Relationship Between Socioeconomic Status and Physical Fitness in Junior High School Students

Group 6

Members: Divya, Aruni, Ethan, James, Jonathan, Tiffany

27 October 2015

1

Agenda [TBC: Fill in last]

❶ Priority Health Issue

❷Pathways between SES and PA/PT

❸Critique of Paper’s Theoretical Construct

Application to public health practice

2

Priority Health Issues Item ❷

3

1

4

Setting the context… “SES and Physical Fitness in Junior High”

▪ Physical Activity (PA) ▪ Play, work, transportation, and recreational activities.▪ Light, moderate and vigorous PA categories ▪ Globally recommended: 150 minutes of moderate-intensity PA per week▪ Low PA is a risk factor for mortality and morbidities

▪ Physical Fitness (PF)▪ Carrying out daily tasks with vigor and alertness, without undue fatigue and

with ample energy▪ Dependent on types, intensity, duration and frequency of physical activity▪ E.g. cardiorespiratory, strength, endurance, flexibility

▪ Junior High ▪ Elementary (7-11yo) -> Junior High (11-13 yo) -> High School -> College

5

Study Objectives & Priority Health Issues

▪ Comparison with other studies ▪ Usual focus of SES as a determinant:

▪ Weight status▪ Availability of facilities for recreation in areas of low SES▪ Level of physical activity between different SES groups

▪ Objective: To investigate impact of SES on PF in Junior High School students.

▪ Target Behaviour: Adolescents to meet PF level defined by FITNESSGRAM Healthy Fitness Zone

▪ Conclusion: Only significant differences observed for girls from lower SES groups

▪ Suggested follow-up▪ Need for identification of risk factors for this sub-group of school-aged adolescence as risk

factors may differ▪ Need for specific interventions developed to address this sub-group

Pathways between SES and PA/PFItem ❷

6

2

7

Pathway between SES and Health

Low SES

Low *Physical Activity

Poor Physical Fitness

Poor Health

+

Social Selection

Social Causation

8

Ecological Model for Physical Activity

Figure 1: The ecological model for physical activity. From Sallis J.F., Cervero R.B., Ascher W., Henderson K.A., Kraft M.K., & Kerr J. (2006). An ecological approach to creating active living communities. Annual Review of Public Health, 27 297-322

Poor Diet/Malnutrition

Lack of health education from

parents or community

Lack of knowledge on health promotion

Co-morbidities eg. Obesity

More sedentary behavior

Parents’ Education

Health Risks

Low Physical Activity

Parents’ Earning capacity

Psychosocial Factors

eg. Gender differences

Social Pathway

Parents’ Occupation

Low self-esteem/self-efficacy

Lower stamina and energy

Unhealthy habits (smoking, alcohol

consumption)

Need to work part-time or help with

housework

SES-related factors

No time for physical activities Factors from

article

Factors identified by team

Reinforce unhealthy living

9

10

Structural Pathway

Less recreational facilities in community

Type of schools

attended

Poor access to Healthcare

services

Less motivation to participate in Physical Education lessons and

CCAsPoor and unsafe neighborhood

Limited accessibility to

choices of activities in school

& community

SES-related factors

Fear of getting injured

Factors from article

Factors identified by team

More sedentary behavior

Health Risks

Low Physical Activity

Lower stamina and energy

11

Policy Pathway

Social mobility

Urban Planning

Low social expenditure

SES related factors

Healthcare policies

Low affordability/accessibility to facilities & programs

Factors from article

Factors identified by team

More sedentary behavior

Health Risks

Low Physical Activity

Lower stamina and energy

12

Socioeconomic Status (Education)

▪ Increased knowledge▪ Educated parents and child▪ Understands importance of health and physical activity

▪ Increased cognitive capacity▪ For both parents and child▪ Make better decisions to keep healthy (e.g. exercise)

▪ Better access to resources▪ Exercise equipment, gear, classes

▪ Inherent social value▪ Prestige of excelling in sports

13

Education level affects exercise patterns

National Center for Health Statistics, 2008

14

Socioeconomic Status (Income)

▪ Social pathway▪ Sense of “relative deprivation” may lead to disinterest in

exercise▪ Other more pressing needs to meet

▪ Structural pathway▪ Poorer access to exercise facilities

▪ Policy pathway▪ Social and health policies that may benefit the higher income▪ Lack of awareness of these policies in the lower income

15

Income affects physical activity

U. S. Centers for Medicare & Medicaid Services, Office of the Actuary.

Critique of Paper’s Theoretical ConstructItem ❷

16

3

17

Framework: Social-Economics Impact on Health

▪ SES as an important social determinant of health ▪ Physical fitness as a surrogate of health▪ Relates to different pathways e.g. poverty, education,

nutrition, access to infrastructure▪ Impact felt even at young age (Junior High School ~ 11-

13 yo)

▪ Secondary findings of gender as another important social determinant of health behaviour▪ Girls affected▪ Boys not affected

18

Simplified Core Determinants of Health

19

Complex Web in Reality

20

Strengths

▪ Use of objective, quantifiable measure of physical fitness (vs physical activity)Widely adopted (in US schools)Prior studies used more subjective measures of physical activity

(questionnaires on frequency of activity, short term accelerometer)

▪ Well documented associations between physical fitness and health outcomes (Blair et al. JAMA 1995)

+

21

Limitations▪ Effects of other key issues relating to physical fitness which may override influence of SES

▪ Education policy and emphasis on physical activity ▪ Overall environment, national infrastructure ▪ Different welfare support e.g. in Nordic countries with strong welfare support, SES

may not play as significant a role

▪ Gender-related socialisation▪ Different expectations and roles in different cultures/ethnicity ▪ Differences in biology and behaviour amongst adolescent males and females

▪ Individuality and Modernity▪ Adolescents celebrate individuality, make choices without influence of social

economic structures ▪ Adolescents increasingly influenced by own interests and new environment e.g.

school

-

22

Limitations

▪ Longer term impact ▪ Verification if this is consistent with older adolescents (and something that is brought

into adulthood). ▪ NOTE: Some studies indicate that weaker or no association between low SES and

PA/PT in older adolescents

▪ Limitations on practical intervention based on physical fitness▪ Physical Fitness - academically meaningful, but challenges in rolling out public health

interventions based on PT

▪ Defining low and high SES groups▪ Based primarily on Federal Free Lunch program▪ Only binary categories▪ Single centre public school

-

Application to Public Health Practice e.g. Singapore

Item ❷

23

4

24

Public Health Implications in Singapore

▪ SES: Key consideration in public health planning and policy▪ Applicable at all levels of influence

=

25

Public Health Implications in Singapore

▪ Mechanistic pathways plausible and may hold true in Singapore

▪ Various other studies have shown links between SES and other health outcomes

=

26

Food for Thought in Singapore

▪ For all public health policy, particular focus should be paid to the low SES group

▪ Studies have shown increased adverse health outcomes

▪ Issues to grapple with:▪ Identification of this lower SES group▪ Reaching out and education of this group▪ Behavioural change - balance between needs and wants▪ Support and networks

▪ Lower SES: Low perceived threat, high perceived barriers and lower self efficacy

27

Individual

▪ Tailored, relatable, simple/ pictorial messages in mother tongue

▪ Lay community volunteers▪ Subsidized cost, combined with incentives▪ Availability and accessibility to resources▪ Reinforcement

HBM + TTM

▪ Lower SES communities: Shared environmental exposures, infrastructure, attitudes, beliefs

28

▪ Important group for targeted interventions▪ Start where people are▪ More material to raise critical consciousness▪ Creative way of increasing community

capacity and social capital▪ Relatable community leaders for

observational learning

SLT/SCTDiffusion of innovation

Society and Community

▪ Lower SES: Less control over nature, hours and load of work

▪ Higher prevalence of HTN,DM, CAD, Depression..▪ More Occupational hazards

29

▪ Implementing and institutionalizing strategies to promote autonomy > involve in decision making

▪ Workplace safety and health▪ Healthy eating for construction workers▪ Work place health screening > CKD and taxi

drivers

Stage Theory

Organisational

▪ Access to education▪ Vicious cycle of poverty▪ Scholarships/bursaries to children from low SES

families

▪ Access to healthcare▪ CHAS, Medisave, Medishield

▪ Access to infrastructure▪ Affordable housing > Ease overcrowding >

Reduce childhood asthma

30

Policy

31

Summary [TBC]

▪ Text▪ Text

❶ Text

▪ Text▪ Text▪ Text▪ Text

▪ Text

❷ Text

❸ Text

❹ Text▪ Text

Thank You

32

33

References

▪ Stalsberg R. Effects of socioeconomic status on the physical activity in adolescents: a systematic review of the evidence, 2009

▪ Bauman Z. The individualized society. Cambridge: Cambridge Polity Press, 2001.▪ Humbert M et al. Factors that influence physical activity participation among high- and low-SES youth. Qual

Health Res. 2006 Apr;16(4):467-83.

34

Socioeconomic Status and Physical Activity

Socioeconomic Status▪ Measured by

▪ Educational level▪ Parents’ occupations▪ Income (economic) ▪ Neighborhood-related

Physical Activity▪ Measured by

▪ Duration▪ Frequency▪ Intensity