Characteristics of Active Home-to-School Transportation Among Children Living in North Macedonia: WHO COSI Rounds 5 and 6
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Date
2025-05
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The Ohio State University
Abstract
The Republic of North Macedonia is located in the Balkan region with a population of around 2 million inhabitants. North Macedonia has a rich history with influences from the Roman Empire, the Ottoman Empire, and other ex-Yugoslavian nations. Mirroring other regions of Europe, childhood obesity rates have increased throughout the years, with North Macedonia being regularly above the European average. Physical activity plays a central role in childhood obesity, and active transport to school is a broadly practiced, consistent measure that contributes to childhood activity across Europe. To explore characteristics of active home-to-school transportation over time in North Macedonia, we used the Childhood Obesity Surveillance Initiative (COSI). COSI was founded in 2006 due to growing concern about obesity rates in Europe as a project under the World Health Organization (WHO). North Macedonia joined COSI in the second round in 2009. COSI is a nationally representative survey aimed at collecting health information from students, their schools, and their parents. From secondary analysis, we hypothesized that personal characteristics (ex. sex, BMI) and built environment (ex. parental perceived safety, distance) would be significant predictors on whether children engaged in active round-trip school transportation in Round 5 (2019) and Round 6 (2022) of COSI. Using combined data from Rounds 5 and 6 (n=5413), a multivariate logistic regression model was used to assess the association of children’s personal characteristics, family characteristics, built environment, and active living behaviors on their use of round-trip active transportation, while simultaneously controlling for the effect of all covariates. For the purposes of multivariate logistic regression analyses, responses to the round-trip transportation item were dichotomized as active and inactive. Results of the multiple logistic regression models were reported in adjusted odds ratios (aORs) with corresponding 95% confidence intervals (CIs). Statistical significance was set at p<0.01 a priori. Personal characteristics and active living behaviors did not significantly predict whether students were involved in active transport as built environment and family characteristics did.
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Keywords
Secondary Analysis, Obesity, North Macedonia, Active Transport, Public Health