Participation of university community members in Health Promoting University (HPU) initiatives.

Background: Several universities around the world have adopted the settings approach to health to create a Health Promoting University (HPU) initiative. Health promoting initiatives are built on the values of health promotion, with participation being one of the most important. Despite the above, there is little information on how university community members participate in HPU initiatives. This study aims to describe the participation of university community members in HPU initiatives in universities around the world. Methods: An online questionnaire was sent to representatives of universities that have implemented a HPU initiative. The questionnaire inquired about the level and nature of participation of university community members (students, professors, and administrative/technical staff) at different levels. Three levels of participation ranged from lower to higher levels were considered: (a) information delivery strategies; (b) consultation strategies and (c) involvement in design, planning and decision-making processes. Results: At least the 50% of the universities implemented strategies so that all the members of the community could participate at all levels. Information delivery strategies were the most often used, with students being the main target group. Consultation strategies were aimed mainly at students and professors, whilst professors participated most actively in the design, planning and decision-making. Conclusion: Different participation strategies are used in the HPU initiatives. Information delivery strategies, which represent the lowest level of participation, were the most often reported. Higher levels of participation were less used in the HPU initiatives. HPU initiatives should seek for strategies to provide more high-level participation to all university community members.

[Dietary and physical activity practices and preferences in children: An approach from school parliaments in educational public establishments]. / Prácticas y preferencias alimentarias y de actividad física en niños y niñas: Una aproximación desde los Parlamentos Escolares en establecimientos educacionales.

In Chile, overnutrition continues to increase, especially affecting children. Solving this public health problem requires the development of promotion and prevention strategies that consider the suggestions of the communities, especially those of the children themselves. OBJECTIVE: To know the opinions and suggestions of third and fourth-grade children from schools in the southern area of Santiago, Chile, regarding their eating practices and physical activity, as part of the FONDEF IT 1810016 project. SUBJECTS AND METHOD: Seven School Meetings were held in seven schools using a participatory qualitative methodology, collecting the opinions of 176 children regarding both their food and physical activity habits and preferences. RESULTS: The most consumed and preferred foods are those easy to prepare and highly available, such as bread, pasta, and milk. Foods that require preparation or are less available, such as fish, legumes, fruits, vegetables, and homemade preparations, are less consumed and have less preference. Regarding physical activities, video games and soccer stand out. Students propose increasing the hours of physical education and recesses and improving the availability and access to healthy foods in school environments as a solution strategy. CONCLUSIONS: School Meetings as a participatory strategy contribute to the joint generation of knowledge. The need to include communities as participants in health initiatives recognizes, through their role, children as subjects of rights.

Time reallocation of physical behaviours induced by endurance exercise in physically active individuals.

Increasing moderate-vigorous physical activity (MVPA) through exercise requires reallocating time from other physical behaviour(s). We aimed to determine the reallocations induced by endurance exercise in physically active individuals. We also searched for behavioural compensatory responses, and explored the effect of exercise on daily energy expenditure. Fourteen participants (8 women; median age 37.8 [IQR 29.9-48.5] yr) exercised on Monday, Wednesday, and Friday mornings (cycling MVPA, 65 min/session; "exercise days"), and avoided exercising on Tuesday and Thursday ("rest days"). Time spent on sleep, sedentary behaviour, light-intensity physical activity, and MVPA was determined each day by accelerometers and logs. An energy expenditure index was computed considering minutes spent on each behaviour and fixed metabolic equivalents. We found that all participants had lower sleep and higher total (including exercise) MVPA on exercise days compared to rest days. Thus, on exercise vs. rest days, sleep was lower (490 [453-553] vs. 553 [497-599] min/day, respectively, P < 0.001), and total MVPA was higher (86 [80-101] vs. 23 [15-45] min/day, respectively; P < 0.001). No differences in other physical behaviours were detected. Notably, exercise not only induced reallocations (i.e. less time in other behaviours) but also behavioural compensatory responses in some participants (e.g. increased sedentary behaviour). This rearrangement of physical behaviours manifested in exercise-induced increases in energy expenditure from 96 to 232 MET × min/day. In conclusion, active individuals reallocated time from sleep to accommodate morning exercise. Yet exercise induced variable rearrangements of behaviours, with some individuals manifesting compensatory responses. Understanding individual rearrangements may help improve exercise interventions.

Adults are recommended to engage in moderate-vigorous physical activity (MVPA) to maintain health. But including exercise sessions within a day inevitably requires reallocating time from other physical behaviour(s): sleep, sedentary behaviour, or physical activity.We studied the time reallocations induced by 65 min/day of morning exercise (cycling MVPA) in physically active participants.Participants spent less time sleeping and higher time on total (including exercise) MVPA on days that included exercise compared to days without exercise. Thus, participants reallocated sleep time to accommodate morning exercise sessions.Some participants also spent higher time on sedentary behaviour during days that included exercise compared to days without exercise. This probably represents a behavioural compensatory response to exercise-induced fatigue.Together, time reallocations and behavioural compensatory responses led to a rearrangement of daily time spent on physical behaviours. This rearrangement was estimated to produce large interindividual variability in the increase in energy expenditure induced by exercise.

Elevated Risk of Overweight/Obesity-Related Markers and Low Muscular Fitness in Children Attending Public Schools in Chile.

In Chile, children of low socioeconomic status usually attend public schools and have few opportunities to engage in healthy behaviors. This may increase their risk of overweight/obesity and low muscular fitness. Therefore, we aimed to determine the association between the school type attended with overweight/obesity-related markers and the muscular fitness of children in Chile. We included 1410 children (6-13 years old) attending public, subsidized, or private schools. Overweight/obesity-related markers included BMI Z-scores, waist circumference, and body fat percentage. Muscular fitness assessment included handgrip strength and standing long jump. The odds ratios [95% CI] of overweight/obesity, elevated waist circumference, elevated body fat, low handgrip strength, and low standing long jump were compared between school types. Compared with boys attending public schools, those attending subsidized or private schools had lower odds ratios of low handgrip strength (0.63 [0.42-0.94] and 0.44 [0.25-0.78], respectively). Girls attending subsidized schools, compared with those in public schools, had lower odds of overweight/obesity (0.63 [0.44-0.90]) and of having low handgrip strength (0.51 [0.34-0.78]). Compared with girls in public schools, those attending private schools had lower odds (vs. public schools) of overweight/obesity (0.45 [0.28-0.74]), of having elevated body fat (0.53 [0.29-0.96]), and of having low standing long jump (0.41 [0.21-0.77]). The elevated risk of overweight/obesity-related markers and lower muscular fitness in children, particularly girls, attending public schools increase their current and future disease risk. This suggests that childhood socioeconomic status plays a central role in determining disease risk. Health-promoting interventions specifically focused on children from disadvantaged contexts are required.

Work/household, transport, and leisure domains account for the sex gap in physical activity in Chile.

Background: Women usually have lower levels of moderate-vigorous physical activity (MVPA) than men. This sex gap can be accounted for by differences in MVPA in the work/household, transport, and/or leisure domains. Identifying where the differences lay in a context-specific manner may help close the gap. We aimed to compare MVPA by domain, and the relative contribution of each domain to total MVPA, between men and women in Chile. Methods: We analyzed the cross-sectional National Health Survey of Chile 2016-2017 (n = 5,056, 64% women, ≥18 years old). MVPA was estimated with the Global Physical Activity Questionnaire. MVPA was expressed in MET × min/week, and the relative contribution to total MVPA by each domain was expressed as percentage. Analyses were conducted including all participants, and also including participants reporting >0 MET × min/week of MVPA (relative contributions can only be computed in the latter). Results: Including all participants, women (vs. men) had lower MVPA (median [25-75th percentile]) for work/household (0 [0-960] vs. 0 [0-5,760] MET × min/week), for transport (360 [0-1,200] vs. 600 [0-1,680] MET × min/week), and for leisure domains (0 [0-0] vs. 0 [0-480] MET × min/week). Including only participants with >0 MET × min/week of MVPA, women (vs. men) had lower mean relative contributions to total MVPA from work/household (31.3 vs. 35.9%) and leisure domains (10.8 vs. 16.3%, respectively), but higher from the transport domain (57.9 vs. 47.8%). Conclusion: In Chile, differences in all physical activity domains account for the sex gap in MVPA. Strategies to break job stereotypes, increase opportunities for leisure, and ease active transport are required to encourage MVPA in women.

Association of physical activity, muscular strength, and obesity indicators with self-concept in Chilean children.

Introduction: Objectives: the present study examined the association of physical activity, muscular strength, and obesity indicators with self-concept in Chilean children. Methods: this cross-sectional study included 1078 Chilean children (mean age: 9.1 years [standard deviation: 1.1]; 598 boys). Physical activity was evaluated using the Physical Activity Questionnaire for Older Children. Upper and lower limb strength was evaluated using a digital dynamometer and standing long jump performance, respectively. The general strength index was calculated based on z-score values. Obesity indicators used were height, weight, body mass index, and body fat. The self-concept test was used to determine the academic, social, emotional, family, physical self-concept dimensions and total self-concept of children. Results: the mean total self-concept was 3.3 (standard deviation: 0.5). Physical activity was associated with academic (ß: 0.32; p = 0.03), social (ß: 0.24; p = 0.04), family (ß: 0.13; p = 0.01), physical (ß: 0.46; p = 0.01) self-concept dimensions and total self-concept (ß: 0.22; p = 0.01), regardless of sex and age. Upper limb strength and general strength index were negatively associated with academic self-concept dimensions (ß: -0.02; p = 0.01 and ß: -0.13; p = 0.02) and total self-concept (ß: -0.04; p = 0.01). Body weight and body mass index were negatively associated with academic (ß: -0.01; p = 0.01 and ß: -0.01; p = 0.02) and physical self-concept dimensions (ß: -0.03; p = 0.03). Conclusions: these findings suggest that physical activity is positively related with self-concept. Thus, physical activity and self-percept must be considered as an essential social cognitive perspective to provide suitable mental health in children.

Introducción: Objetivos: el presente estudio examinó la asociación de indicadores de actividad física, fuerza muscular y obesidad con el autoconcepto en niños chilenos. Métodos: este estudio transversal incluyó a 1078 niños chilenos (edad media: 9,1 años [desviación estándar: 1,1]; 598 niños). La actividad física se evaluó mediante el Physical Activity Questionnaire for Older Children. La fuerza de los miembros superiores e inferiores se evaluó utilizando un dinamómetro digital y el rendimiento en salto de longitud de pie. El índice de fuerza general se calculó en base a los valores de z-score. Los indicadores de obesidad utilizados fueron altura, peso, índice de masa corporal y grasa corporal. Se utilizó el test de autoconcepto para determinar las dimensiones académicas, social, emocional, familiar, físico y autoconcepto total. Resultados: la muestra total presento un autoconcepto promedio de 3,3 (desviación estándar: 0,5). La actividad física se asocio con autoconcepto académico (ß: 0,32; p = 0,03), social (ß: 0,24; p = 0,04), familiar (ß: 0,13; p = 0,01), físico (ß: 0,46; p = 0,01) y total (ß: 0,22; p = 0,01). La fuerza muscular de miembros superiores y el índice general de fuerza se asociaran negativamente con al autoconcepto académico (ß: -0,02; p = 0,01 y ß: -0,13; p = 0,02) y total (ß: -0,04; p = 0,01). Mientras que el peso corporal e índice de masa corporal se asociaron negativamente con autoconcepto académico (ß: -0,01; p = 0,01 y ß: -0,01; p = 0,02) y físico (ß: -0,03; p = 0,03). Conclusiones: estos hallazgos sugieren que la actividad física se relaciona positivamente con el autoconcepto. Así, la actividad física y la autopercepción deben ser consideradas como una perspectiva cognitiva social imprescindible para proporcionar una adecuada salud mental en los niños.

Food Availability in Different Food Environments Surrounding Schools in a Vulnerable Urban Area of Santiago, Chile: Exploring Socioeconomic Determinants.

The analysis of the food environment is used to identify areas with gaps in the availability of healthy foods and can be used as a public policy assessment tool. In recent decades, Chile has implemented several strategies and regulations to improve food environments, with encouraging results. Little is known about the scope of these measures in socially vulnerable environments. This study is part of a project that seeks to build an integrated intervention model for healthy school environments in a vulnerable area of Santiago, Chile. The objective of this study was to evaluate the availability of healthy and unhealthy foods around schools and the relationship between it and socioeconomic determinants of the school community in the Chilean context. A cross-sectional study to measure the food environment of informal markets (street food), formal markets (stores), and institutions (schools) was conducted in and around 12 schools (100 m surrounding schools) in a vulnerable urban area of Santiago, Chile. A lack of healthy foods was observed, which was related to some socio-economic determinants and the multidimensional poverty was the most relevant. The diagnosis of food environments around schools can represent an important target for governments to implement policies focused at improving the availability of healthy foods.

Prevalence and co-occurrence of lifestyle risk factors for non-communicable diseases according to sociodemographic characteristics among adults Chilean residents.

To examine the prevalence and co-occurrence of lifestyle risk factors for non-communicable diseases (NCDs) according to sociodemographic characteristics in Chilean residents. A cross-sectional study based on data from 5995 adults from the Chilean National Health Survey. The lifestyle risk factors included were physical inactivity, tobacco consumption, alcohol consumption, low fruits and vegetable consumption, and overweight/obesity. The most frequent risk factor was overweight/obesity (75.6%), followed by alcohol consumption (74.8%), low fruits and vegetable consumption (51.7%), physical inactivity (36.3%), and tobacco consumption (27.9%). Only 1.0% of the participants did not present any risk factor, while 9.6%, 30.4%, 34.0%, 20.3%, and 4.7% accumulated one, two, three, four, and five risk factors. Men (OR 1.56; 95% CI 1.18; 2.04), people who have secondary education (OR 1.59; 95% CI 1.20; 2.10), and those with lower household income (OR 1.39; 95% CI 1.09; 1.59) had higher odds of three or more risk factors. Associations were inverse for older adults (OR 0.57; 95% CI 0.41; 0.79) and rural geographic areas (OR 0.77; 95% CI 0.67; 0.89). The prevalence of risk factors for NCDs is fairly high in Chilean residents. Interventions may need to target these co-occurrences rather than emphasizing individual risk factors for NCDs. Interventions could further consider these co-occurrences as a potential target for population stratification.

[Physical inactivity versus sedentariness: analysis of the chilean national health survey 2016-2017]. / Inactividad física versus sedentarismo: análisis de la Encuesta Nacional de Salud de Chile 2016-2017.

BACKGROUND: Physical inactivity and sedentariness are independent risk factors for mortality. Physical inactivity is defined as engaging in insufficient moderate/vigorous physical activity (i.e. not meeting the WHO's recommendations). Sedentariness is defined according to sedentary behavior; evidence suggests that > 8 h/d could serve to consider a person as sedentary. The Chilean National Health Survey 2016-2017 (NHS), using a single question (Question-NHS), considered as "sedentary" those who did not engage in sports or physical activity for ≥ 30 min, ≥ 3 times/wk. Thus, it attempted to estimate sedentariness without considering sedentary behavior. AIM: To determine the prevalence of physical inactivity and sedentariness in Chile, and to contrast such results with the Question-NHS. MATERIAL AND METHODS: We analyzed data from 5564 participants of the 2016-2017 NHS, aged ≥ 18 years. The Global Physical Activity Questionnaire was used to determine moderate/vigorous physical activity and sedentary behavior. We defined physical inactivity as having < 600 MET × min/wk of moderate/vigorous physical activity, and sedentariness as having > 8 h/d of sedentary behavior. RESULTS: The prevalences [95% confidence intervals] of physical inactivity and sedentariness were 32% [29-34] and 6% [5-7] respectively, while 3% [2-4] were both physically inactive and sedentary. The Question-NHS classified 88% [86-89] as "sedentary", but among them, 35% were physically inactive and 6% were sedentary. CONCLUSIONS: One third of adults are inactive, one out of ten is sedentary, and one out of twenty is inactive and sedentary. The Question-NHS overestimates the population at risk.

Lifestyle Habits and Health Indicators in Migrants and Native Schoolchildren in Chile.

In Chile, the migrant population has increased in the last years. Migrants adopt behaviors of this new culture, which can have an effect on their health. Contradictory results regarding differences between migrant and native children have been reported. The aim of this study was to explore the associations between nationality with health indicator and lifestyle habits among schoolchildren in Chile. A cross-sectional and observational study with a non-probabilistic sample was conducted in 1033 children (86.4% Chilean and 13.6% migrant) from second to fourth grade of seven public schools from low-income municipalities from the Metropolitan Region, Chile. Anthropometric measurements (weight, height, waist circumference, triceps and subscapular folds), handgrip strength, and standing long jump measurements, physical activity, self-esteem and food guidelines accomplishments were determined. Migrant children presented lower body mass index (BMI), Z-BMI, body fat% and waist circumference values; and higher handgrip strength, standing long jump, and more satisfactory compliance with food guidelines than natives (p < 0.05). No significant difference for physical activity and self-esteem was observed. In the adjusted models, migrants presented lower odds for overweight/obesity, risk of abdominal obesity, low handgrip strength and unsatisfactory food guidelines accomplishment in all models (p < 0.05). The nutritional and muscular fitness of migrant children was better than that of the Chilean ones.

Accelerometer-Measured Daily Step Counts and Adiposity Indicators among Latin American Adults: A Multi-Country Study.

The aim of the present study was to examine the sex-related associations between accelerometer-measured daily step counts and adiposity indicators in adults from eight Latin American countries. We analyzed data from 2524 adults (aged 18-65 years) from the Latin American Study of Nutrition and Health. Device-measured daily step counts were measured by accelerometers (ActiGraph GT3X). The outcomes were body mass index (BMI; (kg/m2), waist and neck circumference (in cm). Overall, the mean of daily steps counts, BMI, waist and neck circumference were 10699.8, 27.3, 89.6, and 35.8. Weak and negative associations were observed between daily steps counts and BMI (r = -0.17; p < 0.05) and waist circumference (r = -0.16; p < 0.05); however, step counts was not associated with neck circumference. Daily steps counts were negatively associated with BMI (ß: -0.054; 95%CI: -0.077; -0.012) and waist circumference (-0.098; -0.165; -0.030) independently of age and socioeconomic level. In men, there were significant negative associations between daily steps counts with BMI (-0.075; -0.119; -0.031) and waist circumference (-0.140; -0.233; -0.048), and in women, there was no significant association with either of the body composition indicators. The findings from this study need to be examined in prospective settings that use device-measured from Latin America.

Muscular Strength of Upper and Lower Limbs and Self-Esteem in Chilean SchoolChildren: Independent Associations with Body Composition Indicators.

The aim of this study was to analyze the relationship between muscular strength from upper and lower limbs with self-esteem among Chilean schoolchildren, drawing independent associations with body composition indicators. The sample consisted of 1078 schoolchildren. The muscular strength of the upper and lower limbs was evaluated using a digital dynamometer and long jump performance. The general strength index was calculated based on Z-score values. Rosenberg's test was used to determine the level of self-esteem of participants. Body fat and body mass index were employed as body composition indicators. Boys had significantly more upper and lower strength, and a general strength index higher than girls (11.7 vs. 10.6; 109.7 vs. 97.4; 0.19 vs. -0.24, respectively). For boys and girls combined, there were no significant associations between all muscular strength variables and self-esteem. In boys, upper and lower limb strength was positively associated with self-esteem. In girls, no association between muscular strength and self-esteem was found. In both sexes, the general strength index was not associated with self-esteem. Strategies and programs that promote mental health and muscular strength among schoolchildren, specifically in boys, are needed.

Factors influencing the implementation of the Health Promoting University initiative: experiences of Ibero-American universities.

The Health Promoting University (HPU) concept encourages universities to incorporate health into the university context. HPU initiatives exist worldwide, yet information on how universities translate the HPU concept into actions is scarce. This study aimed to identify the factors influencing the implementation of HPU initiatives in Ibero-American universities. Semi-structured interviews were held with seventeen representatives of universities in Ibero-America that had implemented an HPU initiative. All interviewees had been involved in the initiative and had occupied a position of responsibility for at least 1 year before the study. The interviews were carried out remotely, and the data were analyzed using an inductive approach. The main factors influencing the implementation of an HPU initiative were political support by the university authorities, coordination structure, funding, collaboration inside and outside university and participation of the university community. Among them, political support by the university authorities was considered the most important, although some initiatives succeeded without it and managed to obtain support during the implementation process. This study is one of the first to investigate the factors influencing the implementation of the HPU concept. A better understanding of these factors would enable universities to address them to develop the HPU initiative in the best possible conditions.

Inactividad física versus sedentarismo: análisis de la Encuesta Nacional de Salud de Chile 2016-2017

Background: Physical inactivity and sedentariness are independent risk factors for mortality. Physical inactivity is defined as engaging in insufficient moderate/vigorous physical activity (i.e. not meeting the WHO's recommendations). Sedentariness is defined according to sedentary behavior; evidence suggests that > 8 h/d could serve to consider a person as sedentary. The Chilean National Health Survey 2016-2017 (NHS), using a single question (Question-NHS), considered as "sedentary" those who did not engage in sports or physical activity for ≥ 30 min, ≥ 3 times/wk. Thus, it attempted to estimate sedentariness without considering sedentary behavior. Aim: To determine the prevalence of physical inactivity and sedentariness in Chile, and to contrast such results with the Question-NHS. Material and Methods: We analyzed data from 5564 participants of the 2016-2017 NHS, aged ≥ 18 years. The Global Physical Activity Questionnaire was used to determine moderate/vigorous physical activity and sedentary behavior. We defined physical inactivity as having 8 h/d of sedentary behavior. Results: The prevalences [95% confidence intervals] of physical inactivity and sedentariness were 32% [29-34] and 6% [5-7] respectively, while 3% [2-4] were both physically inactive and sedentary. The Question-NHS classified 88% [86-89] as "sedentary", but among them, 35% were physically inactive and 6% were sedentary. Conclusions: One third of adults are inactive, one out of ten is sedentary, and one out of twenty is inactive and sedentary. The Question-NHS overestimates the population at risk.

How do universities implement the Health Promoting University concept?

The Health Promoting University (HPU) concept encourages universities to incorporate health into the university culture, processes and policies in an effort to promote the health of the university community. Universities worldwide have adopted the approach and a framework for action has been developed to guide universities to become a HPU. However, information on how universities translate the framework into actions is scarce. This study explored the way in which 54 universities from 25 countries across the world implemented the HPU framework. An online questionnaire was used to assess the action areas and items of work addressed by the universities and to determine their adherence to the components of the HPU framework: use of the whole systems approach; multiservice collaboration; recognition by the university authorities; funding availability; membership of a HPU network and evaluation of the initiative. The results showed that these components were addressed by most universities. A Multi Correspondence and cluster analysis identified four types of universities based on the implementation of the components: 'emerging' HPUs that are not recognized by the university authorities and tend to not apply the whole systems approach or evaluation of the initiative, and 'established' HPUs that are recognized by the authorities, apply the whole systems approach and evaluate the initiative but that differ with regard to funding and membership of a HPU network. These results demonstrate that universities implement the HPU framework for action differently in order to become a Health Promoting University.

Implementing the Health Promoting University approach in culturally different contexts: a systematic review.

INTRODUCTION: Universities represent a valuable opportunity to promote health and well-being. Based on the setting approach, the Health Promoting Universities concept has been developed in different countries and contexts. However, the implementation process remains poorly documented. This systematic review aims to describe how universities have implemented the Health Promoting University concept in different cultural contexts. METHODS: Pubmed, Medline, Lilacs and Scielo were searched for articles on Health Promoting Universities, published between 1995 and 2015. Studies detailing the implementation of a Health Promoting University approach were included. Selected articles were content analysed paying attention to: (a) the definition of a Health Promoting University; (b) priority areas of action; (c) items of work; (d) coordination of the project; (e) evaluation; and (f) adaptation to the cultural context. RESULTS: Twelve studies were identified for in-depth analysis. Of those, three were theoretical papers, and nine were intervention studies. The programmes described in the selected studies are mostly based on the guidelines of the Edmonton Charter. They incorporated the main areas of action and items of works proposed by the Health Promoting University framework. The implementation of healthy policies and incorporation of health promotion in the curriculum are remaining challenges. Strategies to facilitate adaptation to context include: stakeholder participation in planning and implementation, adaptation of educational material and analysis of needs. CONCLUSIONS: The review suggests that most of the universities work towards similar goals, relying on the Health Promoting University framework, yet that the way in which initiatives are implemented depends on the context.