A regional vision of physical activity, sedentary behaviour and physical education in adolescents from Latin America and the Caribbean: results from 26 countries

A regional vision of physical activity, sedentary behaviour and physical education in adolescents... Abstract Background Latin America and the Caribbean (LAC) countries, have been historically under-represented due to the lack of surveillance of physical behaviours in young populations. Therefore, the aim of this study was to describe and compare overall physical activity (PA), active transportation to and from school (i.e. walking or cycling), physical education (PE) participation, and sedentary behaviour (SB) in adolescents from 26 countries in LAC. Methods Data were collected in the Global School-based Student Health Survey (2007–13). Prevalences for each physical behaviour were compared by sex across the region. Results In total, 64 034 adolescents provided complete data (age range: 11 to 18 years; 47.7% male). Only about 15% of adolescents in LAC countries were physically active (at least 60 min/day of moderate-to-vigorous PA) with most countries showing sex disparities. Overall, 41.9% reported being active for transportation to and from school at least 3 days per week. In 12 countries, at least 50% of the adolescents reported sitting ≥3 h per day outside school, and a third of adolescents reported participation in PE classes on 3 days or more per week. Conclusions The study sets a challenge for the LAC region, as physical inactivity and SB are highly prevalent across all countries. Gender inequity was shown in most countries, with boys reporting more active behaviours. Regional and national actions for implementing policies to revert this situation are urgent. Physical inactivity, surveillance, active transportation, sitting, inequity, physical education provision, sedentary lifestyle Key Messages Only 15% of adolescents from Latin America and the Caribbean (LAC) countries met the physical activity recommendations. Sedentary behaviour was highly prevalent in LAC countries and was positively correlated with the Human Development Index. Sex disparities in physical behaviours were shown in most LAC countries. Although LAC countries have high levels of policy implementation for physical education in schools, only a third of adolescents reported participation in physical education classes on 3 days or more per week. Introduction Physical inactivity and sedentary behaviour (SB) are highly prevalent in adolescents across the world and are affecting not only high-income nations, but also low- and middle-income countries (LMICs).1–3 Therefore, a global call for action has been made to join efforts among countries in order to improve knowledge and change the world trend of increasing physical inactivity and SB.4,5 However, some regions, especially Latin America and the Caribbean (LAC), have been historically under-represented due to the lack of surveillance in this age group.6 To tackle this multinational issue, the World Health Organization (WHO) planned a Global School Health Survey (GSHS).7,8 Since 2003, the GSHS has been implemented to obtain systematic information among 13- to 17-year-old students to support programmes and policies for school and youth health globally. The GSHS offers an opportunity to better understand physical behaviours as a part of monitoring physical activity (PA) and SB,7 and includes other related factors that make contributions to increasing the chances of meeting PA recommendations in adolescents, such as active transportation (AT) and physical education (PE).9,10 Advances in monitoring and regional analysis of the current levels of physical behaviours in adolescents will provide a better picture for understanding cross-national differences in LAC countries and, therefore, help in the design of informed policies for PA promotion. The aim of this study was to describe and compare overall PA, PA for transportation, PE participation, and SB in adolescents from 26 countries in LAC. Methods Sampling Public data of 26 countries from LAC included in the GSHS were analysed in those surveys conducted between 2007 and 2013. Country participation was voluntary. A two-stage cluster sample design was used to produce representative data of adolescent students for each country. At the first stage, schools were selected with probability proportional to enrolment size. At the second stage, classes were randomly selected and all students in selected classes were eligible to participate.7 All countries provided nationally representative samples, except for Colombia and Ecuador, which provided data from their capital cities only. Questionnaires were self-administered and completed during one regular class period. Student participation was voluntary and private. Informed consent was completed by students, parents and schools’ representatives. Instrument The GSHS questionnaire included 10 core modules that address the leading causes of morbidity and mortality among children and adults worldwide.7 Countries were required to include at least six of the 10 core modules with no changes in their questionnaires. Age, height and weight were self-reported. Body mass index (BMI) was calculated by dividing the weight in kilograms by height in metres squared. From the median BMI for age and sex, students were categorized as overweight if their BMI was >+1 standard deviation (SD) and obese if their BMI was >+2SD using the WHO growth reference.11 PA was assessed with the following question: ‘During the past 7 days, on how many days were you physically active for a total of at least 60 minutes per day? Add up all the time you spent in any kind of physical activity each day’. Adolescents were classified as ‘physically active’ if they engaged in PA for at least 60 min every day of the week. The question: ‘During the past 7 days, on how many days did you walk or ride a bicycle to or from school?’ was used to assess AT. Adolescents were classified as ‘active for transport’ if they rode or walked to and from school on at least 3 days during the past 7 days. PE class participation was assessed by asking: ‘During this school year, on how many days did you go to physical education class each week?’. SB was assessed with the question: ‘How much time do you spend during a typical or usual day sitting and watching television, playing computer games, talking with friends or doing other sitting activities, such as (country-specific examples)?’. Adolescents were considered ‘sedentary’ if they spent 3 or more h per day sitting outside school.12 Statistical analysis Participants with missing data for age, sex, number of physically active days, number of days for active transport, number of PE classes per day, and amount of time spent sitting outside school were excluded from the analysis, except for countries in which those core modules were not included. Survey data settings in Stata, version 13 (StataCorp, College Station, TX, USA) were used to consider the weighting for each observation and the two-stage sample design of the GSHS. Data were summarized in medians (percentiles) and percentages [95% confidence interval (CI)]. Relative differences of prevalences for each domain between sexes and by country were also calculated and used as measure of disparity. Logistic regressions were used to assess differences between sexes. Spearman correlational analyses were performed to assess how both prevalences and relative differences between sexes of PA, AT, PE participation and SB were individually correlated to some global and demographic indices, including: the Human Development Index (HDI, 2008–16 data, a high index represents greater human development),13 Gender Inequality Index (GII, 2016 data, a higher score represents greater gender inequality)14 and the Gini Coefficient (GC, 2010–15 data, a higher coefficient represents greater income inequality).15,16 The GII was unavailable for most Caribbean countries, such as Cayman Islands, British Virgin Islands, Montserrat, Saint Kitts and Nevis, Grenada, Dominica and Saint Vincent, and the Grenadines (7/26), and the GC was missing for Antigua and Barbuda, Bahamas, Guyana, Montserrat, Saint Kitts and Nevis, and Trinidad and Tobago (5/26). The motorization rate (MR, number of all vehicles per 1000 inhabitants) was also used to assess its correlation with physical behaviours.17 Age and sex were included for covariate adjustment in comparisons across groups and correlations. Results In total, 64 034 adolescents from 26 LAC countries provided complete data out of 79 419 surveyed participants. Survey and sample characteristics of the study are shown in Table 1. The average response rate was 79.8% and ranged from 60.0% (Chile) to 90.0% (British Virgin Islands, and Trinidad and Tobago). The percentage of male participants ranged from 43.6% (Grenada) to 52.9% (Guatemala). The lowest prevalence of overweight participants was observed in Colombia (10.8%) and the highest was found in Chile (28.6%). Obesity prevalence by country ranged from 1.2% (Colombia) to 21.5% (Argentina). No demographic differences were observed between students with complete data and those excluded because of missing data. Table 1 Survey year, response rate, sample size and characteristics for each Latin American and Caribbean country included in the study Country Survey year Response rate (%) Total sampleb Mean age (95% CI) Male % Overweight % Obesity % Antigua and Barbuda 2009 67 1112 13.9 (13.9–14.0) 51.9 – – Argentina 2012 71 16 383 14.4 (14.3–14.4) 48.2 21.9 6.0 Bahamas 2013 78 1124 13.5 (13.4–13.6) 47.0 23.6 21.5 Barbados 2011 73 1266 14.2 (14.1–14.2) 50.4 17.6 14.6 Belize 2011 88 1834 13.9 (13.6–14.1) 47.9 23.2 13.3 Bolivia 2012 88 3296 14.4 (14.2–14.6) 50.8 17.8 4.8 British Virgin Islands 2009 90 1429 14.1 (14.0–14.1) 47.4 20.1 19.9 Cayman Islands 2007 79 1162 13.9 (13.9–14.0) 48.8 20.9 12.8 Chile 2013 60 1888 15.1 (14.8–15.4) 48.3 28.6 14.1 Colombiaa 2007 83 1705 14.2 (13.9–14.5) 45.8 10.8 1.2 Costa Rica 2009 72 2601 14.3 (14.1–14.5) 50.4 19.1 9.0 Dominica 2009 84 1464 14.0 (13.7–14.4) 50.4 16.3 10.1 El Salvador 2013 88 1783 14.2 (14.1–14.4) 51.7 19.7 9.2 Ecuadora 2007 86 2105 13.4 (13.2–13.7) 51.3 24.2 8.3 Grenada 2008 78 1364 14.1 (13.7–14.4) 43.6 – – Guatemala 2009 81 5194 14.3 (14.2–14.4) 52.9 20.0 7.6 Guyana 2010 76 2215 14.3 (14.2–14.5) 48.1 11.1 4.4 Honduras 2012 79 1644 13.9 (13.7–14.0) 46.7 13.1 5.2 Montserrat 2008 78 194 14.3 (14.1–14.5) 45.8 – – Peru 2010 85 2806 14.4 (14.3–14.5) 50.5 16.9 3.0 Saint Kitts and Nevis 2011 70 1627 14.5 (14.4–14.5) 50.3 18.4 14.2 Saint Lucia 2007 82 1227 14.1 (13.7–14.4) 45.0 – – Saint Vincent and Grenadines 2007 84 1191 13.7 (13.3–14.0) 45.8 – – Suriname 2009 89 1568 14.7 (14.5–15.0) 49.0 13.2 6.8 Trinidad and Tobago 2011 90 2543 13.7 (13.6–13.9) 48.9 15.4 14.0 Uruguay 2012 77 3309 14.4 (14.3–14.5) 45.4 19.7 6.9 Country Survey year Response rate (%) Total sampleb Mean age (95% CI) Male % Overweight % Obesity % Antigua and Barbuda 2009 67 1112 13.9 (13.9–14.0) 51.9 – – Argentina 2012 71 16 383 14.4 (14.3–14.4) 48.2 21.9 6.0 Bahamas 2013 78 1124 13.5 (13.4–13.6) 47.0 23.6 21.5 Barbados 2011 73 1266 14.2 (14.1–14.2) 50.4 17.6 14.6 Belize 2011 88 1834 13.9 (13.6–14.1) 47.9 23.2 13.3 Bolivia 2012 88 3296 14.4 (14.2–14.6) 50.8 17.8 4.8 British Virgin Islands 2009 90 1429 14.1 (14.0–14.1) 47.4 20.1 19.9 Cayman Islands 2007 79 1162 13.9 (13.9–14.0) 48.8 20.9 12.8 Chile 2013 60 1888 15.1 (14.8–15.4) 48.3 28.6 14.1 Colombiaa 2007 83 1705 14.2 (13.9–14.5) 45.8 10.8 1.2 Costa Rica 2009 72 2601 14.3 (14.1–14.5) 50.4 19.1 9.0 Dominica 2009 84 1464 14.0 (13.7–14.4) 50.4 16.3 10.1 El Salvador 2013 88 1783 14.2 (14.1–14.4) 51.7 19.7 9.2 Ecuadora 2007 86 2105 13.4 (13.2–13.7) 51.3 24.2 8.3 Grenada 2008 78 1364 14.1 (13.7–14.4) 43.6 – – Guatemala 2009 81 5194 14.3 (14.2–14.4) 52.9 20.0 7.6 Guyana 2010 76 2215 14.3 (14.2–14.5) 48.1 11.1 4.4 Honduras 2012 79 1644 13.9 (13.7–14.0) 46.7 13.1 5.2 Montserrat 2008 78 194 14.3 (14.1–14.5) 45.8 – – Peru 2010 85 2806 14.4 (14.3–14.5) 50.5 16.9 3.0 Saint Kitts and Nevis 2011 70 1627 14.5 (14.4–14.5) 50.3 18.4 14.2 Saint Lucia 2007 82 1227 14.1 (13.7–14.4) 45.0 – – Saint Vincent and Grenadines 2007 84 1191 13.7 (13.3–14.0) 45.8 – – Suriname 2009 89 1568 14.7 (14.5–15.0) 49.0 13.2 6.8 Trinidad and Tobago 2011 90 2543 13.7 (13.6–13.9) 48.9 15.4 14.0 Uruguay 2012 77 3309 14.4 (14.3–14.5) 45.4 19.7 6.9 a Only regional representation. b Participants with no missing data. Table 1 Survey year, response rate, sample size and characteristics for each Latin American and Caribbean country included in the study Country Survey year Response rate (%) Total sampleb Mean age (95% CI) Male % Overweight % Obesity % Antigua and Barbuda 2009 67 1112 13.9 (13.9–14.0) 51.9 – – Argentina 2012 71 16 383 14.4 (14.3–14.4) 48.2 21.9 6.0 Bahamas 2013 78 1124 13.5 (13.4–13.6) 47.0 23.6 21.5 Barbados 2011 73 1266 14.2 (14.1–14.2) 50.4 17.6 14.6 Belize 2011 88 1834 13.9 (13.6–14.1) 47.9 23.2 13.3 Bolivia 2012 88 3296 14.4 (14.2–14.6) 50.8 17.8 4.8 British Virgin Islands 2009 90 1429 14.1 (14.0–14.1) 47.4 20.1 19.9 Cayman Islands 2007 79 1162 13.9 (13.9–14.0) 48.8 20.9 12.8 Chile 2013 60 1888 15.1 (14.8–15.4) 48.3 28.6 14.1 Colombiaa 2007 83 1705 14.2 (13.9–14.5) 45.8 10.8 1.2 Costa Rica 2009 72 2601 14.3 (14.1–14.5) 50.4 19.1 9.0 Dominica 2009 84 1464 14.0 (13.7–14.4) 50.4 16.3 10.1 El Salvador 2013 88 1783 14.2 (14.1–14.4) 51.7 19.7 9.2 Ecuadora 2007 86 2105 13.4 (13.2–13.7) 51.3 24.2 8.3 Grenada 2008 78 1364 14.1 (13.7–14.4) 43.6 – – Guatemala 2009 81 5194 14.3 (14.2–14.4) 52.9 20.0 7.6 Guyana 2010 76 2215 14.3 (14.2–14.5) 48.1 11.1 4.4 Honduras 2012 79 1644 13.9 (13.7–14.0) 46.7 13.1 5.2 Montserrat 2008 78 194 14.3 (14.1–14.5) 45.8 – – Peru 2010 85 2806 14.4 (14.3–14.5) 50.5 16.9 3.0 Saint Kitts and Nevis 2011 70 1627 14.5 (14.4–14.5) 50.3 18.4 14.2 Saint Lucia 2007 82 1227 14.1 (13.7–14.4) 45.0 – – Saint Vincent and Grenadines 2007 84 1191 13.7 (13.3–14.0) 45.8 – – Suriname 2009 89 1568 14.7 (14.5–15.0) 49.0 13.2 6.8 Trinidad and Tobago 2011 90 2543 13.7 (13.6–13.9) 48.9 15.4 14.0 Uruguay 2012 77 3309 14.4 (14.3–14.5) 45.4 19.7 6.9 Country Survey year Response rate (%) Total sampleb Mean age (95% CI) Male % Overweight % Obesity % Antigua and Barbuda 2009 67 1112 13.9 (13.9–14.0) 51.9 – – Argentina 2012 71 16 383 14.4 (14.3–14.4) 48.2 21.9 6.0 Bahamas 2013 78 1124 13.5 (13.4–13.6) 47.0 23.6 21.5 Barbados 2011 73 1266 14.2 (14.1–14.2) 50.4 17.6 14.6 Belize 2011 88 1834 13.9 (13.6–14.1) 47.9 23.2 13.3 Bolivia 2012 88 3296 14.4 (14.2–14.6) 50.8 17.8 4.8 British Virgin Islands 2009 90 1429 14.1 (14.0–14.1) 47.4 20.1 19.9 Cayman Islands 2007 79 1162 13.9 (13.9–14.0) 48.8 20.9 12.8 Chile 2013 60 1888 15.1 (14.8–15.4) 48.3 28.6 14.1 Colombiaa 2007 83 1705 14.2 (13.9–14.5) 45.8 10.8 1.2 Costa Rica 2009 72 2601 14.3 (14.1–14.5) 50.4 19.1 9.0 Dominica 2009 84 1464 14.0 (13.7–14.4) 50.4 16.3 10.1 El Salvador 2013 88 1783 14.2 (14.1–14.4) 51.7 19.7 9.2 Ecuadora 2007 86 2105 13.4 (13.2–13.7) 51.3 24.2 8.3 Grenada 2008 78 1364 14.1 (13.7–14.4) 43.6 – – Guatemala 2009 81 5194 14.3 (14.2–14.4) 52.9 20.0 7.6 Guyana 2010 76 2215 14.3 (14.2–14.5) 48.1 11.1 4.4 Honduras 2012 79 1644 13.9 (13.7–14.0) 46.7 13.1 5.2 Montserrat 2008 78 194 14.3 (14.1–14.5) 45.8 – – Peru 2010 85 2806 14.4 (14.3–14.5) 50.5 16.9 3.0 Saint Kitts and Nevis 2011 70 1627 14.5 (14.4–14.5) 50.3 18.4 14.2 Saint Lucia 2007 82 1227 14.1 (13.7–14.4) 45.0 – – Saint Vincent and Grenadines 2007 84 1191 13.7 (13.3–14.0) 45.8 – – Suriname 2009 89 1568 14.7 (14.5–15.0) 49.0 13.2 6.8 Trinidad and Tobago 2011 90 2543 13.7 (13.6–13.9) 48.9 15.4 14.0 Uruguay 2012 77 3309 14.4 (14.3–14.5) 45.4 19.7 6.9 a Only regional representation. b Participants with no missing data. In most countries, boys had more active days per week than girls (Table 2). The weighted average percentage (by population size) of physically active adolescents across LAC countries was 15.5%. The least active adolescents were observed in Saint Vincent and Grenadines (12.8%), and the most active adolescents were from Antigua and Barbuda (22.8%). Only four countries had more than 20% of physically active adolescents (Antigua and Barbuda, Belize, Montserrat, and Trinidad and Tobago) (Figure 1A). The countries with the largest relative differences in percentage of active adolescents between boys and girls were Chile (49.2%), Costa Rica (51.0%), and Uruguay (60.1%). Only the relative difference between active boys and girls per country was positively correlated with the HDI (rho = 0.50, P = 0.01) and negatively correlated with the GII (rho=−0.58, P = 0.01) (Supplementary Figures, available as Supplementary data at IJE online). No correlations were observed between PA and the other indices (GC (P = 0.32), MR (P = 0.11)). Table 2 Median (P25–P75) days per week that adolescents engaged physical activity for at least 60 min and the percentage of physically active adolescents in Latin America and the Caribbean Country Median active days per week (P25–P75) Percentage of physically active adolescents on 7 days per week (95% CI) Overall Male Female P Overall Male Female P Antigua and Barbuda 2 (0–6) 3 (0–7) 2 (0–5) <0.001 22.8 (20.3–25.6) 28.5 (24.5–32.9) 16.7 (13.9–20.1) <0.001 Argentina 3 (1–5) 3 (2–6) 2 (1–4) <0.001 16.7 (15.6–17.8) 21.7 (20.2–23.2) 12.1 (11.0–13.4) <0.001 Bahamas 2 (0–4) 2 (0–5) 1 (0–4) 0.001 15.5 (13.3–17.8) 19.7 (16.3–23.7) 11.6 (9.3–14.4) <0.001 Barbados 2 (0–5) 3 (0–7) 2 (0–4) <0.001 18.6 (16.6–20.7) 24.7 (21.5–28.2) 12.9 (10.7–15.5) <0.001 Belize 2 (0–5) 3 (0–6) 2 (0–5) 0.001 21.2 (18.9–23.7) 24.6 (21.7–27.7) 18.0 (15.6–20.8) <0.001 Bolivia 2 (1–4) 2 (1–5) 2 (1–4) 0.001 13.9 (12.6–15.3) 16.6 (14.7–18.7) 11.1 (9.5–13.0) <0.001 British Virgin Islands 2 (0–5) 2 (0–6) 2 (0–4) <0.001 17.3 (15.5–19.3) 22.4 (19.4–25.7) 12.9 (10.8–15.3) <0.001 Cayman Islands 3 (1–5) 3 (1–6) 2 (0–4) <0.001 14.0 (12.1–16.2) 17.8 (14.7–21.4) 10.3 (8.1–13.0) <0.001 Chile 2 (1–5) 3 (1–5) 2 (1–4) <0.001 13.6 (11.9–15.6) 18.3 (15.5–21.4) 9.3 (7.0–12.4) <0.001 Colombiaa 2 (1–4) 2 (1–5) 1 (0–4) 0.001 15.4 (13.1–18.0) 16.8 (13.9–20.1) 14.2 (10.8–18.6) 0.32 Costa Rica 2 (1–5) 3 (1–6) 2 (1–4) <0.001 18.5 (16.5–20.6) 24.7 (22.5–27.1) 12.1 (9.7–15.0) <0.001 Dominica 1 (0–4) 1 (0–4) 1 (0–4) 0.28 16.1 (13.9–18.5) 16.6 (13.2–20.7) 15.5 (12.9–18.6) 0.64 El Salvador 1 (0–4) 2 (0–5) 1 (0–3) <0.001 13.0 (10.9–15.5) 16.1 (13.1–19.5) 9.7 (7.3–12.7) 0.003 Ecuadora 2 (1–4) 2 (1–5) 2 (1–3) 0.001 14.5 (13.3–15.7) 18.0 (16.3–19.8) 10.8 (8.6–13.4) <0.001 Grenada 1 (0–4) 1 (0–4) 1 (0–3) 0.2 14.7 (12.6–17.1) 16.8 (13.5–20.8) 13.1 (10.8–15.8) 0.06 Guatemala 2 (1–4) 2 (1–5) 1 (1–3) 0.007 15.6 (13.0–18.5) 18.8 (16.2–21.6) 12.0 (8.6–16.4) <0.001 Guyana 1 (0–4) 1 (0–4) 1 (0–3) 0.002 15.6 (12.7–19.1) 18.3 (13.7–23.9) 13.2 (10.4–16.7) 0.05 Honduras 1 (0–4) 2 (1–5) 1 (0–3) <0.001 15.8 (13.8–18.0) 19.4 (16.9–22.2) 12.6 (9.9–15.8) 0.002 Montserrat 2 (0–5) 2 (0–5) 2 (1–5) 0.85 20.7 (15.5–27.2) 18.3 (11.6–27.6) 22.8 (15.5–32.3) 0.44 Peru 2 (1–5) 2 (1–5) 2 (1–4) 0.27 15.4 (13.7–17.2) 16.5 (14.2–19.2) 14.2 (12.5–16.2) 0.08 Saint Kitts and Nevis 2 (0–5) 2 (0–5) 1 (0–4) <0.001 18.8 (16.8–20.9) 23.1 (20.0–26.5) 14.4 (12.2–16.9) <0.001 Saint Lucia 2 (0–4) 2 (0–5) 1 (0–4) 0.07 15.4 (12.9–18.3) 16.8 (13.5–20.6) 14.3 (11.3–17.9) 0.23 Saint Vincent and Grenadines 1 (0–3) 1 (0–4) 1 (0–3) <0.001 12.8 (10.7–15.2) 14.7 (11.9–18.1) 11.1 (8.5–14.4) 0.08 Suriname 2 (0–5) 2 (1–5) 2 (0–4) <0.001 19.3 (16.6–22.4) 22.4 (18.5–26.7) 16.4 (14.1–19.0) 0.007 Trinidad and Tobago 2 (0–5) 3 (0–6) 2 (0–4) <0.001 20.5 (17.5–23.9) 24.7 (21.2–28.5) 16.5 (13.9–19.6) <0.001 Uruguay 2 (1–5) 4 (2–6) 2 (0–3) <0.001 15.3 (13.7–17.1) 22.8 (20.4–25.3) 9.1 (7.8–10.7) <0.001 Country Median active days per week (P25–P75) Percentage of physically active adolescents on 7 days per week (95% CI) Overall Male Female P Overall Male Female P Antigua and Barbuda 2 (0–6) 3 (0–7) 2 (0–5) <0.001 22.8 (20.3–25.6) 28.5 (24.5–32.9) 16.7 (13.9–20.1) <0.001 Argentina 3 (1–5) 3 (2–6) 2 (1–4) <0.001 16.7 (15.6–17.8) 21.7 (20.2–23.2) 12.1 (11.0–13.4) <0.001 Bahamas 2 (0–4) 2 (0–5) 1 (0–4) 0.001 15.5 (13.3–17.8) 19.7 (16.3–23.7) 11.6 (9.3–14.4) <0.001 Barbados 2 (0–5) 3 (0–7) 2 (0–4) <0.001 18.6 (16.6–20.7) 24.7 (21.5–28.2) 12.9 (10.7–15.5) <0.001 Belize 2 (0–5) 3 (0–6) 2 (0–5) 0.001 21.2 (18.9–23.7) 24.6 (21.7–27.7) 18.0 (15.6–20.8) <0.001 Bolivia 2 (1–4) 2 (1–5) 2 (1–4) 0.001 13.9 (12.6–15.3) 16.6 (14.7–18.7) 11.1 (9.5–13.0) <0.001 British Virgin Islands 2 (0–5) 2 (0–6) 2 (0–4) <0.001 17.3 (15.5–19.3) 22.4 (19.4–25.7) 12.9 (10.8–15.3) <0.001 Cayman Islands 3 (1–5) 3 (1–6) 2 (0–4) <0.001 14.0 (12.1–16.2) 17.8 (14.7–21.4) 10.3 (8.1–13.0) <0.001 Chile 2 (1–5) 3 (1–5) 2 (1–4) <0.001 13.6 (11.9–15.6) 18.3 (15.5–21.4) 9.3 (7.0–12.4) <0.001 Colombiaa 2 (1–4) 2 (1–5) 1 (0–4) 0.001 15.4 (13.1–18.0) 16.8 (13.9–20.1) 14.2 (10.8–18.6) 0.32 Costa Rica 2 (1–5) 3 (1–6) 2 (1–4) <0.001 18.5 (16.5–20.6) 24.7 (22.5–27.1) 12.1 (9.7–15.0) <0.001 Dominica 1 (0–4) 1 (0–4) 1 (0–4) 0.28 16.1 (13.9–18.5) 16.6 (13.2–20.7) 15.5 (12.9–18.6) 0.64 El Salvador 1 (0–4) 2 (0–5) 1 (0–3) <0.001 13.0 (10.9–15.5) 16.1 (13.1–19.5) 9.7 (7.3–12.7) 0.003 Ecuadora 2 (1–4) 2 (1–5) 2 (1–3) 0.001 14.5 (13.3–15.7) 18.0 (16.3–19.8) 10.8 (8.6–13.4) <0.001 Grenada 1 (0–4) 1 (0–4) 1 (0–3) 0.2 14.7 (12.6–17.1) 16.8 (13.5–20.8) 13.1 (10.8–15.8) 0.06 Guatemala 2 (1–4) 2 (1–5) 1 (1–3) 0.007 15.6 (13.0–18.5) 18.8 (16.2–21.6) 12.0 (8.6–16.4) <0.001 Guyana 1 (0–4) 1 (0–4) 1 (0–3) 0.002 15.6 (12.7–19.1) 18.3 (13.7–23.9) 13.2 (10.4–16.7) 0.05 Honduras 1 (0–4) 2 (1–5) 1 (0–3) <0.001 15.8 (13.8–18.0) 19.4 (16.9–22.2) 12.6 (9.9–15.8) 0.002 Montserrat 2 (0–5) 2 (0–5) 2 (1–5) 0.85 20.7 (15.5–27.2) 18.3 (11.6–27.6) 22.8 (15.5–32.3) 0.44 Peru 2 (1–5) 2 (1–5) 2 (1–4) 0.27 15.4 (13.7–17.2) 16.5 (14.2–19.2) 14.2 (12.5–16.2) 0.08 Saint Kitts and Nevis 2 (0–5) 2 (0–5) 1 (0–4) <0.001 18.8 (16.8–20.9) 23.1 (20.0–26.5) 14.4 (12.2–16.9) <0.001 Saint Lucia 2 (0–4) 2 (0–5) 1 (0–4) 0.07 15.4 (12.9–18.3) 16.8 (13.5–20.6) 14.3 (11.3–17.9) 0.23 Saint Vincent and Grenadines 1 (0–3) 1 (0–4) 1 (0–3) <0.001 12.8 (10.7–15.2) 14.7 (11.9–18.1) 11.1 (8.5–14.4) 0.08 Suriname 2 (0–5) 2 (1–5) 2 (0–4) <0.001 19.3 (16.6–22.4) 22.4 (18.5–26.7) 16.4 (14.1–19.0) 0.007 Trinidad and Tobago 2 (0–5) 3 (0–6) 2 (0–4) <0.001 20.5 (17.5–23.9) 24.7 (21.2–28.5) 16.5 (13.9–19.6) <0.001 Uruguay 2 (1–5) 4 (2–6) 2 (0–3) <0.001 15.3 (13.7–17.1) 22.8 (20.4–25.3) 9.1 (7.8–10.7) <0.001 Active day defined as engaging in moderate-to-vigorous physical activity for at least 60 min per day. Differences were adjusted by age and gender. a Only regional representation. Table 2 Median (P25–P75) days per week that adolescents engaged physical activity for at least 60 min and the percentage of physically active adolescents in Latin America and the Caribbean Country Median active days per week (P25–P75) Percentage of physically active adolescents on 7 days per week (95% CI) Overall Male Female P Overall Male Female P Antigua and Barbuda 2 (0–6) 3 (0–7) 2 (0–5) <0.001 22.8 (20.3–25.6) 28.5 (24.5–32.9) 16.7 (13.9–20.1) <0.001 Argentina 3 (1–5) 3 (2–6) 2 (1–4) <0.001 16.7 (15.6–17.8) 21.7 (20.2–23.2) 12.1 (11.0–13.4) <0.001 Bahamas 2 (0–4) 2 (0–5) 1 (0–4) 0.001 15.5 (13.3–17.8) 19.7 (16.3–23.7) 11.6 (9.3–14.4) <0.001 Barbados 2 (0–5) 3 (0–7) 2 (0–4) <0.001 18.6 (16.6–20.7) 24.7 (21.5–28.2) 12.9 (10.7–15.5) <0.001 Belize 2 (0–5) 3 (0–6) 2 (0–5) 0.001 21.2 (18.9–23.7) 24.6 (21.7–27.7) 18.0 (15.6–20.8) <0.001 Bolivia 2 (1–4) 2 (1–5) 2 (1–4) 0.001 13.9 (12.6–15.3) 16.6 (14.7–18.7) 11.1 (9.5–13.0) <0.001 British Virgin Islands 2 (0–5) 2 (0–6) 2 (0–4) <0.001 17.3 (15.5–19.3) 22.4 (19.4–25.7) 12.9 (10.8–15.3) <0.001 Cayman Islands 3 (1–5) 3 (1–6) 2 (0–4) <0.001 14.0 (12.1–16.2) 17.8 (14.7–21.4) 10.3 (8.1–13.0) <0.001 Chile 2 (1–5) 3 (1–5) 2 (1–4) <0.001 13.6 (11.9–15.6) 18.3 (15.5–21.4) 9.3 (7.0–12.4) <0.001 Colombiaa 2 (1–4) 2 (1–5) 1 (0–4) 0.001 15.4 (13.1–18.0) 16.8 (13.9–20.1) 14.2 (10.8–18.6) 0.32 Costa Rica 2 (1–5) 3 (1–6) 2 (1–4) <0.001 18.5 (16.5–20.6) 24.7 (22.5–27.1) 12.1 (9.7–15.0) <0.001 Dominica 1 (0–4) 1 (0–4) 1 (0–4) 0.28 16.1 (13.9–18.5) 16.6 (13.2–20.7) 15.5 (12.9–18.6) 0.64 El Salvador 1 (0–4) 2 (0–5) 1 (0–3) <0.001 13.0 (10.9–15.5) 16.1 (13.1–19.5) 9.7 (7.3–12.7) 0.003 Ecuadora 2 (1–4) 2 (1–5) 2 (1–3) 0.001 14.5 (13.3–15.7) 18.0 (16.3–19.8) 10.8 (8.6–13.4) <0.001 Grenada 1 (0–4) 1 (0–4) 1 (0–3) 0.2 14.7 (12.6–17.1) 16.8 (13.5–20.8) 13.1 (10.8–15.8) 0.06 Guatemala 2 (1–4) 2 (1–5) 1 (1–3) 0.007 15.6 (13.0–18.5) 18.8 (16.2–21.6) 12.0 (8.6–16.4) <0.001 Guyana 1 (0–4) 1 (0–4) 1 (0–3) 0.002 15.6 (12.7–19.1) 18.3 (13.7–23.9) 13.2 (10.4–16.7) 0.05 Honduras 1 (0–4) 2 (1–5) 1 (0–3) <0.001 15.8 (13.8–18.0) 19.4 (16.9–22.2) 12.6 (9.9–15.8) 0.002 Montserrat 2 (0–5) 2 (0–5) 2 (1–5) 0.85 20.7 (15.5–27.2) 18.3 (11.6–27.6) 22.8 (15.5–32.3) 0.44 Peru 2 (1–5) 2 (1–5) 2 (1–4) 0.27 15.4 (13.7–17.2) 16.5 (14.2–19.2) 14.2 (12.5–16.2) 0.08 Saint Kitts and Nevis 2 (0–5) 2 (0–5) 1 (0–4) <0.001 18.8 (16.8–20.9) 23.1 (20.0–26.5) 14.4 (12.2–16.9) <0.001 Saint Lucia 2 (0–4) 2 (0–5) 1 (0–4) 0.07 15.4 (12.9–18.3) 16.8 (13.5–20.6) 14.3 (11.3–17.9) 0.23 Saint Vincent and Grenadines 1 (0–3) 1 (0–4) 1 (0–3) <0.001 12.8 (10.7–15.2) 14.7 (11.9–18.1) 11.1 (8.5–14.4) 0.08 Suriname 2 (0–5) 2 (1–5) 2 (0–4) <0.001 19.3 (16.6–22.4) 22.4 (18.5–26.7) 16.4 (14.1–19.0) 0.007 Trinidad and Tobago 2 (0–5) 3 (0–6) 2 (0–4) <0.001 20.5 (17.5–23.9) 24.7 (21.2–28.5) 16.5 (13.9–19.6) <0.001 Uruguay 2 (1–5) 4 (2–6) 2 (0–3) <0.001 15.3 (13.7–17.1) 22.8 (20.4–25.3) 9.1 (7.8–10.7) <0.001 Country Median active days per week (P25–P75) Percentage of physically active adolescents on 7 days per week (95% CI) Overall Male Female P Overall Male Female P Antigua and Barbuda 2 (0–6) 3 (0–7) 2 (0–5) <0.001 22.8 (20.3–25.6) 28.5 (24.5–32.9) 16.7 (13.9–20.1) <0.001 Argentina 3 (1–5) 3 (2–6) 2 (1–4) <0.001 16.7 (15.6–17.8) 21.7 (20.2–23.2) 12.1 (11.0–13.4) <0.001 Bahamas 2 (0–4) 2 (0–5) 1 (0–4) 0.001 15.5 (13.3–17.8) 19.7 (16.3–23.7) 11.6 (9.3–14.4) <0.001 Barbados 2 (0–5) 3 (0–7) 2 (0–4) <0.001 18.6 (16.6–20.7) 24.7 (21.5–28.2) 12.9 (10.7–15.5) <0.001 Belize 2 (0–5) 3 (0–6) 2 (0–5) 0.001 21.2 (18.9–23.7) 24.6 (21.7–27.7) 18.0 (15.6–20.8) <0.001 Bolivia 2 (1–4) 2 (1–5) 2 (1–4) 0.001 13.9 (12.6–15.3) 16.6 (14.7–18.7) 11.1 (9.5–13.0) <0.001 British Virgin Islands 2 (0–5) 2 (0–6) 2 (0–4) <0.001 17.3 (15.5–19.3) 22.4 (19.4–25.7) 12.9 (10.8–15.3) <0.001 Cayman Islands 3 (1–5) 3 (1–6) 2 (0–4) <0.001 14.0 (12.1–16.2) 17.8 (14.7–21.4) 10.3 (8.1–13.0) <0.001 Chile 2 (1–5) 3 (1–5) 2 (1–4) <0.001 13.6 (11.9–15.6) 18.3 (15.5–21.4) 9.3 (7.0–12.4) <0.001 Colombiaa 2 (1–4) 2 (1–5) 1 (0–4) 0.001 15.4 (13.1–18.0) 16.8 (13.9–20.1) 14.2 (10.8–18.6) 0.32 Costa Rica 2 (1–5) 3 (1–6) 2 (1–4) <0.001 18.5 (16.5–20.6) 24.7 (22.5–27.1) 12.1 (9.7–15.0) <0.001 Dominica 1 (0–4) 1 (0–4) 1 (0–4) 0.28 16.1 (13.9–18.5) 16.6 (13.2–20.7) 15.5 (12.9–18.6) 0.64 El Salvador 1 (0–4) 2 (0–5) 1 (0–3) <0.001 13.0 (10.9–15.5) 16.1 (13.1–19.5) 9.7 (7.3–12.7) 0.003 Ecuadora 2 (1–4) 2 (1–5) 2 (1–3) 0.001 14.5 (13.3–15.7) 18.0 (16.3–19.8) 10.8 (8.6–13.4) <0.001 Grenada 1 (0–4) 1 (0–4) 1 (0–3) 0.2 14.7 (12.6–17.1) 16.8 (13.5–20.8) 13.1 (10.8–15.8) 0.06 Guatemala 2 (1–4) 2 (1–5) 1 (1–3) 0.007 15.6 (13.0–18.5) 18.8 (16.2–21.6) 12.0 (8.6–16.4) <0.001 Guyana 1 (0–4) 1 (0–4) 1 (0–3) 0.002 15.6 (12.7–19.1) 18.3 (13.7–23.9) 13.2 (10.4–16.7) 0.05 Honduras 1 (0–4) 2 (1–5) 1 (0–3) <0.001 15.8 (13.8–18.0) 19.4 (16.9–22.2) 12.6 (9.9–15.8) 0.002 Montserrat 2 (0–5) 2 (0–5) 2 (1–5) 0.85 20.7 (15.5–27.2) 18.3 (11.6–27.6) 22.8 (15.5–32.3) 0.44 Peru 2 (1–5) 2 (1–5) 2 (1–4) 0.27 15.4 (13.7–17.2) 16.5 (14.2–19.2) 14.2 (12.5–16.2) 0.08 Saint Kitts and Nevis 2 (0–5) 2 (0–5) 1 (0–4) <0.001 18.8 (16.8–20.9) 23.1 (20.0–26.5) 14.4 (12.2–16.9) <0.001 Saint Lucia 2 (0–4) 2 (0–5) 1 (0–4) 0.07 15.4 (12.9–18.3) 16.8 (13.5–20.6) 14.3 (11.3–17.9) 0.23 Saint Vincent and Grenadines 1 (0–3) 1 (0–4) 1 (0–3) <0.001 12.8 (10.7–15.2) 14.7 (11.9–18.1) 11.1 (8.5–14.4) 0.08 Suriname 2 (0–5) 2 (1–5) 2 (0–4) <0.001 19.3 (16.6–22.4) 22.4 (18.5–26.7) 16.4 (14.1–19.0) 0.007 Trinidad and Tobago 2 (0–5) 3 (0–6) 2 (0–4) <0.001 20.5 (17.5–23.9) 24.7 (21.2–28.5) 16.5 (13.9–19.6) <0.001 Uruguay 2 (1–5) 4 (2–6) 2 (0–3) <0.001 15.3 (13.7–17.1) 22.8 (20.4–25.3) 9.1 (7.8–10.7) <0.001 Active day defined as engaging in moderate-to-vigorous physical activity for at least 60 min per day. Differences were adjusted by age and gender. a Only regional representation. Figure 1 View largeDownload slide Regional distribution of adolescents physically active for at least 60 min per day (A), active for transportation to and from school at least 3 times per week (B), who reported 3 or more physical education classes per week (C), and who spent 3 or more hours sitting per day outside school hours (D) in Latin America. Figure 1 View largeDownload slide Regional distribution of adolescents physically active for at least 60 min per day (A), active for transportation to and from school at least 3 times per week (B), who reported 3 or more physical education classes per week (C), and who spent 3 or more hours sitting per day outside school hours (D) in Latin America. Overall, the median days active for transport to and from school ranged from 0 to 4 days per week (Table 3). The weighted prevalence of AT in adolescents from LAC was 41.9%, with large variability between countries (Figure 1B). The three countries with higher prevalence of AT (Peru, Argentina and Uruguay) were also those with higher median number of active days (median = 4). The largest relative differences in the percentage of active adolescents in transportation between the sexes were observed in Cayman Islands (36.2%), Saint Lucia (24.9%) and Colombia (21.0%). The only two countries that reported higher median number of days active for transport in women were Colombia and Peru. The overall prevalence of AT in adolescents by country was positively correlated with the GC (rho = 0.51, P = 0.022) (Supplementary Material, available as Supplementary data at IJE online), whereas no correlation was observed between AT and the other indices (GII (P = 0.98), HDI (P = 0.48) and MR (P = 0.51)). Table 3 Median (P25–P75) days per week that adolescents walked or rode a bicycle to and from school and percentage of adolescents active for transport in Latin America and the Caribbean Country Median active transport days per week (p25–p75) Percentage of active transport to and from school (95% CI) Overall Male Female P Overall Male Female P Antigua and Barbuda 0 (0-5) 0 (0-5) 0 (0-5) 0.14 35.0 (32.1-38.0) 32.7 (28.6-37.1) 37.5 (33.5-41.7) 0.072 Argentina 4 (0-7) 4 (0-7) 4 (0-7) 0.06 55.2 (52.5-57.9) 56.2 (52.9-59.4) 54.8 (51.5-57.3) 0.24 Bahamas 0 (0-2) 0 (0-2) 0 (0-2) 0.44 24.3 (21.9-26.8) 24.7 (21.1-28.7) 23.9 (20.8-27.4) 0.86 Barbados 0 (0-0) 0 (0-1) 0 (0-0) 0.01 16.0 (14.1-18.0) 17.3 (14.5-20.5) 14.7 (12.4-17.4) 0.202 Belize 2 (0-7) 3 (0-7) 2 (0-7) 0.04 49.5 (41.6-57.4) 50.9 (43.2-58.6) 48.2 (39.9-56.5) 0.036 Bolivia 2 (0-7) 2 (0-7) 2 (0-7) 0.1 47.6 (45.8-49.4) 45.8 (43.2-48.4) 49.4 (46.8-52.0) 0.042 British Virgin Islands 0 (0-3) 0 (0-3) 0 (0-3) 0.59 26.5 (24.4-28.8) 26.1 (22.9-29.6) 26.9 (24.0-30.0) 0.73 Cayman Islands 0 (0-0) 0 (0-0) 0 (0-0) <0.001 11.6 (9.8-13.6) 14.1 (11.3-17.4) 9.2 (7.2-11.7) 0.010 Chile 2 (0-6) 2 (0-6) 2 (0-7) 0.93 48.0 (42.8-53.2) 47.0 (42.5-51.7) 48.9 (41.6-56.1) 0.56 Colombiaa 1 (0-7) 0 (0-5) 1 (0-7) 0.02 41.5 (34.4-49.1) 36.8 (29.2-45.1) 45.5 (37.8-53.5) 0.003 Costa Rica 1 (0-7) 1 (0-7) 1 (0-7) 0.78 44.9 (39.3-50.0) 44.2 (38.7-49.9) 45.0 (38.8-51.3) 0.64 Dominica 1 (0-2) 1 (0-2) 1 (0-3) 0.16 24.5 (21.8-27.3) 23.2 (19.4-27.4) 25.8 (22.5-29.4) 0.276 El Salvador 1 (0-7) 1 (0-7) 1 (0-7) 0.87 45.9 (39.7-52.1) 44.9 (37.1-53.0) 46.9 (40.6-53.2) 0.57 Ecuadora 0 (0-2) 0 (0-2) 0 (0-2) 0.19 22.6 (19.7-25.8) 24.2 (21.4-27.2) 21.0 (17.1-25.4) 0.079 Grenada 0 (0-2) 0 (0-2) 0 (0-1) 0.04 20.6 (18.3-23.1) 20.4 (16.9-24.5) 20.8 (17.8-24.1) 0.92 Guatemala 1 (0-5) 1 (0-5) 1 (0-5) 0.19 38.9 (35.6-42.4) 40.7 (35.7-45.8) 37.0 (32.6-41.7) 0.289 Guyana 0 (0-4) 0 (0-5) 0 (0-3) 0.007 30.6 (25.7-36.0) 32.9 (27.3-39.1) 28.5 (23.1-34.6) 0.129 Honduras 2 (0-7) 2 (0-7) 1 (0-7) 0.13 47.1 (40.9-53.4) 49.8 (43.6-56.0) 44.7 (36.8-53.0) 0.198 Montserrat 0 (0-2) 0 (0-2) 0 (0-4) 0.74 24.2 (18.3-31.2) 21.8 (14.2-32.0) 26.2 (18.1-36.4) 0.661 Peru 4 (0-7) 3 (0-7) 5 (0-7) 0.03 54.7 (50.0-59.4) 51.5 (47.0-56.0) 58.0 (51.8-63.9) 0.015 Saint Kitts and Nevis 0 (0-5) 0 (0-5) 0 (0-5) 0.83 34.5 (32.1-37.0) 33.2 (29.6-37.0) 35.8 (32.6-39.1) 0.28 Saint Lucia 0 (0-0) 0 (0-1) 0 (0-0) 0.02 17.3 (14.9-20.1) 20.3 (16.8-24.3) 14.9 (11.8-18.5) 0.037 Saint Vincent and Grenadines 0 (0-3) 0 (0-2) 0 (0-3) 0.42 25.2 (22.0-28.7) 24.6 (20.5-29.3) 25.7 (21.3-30.6) 0.65 Suriname 1 (0-7) 1 (0-7) 1 (0-7) 0.56 45.8 (40.0-51.7) 45.6 (40.5-50.9) 46.0 (38.5-53.7) 0.826 Trinidad and Tobago 0 (0-2) 0 (0-2) 0 (0-1) 0.46 21.6 (18.2-25.5) 22.6 (19.1-26.5) 20.7 (15.8-26.7) 0.47 Uruguay 4 (0-7) 5 (0-7) 4 (0-7) 0.16 55.8 (50.5-61.1) 57.4 (51.7-62.9) 54.5 (48.6-60.3) 0.216 Country Median active transport days per week (p25–p75) Percentage of active transport to and from school (95% CI) Overall Male Female P Overall Male Female P Antigua and Barbuda 0 (0-5) 0 (0-5) 0 (0-5) 0.14 35.0 (32.1-38.0) 32.7 (28.6-37.1) 37.5 (33.5-41.7) 0.072 Argentina 4 (0-7) 4 (0-7) 4 (0-7) 0.06 55.2 (52.5-57.9) 56.2 (52.9-59.4) 54.8 (51.5-57.3) 0.24 Bahamas 0 (0-2) 0 (0-2) 0 (0-2) 0.44 24.3 (21.9-26.8) 24.7 (21.1-28.7) 23.9 (20.8-27.4) 0.86 Barbados 0 (0-0) 0 (0-1) 0 (0-0) 0.01 16.0 (14.1-18.0) 17.3 (14.5-20.5) 14.7 (12.4-17.4) 0.202 Belize 2 (0-7) 3 (0-7) 2 (0-7) 0.04 49.5 (41.6-57.4) 50.9 (43.2-58.6) 48.2 (39.9-56.5) 0.036 Bolivia 2 (0-7) 2 (0-7) 2 (0-7) 0.1 47.6 (45.8-49.4) 45.8 (43.2-48.4) 49.4 (46.8-52.0) 0.042 British Virgin Islands 0 (0-3) 0 (0-3) 0 (0-3) 0.59 26.5 (24.4-28.8) 26.1 (22.9-29.6) 26.9 (24.0-30.0) 0.73 Cayman Islands 0 (0-0) 0 (0-0) 0 (0-0) <0.001 11.6 (9.8-13.6) 14.1 (11.3-17.4) 9.2 (7.2-11.7) 0.010 Chile 2 (0-6) 2 (0-6) 2 (0-7) 0.93 48.0 (42.8-53.2) 47.0 (42.5-51.7) 48.9 (41.6-56.1) 0.56 Colombiaa 1 (0-7) 0 (0-5) 1 (0-7) 0.02 41.5 (34.4-49.1) 36.8 (29.2-45.1) 45.5 (37.8-53.5) 0.003 Costa Rica 1 (0-7) 1 (0-7) 1 (0-7) 0.78 44.9 (39.3-50.0) 44.2 (38.7-49.9) 45.0 (38.8-51.3) 0.64 Dominica 1 (0-2) 1 (0-2) 1 (0-3) 0.16 24.5 (21.8-27.3) 23.2 (19.4-27.4) 25.8 (22.5-29.4) 0.276 El Salvador 1 (0-7) 1 (0-7) 1 (0-7) 0.87 45.9 (39.7-52.1) 44.9 (37.1-53.0) 46.9 (40.6-53.2) 0.57 Ecuadora 0 (0-2) 0 (0-2) 0 (0-2) 0.19 22.6 (19.7-25.8) 24.2 (21.4-27.2) 21.0 (17.1-25.4) 0.079 Grenada 0 (0-2) 0 (0-2) 0 (0-1) 0.04 20.6 (18.3-23.1) 20.4 (16.9-24.5) 20.8 (17.8-24.1) 0.92 Guatemala 1 (0-5) 1 (0-5) 1 (0-5) 0.19 38.9 (35.6-42.4) 40.7 (35.7-45.8) 37.0 (32.6-41.7) 0.289 Guyana 0 (0-4) 0 (0-5) 0 (0-3) 0.007 30.6 (25.7-36.0) 32.9 (27.3-39.1) 28.5 (23.1-34.6) 0.129 Honduras 2 (0-7) 2 (0-7) 1 (0-7) 0.13 47.1 (40.9-53.4) 49.8 (43.6-56.0) 44.7 (36.8-53.0) 0.198 Montserrat 0 (0-2) 0 (0-2) 0 (0-4) 0.74 24.2 (18.3-31.2) 21.8 (14.2-32.0) 26.2 (18.1-36.4) 0.661 Peru 4 (0-7) 3 (0-7) 5 (0-7) 0.03 54.7 (50.0-59.4) 51.5 (47.0-56.0) 58.0 (51.8-63.9) 0.015 Saint Kitts and Nevis 0 (0-5) 0 (0-5) 0 (0-5) 0.83 34.5 (32.1-37.0) 33.2 (29.6-37.0) 35.8 (32.6-39.1) 0.28 Saint Lucia 0 (0-0) 0 (0-1) 0 (0-0) 0.02 17.3 (14.9-20.1) 20.3 (16.8-24.3) 14.9 (11.8-18.5) 0.037 Saint Vincent and Grenadines 0 (0-3) 0 (0-2) 0 (0-3) 0.42 25.2 (22.0-28.7) 24.6 (20.5-29.3) 25.7 (21.3-30.6) 0.65 Suriname 1 (0-7) 1 (0-7) 1 (0-7) 0.56 45.8 (40.0-51.7) 45.6 (40.5-50.9) 46.0 (38.5-53.7) 0.826 Trinidad and Tobago 0 (0-2) 0 (0-2) 0 (0-1) 0.46 21.6 (18.2-25.5) 22.6 (19.1-26.5) 20.7 (15.8-26.7) 0.47 Uruguay 4 (0-7) 5 (0-7) 4 (0-7) 0.16 55.8 (50.5-61.1) 57.4 (51.7-62.9) 54.5 (48.6-60.3) 0.216 Active transport defined as walking or riding a bike at least 3 days during the past 7 days. Differences were adjusted by age and gender. a Only regional representation. Table 3 Median (P25–P75) days per week that adolescents walked or rode a bicycle to and from school and percentage of adolescents active for transport in Latin America and the Caribbean Country Median active transport days per week (p25–p75) Percentage of active transport to and from school (95% CI) Overall Male Female P Overall Male Female P Antigua and Barbuda 0 (0-5) 0 (0-5) 0 (0-5) 0.14 35.0 (32.1-38.0) 32.7 (28.6-37.1) 37.5 (33.5-41.7) 0.072 Argentina 4 (0-7) 4 (0-7) 4 (0-7) 0.06 55.2 (52.5-57.9) 56.2 (52.9-59.4) 54.8 (51.5-57.3) 0.24 Bahamas 0 (0-2) 0 (0-2) 0 (0-2) 0.44 24.3 (21.9-26.8) 24.7 (21.1-28.7) 23.9 (20.8-27.4) 0.86 Barbados 0 (0-0) 0 (0-1) 0 (0-0) 0.01 16.0 (14.1-18.0) 17.3 (14.5-20.5) 14.7 (12.4-17.4) 0.202 Belize 2 (0-7) 3 (0-7) 2 (0-7) 0.04 49.5 (41.6-57.4) 50.9 (43.2-58.6) 48.2 (39.9-56.5) 0.036 Bolivia 2 (0-7) 2 (0-7) 2 (0-7) 0.1 47.6 (45.8-49.4) 45.8 (43.2-48.4) 49.4 (46.8-52.0) 0.042 British Virgin Islands 0 (0-3) 0 (0-3) 0 (0-3) 0.59 26.5 (24.4-28.8) 26.1 (22.9-29.6) 26.9 (24.0-30.0) 0.73 Cayman Islands 0 (0-0) 0 (0-0) 0 (0-0) <0.001 11.6 (9.8-13.6) 14.1 (11.3-17.4) 9.2 (7.2-11.7) 0.010 Chile 2 (0-6) 2 (0-6) 2 (0-7) 0.93 48.0 (42.8-53.2) 47.0 (42.5-51.7) 48.9 (41.6-56.1) 0.56 Colombiaa 1 (0-7) 0 (0-5) 1 (0-7) 0.02 41.5 (34.4-49.1) 36.8 (29.2-45.1) 45.5 (37.8-53.5) 0.003 Costa Rica 1 (0-7) 1 (0-7) 1 (0-7) 0.78 44.9 (39.3-50.0) 44.2 (38.7-49.9) 45.0 (38.8-51.3) 0.64 Dominica 1 (0-2) 1 (0-2) 1 (0-3) 0.16 24.5 (21.8-27.3) 23.2 (19.4-27.4) 25.8 (22.5-29.4) 0.276 El Salvador 1 (0-7) 1 (0-7) 1 (0-7) 0.87 45.9 (39.7-52.1) 44.9 (37.1-53.0) 46.9 (40.6-53.2) 0.57 Ecuadora 0 (0-2) 0 (0-2) 0 (0-2) 0.19 22.6 (19.7-25.8) 24.2 (21.4-27.2) 21.0 (17.1-25.4) 0.079 Grenada 0 (0-2) 0 (0-2) 0 (0-1) 0.04 20.6 (18.3-23.1) 20.4 (16.9-24.5) 20.8 (17.8-24.1) 0.92 Guatemala 1 (0-5) 1 (0-5) 1 (0-5) 0.19 38.9 (35.6-42.4) 40.7 (35.7-45.8) 37.0 (32.6-41.7) 0.289 Guyana 0 (0-4) 0 (0-5) 0 (0-3) 0.007 30.6 (25.7-36.0) 32.9 (27.3-39.1) 28.5 (23.1-34.6) 0.129 Honduras 2 (0-7) 2 (0-7) 1 (0-7) 0.13 47.1 (40.9-53.4) 49.8 (43.6-56.0) 44.7 (36.8-53.0) 0.198 Montserrat 0 (0-2) 0 (0-2) 0 (0-4) 0.74 24.2 (18.3-31.2) 21.8 (14.2-32.0) 26.2 (18.1-36.4) 0.661 Peru 4 (0-7) 3 (0-7) 5 (0-7) 0.03 54.7 (50.0-59.4) 51.5 (47.0-56.0) 58.0 (51.8-63.9) 0.015 Saint Kitts and Nevis 0 (0-5) 0 (0-5) 0 (0-5) 0.83 34.5 (32.1-37.0) 33.2 (29.6-37.0) 35.8 (32.6-39.1) 0.28 Saint Lucia 0 (0-0) 0 (0-1) 0 (0-0) 0.02 17.3 (14.9-20.1) 20.3 (16.8-24.3) 14.9 (11.8-18.5) 0.037 Saint Vincent and Grenadines 0 (0-3) 0 (0-2) 0 (0-3) 0.42 25.2 (22.0-28.7) 24.6 (20.5-29.3) 25.7 (21.3-30.6) 0.65 Suriname 1 (0-7) 1 (0-7) 1 (0-7) 0.56 45.8 (40.0-51.7) 45.6 (40.5-50.9) 46.0 (38.5-53.7) 0.826 Trinidad and Tobago 0 (0-2) 0 (0-2) 0 (0-1) 0.46 21.6 (18.2-25.5) 22.6 (19.1-26.5) 20.7 (15.8-26.7) 0.47 Uruguay 4 (0-7) 5 (0-7) 4 (0-7) 0.16 55.8 (50.5-61.1) 57.4 (51.7-62.9) 54.5 (48.6-60.3) 0.216 Country Median active transport days per week (p25–p75) Percentage of active transport to and from school (95% CI) Overall Male Female P Overall Male Female P Antigua and Barbuda 0 (0-5) 0 (0-5) 0 (0-5) 0.14 35.0 (32.1-38.0) 32.7 (28.6-37.1) 37.5 (33.5-41.7) 0.072 Argentina 4 (0-7) 4 (0-7) 4 (0-7) 0.06 55.2 (52.5-57.9) 56.2 (52.9-59.4) 54.8 (51.5-57.3) 0.24 Bahamas 0 (0-2) 0 (0-2) 0 (0-2) 0.44 24.3 (21.9-26.8) 24.7 (21.1-28.7) 23.9 (20.8-27.4) 0.86 Barbados 0 (0-0) 0 (0-1) 0 (0-0) 0.01 16.0 (14.1-18.0) 17.3 (14.5-20.5) 14.7 (12.4-17.4) 0.202 Belize 2 (0-7) 3 (0-7) 2 (0-7) 0.04 49.5 (41.6-57.4) 50.9 (43.2-58.6) 48.2 (39.9-56.5) 0.036 Bolivia 2 (0-7) 2 (0-7) 2 (0-7) 0.1 47.6 (45.8-49.4) 45.8 (43.2-48.4) 49.4 (46.8-52.0) 0.042 British Virgin Islands 0 (0-3) 0 (0-3) 0 (0-3) 0.59 26.5 (24.4-28.8) 26.1 (22.9-29.6) 26.9 (24.0-30.0) 0.73 Cayman Islands 0 (0-0) 0 (0-0) 0 (0-0) <0.001 11.6 (9.8-13.6) 14.1 (11.3-17.4) 9.2 (7.2-11.7) 0.010 Chile 2 (0-6) 2 (0-6) 2 (0-7) 0.93 48.0 (42.8-53.2) 47.0 (42.5-51.7) 48.9 (41.6-56.1) 0.56 Colombiaa 1 (0-7) 0 (0-5) 1 (0-7) 0.02 41.5 (34.4-49.1) 36.8 (29.2-45.1) 45.5 (37.8-53.5) 0.003 Costa Rica 1 (0-7) 1 (0-7) 1 (0-7) 0.78 44.9 (39.3-50.0) 44.2 (38.7-49.9) 45.0 (38.8-51.3) 0.64 Dominica 1 (0-2) 1 (0-2) 1 (0-3) 0.16 24.5 (21.8-27.3) 23.2 (19.4-27.4) 25.8 (22.5-29.4) 0.276 El Salvador 1 (0-7) 1 (0-7) 1 (0-7) 0.87 45.9 (39.7-52.1) 44.9 (37.1-53.0) 46.9 (40.6-53.2) 0.57 Ecuadora 0 (0-2) 0 (0-2) 0 (0-2) 0.19 22.6 (19.7-25.8) 24.2 (21.4-27.2) 21.0 (17.1-25.4) 0.079 Grenada 0 (0-2) 0 (0-2) 0 (0-1) 0.04 20.6 (18.3-23.1) 20.4 (16.9-24.5) 20.8 (17.8-24.1) 0.92 Guatemala 1 (0-5) 1 (0-5) 1 (0-5) 0.19 38.9 (35.6-42.4) 40.7 (35.7-45.8) 37.0 (32.6-41.7) 0.289 Guyana 0 (0-4) 0 (0-5) 0 (0-3) 0.007 30.6 (25.7-36.0) 32.9 (27.3-39.1) 28.5 (23.1-34.6) 0.129 Honduras 2 (0-7) 2 (0-7) 1 (0-7) 0.13 47.1 (40.9-53.4) 49.8 (43.6-56.0) 44.7 (36.8-53.0) 0.198 Montserrat 0 (0-2) 0 (0-2) 0 (0-4) 0.74 24.2 (18.3-31.2) 21.8 (14.2-32.0) 26.2 (18.1-36.4) 0.661 Peru 4 (0-7) 3 (0-7) 5 (0-7) 0.03 54.7 (50.0-59.4) 51.5 (47.0-56.0) 58.0 (51.8-63.9) 0.015 Saint Kitts and Nevis 0 (0-5) 0 (0-5) 0 (0-5) 0.83 34.5 (32.1-37.0) 33.2 (29.6-37.0) 35.8 (32.6-39.1) 0.28 Saint Lucia 0 (0-0) 0 (0-1) 0 (0-0) 0.02 17.3 (14.9-20.1) 20.3 (16.8-24.3) 14.9 (11.8-18.5) 0.037 Saint Vincent and Grenadines 0 (0-3) 0 (0-2) 0 (0-3) 0.42 25.2 (22.0-28.7) 24.6 (20.5-29.3) 25.7 (21.3-30.6) 0.65 Suriname 1 (0-7) 1 (0-7) 1 (0-7) 0.56 45.8 (40.0-51.7) 45.6 (40.5-50.9) 46.0 (38.5-53.7) 0.826 Trinidad and Tobago 0 (0-2) 0 (0-2) 0 (0-1) 0.46 21.6 (18.2-25.5) 22.6 (19.1-26.5) 20.7 (15.8-26.7) 0.47 Uruguay 4 (0-7) 5 (0-7) 4 (0-7) 0.16 55.8 (50.5-61.1) 57.4 (51.7-62.9) 54.5 (48.6-60.3) 0.216 Active transport defined as walking or riding a bike at least 3 days during the past 7 days. Differences were adjusted by age and gender. a Only regional representation. Nineteen countries provided information about PE participation among adolescents (Table 4). Five countries reported that less than 20% of adolescents went to PE classes on ≥3 days each week (Figure 1C). Adolescents from El Salvador (37.8%), Uruguay (34.8%) and Costa Rica (34.0%) were those with higher percentages of participation in PE on ≥3 days per week. Higher PE participation among boys than girls on 3 or more days per week was observed only in Argentina (P < 0.001), Guatemala (P = 0.001) and Saint Lucia (P = 0.001). Two countries showed 30% or more adolescents that reported PE participation on 5 or more days per week (Costa Rica and El Salvador). PE participation was not correlated with any of the global indices. Table 4 Percentage of adolescents who went to physical education classes on at least 3 and 5 or more days per week in Latin America and the Caribbean Country Percentage of PE class on 3 or more days each week (95% CI) Percentage of PE class on 5 or more days each week (95% CI) Overall Male Female P Overall Male Female P Antigua and Barbuda 26.4 (23.6-29.1) 27.4 (23.4-31.4) 25.2 (21.5-28.9) 0.44 21.1 (18.7-23.6) 21.6 (18.0-25.2) 20.7 (17.3-24.1) 0.73 Argentina 23.6 (22.4-24.8) 26.3 (24.4-28.2) 21.1 (19.6-22.6) <0.001 18.8 (17.6-19.9) 21.1 (19.3-22.9) 16.6 (15.2-18.0) <0.001 Bahamas 19.8 (17.4-22.3) 22.2 (18.4-26.1) 17.7 (14.6-20.7) 0.07 13.9 (11.9-16.0) 16.2 (12.8-19.5) 11.9 (9.3-14.5) 0.05 Barbados 33.5 (30.8-36.2) 35.6 (31.6-40.0) 31.4 (27.8-35.0) 0.13 29.4 (26.7-32.0) 32.1 (28.2-36.1) 26.5 (23.1-30.0) 0.04 Belize 19.1 (15.4-23.4) 20.6 (16.7-25.1) 17.7 (13.6-22.8) 0.13 13.0 (11.4-14.6) 14.3 (10.8-18.7) 11.5 (9.4-14.0) 0.08 Bolivia 31.3 (29.2-33.4) 32.7 (29.6–35.7) 29.9 (27.0-32.8) 0.18 27.3 (25.3-29.3) 28.7 (26.0-31.5) 25.8 (22.9-28.7) 0.14 British Virgin Islands 24.5 (22.2-26.7) 25.9 (22.4-29.3) 23.2 (20.3-26.2) 0.24 21.6 (19.5-23.8) 23.2 (19.9-26.5) 20.2 (17.4-23.0) 0.734 Cayman Islands – – – – – – – – Chile 33.0 (30.7-35.3) 32.6 (30.0-35.2) 33.4 (29.5-37.3) 0.74 28.3 (25.6-31.0) 28.4 (25.7-31.1) 28.2 (24.2-32.2) 0.92 Colombiaa – – – – – – – – Costa Rica 34.0 (29.8-38.4) 35.6 (31.0-40.4) 32.4 (27.8-37.4) 0.11 30.0 (26.5-33.8) 31.0 (26.9-35.3) 29.0 (25.1-33.3) 0.32 Dominica 23.9 (21.1-27.0) 24.2 (20.4-28.3) 23.7 (19.8-28.1) 0.86 18.9 (16.0-22.0) 18.6 (15.0-22.7) 19.1 (15.6-23.3) 0.82 El Salvador 37.8 (35.0-40.6) 39.2 (35.0-43.5) 36.3 (32.7-40.1) 0.31 34.4 (31.7-37.2) 35.1 (31.1-39.4) 33.6 (30.2-37.3) 0.58 Ecuadora – – – – – – – – Grenada – – – – – – – – Guatemala 29.0 (23.3-35.4) 31.1 (25.7-36.9) 26.6 (20.7-33.5) 0.001 22.7 (21.2-24.3) 24.6 (22.2-27.1) 20.6 (19.0-22.3) 0.004 Guyana 19.0 (16.1-22.3) 20.2 (17.4-23.4) 17.9 (14.3-22.2) 0.19 11.6 (9.8-13.8) 12.0 (9.7-14.8) 11.3 (9.4-13.5) 0.52 Honduras 30.5 (27.2-33.9) 33.4 (29.1-37.7) 28.0 (23.5-32.5) 0.08 26 (23.5-29.9) 28.5 (24.5-32.5) 25.0 (20.9-29.2) 0.18 Montserrat – – – – – – – – Peru 2.2 (0.0-3.9) 2.4 (0.0-4.2) 1.9 (0.0-3.7) 0.30 1.5 (0.0-3.1) 1.7 (0.0-3.4) 1.4 (0.0-2.8) 0.49 Saint Kitts and Nevis – – – – – – – – Saint Lucia 19.4 (17.4-21.4) 22.7 (19.5-25.8) 16.1 (13.7-18.5) 0.001 15.8 (14.0-17.7) 18.1 (15.2-20.9) 13.6 (11.4-15.8) 0.01 Saint Vincent and Grenadines – – – – – – – – Suriname 21.1 (18.6-23.7) 22.4 (19.3-25.6) 19.9 (16.5-23.2) 0.18 15.8 (14.2-17.5) 16.7 (14.4-18.9) 15.0 (12.4-17.7) 0.35 Trinidad and Tobago 29.2 (25.6-33.1) 29.7 (24.8-35.0) 28.8 (25.0-32.9) 0.73 20.7 (18.8-22.7) 21.3 (17.5-25.6) 20.1 (18.4-22.0) 0.62 Uruguay 34.8 (32.1-37.6) 34.6 (31.5-37.8) 35.0 (32.0-38.2) 0.76 26.6 (24.8-28.6) 26.6 (24.0-29.5) 26.6 (24.7-28.6) 0.99 Country Percentage of PE class on 3 or more days each week (95% CI) Percentage of PE class on 5 or more days each week (95% CI) Overall Male Female P Overall Male Female P Antigua and Barbuda 26.4 (23.6-29.1) 27.4 (23.4-31.4) 25.2 (21.5-28.9) 0.44 21.1 (18.7-23.6) 21.6 (18.0-25.2) 20.7 (17.3-24.1) 0.73 Argentina 23.6 (22.4-24.8) 26.3 (24.4-28.2) 21.1 (19.6-22.6) <0.001 18.8 (17.6-19.9) 21.1 (19.3-22.9) 16.6 (15.2-18.0) <0.001 Bahamas 19.8 (17.4-22.3) 22.2 (18.4-26.1) 17.7 (14.6-20.7) 0.07 13.9 (11.9-16.0) 16.2 (12.8-19.5) 11.9 (9.3-14.5) 0.05 Barbados 33.5 (30.8-36.2) 35.6 (31.6-40.0) 31.4 (27.8-35.0) 0.13 29.4 (26.7-32.0) 32.1 (28.2-36.1) 26.5 (23.1-30.0) 0.04 Belize 19.1 (15.4-23.4) 20.6 (16.7-25.1) 17.7 (13.6-22.8) 0.13 13.0 (11.4-14.6) 14.3 (10.8-18.7) 11.5 (9.4-14.0) 0.08 Bolivia 31.3 (29.2-33.4) 32.7 (29.6–35.7) 29.9 (27.0-32.8) 0.18 27.3 (25.3-29.3) 28.7 (26.0-31.5) 25.8 (22.9-28.7) 0.14 British Virgin Islands 24.5 (22.2-26.7) 25.9 (22.4-29.3) 23.2 (20.3-26.2) 0.24 21.6 (19.5-23.8) 23.2 (19.9-26.5) 20.2 (17.4-23.0) 0.734 Cayman Islands – – – – – – – – Chile 33.0 (30.7-35.3) 32.6 (30.0-35.2) 33.4 (29.5-37.3) 0.74 28.3 (25.6-31.0) 28.4 (25.7-31.1) 28.2 (24.2-32.2) 0.92 Colombiaa – – – – – – – – Costa Rica 34.0 (29.8-38.4) 35.6 (31.0-40.4) 32.4 (27.8-37.4) 0.11 30.0 (26.5-33.8) 31.0 (26.9-35.3) 29.0 (25.1-33.3) 0.32 Dominica 23.9 (21.1-27.0) 24.2 (20.4-28.3) 23.7 (19.8-28.1) 0.86 18.9 (16.0-22.0) 18.6 (15.0-22.7) 19.1 (15.6-23.3) 0.82 El Salvador 37.8 (35.0-40.6) 39.2 (35.0-43.5) 36.3 (32.7-40.1) 0.31 34.4 (31.7-37.2) 35.1 (31.1-39.4) 33.6 (30.2-37.3) 0.58 Ecuadora – – – – – – – – Grenada – – – – – – – – Guatemala 29.0 (23.3-35.4) 31.1 (25.7-36.9) 26.6 (20.7-33.5) 0.001 22.7 (21.2-24.3) 24.6 (22.2-27.1) 20.6 (19.0-22.3) 0.004 Guyana 19.0 (16.1-22.3) 20.2 (17.4-23.4) 17.9 (14.3-22.2) 0.19 11.6 (9.8-13.8) 12.0 (9.7-14.8) 11.3 (9.4-13.5) 0.52 Honduras 30.5 (27.2-33.9) 33.4 (29.1-37.7) 28.0 (23.5-32.5) 0.08 26 (23.5-29.9) 28.5 (24.5-32.5) 25.0 (20.9-29.2) 0.18 Montserrat – – – – – – – – Peru 2.2 (0.0-3.9) 2.4 (0.0-4.2) 1.9 (0.0-3.7) 0.30 1.5 (0.0-3.1) 1.7 (0.0-3.4) 1.4 (0.0-2.8) 0.49 Saint Kitts and Nevis – – – – – – – – Saint Lucia 19.4 (17.4-21.4) 22.7 (19.5-25.8) 16.1 (13.7-18.5) 0.001 15.8 (14.0-17.7) 18.1 (15.2-20.9) 13.6 (11.4-15.8) 0.01 Saint Vincent and Grenadines – – – – – – – – Suriname 21.1 (18.6-23.7) 22.4 (19.3-25.6) 19.9 (16.5-23.2) 0.18 15.8 (14.2-17.5) 16.7 (14.4-18.9) 15.0 (12.4-17.7) 0.35 Trinidad and Tobago 29.2 (25.6-33.1) 29.7 (24.8-35.0) 28.8 (25.0-32.9) 0.73 20.7 (18.8-22.7) 21.3 (17.5-25.6) 20.1 (18.4-22.0) 0.62 Uruguay 34.8 (32.1-37.6) 34.6 (31.5-37.8) 35.0 (32.0-38.2) 0.76 26.6 (24.8-28.6) 26.6 (24.0-29.5) 26.6 (24.7-28.6) 0.99 Differences were adjusted by age and gender. a Only regional representation. Table 4 Percentage of adolescents who went to physical education classes on at least 3 and 5 or more days per week in Latin America and the Caribbean Country Percentage of PE class on 3 or more days each week (95% CI) Percentage of PE class on 5 or more days each week (95% CI) Overall Male Female P Overall Male Female P Antigua and Barbuda 26.4 (23.6-29.1) 27.4 (23.4-31.4) 25.2 (21.5-28.9) 0.44 21.1 (18.7-23.6) 21.6 (18.0-25.2) 20.7 (17.3-24.1) 0.73 Argentina 23.6 (22.4-24.8) 26.3 (24.4-28.2) 21.1 (19.6-22.6) <0.001 18.8 (17.6-19.9) 21.1 (19.3-22.9) 16.6 (15.2-18.0) <0.001 Bahamas 19.8 (17.4-22.3) 22.2 (18.4-26.1) 17.7 (14.6-20.7) 0.07 13.9 (11.9-16.0) 16.2 (12.8-19.5) 11.9 (9.3-14.5) 0.05 Barbados 33.5 (30.8-36.2) 35.6 (31.6-40.0) 31.4 (27.8-35.0) 0.13 29.4 (26.7-32.0) 32.1 (28.2-36.1) 26.5 (23.1-30.0) 0.04 Belize 19.1 (15.4-23.4) 20.6 (16.7-25.1) 17.7 (13.6-22.8) 0.13 13.0 (11.4-14.6) 14.3 (10.8-18.7) 11.5 (9.4-14.0) 0.08 Bolivia 31.3 (29.2-33.4) 32.7 (29.6–35.7) 29.9 (27.0-32.8) 0.18 27.3 (25.3-29.3) 28.7 (26.0-31.5) 25.8 (22.9-28.7) 0.14 British Virgin Islands 24.5 (22.2-26.7) 25.9 (22.4-29.3) 23.2 (20.3-26.2) 0.24 21.6 (19.5-23.8) 23.2 (19.9-26.5) 20.2 (17.4-23.0) 0.734 Cayman Islands – – – – – – – – Chile 33.0 (30.7-35.3) 32.6 (30.0-35.2) 33.4 (29.5-37.3) 0.74 28.3 (25.6-31.0) 28.4 (25.7-31.1) 28.2 (24.2-32.2) 0.92 Colombiaa – – – – – – – – Costa Rica 34.0 (29.8-38.4) 35.6 (31.0-40.4) 32.4 (27.8-37.4) 0.11 30.0 (26.5-33.8) 31.0 (26.9-35.3) 29.0 (25.1-33.3) 0.32 Dominica 23.9 (21.1-27.0) 24.2 (20.4-28.3) 23.7 (19.8-28.1) 0.86 18.9 (16.0-22.0) 18.6 (15.0-22.7) 19.1 (15.6-23.3) 0.82 El Salvador 37.8 (35.0-40.6) 39.2 (35.0-43.5) 36.3 (32.7-40.1) 0.31 34.4 (31.7-37.2) 35.1 (31.1-39.4) 33.6 (30.2-37.3) 0.58 Ecuadora – – – – – – – – Grenada – – – – – – – – Guatemala 29.0 (23.3-35.4) 31.1 (25.7-36.9) 26.6 (20.7-33.5) 0.001 22.7 (21.2-24.3) 24.6 (22.2-27.1) 20.6 (19.0-22.3) 0.004 Guyana 19.0 (16.1-22.3) 20.2 (17.4-23.4) 17.9 (14.3-22.2) 0.19 11.6 (9.8-13.8) 12.0 (9.7-14.8) 11.3 (9.4-13.5) 0.52 Honduras 30.5 (27.2-33.9) 33.4 (29.1-37.7) 28.0 (23.5-32.5) 0.08 26 (23.5-29.9) 28.5 (24.5-32.5) 25.0 (20.9-29.2) 0.18 Montserrat – – – – – – – – Peru 2.2 (0.0-3.9) 2.4 (0.0-4.2) 1.9 (0.0-3.7) 0.30 1.5 (0.0-3.1) 1.7 (0.0-3.4) 1.4 (0.0-2.8) 0.49 Saint Kitts and Nevis – – – – – – – – Saint Lucia 19.4 (17.4-21.4) 22.7 (19.5-25.8) 16.1 (13.7-18.5) 0.001 15.8 (14.0-17.7) 18.1 (15.2-20.9) 13.6 (11.4-15.8) 0.01 Saint Vincent and Grenadines – – – – – – – – Suriname 21.1 (18.6-23.7) 22.4 (19.3-25.6) 19.9 (16.5-23.2) 0.18 15.8 (14.2-17.5) 16.7 (14.4-18.9) 15.0 (12.4-17.7) 0.35 Trinidad and Tobago 29.2 (25.6-33.1) 29.7 (24.8-35.0) 28.8 (25.0-32.9) 0.73 20.7 (18.8-22.7) 21.3 (17.5-25.6) 20.1 (18.4-22.0) 0.62 Uruguay 34.8 (32.1-37.6) 34.6 (31.5-37.8) 35.0 (32.0-38.2) 0.76 26.6 (24.8-28.6) 26.6 (24.0-29.5) 26.6 (24.7-28.6) 0.99 Country Percentage of PE class on 3 or more days each week (95% CI) Percentage of PE class on 5 or more days each week (95% CI) Overall Male Female P Overall Male Female P Antigua and Barbuda 26.4 (23.6-29.1) 27.4 (23.4-31.4) 25.2 (21.5-28.9) 0.44 21.1 (18.7-23.6) 21.6 (18.0-25.2) 20.7 (17.3-24.1) 0.73 Argentina 23.6 (22.4-24.8) 26.3 (24.4-28.2) 21.1 (19.6-22.6) <0.001 18.8 (17.6-19.9) 21.1 (19.3-22.9) 16.6 (15.2-18.0) <0.001 Bahamas 19.8 (17.4-22.3) 22.2 (18.4-26.1) 17.7 (14.6-20.7) 0.07 13.9 (11.9-16.0) 16.2 (12.8-19.5) 11.9 (9.3-14.5) 0.05 Barbados 33.5 (30.8-36.2) 35.6 (31.6-40.0) 31.4 (27.8-35.0) 0.13 29.4 (26.7-32.0) 32.1 (28.2-36.1) 26.5 (23.1-30.0) 0.04 Belize 19.1 (15.4-23.4) 20.6 (16.7-25.1) 17.7 (13.6-22.8) 0.13 13.0 (11.4-14.6) 14.3 (10.8-18.7) 11.5 (9.4-14.0) 0.08 Bolivia 31.3 (29.2-33.4) 32.7 (29.6–35.7) 29.9 (27.0-32.8) 0.18 27.3 (25.3-29.3) 28.7 (26.0-31.5) 25.8 (22.9-28.7) 0.14 British Virgin Islands 24.5 (22.2-26.7) 25.9 (22.4-29.3) 23.2 (20.3-26.2) 0.24 21.6 (19.5-23.8) 23.2 (19.9-26.5) 20.2 (17.4-23.0) 0.734 Cayman Islands – – – – – – – – Chile 33.0 (30.7-35.3) 32.6 (30.0-35.2) 33.4 (29.5-37.3) 0.74 28.3 (25.6-31.0) 28.4 (25.7-31.1) 28.2 (24.2-32.2) 0.92 Colombiaa – – – – – – – – Costa Rica 34.0 (29.8-38.4) 35.6 (31.0-40.4) 32.4 (27.8-37.4) 0.11 30.0 (26.5-33.8) 31.0 (26.9-35.3) 29.0 (25.1-33.3) 0.32 Dominica 23.9 (21.1-27.0) 24.2 (20.4-28.3) 23.7 (19.8-28.1) 0.86 18.9 (16.0-22.0) 18.6 (15.0-22.7) 19.1 (15.6-23.3) 0.82 El Salvador 37.8 (35.0-40.6) 39.2 (35.0-43.5) 36.3 (32.7-40.1) 0.31 34.4 (31.7-37.2) 35.1 (31.1-39.4) 33.6 (30.2-37.3) 0.58 Ecuadora – – – – – – – – Grenada – – – – – – – – Guatemala 29.0 (23.3-35.4) 31.1 (25.7-36.9) 26.6 (20.7-33.5) 0.001 22.7 (21.2-24.3) 24.6 (22.2-27.1) 20.6 (19.0-22.3) 0.004 Guyana 19.0 (16.1-22.3) 20.2 (17.4-23.4) 17.9 (14.3-22.2) 0.19 11.6 (9.8-13.8) 12.0 (9.7-14.8) 11.3 (9.4-13.5) 0.52 Honduras 30.5 (27.2-33.9) 33.4 (29.1-37.7) 28.0 (23.5-32.5) 0.08 26 (23.5-29.9) 28.5 (24.5-32.5) 25.0 (20.9-29.2) 0.18 Montserrat – – – – – – – – Peru 2.2 (0.0-3.9) 2.4 (0.0-4.2) 1.9 (0.0-3.7) 0.30 1.5 (0.0-3.1) 1.7 (0.0-3.4) 1.4 (0.0-2.8) 0.49 Saint Kitts and Nevis – – – – – – – – Saint Lucia 19.4 (17.4-21.4) 22.7 (19.5-25.8) 16.1 (13.7-18.5) 0.001 15.8 (14.0-17.7) 18.1 (15.2-20.9) 13.6 (11.4-15.8) 0.01 Saint Vincent and Grenadines – – – – – – – – Suriname 21.1 (18.6-23.7) 22.4 (19.3-25.6) 19.9 (16.5-23.2) 0.18 15.8 (14.2-17.5) 16.7 (14.4-18.9) 15.0 (12.4-17.7) 0.35 Trinidad and Tobago 29.2 (25.6-33.1) 29.7 (24.8-35.0) 28.8 (25.0-32.9) 0.73 20.7 (18.8-22.7) 21.3 (17.5-25.6) 20.1 (18.4-22.0) 0.62 Uruguay 34.8 (32.1-37.6) 34.6 (31.5-37.8) 35.0 (32.0-38.2) 0.76 26.6 (24.8-28.6) 26.6 (24.0-29.5) 26.6 (24.7-28.6) 0.99 Differences were adjusted by age and gender. a Only regional representation. The percentages of adolescents who reported sitting 3 or more h per day outside school are shown in Table 5. Overall, the percentages of sedentary adolescents ranged from 24.2% (Guatemala) to 65.0% (Barbados). In 12 countries, at least 50% of the adolescents reported sitting ≥3 h per day outside school (Figure 1D). Eleven countries showed differences in sitting between sexes, with higher percentages observed among girls for all of them. The largest relative differences between girls and boys were found in Trinidad and Tobago (18.8%), Bahamas (19.4%) and Saint Kitts and Nevis (21.8%). The prevalence of sedentary adolescents by country was positively correlated with HDI (rho = 0.79, P = 0.001) and negatively correlated with GII (rho=−0.74, P = 0.001) (Supplementary Material, available as Supplementary data at IJE online). Countries with higher HDI showed smaller relative differences between boys and girls in SB than those with lower HDI (rho=−0.58, P = 0.002). Table 5 Percentage of adolescents who spent 3 or more hours per day in sedentary behaviour outside school Country Percentage of 3 or more hours per day in SB (95% CI) Overall Male Female P Antigua and Barbuda 54.9 (51.8-58.0) 50.7 (46.2-55.2) 59.4 (55.2-63.7) 0.006 Argentina 50.8 (49.4-52.1) 46.7 (44.7-48.8) 54.5 (52.7-56.4) <0.001 Bahamas 54.5 (51.4-57.6) 49.4 (44.7-54.1) 59.0 (55.0-63.1) 0.003 Barbados 65.0 (62.2-67.7) 60.8 (56.7-64.8) 69.2 (65.6-72.9) 0.003 Belize 37.9 (34.1-41.9) 35.4 (31.4-39.5) 40.3 (35.2-45.6) 0.05 Bolivia 24.6 (21.8-27.4) 25.2 (21.7-28.7) 23.9 (20.5-27.3) 0.51 British Virgin Islands 61.7 (59.1-64.2) 57.7 (53.8-61.6) 65.2 (61.8-68.6) 0.005 Cayman Islands 56.9 (54.0-59.8) 52.2 (47.9-56.6) 61.4 (57.4-65.2) 0.002 Chile 54.0 (50.3-57.7) 50.1 (44.9-55.3) 57.7 (53.7-61.8) 0.02 Colombiaa 51.8 (47.5-56.1) 50.9 (46.1-55.8) 52.5 (47.0-58.0) 0.59 Costa Rica 43.6 (40.2-47.1) 40.9 (37.4-44.5) 46.3 (42.2-50.4) 0.002 Dominica – – – – El Salvador 34.5 (30.1-39.3) 32.1 (27.1-37.5) 37.1 (31.4-43.2) 0.11 Ecuadora 28.6 (26.1-31.2) 30.3 (26.0-35.0) 26.8 (24.0-29.8) 0.22 Grenada 40.9 (37.5-44.4) 40.7 (35.0-46.8) 41.0 (37.0-45.1) 0.94 Guatemala 24.2 (20.6-28.4) 24.2 (21.1-27.5) 24.4 (19.7-29.8) 0.90 Guyana 36.1 (31.6-40.8) 36.1 (31.8-40.7) 36.0 (30.8-41.6) 0.95 Honduras 30.2 (27.5-33.0) 29.8 (26.3-33.3) 30.6 (26.8-34.4) 0.72 Montserrat 50.7 (43.0-58.4) 50.5 (39.5-61.5) 50.8 (40.1-61.6) 0.97 Peru 28.8 (25.4-32.2) 28.8 (25.3-32.4) 28.8 (24.0-33.6) 0.99 Saint Kitts and Nevis 59.0 (56.4-61.5) 53.2 (49.4-57.1) 64.8 (61.6-68.0) <0.001 Saint Lucia 53.7 (49.5-57.9) 55.7 (50.0-61.3) 52.1 (46.6-57.6) 0.33 Saint Vincent and Grenadines 39.1 (35.7-42.5) 41.4 (36.4-46.4) 37.1 (32.9-41.4) 0.17 Suriname 39.4 (35.4-43.3) 40.8 (36.7-44.9) 38.0 (33.4-42.6) 0.18 Trinidad and Tobago 43.8 (40.4-47.2) 40.0 (33.2-47.2) 47.5 (44.3-50.6) 0.07 Uruguay 59.0 (56.2-61.8) 56.1 (52.6-59.6) 61.4 (57.8-64.9) 0.02 Country Percentage of 3 or more hours per day in SB (95% CI) Overall Male Female P Antigua and Barbuda 54.9 (51.8-58.0) 50.7 (46.2-55.2) 59.4 (55.2-63.7) 0.006 Argentina 50.8 (49.4-52.1) 46.7 (44.7-48.8) 54.5 (52.7-56.4) <0.001 Bahamas 54.5 (51.4-57.6) 49.4 (44.7-54.1) 59.0 (55.0-63.1) 0.003 Barbados 65.0 (62.2-67.7) 60.8 (56.7-64.8) 69.2 (65.6-72.9) 0.003 Belize 37.9 (34.1-41.9) 35.4 (31.4-39.5) 40.3 (35.2-45.6) 0.05 Bolivia 24.6 (21.8-27.4) 25.2 (21.7-28.7) 23.9 (20.5-27.3) 0.51 British Virgin Islands 61.7 (59.1-64.2) 57.7 (53.8-61.6) 65.2 (61.8-68.6) 0.005 Cayman Islands 56.9 (54.0-59.8) 52.2 (47.9-56.6) 61.4 (57.4-65.2) 0.002 Chile 54.0 (50.3-57.7) 50.1 (44.9-55.3) 57.7 (53.7-61.8) 0.02 Colombiaa 51.8 (47.5-56.1) 50.9 (46.1-55.8) 52.5 (47.0-58.0) 0.59 Costa Rica 43.6 (40.2-47.1) 40.9 (37.4-44.5) 46.3 (42.2-50.4) 0.002 Dominica – – – – El Salvador 34.5 (30.1-39.3) 32.1 (27.1-37.5) 37.1 (31.4-43.2) 0.11 Ecuadora 28.6 (26.1-31.2) 30.3 (26.0-35.0) 26.8 (24.0-29.8) 0.22 Grenada 40.9 (37.5-44.4) 40.7 (35.0-46.8) 41.0 (37.0-45.1) 0.94 Guatemala 24.2 (20.6-28.4) 24.2 (21.1-27.5) 24.4 (19.7-29.8) 0.90 Guyana 36.1 (31.6-40.8) 36.1 (31.8-40.7) 36.0 (30.8-41.6) 0.95 Honduras 30.2 (27.5-33.0) 29.8 (26.3-33.3) 30.6 (26.8-34.4) 0.72 Montserrat 50.7 (43.0-58.4) 50.5 (39.5-61.5) 50.8 (40.1-61.6) 0.97 Peru 28.8 (25.4-32.2) 28.8 (25.3-32.4) 28.8 (24.0-33.6) 0.99 Saint Kitts and Nevis 59.0 (56.4-61.5) 53.2 (49.4-57.1) 64.8 (61.6-68.0) <0.001 Saint Lucia 53.7 (49.5-57.9) 55.7 (50.0-61.3) 52.1 (46.6-57.6) 0.33 Saint Vincent and Grenadines 39.1 (35.7-42.5) 41.4 (36.4-46.4) 37.1 (32.9-41.4) 0.17 Suriname 39.4 (35.4-43.3) 40.8 (36.7-44.9) 38.0 (33.4-42.6) 0.18 Trinidad and Tobago 43.8 (40.4-47.2) 40.0 (33.2-47.2) 47.5 (44.3-50.6) 0.07 Uruguay 59.0 (56.2-61.8) 56.1 (52.6-59.6) 61.4 (57.8-64.9) 0.02 Differences were adjusted by age and gender. a Only regional representation. Table 5 Percentage of adolescents who spent 3 or more hours per day in sedentary behaviour outside school Country Percentage of 3 or more hours per day in SB (95% CI) Overall Male Female P Antigua and Barbuda 54.9 (51.8-58.0) 50.7 (46.2-55.2) 59.4 (55.2-63.7) 0.006 Argentina 50.8 (49.4-52.1) 46.7 (44.7-48.8) 54.5 (52.7-56.4) <0.001 Bahamas 54.5 (51.4-57.6) 49.4 (44.7-54.1) 59.0 (55.0-63.1) 0.003 Barbados 65.0 (62.2-67.7) 60.8 (56.7-64.8) 69.2 (65.6-72.9) 0.003 Belize 37.9 (34.1-41.9) 35.4 (31.4-39.5) 40.3 (35.2-45.6) 0.05 Bolivia 24.6 (21.8-27.4) 25.2 (21.7-28.7) 23.9 (20.5-27.3) 0.51 British Virgin Islands 61.7 (59.1-64.2) 57.7 (53.8-61.6) 65.2 (61.8-68.6) 0.005 Cayman Islands 56.9 (54.0-59.8) 52.2 (47.9-56.6) 61.4 (57.4-65.2) 0.002 Chile 54.0 (50.3-57.7) 50.1 (44.9-55.3) 57.7 (53.7-61.8) 0.02 Colombiaa 51.8 (47.5-56.1) 50.9 (46.1-55.8) 52.5 (47.0-58.0) 0.59 Costa Rica 43.6 (40.2-47.1) 40.9 (37.4-44.5) 46.3 (42.2-50.4) 0.002 Dominica – – – – El Salvador 34.5 (30.1-39.3) 32.1 (27.1-37.5) 37.1 (31.4-43.2) 0.11 Ecuadora 28.6 (26.1-31.2) 30.3 (26.0-35.0) 26.8 (24.0-29.8) 0.22 Grenada 40.9 (37.5-44.4) 40.7 (35.0-46.8) 41.0 (37.0-45.1) 0.94 Guatemala 24.2 (20.6-28.4) 24.2 (21.1-27.5) 24.4 (19.7-29.8) 0.90 Guyana 36.1 (31.6-40.8) 36.1 (31.8-40.7) 36.0 (30.8-41.6) 0.95 Honduras 30.2 (27.5-33.0) 29.8 (26.3-33.3) 30.6 (26.8-34.4) 0.72 Montserrat 50.7 (43.0-58.4) 50.5 (39.5-61.5) 50.8 (40.1-61.6) 0.97 Peru 28.8 (25.4-32.2) 28.8 (25.3-32.4) 28.8 (24.0-33.6) 0.99 Saint Kitts and Nevis 59.0 (56.4-61.5) 53.2 (49.4-57.1) 64.8 (61.6-68.0) <0.001 Saint Lucia 53.7 (49.5-57.9) 55.7 (50.0-61.3) 52.1 (46.6-57.6) 0.33 Saint Vincent and Grenadines 39.1 (35.7-42.5) 41.4 (36.4-46.4) 37.1 (32.9-41.4) 0.17 Suriname 39.4 (35.4-43.3) 40.8 (36.7-44.9) 38.0 (33.4-42.6) 0.18 Trinidad and Tobago 43.8 (40.4-47.2) 40.0 (33.2-47.2) 47.5 (44.3-50.6) 0.07 Uruguay 59.0 (56.2-61.8) 56.1 (52.6-59.6) 61.4 (57.8-64.9) 0.02 Country Percentage of 3 or more hours per day in SB (95% CI) Overall Male Female P Antigua and Barbuda 54.9 (51.8-58.0) 50.7 (46.2-55.2) 59.4 (55.2-63.7) 0.006 Argentina 50.8 (49.4-52.1) 46.7 (44.7-48.8) 54.5 (52.7-56.4) <0.001 Bahamas 54.5 (51.4-57.6) 49.4 (44.7-54.1) 59.0 (55.0-63.1) 0.003 Barbados 65.0 (62.2-67.7) 60.8 (56.7-64.8) 69.2 (65.6-72.9) 0.003 Belize 37.9 (34.1-41.9) 35.4 (31.4-39.5) 40.3 (35.2-45.6) 0.05 Bolivia 24.6 (21.8-27.4) 25.2 (21.7-28.7) 23.9 (20.5-27.3) 0.51 British Virgin Islands 61.7 (59.1-64.2) 57.7 (53.8-61.6) 65.2 (61.8-68.6) 0.005 Cayman Islands 56.9 (54.0-59.8) 52.2 (47.9-56.6) 61.4 (57.4-65.2) 0.002 Chile 54.0 (50.3-57.7) 50.1 (44.9-55.3) 57.7 (53.7-61.8) 0.02 Colombiaa 51.8 (47.5-56.1) 50.9 (46.1-55.8) 52.5 (47.0-58.0) 0.59 Costa Rica 43.6 (40.2-47.1) 40.9 (37.4-44.5) 46.3 (42.2-50.4) 0.002 Dominica – – – – El Salvador 34.5 (30.1-39.3) 32.1 (27.1-37.5) 37.1 (31.4-43.2) 0.11 Ecuadora 28.6 (26.1-31.2) 30.3 (26.0-35.0) 26.8 (24.0-29.8) 0.22 Grenada 40.9 (37.5-44.4) 40.7 (35.0-46.8) 41.0 (37.0-45.1) 0.94 Guatemala 24.2 (20.6-28.4) 24.2 (21.1-27.5) 24.4 (19.7-29.8) 0.90 Guyana 36.1 (31.6-40.8) 36.1 (31.8-40.7) 36.0 (30.8-41.6) 0.95 Honduras 30.2 (27.5-33.0) 29.8 (26.3-33.3) 30.6 (26.8-34.4) 0.72 Montserrat 50.7 (43.0-58.4) 50.5 (39.5-61.5) 50.8 (40.1-61.6) 0.97 Peru 28.8 (25.4-32.2) 28.8 (25.3-32.4) 28.8 (24.0-33.6) 0.99 Saint Kitts and Nevis 59.0 (56.4-61.5) 53.2 (49.4-57.1) 64.8 (61.6-68.0) <0.001 Saint Lucia 53.7 (49.5-57.9) 55.7 (50.0-61.3) 52.1 (46.6-57.6) 0.33 Saint Vincent and Grenadines 39.1 (35.7-42.5) 41.4 (36.4-46.4) 37.1 (32.9-41.4) 0.17 Suriname 39.4 (35.4-43.3) 40.8 (36.7-44.9) 38.0 (33.4-42.6) 0.18 Trinidad and Tobago 43.8 (40.4-47.2) 40.0 (33.2-47.2) 47.5 (44.3-50.6) 0.07 Uruguay 59.0 (56.2-61.8) 56.1 (52.6-59.6) 61.4 (57.8-64.9) 0.02 Differences were adjusted by age and gender. a Only regional representation. Discussion This study summarized nationally representative data regarding PA, SB, AT and PE participation among adolescents from 26 countries across LAC. Overall, boys were more physically active than girls in 18 of 26 countries (69.2%). Most prevalence differences in AT favoured boys, except for Colombia. PE participation on 3 or more days each week ranged from 2.2% (Peru) to 37.8% (El Salvador), but sex differences in PE participation were observed in only three countries. The prevalence of adolescents who spent 3 or more  h per day in SB outside school was higher than 50% in half of the included countries, with most reporting higher prevalence of SB in girls than boys. Only about 15% of adolescents in LAC countries were physically active, with most countries showing sex disparities. Therefore, the weighted overall prevalence of physical inactivity reported in this study was higher than the prevalence reported for this region (81.2%) in 2010.18 Gender inequality in PA levels remains an issue not only for this age group, but also for adults.19 As physical inactivity is affected through several levels of influence (i.e. individual, social and built environment, policy), to better understand this global issue, future monitoring strategies at national level should include those dimensions. International initiatives such as the Active Healthy Kids Global Alliance (AHKGA) have developed a matrix to compare countries from several regions in a number of indicators related to PA.20,21 The last AHKGA report showed that countries with high GII, such as some Latin American countries (Brazil, Chile, Colombia, Mexico and Venezuela),22–26 tended to report worst grades in overall PA when compared with those with lower GII (The Netherlands, Slovenia and Denmark) at a global level.20 Although it is difficult to explain a complex behaviour with one isolated index, in our study countries with high HDI, such as Chile and Argentina, were those with greater gender inequities in PA, as similarly shown by those with lower GII. These findings reflect the uneven distribution of these behaviours when considering these types of indices in LAC, especially when economic growth in the region has not always been accompanied by equality of wealth and opportunities (e.g. health or education access) within countries.27,28 Overall, AT showed high variability across countries (ranging from 11.6% to 55.8%); only three countries reported a median number of 4 days per week and about a quarter showed differences by sex. Our findings suggest that AT in LAC countries would not be limited by vehicle availability or economic development, as there was no clear pattern in the prevalence of AT or relative differences between sexes by MR or other indices. Regional differences may be explained by other factors, such as traffic policies (i.e. speed regulation), educational equity (i.e. access and facilities in schools) and urban planning (i.e. schools embedded in neighbourhoods), among others. AT is an important strategy not only for increasing PA in children, but also for promoting community connectedness and environmental safety.29 The context in LAC countries requires a major coordination effort, as this behaviour is often limited by other factors such as perceived traffic, stranger danger or crime safety, which are commonly reported as barriers by parents.30 Therefore, policy makers, authorities and other key actors should conceive multilevel interventions as interdisciplinary strategies (i.e. coordination between transport, urban planning and education departments) for implementing successful programmes, as they have associated and convergent impacts in terms of individual health, traffic, pollution and safety, among others. Overall, less than a third of adolescents from LAC countries reported having PE on 3 or more days per week. This is the first report of PE class participation in the GSHS, but results are in line with the findings of the 2013 Worldwide Survey of School Physical Education, which indicated that the allocated time for PE in schools from LAC countries (90 and 94 min/week at primary and secondary levels, respectively) was comparable to that allocated in African and Asian nations, but lower than in Europe, the USA and Oceania.31 PE is a fundamental opportunity for promoting PA, not only in school environments but also outside school. Although there is a global tendency in the reduction of time allocated for PE from 2000 to 2013,31,32 LAC countries have led the globe as they have increased minutes of PE per week by 17 min for primary and 7 min for secondary levels since 2007.31 LAC countries have also increased the percentage of prescribed national PE curricula from 67% in 2007 to 96% in 2013, increased implementation of PE in schools from 50% in 2000 to 89% in 2013 and decreased PE cancellations from 80% in 2000 to 52% in 2013.31 Although, LAC countries have shown positive changes for positioning PE in schools, there is a lot of space for improvement, as only about 10% met the minimum recommendation of 2 h per week.31 Therefore, the effects of the high level of implementation of PE policies on health indicators in LAC countries as reported by the United Nations Educational, Scientific and Cultural Organization (UNESCO) in the past 5 years are still to be assessed. About half of the included LAC countries in this study reported sitting 3 or more h per day outside school hours in more than 50% of the studied population. When contrasting our findings with the previous GSHS,12 LAC countries are still lagging compared with other regions. To the best of our knowledge, the HDI has not been compared with SB in other age groups and countries. In our study, prevalences of SB in adolescents were highly correlated with the HDI by country, which may suggest that more developed countries tend to have greater access to more sedentary environments or attractions outside school hours. Also, countries with greater HDI were less unequal when SB by sex was compared. Lessons can be learnt from LAC countries with lower HDI, as SB may continue to rise as they develop, requiring comprehensive strategies for promoting an active life while reducing time spent in sedentary activities in this age group. Despite regional representativeness being high, some large countries such as Brazil or Mexico were missing. Future monitoring strategies should make the effort to include those countries, as well as others such as Paraguay, Jamaica or Panama, which do not often report PA in the scientific literature. Overall response rate was acceptable, as 19/26 LAC countries had at least a 75% response rate. However, some countries had much lower rates (e.g. Chile had 60%) with no report or further analysis about non-responders. Colombia and Ecuador had only sub-national representation (capital cities), which may affect interpretation of data when translating this to the national level. Although we used the latest available GSHS for each country, data ranged from 2007 to 2013. We acknowledge that this wide distribution in report dates may affect comparisons, as most countries are suffering rapid epidemiological and economic transitions with potential effects on lifestyles, including PA. Therefore, further studies using these samples may consider the comparison between datasets from the same years when available. Data collection was not designed to account for seasonal variability which may affect activity behaviours, exacerbating differences within and between countries,33 especially considering variation in opportunities and preferences for being physically active between sexes.34,35 Findings related to correlation analyses should be used with caution, as it is hard to identify causality with these methods and study designs. Also, the GII and GC were unavailable for most Caribbean countries, limiting extrapolation to that area of the region. Finally, no information about reliability and validity of the instrument or questions was provided for the included countries. However, a report from Fiji that used the same questionnaire showed kappa values ranging from 0.30 to 0.50 and percent agreement from 41% to 75%.36 Comparison with objective tools may provide a different or complementary perspective to these findings. Conclusion The study sets a challenge for the LAC region, as physical inactivity and SB are highly prevalent across all countries. Gender inequities in PA and SB are shown in most countries. Therefore, specific strategies for engaging girls should be adopted to assure equitable access to PA opportunities. Prevalences of physical inactivity and AT have not shown a clear pattern in terms of development. Thus, policy makers and intervention designers should consider exchanging experiences from other countries to adapt them to their own cultural values or customs, as some countries are advancing and leading in these matters. Current data have shown that less than a third of adolescents are participating in PE classes on 3 or more days per week in the region. Thus, the value of PA for developing not only better health but also social, cultural and economic benefits must be something that authorities should not forget in their government plans, especially when allocating budget proposals for stopping and reverting inequities related to this complex situation. Supplementary Data Supplementary data are available at IJE online. Funding N.A.F. was supported by CONICYT FONDECYT 2016 11160720. J.C.O. was supported by Beca de Inserción de Investigadores Postdoctorales en la Universidad de La Frontera (RE 2960 2008) and CONICYT FONDECYT 2017 11170525. C.C.M. was supported by CONICYT FONDECYT 2016 11160703. Acknowledgements We gratefully acknowledge the work of the survey coordinators for each country: Mrs Cleo Clothilda Hampson (Antigua and Barbuda), Mr Bruno Linetzky (Argentina), Mrs Kelly Kavanagh Salmond (Bahamas), Dr Elizabeth Ferdinand (Barbados), Mr Englebert Emmanuel (Belize), Mr Casto Villarroel (Bolivia), Mr Ive Geroge (British Virgin Islands), Mrs Clara Smith (Cayman Islands), Mr Sergio Loayza and Mr Rodrigo Fuentes (Chile), Mrs Andrea Yanira (Colombia), Mrs Xinia Gomez (Costa Rica), Mrs Joan Henry (Dominica), Mrs Guadalupe Razeghi (El Salvador), Dr Christine La Grenade and Dr Sekai Turner (Grenada), Mrs Olivia Brathwaite Dick (Guatemala), Dr Marcia Paltoo (Guyana), Mrs Sandra Sanchez (Honduras), Mr Elijah Silcott (Montserrat), Mrs Fresia Cardenas (Peru), Mr Clifford Griffin (Saint Kitts and Nevis), Mr Cyprian Yarde (St Lucia), Mrs Patsy Wyllie (St Vincent and the Grenadines), Mrs Maureen Van Dijk (Suriname), Dr Gebre Yitade and Dr Akenath Misir (Trinidad and Tobago) and Mrs Susana Grumbaum (Uruguay). 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Google Scholar CrossRef Search ADS PubMed 23 Galaviz KI , Arroyo MA , Gonzalez-Casanova I et al. Results from Mexico’s 2016 report card on physical activity for children and youth . J Phys Act Health 2016 ; 13 : S206 – 12 . Google Scholar CrossRef Search ADS PubMed 24 Gonzalez SA , Castiblanco MA , Arias-Gomez LF et al. Results from Colombia’s 2016 report card on physical activity for children and youth . J Phys Act Health 2016 ; 13(Suppl 2) : S129 – 36 . Google Scholar CrossRef Search ADS 25 Herrera-Cuenca M , Mendez-Perez B , Morales VCT et al. Results from Venezuela’s 2016 report card on physical activity for children and youth . J Phys Act Health 2016 ; 13 : S314 – 29 . Google Scholar CrossRef Search ADS PubMed 26 Nardo N Jr , Silva DA , de Moraes Ferrari GL et al. Results from Brazil’s 2016 report card on physical activity for children and youth . J Phys Act Health 2016 ; 13 : S104 – 09 . Google Scholar CrossRef Search ADS PubMed 27 Casas JA , Dachs J , Bambas A. Health disparities in Latin America and the Caribbean: the role of social and economic determinants . In: Equity and Health Views from the Pan American Sanitary Bureau [Internet] . Washington, DC, 2001. Available from: http://www1.paho.org/English/DBI/OP08.htm (26 July 2017, date last accessed). 28 Loayza N , Fajnzylber P , Calderon C. Economic Growth in Latin America and the Caribbean: Stylized Facts, Explanations, and Forecasts . Washington, DC : World Bank Publications , 2005 . Google Scholar CrossRef Search ADS 29 Smith L , Norgate SH , Cherrett T , Davies N , Winstanley C , Harding M. Walking school buses as a form of active transportation for children—a review of the evidence . J School Health 2015 ; 85 : 197 – 210 . Google Scholar CrossRef Search ADS PubMed 30 Esteban-Cornejo I , Carlson JA , Conway TL et al. Parental and adolescent perceptions of neighborhood safety related to adolescents’ physical activity in their neighborhood . Res Q Exerc Sport 2016 ; 87 : 191 – 99 . Google Scholar CrossRef Search ADS PubMed 31 UNESCO . World-wide Survey of School Physical Education . Paris : UNESCO , 2014 . 32 Hardman K. Physical education in schools: a global perspective . Kinesiology 2008 ; 40 : 5 – 28 . 33 Tucker P , Gilliland J. The effect of season and weather on physical activity: a systematic review . Public Health 2007 ; 121 : 909 – 22 . Google Scholar CrossRef Search ADS PubMed 34 Hjorth MF , Chaput JP , Michaelsen K , Astrup A , Tetens I , Sjodin A. Seasonal variation in objectively measured physical activity, sedentary time, cardio-respiratory fitness and sleep duration among 8-11 year-old Danish children: a repeated-measures study . BMC Public Health 2013 ; 13 : 808. Google Scholar CrossRef Search ADS PubMed 35 Silva P , Santos R , Welk G , Mota J. Seasonal differences in physical activity and sedentary patterns: the relevance of the PA context . J Sports Sci Med 2011 ; 10 : 66 – 72 . Google Scholar PubMed 36 Becker AE , Roberts AL , Perloe A et al. Youth health-risk behavior assessment in Fiji: the reliability of Global School-based Student Health Survey content adapted for ethnic Fijian girls . Ethn Health 2010 ; 15 : 181 – 97 . Google Scholar CrossRef Search ADS PubMed © The Author(s) 2018; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png International Journal of Epidemiology Oxford University Press

A regional vision of physical activity, sedentary behaviour and physical education in adolescents from Latin America and the Caribbean: results from 26 countries

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Oxford University Press
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© The Author(s) 2018; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association
ISSN
0300-5771
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1464-3685
D.O.I.
10.1093/ije/dyy033
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Abstract

Abstract Background Latin America and the Caribbean (LAC) countries, have been historically under-represented due to the lack of surveillance of physical behaviours in young populations. Therefore, the aim of this study was to describe and compare overall physical activity (PA), active transportation to and from school (i.e. walking or cycling), physical education (PE) participation, and sedentary behaviour (SB) in adolescents from 26 countries in LAC. Methods Data were collected in the Global School-based Student Health Survey (2007–13). Prevalences for each physical behaviour were compared by sex across the region. Results In total, 64 034 adolescents provided complete data (age range: 11 to 18 years; 47.7% male). Only about 15% of adolescents in LAC countries were physically active (at least 60 min/day of moderate-to-vigorous PA) with most countries showing sex disparities. Overall, 41.9% reported being active for transportation to and from school at least 3 days per week. In 12 countries, at least 50% of the adolescents reported sitting ≥3 h per day outside school, and a third of adolescents reported participation in PE classes on 3 days or more per week. Conclusions The study sets a challenge for the LAC region, as physical inactivity and SB are highly prevalent across all countries. Gender inequity was shown in most countries, with boys reporting more active behaviours. Regional and national actions for implementing policies to revert this situation are urgent. Physical inactivity, surveillance, active transportation, sitting, inequity, physical education provision, sedentary lifestyle Key Messages Only 15% of adolescents from Latin America and the Caribbean (LAC) countries met the physical activity recommendations. Sedentary behaviour was highly prevalent in LAC countries and was positively correlated with the Human Development Index. Sex disparities in physical behaviours were shown in most LAC countries. Although LAC countries have high levels of policy implementation for physical education in schools, only a third of adolescents reported participation in physical education classes on 3 days or more per week. Introduction Physical inactivity and sedentary behaviour (SB) are highly prevalent in adolescents across the world and are affecting not only high-income nations, but also low- and middle-income countries (LMICs).1–3 Therefore, a global call for action has been made to join efforts among countries in order to improve knowledge and change the world trend of increasing physical inactivity and SB.4,5 However, some regions, especially Latin America and the Caribbean (LAC), have been historically under-represented due to the lack of surveillance in this age group.6 To tackle this multinational issue, the World Health Organization (WHO) planned a Global School Health Survey (GSHS).7,8 Since 2003, the GSHS has been implemented to obtain systematic information among 13- to 17-year-old students to support programmes and policies for school and youth health globally. The GSHS offers an opportunity to better understand physical behaviours as a part of monitoring physical activity (PA) and SB,7 and includes other related factors that make contributions to increasing the chances of meeting PA recommendations in adolescents, such as active transportation (AT) and physical education (PE).9,10 Advances in monitoring and regional analysis of the current levels of physical behaviours in adolescents will provide a better picture for understanding cross-national differences in LAC countries and, therefore, help in the design of informed policies for PA promotion. The aim of this study was to describe and compare overall PA, PA for transportation, PE participation, and SB in adolescents from 26 countries in LAC. Methods Sampling Public data of 26 countries from LAC included in the GSHS were analysed in those surveys conducted between 2007 and 2013. Country participation was voluntary. A two-stage cluster sample design was used to produce representative data of adolescent students for each country. At the first stage, schools were selected with probability proportional to enrolment size. At the second stage, classes were randomly selected and all students in selected classes were eligible to participate.7 All countries provided nationally representative samples, except for Colombia and Ecuador, which provided data from their capital cities only. Questionnaires were self-administered and completed during one regular class period. Student participation was voluntary and private. Informed consent was completed by students, parents and schools’ representatives. Instrument The GSHS questionnaire included 10 core modules that address the leading causes of morbidity and mortality among children and adults worldwide.7 Countries were required to include at least six of the 10 core modules with no changes in their questionnaires. Age, height and weight were self-reported. Body mass index (BMI) was calculated by dividing the weight in kilograms by height in metres squared. From the median BMI for age and sex, students were categorized as overweight if their BMI was >+1 standard deviation (SD) and obese if their BMI was >+2SD using the WHO growth reference.11 PA was assessed with the following question: ‘During the past 7 days, on how many days were you physically active for a total of at least 60 minutes per day? Add up all the time you spent in any kind of physical activity each day’. Adolescents were classified as ‘physically active’ if they engaged in PA for at least 60 min every day of the week. The question: ‘During the past 7 days, on how many days did you walk or ride a bicycle to or from school?’ was used to assess AT. Adolescents were classified as ‘active for transport’ if they rode or walked to and from school on at least 3 days during the past 7 days. PE class participation was assessed by asking: ‘During this school year, on how many days did you go to physical education class each week?’. SB was assessed with the question: ‘How much time do you spend during a typical or usual day sitting and watching television, playing computer games, talking with friends or doing other sitting activities, such as (country-specific examples)?’. Adolescents were considered ‘sedentary’ if they spent 3 or more h per day sitting outside school.12 Statistical analysis Participants with missing data for age, sex, number of physically active days, number of days for active transport, number of PE classes per day, and amount of time spent sitting outside school were excluded from the analysis, except for countries in which those core modules were not included. Survey data settings in Stata, version 13 (StataCorp, College Station, TX, USA) were used to consider the weighting for each observation and the two-stage sample design of the GSHS. Data were summarized in medians (percentiles) and percentages [95% confidence interval (CI)]. Relative differences of prevalences for each domain between sexes and by country were also calculated and used as measure of disparity. Logistic regressions were used to assess differences between sexes. Spearman correlational analyses were performed to assess how both prevalences and relative differences between sexes of PA, AT, PE participation and SB were individually correlated to some global and demographic indices, including: the Human Development Index (HDI, 2008–16 data, a high index represents greater human development),13 Gender Inequality Index (GII, 2016 data, a higher score represents greater gender inequality)14 and the Gini Coefficient (GC, 2010–15 data, a higher coefficient represents greater income inequality).15,16 The GII was unavailable for most Caribbean countries, such as Cayman Islands, British Virgin Islands, Montserrat, Saint Kitts and Nevis, Grenada, Dominica and Saint Vincent, and the Grenadines (7/26), and the GC was missing for Antigua and Barbuda, Bahamas, Guyana, Montserrat, Saint Kitts and Nevis, and Trinidad and Tobago (5/26). The motorization rate (MR, number of all vehicles per 1000 inhabitants) was also used to assess its correlation with physical behaviours.17 Age and sex were included for covariate adjustment in comparisons across groups and correlations. Results In total, 64 034 adolescents from 26 LAC countries provided complete data out of 79 419 surveyed participants. Survey and sample characteristics of the study are shown in Table 1. The average response rate was 79.8% and ranged from 60.0% (Chile) to 90.0% (British Virgin Islands, and Trinidad and Tobago). The percentage of male participants ranged from 43.6% (Grenada) to 52.9% (Guatemala). The lowest prevalence of overweight participants was observed in Colombia (10.8%) and the highest was found in Chile (28.6%). Obesity prevalence by country ranged from 1.2% (Colombia) to 21.5% (Argentina). No demographic differences were observed between students with complete data and those excluded because of missing data. Table 1 Survey year, response rate, sample size and characteristics for each Latin American and Caribbean country included in the study Country Survey year Response rate (%) Total sampleb Mean age (95% CI) Male % Overweight % Obesity % Antigua and Barbuda 2009 67 1112 13.9 (13.9–14.0) 51.9 – – Argentina 2012 71 16 383 14.4 (14.3–14.4) 48.2 21.9 6.0 Bahamas 2013 78 1124 13.5 (13.4–13.6) 47.0 23.6 21.5 Barbados 2011 73 1266 14.2 (14.1–14.2) 50.4 17.6 14.6 Belize 2011 88 1834 13.9 (13.6–14.1) 47.9 23.2 13.3 Bolivia 2012 88 3296 14.4 (14.2–14.6) 50.8 17.8 4.8 British Virgin Islands 2009 90 1429 14.1 (14.0–14.1) 47.4 20.1 19.9 Cayman Islands 2007 79 1162 13.9 (13.9–14.0) 48.8 20.9 12.8 Chile 2013 60 1888 15.1 (14.8–15.4) 48.3 28.6 14.1 Colombiaa 2007 83 1705 14.2 (13.9–14.5) 45.8 10.8 1.2 Costa Rica 2009 72 2601 14.3 (14.1–14.5) 50.4 19.1 9.0 Dominica 2009 84 1464 14.0 (13.7–14.4) 50.4 16.3 10.1 El Salvador 2013 88 1783 14.2 (14.1–14.4) 51.7 19.7 9.2 Ecuadora 2007 86 2105 13.4 (13.2–13.7) 51.3 24.2 8.3 Grenada 2008 78 1364 14.1 (13.7–14.4) 43.6 – – Guatemala 2009 81 5194 14.3 (14.2–14.4) 52.9 20.0 7.6 Guyana 2010 76 2215 14.3 (14.2–14.5) 48.1 11.1 4.4 Honduras 2012 79 1644 13.9 (13.7–14.0) 46.7 13.1 5.2 Montserrat 2008 78 194 14.3 (14.1–14.5) 45.8 – – Peru 2010 85 2806 14.4 (14.3–14.5) 50.5 16.9 3.0 Saint Kitts and Nevis 2011 70 1627 14.5 (14.4–14.5) 50.3 18.4 14.2 Saint Lucia 2007 82 1227 14.1 (13.7–14.4) 45.0 – – Saint Vincent and Grenadines 2007 84 1191 13.7 (13.3–14.0) 45.8 – – Suriname 2009 89 1568 14.7 (14.5–15.0) 49.0 13.2 6.8 Trinidad and Tobago 2011 90 2543 13.7 (13.6–13.9) 48.9 15.4 14.0 Uruguay 2012 77 3309 14.4 (14.3–14.5) 45.4 19.7 6.9 Country Survey year Response rate (%) Total sampleb Mean age (95% CI) Male % Overweight % Obesity % Antigua and Barbuda 2009 67 1112 13.9 (13.9–14.0) 51.9 – – Argentina 2012 71 16 383 14.4 (14.3–14.4) 48.2 21.9 6.0 Bahamas 2013 78 1124 13.5 (13.4–13.6) 47.0 23.6 21.5 Barbados 2011 73 1266 14.2 (14.1–14.2) 50.4 17.6 14.6 Belize 2011 88 1834 13.9 (13.6–14.1) 47.9 23.2 13.3 Bolivia 2012 88 3296 14.4 (14.2–14.6) 50.8 17.8 4.8 British Virgin Islands 2009 90 1429 14.1 (14.0–14.1) 47.4 20.1 19.9 Cayman Islands 2007 79 1162 13.9 (13.9–14.0) 48.8 20.9 12.8 Chile 2013 60 1888 15.1 (14.8–15.4) 48.3 28.6 14.1 Colombiaa 2007 83 1705 14.2 (13.9–14.5) 45.8 10.8 1.2 Costa Rica 2009 72 2601 14.3 (14.1–14.5) 50.4 19.1 9.0 Dominica 2009 84 1464 14.0 (13.7–14.4) 50.4 16.3 10.1 El Salvador 2013 88 1783 14.2 (14.1–14.4) 51.7 19.7 9.2 Ecuadora 2007 86 2105 13.4 (13.2–13.7) 51.3 24.2 8.3 Grenada 2008 78 1364 14.1 (13.7–14.4) 43.6 – – Guatemala 2009 81 5194 14.3 (14.2–14.4) 52.9 20.0 7.6 Guyana 2010 76 2215 14.3 (14.2–14.5) 48.1 11.1 4.4 Honduras 2012 79 1644 13.9 (13.7–14.0) 46.7 13.1 5.2 Montserrat 2008 78 194 14.3 (14.1–14.5) 45.8 – – Peru 2010 85 2806 14.4 (14.3–14.5) 50.5 16.9 3.0 Saint Kitts and Nevis 2011 70 1627 14.5 (14.4–14.5) 50.3 18.4 14.2 Saint Lucia 2007 82 1227 14.1 (13.7–14.4) 45.0 – – Saint Vincent and Grenadines 2007 84 1191 13.7 (13.3–14.0) 45.8 – – Suriname 2009 89 1568 14.7 (14.5–15.0) 49.0 13.2 6.8 Trinidad and Tobago 2011 90 2543 13.7 (13.6–13.9) 48.9 15.4 14.0 Uruguay 2012 77 3309 14.4 (14.3–14.5) 45.4 19.7 6.9 a Only regional representation. b Participants with no missing data. Table 1 Survey year, response rate, sample size and characteristics for each Latin American and Caribbean country included in the study Country Survey year Response rate (%) Total sampleb Mean age (95% CI) Male % Overweight % Obesity % Antigua and Barbuda 2009 67 1112 13.9 (13.9–14.0) 51.9 – – Argentina 2012 71 16 383 14.4 (14.3–14.4) 48.2 21.9 6.0 Bahamas 2013 78 1124 13.5 (13.4–13.6) 47.0 23.6 21.5 Barbados 2011 73 1266 14.2 (14.1–14.2) 50.4 17.6 14.6 Belize 2011 88 1834 13.9 (13.6–14.1) 47.9 23.2 13.3 Bolivia 2012 88 3296 14.4 (14.2–14.6) 50.8 17.8 4.8 British Virgin Islands 2009 90 1429 14.1 (14.0–14.1) 47.4 20.1 19.9 Cayman Islands 2007 79 1162 13.9 (13.9–14.0) 48.8 20.9 12.8 Chile 2013 60 1888 15.1 (14.8–15.4) 48.3 28.6 14.1 Colombiaa 2007 83 1705 14.2 (13.9–14.5) 45.8 10.8 1.2 Costa Rica 2009 72 2601 14.3 (14.1–14.5) 50.4 19.1 9.0 Dominica 2009 84 1464 14.0 (13.7–14.4) 50.4 16.3 10.1 El Salvador 2013 88 1783 14.2 (14.1–14.4) 51.7 19.7 9.2 Ecuadora 2007 86 2105 13.4 (13.2–13.7) 51.3 24.2 8.3 Grenada 2008 78 1364 14.1 (13.7–14.4) 43.6 – – Guatemala 2009 81 5194 14.3 (14.2–14.4) 52.9 20.0 7.6 Guyana 2010 76 2215 14.3 (14.2–14.5) 48.1 11.1 4.4 Honduras 2012 79 1644 13.9 (13.7–14.0) 46.7 13.1 5.2 Montserrat 2008 78 194 14.3 (14.1–14.5) 45.8 – – Peru 2010 85 2806 14.4 (14.3–14.5) 50.5 16.9 3.0 Saint Kitts and Nevis 2011 70 1627 14.5 (14.4–14.5) 50.3 18.4 14.2 Saint Lucia 2007 82 1227 14.1 (13.7–14.4) 45.0 – – Saint Vincent and Grenadines 2007 84 1191 13.7 (13.3–14.0) 45.8 – – Suriname 2009 89 1568 14.7 (14.5–15.0) 49.0 13.2 6.8 Trinidad and Tobago 2011 90 2543 13.7 (13.6–13.9) 48.9 15.4 14.0 Uruguay 2012 77 3309 14.4 (14.3–14.5) 45.4 19.7 6.9 Country Survey year Response rate (%) Total sampleb Mean age (95% CI) Male % Overweight % Obesity % Antigua and Barbuda 2009 67 1112 13.9 (13.9–14.0) 51.9 – – Argentina 2012 71 16 383 14.4 (14.3–14.4) 48.2 21.9 6.0 Bahamas 2013 78 1124 13.5 (13.4–13.6) 47.0 23.6 21.5 Barbados 2011 73 1266 14.2 (14.1–14.2) 50.4 17.6 14.6 Belize 2011 88 1834 13.9 (13.6–14.1) 47.9 23.2 13.3 Bolivia 2012 88 3296 14.4 (14.2–14.6) 50.8 17.8 4.8 British Virgin Islands 2009 90 1429 14.1 (14.0–14.1) 47.4 20.1 19.9 Cayman Islands 2007 79 1162 13.9 (13.9–14.0) 48.8 20.9 12.8 Chile 2013 60 1888 15.1 (14.8–15.4) 48.3 28.6 14.1 Colombiaa 2007 83 1705 14.2 (13.9–14.5) 45.8 10.8 1.2 Costa Rica 2009 72 2601 14.3 (14.1–14.5) 50.4 19.1 9.0 Dominica 2009 84 1464 14.0 (13.7–14.4) 50.4 16.3 10.1 El Salvador 2013 88 1783 14.2 (14.1–14.4) 51.7 19.7 9.2 Ecuadora 2007 86 2105 13.4 (13.2–13.7) 51.3 24.2 8.3 Grenada 2008 78 1364 14.1 (13.7–14.4) 43.6 – – Guatemala 2009 81 5194 14.3 (14.2–14.4) 52.9 20.0 7.6 Guyana 2010 76 2215 14.3 (14.2–14.5) 48.1 11.1 4.4 Honduras 2012 79 1644 13.9 (13.7–14.0) 46.7 13.1 5.2 Montserrat 2008 78 194 14.3 (14.1–14.5) 45.8 – – Peru 2010 85 2806 14.4 (14.3–14.5) 50.5 16.9 3.0 Saint Kitts and Nevis 2011 70 1627 14.5 (14.4–14.5) 50.3 18.4 14.2 Saint Lucia 2007 82 1227 14.1 (13.7–14.4) 45.0 – – Saint Vincent and Grenadines 2007 84 1191 13.7 (13.3–14.0) 45.8 – – Suriname 2009 89 1568 14.7 (14.5–15.0) 49.0 13.2 6.8 Trinidad and Tobago 2011 90 2543 13.7 (13.6–13.9) 48.9 15.4 14.0 Uruguay 2012 77 3309 14.4 (14.3–14.5) 45.4 19.7 6.9 a Only regional representation. b Participants with no missing data. In most countries, boys had more active days per week than girls (Table 2). The weighted average percentage (by population size) of physically active adolescents across LAC countries was 15.5%. The least active adolescents were observed in Saint Vincent and Grenadines (12.8%), and the most active adolescents were from Antigua and Barbuda (22.8%). Only four countries had more than 20% of physically active adolescents (Antigua and Barbuda, Belize, Montserrat, and Trinidad and Tobago) (Figure 1A). The countries with the largest relative differences in percentage of active adolescents between boys and girls were Chile (49.2%), Costa Rica (51.0%), and Uruguay (60.1%). Only the relative difference between active boys and girls per country was positively correlated with the HDI (rho = 0.50, P = 0.01) and negatively correlated with the GII (rho=−0.58, P = 0.01) (Supplementary Figures, available as Supplementary data at IJE online). No correlations were observed between PA and the other indices (GC (P = 0.32), MR (P = 0.11)). Table 2 Median (P25–P75) days per week that adolescents engaged physical activity for at least 60 min and the percentage of physically active adolescents in Latin America and the Caribbean Country Median active days per week (P25–P75) Percentage of physically active adolescents on 7 days per week (95% CI) Overall Male Female P Overall Male Female P Antigua and Barbuda 2 (0–6) 3 (0–7) 2 (0–5) <0.001 22.8 (20.3–25.6) 28.5 (24.5–32.9) 16.7 (13.9–20.1) <0.001 Argentina 3 (1–5) 3 (2–6) 2 (1–4) <0.001 16.7 (15.6–17.8) 21.7 (20.2–23.2) 12.1 (11.0–13.4) <0.001 Bahamas 2 (0–4) 2 (0–5) 1 (0–4) 0.001 15.5 (13.3–17.8) 19.7 (16.3–23.7) 11.6 (9.3–14.4) <0.001 Barbados 2 (0–5) 3 (0–7) 2 (0–4) <0.001 18.6 (16.6–20.7) 24.7 (21.5–28.2) 12.9 (10.7–15.5) <0.001 Belize 2 (0–5) 3 (0–6) 2 (0–5) 0.001 21.2 (18.9–23.7) 24.6 (21.7–27.7) 18.0 (15.6–20.8) <0.001 Bolivia 2 (1–4) 2 (1–5) 2 (1–4) 0.001 13.9 (12.6–15.3) 16.6 (14.7–18.7) 11.1 (9.5–13.0) <0.001 British Virgin Islands 2 (0–5) 2 (0–6) 2 (0–4) <0.001 17.3 (15.5–19.3) 22.4 (19.4–25.7) 12.9 (10.8–15.3) <0.001 Cayman Islands 3 (1–5) 3 (1–6) 2 (0–4) <0.001 14.0 (12.1–16.2) 17.8 (14.7–21.4) 10.3 (8.1–13.0) <0.001 Chile 2 (1–5) 3 (1–5) 2 (1–4) <0.001 13.6 (11.9–15.6) 18.3 (15.5–21.4) 9.3 (7.0–12.4) <0.001 Colombiaa 2 (1–4) 2 (1–5) 1 (0–4) 0.001 15.4 (13.1–18.0) 16.8 (13.9–20.1) 14.2 (10.8–18.6) 0.32 Costa Rica 2 (1–5) 3 (1–6) 2 (1–4) <0.001 18.5 (16.5–20.6) 24.7 (22.5–27.1) 12.1 (9.7–15.0) <0.001 Dominica 1 (0–4) 1 (0–4) 1 (0–4) 0.28 16.1 (13.9–18.5) 16.6 (13.2–20.7) 15.5 (12.9–18.6) 0.64 El Salvador 1 (0–4) 2 (0–5) 1 (0–3) <0.001 13.0 (10.9–15.5) 16.1 (13.1–19.5) 9.7 (7.3–12.7) 0.003 Ecuadora 2 (1–4) 2 (1–5) 2 (1–3) 0.001 14.5 (13.3–15.7) 18.0 (16.3–19.8) 10.8 (8.6–13.4) <0.001 Grenada 1 (0–4) 1 (0–4) 1 (0–3) 0.2 14.7 (12.6–17.1) 16.8 (13.5–20.8) 13.1 (10.8–15.8) 0.06 Guatemala 2 (1–4) 2 (1–5) 1 (1–3) 0.007 15.6 (13.0–18.5) 18.8 (16.2–21.6) 12.0 (8.6–16.4) <0.001 Guyana 1 (0–4) 1 (0–4) 1 (0–3) 0.002 15.6 (12.7–19.1) 18.3 (13.7–23.9) 13.2 (10.4–16.7) 0.05 Honduras 1 (0–4) 2 (1–5) 1 (0–3) <0.001 15.8 (13.8–18.0) 19.4 (16.9–22.2) 12.6 (9.9–15.8) 0.002 Montserrat 2 (0–5) 2 (0–5) 2 (1–5) 0.85 20.7 (15.5–27.2) 18.3 (11.6–27.6) 22.8 (15.5–32.3) 0.44 Peru 2 (1–5) 2 (1–5) 2 (1–4) 0.27 15.4 (13.7–17.2) 16.5 (14.2–19.2) 14.2 (12.5–16.2) 0.08 Saint Kitts and Nevis 2 (0–5) 2 (0–5) 1 (0–4) <0.001 18.8 (16.8–20.9) 23.1 (20.0–26.5) 14.4 (12.2–16.9) <0.001 Saint Lucia 2 (0–4) 2 (0–5) 1 (0–4) 0.07 15.4 (12.9–18.3) 16.8 (13.5–20.6) 14.3 (11.3–17.9) 0.23 Saint Vincent and Grenadines 1 (0–3) 1 (0–4) 1 (0–3) <0.001 12.8 (10.7–15.2) 14.7 (11.9–18.1) 11.1 (8.5–14.4) 0.08 Suriname 2 (0–5) 2 (1–5) 2 (0–4) <0.001 19.3 (16.6–22.4) 22.4 (18.5–26.7) 16.4 (14.1–19.0) 0.007 Trinidad and Tobago 2 (0–5) 3 (0–6) 2 (0–4) <0.001 20.5 (17.5–23.9) 24.7 (21.2–28.5) 16.5 (13.9–19.6) <0.001 Uruguay 2 (1–5) 4 (2–6) 2 (0–3) <0.001 15.3 (13.7–17.1) 22.8 (20.4–25.3) 9.1 (7.8–10.7) <0.001 Country Median active days per week (P25–P75) Percentage of physically active adolescents on 7 days per week (95% CI) Overall Male Female P Overall Male Female P Antigua and Barbuda 2 (0–6) 3 (0–7) 2 (0–5) <0.001 22.8 (20.3–25.6) 28.5 (24.5–32.9) 16.7 (13.9–20.1) <0.001 Argentina 3 (1–5) 3 (2–6) 2 (1–4) <0.001 16.7 (15.6–17.8) 21.7 (20.2–23.2) 12.1 (11.0–13.4) <0.001 Bahamas 2 (0–4) 2 (0–5) 1 (0–4) 0.001 15.5 (13.3–17.8) 19.7 (16.3–23.7) 11.6 (9.3–14.4) <0.001 Barbados 2 (0–5) 3 (0–7) 2 (0–4) <0.001 18.6 (16.6–20.7) 24.7 (21.5–28.2) 12.9 (10.7–15.5) <0.001 Belize 2 (0–5) 3 (0–6) 2 (0–5) 0.001 21.2 (18.9–23.7) 24.6 (21.7–27.7) 18.0 (15.6–20.8) <0.001 Bolivia 2 (1–4) 2 (1–5) 2 (1–4) 0.001 13.9 (12.6–15.3) 16.6 (14.7–18.7) 11.1 (9.5–13.0) <0.001 British Virgin Islands 2 (0–5) 2 (0–6) 2 (0–4) <0.001 17.3 (15.5–19.3) 22.4 (19.4–25.7) 12.9 (10.8–15.3) <0.001 Cayman Islands 3 (1–5) 3 (1–6) 2 (0–4) <0.001 14.0 (12.1–16.2) 17.8 (14.7–21.4) 10.3 (8.1–13.0) <0.001 Chile 2 (1–5) 3 (1–5) 2 (1–4) <0.001 13.6 (11.9–15.6) 18.3 (15.5–21.4) 9.3 (7.0–12.4) <0.001 Colombiaa 2 (1–4) 2 (1–5) 1 (0–4) 0.001 15.4 (13.1–18.0) 16.8 (13.9–20.1) 14.2 (10.8–18.6) 0.32 Costa Rica 2 (1–5) 3 (1–6) 2 (1–4) <0.001 18.5 (16.5–20.6) 24.7 (22.5–27.1) 12.1 (9.7–15.0) <0.001 Dominica 1 (0–4) 1 (0–4) 1 (0–4) 0.28 16.1 (13.9–18.5) 16.6 (13.2–20.7) 15.5 (12.9–18.6) 0.64 El Salvador 1 (0–4) 2 (0–5) 1 (0–3) <0.001 13.0 (10.9–15.5) 16.1 (13.1–19.5) 9.7 (7.3–12.7) 0.003 Ecuadora 2 (1–4) 2 (1–5) 2 (1–3) 0.001 14.5 (13.3–15.7) 18.0 (16.3–19.8) 10.8 (8.6–13.4) <0.001 Grenada 1 (0–4) 1 (0–4) 1 (0–3) 0.2 14.7 (12.6–17.1) 16.8 (13.5–20.8) 13.1 (10.8–15.8) 0.06 Guatemala 2 (1–4) 2 (1–5) 1 (1–3) 0.007 15.6 (13.0–18.5) 18.8 (16.2–21.6) 12.0 (8.6–16.4) <0.001 Guyana 1 (0–4) 1 (0–4) 1 (0–3) 0.002 15.6 (12.7–19.1) 18.3 (13.7–23.9) 13.2 (10.4–16.7) 0.05 Honduras 1 (0–4) 2 (1–5) 1 (0–3) <0.001 15.8 (13.8–18.0) 19.4 (16.9–22.2) 12.6 (9.9–15.8) 0.002 Montserrat 2 (0–5) 2 (0–5) 2 (1–5) 0.85 20.7 (15.5–27.2) 18.3 (11.6–27.6) 22.8 (15.5–32.3) 0.44 Peru 2 (1–5) 2 (1–5) 2 (1–4) 0.27 15.4 (13.7–17.2) 16.5 (14.2–19.2) 14.2 (12.5–16.2) 0.08 Saint Kitts and Nevis 2 (0–5) 2 (0–5) 1 (0–4) <0.001 18.8 (16.8–20.9) 23.1 (20.0–26.5) 14.4 (12.2–16.9) <0.001 Saint Lucia 2 (0–4) 2 (0–5) 1 (0–4) 0.07 15.4 (12.9–18.3) 16.8 (13.5–20.6) 14.3 (11.3–17.9) 0.23 Saint Vincent and Grenadines 1 (0–3) 1 (0–4) 1 (0–3) <0.001 12.8 (10.7–15.2) 14.7 (11.9–18.1) 11.1 (8.5–14.4) 0.08 Suriname 2 (0–5) 2 (1–5) 2 (0–4) <0.001 19.3 (16.6–22.4) 22.4 (18.5–26.7) 16.4 (14.1–19.0) 0.007 Trinidad and Tobago 2 (0–5) 3 (0–6) 2 (0–4) <0.001 20.5 (17.5–23.9) 24.7 (21.2–28.5) 16.5 (13.9–19.6) <0.001 Uruguay 2 (1–5) 4 (2–6) 2 (0–3) <0.001 15.3 (13.7–17.1) 22.8 (20.4–25.3) 9.1 (7.8–10.7) <0.001 Active day defined as engaging in moderate-to-vigorous physical activity for at least 60 min per day. Differences were adjusted by age and gender. a Only regional representation. Table 2 Median (P25–P75) days per week that adolescents engaged physical activity for at least 60 min and the percentage of physically active adolescents in Latin America and the Caribbean Country Median active days per week (P25–P75) Percentage of physically active adolescents on 7 days per week (95% CI) Overall Male Female P Overall Male Female P Antigua and Barbuda 2 (0–6) 3 (0–7) 2 (0–5) <0.001 22.8 (20.3–25.6) 28.5 (24.5–32.9) 16.7 (13.9–20.1) <0.001 Argentina 3 (1–5) 3 (2–6) 2 (1–4) <0.001 16.7 (15.6–17.8) 21.7 (20.2–23.2) 12.1 (11.0–13.4) <0.001 Bahamas 2 (0–4) 2 (0–5) 1 (0–4) 0.001 15.5 (13.3–17.8) 19.7 (16.3–23.7) 11.6 (9.3–14.4) <0.001 Barbados 2 (0–5) 3 (0–7) 2 (0–4) <0.001 18.6 (16.6–20.7) 24.7 (21.5–28.2) 12.9 (10.7–15.5) <0.001 Belize 2 (0–5) 3 (0–6) 2 (0–5) 0.001 21.2 (18.9–23.7) 24.6 (21.7–27.7) 18.0 (15.6–20.8) <0.001 Bolivia 2 (1–4) 2 (1–5) 2 (1–4) 0.001 13.9 (12.6–15.3) 16.6 (14.7–18.7) 11.1 (9.5–13.0) <0.001 British Virgin Islands 2 (0–5) 2 (0–6) 2 (0–4) <0.001 17.3 (15.5–19.3) 22.4 (19.4–25.7) 12.9 (10.8–15.3) <0.001 Cayman Islands 3 (1–5) 3 (1–6) 2 (0–4) <0.001 14.0 (12.1–16.2) 17.8 (14.7–21.4) 10.3 (8.1–13.0) <0.001 Chile 2 (1–5) 3 (1–5) 2 (1–4) <0.001 13.6 (11.9–15.6) 18.3 (15.5–21.4) 9.3 (7.0–12.4) <0.001 Colombiaa 2 (1–4) 2 (1–5) 1 (0–4) 0.001 15.4 (13.1–18.0) 16.8 (13.9–20.1) 14.2 (10.8–18.6) 0.32 Costa Rica 2 (1–5) 3 (1–6) 2 (1–4) <0.001 18.5 (16.5–20.6) 24.7 (22.5–27.1) 12.1 (9.7–15.0) <0.001 Dominica 1 (0–4) 1 (0–4) 1 (0–4) 0.28 16.1 (13.9–18.5) 16.6 (13.2–20.7) 15.5 (12.9–18.6) 0.64 El Salvador 1 (0–4) 2 (0–5) 1 (0–3) <0.001 13.0 (10.9–15.5) 16.1 (13.1–19.5) 9.7 (7.3–12.7) 0.003 Ecuadora 2 (1–4) 2 (1–5) 2 (1–3) 0.001 14.5 (13.3–15.7) 18.0 (16.3–19.8) 10.8 (8.6–13.4) <0.001 Grenada 1 (0–4) 1 (0–4) 1 (0–3) 0.2 14.7 (12.6–17.1) 16.8 (13.5–20.8) 13.1 (10.8–15.8) 0.06 Guatemala 2 (1–4) 2 (1–5) 1 (1–3) 0.007 15.6 (13.0–18.5) 18.8 (16.2–21.6) 12.0 (8.6–16.4) <0.001 Guyana 1 (0–4) 1 (0–4) 1 (0–3) 0.002 15.6 (12.7–19.1) 18.3 (13.7–23.9) 13.2 (10.4–16.7) 0.05 Honduras 1 (0–4) 2 (1–5) 1 (0–3) <0.001 15.8 (13.8–18.0) 19.4 (16.9–22.2) 12.6 (9.9–15.8) 0.002 Montserrat 2 (0–5) 2 (0–5) 2 (1–5) 0.85 20.7 (15.5–27.2) 18.3 (11.6–27.6) 22.8 (15.5–32.3) 0.44 Peru 2 (1–5) 2 (1–5) 2 (1–4) 0.27 15.4 (13.7–17.2) 16.5 (14.2–19.2) 14.2 (12.5–16.2) 0.08 Saint Kitts and Nevis 2 (0–5) 2 (0–5) 1 (0–4) <0.001 18.8 (16.8–20.9) 23.1 (20.0–26.5) 14.4 (12.2–16.9) <0.001 Saint Lucia 2 (0–4) 2 (0–5) 1 (0–4) 0.07 15.4 (12.9–18.3) 16.8 (13.5–20.6) 14.3 (11.3–17.9) 0.23 Saint Vincent and Grenadines 1 (0–3) 1 (0–4) 1 (0–3) <0.001 12.8 (10.7–15.2) 14.7 (11.9–18.1) 11.1 (8.5–14.4) 0.08 Suriname 2 (0–5) 2 (1–5) 2 (0–4) <0.001 19.3 (16.6–22.4) 22.4 (18.5–26.7) 16.4 (14.1–19.0) 0.007 Trinidad and Tobago 2 (0–5) 3 (0–6) 2 (0–4) <0.001 20.5 (17.5–23.9) 24.7 (21.2–28.5) 16.5 (13.9–19.6) <0.001 Uruguay 2 (1–5) 4 (2–6) 2 (0–3) <0.001 15.3 (13.7–17.1) 22.8 (20.4–25.3) 9.1 (7.8–10.7) <0.001 Country Median active days per week (P25–P75) Percentage of physically active adolescents on 7 days per week (95% CI) Overall Male Female P Overall Male Female P Antigua and Barbuda 2 (0–6) 3 (0–7) 2 (0–5) <0.001 22.8 (20.3–25.6) 28.5 (24.5–32.9) 16.7 (13.9–20.1) <0.001 Argentina 3 (1–5) 3 (2–6) 2 (1–4) <0.001 16.7 (15.6–17.8) 21.7 (20.2–23.2) 12.1 (11.0–13.4) <0.001 Bahamas 2 (0–4) 2 (0–5) 1 (0–4) 0.001 15.5 (13.3–17.8) 19.7 (16.3–23.7) 11.6 (9.3–14.4) <0.001 Barbados 2 (0–5) 3 (0–7) 2 (0–4) <0.001 18.6 (16.6–20.7) 24.7 (21.5–28.2) 12.9 (10.7–15.5) <0.001 Belize 2 (0–5) 3 (0–6) 2 (0–5) 0.001 21.2 (18.9–23.7) 24.6 (21.7–27.7) 18.0 (15.6–20.8) <0.001 Bolivia 2 (1–4) 2 (1–5) 2 (1–4) 0.001 13.9 (12.6–15.3) 16.6 (14.7–18.7) 11.1 (9.5–13.0) <0.001 British Virgin Islands 2 (0–5) 2 (0–6) 2 (0–4) <0.001 17.3 (15.5–19.3) 22.4 (19.4–25.7) 12.9 (10.8–15.3) <0.001 Cayman Islands 3 (1–5) 3 (1–6) 2 (0–4) <0.001 14.0 (12.1–16.2) 17.8 (14.7–21.4) 10.3 (8.1–13.0) <0.001 Chile 2 (1–5) 3 (1–5) 2 (1–4) <0.001 13.6 (11.9–15.6) 18.3 (15.5–21.4) 9.3 (7.0–12.4) <0.001 Colombiaa 2 (1–4) 2 (1–5) 1 (0–4) 0.001 15.4 (13.1–18.0) 16.8 (13.9–20.1) 14.2 (10.8–18.6) 0.32 Costa Rica 2 (1–5) 3 (1–6) 2 (1–4) <0.001 18.5 (16.5–20.6) 24.7 (22.5–27.1) 12.1 (9.7–15.0) <0.001 Dominica 1 (0–4) 1 (0–4) 1 (0–4) 0.28 16.1 (13.9–18.5) 16.6 (13.2–20.7) 15.5 (12.9–18.6) 0.64 El Salvador 1 (0–4) 2 (0–5) 1 (0–3) <0.001 13.0 (10.9–15.5) 16.1 (13.1–19.5) 9.7 (7.3–12.7) 0.003 Ecuadora 2 (1–4) 2 (1–5) 2 (1–3) 0.001 14.5 (13.3–15.7) 18.0 (16.3–19.8) 10.8 (8.6–13.4) <0.001 Grenada 1 (0–4) 1 (0–4) 1 (0–3) 0.2 14.7 (12.6–17.1) 16.8 (13.5–20.8) 13.1 (10.8–15.8) 0.06 Guatemala 2 (1–4) 2 (1–5) 1 (1–3) 0.007 15.6 (13.0–18.5) 18.8 (16.2–21.6) 12.0 (8.6–16.4) <0.001 Guyana 1 (0–4) 1 (0–4) 1 (0–3) 0.002 15.6 (12.7–19.1) 18.3 (13.7–23.9) 13.2 (10.4–16.7) 0.05 Honduras 1 (0–4) 2 (1–5) 1 (0–3) <0.001 15.8 (13.8–18.0) 19.4 (16.9–22.2) 12.6 (9.9–15.8) 0.002 Montserrat 2 (0–5) 2 (0–5) 2 (1–5) 0.85 20.7 (15.5–27.2) 18.3 (11.6–27.6) 22.8 (15.5–32.3) 0.44 Peru 2 (1–5) 2 (1–5) 2 (1–4) 0.27 15.4 (13.7–17.2) 16.5 (14.2–19.2) 14.2 (12.5–16.2) 0.08 Saint Kitts and Nevis 2 (0–5) 2 (0–5) 1 (0–4) <0.001 18.8 (16.8–20.9) 23.1 (20.0–26.5) 14.4 (12.2–16.9) <0.001 Saint Lucia 2 (0–4) 2 (0–5) 1 (0–4) 0.07 15.4 (12.9–18.3) 16.8 (13.5–20.6) 14.3 (11.3–17.9) 0.23 Saint Vincent and Grenadines 1 (0–3) 1 (0–4) 1 (0–3) <0.001 12.8 (10.7–15.2) 14.7 (11.9–18.1) 11.1 (8.5–14.4) 0.08 Suriname 2 (0–5) 2 (1–5) 2 (0–4) <0.001 19.3 (16.6–22.4) 22.4 (18.5–26.7) 16.4 (14.1–19.0) 0.007 Trinidad and Tobago 2 (0–5) 3 (0–6) 2 (0–4) <0.001 20.5 (17.5–23.9) 24.7 (21.2–28.5) 16.5 (13.9–19.6) <0.001 Uruguay 2 (1–5) 4 (2–6) 2 (0–3) <0.001 15.3 (13.7–17.1) 22.8 (20.4–25.3) 9.1 (7.8–10.7) <0.001 Active day defined as engaging in moderate-to-vigorous physical activity for at least 60 min per day. Differences were adjusted by age and gender. a Only regional representation. Figure 1 View largeDownload slide Regional distribution of adolescents physically active for at least 60 min per day (A), active for transportation to and from school at least 3 times per week (B), who reported 3 or more physical education classes per week (C), and who spent 3 or more hours sitting per day outside school hours (D) in Latin America. Figure 1 View largeDownload slide Regional distribution of adolescents physically active for at least 60 min per day (A), active for transportation to and from school at least 3 times per week (B), who reported 3 or more physical education classes per week (C), and who spent 3 or more hours sitting per day outside school hours (D) in Latin America. Overall, the median days active for transport to and from school ranged from 0 to 4 days per week (Table 3). The weighted prevalence of AT in adolescents from LAC was 41.9%, with large variability between countries (Figure 1B). The three countries with higher prevalence of AT (Peru, Argentina and Uruguay) were also those with higher median number of active days (median = 4). The largest relative differences in the percentage of active adolescents in transportation between the sexes were observed in Cayman Islands (36.2%), Saint Lucia (24.9%) and Colombia (21.0%). The only two countries that reported higher median number of days active for transport in women were Colombia and Peru. The overall prevalence of AT in adolescents by country was positively correlated with the GC (rho = 0.51, P = 0.022) (Supplementary Material, available as Supplementary data at IJE online), whereas no correlation was observed between AT and the other indices (GII (P = 0.98), HDI (P = 0.48) and MR (P = 0.51)). Table 3 Median (P25–P75) days per week that adolescents walked or rode a bicycle to and from school and percentage of adolescents active for transport in Latin America and the Caribbean Country Median active transport days per week (p25–p75) Percentage of active transport to and from school (95% CI) Overall Male Female P Overall Male Female P Antigua and Barbuda 0 (0-5) 0 (0-5) 0 (0-5) 0.14 35.0 (32.1-38.0) 32.7 (28.6-37.1) 37.5 (33.5-41.7) 0.072 Argentina 4 (0-7) 4 (0-7) 4 (0-7) 0.06 55.2 (52.5-57.9) 56.2 (52.9-59.4) 54.8 (51.5-57.3) 0.24 Bahamas 0 (0-2) 0 (0-2) 0 (0-2) 0.44 24.3 (21.9-26.8) 24.7 (21.1-28.7) 23.9 (20.8-27.4) 0.86 Barbados 0 (0-0) 0 (0-1) 0 (0-0) 0.01 16.0 (14.1-18.0) 17.3 (14.5-20.5) 14.7 (12.4-17.4) 0.202 Belize 2 (0-7) 3 (0-7) 2 (0-7) 0.04 49.5 (41.6-57.4) 50.9 (43.2-58.6) 48.2 (39.9-56.5) 0.036 Bolivia 2 (0-7) 2 (0-7) 2 (0-7) 0.1 47.6 (45.8-49.4) 45.8 (43.2-48.4) 49.4 (46.8-52.0) 0.042 British Virgin Islands 0 (0-3) 0 (0-3) 0 (0-3) 0.59 26.5 (24.4-28.8) 26.1 (22.9-29.6) 26.9 (24.0-30.0) 0.73 Cayman Islands 0 (0-0) 0 (0-0) 0 (0-0) <0.001 11.6 (9.8-13.6) 14.1 (11.3-17.4) 9.2 (7.2-11.7) 0.010 Chile 2 (0-6) 2 (0-6) 2 (0-7) 0.93 48.0 (42.8-53.2) 47.0 (42.5-51.7) 48.9 (41.6-56.1) 0.56 Colombiaa 1 (0-7) 0 (0-5) 1 (0-7) 0.02 41.5 (34.4-49.1) 36.8 (29.2-45.1) 45.5 (37.8-53.5) 0.003 Costa Rica 1 (0-7) 1 (0-7) 1 (0-7) 0.78 44.9 (39.3-50.0) 44.2 (38.7-49.9) 45.0 (38.8-51.3) 0.64 Dominica 1 (0-2) 1 (0-2) 1 (0-3) 0.16 24.5 (21.8-27.3) 23.2 (19.4-27.4) 25.8 (22.5-29.4) 0.276 El Salvador 1 (0-7) 1 (0-7) 1 (0-7) 0.87 45.9 (39.7-52.1) 44.9 (37.1-53.0) 46.9 (40.6-53.2) 0.57 Ecuadora 0 (0-2) 0 (0-2) 0 (0-2) 0.19 22.6 (19.7-25.8) 24.2 (21.4-27.2) 21.0 (17.1-25.4) 0.079 Grenada 0 (0-2) 0 (0-2) 0 (0-1) 0.04 20.6 (18.3-23.1) 20.4 (16.9-24.5) 20.8 (17.8-24.1) 0.92 Guatemala 1 (0-5) 1 (0-5) 1 (0-5) 0.19 38.9 (35.6-42.4) 40.7 (35.7-45.8) 37.0 (32.6-41.7) 0.289 Guyana 0 (0-4) 0 (0-5) 0 (0-3) 0.007 30.6 (25.7-36.0) 32.9 (27.3-39.1) 28.5 (23.1-34.6) 0.129 Honduras 2 (0-7) 2 (0-7) 1 (0-7) 0.13 47.1 (40.9-53.4) 49.8 (43.6-56.0) 44.7 (36.8-53.0) 0.198 Montserrat 0 (0-2) 0 (0-2) 0 (0-4) 0.74 24.2 (18.3-31.2) 21.8 (14.2-32.0) 26.2 (18.1-36.4) 0.661 Peru 4 (0-7) 3 (0-7) 5 (0-7) 0.03 54.7 (50.0-59.4) 51.5 (47.0-56.0) 58.0 (51.8-63.9) 0.015 Saint Kitts and Nevis 0 (0-5) 0 (0-5) 0 (0-5) 0.83 34.5 (32.1-37.0) 33.2 (29.6-37.0) 35.8 (32.6-39.1) 0.28 Saint Lucia 0 (0-0) 0 (0-1) 0 (0-0) 0.02 17.3 (14.9-20.1) 20.3 (16.8-24.3) 14.9 (11.8-18.5) 0.037 Saint Vincent and Grenadines 0 (0-3) 0 (0-2) 0 (0-3) 0.42 25.2 (22.0-28.7) 24.6 (20.5-29.3) 25.7 (21.3-30.6) 0.65 Suriname 1 (0-7) 1 (0-7) 1 (0-7) 0.56 45.8 (40.0-51.7) 45.6 (40.5-50.9) 46.0 (38.5-53.7) 0.826 Trinidad and Tobago 0 (0-2) 0 (0-2) 0 (0-1) 0.46 21.6 (18.2-25.5) 22.6 (19.1-26.5) 20.7 (15.8-26.7) 0.47 Uruguay 4 (0-7) 5 (0-7) 4 (0-7) 0.16 55.8 (50.5-61.1) 57.4 (51.7-62.9) 54.5 (48.6-60.3) 0.216 Country Median active transport days per week (p25–p75) Percentage of active transport to and from school (95% CI) Overall Male Female P Overall Male Female P Antigua and Barbuda 0 (0-5) 0 (0-5) 0 (0-5) 0.14 35.0 (32.1-38.0) 32.7 (28.6-37.1) 37.5 (33.5-41.7) 0.072 Argentina 4 (0-7) 4 (0-7) 4 (0-7) 0.06 55.2 (52.5-57.9) 56.2 (52.9-59.4) 54.8 (51.5-57.3) 0.24 Bahamas 0 (0-2) 0 (0-2) 0 (0-2) 0.44 24.3 (21.9-26.8) 24.7 (21.1-28.7) 23.9 (20.8-27.4) 0.86 Barbados 0 (0-0) 0 (0-1) 0 (0-0) 0.01 16.0 (14.1-18.0) 17.3 (14.5-20.5) 14.7 (12.4-17.4) 0.202 Belize 2 (0-7) 3 (0-7) 2 (0-7) 0.04 49.5 (41.6-57.4) 50.9 (43.2-58.6) 48.2 (39.9-56.5) 0.036 Bolivia 2 (0-7) 2 (0-7) 2 (0-7) 0.1 47.6 (45.8-49.4) 45.8 (43.2-48.4) 49.4 (46.8-52.0) 0.042 British Virgin Islands 0 (0-3) 0 (0-3) 0 (0-3) 0.59 26.5 (24.4-28.8) 26.1 (22.9-29.6) 26.9 (24.0-30.0) 0.73 Cayman Islands 0 (0-0) 0 (0-0) 0 (0-0) <0.001 11.6 (9.8-13.6) 14.1 (11.3-17.4) 9.2 (7.2-11.7) 0.010 Chile 2 (0-6) 2 (0-6) 2 (0-7) 0.93 48.0 (42.8-53.2) 47.0 (42.5-51.7) 48.9 (41.6-56.1) 0.56 Colombiaa 1 (0-7) 0 (0-5) 1 (0-7) 0.02 41.5 (34.4-49.1) 36.8 (29.2-45.1) 45.5 (37.8-53.5) 0.003 Costa Rica 1 (0-7) 1 (0-7) 1 (0-7) 0.78 44.9 (39.3-50.0) 44.2 (38.7-49.9) 45.0 (38.8-51.3) 0.64 Dominica 1 (0-2) 1 (0-2) 1 (0-3) 0.16 24.5 (21.8-27.3) 23.2 (19.4-27.4) 25.8 (22.5-29.4) 0.276 El Salvador 1 (0-7) 1 (0-7) 1 (0-7) 0.87 45.9 (39.7-52.1) 44.9 (37.1-53.0) 46.9 (40.6-53.2) 0.57 Ecuadora 0 (0-2) 0 (0-2) 0 (0-2) 0.19 22.6 (19.7-25.8) 24.2 (21.4-27.2) 21.0 (17.1-25.4) 0.079 Grenada 0 (0-2) 0 (0-2) 0 (0-1) 0.04 20.6 (18.3-23.1) 20.4 (16.9-24.5) 20.8 (17.8-24.1) 0.92 Guatemala 1 (0-5) 1 (0-5) 1 (0-5) 0.19 38.9 (35.6-42.4) 40.7 (35.7-45.8) 37.0 (32.6-41.7) 0.289 Guyana 0 (0-4) 0 (0-5) 0 (0-3) 0.007 30.6 (25.7-36.0) 32.9 (27.3-39.1) 28.5 (23.1-34.6) 0.129 Honduras 2 (0-7) 2 (0-7) 1 (0-7) 0.13 47.1 (40.9-53.4) 49.8 (43.6-56.0) 44.7 (36.8-53.0) 0.198 Montserrat 0 (0-2) 0 (0-2) 0 (0-4) 0.74 24.2 (18.3-31.2) 21.8 (14.2-32.0) 26.2 (18.1-36.4) 0.661 Peru 4 (0-7) 3 (0-7) 5 (0-7) 0.03 54.7 (50.0-59.4) 51.5 (47.0-56.0) 58.0 (51.8-63.9) 0.015 Saint Kitts and Nevis 0 (0-5) 0 (0-5) 0 (0-5) 0.83 34.5 (32.1-37.0) 33.2 (29.6-37.0) 35.8 (32.6-39.1) 0.28 Saint Lucia 0 (0-0) 0 (0-1) 0 (0-0) 0.02 17.3 (14.9-20.1) 20.3 (16.8-24.3) 14.9 (11.8-18.5) 0.037 Saint Vincent and Grenadines 0 (0-3) 0 (0-2) 0 (0-3) 0.42 25.2 (22.0-28.7) 24.6 (20.5-29.3) 25.7 (21.3-30.6) 0.65 Suriname 1 (0-7) 1 (0-7) 1 (0-7) 0.56 45.8 (40.0-51.7) 45.6 (40.5-50.9) 46.0 (38.5-53.7) 0.826 Trinidad and Tobago 0 (0-2) 0 (0-2) 0 (0-1) 0.46 21.6 (18.2-25.5) 22.6 (19.1-26.5) 20.7 (15.8-26.7) 0.47 Uruguay 4 (0-7) 5 (0-7) 4 (0-7) 0.16 55.8 (50.5-61.1) 57.4 (51.7-62.9) 54.5 (48.6-60.3) 0.216 Active transport defined as walking or riding a bike at least 3 days during the past 7 days. Differences were adjusted by age and gender. a Only regional representation. Table 3 Median (P25–P75) days per week that adolescents walked or rode a bicycle to and from school and percentage of adolescents active for transport in Latin America and the Caribbean Country Median active transport days per week (p25–p75) Percentage of active transport to and from school (95% CI) Overall Male Female P Overall Male Female P Antigua and Barbuda 0 (0-5) 0 (0-5) 0 (0-5) 0.14 35.0 (32.1-38.0) 32.7 (28.6-37.1) 37.5 (33.5-41.7) 0.072 Argentina 4 (0-7) 4 (0-7) 4 (0-7) 0.06 55.2 (52.5-57.9) 56.2 (52.9-59.4) 54.8 (51.5-57.3) 0.24 Bahamas 0 (0-2) 0 (0-2) 0 (0-2) 0.44 24.3 (21.9-26.8) 24.7 (21.1-28.7) 23.9 (20.8-27.4) 0.86 Barbados 0 (0-0) 0 (0-1) 0 (0-0) 0.01 16.0 (14.1-18.0) 17.3 (14.5-20.5) 14.7 (12.4-17.4) 0.202 Belize 2 (0-7) 3 (0-7) 2 (0-7) 0.04 49.5 (41.6-57.4) 50.9 (43.2-58.6) 48.2 (39.9-56.5) 0.036 Bolivia 2 (0-7) 2 (0-7) 2 (0-7) 0.1 47.6 (45.8-49.4) 45.8 (43.2-48.4) 49.4 (46.8-52.0) 0.042 British Virgin Islands 0 (0-3) 0 (0-3) 0 (0-3) 0.59 26.5 (24.4-28.8) 26.1 (22.9-29.6) 26.9 (24.0-30.0) 0.73 Cayman Islands 0 (0-0) 0 (0-0) 0 (0-0) <0.001 11.6 (9.8-13.6) 14.1 (11.3-17.4) 9.2 (7.2-11.7) 0.010 Chile 2 (0-6) 2 (0-6) 2 (0-7) 0.93 48.0 (42.8-53.2) 47.0 (42.5-51.7) 48.9 (41.6-56.1) 0.56 Colombiaa 1 (0-7) 0 (0-5) 1 (0-7) 0.02 41.5 (34.4-49.1) 36.8 (29.2-45.1) 45.5 (37.8-53.5) 0.003 Costa Rica 1 (0-7) 1 (0-7) 1 (0-7) 0.78 44.9 (39.3-50.0) 44.2 (38.7-49.9) 45.0 (38.8-51.3) 0.64 Dominica 1 (0-2) 1 (0-2) 1 (0-3) 0.16 24.5 (21.8-27.3) 23.2 (19.4-27.4) 25.8 (22.5-29.4) 0.276 El Salvador 1 (0-7) 1 (0-7) 1 (0-7) 0.87 45.9 (39.7-52.1) 44.9 (37.1-53.0) 46.9 (40.6-53.2) 0.57 Ecuadora 0 (0-2) 0 (0-2) 0 (0-2) 0.19 22.6 (19.7-25.8) 24.2 (21.4-27.2) 21.0 (17.1-25.4) 0.079 Grenada 0 (0-2) 0 (0-2) 0 (0-1) 0.04 20.6 (18.3-23.1) 20.4 (16.9-24.5) 20.8 (17.8-24.1) 0.92 Guatemala 1 (0-5) 1 (0-5) 1 (0-5) 0.19 38.9 (35.6-42.4) 40.7 (35.7-45.8) 37.0 (32.6-41.7) 0.289 Guyana 0 (0-4) 0 (0-5) 0 (0-3) 0.007 30.6 (25.7-36.0) 32.9 (27.3-39.1) 28.5 (23.1-34.6) 0.129 Honduras 2 (0-7) 2 (0-7) 1 (0-7) 0.13 47.1 (40.9-53.4) 49.8 (43.6-56.0) 44.7 (36.8-53.0) 0.198 Montserrat 0 (0-2) 0 (0-2) 0 (0-4) 0.74 24.2 (18.3-31.2) 21.8 (14.2-32.0) 26.2 (18.1-36.4) 0.661 Peru 4 (0-7) 3 (0-7) 5 (0-7) 0.03 54.7 (50.0-59.4) 51.5 (47.0-56.0) 58.0 (51.8-63.9) 0.015 Saint Kitts and Nevis 0 (0-5) 0 (0-5) 0 (0-5) 0.83 34.5 (32.1-37.0) 33.2 (29.6-37.0) 35.8 (32.6-39.1) 0.28 Saint Lucia 0 (0-0) 0 (0-1) 0 (0-0) 0.02 17.3 (14.9-20.1) 20.3 (16.8-24.3) 14.9 (11.8-18.5) 0.037 Saint Vincent and Grenadines 0 (0-3) 0 (0-2) 0 (0-3) 0.42 25.2 (22.0-28.7) 24.6 (20.5-29.3) 25.7 (21.3-30.6) 0.65 Suriname 1 (0-7) 1 (0-7) 1 (0-7) 0.56 45.8 (40.0-51.7) 45.6 (40.5-50.9) 46.0 (38.5-53.7) 0.826 Trinidad and Tobago 0 (0-2) 0 (0-2) 0 (0-1) 0.46 21.6 (18.2-25.5) 22.6 (19.1-26.5) 20.7 (15.8-26.7) 0.47 Uruguay 4 (0-7) 5 (0-7) 4 (0-7) 0.16 55.8 (50.5-61.1) 57.4 (51.7-62.9) 54.5 (48.6-60.3) 0.216 Country Median active transport days per week (p25–p75) Percentage of active transport to and from school (95% CI) Overall Male Female P Overall Male Female P Antigua and Barbuda 0 (0-5) 0 (0-5) 0 (0-5) 0.14 35.0 (32.1-38.0) 32.7 (28.6-37.1) 37.5 (33.5-41.7) 0.072 Argentina 4 (0-7) 4 (0-7) 4 (0-7) 0.06 55.2 (52.5-57.9) 56.2 (52.9-59.4) 54.8 (51.5-57.3) 0.24 Bahamas 0 (0-2) 0 (0-2) 0 (0-2) 0.44 24.3 (21.9-26.8) 24.7 (21.1-28.7) 23.9 (20.8-27.4) 0.86 Barbados 0 (0-0) 0 (0-1) 0 (0-0) 0.01 16.0 (14.1-18.0) 17.3 (14.5-20.5) 14.7 (12.4-17.4) 0.202 Belize 2 (0-7) 3 (0-7) 2 (0-7) 0.04 49.5 (41.6-57.4) 50.9 (43.2-58.6) 48.2 (39.9-56.5) 0.036 Bolivia 2 (0-7) 2 (0-7) 2 (0-7) 0.1 47.6 (45.8-49.4) 45.8 (43.2-48.4) 49.4 (46.8-52.0) 0.042 British Virgin Islands 0 (0-3) 0 (0-3) 0 (0-3) 0.59 26.5 (24.4-28.8) 26.1 (22.9-29.6) 26.9 (24.0-30.0) 0.73 Cayman Islands 0 (0-0) 0 (0-0) 0 (0-0) <0.001 11.6 (9.8-13.6) 14.1 (11.3-17.4) 9.2 (7.2-11.7) 0.010 Chile 2 (0-6) 2 (0-6) 2 (0-7) 0.93 48.0 (42.8-53.2) 47.0 (42.5-51.7) 48.9 (41.6-56.1) 0.56 Colombiaa 1 (0-7) 0 (0-5) 1 (0-7) 0.02 41.5 (34.4-49.1) 36.8 (29.2-45.1) 45.5 (37.8-53.5) 0.003 Costa Rica 1 (0-7) 1 (0-7) 1 (0-7) 0.78 44.9 (39.3-50.0) 44.2 (38.7-49.9) 45.0 (38.8-51.3) 0.64 Dominica 1 (0-2) 1 (0-2) 1 (0-3) 0.16 24.5 (21.8-27.3) 23.2 (19.4-27.4) 25.8 (22.5-29.4) 0.276 El Salvador 1 (0-7) 1 (0-7) 1 (0-7) 0.87 45.9 (39.7-52.1) 44.9 (37.1-53.0) 46.9 (40.6-53.2) 0.57 Ecuadora 0 (0-2) 0 (0-2) 0 (0-2) 0.19 22.6 (19.7-25.8) 24.2 (21.4-27.2) 21.0 (17.1-25.4) 0.079 Grenada 0 (0-2) 0 (0-2) 0 (0-1) 0.04 20.6 (18.3-23.1) 20.4 (16.9-24.5) 20.8 (17.8-24.1) 0.92 Guatemala 1 (0-5) 1 (0-5) 1 (0-5) 0.19 38.9 (35.6-42.4) 40.7 (35.7-45.8) 37.0 (32.6-41.7) 0.289 Guyana 0 (0-4) 0 (0-5) 0 (0-3) 0.007 30.6 (25.7-36.0) 32.9 (27.3-39.1) 28.5 (23.1-34.6) 0.129 Honduras 2 (0-7) 2 (0-7) 1 (0-7) 0.13 47.1 (40.9-53.4) 49.8 (43.6-56.0) 44.7 (36.8-53.0) 0.198 Montserrat 0 (0-2) 0 (0-2) 0 (0-4) 0.74 24.2 (18.3-31.2) 21.8 (14.2-32.0) 26.2 (18.1-36.4) 0.661 Peru 4 (0-7) 3 (0-7) 5 (0-7) 0.03 54.7 (50.0-59.4) 51.5 (47.0-56.0) 58.0 (51.8-63.9) 0.015 Saint Kitts and Nevis 0 (0-5) 0 (0-5) 0 (0-5) 0.83 34.5 (32.1-37.0) 33.2 (29.6-37.0) 35.8 (32.6-39.1) 0.28 Saint Lucia 0 (0-0) 0 (0-1) 0 (0-0) 0.02 17.3 (14.9-20.1) 20.3 (16.8-24.3) 14.9 (11.8-18.5) 0.037 Saint Vincent and Grenadines 0 (0-3) 0 (0-2) 0 (0-3) 0.42 25.2 (22.0-28.7) 24.6 (20.5-29.3) 25.7 (21.3-30.6) 0.65 Suriname 1 (0-7) 1 (0-7) 1 (0-7) 0.56 45.8 (40.0-51.7) 45.6 (40.5-50.9) 46.0 (38.5-53.7) 0.826 Trinidad and Tobago 0 (0-2) 0 (0-2) 0 (0-1) 0.46 21.6 (18.2-25.5) 22.6 (19.1-26.5) 20.7 (15.8-26.7) 0.47 Uruguay 4 (0-7) 5 (0-7) 4 (0-7) 0.16 55.8 (50.5-61.1) 57.4 (51.7-62.9) 54.5 (48.6-60.3) 0.216 Active transport defined as walking or riding a bike at least 3 days during the past 7 days. Differences were adjusted by age and gender. a Only regional representation. Nineteen countries provided information about PE participation among adolescents (Table 4). Five countries reported that less than 20% of adolescents went to PE classes on ≥3 days each week (Figure 1C). Adolescents from El Salvador (37.8%), Uruguay (34.8%) and Costa Rica (34.0%) were those with higher percentages of participation in PE on ≥3 days per week. Higher PE participation among boys than girls on 3 or more days per week was observed only in Argentina (P < 0.001), Guatemala (P = 0.001) and Saint Lucia (P = 0.001). Two countries showed 30% or more adolescents that reported PE participation on 5 or more days per week (Costa Rica and El Salvador). PE participation was not correlated with any of the global indices. Table 4 Percentage of adolescents who went to physical education classes on at least 3 and 5 or more days per week in Latin America and the Caribbean Country Percentage of PE class on 3 or more days each week (95% CI) Percentage of PE class on 5 or more days each week (95% CI) Overall Male Female P Overall Male Female P Antigua and Barbuda 26.4 (23.6-29.1) 27.4 (23.4-31.4) 25.2 (21.5-28.9) 0.44 21.1 (18.7-23.6) 21.6 (18.0-25.2) 20.7 (17.3-24.1) 0.73 Argentina 23.6 (22.4-24.8) 26.3 (24.4-28.2) 21.1 (19.6-22.6) <0.001 18.8 (17.6-19.9) 21.1 (19.3-22.9) 16.6 (15.2-18.0) <0.001 Bahamas 19.8 (17.4-22.3) 22.2 (18.4-26.1) 17.7 (14.6-20.7) 0.07 13.9 (11.9-16.0) 16.2 (12.8-19.5) 11.9 (9.3-14.5) 0.05 Barbados 33.5 (30.8-36.2) 35.6 (31.6-40.0) 31.4 (27.8-35.0) 0.13 29.4 (26.7-32.0) 32.1 (28.2-36.1) 26.5 (23.1-30.0) 0.04 Belize 19.1 (15.4-23.4) 20.6 (16.7-25.1) 17.7 (13.6-22.8) 0.13 13.0 (11.4-14.6) 14.3 (10.8-18.7) 11.5 (9.4-14.0) 0.08 Bolivia 31.3 (29.2-33.4) 32.7 (29.6–35.7) 29.9 (27.0-32.8) 0.18 27.3 (25.3-29.3) 28.7 (26.0-31.5) 25.8 (22.9-28.7) 0.14 British Virgin Islands 24.5 (22.2-26.7) 25.9 (22.4-29.3) 23.2 (20.3-26.2) 0.24 21.6 (19.5-23.8) 23.2 (19.9-26.5) 20.2 (17.4-23.0) 0.734 Cayman Islands – – – – – – – – Chile 33.0 (30.7-35.3) 32.6 (30.0-35.2) 33.4 (29.5-37.3) 0.74 28.3 (25.6-31.0) 28.4 (25.7-31.1) 28.2 (24.2-32.2) 0.92 Colombiaa – – – – – – – – Costa Rica 34.0 (29.8-38.4) 35.6 (31.0-40.4) 32.4 (27.8-37.4) 0.11 30.0 (26.5-33.8) 31.0 (26.9-35.3) 29.0 (25.1-33.3) 0.32 Dominica 23.9 (21.1-27.0) 24.2 (20.4-28.3) 23.7 (19.8-28.1) 0.86 18.9 (16.0-22.0) 18.6 (15.0-22.7) 19.1 (15.6-23.3) 0.82 El Salvador 37.8 (35.0-40.6) 39.2 (35.0-43.5) 36.3 (32.7-40.1) 0.31 34.4 (31.7-37.2) 35.1 (31.1-39.4) 33.6 (30.2-37.3) 0.58 Ecuadora – – – – – – – – Grenada – – – – – – – – Guatemala 29.0 (23.3-35.4) 31.1 (25.7-36.9) 26.6 (20.7-33.5) 0.001 22.7 (21.2-24.3) 24.6 (22.2-27.1) 20.6 (19.0-22.3) 0.004 Guyana 19.0 (16.1-22.3) 20.2 (17.4-23.4) 17.9 (14.3-22.2) 0.19 11.6 (9.8-13.8) 12.0 (9.7-14.8) 11.3 (9.4-13.5) 0.52 Honduras 30.5 (27.2-33.9) 33.4 (29.1-37.7) 28.0 (23.5-32.5) 0.08 26 (23.5-29.9) 28.5 (24.5-32.5) 25.0 (20.9-29.2) 0.18 Montserrat – – – – – – – – Peru 2.2 (0.0-3.9) 2.4 (0.0-4.2) 1.9 (0.0-3.7) 0.30 1.5 (0.0-3.1) 1.7 (0.0-3.4) 1.4 (0.0-2.8) 0.49 Saint Kitts and Nevis – – – – – – – – Saint Lucia 19.4 (17.4-21.4) 22.7 (19.5-25.8) 16.1 (13.7-18.5) 0.001 15.8 (14.0-17.7) 18.1 (15.2-20.9) 13.6 (11.4-15.8) 0.01 Saint Vincent and Grenadines – – – – – – – – Suriname 21.1 (18.6-23.7) 22.4 (19.3-25.6) 19.9 (16.5-23.2) 0.18 15.8 (14.2-17.5) 16.7 (14.4-18.9) 15.0 (12.4-17.7) 0.35 Trinidad and Tobago 29.2 (25.6-33.1) 29.7 (24.8-35.0) 28.8 (25.0-32.9) 0.73 20.7 (18.8-22.7) 21.3 (17.5-25.6) 20.1 (18.4-22.0) 0.62 Uruguay 34.8 (32.1-37.6) 34.6 (31.5-37.8) 35.0 (32.0-38.2) 0.76 26.6 (24.8-28.6) 26.6 (24.0-29.5) 26.6 (24.7-28.6) 0.99 Country Percentage of PE class on 3 or more days each week (95% CI) Percentage of PE class on 5 or more days each week (95% CI) Overall Male Female P Overall Male Female P Antigua and Barbuda 26.4 (23.6-29.1) 27.4 (23.4-31.4) 25.2 (21.5-28.9) 0.44 21.1 (18.7-23.6) 21.6 (18.0-25.2) 20.7 (17.3-24.1) 0.73 Argentina 23.6 (22.4-24.8) 26.3 (24.4-28.2) 21.1 (19.6-22.6) <0.001 18.8 (17.6-19.9) 21.1 (19.3-22.9) 16.6 (15.2-18.0) <0.001 Bahamas 19.8 (17.4-22.3) 22.2 (18.4-26.1) 17.7 (14.6-20.7) 0.07 13.9 (11.9-16.0) 16.2 (12.8-19.5) 11.9 (9.3-14.5) 0.05 Barbados 33.5 (30.8-36.2) 35.6 (31.6-40.0) 31.4 (27.8-35.0) 0.13 29.4 (26.7-32.0) 32.1 (28.2-36.1) 26.5 (23.1-30.0) 0.04 Belize 19.1 (15.4-23.4) 20.6 (16.7-25.1) 17.7 (13.6-22.8) 0.13 13.0 (11.4-14.6) 14.3 (10.8-18.7) 11.5 (9.4-14.0) 0.08 Bolivia 31.3 (29.2-33.4) 32.7 (29.6–35.7) 29.9 (27.0-32.8) 0.18 27.3 (25.3-29.3) 28.7 (26.0-31.5) 25.8 (22.9-28.7) 0.14 British Virgin Islands 24.5 (22.2-26.7) 25.9 (22.4-29.3) 23.2 (20.3-26.2) 0.24 21.6 (19.5-23.8) 23.2 (19.9-26.5) 20.2 (17.4-23.0) 0.734 Cayman Islands – – – – – – – – Chile 33.0 (30.7-35.3) 32.6 (30.0-35.2) 33.4 (29.5-37.3) 0.74 28.3 (25.6-31.0) 28.4 (25.7-31.1) 28.2 (24.2-32.2) 0.92 Colombiaa – – – – – – – – Costa Rica 34.0 (29.8-38.4) 35.6 (31.0-40.4) 32.4 (27.8-37.4) 0.11 30.0 (26.5-33.8) 31.0 (26.9-35.3) 29.0 (25.1-33.3) 0.32 Dominica 23.9 (21.1-27.0) 24.2 (20.4-28.3) 23.7 (19.8-28.1) 0.86 18.9 (16.0-22.0) 18.6 (15.0-22.7) 19.1 (15.6-23.3) 0.82 El Salvador 37.8 (35.0-40.6) 39.2 (35.0-43.5) 36.3 (32.7-40.1) 0.31 34.4 (31.7-37.2) 35.1 (31.1-39.4) 33.6 (30.2-37.3) 0.58 Ecuadora – – – – – – – – Grenada – – – – – – – – Guatemala 29.0 (23.3-35.4) 31.1 (25.7-36.9) 26.6 (20.7-33.5) 0.001 22.7 (21.2-24.3) 24.6 (22.2-27.1) 20.6 (19.0-22.3) 0.004 Guyana 19.0 (16.1-22.3) 20.2 (17.4-23.4) 17.9 (14.3-22.2) 0.19 11.6 (9.8-13.8) 12.0 (9.7-14.8) 11.3 (9.4-13.5) 0.52 Honduras 30.5 (27.2-33.9) 33.4 (29.1-37.7) 28.0 (23.5-32.5) 0.08 26 (23.5-29.9) 28.5 (24.5-32.5) 25.0 (20.9-29.2) 0.18 Montserrat – – – – – – – – Peru 2.2 (0.0-3.9) 2.4 (0.0-4.2) 1.9 (0.0-3.7) 0.30 1.5 (0.0-3.1) 1.7 (0.0-3.4) 1.4 (0.0-2.8) 0.49 Saint Kitts and Nevis – – – – – – – – Saint Lucia 19.4 (17.4-21.4) 22.7 (19.5-25.8) 16.1 (13.7-18.5) 0.001 15.8 (14.0-17.7) 18.1 (15.2-20.9) 13.6 (11.4-15.8) 0.01 Saint Vincent and Grenadines – – – – – – – – Suriname 21.1 (18.6-23.7) 22.4 (19.3-25.6) 19.9 (16.5-23.2) 0.18 15.8 (14.2-17.5) 16.7 (14.4-18.9) 15.0 (12.4-17.7) 0.35 Trinidad and Tobago 29.2 (25.6-33.1) 29.7 (24.8-35.0) 28.8 (25.0-32.9) 0.73 20.7 (18.8-22.7) 21.3 (17.5-25.6) 20.1 (18.4-22.0) 0.62 Uruguay 34.8 (32.1-37.6) 34.6 (31.5-37.8) 35.0 (32.0-38.2) 0.76 26.6 (24.8-28.6) 26.6 (24.0-29.5) 26.6 (24.7-28.6) 0.99 Differences were adjusted by age and gender. a Only regional representation. Table 4 Percentage of adolescents who went to physical education classes on at least 3 and 5 or more days per week in Latin America and the Caribbean Country Percentage of PE class on 3 or more days each week (95% CI) Percentage of PE class on 5 or more days each week (95% CI) Overall Male Female P Overall Male Female P Antigua and Barbuda 26.4 (23.6-29.1) 27.4 (23.4-31.4) 25.2 (21.5-28.9) 0.44 21.1 (18.7-23.6) 21.6 (18.0-25.2) 20.7 (17.3-24.1) 0.73 Argentina 23.6 (22.4-24.8) 26.3 (24.4-28.2) 21.1 (19.6-22.6) <0.001 18.8 (17.6-19.9) 21.1 (19.3-22.9) 16.6 (15.2-18.0) <0.001 Bahamas 19.8 (17.4-22.3) 22.2 (18.4-26.1) 17.7 (14.6-20.7) 0.07 13.9 (11.9-16.0) 16.2 (12.8-19.5) 11.9 (9.3-14.5) 0.05 Barbados 33.5 (30.8-36.2) 35.6 (31.6-40.0) 31.4 (27.8-35.0) 0.13 29.4 (26.7-32.0) 32.1 (28.2-36.1) 26.5 (23.1-30.0) 0.04 Belize 19.1 (15.4-23.4) 20.6 (16.7-25.1) 17.7 (13.6-22.8) 0.13 13.0 (11.4-14.6) 14.3 (10.8-18.7) 11.5 (9.4-14.0) 0.08 Bolivia 31.3 (29.2-33.4) 32.7 (29.6–35.7) 29.9 (27.0-32.8) 0.18 27.3 (25.3-29.3) 28.7 (26.0-31.5) 25.8 (22.9-28.7) 0.14 British Virgin Islands 24.5 (22.2-26.7) 25.9 (22.4-29.3) 23.2 (20.3-26.2) 0.24 21.6 (19.5-23.8) 23.2 (19.9-26.5) 20.2 (17.4-23.0) 0.734 Cayman Islands – – – – – – – – Chile 33.0 (30.7-35.3) 32.6 (30.0-35.2) 33.4 (29.5-37.3) 0.74 28.3 (25.6-31.0) 28.4 (25.7-31.1) 28.2 (24.2-32.2) 0.92 Colombiaa – – – – – – – – Costa Rica 34.0 (29.8-38.4) 35.6 (31.0-40.4) 32.4 (27.8-37.4) 0.11 30.0 (26.5-33.8) 31.0 (26.9-35.3) 29.0 (25.1-33.3) 0.32 Dominica 23.9 (21.1-27.0) 24.2 (20.4-28.3) 23.7 (19.8-28.1) 0.86 18.9 (16.0-22.0) 18.6 (15.0-22.7) 19.1 (15.6-23.3) 0.82 El Salvador 37.8 (35.0-40.6) 39.2 (35.0-43.5) 36.3 (32.7-40.1) 0.31 34.4 (31.7-37.2) 35.1 (31.1-39.4) 33.6 (30.2-37.3) 0.58 Ecuadora – – – – – – – – Grenada – – – – – – – – Guatemala 29.0 (23.3-35.4) 31.1 (25.7-36.9) 26.6 (20.7-33.5) 0.001 22.7 (21.2-24.3) 24.6 (22.2-27.1) 20.6 (19.0-22.3) 0.004 Guyana 19.0 (16.1-22.3) 20.2 (17.4-23.4) 17.9 (14.3-22.2) 0.19 11.6 (9.8-13.8) 12.0 (9.7-14.8) 11.3 (9.4-13.5) 0.52 Honduras 30.5 (27.2-33.9) 33.4 (29.1-37.7) 28.0 (23.5-32.5) 0.08 26 (23.5-29.9) 28.5 (24.5-32.5) 25.0 (20.9-29.2) 0.18 Montserrat – – – – – – – – Peru 2.2 (0.0-3.9) 2.4 (0.0-4.2) 1.9 (0.0-3.7) 0.30 1.5 (0.0-3.1) 1.7 (0.0-3.4) 1.4 (0.0-2.8) 0.49 Saint Kitts and Nevis – – – – – – – – Saint Lucia 19.4 (17.4-21.4) 22.7 (19.5-25.8) 16.1 (13.7-18.5) 0.001 15.8 (14.0-17.7) 18.1 (15.2-20.9) 13.6 (11.4-15.8) 0.01 Saint Vincent and Grenadines – – – – – – – – Suriname 21.1 (18.6-23.7) 22.4 (19.3-25.6) 19.9 (16.5-23.2) 0.18 15.8 (14.2-17.5) 16.7 (14.4-18.9) 15.0 (12.4-17.7) 0.35 Trinidad and Tobago 29.2 (25.6-33.1) 29.7 (24.8-35.0) 28.8 (25.0-32.9) 0.73 20.7 (18.8-22.7) 21.3 (17.5-25.6) 20.1 (18.4-22.0) 0.62 Uruguay 34.8 (32.1-37.6) 34.6 (31.5-37.8) 35.0 (32.0-38.2) 0.76 26.6 (24.8-28.6) 26.6 (24.0-29.5) 26.6 (24.7-28.6) 0.99 Country Percentage of PE class on 3 or more days each week (95% CI) Percentage of PE class on 5 or more days each week (95% CI) Overall Male Female P Overall Male Female P Antigua and Barbuda 26.4 (23.6-29.1) 27.4 (23.4-31.4) 25.2 (21.5-28.9) 0.44 21.1 (18.7-23.6) 21.6 (18.0-25.2) 20.7 (17.3-24.1) 0.73 Argentina 23.6 (22.4-24.8) 26.3 (24.4-28.2) 21.1 (19.6-22.6) <0.001 18.8 (17.6-19.9) 21.1 (19.3-22.9) 16.6 (15.2-18.0) <0.001 Bahamas 19.8 (17.4-22.3) 22.2 (18.4-26.1) 17.7 (14.6-20.7) 0.07 13.9 (11.9-16.0) 16.2 (12.8-19.5) 11.9 (9.3-14.5) 0.05 Barbados 33.5 (30.8-36.2) 35.6 (31.6-40.0) 31.4 (27.8-35.0) 0.13 29.4 (26.7-32.0) 32.1 (28.2-36.1) 26.5 (23.1-30.0) 0.04 Belize 19.1 (15.4-23.4) 20.6 (16.7-25.1) 17.7 (13.6-22.8) 0.13 13.0 (11.4-14.6) 14.3 (10.8-18.7) 11.5 (9.4-14.0) 0.08 Bolivia 31.3 (29.2-33.4) 32.7 (29.6–35.7) 29.9 (27.0-32.8) 0.18 27.3 (25.3-29.3) 28.7 (26.0-31.5) 25.8 (22.9-28.7) 0.14 British Virgin Islands 24.5 (22.2-26.7) 25.9 (22.4-29.3) 23.2 (20.3-26.2) 0.24 21.6 (19.5-23.8) 23.2 (19.9-26.5) 20.2 (17.4-23.0) 0.734 Cayman Islands – – – – – – – – Chile 33.0 (30.7-35.3) 32.6 (30.0-35.2) 33.4 (29.5-37.3) 0.74 28.3 (25.6-31.0) 28.4 (25.7-31.1) 28.2 (24.2-32.2) 0.92 Colombiaa – – – – – – – – Costa Rica 34.0 (29.8-38.4) 35.6 (31.0-40.4) 32.4 (27.8-37.4) 0.11 30.0 (26.5-33.8) 31.0 (26.9-35.3) 29.0 (25.1-33.3) 0.32 Dominica 23.9 (21.1-27.0) 24.2 (20.4-28.3) 23.7 (19.8-28.1) 0.86 18.9 (16.0-22.0) 18.6 (15.0-22.7) 19.1 (15.6-23.3) 0.82 El Salvador 37.8 (35.0-40.6) 39.2 (35.0-43.5) 36.3 (32.7-40.1) 0.31 34.4 (31.7-37.2) 35.1 (31.1-39.4) 33.6 (30.2-37.3) 0.58 Ecuadora – – – – – – – – Grenada – – – – – – – – Guatemala 29.0 (23.3-35.4) 31.1 (25.7-36.9) 26.6 (20.7-33.5) 0.001 22.7 (21.2-24.3) 24.6 (22.2-27.1) 20.6 (19.0-22.3) 0.004 Guyana 19.0 (16.1-22.3) 20.2 (17.4-23.4) 17.9 (14.3-22.2) 0.19 11.6 (9.8-13.8) 12.0 (9.7-14.8) 11.3 (9.4-13.5) 0.52 Honduras 30.5 (27.2-33.9) 33.4 (29.1-37.7) 28.0 (23.5-32.5) 0.08 26 (23.5-29.9) 28.5 (24.5-32.5) 25.0 (20.9-29.2) 0.18 Montserrat – – – – – – – – Peru 2.2 (0.0-3.9) 2.4 (0.0-4.2) 1.9 (0.0-3.7) 0.30 1.5 (0.0-3.1) 1.7 (0.0-3.4) 1.4 (0.0-2.8) 0.49 Saint Kitts and Nevis – – – – – – – – Saint Lucia 19.4 (17.4-21.4) 22.7 (19.5-25.8) 16.1 (13.7-18.5) 0.001 15.8 (14.0-17.7) 18.1 (15.2-20.9) 13.6 (11.4-15.8) 0.01 Saint Vincent and Grenadines – – – – – – – – Suriname 21.1 (18.6-23.7) 22.4 (19.3-25.6) 19.9 (16.5-23.2) 0.18 15.8 (14.2-17.5) 16.7 (14.4-18.9) 15.0 (12.4-17.7) 0.35 Trinidad and Tobago 29.2 (25.6-33.1) 29.7 (24.8-35.0) 28.8 (25.0-32.9) 0.73 20.7 (18.8-22.7) 21.3 (17.5-25.6) 20.1 (18.4-22.0) 0.62 Uruguay 34.8 (32.1-37.6) 34.6 (31.5-37.8) 35.0 (32.0-38.2) 0.76 26.6 (24.8-28.6) 26.6 (24.0-29.5) 26.6 (24.7-28.6) 0.99 Differences were adjusted by age and gender. a Only regional representation. The percentages of adolescents who reported sitting 3 or more h per day outside school are shown in Table 5. Overall, the percentages of sedentary adolescents ranged from 24.2% (Guatemala) to 65.0% (Barbados). In 12 countries, at least 50% of the adolescents reported sitting ≥3 h per day outside school (Figure 1D). Eleven countries showed differences in sitting between sexes, with higher percentages observed among girls for all of them. The largest relative differences between girls and boys were found in Trinidad and Tobago (18.8%), Bahamas (19.4%) and Saint Kitts and Nevis (21.8%). The prevalence of sedentary adolescents by country was positively correlated with HDI (rho = 0.79, P = 0.001) and negatively correlated with GII (rho=−0.74, P = 0.001) (Supplementary Material, available as Supplementary data at IJE online). Countries with higher HDI showed smaller relative differences between boys and girls in SB than those with lower HDI (rho=−0.58, P = 0.002). Table 5 Percentage of adolescents who spent 3 or more hours per day in sedentary behaviour outside school Country Percentage of 3 or more hours per day in SB (95% CI) Overall Male Female P Antigua and Barbuda 54.9 (51.8-58.0) 50.7 (46.2-55.2) 59.4 (55.2-63.7) 0.006 Argentina 50.8 (49.4-52.1) 46.7 (44.7-48.8) 54.5 (52.7-56.4) <0.001 Bahamas 54.5 (51.4-57.6) 49.4 (44.7-54.1) 59.0 (55.0-63.1) 0.003 Barbados 65.0 (62.2-67.7) 60.8 (56.7-64.8) 69.2 (65.6-72.9) 0.003 Belize 37.9 (34.1-41.9) 35.4 (31.4-39.5) 40.3 (35.2-45.6) 0.05 Bolivia 24.6 (21.8-27.4) 25.2 (21.7-28.7) 23.9 (20.5-27.3) 0.51 British Virgin Islands 61.7 (59.1-64.2) 57.7 (53.8-61.6) 65.2 (61.8-68.6) 0.005 Cayman Islands 56.9 (54.0-59.8) 52.2 (47.9-56.6) 61.4 (57.4-65.2) 0.002 Chile 54.0 (50.3-57.7) 50.1 (44.9-55.3) 57.7 (53.7-61.8) 0.02 Colombiaa 51.8 (47.5-56.1) 50.9 (46.1-55.8) 52.5 (47.0-58.0) 0.59 Costa Rica 43.6 (40.2-47.1) 40.9 (37.4-44.5) 46.3 (42.2-50.4) 0.002 Dominica – – – – El Salvador 34.5 (30.1-39.3) 32.1 (27.1-37.5) 37.1 (31.4-43.2) 0.11 Ecuadora 28.6 (26.1-31.2) 30.3 (26.0-35.0) 26.8 (24.0-29.8) 0.22 Grenada 40.9 (37.5-44.4) 40.7 (35.0-46.8) 41.0 (37.0-45.1) 0.94 Guatemala 24.2 (20.6-28.4) 24.2 (21.1-27.5) 24.4 (19.7-29.8) 0.90 Guyana 36.1 (31.6-40.8) 36.1 (31.8-40.7) 36.0 (30.8-41.6) 0.95 Honduras 30.2 (27.5-33.0) 29.8 (26.3-33.3) 30.6 (26.8-34.4) 0.72 Montserrat 50.7 (43.0-58.4) 50.5 (39.5-61.5) 50.8 (40.1-61.6) 0.97 Peru 28.8 (25.4-32.2) 28.8 (25.3-32.4) 28.8 (24.0-33.6) 0.99 Saint Kitts and Nevis 59.0 (56.4-61.5) 53.2 (49.4-57.1) 64.8 (61.6-68.0) <0.001 Saint Lucia 53.7 (49.5-57.9) 55.7 (50.0-61.3) 52.1 (46.6-57.6) 0.33 Saint Vincent and Grenadines 39.1 (35.7-42.5) 41.4 (36.4-46.4) 37.1 (32.9-41.4) 0.17 Suriname 39.4 (35.4-43.3) 40.8 (36.7-44.9) 38.0 (33.4-42.6) 0.18 Trinidad and Tobago 43.8 (40.4-47.2) 40.0 (33.2-47.2) 47.5 (44.3-50.6) 0.07 Uruguay 59.0 (56.2-61.8) 56.1 (52.6-59.6) 61.4 (57.8-64.9) 0.02 Country Percentage of 3 or more hours per day in SB (95% CI) Overall Male Female P Antigua and Barbuda 54.9 (51.8-58.0) 50.7 (46.2-55.2) 59.4 (55.2-63.7) 0.006 Argentina 50.8 (49.4-52.1) 46.7 (44.7-48.8) 54.5 (52.7-56.4) <0.001 Bahamas 54.5 (51.4-57.6) 49.4 (44.7-54.1) 59.0 (55.0-63.1) 0.003 Barbados 65.0 (62.2-67.7) 60.8 (56.7-64.8) 69.2 (65.6-72.9) 0.003 Belize 37.9 (34.1-41.9) 35.4 (31.4-39.5) 40.3 (35.2-45.6) 0.05 Bolivia 24.6 (21.8-27.4) 25.2 (21.7-28.7) 23.9 (20.5-27.3) 0.51 British Virgin Islands 61.7 (59.1-64.2) 57.7 (53.8-61.6) 65.2 (61.8-68.6) 0.005 Cayman Islands 56.9 (54.0-59.8) 52.2 (47.9-56.6) 61.4 (57.4-65.2) 0.002 Chile 54.0 (50.3-57.7) 50.1 (44.9-55.3) 57.7 (53.7-61.8) 0.02 Colombiaa 51.8 (47.5-56.1) 50.9 (46.1-55.8) 52.5 (47.0-58.0) 0.59 Costa Rica 43.6 (40.2-47.1) 40.9 (37.4-44.5) 46.3 (42.2-50.4) 0.002 Dominica – – – – El Salvador 34.5 (30.1-39.3) 32.1 (27.1-37.5) 37.1 (31.4-43.2) 0.11 Ecuadora 28.6 (26.1-31.2) 30.3 (26.0-35.0) 26.8 (24.0-29.8) 0.22 Grenada 40.9 (37.5-44.4) 40.7 (35.0-46.8) 41.0 (37.0-45.1) 0.94 Guatemala 24.2 (20.6-28.4) 24.2 (21.1-27.5) 24.4 (19.7-29.8) 0.90 Guyana 36.1 (31.6-40.8) 36.1 (31.8-40.7) 36.0 (30.8-41.6) 0.95 Honduras 30.2 (27.5-33.0) 29.8 (26.3-33.3) 30.6 (26.8-34.4) 0.72 Montserrat 50.7 (43.0-58.4) 50.5 (39.5-61.5) 50.8 (40.1-61.6) 0.97 Peru 28.8 (25.4-32.2) 28.8 (25.3-32.4) 28.8 (24.0-33.6) 0.99 Saint Kitts and Nevis 59.0 (56.4-61.5) 53.2 (49.4-57.1) 64.8 (61.6-68.0) <0.001 Saint Lucia 53.7 (49.5-57.9) 55.7 (50.0-61.3) 52.1 (46.6-57.6) 0.33 Saint Vincent and Grenadines 39.1 (35.7-42.5) 41.4 (36.4-46.4) 37.1 (32.9-41.4) 0.17 Suriname 39.4 (35.4-43.3) 40.8 (36.7-44.9) 38.0 (33.4-42.6) 0.18 Trinidad and Tobago 43.8 (40.4-47.2) 40.0 (33.2-47.2) 47.5 (44.3-50.6) 0.07 Uruguay 59.0 (56.2-61.8) 56.1 (52.6-59.6) 61.4 (57.8-64.9) 0.02 Differences were adjusted by age and gender. a Only regional representation. Table 5 Percentage of adolescents who spent 3 or more hours per day in sedentary behaviour outside school Country Percentage of 3 or more hours per day in SB (95% CI) Overall Male Female P Antigua and Barbuda 54.9 (51.8-58.0) 50.7 (46.2-55.2) 59.4 (55.2-63.7) 0.006 Argentina 50.8 (49.4-52.1) 46.7 (44.7-48.8) 54.5 (52.7-56.4) <0.001 Bahamas 54.5 (51.4-57.6) 49.4 (44.7-54.1) 59.0 (55.0-63.1) 0.003 Barbados 65.0 (62.2-67.7) 60.8 (56.7-64.8) 69.2 (65.6-72.9) 0.003 Belize 37.9 (34.1-41.9) 35.4 (31.4-39.5) 40.3 (35.2-45.6) 0.05 Bolivia 24.6 (21.8-27.4) 25.2 (21.7-28.7) 23.9 (20.5-27.3) 0.51 British Virgin Islands 61.7 (59.1-64.2) 57.7 (53.8-61.6) 65.2 (61.8-68.6) 0.005 Cayman Islands 56.9 (54.0-59.8) 52.2 (47.9-56.6) 61.4 (57.4-65.2) 0.002 Chile 54.0 (50.3-57.7) 50.1 (44.9-55.3) 57.7 (53.7-61.8) 0.02 Colombiaa 51.8 (47.5-56.1) 50.9 (46.1-55.8) 52.5 (47.0-58.0) 0.59 Costa Rica 43.6 (40.2-47.1) 40.9 (37.4-44.5) 46.3 (42.2-50.4) 0.002 Dominica – – – – El Salvador 34.5 (30.1-39.3) 32.1 (27.1-37.5) 37.1 (31.4-43.2) 0.11 Ecuadora 28.6 (26.1-31.2) 30.3 (26.0-35.0) 26.8 (24.0-29.8) 0.22 Grenada 40.9 (37.5-44.4) 40.7 (35.0-46.8) 41.0 (37.0-45.1) 0.94 Guatemala 24.2 (20.6-28.4) 24.2 (21.1-27.5) 24.4 (19.7-29.8) 0.90 Guyana 36.1 (31.6-40.8) 36.1 (31.8-40.7) 36.0 (30.8-41.6) 0.95 Honduras 30.2 (27.5-33.0) 29.8 (26.3-33.3) 30.6 (26.8-34.4) 0.72 Montserrat 50.7 (43.0-58.4) 50.5 (39.5-61.5) 50.8 (40.1-61.6) 0.97 Peru 28.8 (25.4-32.2) 28.8 (25.3-32.4) 28.8 (24.0-33.6) 0.99 Saint Kitts and Nevis 59.0 (56.4-61.5) 53.2 (49.4-57.1) 64.8 (61.6-68.0) <0.001 Saint Lucia 53.7 (49.5-57.9) 55.7 (50.0-61.3) 52.1 (46.6-57.6) 0.33 Saint Vincent and Grenadines 39.1 (35.7-42.5) 41.4 (36.4-46.4) 37.1 (32.9-41.4) 0.17 Suriname 39.4 (35.4-43.3) 40.8 (36.7-44.9) 38.0 (33.4-42.6) 0.18 Trinidad and Tobago 43.8 (40.4-47.2) 40.0 (33.2-47.2) 47.5 (44.3-50.6) 0.07 Uruguay 59.0 (56.2-61.8) 56.1 (52.6-59.6) 61.4 (57.8-64.9) 0.02 Country Percentage of 3 or more hours per day in SB (95% CI) Overall Male Female P Antigua and Barbuda 54.9 (51.8-58.0) 50.7 (46.2-55.2) 59.4 (55.2-63.7) 0.006 Argentina 50.8 (49.4-52.1) 46.7 (44.7-48.8) 54.5 (52.7-56.4) <0.001 Bahamas 54.5 (51.4-57.6) 49.4 (44.7-54.1) 59.0 (55.0-63.1) 0.003 Barbados 65.0 (62.2-67.7) 60.8 (56.7-64.8) 69.2 (65.6-72.9) 0.003 Belize 37.9 (34.1-41.9) 35.4 (31.4-39.5) 40.3 (35.2-45.6) 0.05 Bolivia 24.6 (21.8-27.4) 25.2 (21.7-28.7) 23.9 (20.5-27.3) 0.51 British Virgin Islands 61.7 (59.1-64.2) 57.7 (53.8-61.6) 65.2 (61.8-68.6) 0.005 Cayman Islands 56.9 (54.0-59.8) 52.2 (47.9-56.6) 61.4 (57.4-65.2) 0.002 Chile 54.0 (50.3-57.7) 50.1 (44.9-55.3) 57.7 (53.7-61.8) 0.02 Colombiaa 51.8 (47.5-56.1) 50.9 (46.1-55.8) 52.5 (47.0-58.0) 0.59 Costa Rica 43.6 (40.2-47.1) 40.9 (37.4-44.5) 46.3 (42.2-50.4) 0.002 Dominica – – – – El Salvador 34.5 (30.1-39.3) 32.1 (27.1-37.5) 37.1 (31.4-43.2) 0.11 Ecuadora 28.6 (26.1-31.2) 30.3 (26.0-35.0) 26.8 (24.0-29.8) 0.22 Grenada 40.9 (37.5-44.4) 40.7 (35.0-46.8) 41.0 (37.0-45.1) 0.94 Guatemala 24.2 (20.6-28.4) 24.2 (21.1-27.5) 24.4 (19.7-29.8) 0.90 Guyana 36.1 (31.6-40.8) 36.1 (31.8-40.7) 36.0 (30.8-41.6) 0.95 Honduras 30.2 (27.5-33.0) 29.8 (26.3-33.3) 30.6 (26.8-34.4) 0.72 Montserrat 50.7 (43.0-58.4) 50.5 (39.5-61.5) 50.8 (40.1-61.6) 0.97 Peru 28.8 (25.4-32.2) 28.8 (25.3-32.4) 28.8 (24.0-33.6) 0.99 Saint Kitts and Nevis 59.0 (56.4-61.5) 53.2 (49.4-57.1) 64.8 (61.6-68.0) <0.001 Saint Lucia 53.7 (49.5-57.9) 55.7 (50.0-61.3) 52.1 (46.6-57.6) 0.33 Saint Vincent and Grenadines 39.1 (35.7-42.5) 41.4 (36.4-46.4) 37.1 (32.9-41.4) 0.17 Suriname 39.4 (35.4-43.3) 40.8 (36.7-44.9) 38.0 (33.4-42.6) 0.18 Trinidad and Tobago 43.8 (40.4-47.2) 40.0 (33.2-47.2) 47.5 (44.3-50.6) 0.07 Uruguay 59.0 (56.2-61.8) 56.1 (52.6-59.6) 61.4 (57.8-64.9) 0.02 Differences were adjusted by age and gender. a Only regional representation. Discussion This study summarized nationally representative data regarding PA, SB, AT and PE participation among adolescents from 26 countries across LAC. Overall, boys were more physically active than girls in 18 of 26 countries (69.2%). Most prevalence differences in AT favoured boys, except for Colombia. PE participation on 3 or more days each week ranged from 2.2% (Peru) to 37.8% (El Salvador), but sex differences in PE participation were observed in only three countries. The prevalence of adolescents who spent 3 or more  h per day in SB outside school was higher than 50% in half of the included countries, with most reporting higher prevalence of SB in girls than boys. Only about 15% of adolescents in LAC countries were physically active, with most countries showing sex disparities. Therefore, the weighted overall prevalence of physical inactivity reported in this study was higher than the prevalence reported for this region (81.2%) in 2010.18 Gender inequality in PA levels remains an issue not only for this age group, but also for adults.19 As physical inactivity is affected through several levels of influence (i.e. individual, social and built environment, policy), to better understand this global issue, future monitoring strategies at national level should include those dimensions. International initiatives such as the Active Healthy Kids Global Alliance (AHKGA) have developed a matrix to compare countries from several regions in a number of indicators related to PA.20,21 The last AHKGA report showed that countries with high GII, such as some Latin American countries (Brazil, Chile, Colombia, Mexico and Venezuela),22–26 tended to report worst grades in overall PA when compared with those with lower GII (The Netherlands, Slovenia and Denmark) at a global level.20 Although it is difficult to explain a complex behaviour with one isolated index, in our study countries with high HDI, such as Chile and Argentina, were those with greater gender inequities in PA, as similarly shown by those with lower GII. These findings reflect the uneven distribution of these behaviours when considering these types of indices in LAC, especially when economic growth in the region has not always been accompanied by equality of wealth and opportunities (e.g. health or education access) within countries.27,28 Overall, AT showed high variability across countries (ranging from 11.6% to 55.8%); only three countries reported a median number of 4 days per week and about a quarter showed differences by sex. Our findings suggest that AT in LAC countries would not be limited by vehicle availability or economic development, as there was no clear pattern in the prevalence of AT or relative differences between sexes by MR or other indices. Regional differences may be explained by other factors, such as traffic policies (i.e. speed regulation), educational equity (i.e. access and facilities in schools) and urban planning (i.e. schools embedded in neighbourhoods), among others. AT is an important strategy not only for increasing PA in children, but also for promoting community connectedness and environmental safety.29 The context in LAC countries requires a major coordination effort, as this behaviour is often limited by other factors such as perceived traffic, stranger danger or crime safety, which are commonly reported as barriers by parents.30 Therefore, policy makers, authorities and other key actors should conceive multilevel interventions as interdisciplinary strategies (i.e. coordination between transport, urban planning and education departments) for implementing successful programmes, as they have associated and convergent impacts in terms of individual health, traffic, pollution and safety, among others. Overall, less than a third of adolescents from LAC countries reported having PE on 3 or more days per week. This is the first report of PE class participation in the GSHS, but results are in line with the findings of the 2013 Worldwide Survey of School Physical Education, which indicated that the allocated time for PE in schools from LAC countries (90 and 94 min/week at primary and secondary levels, respectively) was comparable to that allocated in African and Asian nations, but lower than in Europe, the USA and Oceania.31 PE is a fundamental opportunity for promoting PA, not only in school environments but also outside school. Although there is a global tendency in the reduction of time allocated for PE from 2000 to 2013,31,32 LAC countries have led the globe as they have increased minutes of PE per week by 17 min for primary and 7 min for secondary levels since 2007.31 LAC countries have also increased the percentage of prescribed national PE curricula from 67% in 2007 to 96% in 2013, increased implementation of PE in schools from 50% in 2000 to 89% in 2013 and decreased PE cancellations from 80% in 2000 to 52% in 2013.31 Although, LAC countries have shown positive changes for positioning PE in schools, there is a lot of space for improvement, as only about 10% met the minimum recommendation of 2 h per week.31 Therefore, the effects of the high level of implementation of PE policies on health indicators in LAC countries as reported by the United Nations Educational, Scientific and Cultural Organization (UNESCO) in the past 5 years are still to be assessed. About half of the included LAC countries in this study reported sitting 3 or more h per day outside school hours in more than 50% of the studied population. When contrasting our findings with the previous GSHS,12 LAC countries are still lagging compared with other regions. To the best of our knowledge, the HDI has not been compared with SB in other age groups and countries. In our study, prevalences of SB in adolescents were highly correlated with the HDI by country, which may suggest that more developed countries tend to have greater access to more sedentary environments or attractions outside school hours. Also, countries with greater HDI were less unequal when SB by sex was compared. Lessons can be learnt from LAC countries with lower HDI, as SB may continue to rise as they develop, requiring comprehensive strategies for promoting an active life while reducing time spent in sedentary activities in this age group. Despite regional representativeness being high, some large countries such as Brazil or Mexico were missing. Future monitoring strategies should make the effort to include those countries, as well as others such as Paraguay, Jamaica or Panama, which do not often report PA in the scientific literature. Overall response rate was acceptable, as 19/26 LAC countries had at least a 75% response rate. However, some countries had much lower rates (e.g. Chile had 60%) with no report or further analysis about non-responders. Colombia and Ecuador had only sub-national representation (capital cities), which may affect interpretation of data when translating this to the national level. Although we used the latest available GSHS for each country, data ranged from 2007 to 2013. We acknowledge that this wide distribution in report dates may affect comparisons, as most countries are suffering rapid epidemiological and economic transitions with potential effects on lifestyles, including PA. Therefore, further studies using these samples may consider the comparison between datasets from the same years when available. Data collection was not designed to account for seasonal variability which may affect activity behaviours, exacerbating differences within and between countries,33 especially considering variation in opportunities and preferences for being physically active between sexes.34,35 Findings related to correlation analyses should be used with caution, as it is hard to identify causality with these methods and study designs. Also, the GII and GC were unavailable for most Caribbean countries, limiting extrapolation to that area of the region. Finally, no information about reliability and validity of the instrument or questions was provided for the included countries. However, a report from Fiji that used the same questionnaire showed kappa values ranging from 0.30 to 0.50 and percent agreement from 41% to 75%.36 Comparison with objective tools may provide a different or complementary perspective to these findings. Conclusion The study sets a challenge for the LAC region, as physical inactivity and SB are highly prevalent across all countries. Gender inequities in PA and SB are shown in most countries. Therefore, specific strategies for engaging girls should be adopted to assure equitable access to PA opportunities. Prevalences of physical inactivity and AT have not shown a clear pattern in terms of development. Thus, policy makers and intervention designers should consider exchanging experiences from other countries to adapt them to their own cultural values or customs, as some countries are advancing and leading in these matters. Current data have shown that less than a third of adolescents are participating in PE classes on 3 or more days per week in the region. Thus, the value of PA for developing not only better health but also social, cultural and economic benefits must be something that authorities should not forget in their government plans, especially when allocating budget proposals for stopping and reverting inequities related to this complex situation. Supplementary Data Supplementary data are available at IJE online. Funding N.A.F. was supported by CONICYT FONDECYT 2016 11160720. J.C.O. was supported by Beca de Inserción de Investigadores Postdoctorales en la Universidad de La Frontera (RE 2960 2008) and CONICYT FONDECYT 2017 11170525. C.C.M. was supported by CONICYT FONDECYT 2016 11160703. Acknowledgements We gratefully acknowledge the work of the survey coordinators for each country: Mrs Cleo Clothilda Hampson (Antigua and Barbuda), Mr Bruno Linetzky (Argentina), Mrs Kelly Kavanagh Salmond (Bahamas), Dr Elizabeth Ferdinand (Barbados), Mr Englebert Emmanuel (Belize), Mr Casto Villarroel (Bolivia), Mr Ive Geroge (British Virgin Islands), Mrs Clara Smith (Cayman Islands), Mr Sergio Loayza and Mr Rodrigo Fuentes (Chile), Mrs Andrea Yanira (Colombia), Mrs Xinia Gomez (Costa Rica), Mrs Joan Henry (Dominica), Mrs Guadalupe Razeghi (El Salvador), Dr Christine La Grenade and Dr Sekai Turner (Grenada), Mrs Olivia Brathwaite Dick (Guatemala), Dr Marcia Paltoo (Guyana), Mrs Sandra Sanchez (Honduras), Mr Elijah Silcott (Montserrat), Mrs Fresia Cardenas (Peru), Mr Clifford Griffin (Saint Kitts and Nevis), Mr Cyprian Yarde (St Lucia), Mrs Patsy Wyllie (St Vincent and the Grenadines), Mrs Maureen Van Dijk (Suriname), Dr Gebre Yitade and Dr Akenath Misir (Trinidad and Tobago) and Mrs Susana Grumbaum (Uruguay). 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Youth health-risk behavior assessment in Fiji: the reliability of Global School-based Student Health Survey content adapted for ethnic Fijian girls . Ethn Health 2010 ; 15 : 181 – 97 . Google Scholar CrossRef Search ADS PubMed © The Author(s) 2018; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)

Journal

International Journal of EpidemiologyOxford University Press

Published: Mar 15, 2018

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