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1.  Physical activity and overweight among adolescents on the Texas-Mexico border 
Objective
To investigate differences in associations between physical activity and overweight for students in two adjacent areas on the border between Mexico and the United States of America: students in the city of Matamoros, Mexico, and Mexican-American students in the Lower Rio Grande Valley (LRGV) area of southern Texas. Since the extremely high prevalence of overweight among Mexican-American adolescents is well-recognized, we wanted to determine whether overweight has become a problem among Mexican adolescents.
Methods
Students from 6 schools (n = 669), representing 12% of the ninth-grade students in Matamoros during 2002-2003, and students from 13 high schools (n = 4 736), representing 22% of the ninth-grade students in the LRGV during 2000-2001, completed questionnaires. Polytomous logistic regression was performed to estimate the risk of being at risk of overweight (≥85th percentile to <95th percentile of body mass index (BMI) for age and sex) and the risk of being overweight (≥95th percentile of BMI-for-age and sex) versus normal weight associated with measures of physical activity. For simplicity normal weight includes underweight.
Results
A higher percentage of adolescents in the LRGV were at risk of overweight (17.2%) in comparison with adolescents from Matamoros (14.8%). The percentages of LRGV and Matamoros adolescents who were overweight were identical (16.9%). LRGV adolescent boys (OR = 0.87, 95% CI = 0.77-0.98) who participated in team sports were less likely to be at or above the 85th percentile of BMI-for-age and sex. Although of borderline significance, Matamoros and LRGV adolescent boys who participated in physical education classes were less likely to be at risk of overweight. Neither in Matamoros nor LRGV students were any of the various physical activity categories or levels associated with being at risk of overweight or being overweight.
Conclusions
Nearly one-third of the students in both Matamoros and the LRGV are at risk of overweight and are overweight. Implementation of interventions on healthful dietary choices and participation in physical education classes and sports teams are essential for reducing the extremely high prevalence of overweight among students on both sides of the Texas/Mexico border.
ABSTRACT. Spanish.
Objetivo: Investigar si hay diferencias en las asociaciones entre la actividad física y el sobrepeso observadas en estudiantes de dos zonas colindantes en la frontera mexicanoestadounidense: estudiantes de la ciudad de Matamoros, México, y estudiantes mexicanoestadounidenses del valle a lo largo de la desembocadura del Río Bravo (VRB) en la parte sur del estado de Texas. Dada la consabida prevalencia extremadamente alta de sobrepeso en adolescentes mexicanoestadounidenses, los autores queríamos determinar si el sobrepeso también se ha convertido en un problema entre adolescentes mexicanos.
Métodos: Estudiantes de 6 escuelas (n = 653), que comprenden 11% de los estudiantes de noveno grado en Matamoros durante 2002–2003, y estudiantes de 13 bachilleratos (n = 4 736), que comprenden 22% de los estudiantes de noveno grado del VRB durante 2000–2001, contestaron cuestionarios. Se llevó a cabo una regresión logística politómica a fin de calcular el riesgo de estar en riesgo de tener sobrepeso (≥85.° percentil a <95.° percentil de índice de masa corporal (IMC) para la edad y el sexo) y el riesgo de tener sobrepeso (≥95.° percentil de índice de masa corporal (IMC) para la edad y el sexo), frente a un peso normal, que se asociaban con distintos grados de actividad física. En aras de la sencillez, en la clasificación del peso normal también se abarcó la insuficiencia de peso.
Resultados: Un mayor porcentaje de adolescentes estaban en riesgo de sufrir sobrepeso en el VRB (17%) que en Matamoros (15%). Los porcentajes de adolescentes de VRB y de Matamoros que tenían sobrepeso fueron idénticos (17%). Los varones adolescentes en el VRB (razón de posibilidades [RP] = 0,87; IC95% = 0,77 a 0,98) que participaron en deportes en equipo tuvieron una menor probabilidad de estar en riesgo de tener sobrepeso. No se encontraron asociaciones entre ningunas de las demás categorías de actividad física por un lado, y estar en riesgo de sufrir sobrepeso o tener sobrepeso por el otro, ni en estudiantes de Matamoros ni en los del VRB.
Conclusiones: Casi una tercera parte de los estudiantes tanto en Matamoros como en el VRB está en riesgo de tener sobrepeso o tiene sobrepeso. La puesta en práctica de intervenciones para fomentar hábitos alimentarios sanos y la participación en clases de educación física y en deportes en equipo es una medida esencial para reducir la prevalencia extremadamente alta de sobrepeso observada en estudiantes a ambos lados de la frontera entre México y Estados Unidos.
PMCID: PMC1525222  PMID: 16723065
Overweight; physical fitness; adolescent; Mexican-Americans; Mexico; Texas
2.  An Exploratory Study of Physical Activity and Over-Weight in Two Senior High Schools in The Accra Metropolis 
Ghana Medical Journal  2013;47(4):197-203.
Summary
Background
Overweight and physical inactivity are major risk factors for non-communicable diseases. However, little evidence on physical activity, and overweight exists to support intervention in specific sub-populations including adolescents in low-income settings like Ghana. This study aimed at estimating overweight and determining the pattern and level of physical activity among senior high school students in the Accra Metropolis.
Methods
A cross-sectional study was conducted in the Accra Metropolis, among senior high school students, ages 15 to 19 years. Participants were selected using a two-stage cluster sampling technique. Structured questionnaire and anthropometric measurement were employed to gather information for the study. Students were considered as overweight if their Body Mass Index (BMI) ≥ +1SD, and obese if BMI ≥ +2SD.
Results
Out of 444 students, 17% were classified as engaging in low level physical activity, 49% in moderate activity, and 34% in high level of physical activity. Much of the activity in boys was recreational while among girls, was due to domestic chores. The prevalence of overweight was 11.7%. Overweight prevalence was higher among female students (15.6%) compared to 4.5% in males. Furthermore the risk of overweight was lower among students who engaged in high physical activity than those engaged in low activity. Overweight was independently associated with physical activity (p=0.01), sex (p=0.001) and age (p=0.01), after controlling for age sex and physical activity and diet.
Conclusion
Majority of students in the study engaged in moderate to high physical activity. The prevalence of overweight was 11.7%. Physical activity was significantly related to overweight among students in the study.
PMCID: PMC3961858  PMID: 24669026
Overweight; Physical Activity; School; Adolescent; Diet; Ghana
3.  A Community–School District–University Partnership for Assessing Physical Activity of Tweens 
Preventing Chronic Disease  2008;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.
PMCID: PMC2644589  PMID: 19080021
4.  Influence of Sports, Physical Education, and Active Commuting to School on Adolescent Weight Status 
Pediatrics  2012;130(2):e296-e304.
OBJECTIVE:
To compare the associations between weight status and different forms of physical activity among adolescents.
METHODS:
We conducted telephone surveys with 1718 New Hampshire and Vermont high school students and their parents as part of a longitudinal study of adolescent health. We surveyed adolescents about their team sports participation, other extracurricular physical activity, active commuting, physical education, recreational activity for fun, screen time, diet quality, and demographics. Overweight/obesity (BMI for age ≥ 85th percentile) and obesity (BMI for age ≥ 95 percentile) were based on self-reported height and weight.
RESULTS:
Overall, 29.0% (n = 498) of the sample was overweight/obese and 13.0% (n = 223) were obese. After adjustments, sports team participation was inversely related to overweight/obesity (relative risk [RR] = 0.73 [95% confidence interval (CI): 0.61, 0.87] for >2 sports teams versus 0) and obesity (RR = 0.61 [95% CI: 0.45, 0.81] for >2 sports teams versus 0). Additionally, active commuting to school was inversely related to obesity (RR = 0.67 [95% CI: 0.45, 0.99] for >3.5 days per week versus 0). Attributable risk estimates suggest obesity prevalence would decrease by 26.1% (95% CI: 9.4%, 42.8%) if all adolescents played on 2 sports teams per year and by 22.1% (95% CI: 0.1%, 43.3%) if all adolescents walked/biked to school at least 4 days per week.
CONCLUSIONS:
Team sport participation had the strongest and most consistent inverse association with weight status. Active commuting to school may reduce the risk of obesity, but not necessarily overweight, and should be studied further. Obesity prevention programs should consider strategies to increase team sport participation among all students.
doi:10.1542/peds.2011-2898
PMCID: PMC3408684  PMID: 22802608
overweight; obesity; exercise; sports; team sports; physical education; active travel; walking; bicycling; commuting; adolescent; body weight; secondary school
5.  Relationship between Frequency and Intensity of Physical Activity and Health Behaviors of Adolescents 
The Journal of school health  2010;80(3):10.1111/j.1746-1561.2009.00477.x.
Background
While studies have determined the importance of physical activity in advancing health outcomes, relatively few have explored the relationship between exercise and various health behaviors of adolescents. The purpose of this study was to examine the relationship between frequency and intensity of physical activity and both health risk and health promoting behaviors of adolescents.
Methods
Data were collected from 822 students attending a large, diverse suburban high school in northeast Florida using a self-administered survey. Multivariate analysis of variance (MANOVA) and analysis of variance (ANOVA) tests examined differences on mean health behavior measures on three exercise frequency levels (low, medium, and high) and two intensity levels (vigorous physical activity: VPA, and moderate physical activity: MPA).
Results
Results showed adolescents engaged in high levels of VPA used marijuana less frequently (p=0.05) and reported heavy use of marijuana less frequently (p=0.03); consumed greater amounts of healthy carbohydrates (p<0.001) and healthy fats in their diets (p<0.001); used stress management techniques more frequently (p<0.001); and reported a higher quality of sleep (p=0.01) than those engaged in low levels of VPA. Fewer differences were found on frequency of MPA and health behaviors of adolescents.
Conclusion
These findings suggest that adolescents who frequently participate in VPA may be less likely to engage in drug use, and more likely to participate in a number of health promoting behaviors. Longitudinal and experimental studies are needed to determine what role frequent VPA may play in the onset and maintenance of health enhancing and protecting behaviors among adolescent populations.
doi:10.1111/j.1746-1561.2009.00477.x
PMCID: PMC3866093  PMID: 20236415
Adolescent health; physical fitness; health behaviors
6.  Determinants of Overweight and Obesity in Affluent Adolescent in Surat City, South Gujarat region, India 
Background:
Obesity is a major global burden. Low levels of physical activity, TV watching, and dietary pattern are modifiable risk factors for overweight and obesity in adolescent.
Objective:
The objective of this study was to determine risk factors for overweight and obesity among affluent adolescent, in Surat city in south Gujarat.
Design:
Cross sectional from July 2009 to April 2010.
Setting:
Two private schools with tuition fees more than Rs. 2000 per month, were selected randomly using a random table.
Participants:
The participants were adolescents, 12 to 15 years of age.
Data collection:
Pre-designed and pre-tested questionnaire was used to elicit the information about dietary history and physical activity.
Measurement:
Height and weight was measured and BMI was calculated. Overweight and obesity were assessed by BMI for age. Student who had BMI for age <85th and <95th percentile of reference population were classified as overweight and BMI for age <95th percentile of reference population were classified as obese (IAP Growth Monitoring Guidelines for Children from Birth to 18 Year).
Result:
The overall prevalence of obesity and overweight was 6.55% and 13.9% (boys: 6.7% and 15.1%; girls 6.4% and 13.35%). Final model of multiple logistic regression analysis showed that important determinants of overweight and obesity were low levels of physical activity, watching television or playing computer games, and consuming junk foods, snacks and carbonated drinks.
Conclusion:
The magnitude of obesity and overweight among affluent adolescent of Surat city was found to be 6.55% and 13.9%, respectively. Low level of physical activity, watching TV or playing computer games, and dietary pattern predisposed the adolescent to overweight/obesity.
doi:10.4103/0970-0218.91418
PMCID: PMC3263151  PMID: 22279261
Adolescent; India; obesity; risk factors
7.  Physical Activity, Watching Television, and the Risk of Obesity in Students, Texas, 2004-2005 
Preventing Chronic Disease  2011;8(3):A61.
Introduction
The epidemic of childhood obesity has been well-documented. Prevalence of obesity among students in Texas is higher than the US prevalence. Our objective was to understand the combined influence of physical activity and television viewing on weight status of students in Texas.
Methods
Students in grades 4, 8, and 11 participated in the School Physical Activity and Nutrition survey during the 2004-2005 academic year. Multinomial logistic regression tested the associations between both being overweight and obese (vs underweight/normal weight) and the combined influence of physical activity and watching television, adjusting for age, grade, race/ethnicity, language spoken at home, and percentage of economically disadvantaged students in the school. We used 5 physical activity indicators to describe students' physical activity.
Results
Girls who participated in less than 3 days of exercise per week to strengthen or tone muscles and watched 2 hours or less per day of television had increased odds of being obese (adjusted odds ratio, 1.8; 95% confidence interval, 1.1-3.0) compared with girls who participated in 3 or more days per week of exercise to strengthen or tone muscles and watched 2 hours or less per day of television. Boys in our study who watched 3 or more hours per day of television and did not meet physical activity recommendations had increased odds of being obese in all of our 5 physical activity indicators.
Conclusion
Although results varied by physical activity indicator and sex, our findings provide further evidence for the combined effect of high television watching and low physical activity engagement on the risk for obesity in children and adolescents.
PMCID: PMC3103566  PMID: 21477501
8.  Trajectories of Objectively Measured Physical Activity among Secondary Students in Canada in the Context of a Province-Wide Physical Education Policy: A Longitudinal Analysis 
Journal of Obesity  2014;2014:958645.
Lower levels of physical activity are associated with childhood obesity. School physical education (PE) policies have been identified as critical to improve child and adolescent physical activity levels but there has been little evaluation of such policies. In the province of Manitoba, Canada, the government implemented a mandatory PE policy in secondary schools designed to increase the daily physical activity levels of adolescents. The objective of this study was to examine the longitudinal changes in and the factors associated with the physical activity trajectories of adolescents in Manitoba during their tenure as secondary school students in the context of this school PE policy. The results found, despite the PE policy, a grade-related decline in the physical activity trajectories of adolescents; however, the decline in physical activity was attenuated among adolescents with low and moderate baseline physical activity compared to adolescents with high baseline physical activity and among adolescents who attended schools in neighbourhoods of low compared to high socioeconomic status. There are several possible explanations for these findings, including the influence of the PE policy on the PA patterns of adolescent subpopulations that tend to be at higher risk for inactivity in both childhood and adult life.
doi:10.1155/2014/958645
PMCID: PMC3942104  PMID: 24672714
9.  Association of the Waist-to-Height Ratio with Cardiovascular Risk Factors in Children and Adolescents: The Three Cities Heart Study 
Objectives:
To determine the best anthropometric index in relation to cardiovascular disease risk factors among children and adolescents.
Methods:
This cross-sectional school-based study was conducted among a random sample of 3179 students, aged 6 to 18 years, in three large cities in Brazil.
Results:
The prevalence of overweight and obesity was 10% and 5%, respectively. In relation to the students in the lower quartile (Q1) of the distribution of subscapular skinfold, the students in the upper quartile (Q4) presented a 2.0 times higher risk (odds ratio) of having elevated total cholesterol levels. Overweight and obese students had a 3.3 times higher risk of having elevated systolic blood pressure, and a 1.9 times higher risk of elevated diastolic blood pressure than other students. The less active students presented a 1.58 times higher risk of having waist-to-height ratio (WHtR) above the upper tertile (Q3). WHtR mean values was 0.46 (SE 0.00) presented the largest area under the curve (AUC) [0.613 (CI995%:0.578-0.647)] for high total cholesterol levels, [0.546 (CI995%: 0.515-0.578)] for low HDL-C levels, and [0.614 (CI95%: 0.577-0.651)] for high LDL-C levels, while body mass index presented the largest AUC [0.669 (CI95%: 0.64-0.699)] for increased diastolic blood pressure followed by the waist circumference for increased systolic blood pressure [0.761 (CI95%: 0.735-0.787)].
Conclusions:
WHtR is considered as a simple and accurate anthropometric parameter that identifies youth with cardiovascular risk factors. In this study, WHtR above 0.44 was indicative of risk factors in children and adolescents. These findings can be applied in future preventive strategies against CVDs, and screening programs.
PMCID: PMC3075487  PMID: 21677765
Anthropometry; Cardiovascular risk factors; Multicenter study; Obesity; Pediatrics; Brazil
10.  Adolescent Weight Status and Related Behavioural Factors: Web Survey of Physical Activity and Nutrition 
Journal of Obesity  2011;2012:342386.
Purpose. To identify whether non-overweight students were different from their overweight or obese peers with respect to diet, suboptimal meal behaviours, and physical activity using a self-administered web-based survey. Methods. 4097 adolescents living in Alberta, Canada completed Web-SPAN (Web Survey of Physical Activity and Nutrition). Students were classified as overweight or obese, and differences were described in terms of nutrient intakes, physical activity, and meal behaviours. Results. Non-overweight students consumed significantly more carbohydrate and fibre, and significantly less fat and high calorie beverages, and had a higher frequency of consuming breakfast and snacks compared to overweight or obese students. Both non-overweight and overweight students were significantly more active than obese students. Conclusions. This research supports the need to target suboptimal behaviours such as high calorie beverage consumption, fat intake, breakfast skipping, and physical inactivity. School nutrition policies and mandatory physical education for all students may help to improve weight status in adolescents.
doi:10.1155/2012/342386
PMCID: PMC3228322  PMID: 22175005
11.  Intervention for Spanish Overweight Teenagers in Physical Education Lessons 
Physical education is a favourable educational framework for the development of programmes aimed at increasing physical activity in children and thus reducing sedentarism. The progressive increase of overweight students demands global control and follow-up measurement of these behaviours in both in and out of school. The pedometer can be a useful tool in this field. It is easy to use and allow Physical Education (PE) departments to quantify their students' number of steps/day. The aim of this study was to determine the effect of a pedometer intervention on body fat and BMI levels in overweight teenagers. Besides, the effects of the programme are analysed according to two other variables: pedometer ownership and gender, distinguishing between out-of-school and school hours, weekdays and weekends. The sample comprises 112 overweight students (49 boys and 63 girls) from 5 secondary schools. Participants were asked to follow a physical activity programme consisting on a minimum of 12000 and 10000 steps/day for boys and girls, respectively. It also allowed them to get up to 2 extra points in their PE marks. Results were measured after 6 weeks of programme application as well as after 6 weeks of retention. Results revealed significantly reduced BMI in the teenagers with their own pedometer (p < 0.05). The difference observed in the number of steps/day between boys (12050) and girls (9566) was significant in all measured time periods (p < 0.05). Besides, both overweight boys and girls were observed to take 1000 steps/day less at weekends than in weekdays. Therefore, it is concluded that the proposal of 12000 and 10000 steps for overweight boys and girls, respectively, accompanied by a reinforcement programme in their final PE marks, seems sufficient to obtain significant BMI reductions. Besides, PE is shown a favourable framework for the proposal of pedometer-impelled weight loss programmes in overweight youth.
Key pointsA programme of 12000 and 10000 steps for overweight boys and girls, respectively with reinforcement in physical education marks, the body mass index improves.Body mass index more reduced was in Spanish adolescent overweight that used their own pedometer.The steps/day between boys (12050) and girls (9566) with overweight was different (p < 0.05).Overweight boys and girls were observed to take 1000 steps/day less at weekends than in weekdays.In physical education is possible to apply a programme of steps in obese youth of secondary education schools.
PMCID: PMC3737870  PMID: 24149205
Pedometer; overweight; school physical education; body mass index; body fat
12.  Association between Physical Inactivity and Academic Record in Korean Adolescents 
Iranian Journal of Public Health  2012;41(10):36-42.
Background:
The purpose of this study was to investigate the association between physical inactivity and academic record in Korean adolescents.
Methods:
Adolescent students from the first grade of middle school to the third grade of high school (n=75,066) participated in the 5th Korea Youth Risk Behavior Web-based Survey project in 2009. The association between physical inactivity and academic record was assessed using multivariate logistic regression analysis after adjusting for gender, age, body mass index, family’s socioeconomic status, parents’ education level, and frequency of vigorous or moderate physical activity (PA) as well as muscular strength exercises.
Results:
During weekdays, the odds ratios (ORs) (95% confidence interval [CI]) for reporting a higher than average academic record, as compared with <1 hour of physical inactivity per day, was 0.796 (0.761–0.832, for ≥1 to <2 hours, 0.632 (0.603–0.663, for ≥2 to <3 hours, 0.567 (0.535–0.601, for ≥3 to <4 hours, and 0.494 (0.468–0.522, P < 0.001 for all cases) for ≥4 hours of physical inactivity per day. During the weekends, the ORs (95% CI) for reporting a higher than average academic record, as compared with <1 hour of physical inactivity per day, were 0.901 (0.848–0.957, P = 0.001) for ≥3 to <4 hours and 0.785 (0.743–0.830, P < 0.001) for ≥4 hours of physical inactivity per day.
Conclusion:
Korean adolescents who spend more time engaged in physical inactivity are predisposed to a below-average academic record.
PMCID: PMC3494229  PMID: 23308350
Adolescent; Korea Youth Risk Behavior Web-based Survey-V; Physical inactivity; Academic record
13.  Changes in physical activity levels, lesson context, and teacher interaction during physical education in culturally and linguistically diverse Australian schools 
Background
Recent data show that only 15% of Australian adolescents participate in adequate amounts of physical activity (PA) and those students from Asian and Middle-Eastern backgrounds in Grades 6–12 are significantly less active than their English-speaking background peers. Schools have recently been recognised as the most widely used and cost-effective setting for promoting PA among youth and one domain within schools where PA can occur regularly for all youth, regardless of cultural background or socio-economic status, is during physical education (PE).
Methods
This study describes changes in physical activity (PA), lesson context and teacher interaction in physical education over the first two years in culturally and linguistically diverse secondary schools. Grade 7 PE classes in six schools were randomly observed using systematic direct observation (n = 81) and then followed up over the same period (n = 51) twelve months later.
Results
There was no significant decline in moderate-to-vigorous physical activity (MVPA) during PE (MD = −4.8%; p = .777), but a significant decline and medium negative effect in time spent in vigorous physical activity (VPA) (MD = −7.9%; p = .009) during PE was observed. Significant declines and large negative effects over time in percentage of PE time spent in management (MD = −8.8%; p < .001) and the number of observations where teachers promoted PA (MD = −20.7%; p < .001).
Conclusions
The decline of VPA and teacher promotion of PA in culturally and linguistically diverse schools is of concern. Given the declines in VPA and the increases in time spent in game play, further research is needed to ascertain whether PE instruction could be improved by focussing on skill instruction and fitness in a games-based PE instruction model. Further research for increasing teacher promotion of PA during PE is needed.
doi:10.1186/1479-5868-9-114
PMCID: PMC3515340  PMID: 22989149
Direct observation; Cohort study; Feedback; Adolescents; Sport; Pedagogy
14.  The Relationship Between School Performance and the Number of Physical Education Classes Attended by Korean Adolescent Students 
Increased physical activity (PA) is the relationship with improved cognitive and memory functions of the brain. The physical education (PE) classes held in school comprise a type of PA. However, there is no epidemiological evidence showing a relationship between school performance and the number of PE classes attended per week in adolescent students. Therefore, the purpose of this study is to examine whether the number of PE classes attended per week is related with school performance in Korean adolescent students. In 2009, 75,066 adolescent students from middle school first grade to high school third grade participated in the 5th Korea Youth Risk Behavior Web-based Survey (KYRBWS-V) project. The relationship between school performance and the number of PE classes attended per week was assessed using multivariate logistic regression analysis after adjusting for covariate variables such as gender, age, body mass index, parents' education level, family's economic status, vigorous and moderate PA, and muscle strengthening exercises. The odds ratio (OR) for attending <3 PE classes per week and school performance was 1.125 for good school performance, 1.147 for average school performance, 1.146 for poor school performance, and 1.191 for very poor school performance, when compared to very good school performance. It was concluded that attending ≥3 PE classes per week was positively correlated with improved school performance and that attending <3 PE classes per week was negatively correlated with school performance in Korean adolescent students.
Key pointsKorean adolescents, attending ≥3 PE classes per week was positively correlated with school performance.Korean adolescents, attending <3 PE classes per week was negatively correlated with school performance.
PMCID: PMC3737878  PMID: 24149194
Adolescent; Korea Youth Risk Behavior Web-based Survey; physical education classes; school performance
15.  Assessing and Quantifying High Risk: Comparing Risky Behaviors by Youth in an Urban, Disadvantaged Community with Nationally Representative Youth 
Public Health Reports  2009;124(2):224-233.
SYNOPSIS
Objective
This study examined whether youth who live in an urban, disadvantaged community are significantly more likely than youth representing the nation to engage in a range of health-compromising behaviors.
Methods
Analyses were based on the Youth Violence Survey conducted in 2004 and administered to students (n=4,131) in a high-risk school district. Students in ninth grade (n=1,114) were compared with ninth-grade students in the 2003 national Youth Risk Behavior Survey (n=3,674) and the National Longitudinal Study of Adolescent Health conducted in 1995/1996 (n=3,523). Analyses assessed the differences in prevalence of risk and protective factors among ninth-grade students from the three studies using Chi-square tests.
Results
The results showed that youth in this urban, disadvantaged community were significantly more likely than their peers across the country to report vandalism, theft, violence, and selling drugs. Youth in this community also reported significantly less support from their homes and schools, and less monitoring by their parents. Moreover, youth in this community were significantly less likely to binge drink or initiate alcohol use prior to age 13 than youth across the U.S.
Conclusions
Youth who live in this urban, disadvantaged community reported significantly higher prevalence of some, but not all, risky behaviors than nationally representative U.S. youth. These findings highlight that some caution is justified when defining what might constitute high risk and that demographic and other characteristics need to be carefully considered when targeting certain high-risk behaviors.
PMCID: PMC2646479  PMID: 19320364
16.  Prevalence of Overweight Among Elementary and Middle School Students in Mississippi Compared With Prevalence Data From the Youth Risk Behavior Surveillance System 
Preventing Chronic Disease  2006;3(3):A84.
Introduction
The purpose of the Child and Youth Prevalence of Overweight Survey was to estimate the prevalence of overweight and at risk for becoming overweight among children in Mississippi (grades 1–8) using height and weight measures instead of self-report and to compare the findings for grades 6 through 8 with data from the Youth Risk Behavior Surveillance System for middle school students (grades 6–8).
Methods
Students in randomly selected classes from 37 sampled elementary and middle schools throughout Mississippi participated in the study. School staff were trained to collect height and weight data using a standardized procedure.
Results
Overall, 24.0% of students in grades 1 through 8 were found to be overweight, and another 14.7% were at risk for becoming overweight. With the exception of sixth grade, there was a trend of increasing prevalence of overweight by grade (17.5% in grade 1 compared with 31.3% in grade 8). In the Child and Youth Prevalence of Overweight Survey, 25.2% of students in grades 6 through 8 were found to be overweight, compared with 18.5% in the Youth Risk Behavior Surveillance System.
Conclusion
A high percentage of students in Mississippi are already overweight in first grade, and the prevalence tends to increase by grade. Data collected from middle school students through measured heights and weights in the Child and Youth Prevalence of Overweight Survey were higher than self-reported data from the Youth Risk Behavior Surveillance System. Our data suggest that self-reported data underestimate the prevalence of overweight among middle school students. Efforts to monitor students' body mass index and assess effectiveness of interventions should include all grades and use measured heights and weights rather than self-reports.
PMCID: PMC1636714  PMID: 16776885
17.  Effects of a recreational physical activity and healthy habits orientation program, using an illustrated diary, on the cardiovascular risk profile of overweight and obese schoolchildren: a pilot study in a public school in Brasilia, Federal District, Brazil 
Introduction
Educative strategies need to be adopted to encourage the consumption of healthy foods and to promote physical activity in childhood and adolescence. The effects of recreational physical activity and a health-habit orientation program using an illustrated diary on the cardiovascular risk profile of overweight and obese children was investigated.
Methods
The weight and height of 314 schoolchildren aged between 9 and 11 years old, in a public school in Brasilia, Federal District, Brazil, were recorded. According to the body mass index (BMI) classification proposed by the World Health Organization, 84 were overweight or obese for their age and sex. Of these children, 34 (40%) participated in the study. Students were divided into two groups matched for sex, age, BMI, percent body fat (%BF): the intervention group (IG, n = 17) and the control group (CG, n = 17). The IG underwent a program of 10 weeks of exercise with recreational activities and health-habit orientation using an illustrated diary of habits, while no such interventions were used with the CG during the study period. Before and after the intervention, the children’s weight, height, BMI, %BF, waist circumference (WC), maximum oxygen intake (VO2max), total cholesterol (TC), high density lipoprotein (HDL), low density lipoprotein (LDL), triglycerides, glucose, eating habits, and physical activity level (PAL) were assessed. In analyzing the data, we used descriptive statistics and paired and unpaired t-tests, using a significance level of 0.05. For assessment of dietary habits, a questionnaire, contingency tables, and the chi-squared test were used, with <0.05 set as the significance level.
Results
After 10 weeks of intervention, the IG showed a reduction in BMI (pre: 22.2 ± 2.1 kg/m2 versus [vs] post: 21.6 ± 2.1 kg/m2, P < 0.01); WC (pre: 70.1 ± 6.1 cm vs post: 69.1 ± 5.8 cm, P < 0.01); %BF (pre: 29.2% ± 4.6% vs post: 28.0% ± 4.8%, P < 0.01); systolic blood pressure (P < 0.01); VO2max (P = 0.014); TC (P < 0.01); LDL (P < 0.01); triglycerides (P < 0.01); and intake of candy (P < 0.01) and soda drinks (P < 0.01), while an increase in the consumption of fruit (P < 0.01) and PAL (P < 0.01) were observed. The CG did not show any change in the health parameters assessed.
Conclusion
The program was effective in reducing risk factors for cardiovascular disease and the use of an illustrative diary may have been the key to this result, since students were motivated to change their poor eating habits and to increase their physical activity level.
doi:10.2147/DMSO.S52166
PMCID: PMC3848643  PMID: 24348058
obesity; cardiovascular disease; physical activity level; body mass index; risk factor; motivation; children; change of habits
18.  Body Mass Index and Blood Pressure Screening in a Rural Public School System: the Healthy Kids Project 
Preventing Chronic Disease  2006;3(4):A114.
Introduction
All students (N = 2053) in Anadarko public schools, grades kindergarten through 12, were invited to be screened for height, weight, and blood pressure to assess the health status of this multiracial, multiethnic (American Indian, white, African American, and Hispanic) population in southwestern Oklahoma.
Methods
The Centers for Disease Control and Prevention's 2000 growth charts were used to determine body mass index (BMI) percentiles, and standards from the National High Blood Pressure Education Program Working Group on Hypertension Control in Children and Adolescents were used to assess blood pressure.
Results
Seven hundred sixty-nine students with active consent participated in the screening. Of these, approximately 28% were overweight. American Indians were at significantly greater risk of being overweight or at risk for overweight than whites (relative risk [RR], 1.4; 95% confidence interval [CI], 1.1–1.7) as were African Americans (RR, 1.5; 95% CI, 1.1–2.0), whereas Hispanics (RR, 1.3; 95% CI, 0.9–2.0) did not have a statistically significant increased risk compared with whites. BMI at or above the 95th percentile was strongly associated with elevated blood pressure (≥90th percentile) (RR, 3.8; 95% CI, 2.6–5.4).
Conclusion
Students who participated in this BMI screening in the Anadarko public school system evidenced high rates of excess weight, with American Indians and African Americans at greatest risk. Elevated BMI was strongly associated with elevated blood pressure.
PMCID: PMC1779278  PMID: 16978489
19.  Association between physical activity and metabolic syndrome: a cross sectional survey in adolescents in Ho Chi Minh City, Vietnam 
BMC Public Health  2010;10:141.
Background
The emerging epidemic of overweight/obesity in adolescents in Ho Chi Minh City, Vietnam underlines the importance of studying the metabolic syndrome in Vietnamese adolescents who are becoming progressively more inactive. No study in Vietnam has examined the association of metabolic syndrome with moderate to vigorous physical activity (PA) levels among adolescents. We aimed to examine this association in a sample of urban adolescents from Ho Chi Minh City.
Methods
A cross-sectional assessment was conducted in 2007 on a representative sample of 693 high-school students from urban districts in Ho Chi Minh City. Metabolic syndrome was defined according to the International Diabetes Federation criteria and physical activity was measured with Actigraph accelerometers. The association between physical activity and metabolic syndrome was assessed by using multiple logistic regression models.
Results
Overall 4.6% of the adolescents and 11.8% of the overweight/obese adolescents had metabolic syndrome. Elevated BP was the most common individual component of the metabolic syndrome (21.5%), followed by hypertriglyceridemia (11.1%). After adjusting for other study factors, the odds of metabolic syndrome among youth in the lowest physical activity group (<43 minutes of physical activity/day) were five times higher than those in the highest physical activity group (>103 minutes/day) (AOR = 5.3, 95% CI: 1.5, 19.1). Metabolic syndrome was also positively associated with socioeconomic status (AOR = 9.4, 95% CI: 2.1, 42.4).
Conclusions
A more physically active lifestyle appears to be associated with a lower odds of metabolic syndrome in Vietnamese adolescents. Socio-economic status should be taken into account when planning interventions to prevent adolescent metabolic syndrome.
doi:10.1186/1471-2458-10-141
PMCID: PMC2847981  PMID: 20236509
20.  Policy Implications for Local Application of the 2009 Youth Risk Behavior Survey, Duval County, Florida 
Introduction
Youth Risk Behavior Survey (YRBS) data have rarely been analyzed at the subcounty level. The purpose of this study was to explore the feasibility of such analysis and its potential to inform local policy and resource allocation.
Methods
We administered the 2009 YRBS to 5,860 students from 46 public middle and high schools in Duval County, Florida. In addition to asking core questions, we asked a set of questions customized for local needs, including questions about zip codes. These data were used to simulate subcounty areas consistent with areas identified by behavioral, morbidity, mortality, and health disparity surveillance. We oversampled Duval County and used weighting procedures that adjusted for subcounty areas.
Results
Many Duval County health risk behavior rates were higher than those for Florida overall but did not vary significantly within the county. Physical activity and violence-related behaviors were exceptions that reflect major health disparities in parts of the county with a high proportion of racial/ethnic minorities.
Conclusion
This study demonstrated that collecting subcounty data in large metropolitan areas is feasible and that analysis of these data at the local level has implications for policy. Some health risk behaviors were common across the county, indicating the need for health promotion and disease prevention programs at the school district level. Other health risk behaviors were more prevalent in specific areas of the county and may have been exacerbated by state or local policies such as restrictions on physical education. Health disparities remain a challenge throughout the country; reducing them will require more extensive data-driven problem solving at state and local levels.
PMCID: PMC3406740  PMID: 22537910
21.  Association Between Sedentary Behavior, Physical Activity, and Obesity: Inactivity Among Active Kids 
Preventing Chronic Disease  2008;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 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.
PMCID: PMC2644601  PMID: 19080032
22.  Multicomponent Interventions to Enhance Influenza Vaccine Delivery to Adolescents 
Pediatrics  2011;128(5):e1092-e1099.
OBJECTIVE:
To compare school- versus provider-based approaches to improving influenza vaccination coverage among adolescents in rural Georgia.
METHODS:
We used a nonrandomized, 3-armed design: (1) a middle- and high school-based influenza vaccination intervention in 1 county; (2) a provider-based influenza vaccination intervention in a second county; and (3) a standard-of-care condition in a third county. Interventions also included distribution of an educational brochure, school presentations, and community-based outreach to enhance vaccine knowledge and awareness among adolescents and their parents.
RESULTS:
During the 2008–2009 influenza season, 70 (19%) of 370 students were vaccinated in the school-based county and 110 (15%) of 736 students were vaccinated in the provider-based county, compared with 71 (8%) of 889 students in the standard-of-care county (risk ratio [RR]school: 2.4 [95% confidence interval (CI): 1.7–3.2]; RRprovider: 1.9 [95% CI: 1.4–2.5]). During 2009–2010, seasonal influenza vaccination coverage was 114 (30.4%) of 375 of students in the school-based county, 122 (16.9%) of 663 of students in the provider-based county, and 131 (15.2%) of 861 students in the standard-of-care county (RRschool: 2.3 [95% CI: 1.9–2.9]; RRprovider: 1.2 [95% CI: 0.97–1.5]).
CONCLUSIONS:
Special efforts to promote influenza vaccination among rural, predominantly black students were associated with increased vaccination coverage. The school-based influenza vaccination intervention was associated with the highest levels of vaccination coverage. This study revealed the efficacy of school-based influenza education to improve vaccination rates among adolescents.
doi:10.1542/peds.2011-0453
PMCID: PMC3387882  PMID: 21987709
influenza vaccine; school-based clinics; adolescents; pandemic preparedness
23.  Lifestyle and Overweight Among Japanese Adolescents: The Toyama Birth Cohort Study 
Journal of Epidemiology  2009;19(6):303-310.
Objective
To investigate the effects of lifestyle factors on overweight among Japanese adolescents.
Methods
We studied 5753 junior high school students (2842 boys and 2911 girls) aged 12 to 13 years. The students were residents of Toyama prefecture, Japan and completed a questionnaire about their height, weight, and lifestyle factors, in June and July 2002. Subjects with a body-mass index (BMI) higher than age- and sex-specific cut-off points were defined as obese. Parental overweight was defined as a BMI of 25 or higher. Logistic regression analysis was used to examine associations between lifestyle factors and overweight.
Results
Skipping breakfast, eating quickly, excessive eating, physical inactivity, and long hours of TV watching were positively and significantly associated with overweight in both sexes. There was a negative association between snacking and overweight in girls (P < 0.001); no such association was found in boys (P > 0.05). Nighttime snacking was negatively associated with overweight in boys and girls (P < 0.05). Extended video game playing (≥2 hours; OR = 2.00, P = 0.012) and short sleep duration (<7 hours; OR = 1.81, P = 0.004) were significantly associated with overweight in girls only. The respective risks of overweight that derived from the subjects’ fathers and mothers were 2.0 and 2.5 times, respectively, in boys and 1.9 and 3.0 times in girls.
Conclusions
Parental overweight, skipping breakfast, eating quickly, excessive eating, long hours of TV watching, long hours of video game playing, physical inactivity, and short sleep duration were associated with adolescent overweight. Furthermore, there were significant negative associations between adolescent overweight and snacking in girls and nighttime snacking in both sexes.
doi:10.2188/jea.JE20080095
PMCID: PMC3924099  PMID: 19776497
overweight; lifestyle factors; adolescents; Japan; Toyama birth cohort study
24.  Cardiovascular risk factors in multi-ethnic middle school students: the HEALTHY primary prevention trial 
Pediatric Obesity  2012;7(3):230-239.
Objective
To examine the effects of an integrated, multi-component, school-based intervention program on cardiovascular disease (CVD) risk factors among a multi-ethnic cohort of middle school students.
Methods
HEALTHY was a cluster randomized, controlled, primary prevention trial. Middle school was the unit of randomization and intervention. Half the schools were assigned to an intervention program consisting of changes to the total school food environment and physical education classes, enhanced by educational outreach and behavior change activities and promoted by a social marketing campaign consisting of reinforcing messages and images. Outcome data reported (anthropometrics, blood pressure, and fasting lipid levels) were collected on a cohort of students enrolled at the start of 6th grade (~11-12 years old) and followed to end of 8th grade (~13-14 years old).
Results
42 middle schools were enrolled at 7 field centers; 4363 students provided both informed consent and CVD data at baseline and end of study. The sample was 52.7% female, 54.5% Hispanic, 17.6% non-Hispanic Black, 19.4% non-Hispanic White, and 8.5% other racial/ethnic combinations, and 49.6% were categorized as overweight or obese (BMI ≥ 85th percentile) at baseline. A significant intervention effect was detected in the prevalence of hypertension in non-Hispanic Black and White males. The intervention produced no significant changes in lipid levels.
Conclusions
The prevalence of some CVD risk factors is high in minority middle school youth and particularly males. A multi-component, school-based program achieved only modest reductions in these risk factors; however, promising findings occurred in non-Hispanic Black and White males with hypertension.
doi:10.1111/j.2047-6310.2011.00042.x
PMCID: PMC3348358  PMID: 22461375
cardiovascular disease risk; obesity; multi-ethnic; middle school; cluster design
25.  Correlation of Obesity With Elevated Blood Pressure Among Racial/Ethnic Minority Children in Two Los Angeles Middle Schools 
Preventing Chronic Disease  2008;5(2):A46.
Introduction
To identify anthropometric and fitness correlates of elevated blood pressure, serum cholesterol, and glycated hemoglobin, we examined anthropometric and physiologic biomarkers among racial/ethnic minority children aged 11 to 13 years in two urban Los Angeles middle schools. We explored the potential for using obesity or fitness level as screening variables for cardiovascular disease risk factors in these students.
Methods
During regularly scheduled physical education classes, we collected data on demographic characteristics, height, weight, blood pressure, nonfasting total serum cholesterol, glycated hemoglobin, time to run/walk 1 mile, and a range of self-reported behaviors. A total of 199 sixth-graders (121 Latinos, 78 African Americans) participated in the study.
Results
Bivariate analyses indicated that 48.6% of sixth-graders were of desirable weight, 17.5% were overweight, 29.9% were at risk for overweight, and 4.0% were underweight. Higher weight was associated with higher levels of serum cholesterol, systolic blood pressure, and diastolic blood pressure (P values for all associations <.02) but not with glycated hemoglobin. Multivariate analyses maintained the findings with regard to blood pressure but not serum cholesterol.
Conclusion
Overweight status could be a screening variable for identifying youth at risk for high blood pressure. Obesity prevention and intervention programs and policies need to target low-income racial/ethnic minority children. Assessment of hypertension status also seems warranted in low-income racial/ethnic minority sixth-graders, as does early intervention for children at high risk.
PMCID: PMC2396977  PMID: 18341781

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