Background
Methods
Study design and study population
Outcome variables
Individual (child) level explanatory variables
School level explanatory variables
Statistical analysis
Results
Overall | Private | Public | p-value | |
---|---|---|---|---|
Continuous variables* | ||||
Individual level (N = 543) | ||||
Age (years) a | 10 (9, 11) | 10 (9,11) | 10 (9,11) | 0.756 |
BMI (kg/m2) | 17.03 (3.56) | 17.72 (4.29) | 16.34 (2.47) | < 0.0001 |
WHtR | 0.43 (0.05) | 0.43 (0.06) | 0.42 (0.03) | 0.026 |
Household wealth index | 0.27 (−1.47, 1.69) | 1.10 (−0.11, 2.16) | − 0.87 (−2.43, 0.51) | < 0.0001 |
School level (n = 14) | ||||
School level SES | 0.11 (−0.34, 0.79) | 0.78 (0.34, 1.27) | −0.34 (−1.73, − 0.20) | < 0.0001 |
Healthful foods | 2.44 (1.06) | 3.16 ± 0.85 | 1.72 ± 0.70 | < 0.0001 |
Less healthful foods | 8.24 (2.04) | 9.10 ± 1.07 | 7.37 ± 2.39 | < 0.0001 |
PA facility index | 3.54 (1.30) | 4.21 ± 1.07 | 2.87 ± 1.16 | < 0.0001 |
Minutes per week for PA | 69.00 (16.43) | 76.5 ± 19.31 | 60.00 ± 0.00 | < 0.0001 |
After-school recreational facilities | 0.65 (0.97) | 0.93 ± 1.23 | 0.37 ± 0.48 | < 0.0001 |
Support for active transport | 2.59 (1.19) | 2.75 ± 1.12 | 2.43 ± 1.24 | 0.002 |
Perceived neighbourhood quality | 3.71 (1.83) | 3.99 ± 1.11 | 3.43 ± 2.3 | 0.0004 |
Categorical variables* | ||||
Individual level | ||||
Sex | 0.833 | |||
Boys | 37.6 (204) | 49.5 (101) | 50.5 (103) | |
Girls | 62.4 (339) | 50.5 (171) | 49.5 (168) | |
Household SES | < 0.0001 | |||
Poor | 40.1 (218) | 26.1 (57) | 73.9 (161) | |
Middle | 40.0 (217) | 60.4 (131) | 39.6 (86) | |
Rich | 19.9 (108) | 77.8 (84) | 22.2 (24) | |
Overweight (including obesity) | 16.4 (89) | 73.0 (65) | 27.0 (24) | < 0.0001 |
Abdominal obesity | 18.8 (102) | 63.7 (65) | 36.3 (37) | 0.002 |
School level | ||||
Physical activity policies and practices | 94.3 (512) | 47.1 (241) | 52.9 (271) | < 0.0001 |
Nutrition and healthy eating policies and practices | 90.4 (491) | 44.8 (220) | 55.2 (271) | < 0.0001 |
Physical activity on timetable | 81.7 (444) | 88.6 (241) | 74.9 (203) | < 0.0001 |
School cafeteria | 52.8 (287) | 73.9 (212) | 26.1 (75) | < 0.0001 |
School shop | 34.4 (187) | 100. 0 (187) | – | < 0.0001 |
Fast food outlets close to school | 95.0 (516) | 52.7 (272) | 47.3 (244) | < 0.0001 |
Factors associated with overweight (including obesity)
Univariable models a | Multivariable models b | |||||
---|---|---|---|---|---|---|
OR (95% CI) | SE | p-value | OR 95% CI | SE | p-value | |
Intercept (null model) | 0.150 (0.074, 0.303) | 0.054 | ||||
Age | 0.931 (0.710, 1.220) | 0.128 | 0.604 | 1.031 (0.791, 1.343) | 0.139 | 0.823 |
Sex (Boys) | 0.901 (0.540, 1.502) | 0.235 | 0.689 | 0.921 (0.551, 1.540) | 0.241 | 0.755 |
Median household wealth index | 1.068 (0.915, 1.246) | 0.084 | 0.404 | – | – | – |
Household SES | ||||||
Poor | 1 | |||||
Middle | 1.398 (0.751, 2.560) | 0.442 | 0.290 | – | – | – |
Rich | 1.220 (0.562, 2.648) | 0.482 | 0.615 | – | – | – |
School level SES | 2.052 (1.433, 2.939) | 0.376 |
< 0.0001
| 1.998 (1.153, 3.462) | 0.560 |
0.014
|
School type (Private) | 4.190 (1.350, 13.004) | 2.421 |
0.013
| 0.399 (0.110, 1.442) | 0.262 | 0.161 |
School cafeteria | 3.815 (1.245, 11.690) | 2.179 |
0.019
| 1.329 (0.458, 3.857) | 0.722 | 0.601 |
School shop | 5.067 (1.744, 14.721) | 2.757 |
0.003
| 1.343 (0.557, 3.237) | 0.603 | 0.511 |
Fast food outlets close to school | 1.379 (0.091, 20.851) | 1.911 | 0.871 | – | – | – |
Healthful foods | 2.313 (1.265, 4.229) | 0.712 |
0.006
| 1.577 (1.055, 2.358) | 0.323 |
0.026
|
Less healthful foods | 1.274 (0.946, 1.716) | 0.193 | 0.110 | 0.944 (0.735, 1.214) | 0.121 | 0.656 |
PA facility index | 0.848 (0.672, 1.071) | 0.101 | 0.167 | 0.835 (0.661, 1.054) | 0.099 | 0.129 |
Minutes per week for PA | 0.980 (0.935, 1.028) | 0.024 | 0.420 | – | – |
–
|
School support for active transport | 0.936 (0.547, 1.603) | 0.267 | 0.810 | – | – |
–
|
Perceived neighbourhood quality | 1.263 (0.845, 1.887) | 0.259 | 0.255 | – | – |
–
|
After-school recreational facilities | 1.849 (1.187, 2.883) | 0.419 |
0.007
| 1.375 (1.013, 1.866) | 0.214 |
0.041
|
Physical activity policies and practices | 0.217 (0.020, 2.325) | 0.263 | 0.207 | – | – |
–
|
Nutrition and healthy eating policies and practices | 1.076 (0.131, 8.808) | 1.154 | 0.946 | – | – |
–
|
Physical activity on timetable | 0.571 (0.087, 3.741) | 0.547 | 0.559 | – | – |
–
|
Random effects
| ||||||
School level | 1.408 (0.485, 4.090) | 0.766 | ||||
ICC | 0.300 (0.128, 0.554) | 0.114 |
Factors associated with abdominal obesity
Univariable model a | Multivariable model b | |||||
---|---|---|---|---|---|---|
OR (95% CI) | SE | p-value | OR (95% CI) | SE | p-value | |
Intercept (null model) | 0.209 (0.120, 0.362) | 0.059 | ||||
Age | 1.108 (0.857, 1.432) | 0.145 | 0.433 | 1.145 (0.891, 1.471) | 0.146 | 0.289 |
Sex (Boy) | 0.879 (0.545, 1.418) | 0.214 | 0.597 | 0.888 (0.549, 1.437) | 0.218 | 0.629 |
Median household wealth index | 1.018 (0.885, 1.170) | 0.072 | 0.805 | – | – |
–
|
Household SES | ||||||
Poor | 1 | – | – | – | ||
Middle | 1.262 (0.721, 2.211) | 0.361 | 0.416 | – | – | – |
Rich | 1.236 (0.607, 2.517) | 0.448 | 0.559 | – | – | – |
School level SES | 1.636 (1.155, 2.317) | 0.290 |
0.006
| 1.501 (0.951, 2.369) | 0.349 | 0.081 |
School type (Private) | 2.420 (0.880, 6.655) | 1.249 | 0.087 | 0.489 (0.150, 1.593) | 0.295 | 0.235 |
School cafeteria | 2.661 (1.017, 6.962) | 1.306 |
0.046
| 1.401 (0.678, 2.896) | 0. 519 | 0.362 |
School shop | 3.473 (1.410, 8.555) | 1.597 |
0.007
| 1.234 (0.531, 2.871) | 0.532 | 0.625 |
Fast food outlets close to school | 0.597 (0.075, 4.756) | 0.632 | 0.626 | – | – | – |
Healthful foods | 1.556 (0.968, 2.503) | 0.377 | 0.068 | 1.253 (0.881, 1.783) | 0.225 | 0.210 |
Less healthful foods | 1.166 (0.910, 1.495) | 0.148 | 0.224 | |||
PA facility index | 0.822 (0.663, 1.019) | 0.090 | 0.073 | 0.782 (0.627, 0.974) | 0.088 |
0.028
|
Minutes per week for PA | 0.993 (0.960, 1.027) | 0.017 | 0.694 | – | – |
–
|
School support for active transport | 0.940 (0.614, 1.438) | 0.204 | 0.775 | – | – |
–
|
Perceived neighbourhood quality | 1.128 (0.821, 1.550) | 0.183 | 0.456 | – | – |
–
|
After-school PA facilities | 1.815 (1.323, 2.492) | 0.293 |
< 0.0001
| 1.642 (1.233, 2.187) | 0.240 |
0.001
|
Physical activity policies and practices | 0.308 (0.046, 2.081) | 0.300 | 0.227 | – | – |
–
|
Nutrition and healthy eating policies and practices | 0.715 (0.149, 3.427) | 0.512 | 0.675 | – | – |
–
|
Physical activity on timetable | 0.702 (0.157, 3.132) | 0.535 | 0.642 | – | – |
–
|
Random effects
| ||||||
School level | 0.871 (0.299, 2.421) | 0.044 | ||||
ICC | 0.206 (0.083, 0.424) | 0.087 |
Factors associated with BMI
Model 1 Null model | Model 2 Individual | Model 3 School | Model 4 Individual & school | |||||
---|---|---|---|---|---|---|---|---|
Estimate (95% CI) | SE | Estimate (95% CI) | SE | Estimate (95% CI) | SE | Estimate (95% CI) | SE | |
Fixed effects | ||||||||
Individual level
| ||||||||
Intercept | 17.136 (16.233, 18.038) | 0.460 | ||||||
Age | 0.304 (−0.002, 0.609) | 0.156 | 0.396 (0.102, 0.691)* | 0.150 | ||||
Sex (Boys) | 0.011 (−0.563, 0.583) | 0.293 | 0.001 (− 0.571, 0.573) | 0.292 | ||||
Household wealth index | 0.010 (−0.152, 0.172) | 0.083 | ||||||
Household SES | ||||||||
Poor (ref) | ||||||||
Middle | 0.113 (−0.547, 0.774) | 0.337 | ||||||
Rich | 0.132 (−0.726, 0.990) | 0.438 | ||||||
School level
| ||||||||
School level SES | 0.959 (0.481, 1.437)** | 0.244 | 1.015 (0.499, 1.530)** | 0.263 | ||||
School type (private) | 1.744 (0.185, 3.303)* | 0.795 | −1.795 (−3.078, −0.513)* | 0.654 | ||||
School cafeteria | 1.832 (0.324, 3.340)* | 0.769 | 0.742 (−0.330, 1.814) | 0.547 | ||||
School shop | 2.344 (0.926, 3.762)* | 0.724 | 0.276 (−0.781, 1.333) | 0.539 | ||||
Fast foods restaurants close to school | 1.101 (−2.401, 4.602) | 1.787 | – | – | ||||
Healthful foods | 0.769 (0.012, 1.526)* | 0.386 | 0.306 (−0.136, 0.748) | 0.225 | ||||
Less healthful foods | 0.382 (0.003, 0.762)* | 0.194 | −0.094 (− 0.306, 0.119) | 0.108 | ||||
PA facility index | −0.143 (− 0.391, 0.105) | 0.126 | – | – | ||||
Minutes per week for PA | −0.014 (− 0.064, 0.035) | 0.025 | – | – | ||||
School support for active transport | −0.136 (− 0.840, 0.568) | 0.359 | – | – | ||||
Perceived neighbourhood quality | 0.176 (−0.327, 0.678) | 0.256 | – | – | ||||
After school recreational facilities | 1.134 (0.562, 1.705)** | 0.291 | 0.894 (0.525, 1.263)** | 0.23 | ||||
Physical activity policy | −2.957 (−6.088, 0.174) | 1.597 |
–
| – | ||||
Nutrition policy & healthy eating policy | −0.657 (−3.247, 1.933) | 1.321 | – | – | ||||
Physical activity on timetable | −1.098 (3.585, 1.389) | 1.269 | – | – | ||||
Random effects
| ||||||||
Individual level | 10.802 (9.574, 12.187)** | 0.665 | ||||||
School level | 2.650 (1.121, 6.265)** | 1.163 | ||||||
ICC | 0.197 (0.093, 0.370) | 0.070 |