of obesity differed significantly between boys and girls in urban children (chi(2) = 13, p < 0.001), no significant difference was detected in the prevalence between boys and girls from rural areas (chi(2) = 0.4, p > 0.5). The prevalence of obesity was significantly higher in private schools than in public schools (chi(2) = 48, p < 0.0001). The prevalence of overweight and obese Turkish children aged 6-17 years is considerably lower than in most European countries. The children in urban settings and higher socioeconomic groups had a higher prevalence of overweight and obesity. The Westernisation of the behaviour patterns of children and living in an urban setting in a developing country are risk factors for obesity.

Singh, G. K., M. D. Kogan, et al. (2008). "Racial/ethnic, socioeconomic, and behavioral determinants of childhood and adolescent obesity in the United States: analyzing independent and joint associations." Ann Epidemiol 18(9): 682-95.

PURPOSE: This study examines independent and joint associations between several socioeconomic, demographic, and behavioral characteristics and obesity prevalence among 46,707 children aged 10-17 years in the United States. METHODS: The 2003 National Survey of Children's Health was used to calculate obesity prevalence. Logistic regression was used to estimate odds of obesity and adjusted prevalence. RESULTS: Ethnic minority status, non-metropolitan residence, lower socioeconomic status (SES) and social capital, higher television viewing, and higher physical inactivity levels were all independently associated with higher obesity prevalence. Adjusted obesity prevalence varied by age, gender, race/ethnicity, and SES. Compared with affluent white children, the odds of obesity were 2.7, 1.9 and 3.2 times higher for the poor Hispanic, white, and black children, respectively. Hispanic, white, and black children watching television 3 hours or more per day had 1.8, 1.9, and 2.5 times higher odds of obesity than white children who watched television less than 1 hour/day, respectively. Poor children with a sedentary lifestyle had 3.7 times higher odds of obesity than their active, affluent counterparts (adjusted prevalence, 19.8% vs. 6.7%). CONCLUSIONS: Race/ethnicity, SES, and behavioral factors are independently related to childhood and adolescent obesity. Joint effects by gender, race/ethnicity, and SES indicate the potential for

71 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 considerable reduction in the existing disparities in childhood obesity in the United States.

Sutherland, R., M. Finch, et al. (2008). "Higher prevalence of childhood overweight and obesity in association with gender and socioeconomic status in the Hunter region of New South Wales." Nutrition & Dietetics 65(3): 192-197.

Objective: To determine the prevalence of overweight and obesity in primary school-aged children in the Hunter region and examine associations with gender, age, socioeconomic status (SES) and geographical location. Design: Cross-sectional survey of a stratified sample of randomly selected government primary schools in the Hunter region with SES defined by Socio-Economic Index For Areas index and geographical location based on school education areas. Subjects: A total of 2224 out of 5206 (42.7%) primary school children from randomly selected government primary schools representing year 1 to year 6 (x = 9.61 +/- 1.7). Setting: Sixteen government primary schools in the Hunter Region of New South Wales. Main outcome measures: Overweight and obesity were assessed using the international body mass index cut points, standardised for both age and gender as defined by Cole. Data analyses: Chi square (alpha = 0.05) was used to compare prevalence across categories of gender, age, SES or geographical location. Results: Of the 2224 children who had their height and weight measured, 28.35% (n = 606) were either overweight (n = 415, 19.3%) or obese (n = 191, 9.06%). Significant differences in the prevalence of combined overweight and obesity were observed between children residing in high and low socioeconomic areas, by ages and between boys and girls. Conclusion or application: The prevalence of childhood obesity is high and appears more prevalent in girls, in children residing in low-income areas and at specific ages. Determinants of the observed differences will need to be investigated in order to address the higher prevalence of childhood obesity in high-risk population groups.

Timperio, A., J. Salmon, et al. (2008). "Is dog ownership or dog walking associated with weight status in children and their parents?" Health Promotion Journal Of Australia 19(1): 60-63.

Issue addressed: Several studies have shown that clog owners do more physical activity than non-owners; however, associations with weight Status are unknown. This study examined associations between clog ownership, frequency of dog walking and weight status among children and their parents. Methods: Height and weight were measured for 281 children aged 5-6 years and 864 children aged 10-12 years. One parent reported their own and their partner's height and weight (n = 1,1108), clog ownership, usual frequency their child walks a clog, and usual frequency of walking the clog as a family. Logistic regression analyses were adjusted for sex (children only), physical activity, education, neighbourhood SES, parental weight status (children only) and clustering by school. Results: Dog ownership ranged from 45-57% in the two age groups. Nearly one in four 5-6 year-olds and 37% of 10-12 year-olds walked a clog at least once/week. Weekly clog walking as a family was reported by 24-28% of respondents. The odds of being overweight or obese were lower among younger children who owned a dog (OR=0.5, 95% Cl 0.3-0.8) and higher among mothers whose family walked the clog together (OR = 1.3, 95% Cl 1.0-1.7). Conclusions: Dog ownership may offer some

72 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 protection from overweight among young children. It is important that families with a clog are encouraged to walk or play with it regularly. Associations with weight status may depend on the type of clog owned, length of ownership and the nature of walks or interaction.

Trogdon, J. G., J. Nonnemaker, et al. (2008). "Peer effects in adolescent overweight." J Health Econ 27(5): 1388-99.

This study is the first to estimate peer effects for adolescent weight. We use data from the National Longitudinal Study of Adolescent Health (Add Health) and define peer groups using nominated friends within schools. Endogenous peer groups are accounted for using a combination of school fixed effects, instrumental variables, and alternative definitions of peers (i.e., grade-level peers). Mean peer weight is correlated with adolescent weight, even after controlling endogenous peer groups. The impact of peer weight is larger among females and adolescents with high body mass index. The results are consistent with social multipliers for adolescent overweight policies.

Tsai, A. C. and Y. R. Lin (2008). "Sex and ethnic disparities in weight and height among children of transnational couples, aborigines, and Han Chinese in Taiwan." Nutr Res 28(10): 664-70.

In this study, we examined sex and ethnic disparities in growth and body mass index (BMI) status among schoolchildren of transnational families, the aborigines and Han Taiwanese in Nantou, Taiwan. We tested the hypothesis that cultural and social factors of the transnational couples could impact the growth status of their children. The study also determined the factors associated with the growth status of schoolchildren. A total of 1674 school age children in the county were cluster sampled, and their weight and height data were statistically analyzed by 1-way analysis of variance, chi(2) test, and linear regression analysis according to sex, ethnicity, and residential locations. The institutional review board of Asia University, Taiwan, ROC, approved the study protocol. Results showed that aboriginal boys were significantly shorter in stature than sons of the transnational couples and Han Taiwanese. However, weight and BMI were not different among the 3 groups. Daughters of the transnational couples were significantly shorter and lighter, whereas the aboriginal girls were shorter but not lighter and had significantly greater BMI compared with their Han Taiwanese counterparts. Regression analysis revealed significant associations of weight and BMI with sex and ethnicity. Results suggest that culture plays a role in sex disparity. Ethnic and sex disparities in growth status exist in Taiwan. Aboriginal boys and girls are shorter but not lighter compared with their Han Taiwanese counterparts, whereas daughters but not sons of transnational couples are shorter and lighter compared with Han Taiwanese counterparts. These findings are useful information for the educators and healthcare policy makers for improving diet and health.

van Sluijs, E. M., A. Page, et al. (2008). "Behavioural and social correlates of sedentary time in young people." Br J Sports Med.

OBJECTIVE: To identify behavioural and social correlates of objectively- measured sedentary time in young people. DESIGN: Cross-sectional analysis of data from the European Youth Heart Study (EYHS). SETTING: Schools in Denmark, Estonia, Portugal and Norway. PARTICIPANTS: Invited using a two-stage cluster sampling procedure. Analyses include 2107 children (9-10 years) and adolescents (14-15 years). Assessment of independent variables: Seven behavioral and 15 social variables assessed by parental and computerized child questionnaires. MAIN OUTCOME MEASURE: Sedentary activity as assessed by accelerometry (10-minute blocks at <200 counts/minute). Analyses were stratified by country and interactions with grade and gender were investigated. RESULTS: Adolescents were more sedentary than children (335.4 (SD: 90.4) vs. 217.2 (SD: 75.6) minutes/day, p<0.001). Patterns of associations differed across countries. High computer use and no television viewing before school in Norway, and being sedentary during school-breaks in Estonia were positively associated with sedentary time. No behavioural variables were associated with sedentary time in the Danish and Portuguese models. Socioeconomic position was positively associated with sedentary time in Portugal and Estonia, father inverted exclamation mark|s body mass index negatively in the Estonian model. Norwegian participants with a games console at home and Portuguese participants with a television in their bedroom were more sedentary. CONCLUSIONS: A single strategy aimed at reducing sedentary behaviour is unlikely to be effective across Europe as the target populations and behaviours of focus differ between countries. Targeting high socioeconomic groups in Portugal and Estonia or focusing on reducing computer use in Norway might be effective intervention strategies to reduce overall sedentary time.

Social Environment and Physical Activity/Obesity (Adults)

Ackerson, L. K., I. Kawachi, et al. (2008). "Geography of underweight and overweight among women in India: A multilevel analysis of 3204 neighborhoods in 26 states." Economics & Human Biology 6(2): 264-280.

We investigated the geographic distribution and the relationship with neighborhood wealth of underweight and overweight in India. Using multilevel modeling techniques, we calculated state-specific smoothed shrunken state residuals of overweight and underweight, neighborhood and state variation of nutritional status, and the relationships between neighborhood wealth and nutritional status of 76,681 women living in 3204 neighborhoods in 26 Indian states. We found a substantial variation in overweight and underweight at the neighborhood and state levels, net of what could be attributed to individual-level factors. Neighborhood wealth was associated with increased levels of overweight and decreased levels of underweight, and was found to modify the relationship between personal living standard and nutritional status. These findings suggest that interventions to address, the double burden of undernutrition and overnutrition in India must take into account state and neighborhood characteristics in order to be successful. (C) 2008 Elsevier B.V. All rights reserved.

Annear, M. J., G. Cushman, et al. (2009). "Leisure time physical activity differences among older adults from diverse socioeconomic neighborhoods." Health Place 15(2): 482-90.

This paper examines how neighborhood deprivation potentially affects older adults' participation in leisure time physical activity (LTPA). Recall surveys and semi- structured interviews were conducted with 63 elderly residents of high- and low- deprivation neighborhoods in Christchurch, New Zealand. Results showed that residing in a neighborhood of high socioeconomic deprivation was potentially associated with significantly lower levels of neighborhood-based LTPA and that this effect appeared to be partly mediated by deleterious physical and social environmental conditions. These results suggest that strategies to promote increased participation in LTPA among older adults may need to consider intervening in the physical and social environment in highly deprived neighborhoods.

Casey, A. A., M. Elliott, et al. (2008). "Impact of the food environment and physical activity environment on behaviors and weight status in rural U.S. communities." Prev Med 47(6): 600-4.

OBJECTIVE: To examine the association between weight status and characteristics of the food and physical activity environments among adults in rural U.S. communities. METHOD: Cross-sectional telephone survey data from rural residents were used to examine the association between obesity (body mass index [BMI] >30 kg/m(2)) and perceived access to produce and low-fat foods, frequency and location of food shopping and restaurant dining, and environmental factors that support physical activity. Data were collected from July to September 2005 in Missouri, Arkansas, and Tennessee. Logistic regression models (N=826) adjusted for age, education and gender comparing normal weight to obese respondents. RESULTS: Eating out frequently, specifically at buffets, cafeterias, and fast food restaurants was associated with higher rates of obesity. Perceiving the community as unpleasant for physical activity was also associated with obesity. CONCLUSION: Adults in rural communities were less likely to be obese when perceived food and physical activity environments supported healthier behaviors. Additional environmental and behavioral factors relevant to rural adults should be examined in under-studied rural U.S. populations.

Cohen-Cole, E. and J. M. Fletcher (2008). "Is obesity contagious? Social networks vs. environmental factors in the obesity epidemic." J Health Econ 27(5): 1382-7.

This note's aim is to investigate the sensitivity of Christakis and Fowler's claim [Christakis, N., Fowler, J., 2007. The spread of obesity in a large social network over 32 years. The New England Journal of Medicine 357, 370-379] that obesity has spread through social networks. It is well known in the economics literature that failure to include contextual effects can lead to spurious inference on "social network effects." We replicate the NEJM results using their specification and a complementary dataset. We find that point estimates of the "social network effect" are reduced and become statistically indistinguishable from zero once standard econometric techniques are implemented. We further note the presence of estimation bias resulting from use of an incorrectly specified dynamic model.

Drewnowski, A., C. Rehm, et al. (2009). "Poverty and childhood overweight in California Assembly districts." Health Place 15(2): 631-5.

OBJECTIVES: The goal of the present study was to determine the association between childhood overweight and area-based socioeconomic indicators in California Assembly districts. DESIGN: A cross-sectional ecologic study. PARTICIPANTS: California public school students. MAIN EXPOSURE: Poverty and demographic data for California Assembly districts were based on the 2000 Census and obtained from the UCLA Center for Health Policy Research. OUTCOME MEASURES: Overall and 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

76 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 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

77 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 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

78 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 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

83 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 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

84 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 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

87 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 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

90 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 the MSU IRB. At the beginning and the end of the school year students undergo a CVD risk factor assessment conducted by MSU medical students and graduate students. Key intervention components include eight lesson plans (conducted bi-monthly) designed to promote heart healthy nutrition and PA behaviors conducted by PE teachers with assistance from MSU undergraduate dietetic and kinesiology students (Spartners). The final 10 minutes of each lesson, MSU Spartners conduct small breakout/discussion groups with the 5th grade students. Additionally, each Spartner case manages/mentors two to three 5th grade students using a web-based goal setting and tracking protocol throughout the school year. DISCUSSION: This paper describes the rationale, development, and methods of the Spartners for Heart Health program. This is a multilevel intervention designed to promote heart healthy behaviors and prevent or manage CVD risk factors in children. We believe this will be a viable sustainable intervention that can be disseminated and adopted by other institutions with minimal cost by engaging college students as an integral part of the measurement and intervention teams.

Davey, R. C., T. Cochrane, et al. (2008). "Design of a pragmatic cluster randomised controlled trial: ecological approach to increasing physical activity in an urban community." Contemp Clin Trials 29(5): 774-82.

This study was set up to test an ecological intervention using a pragmatic cluster randomised controlled design (RCT) aimed at increasing physical activity (PA) within the community in a deprived inner-city area in the UK. The research will provide a detailed mapping (using Graphical Information Systems GIS) of the environment at lower super output area (SOA) level in Stoke-on-Trent (SoT) and will evaluate the relationship between the environment, PA behaviour, health and healthcare utilisation. The environmental mapping will aggregate data from a wide range of available databases, augmented by local data gathering and validation, to produce a comprehensive geo-coded map of 10 SOAs (covering a population ~15,000). GIS will be used to derive indices through which to evaluate the relationship between environmental characteristics and levels of physical activity and health, using Hierarchical Linear Modelling (HLM). Environmental indices used will include: proximity of PA spaces and facilities, street connectivity, land use mix, population density, mass transport provision, traffic, safety, crime, proximity of food outlets and shops, "Walkability Index", weather and indices of multiple deprivation (IMD). The areas for mapping, baseline assessment and intervention will be considered in two parts, a) community-based and b) schools-based. The effectiveness of the community-based intervention will be assessed by an independent panel survey conducted at baseline and at 2 years follow-up, with an expected 10% increase in the proportion of the population more active in the intervention arm. Effectiveness of the schools-based intervention will be designed to detect an increase of ~15 min/day in school children's moderate to vigorous PA (MVPA). Resource use, cost, willingness to pay and incidental consequences data will be collected alongside the community-based intervention to enable economic modelling from health and social care, societal, other public service and participant perspectives. Findings from the project will inform public policy for increasing population PA and improving neighbourhoods and urban design.

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 (p<0.001) sitting times. In the intervention community, total daily sitting time decreased more in the participants who increased their step counts (-18 min/day; t=2.5; p=0.012), than in those who did not (no change; t=0.8, ns). CONCLUSIONS: After 1 year of intervention, total, weekday, and weekend day sitting times were reduced in the intervention community, while sitting time increased in the comparison community.

Estabrooks, P. A., M. Bradshaw, et al. (2008). "Determining the impact of Walk Kansas: Applying a team-building approach to community physical activity promotion." Annals Of Behavioral Medicine 36(1): 1-12.

Background Research and practice partnerships have the potential to enhance the translation of research findings into practice. Purpose This paper describes such a partnership in the development of Walk Kansas (WK) and highlights individual and organizational level outcomes. Method Phase 1 examined: (a) the reach of WK, (b) physical activity changes, and (c) maintenance of physical activity changes 6 months after the program was completed. Phase 2 explored WK adoption and sustainability over 5 years. Results WK attracted a large number of participants who were more likely to be female, more active, and older than the adult population within the counties where they resided. Inactive or insufficiently active participants at baseline experienced significant increases in both moderate (p < 0.001) and vigorous (p < 0.001) physical activity. A random selection of participants who were assessed 6 months post-program did not demonstrate a significant decrease in moderate or vigorous activity between program completion and 6-month follow-up. The number of counties adopting the program increased across years, peaking at 97 in 2006 and demonstrated the sustainability of the WK over 5 years. Conclusions WK is effective, has a broad reach, and enables participants to maintain increased activity. It also shows promise for broad adoption and sustainability.

Ferney, S. L., A. L. Marshall, et al. (2008). "Randomized trial of a neighborhood environment-focused physical activity website intervention." Prev Med.

OBJECTIVE: To evaluate the use of a local neighborhood environment-focused physical activity website and its effects on walking and overall physical activity in middle-aged adults. METHOD: One-hundred and six (72% women) inactive adults aged 52+/-4.6 years were randomly allocated to receive access to a neighborhood environment-focused website, (Neighborhood group, n=52) or a motivational- information website (Comparison group n=54). Participants also received eleven emails over the 26 weeks. Study outcomes were objectively-monitored website use, and self- reported total walking (min/wk), total physical activity (min/wk) and neighborhood walking (min/wk) collected at baseline, 12 and 26 weeks. The study was conducted between August 2005 and February 2006 in Brisbane, Australia. RESULTS: Website use was significantly greater among Neighborhood participants (p=0.01). Statistically significant increases in walking and total physical activity were observed in both groups. There was also a statistically significant interaction effect for total physical activity, with Neighborhood group participants maintaining more of their initial increase in physical activity at week-26 (p<0.05). Further, those in the Neighborhood group who used the website more often reported significantly more walking along the community trail at week-26 (p=0.05) compared with those who did not. CONCLUSIONS: A local neighborhood-environment focused physical activity website was more effective at engaging participants than a motivational-information website. Moreover, its use resulted in meaningful increases in physical activity relative to the comparison website.

Ford, M. A. and D. Torok (2008). "Motivational signage increases physical activity on a college campus." Journal Of American College Health 57(2): 242-244.

Objective: The authors evaluated whether motivational signage influenced rates of stair use relative to elevator use on a college campus. Participants: In March and April 2004, the authors observed students, faculty, staff, and any visitors accessing a college campus building. Methods: During Phase I, the authors monitored ascending stair and elevator use at the same time each weekday (Monday-Friday). During Phase II, the authors placed motivational signs encouraging stair use at the bottom of the stairs and outside and inside the elevators. During the third week (Phase III), the authors removed the signs. Results: The authors observed 18,389 ascending trips during the 3 weeks of the study. Motivational signs significantly contributed to an 18.6% increase in stair use in the second week, which was maintained in the following week. Conclusions: The signage intervention successfully enhanced physical activity on a college campus by providing educational health tips that may have served as motivation to choose the stairs.

Gao, Y., S. Griffiths, et al. (2008). "Community-based interventions to reduce overweight and obesity in China: a systematic review of the Chinese and English literature." J Public Health (Oxf) 30(4): 436-48.

BACKGROUND: Overweight and obesity pose a challenge to public health in China. According to Chinese definition, 303 million Chinese are overweight (body mass index, BMI >or= 24 kg m(-2)). Among them, 73 million are clinically obese (BMI >or= 28 kg m(-2)). In line with the global trend, the rate of obesity in China continues to increase, with associated morbidity and mortality. This study was to identify interventions, which are effective in Mainland Chinese society. METHODS: All 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

95 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 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

97 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 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

100 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 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

104 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 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

105 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 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

110 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 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

111 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 and Southern Italy, except for Sardinia, where the values were similar to that of Northern Italy. Beyond BMI, the most frequently collected variables were dietary pattern, physical activity, and lifestyle. School is the main site of investigation; third grades (8-9 years) is the most studied age group. The urgency to develop actions to contrast obesity in childhood is confirmed by the prevalence values observed in the Italian regions.

Cardoso, H. and C. Padez (2008). "Changes in height, weight, BMI and in the prevalence of obesity among 9-to 11-year-old affluent Portuguese schoolboys, between 1960 and 2000." Annals Of Human Biology 35(6): 624-638.

Background: There is a lack of detailed series of growth data that can be used to analyse secular trends in growth and obesity of Portuguese children. Aim: The purpose of this study was to examine the secular trend in height, weight, BMI and in the prevalence of obesity (including overweight), during the last four decades, in a sample of high socioeconomic status Portuguese boys. Subjects and methods: All candidates (9-11 years) to a military boarding school (Colegio Militar) in Lisbon, Portugal, examined between 1962 and 2006 were the subjects of this study. Records of height and weight measured during medical examination were obtained (n=3176). Body mass index (kg m-2) (BMI) was calculated and the International Obesity Taskforce (IOTF) cut-offs were used to define overweight and obesity. Results: The data obtained provide evidence for accelerating rates of overweight and obesity in affluent Portuguese boys, concomitant with a greater secular increase in mean weight, compared to that of height. Obesity (including overweight) more than doubled in the group of 9-year-olds (highest prevalence of 47.3% in 2000) and tripled in the group of 10- and 11-year-olds with greatest changes occurring between 1990 and 2000. Conclusion: The results suggest that a high family income does not necessarily translate into more informed choices about healthy foods and lifestyles, with a strong influence in the prevalence of obesity. This pattern of association between socio-economic status and obesity may reflect a late socio-economic transition of Portugal, compared to that of other high-income countries.

Carnell, S. and J. Wardle (2008). "Appetite and adiposity in children: evidence for a behavioral susceptibility theory of obesity." American Journal Of Clinical Nutrition 88(1): 22-29.

Background: Pressures from the "obesogenic" environment are driving up obesity rates, but adiposity still varies widely within the population. Appetitive characteristics could underlie differences in susceptibility to the environment. Objective: We examined associations between adiposity and 2 appetitive traits: satiety responsiveness and food cue responsiveness in children. Design: Parents of 2 groups of children, 8-11-y-olds (n = 10 364) from a population-based twin cohort and 3-5-y-olds (n = 572) from a community sample, completed the Child Eating Behavior Questionnaire. Adiposity was indexed with body mass index (BMI; in kg/m(2)) SD scores. For the 8-11-y-olds, waist circumference was also recorded and used to derive waist SD scores. Results: In both samples, higher

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

114 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 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<0.001) after adjustment for potential confounders. Participants who did not cycle to school at baseline, but who had changed to cycling at follow-up, were significantly fitter (0.33 W kg(-1)) than those who did not cycle to school at either time point (P=0.001), a difference of 9%. CONCLUSION: Cycling to school may contribute to higher cardiovascular fitness in young people.

Davis, A. M., R. L. James, et al. (2008). "Pediatric obesity attitudes, services, and information among rural parents: a qualitative study." Obesity (Silver Spring) 16(9): 2133-40.

The objective of this study was to learn more about the attitudes concerning pediatric obesity among rural parents, the barriers these parents face in trying to help their children attain a healthy weight status, and the pediatric weight loss services currently available in small rural communities. A series of eight qualitative focus groups were conducted with 21 parents of overweight rural children in third through fifth grade. Eight saturated themes resulted indicating that parents (i) believe overweight children are lazy, (ii) are concerned about the weight of their children, (iii) believe that some individuals will be overweight no matter what they do, and (iv) have tried a variety of techniques to help their children lose weight. Barriers to helping their children lose weight unique to their rural status included lack of weight loss resources in their

115 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 community, lack of exercise facilities, and lack of low-fat or low-calorie options in grocery stores. Rural families of overweight children encounter many barriers to healthier living, some of which are unique to their rural status.

Dencker, M., O. Thorsson, et al. (2008). "Daily physical activity related to aerobic fitness and body fat in an urban sample of children." Scandinavian Journal Of Medicine & Science In Sports 18(6): 728-735.

This study evaluates associations between objectively measured daily physical activity vs aerobic fitness and body fat in children aged 8-11 years. A cross-sectional study of 225 children aged 7.9-11.1 years was performed. Abdominal fat mass (AFM) and total body fat (TBF) were quantified by dual-energy x-ray absorptiometry. TBF was calculated as percentage of total body mass (BF%). Body fat distribution was calculated as AFM/TBF. Aerobic fitness was measured by indirect calorimetry during a maximal cycle ergometer exercise test. Daily physical activity was assessed by accelerometers for 4 days and daily accumulation of moderate-to-vigorous and vigorous activity was calculated. Significant relationships (P < 0.05) existed for vigorous activity vs ln BF% (r=-0.40), ln AFM (r=-0.35), TBF/AFM (r=-0.22) and aerobic fitness (r=0.38), whereas moderate-to-vigorous activity displayed weaker relationships (-0.22, -0.18, -0.12 NS, and 0.25). Multiple regression analyses with inclusion of possible confounders concluded that vigorous activity was independently related to aerobic fitness and ln BF% or ln AFM. Moderate-to-vigorous activity was only independently related to aerobic fitness. In this population, low daily accumulation of vigorous activity was, already in children aged 8- 11 years, associated with more body fat and lower aerobic fitness. A similar relation was not found for daily accumulation of moderate-to-vigorous activity.

Deshpande, A. D., E. A. Dodson, et al. (2008). "Physical Activity and Diabetes: Opportunities for Prevention Through Policy." Physical Therapy 88(11): 1425-1435.

Over the past decade, the prevalence of type 2 diabetes mellitus has reached epidemic levels in the United States and other developed countries. With a concomitant rise in obesity levels in the United States and advances in the treatment of diabetes and its complications, the prevalence of diabetes is expected to continue to rise through the year 2050. Despite strong evidence that regular physical activity can prevent or delay the onset of diabetes, too many Americans are not meeting the recommended levels of regular physical activity. Although most physical activity interventions to date have been focused on characteristics of the individual, more-recent studies have considered how changing characteristics of the social and physical environment in which people live may ultimately have a greater impact on increasing population levels of physical activity. Policy interventions are a way to make sustainable changes in the physical environment of a community and thus provide support for other intrapersonal and interpersonal behavioral change interventions. Policy changes also can affect the social norms that shape behavior. The purposes of this perspective article are: (1) to describe the rationale

116 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 for population approaches to primary prevention of type 2 diabetes, (2) to discuss how policy interventions can increase physical activity levels within populations, and (3) to provide recommendations for the role of physical therapists in interventions that can increase the level of physical activity in communities. Public health approaches to curb the diabetes epidemic are urgently needed. Policy interventions to increase population levels of physical activity show promise for diabetes prevention. Physical therapists are uniquely suited to influence primary prevention efforts for diabetes.

Fagan, H. B., J. Diamond, et al. (2008). "Perception, Intention, and Action in Adolescent Obesity." Journal Of The American Board Of Family Medicine 21(6): 555-561.

Background: Insight into adolescents' weight-loss behavior is needed. Methods: Survey data were obtained from overweight and obese adolescents in the Youth Risk Behavioral Survey (YRBS) in Delaware. Cross tabulations were used to determine the frequency of accurate perception, recent action, and current intention regarding weight loss. Multivariable analysis identified factors associated with recent action to lose weight. Results: From 2728 records, 482 overweight adolescents and 398 obese adolescents were identified. Most obese (83%) and overweight (79%) adolescents reported recent action to lose weight. Most obese (75%) and overweight (65%) adolescents intended to lose weight. Obese and overweight adolescents who reported a current intention to lose weight were more likely to have taken recent action to lose weight (odds ratio [OR], 11.6 and 6.6, respectively). Conclusions: The percentage of obese and overweight adolescents who have an accurate perception of weight, intend to lose weight, and have taken recent action to lose weight suggests that this group is highly engaged in weight-related behavior change. Compared with their obese peers, overweight adolescents seem less engaged in weight change behavior. There is a strong association in both groups between intention and recent action, and this association indicates that obese and overweight adolescents are highly motivated to change their weight. (J Am Board Fam Med 2008; 21: 555-61.)

Faulkner, G. E., R. N. Buliung, et al. (2009). "Active school transport, physical activity levels and body weight of children and youth: a systematic review." Prev Med 48(1): 3-8.

OBJECTIVES: Active school transport (AST) may be an important source of children's physical activity (PA). Innovative solutions that increase PA time for children, without putting added pressure on the school curriculum, merit consideration. Before implementing such solutions, it is important to demonstrate that active school transport is associated with health-related outcomes. METHODS: Following a standardized protocol, we conducted a systematic review of published research to address this question and explore whether children who actively commute to school also have a healthier body weight. Online searches of 5 electronic databases were conducted. Potential studies were screened on the basis of objective measures of physical activity. RESULTS: Thirteen studies were included in this review. Nine studies demonstrated that children who

117 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 actively commute to school accumulate significantly more PA and two studies reported that they expended significantly more kilocalories per day. Where studies examined body weight (n=10), only one reported active commuters having a lower body weight. CONCLUSIONS: These studies demonstrate that active school commuters tend to be more physically active overall than passive commuters. However, evidence for the impact of AST in promoting healthy body weights for children and youth is not compelling.

Fernandes, R. A., J. Casonatto, et al. (2008). "[Risk of overweight in adolescents from different socioeconomic levels]." Rev Assoc Med Bras 54(4): 334-8.

BACKGROUND: To analyze the association between risk factors and presence of overweight in adolescents from different socioeconomic levels. METHODS: A cross- section analysis with 888 youths recruited from both genders with ages ranging from 11 to 17 years was carried out. The body mass index was calculated through body mass and height values, and was used as the overweight indicator. Physical activity, food intake, and socioeconomic levels (high and low) were obtained by questionnaires. Data were analyzed by chi-square test and binary logistic regression. RESULTS: For adolescents in the lower socioeconomic level, both inadequate food intake (Odds Ratio [OR]= 4.59) and parent overweight (OR= 5.33) were associated to overweight. Among adolescents in the higher socioeconomic level, maternal education (OR= 0.57), study in private school (OR= 3.04), and parent overweight (OR= 3.47) were associated to development of overweight. CONCLUSION: In both socioeconomic levels, parent overweight was an important risk factor associated with overweight. The other risk factors were different among the socioeconomic levels.

Foley, L., H. Prapavessis, et al. (2008). "Predicting physical activity intention and behavior in school-age children." Pediatric Exercise Science 20(3): 342-356.

Two studies were conducted to predict physical activity in school-aged children. Study I tested the utility of an integrated model in predicting physical activity (PA) intention and behavior-the theory of planned behavior (TPB) and self-efficacy theory. Six hundred and forty-five New Zealand children (aged 11-13 years) completed measures corresponding to the integrated model and a self-reported measure of PA one week later. Perceived behavioral control (PBC) and subjective norm were the two strongest predictors of intentions. Task efficacy and barrier efficacy were the two strongest predictors of PA. A second study (Study 2) was conducted to determine whether the self- efficacy measures could discriminate objectively measured PA levels. Sixty-seven Canadian children (aged 11-13 years) completed task and barrier self-efficacy measures. The following week, children classified as 'high' (n = 11) and 'lower' (n = 7) for both task and barrier efficacy wore an Actical(R) monitor for seven consecutive days to provide activity-related energy expenditure (AEE) data. Results showed that children with high efficacy expended significantly greater AEE than their lower efficacious counterparts.

Findings from these two studies provide support for the use of self-efficacy interventions as a potentially useful means of increasing PA levels among school-aged children.

Gidlow, C., T. Cochrane, et al. (2008). "In-school and out-of-school physical activity in primary and secondary school children." Journal Of Sports Sciences 26(13): 1411-1419.

The aim of this study was to compare in-school and out-of-school physical activity within a representative sample. Socio-demographic, physical activity, and anthropometric data were collected from a random sample of children (250 boys, 253 girls) aged 3-16 years attending nine primary and two secondary schools. Actigraph GT1M accelerometers, worn for seven days, were used to estimate physical activity levels for in-school (typically 09.00-15.00h), out-of-school (weekday), and weekend periods. Physical activity as accelerometer counts per minute were lower in school versus out of school overall (in school: 437.2172.9; out of school: 575.5202.8; P0.001), especially in secondary school pupils (secondary: 321.6127.5; primary: 579.2216.3; P0.001). Minutes of moderate-to-vigorous physical activity accumulated in school accounted for 29.49.8% of total weekly moderate-to-vigorous physical activity overall but varied by sector (preschool: 37.46.2%; primary: 33.68.1%; secondary: 23.09.3%; F=114.3, P0.001). Approximately half of the children with the lowest in-school activity compensated out of school during the week (47.4%) and about one-third at the weekend (30.0%). Overall, physical activity during the school day appears to be lower than that out of school, especially in secondary school children, who accumulate a lower proportion of their total weekly moderate-to-vigorous physical activity at school than younger children. As low in-school activity was compensated for beyond the school setting by less than half of children, promoting physical activity within the school day is important, especially in secondary schools.

Hudson, C. E. (2008). "Being overweight and obese: Black children ages 2-5 years." Abnf J 19(3): 89-91.

Obesity in children is a significant public health concern. The prevalence of obesity in Black preschoolers (ages 2-5 years) is slightly higher than in whites. However, by age 6, Black children experience higher obesity prevalence. The consequences to health throughout childhood and into adulthood have both medical and economic cost to individuals and society. Factors associated with obesity in preschool children are lifestyle behaviors such as diet, level of activity, culture, environment, and parental perceptions. Programs should target young Black children and their families to reduce the incidence of obesity and promoting healthy behaviors could aid in eliminating health disparities and improving quality of life. Nurses need to provide comprehensive culturally appropriate strategies at community and individual/family levels to prevent overweight and obesity in children.

Hulley, A., N. Bentley, et al. (2008). "Active and passive commuting to school: influences on affect in primary school children." Res Q Exerc Sport 79(4): 525-34.

Active commuting among school children is being encouraged for physical and environmental reasons, but little is known about its influence on affect. The aim of this study was to test the hypothesis that children who walk further to school experience increased arousal and affective valence compared with children who walk a short distance. This was assessed with the children's feeling scale (CFS) and children's felt arousal scale (CFAS). Distance walked to school and affective change between home and school were assessed over a 2-week period in 99 children between 5 and 10 years of age. Home to school differences in CFS and CFAS scores were compared in children who walked a short (100-300 m); medium (301-500 m), and long distance (over 500 m). Although differences were not always statistically significant, there was evidence that the children who walked further reported a greater increase in their CFAS scores between home and school (average eta2 = .08, range: .01-.15) and, to a lesser extent, in their CFS scores (eta2 = .04, range: .002-.06). Further research is needed to explore whether there is an optimum walking distance and the contribution of other factors, especially social contacts during commuting, the environment, and the weather.

Ivanova, L., P. Dimitrov, et al. (2008). "Prevalence of obesity and overweight among urban adults in Bulgaria." Public Health Nutr 11(12): 1407-10.

OBJECTIVE: The prevalence of obesity is increasing in transitional countries, but extensive data on some countries, such as Bulgaria, are still lacking. Therefore, the objective of the present study was to estimate the prevalence of overweight and obesity, relative to gender and income, among adults in Sofia, Bulgaria. DESIGN: Cross-sectional survey to collect data on diet, health, BMI and income using a brief questionnaire on diet and income. Data were analysed using analysis of covariance to determine differences within and between income and gender groups. SETTING: Sofia, Bulgaria. SUBJECTS: Adults living in the city of Sofia, Bulgaria. RESULTS: For adults 30-60 years of age, 35.1 % were overweight and 6.2 % were obese. The proportion of overweight and obesity was higher among men than women (44.8 % v. 32.4 % and 6.0 % v. 4.7 %, respectively). With respect to income, BMI decreased as income increased. For men, BMI was highest for the lowest and highest income groups, whereas for women lower income was associated with a higher BMI. CONCLUSION: The prevalence of overweight and obesity appears to be an emerging problem in some sectors of Bulgarian society, based on our data from the largest urban area of the country. These data provide new information on the divergence in health and disease risk in a country that is still economically challenged and may be facing the nutrition transition.

Ji, C. Y. and T. J. Chen (2008). "Secular changes in stature and body mass index for Chinese youth in sixteen major cities, 1950s-2005." American Journal Of Human Biology 20(5): 530-537.

Evidence shows a secular trend in physical growth in China in recent years. We analyze the secular trend of stature and body mass index (BMI) for the period 1950s- 2005 to provide biological evidence for policy-makers to identify measures for improving Chinese children's health. Data come from the historical records in 1950s and the successive cycles of the Chinese National Survey on Student's Constitution and Health. Subjects were 7- to 18-year-old youth from 16 cities. Sex-age differences in mean stature and BMI values, between the surveys were analyzed, and the increments per decade were compared. An overall positive secular trend was found in 1950s-2005. Mean stature of the 18-year olds increased from 166.6 to 173.4 cm for males and from 155.8 to 161.2 cm for females, yielding rates of 1.3 and 1.1 cm/decade; the overall increments of BMI values were 2.6 for males and 1.8 for females, yielding rates of 0.8 and 0.6/decade, respectively. The most significant changes occurred during puberty. The overall positive secular trend is closely associated with the socioeconomic progress and the improvement of livelihood. Strong evidence suggests that in China this trend will be continued for many years. Further studies are needed to explore how to ensure healthy changes for poorer rural youth. Effective preventive strategies and measures should be taken to prevent the progressive increase in the prevalence of childhood obesity accompanying this trend.

Ji, C. Y. and T. O. Cheng (2008). "Prevalence and geographic distribution of childhood obesity in China in 2005." Int J Cardiol 131(1): 1-8.

China now joins the world epidemic of childhood obesity. Because of the large disparity of environmental conditions across various sub-populations, accurate prevalence of obesity/overweight cannot be estimated by population-based approaches. Using a resident-based targeted approach, we determined the geographical distribution of childhood obesity in China and analyzed the specific factors related to the increasing prevalence of obesity in each of its ten regions. An alarming increase in the prevalence of obesity has spread all over China, except for the poverty western rural areas. In 2005, the prevalence of combined childhood overweight and obesity in China reached 32.5% for males and 17.6% for females in the northern coastal big cities, suggesting that the obesity prevalence in some urban Chinese populations has approached that of the developed countries. The prevalence of obesity in the affluent rural sub-populations first exceeded that in some urban populations; then, as they learned their lessons and revised their lifestyles, the prevalence declined to a lower level approaching that of the transitional societies of other countries. The geographical distribution of obesity prevalence in China is mainly caused by the large disparity in the socioeconomic status related to dietary and lifestyle changes in modern China. Multiple and integrated interventions are urgently needed to halt the epidemic of childhood obesity by tackling its basic causes such as fast food, automobiles, television and lack of exercise. The differing prevalences in different regions of China offer an opportunity to reverse this alarming, growing epidemic of childhood obesity in the world's most populous country.

Ji, C. Y. and T. O. Cheng (2009). "Epidemic increase in overweight and obesity in Chinese children from 1985 to 2005." Int J Cardiol 132(1): 1-10.

This study tracks the temporal changes in prevalence of childhood and adolescent overweight and obesity in different regions of China from 1985 to 2005. Using a series data of the Chinese National Survey on Students Constitution and Health, we compared the temporal changes over a 20-year period of the prevalence of overweight and obesity among ten regions in China for school-aged children between 7 and 18 years of age. Large disparities in the temporal changes of obesity prevalence exist in different regions of China. North coastal residents, especially those of the upper socioeconomic status, had the earliest and largest increase in prevalence. Similar increases then followed successively in other regions of upper, moderate and low socioeconomic status, and finally in the affluent rural regions. No significant increase was found in the developing rural areas. Regions where the obesity epidemic occurred late also began to show rather rapid increases in prevalence in recent years. In 2005, the national estimates indicated that 7.73% of Chinese youth are overweight and 3.71% of them are obese, representing an estimated 21.37 million Chinese children (13.43 million boys and 7.94 million girls).

Kamtsios, S. and N. Digelidis (2008). "Physical activity levels, exercise attitudes, self- perceptions and BMI type of 11 to 12-year-old children." J Child Health Care 12(3): 232- 40.

This study examined elementary school pupils with different body mass index (BMI) as to attitudes towards exercise, self-perception, lesson satisfaction in physical education and participation in physical activity. Seven hundred and seventy-five pupils participated in this study, aged 11-12 years. The study was conducted through questionnaires. Students were divided according to their BMI: normal, overweight and obese. Two-way analysis of variance was used, with gender and BMI type as independent variables. The results revealed that when compared to students with a normal BMI, the obese and overweight students had lower scores in lesson satisfaction, negative views of their body and reduced levels of physical activity. Also, the results showed that the obese and overweight students adopted more sedentary daily habits, such as many hours of TV watching and PC usage. The results of this study imply the need for necessary school interventions in order to encourage healthier behaviours and habits.

Katzmarzyk, P. T., L. A. Baur, et al. (2008). "International conference on physical activity and obesity in children: summary statement and recommendations." Applied Physiology Nutrition And Metabolism-Physiologie Appliquee Nutrition Et Metabolisme 33(2): 371-388.

The increasing prevalence of obesity among the world's children and youth was the impetus for an international conference convened in Toronto, Canada, to examine issues related to physical activity and obesity in children (24-27 June 2007). The goal of

122 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 the conference was to assimilate, interpret, and share scientific evidence with key stakeholders to develop recommendations concerning effective physical activity policies and programs to address obesity in children. The conference was attended by approximately 1000 delegates from 33 countries who gathered to listen to the invited speakers and to share information on promising practices related to the promotion of physical activity with the aim of reducing the burden of obesity in children. The major topics addressed at the conference included the biological and behavioural causes of obesity, current and past levels of physical activity and sedentarism in children, the role of the social, family, and built environments in addressing the physical activity deficit, and the role of legislation and industry in promoting physical activity. Promising physical activity interventions among children were presented, and important research, policy, and practice recommendations to address the issue of physical inactivity and obesity were provided.

Kral, T. V. E., A. J. Stunkard, et al. (2008). "Beverage consumption born at different risk of patterns of children obesity." Obesity 16(8): 1802-1808.

Background: Increased intake of sugar-sweetened beverages and fruit juice has been associated with overweight in children. Objective: This study prospectively assessed beverage consumption patterns and their relationship with weight status in a cohort of children born at different risk for obesity. Methods and Procedures: Participants were children born at low risk (n = 27) or high risk (n = 22) for obesity based on maternal prepregnancy BMI (kg/m(2)). Daily beverage consumption was generated from 3-day food records from children aged 3-6 years and coded into seven beverage categories (milk, fruit juice, fruit drinks, caloric and noncaloric soda, soft drinks including and excluding fruit juice). Child anthropometric measures were assessed yearly. Results: High-risk children consumed a greater percentage of daily calories from beverages at age 3, more fruit juice at ages 3 and 4, more soft drinks (including fruit juice) at ages 3-5, and more soda at age 6 compared to low-risk children. Longitudinal analyses showed that a greater 3-year increase in soda intake was associated with an increased change in waist circumference, whereas a greater increase in milk intake was associated with a reduced change in waist circumference. There was no significant association between change in intake from any of the beverage categories and change in BMI z-score across analyses. Discussion: Children's familial predisposition to obesity may differentially affect their beverage consumption patterns. Future research should examine the extent to which dietary factors may play a role in pediatric body fat deposition over time.

Kumar, H. N. H., P. Mohanan, et al. (2008). "Prevalence of overweight and obesity among pre-school children in semi urban South India." Indian Pediatrics 45(6): 497-499.

This study was conducted to ascertain the prevalence of overweight and obesity in 425 pre-school children (2 to 5 years) using the new Child Growth Standards released by the World Health Organization. Overweight and obesity were defined as body mass index

(BMI) > 85th and 95th percentiles for that age and sex, respectively. The prevalence of overweight and obesity was 4.5% and 1.4%, respectively.

Kurokawa, N., K. Nakai, et al. (2008). "Trends in growth status among schoolchildren in Sendai, Japan, 1994-2003: leveling-off of mean body height and weight." Tohoku J Exp Med 216(4): 371-5.

Secular changes in growth have been well documented in various world populations, with secular increase especially noticeable in the developed countries. Accordingly, we have been monitoring the secular changes in growth status among the 6th year children in primary schools (6thPS, 11-12 years old) and 3rd year children in junior high schools (3rdJHS, 14-15 years old) in the city of Sendai since 1934. After World War II, both primary school children and junior high school students showed marked increases in height and weight up to the early 1970s. Acceleration and the subsequent reduction in the degree of acceleration in growth were observed in 1965-1974 and 1975-1984, respectively, and were followed by reacceleration in 1985-1994. The aim of this study was to assess the growth changes among Sendai schoolchildren in 1994- 2003. The period between 1994 and 1999 was characterized by positive trends both in height and weight among schoolchildren. However, the degree of the increases in height and weight was diminished between 1999 and 2003. The linear regression analysis revealed the significant increases in mean weight during the 10-year study period in 6thPS boys and 3rdJHS boys and girls. In contrast, there was no significant increase in mean height in any group. These findings suggest the leveling-off of the mean body height and weight among schoolchildren in Sendai at the end of the 20th century. Additional study is needed to examine possible explanations and consequences of these secular trends.

Lagiou, A. and M. Parava (2008). "Correlates of childhood obesity in Athens, Greece." Public Health Nutr 11(9): 940-5.

OBJECTIVE: Childhood obesity is a growing public health problem. We have examined the association between sociodemographic profile and eating and physical activity patterns with overweight among primary-school students in Athens, Greece. DESIGN: Cross-sectional study. SETTING: Eleven primary schools in the greater Athens area, Greece. SUBJECTS: A total of 633 children aged 10-12 years (50 % boys, 50 % girls) were interviewed in person during spring 2003. Multivariate logistic regression was used to investigate the association between eating and physical activity patterns and overweight (> or =85th sex- and age-specific BMI centile). Results are presented as odds ratios and 95 % confidence intervals. RESULTS: Overweight was more common among girls than among boys (OR=1.73; 95% CI 1.11, 2.69) and substantially less common among children born outside Greece (OR=0.46; CI 0.22, 0.95). Reported physical activity (per 1.5 h per day) was unrelated to overweight (OR=0.97; CI 0.85, 1.12) but patent physical inactivity, operationalised as time spent

124 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 watching television or working/playing with the computer (per 1.5 h per day) was a highly significant predictor of overweight (OR=1.20; CI 1.05, 1.36). Composition of diet was unrelated to overweight but the daily number of eating occasions, controlling for total energy intake, was significantly inversely associated with overweight (OR=0.61; CI 0.48, 0.76). CONCLUSIONS: The principal factor underlying overweight among children in Athens appears to be the extended inactivity imposed by modern childhood lifestyles. An intriguing finding is that spreading a given energy intake over several eating occasions was inversely associated with the likelihood of childhood obesity.

Laurson, K. R., J. C. Eisenmann, et al. (2008). "Combined influence of physical activity and screen time recommendations on childhood overweight." Journal Of Pediatrics 153(2): 209-214.

Objectives To examine the combined influence of physical activity and screen time (television and video games) on the odds of being overweight and to evaluate the utility of current public policy recommendations. Study design Physical activity was assessed by a pedometer and screen time was assessed by survey in a sample of 709 children age 7 to 12 years. The percentage of subjects meeting current physical activity and screen time recommendations was calculated. Cross-tabulated physical activity- screen time groups were formed depending on whether or not the children were meeting current recommendations. Logistic regression was used to examine the influence of physical activity and screen time on the odds of being overweight. Results Children meeting physical activity and screen time recommendations were the least likely to be overweight. Approximately 10% of the boys and 20% of the girls meeting both recommendations were overweight, compared with 35% to 40% of those who did not meet either recommendation. Screen time and physical activity appeared to be equivalent risk factors for boys, even though physical activity in girls was more strongly associated with body mass index. Conclusions Children not meeting the physical activity or screen time recommendations were 3 to 4 times more likely to be overweight than those complying with both recommendations.

Lee, M. C., M. R. Orenstein, et al. (2008). "Systematic review of active commuting to school and childrens physical activity and weight." J Phys Act Health 5(6): 930-49.

BACKGROUND: The recent decline in children's active commuting (walking or biking) to school has become an important public health issue. Recent programs have promoted the positive effects of active commuting on physical activity (PA) and overweight. However, the evidence supporting such interventions among schoolchildren has not been previously evaluated. METHODS: This article presents the results of a systematic review of the association between active commuting to school and outcomes of PA, weight, and obesity in children. RESULTS: We found 32 studies that assessed the association between active commuting to school and PA or weight in children. Most studies assessing PA outcomes found a positive association between active commuting

125 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 and overall PA levels. However, almost all studies were cross-sectional in design and did not indicate whether active commuting leads to increased PA or whether active children are simply more likely to walk. Only 3 of 18 studies examining weight found consistent results, suggesting that there might be no association between active commuting and reduced weight or body mass index. CONCLUSION: Although there are consistent findings from cross-sectional studies associating active commuting with increased total PA, interventional studies are needed to help determine causation.

Loucaides, C. A. and R. Jago (2008). "Differences in physical activity by gender, weight status and travel mode to school in Cypriot children." Prev Med 47(1): 107-11.

OBJECTIVE: More information about children's physical activity during different periods of the day is needed. The purpose of this study was to describe children's physical activity during the segmented school day and examine potential differences during different periods of the day across gender, travel mode to school and weight status. METHODS: School children (N=247) wore pedometers for four consecutive school days and recorded their steps during the before school period, the 20-min school break, the whole school period, the after school period and for the whole day. Children also reported how they traveled to school. Data were collected in Cyprus, in January/February of 2007. RESULTS: T-tests indicated that boys took significantly higher steps than girls throughout all the segments of the day (p<0.001) and children who walked to school exhibited higher step counts during the before school period (p<0.001), the after school period (p<0.01), and the whole day (p<0.01) in comparison to children who used motorized transport. A three-way ANOVA revealed significant two-way interactions between weight status and travel mode to school. CONCLUSION: Results suggest that there is a need to promote physical activity among children, especially among girls. Promoting active transport to school may further enhance the effectiveness of intervention programs.

Mackett, R. L. and J. Paskins (2008). "Children's physical activity: The contribution of playing and walking." Children & Society 22(5): 345-357.

This paper draws on research in which 200 children were fitted with motion sensors and asked to keep travel and activity diaries. The findings show that walking and playing away from home can contribute significantly to children's volume of physical activity, with consequent implications for their health. Not only do both playing and walking provide high levels of physical activity, they are linked to other behaviours which further augment the level of physical activity. Children who walk rather than use the car tend to be generally more active than other children, and children tend to be more active when they are out of their homes than when they are in them. The findings are placed in the context of other research about children's travel and physical activity, and conclusions drawn about the need to reverse current trends in children's patterns of travel

Maher, E. J., G. H. Li, et al. (2008). "Preschool child care participation and obesity at the start of kindergarten." Pediatrics 122(2): 322-330.

OBJECTIVE. We examined the association between type of child care, participation in different types of child care in the year before kindergarten and the likelihood of obesity at the start of kindergarten. METHODS. Using a nationally representative sample of 15 691 first-time kindergartners from the Early Childhood Longitudinal Study-Kindergarten Cohort, we used logistic regression to estimate the relationship between type of primary child care arrangement and children's likelihood of being obese at the start of kindergarten. Our models controlled for family and child characteristics associated with obesity and choice of child care. To examine differential effects of child care participation for groups at high risk for obesity, we tested interactions between children's ethnicity and income with primary type of child care. RESULTS. At the start of kindergarten, 12% of the children were obese. Without controlling for other characteristics of children and families, children not in child care were significantly less likely and children in family, friend, and neighbor care were significantly more likely to be obese than children in other primary child care arrangements. White children were significantly less likely and Latino children more likely to be obese than children of other ethnic groups. After controlling for relevant child and family characteristics, children in family, friend, and neighbor care and non-Latino children in Head Start were more likely to be obese than children not in child care. For Latino children, however, participation in some types of nonparental child care had protective effects on their likelihood of being obese. CONCLUSIONS. Primary type of child care is associated with children's obesity. For Latino children, who are at a greater risk of being obese, participation in nonparental child care seems to have a protective effect. These results suggest that child care settings may be an important site for policy intervention during a crucial developmental period. Efforts to help family, friend, and neighbor caregivers support children's physical health may be warranted.

Malina, R. M., M. E. P. a. Reyes, et al. (2008). "Physical activity in youth from a subsistence agriculture community in the Valley of Oaxaca, southern Mexico." Applied Physiology, Nutrition & Metabolism 33(4): 819.

Observations of activities of contemporary subsistence agricultural communities may provide insights into the lifestyle of youth of 2 to 3 generations ago. The purpose of this study was to document age- and sex-associated variation in household activities and daily steps walking to school of youth 9-17 years in an indigenous subsistence agricultural community in Oaxaca, southern Mexico. Activities during leisure were also considered. A cross-sectional survey of a rural Zapotec-speaking community was undertaken, and respondents included 118 boys and 152 girls, aged 8.7-17.9 years.

Household and leisure activities were documented by questionnaire and subsequent interview. Household activities were classified by estimated intensity for before and after school and on the weekend, and an estimate of METS per day accumulated while doing chores was derived. Number of steps from home to school was estimated. Contingency table analysis and MANCOVA controlling for age was used to evaluate results. Household activities tended to cluster at light and moderate intensities in girls and at moderate to moderate-to-vigorous intensities in boys. Estimated METS per day in ~2 h of chores differed significantly by sex. Secondary school girls expended significantly more METS per day in chores than primary school girls, but there was no difference by school level in boys. The daily round trip from home to school was ~2400 steps for primary students and ~2700 and ~3100 steps for secondary boys and girls, respectively. Television viewing and participation in sports were major leisure activities for boys and girls. Daily household chores, walking, and leisure activities suggest moderately active and moderately-to-vigorously active lifestyles in girls and boys, respectively, in this indigenous subsistence agricultural community. Lâ€™observation des activitÃ©s des communautÃ©s agricoles contemporaines travaillant Ã des fins de subsistance peut nous donner une image du... ABSTRACT FROM AUTHOR

Martinez, S. M., G. X. Ayala, et al. (2008). "Active transportation and acculturation among Latino children in San Diego County." Prev Med 47(3): 313-8.

OBJECTIVES: To examine multiple measures of acculturation and their association with walking to school in a large population-based sample in San Diego, California. METHODS: The sample consisted of predominantly Latino children and their parents (n=812) who participated in a study to maintain healthy weights from kindergarten through 2nd grade (2004-2007). Acculturation and walking/driving to and from school were assessed through parent-proxy surveys. RESULTS: Children of foreign-born child-parent dyads walked to school more frequently than their counterparts (F=7.71, df=5, 732, p<.001). Similarly, parents who reported living in the U.S. for less than or equal to 12 years reported more walking to school by their children compared with parents living in the U.S. for more than 12 years (F=10.82, df=4, 737, p<.001). Finally, English-speaking females walked to school more frequently than Spanish- speaking and bilingual females. CONCLUSION: This study explores Latino children's walking to and from school using four measures of acculturation. In this cross-sectional study, being less acculturated was associated with more walking to school among children living in South San Diego County.

Muth, N. D. (2008). "Preventing Childhood Obesity." IDEA Fitness Journal 5(7): 58.

The article looks at the efforts to overcome childhood obesity in the U.S. Prevalence of obesity increased from 5% in the 1960s to 17% in 2004. The Office of the Surgeon General launched the Childhood Overweight and Obesity Prevention Initiative to coordinate and expand programs for preventing obesity. A fitness facility was

128 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 introduced by Overtime Fitness Inc. founders to address the special interests and needs of teens. Highlights of the report "Progress in Preventing Childhood Obesity: How Do We Measure Up?" are presented.

Nader, P. R., R. H. Bradley, et al. (2008). "Moderate-to-vigorous physical activity from ages 9 to 15 years." Jama 300(3): 295-305.

CONTEXT: Decreased physical activity plays a critical role in the increase in childhood obesity. Although at least 60 minutes per day of moderate-to-vigorous physical activity (MVPA) is recommended, few longitudinal studies have determined the recent patterns of physical activity of youth. OBJECTIVE: To determine the patterns and determinants of MVPA of youth followed from ages 9 to 15 years. DESIGN, SETTING, AND PARTICIPANTS: Longitudinal descriptive analyses of the 1032 participants in the 1991-2007 National Institute of Child Health and Human Development Study of Early Child Care and Youth Development birth cohort from 10 study sites who had accelerometer-determined minutes of MVPA at ages 9 (year 2000), 11 (2002), 12 (2003), and 15 (2006) years. Participants included boys (517 [50.1%]) and girls (515 [49.9%]); 76.6% white (n = 791); and 24.5% (n = 231) lived in low-income families. MAIN OUTCOME MEASURE: Mean MVPA minutes per day, determined by 4 to 7 days of monitored activity. RESULTS: At age 9 years, children engaged in MVPA approximately 3 hours per day on both weekends and weekdays. Weekday MVPA decreased by 38 minutes per year, while weekend MVPA decreased by 41 minutes per year. By age 15 years, adolescents were only engaging in MVPA for 49 minutes per weekday and 35 minutes per weekend day. Boys were more active than girls, spending 18 and 13 more minutes per day in MVPA on the weekdays and weekends, respectively. The rate of decrease in MVPA was the same for boys and girls. The estimated age at which girls crossed below the recommended 60 minutes of MVPA per day was approximately 13.1 years for weekday activity compared with boys at 14.7 years, and for weekend activity, girls crossed below the recommended 60 minutes of MVPA at 12.6 years compared with boys at 13.4 years. CONCLUSION: In this study cohort, measured physical activity decreased significantly between ages 9 and 15 years.

Neovius, M. and F. Rasmussen (2008). "Evaluation of BMI-based classification of adolescent overweight and obesity: choice of percentage body fat cutoffs exerts a large influence. The COMPASS study." Eur J Clin Nutr 62(10): 1201-7.

OBJECTIVE: To determine the impact of commonly used body fat percentage (%BF) references when evaluating the sensitivity, specificity and misclassifications of body mass index (BMI) for obesity screening in adolescence. SUBJECTS/METHODS: A community-based sample of 3334 adolescents aged 15.2+/-0.6 years was studied. Weight, height and %BF were measured. Sensitivity, specificity, predictive values and type and extent of misclassifications were calculated. True-positive subjects for overweight and obesity were defined by recently published paediatric %BF cutoffs, 85th and 95th

129 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 percentiles from the present study population, and an older %BF reference. RESULTS: Regardless of %BF reference used, specificities were high (>0.98 for obesity and >0.90 for overweight) in both sexes, with values for overweight consistently higher for girls (P<0.05). Sensitivities were much lower, with boys ranging from 0.52 to 0.74 for overweight, and 0.24 to 0.43 for obesity. Corresponding sensitivities for girls were 0.42- 0.66 and 0.22-0.46. Large discrepancies were seen in total number of misclassifications, with published references resulting in twice as many misclassified for overweight (620, 514 vs 362) when compared to the cutoffs from the study population. For obesity, the difference was even greater (367 vs 133). CONCLUSIONS: No matter which %BF reference used, specificity of BMI was high, and sensitivity low for both sexes. Population percentiles resulted in somewhat lower specificity but much higher sensitivity, and many more correctly classified compared to when cutoffs from the literature were used. The choice of %BF reference in evaluations of BMI-based classification systems has a large impact on the outcome. Sensitivity analyses are therefore warranted.

Oulamara, H., A. Nacer Agli, et al. (2008). "Changes in the prevalence of overweight, obesity and thinness in Algerian children between 2001 and 2006." Int J Pediatr Obes: 1- 3.

Annual cross-sectional studies were performed between 2001 and 2006 in Algeria in order to evaluate the nutritional status and determine the changes in prevalence of categories of nutritional status, according to the International Obesity Task Force (IOTF) criteria for overweight and obesity and Cole's criteria for thinness. A total of 19263 children aged 6 to 10 years originating from three economically different areas were enrolled in the study. The overall prevalence of thinness decreased from 34.3% (95% CI: 32.4-36.2) to 24.5% (95% CI: 22.6-26.4) (p<0.0001). Overweight, including obesity, increased from 6.8% (95% CI: 5.7-7.8) to 9.5% (95% CI: 8.2-10.8) (p=0.001) mainly due to overweight excluding obesity. Children in urban areas showed the most marked decrease in thinness and increase in overweight as opposed to those from rural areas where overweight and obesity remained stable over time.

Ozturk, A., M. M. Mazicioglu, et al. (2008). "Reference Body Mass Index Curves for Turkish Children 6 to 18 Years of Age." Journal Of Pediatric Endocrinology & Metabolism 21(9): 827-836.

Aim: To determine reference body mass index (BMI) curves for Turkish children 6 to 18 years old and to compare with BMI in other countries. Methods: A cross-sectional study conducted in Kayseri, Turkey. A total of 5,727 children (2,942 girls, 2,785 boys) aged between 6 and 18 years were selected to construct a reference curve using LMS method. Results: BMI age reference charts of Turkish children were constructed. The 50(th) percentile curve of Turkish girls is lower than Italian and Turkish girls in The Netherlands but higher than Iranian girls. The 50(th) percentile curve of Turkish boys is

130 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 lower than Italian and Turkish boys in The Netherlands and similar to Iranian boys after 13 years of age. Conclusion: BMI references of Turkish children are lower than in South East Europe, UK and North American populations, but higher than in Central European and Scandinavian countries.

Pearce, A., R. Jenkins, et al. (2008). "An evaluation of UK secondary data sources for the study of childhood obesity, physical activity and diet." Child Care Health And Development 34(6): 701-709.

Background This study assesses the potential of secondary datasets for measuring recent and future trends in childhood obesity, physical activity and diet in the UK, at national, regional and sub-regional levels, and in relation to inequalities. Methods Relevant datasets were identified using online searches; they were excluded if they had low sample sizes, were assembled prior to 1990 or on only one occasion, were not potentially accessible, or were limited to a specific population. Remaining datasets were assessed according to content, sampling frame and size, timing and ability to be used to assess inequalities and regional trends. Results A total of 96 datasets were identified, but only 11 had the potential to be used to assess trends. Eight of these contained data on physical activity, 8 on diet and 3 on obesity. The period over which trends might be assessed varied from 2 years to over 10, with over half of the datasets expected to continue data collection into the future. Most had the potential to be used to assess inequalities and also regional and sub-regional level trends, albeit with relatively small sample sizes. There were some limitations to the datasets, such as non-objective measures of diet and physical activity and, in some, low response rates, which would require further consideration when utilizing individual datasets. Conclusions Awareness of the potential of secondary datasets for monitoring trends in childhood obesity should be raised, alongside the financial and intellectual capacity to enhance and exploit them.

Raudsepp, L., I. Neissaar, et al. (2008). "Longitudinal Stability of Sedentary Behaviors and Physical Activity During Early Adolescence." Pediatric Exercise Science 20(3): 251.

The purpose of this study was to examine the stability of sedentary behaviors and physical activity in Estonian school children aged 11-12 year at the beginning of the study. In addition, the consequence of changes in sedentary behaviors on a change in physical activity was investigated. Adolescents (N = 345) completed the 3-Day Physical Activity Recall on four occasions over a 22-month period. Results indicated the curvilinear changes in sedentary behaviors and physical activity across time. There was a significant decrease in physical activity and an increase in sedentary behaviors across three years. Stability coefficients indicated a moderate differential stability of the sedentary behaviors (ranged from 0.31 to 0.64) and physical activity (ranged from 0.36 to 0.59) during early adolescence. Latent growth modeling indicated that increase in sedentary behaviors across a 22-month period was inversely associated with a change in

131 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 physical activity. Interventions targeted at "high-risk" groups to reduce sedentary behaviors during early adolescence are encouraged.

Savva, S. C., M. J. Tornaritis, et al. (2008). "Prevalence of overweight and obesity among 11-year-old children in Cyprus, 1997-2003." International Journal Of Pediatric Obesity 3(3): 186-192.

Objectives. To report 5-year changes in the prevalence of overweight and obesity in 11-year-old children in Cyprus. Methods. This was a school-based study performed in Cyprus. A total of 14 090 11-year-old children (males: 51.2%), who had been examined in the 1997-8 and 2002-3 school years, were included in the study. The International Obesity Task Force (IOTF) cut-offs were used to define overweight and obese subjects, and logistic regression models were used to estimate 5-year trends. Results. The overall prevalence of overweight children was slightly higher in the second period but this change was not statistically significant. There was only a significant increase in overweight boys in rural areas; odds ratio (OR) (95% confidence interval [CI]) for the 5- year period was 1.33 (1.10, 1.62; p = 0.004). The overall relative increase in obesity was 17.9% and the OR (95% CI) was 1.22 (1.07, 1.38; p = 0.003). Although the prevalence of obesity was higher in males in both periods, the relative increase was substantially higher in females, 29.6% vs. 11.4%. The relative increase was also higher in rural (35.9%) compared with urban areas (8.7%); ORs (95% CI) 1.46 (1.17, 1.81) vs. 1.10 (0.94, 1.29), respectively. Conclusions. This is the first report documenting increasing rates of obesity among school-aged children in Cyprus. Females and children living in rural areas experienced the most striking increases. The prevalence of overweight increased only in males living in rural areas.

Sirard, J. R., M. Y. Kubik, et al. (2008). "Objectively Measured Physical Activity in Urban Alternative High School Students." Medicine And Science In Sports And Exercise 40(12): 2088-2095.

Introduction: Alternative high school (AHS) students are an underserved population of youth at greater risk for poor health behaviors and outcomes. Little is known about their physical activity patterns. Purpose: The purpose of this study was to describe 1) physical activity levels of students attending alternative high schools (AHS) in St. Paul/Minneapolis, MN, and 2) compliance with wearing a physical activity accelerometer. Methods: Sixty-five students (59% male, 65% <18 yr old, 51% African American, 17% Caucasian, 32% mixed and other) wore an accelerometer during all waking hours for 7 d as part of the baseline assessment for a school-based physical activity and dietary behavior intervention. Accelerometer data were reduced to summary variables using a custom software program. Compliance with wearing the accelerometer was assessed by the number of days with >= 10 h of data. Accelerometer counts per minute and minutes spent in moderate-to-vigorous physical activity (MVPA) were calculated. Results: Students averaged 323 +/- 143.0 counts.min(-1) and 51 +/- 25.5

132 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 min.d(-1) of MVPA. Minutes of MVPA.d(-1) were greater on weekdays compared with the weekend (52 +/- 27.3 vs 43 +/- 39.7 min.d(-1), respectively; P = 0.05). However, students wore the accelerometer less on the weekends (weekdays 17.2 +/- 3.0, weekend = 14.9 +/- 6.8 h.d(-1)) Expressing minutes of MVPA as a percentage of the number of minutes of available data. students spent approximately 5% of their time in MVPA on weekdays and weekends. Forty-five percent of students had 7 d of data, 51% had 4-6 d, and 5% had fewer than 4 d. On average, students wore the accelerometer for 17 +/- 3.2 h.d(-1) (range = 12.0-23.8 h.d(-1)). Conclusion: Compliance was high (95% of students provided at least 4 d of data), and physical activity was relatively low representing a vulnerable population in need of further study and intervention.

Smith, D. T., R. T. Bartee, et al. (2009). "Prevalence of overweight and influence of out- of-school seasonal periods on body mass index among American Indian schoolchildren." Prev Chronic Dis 6(1): A20.

INTRODUCTION: The prevalence of overweight and obesity among American Indian youth may be 2 to 3 times higher than the national average. Whether weight gain during discrete out-of-school periods is occurring and contributing to the prevalence of overweight and obesity in this population is unknown. METHODS: We obtained repeated cross-sectional body mass index (BMI) samples from third-, fourth-, fifth-, seventh-, and eighth-grade boys and girls who reside on the Wind River Indian Reservation in central Wyoming. We collected measures at the beginning of 2 school years (N = 251), during 2 holiday breaks (N = 226), and during 1 summer recess (N = 141). We determined prevalence of normal weight and overweight among participants by grade level, and we calculated paired comparisons of BMI, BMI z score, and weight status during the holiday breaks and summer recess. RESULTS: Combined prevalence of at risk for overweight and overweight was 62.0% for boys and 56.6% for girls. For fifth- grade girls, significant increases in BMI (P = .01) and z score (P < .001) occurred over the holiday break. BMI increased significantly over the summer among third- and fifth- grade girls and among fourth-grade boys, but changes in z scores were nonsignificant. We observed an increase in weight status by out-of-school time in BMI (P < .001) for schoolchildren at or above the 85th BMI percentile over the summer recess, but corresponding z scores did not change. CONCLUSION: Prevalence of overweight among American Indian schoolchildren was higher than national estimates and higher than the prevalence in other similarly aged American Indian youth. Increases in BMI during out- of-school periods are likely due to normal growth, except among fifth-grade girls.

So, H. K., E. A. S. Nelson, et al. (2008). "Secular changes in height, weight and body mass index in Hong Kong Children." Bmc Public Health 8.

Background: Large population growth surveys of children and adolescents aged 6 to 18 y were undertaken in Hong Kong in 1963 and 1993. The global epidemic of obesity is a major public health concern. To monitor the impact of this epidemic in Hong Kong

133 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 children and to identify secular changes in growth, a further growth survey was undertaken in 2005/6. Methods: Cross-sectional height and weight measurements of 14,842 children and adolescents aged 6 to 18 y from Hong Kong's 18 districts were obtained during the 2005/6 school year. Percentile curves were constructed using LMS method and sex-specific percentile values of weight-forage, height-for-age, and BMI-for- age were compared with those data from 1963 and 1993. Results: Secular changes in height, weight and BMI were noted between 1963 and 1993 and between 1993 and 2005/6. In the latter period, greater changes were observed at younger ages, and particularly in boys. On an annual basis, the 1993-2005/6 changes were less than those during 1963-1993. Using the International Obesity Task Force cut-offs, 16.7% of children were overweight or obese in 2005/6, which was a 5.1% increase since 1993. Conclusion: These data provide policy-makers with further evidence of the secular changes in child growth and the increasing obesity epidemic among Hong Kong children.

van Sluijs, E. M., P. M. Skidmore, et al. (2008). "Physical activity and dietary behaviour in a population-based sample of British 10-year old children: the SPEEDY study (Sport, Physical activity and Eating behaviour: environmental Determinants in Young people)." BMC Public Health 8: 388.

BACKGROUND: The SPEEDY study was set up to quantify levels of physical activity (PA) and dietary habits and the association with potential correlates in 9-10 year old British school children. We present here the analyses of the PA, dietary and anthropometry data. METHODS: In a cross-sectional study of 2064 children (926 boys, 1138 girls) in Norfolk, England, we collected anthropometry data at school using standardised procedures. Body mass index (BMI) was used to define obesity status. PA was assessed with the Actigraph accelerometer over 7 days. A cut-off of > or = 2000 activity counts was used to define minutes of moderate-to-vigorous PA (MVPA). Dietary habits were assessed using the Health Behaviour in School Children food questionnaire. Weight status was defined using published international cut-offs (Cole, 2000). Differences between groups were assessed using independent t-tests for continuous data and chi-squared tests for categorical data. RESULTS: Valid PA data (>500 minutes per day on > or = 3 days) was available for 1888 children. Mean (+/- SD) activity counts per minute among boys and girls were 716.5 +/- 220.2 and 635.6 +/- 210.6, respectively (p < 0.001). Boys spent an average of 84.1 +/- 25.9 minutes in MVPA per day compared to 66.1 +/- 20.8 among girls (p < 0.001), with an average of 69.1% of children accumulating 60 minutes each day. The proportion of children classified as overweight and obese was 15.0% and 4.1% for boys and 19.3% and 6.6% for girls, respectively (p = 0.001). Daily consumption of at least one portion of fruit and of vegetables was 56.8% and 49.9% respectively, with higher daily consumption in girls than boys and in children from higher socioeconomic backgrounds. CONCLUSION: Results indicate that almost 70% of children meet national PA guidelines, indicating that a prevention of decline, rather than increasing physical activity levels, might be an appropriate intervention target. Promotion of daily fruit and vegetable intake in this age group is also warranted, possibly focussing on children from lower socioeconomic backgrounds.

Vicente-Rodriguez, G., J. P. Rey-Lopez, et al. (2008). "Television watching, videogames, and excess of body fat in Spanish adolescents: The AVENA study." Nutrition 24(7-8): 654-662.

Objective: We assessed the individual association of sedentary behaviors with the risk of overweight and excess body fat (overfat) in adolescents. Methods: A representative sample (1960 subjects, 1012 males, age 13-18.5 y) of Spanish adolescents was studied within the framework of the Alimentacion y Valoracion del Estado Nutricional de los Adolescentes (AVENA) study. Television (TV) watching, videogame and computer usage, doing homework, and the way students got to school, physical activity, and socioeconomic status were analyzed. Anthropometrics were measured to describe overweight (International Obesity Task Force cutoffs for body mass index) and overfat (body fat percentage >85th percentile). Results: When all subjects were considered as an entire group, the overweight risk increased by 15.8% (P < 0.05) per increasing hour of TV watching. The overweight risks decreased by 32.5% in females, 22% per increasing year of age, and 12.5% by increasing socioeconomic status by I U (all Ps < 0.05). The obesity risks decreased with age by 17.8% per year in males and 27.1% in females (both Ps < 0.05). The overfat risks increased by 26.8% and 9.4% per increasing hour of TV and weekend videogame usage, respectively (both Ps < 0.05). In males, the overfat risk increased by 21.5% per increasing hour in weekend videogame usage (P < 0.05). Each hour of TV use increased the overfat risks by 22% in males and 28.3% in females (both Ps < 0.05). Conclusions: Time spent watching TV increased the risk of overweight and obesity in Spanish adolescents, but the effect was influenced by age, sex, and socioeconomic status. Moreover, an excess of body fat was more directly explained by the time spent watching TV and playing videogames during the weekend. (C) 2008 Elsevier Inc. All rights reserved.

Vuorela, N., M. T. Saha, et al. (2009). "Prevalence of overweight and obesity in 5- and 12-year-old Finnish children in 1986 and 2006." Acta Paediatr 98(3): 507-12.

OBJECTIVE: To investigate the prevalence and the trends of overweight and obesity in Finnish 5- and 12-year-old children in 1986 and 2006. DESIGN: Retrospective cross-sectional study. Subjects and methods: Anthropometric data were collected retrospectively from health examinations in Tampere and in three rural municipalities. The size of the 5- and 12-year-old cohorts were 2108 in 1986 and 4013 in 2006, respectively. The body mass index (BMI) was calculated. Overweight and obesity was estimated using the International Obesity Task Force cutoff values (ISO BMI). RESULTS: The prevalence of overweight (ISO BMI >25) and obesity (ISO BMI >30) in 5-year-old boys in 2006 was 9.8% and 2.5% and in girls 17.7% and 2.5%, respectively. At the age of 12 years, the corresponding figures in boys were 23.6% and 4.7% and in girls 19.1% and 3.2%. Between 1986 and 2006, the prevalence of overweight in 12-year- old children had increased 1.8 fold in boys (p < 0.001) and 1.5 fold in girls (p = 0.008). Overweight was significantly more common in rural than in urban areas.

CONCLUSION: During the last 20 years the prevalence of overweight has markedly increased in 12-year-old Finnish children, but remained nearly unchanged in 5-year-old children.

Williamson, D. A., C. M. Champagne, et al. (2008). "Increased obesity in children living in rural communities of Louisiana." Int J Pediatr Obes: 1-6.

Objective. Rates of obesity among children have been rising in recent years. Information on the prevalence of obesity in children living in rural communities is needed. We report the prevalence of overweight and obesity in children enrolled in grades 4 to 6 who live in rural areas of Louisiana, USA. Methods and Procedures. These data were collected as baseline assessment for the Louisiana (LA) Health project. Height, weight, and estimates of body fat (using body impedance analysis) were collected on 2 709 children. Average age was 10.5 years and the sample composition was 57.3% girls, 61.7% African-American, 36.0% Caucasian, and 2.3% other minority. A majority of children (77%) met the criterion for poverty status. Results. The distribution of body mass index (BMI) percentile was highly skewed toward obesity. The most frequent BMI percentile scores were 98(th) and 99(th) percentile. Using Centers for Disease Control and Prevention (CDC) norms, the overall prevalence of obesity was 27.4%, and for overweight was 45.1%, of which 17.7% were between the 85(th) and 95(th) percentile. The prevalence of childhood overweight and obesity were much higher than the national norm and this increased prevalence was observed in both genders and in Caucasian and African-American children. Discussion. The prevalence of childhood overweight and obesity was found to be much higher in rural and primarily poor (77%) children living in Louisiana when compared with national norms. This observation suggests that rural children from Louisiana may be experiencing an epidemic of obesity that exceeds national prevalence estimates.

Wong, S. L. and S. T. Leatherdale (2009). "Association between sedentary behavior, physical activity, and obesity: inactivity among active kids." Prev Chronic Dis 6(1): A26.

INTRODUCTION: Sedentary behavior and physical activity are not mutually exclusive behaviors. The relative risk of overweight for adolescents who are highly sedentary and highly physically active is unclear. A better understanding of the relationship between sedentary behaviors, physical activity, and body mass index (BMI) would provide insight for developing interventions to prevent or reduce overweight. METHODS: Using the physical activity module of the School Health Action, Planning and Evaluation System (SHAPES), we collected data from 25,060 students in grades 9 through 12 from 76 secondary schools in Ontario, Canada. Sex-specific logistic regression analyses were performed to examine how BMI, weight perceptions, social influences, team sports participation, and smoking behavior were associated with being 1) high active-high sedentary, 2) low active-low sedentary, and 3) low active-high sedentary. RESULTS: Low active-high sedentary boys were more likely to be overweight

136 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 than high active-low sedentary boys (adjusted odds ratio [AOR], 1.60; 95% confidence interval [CI], 1.01-2.58). When compared with high active-low sedentary girls, girls who were low active-high sedentary (OR, 2.24; 95% CI, 1.23-4.09) or high active-high sedentary (OR, 1.91; 95% CI, 1.01-3.61) were more likely to be overweight. CONCLUSION: Sedentary behavior may moderate the relationship between physical activity and overweight. Developing a better understanding of sedentary behavior in relation to physical activity and overweight is critical for preventing and reducing overweight among youth.

Zhang, C. X., Y. M. Chen, et al. (2008). "Energy expenditure and energy intake in 10-12 years obese and non-obese Chinese children in a Guangzhou boarding school." Asia Pacific Journal Of Clinical Nutrition 17(2): 235-242.

Objective: The objective of this study was to observe the variation of energy intake and energy expenditure in the obese Chinese children. Methods: Basic metabolic rate was measured by using open-circuit indirect calorimetry in 54 obese children and 60 non-obese children aged 10-12 years in a full-time boarding school in Guangzhou suburb, China. Total energy expenditure was estimated by using a factorial method. Dietary intake was surveyed by the weighed inventory method. Physical activity was determined using a 2-day activity diary. Results: Univariate analysis showed that basic metabolic rate was significantly higher (p<0.05) in obese children than in non-obese ones, but the significant difference disappeared after controlling for fat free mass and fat mass. Energy intake and total energy expenditure were significantly higher (p<0.05) in obese than in non-obese children. Obese children spent more time in sleeping and light physical activity, but less time in moderate physical activity and vigorous physical activity than non-obese children (p<0.05). Conclusions: Compared to non-obese children, both energy intake and expenditure were higher in obese Chinese children. It appears that an area for preventive strategies may be to encourage increased physical activity expenditure in this age group.

Zhang, L., P. J. Fos, et al. (2008). "Body mass index and health related quality of life in elementary school children: a pilot study." Health And Quality Of Life Outcomes 6.

Background: We investigated the relationship between Body Mass Index (BMI) and health-related quality of life (HRQOL) indicated by baseline health status in elementary school children. Methods: Data were obtained via parents whose children enrolled in an elementary school, kindergarten to fourth grade, in southern Mississippi in spring 2004. Parents completed the SF-10 for Children (TM), a brief 10-item questionnaire designed to measure children's HRQOL on a voluntary basis. Results: A total of 279 parents completed the questionnaires for their children. On average, physical and psychosocial summary scores, major indicators for HRQOL, were significantly higher among the elementary school children in our study relative to those from U. S. children overall (p < 0.0001 and p = 0.0007, respectively). Males tended to have better

137 Active Living Research Literature Summary 2008 Draft Published Aug. 2009 physical functioning than their female classmates, whereas females had better psychosocial health. Overall, except for third graders, the physical summary scores increased as grade level increased. The means for psychosocial score fluctuated without a clear pattern over the five grade levels. High level of BMI was significantly associated with children's physical summary scores below 50, a norm used for U. S. children (p = 0.003). Gender and grade were not significant predictors of children's physical and psychosocial scores. Discussion: This study can be used as baseline information to track changes over time, in BMI and health status among the elementary school children. In addition, this study can be used to investigate relationships between BMI, health status, intellectual ability, and performance in school. Conclusion: The findings suggest that programs designed to encourage children to lose weight in a healthy manner, thus reducing their BMI, could improve the physical and psychosocial health, and subsequently increase HRQOL.

Zhang, Y. X. and S. R. Wang (2008). "Distribution of body mass index and the prevalence changes of overweight and obesity among adolescents in Shandong, China from 1985 to 2005." Ann Hum Biol 35(5): 547-55.

BACKGROUND: There is strong evidence of a positive secular trend in physical growth and body mass index (BMI) in most of the world over the last 20 years. However, no studies on this trend have been reported in Shandong Province, China. AIM: The present study assessed the secular trend in BMI in Shandong Province during the past 20 years and the prevalence of overweight and obesity among adolescents. SUBJECTS AND METHODS: The BMI of adolescents aged 7-18 was calculated using data from three national surveys on students' constitution and health carried out by the government in 1985, 1995 and 2005 in Shandong Province, China. The distribution of BMI was reported, and the prevalence of overweight and obesity were obtained according to the screening criteria of overweight and obesity for Chinese students using BMI. Results: In the past 20 years, the P(50) (percentile 50) of BMI increased rapidly. The average increments of BMI were 2.05 kg m(-2) (Urban male), 1.08 kg m(-2) (Urban female), 1.11 kg m(-2) (Rural male) and 0.57 kg m(-2) (Rural female). The prevalence of overweight and obesity increased rapidly: for overweight from 3.08% (Urban male), 2.67% (Urban female), 0.74% (Rural male) and 1.50% (Rural female) in 1985 to 17.52% (Urban male), 10.56% (Urban female), 11.06% (Rural male) and 7.01% (Rural female) in 2005; and for obesity from 0.52% (Urban male), 0.36% (Urban female), 0.03% (Rural male) and 0.11% (Rural female) in 1985 to 14.50% (Urban male), 6.79% (Urban female), 7.11% (Rural male) and 4.71% (Rural female) in 2005. CONCLUSION: The average value of BMI has increased over time; overweight and obesity among adolescents has become a serious public health problem. Comprehensive evidence-based strategies of intervention should be introduced, including periodic monitoring.