Advocating for Implementation of the Global Action Plan on Physical Activity: Challenges and Support Requirements.

BACKGROUND: There is limited understanding of the challenges experienced and supports required to aid effective advocacy of the Global Action Plan on Physical Activity (GAPPA). The purpose of this study was to assess the challenges experienced and supports needed to advocate for the GAPPA across countries of different income levels. METHODS: Stakeholders working in an area related to the promotion of physical activity were invited to complete an online survey. The survey assessed current awareness and engagement with the GAPPA, factors related to advocacy, and the perceived challenges and supports related to advocacy for implementation of the GAPPA. Closed questions were analyzed in SPSS, with a Pearson's chi-square test used to assess differences between country income level. Open questions were analyzed using inductive thematic analysis. RESULTS: Participants (n = 518) from 81 countries completed the survey. Significant differences were observed between country income level for awareness of the GAPPA and perceived country engagement with the GAPPA. Challenges related to advocacy included a lack of support and engagement, resources, priority, awareness, advocacy education and training, accessibility, and local application. Supports needed for future advocacy included guidance and support, cooperation and alliance, advocacy education and training, and advocacy resources. CONCLUSIONS: Although stakeholders from different country income levels experience similar advocacy challenges and required supports, how countries experience these can be distinct. This research has highlighted some specific ways in which those involved in the promotion of physical activity can be supported to scale up advocacy for the GAPPA. When implementing such supports, consideration of regional, geographic, and cultural barriers and opportunities is important to ensure they are effective and equitable.

Associations between Screen-Based Activities, Physical Activity, and Dietary Habits in Mexican Schoolchildren.

Screen-based activities are associated with increased risk of obesity and contribute to physical inactivity and poor dietary habits. The primary aim of this study was to examine the associations among screen-based activities, physical activity, and dietary habits in school-aged children in Guadalajara, Puerto Vallarta, and Mexico City, Mexico. The secondary aim was to examine these associations across sex. The School Physical Activity and Nutrition survey was used to assess screen-based activities (TV watching, video game use, computer use), physical activity, and dietary habits. Organized activity/sports participation, unhealthy dietary habits, and household income were correlated with screen-based activities. While TV watching was associated with decreased participation in organized activity/sports participation, computer and video game use was associated with increased organized activity/sports participation. Boys engaged in more TV watching and video game use compared to girls. All screen-based activities were associated with age among boys; whereas video game and computer use were associated with higher income among girls. These findings suggest a need for sex- and age-specific strategies that acknowledge the differential use of screen-based activities across sex and age. Future research should continue to identify underlying correlates linking screen-based activities with health behaviors to inform strategies to reduce screen-time in Mexican children.

Characterization of the School Neighborhood Food Environment in Three Mexican Cities.

Food resources in school neighborhoods can negatively influence diet; however, this environment is understudied. This study characterized the school neighborhood food environment in Guadalajara (n=11), Puerto Vallarta (n=7), and Mexico City (n=14). Convenience stores, table-service restaurants, and taco stands were highly available in all three cities. Grocery stores were highly available in Mexico City school neighborhoods, yet less frequently observed in Guadalajara and Puerto Vallarta. Socioeconomic differences in food cart and grocery store availability were observed in Guadalajara and Puerto Vallarta. Policy and intervention strategies are needed to address the saturation of food resources in Mexico school neighborhoods.

Applying the RE-AIM conceptual framework for the promotion of physical activity in low- and middle-income countries / Aplicando o modelo RE-AIM para a promoção da atividade física em países de baixa e média renda / Aplicando el marco conceptual RE-AIM para la promoción de la actividad física en países de ingreso bajo y médio

ABSTRACT Objective: the RE-AIM framework has been widely used to evaluate internal and external validity of interventions aimed to promote physical activity, helping to provide comprehensive evaluation of the reach, efficacy, adoption, implementation and maintenance of research and programming. Despite this progress, the RE-AIM framework has not been used widely in Latin America. The purpose of this manuscript is to describe the RE-AIM framework, the process and materials developed for a one-day workshop in Guadalajara, and the acceptability and satisfaction of participants that attended the workshop. Methods: lecture, interactive examples and an agenda were developed for a one-day RE-AIM workshop over a three month period. Results: thirty two health care practitioners (M age = 30.6, SD=9.9 years) attended the workshop. Most (100%) rated the workshop as credible, useful (100%) and intended to apply it in current or future research (95%). Conclusion: results suggest intuitive appeal of the RE-AIM framework, and provide a strategy for introducing the utility and practical application of the framework in practice settings in Mexico and Latin America.

RESUMO Objetivo: o modelo RE-AIM tem sido amplamente utilizado para avaliar a validade interna e externa de intervenções que objetivam promover atividade física, auxiliando a fornecer uma avaliação abrangente do alcance, eficácia, adoção, implementação e manutenção de pesquisas e programas. Apesar deste progresso, o modelo RE-AIM não tem sido amplamente utilizado na América Latina. O objetivo deste artigo é descrever o modelo RE-AIM, o processo e os materiais desenvolvidos para uma oficina de um dia de duração em Guadalajara e a aceitabilidade e satisfação dos participantes que compareceram na oficina. Métodos: durante o período de três meses, palestras e exercícios interativos foram desenvolvidos para uma oficina de um dia sobre o modelo RE-AIM. Resultados: trinta e dois profissionais de saúde (Média de idade=30,6±9,9 anos) participaram da oficina. A maioria dos participantes classificou a oficina como credível (100%), útil (100%) e pretende aplicar o que foi aprendido em investigações atuais ou futuras (95%). Conclusão: os resultados sugerem que o modelo RE-AIM é um recurso intuitivo e fornecem uma estratégia para a apresentação da utilidade e aplicação prática do modelo em cenários práticos no México e na América Latina.

RESUMEN Objetivo: el marco RE-AIM ha sido ampliamente utilizado para evaluar la validez interna y externa de intervenciones destinadas a promover la actividad física, ayudando a proporcionar una evaluación exhaustiva de la cobertura, eficacia/efectividad, adopción, implementación y mantenimiento de programas sobre actividad física. A pesar de este progreso, el marco RE-AIM no se ha utilizado ampliamente en América Latina. El objetivo de este artículo es presentar el marco conceptual RE-AIM, describir el proceso y los materiales desarrollados para un taller en Guadalajara; y reportar la aceptabilidad y satisfacción de los participantes que acudieron al taller. Métodos: durante un período de tres meses, se desarrolló un taller sobre el marco RE-AIM. El taller duró un día e incluyó una conferencia y ejercicios interactivos. Resultados: treinta y dos profesionales de la salud (edad media = 30.6 [±9.9 años]) participaron en el taller. La mayoría calificó el taller como creíble, útil (100%) y manifestó la intención de aplicar lo aprendido en investigaciones actuales o futuras (95%). Conclusión: los resultados sugieren que el marco RE-AIM es intuitivamente atractivo y que el curso es una estrategia adecuada para introducir la utilidad y aplicación práctica del marco en espacios de práctica en América Latina.

Physical Activity and Anthropometric Characteristics Among Urban Youth in Mexico: A Cross-Sectional Study.

BACKGROUND: Obesity is a critical problem among Mexican youth, but few studies have investigated associations among physical activity (PA) modes and anthropometrics in this population. This study examined associations among active commuting to school (ACS), sports or other organized PA, outdoor play, and body mass index (BMI) percentile and waist circumference (WC) among Mexican youth. METHODS: Parents of school children (N = 1996, ages 6 to 14 years, 53.1% female) in 3 Mexican cities reported PA participation using the (modified) fourth grade School Physical Activity and Nutrition Survey. Trained assessors measured BMI percentile and WC in person. RESULTS: Parents reported that 52.3% of children engaged in ACS, 57.3% participated in sports or organized PA, and a median of 2 days in the previous week with at least 30 minutes of outdoor play. In complete case analyses (n = 857), ACS was negatively associated with BMI percentile, and outdoor play was negatively associated with WC after adjusting for school, age, sex, and income. In analyses incorporating data from multiple imputation (N = 1996), outdoor play was negatively associated with WC (all Ps < . 05). CONCLUSIONS: ACS and outdoor play are favorably associated with anthropometrics and may help prevent childhood obesity in Mexico. ACS and outdoor play should be priorities for increasing youth PA in Mexico.

Influence of parental perception of school safety and gender on children's physical activity in Mexico: A cross sectional study.

OBJECTIVE: This cross sectional study aims to determine the effects of gender and parental perception of safety at school on children's physical activity (PA) levels. MATERIALS AND METHODS: Parents of school aged Mexican children residing in Guadalajara, Mexico City, and Puerto Vallarta, completed surveys about their children's PA measures. The physical activity indicators were evaluated using linear and logistical regression models. RESULTS: Analysis did not indicate that gender moderated the relationship between parental perception of safety and PA measures, but significant gender issues exist with girls participating less than boys in the three measures of PA in this study (p<0.001). CONCLUSION: Results suggest the need for additional interventions promoting physical activity in girls in Mexico.

Influence of parental perception of school safety and gender on children's physical activity in Mexico: A cross sectional study / Influencia de la percepción de los padres sobre seguridad escolar y del género en la actividad física de niños en México: un estudio transversal

Objective. This cross sectional study aims to determine the effects of gender and parental perception of safety at school on children's physical activity (PA) levels. Materials and methods. Parents of school aged Mexican children residing in Guadalajara, Mexico City, and Puerto Vallarta, completed surveys about their children's PA measures. The physical activity indicators were evaluated using linear and logistical regression models. Results. Analysis did not indicate that gender moderated the relationship between parental perception of safety and PA measures, but significant gender issues exist with girls participating less than boys in the three measures of PA in this study (p<0.001). Conclusion. Results suggest the need for additional interventions promoting physical activity in girls in Mexico.

Objetivo. Determinar los efectos de género y percepción paternal de la seguridad en escuelas, en niveles de actividad física (AF) en los niños. Material y métodos. Padres con hijos escolares residentes en Guadalajara, Ciudad de México, y Puerto Vallarta, completaron encuestas sobre los niveles de AF de sus hijos. Se evaluaron los indicadores de AF usando modelos de regresión lineal y logística. Resultados. El análisis no indica que el género modere la relación entre percepción de seguridad y medidas de AF, pero hay indicadores significativos de que las niñas participan menos que los varones en las medidas de AF de este estudio (p<0.001). Conclusión. Los resultados sugieren la necesidad de intervenciones adicionales que promuevan la AF en niñas mexicanas.

A Multisite Study of Environmental Correlates of Active Commuting to School in Mexican Children.

BACKGROUND: Mexican children often use active commuting to school (ACS). In order to maintain high levels of ACS it is important to understand correlates of ACS in this population. However, most evidence comes from high-income countries (HICs). We examined multilevel correlates of ACS in children attending public schools in 3 Mexican cities. METHODS: Information on 1191 children (grades 3 to 5) attending 26 schools was retrieved from questionnaires, neighborhood audits, and geographic information systems data. Multilevel logistic modeling was used to explore individual and environmental correlates of ACS at 400-m and 800-m buffers surrounding schools. RESULTS: Individual positive correlates for ACS included age (6-8 years vs 9-11 years, odds ratio [OR] = 1.5; 6-8 years vs ≥12 years: OR = 2.1) and ≥ 6 adults at home (OR = 2.0). At the 400-m buffer, more ACS was associated with lower walkability (OR = 0.87), presence of posted speed limits (< 6% vs > 12%: OR = 0.36) and crossing aids (< 6% vs 6-20%: OR = 0.25; > 20%: OR = 0.26), as well as higher sidewalk availability (< 70% vs > 90%: OR = 4.5). Similar relationships with speed limits and crossing aids were observed at the 800m buffer. CONCLUSIONS: Findings contrast with those reported in HICs, underscoring the importance of considering the local context when developing strategies to promote ACS. Future studies are needed to replicate these relationships and investigate the longitudinal impact of improving active transportation infrastructure and policies.

Using the RE-AIM framework to evaluate physical activity public health programs in México.

BACKGROUND: Physical activity (PA) public health programming has been widely used in Mexico; however, few studies have documented individual and organizational factors that might be used to evaluate their public health impact. The RE-AIM framework is an evaluation tool that examines individual and organizational factors of public health programs. The purpose of this study was to use the RE-AIM framework to determine the degree to which PA programs in Mexico reported individual and organizational factors and to investigate whether reporting differed by the program's funding source. METHODS: Public health programs promoting PA were systematically identified during 2008-2013 and had to have an active program website. Initial searches produced 23 possible programs with 12 meeting inclusion criteria. A coding sheet was developed to capture behavioral, outcome and RE-AIM indicators from program websites. RESULTS: In addition to targeting PA, five (42%) programs also targeted dietary habits and the most commonly reported outcome was change in body composition (58%). Programs reported an average of 11.1 (±3.9) RE-AIM indicator items (out of 27 total). On average, 45% reported reach indicators, 34% reported efficacy/effectiveness indicators, 60% reported adoption indicators, 40% reported implementation indicators, and 35% reported maintenance indicators. The proportion of RE-AIM indicators reported did not differ significantly for programs that were government supported (M = 10, SD = 3.1) and programs that were partially or wholly privately or corporately supported (M = 12.0, SD = 4.4). CONCLUSION: While reach and adoption of these programs were most commonly reported, there is a need for stronger evaluation of behavioral and health outcomes before the public health impact of these programs can be established.

Associations between physical activity, cardiorespiratory fitness, and obesity in Mexican children

OBJECTIVE: To examine the independent relation of physical activity (PA) and cardiorespiratory fitness (fitness) with measures of obesity in Mexican children. MATERIALS AND METHODS: Children (N=193) in 5th and 6th grade from Guadalajara participated. Body mass index (BMI), sum of skinfolds (SS) and waist circumference (WC) were measured. PA was measured over four days using pedometry and fitness was measured using the 20 meter shuttle-run test. RESULTS: Fitness and PA were negatively related to the obesity measures in boys and girls (r=-0.57 to -0.64 and r=-0.18 to -0.23 respectively). Age adjusted significant differences in WC, BMI, and SS were observed between the lowest and highest fitness tertiles for boys and girls (p<.01). Age, gender, and PA adjusted fitness explained 23 to 34% of the variance on WC (r²=0.23, p<.01), BMI (r²=0.23, p<.01), and SS (r²=0.34, p<.01). CONCLUSION: Fitness is a stronger correlate and better predictor of obesity than PA in this sample.

OBJETIVO: Examinar la relación independiente entre actividad física (AF) y acondicionamiento cardiorrespiratorio (fitness) con obesidad en niños mexicanos. MATERIAL Y MÉTODOS: Participaron 193 niños de Guadalajara en 5to y 6to grado de primaria. Se midieron índice de masa corporal (IMC), suma de pliegues cutáneos (SP) y circunferencia de cintura (CC). La AF se midió con podometría durante cuatro días y acondicionamiento usando la prueba de 20 metros shuttle-run. RESULTADOS: Acondicionamiento y AF estuvieron negativamente relacionados con obesidad en niños y niñas (r=-0.57 a -0.64 y r=-0.18 a -0.23 respectivamente). Ajustando por edad, se observaron diferencias significativas en CC, IMC y SP entre los terciles de acondicionamiento bajo y alto en niños y niñas (p<.01). Ajustando por edad, género y AF, el acondicionamiento explicó de 23 a 34% de la varianza en CC (r²=0.23, p<.01), IMC (r²=0.23, p<.01) y SP (r²=0.34, p<.01). CONCLUSIÓN: El acondicionamiento es un mejor predictor de obesidad que la AF en esta muestra.

Associations between physical activity, cardiorespiratory fitness, and obesity in Mexican children.

OBJECTIVE: To examine the independent relation of physical activity (PA) and cardiorespiratory fitness (fitness) with measures of obesity in Mexican children. MATERIALS AND METHODS: Children (N=193) in 5th and 6th grade from Guadalajara participated. Body mass index (BMI), sum of skinfolds (SS) and waist circumference (WC) were measured. PA was measured over four days using pedometry and fitness was measured using the 20 meter shuttle-run test. RESULTS: Fitness and PA were negatively related to the obesity measures in boys and girls (r=-0.57 to -0.64 and r=-0.18 to -0.23 respectively). Age adjusted significant differences in WC, BMI, and SS were observed between the lowest and highest fitness tertiles for boys and girls (p<.01). Age, gender, and PA adjusted fitness explained 23 to 34% of the variance on WC (r²=0.23, p<.01), BMI (r²=0.23, p<.01), and SS (r²=0.34, p<.01). CONCLUSION: Fitness is a stronger correlate and better predictor of obesity than PA in this sample.