Predictors healthy physical condition from Social Determinants in Colombian schoolchildren: Multicenter study Predictores de condición física saludable desde Determinantes Sociales en escolares colombianos: Estudio multicéntrico

Today it is necessary to analyze health and living conditions with the so-called Social and Economic Determinants approach as relevant variables to determine the healthy physical condition behavior of school children. The objective was to estimate the best predictive model of the Social Determinants of Health and of the healthy physical condition of Colombian school children. The present was a socio-sport study, through a quantitative descriptive statistical analysis. A total of 3458 school children aged 10 to 18 from 10 cities in Colombia participated. A survey was applied to establish the Social Determinants of Health and the healthy physical condition was objectively evaluated through the extended version of the ALPHA FITNESS battery. As results, the following were obtained: a higher percentage of 15-year-old men had a healthy physical condition, age, being active, unhealthy habits, leisure activities and body mass index, and socioeconomic level, coexistence and educational level showed a statistically significant association with healthy physical condition. It is concluded that the body mass index (BMI), the permanence of the father, the number of daily meals, being a beneficiary of a school restaurant, the number of hours that he sleeps at night, are the social determinants of health that are associated with the healthy physical condition variable, in turn, the binary logit model has a good predictive capacity (70.1%).


Introduction
The social determinants of health (from now on, DSS will be used to address them) play a fundamental role in the adoption of risk and protective factors for individuals, as well as in the development of diseases. Therefore, systematic and individualized processes are required to provide people with the knowledge to modify their lifestyles through a conscious attitude towards risk situations. (Fernández Regla et al., 2019) SHDs are defined as the circumstances in which people are born, grow, live, work and age (Palomino, et al, 2014). The analysis of inequalities is a challenge for global development, recognizing that heterogeneity in access to services and, consequently, in results from different areas of development, become obstacles to achieving sustainable development (United Nations. Trends in international migration 2015, Malmusi et al, 2014), these differences are 2021, Retos, 39, 182-186 © Copyright: Federación Española de Asociaciones de Docentes de Educación Física (FEADEF) ISSN: Edición impresa: 1579-1726. Edición Web: 1988-2041 not only explained by aspects related to access to social services, but they also highlight the social and individual determinants of health and the public sports system as elements that increase them (Blanco-Becera et al., 2014) and do not guarantee equal opportunities in extracurricular sports activities (Jiménez et al., 2019).
The health-related physical condition, (CFS, so called from here on), is defined as the ability of a person to perform activities of daily living with vigor, and refers to those components of the physical condition that are related to health: aerobic capacity; musculoskeletal capacity; motor capacity, and body composition (Ruiz et al., 2011). Different studies show the relationships between CFS levels and the DSS, showing as a result that physical practice promotion strategies must be assumed in order to improve the health of adolescents and young people, where interventions should focus on favoring people's healthy lifestyles, increase the level of physical exercise practice in a greater percentage in women, better access to health services, health promotion programs and prevention of chronic no communicable Fecha recepción: 23-01-20. Fecha de aceptación: 01-06-20 Jose Armando Vidarte Claros jovida@autonoma.edu.co diseases among others. (Secchi et al., 2014;Arriscado et al., 2014;Fernández, Canet, & Giné-Garriga, 2016;Palomino et al., 2017).
This highlights the importance of assessing the healthy physical condition of adolescents and young people and seeking relationships with the DSS, therefore, the objective of the research was to establish the CFS predictive the DSS in Colombian schoolchildren.

Participants
It was a socio-sports study, by means of a quantitative descriptive statistical analysis. The population was made up of school children between 12 and 18 years old from public and private schools in the cities of Manizales, Armenia, Pasto, Popayán Valledupar, Tuluá Riosucio, Villamaría, Chinchiná and Dosquebradas, where a probability sampling was carried out (simple random sampling). A 95% confidence interval, 84% statistical power, and an expected correlation of 0.30 were taken into account. A representative sample size of 345 schoolchildren per city was established, for a total of 3,458 schoolchildren who met the inclusion criteria. The selection was made at random in public and private schools in the cities, taking into account a proportion of 60% public and 40% private. Consent and informed consent were obtained in accordance with the provisions of resolution 008430 of the Colombian Ministry of Social Protection and the e Helsinky declaration. The Committee on Institutional Bioethics has approved the proposal.

Techniques and instruments
Survey and observation techniques were used as techniques. The instruments used were the DSS survey format and the ALPHA battery field tests extended format (Secchi et al., 2014;Ruiz et al., 2011). The body composition was established from measuring the size, for this the portable stadiometer (SECA 206®; Hamburg Germany) (range 0 -220 cm) of 1 mm precision was used. The weight was measured with Tanita floor scale (model TBF-10GS ™, Arlington Heights, IL 60005, USA) with a maximum capacity of 200 kg and a minimum of 100 g. With these variables, the BMI in Kg / m2 was calculated, adopting the cut-off limits recommended by the World Health Organization (WHO), the waist perimeter was evaluated with a plastic measuring tape with a precision of 1 mm (Holtain Ltd., Crymych Dyfed, RU) and the fat percentage was determined from the tricipital and subscapular skin folds, which were measured with an adipometer (Lange) of 1.0 mm accuracy, this percentage of body fat was estimated from the equations proposed by Slaughter et al, (1988) and used in different investigations such as those of Castro et al, (2108 andZamora et al, (2018) using the triceps and subscapular folds. Skeletal muscle capacity was determined with the test of manual clamping force using a dynamometer with adjustable grip (TKK5101 Grip D; Takey, Tokyo Japan) and the explosive force of lower limbs by testing the long jump feet to feet together, the motorcycle capacity was determined by the 4 x 10 m agility speed test and aerobic capacity was evaluated with the Léger test (Castro et al., 2010;Vicente-Rodríguez et al., 2012Léger et al, 1994. The final healthy physical condition was found according to the provisions of the ALPHAFITNESS battery protocol, taking into account first establishing each of the components and then the total sum of them determines the healthy physical condition. It is clear that in the case of this study, below 3.0 it is defined as unhealthy physical condition

Statistic analysis
Central tendency and variability or dispersion measures were calculated for quantitative variables included in the study and which allowed univariate descriptive analysis. The bivariate analysis was developed from the possible relationships between the variables of the study, applying parametric tests of Chi-square relationship. Significance was determined with a p<0.05. From the statistically significant relationships in the bivariate analysis, the multivariate analysis of binary logistic regression was performed. The statistical analysis was performed in the SPSS version 24 program (licensed by the Universidad Autónoma de Manizales).

Results
A total of 3,458 schoolchildren participated in the study, with an average age of 14.98 ± 1.98 years, distributed according to sex in a 1:1 ratio, with a greater percentage studying in official schools, and belonging to the middle socioeconomic stratum. Table 1 shows how, by age, men aged 15 and over are found to have a higher percentage of healthy physical condition compared to women. Tables 2 and 3 show the summary of the relationship between intermediate social determinants and healthy physical condition, showing that the variables that show a statistically significant association are age, way of travelling to school, being a beneficiary of the school restaurant, consumption of liquor, consumption of liquor at home in the last 6 houses, how many hours you sleep at night, relax and enjoy your free time, physical activity, physical exercise, sport and body mass index.
By relating the Social Structural Determinants to healthy physical condition in tobacco 4, it is shown that there is a statistically significant association with the type of school, socioeconomic status, marital status of the parents, with whom the child lives (father) and the educational level of the mother (Table 3). Table 4 shows the Logit model for the condition of being healthy as a function of factors such as body mass index (BMI), fatherhood, number of meals consumed per day, being a beneficiary of school restaurant and number of hours of sleep at night, all coefficients are statistically significant, which allows us to conclude that these variables present association with the physical condition variable.
What graph 1 shows is that not being a beneficiary of the school restaurant increases the chances of having an unhealthy physical condition.
The model has a good predictive capacity (70.1%) and is more capable of predicting the unhealthy (96.2%) than the healthy, Table 5. This allows us to predict that, as with a one unit increase in BMI, the probability of having an unhealthy physical condition increases by 1.25% while keeping all other variables constant. Having a grandparent increases the probability of having a healthy physical condition by 4.4%, likewise eating one more meal by 1.9%, and sleeping one more hour by 3.5%, finally, not being a beneficiary of the restaurant decreases the probability of having a healthy physical condition. The Hosmer and Lemeshow test shows that the model has an acceptable fit, and meets the validation assumptions. This allows for a prediction of an individual who has the following characteristics: lives with grandparents, eats three meals a day, is not a beneficiary of a school restaurant, sleeps 7 hours and has a BMI of 20.7 kg/ cm2, the estimated model has a 75.89% probability of having an unhealthy physical condition.

Discussion
The results found in the present study show great similarity for the age variable with the research works of Prieto et al., (2015) where the mean was 12.9 ± 2.6 years, of Delgado-Floody et al, (2019), who worked with schoolchildren with a mean age of 12.00 ± 1.23 years, by Martínez et al, at ages 11.87± 0, 38 years but different from the average age in the studies by Martínez-Baena et al., (2018), who worked with schoolchildren with ages 14.4 ± 2.8 years.
Both men and women from the age of 15 onwards have an unhealthy physical condition, which increases with age. These data are consistent with studies that state that as schoolchildren increase in age their physical condition and physical activity levels decrease (Hernández-Mosqueira, 2015; Cervantes-De la Torre, 2017; Rosa-Guillamon et al., 2019Z urita-Ortega, 2018).
In the present study the Intermediate Determinants age, staying active, unhealthy habits, leisure activities and BMI and the Structural Determinants socioeconomic level, cohabitation and educational level showed a statistically significant association with healthy physical condition. It should be noted that a large number of studies establish a relationship between physical condition and many of the variables that in the present study showed an association. For example, in relation to age, they show that this relationship is negative, i.e. the older the person, the less physical condition, which denotes non-linearity (Bauman et al., 2009;Palomino et al., 2017;Prieto Benavidez et al., 2015;Delgado -Floody et al, 2019), those that show how it is in adulthood where physical activity practice increases again and physical condition improves (Humphreys and Ruseski 2010) those that establish how BMI is closely related to diet, physical activity practice and parents' schooling (Bucco-dos Santos,& Zubiaur-Gonzales 2013; Díaz- Martínez et al, 2013;Cubidos de Carrillo, 2015;Zurita-Ortega et al., 2018;), who propose how sleep restriction is a risk factor associated with the presence of obesity (Duran et al., 2012;Reverter-Masia et al., 2017), those who mention the importance of staying active, i.e., engaging in physical activity, physical exercise and sport, and their relationship with different social and cultural aspects (Alvarez, et al., 2020) those that show that schoolchildren with physically active parents are more inclined to practice sport (Zurita-Ortega, 2018, Solis-Urra et al, 2019). Based on the above associations, it was found that the social determinants of health that predict healthy physical condition are BMI, living with the father, number of meals he consumes per day, being a beneficiary at the school restaurant and hours he sleeps at night, which are modifiable, an aspect that invites to continue insisting on processes of construction and implementation of effective nutrition programs, lifestyles and social coexistence that help improve the physical condition of schoolchildren as well as other studies suggest (Wilkinson, 2016 ;Carulla, et al., 2019;Ochoa-Martínez et al ,. 2018).
The importance of addressing the issue of DSS, becomes relevant from the results of this study because it shows how to continue promoting the practice of physical activity, the recommendations made by the WHO on a frequent basis should be stressed, the duration and time of its practice and requires governmental entities to pay close attention to the not only social but also behavioural problems that this causes and that are becoming public health problems. In addition, they provide new data on the relation DSS and healthy physical condition where the importance of the subject Physical Education in school and in the various programs of extracurricular physical activity must be emphasize and the direct relationship with the health of schoolchildren.