- Email: [email protected]
Association between active commuting to school, weight and physical activity status in ethnically diverse adolescents predominately living in deprived communities
Public Health 123 (2009) 39–41
Contents lists available at ScienceDirect
Public Health journal homepage: www.elsevierhealth.com/journals/pubh
Short Communication
Association between active commuting to school, weight and physical activity status in ethnically diverse adolescents predominately living in deprived communities F. Baig a, M.A. Hameed a, M. Li a, G. Shorthouse a, A.K. Roalfe b, A. Daley b, * a b
Medical School, University of Birmingham, UK Primary Care and General Practice, Medical School University of Birmingham, UK
a r t i c l e i n f o Article history: Received 5 July 2007 Received in revised form 25 April 2008 Accepted 27 August 2008 Available online 1 December 2008
Increasing attention is being given to the role of active commuting to school as a means of promoting active lifestyles in young people. A recent study highlighted that school children who actively commute to school may be at lower risk of being overweight than their inactive counterparts.1 Whilst programmes/ interventions that promote active commuting to school have been implemented,2,3 a paucity of research has related this to objectively determined health outcomes. Most previous studies have focused on primary school children who are potentially less involved in the decision-making process about the mode of transport taken to school compared with adolescents. In addition, children from ethnic minority groups and those living in deprived communities have been under-represented in previous research of this type. This is important as ethnic minority children have been found to be less active and more likely to be overweight/obese than White children.4 This study aimed to document the prevalence of active commuting to/from school in children of different ethnicities living in deprived communities, and to investigate the association between ethnicity, physical activity during the school day, weight status and mode of transportation to school. Two single sex (one boy and one girls) and one mixed sex urban state schools in Birmingham that comprised a high proportion of children from ethnic minority groups without walk-to-school schemes were purposefully recruited. All children aged 11–14 years in each school were invited to participate. Participants were asked to indicate their age and postcode. Ethnicity was determined using questions from the England and Wales 2001 Census. Participants * Corresponding author. University of Birmingham, Primary Care and General Practice, Edgbaston, Birmingham, UK. Tel.: þ44 121 414 3762. E-mail address: [email protected] (A. Daley).
were asked to indicate their dominant mode of travel (car, bus, walking, train or cycling) to/from school in the previous 7 days and past 12 months using items from a previous study.5 Given that distance to school is likely to be an important barrier to active commuting, participants were also asked to report the amount of time (in minutes) it would take to commute from home to school by walking. Physical activity during school time was determined by asking, ‘In the last 7 days, during your physical education (PE) classes, how often were you very active (playing hard, jumping, throwing)?’ and by the item, ‘In the last 7 days, what did you normally do at lunch time (besides eating lunch)?’ Height and weight were recorded and weight status (body mass index) was established according to UK reference data.6 Data collection at the schools was carried out during PE classes by third year medical students. The questionnaire is available from the corresponding author on request. The process of data reduction for physical activity during the school day scores is outlined in Appendix 1. The Index of Multiple Deprivation (IMD) rank quartile score was calculated for each participant using their postcode. Young (11–12 years) and old (13– 14 years) age groups were also derived. Mode of travel to/from school over the previous 7 days and past 12 months was simplified into active (walking and cycling) or passive (bus, car and train) modes of travel. Binary logistic regression analysis was performed to identify independent associations between walking to school categories (active versus passive) and demographic and physical activity at school variables, while adjusting for all other variables in the analysis. The potential confounding effect of walking distance to school was accounted for by its inclusion in the models as a continuous variable; many previous studies have failed to take account of this important variable. The sample size was sufficient to estimate a 50% prevalence rate of walking to school with 4% precision (95% confidence interval). In total, 673 of 740 adolescents (mean age 12.6 years) from three schools (n ¼ 376, 91 and 206, respectively) completed the study outcomes. Of these, 58.2% were of White ethnicity. The majority (75.1%) of participants lived in deprived communities, as determined by IMD rank quartile score, and 27.1% were receiving free school meals (UK average in the UK for middle and secondary schools is 10.8%).7 Of the non-White participants, 65.1% were South Asian, 18.2% were Black Afro-Caribbean, 3.9% were Chinese and
0033-3506/$ – see front matter Ó 2008 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.puhe.2008.08.004
40
F. Baig et al. / Public Health 123 (2009) 39–41
12.8% originated from other minority ethnicities. Just over half (55.5%) were female, 23.3% were overweight and 9.1% were obese. Significantly more non-White children (37.0%) were overweight/ obese than White children (29.1%) (c ¼ 4.69, P < 0.03). Most (81.3%) children lived within a 30-min walk of their school and 44.9% lived within a 15-min walk. No participants cycled to school. In the previous 7 days and past 12 months, 56.0% and 59.6% of participants had mainly walked to/from school, respectively. Participants of White ethnicity were more likely to have walked to/from school in the previous 7 days (P < 0.001) and past 12 months (P < 0.001) than non-White children. Girls were more likely to have walked to/from school in the previous 7 days (P < 0.001) and past 12 months (P < 0.001) than boys. In addition, older participants were more likely to have walked to/from school than younger children (P < 0.01) in the previous 7 days (Table 1). Most participants lived within a 30-min walk of their school, but only half actively commuted to/from school regularly. The prevalence of walking to/from school in this study was similar to the national average of 49.1%8; 56.0% of participants indicated that they had mainly walked to/from school in the previous 7 days and 59.6% had mainly walked to/from school in the past 12 months. Other studies conducted in the UK have demonstrated a higher prevalence of walking to school than reported here, ranging from 64% to 69%,5 although these studies were based on primary school children; active commuting to school is likely to be higher in primary school children than secondary school children, as the latter typically travel further to get to school. Walking to school was not significantly associated with physical activity patterns at school. An explanation for these counter-intuitive findings may be that children who walk to/from school are less active at other times during their day, and that children who do not walk to/from school accumulate physical activity at other times during the day, resulting in no net gain in the amount of physical activity achieved by these two groups of children. In line with these findings, several other studies have failed to find an association between active commuting to school and body mass index.9 Whilst weight status was not associated with walking to/ from school, there may be many other public health and
community benefits to be gained from encouraging children to actively commute to/from school, such as lower environmental pollution and road congestion. White children were more likely to actively commute to school than children from ethnic minority groups. Given that ethnic minority adults are less likely to engage in physical activity, this may manifest in their children being less likely to walk to school. These findings contradict past studies conducted in other countries9 that have found non-English-speaking/minority children to be more likely to walk to school then their White peers. Disparities between studies may simply be related to differences by country and/or the deprivation levels of participants within studies. Nevertheless, findings have highlighted that children from ethnic minorities may need to be the focus of public health campaigns that encourage more active commuting to/from school. Girls were more likely to actively commute to school than boys. This finding was unexpected since girls are reported to be less willing to be physically active generally, and because of the potential concerns (stranger danger) that parents may have about their daughters walking to school, leading to greater discouragement to do so. It may be that girls from deprived communities have reduced fears about walking in their neighbourhood compared with girls living in more affluent areas. Given that girls are consistently found to be less active than boys, promoting active commuting to school in girls may be one means by which this trend can be reversed. Older children were found to be more likely to walk to/from school compared with their younger peers. Parental views on environmental factors (e.g. road traffic) and fear of strangers are prominent determinants of a child walking to school,10 and this may be particularly true for younger children. In conclusion, weight status was not associated with walking to/ from school, and it may be that other types of non-curricular physical activities are better predictors of children’s weight status than mode of transport to school. Given the contradictory nature of research, further studies are still required before any conclusions can be made about the health benefits of active commuting to school in adolescents from deprived communities. The high levels of overweight and obesity recorded in this study are certainly a cause for concern, particularly with regard to non-White children.
Table 1 Factors associated with active commuting to/from school in adolescents living in deprived communitiesa
Acknowledgements
Ethnicity Non-White (n ¼ 281) White (n ¼ 392) Gender Male (n ¼ 301) Female (n ¼ 372) Age (years) 11–12 (n ¼ 281) 13–14 (n ¼ 392) Activity at school Low/inactive (n ¼ 40) Moderately active (n ¼ 450) Highly active (n ¼ 183) Weight statusb Underweight/normal (n ¼ 455) Overweight (n ¼ 157) Obese (n ¼ 61)
The authors would like to thank the schools involved in this research.
Actively commuted to school in previous 7 days
Actively commuted to school in previous 12 months
OR
95% CI
OR
95% CI
Ethical approval
1.00 9.82
5.84–16.50
1.00 7.07
4.27–11.71
The South Birmingham Student Ethics Committee issued approval for this study.
1.00 3.63
2.15–6.12
1.00 3.34
2.01–5.57
1.00 1.77
1.16–2.70
1.00 1.23
0.81–1.86
1.00 1.20 1.07
0.50–2.88 0.40–2.56
1.00 1.28 0.90
0.54–3.00 0.37–2.22
1.00 1.24 0.77
0.76–2.02 0.38–1.56
1.00 0.86 0.94
0.53–1.37 0.47–1.89
Funding None declared. Competing interests None declared. Appendix 1
OR, odds ratio; CI, confidence interval. a Each covariate adjusted for all others and data adjusted for walking distance from home to school (continuous variable). b Weight status (body mass index) was established according to UK age and sex reference data.6
Categories for physical activity during the school day were created by aggregating scores for participants’ physical activity levels in PE classes with participants’ physical activity status at lunch time. Physical activity levels in PE classes were coded into scores ranging from 1 to 5 (1 ¼ ‘I don’t do PE’ and 5 ¼ ‘always very active during PE’).
F. Baig et al. / Public Health 123 (2009) 39–41
This procedure was repeated for physical activity pattterns at lunch time (1 ¼ ‘sat down’ and 5 ¼ ‘ran and played hard most of the time’). A composite score of the data that ranged from 2 to 10 was calculated. On this basis, participants were coded as either low/inactive (scores between 2 and 4), moderately active (scores between 5 and 7) and highly active (scores between 8 and 10). References 1. Rosenberg DE, Sallis JF, Conway TL, Cain KL, McKenzie TL. Active transportation to school over 2 years in relation to weight status and physical activity. Obesity 2006;14:1771–6. 2. McKee R, Mutrie N, Crawford F, Green B. Promoting walking to school: results of a quasi-experimental trial. J Epidemiol Community Health 2007;61:818–23. 3. Boarnet MG, Anderson CL, Day K, McMillan T, Alfonzo M. Evaluation of the California safe routes to school legislation urban form changes and children’s active transportation to school. Am J Prev Med 2005;28(Suppl. 2): 134–40.
41
4. Saxena S, Ambler G, Cole TJ, Majeed A. Ethnic group differences in overweight and obese children and young people in England: cross sectional survey. Arch Dis Child 2004;89:30–6. 5. Alton D, Adab A, Roberts L, Barrett T. Relationship between walking levels and perceptions of the local neighbourhood environment. Arch Dis Child 2006;92:29–33. 6. Cole TJ, Freeman JV, Preece MA. Body mass index reference curves for the UK. Arch Dis Child 1990;1995(73):25–9. 7. Department for Education and Skills, National Assembly for Wales, Scottish Executive, Northern Ireland Department of Education, Office for National Statistics. School meal arrangements 2002/03. London: Department for Education and Skills. 8. Department for Transport. National travel survey 2003 & 2004. Technical report. Available from: http://www.dft.gov.uk/stellent/groups/dft_transstats/ documents/downloadable/dft_transstats_610097.pdf [last accessed 4.01.07]. 9. Evenson KR, Huston SL, McMillen BJ, Bors P, Ward DS. Statewide prevalence and correlates of walking and bicycling to school. Arch Pediatr Adolesc Med 2003;157:887–92. 10. Timperio A, Ball K, Salmon J, Roberts R, Giles-Corti B, Simmons D, et al. Personal, family, social, and environmental correlates of active commuting to school. Am J Prev Med 2006;30:45–51.
Contents lists available at ScienceDirect
Public Health journal homepage: www.elsevierhealth.com/journals/pubh
Short Communication
Association between active commuting to school, weight and physical activity status in ethnically diverse adolescents predominately living in deprived communities F. Baig a, M.A. Hameed a, M. Li a, G. Shorthouse a, A.K. Roalfe b, A. Daley b, * a b
Medical School, University of Birmingham, UK Primary Care and General Practice, Medical School University of Birmingham, UK
a r t i c l e i n f o Article history: Received 5 July 2007 Received in revised form 25 April 2008 Accepted 27 August 2008 Available online 1 December 2008
Increasing attention is being given to the role of active commuting to school as a means of promoting active lifestyles in young people. A recent study highlighted that school children who actively commute to school may be at lower risk of being overweight than their inactive counterparts.1 Whilst programmes/ interventions that promote active commuting to school have been implemented,2,3 a paucity of research has related this to objectively determined health outcomes. Most previous studies have focused on primary school children who are potentially less involved in the decision-making process about the mode of transport taken to school compared with adolescents. In addition, children from ethnic minority groups and those living in deprived communities have been under-represented in previous research of this type. This is important as ethnic minority children have been found to be less active and more likely to be overweight/obese than White children.4 This study aimed to document the prevalence of active commuting to/from school in children of different ethnicities living in deprived communities, and to investigate the association between ethnicity, physical activity during the school day, weight status and mode of transportation to school. Two single sex (one boy and one girls) and one mixed sex urban state schools in Birmingham that comprised a high proportion of children from ethnic minority groups without walk-to-school schemes were purposefully recruited. All children aged 11–14 years in each school were invited to participate. Participants were asked to indicate their age and postcode. Ethnicity was determined using questions from the England and Wales 2001 Census. Participants * Corresponding author. University of Birmingham, Primary Care and General Practice, Edgbaston, Birmingham, UK. Tel.: þ44 121 414 3762. E-mail address: [email protected] (A. Daley).
were asked to indicate their dominant mode of travel (car, bus, walking, train or cycling) to/from school in the previous 7 days and past 12 months using items from a previous study.5 Given that distance to school is likely to be an important barrier to active commuting, participants were also asked to report the amount of time (in minutes) it would take to commute from home to school by walking. Physical activity during school time was determined by asking, ‘In the last 7 days, during your physical education (PE) classes, how often were you very active (playing hard, jumping, throwing)?’ and by the item, ‘In the last 7 days, what did you normally do at lunch time (besides eating lunch)?’ Height and weight were recorded and weight status (body mass index) was established according to UK reference data.6 Data collection at the schools was carried out during PE classes by third year medical students. The questionnaire is available from the corresponding author on request. The process of data reduction for physical activity during the school day scores is outlined in Appendix 1. The Index of Multiple Deprivation (IMD) rank quartile score was calculated for each participant using their postcode. Young (11–12 years) and old (13– 14 years) age groups were also derived. Mode of travel to/from school over the previous 7 days and past 12 months was simplified into active (walking and cycling) or passive (bus, car and train) modes of travel. Binary logistic regression analysis was performed to identify independent associations between walking to school categories (active versus passive) and demographic and physical activity at school variables, while adjusting for all other variables in the analysis. The potential confounding effect of walking distance to school was accounted for by its inclusion in the models as a continuous variable; many previous studies have failed to take account of this important variable. The sample size was sufficient to estimate a 50% prevalence rate of walking to school with 4% precision (95% confidence interval). In total, 673 of 740 adolescents (mean age 12.6 years) from three schools (n ¼ 376, 91 and 206, respectively) completed the study outcomes. Of these, 58.2% were of White ethnicity. The majority (75.1%) of participants lived in deprived communities, as determined by IMD rank quartile score, and 27.1% were receiving free school meals (UK average in the UK for middle and secondary schools is 10.8%).7 Of the non-White participants, 65.1% were South Asian, 18.2% were Black Afro-Caribbean, 3.9% were Chinese and
0033-3506/$ – see front matter Ó 2008 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.puhe.2008.08.004
40
F. Baig et al. / Public Health 123 (2009) 39–41
12.8% originated from other minority ethnicities. Just over half (55.5%) were female, 23.3% were overweight and 9.1% were obese. Significantly more non-White children (37.0%) were overweight/ obese than White children (29.1%) (c ¼ 4.69, P < 0.03). Most (81.3%) children lived within a 30-min walk of their school and 44.9% lived within a 15-min walk. No participants cycled to school. In the previous 7 days and past 12 months, 56.0% and 59.6% of participants had mainly walked to/from school, respectively. Participants of White ethnicity were more likely to have walked to/from school in the previous 7 days (P < 0.001) and past 12 months (P < 0.001) than non-White children. Girls were more likely to have walked to/from school in the previous 7 days (P < 0.001) and past 12 months (P < 0.001) than boys. In addition, older participants were more likely to have walked to/from school than younger children (P < 0.01) in the previous 7 days (Table 1). Most participants lived within a 30-min walk of their school, but only half actively commuted to/from school regularly. The prevalence of walking to/from school in this study was similar to the national average of 49.1%8; 56.0% of participants indicated that they had mainly walked to/from school in the previous 7 days and 59.6% had mainly walked to/from school in the past 12 months. Other studies conducted in the UK have demonstrated a higher prevalence of walking to school than reported here, ranging from 64% to 69%,5 although these studies were based on primary school children; active commuting to school is likely to be higher in primary school children than secondary school children, as the latter typically travel further to get to school. Walking to school was not significantly associated with physical activity patterns at school. An explanation for these counter-intuitive findings may be that children who walk to/from school are less active at other times during their day, and that children who do not walk to/from school accumulate physical activity at other times during the day, resulting in no net gain in the amount of physical activity achieved by these two groups of children. In line with these findings, several other studies have failed to find an association between active commuting to school and body mass index.9 Whilst weight status was not associated with walking to/ from school, there may be many other public health and
community benefits to be gained from encouraging children to actively commute to/from school, such as lower environmental pollution and road congestion. White children were more likely to actively commute to school than children from ethnic minority groups. Given that ethnic minority adults are less likely to engage in physical activity, this may manifest in their children being less likely to walk to school. These findings contradict past studies conducted in other countries9 that have found non-English-speaking/minority children to be more likely to walk to school then their White peers. Disparities between studies may simply be related to differences by country and/or the deprivation levels of participants within studies. Nevertheless, findings have highlighted that children from ethnic minorities may need to be the focus of public health campaigns that encourage more active commuting to/from school. Girls were more likely to actively commute to school than boys. This finding was unexpected since girls are reported to be less willing to be physically active generally, and because of the potential concerns (stranger danger) that parents may have about their daughters walking to school, leading to greater discouragement to do so. It may be that girls from deprived communities have reduced fears about walking in their neighbourhood compared with girls living in more affluent areas. Given that girls are consistently found to be less active than boys, promoting active commuting to school in girls may be one means by which this trend can be reversed. Older children were found to be more likely to walk to/from school compared with their younger peers. Parental views on environmental factors (e.g. road traffic) and fear of strangers are prominent determinants of a child walking to school,10 and this may be particularly true for younger children. In conclusion, weight status was not associated with walking to/ from school, and it may be that other types of non-curricular physical activities are better predictors of children’s weight status than mode of transport to school. Given the contradictory nature of research, further studies are still required before any conclusions can be made about the health benefits of active commuting to school in adolescents from deprived communities. The high levels of overweight and obesity recorded in this study are certainly a cause for concern, particularly with regard to non-White children.
Table 1 Factors associated with active commuting to/from school in adolescents living in deprived communitiesa
Acknowledgements
Ethnicity Non-White (n ¼ 281) White (n ¼ 392) Gender Male (n ¼ 301) Female (n ¼ 372) Age (years) 11–12 (n ¼ 281) 13–14 (n ¼ 392) Activity at school Low/inactive (n ¼ 40) Moderately active (n ¼ 450) Highly active (n ¼ 183) Weight statusb Underweight/normal (n ¼ 455) Overweight (n ¼ 157) Obese (n ¼ 61)
The authors would like to thank the schools involved in this research.
Actively commuted to school in previous 7 days
Actively commuted to school in previous 12 months
OR
95% CI
OR
95% CI
Ethical approval
1.00 9.82
5.84–16.50
1.00 7.07
4.27–11.71
The South Birmingham Student Ethics Committee issued approval for this study.
1.00 3.63
2.15–6.12
1.00 3.34
2.01–5.57
1.00 1.77
1.16–2.70
1.00 1.23
0.81–1.86
1.00 1.20 1.07
0.50–2.88 0.40–2.56
1.00 1.28 0.90
0.54–3.00 0.37–2.22
1.00 1.24 0.77
0.76–2.02 0.38–1.56
1.00 0.86 0.94
0.53–1.37 0.47–1.89
Funding None declared. Competing interests None declared. Appendix 1
OR, odds ratio; CI, confidence interval. a Each covariate adjusted for all others and data adjusted for walking distance from home to school (continuous variable). b Weight status (body mass index) was established according to UK age and sex reference data.6
Categories for physical activity during the school day were created by aggregating scores for participants’ physical activity levels in PE classes with participants’ physical activity status at lunch time. Physical activity levels in PE classes were coded into scores ranging from 1 to 5 (1 ¼ ‘I don’t do PE’ and 5 ¼ ‘always very active during PE’).
F. Baig et al. / Public Health 123 (2009) 39–41
This procedure was repeated for physical activity pattterns at lunch time (1 ¼ ‘sat down’ and 5 ¼ ‘ran and played hard most of the time’). A composite score of the data that ranged from 2 to 10 was calculated. On this basis, participants were coded as either low/inactive (scores between 2 and 4), moderately active (scores between 5 and 7) and highly active (scores between 8 and 10). References 1. Rosenberg DE, Sallis JF, Conway TL, Cain KL, McKenzie TL. Active transportation to school over 2 years in relation to weight status and physical activity. Obesity 2006;14:1771–6. 2. McKee R, Mutrie N, Crawford F, Green B. Promoting walking to school: results of a quasi-experimental trial. J Epidemiol Community Health 2007;61:818–23. 3. Boarnet MG, Anderson CL, Day K, McMillan T, Alfonzo M. Evaluation of the California safe routes to school legislation urban form changes and children’s active transportation to school. Am J Prev Med 2005;28(Suppl. 2): 134–40.
41
4. Saxena S, Ambler G, Cole TJ, Majeed A. Ethnic group differences in overweight and obese children and young people in England: cross sectional survey. Arch Dis Child 2004;89:30–6. 5. Alton D, Adab A, Roberts L, Barrett T. Relationship between walking levels and perceptions of the local neighbourhood environment. Arch Dis Child 2006;92:29–33. 6. Cole TJ, Freeman JV, Preece MA. Body mass index reference curves for the UK. Arch Dis Child 1990;1995(73):25–9. 7. Department for Education and Skills, National Assembly for Wales, Scottish Executive, Northern Ireland Department of Education, Office for National Statistics. School meal arrangements 2002/03. London: Department for Education and Skills. 8. Department for Transport. National travel survey 2003 & 2004. Technical report. Available from: http://www.dft.gov.uk/stellent/groups/dft_transstats/ documents/downloadable/dft_transstats_610097.pdf [last accessed 4.01.07]. 9. Evenson KR, Huston SL, McMillen BJ, Bors P, Ward DS. Statewide prevalence and correlates of walking and bicycling to school. Arch Pediatr Adolesc Med 2003;157:887–92. 10. Timperio A, Ball K, Salmon J, Roberts R, Giles-Corti B, Simmons D, et al. Personal, family, social, and environmental correlates of active commuting to school. Am J Prev Med 2006;30:45–51.