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Kristine A. Madsen, MD, MPH; Wendi Gosliner, MPH, RD; Gail Woodward-Lopez, MPH, RD; Patricia B. Crawford, DrPH, RD

Arch Pediatr Adolesc Med. 2009;163(11):1014-1021.

Objective  To identify physical activity opportunities linked to fitness and weight status among adolescents in low-income communities.

Design, Setting, and Participants  Cross-sectional, ecological analysis of 9268 seventh- and ninth-grade students in 19 public schools participating in The California Endowment's Healthy Eating Active Communities program.

Main Outcome Measures  Cardiorespiratory fitness (mile time) and body mass index. Independent variables included students' perceptions and behaviors related to daily physical activity opportunities, assessed via anonymous survey. Ecological analysis was used to link survey data with fitness and body mass index data within each school. Linear regression identified associations between youths' perceptions/behaviors and fitness/body mass index.

Results  As the proportion of students reporting enjoying physical education, walking to school, and spending 20 minutes or longer in exercise during physical education increased from 0% to 100%, mile time decreased overall (–2.7 minutes; P = .03), mile time decreased among seventh graders (–3.3 minutes; P = .02), and body mass index z scores decreased among ninth graders (–0.7; P = .045), respectively. Each additional day students reported being active on school grounds outside school hours was associated with decreased mile time (–0.5 minute; P = .02). Active transport to school was associated with poorer weight status and greater odds of purchasing food while in transit (odds ratio = 1.5; P < .001).

Conclusions  Physical education is a valuable policy opportunity to improve student health. Promoting active transport may improve fitness but must be done in conjunction with community partnerships to improve the food environment in the vicinity of schools. Promoting the use of school grounds outside school hours (such as after-school programs) should also be prioritized in response to youth obesity.

Author Affiliations: Department of Pediatrics, University of California, San Francisco.

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