The school environment and adolescent physical activity and sedentary behaviour: a mixed-studies systematic review.

There is increasing academic and policy interest in interventions aiming to promote young people's health by ensuring that the school environment supports healthy behaviours. The purpose of this review was to summarize the current evidence on school-based policy, physical and social-environmental influences on adolescent physical activity and sedentary behaviour. Electronic databases were searched to identify studies that (1) involved healthy adolescents (11-18 years old), (2) investigated school-environmental influences and (3) reported a physical activity and/or sedentary behaviour outcome or theme. Findings were synthesized using a non-quantitative synthesis and thematic analysis. Ninety-three papers of mixed methodological quality were included. A range of school-based policy (e.g. break time length), physical (e.g. facilities) and social-environmental (e.g. teacher behaviours) factors were associated with adolescent physical activity, with limited research on sedentary behaviour. The mixed-studies synthesis revealed the importance of specific activity settings (type and location) and intramural sport opportunities for all students. Important physical education-related factors were a mastery-oriented motivational climate and autonomy supportive teaching behaviours. Qualitative evidence highlighted the influence of the wider school climate and shed light on complexities of the associations observed in the quantitative literature. This review identifies future research needs and discusses potential intervention approaches to be considered.

Measuring the food and built environments in urban centres: reliability and validity of the EURO-PREVOB Community Questionnaire.

OBJECTIVES: The authors designed an instrument to measure objectively aspects of the built and food environments in urban areas, the EURO-PREVOB Community Questionnaire, within the EU-funded project 'Tackling the social and economic determinants of nutrition and physical activity for the prevention of obesity across Europe' (EURO-PREVOB). This paper describes its development, reliability, validity, feasibility and relevance to public health and obesity research. STUDY DESIGN: The Community Questionnaire is designed to measure key aspects of the food and built environments in urban areas of varying levels of affluence or deprivation, within different countries. The questionnaire assesses (1) the food environment and (2) the built environment. METHODS: Pilot tests of the EURO-PREVOB Community Questionnaire were conducted in five to 10 purposively sampled urban areas of different socio-economic status in each of Ankara, Brno, Marseille, Riga, and Sarajevo. Inter-rater reliability was compared between two pairs of fieldworkers in each city centre using three methods: inter-observer agreement (IOA), kappa statistics, and intraclass correlation coefficients (ICCs). RESULTS: Data were collected successfully in all five cities. Overall reliability of the EURO-PREVOB Community Questionnaire was excellent (inter-observer agreement (IOA) > 0.87; intraclass correlation coefficients (ICC)s > 0.91 and kappa statistics > 0.7. However, assessment of certain aspects of the quality of the built environment yielded slightly lower IOA coefficients than the quantitative aspects. CONCLUSIONS: The EURO-PREVOB Community Questionnaire was found to be a reliable and practical observational tool for measuring differences in community-level data on environmental factors that can impact on dietary intake and physical activity. The next step is to evaluate its predictive power by collecting behavioural and anthropometric data relevant to obesity and its determinants.

Obesity and socioeconomic status in developing countries: a systematic review.

We undertook a systematic review of studies assessing the association between socioeconomic status (SES) and measured obesity in low- and middle-income countries (defined by the World Bank as countries with per capita income up to US$12,275) among children, men and women. The evidence on the subject has grown significantly since an earlier influential review was published in 2004. We find that in low-income countries or in countries with low human development index (HDI), the association between SES and obesity appears to be positive for both men and women: the more affluent and/or those with higher educational attainment tend to be more likely to be obese. However, in middle-income countries or in countries with medium HDI, the association becomes largely mixed for men and mainly negative for women. This particular shift appears to occur at an even lower level of per capita income than suggested by an influential earlier review. By contrast, obesity in children appears to be predominantly a problem of the rich in low- and middle-income countries.

Does social capital determine health? Evidence from eight transition countries.

There is growing interest in the role of social relationships in explaining patterns of health. We contribute to this debate by investigating the impact of social capital on self-reported health for eight countries from the Commonwealth of Independent States. We rely on three indicators of social capital at the individual level (trust, participation in local organisations, social isolation) and employ alternative procedures to estimate consistently the impact of social capital on health. The three social capital indicators are choice variables and are hence, by definition, endogenously determined. We attempt to circumvent the endogeneity problems by using instrumental variable estimates. Our results show that the individual degree of trust is positively and significantly correlated with health, this being true with least squares estimators as well as when relying on instrumental variable estimators with (and without) community fixed effects. Similarly, social isolation is negatively and significantly associated with health, irrespective of the procedure of estimation. On the other hand, the effect of being a member of a Putnamesque organisation is more ambiguous and usually not significantly related to health.

[Economic aspects of prevention: an international perspective]. / Okonomische Aspekte der Prävention: Eine internationale Perspektive.

This article provides an overview of selected economic aspects of primary prevention, from an international perspective. It starts by qualifying two widely held myths about the economics of prevention. It then discusses two core components of the economic argument for (or against) prevention: first, this involves providing a very basic, efficiency-based rationale for a role of government in prevention; second, we review the existing evidence on the cost-effectiveness of primary prevention. While a fair amount of encouraging evidence exists, there has definitely been far more cost-effectiveness research on clinical than on non-clinical primary prevention (e. g., health promotion). The article seeks to explain this comparative shortage, which carries over to pure effectiveness research on prevention. It concludes by arguing the economic case for a role of government not only in prevention but also, and even more so, in research on non-clinical prevention.