Relationships between several built environment factors and physical activity and walking behavior are well established, but internationally-comparable built environment measures are lacking. The Microscale Audit of Pedestrian Streetscapes (MAPS)-Global is an observational measure of detailed streetscape features relevant to physical activity that was developed for international use. This study examined the inter-observer reliability of the instrument in five countries. MAPS-Global was developed by compiling concepts and items from eight environmental measures relevant to walking and bicycling. Inter-rater reliability data were collected in neighborhoods selected to vary on geographic information system (GIS)-derived macro-level walkability in five countries (Australia, Belgium, Brazil, Hong Kong-China, and Spain). MAPS-Global assessments (n = 325) were completed in person along a ≥ 0.25 mile route from a residence toward a non-residential destination, and a commercial block was also rated for each residence (n = 82). Two raters in each country rated each route independently. A tiered scoring system was created that summarized items at multiple levels of aggregation, and positive and negative valence scores were created based on the expected effect on physical activity. The intraclass correlation coefficient (ICC) was computed for scales and selected items using one-way random models. Overall, 86.6% of individual items and single item indicators showed excellent agreement (ICC ≥ 0.75), and 13.4% showed good agreement (ICC = 0.60–0.74). All subscales and overall summary scores showed excellent agreement. Six of 123 items were too rare to compute the ICC. The median ICC for items and scales was 0.92 with a range of 0.50–1.0. Aesthetics and social characteristics showed lower ICCs than other sub-scales, but reliabilities were still in the excellent range (ICC ≥ 0.75). Evaluation of inter-observer reliability of MAPS-Global across five countries indicated all items and scales had “good” or “excellent” reliability. The results demonstrate that trained observers from multiple countries were able to reliably conduct observations of both residential and commercial areas with the new MAPS-Global instrument. Next steps are to evaluate construct validity in relation to physical activity in multiple countries and gain experience with using MAPS-Global for research and practice applications.

Summarize the effects of interventions designed to promote physical activity during elementary school recess in children between 5 and 10 years old. Effective school interventions for children can promote physical activity and healthy behaviors. PubMed, Scopus, Bireme, SciELO, Web of Science, PsychINFO, Proquest, Physical Education Index, Sports Discus, and Eric databases were included in the data search. Original intervention articles on physical activity that used regression methods, published between 2000 and 2019 in English, Portuguese and Spanish were analyzed. Analyses were performed in 2019. Outcomes were organized according to the direction of the association by independent variables. Ten articles were considered eligible for data extraction and evaluation. Several strategies were used including playground markings, demarcation of physical activities zones, group activities, availability of sports equipment and facilities. Most of the studies were conducted in the United States. Recess periods ranged from 20-94 min per day and intervention time ranged from 6 weeks to 2 years. Recess duration and intervention effects were positively associated with physical activity. Gender (girls) and age (oldest) were negatively associated with physical activity during recess. Interventions based on modifications of school environment such as playground markings demarcation of physical activities zones, group activities, availability of sports equipment and facilities are cheap and cost-effective for increasing physical activity in school recess.

OBJECTIVE: To analyze the moderator effect of socioeconomic status in the association between the perceived environment and active commuting to school. METHODS: A total of 495 adolescents and their parents were interviewed. Perceived environment was operationalized in traffic and crime safety and assessed with the Neighborhood Environment Walkability Scale. Active commuting was self-reported by the adolescents, categorized in walking, bicycling or skating at least one time/week. Socioeconomic status was used as moderator effect, reported from adolescents’ parents or guardians using Brazilian standardized socioeconomic status classification. Analyses were performed with Poisson regression on Stata 12.0. RESULTS: Prevalence of active commuting was 63%. Adolescents with low socioeconomic status who reported “it is easy to observe pedestrians and cyclists” were more likely to actively commute to school (PR = 1.18, 95%CI 1.03–1.13). Adolescents with low socioeconomic status whose parents or legal guardians reported positively to “being safe crossing the streets” had increased probability of active commuting to school (PR = 1.10, 95%CI 1.01–1.20), as well as those with high socioeconomic status with “perception of crime” were positively associated to the outcome (PR = 1.33, 95%CI 1.03–1.72). CONCLUSIONS: Socioeconomic status showed moderating effects in the association between the perceived environment and active commuting to school.

RESUMO: Introdução: A prática de deslocamento ativo para a escola pode ser uma maneira de aumentar a atividade física entre os adolescentes, no entanto pouco se sabe sobre o ambiente no entorno das escolas, bem como a distância até a escola pode afetar esse comportamento. Objetivo: Analisar a associação entre as características do ambiente no entorno da escola, a distância da residência e o deslocamento ativo de adolescentes de Curitiba, Brasil. Métodos: Quatrocentos e noventa e três adolescentes foram entrevistados e 124 escolas foram avaliadas. As variáveis do estudo incluíram as características de acessibilidade no entorno da escola por observação sistemática e a distância da residência até a escola por Sistemas de Informações Geográficas (SIG). Resultados: A presença de “placas de segurança” (RP = 0,78; IC95% 0,66 - 0,91; p = 0,003) apresentou associação inversa ao deslocamento ativo dos adolescentes, bem como as distâncias 1.500-3.500 m (RP = 0,53; IC95% 0,40 - 0,71; p < 0,001) e ≥ 3.501 m (RP = 0,29; IC95% 0,18 - 0,45; p < 0,001). No geral, o entorno das escolas se mostrou favorável à caminhada. Conclusão: A segurança no trânsito e a distância entre a escola e a residência associaram-se com o deslocamento ativo entre adolescentes do estudo. Políticas que integrem acesso a escolas próximas à residência e segurança no trânsito podem contribuir para o incentivo ao deslocamento ativo até a escola entre adolescentes.

Aim: To test the association between sociodemographic and social characteristics with COVID-19 cases and deaths in small and large Brazilian cities. Methods: This ecological study included COVID-19 data available in State Health Secretaries (managed by brasil.io API) and three national databases (IBGE, DATASUS and Embrapa). Temporal spread of COVID-19 in Brazil during the first year considered as outcome: a) days until 1^st case in each city since 1^st in the country; b) days until 1,000 cases/100,000 inhabitants since 1^st case in each city; c) days until 1^st death until 50 deaths/100,000 inhabitants. Covariates included geographic region, city social and environmental characteristics, housing conditions, job characteristics, socioeconomic and inequalities characteristics, and health services and coverage. The analysis were stratified by city size into small (<100,000 inhabitants) and large cities (≥100,00 inhabitants). Multiple linear regressions were performed to test associations of all covariates to adjust to potential confounders. Results: In small cities, the first cases were reported after 82.2 days and 1,000 cases/100,000 were reported after 117.8 days, whereas in large cities these milestones were reported after 32.1 and 127.7 days, respectively. For first death, small and large cities took 121.6 and 36.0 days, respectively. However, small cities were associated with more vulnerability factors to first case arrival in 1,000 cases/100,000 inhabitants, first death and 50 deaths/100,000 inhabitants. North and Northeast regions positively associated with faster COVID-19 incidence, whereas South and Southeast were least. Conclusion: Social and built environment characteristics and inequalities were associated with COVID-19 cases spread and mortality incidence in Brazilian cities.

Counseling by health professionals has promising results in behavior change and is recommended as part of integrated community interventions. However, the knowledge about sedentary behavior (SB) counseling is incipient. The study aimed to identify the prevalence and explore the associated factors with SB counseling received from healthcare professionals by adults in primary health care (PHC) in Brazil. A cross-sectional study was conducted in 2019 that included a representative sample of 779 users in all 15 basic health units (BHU) in São José dos Pinhais, Paraná. We identified those who reported having received SB counseling during a consultation. The association between the sociodemographic factors, chronic diseases, access to health services, physical activity, SB, and counseling were analyzed using Poisson regression in a hierarchical model. The prevalence of counseling was 12.2% (95% CI: 10.1–14.7%); it was higher in women (PR: 1.77; 95% CI: 1.10–2.83), those aged ≥60 yrs (PR: 1.84; 95% CI: 1.14–2.98), BMI ≥ 30 kg/m² (PR: 2.60; 95% CI: 1.31–5.17), who consume ≥3 medications (PR: 2.21; 95% CI: 1.06–4.59), and those who spend a prolonged period of the day engaged in SB (4th quartile PR: 3.44; 95% CI: 1.88–6.31). The results highlight that SB counseling is underutilized and incipient in PHC. Understanding these results can help managers and healthcare professionals in BHU teams to implement and direct specific actions to reduce SB in adults through counseling.