Geographic Variation in Cardiorespiratory Fitness Among South Carolina Students: Examining Contributions of Community, School, and Individual Factors.

Abstract

Context: Cardiorespiratory fitness (CRF) exerts a powerful influence on health. The distribution of cardiovascular risk factors, including CRF, varies across geographic places and is likely influenced by multiple factors at the community, neighborhood, and school levels. In South Carolina, Councils of Government (COGs) serve as regional planning organizations that guide the development and implementation of federal, state, and local initiatives-many of which can influence health-related sectors such as education, parks and recreation, and public health.

Objectives: To describe geographic patterns in students' CRF among COG regions in South Carolina and to identify community and school factors that account for the observed variations.

Design: Cross-sectional observational study.

Setting: Using data from the South Carolina FitnessGram project (school year 2018-2019), the analytic sample included public school students from 710 public schools, 64 school districts, and 10 COGs (defined as a regional planning entity that provides a "uniform geographical framework within which the planning, programming, and delivery of services might be undertaken with maximum efficiency and effectiveness").

Participants: 74 456 students in grades 5, 8, and 9-12 (high school).

Main outcome measure: Percentage of students in each COG that achieved the CRF healthy fitness zone (HFZ), as assessed by FitnessGram.

Results: The sample had a mean age of 12.9 (1.9) years, was 51.7% male, and 51.8% identified as non-Hispanic White. Approximately half (51.3%) achieved the CRF HFZ. Significant differences in the proportion of students achieving the CRF HFZ were observed across COGs before and after adjusting for student, community, and school variables using multivariate analysis ( P < .001). Supportive school and community environments were positively and independently associated with the percentage of students achieving the CRF HFZ.

Conclusions: Findings indicate that population-level youth fitness may be influenced by school and community factors that are amendable through policy actions taken by local government and planning organizations.