Descriptive epidemiology of the prevalence of adolescent active travel to school in Asia: a cross-sectional study from 31 countries.
BMJ Open 2022 ; 12: e057082.
Maulida R, Ikeda E, Oni T, van Sluijs EMF
DOI : 10.1136/bmjopen-2021-057082
PubMed ID : 35393319
PMCID : PMC8991057
URL : https://bmjopen.bmj.com/content/12/4/e057082
This study aimed to examine the prevalence of adolescent active travel to school (ATS) across 31 countries and territories in Asia, overall and by age group, sex and body mass index (BMI) category.
31 Asian countries.
152 368 adolescents aged 13-17 years with complete data for age, sex, measured weight and height and active travel to school from 31 Asian countries from the Global School-based student Health Survey (GSHS).
Self-reported active travel to school categorised into passive (0 days) and active (1-7 days).
Overall prevalence of adolescent ATS in Asia based on random-effect meta-analysis was 55%, ranging from 18% (UAE) to 84% (Myanmar). There was limited subregional variation: 47% in the Eastern Mediterranean (EM), 56% in the South East Asia and 64% in the Western Pacific. Summarised by random-effect meta-analysis, being an older adolescent aged 16 years and older (vs younger age below 16 years: OR: 1.08; 95% CI: 1.00 to 1.16) was positively associated with ATS. This association was strongest in EM countries. Summarised by random-effect meta-analysis, females (vs males: OR: 0.79; 95% CI: 0.71 to 0.89) and adolescents with overweight/obesity (vs underweight and normal BMI: OR: 0.92; 95% CI: 0.86 to 0.99) were less likely to use ATS. Association with sex was strongest in EM countries. Heterogeneity was considerable in all meta-analyses.
The prevalence of adolescent ATS in Asia varies substantially. Overall, older and male adolescents, and adolescents with underweight and normal BMI category are more likely to actively travel to school. However, the main contributor to differences in ATS between and within regions remain unknown. Although there is substantial scope for improving ATS rates in Asia, any policy actions and interventions should be cognisant of local built, social and natural environmental contexts that may influence active travel behaviour.
What is the purpose of the study?
Globally, 80% of adolescents are not doing enough physical activity, and as they become older, the amount of physical activity they do become less. One way to promote their physical activity is by having adolescents walk and cycle to school. This is because many of them are enrolled in schools and commute to school at least 5 days in a week.
To properly design future studies, interventions, and policies on walking and cycling to school, we need to understand the current situation in a particular region. However, little is known about the proportion of walking and cycling to school among adolescents in Asia. Asia is the largest and most populous continent, with a population of 4.6 billion, where many countries are emerging economies. Therefore, this study was aimed to get a better understanding of walking and cycling to school among adolescents in Asia.
What we did
We pooled percentages of who walk or cycle to school from 152,368 adolescents from 31 countries in Asia. We calculated the overall percentage and the percentages by three subregions. We also compared percentages of walking and cycling to school of younger and older adolescents, female and male adolescents, and adolescents with overweight and obesity and adolescents with underweight and normal weight.
What did we find?
Overall percentage of adolescent walking and cycling to school was 55%, with the lowest percentage of 18% in United Arab Emirates, and the highest percentage of 84% in Myanmar. The percentages by subregions were varied: 47% in the Eastern Mediterranean (EM), 56% in the South East Asia and 64% in the Western Pacific. Older and male adolescents, and adolescents with underweight and normal weight were more likely to walk or cycle to school.
What were our conclusions?
While about half of adolescents in Asia walk or cycle to school, the percentages by subregions varied. In Asia, older adolescent, male adolescent, and adolescent with underweight and normal weight are more likely to walk and cycle to school. Although there is substantial scope for improving walking and cycling among adolescents in Asia, any policy actions and interventions should recognise the potential different factors and contexts that may influence walking and cycling to school among adolescents in Asia.