Patterns and Associated Factors of Physical Activity among Adolescents in Nigeria

Association of Perceived Neighbourhood Walkability with Self-Reported Physical Activity and Body Mass Index in South African Adolescents

Adolescence is a life stage critical to the establishment of healthy behaviours, including physical activity (PA). Factors associated with the built environment have been shown to impact PA across the life course. We examined the sociodemographic differences in, and associations between, perceived neighbourhood walkability, PA, and body mass index (BMI) in South African adolescents. We recruited a convenience sample (n = 143; 13-18 years; 65% female) of students from three high schools (middle/high and low-income areas). Participants completed a PA questionnaire and the Neighbourhood Environment Walkability Scale (NEWS)-Africa and anthropometry measurements. Multivariable linear regression was used to examine various relationships. We found that, compared with adolescents living in middle/high income neighbourhoods, those living in low-income neighbourhoods had lower perceived walkability and PA with higher BMI percentiles. The associations between neighbourhood walkability and PA were inconsistent. In the adjusted models, land use diversity and personal safety were associated with club sports participation, street connectivity was positively associated with school sports PA, and more favourable perceived walkability was negatively associated with active transport. Overall, our findings suggest that the perceived walkability of lower income neighbourhoods is worse in comparison with higher income neighbourhoods, though the association with PA and BMI is unclear.

Trajectories of 24-Hour Physical Activity Distribution and Relationship with Dyslipidemia

The association between physical activity (PA) and dyslipidemia is well known, but the relationship between a temporal pattern of PA and dyslipidemia remain unknown. Here, we aimed to identify the intensity and temporal patterns of PA clustered by the trajectory model and their relationship with dyslipidemia. The participants were 701 adults (305 males) aged 18−60 years undergoing continuous measurement of PA with Actigraph GT3X+ accelerometers for at least 3 days. A trajectory analysis was applied based on moderate-to-vigorous intensity physical activity (MVPA) accumulated values over every period per day. The association between PA and dyslipidemia was estimated using a logistic regression model. Four distinct PA trajectory groups in the population were identified (continued low, stable and moderate, late increasing, and early increasing). Specifically, the “moderate and stable group” was associated with a decreased rate of high TG (p < 0.05) and the “moderate and stable group” and “late increasing group” were associated with decreased rates of low HDL-C (p < 0.05). In conclusion, there were four activity trajectory groups in this population and the continued low PA trajectory was associated with a high prevalent rate of an abnormal lipid profile, and continued and moderate activity or late afternoon increasing activity might have lower HDL-C distribution.

Barriers and facilitators of physical activity among school attending adolescents in Lagos State, Nigeria: A qualitative study exploring views and experiences of decision-makers in secondary schools

Background and Aims

Schools represent a unique setting for promoting lifelong physical activity during critical development stages of life. Opportunities for in-school physical activity largely depend upon school-level policies, practices, and administrative support. A significant information gap exists on the factors influencing adolescents' participation in school-based physical activity programs in Nigeria. This study aimed to identify and explore the barriers and facilitators of physical activity in school-attending adolescents in Lagos State, Nigeria.

Methods

A qualitative study, using semistructured interviews, was conducted to explore the views and experiences of 21 decision-makers who were responsible for planning the physical and health education curriculum in secondary schools in Lagos State, Nigeria. Data were analyzed using the thematic analysis framework.

Results

Eight themes were identified and explored. The barriers were (i) students' characteristics, (ii) parental objections, (iii) no prioritization of physical activity, (iv) insufficient resources, and (v) challenges with schools' initiatives. The facilitators were (vi) students' interests, (vii) students' awareness of benefits, and (viii) schools' initiatives.

Conclusion

Our study findings can help in designing interventions to increase physical activity among school-attending adolescents in Lagos, Nigeria.

Prevalence of Obesity and Anemia Among Early Adolescents in Junior Secondary Schools: A Cross-Sectional Study in Ouagadougou, Burkina Faso

BACKGROUND

The school presents an ideal environment to positively impact the long-term health and nutrition outcomes of early adolescents, who are at risk of obesity and anemia.

METHODS

In this cross-sectional survey, we described differences in weight and anemia by sociodemographic, diet and physical activity indicators among 1059 students aged 11 to 15 years from 22 junior secondary schools in Ouagadougou, Burkina Faso. Weight was based on body mass index (BMI) z-scores according to the WHO reference and anemia status was defined by standardized hemoglobin (Hb) measure cut-offs. We calculated dietary diversity scores (DDS) from a 24-hour dietary recall and a global diet quality score (GDQS) from a 7-day dietary recall.

RESULTS

The prevalence of obesity (5%) and anemia (50%) was relatively high among the students, which differed significantly between gender, household wealth and school grade, but not age groups. Eighteen percent of the female adolescents were overweight or obese and 22% were moderately anemic compared to 13% and 16% of the male adolescents. Dietary diversity was significantly different between weight categories, but not anemia status. For physical activity, those taking transportation to school were significantly more likely to be overweight or obese. In adjusted multivariable Poisson regression analyses, only the DDS was significantly associated with thinness and both thinness and anemia, while taking transportation to school was significantly associated with overweight among adolescents.

CONCLUSION

We encourage the promotion of school-based interventions and provision of a curriculum on health and healthy eating in order to reduce obesity, anemia, and its comorbidities.

Levels and Patterns of Physical Activity and Sedentary Behaviour of Primary School Learners in Lagos State, Nigeria

BACKGROUND

Physical activity (PA) and sedentary behaviour (SB) assessment in children is critical for the prevention of noncommunicable diseases. African studies examining PA and SB of primary school-age children are few. This study investigated PA, SB levels and their correlates among primary school children in Lagos, Nigeria.

METHOD

In a cross-sectional study of 733 learners, their self-reported PA and SB were assessed using the Children PA Questionnaire (CPAQ) (6-9 years age category) and Youth Activity Profile (YAP) (10-12 years age category) while pedometers were used for objective PA and SB assessment, and socioeconomic status (SES) index were measured using a structured questionnaire. Standardised procedures were used for anthropometric and cardiovascular measures. Results Based on CPAQ, 87.5% and 100% of the learners aged 6-9 years met the recommended PA and SB guidelines, respectively which were lower with pedometers (72.8% and 87.3%). The proportion of boys aged 6-9 years who met the guidelines for PA and SB (using pedometer) was significantly higher than that of the girls(PA: 80.7% vs. 64%, p = 0.018; SB: 94% vs. 80%, p = 0.008). Self-reported PA was positively associated with age (CPAQ: B = 455.39, p < 0.001; YAP: B = 1.638, p = 0.009) and negatively with SES (CPAQ: B = -201.39, p < 0.001; YAP: B = -1.000, p < 0.001). Objective PA was positively associated with waist to hip ratio(WHR) (6-9 years: B = 66090.24, p = 0.032) and negatively with sex (6-9 years: B = -5533.41, p = 0.027) and hip circumference (10-12 years: B = -1269.13, p = 0.017). SB was associated with SES in learners aged 10-12 years (B = -0.282, p = 0.003).

CONCLUSION

High SES is a major predictor of reduced PA among these cohort of learners.

Nigerian physiotherapists’ knowledge, current practice and perceptions of their role for promoting physical activity: A cross-sectional survey

Background

Nigeria has the highest rates of physical inactivity in Africa. As physical inactivity is a leading global risk factor for non-communicable diseases (NCD), physical activity promotion is a strategy for their mitigation. Physiotherapists are already ideally situated to undertake this role and can assist in the reversal of NCD. Gaining insight into how physiotherapists in Nigeria perceive their role in relation to physical activity promotion is needed to ensure this undertaking will be effective. This national survey aimed to investigate Nigerian physiotherapists’ knowledge and current practice for promoting physical activity across Nigeria and perceptions of their role related to this.

Methods

Following ethical approval, a cross-sectional, online questionnaire survey design was employed to investigate the aim. 330 qualified physiotherapists, working across Nigeria were recruited. Internal consistency of the survey was examined using Cronbach’s alpha. Descriptive statistics were used to analyse closed questions. Thematic content analysis was used to analyse open-ended questions. Chi-square inferential statistic was used to investigate the association between variables with alpha interpreted at a level of 0.05.

Results

The internal consistency of the questionnaire survey was good overall (Cronbach Alpha α = 0.71). 330 physiotherapists participated. 99.4% agreed that discussing the benefits of a physically active lifestyle with patients is part of their role. However, over 60% did not feel confident in suggesting specific physical activity programs for their patients. 59.7% were aware of one or more physical activity guideline. However, only 49.1% were incorporating it into their practice. 85.5% felt that developing a physical activity guideline specifically for Nigeria would promote physical activity. 63.3% of respondents did not use any resource in promoting physical activity. An association was found between the physiotherapist’s awareness of physical activity guidelines and male sex (χ² = 8.95, df = 2, p = 0.01).

Conclusion

Whilst most physiotherapists had a positive perception of their role in promoting physical activity, translating this into practice would seem to be challenging. A systems approach to physical activity health promotion is recommended with the need for a commitment by the Nigerian Government to the development and implementation of national guidelines. Incorporating more training in physiotherapy education could foster more confidence in the delivery of these guidelines. Greater use of resources and working with community organisations could help to optimise physical activity uptake in Nigeria.

'Children eat all things here': a qualitative study of mothers' perceptions and cultural beliefs about underweight and overweight children and adolescents in selected communities in two Nigerian states

INTRODUCTION

The perception of mothers about causes of underweight and overweight among children or adolescents and associated cultural beliefs may influence nutritional status. However, data from qualitative studies on this subject and regarding age 6-19 are scarce in Nigeria.

OBJECTIVE

This study aimed to explore mothers' perceptions and cultural beliefs about underweight and overweight children and adolescents in selected communities in a northern and a southern Nigerian state.

DESIGN

This was a qualitative study using focus group discussions (FGD). Eight FGD sessions were held. The interviews were transcribed verbatim, and the transcripts were coded and analysed using NVivo V.11, and direct quotations representing the themes generated from the perspectives were cited as appropriate.

SETTING

The study was carried out in eight randomly selected rural and urban communities in Gombe and Osun states of Nigeria.

PARTICIPANTS

Seventy-six mothers of children and adolescents aged 6-19 years.

RESULTS

The mothers identified concepts, causes and community experience of underweight and overweight children and adolescents, however, some gaps and misconceptions were observed. These included perspectives that suggest a limited understanding of the concepts of mild and moderate malnutrition and stunting and citing of 'witches and wizards' as causes of malnutrition. The mothers observed that being underweight was more prevalent in rural communities of Osun and Gombe states, while overweight was more prevalent in urban communities in Osun state. The majority of the women reported no known food taboo or restrictions, and no cultural beliefs relating to the nutrition of children and adolescents.

CONCLUSION

Gaps and misconceptions exist in the perceptions of mothers on underweight and overweight children and adolescents. Food taboos, food restrictions and other cultural beliefs were not reported by majority of the mothers. Educational programmes for mothers on child/adolescent nutrition should target identified gaps and misconceptions.

Gender Difference and Correlates of Physical Activity Among Urban Children and Adolescents in Ethiopia: A Cross-Sectional Study

Background

Studies indicate that children and adolescent populations in most countries show a low level of physical activity (PA) and an increasing prevalence of obesity. Addressing gender disparity in PA is the main element of public health programs. There is currently a paucity of studies, particularly, in developing countries that investigate gender differences and correlates of PA among children and adolescents.

Objective

The study is aimed to assess the gender difference and correlates of PA among children and adolescents in Ethiopia.

Methods

An observational population-based cross-sectional study was conducted in representative samples of children and adolescents in the capital city of Ethiopia, Addis Ababa. Multivariable logistic regression models with robust estimation of SEs were fitted to predict the odds ratios (ORs) and 95% CIs.

Results

A total of 632 children and adolescents-parent dyads were included in the study. More boys than girls (17.0 and 11.7%) were engaged in moderate intensity PA 3 days a week or more (p = 0.057). Age, mothers working in a private business, attending public schools, longer sleep duration, and being taught the benefits of PA were positively associated with meeting moderate-to-vigorous PA (MVPA) in both sexes combined and in a sub-sample of boys. Furthermore, an inverse association was found between overweight/obesity and MVPA in the overall children and girls as well. For moderate PA (MPA); the age of the children, maternal education and occupation, school type, overweight/obesity, and sleep duration on school nights were significant correlates among the studied children.

Conclusions

The present study provided evidence of several correlates identified associated with meeting MVPA and MPA in both sexes combined. Girls are less likely than boys to engage in PA. Therefore, there is a need to take into perspectives the provision of a comprehensive multifaceted health behavior modification and interventions, such as focused and regular physical education in schools.

Physical activity and sedentary behaviour of female adolescents in Indonesia: A multi-method study on duration, pattern and context

Background/Objective

Exploring comprehensive information on the duration, pattern and context of physical activity and sedentary behaviour is important to develop effective policies and interventions. Especially in lower- and middle-income countries, our understanding of these health-behaviours is limited. Our study aimed to investigate physical activity and sedentary behaviour of female Indonesian adolescents by using a multi-method approach.

Methods

Female adolescents (n = 5; 13–15 years old) from Yogyakarta, Indonesia wore accelerometers and automated wearable cameras for four days, and completed diaries, and interviews between February and March 2020.

Results

Participants’ activity, especially on non-school days, was dominated by light-intensity physical activity. Four of the 5 participants did not meet the physical activity guidelines. Participants spent a great proportion of time on screen-based sedentary behaviour (school days: 83.2% of wear time; non-school days: 75.7% of wear time). During school days, most physical activity and sedentary behaviour was done at school. Screen time was mainly done on the school day evenings and weekend mornings. Participants mostly used smartphones in the bedroom and living room in a solitary environment. Interviews suggest that the high amount of screen time seemed to be influenced by a lack of awareness of current guidelines, the feeling of urgency to check information, and the lack of parental supervision. Non-screen-based sedentary behaviour comprised just over 10% of total camera images.

Conclusion

The use of a multi-method approach facilitated a rich understanding of the duration, patterns, and contexts of physical activity and sedentary behaviour in participants. Future studies might consider using similar methods in a larger sample.

Physical activity domains, levels, and health-related quality of life among Nigerian adolescents during the coronavirus disease 2019 pandemic

Introduction:

The coronavirus disease 2019 pandemic spurred unprecedented public health measures to curb its spread. Such measures might have negatively impacted adolescents’ participation in physical activity and health-related quality of life. However, the evidence is unclear in Nigerian adolescents. This study assessed the physical activity domains, levels, and health-related quality of life in Nigerian adolescents during the coronavirus disease 2019 pandemic.

Methods:

The sample consisted of 430 students in public secondary schools in Nsukka, Enugu State. The students were randomly selected to participate in the cross-sectional study between November 2020 and April 2021. The Demographic Profile Form, International Physical Activity Questionnaire, Short Form-36 Health Survey, and Perceived Susceptibility to coronavirus disease 2019 Infection Questionnaire were used for data collection. Descriptive statistics, Chi-square test, independent-samples t-test, univariate ANOVA, and multiple linear regressions were conducted using SPSS version 25.

Results:

The mean score of total physical activity (MET-min/week) was 1651.3 (SD = 842.18). The mean overall score of health-related quality of life was 78.30 (SD = 16.43). The mental health component of health-related quality of life showed that adolescents had poor mental health status. Female adolescents had higher mean scores in physical component summary (M = 83.03; SD = 27.36) and mental component summary (M = 51.19; SD = 8.69) than the male adolescents, physical component summary (M = 69.0; SD = 21.65) and mental component summary (M = 46.15; SD = 10.71).

Conclusion:

The findings showed a significant positive association among gender, class of study, parental type, perceived susceptibility to coronavirus disease 2019, and physical activity domains, levels, and health-related quality of life. In addition, boys had a higher mean score of total physical activity (MET-min/week) than the girls. More girls were less active than the boys. However, concerning the health-related quality of life, girls had higher mean scores in physical component summary and mental component summary than boys. Physical activity interventions that specifically target female adolescents’ physical activity participation are needed. Also, mental health interventions are needed to improve the mental health status of adolescents, especially boys in the post–coronavirus disease 2019 era.

Recommendations to Enhance Parental Involvement and Adolescent Participation in Physical Activity

Background: Adolescents are influenced by external factors which may impact their level of physical activity. Parents require specific strategies to become involved and to increase physical activity participation in adolescence. Objective: Thus, the current study aimed to design recommendations to increase physical activity participation and parental involvement. Methods: The current study forms part of a broader mixed-method study in which the results of the phases and stages of the pre-studies informed the current study. Thus, the current study uses an agreement workshop to develop recommendations with stakeholder and expert input in two rounds. Participants were invited to participate in the current study n = 100, and n = 65 participated in round one. Round two consisted of n = 20 experts invited to an agreement workshop, with n = 11 attending and making an input on the final recommendations. Therefore, experts and parents in the field of parenting, physical activity, and physical education, were invited to participate in the study rounds. After each round, the responses from the panellists were collated, interpreted, and developed into a framework for recommendations using thematic analysis. Themes were generated and refined using an agreement format. Results: After results from the stages and phases were consolidated and refined, six themes and 51 sub-themes were identified in a framework for recommendations. The framework was further refined using expert input and the final recommendations were derived using an agreement or agreement. Thus, with input from experts input through the agreement workshop, the findings were discussed, refined, and drafted into recommendations. Agreement and agreement were achieved on six broad recommendations and fifty-one sub-themes. The final recommendations were presented in the current study to increase parental involvement and physical activity in adolescents. Discussion: Recommendations and physical activity resources were developed and are presented as a form of support to parents and adolescents. The recommendations are intended as a source of unbiased information for parents to become more involved and for adolescents to increase physical activity participation.

Individual and contextual factors associated with under- and over-nutrition among school-aged children and adolescents in two Nigerian states: a multi-level analysis

OBJECTIVE

This study aimed to identify individual and contextual factors that are associated with under- and over-nutrition among school-aged children and adolescents in two Nigerian states.

DESIGN

Community-based cross-sectional study.

SETTING

The study was carried out in rural and urban communities of Osun and Gombe States in Nigeria.

PARTICIPANTS

A total of 1200 school-aged children and adolescents.

RESULTS

Multi-level analysis showed that the full models accounted for about 82 % and 39 % of the odds of thinness or overweight/obese across the communities, respectively. Household size (adjusted OR (aOR) 1·10; P = 0·001; 95 % CI (1·04, 1·16)) increased the odds, while the upper wealth index (aOR 0·43; P = 0·016; 95 % CI (0·22, 0·86)) decreased the odds of thinness. Age (aOR 0·86; P < 0·001; 95 % CI (1·26, 8·70)), exclusive breastfeeding (aOR 0·46; P = 0·010; 95 % CI (0·25, 0·83)), physical activity (aOR 0·55; P = 0·001; 95 % CI (0·39, 0·78)) and the upper wealth index (aOR 0·47; P = 0·018; 95 % CI (0·25, 0·88)) were inversely related with overweight/obesity, while residing in Osun State (aOR 3·32; P = 0·015; 95 % CI (1·26, 1·70)), female gender (aOR 1·73; P = 0·015; 95 % CI (1·11, 2·69)) and screen time > 2 h/d (aOR 2·33; P = 0·005; 95 % CI (1·29, 4·19)) were positively associated with overweight/obesity.

CONCLUSIONS

The study shows that selected community and individual-level factors are strongly associated with thinness and overweight/obesity among school-aged children and adolescents.

Socioeconomic and gendered inequities in travel behaviour in Africa: Mixed-method systematic review and meta-ethnography

Travel has individual, societal and planetary health implications. We explored socioeconomic and gendered differences in travel behaviour in Africa, to develop an understanding of travel-related inequity. We conducted a mixed-methods systematic review (PROSPERO CRD42019124802). In 2019, we searched MEDLINE, TRID, SCOPUS, Web of Science, LILACS, SciELO, Global Health, Africa Index Medicus, CINAHL and MediCarib for studies examining travel behaviour by socioeconomic status and gender in Africa. We appraised study quality using Critical Appraisal Skills Programme checklists. We synthesised qualitative data using meta-ethnography, followed by a narrative synthesis of quantitative data, and integrated qualitative and quantitative strands using pattern matching principles. We retrieved 103 studies (20 qualitative, 24 mixed-methods, 59 quantitative). From the meta-ethnography, we observed that travel is: intertwined with social mobility; necessary to access resources; associated with cost and safety barriers; typified by long distances and slow modes; and dictated by gendered social expectations. We also observed that: motorised transport is needed in cities; walking is an unsafe, 'captive' mode; and urban and transport planning are uncoordinated. From these observations, we derived hypothesised patterns that were tested using the quantitative data, and found support for these overall. In lower socioeconomic individuals, travel inequity entailed reliance on walking and paratransit (informal public transport), being unable to afford travel, travelling less overall, and travelling long distances in hazardous conditions. In women and girls, travel inequity entailed reliance on walking and lack of access to private vehicles, risk of personal violence, societally-imposed travel constraints, and household duties shaping travel. Limitations included lack of analytical rigour in qualitative studies and a preponderance of cross-sectional quantitative studies (offering a static view of an evolving process). Overall, we found that travel inequity in Africa perpetuates socioeconomic and gendered disadvantage. Proposed solutions focus on improving the safety, efficiency and affordability of public transport and walking.

Qualitative views of Nigerian school principals and teachers on the barriers and opportunities for promoting students' physical activity behaviours within the school settings

Background

Insufficient physical activity (PA) is a growing public health challenge among Nigerian adolescents. Significant information gap exists on the school-related factors which influence the participation of adolescents in school-based physical activity programmes in Nigeria. This study was conducted to document the qualitative views of school principals and teachers on the barriers and opportunities for promoting the physical activity behaviours of adolescents within the school settings in light of the socio-ecological model.

Methods

This was a qualitative study conducted in 12 public and private schools in two local government areas of Oyo state, Nigeria. Two key sources and data collection methods (i.e key informant interviews and focus group discussions) were used. Six key informant interviews were held with school principals and six focus group discussions with classroom teachers using pre-tested guides. Data was analysed using thematic analysis.

Results

Fourteen sub-themes were identified as barriers to PA and linked to different levels of the socio-ecological model. Three themes were categorised as parental factors, three themes as socio-cultural and religious factors while the school-related factors had eight sub-themes. Specifically, the school-related barriers were the declining number of trained physical health education teachers, limited opportunities for continuing education and low prioritisation of physical health education. Other school-related factors such as increasing demand for classroom academic time, negative attitudinal dispositions of other teachers and inadequate funding for schools which hampered the provision of facilities and equipment were identified as factors that limit the effective implementation of policies and programmes for physical activity in schools. Opportunities to promote PA within the school settings during assemblies, breaktime, after-school and inter-house sports competition exist. However, these opportunities are hampered by competing academic time, security threats, fear of causalities to students due to poor supervision after school, poor funding and brawling associated with competitive school-based sporting events.

Conclusions

Factors that contribute to insufficient physical activity among in-school adolescents in the school settings are multi-factorial. Implementation of holistic, multi-component interventions which address the social-cultural and school-level factors and enhance students’ opportunities for physical activity in schools are recommended.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12327-x.

Proportion of School Attending Adolescents Meeting the Recommended Moderate-to-Vigorous Physical Activity Level and Its Predictors in Lagos, Nigeria

We aimed to assess the proportion of school attending adolescents who reached the recommended moderate-to-vigorous physical activity (MVPA) level in Lagos State, Nigeria, as well as the predictors associated with it. A cross-sectional study was conducted among 720 adolescents aged 12-19 years from 20 schools in Lagos State in 2020. MVPA level was assessed using the Activity Questionnaire for Adults and Adolescents. Predictors assessed were socio-demographic variables, anthropometric measurements, sedentary behaviour, self-efficacy, perceived benefits, and perceived barriers. Complete data was provided by 528 adolescents for the study (73% response rate). The recommended MVPA level was reached by 82.8% (95% CI 79.3-85.7) of the participants. Participants spent a median time of 44 (IQR 12.9, 110) minutes of MVPA per day on household-based activities, followed by school-based activities (21.4; 4.3, 50.4), active transportation (14.3; 0, 35), sport-based activities (8.6; 0, 58.9) and leisure-based activities (8.6; 1.1, 34.3). Participants in public schools were four times more likely to meet the recommended MVPA level compared to those in private schools (OR 3.97, 95% CI 2.46-6.42). A high proportion of school adolescents met the recommended MVPA level in Lagos State, Nigeria. Our study suggests that interventions for promoting MVPA should be targeted to private schools.

Clustering Lifestyle Risk Behaviors among Vietnamese Adolescents and Roles of School: A Bayesian Multilevel Analysis of Global School-Based Student Health Survey 2019

Background

Adolescence is a vulnerable period for many lifestyle risk behaviors. In this study, we aimed to 1) examine a clustering pattern of lifestyle risk behaviors; 2) investigate roles of the school health promotion programs on this pattern among adolescents in Vietnam.

Methods

We analyzed data of 7,541 adolescents aged 13–17 years from the 2019 nationally representative Global School-based Student Health Survey, conducted in 20 provinces and cities in Vietnam. We applied the latent class analysis to identify groups of clustering and used Bayesian 2-level logistic regressions to evaluate the correlation of school health promotion programs on these clusters. We reassessed the school effect size by incorporating different informative priors to the Bayesian models.

Findings

The most frequent lifestyle risk behavior among Vietnamese adolescents was physical inactivity, followed by unhealthy diet, and sedentary behavior. Most of students had a cluster of at least two risk factors and nearly a half with at least three risk factors. Latent class analysis detected 23% males and 18% females being at higher risk of lifestyle behaviors. Consistent through different priors, high quality of health promotion programs associated with lower the odds of lifestyle risk behaviors (highest quality schools vs. lowest quality schools; males: Odds ratio (OR) = 0·67, 95% Highest Density Interval (HDI): 0·46 – 0·93; females: OR = 0·69, 95% HDI: 0·47 – 0·98).

Interpretation

Our findings demonstrated the clustering of specific lifestyle risk behaviors among Vietnamese in-school adolescents. School-based interventions separated for males and females might reduce multiple health risk behaviors in adolescence.

Funding

The 2019 Global School-based Student Health Survey was conducted with financial support from the World Health Organization. The authors received no funding for the data analysis, data interpretation, manuscript writing, authorship, and/or publication of this article.

Relationship Between Physical Activity Levels and Psychological Well-Being Among Male University Students in South East, Nigeria: A Cross-Sectional Study

This study aimed to evaluate the associations between physical activity (PA) and psychological well-being (PWB) among male university students. An institutionally based cross-sectional study was completed by 243 young men aged 18–30 years in a Nigerian public university. PA was measured using the International Physical Activity Questionnaire-Short Form (IPAQ-SF), and PWB was measured by Ryff’s Scale of Psychological Well-being (PWB). The mean age of the participants was 24.9 (SD = 7.61) and majority (39.1%) of the participants was aged 18–22 years. Regarding PA, 16.0%, 64.2%, and 19.8% of the participants had low, moderate, and high PA levels, respectively. The mean total PWB score was 119.9 (SD = 23.64). For the domains of PWB, male students had mean scores of 25.73 (SD = 6.05), 19.42 (SD = 6.82), 25.75 (6.10), 14.12 (SD = 3.89), 13.70 (SD = 4.04) and 21.12 (4.92) for self-acceptance, autonomy, positive relations, environmental mastery, purpose in life and personal growth, respectively. Total PA (total MET min/week) was associated with the total PWB scores (β = 0.13, p < .05). The total PA METs was significantly associated with self-acceptance (β = 0.13, p < .05). positive relations (β = 0.16, p < .05), purpose in life (β = 0.39, p < .05). Vigorous PA METs showed significantly negative effect on personal growth (β = −0.28, p < .05) and accounted for 2.0% of the variance of personal growth. PA accounted for 2.5% and 1.2% of the variance of positive relations and purpose in life, respectively., Most of the young men had moderate levels of PA and PWB. PA was significantly associated with PWB among the young men. Male sensitive evidence-based health promotion interventions should aim at promoting PA and PWB among male university students.

Magnitude of Overweight, Obesity and Insufficient Physical Sports Activities Among Secondary School Students in Kinondoni Municipal, Dar es Salaam

INTRODUCTION

There is an overwhelming increase of Non-Communicable Disease worldwide such as diabetes and cardiovascular diseases. Overweight and obesity are highly associated with development of these diseases. Unhealthy lifestyle such as excessive sugar, alcohol intake and lack of adequate physical activities has been associated with development of obesity. However, these risk factors are not well elucidated among adolescents in Tanzania. We conducted this survey to determine obesity, overweight, self-reported physical activities, and preferred foods among secondary school students in Kinondoni Municipal in Dar es salaam, Tanzania.

METHODS

A cross sectional descriptive survey was conducted among secondary school students at Kambangwa and Makumbusho secondary schools in Kinondoni municipal in Dar es Salaam city. A simple random sampling technique was used to select participating schools with systemic random selection procedure was used to select participants. A pre structured, self-administered questionnaire was used to collect demographic information from the participants. Anthropometric measurement for Body Mass Index (BMI) was done using standard tools. Interpretation of the findings was done using World Health Organization (WHO) standard charts for age and sex. Data were analysed using Statistical Package for Social Sciences (SPSS version 20; SPSS Inc., Chicago, US).

RESULTS

A total of 234 participants were enrolled in the study. A total of 204 (87.2%) of study participants reported to regularly participate in physical sports activities. Furthermore, Males reported to participate more in physical sports activities compared to females (χ2 (1) =8.13., p = 0.004). During sex-wise comparison, 30 (46.2%) of males reported to participate in sports once per week compared to 71 (51.5%) of females. Reported frequency was influenced by participants' sex (χ2 (3) =16.4., p= 0.001). A total of 28 (12%) participants reported fruits as their favourite food. Food preference was influenced by the participants' sex (X 2 (5) =13.1., p < 0.02). 32(47.7%) of males reported fresh fruits juice as their favourite drink compared to 106(63.5%) of females) while 6(9%) of males reported to prefer commercial industrial juice compared to 4 (2.4%) of females.

CONCLUSION

Obesity and overweight are prevalent among secondary school adolescents in Kinondoni Municipal, Dar es salaam. In addition, the magnitude of physical activities was below the recommended amount. Therefore, awareness campaigns and advocacy programs aiming at preventive measures against NCDs such as healthy eating behaviour and promotion of physical activities among adolescents should be given high priority.

A study on physical activity by a need-based curriculum for students in a rural area of West Bengal

BACKGROUND

Students must be made aware about the essentiality of optimum level of physical activity and the fact that it is the key to good health and an important technique to prevent and control a lot of noncommunicable diseases including depression and other related mental ill-health.

MATERIALS AND METHODS

It was an institution-based intervention study among 187 Madrasah students of classes VII and VIII, conducted in five-phase assessment of the training needs of Madrasah students on different aspects of healthy lifestyle, development of a need-based module to be used by teachers to impart training of students through classroom setting, training of teachers to use the module to train students, training of students by the trained teachers in classroom setting, and evaluation of effectiveness of the training module.

RESULTS

The mean pretest knowledge score in study Madrasah was 2.64 ± 1.35 (Mean ± SD) and post test score was 4.13 ± 0.88 (Mean ± SD). In paired t-test, t-value was 13.54 and P < 0.05 with effect size of 1.370 (Cohen's d). Practice related to the mean score in pretest was 2.38 ± 1.08 and posttest score was 2.73 ± 1.03. In paired test, t-value was 6.25 and P < 0.05 with effect size of 0.458 (Cohen's d).

CONCLUSIONS

The study revealed the effectiveness of training by teachers using the module developed by the researcher to address significant changes in lifestyle-related issues.

Prevalence and socio-demographic correlates of accelerometer measured physical activity levels of school-going children in Kampala city, Uganda

Background

The current international physical activity guidelines for health recommend children to engage in at least 60 minutes of moderate-to-vigorous physical activity (MVPA) daily. Yet, accurate prevalence estimates of physical activity levels of children are unavailable in many African countries due to the dearth of accelerometer-measured physical activity data. The aim of this study was to describe the prevalence and examine the socio-demographic correlates of accelerometer-measured physical activity among school-going children in Kampala city, Uganda.

Methods

A cross-sectional study design was used to recruit a sample of 10–12 years old school-going children (n = 256) from 7 primary schools (3 public schools and 4 private schools) in Kampala city, Uganda. Sedentary time, light-intensity physical activity (LPA), moderate-intensity physical activity (MPA) and vigorous-intensity physical activity (VPA) were measured by accelerometers (ActiGraph GT3X+ [Pensacola, Florida, USA]) over a seven-day period. Socio-demographic factors were assessed by a parent/guardian questionnaire. Weight status was generated from objectively measured height and weight and computed as body mass index (BMI). Multi-level logistic regressions identified socio-demographic factors that were associated with meeting physical activity guidelines.

Results

Children’s sedentary time was 9.8±2.1 hours/day and MVPA was 56±25.7 minutes/day. Only 36.3% of the children (38.9% boys, 34.3% girls) met the physical activity guidelines. Boys, thin/normal weight and public school children had significantly higher mean daily MVPA levels. Socio-demographic factors associated with odds of meeting physical activity guidelines were younger age (OR = 0.68; 95% CI = 0.55–0.84), thin/normal weight status (OR = 4.08; 95% CI = 1.42–11.76), and socioeconomic status (SES) indicators such as lower maternal level of education (OR = 2.43; 95% CI = 1.84–3.21) and no family car (OR = 0.31; 95% CI = 0.17–0.55).

Conclusion

Children spent a substantial amount of time sedentary and in LPA and less time in MVPA. Few children met the physical activity guidelines. Lower weight status, lower maternal education level and no family car were associated with meeting physical activity guidelines. Effective interventions and policies to increase physical activity among school-going children in Kampala, are urgently needed.

Is physical activity associated with resting heart rate in boys and girls? A representative study controlled for confounders

OBJECTIVE

Investigate the relationship between different domains of physical activity and resting heart rate (RHR) in boys and girls.

METHOD

The sample included 1011 adolescents, aged between 10 and 17 years. RHR was measured by a heart rate monitor and physical activity was assessed in total and in three different domains (school, occupational, and sports practice) by a questionnaire. Anthropometry was directly obtained for body mass index and central fat. Ethnicity, sedentary behavior, and smoking habits were self-reported and used to adjust the analysis, through hierarchical linear regression.

RESULTS

Total physical activity was associated with low RHR in boys (β=-0.52; 95% CI: -0.92, -0.12) and girls (β=-0.67; 95% CI: -1.07, -0.28). Although sporting physical activities were associated with low RHR in both boys (β=-0.58; 95% CI: -1.05, -0.11) and girls (β=-0.87; 95% CI: -1.34, -0.39), occupational physical activity was related to low RHR only in boys (β=-1.56; 95% CI: -2.99, -0.14).

CONCLUSION

The practice of physical activity in the sport practice domain and total physical activity were related to low RHR in both sexes, while occupational physical activities were associated with RHR only in boys.

Are senior high school students in Ghana meeting WHO's recommended level of physical activity? Evidence from the 2012 Global School-based Student Health Survey Data

Introduction

Physical activity (PA) has both short- and long-term importance. In this study we sought to assess the prevalence and correlates of PA among 1,542 Senior High School (SHS) students.

Methods

A cross-sectional study was conducted in Ghana among SHS students using the 2012 version of the Ghana Global School-based Student Health Survey (GSHS) data, which utilised two-stage cluster sampling technique. The population for the study comprised SHS students. The outcome variable was physical activity. The data were analysed using STATA version 14.2 for Mac OS. Both bivariate and multivariate analyses were employed. At the bivariate level, Pearson chi-square test between each independent variable and PA was conducted and the level of statistical significance was set at 5%. All the significant variables from the chi-square test were selected for the multivariate analysis. In the multivariate analysis, Poisson regression with robust variance was performed to estimate crude and adjusted prevalence ratios (APR).

Results

It was found that 25.0% (29.0% males and 21.9% females) of SHS students were physically active. Female students (APR = 0.78, 95% CI = 0.65, 0.94), students in SHS 2 (APR = 0.76, 95% CI = 0.577, 0.941) and SHS3 (APR = 0.79, 95% CI = 0.63, 0.93), and those who went hungry (APR = 0.77, 95% CI = 0.65, 0.92) were less likely to be physically active compared to males, those in SHS1 and those who did not go hungry respectively. On the other hand, students who actively commuted to school (APR = 2.40, 95% CI = 1.72, 2.42) and got support from their peers were more likely to be physically active (APR = 1.62, 95% CI = 1.09–2.41).

Conclusion

Only a quarter of SHS students who participated in the 2012 version of the GSHS met the WHO’s recommended level of physical activity. Sex, grade/form and experience of hunger are associated with physical activity. Physical activity is a major component of any health promotion program. Policies and programmes targeting improvement in physical activity among SHS students should take these associated factors into consideration.

Nutritional status and Cardiometabolic health among adolescents; findings from southwestern Nigeria

BACKGROUND

Obesity has been associated with an increased risk for cardio-metabolic diseases. The prevalence of obesity among adolescents is increasing worldwide, including Nigeria, but only little data exist on the relationship of nutritional status with cardio-metabolic health among adolescents in Nigeria. This study therefore investigated the relationship of nutrition status, raised blood pressure, glucose intolerance and risk for metabolic diseases among adolescents in southwestern Nigeria.

METHODS

This was a cross-sectional study conducted among 313 in-school adolescents in Ile-Ife, southwestern Nigeria. The respondents were selected using multi-stage sampling technique, and data were collected using pre-tested structured questionnaires. Anthropometric, blood pressure and random blood glucose measurements were done using standard protocols. Nutritional assessment was done using the World Health Organization (WHO) 2007 reference. Pre-hypertension and hypertension were measured using percentiles for gender, age and height. Analysis was done using IBM SPSS and the level of significance was set at p ≤ 0.05.

RESULTS

The mean age of the respondents was 14.4 ± 2.0 years. The prevalence of overweight and obesity was 10.2%, and it was significantly higher among females (12.5%) than males (7.0%). The prevalence of systolic and diastolic pre-hypertension was 10.9 and 11.5% respectively, while the prevalence for systolic and diastolic hypertension were 14.4 and 8.6% respectively. Using WHtR to assess cardio-metabolic risk, 7.3% of the respondents were at risk. There were statistically significant relationships between BMI, WHtR and blood pressure levels (< 0.05).

CONCLUSIONS

The prevalence of overweight/obesity among the adolescents was relatively high, and this was significantly associated with elevated blood pressure and increased risk for cardio-metabolic diseases. There is need for more interest and intervention by stakeholders into the cardio-metabolic health of adolescents in Nigeria.

Gender differences in nutritional status, diet and physical activity among adolescents in eight countries in sub-Saharan Africa

OBJECTIVE

The objective of this study was to evaluate gender differences in nutritional status, dietary intake, physical activity and hand hygiene among adolescents from diverse geographical settings in sub-Saharan Africa.

METHODS

This study utilised cross-sectional data from six countries (Burkina Faso, Ethiopia, Ghana, Nigeria, Tanzania and Uganda) within the ARISE Adolescent Health Survey (n = 7625). Body mass index (BMI) was calculated using measured heights and weights, and z-scores were calculated based on the 2007 WHO growth standards for age and sex. Information on demographics, diet and health behaviours was collected through face-to-face interviews using a standardised questionnaire. Site-specific and pooled prevalence ratios were determined.

RESULTS

The prevalence of underweight, overweight and stunting pooled across sites was 14.3%, 6.8% and 18.1%, respectively. Female sex was associated with a lower risk of being underweight (pooled prevalence ratio 0.66, 95% 0.57, 0.77) and stunted (pooled PR 0.63, 95% CI 0.55, 0.71), but a higher risk of being overweight (pooled PR 1.60, 95% CI 1.26, 2.06). Females were also less likely to exercise for 1 h or more per day (pooled PR 0.77, 95% CI 0.67, 0.88), and more likely to wash hands after using toilets or latrines and to wash hands with soap (pooled PRs 1.13, 95% CI 1.05, 1.21 and 1.35, 95% CI 1.23, 1.45, respectively).

CONCLUSION

Our results emphasise that sex is a key predictor of nutritional status among sub-Saharan African adolescents and suggest that gender-specific interventions may be required to reduce the double burden of under- and overnutrition.

Clustering of lifestyle risk behaviours and its determinants among school-going adolescents in a middle-income country: a cross-sectional study

Background

Lifestyle risk behaviours such as smoking, alcohol consumption, physical inactivity, sedentary behaviour and low fruit/vegetable intake have been identified as the major causes of chronic diseases. Such behaviours are usually instigated in adolescence and tend to persist into adulthood. Studies on the clustering of lifestyle risk behaviours among adolescents are scarce, particularly in developing countries. Therefore, the present paper aimed to determine the clustering of lifestyle risk behaviours and its determinants among school-going adolescents in Malaysia.

Methods

Data were extracted from a cross-sectional study, the Malaysian Adolescent Health Risk Behaviour (MyAHRB) study, which was conducted from May to September 2013 across 11 states in Peninsular Malaysia. A two-stage proportionate-to-size sampling method was employed to select a total of 3578 school-going adolescents aged 16–17 years from 20 selected schools in urban and rural settlements, respectively. The MyAHRB study adopted a set of self-administered questionnaires adapted from the Global School-based Student’s Health Survey (GSHS) and the Youth Risk Behaviour Surveillance.

Results

The results from the analysis of 2991 school-going adolescents aged 16–17 years showed that 16 (in boys) and 15 (in girls) out of 32 combinations of lifestyle risk behaviours clustered. Girls (aOR 2.82, 95% CI: 2.32–3.43) were significantly more likely to have clustered risk behaviours than boys; however, no significant associated factors were observed among girls. In contrast, boys of Malay descent (aOR 0.64, 95% CI: 0.46–0.89) or boys who had at least three friends (aOR 0.65, 95% CI: 0.43–0.99) were less likely to engage in multiple risk behaviours.

Conclusion

The present study demonstrated the clustering of multiple risk behaviours that occurred in both genders; these results suggest that multiple behaviour intervention programmes, instead of programmes based on siloed approaches, should be advocated and targeted to the high-risk sub-populations identified in the present study.

Impact of school and work status on diet and physical activity in rural Guatemalan adolescent girls: a qualitative study

In low‐ and middle‐income countries, gender norms and access to energy‐dense, nutrient‐poor foods are well‐studied determinants of food and physical activity choices for adolescent girls. However, most work has been done in urban and school settings. In many settings, a large proportion of the adolescent population is rural or not enrolled in school. We conducted in‐depth interviews with 20 adolescent girls (ages 15–19) in Tecpán, Guatemala, a rural, largely indigenous Maya community. Interviews were coded and themes analyzed for insights into eating habits, food choices, and physical activity. Twelve participants were enrolled in school and eight were employed and not in school. Girls enrolled in school had more disrupted eating schedules and consumed more energy‐dense, nutrient‐poor foods. Girls not enrolled in school had fewer opportunities for physical activity and were more sedentary. To our knowledge, this study is the first in a low‐ and middle‐income country to consider diet and physical activity of adolescent girls enrolled and not enrolled in school. Key implications include (1) the need to reduce exposure to nutrient‐poor foods and promote healthy eating schedules in schools, and (2) the need to create community‐based opportunities for the activity for girls no longer enrolled in school.

Level, motivation and barriers to participate in physical activity among late adolescents in Puducherry

BACKGROUND

One in every ten deaths globally is accounted for by physical inactivity-related risks. Adolescents constitute 18% of the world's total population and are at risk of becoming physically inactive in the future. Thus, this study aims to find the level of physical activity (PA) among late adolescents and factors that motivate and prevent them from being active.

METHODOLOGY

Four hundred and fifty adolescents in the age group of 18-19 years were included in the study. Standardized self-administered questionnaires such as the Global Physical Activity Questionnaire and the Behavioral Regulation in Exercise Questionnaire were used to assess the level of PA and level of motivation, respectively. In addition, barriers to participating in PA were also elicited.

RESULTS

This study found that about one third of the subjects (32.4%) were physically inactive. The motivation levels were more pooled towards the self-determined motives and girls are more motivated towards PA than boys. However, PA among males is significantly higher than females. Healthy practices in families was also found to have significant association with increased PA. The major barriers found were the excessive use of electronic gadgets and lethargy.

CONCLUSION

One third of the adolescents in this study were physically inactive and several barriers that prevent them from taking up PA were elicited. Therefore, efforts should be taken to emphasize the importance of physical activity among individuals, family members and the peers at institutional level and community level so as to lay foundations for healthy lifestyles in the future. Basic prevention in the emergence of risk factors for non-communicable diseases (NCDs) like PA is vital to curb the growing burden of chronic diseases in our country.

Exploring Neighborhood Environments and Active Commuting in Chennai, India

Few studies assess built environment correlates of active commuting in low-and-middle-income countries (LMICs), but the different context could yield distinct findings. Policies and investments to promote active commuting remain under-developed in LMICs like India, which grapples with traffic congestion, lack of activity-supportive infrastructure, poor enforcement of traffic rules and regulations, air pollution, and overcrowding. This cross-sectional study investigated associations between home neighborhood environment characteristics and active commuting in Chennai, India. Adults (N = 370, 47.2% female, mean age = 37.9 years) were recruited from 155 wards in the metropolitan area of Chennai in southern India between January and June 2015. Participants self-reported their usual mode of commute to work, with responses recoded into three categories: (1) multi-modal or active commuting (walking and bicycling; n = 56); (2) public transit (n = 52); and (3) private transport (n = 111). Environmental attributes around participants’ homes were assessed using the Neighborhood Environment Walkability Scale for India (NEWS-India). Associations between environmental characteristics and likelihood of active commuting and public transit use were modeled using logistic regression with private transport (driving alone or carpool) as the reference category, adjusting for age, gender, and household car ownership. Consistent with other international studies, participants living in neighborhoods with a mix of land uses and a transit stop within a 10-minute walk from home were more likely to use active commuting (both p < 0.01). Land-use mix was significantly associated with the use of public transit compared to private transport (adjusted odds ratio (aOR) = 5.2, p = 0.002). Contrary to findings in high-income countries, the odds of active commuting were reduced with improved safety from crime (aOR = 0.2, p = 0.003), aesthetics (aOR = 0.2, p = 0.05), and street connectivity (aOR = 0.2, p = 0.003). Different environmental attributes were associated with active commuting, suggesting that these relationships are complex and may distinctly differ from those in high-income countries. Unexpected inverse associations of perceived safety from crime and aesthetics with active commuting emphasize the need for high-quality epidemiologic studies with greater context specificity in the study of physical activity in LMICs. Findings have public health implications for India and suggest that caution should be taken when translating evidence across countries.

Development and convergent validity of new self-administered questionnaires of active transportation in three African countries: Kenya, Mozambique and Nigeria

BACKGROUND

There is currently a rapid physical activity transition taking place in developing countries that includes a decrease in active transportation. Building on findings from an earlier systematic review, this paper describes the development and convergent validity of self-administered child and parent questionnaires assessing active transportation of children in three African countries: Kenya, Mozambique and Nigeria.

METHODS

A pilot study was conducted to examine the convergent validity of the developed questionnaires by comparing responses between children and their parents (N = 121; n = 43 for Mozambique, n = 24 for Kenya and n = 54 for Nigeria). After modification, the questionnaires were then administered to a larger convenient sample of both children and parents from Kenya (n = 1123), Mozambique (n = 1097) and Nigeria (n = 831) which defined the main study. The questionnaires assessed active transportation to/from 8 categories of destinations including school, friends' and relatives' home/houses, parks and playgrounds among others. Twenty items were used to assess child - and parent-perceived barriers to active transportation, and the parent questionnaire inquired about parent education and availability of cars, motorcycles, and bicycles. Spearman's rho was used to compare children's mode of travel in the pilot study while the prevalence-adjusted bias-adjusted kappa (PABAK) coefficient was used to compare convergent validity between children's and parents responses on active transportation in the main study.

RESULTS

Findings of the main study show that convergent validity for active transportation to and from each destination in the combined sample ranged from 0.472 (from school) to 0.998 (to other places). Convergent validity for challenges/barriers to active transportation to school ranged from fair (0.30 - The route does not have good lighting) to substantial (0.77 - My child has a disability). It varied between countries from fair (n = 11-items) to moderate (n = 9-items) agreement in Kenya and from poor (n = 2-items) to fair (n = 16-items) agreement in Nigeria. Data from Mozambique was however missing and therefore could be included.

CONCLUSIONS

The questionnaires provided valid information on the number of trips to/from various destinations and show acceptable and modest convergent validity for measuring barriers to active transport in a sample of children from three African countries. These questionnaires may be suitable for future research on active transport among school children in Sub-Saharan African countries.

A Cross-Sectional Examination of Physical Activity Levels and Their Socio-Demographic Determinants in Southern Tanzania

Physical activity is essential for healthy aging. Evidence suggests that vigorous-intensity physical activity (VPA) may be more beneficial than moderate-intensity physical activity (MPA). We examined physical activity levels (MPA, VPA and total physical activity), and their socio-demographic determinants in 2311 participants (15–93 years; 68% women) of the MZIMA Open Community Cohort, who had complete relevant data. Physical activity levels were estimated in minutes per week across three domains—work, leisure and transport. We created three outcome variables: low MPA (<150 min per week of MPA), low VPA (<75 min per week of VPA) and insufficient physical activity (IPA: <150 min per week of total physical activity) and applied sample-weighted multivariable logistic regression to assess associations with potential socio-demographic determinants. Prevalence of IPA, low MPA and low VPA were 25%, 26% and 65% respectively. IPA and low MPA were correlated (Spearman R = 0.98; p < 0.001). Work, leisure and transport contributed 54%, 25% and 21% to total physical activity respectively. IPA and low VPA were significantly associated with female sex, lower education, non-manual occupation and frequent fruit consumption. We observed significant differences by sex (P_{heterogeneity} < 0.001), on the associations between education and IPA, and between age, occupation and low VPA. In conclusion, low levels of VPA, which were more pronounced in women, support the monitoring and promotion of VPA alongside overall physical activity. Leisure-related activities should also be promoted towards gains in vigorous-intensity and total physical activity in this setting.

Prevalence and correlates of low physical activity in the Iranian population: National survey on non-communicable diseases in 2011

To assess the prevalence and correlates of low physical activity among Iranian population aged 15-64 years. We used the data collected in National Surveillance of Risk Factors of Non-Communicable Diseases in Iran, 2011. Physical activity was categorized in 3 levels of low, moderate, and high based on a Persian version of Global Physical Activity Questionnaire. The multistage cluster sampling design was accounted for using complex survey analysis method. The sample included 10016 individuals; 41.7% (n = 4178) were men and 58.3% (n = 5837) were women. The mean (SD) age of participants was 38.8 (14.9) years also, and 69.8% (n = 6991) of the participants were from urban areas. The prevalence of low physical activity in the whole population was estimated to be 44.8% (95% CI: 41.7, 48.1). The odds of lower physical activity in the women were 3 times greater than men (OR = 3.14; 95% CI: 2.64, 3.57); in the wealthiest people was 25% lower than the poorest people (OR = 0.75; 95% CI: 0.60, 0.94). The odds of lower physical activity in the age groups 55-64 years were 44% greater than the youngest age groups 15-24 years (OR = 1.44; 95% CI: 1.23, 1.68). The odds of lower physical activity in the obese participants were 18% greater than normal-weight people (OR = 1.18; 95% CI: 1.01, 1.38).). The odds of lower physical activity in diabetic patients were 30% greater than healthy people (OR: 1.30; 95% CI: 1.07, 1.57). The prevalence of low physical activity in Iran, 2011 was high. The correlates of low physical activity in Iran are different to those of Western populations. The main associated factors with low physical activity were female gender, urban area, low socioeconomic status, obesity, diabetes, and older age. Public health policies should target the groups at highest risk of low physical activity.

Perceived barriers to achieving a healthy weight: a qualitative study using focus groups at public and private schools in Guatemala City

BACKGROUND

Overweight prevalence among Guatemalan girls is higher in public than in private schools. Little is known about adolescent girls' perceptions of the right ways to achieve a healthy weight. This study examines public and private school adolescent girls' perceptions of a "healthy weight," and barriers and facilitators to achieving it.

METHODS

We conducted 4 focus groups in public and private schools in Guatemala City with girls from 13 to 15 years old. The discussion guide included open-ended questions and activities aimed at examining perceptions of "healthy weight" and barriers and motivators to achieving it within the school environment. Focus groups were audio-recorded and transcribed. Data analyses followed established methods of content analysis.

RESULTS

Twenty-eight girls (private school, n = 12; public school, n = 16) of ages ranging from 13.1 to 15.9 years (median, 14, IQR, 13.6-14.9) participated in the study. Girls identified images of thin and fit women as healthy. They cited healthy eating and physical activity as ways to achieve a healthy weight. Within the school environment, barriers to maintaining a healthy weight included a lack of healthy food options and the prioritization of sports for boys over girls. In public schools, facilities were less than optimal; in private schools, girls' access to facilities was limited. Public school girls stated that their uniforms were inappropriate for exercising.

CONCLUSION

Our findings support the need to provide more healthy food options in Guatemalan schools. In addition, physical activity for girls should be promoted and facilities made available for their use.