Abstract
Neighborhood environments can support fitness-promoting behavior, yet little is known about their influence on youth physical fitness outcomes over time. We examined longitudinal ...associations between neighborhood opportunity and youth physical fitness among New York City (NYC) public school youth. The Child Opportunity Index (COI), a composite index of 29 indicators measuring neighborhood opportunity at the census-tract level, along with scores on 4 selected COI indicators were linked to NYC FITNESSGRAM youth data at baseline. Fitness outcomes (measured annually, 2011–2018) included body mass index, curl-ups, push-ups, and Progressive Aerobic Cardiovascular Endurance Run (PACER) laps. Unstratified and age-stratified, adjusted, 3-level generalized linear mixed models, nested by census tract and time, estimated the association between COI and fitness outcomes. The analytical sample (n = 204,939) lived in very low (41%) or low (30%) opportunity neighborhoods. Unstratified models indicated that overall COI is modestly associated with improved youth physical fitness outcomes. The strongest opportunity-fitness associations were observed for PACER. Stratified models show differences in associations across younger vs. older youth. We find that neighborhood factors are associated with youth fitness outcomes over time, with the strength of the associations dependent on age. Future implications include better informed place-based interventions tailored to specific life stages to promote youth health.
Abstract
NYC FITNESSGRAM, monitored by the New York City (NYC) Department of Education and the NYC Department of Health and Mental Hygiene, functions as the NYC Department of Education’s citywide ...youth fitness surveillance program. Here we present the methods, characteristics, and data used in this surveillance system to monitor physical fitness in public school students (grades kindergarten through 12; initiated in 2006; n = 6,748,265 observations; mean sample of 519,097 observations per year to date) in New York, New York. Youth physical fitness prevalence estimates, longitudinal trends, and spatial analyses may be investigated using continuous fitness composite percentile scores and Cooper Institute for Aerobic Research–defined sex- and age-specific Healthy Fitness Zones. Healthy Fitness Zones are based on individual-child fitness test performance, with standard errors clustered at the school and student levels and adjusted for sociodemographic characteristics. Results may be used to show trends in youth fitness attainment over time and highlight disparities in the fitness prevalence of NYC students. In sum, continuous fitness composite percentile scores offer the opportunity for prospective tracking of shifts in youth physical fitness on a population scale and across subpopulations. NYC FITNESSGRAM can accompany a growing body of surveillance tools demonstrating the potential for population-level surveillance tools to promote global public health.
Obesity is associated with poorer youth fitness. However, little research has examined the magnitude of this relationship in youth with severe obesity. Therefore, we sought to determine the ...relationship between increasing weight status and fitness within a sample of children and adolescents from New York City public schools.
This study utilized longitudinal data from the NYC Fitnessgram dataset years 2010-2018. Height and weight along with fitness were measured annually during physical education classes. Severity of obesity was defined using body mass index relative to the 95th percentile and then categorized into classes. A composite measure of fitness was calculated based on scores for three fitness tests: aerobic capacity, muscular strength, and muscular endurance. To examine the weight status-fitness relationship, repeated measures mixed models with random-intercepts were constructed. Stratified models examined differences by demographic factors.
The sample included 917,554 youth (51.8% male, 39.3% Hispanic, 29.9% non-Hispanic Black, 14.0%, 4.6%, and 1.6% class I, II and III obesity, respectively). Compared to youth with healthy weight, increasing severity of obesity was associated with decreased fitness: overweight (β = - 0.28, 95% CI:-0.29;-0.28), class I obesity (β = - 0.60, 95% CI:-0.60; - 0.60), class II obesity (β = - 0.94, 95% CI:-0.94; - 0.93), and class III obesity (β = - 1.28; 95% CI:-1.28; - 1.27). Stratified models showed the association was stronger among male and non-Hispanic White youth.
Findings revealed that more severe obesity was associated with lower fitness. Future research is needed to develop targeted interventions to improve fitness in youth with obesity.
Physical activity is strongly associated with health benefits in youth, although wide disparities in physical activity persist across sex, race/ethnicity, and income. Active transportation is an ...important source of youth physical activity. We aimed to describe active transportation patterns for United States adolescents and young adults ages 12–25 years across sociodemographic and weight status characteristics.
Cross-sectional secondary data analyses were based on self-reported transportation-related physical activity using the National Health and Nutrition Examination Survey, 2007-2016.
Of the sample (n = 8,680; population represented, N = 57,768,628), 4,300 (49.5%) were adolescents (12-17 y), and 4,380 (50.4%) were young adults (18-25 y). Male adolescents were more likely to participate in any (risk ratio RR = 1.3; 95% confidence interval CI, 1.16-1.40) and daily (RR = 1.3; 95% CI, 1.06-1.63) active transportation than females. Black (RR = 1.1; 95% CI, 1.01-1.31) and Hispanic (RR = 1.2; 95% CI, 1.05-1.31) adolescents were more likely to engage in any active transportation than whites. Young adult males were more likely to participate in any (RR = 1.3; 95% CI, 1.20-1.50) and daily (RR = 1.3; 95% CI, 1.08-1.55) active transportation than females. Young adults with a lower family income, and both adolescents and young adults with a lower household education, were more likely to engage in any and daily active transportation. We also observed an inverse relationship between weight class and active transportation participation.
Active transportation was higher in males, minority, and lower income youth. Our study findings provide evidence for physical activity interventions, suggesting active transportation is a feasible target for low-income and minority youth to reduce physical activity disparities and support optimal health.
Safe and effective treatment exists for childhood obesity, but treatment recommendations have largely not been translated into practice, particularly among racial and ethnic minorities and low-wealth ...populations. A key gap is meeting the recommended treatment of ≥26 h of lifestyle modification over 6-12 months. Fit Together is an effective treatment model that meets these recommendations by integrating healthcare and community resources. Pediatric providers screen children for obesity, deliver counseling, and treat co-morbidities, while Parks and Recreation partners provide recreation space for a community nutrition and physical activity program.
This study will use a hybrid type II implementation-effectiveness design to evaluate the effectiveness of an online implementation platform (the Playbook) for delivering Fit Together. Clinical and community partners in two North Carolina communities will implement Fit Together, using the Playbook, an implementation package designed to facilitate new partnerships, guide training activities, and provide curricular materials needed to implement Fit Together. An interrupted time series design anchored in the Process Redesign Framework will be used to evaluate implementation and effectiveness outcomes in intervention sites. Implementation measures include semi-structured interviews with partners, before and after the implementation of Fit Together, and quantitative measures assessing several constructs within the Process Redesign Framework. The participants will be children 6-11 years old with obesity and their families (n=400). Effectiveness outcomes include a change in child body mass index and physical activity from baseline to 6 and 12 months, as compared with children receiving usual care. Findings will be used to inform the design of a dissemination strategy guided by the PCORI Dissemination Framework.
This project addresses the knowledge-to-action gap by developing evidence-based implementation tools that allow clinicians and communities to deliver effective pediatric obesity treatment recommendations. Future dissemination of these tools will allow more children who have obesity and their families to have access to effective, evidence-based care in diverse communities.
ClinicalTrials.gov identifier: NCT05455190 . Registered on 13 July 2022.
This paper aims to examine the association between asthma severity and one-year lagged fitness in New York City Public school youth by neighborhood opportunity.
Using the Child Opportunity Index 2.0 ...and individual-level repeated measures NYC Office of School Health (OSH) fitness surveillance data (2010-2018), we ran multilevel mixed models stratified by neighborhood opportunity, adjusting for sex, race/ethnicity, grade level, poverty status, and time. Asthma severity was based on a physician-completed Asthma Medication Administration Form (MAF) from each school year and drawn from the Automated Student Health Record (ASHR).
Across all youth in grades 4-12 (n = 939,598; 51.7 % male; 29.9 % non-Hispanic Black, 39.3 % Hispanic; 70.0 % high poverty), lower neighborhood opportunity was associated with lower subsequent fitness. Youth with severe asthma and very low and low neighborhood opportunity had the lowest 1-year lagged fitness z-scores - 0.24 (95 % CI, -0.34 to -0.14) and - 0.26 (95 % CI, -0.32 to -0.20), respectively, relative to youth with no asthma and very high opportunity.
An inverse longitudinal relationship between asthma severity and subsequent fitness was observed. Study findings have implications for public health practitioners to promote physical activity and improved health equity for youth with asthma, taking neighborhood factors into account.
To provide recommendations for future common data element (CDE) development and collection that increases community partnership, harmonizes data interpretation, and continues to reduce barriers of ...mistrust between researchers and underserved communities.
We conducted a cross-sectional qualitative and quantitative evaluation of mandatory CDE collection among Rapid Acceleration of Diagnostics-Underserved Populations Return to School project teams with various priority populations and geographic locations in the United States to: (1) compare racial and ethnic representativeness of participants completing CDE questions relative to participants enrolled in project-level testing initiatives and (2) identify the amount of missing CDE data by CDE domain. Additionally, we conducted analyses stratified by aim-level variables characterizing CDE collection strategies.
There were 15 study aims reported across the 13 participating Return to School projects, of which 7 (47%) were structured so that CDEs were fully uncoupled from the testing initiative, 4 (27%) were fully coupled, and 4 (27%) were partially coupled. In 9 (60%) study aims, participant incentives were provided in the form of monetary compensation. Most project teams modified CDE questions (8/13; 62%) to fit their population. Across all 13 projects, there was minimal variation in the racial and ethnic distribution of CDE survey participants from those who participated in testing; however, fully uncoupling CDE questions from testing increased the proportion of Black and Hispanic individuals participating in both initiatives.
Collaboration with underrepresented populations from the early study design process may improve interest and participation in CDE collection efforts.
Severe persistent childhood asthma is associated with low physical activity and may be associated with poor physical fitness. Research on the asthma severity-fitness association longitudinally and ...across sociodemographic subgroups is needed to inform fitness interventions targeting youth with asthma. We evaluated the relationship between asthma severity (categorized as severe, mild, or no asthma) and subsequent fitness in New York City (NYC) public school youth enrolled in grades 4–12 using the NYC Fitnessgram dataset (2010–2018). Longitudinal mixed models with random intercepts were fit to test the association between asthma severity and one-year lagged fitness z-scores by clustering repeated annual observations at the student level. Models were adjusted for sex, race/ethnicity, grade level, poverty status, time, and stratified by sociodemographic factors. The analytic sample included 663,137 students (51% male; 31% non-Hispanic Black, 40% Hispanic; 55% in grades 4–8, 70% high poverty; 87%, 11% and 1% with no, mild, and severe asthma, respectively). Students with severe asthma and mild asthma demonstrated −0.19 (95% CI, −0.20 to −0.17) and − 0.10 (95% CI, −0.11 to −0.10), respectively, lower fitness z-scores in the subsequent year relative to students without asthma. After stratifying by demographics, the magnitude of the asthma severity-fitness relationship was highest for non-Hispanic white vs. all other racial/ethnic subgroups, and was similar across sex, grade level, and household poverty status. Overall, we observed an inverse longitudinal relationship between asthma severity and subsequent fitness among urban youth, particularly non-Hispanic Whites. Future research should examine how neighborhood-level factors impact the asthma severity-fitness relationship across racial/ethnic subgroups.
•Severe persistent childhood asthma may be associated with poor physical fitness.•We evaluated the relationship between asthma severity and subsequent youth fitness.•We observed an inverse longitudinal association between asthma severity and fitness.•The asthma severity-fitness association was strongest among non-Hispanic Whites.•This work can inform targeted fitness interventions for youth with asthma.
Routine adolescent physical activity is a well-established predictor of positive health across the lifespan, although wide disparities in youth physical activity engagement persist across sex and ...race/ethnicity. Transportation barriers may be related to adolescents’ ability to access physical activity opportunities. This study examines the association between neighborhood public transportation usage and adolescent physical activity using a national sample.
Cross-sectional data were drawn from the Family Life, Activity, Sun, Health, and Eating study (2014), a national sample of adolescents aged 12–17 years. Linear regression examined the association between neighborhood public transportation usage on the basis of neighborhood-level public transportation use and individual-level youth moderate-to-vigorous physical activity minutes per week. Models were developed for weekday, weekend, and combined moderate-to-vigorous physical activity for all youth and across sex and race/ethnicity subgroups. Analyses were run in 2020.
The final analytic data set included 1,247 adolescents aged 12–17 years (71% non-Hispanic White, 49% male, mean age=14.52 SD=1.59 years). Adjusted models showed a stronger magnitude of association between high neighborhood public transportation usage and both weekday (β=8.79, 95% CI=1.00, 16.59) and combined (β=13.74, 95% CI=1.14, 26.35) moderate-to-vigorous physical activity than between low/moderate neighborhood public transportation usage and moderate-to-vigorous physical activity. The magnitude of the neighborhood public transportation usage–moderate-to-vigorous physical activity association was strongest among non-Hispanic Black and Hispanic adolescent girls.
This study found an association between neighborhood public transportation usage and adolescent moderate-to-vigorous physical activity, particularly among non-Hispanic Black and Hispanic adolescent girls. Findings from this research have the potential to inform targeted interventions for promoting adolescent physical activity to ultimately reduce chronic health disparities across the lifespan.
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