Leisure-time physical activity in university students from 23 countries: associations with health beliefs, risk awareness, and national economic development
Introduction
The health benefits of leisure-time physical activity are widely recognized, as inactivity is associated with increased risk of coronary heart disease, various cancers, obesity, and other health problems [1], [2]. The recommendation to increase physical activity is a key element of health-promotion strategies in many countries, and of international initiatives targeted at developed and developing countries such as the WHO Mega Country Health Promotion Network [3], [4]. Surveys from individual countries indicate that the prevalence of adequate physical activity is relatively high in children and adolescents [5], [6] but substantially lower in adults, suggesting that late adolescence and early adult life may be a critical period of transition [7], [8]. It is important therefore to monitor trends in physical activity in young adults, and to understand factors such as attitudes and knowledge of health benefits that may be associated with activity levels.
International comparisons are valuable from the perspective of global public health since they help define variations in physical activity in different cultures, point to common determinants across countries, suggest countries or regions in most need of intervention, and highlight good practice in health promotion. Unfortunately, the measurement of leisure-time physical activity is complex, and surveys using different methods are difficult to compare [9]. There have been relatively few substantial international studies of comparable samples from different countries [5], [10], [11], [12], and these have predominately focused on Europe. Information concerning leisure-time physical activity in developing and Pacific Asian countries is sparse. Consequently, it has not yet been possible to formulate models of the evolution of leisure physical activity in relation to levels of national economic development, as have been proposed for other health-related behaviors such as smoking [13].
This study assessed leisure-time physical activity in university students from 23 countries, analyzing the prevalence of inactivity and activity at recommended levels of three or more times a week [14]. We investigated whether there were systematic differences in physical activity across countries related to national economic development, and to geographical, cultural, and political groupings. The strength of individual attitudes concerning the benefits of physical activity and knowledge about the role of physical activity in preventing chronic disease was also evaluated. These psychological variables are relevant for planning health education, and may be associated with increased frequency of leisure-time physical activity [15]. We used multilevel modeling to assess the associations between leisure-time physical activity and individual-level factors (attitudes, risk awareness) and ecological-level factors (national economic development) simultaneously. Because data were collected from university students rather than representative samples of young adults in each country, we cross-validated international differences in reported activity levels by comparison with existing data sets that included several of the countries sampled [10].
Section snippets
Methods
These analyses were based on data from the International Health and Behaviour Survey (IHBS), a cross-sectional questionnaire study of health behaviors and attitudes in 19,298 university students from 23 countries, carried out between 1999 and 2001. Assessments of physical activity were identical to those included in the European Health Behaviour Survey (EHBS), conducted between 1989 and 1991 [12], [16]. The study was carried out with a network of collaborators in participating countries (see
Prevalence of leisure-time physical activity
The age-adjusted prevalence of physical inactivity is shown in Fig. 1, and the prevalence of activity at recommended levels in Fig. 2. Overall, more women than men reported no leisure-time physical activity (38%, CI 37–39 vs. 27%, CI 26–28, P < 0.0001). The differences were significant (P < 0.01 or less) in 16 of the 23 countries, but were not reliable in Germany, Hungary, Iceland, Ireland, Japan, the Netherlands, or the United States. The prevalence of inactivity varied markedly across country
Discussion
Analysis of the prevalence of physical activity confirmed our expectation that there would be wide variations between country samples. Similar variations in Europe have been observed in other studies [10], [11], [12]. We used two overlapping strategies to try to understand the pattern across countries. The first was to group countries by political, cultural, and geographical criteria. The countries included in the North-Western European and the United States category are all mature democracies
Acknowledgements
This research was supported by Cancer Research UK and by the Economic and Social Research Council, UK. The following colleagues participated in data collection for the International Study of Health and Behaviour—Diepenbeek, Belgium: Jan Vinck; Sophia, Bulgaria: Irina Todorova; Bogotá, Colombia: Pablo Sanabria-Ferrand and Diana Urrego; Paris, France: France Bellisle and Anne Marie Dalix; Wuppertal and Marburg, Germany: Claus Vögele and Gudrun Sartory; Athens, Greece: Bettina Davou and Antonis
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