title: Do school-based physical activity interventions increase or reduce inequalities in health?
abstract: Little is known about the effectiveness of school-based health promotion on physical activity inequalities among children from low-income areas. This study compared the two-year change in physical activity among 10-11 year-old children attending schools with and without health promotion programs by activity level, body weight status, and socioeconomic backgrounds to assess whether health promotion programs reduce or exacerbate health inequalities. This was a quasi-experimental trial of a Comprehensive School Health (CSH) program implemented in schools located in socioeconomically disadvantaged neighbourhoods in Edmonton, Alberta, Canada. In the spring of 2009 and 2011, pedometer (7 full days) and demographic data were collected from cross-sectional samples of grade five children from 10 intervention and 20 comparison schools. Socioeconomic status was determined from parent self-report. Low-active, active, and high-active children were defined according to step-count tertiles. Multilevel linear regression methods adjusted for potential confounders were used to assess the relative inequity in physical activity and were compared between groups and over-time. In 2009, a greater proportion of students in the intervention schools were overweight (38% vs. 31% p = 0.03) and were less active (10,827 vs. 12,265 steps/day p < 0.001). Two years later, the relative difference in step-counts between intervention and comparison schools reduced from -15.5% to 0% among low-active students, from -13.4% to 0% among active students, and from -15.1% to -2.7% among high-active students. The relative difference between intervention and comparison schools reduced from -11.1% to -1.6% among normal weight students, from -16.8% to -1.4% among overweight students, and was balanced across socioeconomic subgroups. These findings demonstrate that CSH programs implemented in socioeconomically disadvantaged neighbourhoods reduced inequalities in physical activity. Investments in school-based health promotion are a viable, promising, and important approach to improve physical activity and prevent childhood obesity, and may also reduce inequalities in health.
authors.affiliation: School of Public Health, University of Alberta, Population Health Intervention Research Unit, 3-50 University Terrace, 8303 112 Street, Edmonton, Alberta, Canada T6G2T4. Electronic address: kerry.vanderploeg@ualberta.ca.
authors.forename: Kerry A
authors.initials: KA
authors.lastname: Vander Ploeg
authors.affiliation: School of Public Health, University of Alberta, 3-268 Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, Alberta, Canada T6G1C9. Electronic address: katerina.maximova@ualberta.ca.
authors.forename: Katerina
authors.initials: K
authors.lastname: Maximova
authors.affiliation: Department of Pediatrics and Child Health, Faculty of Medicine, University of Manitoba, Manitoba Institute of Child Health, 513-715 McDermot Avenue, Winnipeg, Manitoba, Canada R3E3P4. Electronic address: jmcgavock@mich.ca.
authors.forename: Jonathan
authors.initials: J
authors.lastname: McGavock
authors.affiliation: School of Public Health, University of Alberta, Population Health Intervention Research Unit, 3-50 University Terrace, 8303 112 Street, Edmonton, Alberta, Canada T6G2T4. Electronic address: wendy.davis@ualberta.ca.
authors.forename: Wendy
authors.initials: W
authors.lastname: Davis
authors.affiliation: School of Public Health, University of Alberta, Population Health Intervention Research Unit, 3-50 University Terrace, 8303 112 Street, Edmonton, Alberta, Canada T6G2T4. Electronic address: paul.veugelers@ualberta.ca.
authors.forename: Paul
authors.initials: P
authors.lastname: Veugelers
mesh_terms: D000416:Alberta / Q000453:epidemiology; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D009043:Motor Activity; D009765:Obesity / Q000453:epidemiology; D015397:Program Evaluation; D012572:School Health Services; D012959:Socioeconomic Factors
keywords: Child; Health promotion; Inequalities; Physical activity; School health