International physical activity and built environment study of adolescents: IPEN Adolescent design, protocol and measures

Kelli L. Cain, Jo Salmon, Terry L. Conway, Ester Cerin, Erica Hinckson, Josef Mitáš, Jasper Schipperijn, Lawrence D. Frank, Ranjit Mohan Anjana, Anthony Barnett, Jan Dygrýn, Mohammed Zakiul Islam, Javier Molina-García, Mika Moran, Wan Abdul Manan Wan Muda, Adewale L. Oyeyemi, Rodrigo Reis, Maria Paula Santos, Tanja Schmidt, Grant M. SchofieldAnna Timperio, Delfien van Dyck, James F. Sallis

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction Only international studies can provide the full variability of built environments and accurately estimate effect sizes of relations between contrasting environments and health-related outcomes. The aims of the International Physical Activity and Environment Study of Adolescents (IPEN Adolescent) are to estimate the strength, shape and generalisability of associations of the community environment (geographic information systems (GIS)-based and self-reported) with physical activity and sedentary behaviour (accelerometer-measured and self-reported) and weight status (normal/overweight/obese). Methods and analysis The IPEN Adolescent observational, cross-sectional, multicountry study involves recruiting adolescent participants (ages 11–19 years) and one parent/guardian from neighbourhoods selected to ensure wide variations in walkability and socioeconomic status using common protocols and measures. Fifteen geographically, economically and culturally diverse countries, from six continents, participated: Australia, Bangladesh, Belgium, Brazil, Czech Republic, Denmark, Hong Kong SAR, India, Israel, Malaysia, New Zealand, Nigeria, Portugal, Spain and USA. Countries provided survey and accelerometer data (15 countries), GIS data (11), global positioning system data (10), and pedestrian environment audit data (8). A sample of n=6950 (52.6% female; mean age=14.5, SD=1.7) adolescents provided survey data, n=4852 had 4 or more 8+ hours valid days of accelerometer data, and n=5473 had GIS measures. Physical activity and sedentary behaviour were measured by waist-worn ActiGraph accelerometers and self-reports, and body mass index was used to categorise weight status. Ethics and dissemination Ethical approval was received from each study site’s Institutional Review Board for their in-country studies. Informed assent by adolescents and consent by parents was obtained for all participants. No personally identifiable information was transferred to the IPEN coordinating centre for pooled datasets. Results will be communicated through standard scientific channels and findings used to advance the science of environmental correlates of physical activity, sedentary behaviour and weight status, with the ultimate goal to stimulate and guide actions to create more activity-supportive environments internationally.

Original languageEnglish
Article numbere046636
JournalBMJ Open
Volume11
Issue number1
DOIs
StatePublished - 18 Jan 2021

Bibliographical note

Funding Information:
Health and Madras Medical Diabetes Research Fund Research – Hong Kong Foundation SAR 10111501 and National Heart, Lung, & Blood Institute (R01 HL11 1378)

Funding Information:
Data collection in Portugal was supported by the Portuguese Foundation for Science and Technology. Data collection in Spain was supported partially by Generalitat Valenciana, Spain grant: GV-2013-087. Data collection in the USA (TEAN) was supported by NIH grant: R01 HL083454. AT was supported by a Future Leader Fellowship from the National Health Foundation of Australia (grant: ID100046) during the conduct of this study. EC was supported by an Australian Research Council Future Fellowship grant: FT140100085. JS is supported by a Leadership Level 2 Fellowship, National Health and Medical Research Council Australia (APP 1176885).

Funding Information:
Funding for the International Physical Activity and Environment Network Adolescent study was made possible by a grant from the National Institutes of Health (NIH) grant: R01 HL111378. Data collection in Belgium was supported partially by the Research Foundation Flanders (FWO) grant: FWO12/ASP/102. Data collection in Brazil was supported partially by the Brazilian National Council for Scientific and Technological Development grant: 306836/2011-4. Data collection in the Czech Republic was funded by the Czech Science Foundation grants: GA14-26896S and GA17-24378S. Data collection in Denmark was supported partially by the University of Southern Denmark. The Hong Kong study (iHealt(H) was supported by the Health and Medical Research Fund (Food and Health Bureau, Government of the Hong Kong SAR, PR of China) grant:10111501. Data collection in India (BE ACTIV India! study) was supported by an in-house grant from Madras Diabetes Research Foundation (MDRF), Chennai. The Israeli study was supported by a grant from the Israel Science Foundation ? ISF grant: 916/12. Data collection in Malaysia was supported partially by a Universiti Sains Malaysia International Research Collaboration Grant. Data collection in New Zealand (BEANZ study) was funded by the Health Research Council (HRC) of New Zealand grant: HRC12/329. Data collection in Portugal was supported by the Portuguese Foundation for Science and Technology. Data collection in Spain was supported partially by Generalitat Valenciana, Spain grant: GV-2013-087. Data collection in the USA (TEAN) was supported by NIH grant: R01 HL083454. AT was supported by a Future Leader Fellowship from the National Health Foundation of Australia (grant: ID100046) during the conduct of this study. EC was supported by an Australian Research Council Future Fellowship grant: FT140100085. JS is supported by a Leadership Level 2 Fellowship, National Health and Medical Research Council Australia (APP 1176885).

Funding Information:
Funding Funding for the International Physical Activity and Environment Network Adolescent study was made possible by a grant from the National Institutes of Health (NIH) grant: R01 HL111378. Data collection in Belgium was supported partially by the Research Foundation Flanders (FWO) grant: FWO12/ASP/102. Data collection in Brazil was supported partially by the Brazilian National Council for Scientific and Technological Development grant: 306836/2011-4. Data collection in the Czech Republic was funded by the Czech Science Foundation grants: GA14-26896S and GA17-24378S. Data collection in Denmark was supported partially by the University of Southern Denmark. The Hong Kong study (iHealt(H) was supported by the Health and Medical Research Fund (Food and Health Bureau, Government of the Hong Kong SAR, PR of China) grant:10111501. Data collection in India (BE ACTIV India! study) was supported by an in-house grant from Madras Diabetes Research Foundation (MDRF), Chennai. The Israeli study was supported by a grant from the Israel Science Foundation – ISF grant: 916/12. Data collection in Malaysia was supported partially by a Universiti Sains Malaysia International Research Collaboration Grant. Data collection in New Zealand (BEANZ study) was funded by the Health Research Council (HRC) of New Zealand grant: HRC12/329.

Funding Information:
To achieve a diverse set of participating countries that would maximise variability in built environments, investigators were invited to complete applications for inclusion in the IPEN Adolescent grant proposal. Invitations to apply were sent by email to about 400 people who had registered on the IPEN website (www.ipenproject.org). Interested investigators provided information about such issues as country to be represented, city(ies) from which adolescents would be recruited, availability of GIS data related to walkability, training and experience with PA and built environment research of key investigators, list of relevant publications, potential to apply for study funding within the country, and willingness to contribute data for international pooled analyses. An international Executive Committee reviewed the applications and selected investigators who best met these criteria for inclusion in the grant proposal to the US National Institutes of Health (NIH): ► Environmental variability: ability to recruit and collect data from adolescents (11–19 years of age) residing in areas varying in walkability and SES, defined using GIS and census data. ► Number of participants: the countries were instructed to aim for at least 300 participants contributing accelerometer data, built environment data and PA surveys. ► Primary investigator qualifications and experience: investigators were accepted who demonstrated the highest academic qualifications and experience either through participation in the IPEN Adult study or use of similar protocols for neighbourhood selection procedures, participant recruitment, accelerometer data collection, quality control and data manage-ment, as well as creation of GIS variables that could be applied in the IPEN Adolescent study. Countries that did not have the capacity to create GIS variables but met the other criteria were included in the study as ‘exploratory’ countries. Exploratory countries were asked to aim for recruiting at least 150 participants with survey and accelerometer data. ► International diversity: there was a goal to represent all inhabited continents in IPEN Adolescent, with countries ranging from low income to high income. In the grant proposal, data collection in seven countries was to be funded by the NIH grant, with eight additional countries obtaining their own funding. Ultimately, 15 countries from 6 continents completed data collection and contributed data (table 2, figure 2). Two of the countries were low income (Bangladesh, Nigeria) and three were middle income (Brazil, India, Malaysia). National variability in economic, population and health indicators across countries represented within IPEN Adolescent is shown in table 1. Data were sourced from websites that compile international statistics (eg, WHO, Global Observatory on PA). The gross domestic product per capita in 2017–2018 US dollars ranged from US$4200 (Bangladesh) to US$64 500 (Hong Kong). Obesity rates for adolescents ranged from 1.3% (Nigeria) to 22.3% (USA) for males and 1.1% (India) to 19.0% (USA) for females. Life expectancy ranged from 54.8 (Nigeria) to 84.8 (Hong Kong) years while deaths from non-communicable diseases ranged from 29% (Nigeria) to 91% (Spain). The prevalence of adolescents meeting PA guideline ranged from 8.4% (Hong Kong) to 33.5% (Bangladesh), while deaths related to physical inactivity ranged from 1.3% (Nigeria) to 16.4% (Malaysia). Population per square kilometre ranged from 3.3 (Australia) to 6756.7 (Hong Kong). Finally, car ownership per 1000 population ranged from 4 (Bangladesh) to 860 (New Zealand).

Funding Information:
Universiti Health Sains Malaysia Research International Council of Research New Zealand Collaboration (HRC12/329) Grant (IReC) and National Heart, Lung, & Blood Institute (R01 HL11 1378)

Funding Information:
Research Centre (CIAFEL) supported by FCT (Portuguese Foundation for Science and Technology)

Publisher Copyright:
© Author(s) (or their employer(s)) 2021.

ASJC Scopus subject areas

  • General Medicine

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