Active school commuting in adolescents from 28 countries across Africa, the Americas, and Asia: a temporal trends study

Correlates of active commuting to school across two generations: the Cardiovascular Risk in Young Finns Study

AIMS

Active commuting to school (ACS), a source of physical activity (PA), has declined in many countries over recent decades. This study investigates ACS and the factors associated with it among Finnish children and adolescents across two generations: those born between 1965-74 and 1998-2010. We also explore potential generational differences in these associations.

METHODS

School commuting was self-reported by 2075 participants of the ongoing population-based Young Finns Study in 1983 (generation 1 (G1), aged 9-18, 52% female), and by their 1137 offspring in 2018 (generation 2 (G2), aged 8-20, 53% female). Factors associated with ACS and the moderating effect of generation on these associations were examined using generalized estimating equation models for clustered binary data, for summer and winter seasons separately.

RESULTS

A greater distance to school (p < 0.001) and belonging to G2 (p ⩽ 0.049) were negatively associated with ACS during both seasons. High parental leisure-time PA (p ⩽ 0.025 for both seasons) and urban living area (p < 0.001 for summer) were positively associated with ACS. Generation moderated the associations of school grade and parental income with ACS in the summer (p ⩽ 0.015). Among G1 only, attending lower secondary school (vs. primary school) was negatively associated with ACS, while higher parental income was positively associated with ACS. Neither gender nor parental education was associated with ACS.

CONCLUSIONS

ACS was less common among the younger generation. Several correlates of ACS were identified, with generational differences. These findings can inform further research and guide policy decisions to promote ACS and ultimately enhance the PA of children and adolescents.

Global Physical Activity, Active Commuting to School, and Sedentary Behavior Among Latin American Adolescents: Global School-Based Student Health Survey and the National School Health Survey

BACKGROUND

This study aimed to compare the overall prevalence, stratified by sex and age group of global physical activity (GPA), active commuting to school (ACS), and sedentary behavior (SB) among adolescents from ten Latin American countries, and to assess the correlation of Development Index with the indicators.

METHODS

This research is grounded on data from the Global School-Based Student Health Survey (2009-2015) and the 2015 Brazilian National School Health Survey. The prevalence and 95% confidence intervals for GPA (≥5 d/wk), ACS (≥1 d/wk), and SB (>2 h/d) were calculated using the chi-square test to compare the sexes (male; female) and age group (≤13 y; 14 y; 15 y; ≥16 y). We also performed Pearson correlation analysis with the Human Development Index.

RESULTS

The prevalence of indicators ranged from 16.1% to 28.2% for GPA, from 56.7% to 71.2% for ACS, and from 20.7% to 62.6% for SB. Boys generally had a higher prevalence of GPA and ACS, and girls had a higher prevalence of SB. The prevalence of the indicators by age group varied between countries, with significant differences observed in some, depending on each indicator. A positive correlation was observed between Human Development Index, GPA, and SB.

CONCLUSION

Health promotion policies must include guidelines that encourage and promote a more active and less sedentary lifestyle among young people in Latin America, considering specific groups, the local socioeconomic context, and differences between countries.

Applying the multiphase optimization strategy to evaluate the feasibility and effectiveness of an online road safety education intervention for children and parents: a pilot study

BACKGROUND

Reports of children's engagement in active transportation outline low participation rates in many countries despite many associated mental, physical, and social health benefits. One of the main contributors to this phenomenon is a cited lack of education and knowledge among children regarding active travel (AT), specifically road safety. To address this issue, the aim of this study was to evaluate the feasibility and effectiveness of an online road safety education intervention to promote AT among children and their parents.

METHODS

Applying the Multiphase Optimization Strategy (MOST) for intervention development, implementation, and evaluation, we designed and assessed a four-module online road safety education intervention with a sample of 57 parent-child dyads using a 23 factorial design featuring both qualitative and quantitative analyses.

RESULTS

Main intervention feasibility findings include positive and critical feedback on the program's content and design, and moderate participant engagement as reflected by program retention and completion rates. With respect to the preliminary intervention effectiveness on children, a significant improvement in road safety knowledge scores was observed for groups that feature the "wheeling safety and skills" module. Slight improvements in AT knowledge scores across all the intervention groups were observed, but were not of significance. Preliminary intervention effectiveness on select parental AT practices and perceptions saw significant improvements in some groups. Groups that featured the 'wheeling safety and skills' module exhibited significantly higher guided choice scores upon completion of the program than those who did not receive this component.

CONCLUSION

The MOST framework allowed us to design and evaluate the feasibility and preliminary effectiveness of an online road safety education intervention. The developed intervention has demonstrated that it has the potential to improve children's road safety knowledge and some areas of parental AT practices and perceptions, to which improvements may be attributed to the inclusion of the "wheeling safety and skills" module, suggesting that the targeted focus on cycling skills is a prioritized area. AT programming and practice implications are discussed. Future research is encouraged to refine modules to better reflect the priorities of children and parents and to test these refined components among larger samples.

WORD COUNT

9,391 (excludes abstract, tables, figures, abbreviations, and references).

Weekend physical activity profiles and their relationship with quality of life: The SOPHYA cohort of Swiss children and adolescents

INTRODUCTION

Quality of life (QoL) is an important health indicator among children and adolescents. Evidence on the effect of physical activity (PA)-related behaviors on QoL among youth remains inconsistent. Conventional accelerometer-derived PA metrics and guidelines with a focus on whole weeks may not adequately characterize QoL relevant PA behavior.

OBJECTIVE

This study aims to a) identify clusters of accelerometer-derived PA profiles during weekend days among children and adolescents living in Switzerland, b) assess their cross-sectional and predictive association with overall QoL and its dimensions, and c) investigate whether the associations of QoL with the newly identified clusters persist upon adjustment for the commonly used PA metrics moderate-to-vigorous physical activity (MVPA) and time spent in sedentary behavior (SB).

METHODS

The population-based Swiss children's Objectively measured PHYsical Activity (SOPHYA) cohort among children and adolescents aged 6 to 16 years was initiated at baseline in 2013. PA and QoL information was obtained twice over a five-year follow-up period. The primary endpoint is the overall QoL score and its six dimension scores obtained by KINDL® questionnaire. The primary predictor is the cluster membership of accelerometer-derived weekend PA profile. Clusters were obtained by applying the k-medoid algorithm to the distance matrix of profiles obtained by pairwise alignments of PA time series using the Dynamic Time Warping (DTW) algorithm. Secondary predictors are accelerometer-derived conventional PA metrics MVPA and SB from two combined weekend days. Linear regression models were applied to assess a) the cross-sectional association between PA cluster membership and QoL at baseline and b) the predictive association between PA cluster membership at baseline and QoL at follow-up, adjusting for baseline QoL.

RESULTS

The study sample for deriving PA profile clusters consisted of 51.4% girls and had an average age of 10.9 [SD 2.5] years). The elbow and silhouette methods indicated that weekend PA profiles are best classified in two or four clusters. The most differentiating characteristic for the two-clusters classification ("lower activity" and "high activity"), and the four-clusters classification ("inactive", "low activity", "medium activity", and "high activity"), respectively was the participant's mean counts per 15-seconds epoch. Participants assigned to high activity clusters were younger and more often male. Neither the clustered PA profiles nor MVPA or SB were cross-sectionally or predictively associated with overall QoL. The only association of a conventional PA metrics with QoL while adjusting for cluster membership was observed between MVPA during the weekend days and social well-being with a mean score difference of 2.4 (95%CI: 0.3 to 4.5; p = 0.025).

CONCLUSION

The absence of strong associations of PA metrics for the weekend with QoL, except for the positive association between MVPA during the weekend days and social well-being, is in line with results from two randomized studies not showing efficacy of PA interventions on youth QoL. But because PA decreases with age, its promotion and relevance to QoL remain important research topics. Larger longitudinal study samples with more than two follow-up time points of children and adolescents are needed to derive new novel accelerometer-derived PA profiles and to associate them with QoL dimensions.

A community health worker led approach to cardiovascular disease prevention in the UK-SPICES-Sussex (scaling-up packages of interventions for cardiovascular disease prevention in selected sites in Europe and Sub-saharan Africa): an implementation research project

Background

This paper describes a UK-based study, SPICES-Sussex, which aimed to co-produce and implement a community-based cardiovascular disease (CVD) risk assessment and reduction intervention to support under-served populations at moderate risk of CVD. The objectives were to enhance stakeholder engagement; to implement the intervention in four research sites and to evaluate the use of Voluntary and Community and Social Enterprises (VCSE) and Community Health Worker (CHW) partnerships in health interventions.

Methods

A type three hybrid implementation study design was used with mixed methods data. This paper represents the process evaluation of the implementation of the SPICES-Sussex Project. The evaluation was conducted using the RE-AIM framework.

Results

Reach: 381 individuals took part in the risk profiling questionnaire and forty-one women, and five men participated in the coaching intervention. Effectiveness: quantitative results from intervention participants showed significant improvements in CVD behavioural risk factors across several measures. Qualitative data indicated high acceptability, with the holistic, personalised, and person-centred approach being valued by participants. Adoption: 50% of VCSEs approached took part in the SPICES programme, The CHWs felt empowered to deliver high-quality and mutually beneficial coaching within a strong project infrastructure that made use of VCSE partnerships. Implementation: Co-design meetings resulted in local adaptations being made to the intervention. 29 (63%) of participants completed the intervention. Practical issues concerned how to embed CHWs in a health service context, how to keep engaging participants, and tensions between research integrity and the needs and expectations of those in the voluntary sector. Maintenance: Several VCSEs expressed an interest in continuing the intervention after the end of the SPICES programme.

Conclusion

Community-engagement approaches have the potential to have positively impact the health and wellbeing of certain groups. Furthermore, VCSEs and CHWs represent a significant untapped resource in the UK. However, more work needs to be done to understand how links between the sectors can be bridged to deliver evidence-based effective alternative preventative healthcare. Reaching vulnerable populations remains a challenge despite partnerships with VCSEs which are embedded in the community. By showing what went well and what did not, this project can guide future work in community engagement for health.

Physical activity and sedentary behavior among school-going adolescents in low- and middle-income countries: insights from the global school-based health survey

Background

The Global School Student Health Survey (GSHS) is being carried out by students in various countries across the globe to advance improved health programs for youth. However, in comparison to high-income countries, adolescents in low- and middle-income countries (LMICs) are generally at an early stage of understanding regarding physical activity (PA) and sedentary behavior (SB), often exhibiting low levels of PA and high levels of SB. Furthermore, there is limited evidence connecting PA and SB in school-going adolescents from LMICs.

Purpose

The objective of this review was to synthesize the available evidence regarding PA and sedentary behavior among school-going adolescents in LMICs using data from the GSHS.

Method

On March 18, 2023, a systematic literature search was performed across four electronic databases, namely Web of Science, PubMed, ScienceDirect, and EBSCO with n odaterestrictions. Studies were eligible if they: (1) utilization of data sourced from the Global Student-based Health Survey; (2) exploration of physical activity; (3) specific focus on adolescents; (4) conducted in low- and middle-income countries; (5) study design encompassing observational; (6) published as English journal articles.

Results

Among the 29 studies included in the analysis, the majority revealed elevated levels of sedentary behavior and diminished levels of PA in low- and middle-income countries. Furthermore, notable disparities in physical engagement and sedentary behavior were noted between male and female adolescents (p < 0.001). Augmented PA among teenagers was observed to correlate with higher consumption of vegetables and fruits (AOR = 1.30; 95% CI [1.13-1.50]; p < 0.001), decreased alcohol consumption, and a reduced prevalence of loneliness and depression (aOR 1.37, 95% CI [1.18-1.59]).

Conclusions

The results of this review affirm that in contrast to high-income countries, adolescents in low- and middle-income countries (LMICs) are in the early stages of comprehending physical activity, marked by low levels of PA. Physical activity and sedentary behavior in school-going adolescents from LMICs appear to be influenced by factors such as policies, cultural norms, socioeconomic conditions, as well as gender, and age.

Nrf2 Pathway and Oxidative Stress as a Common Target for Treatment of Diabetes and Its Comorbidities

Diabetes is a chronic disease that induces many comorbidities, including cardiovascular disease, nephropathy, and liver damage. Many mechanisms have been suggested as to how diabetes leads to these comorbidities, of which increased oxidative stress in diabetic patients has been strongly implicated. Limited knowledge of antioxidative antidiabetic drugs and substances that can address diabetic comorbidities through the nuclear factor erythroid 2-related factor 2 (Nrf2) pathway calls for detailed investigation. This review will describe how diabetes increases oxidative stress, the general impact of that oxidative stress, and how oxidative stress primarily contributes to diabetic comorbidities. It will also address how treatments for diabetes, especially focusing on their effects on the Nrf2 antioxidative pathway, have been shown to similarly affect the Nrf2 pathway of the heart, kidney, and liver systems. This review demonstrates that the Nrf2 pathway is a common pathogenic component of diabetes and its associated comorbidities, potentially identifying this pathway as a target to guide future treatments.