Gender Difference in Health Condition Among Emirati Adolescent: Role of Environment and Parent Perceptions

Gender Difference in Health Condition Among Emirati Adolescent: Role of Environment and Parent Perceptions | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Gender Difference in Health Condition Among Emirati Adolescent: Role of Environment and Parent Perceptions Praveen Maghelal, Khaled Alawadi, Abeer Wahdain This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-623152/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: The United Arab Emirates (UAE) is one of the developed nations in the middle-east with the obesity rate among the youth two to three times greater than the international standards. Therefore, this research aims to study the variation of perception of the built environment among Emirati male and female adolescents and their parents. Also, the role of determinants of the health condition of Emirati adolescents is analyzed. Method: A total of 335 students (aged 14-20) from six schools in the Al Ain region of Abu Dhabi Emirate and 250 parent responses were used to conduct the mean-test of perception of hindrances and multinomial logit of the health condition using the perception, behavior and built environment measures. Results: Emirati males perceive the built environment factors as barriers more than female adolescents. Parents perceive street-crossing (p<0.016) and sidewalk characteristics (p<0.020) to be more of a hindrance to walking to school than students. Traffic exposure and walkability at home and schools report a significant effect on the health condition of the Emirati adolescents along with the self-reported physical activity. Marginal effect reports sedentary and low-levels of activity predicts the probability of an Emirati adolescent being not just overweight or obese (p<0.001), but also underweight (p<0.05) Conclusion: Recommendations for parents and school authorities, Abu Dhabi Municipality and Urban Planning department, and to enhance the built environment are discussed. Also recommendation to address both, levels of obesity and being underweight, are discussed. Health Economics & Outcomes Research Health Policy Obesity Health Condition Emirati Adolescents Parent Perception United Arab Emirates Figures Figure 1 Background The health statistics of the United Arab Emirates (UAE) reports that obesity among children and adolescence in UAE is high and drastically increasing [ 1 ]. The obesity rate among Emirate youth is two to three times greater than the international standards [ 2 ] and is related to the low levels of physical activity (PA) [ 3 ]. In 2016, a study confirmed that the level of PA of UAE children does not reach the required level of PA per day [ 4 ]. The lack of PA resulting from the current lifestyle is considered the main reason behind increasing adverse health conditions, including obesity among the UAE population [ 5 ]. The ‘executive regulation concerning the school transport’ by the Abu Dhabi Department of Education and Knowledge (ADEK), restricts students from crossing major roads with a designated speed of more than 40kmph to reduce exposure to high traffic. Also, the built-environment around the school and homes of the school-going children do not support walking in general. This could hinder student or parent’s choice of walking to school and hence reduce opportunities for physical activity. This may lead to a negative perception of the built environment for both the parents and the children as individuals who usually are not engaged in walking have a higher negative perception of the environment [ 6 ]. Few studies in the last decade have investigated the determinants of obesity in the UAE or the Emirati population and even less specifically target the adolescent population [ 7 ]. Most studies focus on either obesity or overweight and not on the overall health condition among the UAE population [ 8 ]. To our knowledge, none of them included parent perception to analyze the overall health of the Emirati adolescents as comprehensively. Additionally, we examine the predicted probabilities of levels of physical activity on health conditions of Emirati adolescent, a rarity in obesity studies. This study, therefore, examines the perception of the built-environment among Emirati male and female adolescents and check if their perception varies with parent’s perception. This study also analyzes the role of determinants of built-environment (both subjective and objective), parent and adolescent perceptions, and constraints (traffic exposure) and level of physical on the health condition of the Emirati adolescents. The outcome of this can provide important implications to enhance the levels of physical activity, improve the health conditions of the Emirati adolescents, and enhance the environment to change the perception of parents and adolescents. It should be noted that this study all adolescents refer to the ‘Emirati’ adolescents in this study. Parent-Child Perception of Built-Environment The parents-child perception of the built-environment has reported varying results. Some studies suggest the parents often exhibit concerns related to the different factors (demographic, and built environment factors) that usually deter the use of non-motorized transportation modes [ 9 ]. Other studies report that parents are more likely to exhibit high levels of confidence regarding their children’s capability to navigate the built environment safely [ 10 ]. Also, seemingly independent children are often capable of taking care of themselves and can maneuver traffic and the networking routes to reach the intended destination, whether it is school or home [ 11 ]. This attitude thus plays a critical role in the parent permitting the child to walk to school or to utilize the inactive means of transportation that is often more secure [ 12 ]. Also, gender studies report male children to be more physically active than females [ 13 ] and hence several studies focus on improving the health and activities for female children and adolescents [ 14 ]. Parental and child safety concerns are likely to be reduced by the creation of safer routes to schools by reducing traffic volume and speed as well as improving the availability and quality of sidewalks in neighborhoods surrounding schools. Integrating strategies that make safer school routes and ease concerns surrounding safety by educating children about walking safely in their neighborhoods have been recommended to encourage walking safe and effective [ 15 ]. Walkability and Physical Activity Built environment factors such as distance, travel time, safety, urban form and density, land use, and street design (i.e., speed limit, traffic capacity, sidewalk, crosswalk, street connectivity) are related to active transport to school, including distance and route network [ 15 , 16 ]. Neighborhoods with a high score of walkability- high street connectivity and low traffic-, witnessed the increased likeliness of children walking to school and report higher levels of physical activity. Conversely, neighbourhoods that have high connectivity in addition to high traffic volume had children that are less likely to walk and act as a deterrent to achieving the recommended levels of physical activity and negatively impacts the satisfaction and the social capital of the neighborhood [ 17 ]. Thus, the context of the home and school environment is essential and needs to accommodate a higher concentration of pedestrians [ 18 ]. Other built-environment variables such as the land use mix, residential density, and street connectivity are the critical factors for assessing the walkability of a location and can provide insights for design and policy recommendations [ 19 ]. Methods Study Area This study was conducted in the Emirate of Abu Dhabi, the capital of UAE and also the largest of the seven emirates as it occupies 87% of the total area of the UAE. The Emirates of Abu Dhabi consists of three regions: Abu Dhabi-the capital central region, the Al Ain region, and the Western region, as shown in Fig. 1 . Study population School-going children within the age group of 14–20 years (from 10th to 12th grade) from six schools from Al Ain were selected for this study. ADEK provided the approval to survey school students and their parents in public and private schools for this study, and IRB approval was obtained for human subject research from the institution. Informed consent was obtained from the parents and school children for the study. As public schools in the UAE are not co-ed schools, a pair of boys and girls school in the same district were selected. One private school from one of these districts was included in the study. Survey Content and Administration Parents were sent consent forms to request approval to volunteer and let their kids volunteer in the study. Student completed the survey in school while the parents who agreed to participate in the study completed the survey and sent it to the school. The school representatives were educated about the purpose and goals of this study to answer any questions. The survey inquired about the socio-economic, demographic, behavioral, and perception questions. Both the student and parent surveys were translated into Arabic (the local language in UAE) and were administered to the respondents. Measures Dependent Variable: Health Condition The measure of the Body Mass Index (BMI) based on age and gender specification from the International Obesity Task Force (IOTF) [ 20 ] were categorized as underweight, healthy weight, overweight, and obese health condition for students. These categorical measures of health condition were used as the dependent variable for the adolescents. The BMI for the participants was calculated by dividing the weight of each student by square of their height. Physical Activity Score The physical activity score was calculated based on student’s responses about their active and sedentary behavior. The alpha value of the score was over 0.65 and hence was used further for the analysis. The outcome categories ranged from: Sedentary (1: -5-0); Low Activity (2: 1–6); Moderate Activity (3: 7–13); High Activity (4: 14–20); Vigorous (5: 21–27). Built-Environment Perceptions Perception of parent and the adolescent identified their concerns related to the constructs of sidewalk, street, traffic, safety, and appeal of the built environment. The concerns for each of the above constructs were summed to calculate the perception of concerns related to the five built-environment constructs. Walkability Index The walkability index for schools and homes was calculated as the sum of intersection density, residential density, and land use mix [ 21 ]. The z-score for each variable – residential density, street connectivity, and land use mix was calculated and aggregated for 400m from the six schools and residences of individual student using: Walkability Index (WI) = z-score (residential density) + 2*z-score (intersection density) + z-score (Land use mix) Exposure to Traffic: The regulation by the ADEK restricts students from crossing major roads with designated speeds of 40kmph and above. Hence to evaluate the traffic exposure as a measure of speed, we used the the ratio of [length of (Highways + Majorroads)/ length of secondary roads] for the same catchments area as for the walkability index at both origin and destination [ 18 ]. Results And Discussion Based on the International Obesity Task Force (IOTF) categories, male and female students were grouped into four health categories. About 30% of females and 40% of males are either overweight or obese (Table 1 ). While close to two-third of emirate females were in the normal weight category, only half of their counterparts were in the normal weight category. This suggests male adolescents are at higher risk of various health concerns related to physical inactivity than females. Table 1 Health condition based on reported BMI of Emirati male and female adolescents Health Code Emirati Adolescents Female Male 1 - Underweight 10 (7.5%) 9 (11.1%) 2 - Normal Weight 83 (62.4%) 40 (49.4%) 3 - Overweight 21 (15.8%) 8 (9.9%) 4 - Obese 19 (14.3%) 24 (29.6%) 133 (62.1%) 81 (37.9%) Perception of Male and Female Adolescents The perception of the built environment was compared for Male and Female adolescents to assess if their perceptions varied from each other. If so, who among both the sex perceived the environment to be less suitable to walk and also if the difference was statistically significant. Of the total 250 respondents, 158 were female respondents, and 92 were male (Table 2 ). The respondents marked all concerns under each of these built-environment characteristics that they perceived to be a hindrance. Responses indicate, on average, male adolescents perceived higher average concerns than the females, and the differences were statistically significant for all the built-environment constructs. The street crossing concern for the males almost twice as much as the average concerns of female adolescents. We checked if the difference was due to exposure (walking to school) to the environment. The reported average walking for male and females were not significantly different, which indicates that male adolescent reported higher concerns about the built environment. Table 2 Two sample t-test to test the differences in the perception of built environment varies between male and female. Built-Environment characteristics Female (Obs. 158) Male (Obs. 92) t P value Mean (SD) Mean (SD) Side walks 1.39 (1.67) 2.35 (2.52) -3.24 0.000 Street crossing 2.04 (2.16) 4.00 (2.65) -6.01 0.000 Traffic 1.68 (2.08) 2.58 (2.56) -2.84 0.003 Safety 1.98 (2.07) 3.08 (2.65) -3.43 0.000 Appeal 1.91 (1.86) 2.92 (2.63) -3.27 0.000 Contrary to several studies, male adolescents report higher concerns or negative perception of the built-environment than female adolescents. This negative perception may be mediated because of two reasons. Firstly, male are associated with more sedentary behavior and engage with indoor recreational activities than being involved in outdoor sports. Secondly, males are known to receive their licenses earlier and drive more than their female counterparts. Further studies that can assess the activities of both male and female adolescents using objective measures such as accelerometer can provide more evidence to this posit. Parent and Adolescent Perceptions Parent perception of the built-environment was compared with the perception of adolescents (both male and female). On average, the parent perception varied from the children for the sidewalks and the street-crossing (Table 3 ). The traffic, safety, and appeal of the environment were not significantly different for the parents and adolescents. While parent’s perception of the street-crossing reported lower average than the children, sidewalk characteristics were of higher concern for parents in comparison to the children. Table 3 Two sample t-test to test the differences in the perception of built environment vary between children and their parents Built-Environment characteristics Parents (Obs. 151) Children (Obs. 250) t P value Mean (SD) Mean (SD) Side walks 2.14 (1.35) 1.74 (2.07) -2.06 0.020 Street crossing 2.25 (2.22) 2.76 (2.52) 2.15 0.016 Traffic 2.03 (2.12) 2.01 (2.30) -0.09 0.463 Safety 2.23 (2.36) 2.39 (2.36) 0.74 0.227 Appeal 2.28 (1.97) 2.28 (2.23) -0.02 0.509 Parent perceptions are generally more negative to let their children walk than their children’s perception. Given that, it was surprising to observe that parents reported lesser concerns on average about the street-crossing in comparison to their children. While about 40–50% of adolescents were concerned about the width of the street with marked crosswalks, only about 30% of the parents were concerned about the same. The parents preferred the presence of crossing guard while the kids were keen about having a marked pedestrian crossing for them to cross the street. The Determinant of Adolescent Health Condition The determinants of the health condition of the adolescents were assessed using four multinomial models (Table 4 ). The first or the base model assessed the determinants related only to the perception, age, and sex of the adolescents. The second model built on the base with the inclusion of levels of reported physical activity among these adolescents. The third model assessed the impact of the objective measures of walkability index and traffic exposure, while the full model included the parent’s perception of the built environment. While the r-square for the multinomial regression output is changed in log-likelihood from the intercept-only model to the four models, and unlike the linear regression, it cannot be interpreted the same way, higher the r-square value the better is generally accepted for comparison of models [ 22 ]. The r-square value improved the predictability of health condition from the base model with the perception of children and their characteristics from seven percent to 40% in the full model with parent’s perception, physical activity levels, and objective measures of the built environment. While the results of all four models are narrated, for discussion purposes, the full model will be elaborated for its implication on the health conditions of adolescents in UAE. The results from all four models indicate that the odds that adolescents who have higher concerns with street-crossing (p < 0.05) would be underweight was 2.2 times higher than being normal weight. However, the odds that they would be underweight decreased by three times if they were physically active while being overweight or obese were not statistically significant. Also, the odds that the male adolescent would be either underweight or obese increased by 2.5 times and about 20 times, respectively, than their female counterparts (p < 0.05). The levels of physical activity reported similar results across the three models. Results indicate higher the levels of physical activity lesser are the odds that the adolescent would be underweight in comparison to being normal weight. This suggests that physical activity can not only mitigate the chances of overweight or obesity but can help reduce the chances of an adolescent being underweight. The objective assessment of the built environment reported an interesting relation with the health condition of the adolescents. The exposure to traffic at destination (schools) reduces the odds that adolescents would be overweight by eight times in comparison to being normal weight. However, exposure to traffic at origin (home location) increases the odds by about four times (full model) that adolescents would be overweight or obese in comparison to being normal weight. This indicates, higher exposure to traffic near the adolescent’s household tends to negatively impact the health condition of the adolescents, which complements other studies [ 23 ]. However, with an increase in exposure to traffic near schools, the odds that adolescents would be negatively impacted reduces. This could be as the exposure is calculated only for the six study schools. Also, opportunities to engage in PA at school may negate the effect of traffic exposure. However, further studies can confirm the postulate to inform transportation policies around the schools in UAE. Better walkability at origin (homes) decreases the odds of adolescents being obese, while better walkability at destination (school) increases the odds of adolescents being overweight (by twice) or obese (by 13 times) in comparison to being normal weight. Does this indicate, a walkable environment around the schools does not help the health outcomes of the school-going children? While, again, this is contrary to most studies, this is indicative of several factors such as siting of school and policies related to walking around the school (policy restricting students walking on the road with speed higher than 40kms). Studies report siting of the school is an important consideration to encourage PA among school-going children [ 24 ]. Table 4 Multinomial Logistic regression of health condition of Adolescents Variables Adolescent Characteristics & Perception Adolescent Physical Activity Objective Built-Environment Parent Perception Base-case: Normal Weight Underweight Overweight Obese Underweight Overweight Obese Underweight Overweight Obese Underweight Overweight Obese Age (Child) 0.326 -0.179 0.174 0.346 -0.185 0.181 0.411 -0.296 0.141 0.429 -0.364 0.102 Sex (male) 0.198 -0.358 0.807*** 0.372 -0.294 0.836*** 0.863 -0.363 1.399** 2.575** 4 0.453*** 19.462* Perception of sidewalk (child) 0.113 0.104 0.090 0.121 0.104 0.089 -0.032 0.160 0.068 0.109 0.193 -0.467 Perception of Street-Crossing (child) 0.356*** 0.057 -0.005 0.360*** 0.051 0.002 0.470*** 0.009 0.110 2.223** -0.119 -0.077 Perception of Traffic (child) 0.115 0.136 -0.043 0.035 0.110 -0.060 0.130 0.220 a -0.012 -0.783 0.446*** 0.151 Perception of Safety (child) -0.221 -0.038 -0.050 -0.197 -0.032 -0.043 -0.245 0.018 -0.133 -0.828*** -0.050 0.137 Perception of Appeal (child) -0.157 -0.097 0.156 -0.139 -0.092 0.163 -0.196 -0.245 0.098 -1.681 -0.036 0.416 a Levels of Physical Activity -0.473*** -0.240 -0.143 -0.635*** -0.246 -0.117 -3.193** -0.036 0.056 Walkability Index at Origin -0.371 0.228 -0.038 -2.683** -0.632 -1.081*** Walkability Index at Destination 0.299 0.635 0.391 -0.252 2.160*** 13.070* Traffic Exposure at Origin -0.697 1.485 1.443*** -2.449 4.066*** 3.950* Traffic Exposure at Destination -0.739 -8.063*** -1.051 -0.904 -13.900*** -55.98* Perception of Traffic (parent) 0.435 a -0.021 -0.010 Perception of Street-Crossing (parent) 0.054 -0.642*** -0.308 Perception of Safety (parent) -0.260 0.387 0.124 Perception of Appeal (parent) 0.458 -0.124 -0.036 Obs 213 213 175 105 Wald Chi2 (21) 42.10 58.63 70.37 1981.44 Prob > chi2 0.0041 0.0001 0.0005 0.000 df 24 27 39 51 Psuedo R2 0.070 0.081 0.163 0.404 AIC 495.91 492.502 409.350 237.330 BIC 575.581 583.257 532.777 372.682 *p < 0.05, **p < 0.01, ***p < 0.001 Also, higher concerns with sidewalk and traffic increased the odds of adolescents being underweight and obese, respectively. However, higher concerns with safety reduces the odds of the adolescents being underweight in comparison to being normal weight. Surprisingly, parent with higher concerns about street-crossings was associated with lower odds of their children being overweight (p < 0.05) in comparison to being normal weight which is contrary to assumption. Predicting Probability of Health Condition The marginal effect of levels of physical activity on health conditions were estimated (Fig. 2). Table 5 reports the probability of an adolescent being underweight is 13.4% and 6.4% given that they report sedentary and low levels. It is hence important to propose specific policies to encourage high levels of physical activity not only to deal with overweight ot obesity in adolescents, but also to mitigate negative health impact of being underweight. Also the probability of an adolescent being overweight or obese is significantly related to sedentary, low and moderate levels of physical activity. However, the probability of adolescent being overweight and obeses when engaged is vigorous physical activity is about 13% and 20% respectively, while the rest of the predictors are set to their mean values. This could indicate the influence of improper diet, psychological factor or genetic [ 25 ]. Although outside the scope of this study, future studies to assess these factors could provide more insight. Table 5 Marginal effect of activity levels on health conditions Levels of Activity Health Condition of Adolescents Underweight Overweight Obese Sedentary 0.134* (0.063) 0.248*** (0.076) 0.303*** (0.087) Low 0.064* (0.026) 0.106** (0.037) 0.136*** (0.041) Moderate 0.053 (0.029) 0.127** (0.049) 0.232*** (0.062) High 0.094 (0.099) 0.000** (0.000) 0.073 (0.072) Vigorous 0.018 (0.018) 0.129** (0.056) 0.199** (0.065) *p < 0.05; **p < 0.01; ***p < 0.001 Conclusion And Implications The United Arab Emirates (UAE) scored an ‘F’ on the levels of physical activity and a C- on sedentary behavior in the Global Matrix 3.0 physical activity report card grades for children and youth [ 26 ]. This is indicative of an increase in levels of obesity both in the children and adolescents in the UAE. These outcomes of this study have importation implications for the built-environment, health of the adolescents, and encouraging PA. Implications for Built-Environment In general, the built environment is perceived to be non-conforming for walking by both females and males. They had major concerns with the constructs of street-crossing and safety of the built environment. Within the construct of street-crossing, the issue of the width of the street, and availability of marked crosswalks was of major concern to the adolescents. Within the construct of safety, the adolescents were concerned about the amount of traffic and unsafe driving behavior on the roads adjoining schools and homes. Street design approaches such as the introduction of “road diets” with curb-cuts at the intersections with textured crosswalks, crossing island, and lane narrowing could improve the perception of safety and concerns related to street-crossing. Studies report such interventions can reduce road crashes by about 6% − 18.8% [ 27 ]. Both traffic exposure and walkability around the homes of the adolescents have an impact on the health conditions of the adolescents. A better walkable environment with a higher land-use mix and density can encourage more walking [ 28 , 29 ], and reduce the chances of both being underweight and obese in Adolescents. The Department of Urban Planning and Municipalities of Abu Dhabi (ADPM) have suggested implementing the Urban Street Design Manual projects in Al Ain with special consideration to the needs of pedestrians [ 28 ]. Implementation of this approach in core residential areas (trip origins) can reduce vehicle speeds, cut-through traffic, and general traffic noise. Additionally, reduction of speed limits on major roads, especially on designated routes for children to walk to and from school could encourage walking within the neighborhood. In Abu Dhabi, the main concern is about the policies surrounding built environment that make it hard to walk to school [ 30 ]. ADEK and ADPM can find transformative strategic plans to promote active commuting to school as the primary mode of transportation. They could follow the example of projects in California that enhanced traffic safety along routes to school (for example, widening of crosswalks and sidewalk improvements), which led to significantly greater walking or biking for children [ 31 ]. Implications for Health of Adolescents A study by Al-Haddad et al [ 32 ] reported that both male and female in UAE tend to be about twice overweight compared to international standards. In this study, obesity and overweight in male adolescents were about 10% more than female adolescents. Several socio-cultural and behavior factors specific to the region could be attributed to this difference. Culturally, males are the majority of the workforce in the UAE and are engaged in driving more than women. About 75 percent of all trips in the emirate of Abu Dhabi is made by the male [ 33 ]. Studies indicate a high correlation of driving behavior and obesity [ 34 ], which could be one of the driving factors for higher rates of overweight and obesity among men. A recent study confirmed the high rates of obesity in males in the UAE. It established sedentary behavior as one of the major causes of the obesity epidemic in males [ 35 ]. Creating opportunities to engage them in outdoor activities such as soccer and basketball games, a preferred sports activity in the region, within their neighborhood with a directive to engage in outdoor activity should be encouraged among the adolescents and youth in the emirate. Another less addressed issue with health outcomes is the assessment and impact of underweight [ 36 ]. Being a male adolescent is positively associated with being underweight. While significant factors relate to malnutrition and dietary habits, fatigue, emotional, genetic, and psychological factors, and smoking are other factors that can lead to adolescence’ underweight health condition. Research suggests using “effective public health programs that can simultaneously promote a healthy lifestyle, improve diet quality, and address both undernutrition and chronic disease” [ 25 ]. Health policies that regulate dietary intake both at school and at home need to be promoted. Recently schools in Abu Dhabi restricted the availability of high-calorie food at school. Extending that by providing good dietary plans for students in school can regulate this further and provide the necessary support to curb the issue of underweight in adolescents. Implications for Enhancing Physical Activity: Planning and Policy The school environment can provide “quality physical education and supportive environment for a long-lasting healthy and active lifestyle” [ 37 ]. Health and physical literacy at schools can provide needed knowledge, motivation, and engagement in physical activity. Control competence allows self-directed structuring and pacing of physical activity, which has shown to be more effective [ 38 ]. ADEK policies to actively engage schools to develop control competence approaches for children and adolescents in school can instill PA behaviors that could last until adulthood. Outside the school environment, the physical environment around the homes of adolescents can provide opportunities for engagement in an active lifestyle. Emirati housing communities lack sizeable open play areas and mixed use development to provide opportunities for after-school activities [ 39 ]. Small-area planning approaches such as Transit-Oriented Development (TOD) or Neighborhood Planning Unit (NPU) that incorporate better connectivity, land use mix, and open area planning for Emirati housing neighborhood needs to be proposed. By doing so, the Abu Dhabi Department of Planning and Municipality can enhance the accessibility within these neighbourhood [ 40 ]. In addition, “compact” urban fabrics increase opportunities for social interaction and sustain alternate modes of transport such as cycling, walking, and mass transit. Emirati neighborhoods for several decades have been designed as low density developments with no diversity in land use. For that reason, neighborhood design requires an overhaul; new ideologies like compactness, connecitgivty, diversity, and prosimity must be promoted to connect people woth people and people with their destinations. The street design manual of Abu Dhabi should develop street sections to enhance accessibility and connectivity to schools from residences. A street section that includes wide sidewalk and bike lanes, with minimum lane width and lower speed limits, needs to consider for inclusion in the Abu Dhabi Street Manual. Also, alternative approaches such as pedestrian bridges for students to circumvent major roads with high speed to reduce exposure to high traffic should be incorporated in the design manual. In existing neighborhoods, retrofitting and improving alleys’ physical conditions and appearance could also enhance their use and thus support walkability. Recommended physical improvement plans include paving, landscaping, and upgrading lighting to promote walking. Such improvements may be particularly helpful in suburban neighborhoods, where alleys are often unpaved, not utilized, improperly lit, and obstructed by debris and vegetation [ 41 ]. Although it’s important to improve the environment to increase the physical activity levels, it is also important to increase the awareness of the benefits of physical activity among parents. A recent study stated that to enhance the ability to engage in physical activity, it is important to improve the built environment and raise awareness by educating the parents [ 42 ]. The outcomes of this study provide implications to improve the overall health condition for adolescents in Abu Dhabi. While these implications are specific to Abu Dhabi and UAE, major cities in the middle-east have similar socio-cultural, topographic, and demographic characteristics. They can implement similar approaches to enhance the health condition of their local population. However, the policy and planning recommendations are adaptable for all municipalities and schools proactive in improving the built environment and health conditions of school-aged children. Abbreviations UAE – United Arab Emirates TOD - Transit-Oriented Development NPU - Neighborhood Planning Unit ADEK – Abu Dhabi Department of Education and Knowledge PA – Physical Activity ADPM - Abu Dhabi Department of Urban Planning and Municipalities IOTF - International Obesity Task Force IRB – Institutional Review Board BMI – Body Mass Index Declarations Ethics approval and consent to participate The study was approved by the Abu Dhabi Department of Education and Knowledge (ADEK). The survey instruments for the school, parent and child were approved by the Khalifa University Institutional Review Board. Consent forms were signed by the representative of each study school. Signed approval was obtained from parents for their own participation and participation of their children in the study. Only students who received approvals from their parents were administered the survey for this study. Consent for publication The consent for publication was obtained from all school representative, parents for themselves and their children. Availability of data and materials The ADEK approvals do not permit us to share the data with any third party and restricts us from use and distribution of the same without their permission, given the privacy rules in the United Arab Emirates. Competing interests The authors declare that they have no competing interests Funding This study was conducted without any financial support from any agencies or institutions. Authors' contributions PM was responsible for conception, analysis and monitoring of the study. AW was responsible for data collections and approvals. PM, KA and AW analysed and interpreted the data and its implications. PM and KA were responsible for drafting the manuscript. All the authors have read and approved the content of the manuscript. Acknowledgements The authors acknowledge the support and advice provided by the Abu Dhabi Department of Knowledge and Education and the School representative who agreed to participate in the studyand support our data collection. References Al Junaibi A, Abdulle A, Sabri S, et al. The prevalence and potential determinants of obesity among school children and adolescents in Abu Dhabi, United Arab Emirates. Int. J. Obes. 2013;37(1):68-74. Al-haddad FH, Little BB, Abdul Ghafoor AG. Childhood obesity in United Arab Emirates schoolchildren: a national study. Ann Hum Biol 2005;32(1):72-9. Ali HI, Ng SW, Zaghloul S, et al. High proportion of 6 to 18-year-old children and adolescents in the United Arab Emirates are not meeting dietary recommendations. Nutr. Res. 2013;33(6):447-56. Paulo MS, Nauman J, Abdulle A, et al. Results from the United Arab Emirates’ 2018 report card on physical activity for children and youth. J Phys Activ Health 2018;15(s2):S419-21. Bunc V, Skalská M. 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Do parental perceptions of the neighbourhood environment influence children’s independent mobility? Evidence from Toronto, Canada. Urb Std 2014;51(16):3401-19. Timperio A, Crawford D, Telford A, Salmon J. Perceptions about the local neighborhood and walking and cycling among children. Prev Med. 2004;38(1):39-47. Grao‐Cruces A, Segura‐Jiménez V, Conde‐Caveda J, García‐Cervantes L, Martínez‐Gómez D, Keating XD, Castro‐Piñero J. The role of school in helping children and adolescents reach the physical activity recommendations: The UP&DOWN study. J Sch Health. 2019;89(8):612-8. Kazim AA, Almarzooqi MS, Karavetian M. The Prevalence and Determents of Eating disorders among Emirati Female Students Aged 14–19 Years in Ajman, UAE. J Food Nutr Disord 6 2017;2:2. Badri MA. School travel modes: factors influencing parental choice in Abu Dhabi. Intl J Edu Eco Dev 2013;4(3):203-18. Trapp GS, Giles-Corti B, Christian HE, et al. Increasing children’s physical activity: Individual, social, and environmental factors associated with walking to and from school. Health Educ Behav 2012;39(2):172-82. Maghelal P, Natesan P, Naderi JR, Kweon BS. Investigating the use of virtual reality for pedestrian environments. J Archit Plann Res 2011:104-17. Al-Ali A, Maghelal P, Alawadi K. Assessing Neighborhood Satisfaction and Social Capital in a Multi-Cultural Setting of an Abu Dhabi Neighborhood. Sustain 2020;12(8):3200. Giles-Corti B, Wood G, Pikora T, et al. School site and the potential to walk to school: The impact of street connectivity and traffic exposure in school neighborhoods. Health Place 2011;17(2):545-50. Leslie E, Coffee N, Frank L, et al. Walkability of local communities: using geographic information systems to objectively assess relevant environmental attributes. Health Place 2007;13(1):111-22. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 2000;320(7244):1240. Frank LD, Sallis JF, Saelens BE, et al. The development of a walkability index: application to the Neighborhood Quality of Life Study. Br J Sports Med 2010;44(13):924-33. Heinzl H, Waldhör T, Mittlböck M. Careful use of pseudo R‐squared measures in epidemiological studies. Stat Med. 2005 Sep 30;24(18):2867-72. Schlossberg M, Greene J, Phillips PP, et al. School trips: effects of urban form and distance on travel mode. J Am Plann Assoc 2006;72(3):337-46. Yu CY, Zhu X. Planning for safe schools: impacts of school siting and surrounding environments on traffic safety. J Plan Educ Res 2016;36(4):476-86. Doak C, Adair L, Bentley M, Fengying Z, Popkin B. The underweight/overweight household: an exploration of household sociodemographic and dietary factors in China. Pub Health Nutr. 2002;5(1a):215-21. Aubert S, Barnes JD, Abdeta C, et al. Global matrix 3.0 physical activity report card grades for children and youth: results and analysis from 49 countries. J Phys Activ Health 2018;15(s2):S251-73. Pawlovich MD, Li W, Carriquiry A, Welch T. Iowa's experience with road diet measures: Use of Bayesian approach to assess impacts on crash frequencies and crash rates. Transp Res Rec 2006;1953(1):163-71. Pimenta AR, Maghelal PK, Alawadi K. Are transit-adjacent developments effective neighborhood design models to help meet the recommended weekly physical activity levels? The case of Abu Dhabi. Int J Sustain Transp 2020;21:1-2. Alawadi K, Benkraouda O. The debate over neighborhood density in Dubai: Between theory and practicality. J Plan Educ Res 2019;39(1):18-34. Badri MA, Ustadi AM, Pierson L, Al Dramaki M. Mode of travel and the decision to allow children to walk or bike to schools—The Abu Dhabi experience. Open J Prev Med. 2012; 2(4):514–527. Boarnet MG, Anderson CL, Day K, et al. Evaluation of the California Safe Routes to School legislation: urban form changes and children’s active transportation to school. Am J Prev Med 2005;28(2):134-40. Al-haddad FH, Little BB, Abdul Ghafoor AG. Childhood obesity in United Arab Emirates schoolchildren: a national study. Ann Hum Biol 2005;32(1):72-9.. Abu Dhabi Household Travel Diary Survey. Abu Dhabi Department of Transportation, Abu Dhabi UAE 2015. Swanson KC, McCormack GR. The relations between driving behavior, physical activity, and weight status among Canadian adults. J Phys Activ Health 2012;9(3):352-9. Gulf News. UAE: Nearly 70 per cent Emirati male adults under 30 'are obese'. 2019 Jul accessed at https://gulfnews.com/uae/health/uae-nearly-70-per-cent-emirati-male-adults-under-30-are-obese-1.65102616 Uzogara SG. Underweight, the less discussed type of unhealthy weight and its implications: a review. Am J Food Technol Nutr Res 2016;3(5):126. World Health Organization. Global action plan on physical activity 2018-2030: more active people for a healthier world. World Health Organization; 2019. Haible S, Volk C, Demetriou Y, et al. Physical Activity-Related Health Competence, Physical Activity, and Physical Fitness: Analysis of Control Competence for the Self-Directed Exercise of Adolescents. Int J Environ Res Public Health 2020;17(1):39. Alawadi K. A return to the old landscape? Balancing physical planning ideals and cultural constraints in Dubai’s residential neighborhoods. J Hous Built Environ 2019;34(1):235-63. Almardood MA, Maghelal P. Enhancing the use of transit in arid regions: Case of Abu Dhabi. Int J Sustain Transp 2019;28:1-4. Scoppa M, Bawazir K, Alawadi K. Walking the superblocks: Street layout efficiency and the sikkak system in Abu Dhabi. Sustain Cities Soc 2018;38:359-69. Alawadi K, Benkraouda O. What happened to Abu Dhabi’s urbanism? The question of regional integration. J Urban Des 2018;23(3):367-94. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-623152","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research","associatedPublications":[],"authors":[{"id":34566788,"identity":"4dc7f162-c036-461b-b844-d7493bc7dc6f","order_by":0,"name":"Praveen Maghelal","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA30lEQVRIiWNgGAWjYJACZgYGCwY+9gYg08CCaC0SDGw8B0BaJEjRIpEAYhOhxVzs8OPXBRUS8mySz69u+FEgwcDf3p2AV4vl7DQz6xlnJAzbpHPKbvYAHSZx5uwGvFoMbieYGfO2STACtaTd4AFqMZDIJaQl/Zsx7z8J+zbJM2k3/xCnJcf4MW+DRGKbBPux20TZYjk7p4yZ55hEchtPDtttGQMJHoJ+MZdO3/yZp8bGtp/9+LObb/7YyPG39xJwGAMwRiBMHgMwiVc5VAvzBwiT/QFB1aNgFIyCUTAyAQAQjUHeDbWUwQAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0003-0324-9955","institution":"Khalifa University of Science Technology - Masdar City Campus","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Praveen","middleName":"","lastName":"Maghelal","suffix":""},{"id":34566789,"identity":"cad8116f-826d-4533-ab60-74214732c64d","order_by":1,"name":"Khaled Alawadi","email":"","orcid":"","institution":"Khalifa University of Science Technology - Abu Dhabi Campus: Khalifa University of Science and Technology","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Khaled","middleName":"","lastName":"Alawadi","suffix":""},{"id":34566790,"identity":"c95b5f9f-b0a8-40c5-ab3d-8ce0575e4a62","order_by":2,"name":"Abeer Wahdain","email":"","orcid":"","institution":"Khalifa University of Science Technology - Abu Dhabi Campus: Khalifa University of Science and Technology","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Abeer","middleName":"","lastName":"Wahdain","suffix":""}],"badges":[],"createdAt":"2021-06-15 10:43:50","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-623152/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-623152/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":10704866,"identity":"31b8b7c1-cf6d-44b2-a2e1-8e84272566c4","added_by":"auto","created_at":"2021-06-23 17:37:48","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":68475,"visible":true,"origin":"","legend":"The city of Al Ain is located in the eastern side of the Capital Center and shares its borders with the Sultanate of Oman. Source: Author. Note: The designations employed and the presentation of the material on this map do not imply the expression of any opinion whatsoever on the part of Research Square concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. This map has been provided by the authors.","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-623152/v1/29fac47bab9c5c3ceeb77f61.jpg"},{"id":13700134,"identity":"b4532764-a3f2-43ab-b809-ec4f47042dc8","added_by":"auto","created_at":"2021-09-17 13:23:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":352590,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-623152/v1/8a2aaa11-701c-411c-80d4-f239f9984010.pdf"}],"financialInterests":"","formattedTitle":"\u003cp\u003eGender Difference in Health Condition Among Emirati Adolescent: Role of Environment and Parent Perceptions\u003c/p\u003e","fulltext":[{"header":"Background","content":" \u003cp\u003eThe health statistics of the United Arab Emirates (UAE) reports that obesity among children and adolescence in UAE is high and drastically increasing [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The obesity rate among Emirate youth is two to three times greater than the international standards [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] and is related to the low levels of physical activity (PA) [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In 2016, a study confirmed that the level of PA of UAE children does not reach the required level of PA per day [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The lack of PA resulting from the current lifestyle is considered the main reason behind increasing adverse health conditions, including obesity among the UAE population [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe \u0026lsquo;executive regulation concerning the school transport\u0026rsquo; by the Abu Dhabi Department of Education and Knowledge (ADEK), restricts students from crossing major roads with a designated speed of more than 40kmph to reduce exposure to high traffic. Also, the built-environment around the school and homes of the school-going children do not support walking in general. This could hinder student or parent\u0026rsquo;s choice of walking to school and hence reduce opportunities for physical activity. This may lead to a negative perception of the built environment for both the parents and the children as individuals who usually are not engaged in walking have a higher negative perception of the environment [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFew studies in the last decade have investigated the determinants of obesity in the UAE or the Emirati population and even less specifically target the adolescent population [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Most studies focus on either obesity or overweight and not on the overall health condition among the UAE population [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. To our knowledge, none of them included parent perception to analyze the overall health of the Emirati adolescents as comprehensively. Additionally, we examine the predicted probabilities of levels of physical activity on health conditions of Emirati adolescent, a rarity in obesity studies.\u003c/p\u003e \u003cp\u003eThis study, therefore, examines the perception of the built-environment among Emirati male and female adolescents and check if their perception varies with parent\u0026rsquo;s perception. This study also analyzes the role of determinants of built-environment (both subjective and objective), parent and adolescent perceptions, and constraints (traffic exposure) and level of physical on the health condition of the Emirati adolescents. The outcome of this can provide important implications to enhance the levels of physical activity, improve the health conditions of the Emirati adolescents, and enhance the environment to change the perception of parents and adolescents. It should be noted that this study all adolescents refer to the \u0026lsquo;Emirati\u0026rsquo; adolescents in this study.\u003c/p\u003e \u003cp\u003eParent-Child Perception of Built-Environment\u003c/p\u003e \u003cp\u003eThe parents-child perception of the built-environment has reported varying results. Some studies suggest the parents often exhibit concerns related to the different factors (demographic, and built environment factors) that usually deter the use of non-motorized transportation modes [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Other studies report that parents are more likely to exhibit high levels of confidence regarding their children\u0026rsquo;s capability to navigate the built environment safely [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Also, seemingly independent children are often capable of taking care of themselves and can maneuver traffic and the networking routes to reach the intended destination, whether it is school or home [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. This attitude thus plays a critical role in the parent permitting the child to walk to school or to utilize the inactive means of transportation that is often more secure [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Also, gender studies report male children to be more physically active than females [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] and hence several studies focus on improving the health and activities for female children and adolescents [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eParental and child safety concerns are likely to be reduced by the creation of safer routes to schools by reducing traffic volume and speed as well as improving the availability and quality of sidewalks in neighborhoods surrounding schools. Integrating strategies that make safer school routes and ease concerns surrounding safety by educating children about walking safely in their neighborhoods have been recommended to encourage walking safe and effective [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWalkability and Physical Activity\u003c/p\u003e \u003cp\u003eBuilt environment factors such as distance, travel time, safety, urban form and density, land use, and street design (i.e., speed limit, traffic capacity, sidewalk, crosswalk, street connectivity) are related to active transport to school, including distance and route network [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNeighborhoods with a high score of walkability- high street connectivity and low traffic-, witnessed the increased likeliness of children walking to school and report higher levels of physical activity. Conversely, neighbourhoods that have high connectivity in addition to high traffic volume had children that are less likely to walk and act as a deterrent to achieving the recommended levels of physical activity and negatively impacts the satisfaction and the social capital of the neighborhood [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Thus, the context of the home and school environment is essential and needs to accommodate a higher concentration of pedestrians [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Other built-environment variables such as the land use mix, residential density, and street connectivity are the critical factors for assessing the walkability of a location and can provide insights for design and policy recommendations [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e "},{"header":"Methods","content":"\u003cp\u003eStudy Area\u003c/p\u003e\n\u003cp\u003eThis study was conducted in the Emirate of Abu Dhabi, the capital of UAE and also the largest of the seven emirates as it occupies 87% of the total area of the UAE. The Emirates of Abu Dhabi consists of three regions: Abu Dhabi-the capital central region, the Al Ain region, and the Western region, as shown in Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"Section2\" id=\"Sec3\"\u003e\n \u003cp\u003eStudy population\u003c/p\u003e\n \u003cp\u003eSchool-going children within the age group of 14\u0026ndash;20 years (from 10th to 12th grade) from six schools from Al Ain were selected for this study. ADEK provided the approval to survey school students and their parents in public and private schools for this study, and IRB approval was obtained for human subject research from the institution. Informed consent was obtained from the parents and school children for the study. As public schools in the UAE are not co-ed schools, a pair of boys and girls school in the same district were selected. One private school from one of these districts was included in the study.\u003c/p\u003e\n \u003cp\u003eSurvey Content and Administration\u003c/p\u003e\n \u003cp\u003eParents were sent consent forms to request approval to volunteer and let their kids volunteer in the study. Student completed the survey in school while the parents who agreed to participate in the study completed the survey and sent it to the school. The school representatives were educated about the purpose and goals of this study to answer any questions. The survey inquired about the socio-economic, demographic, behavioral, and perception questions. Both the student and parent surveys were translated into Arabic (the local language in UAE) and were administered to the respondents.\u003c/p\u003e\n \u003cdiv class=\"Section3\" id=\"Sec4\"\u003e\n \u003cp\u003eMeasures\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eDependent Variable: Health Condition\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eThe measure of the Body Mass Index (BMI) based on age and gender specification from the International Obesity Task Force (IOTF) [\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e] were categorized as underweight, healthy weight, overweight, and obese health condition for students. These categorical measures of health condition were used as the dependent variable for the adolescents. The BMI for the participants was calculated by dividing the weight of each student by square of their height.\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv class=\"Section3\" id=\"Sec5\"\u003e\n \u003cp\u003e\u003cem\u003ePhysical Activity Score\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eThe physical activity score was calculated based on student\u0026rsquo;s responses about their active and sedentary behavior. The alpha value of the score was over 0.65 and hence was used further for the analysis. The outcome categories ranged from: Sedentary (1: -5-0); Low Activity (2: 1\u0026ndash;6); Moderate Activity (3: 7\u0026ndash;13); High Activity (4: 14\u0026ndash;20); Vigorous (5: 21\u0026ndash;27).\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv class=\"Section3\" id=\"Sec6\"\u003e\n \u003cp\u003e\u003cem\u003eBuilt-Environment Perceptions\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003ePerception of parent and the adolescent identified their concerns related to the constructs of sidewalk, street, traffic, safety, and appeal of the built environment. The concerns for each of the above constructs were summed to calculate the perception of concerns related to the five built-environment constructs.\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv class=\"Section3\" id=\"Sec7\"\u003e\n \u003cp\u003e\u003cem\u003eWalkability Index\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eThe walkability index for schools and homes was calculated as the sum of intersection density, residential density, and land use mix [\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e]. The z-score for each variable \u0026ndash; residential density, street connectivity, and land use mix was calculated and aggregated for 400m from the six schools and residences of individual student using: Walkability Index (WI)\u0026thinsp;=\u0026thinsp;z-score (residential density)\u0026thinsp;+\u0026thinsp;2*z-score (intersection density)\u0026thinsp;+\u0026thinsp;z-score (Land use mix)\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv class=\"Section3\" id=\"Sec8\"\u003e\n \u003cp\u003e\u003cem\u003eExposure to Traffic:\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eThe regulation by the ADEK restricts students from crossing major roads with designated speeds of 40kmph and above. Hence to evaluate the traffic exposure as a measure of speed, we used the the ratio of [length of (Highways\u0026thinsp;+\u0026thinsp;Majorroads)/ length of secondary roads] for the same catchments area as for the walkability index at both origin and destination [\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"Results And Discussion","content":"\u003cp\u003eBased on the International Obesity Task Force (IOTF) categories, male and female students were grouped into four health categories. About 30% of females and 40% of males are either overweight or obese (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). While close to two-third of emirate females were in the normal weight category, only half of their counterparts were in the normal weight category. This suggests male adolescents are at higher risk of various health concerns related to physical inactivity than females.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u003ctable border=\"1\" id=\"Tab1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eHealth condition based on reported BMI of Emirati male and female adolescents\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHealth Code\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eEmirati Adolescents\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 - Underweight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (7.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (11.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 - Normal Weight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e83 (62.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40 (49.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 - Overweight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21 (15.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (9.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 - Obese\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19 (14.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24 (29.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e133 (62.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81 (37.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePerception of Male and Female Adolescents\u003c/p\u003e\n\u003cp\u003eThe perception of the built environment was compared for Male and Female adolescents to assess if their perceptions varied from each other. If so, who among both the sex perceived the environment to be less suitable to walk and also if the difference was statistically significant. Of the total 250 respondents, 158 were female respondents, and 92 were male (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). The respondents marked all concerns under each of these built-environment characteristics that they perceived to be a hindrance. Responses indicate, on average, male adolescents perceived higher average concerns than the females, and the differences were statistically significant for all the built-environment constructs. The street crossing concern for the males almost twice as much as the average concerns of female adolescents. We checked if the difference was due to exposure (walking to school) to the environment. The reported average walking for male and females were not significantly different, which indicates that male adolescent reported higher concerns about the built environment.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u003ctable border=\"1\" id=\"Tab2\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eTwo sample t-test to test the differences in the perception of built environment varies between male and female.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eBuilt-Environment\u003c/p\u003e\n \u003cp\u003echaracteristics\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003cp\u003e(Obs. 158)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003cp\u003e(Obs. 92)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSide walks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.39 (1.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.35 (2.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-3.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStreet crossing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.04 (2.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.00 (2.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-6.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTraffic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.68 (2.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.58 (2.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-2.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSafety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.98 (2.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.08 (2.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-3.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAppeal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.91 (1.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.92 (2.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-3.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eContrary to several studies, male adolescents report higher concerns or negative perception of the built-environment than female adolescents. This negative perception may be mediated because of two reasons. Firstly, male are associated with more sedentary behavior and engage with indoor recreational activities than being involved in outdoor sports. Secondly, males are known to receive their licenses earlier and drive more than their female counterparts. Further studies that can assess the activities of both male and female adolescents using objective measures such as accelerometer can provide more evidence to this posit.\u003c/p\u003e\n\u003cp\u003eParent and Adolescent Perceptions\u003c/p\u003e\n\u003cp\u003eParent perception of the built-environment was compared with the perception of adolescents (both male and female). On average, the parent perception varied from the children for the sidewalks and the street-crossing (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). The traffic, safety, and appeal of the environment were not significantly different for the parents and adolescents. While parent\u0026rsquo;s perception of the street-crossing reported lower average than the children, sidewalk characteristics were of higher concern for parents in comparison to the children.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u003ctable border=\"1\" id=\"Tab3\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eTwo sample t-test to test the differences in the perception of built environment vary between children and their parents\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eBuilt-Environment\u003c/p\u003e\n \u003cp\u003echaracteristics\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eParents\u003c/p\u003e\n \u003cp\u003e(Obs. 151)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eChildren\u003c/p\u003e\n \u003cp\u003e(Obs. 250)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSide walks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.14 (1.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.74 (2.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-2.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.020\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStreet crossing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.25 (2.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.76 (2.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTraffic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.03 (2.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.01 (2.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.463\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSafety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.23 (2.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.39 (2.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.227\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAppeal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.28 (1.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.28 (2.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.509\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eParent perceptions are generally more negative to let their children walk than their children\u0026rsquo;s perception. Given that, it was surprising to observe that parents reported lesser concerns on average about the street-crossing in comparison to their children. While about 40\u0026ndash;50% of adolescents were concerned about the width of the street with marked crosswalks, only about 30% of the parents were concerned about the same. The parents preferred the presence of crossing guard while the kids were keen about having a marked pedestrian crossing for them to cross the street.\u003c/p\u003e\n\u003cp\u003eThe Determinant of Adolescent Health Condition\u003c/p\u003e\n\u003cp\u003eThe determinants of the health condition of the adolescents were assessed using four multinomial models (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e). The first or the base model assessed the determinants related only to the perception, age, and sex of the adolescents. The second model built on the base with the inclusion of levels of reported physical activity among these adolescents. The third model assessed the impact of the objective measures of walkability index and traffic exposure, while the full model included the parent\u0026rsquo;s perception of the built environment.\u003c/p\u003e\n\u003cp\u003eWhile the r-square for the multinomial regression output is changed in log-likelihood from the intercept-only model to the four models, and unlike the linear regression, it cannot be interpreted the same way, higher the r-square value the better is generally accepted for comparison of models [\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e]. The r-square value improved the predictability of health condition from the base model with the perception of children and their characteristics from seven percent to 40% in the full model with parent\u0026rsquo;s perception, physical activity levels, and objective measures of the built environment.\u003c/p\u003e\n\u003cp\u003eWhile the results of all four models are narrated, for discussion purposes, the full model will be elaborated for its implication on the health conditions of adolescents in UAE. The results from all four models indicate that the odds that adolescents who have higher concerns with street-crossing (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) would be underweight was 2.2 times higher than being normal weight. However, the odds that they would be underweight decreased by three times if they were physically active while being overweight or obese were not statistically significant. Also, the odds that the male adolescent would be either underweight or obese increased by 2.5 times and about 20 times, respectively, than their female counterparts (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\n\u003cp\u003eThe levels of physical activity reported similar results across the three models. Results indicate higher the levels of physical activity lesser are the odds that the adolescent would be underweight in comparison to being normal weight. This suggests that physical activity can not only mitigate the chances of overweight or obesity but can help reduce the chances of an adolescent being underweight.\u003c/p\u003e\n\u003cp\u003eThe objective assessment of the built environment reported an interesting relation with the health condition of the adolescents. The exposure to traffic at destination (schools) reduces the odds that adolescents would be overweight by eight times in comparison to being normal weight. However, exposure to traffic at origin (home location) increases the odds by about four times (full model) that adolescents would be overweight or obese in comparison to being normal weight. This indicates, higher exposure to traffic near the adolescent\u0026rsquo;s household tends to negatively impact the health condition of the adolescents, which complements other studies [\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e]. However, with an increase in exposure to traffic near schools, the odds that adolescents would be negatively impacted reduces. This could be as the exposure is calculated only for the six study schools. Also, opportunities to engage in PA at school may negate the effect of traffic exposure. However, further studies can confirm the postulate to inform transportation policies around the schools in UAE.\u003c/p\u003e\n\u003cp\u003eBetter walkability at origin (homes) decreases the odds of adolescents being obese, while better walkability at destination (school) increases the odds of adolescents being overweight (by twice) or obese (by 13 times) in comparison to being normal weight. Does this indicate, a walkable environment around the schools does not help the health outcomes of the school-going children? While, again, this is contrary to most studies, this is indicative of several factors such as siting of school and policies related to walking around the school (policy restricting students walking on the road with speed higher than 40kms). Studies report siting of the school is an important consideration to encourage PA among school-going children [\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u003ctable border=\"1\" id=\"Tab4\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eMultinomial Logistic regression of health condition of Adolescents\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eAdolescent Characteristics \u0026amp; Perception\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eAdolescent Physical Activity\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eObjective Built-Environment\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eParent Perception\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBase-case: Normal Weight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnderweight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOverweight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eObese\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnderweight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOverweight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eObese\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnderweight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOverweight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eObese\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnderweight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOverweight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eObese\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge (Child)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.326\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.179\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.174\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.346\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.185\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.181\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.411\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.296\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.429\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.364\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.102\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSex (male)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.198\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.358\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.807***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.372\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.294\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.836***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.863\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.363\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.399**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.575**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 0.453***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.462*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePerception of sidewalk (child)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.090\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.089\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.160\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.068\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.193\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.467\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePerception of Street-Crossing (child)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.356***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.057\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.360***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.051\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.470***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.223**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.119\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.077\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePerception of Traffic (child)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.035\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.060\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.220\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.783\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.446***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.151\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePerception of Safety (child)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.221\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.038\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.050\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.197\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.245\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.828***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.050\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.137\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePerception of Appeal (child)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.157\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.097\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.156\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.139\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.092\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.163\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.196\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.245\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.098\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.681\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.416\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLevels of Physical Activity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.473***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.240\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.635***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.246\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-3.193**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.056\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWalkability Index at Origin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.371\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.228\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.038\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-2.683**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.632\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.081***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWalkability Index at Destination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.299\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.635\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.391\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.252\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.160***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.070*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTraffic Exposure at Origin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.697\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.485\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.443***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-2.449\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.066***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.950*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTraffic Exposure at Destination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.739\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-8.063***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.051\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.904\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-13.900***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-55.98*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePerception of Traffic (parent)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.435\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePerception of Street-Crossing (parent)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.054\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.642***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.308\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePerception of Safety (parent)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.260\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.387\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.124\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePerception of Appeal (parent)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.458\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eObs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e213\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e213\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e175\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWald Chi2 (21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1981.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProb\u0026thinsp;\u0026gt;\u0026thinsp;chi2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.0041\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.0005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003edf\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePsuedo R2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.070\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.081\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.163\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.404\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAIC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e495.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e492.502\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e409.350\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e237.330\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBIC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e575.581\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e583.257\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e532.777\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e372.682\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"13\"\u003e\n \u003cp\u003e*p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, **p\u0026thinsp;\u0026lt;\u0026thinsp;0.01, ***p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAlso, higher concerns with sidewalk and traffic increased the odds of adolescents being underweight and obese, respectively. However, higher concerns with safety reduces the odds of the adolescents being underweight in comparison to being normal weight. Surprisingly, parent with higher concerns about street-crossings was associated with lower odds of their children being overweight (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) in comparison to being normal weight which is contrary to assumption.\u003c/p\u003e\n\u003cp\u003ePredicting Probability of Health Condition\u003c/p\u003e\n\u003cp\u003eThe marginal effect of levels of physical activity on health conditions were estimated (Fig. 2). Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e reports the probability of an adolescent being underweight is 13.4% and 6.4% given that they report sedentary and low levels. It is hence important to propose specific policies to encourage high levels of physical activity not only to deal with overweight ot obesity in adolescents, but also to mitigate negative health impact of being underweight. Also the probability of an adolescent being overweight or obese is significantly related to sedentary, low and moderate levels of physical activity. However, the probability of adolescent being overweight and obeses when engaged is vigorous physical activity is about 13% and 20% respectively, while the rest of the predictors are set to their mean values. This could indicate the influence of improper diet, psychological factor or genetic [\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e]. Although outside the scope of this study, future studies to assess these factors could provide more insight.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable border=\"1\" id=\"Tab5\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eMarginal effect of activity levels on health conditions\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eLevels of Activity\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eHealth Condition of Adolescents\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eUnderweight\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOverweight\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eObese\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSedentary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.134* (0.063)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.248*** (0.076)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.303*** (0.087)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.064* (0.026)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.106** (0.037)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.136*** (0.041)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.053 (0.029)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.127** (0.049)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.232*** (0.062)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.094 (0.099)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000** (0.000)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.073 (0.072)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVigorous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.018 (0.018)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.129** (0.056)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.199** (0.065)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e*p\u0026thinsp;\u0026lt;\u0026thinsp;0.05; **p\u0026thinsp;\u0026lt;\u0026thinsp;0.01; ***p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"Conclusion And Implications","content":" \u003cp\u003eThe United Arab Emirates (UAE) scored an \u0026lsquo;F\u0026rsquo; on the levels of physical activity and a C- on sedentary behavior in the Global Matrix 3.0 physical activity report card grades for children and youth [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. This is indicative of an increase in levels of obesity both in the children and adolescents in the UAE. These outcomes of this study have importation implications for the built-environment, health of the adolescents, and encouraging PA.\u003c/p\u003e \u003cp\u003eImplications for Built-Environment\u003c/p\u003e \u003cp\u003eIn general, the built environment is perceived to be non-conforming for walking by both females and males. They had major concerns with the constructs of street-crossing and safety of the built environment. Within the construct of street-crossing, the issue of the width of the street, and availability of marked crosswalks was of major concern to the adolescents. Within the construct of safety, the adolescents were concerned about the amount of traffic and unsafe driving behavior on the roads adjoining schools and homes. Street design approaches such as the introduction of \u0026ldquo;road diets\u0026rdquo; with curb-cuts at the intersections with textured crosswalks, crossing island, and lane narrowing could improve the perception of safety and concerns related to street-crossing. Studies report such interventions can reduce road crashes by about 6% \u0026minus;\u0026thinsp;18.8% [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBoth traffic exposure and walkability around the homes of the adolescents have an impact on the health conditions of the adolescents. A better walkable environment with a higher land-use mix and density can encourage more walking [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], and reduce the chances of both being underweight and obese in Adolescents. The Department of Urban Planning and Municipalities of Abu Dhabi (ADPM) have suggested implementing the Urban Street Design Manual projects in Al Ain with special consideration to the needs of pedestrians [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Implementation of this approach in core residential areas (trip origins) can reduce vehicle speeds, cut-through traffic, and general traffic noise. Additionally, reduction of speed limits on major roads, especially on designated routes for children to walk to and from school could encourage walking within the neighborhood.\u003c/p\u003e \u003cp\u003eIn Abu Dhabi, the main concern is about the policies surrounding built environment that make it hard to walk to school [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. ADEK and ADPM can find transformative strategic plans to promote active commuting to school as the primary mode of transportation. They could follow the example of projects in California that enhanced traffic safety along routes to school (for example, widening of crosswalks and sidewalk improvements), which led to significantly greater walking or biking for children [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eImplications for Health of Adolescents\u003c/p\u003e \u003cp\u003eA study by Al-Haddad et al [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] reported that both male and female in UAE tend to be about twice overweight compared to international standards. In this study, obesity and overweight in male adolescents were about 10% more than female adolescents. Several socio-cultural and behavior factors specific to the region could be attributed to this difference. Culturally, males are the majority of the workforce in the UAE and are engaged in driving more than women. About 75 percent of all trips in the emirate of Abu Dhabi is made by the male [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Studies indicate a high correlation of driving behavior and obesity [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], which could be one of the driving factors for higher rates of overweight and obesity among men. A recent study confirmed the high rates of obesity in males in the UAE. It established sedentary behavior as one of the major causes of the obesity epidemic in males [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Creating opportunities to engage them in outdoor activities such as soccer and basketball games, a preferred sports activity in the region, within their neighborhood with a directive to engage in outdoor activity should be encouraged among the adolescents and youth in the emirate.\u003c/p\u003e \u003cp\u003eAnother less addressed issue with health outcomes is the assessment and impact of underweight [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Being a male adolescent is positively associated with being underweight. While significant factors relate to malnutrition and dietary habits, fatigue, emotional, genetic, and psychological factors, and smoking are other factors that can lead to adolescence\u0026rsquo; underweight health condition. Research suggests using \u0026ldquo;effective public health programs that can simultaneously promote a healthy lifestyle, improve diet quality, and address both undernutrition and chronic disease\u0026rdquo; [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Health policies that regulate dietary intake both at school and at home need to be promoted. Recently schools in Abu Dhabi restricted the availability of high-calorie food at school. Extending that by providing good dietary plans for students in school can regulate this further and provide the necessary support to curb the issue of underweight in adolescents.\u003c/p\u003e \u003cp\u003eImplications for Enhancing Physical Activity: Planning and Policy\u003c/p\u003e \u003cp\u003eThe school environment can provide \u0026ldquo;quality physical education and supportive environment for a long-lasting healthy and active lifestyle\u0026rdquo; [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Health and physical literacy at schools can provide needed knowledge, motivation, and engagement in physical activity. Control competence allows self-directed structuring and pacing of physical activity, which has shown to be more effective [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. ADEK policies to actively engage schools to develop control competence approaches for children and adolescents in school can instill PA behaviors that could last until adulthood.\u003c/p\u003e \u003cp\u003eOutside the school environment, the physical environment around the homes of adolescents can provide opportunities for engagement in an active lifestyle. Emirati housing communities lack sizeable open play areas and mixed use development to provide opportunities for after-school activities [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Small-area planning approaches such as Transit-Oriented Development (TOD) or Neighborhood Planning Unit (NPU) that incorporate better connectivity, land use mix, and open area planning for Emirati housing neighborhood needs to be proposed. By doing so, the Abu Dhabi Department of Planning and Municipality can enhance the accessibility within these neighbourhood [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. In addition, \u0026ldquo;compact\u0026rdquo; urban fabrics increase opportunities for social interaction and sustain alternate modes of transport such as cycling, walking, and mass transit. Emirati neighborhoods for several decades have been designed as low density developments with no diversity in land use. For that reason, neighborhood design requires an overhaul; new ideologies like compactness, connecitgivty, diversity, and prosimity must be promoted to connect people woth people and people with their destinations.\u003c/p\u003e \u003cp\u003eThe street design manual of Abu Dhabi should develop street sections to enhance accessibility and connectivity to schools from residences. A street section that includes wide sidewalk and bike lanes, with minimum lane width and lower speed limits, needs to consider for inclusion in the Abu Dhabi Street Manual. Also, alternative approaches such as pedestrian bridges for students to circumvent major roads with high speed to reduce exposure to high traffic should be incorporated in the design manual. In existing neighborhoods, retrofitting and improving alleys\u0026rsquo; physical conditions and appearance could also enhance their use and thus support walkability. Recommended physical improvement plans include paving, landscaping, and upgrading lighting to promote walking. Such improvements may be particularly helpful in suburban neighborhoods, where alleys are often unpaved, not utilized, improperly lit, and obstructed by debris and vegetation [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Although it\u0026rsquo;s important to improve the environment to increase the physical activity levels, it is also important to increase the awareness of the benefits of physical activity among parents. A recent study stated that to enhance the ability to engage in physical activity, it is important to improve the built environment and raise awareness by educating the parents [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe outcomes of this study provide implications to improve the overall health condition for adolescents in Abu Dhabi. While these implications are specific to Abu Dhabi and UAE, major cities in the middle-east have similar socio-cultural, topographic, and demographic characteristics. They can implement similar approaches to enhance the health condition of their local population. However, the policy and planning recommendations are adaptable for all municipalities and schools proactive in improving the built environment and health conditions of school-aged children.\u003c/p\u003e "},{"header":"Abbreviations","content":"\u003cp\u003eUAE \u0026ndash; United Arab Emirates\u003c/p\u003e\n\u003cp\u003eTOD - Transit-Oriented Development\u003c/p\u003e\n\u003cp\u003eNPU - Neighborhood Planning Unit\u003c/p\u003e\n\u003cp\u003eADEK \u0026ndash; Abu Dhabi Department of Education and Knowledge\u003c/p\u003e\n\u003cp\u003ePA \u0026ndash; Physical Activity\u003c/p\u003e\n\u003cp\u003eADPM - Abu Dhabi Department of Urban Planning and Municipalities\u003c/p\u003e\n\u003cp\u003eIOTF - International Obesity Task Force\u003c/p\u003e\n\u003cp\u003eIRB \u0026ndash; Institutional Review Board\u003c/p\u003e\n\u003cp\u003eBMI \u0026ndash; Body Mass Index\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Abu Dhabi Department of Education and Knowledge (ADEK). The survey instruments for the school, parent and child were approved by the Khalifa University Institutional Review Board. Consent forms were signed by the representative of each study school. Signed approval was obtained from parents for their own participation and participation of their children in the study. Only students who received approvals from their parents were administered the survey for this study.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eThe consent for publication was obtained from all school representative, parents for themselves and their children.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eThe ADEK approvals do not permit us to share the data with any third party and restricts us from use and distribution of the same without their permission, given the privacy rules in the United Arab Emirates.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis study was conducted without any financial support from any agencies or institutions.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions\u003c/p\u003e\n\u003cp\u003ePM was responsible for conception, analysis and monitoring of the study. AW was responsible for data collections and approvals. PM, KA and AW analysed and interpreted the data and its implications. PM and KA were responsible for drafting the manuscript. All the authors have read and approved the content of the manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eThe authors acknowledge the support and advice provided by the Abu Dhabi Department of\u003c/p\u003e\n\u003cp\u003eKnowledge and Education and the School representative who agreed to participate in the studyand support our data collection.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAl Junaibi A, Abdulle A, Sabri S, et al. The prevalence and potential determinants of obesity among school children and adolescents in Abu Dhabi, United Arab Emirates. Int. J. Obes. 2013;37(1):68-74.\u003c/li\u003e\n \u003cli\u003eAl-haddad FH, Little BB, Abdul Ghafoor AG. Childhood obesity in United Arab Emirates schoolchildren: a national study. 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Physical Activity-Related Health Competence, Physical Activity, and Physical Fitness: Analysis of Control Competence for the Self-Directed Exercise of Adolescents. Int J Environ Res Public Health 2020;17(1):39.\u003c/li\u003e\n \u003cli\u003eAlawadi K. A return to the old landscape? Balancing physical planning ideals and cultural constraints in Dubai\u0026rsquo;s residential neighborhoods. J Hous Built Environ 2019;34(1):235-63.\u003c/li\u003e\n \u003cli\u003eAlmardood MA, Maghelal P. Enhancing the use of transit in arid regions: Case of Abu Dhabi. Int J Sustain Transp 2019;28:1-4.\u003c/li\u003e\n \u003cli\u003eScoppa M, Bawazir K, Alawadi K. Walking the superblocks: Street layout efficiency and the sikkak system in Abu Dhabi. Sustain Cities Soc 2018;38:359-69.\u003c/li\u003e\n \u003cli\u003eAlawadi K, Benkraouda O. What happened to Abu Dhabi\u0026rsquo;s urbanism? The question of regional integration. J Urban Des 2018;23(3):367-94.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Figure","content":"\u003cp\u003eFigure 2 is not available with this version.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Obesity, Health Condition, Emirati Adolescents, Parent Perception, United Arab Emirates","lastPublishedDoi":"10.21203/rs.3.rs-623152/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-623152/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: The United Arab Emirates (UAE) is one of the developed nations in the middle-east with the obesity rate among the youth two to three times greater than the international standards. Therefore, this research aims to study the variation of perception of the built environment among Emirati male and female adolescents and their parents. Also, the role of determinants of the health condition of Emirati adolescents is analyzed. \u003c/p\u003e\u003cp\u003eMethod: A total of 335 students (aged 14-20) from six schools in the Al Ain region of Abu Dhabi Emirate and 250 parent responses were used to conduct the mean-test of perception of hindrances and multinomial logit of the health condition using the perception, behavior and built environment measures. \u003c/p\u003e\u003cp\u003eResults: Emirati males perceive the built environment factors as barriers more than female adolescents. Parents perceive street-crossing (p\u0026lt;0.016) and sidewalk characteristics (p\u0026lt;0.020) to be more of a hindrance to walking to school than students. Traffic exposure and walkability at home and schools report a significant effect on the health condition of the Emirati adolescents along with the self-reported physical activity. Marginal effect reports sedentary and low-levels of activity predicts the probability of an Emirati adolescent being not just overweight or obese (p\u0026lt;0.001), but also underweight (p\u0026lt;0.05)\u003c/p\u003e\u003cp\u003eConclusion: Recommendations for parents and school authorities, Abu Dhabi Municipality and Urban Planning department, and to enhance the built environment are discussed. Also recommendation to address both, levels of obesity and being underweight, are discussed.\u003c/p\u003e","manuscriptTitle":"Gender Difference in Health Condition Among Emirati Adolescent: Role of Environment and Parent Perceptions","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-06-23 17:37:46","doi":"10.21203/rs.3.rs-623152/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0fc2e4b8-3b4f-406d-b790-5b41d6944a5a","owner":[],"postedDate":"June 23rd, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":5214807,"name":"Health Economics \u0026 Outcomes Research"},{"id":5214808,"name":"Health Policy"}],"tags":[],"updatedAt":"2021-06-24T22:42:22+00:00","versionOfRecord":[],"versionCreatedAt":"2021-06-23 17:37:46","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-623152","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-623152","identity":"rs-623152","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}