Do school-based physical activity interventions increase or reduce inequalities in health?

Area of Science:

• Public Health
• Pediatrics
• Health Promotion

Background:

• Physical activity inequalities persist among children in low-income areas.
• The effectiveness of school-based health promotion on these inequalities is not well understood.
• Comprehensive School Health (CSH) programs aim to address health within the school environment.

Purpose of the Study:

• To compare the two-year change in physical activity among children in schools with and without health promotion programs.
• To assess if CSH programs reduce or exacerbate health inequalities based on activity level, body weight, and socioeconomic status.
• To evaluate the impact of CSH on physical activity in socioeconomically disadvantaged neighborhoods.

Main Methods:

• A quasi-experimental trial involving 10 intervention and 20 comparison schools in Edmonton, Alberta.
• Data collected from 10-11 year-old children in 2009 and 2011 using pedometers and demographic surveys.
• Multilevel linear regression analysis adjusted for confounders to compare physical activity changes over time and between groups.

Main Results:

• In 2009, intervention schools had a higher proportion of overweight and less active students.
• Over two years, the relative difference in step-counts between intervention and comparison schools significantly reduced across all activity levels and weight status groups.
• Physical activity inequalities were reduced, with differences becoming balanced across socioeconomic subgroups by 2011.

Conclusions:

• Comprehensive School Health programs implemented in disadvantaged neighborhoods effectively reduced physical activity inequalities among children.
• School-based health promotion is a promising strategy for improving physical activity and preventing childhood obesity.
• Investments in CSH programs can contribute to reducing health inequalities in vulnerable populations.