Abstract
Background
Childhood overweight is a major public health concern. Whereas various studies have documented higher prevalence rates in rural areas compared to urban areas, little is known about what is causing these differences. We sought to identify the factors underlying the overweight differentials by examining physical activity and nutrition behaviours as well as neighbourhood characteristics of urban areas, towns and rural areas across Alberta.
Methods
In 2008, we surveyed 3,421 grade five students and their parents from 148 randomly selected schools. Students completed the Harvard Food Frequency Questionnaire, questions on physical activities, and had their height and weight measured. Parents completed questions on socio-economic background, child’s lifestyle, and neighbourhood perception. We applied multilevel regression methods to quantify the geographic differentials in physical activity, nutrition and neighbourhood facilities.
Results
The prevalence of overweight was 28.5% among Albertan grade five students, with 6.7% being obese. Among students attending schools in towns and rural areas, the prevalence of overweight (obesity) was 29.8% (7.9%) and 30.6% (8.0%), respectively. Compared with students attending urban schools, those attending schools in towns and rural areas reported more physical activity despite perceiving less access to playgrounds/parks and recreational programs (p<0.01). These latter students further reported poorer diets and purchasing more energy-dense foods and snacks at their schools (p<0.01).
Conclusion
Our findings confirmed the existence of geographic differentials in overweight and its underlying causes. The study urges more promotion of healthy eating and active living, particularly in towns and rural areas to reduce geographic inequalities in health.
Key words: Childhood overweight, public health, nutrition, physical activity, geographic gradient, built environment
Résumé
Contexte
Le surpoids dans l’enfance est un grave problème de santé publique. Diverses études font état de taux de prévalence plus élevés en milieu rural qu’en milieu urbain, mais on en sait peu sur les causes de ces écarts. Nous avons voulu cerner les facteurs sous-jacents des écarts dans le surpoids en examinant les comportements d’activité physique et de nutrition et les caractéristiques du quartier dans les zones urbaines, les petites villes et les milieux ruraux de l’Alberta.
Méthode
En 2008, nous avons sondé 3 421 élèves de 5e année dans 148 écoles sélectionnées au hasard, ainsi que leurs parents. Les élèves ont rempli le questionnaire Harvard sur la fréquence de consommation des produits alimentaires et répondu à des questions sur leur activité physique, et nous avons mesuré leur taille et leur poids. Les parents ont répondu à des questions sur leur milieu socioéconomique, le mode de vie de leur enfant et leur perception du quartier. Nous avons appliqué des méthodes de régression multiniveaux pour chiffrer les écarts géographiques dans l’activité physique, la nutrition et les équipements du quartier.
Résultats
La prévalence du surpoids était de 28,5 % chez les élèves de 5e année de l’Alberta; de ce chiffre, 6,7 % étaient obèses. Parmi les élèves qui fréquentaient l’école dans une petite ville ou en milieu rural, la prévalence du surpoids (de l’obésité) était de 29,8 % (7,9 %) et de 30,6 % (8 %), respectivement. Comparés aux élèves en zone urbaine, ils ont déclaré faire plus d’activité physique, malgré leur impression d’avoir accès à moins de terrains de jeu/de parcs et de programmes récréatifs (p<0,01). Ces élèves des petites villes et des milieux ruraux ont aussi déclaré avoir une moins bonne alimentation et acheter davantage d’aliments et de collations riches en calories à l’école (p<0,01).
Conclusion
Nos constatations confirment l’existence d’écarts géographiques dans le surpoids et ses causes sous-jacentes. L’étude plaide en faveur d’une promotion accrue de la saine alimentation et de la vie active, surtout dans les petites villes et en milieu rural, pour réduire les inégalités en santé d’origine géographique.
Mots clés: surpoids dans l’enfance, santé publique, nutrition, exercice physique, gradient géographique, milieu bâti
Footnotes
Conflict of Interest: None to declare.
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