Development and reliability of an audit tool to assess the school physical activity environment across 12 countries

OBJECTIVES: Schools are an important setting to enable and promote physical activity. Researchers have created a variety of tools to perform objective environmental assessments (or ‘audits') of other settings, such as neighborhoods and parks; yet, methods to assess the school physical activity environment are less common. The purpose of this study is to describe the approach used to objectively measure the school physical activity environment across 12 countries representing all inhabited continents, and to report on the reliability and feasibility of this methodology across these diverse settings. METHODS: The International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) school audit tool (ISAT) data collection required an in-depth training (including field practice and certification) and was facilitated by various supporting materials. Certified data collectors used the ISAT to assess the environment of all schools enrolled in ISCOLE. Sites completed a reliability audit (simultaneous audits by two independent, certified data collectors) for a minimum of two schools or at least 5% of their school sample. Item-level agreement between data collectors was assessed with both the kappa statistic and percent agreement. Inter-rater reliability of school summary scores was measured using the intraclass correlation coefficient. RESULTS: Across the 12 sites, 256 schools participated in ISCOLE. Reliability audits were conducted at 53 schools (20.7% of the sample). For the assessed environmental features, inter-rater reliability (kappa) ranged from 0.37 to 0.96; 18 items (42%) were assessed with almost perfect reliability (κ=0.80–0.96), and a further 24 items (56%) were assessed with substantial reliability (κ=0.61–0.79). Likewise, scores that summarized a school's support for physical activity were highly reliable, with the exception of scores assessing aesthetics and perceived suitability of the school grounds for sport, informal games and general play. CONCLUSIONS: This study suggests that the ISAT can be used to conduct reliable objective audits of the school physical activity environment across diverse, international school settings

Relationships between Parental Education and Overweight with Childhood Overweight and Physical Activity in 9-11 Year Old Children: Results from a 12-Country Study

Background: Globally, the high prevalence of overweight and low levels of physical activity among children has serious implications for morbidity and premature mortality in adulthood. Various parental factors are associated with childhood overweight and physical activity. The objective of this paper was to investigate relationships between parental education or overweight, and (i) child overweight, (ii) child physical activity, and (iii) explore household coexistence of overweight, in a large international sample. Methods: Data were collected from 4752 children (9-11 years) as part of the International Study of Childhood Obesity, Lifestyle and the Environment in 12 countries around the world. Physical activity of participating children was assessed by accelerometry, and body weight directly measured. Questionnaires were used to collect parents' education level, weight, and height. Results: Maternal and paternal overweight were positively associated with child overweight. Higher household coexistence of parent-child overweight was observed among overweight children compared to the total sample. There was a positive relationship between maternal education and child overweight in Colombia 1.90 (1.23-2.94) [odds ratio (confidence interval)] and Kenya 4.80 (2.21-10.43), and a negative relationship between paternal education and child overweight in Brazil 0.55 (0.33-0.92) and the USA 0.54 (0.33-0.88). Maternal education was negatively associated with children meeting physical activity guidelines in Colombia 0.53 (0.33-0.85), Kenya 0.35 (0.19-0.63), and Portugal 0.54 (0.31-0.96). Conclusions: Results are aligned with previous studies showing positive associations between parental and child overweight in all countries, and positive relationships between parental education and child overweight or negative associations between parental education and child physical activity in lower economic status countries. Relationships between maternal and paternal education and child weight status and physical activity appear to be related to the developmental stage of different countries. Given these varied relationships, it is crucial to further explore familial factors when investigating child overweight and physical activity

Elevated C-reactive protein in children from risky neighborhoods: evidence for a stress pathway linking neighborhoods and inflammation in children

BACKGROUND: Childhood socioeconomic status is linked to adult cardiovascular disease and disease risk. One proposed pathway involves inflammation due to exposure to a stress-inducing neighborhood environment. Whether CRP, a marker of systemic inflammation, is associated with stressful neighborhood conditions among children is unknown. METHODS AND RESULTS: The sample included 385 children 5-18 years of age from 255 households and 101 census tracts. Multilevel logistic regression analyses compared children and adolescents with CRP levels \u3e3 mg/L to those with levels ≤ 3 mg/L across neighborhood environments. Among children living in neighborhoods (census tracts) in the upper tertile of poverty or crime, 18.6% had elevated CRP levels, in contrast to 7.9% of children living in neighborhoods with lower levels of poverty and crime. Children from neighborhoods with the highest levels of either crime or poverty had 2.7 (95% CI: 1.2-6.2) times the odds of having elevated CRP levels when compared to children from other neighborhoods, independent of adiposity, demographic and behavioral differences. CONCLUSIONS: Children living in neighborhoods with high levels of poverty or crime had elevated CRP levels compared to children from other neighborhoods. This result is consistent with a psychosocial pathway favoring early development of cardiovascular risk that involves chronic stress from exposure to socially- and physically-disordered neighborhoods characteristic of poverty