Public Health, Environmental and Occupational Health
29
Scopus Publications
Scopus Publications
Effects of a school-based cycling intervention on commuting to school behavior and device-measured activity in Spanish adolescents: the PACO cluster-randomized controlled trial Pablo Campos-Garzón, F. Javier Huertas-Delgado, Cristina Cadenas-Sanchez, Javier Molina-García, Yaira Barranco-Ruiz, Palma Chillón International Journal of Behavioral Nutrition and Physical Activity, 2026 Abstract Background Active commuting to/from school (ACS) is associated with multiple health and societal benefits, yet school-based interventions have shown limited success in changing adolescents’ commuting behavior, and their effects on psychosocial factors remain unclear. This study primarily examined the effects of a school-based cycling intervention on the usual mode and frequency of ACS, and ACS-related psychosocial outcomes in Spanish adolescents. Secondary outcomes included device-measured sedentary time and physical activity (PA). Methods A cluster-randomized controlled trial was conducted in eight Spanish secondary schools. A total of 256 adolescents (45.7% girls; mean age 14.4 years) were allocated to an intervention ( n = 127) or control group. The intervention consisted of four weekly sessions delivered during Physical Education classes over one month, combining cycling theory, skills training in closed circuits, and supervised on-road cycling in urban environments. Outcomes were assessed at baseline and post-intervention and included usual mode and weekly frequency of ACS, perceived barriers to ACS, basic psychological need satisfaction in ACS, motivation for ACS, and device-measured sedentary time and PA across daily segments. Results No significant between-group effects were observed for usual mode or frequency of ACS, nor for device-measured sedentary time or PA. Most psychosocial outcomes did not differ between groups. However, perceived environmental/safety barriers increased in the intervention group compared with controls (Δ = 0.22, p = 0.041). Moderation analyses showed that girls in the intervention group reported greater increases in amotivation for ACS than girls in the control group (Δ = 0.54, p = 0.018). Per-protocol analyses revealed higher external motivation (Δ = 0.40, p = 0.029) and amotivation (Δ = 0.38, p = 0.037) in the intervention group, with stronger effects among girls and adolescents from higher socioeconomic backgrounds. Conclusions The school-based cycling program did not change the commuting behavior or device-measured activity. Instead, participation was associated with increased awareness of environmental/safety barriers and higher amotivation, particularly among girls. Per-protocol analyses also revealed increases in external motivation and perceived barriers, particularly among girls and high-SES adolescents. These findings suggest that short-duration, skills-focused cycling interventions may heighten perceived constraints without being sufficient to support behavior change. Future programs may require longer duration, autonomy-supportive delivery, and complementary built environmental and family-level strategies to effectively promote ACS among adolescents. Trial registration ClinicalTrials.gov (Identifier: NCT03937336).
Reconstructing schoolyards with greenery to increase schoolchildren’s physical activity and mitigate climate changes in urban areas: study protocol for a stepped-wedge trial Charlotte Wilén, Viktor H. Ahlqvist, Jairo Hidalgo Migueles, Pablo Campos-Garzón, Micael Dahlén, Kyriaki Kosidou, Karin Rådholm, Pontus Henriksson, Daniel Berglind BMC Public Health, 2026 The benefits of physical activity are well-documented, and healthy habits established in childhood often continue into adulthood. Recent research has shown that schoolyards provide a valuable platform for children to be physically active, with greener spaces in particular enhancing both physical and mental well-being. The City of Stockholm has formally decided to reconstruct 20 schoolyards, incorporating more play areas and greenery. This study will evaluate the impact of these reconstructions, aiming to increase physical activity levels among schoolchildren across all socioeconomic groups, while also contributing to climate change mitigation in urban environments. This study will utilize a stepped-wedge design, where each school undergoing schoolyard reconstruction will serve as both a control and intervention site. Over four years, from 2024 to 2027, five schools will have their schoolyards reconstructed each summer. Control data will be collected in the spring prior to the reconstruction, with follow-up data collected in the spring after the reconstruction. We aim to recruit 3 600 children aged 6 to 12 years. The primary outcome will be changes in physical activity, measured via accelerometers. Secondary outcomes will include changes in musculoskeletal fitness, perceptions of the schoolyard, and environmental impact. Given the 24-hour constraint of daily time, movement behaviors (e.g., MVPA, LPA, SB, and sleep) will be treated as compositional data. Log-ratio transformation will be applied and introduced as outcomes in general linear mixed models, with schools treated as random effects. This large-scale study has the potential to set new guidelines for physical health policies in schools across the City of Stockholm, potentially influencing the well-being of an even greater number of children. Additionally, the study could provide valuable insights into strategies for mitigating climate change through urban design, offering a model for sustainable school environments that promote both health and environmental resilience. The trial has been registered on ClinicalTrials.gov the 19th of May 2023, with the reference number NCT05865782.
Handgrip Strength Reference Values and Compositional Associations with Physical Activity in Early Childhood: A Large Sample Study of Swedish Preschoolers Ana Ramírez-Osuna, Pablo Campos-Garzón, Francisco Javier Huertas-Delgado, Viktor H. Ahlqvist, Charlotte Wilén, Pontus Henriksson, Tommy R. Lundberg, Martin Neovius, Micael Dahlen, Daniel Berglind Sports Medicine Open, 2026 Background Muscular strength is a marker of current health and a predictor of long-term health outcomes in young populations, supporting the inclusion of muscle-strengthening activities into current guidelines and recommendations. Over the last decade, muscular strength has been included in several fitness-test batteries in children and adolescents. However, little is known about its relevance and the feasibility of assessing it in preschool children aged 3–5 years. Therefore, in this cross-sectional study, we aimed to generate reference values for handgrip strength in Swedish preschool children and to examine the associations of device-measured movement behaviours (sedentary time [ST], light physical activity [LPA], moderate-to-vigorous physical activity [MVPA], and sleep duration) with handgrip strength using compositional data analysis. Results A total of 3,218 preschool children (48.53% female) aged 3.0–5.5 years from Sweden were included. Handgrip strength was measured using a validated analog dynamometer following standardized procedures. Movement behaviours were assessed in a subsample of 2,328 children who had both handgrip data and valid accelerometer recordings. Compositional data analysis was used to examine associations between handgrip strength and the 24-hour time-use composition, adjusting for age, sex, body mass index, parental education, and wear time. Age- and sex-specific percentiles for handgrip strength were developed. Boys showed higher handgrip values than girls at all ages (e.g., median increased from 4.08 to 7.42 kg in boys and from 3.45 to 6.87 kg in girls between ages 3 and 5 years). When the proportion of time spent in MVPA increased relative to the other behaviours, handgrip strength rose by + 1.22 kg; the opposite was observed for ST, which related to − 0.84 kg lower handgrip strength. No significant associations were observed for LPA or sleep duration (LPA: β =-0.48 kg, 95% CI: -1.23, 0.27; sleep: β = 0.10 kg, 95% CI: -0.37, 0.57). Conclusion This study provides the first normative reference values for handgrip strength from Northern Europe. These values offer a useful reference for screening and contextual interpretation of muscular strength in preschool children.
Sunny days, cloudy behavior? Associations between weather patterns and movement behaviors in preschoolers using compositional data analysis Pablo Campos-Garzón, Per Tynelius, Michael Lundberg, Charlotte Wilén, Viktor H. Ahlqvist, Jairo H. Migueles, Martin Neovius, Pontus Henriksson, Micael Dahlen, Cecilia Magnusson, Daniel Berglind Environmental Research, 2026 PURPOSE: To investigate associations between daily weather conditions and movement behaviors (moderate-to-vigorous physical activity [MVPA], light physical activity [LPA], and sedentary behavior [SB]) in Swedish preschool children, and whether these differed by sex and day type (weekdays vs. weekends). METHODS: A total of 3307 preschool children (4.5 ± 0.9 years; 48.6% girls) wore accelerometers to measure daily MVPA, LPA, and SB during 14 days across two periods. Weather data (temperature, sunshine, daylight duration, precipitation, and snow) were obtained from the Swedish Meteorological and Hydrological Institute. Principal component analysis followed by k-means clustering classified days into weather categories. Compositional data analysis using isometric log-ratio transformation and linear mixed-effects models estimated associations, with predictions back-transformed to minutes/day using bootstrap procedures. RESULTS: Four weather clusters were identified: sunny and warm, cold and cloudy, rainy, and cloudy days. Weather clusters were significantly associated with daily movement composition (p = 0.001). Compared with sunny and warm days, cold and cloudy days were associated with -15.1 min MVPA, -32.0 min LPA, and +46.5 min SB. Rainy days showed -11.0 min MVPA, -8.3 min LPA, and +19.4 min SB, while cloudy days showed -8.3 min MVPA, -7.2 min LPA, and +15.6 min SB. Sex interactions were not significant (p > 0.05). In contrast, day type significantly modified associations for cold and cloudy and rainy days (p < 0.001), with larger reductions in PA on weekends. CONCLUSION: Daily weather conditions were significantly associated with the movement-behavior composition of Swedish preschool children. These findings demonstrate how short-term environmental variability can substantially influence young children's daily activity patterns. Recognizing weather as a dynamic environmental exposure is therefore essential for accurately interpreting movement behavior data and for understanding how environmental conditions shape human activity patterns in early childhood.
How the built environment characteristics shape parents’ perception of active commuting norms Hanna Forsberg, Pablo Campos-Garzón, Ana Ruiz Alarcón, Iris Díaz- Carrasco, Sergio Campos- Sánchez, Palma Chillón, Francisco Javier Huertas-Delgado Transportation Research Part D Transport and Environment, 2026 Active commuting to school (ACS) is a promising strategy to increase physical activity among adolescents. While characteristics of the built environment influence commuting behaviors, they may also shape parents’ perceptions of social norms related to ACS. This study analyses how subjective and objective built environment characteristics, at both micro- and macro-scale, are associated with parents’ perceptions of the social norm. When the built environment was considered as whole in a multivariable model, only the density of sports facilities (a macro-scale measure) was linked to parents’ perception of social norms, while subjective and micro-scale characteristics were not. These findings imply that environments with visible opportunities for physical activity, such as sports facilities, may shape parental perceptions of ACS as normative behavior. The presence and design of such facilities could be considered in planning, with macro-scale variables emerging as the most informative measure capturing associations with the social norm.
Active commuting to and from school among Spanish adolescents: social inequalities and environmental characteristics Eugeni Vidal-Tortosa, Pablo Campos-Garzón, Ana Ruiz-Alarcón, Javier Molina-García, Jason Gilliland, Palma Chillón Health and Place, 2026 This study examined how socioeconomic status (SES) and parental migration background are associated with two outcomes of active commuting to and from school (ACS): usual travel mode and weekly active trips. It also explored whether home-neighbourhood environmental characteristics help explain these social patterns. We used cross-sectional survey and geospatial data for 366 urban adolescents in Spain. Multilevel regression models examined associations sequentially, first adjusting for sociodemographic variables, then for environmental factors. Adolescents from more disadvantaged backgrounds were more likely to engage in ACS, with inequalities more pronounced for trips from school. Higher SES was associated with lower odds of using active modes to school (OR = 0.72, 95% CI: 0.55-0.93) and from school (OR = 0.70, 95% CI: 0.54-0.92), and with fewer weekly active trips to school (IRR = 0.90, 95% CI: 0.82-1.00) and from school (IRR = 0.90, 95% CI: 0.83-0.99) in the sociodemographic models. Having no parental migration background was associated with lower odds of using active modes from school (OR = 0.46, 95% CI: 0.21-1.00). These associations were attenuated and no longer statistically significant after adjustment for environmental characteristics, with home-school distance emerging as the strongest predictor. These findings suggest that ACS may represent an important opportunity to help reduce broader physical activity disparities, and that environmental characteristics, particularly home-school distance, may help explain observed inequalities. Policy efforts should prioritise support for adolescents who already rely on ACS, particularly on trips from school, by ensuring proximity, walkable environments, and integrated infrastructure and education initiatives.
Active transportation surveillance in children and adolescents: a global review using Active Healthy Kids Global Alliance Global Matrix 4.0 data Pablo Campos-Garzón, Letitia Koen, Salomé Aubert, Olga L. Sarmiento, Mark S. Tremblay, Richard Larouche Journal of Transport and Health, 2026 The current review aims to analyze and synthesize the current state of active transport (AT) surveillance and monitoring among children and adolescents globally, leveraging data from the Global Matrix 4.0 to identify gaps and opportunities for improving AT measurement. Two independent researchers systematically reviewed all evidence sources used by 57 countries/jurisdictions to assign AT grades. AT grades were predominantly in the mid-range, with most countries scoring between C- and B+. Over half (54%) of the countries used nationally representative data, although a substantial proportion relied on subnational or mixed sources. AT indicators were based on self-report questionnaires assessing the usual mode of transport (44%) or frequency of travel (34%), most often completed by children and adolescents. A few data sources included items on duration, trip diaries, and previous-day recall. AT assessment was largely restricted to school travel (66%), with minimal inclusion of other destinations. Less than 10% of sources reported any evidence of validity or reliability. The most frequently reported challenges in grade assignment were related to data limitations, methodological inconsistencies, and limited destination focus. Priorities for improvement of AT included infrastructure development, education and awareness initiatives, and urban and transport planning strategies, with consistent patterns observed across country income groups. This review highlights substantial heterogeneity in how countries monitor AT in children and adolescents. The inconsistent constructs, school-centric focus, and lack of reported reliability and validity of the items/tools hinder meaningful comparisons, long-term surveillance, and accurate assessment of children's and adolescents' actual AT behaviors. • Global analysis shows major inconsistencies in active transport assessment worldwide. • Active transport data mainly rely on single self-report items about school trips. • Non-school destinations and psychometric evidence rarely reported. • Methodological gaps hinder comparability and monitoring of active transport trends. • Call for Delphi consensus to harmonize active transport measures and reporting.
Sex differences in perceived barriers to active commuting to school among Spanish adolescents R.G. Saucedo-Araujo, P. Campos-Garzón, F.D. López-Centeno, J. Mitás, A. Queralt, S. Aznar, Y. Barranco-Ruiz, M. Herrador-Colmenero, P. Chillón Journal of Transport and Health, 2026 To examine sex differences in perceived barriers to active commuting to school (ACS) among Spanish adolescents and analyzed the associations between these barriers and the mode of commuting, including potential sex-specific patterns. In this cross-sectional study, 707 adolescents (53.6% girls; mean age = 14.05 ± 1.18 years) self-reported their mode of commuting and perceived barriers to ACS. Sex differences in perceived barriers (continuous scores from 0 to 1) were examined using linear mixed-effects models. Associations between perceived barriers and mode of commuting (active vs. passive) were analyzed using mixed-effects logistic regression models, fitted with and without sex × barrier interaction terms. All models were adjusted for age and home–school distance, with school included as a random intercept. Overall, no significant associations were observed between sex and perceived barriers, except that girls reported carrying a heavy school backpack as a greater barrier than boys ( p = 0.006). In models without interaction terms, several perceived environmental, safety, and logistical barriers were associated with lower odds of ACS. Sex × barrier interaction analyses indicated modest sex-specific differences, with poor lighting, crime-related concerns, and hilly routes being more strongly associated with lower odds of ACS among girls. Perceived barriers to ACS were largely shared between boys and girls, underscoring the importance of addressing universal environmental and structural constraints related to distance, convenience, traffic, and weather. However, barriers linked to physical effort and safety appear to be particularly relevant for girls’ ACS. These findings suggest that while population-wide strategies are needed to reduce common barriers to ACS, targeted actions addressing physical effort and perceived safety may be especially important to promote ACS among girls. • Boys and girls showed similar overall patterns of perceived barriers. • However, girls perceived carrying a heavy school backpack as a greater barrier than boys. • Environmental and logistical barriers reduced the odds of ACS. • Only a few sex × barrier interactions emerged, mainly involving safety- and terrain-related barriers. • Interventions should focus on universal barriers while considering girls' safety context.
Associations Between Perceived Physical Literacy and DXA-Measured Body Composition in Spanish Adolescents: The ENERGYCO Study Emilio Villa-González, Pablo Campos-Garzón, Manuel Ávila-García, Ana Ramírez-Osuna, David Rodriguez-Sanchez, José Manuel Segura-Díaz, Víctor Manuel Valle-Muñoz Applied Sciences Switzerland, 2026 Background: Physical literacy is a multidimensional construct that may be relevant for promoting active lifestyles and healthy development during adolescence. However, the association between perceived physical literacy (PPL) and body composition assessed by dual-energy X-ray absorptiometry (DXA) remains underexplored. Objective: To examine the association between PPL and DXA-derived body composition parameters in Spanish adolescents. Methods: This cross-sectional study included 56 adolescents (13.2 ± 1.27 years, 28.6% girls). PPL was assessed using the validated Spanish version of the Perceived Physical Literacy Instrument (S-PPLI). Body composition was measured by DXA. Associations between PPL and body composition outcomes were examined using general linear models, adjusting for sex, age, and device-measured moderate-to-vigorous physical activity (MVPA) and sedentary time. Results: Higher PPL was significantly associated with greater lean body mass (β = 0.81; p = 0.02), lean mass index (β = 0.22; p = 0.01), and fat-free mass (β = 0.85; p = 0.01), as well as with higher body mass index (BMI) (β = 0.24; p = 0.03). Conclusions: Higher PPL is associated with more favorable lean-related body composition outcomes in Spanish adolescents, whereas no associations were found with adiposity or bone parameters. These findings highlight PPL as a relevant correlation of lean body composition during adolescence. Given the cross-sectional design, causal inferences cannot be drawn, and future longitudinal and interventional studies are warranted.
Route Choice of Spanish Adolescent Walking Commuters: A Comparison of Actual and Shortest Routes to School Iris Díaz-Carrasco, Palma Chillón, Pablo Campos-Garzón, Javier Molina-García, Sergio Campos-Sánchez Land, 2025 A growing body of scientific literature emphasizes the role of the built environment in shaping commuting behavior among adolescents. However, the comparison of the built environment on adolescents’ route choice remains underexplored. A total of 317 Spanish adolescents participated in the study, of whom 67 adolescents provided a valid GPS-identified walking route between home and school (54.5% girls; mean age = 14.4 ± 0.7 years). Built environment variables—including residential density, number of intersections, land use mix, number of services, number of visible services from the route, street width, walkability, park area, elevation gain, elevation loss, and topographic cost—were measured using 3.28.8 QGIS software. A paired-sample analysis was performed using the Wilcoxon signed-rank test and the sign test to compare the actual route with the shortest available route. The results showed a deviation of 63.96%. Comparisons between the actual routes and the shortest ones revealed a statistically significant difference in the number of intersections (p = 0.009) and topography cost (p = 0.050). Likewise, a significant trend was found with the residential density (p = 0.080). These findings suggest that in this case study, the built environment plays an important role in adolescents’ decision-making when choosing routes for commuting to school. Some urban planning and design recommendations were given to address the results from a school built-environment-oriented approach.
ENERGY expenditure of COmmuting to school (ENERGYCO): protocol for a cluster randomized controlled trial Pablo Campos-Garzón, Víctor Manuel Valle-Muñoz, José Manuel Segura-Díaz, Manuel Ávila-García, Romina Gisele Saucedo-Araujo, Ana Ruiz-Alarcón, Francisco David López-Centeno, Unai A. Pérez De Arrilucea Le Floc’h, Juan M. A. Alcantara, Luis Miguel Medel-Carbonell, David Rodriguez-Sanchez, Ana Ramírez-Osuna, Marina Castillo-Barragán, Estela Águila-Lara, Francisco Javier Huertas-Delgado, Manuel Herrador-Colmenero, Sandra Mandic, Palma Chillón, Yaira Barranco-Ruiz, Emilio Villa-González Frontiers in Public Health, 2025
Convergent Validation of a Self-Reported Commuting to and from School Diary in Spanish Adolescents Patricia Gálvez-Fernández, Manuel Herrador-Colmenero, Pablo Campos-Garzón, Daniel Molina-Soberanes, Romina Gisele Saucedo-Araujo, María Jesús Aranda-Balboa, Amador Jesús Lara-Sánchez, Víctor Segura-Jiménez, Pontus Henriksson, Palma Chillón International Journal of Environmental Research and Public Health, 2023
A school-based randomized controlled trial to promote cycling to school in adolescents: The paco study Palma Chillón, Patricia Gálvez-Fernández, Francisco Javier Huertas-Delgado, Manuel Herrador-Colmenero, Yaira Barranco-Ruiz, Emilio Villa-González, María Jesús Aranda-Balboa, Romina Gisele Saucedo-Araujo, Pablo Campos-Garzón, Daniel Molina-Soberanes, José Manuel Segura-Díaz, Fernando Rodríguez-Rodríguez, Amador Jesús Lara-Sánchez, Ana Queralt, Javier Molina-García, Enrique García Bengoechea, Sandra Mandic International Journal of Environmental Research and Public Health, 2021
