Results From Mexico's 2014 Report Card on Phys ...

'OURTAL Journalof PhysicalAct¡v¡tyand Health,2014,11(Supp1), S74-S78 hltp/dx.doi.orq/10.l1 23/lpah.zofl-4172 @ 2 0 1 4H u m a nK i n e t i c sI ,n c .

OF

Physical Activity

& Health

Official Journalof ISPAH www.JPAHrrournal.com BRIEFREPORT

ResultsFromMexico's2014ReportCard on Phys¡calActivity for ChildrenandYouth Maríadel PilarRodriguezMartinez,KarlaL Galaviz,EdtnaJaureguiUlloa, InesGonzalez-Casanova, and Juan RicardoLopezy Taylor Backgroun.l,tThcMexican Report Card on PhysicalAcLiviLyin children and youth was hrst developedin 2012 asa tool ¿rimeilat inlbrmingpoJicyandpractice.The objectiveof this paperis to updatetheReportCardto reflectthc currentsituationin Mexico. Methodst Aliferature searchwas conductedin SpanishandEnglish using major databases,and complementedwilh government documents andnationalhealthsurveys.Informationon the9 indicatorsoutlinedin theGlobalMatrix ofReportCardGradeswas extracted.Expertsf¡om Mexico and Canadamet to discussand assigna gradeon each indicator ResaÍs: The physicalactivity indicatorwasassigneda C+, which was higherthan in the previousreportcard.Sedentarybehaviorwas assigneda D, which was lowe¡ than the previous report card. OrganizedSportsand Active Transportation,which were not graded in the previous gradesof C and CovemmentandBuilt EnvironmentwereassiSned reportcard,wereassignedgradesof D andB-, respectively. 4 respectively.Family and Peersand Active Play were not graded(INC1. Conclusions: Levels of PA and sedentarybehaviors amongMexican children and youth were below the respectiverecommendedrelerences-The implementationand eflectiveness of cuffent goyemmentstrategiesneed to be determined.The Mexican Repoú Card is a promising knowledge translaliontool that can seryeto inform policies and programsrelatedto physical activity. Keywordst advocacy,policy, health communication,child heahh,knowledgetranslation Physicalactivity(PA) amongchildrenandyouth is associated including obesity prevention.3 with numeroushealthbenefits,r'2 However,the prevalenceof physicalinactivity among children and youth hasreachedalarminglevelsin Mexicoaand acrossthe globe.5PhysicalinactiyityamongMexicanyouth l0-18 yearshas increased47Vair the last 6 years.aThe amount of time Mexican children and youth spendin sedentarybehaviorsis also alarmingly strategiesare neededin Mexico to high.aKnowledgetranslaLion inform public policies and programsaimed at improving levelsof PA and sedentarybehaviorsamong children and youth. A successfulmodel of knowledge translation is the Active Healthy Kids Canada(AHKC) Report Card on Physical Activity fo¡ Children and Youth.67 The AHKC Report Ca¡d has been successfulin influencingpolicies,programsand campaignsaimedal improving PA opportunitiesfor children and youth.3Basedon this model,Mexico launchedits first ReportCard in 2012e successful sponsoredby the CAMBIO program,an internationalcollaborative projectaimedat battlingchildhoodobesityin Mexico.r0The li¡st Mexican Repof Card collated information on 8 indicatorsrelated to PA amongchildrenandyouth nationwide.The main findingsin the first report card were that Mexican children and youth had low levels of PA and high levels of sedenrarybehavior.The fir'streport card also showedthat data for indicators of physical activity were scarceand lackednationalrepresentation.e

the most ¡ecent The 2014 MexicanReportCa¡d summa¡izes behavioramongchildren evidencedealingwith PA and sedentary andyouth thatcanbe usedto inform publicpoliciesandprograms.

Methods

The Mexico Repon Card working group included experts from and academicinstitutionsin Mexico,CanadaandtheUnitedStates, from governmentalagenciesin Mexico. A searchofthe English and SpanishlanguageIiteraturewasconductedin the summerof20l3. The main sourcesof data were the National Health and Nutrition Survey (ENSANUT) 2012,athe NationalYouth Survey2010,r1 reportsfrom public institutionssuchasthe NatioDalCommissionon andpublishedacademic PhysicalCultureandSpods(CONADE),12 articles.The literaturesearchlor publishedaíicles was conducted on major databasesincludingAcademicSearchComplete,EBSCO host, Web of Scienceand Medline for English articles,and on SCIELO, Cochrane México and Bíbliotecq vírtluL en Sqlud for Spanishanicles.Articlesreportingon Mexicanpopulations1-25 yearsof age published from 2010 forwa¡d were included. Consistentwith the Global Matrix of ReportCard Grades,rl we¡e conside¡ed(Table 1). National surveys(n = 2), indicators 9 govemmentreports(n = l0), and academicarticles(n = 22) were examinedto gather information relevantto each indicato¡.Glades for each indicato¡ were assignedby consensusduring a meetrng with held with the Mexican Report Card team and membe¡sfrom the Rod¡iguez Martincz (cor¡espondingauthor: [email protected])is (ITESO), Report Card team. The grading schemefor the Mexican AHKC tle Occidcnte Supcriores dc Estudios the Instituto Tecnológico Report Culd wr¡ bJsedon Ihe nation¡l gra.lingsystem.where Jalisco,México. G¡laviz is with thc SchoolofKincsiolosy anclHcdlü Studnumbe¡s below 5 representfailing grades and numbe¡s above 6 ies, Queen'sUnivcrsity,Kingston, Ontario, Canada.Ulloa is with the Ministry of Health.Jalisoo,Guadalajiua,Jalisco,México 6onzalez-Casanova representapprobatorygrades.raBasedon the AHKC lettergrading scheme,the corrcspondinglettersfor eachgradewere alsoincluded is w¡th the Hubert DepartmentofClobal Health, Rollins School ofPublic Assignedgradeswereas [ollows:9-10 = Health, Emory University.Atlanta, GA. López y Taylor is with the State to facilitateco¡nparisons. A, we are succeedingwith a large majority of children and yooth Councilfo¡the Promotionof Sports(CODE), Guadalajara,Jalisco,México

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lvlexico's 2014ReportCard (811o-l007o),7-8 = B, we are succeedingwith well over half'ol' with childrenand youth(6lVo-80V;):5-ó= C, we are succeeding aboutone-halfofchildrenandyouth (417a-6OVo):34=D, we are succeedingwith relativelyfew children and youth (21% 40olo);and of children with very smallpercentage 0-2 = F, we aresucceeding and yourh (O7a-20Va).

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assessed and the PA neasure enployed in 2006 dill¿red from those recognizingthe increasein PA employedin 2012. Nevertheless, levelsbetween2006 and 20l2 rnd allowing for dilferencesin the methodology,tbe grade lor the 2014 ReportCard was inc¡eased from 5-6.

OrganizedSports Participation:4 (D)

Results

of children10 l4years ENSANUT 2012estirnated thalonly ,117o of ageparticipated in I or more organizedspor'lsin the previousI 2 Grades assignedfor the 2012 and 2014 Mexican Report Cards months while 59% did not participate in organizedsports in the are summa¡izedin Table l. while the front cover is illustrated in previousl2 months.4Rel¡tive to competitivesports,the National Figure l. YouthSportsCamesareheld everyyear in Mexico; youth representing everystatein the countrycompetein 46 sportsdisciplines.22 According to internal reports I'rom the CONADE, about 4 million Overall Physical Activity Level:6 (C+) athletespaÍicipatedin the qualifyingevents,¡rld 24,739athletes Data from ENSANUT 2012 showedthat 597oof Mexican ado- participated in the 2013 games.Givendatafiom ENSANUT 2012 of 60 lescentsbetweenl5 18 yearsmet the PA recommendation and informationon the NationalYouth SportsCarnesa gradeof physicalactivity (MVPA) per minutesof moderate-to-vigorous 4 was assigned. This indicatorwas not gradedin the 2012 MexiENSANUT 2012alsoindicatedthat2370ofthis population can ReportCard due to insufllcientdata.As such,the assigned day.a15 was inactive.However,theseproportionswere betterthan those grade representsthc first assessment of sports participationin reponedin the 2006su¡vey,where3570of children were physically Mexico. Individuul sludiesconductedin activeand 4070were inactive.r6 Mexico showedthat PA decreaseswith age and that activity levels differ by sex.r?2rChangesin PA obse¡vedbetweenENSANUT Active PIay:Incomplete 2006and2012 wereinterpretedwith cautionbecausethe agegroup This indicatorwas not includedin the 2012 ReportCard. It was includedin the 2014 ReportCard to emphasizethe it¡portalrceof unorganizedplay as a naturaltriggerof PA in chilspontaneous, dren.Aclive play has a significantimpact on cnerly expcndrture andshouldbe pan of effortsdirectedat promotingphysicalactivity amongchildren.:lNo datawere availableto gradethis indicatorin the presentReportC¡rd.

ActiveTransportation:7 (8,

Figure 1 - Front covcr of the 2014 Mcxican Report Card on Physical Activitv for ChildrenandYouth.

ENSANUT 2012showedthat66cloofchildrenl0 14yearswalked while a studydonein 2000showedthatvirtuallyall pri to school,a mary schoolchildren6-13 years(n = 688) from bothrural andurban areasin Oaxacaw¡lked to school.2rDifferencesin lhe estimated numberofsteps to schooltakenby boys andgirls welc alsoobserved This indicatorwasnot gradedin thc 2012Repor(Card in this stLrdy.']' The fact datawere nonexistcnt. becausenationallyrepresentative thatthis indicatorwasincludedin ENSANUT 2012is encouraging is beingrecognizedas that activetransportation and demonstrates an import¿ntdo¡nainof PA in Mexico.Basedon tllis trendandthe fact thal more than half of the surveyedchildren engagedin active to school,a gradeof 7 was assigned. transportation

Table1 Gradesfor Each PhysicalActiv¡ty Indicator in the 2012and 2014 Mexican Report Cards lnd¡cator Overall PhysicalActivity Levels OrganizedSport Participation Active Play Activc Transportation SedentaryBehavior Family and Peers School

2012lettergrades*

c INC Not included INC C INC D.

Communityand thc Built Environment

INC

Govemmcnt strategiesand investments

B

2014lettergrades C+ D INC B D INC D F C

* Lerer grudeswere used in rhis Éble ro l¡ci1ir¡rrecomparisonwith oiher rcport crrds. For lhc nutrrber8r.rdc\ plerse sc< lhe re\ulls !cÜLion

576

Rodriguez Martinez et al

SedentaryBehavior:4 (D)

tion. An establishedprogram launchedby the Secrctaryof Health during the previousadministrationis the 5 Pasosprogram,36where Overall,6lqo of lG-l8 years old children and youth spent more children, adults, and older adults are encouragedto engagein PA than 2 hours per day in front of a screen,but the prevalencewas and other healthybehaviors.CONADET2haslaunchedschoolprosignificantlyhigheramongurbanthanrural populations(73% vs. grams, such as TochítoBandera and Tenísve q tu Escuela, wtth Althoughthe CanadianSedentaryBehaviorGuidelines the goal of promoting PA among children at school.Howeyer,the 5l7o).4,24 recommendno more than 2 hours of screentime per day,25more implementation andimpactof suchprogramsremainsunknown.To than one-halfo[ Mexican children and youth did not meet this inform cur¡ent and future programscritical evaluationof existing recommendation.Severalindividual studies indicated that Mexistntegiesis imperative. can children 6-l I yearsspent,on average,2.5-3 hours per day in which was consistentwith ENSANUT 2012 f¡ont of a screen.2r2E of sedentarybehavior estimates.4 Giventhe increasein prevalence (screentime), the grade for this indicator was reducedf¡om 5 in The resultsof lhe 2014MexicanReportCardon PhysicalActivity the 2012ReportCardeto 4 in 2014. of Children and Youth highlight the needto improve gradesfor all indicators where data are available.According to the best availFamilyand Peers:Incomplete ableevidence,nlost Mexican childrenand youth do not meetthe in eitherthe 2012or the2014Mexi- recommendationof 60 minutes of MVPA every day.aMoreover, A gradecouldnot be assigned can Report Cards.Data a¡e lacking, which highlights the needlbr the percentageof children and youth engagingin 2 or more hours systematicdatato gradeindicator. of screentime per day increasedbetween2012 and 2014, suggesl.inga potential worsening of sedentarybehavior patterns in the country. In responseto a growing concem for the epidemic of (D) School:4 childhoodobesity,lthe Mexicangovernmenthasproposedseveral Data on PA and ¡elatedprogramsimplementedin schoolsarc very policies to promote PA in Mexican child¡en and youth.rr However, limited. Existing interyentionstudiesprovide a snapshotof PA in formal evaluationsare slill unclerway,and the elfect of the policy schools.A randomizedcontrol trial in public elementaryschoolsin on childrenand youth PA remainsunknown. Mexico City notedthat lO-year-oldchildren (n = 699) completed, Comparedwith the 2012 MexicanReportcard,resultsof the on average,3513stepsduring a schoolday (inter quartilerange cunent edition show improvementsin severalindicatorswith suf264É693 steps)."A similarstudyin Mexico City publicschools ficient datafor grading (eg, organizedsports,activetranspofiation, showedthat schoolchildren(n = 899) spent 16 and 9 minutesin community and built environment), but poorer grades on other MVPA during physical education(PE) and recess,respectively.r0 indicatorswhere compadsonsare possible(sedentarybehaviorand Although limited to the major metropolitan area of Mexico, the govemment). Small improvements were registeredfor PA levels data suggestrelatively little PA in schools.Although a grade of 3 and school.Although a relatively large inuease (35Vo-597o)in fhe was assignedin the 2012 Repon Card, it was increasedto 4 in the percentageof Mexican child¡en meetingthe PA recommendations cunent report card.The increasewas given mainly becauseof the wasnoted,this is probably an artit'actofmethodologicaldifferences of governmentcfforts, spccilicallythe National implementation editionsoftheMexican b€tweenstudiesin thepreviousandpresent aimed FoodHealthStrategy20l0rr which fostersspecilicstrategies report card. As a result, the overall PA grade was increasedonly at promotingPA within schools. slightly to acknowledgethe positivechangewithout overlooking the potentiallimitations.Similarly,a slight increasein the grade (F) Communityandthe Built Environment:1 fo¡ the school ildicator was decided due to tlle implementatiol'l of the National Food Health Strategy,rrwhich introducedschoolA failing grade was assignedto this indicator in 2014, although a based strategiesfor promoting PA. The impact of such st¡ategies gradecould not be assignedin the 2012 repof card due to the lack is being evaluated.As mentionedearlier,the lack ofpubcurrently of Spons Infrastructure,32 National Census data. Based on the of and on the Municipal SportsCenterswebsite,r3it was concluded lishedevaluationsof nationalpoliciesfor the promotionof PA in that the ayailablesportsand PA relatedinfrastructurewere not suf- Mexican children and youth is a major limitation that needsto be for childrenand youth. Promising addressed. llcientto provideopportunities programsfor promotingPA within the community(eg, VíaRecrc' andfor providing the infrastructureto bike within the city rzcliva)3a Recommendations (eg,Mueveteen Bíci)35havebeenimplemented,but thesestralegies it is impoltant to continuescientificand govhavenot beenscaled-upac¡ossthe country and their effectivenessis Moving forward, to obtain reliableand high quality su¡veillance unknown.More dataa¡e neededto assessboth the availability and emmentaleffofs (both and objective) to evaluatechangesin PA data self-reported the impact of opportunitiesprovided in the community and built and youth.TheseeffoÍs shouldinclude Mexican children Ievels of environmentsof Mexico. evaluationsof the implementation and impact of cufient policies and programsto improve the PA and sedentarybehaviorsamong Government:6 (C) suchas this population.Internationaland nationalcollaboralions, Card, presellt Report of the the development during those formed which included 2010,31 Strategy National Food Health Basedon the fol ward field move thc ideas, aimedat encouragingPA amongchildren,a are a meansto exchangeinnovaLive specinccomponents model Card The Report context. to the Mexican strategies gradeof 7 wasassigned to this indicatorin the 2012 ReportCard. andtailor lo ó in 2014 as thc proposedstrutcgies representsa successfi¡lknowledge translation tool?'8that should The grader¡as tlccreased public policicsand are still in the developmentalor implementationstageeYenthough continueto be used and ¡cfined !o influence addressingphysicalinactivity is a priority for the new adnrinislra- programsin Mexico.

Discussion

Mexico's2014FleportCard

Limitations Becauseofthe linriteddataavailable,only 7 ofthe 9 indicato¡scould be graded.This limits conclusionsand comparisonswith Report Cardsfrom other countdes.Most studieslack national representation and/oradequate¡esearchmethodology.As a result,most olthe resultsin this repof cardare basedon ENSANUT 2012.Further, the PA and sedentarybehaviordata used in this Report C rd were mainly self-reported, which may bias true eslimates.Finally,evidence about the ellectivenessof cur¡ent policies and programsis lacking, which preventsconclusionson their potential to promote PA amongchildrenand youth.

Conclusion PA levels of Mexican children and youth continued to be below the recommendedstaldard of international guidelines.Likewise, children and youth also exceededthe recommendationsfor screen time and as suchhavehigh levelsof sedentarybehavio¡.Nevertheless,govemmentstrategiesto promote PA havebeen implemented over the past few yea¡s,albeit their effectivenessis unknown. The Report Card model representsa successfulknowledge tanslation tool tha(shouldcontinueto be uscdandrelinedto potentiallyinfluencepublicpoliciesandprogramsin Mexico. Acknowledgments oftheMcxicoReporiCardwork Theauthors thankthefollowingmembers to the2014Mexica¡ReportCard.Fortheir inggroupfor thcircontributions Gonzalez, wethankDr JorgeSanchez paficipationin thegradingproccss, of PlieSoRayas,Coordinator AcademicViceRcctorUAG,Dr.Ale.jandro andAnlonio in ITESOUniversity, andllcalthDepa-rtment PhysicalActivity in Dc¡nof MedicalScicnces UAG.Fortheircontribution RiveraCisncros. we thankItzueNavilrroPeña,Managcrof the the datagatheringproccss, ProgramPonteal 100Jalisco.TeresitaMendezB¡avo,MSc. Candidat€ from CONADE. andLic. CiovanniG¿r¡rido.

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