AUTHOR=Dong Yanhui , Chen Manman , Chen Li , Wen Bo , Yang Yide , Wang Zhenghe , Ma Yinghua , Song Yi , Ma Jun , Lau Patrick W. C. 

TITLE=Individual-, Family-, and School-Level Ecological Correlates With Physical Fitness Among Chinese School-Aged Children and Adolescents: A National Cross-Sectional Survey in 2014

JOURNAL=Frontiers in Nutrition

VOLUME=Volume 8 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/nutrition/articles/10.3389/fnut.2021.684286

DOI=10.3389/fnut.2021.684286

ISSN=2296-861X

ABSTRACT=Introduction: To examine the association between the individual, family- and school-level ecological correlates and physical fitness among Chinese children and adolescents. 
Methods: A total of 157,168 children and adolescents 10 to 18 years of age with physical fitness data in 2014, participated in the study. Physical fitness was assessed using 6 tests: forced vital capacity, standing long jump, sit-and-reach, body muscle strength, 50 meter dash, and endurance running. Scores were aggregated to form a summary physical fitness indicator (PFI) which was then classified into 5 levels: low, low-middle, middle, middle-high, and high. Each option of individual, family- and school-level measures was constructed into positive or negative correlate of physical fitness and then accumulated as a composite ecological score.
Results: Among 20 individual-, family- and school-level correlates, 18 were found to be significantly associated with PFI, with high PFI levels being correlated with the positive group of correlates and low PFI levels correlated with the negative group of correlates (P<0.05). High scores of ecological correlates were associated with a high level of PFI (adjusted odds ratio (aOR) = 1.06, 95% CI: 1.06, 1.07)) whereas low scores were associated with a low level of PFI (aOR = 0.95, 95% CI: 0.95, 0.95). The ecological correlates at individual, school- and family-level were shown to be significantly related to high PFI among Chinese children and adolescents aged 10 to 18 years with different aORs of 5.97 (95% CI: 5.51, 6.47), 3.94(3.66, 4.24) and 1.25 (1.19, 1.31). The PAR% of 20 cumulative factors effects due to the negative and positive responses for low PFI levels were 35.9% and 16.1%, and for high PFI levels were 15.3% and 24.1%, among Chinese children and adolescents, respectively. Compared to the correlates at family and school levels, the correlates at individual levels had the largest PAR%. 
Conclusion: Individual, family- and school-multilevel factors had a significant cumulative association with either improving or worsening aspects of physical fitness. Individual level factors remain at the core of physical fitness improvement. Comprehensive policies and measures are urgently needed to enhance Chinese children and adolescents’ physical fitness through involving further individual and environmental factors.