Journal of Physical Activity and Health, 2014, 11, 1212 -1218 http://dx.doi.org/10.1123/jpah.2012-0169 © 2014 Human Kinetics, Inc.
Official Journal of ISPAH www.JPAH-Journal.com ORIGINAL RESEARCH
Daily Physical Activity Behavior Patterns of Hispanic Adolescents in Puerto Rico Alexander Vigo-Valentín, Kimberly A. Bush, and Samuel R. Hodge Background: There is limited evidence on physical activity patterns among Hispanic adolescents in Puerto Rico. This restricts opportunities to implement effective interventions and policies to increase physical activity in schools. The purpose of this study was to examine the physical activity behaviors of adolescents attending middle and high schools in Puerto Rico based on a compendium of moderate to vigorous physical activities including walking, jogging or running, bicycling, sports and more. A secondary purpose was to examine group differences as a function of gender and school level. Method: A cross-sectional survey research design was used. Students (N = 637) attending public middle and high schools completed a Visual 7-Day Physical Activity Recall survey. Both descriptive and inferential analyses were conducted to describe the sample and to determine group differences. Results: Puerto Rican adolescents’ levels of physical activity decreased throughout the week. Only a small proportion of them reached at least 60 minutes everyday of the week. Differences were found between middle and high school students’ daily and weekly participation in physical activities. Conclusions: Most adolescents do not engage in sufficient physical activity. Implications: Implications of the results are discussed and recommendations are articulated for policy makers, educators, and other professionals. Keywords: organized sport, physical education, school policy Public health concerns have risen as a consequence of the worldwide increase in childhood obesity.1 A significant proportion of children in the United States (US) are either overweight or obese.2 Almost one-quarter of Hispanic adolescents living in the US and its territories are within the 95th body mass index (BMI) percentile, placing them in the obese category.2,3 Therefore Hispanic adolescents may have an increased risk of developing health-related diseases. Recent evidence suggests that younger populations may be experiencing a decreased life expectancy due to obesity issues and related health conditions.4 In addition adolescents who are obese are at a higher risk of developing health-related conditions.5–7 In fact, obesity and sedentary lifestyles are contributing factors of diabetes. The International Diabetes Federation predicted within the next 2 decades, at least 552 million people will be living with diabetes.8 The Centers for Disease Control and Prevention (CDC) denoted participation in physical activity is beneficial for all, regardless of age.9 However, physical activity levels tend to decrease from adolescence to adulthood. Physical inactivity has been linked with increased risks of obesity and various chronic diseases.10 There are many benefits of physical activity, nonetheless many youth are inactive, or do not participate at rates that are beneficial and are not reaching the recommended physical activity guidelines for their age. Many adolescents are not physically active at least 60
Vigo-Valentín ([email protected]) is with the Dept of Kinesiology, Towson University, Towson, MD. Bush is with the Dept of Parks, Recreation, and Tourism Management, North Caroline State University, Raleigh, NC. Hodge is with the School of Physical Activity and Educational Services, Ohio State University, Columbus, OH. 1212
minutes most days of the week.11 Aspects including body composition and psychosocial factors such as negative perception and attitudes toward physical activity have been negatively associated with sedentary lifestyles.12 Moreover, socioenvironmental factors may include the lack of transportation, access to adequate facilities, and support from family and friends.13–15 Physical activity motivators vary between boys and girls. Girls have previously reported weight management, being physically active, and involvement in sports as the top reasons for participating in physical activity.16 From birth, girls are typically allowed to take fewer risks during play and are twice more likely to drop out of sport than boys.17 On the other hand, male youths state that participation in physical activity is enjoyable, allows them to socially interact with peers, and has health-related benefits.18 Arguably within the school setting, enhanced opportunities for physical activity (eg, school physical education, active recess, and sport programs) can lead to better academic achievement and healthier lifestyles.19–26 Despite mounting evidence for participating in regular moderate to vigorous physical activity (MVPA), many school-age youth do not have access to physical activity programs and quality physical education.22–24 Currently only about one-third of the students in the US benefit from daily physical education.23 To our knowledge, no study has aimed to investigate the daily physical activity patterns of Hispanic adolescents living in Puerto Rico. To that void, the purpose of this study was to examine the physical activity behaviors of adolescents attending middle and high schools in Puerto Rico based on a compendium of moderate to vigorous physical activities including walking, jogging, bicycling, sports and more. A secondary purpose was to examine group differences as a function of gender and school level. This investigation was part of a larger evaluation project commissioned by the Department of Recreation and Sports of Puerto Rico.
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Methods Research Design This study used a cross-sectional survey research design.27 Data were collected over the duration of 1 week. Upon approval from Puerto Rico’s Department of Education (DOE) and that of local school administrators as well parental consent and child assent forms were signed and later collected from the schools by the Department of Recreation and Sports of Puerto Rico. This study was approved by the university’s Institutional Review Board of the third author.
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Participants’ Demographic Description A total of 300 boys and 337 girls voluntarily participated in the study. The mean age was 14.2 years (SD = 1.7 years). Participants were attending secondary public schools in Puerto Rico. In Puerto Rico, the DOE defines secondary public schools as middle school from 7th to 9th grade and high school from 10th to 12th grade. More than one-half (n = 363; 57%) of the adolescents were in middle school. Secondary schools were sampled randomly from 7 geographical regions (ie, Northwest, North, South Central, Northeast, Southeast, Southwest, and Metropolitan) across the island. Less than 15% of the adolescents were from the Northwest, Northeast, Southwest, or Metropolitan regions. About 30% attended schools in the Southeast region, and 7% in the South Central area. Most of the adolescents reported no disability (90%). However, 33% of the participants did report health-related conditions such as asthma. Furthermore, some 34% of the adolescents were engaging in diverse organized physical activity programs.
Physical Activity Assessment Participants’ completion of the Visual 7-Day Physical Activity Recall (V7-DPAR) survey allowed analysis of daily physical activity patterns. Validation procedures for the V7-DPAR survey were originally reported by Lum (unpublished thesis, 2003) for Englishspeaking students in the US. Further details of the survey were articulated in a recent research study involving Hispanic youth.3 It is apposite to say here that the survey is valid in measuring daily physical activity participation in 1-week periods. The V7-DPAR provides some advantages in comparison with other physical activity scales. One advantage of these scales is the visual illustration of physical activities to enhance the participants’ recollection of physical activity behaviors. Participants are able to report up to 9 different physical activities per day. It allows participants to report day-to-day participation in physical activities over the duration of 1 week (ie, Sunday to Saturday). The V7-DPAR consists of physical activity clipart, several physical activities, and opportunities to record physical activity minutes and environment (eg, organized sport, physical education, and personal benefit). The menu of physical activities includes: walking, volleyball, baseball, weight lifting, basketball, running/jogging, swimming, and bicycling. As well, the V7-DPAR permits adolescents to record other physical activities they have engaged in during the week (eg, dancing, rollerblading). Strategically, these physical activities were grouped based on intensity using an activity compendium.28 That is using the Physical Activity Compendium,28 the first 4 physical activities (ie, walking, volleyball, baseball, and weight lifting) were classified as moderate physical activities, while the following 4 were vigorous physical activities (ie, basketball, running/jogging, swimming, bicycling). When a different physical activity was reported, this activity was identified
in the Physical Activity Compendium28 for its appropriate intensity classification. The total minutes spent participating in each activity per day was reported. The V7-DPAR also allowed adolescents to select whether their physical activities were performed as part of an organized sport, physical education class, or because they engaged in leisure physical activity for personal benefit. They repeated the process for each day of the week from Sunday through Saturday.
Cross-Cultural Validation Consistent with appropriate practice, it was determined that crosscultural language validation29 was necessary to ensure scale validity for use with Spanish-speaking adolescents in Puerto Rico. To that end, Puerto Rican bilingual doctoral students at a university in the US translated the V7-DPAR scale and a participant demographic questionnaire from English to Spanish. Afterward, the translators compared their translated instruments to assure the Spanish language semantic and syntax were accurate and suitable for the intended populations. Then, 2 bilingual faculty/researchers from a university in Puerto Rico back translated to English the Spanish-version of the instruments. Moreover the V7-DPAR survey was field tested and piloted with Hispanic adolescents. In the field test, Hispanic adolescents living in Puerto Rico completed the survey scale and demographic questionnaire and subsequently provided helpful feedback. Then, modifications to the instruments were made as deemed warranted. Then, a pilot study was conducted in Puerto Rico with a different cohort of adolescents. Following these procedures, 2 bilingual faculty/researchers from a university in Puerto Rico back translated to English each modified Spanish-version of the instruments. The result of this cross-cultural validation process assures cultural relevancy and validity of the instruments for use with Hispanic adolescents living in Puerto Rico.
Procedures Before data collection, several training sessions were conducted with the evaluation team members to establish standardized procedures, test the data collection strategies and logistics, and to promote the overall quality of the study. The evaluators’ training included topics on anthropometric measurements and privacy concerns, survey administration, and communication strategies. To meet participant privacy and communication expectations during data collection, the project evaluators were divided into 5 teams. Each team was comprised of both men and women with at least 1 highly fluent bilingual member. Upon arriving at the schools, the evaluation team met with the school principals and teacher(s) to determine the most appropriate setting and protocol for data collection. These strategies differed based on school characteristics and school administrator preferences. For example, in some schools, the library was the most suitable setting for collecting data because of the advantage of accommodating many students simultaneously. However, in other schools the evaluation team moved from one classroom to the other to minimize class disruptions. Once evaluators were in the designated area, the stations were set up to permit the students to complete the demographic questionnaire and V7-DPAR survey and to assess anthropometric (ie, body’s height and weight) measures. At the start of this process members of the evaluation teams, who were also native to Puerto Rico, explained (using Spanish) the study’s purpose and procedures to the participants. They were encouraged to ask questions as needed. Then, the evaluators would instruct them to complete the V7-DPAR. At that point, questions were responded to individual students. There was no time limit for
1214 Vigo-Valentín, Bush, and Hodge
completing the scale. Once the student had finished, the evaluator reviewed the scale to ensure it was fully completed before dismissing the student from the data collection area.
Data Analysis Descriptive analyses were conducted to analyze the day-by-day physical activity behaviors of Hispanic adolescents living in Puerto Rico. All statistical analyses were performed using SPSS v. 20 (IBM, 2011).30 Percentage, means, and standard deviations (SD) are presented to summarize the physical activity patterns. Further analysis of variance (ANOVA) procedures were used to determine group differences for gender (boys and girls) and school level (middle and high schools). The alpha value was set a priori at 0.05.
The descriptive data showed that less than a quarter of the Hispanic adolescents engage in daily physical activity for 60 minutes or more. Table 2 shows the distribution of adolescents achieving at least 60 minutes of daily physical activity. The highest proportion (20%) of students achieving the recommendation of at least 60 minutes of MVPA was reported to occur on Tuesday and Thursday. However, only 13% of the students were physically active most days of the week (ie, 5 days or more). What is more, a mere 6% reached the weekly physical activity recommendations for their age group. Further data analysis showed that middle school students achieved at least 60 minutes of physical activity significantly more often than high school students (F1 = 12.59, P = .00).
Physical Activity Context
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Physical Activity Guidelines Recommendations
Physical Activity Behavior Patterns In general, the results showed Hispanic adolescents gradually decreased their levels of physical activity involvement from Sunday to Saturday. Monday had the highest participation in MVPA. Table 1 shows the proportion of Puerto Rican adolescents participating in physical activity within a one-week period. On Sunday, girls had higher participation in moderate physical activities than boys (F1 = 5.30, P = .02). However, boys engaged more often in vigorous physical activities throughout the week than girls. While, middle school adolescents participated significantly more in moderate physical activities compared with high school adolescents (F1 = 4.73, P = .03). Puerto Rican adolescents mainly participated in 3 types of physical activities. Walking was the most common physical activity engaged in throughout the week. Other common physical activities included volleyball and basketball as either primary or secondary physical activities. Specifically, girls participated more often in walking and volleyball activities, while boys had higher engagement in other types of physical activities such as basketball. In terms of school level, middle school adolescents were more likely to engage in walking, volleyball, and bicycling, while high school adolescents engaged more often in running.
Mostly physical activity participation of Puerto Rican adolescents was reported to occur for personal benefits (eg, walking for exercise). Fewer adolescents engage in physical activity within in the context of organized sports. Unexpectedly the physical education class was the context wherein the lowest proportion of students engaged in physical activities. In terms of school level on Sunday (F1 = 7.86, P = .01), Tuesday (F1 = 4.62, P = .03), Thursday (F1 = 4.42, P = .04), and Saturday (F1 = 8.39, P = .00) middle school students engaged in physical activities significantly more so for personal benefit compared with high school students.
Discussion The end sought in this study was to examine physical activity patterns of Hispanic youths in home, school, and community environments based on a compendium of MVPA. A secondary purpose was to examine group differences as a function of their gender and school level. To that end, we analyzed daily physical activity patterns in regards to types and contexts. It was revealed that most Puerto Rican adolescents were not meeting well-established guidelines for physical activity.9, 37 In light of the findings there is cause for concern because most Puerto Rican adolescents are on a path toward health disparities associated with a lack of regular MVPA in their daily
Table 1 Proportion of Daily Participation in Primary and Secondary Physical Activities Among Hispanic Adolescents Participating in physical activity (n = 637)
Sex
School level
Primary PA Activity
Secondary PA Activity
Boys
Girls
F
P
Middle
High
F
P
Walking, volleyball, basketball
56%
30%
56%
56%
0.01
0.92
63%
47%
15.45
0.00a**
Monday
Walking, volleyball, basketball
59%
30%
62%
57%
1.51
0.22
65%
52%
12.20
0.01a**
Tuesday
Walking, volleyball, basketball
58%
27%
61%
56%
0.57
0.45
62%
54%
5.50
0.02a**
Wednesday
Walking, volleyball, basketball
56%
25%
59%
54%
1.13
0.29
61%
50%
7.69
0.01a**
Thursday
Walking, volleyball, basketball
53%
26%
55%
52%
0.75
0.39
58%
47%
9.07
0.00a**
Friday
Walking, volleyball, basketball
51%
25%
51%
51%
0.00
0.99
56%
45%
9.61
0.00a**
Saturday
Walking, volleyball, basketball
48%
50%
46%
49%
0.83
0.36
56%
39%
17.50
0.00a**
Days
Most common PAs
Sunday
Note. The proportion of adolescents participating in a first and a second physical activity were computed based on the total sample size. * P < .05. ** P < .01. a middle school > high school; b high school > middle school.
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Table 2 Daily Proportion of Hispanic Adolescents Achieving Physical Activity Guidelines (ie, 60 Minutes of PA Most Days of the Week) Achieving physical activity guidelines for adolescents (n = 637)
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Days
Sex
School level
60 minutes or more
F
P
F
P
Sunday
18%
3.70
0.06
0.11
0.74
Monday
19%
2.93
0.08
0.42
0.51
Tuesday
20%
2.27
0.13
2.69
0.10
Wednesday
18%
2.59
0.11
0.41
0.52
Thursday
20%
0.38
0.54
0.62
0.43
Friday
17%
0.98
0.32
0.22
0.64
Saturday
19%
8.23
0.00a**
0.62
0.43
5 days or more
13%
0.68
0.41
0.57
0.45
Everyday
6%
0.02
0.89
1.79
0.18
Note. The proportion of adolescents participating in a first and a second physical activity were computed based on the total sample size. * P < .05; ** P < .01. a
boys > girls; b girls > boys.
lives. Interventions are promptly needed to increase opportunities and engagement in healthier lifestyles. The results are consistent with other findings revealing low levels of physical activity among Hispanic children.31 Moreover in the US, Hispanic adolescents tend to have lower physical activity levels compared with the national average.29 This study revealed a pattern where physical activity participation decreased throughout the week. These important findings are consistent with some evidence demonstrating that children are less physically active during schooldays. For instance, Vermorel and colleagues have shown that adolescents may be less physically active during schooldays.32 However, other evidence has shown that some adolescents exhibit an increased physical activity behavior during weekdays.33 A plausible explanation for the decrease in physical activity from Monday to Friday could be related to school work. Another possible explanation could be the lack of opportunities for Puerto Rican adolescents may have before, during, and after school. School can significantly contribute to the overall physical activity behavior patterns through diverse venues, but currently access to these physical activity opportunities could be limited to high skilled students. Ideally, adolescents should be able to engage in physical activities before and after school, as well as in physical education with high amounts, and during recess and lunchtime. The study’s findings are congruent with past research indicating there are differences in physical activity behavior patterns between boys and girls.17,18 Overall, Puerto Rican boys engage in more vigorous physical activities than girls. Moreover, more boys engaged in vigorous physical activities, while more girls tended to engage in moderate physical activities. As a result, the low levels of vigorous physical activity participation among girls restrict their cardiovascular fitness compared with their male peers. Studies have found that boys’ cardiovascular fitness is enhanced from vigorous physical activity and that boys engage in vigorous physical activity more so than girls.33-35 Further, as reported in this current study, unstructured and structure physical activities seems to favor boys’ participation in physical activities throughout the week. Moreover, engagement in vigorous physical activity may have a negative association with body composition.36 Certainly more program
interventions are imperative, especially for girls, to motivate adolescents to become more physically active at schools and communities. Days with the lowest proportion of students engaging in physical activities lessen the likelihood of preventing or decreasing the probability of developing high blood pressure, heart diseases, diabetes, and cancer as they move into adulthood.4–10,37 Also, the lack of MVPA among adolescents has negative implications to emotional wellness as well.22 That is to say many Hispanic adolescents are missing opportunities to gain psychological, social, and emotional benefits such as higher levels of self-confidence, self-image, and self-esteem from MVPA, which would improve their total wellness and healthy lifestyles. In this study, walking was the most common activity performed among Puerto Rican adolescents. Beyond proper footwear, walking is a physical activity that requires no equipment and can be performed for exercise, transportation, and/or recreational purposes. For Puerto Rican adolescents, these factors appear to increase the likelihood of them engaging in this type of activity. In addition, the study’s participants also preferred volleyball and basketball. While across genders and grade level, physical activity preferences were similar; girls were more likely to engage in walking and volleyball activities. Similar findings have been reported with Hispanic girls in the US. Grieser, Vu, Bedimo-Rung, and Neumark conducted a study to determine the physical activity preferences across diverse ethnic groups.16 They found that walking, as either exercise or transportation, as well as volleyball were among the first 10 physical activities Hispanic girls chose to engage in throughout the week. Participation in these types of physical activities is explainable in regards to social dynamics and physical environments. In Puerto Rico, adolescents are regularly exposed to basketball and volleyball in sport and social spaces through school events, media outlets, and neighborhood gatherings. Moreover, school and community infrastructures usually support basketball and volleyball contests. These social spaces are readily accessible to adolescents during and after the school day. Healthy People 2020 and the World Health Organization stress the importance of children and adolescents participating in at least 60 minutes of MVPA most days of the week.37-38 The CDC (2011) has reported that overall about half of adolescents in the US engage
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1216 Vigo-Valentín, Bush, and Hodge
in at least 60 minutes of physical activity 5 or more days per week. However, less than half of Hispanic adolescents living in the US do so. Approximately half of the adolescents sampled in Puerto Rico engaged in some sort of physical activity during the week, but this finding supports prior evidence showing the prevalence of physical inactivity is of concern for those living in Puerto Rico.39 Despite the fact some Puerto Rican adolescents are participating in physical activities, most of them are not reaching the physical activity recommended guidelines. A very limited proportion of adolescents in Puerto Rico participated in 60 minutes of physical activity most days of the week (ie, 5 or more days). Consequently physical and physiological, emotional, and intellectual benefits that may be obtained from physical activity are limited for this population. Definitely, a multilevel intervention is necessary to generate additional physical activity opportunities. Puerto Rican adolescents must enroll or participate in activities they perceive are targeting their needs. Moreover, health may actually be improved by increasing the total minutes adolescents engage in physical activities.32–35 This result illuminates the fact that public and private agencies should ensure adolescents’ participation in physical activity is safe and appropriate. An important finding in this study is that those adolescents most regularly physically active were driven by intrapersonal factors such as their own motivation. This finding shows some Hispanic adolescents are compelled to engaging in MVPA on their own. On the other hand, more effort is needed to increase the number significantly of adolescents who engage in physical activities in organized sports and physical education classes. Further our findings indicate physical education is not contributing well to adolescents’ overall physical activity participation. Adolescents are either not enrolled in or when they are enrolled perceive that they are not required to be physically active in physical education classes. According to Trudeau and Shepard, students’ positive perceptions about physical education programs seems to decrease through the years.40 Yet, evidence demonstrates that physical education classes with lessons that are developmentally appropriate, relevant, and well-planned have better outcomes at engaging students. Schools must ensure that quality physical education is offered to all students regardless of grade level. Empirical evidence demonstrates that the presence of explicit laws can enhance physical education opportunities for students.41 The Department of Education should make sure all students are enrolled in physical education, as specified in statute, Law #146 of 2000.42 Lending further support to this the National Association for Sports and Physical Education (NASPE) recommends students are physically active at least 50% of the class allocated time.43 Further effort is needed to increase the number of students enrolled in physical education classes, and to promote higher physical activity levels of students during their physical education classes. Additional research is needed to determine whether the current findings are reflective of Hispanic student populations in the US mainland. Cross-sectional survey method presents several potential limitations however, including (a) participants who may not have completed the survey, (b) those who intentionally gave socially acceptable responses only, and (c) an inability for researchers to examine physical activity changes over an extended period of time. To minimize such issues in this study, participants were encouraged to complete the survey with honest responses in their own personal space and time, and a team evaluator was always available to answer questions or address concerns. As well, before students would leave the data collection room, a research team member verified the scale was fully completed.
Physical activity programs and interventions developed to enhance physical activity behaviors of adolescents in Puerto Rico should focus on 3 main areas: (a) schools, (b) communities, and (c) implementation of policies. At the school level, there is a need to build wellness and physical activity programs that contribute to the overall health of adolescents. A well-developed wellness program should include modifications to the traditional multiactivity physical education class, more opportunities to become physically active outside of physical education classes, and changes in school policies that ensure and enhance physical activity opportunities of the adolescents. Due to the high level of adolescents not engaging in physical activity behaviors, the mandatory enrollment in physical education classes of all the students in Puerto Rico becomes imperative. However this matters only if those programs articulate and ensure physical activity is a priority. It is suggested the local government, along with the Department of Education, must do more to enforce Law #146, which obligates schools to provide 180-minutes per week of physical education to all students enrolled in public schools.42 Developing appropriate programs in which Puerto Rican adolescents are physically active before, during, and after school hours can increase students’ physical activity levels. Studies reveal that physical activity programs implemented after schools hours can increase the activity levels among school-age children.44–46 Moreover walking, bicycling, and rollerblading to and from school can serve as effective transportation modalities to provide additional activity opportunities for being physically active.47 Yet, adolescents must feel safe and motivated to use these alternative transportation methods. Arguably as well, the school community should develop short physical activity programs and activities that impact the school recess time. Important to this physical activity advocacy is the offering of school intramural programs as well. A diversity of physical activity opportunities is needed to motivate and encourage the participation of adolescents before, during, and after school hours. The physical activity component can be addressed by increasing opportunities to participate in physical activities based on their physical activity preferences. Moreover, the community, government, and private entities responsible for promoting healthy lifestyles should guarantee access to physical activity facilities and opportunities. As it was revealed in this study, most adolescents performed physical activities for their own personal benefits, most common was their walking. It is imperative, therefore, that physical activity facilities are safe and clean, and have adequate illumination to promote additional types of physical activity. All environmental and social barriers adolescents face potentially decreases their motivation and opportunity to become more physically active.41 Programs for diverse physical activities such as aerobics, social dance, walking, jogging, and cycling can be implemented in the community, especially with the population in the US mainland who may face a higher risk of healthrelated conditions associated with lower levels of physical activity.
Conclusions Those adolescents in Puerto Rico who are not regularly participating in MVPA increase the likelihood of higher body composition indices (overweight and obesity) and the development of health-related conditions such as cardiovascular diseases and diabetes. Many Hispanic adolescents in Puerto Rico are not engaging in sufficient physical activity levels. Although, boys engage more in vigorous physical activities, neither girls nor boys are routinely reaching the recommended amount of minutes for physical activity per day or
Daily Physical Activity Patterns 1217
week. Most adolescents who are physically active spend their time performing physical activities for personal benefit. More attention should be given to providing adolescents in Puerto Rico with the necessary amount of physical activity to achieve healthy lifestyles, especially during physical education classes and organized sports. Further to combat the continued low physical activity participation levels among Hispanic adolescents in Puerto Rico, the Department of Education and local educational entities must implement and enforce policies that can have an impact on not only adolescents’ behaviors, but their parents and communities as well.
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Acknowledgments The authors would like to acknowledge the significant contribution of the Puerto Rico en Forma (Puerto Rico in Shape) evaluation team. In addition, authors would like to thank Dr. David Bernier, former Secretary of the Department of Recreation and Sports of Puerto Rico, for assisting and providing support to conduct this study. This study was partially supported by the Department of Recreation and Sports of Puerto Rico.
References 1. Wang Y, Lobstein T. Worldwide trends in childhood overweight and obesity. Int J Pediatr Obes. 2006;1(1):11–25. PubMed doi:10.1080/17477160600586747 2. Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM. Prevalence of high body mass index in US children and adolescents, 2007-2008. JAMA. 2010;303(3):242–249. PubMed doi:10.1001/jama.2009.2012 3. Vigo-Valentin A, Hodge SR, Kozub FM. Adolescents’ dietary habits, physical activity patterns, and weight status in Puerto Rico. Child Obes. 2011;7(6):488–494. 4. Olshansky SJ, Passaro DJ, Hershow RC, et al. A potential decline in life expectancy in the United States in the 21st century. N Engl J Med. 2007;352(11):1138–1145. PubMed doi:10.1056/NEJMsr043743 5. Abrams P, Levitt Katz LE. Metabolic effects of obesity causing disease in childhood. Curr Opin Endocrinol Diabetes Obes. 2011;18(1):23– 27. PubMed doi:10.1097/MED.0b013e3283424b37 6. Levi Z, Kark JD, Barchana M, et al. Measured body mass index in adolescence and the incidence of colorectal cancer in a cohort of 1.1 million males. Cancer Epidemiol Biomarkers Prev. 2011;20(12):2524– 2531. PubMed doi:10.1158/1055-9965.EPI-11-0531 7. Verbeeten KC, Elks CE, Daneman D, Ong KK. Association between childhood obesity and subsequent Type 1 diabetes: a systematic review and meta-analysis. Diabet Med. 2011;28(1):10. PubMed doi:10.1111/j.1464-5491.2010.03160.x 8. International Diabetes Federation. One adult in ten will have Diabetes by 2030 [Press Release]. http://www.idf.org/media-events/pressreleases/2011/diabetes-atlas-5th-edition. Published November 14, 2011. Accessed December 1, 2011. 9. Centers for Disease Control and Prevention. Promoting better health: promoting better health for young people through physical activity and sports: a report to the President. Washington, DC: U.S. Government Printing Office; 1997. 10. Thompson DR, Obarzanek E, Franko DL, et al. Childhood overweight and cardiovascular disease risk factors: the National Heart, Lung, and Blood Institute Growth and Health Study. J Pediatr. 2007;150(1):18– 25. PubMed doi:10.1016/j.jpeds.2006.09.039 11. Gordon-Larsen P, Nelson MC, Popkin BM. Longitudinal physical activity and sedentary behavior trends: adolescence to adulthood. Am J Prev Med. 2004;27(4):277–283. PubMed doi:10.1016/j. amepre.2004.07.006
12. Fredricks JA, Eccles JS. Is extracurricular participation associated with beneficial outcomes? Concurrent and longitudinal relations. Dev Psychol. 2006;42(4):698–713. PubMed doi:10.1037/0012-1649.42.4.698 13. Kahn JA, Huang B, Gillman MW, et al. Patterns and determinants of physical activity in U.S. adolescents. J Adolesc Health. 2008;42(4):369–377. PubMed doi:10.1016/j.jadohealth.2007.11.143 14. Neumark-Sztainer D, Story M, Hannan PJ, Tharp T, Rex J. Factors associated with changes in physical activity: a cohort study of inactive adolescent girls. Arch Pediatr Adolesc Med. 2003;157(8):803–810. PubMed doi:10.1001/archpedi.157.8.803 15. Van Der Horst K, Paw MJ, Twisk JW, Van Mechelen W. A brief review on correlates of physical activity and sedentariness in youth. Med Sci Sports Exerc. 2007;39(8):1241–1250. PubMed doi:10.1249/ mss.0b013e318059bf35 16. Grieser M, Vu MB, Bedimo-Rung AL, et al. Physical activity attitudes, preferences, and practices in African American, Hispanic, and Caucasian girls. Health Educ Behav. 2006;33:40–51. PubMed doi:10.1177/1090198105282416 17. Kirk D. Empowering girls and women through physical education and sport: advocacy Brief. Bangkok, Thailand: UNESCO; 2012. 18. Allison KR, Dwyer JJ, Goldenberg E, Fein A, Yoshida KK, Boutilier M. Male adolescents’ reasons for participating in physical activity, barriers to participation, and suggestions for increasing participation. Adolescence. 2005;40(157):155–170. PubMed 19. Trudeau F, Shephard RJ. Physical education, school physical activity, school sports and academic performance. Int J Behav Nutr Phys Act. 2008;5:10. PubMed doi:10.1186/1479-5868-5-10 20. Fairclough S, Stratton G. ‘Physical education makes you fit and healthy’. Physical education’s contribution to young people’s physical activity levels. Health Educ Res. 2005;20(1):14–23. PubMed doi:10.1093/her/cyg101 21. Meyer U, Roth R, Zahner L, et al. Contribution of physical education to overall physical activity. Scand J Med Sci Sports. 2011;XXX:12. PubMed 22. Council on Sports Medicine and Fitness; Council on School Health. Active healthy living: prevention of childhood obesity through increased physical activity. Pediatr. 2006;117(5):1834–1842. PubMed doi:10.1542/peds.2006-0472 23. Centers for Disease Control and Prevention. (2010). Youth Risk Behavior Surveillance 2009. Surveillance Summaries. 2010;59SS-5, 1-142. 24. Singh A, Uijtdewilligen L, Twisk JWR, van Mechelen W, Chinapaw MJM. Physical activity and performance at school: a systematic review of the literature including a methodological quality assessment. Arch Pediatr Adolesc Med. 2012;166(1):49–55. PubMed doi:10.1001/ archpediatrics.2011.716 25. Van Dusen DP, Kelder SH, Kohl HW, Ranjit N, Perry CL. Associations of physical fitness and academic performance among schoolchildren. J Sch Health. 2011;81(12):733–740. PubMed doi:10.1111/j.17461561.2011.00652.x 26. Morales J, Pellicer-Chenoll M, García-Masso X, Gomis M, González L-M. Relation between physical activity and academic performance in 3rd-year secondary education students. Percept Mot Skills. 2011;113(2):539–546. PubMed doi:10.2466/06.11.13. PMS.113.5.539-546 27. Thomas JR, Nelson JK, Silverman SJ. Research methods in physical activity. Champaign, IL: Human Kinetics; 2010. 28. Ainsworth BE, Haskell WL, Herrmann SD, et al. 2011 Compendium of Physical Activities: a second update of codes and MET values. Med Sci Sports Exerc. 2011;43(8):1575–1581. PubMed doi:10.1249/ MSS.0b013e31821ece12
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1218 Vigo-Valentín, Bush, and Hodge 29. Banville D, Desrosiers P, Genet-Volet Y. Translating questionnaires and inventories using cross-cultural technique. J Teach Phys Educ. 2000;19:374–387. 30. IBM, Inc. SPSS v.20 for Mac. Chicago, Il; 2011. 31. Centers for Disease Control and Prevention. Nationwide (States, DC, and Territories) – 2005 Physical activity. http://apps.nccd.cdc.gov/ brfss/race.asp?cat=PA&yr=2005&qkey=4418&state=US. Accessed November 30, 2011. 32. M, Vernet J, Bitar A, Fellmann N, Coudert J. Daily energy expenditure, activity patterns, and energy costs of the various activities in French 12-16-y-old adolescents in free living conditions. Eur J Clin Nutr. 2002;56(9):819–829. PubMed doi:10.1038/sj.ejcn.1601395 33. Konharn K, Santos MP, Ribeiro JC. Differences between weekday and weekend levels of moderate-to-vigorous physical activity in Thai adolescents. Asia Pac J Public Health. 2012. PubMed 34. Dencker M, Thorsson O, Karlsson MK, Lindén C, Wollmer P, Andersen LB. Daily physical activity related to aerobic fitness and body fat in an urban sample of children. Scand J Med Sci Sports. 2008;18(6):728–735. PubMed doi:10.1111/j.1600-0838.2007.00741.x 35. Mota J, Silva P, Aires L, Santos MP, Oliveira J, Ribeiro JC. Differences in school-day patterns of daily physical activity in girls according to level of physical activity. J Phys Act Health. 2008;1(5, suppl):S90–S97. PubMed 36. Dencker M, Thorsson O, Karlsson MK, et al. Daily physical activity related to body fat in children aged 8-11 years. J Pediatr. 2006;149:38– 42. PubMed doi:10.1016/j.jpeds.2006.02.002 37. U.S. Department of Health and Human Services. Healthy people 2020: Improving the Health of Americans.Washington DC: U.S. Government Printing Office; 2010. Available at http://www.healthypeople. gov/2020/default.aspx 38. World Health Organization. Global recommendations on physical activity for health. Geneva, Switzerland: WHO Press; 2010.
39. Centers for Disease Control and Prevention. High School Youth Risk Behavior Survey, 2011. http://apps.nccd.cdc.gov/youthonline/App/ QuestionsOrLocations.aspx?CategoryId=6 Accessed October 2, 2012. 40. Trudeau F, Shepard RJ. Contribution of school programmes to physical activity levels and attitudes in children and adults. Sports Med. 2005;35:89–105. PubMed doi:10.2165/00007256-200535020-00001 41. Perna FM, Oh A, Chriqui JF, et al. The association of state law to physical education time allocation in US public schools. Am J Public Health. 2012;102(8):1594–1599. PubMed doi:10.2105/AJPH.2011.300587 42. Department of Education of Puerto Rico. Organic Law Department of Education of Puerto Rico # 146. 2000. 43. National Association for Sports and Physical Education. Physical education is critical to educating the whole child [Position Statement] http://www.aahperd.org/naspe/standards/upload/Physical-EducationIs-Critical-to-Educating-the-Whole-Child-Final-5-19-2011.pdf. Published 2011. Accessed January 20, 2012 44. Taverno Ross SE, Dowda M, Colabianchi N, Saunders R, Pate RR. After-school setting, physical activity, and sedentary behavior in 5th grade boys and girls. Health Place. 2012;18(5):951–955. PubMed doi:10.1016/j.healthplace.2012.06.013 45. Kargarfard M, Kelishadi R, Ziaee V, et al. The impact of an afterschool physical activity program on health-related fitness of mother/ daughter pairs: CASPIAN study. Prev Med. 2012;54(3–4):219–223. PubMed doi:10.1016/j.ypmed.2012.01.010 46. Van Acker R, De Bourdeaudhuij I, De Martelaer K, Seghers J, De Cocker K, Cardon G. The association between socio-ecological factors and having an after-school physical activity program. J Sch Health. 2012;82(9):395–403. PubMed doi:10.1111/j.1746-1561.2012.00711.x 47. Miller WC, Redmond JG, Vaux-Bjerke AT. Activity patterns and perceptions about active transport to school. Am J Health Behav. 2013;37(2):190–198. PubMed doi:10.5993/AJHB.37.2.6
Official Journal of ISPAH www.JPAH-Journal.com ORIGINAL RESEARCH
Daily Physical Activity Behavior Patterns of Hispanic Adolescents in Puerto Rico Alexander Vigo-Valentín, Kimberly A. Bush, and Samuel R. Hodge Background: There is limited evidence on physical activity patterns among Hispanic adolescents in Puerto Rico. This restricts opportunities to implement effective interventions and policies to increase physical activity in schools. The purpose of this study was to examine the physical activity behaviors of adolescents attending middle and high schools in Puerto Rico based on a compendium of moderate to vigorous physical activities including walking, jogging or running, bicycling, sports and more. A secondary purpose was to examine group differences as a function of gender and school level. Method: A cross-sectional survey research design was used. Students (N = 637) attending public middle and high schools completed a Visual 7-Day Physical Activity Recall survey. Both descriptive and inferential analyses were conducted to describe the sample and to determine group differences. Results: Puerto Rican adolescents’ levels of physical activity decreased throughout the week. Only a small proportion of them reached at least 60 minutes everyday of the week. Differences were found between middle and high school students’ daily and weekly participation in physical activities. Conclusions: Most adolescents do not engage in sufficient physical activity. Implications: Implications of the results are discussed and recommendations are articulated for policy makers, educators, and other professionals. Keywords: organized sport, physical education, school policy Public health concerns have risen as a consequence of the worldwide increase in childhood obesity.1 A significant proportion of children in the United States (US) are either overweight or obese.2 Almost one-quarter of Hispanic adolescents living in the US and its territories are within the 95th body mass index (BMI) percentile, placing them in the obese category.2,3 Therefore Hispanic adolescents may have an increased risk of developing health-related diseases. Recent evidence suggests that younger populations may be experiencing a decreased life expectancy due to obesity issues and related health conditions.4 In addition adolescents who are obese are at a higher risk of developing health-related conditions.5–7 In fact, obesity and sedentary lifestyles are contributing factors of diabetes. The International Diabetes Federation predicted within the next 2 decades, at least 552 million people will be living with diabetes.8 The Centers for Disease Control and Prevention (CDC) denoted participation in physical activity is beneficial for all, regardless of age.9 However, physical activity levels tend to decrease from adolescence to adulthood. Physical inactivity has been linked with increased risks of obesity and various chronic diseases.10 There are many benefits of physical activity, nonetheless many youth are inactive, or do not participate at rates that are beneficial and are not reaching the recommended physical activity guidelines for their age. Many adolescents are not physically active at least 60
Vigo-Valentín ([email protected]) is with the Dept of Kinesiology, Towson University, Towson, MD. Bush is with the Dept of Parks, Recreation, and Tourism Management, North Caroline State University, Raleigh, NC. Hodge is with the School of Physical Activity and Educational Services, Ohio State University, Columbus, OH. 1212
minutes most days of the week.11 Aspects including body composition and psychosocial factors such as negative perception and attitudes toward physical activity have been negatively associated with sedentary lifestyles.12 Moreover, socioenvironmental factors may include the lack of transportation, access to adequate facilities, and support from family and friends.13–15 Physical activity motivators vary between boys and girls. Girls have previously reported weight management, being physically active, and involvement in sports as the top reasons for participating in physical activity.16 From birth, girls are typically allowed to take fewer risks during play and are twice more likely to drop out of sport than boys.17 On the other hand, male youths state that participation in physical activity is enjoyable, allows them to socially interact with peers, and has health-related benefits.18 Arguably within the school setting, enhanced opportunities for physical activity (eg, school physical education, active recess, and sport programs) can lead to better academic achievement and healthier lifestyles.19–26 Despite mounting evidence for participating in regular moderate to vigorous physical activity (MVPA), many school-age youth do not have access to physical activity programs and quality physical education.22–24 Currently only about one-third of the students in the US benefit from daily physical education.23 To our knowledge, no study has aimed to investigate the daily physical activity patterns of Hispanic adolescents living in Puerto Rico. To that void, the purpose of this study was to examine the physical activity behaviors of adolescents attending middle and high schools in Puerto Rico based on a compendium of moderate to vigorous physical activities including walking, jogging, bicycling, sports and more. A secondary purpose was to examine group differences as a function of gender and school level. This investigation was part of a larger evaluation project commissioned by the Department of Recreation and Sports of Puerto Rico.
Daily Physical Activity Patterns 1213
Methods Research Design This study used a cross-sectional survey research design.27 Data were collected over the duration of 1 week. Upon approval from Puerto Rico’s Department of Education (DOE) and that of local school administrators as well parental consent and child assent forms were signed and later collected from the schools by the Department of Recreation and Sports of Puerto Rico. This study was approved by the university’s Institutional Review Board of the third author.
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Participants’ Demographic Description A total of 300 boys and 337 girls voluntarily participated in the study. The mean age was 14.2 years (SD = 1.7 years). Participants were attending secondary public schools in Puerto Rico. In Puerto Rico, the DOE defines secondary public schools as middle school from 7th to 9th grade and high school from 10th to 12th grade. More than one-half (n = 363; 57%) of the adolescents were in middle school. Secondary schools were sampled randomly from 7 geographical regions (ie, Northwest, North, South Central, Northeast, Southeast, Southwest, and Metropolitan) across the island. Less than 15% of the adolescents were from the Northwest, Northeast, Southwest, or Metropolitan regions. About 30% attended schools in the Southeast region, and 7% in the South Central area. Most of the adolescents reported no disability (90%). However, 33% of the participants did report health-related conditions such as asthma. Furthermore, some 34% of the adolescents were engaging in diverse organized physical activity programs.
Physical Activity Assessment Participants’ completion of the Visual 7-Day Physical Activity Recall (V7-DPAR) survey allowed analysis of daily physical activity patterns. Validation procedures for the V7-DPAR survey were originally reported by Lum (unpublished thesis, 2003) for Englishspeaking students in the US. Further details of the survey were articulated in a recent research study involving Hispanic youth.3 It is apposite to say here that the survey is valid in measuring daily physical activity participation in 1-week periods. The V7-DPAR provides some advantages in comparison with other physical activity scales. One advantage of these scales is the visual illustration of physical activities to enhance the participants’ recollection of physical activity behaviors. Participants are able to report up to 9 different physical activities per day. It allows participants to report day-to-day participation in physical activities over the duration of 1 week (ie, Sunday to Saturday). The V7-DPAR consists of physical activity clipart, several physical activities, and opportunities to record physical activity minutes and environment (eg, organized sport, physical education, and personal benefit). The menu of physical activities includes: walking, volleyball, baseball, weight lifting, basketball, running/jogging, swimming, and bicycling. As well, the V7-DPAR permits adolescents to record other physical activities they have engaged in during the week (eg, dancing, rollerblading). Strategically, these physical activities were grouped based on intensity using an activity compendium.28 That is using the Physical Activity Compendium,28 the first 4 physical activities (ie, walking, volleyball, baseball, and weight lifting) were classified as moderate physical activities, while the following 4 were vigorous physical activities (ie, basketball, running/jogging, swimming, bicycling). When a different physical activity was reported, this activity was identified
in the Physical Activity Compendium28 for its appropriate intensity classification. The total minutes spent participating in each activity per day was reported. The V7-DPAR also allowed adolescents to select whether their physical activities were performed as part of an organized sport, physical education class, or because they engaged in leisure physical activity for personal benefit. They repeated the process for each day of the week from Sunday through Saturday.
Cross-Cultural Validation Consistent with appropriate practice, it was determined that crosscultural language validation29 was necessary to ensure scale validity for use with Spanish-speaking adolescents in Puerto Rico. To that end, Puerto Rican bilingual doctoral students at a university in the US translated the V7-DPAR scale and a participant demographic questionnaire from English to Spanish. Afterward, the translators compared their translated instruments to assure the Spanish language semantic and syntax were accurate and suitable for the intended populations. Then, 2 bilingual faculty/researchers from a university in Puerto Rico back translated to English the Spanish-version of the instruments. Moreover the V7-DPAR survey was field tested and piloted with Hispanic adolescents. In the field test, Hispanic adolescents living in Puerto Rico completed the survey scale and demographic questionnaire and subsequently provided helpful feedback. Then, modifications to the instruments were made as deemed warranted. Then, a pilot study was conducted in Puerto Rico with a different cohort of adolescents. Following these procedures, 2 bilingual faculty/researchers from a university in Puerto Rico back translated to English each modified Spanish-version of the instruments. The result of this cross-cultural validation process assures cultural relevancy and validity of the instruments for use with Hispanic adolescents living in Puerto Rico.
Procedures Before data collection, several training sessions were conducted with the evaluation team members to establish standardized procedures, test the data collection strategies and logistics, and to promote the overall quality of the study. The evaluators’ training included topics on anthropometric measurements and privacy concerns, survey administration, and communication strategies. To meet participant privacy and communication expectations during data collection, the project evaluators were divided into 5 teams. Each team was comprised of both men and women with at least 1 highly fluent bilingual member. Upon arriving at the schools, the evaluation team met with the school principals and teacher(s) to determine the most appropriate setting and protocol for data collection. These strategies differed based on school characteristics and school administrator preferences. For example, in some schools, the library was the most suitable setting for collecting data because of the advantage of accommodating many students simultaneously. However, in other schools the evaluation team moved from one classroom to the other to minimize class disruptions. Once evaluators were in the designated area, the stations were set up to permit the students to complete the demographic questionnaire and V7-DPAR survey and to assess anthropometric (ie, body’s height and weight) measures. At the start of this process members of the evaluation teams, who were also native to Puerto Rico, explained (using Spanish) the study’s purpose and procedures to the participants. They were encouraged to ask questions as needed. Then, the evaluators would instruct them to complete the V7-DPAR. At that point, questions were responded to individual students. There was no time limit for
1214 Vigo-Valentín, Bush, and Hodge
completing the scale. Once the student had finished, the evaluator reviewed the scale to ensure it was fully completed before dismissing the student from the data collection area.
Data Analysis Descriptive analyses were conducted to analyze the day-by-day physical activity behaviors of Hispanic adolescents living in Puerto Rico. All statistical analyses were performed using SPSS v. 20 (IBM, 2011).30 Percentage, means, and standard deviations (SD) are presented to summarize the physical activity patterns. Further analysis of variance (ANOVA) procedures were used to determine group differences for gender (boys and girls) and school level (middle and high schools). The alpha value was set a priori at 0.05.
The descriptive data showed that less than a quarter of the Hispanic adolescents engage in daily physical activity for 60 minutes or more. Table 2 shows the distribution of adolescents achieving at least 60 minutes of daily physical activity. The highest proportion (20%) of students achieving the recommendation of at least 60 minutes of MVPA was reported to occur on Tuesday and Thursday. However, only 13% of the students were physically active most days of the week (ie, 5 days or more). What is more, a mere 6% reached the weekly physical activity recommendations for their age group. Further data analysis showed that middle school students achieved at least 60 minutes of physical activity significantly more often than high school students (F1 = 12.59, P = .00).
Physical Activity Context
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Physical Activity Guidelines Recommendations
Physical Activity Behavior Patterns In general, the results showed Hispanic adolescents gradually decreased their levels of physical activity involvement from Sunday to Saturday. Monday had the highest participation in MVPA. Table 1 shows the proportion of Puerto Rican adolescents participating in physical activity within a one-week period. On Sunday, girls had higher participation in moderate physical activities than boys (F1 = 5.30, P = .02). However, boys engaged more often in vigorous physical activities throughout the week than girls. While, middle school adolescents participated significantly more in moderate physical activities compared with high school adolescents (F1 = 4.73, P = .03). Puerto Rican adolescents mainly participated in 3 types of physical activities. Walking was the most common physical activity engaged in throughout the week. Other common physical activities included volleyball and basketball as either primary or secondary physical activities. Specifically, girls participated more often in walking and volleyball activities, while boys had higher engagement in other types of physical activities such as basketball. In terms of school level, middle school adolescents were more likely to engage in walking, volleyball, and bicycling, while high school adolescents engaged more often in running.
Mostly physical activity participation of Puerto Rican adolescents was reported to occur for personal benefits (eg, walking for exercise). Fewer adolescents engage in physical activity within in the context of organized sports. Unexpectedly the physical education class was the context wherein the lowest proportion of students engaged in physical activities. In terms of school level on Sunday (F1 = 7.86, P = .01), Tuesday (F1 = 4.62, P = .03), Thursday (F1 = 4.42, P = .04), and Saturday (F1 = 8.39, P = .00) middle school students engaged in physical activities significantly more so for personal benefit compared with high school students.
Discussion The end sought in this study was to examine physical activity patterns of Hispanic youths in home, school, and community environments based on a compendium of MVPA. A secondary purpose was to examine group differences as a function of their gender and school level. To that end, we analyzed daily physical activity patterns in regards to types and contexts. It was revealed that most Puerto Rican adolescents were not meeting well-established guidelines for physical activity.9, 37 In light of the findings there is cause for concern because most Puerto Rican adolescents are on a path toward health disparities associated with a lack of regular MVPA in their daily
Table 1 Proportion of Daily Participation in Primary and Secondary Physical Activities Among Hispanic Adolescents Participating in physical activity (n = 637)
Sex
School level
Primary PA Activity
Secondary PA Activity
Boys
Girls
F
P
Middle
High
F
P
Walking, volleyball, basketball
56%
30%
56%
56%
0.01
0.92
63%
47%
15.45
0.00a**
Monday
Walking, volleyball, basketball
59%
30%
62%
57%
1.51
0.22
65%
52%
12.20
0.01a**
Tuesday
Walking, volleyball, basketball
58%
27%
61%
56%
0.57
0.45
62%
54%
5.50
0.02a**
Wednesday
Walking, volleyball, basketball
56%
25%
59%
54%
1.13
0.29
61%
50%
7.69
0.01a**
Thursday
Walking, volleyball, basketball
53%
26%
55%
52%
0.75
0.39
58%
47%
9.07
0.00a**
Friday
Walking, volleyball, basketball
51%
25%
51%
51%
0.00
0.99
56%
45%
9.61
0.00a**
Saturday
Walking, volleyball, basketball
48%
50%
46%
49%
0.83
0.36
56%
39%
17.50
0.00a**
Days
Most common PAs
Sunday
Note. The proportion of adolescents participating in a first and a second physical activity were computed based on the total sample size. * P < .05. ** P < .01. a middle school > high school; b high school > middle school.
Daily Physical Activity Patterns 1215
Table 2 Daily Proportion of Hispanic Adolescents Achieving Physical Activity Guidelines (ie, 60 Minutes of PA Most Days of the Week) Achieving physical activity guidelines for adolescents (n = 637)
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Days
Sex
School level
60 minutes or more
F
P
F
P
Sunday
18%
3.70
0.06
0.11
0.74
Monday
19%
2.93
0.08
0.42
0.51
Tuesday
20%
2.27
0.13
2.69
0.10
Wednesday
18%
2.59
0.11
0.41
0.52
Thursday
20%
0.38
0.54
0.62
0.43
Friday
17%
0.98
0.32
0.22
0.64
Saturday
19%
8.23
0.00a**
0.62
0.43
5 days or more
13%
0.68
0.41
0.57
0.45
Everyday
6%
0.02
0.89
1.79
0.18
Note. The proportion of adolescents participating in a first and a second physical activity were computed based on the total sample size. * P < .05; ** P < .01. a
boys > girls; b girls > boys.
lives. Interventions are promptly needed to increase opportunities and engagement in healthier lifestyles. The results are consistent with other findings revealing low levels of physical activity among Hispanic children.31 Moreover in the US, Hispanic adolescents tend to have lower physical activity levels compared with the national average.29 This study revealed a pattern where physical activity participation decreased throughout the week. These important findings are consistent with some evidence demonstrating that children are less physically active during schooldays. For instance, Vermorel and colleagues have shown that adolescents may be less physically active during schooldays.32 However, other evidence has shown that some adolescents exhibit an increased physical activity behavior during weekdays.33 A plausible explanation for the decrease in physical activity from Monday to Friday could be related to school work. Another possible explanation could be the lack of opportunities for Puerto Rican adolescents may have before, during, and after school. School can significantly contribute to the overall physical activity behavior patterns through diverse venues, but currently access to these physical activity opportunities could be limited to high skilled students. Ideally, adolescents should be able to engage in physical activities before and after school, as well as in physical education with high amounts, and during recess and lunchtime. The study’s findings are congruent with past research indicating there are differences in physical activity behavior patterns between boys and girls.17,18 Overall, Puerto Rican boys engage in more vigorous physical activities than girls. Moreover, more boys engaged in vigorous physical activities, while more girls tended to engage in moderate physical activities. As a result, the low levels of vigorous physical activity participation among girls restrict their cardiovascular fitness compared with their male peers. Studies have found that boys’ cardiovascular fitness is enhanced from vigorous physical activity and that boys engage in vigorous physical activity more so than girls.33-35 Further, as reported in this current study, unstructured and structure physical activities seems to favor boys’ participation in physical activities throughout the week. Moreover, engagement in vigorous physical activity may have a negative association with body composition.36 Certainly more program
interventions are imperative, especially for girls, to motivate adolescents to become more physically active at schools and communities. Days with the lowest proportion of students engaging in physical activities lessen the likelihood of preventing or decreasing the probability of developing high blood pressure, heart diseases, diabetes, and cancer as they move into adulthood.4–10,37 Also, the lack of MVPA among adolescents has negative implications to emotional wellness as well.22 That is to say many Hispanic adolescents are missing opportunities to gain psychological, social, and emotional benefits such as higher levels of self-confidence, self-image, and self-esteem from MVPA, which would improve their total wellness and healthy lifestyles. In this study, walking was the most common activity performed among Puerto Rican adolescents. Beyond proper footwear, walking is a physical activity that requires no equipment and can be performed for exercise, transportation, and/or recreational purposes. For Puerto Rican adolescents, these factors appear to increase the likelihood of them engaging in this type of activity. In addition, the study’s participants also preferred volleyball and basketball. While across genders and grade level, physical activity preferences were similar; girls were more likely to engage in walking and volleyball activities. Similar findings have been reported with Hispanic girls in the US. Grieser, Vu, Bedimo-Rung, and Neumark conducted a study to determine the physical activity preferences across diverse ethnic groups.16 They found that walking, as either exercise or transportation, as well as volleyball were among the first 10 physical activities Hispanic girls chose to engage in throughout the week. Participation in these types of physical activities is explainable in regards to social dynamics and physical environments. In Puerto Rico, adolescents are regularly exposed to basketball and volleyball in sport and social spaces through school events, media outlets, and neighborhood gatherings. Moreover, school and community infrastructures usually support basketball and volleyball contests. These social spaces are readily accessible to adolescents during and after the school day. Healthy People 2020 and the World Health Organization stress the importance of children and adolescents participating in at least 60 minutes of MVPA most days of the week.37-38 The CDC (2011) has reported that overall about half of adolescents in the US engage
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1216 Vigo-Valentín, Bush, and Hodge
in at least 60 minutes of physical activity 5 or more days per week. However, less than half of Hispanic adolescents living in the US do so. Approximately half of the adolescents sampled in Puerto Rico engaged in some sort of physical activity during the week, but this finding supports prior evidence showing the prevalence of physical inactivity is of concern for those living in Puerto Rico.39 Despite the fact some Puerto Rican adolescents are participating in physical activities, most of them are not reaching the physical activity recommended guidelines. A very limited proportion of adolescents in Puerto Rico participated in 60 minutes of physical activity most days of the week (ie, 5 or more days). Consequently physical and physiological, emotional, and intellectual benefits that may be obtained from physical activity are limited for this population. Definitely, a multilevel intervention is necessary to generate additional physical activity opportunities. Puerto Rican adolescents must enroll or participate in activities they perceive are targeting their needs. Moreover, health may actually be improved by increasing the total minutes adolescents engage in physical activities.32–35 This result illuminates the fact that public and private agencies should ensure adolescents’ participation in physical activity is safe and appropriate. An important finding in this study is that those adolescents most regularly physically active were driven by intrapersonal factors such as their own motivation. This finding shows some Hispanic adolescents are compelled to engaging in MVPA on their own. On the other hand, more effort is needed to increase the number significantly of adolescents who engage in physical activities in organized sports and physical education classes. Further our findings indicate physical education is not contributing well to adolescents’ overall physical activity participation. Adolescents are either not enrolled in or when they are enrolled perceive that they are not required to be physically active in physical education classes. According to Trudeau and Shepard, students’ positive perceptions about physical education programs seems to decrease through the years.40 Yet, evidence demonstrates that physical education classes with lessons that are developmentally appropriate, relevant, and well-planned have better outcomes at engaging students. Schools must ensure that quality physical education is offered to all students regardless of grade level. Empirical evidence demonstrates that the presence of explicit laws can enhance physical education opportunities for students.41 The Department of Education should make sure all students are enrolled in physical education, as specified in statute, Law #146 of 2000.42 Lending further support to this the National Association for Sports and Physical Education (NASPE) recommends students are physically active at least 50% of the class allocated time.43 Further effort is needed to increase the number of students enrolled in physical education classes, and to promote higher physical activity levels of students during their physical education classes. Additional research is needed to determine whether the current findings are reflective of Hispanic student populations in the US mainland. Cross-sectional survey method presents several potential limitations however, including (a) participants who may not have completed the survey, (b) those who intentionally gave socially acceptable responses only, and (c) an inability for researchers to examine physical activity changes over an extended period of time. To minimize such issues in this study, participants were encouraged to complete the survey with honest responses in their own personal space and time, and a team evaluator was always available to answer questions or address concerns. As well, before students would leave the data collection room, a research team member verified the scale was fully completed.
Physical activity programs and interventions developed to enhance physical activity behaviors of adolescents in Puerto Rico should focus on 3 main areas: (a) schools, (b) communities, and (c) implementation of policies. At the school level, there is a need to build wellness and physical activity programs that contribute to the overall health of adolescents. A well-developed wellness program should include modifications to the traditional multiactivity physical education class, more opportunities to become physically active outside of physical education classes, and changes in school policies that ensure and enhance physical activity opportunities of the adolescents. Due to the high level of adolescents not engaging in physical activity behaviors, the mandatory enrollment in physical education classes of all the students in Puerto Rico becomes imperative. However this matters only if those programs articulate and ensure physical activity is a priority. It is suggested the local government, along with the Department of Education, must do more to enforce Law #146, which obligates schools to provide 180-minutes per week of physical education to all students enrolled in public schools.42 Developing appropriate programs in which Puerto Rican adolescents are physically active before, during, and after school hours can increase students’ physical activity levels. Studies reveal that physical activity programs implemented after schools hours can increase the activity levels among school-age children.44–46 Moreover walking, bicycling, and rollerblading to and from school can serve as effective transportation modalities to provide additional activity opportunities for being physically active.47 Yet, adolescents must feel safe and motivated to use these alternative transportation methods. Arguably as well, the school community should develop short physical activity programs and activities that impact the school recess time. Important to this physical activity advocacy is the offering of school intramural programs as well. A diversity of physical activity opportunities is needed to motivate and encourage the participation of adolescents before, during, and after school hours. The physical activity component can be addressed by increasing opportunities to participate in physical activities based on their physical activity preferences. Moreover, the community, government, and private entities responsible for promoting healthy lifestyles should guarantee access to physical activity facilities and opportunities. As it was revealed in this study, most adolescents performed physical activities for their own personal benefits, most common was their walking. It is imperative, therefore, that physical activity facilities are safe and clean, and have adequate illumination to promote additional types of physical activity. All environmental and social barriers adolescents face potentially decreases their motivation and opportunity to become more physically active.41 Programs for diverse physical activities such as aerobics, social dance, walking, jogging, and cycling can be implemented in the community, especially with the population in the US mainland who may face a higher risk of healthrelated conditions associated with lower levels of physical activity.
Conclusions Those adolescents in Puerto Rico who are not regularly participating in MVPA increase the likelihood of higher body composition indices (overweight and obesity) and the development of health-related conditions such as cardiovascular diseases and diabetes. Many Hispanic adolescents in Puerto Rico are not engaging in sufficient physical activity levels. Although, boys engage more in vigorous physical activities, neither girls nor boys are routinely reaching the recommended amount of minutes for physical activity per day or
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week. Most adolescents who are physically active spend their time performing physical activities for personal benefit. More attention should be given to providing adolescents in Puerto Rico with the necessary amount of physical activity to achieve healthy lifestyles, especially during physical education classes and organized sports. Further to combat the continued low physical activity participation levels among Hispanic adolescents in Puerto Rico, the Department of Education and local educational entities must implement and enforce policies that can have an impact on not only adolescents’ behaviors, but their parents and communities as well.
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Acknowledgments The authors would like to acknowledge the significant contribution of the Puerto Rico en Forma (Puerto Rico in Shape) evaluation team. In addition, authors would like to thank Dr. David Bernier, former Secretary of the Department of Recreation and Sports of Puerto Rico, for assisting and providing support to conduct this study. This study was partially supported by the Department of Recreation and Sports of Puerto Rico.
References 1. Wang Y, Lobstein T. Worldwide trends in childhood overweight and obesity. Int J Pediatr Obes. 2006;1(1):11–25. PubMed doi:10.1080/17477160600586747 2. Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM. Prevalence of high body mass index in US children and adolescents, 2007-2008. JAMA. 2010;303(3):242–249. PubMed doi:10.1001/jama.2009.2012 3. Vigo-Valentin A, Hodge SR, Kozub FM. Adolescents’ dietary habits, physical activity patterns, and weight status in Puerto Rico. Child Obes. 2011;7(6):488–494. 4. Olshansky SJ, Passaro DJ, Hershow RC, et al. A potential decline in life expectancy in the United States in the 21st century. N Engl J Med. 2007;352(11):1138–1145. PubMed doi:10.1056/NEJMsr043743 5. Abrams P, Levitt Katz LE. Metabolic effects of obesity causing disease in childhood. Curr Opin Endocrinol Diabetes Obes. 2011;18(1):23– 27. PubMed doi:10.1097/MED.0b013e3283424b37 6. Levi Z, Kark JD, Barchana M, et al. Measured body mass index in adolescence and the incidence of colorectal cancer in a cohort of 1.1 million males. Cancer Epidemiol Biomarkers Prev. 2011;20(12):2524– 2531. PubMed doi:10.1158/1055-9965.EPI-11-0531 7. Verbeeten KC, Elks CE, Daneman D, Ong KK. Association between childhood obesity and subsequent Type 1 diabetes: a systematic review and meta-analysis. Diabet Med. 2011;28(1):10. PubMed doi:10.1111/j.1464-5491.2010.03160.x 8. International Diabetes Federation. One adult in ten will have Diabetes by 2030 [Press Release]. http://www.idf.org/media-events/pressreleases/2011/diabetes-atlas-5th-edition. Published November 14, 2011. Accessed December 1, 2011. 9. Centers for Disease Control and Prevention. Promoting better health: promoting better health for young people through physical activity and sports: a report to the President. Washington, DC: U.S. Government Printing Office; 1997. 10. Thompson DR, Obarzanek E, Franko DL, et al. Childhood overweight and cardiovascular disease risk factors: the National Heart, Lung, and Blood Institute Growth and Health Study. J Pediatr. 2007;150(1):18– 25. PubMed doi:10.1016/j.jpeds.2006.09.039 11. Gordon-Larsen P, Nelson MC, Popkin BM. Longitudinal physical activity and sedentary behavior trends: adolescence to adulthood. Am J Prev Med. 2004;27(4):277–283. PubMed doi:10.1016/j. amepre.2004.07.006
12. Fredricks JA, Eccles JS. Is extracurricular participation associated with beneficial outcomes? Concurrent and longitudinal relations. Dev Psychol. 2006;42(4):698–713. PubMed doi:10.1037/0012-1649.42.4.698 13. Kahn JA, Huang B, Gillman MW, et al. Patterns and determinants of physical activity in U.S. adolescents. J Adolesc Health. 2008;42(4):369–377. PubMed doi:10.1016/j.jadohealth.2007.11.143 14. Neumark-Sztainer D, Story M, Hannan PJ, Tharp T, Rex J. Factors associated with changes in physical activity: a cohort study of inactive adolescent girls. Arch Pediatr Adolesc Med. 2003;157(8):803–810. PubMed doi:10.1001/archpedi.157.8.803 15. Van Der Horst K, Paw MJ, Twisk JW, Van Mechelen W. A brief review on correlates of physical activity and sedentariness in youth. Med Sci Sports Exerc. 2007;39(8):1241–1250. PubMed doi:10.1249/ mss.0b013e318059bf35 16. Grieser M, Vu MB, Bedimo-Rung AL, et al. Physical activity attitudes, preferences, and practices in African American, Hispanic, and Caucasian girls. Health Educ Behav. 2006;33:40–51. PubMed doi:10.1177/1090198105282416 17. Kirk D. Empowering girls and women through physical education and sport: advocacy Brief. Bangkok, Thailand: UNESCO; 2012. 18. Allison KR, Dwyer JJ, Goldenberg E, Fein A, Yoshida KK, Boutilier M. Male adolescents’ reasons for participating in physical activity, barriers to participation, and suggestions for increasing participation. Adolescence. 2005;40(157):155–170. PubMed 19. Trudeau F, Shephard RJ. Physical education, school physical activity, school sports and academic performance. Int J Behav Nutr Phys Act. 2008;5:10. PubMed doi:10.1186/1479-5868-5-10 20. Fairclough S, Stratton G. ‘Physical education makes you fit and healthy’. Physical education’s contribution to young people’s physical activity levels. Health Educ Res. 2005;20(1):14–23. PubMed doi:10.1093/her/cyg101 21. Meyer U, Roth R, Zahner L, et al. Contribution of physical education to overall physical activity. Scand J Med Sci Sports. 2011;XXX:12. PubMed 22. Council on Sports Medicine and Fitness; Council on School Health. Active healthy living: prevention of childhood obesity through increased physical activity. Pediatr. 2006;117(5):1834–1842. PubMed doi:10.1542/peds.2006-0472 23. Centers for Disease Control and Prevention. (2010). Youth Risk Behavior Surveillance 2009. Surveillance Summaries. 2010;59SS-5, 1-142. 24. Singh A, Uijtdewilligen L, Twisk JWR, van Mechelen W, Chinapaw MJM. Physical activity and performance at school: a systematic review of the literature including a methodological quality assessment. Arch Pediatr Adolesc Med. 2012;166(1):49–55. PubMed doi:10.1001/ archpediatrics.2011.716 25. Van Dusen DP, Kelder SH, Kohl HW, Ranjit N, Perry CL. Associations of physical fitness and academic performance among schoolchildren. J Sch Health. 2011;81(12):733–740. PubMed doi:10.1111/j.17461561.2011.00652.x 26. Morales J, Pellicer-Chenoll M, García-Masso X, Gomis M, González L-M. Relation between physical activity and academic performance in 3rd-year secondary education students. Percept Mot Skills. 2011;113(2):539–546. PubMed doi:10.2466/06.11.13. PMS.113.5.539-546 27. Thomas JR, Nelson JK, Silverman SJ. Research methods in physical activity. Champaign, IL: Human Kinetics; 2010. 28. Ainsworth BE, Haskell WL, Herrmann SD, et al. 2011 Compendium of Physical Activities: a second update of codes and MET values. Med Sci Sports Exerc. 2011;43(8):1575–1581. PubMed doi:10.1249/ MSS.0b013e31821ece12
Downloaded by Washington Univ In St Louis on 09/20/16, Volume 11, Article Number 6
1218 Vigo-Valentín, Bush, and Hodge 29. Banville D, Desrosiers P, Genet-Volet Y. Translating questionnaires and inventories using cross-cultural technique. J Teach Phys Educ. 2000;19:374–387. 30. IBM, Inc. SPSS v.20 for Mac. Chicago, Il; 2011. 31. Centers for Disease Control and Prevention. Nationwide (States, DC, and Territories) – 2005 Physical activity. http://apps.nccd.cdc.gov/ brfss/race.asp?cat=PA&yr=2005&qkey=4418&state=US. Accessed November 30, 2011. 32. M, Vernet J, Bitar A, Fellmann N, Coudert J. Daily energy expenditure, activity patterns, and energy costs of the various activities in French 12-16-y-old adolescents in free living conditions. Eur J Clin Nutr. 2002;56(9):819–829. PubMed doi:10.1038/sj.ejcn.1601395 33. Konharn K, Santos MP, Ribeiro JC. Differences between weekday and weekend levels of moderate-to-vigorous physical activity in Thai adolescents. Asia Pac J Public Health. 2012. PubMed 34. Dencker M, Thorsson O, Karlsson MK, Lindén C, Wollmer P, Andersen LB. Daily physical activity related to aerobic fitness and body fat in an urban sample of children. Scand J Med Sci Sports. 2008;18(6):728–735. PubMed doi:10.1111/j.1600-0838.2007.00741.x 35. Mota J, Silva P, Aires L, Santos MP, Oliveira J, Ribeiro JC. Differences in school-day patterns of daily physical activity in girls according to level of physical activity. J Phys Act Health. 2008;1(5, suppl):S90–S97. PubMed 36. Dencker M, Thorsson O, Karlsson MK, et al. Daily physical activity related to body fat in children aged 8-11 years. J Pediatr. 2006;149:38– 42. PubMed doi:10.1016/j.jpeds.2006.02.002 37. U.S. Department of Health and Human Services. Healthy people 2020: Improving the Health of Americans.Washington DC: U.S. Government Printing Office; 2010. Available at http://www.healthypeople. gov/2020/default.aspx 38. World Health Organization. Global recommendations on physical activity for health. Geneva, Switzerland: WHO Press; 2010.
39. Centers for Disease Control and Prevention. High School Youth Risk Behavior Survey, 2011. http://apps.nccd.cdc.gov/youthonline/App/ QuestionsOrLocations.aspx?CategoryId=6 Accessed October 2, 2012. 40. Trudeau F, Shepard RJ. Contribution of school programmes to physical activity levels and attitudes in children and adults. Sports Med. 2005;35:89–105. PubMed doi:10.2165/00007256-200535020-00001 41. Perna FM, Oh A, Chriqui JF, et al. The association of state law to physical education time allocation in US public schools. Am J Public Health. 2012;102(8):1594–1599. PubMed doi:10.2105/AJPH.2011.300587 42. Department of Education of Puerto Rico. Organic Law Department of Education of Puerto Rico # 146. 2000. 43. National Association for Sports and Physical Education. Physical education is critical to educating the whole child [Position Statement] http://www.aahperd.org/naspe/standards/upload/Physical-EducationIs-Critical-to-Educating-the-Whole-Child-Final-5-19-2011.pdf. Published 2011. Accessed January 20, 2012 44. Taverno Ross SE, Dowda M, Colabianchi N, Saunders R, Pate RR. After-school setting, physical activity, and sedentary behavior in 5th grade boys and girls. Health Place. 2012;18(5):951–955. PubMed doi:10.1016/j.healthplace.2012.06.013 45. Kargarfard M, Kelishadi R, Ziaee V, et al. The impact of an afterschool physical activity program on health-related fitness of mother/ daughter pairs: CASPIAN study. Prev Med. 2012;54(3–4):219–223. PubMed doi:10.1016/j.ypmed.2012.01.010 46. Van Acker R, De Bourdeaudhuij I, De Martelaer K, Seghers J, De Cocker K, Cardon G. The association between socio-ecological factors and having an after-school physical activity program. J Sch Health. 2012;82(9):395–403. PubMed doi:10.1111/j.1746-1561.2012.00711.x 47. Miller WC, Redmond JG, Vaux-Bjerke AT. Activity patterns and perceptions about active transport to school. Am J Health Behav. 2013;37(2):190–198. PubMed doi:10.5993/AJHB.37.2.6
