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Spiga F, Davies AL, Tomlinson E, Moore TH, Dawson S, Breheny K, Savović J, Gao Y, Phillips SM, Hillier-Brown F, Hodder RK, Wolfenden L, Higgins JP, Summerbell CD. Interventions to prevent obesity in children aged 5 to 11 years old. Cochrane Database Syst Rev 2024; 5:CD015328. [PMID: 38763517 PMCID: PMC11102828 DOI: 10.1002/14651858.cd015328.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
BACKGROUND Prevention of obesity in children is an international public health priority given the prevalence of the condition (and its significant impact on health, development and well-being). Interventions that aim to prevent obesity involve behavioural change strategies that promote healthy eating or 'activity' levels (physical activity, sedentary behaviour and/or sleep) or both, and work by reducing energy intake and/or increasing energy expenditure, respectively. There is uncertainty over which approaches are more effective and numerous new studies have been published over the last five years, since the previous version of this Cochrane review. OBJECTIVES To assess the effects of interventions that aim to prevent obesity in children by modifying dietary intake or 'activity' levels, or a combination of both, on changes in BMI, zBMI score and serious adverse events. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was February 2023. SELECTION CRITERIA Randomised controlled trials in children (mean age 5 years and above but less than 12 years), comparing diet or 'activity' interventions (or both) to prevent obesity with no intervention, usual care, or with another eligible intervention, in any setting. Studies had to measure outcomes at a minimum of 12 weeks post baseline. We excluded interventions designed primarily to improve sporting performance. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our outcomes were body mass index (BMI), zBMI score and serious adverse events, assessed at short- (12 weeks to < 9 months from baseline), medium- (9 months to < 15 months) and long-term (≥ 15 months) follow-up. We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS This review includes 172 studies (189,707 participants); 149 studies (160,267 participants) were included in meta-analyses. One hundred forty-six studies were based in high-income countries. The main setting for intervention delivery was schools (111 studies), followed by the community (15 studies), the home (eight studies) and a clinical setting (seven studies); one intervention was conducted by telehealth and 31 studies were conducted in more than one setting. Eighty-six interventions were implemented for less than nine months; the shortest was conducted over one visit and the longest over four years. Non-industry funding was declared by 132 studies; 24 studies were funded in part or wholly by industry. Dietary interventions versus control Dietary interventions, compared with control, may have little to no effect on BMI at short-term follow-up (mean difference (MD) 0, 95% confidence interval (CI) -0.10 to 0.10; 5 studies, 2107 participants; low-certainty evidence) and at medium-term follow-up (MD -0.01, 95% CI -0.15 to 0.12; 9 studies, 6815 participants; low-certainty evidence) or zBMI at long-term follow-up (MD -0.05, 95% CI -0.10 to 0.01; 7 studies, 5285 participants; low-certainty evidence). Dietary interventions, compared with control, probably have little to no effect on BMI at long-term follow-up (MD -0.17, 95% CI -0.48 to 0.13; 2 studies, 945 participants; moderate-certainty evidence) and zBMI at short- or medium-term follow-up (MD -0.06, 95% CI -0.13 to 0.01; 8 studies, 3695 participants; MD -0.04, 95% CI -0.10 to 0.02; 9 studies, 7048 participants; moderate-certainty evidence). Five studies (1913 participants; very low-certainty evidence) reported data on serious adverse events: one reported serious adverse events (e.g. allergy, behavioural problems and abdominal discomfort) that may have occurred as a result of the intervention; four reported no effect. Activity interventions versus control Activity interventions, compared with control, may have little to no effect on BMI and zBMI at short-term or long-term follow-up (BMI short-term: MD -0.02, 95% CI -0.17 to 0.13; 14 studies, 4069 participants; zBMI short-term: MD -0.02, 95% CI -0.07 to 0.02; 6 studies, 3580 participants; low-certainty evidence; BMI long-term: MD -0.07, 95% CI -0.24 to 0.10; 8 studies, 8302 participants; zBMI long-term: MD -0.02, 95% CI -0.09 to 0.04; 6 studies, 6940 participants; low-certainty evidence). Activity interventions likely result in a slight reduction of BMI and zBMI at medium-term follow-up (BMI: MD -0.11, 95% CI -0.18 to -0.05; 16 studies, 21,286 participants; zBMI: MD -0.05, 95% CI -0.09 to -0.02; 13 studies, 20,600 participants; moderate-certainty evidence). Eleven studies (21,278 participants; low-certainty evidence) reported data on serious adverse events; one study reported two minor ankle sprains and one study reported the incident rate of adverse events (e.g. musculoskeletal injuries) that may have occurred as a result of the intervention; nine studies reported no effect. Dietary and activity interventions versus control Dietary and activity interventions, compared with control, may result in a slight reduction in BMI and zBMI at short-term follow-up (BMI: MD -0.11, 95% CI -0.21 to -0.01; 27 studies, 16,066 participants; zBMI: MD -0.03, 95% CI -0.06 to 0.00; 26 studies, 12,784 participants; low-certainty evidence) and likely result in a reduction of BMI and zBMI at medium-term follow-up (BMI: MD -0.11, 95% CI -0.21 to 0.00; 21 studies, 17,547 participants; zBMI: MD -0.05, 95% CI -0.07 to -0.02; 24 studies, 20,998 participants; moderate-certainty evidence). Dietary and activity interventions compared with control may result in little to no difference in BMI and zBMI at long-term follow-up (BMI: MD 0.03, 95% CI -0.11 to 0.16; 16 studies, 22,098 participants; zBMI: MD -0.02, 95% CI -0.06 to 0.01; 22 studies, 23,594 participants; low-certainty evidence). Nineteen studies (27,882 participants; low-certainty evidence) reported data on serious adverse events: four studies reported occurrence of serious adverse events (e.g. injuries, low levels of extreme dieting behaviour); 15 studies reported no effect. Heterogeneity was apparent in the results for all outcomes at the three follow-up times, which could not be explained by the main setting of the interventions (school, home, school and home, other), country income status (high-income versus non-high-income), participants' socioeconomic status (low versus mixed) and duration of the intervention. Most studies excluded children with a mental or physical disability. AUTHORS' CONCLUSIONS The body of evidence in this review demonstrates that a range of school-based 'activity' interventions, alone or in combination with dietary interventions, may have a modest beneficial effect on obesity in childhood at short- and medium-term, but not at long-term follow-up. Dietary interventions alone may result in little to no difference. Limited evidence of low quality was identified on the effect of dietary and/or activity interventions on severe adverse events and health inequalities; exploratory analyses of these data suggest no meaningful impact. We identified a dearth of evidence for home and community-based settings (e.g. delivered through local youth groups), for children living with disabilities and indicators of health inequities.
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Affiliation(s)
- Francesca Spiga
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Annabel L Davies
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Eve Tomlinson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Theresa Hm Moore
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Sarah Dawson
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Katie Breheny
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jelena Savović
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Yang Gao
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon, Hong Kong
| | - Sophie M Phillips
- Department of Sport and Exercise Science, Durham University, Durham, UK
- Fuse - Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- Child Health and Physical Activity Laboratory, School of Occupational Therapy, Western University, London, Ontario, Canada
| | - Frances Hillier-Brown
- Fuse - Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- Human Nutrition Research Centre and Population Health Sciences Institute, University of Newcastle, Newcastle, UK
| | - Rebecca K Hodder
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton, Australia
- National Centre of Implementation Science, The University of Newcastle, Callaghan, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
| | - Julian Pt Higgins
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- NIHR Bristol Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Carolyn D Summerbell
- Department of Sport and Exercise Science, Durham University, Durham, UK
- Fuse - Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
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Hodder RK, O'Brien KM, Lorien S, Wolfenden L, Moore TH, Hall A, Yoong SL, Summerbell C. Interventions to prevent obesity in school-aged children 6-18 years: An update of a Cochrane systematic review and meta-analysis including studies from 2015-2021. EClinicalMedicine 2022; 54:101635. [PMID: 36281235 PMCID: PMC9581512 DOI: 10.1016/j.eclinm.2022.101635] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 08/09/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Childhood obesity remains a global public health priority due to the enormous burden it generates. Recent surveillance data suggests there has been a sharp increase in the prevalence of childhood obesity during the COVID-19 pandemic. The Cochrane review of childhood obesity prevention interventions (0-18 years) updated to 2015 is the most rigorous and comprehensive review of randomised controlled trials (RCTs) on this topic. A burgeoning number of high quality studies have been published since that are yet to be synthesised. METHODS An update of the Cochrane systematic review was conducted to include RCT studies in school-aged children (6-18 years) published to 30 June 2021 that assessed effectiveness on child weight (PROSPERO registration: CRD42020218928). Available cost-effectiveness and adverse effect data were extracted. Intervention effects on body mass index (BMI) were synthesised in random effects meta-analyses by setting (school, after-school program, community, home), and meta-regression examined the association of study characteristics with intervention effect. FINDINGS Meta-analysis of 140 of 195 included studies (183,063 participants) found a very small positive effect on body mass index for school-based studies (SMD -0·03, 95%CI -0·06,-0·01; trials = 93; participants = 131,443; moderate certainty evidence) but not after-school programs, community or home-based studies. Subgroup analysis by age (6-12 years; 13-18 years) found no differential effects in any setting. Meta-regression found no associations between study characteristics (including setting, income level) and intervention effect. Ten of 53 studies assessing adverse effects reported presence of an adverse event. Insufficient data was available to draw conclusions on cost-effectiveness. INTERPRETATION This updated synthesis of obesity prevention interventions for children aged 6-18 years, found a small beneficial impact on child BMI for school-based obesity prevention interventions. A more comprehensive assessment of interventions is required to identify mechanisms of effective interventions to inform future obesity prevention public health policy, which may be particularly salient in for COVID-19 recovery planning. FUNDING This research was funded by the National Health and Medical Research Council (NHMRC), Australia (Application No APP1153479).
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Affiliation(s)
- Rebecca K. Hodder
- Hunter New England Population Health, Hunter New England Local Health District, Locked Bag 10, Longworth Avenue, Wallsend, NSW 2287, Australia
- College of Health Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- National Centre of Implementation Science, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, 29 Kookaburra Drive, New Lambton Heights, NSW 2305, Australia
- Corresponding author at: C/- Hunter New England Population Health, Locked Bag 10, Wallsend NSW 2287 Australia.
| | - Kate M. O'Brien
- Hunter New England Population Health, Hunter New England Local Health District, Locked Bag 10, Longworth Avenue, Wallsend, NSW 2287, Australia
- College of Health Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- National Centre of Implementation Science, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, 29 Kookaburra Drive, New Lambton Heights, NSW 2305, Australia
| | - Sasha Lorien
- Hunter New England Population Health, Hunter New England Local Health District, Locked Bag 10, Longworth Avenue, Wallsend, NSW 2287, Australia
- College of Health Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- National Centre of Implementation Science, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, 29 Kookaburra Drive, New Lambton Heights, NSW 2305, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Local Health District, Locked Bag 10, Longworth Avenue, Wallsend, NSW 2287, Australia
- College of Health Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- National Centre of Implementation Science, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, 29 Kookaburra Drive, New Lambton Heights, NSW 2305, Australia
| | - Theresa H.M. Moore
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol National Health Service Foundation Trust, Whitefriars, Lewins Mean, Bristol, BS1 2NT, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Beacon House, Queens Road, Bristol, United Kingdom
| | - Alix Hall
- Hunter New England Population Health, Hunter New England Local Health District, Locked Bag 10, Longworth Avenue, Wallsend, NSW 2287, Australia
- College of Health Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- National Centre of Implementation Science, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, 29 Kookaburra Drive, New Lambton Heights, NSW 2305, Australia
| | - Sze Lin Yoong
- Hunter New England Population Health, Hunter New England Local Health District, Locked Bag 10, Longworth Avenue, Wallsend, NSW 2287, Australia
- College of Health Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- National Centre of Implementation Science, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, 29 Kookaburra Drive, New Lambton Heights, NSW 2305, Australia
- Global Obesity Centre, Institute for Health Transformation, Deakin University, Burwood, VIC 3125, Australia
| | - Carolyn Summerbell
- Department of Sport and Exercise Sciences, Durham University, Stockton Road, Durham DH1 3LE, United Kingdom
- Fuse, The NIHR Centre for Translational Research in Public Health, United Kingdom
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Changes in the nutritional content of children's lunches after the Food Dudes healthy eating programme. J Nutr Sci 2021; 10:e40. [PMID: 34367625 PMCID: PMC8342193 DOI: 10.1017/jns.2021.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/23/2021] [Accepted: 04/30/2021] [Indexed: 12/02/2022] Open
Abstract
Previous research into the effectiveness of healthy eating programmes has shown increases in healthful eating behaviour in primary schools; however, data collection methods have not been sufficiently sensitive to detect micronutrient changes. The present study extends the literature by measuring individual children's intake of macro- and micronutrients at lunchtime, before and after a programme targeting children's consumption of fruit and vegetables, to identify evidence-based health benefits of programme participation. Baseline data were collected over 4 d at lunchtime in two primary schools. The Food Dudes programme was then implemented in the intervention school. Follow-up data were collected over 4 d in each school 2 months after baseline. We employed a validated and sensitive photographic method to estimate individual children's (N 112) consumption of fruit, vegetables, and their intake of calories, macro- and selected micronutrients. Significant changes were observed in the intervention school but not in the control school: Children's consumption of fruit, vegetables, vitamin C and E intake increased, while their total energy consumption, fat, saturated fat, and sodium intake decreased. The present results show that the Food Dudes programme produced a positive nutritional change, with implications for its application as a healthy eating and obesity prevention intervention. These optimistic conclusions should be tested by further research to establish the longevity of the positive effects presented here.
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Mandracchia F, Tarro L, Llauradó E, Valls RM, Solà R. Interventions to Promote Healthy Meals in Full-Service Restaurants and Canteens: A Systematic Review and Meta-Analysis. Nutrients 2021; 13:1350. [PMID: 33919552 PMCID: PMC8073122 DOI: 10.3390/nu13041350] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/13/2021] [Accepted: 04/16/2021] [Indexed: 11/16/2022] Open
Abstract
Out-of-home eating is increasing, but evidence about its healthiness is limited. The present systematic review and meta-analysis aimed to elucidate the effectiveness of full-service restaurant and canteen-based interventions in increasing the dietary intake, food availability, and food purchase of healthy meals. Studies from 2000-2020 were searched in Medline, Scopus, and Cochrane Library using the PRISMA checklist. A total of 35 randomized controlled trials (RCTs) and 6 non-RCTs were included in the systematic review and analyzed by outcome, intervention strategies, and settings (school, community, workplace). The meta-analysis included 16 RCTs (excluding non-RCTs for higher quality). For dietary intake, the included RCTs increased healthy foods (+0.20 servings/day; 0.12 to 0.29; p < 0.001) and decreased fat intake (-9.90 g/day; -12.61 to -7.19; p < 0.001), favoring the intervention group. For food availability, intervention schools reduced the risk of offering unhealthy menu items by 47% (RR 0.53; 0.34 to 0.85; p = 0.008). For food purchases, a systematic review showed that interventions could be partially effective in improving healthy foods. Lastly, restaurant- and canteen-based interventions improved the dietary intake of healthy foods, reduced fat intake, and increased the availability of healthy menus, mainly in schools. Higher-quality RCTs are needed to strengthen the results. Moreover, from our results, intervention strategy recommendations are provided.
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Affiliation(s)
- Floriana Mandracchia
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (F.M.); (L.T.); (R.M.V.); (R.S.)
| | - Lucia Tarro
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (F.M.); (L.T.); (R.M.V.); (R.S.)
- Institut d’Investigació Sanitaria Pere Virgili, 43204 Reus, Spain
| | - Elisabet Llauradó
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (F.M.); (L.T.); (R.M.V.); (R.S.)
| | - Rosa Maria Valls
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (F.M.); (L.T.); (R.M.V.); (R.S.)
| | - Rosa Solà
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (F.M.); (L.T.); (R.M.V.); (R.S.)
- Institut d’Investigació Sanitaria Pere Virgili, 43204 Reus, Spain
- Hospital Universitari Sant Joan de Reus, 43204 Reus, Spain
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Education or Provision? A Comparison of Two School-Based Fruit and Vegetable Nutrition Education Programs in the Netherlands. Nutrients 2020; 12:nu12113280. [PMID: 33114649 PMCID: PMC7693144 DOI: 10.3390/nu12113280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/20/2020] [Accepted: 10/23/2020] [Indexed: 01/20/2023] Open
Abstract
A healthy diet is important for optimal child growth and development. School-based opportunities to encourage children to achieve healthy eating behaviors should be explored. Nutrition education programs can provide school children with classroom-based nutrition education and access to fruits and vegetables (FV). However, the effectiveness of specific program components implemented separately has not yet been comprehensively evaluated. The current study examined effectiveness of individual components of two programs targeting primary school children (n = 1460, n = 37 schools) aged 7–12 years. Nutrition knowledge and FV consumption were measured using a student questionnaire, and presence of school food policies was measured in the teachers’ questionnaire. A quasi-experimental design with three arms compared: (1) schools that implemented both programs: FV provision + education (n = 15), (2) schools that implemented the FV provision program only (n = 12), (3) schools that did not implement either program (n = 10). Outcomes were assessed pre-intervention (T0), during the intervention (T1), and 6 months post-intervention (T2). Results indicated a significant increase in nutrition knowledge for children attending schools that had participated in both programs, compared to control schools (p < 0.01), but no significant increase in FV intake. In schools without food policies, FV provision alone contributed to an increase in child FV intake (p < 0.05).
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Mattson RE, Burns RD, Brusseau TA, Metos JM, Jordan KC. Comprehensive School Physical Activity Programming and Health Behavior Knowledge. Front Public Health 2020; 8:321. [PMID: 32793538 PMCID: PMC7393515 DOI: 10.3389/fpubh.2020.00321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 06/12/2020] [Indexed: 11/13/2022] Open
Abstract
No study to date has examined the effect of a multicomponent school-based physical activity program on health behavior knowledge in a large sample of low-income children from the US. The purpose of this study was to explore the change in physical activity and nutrition knowledge during a Comprehensive School Physical Activity Program (CSPAP) in children. Participants were a convenience sample of 789 children recruited from the 4th to 6th grades from five low-income Title I schools located within the Mountain West Region of the US. Students completed two questionnaires consisting of a physical activity and a nutrition knowledge assessment. Questionnaires were administered at baseline before the commencement of CSPAP and at a 36-week follow-up. Data were analyzed using a 3 × 2 × 2 doubly MANOVA test. Physical activity knowledge scores significantly improved from pretest to posttest during the intervention (p = 0.045, Cohen's d = 0.18). Grade level modified the time effects, with older children in grades 5 and 6 displaying greater improvements in physical activity knowledge than younger children in grade 4 (p = 0.044, Cohen's d = 0.33). There were no significant improvements in nutrition knowledge scores during the CSPAP (p = 0.150). These findings demonstrate that improvements in physical activity knowledge can occur during a multicomponent school-based intervention. Improvements in physical activity knowledge may translate to improvements in habitual physical activity behaviors and positively influence children's health outcomes, especially in older children.
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Affiliation(s)
- Rose E Mattson
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT, United States
| | - Ryan D Burns
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, United States
| | - Timothy A Brusseau
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, United States
| | - Julie M Metos
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT, United States
| | - Kristine C Jordan
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT, United States
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Brown T, Moore THM, Hooper L, Gao Y, Zayegh A, Ijaz S, Elwenspoek M, Foxen SC, Magee L, O'Malley C, Waters E, Summerbell CD. Interventions for preventing obesity in children. Cochrane Database Syst Rev 2019; 7:CD001871. [PMID: 31332776 PMCID: PMC6646867 DOI: 10.1002/14651858.cd001871.pub4] [Citation(s) in RCA: 271] [Impact Index Per Article: 54.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Prevention of childhood obesity is an international public health priority given the significant impact of obesity on acute and chronic diseases, general health, development and well-being. The international evidence base for strategies to prevent obesity is very large and is accumulating rapidly. This is an update of a previous review. OBJECTIVES To determine the effectiveness of a range of interventions that include diet or physical activity components, or both, designed to prevent obesity in children. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsychINFO and CINAHL in June 2015. We re-ran the search from June 2015 to January 2018 and included a search of trial registers. SELECTION CRITERIA Randomised controlled trials (RCTs) of diet or physical activity interventions, or combined diet and physical activity interventions, for preventing overweight or obesity in children (0-17 years) that reported outcomes at a minimum of 12 weeks from baseline. DATA COLLECTION AND ANALYSIS Two authors independently extracted data, assessed risk-of-bias and evaluated overall certainty of the evidence using GRADE. We extracted data on adiposity outcomes, sociodemographic characteristics, adverse events, intervention process and costs. We meta-analysed data as guided by the Cochrane Handbook for Systematic Reviews of Interventions and presented separate meta-analyses by age group for child 0 to 5 years, 6 to 12 years, and 13 to 18 years for zBMI and BMI. MAIN RESULTS We included 153 RCTs, mostly from the USA or Europe. Thirteen studies were based in upper-middle-income countries (UMIC: Brazil, Ecuador, Lebanon, Mexico, Thailand, Turkey, US-Mexico border), and one was based in a lower middle-income country (LMIC: Egypt). The majority (85) targeted children aged 6 to 12 years.Children aged 0-5 years: There is moderate-certainty evidence from 16 RCTs (n = 6261) that diet combined with physical activity interventions, compared with control, reduced BMI (mean difference (MD) -0.07 kg/m2, 95% confidence interval (CI) -0.14 to -0.01), and had a similar effect (11 RCTs, n = 5536) on zBMI (MD -0.11, 95% CI -0.21 to 0.01). Neither diet (moderate-certainty evidence) nor physical activity interventions alone (high-certainty evidence) compared with control reduced BMI (physical activity alone: MD -0.22 kg/m2, 95% CI -0.44 to 0.01) or zBMI (diet alone: MD -0.14, 95% CI -0.32 to 0.04; physical activity alone: MD 0.01, 95% CI -0.10 to 0.13) in children aged 0-5 years.Children aged 6 to 12 years: There is moderate-certainty evidence from 14 RCTs (n = 16,410) that physical activity interventions, compared with control, reduced BMI (MD -0.10 kg/m2, 95% CI -0.14 to -0.05). However, there is moderate-certainty evidence that they had little or no effect on zBMI (MD -0.02, 95% CI -0.06 to 0.02). There is low-certainty evidence from 20 RCTs (n = 24,043) that diet combined with physical activity interventions, compared with control, reduced zBMI (MD -0.05 kg/m2, 95% CI -0.10 to -0.01). There is high-certainty evidence that diet interventions, compared with control, had little impact on zBMI (MD -0.03, 95% CI -0.06 to 0.01) or BMI (-0.02 kg/m2, 95% CI -0.11 to 0.06).Children aged 13 to 18 years: There is very low-certainty evidence that physical activity interventions, compared with control reduced BMI (MD -1.53 kg/m2, 95% CI -2.67 to -0.39; 4 RCTs; n = 720); and low-certainty evidence for a reduction in zBMI (MD -0.2, 95% CI -0.3 to -0.1; 1 RCT; n = 100). There is low-certainty evidence from eight RCTs (n = 16,583) that diet combined with physical activity interventions, compared with control, had no effect on BMI (MD -0.02 kg/m2, 95% CI -0.10 to 0.05); or zBMI (MD 0.01, 95% CI -0.05 to 0.07; 6 RCTs; n = 16,543). Evidence from two RCTs (low-certainty evidence; n = 294) found no effect of diet interventions on BMI.Direct comparisons of interventions: Two RCTs reported data directly comparing diet with either physical activity or diet combined with physical activity interventions for children aged 6 to 12 years and reported no differences.Heterogeneity was apparent in the results from all three age groups, which could not be entirely explained by setting or duration of the interventions. Where reported, interventions did not appear to result in adverse effects (16 RCTs) or increase health inequalities (gender: 30 RCTs; socioeconomic status: 18 RCTs), although relatively few studies examined these factors.Re-running the searches in January 2018 identified 315 records with potential relevance to this review, which will be synthesised in the next update. AUTHORS' CONCLUSIONS Interventions that include diet combined with physical activity interventions can reduce the risk of obesity (zBMI and BMI) in young children aged 0 to 5 years. There is weaker evidence from a single study that dietary interventions may be beneficial.However, interventions that focus only on physical activity do not appear to be effective in children of this age. In contrast, interventions that only focus on physical activity can reduce the risk of obesity (BMI) in children aged 6 to 12 years, and adolescents aged 13 to 18 years. In these age groups, there is no evidence that interventions that only focus on diet are effective, and some evidence that diet combined with physical activity interventions may be effective. Importantly, this updated review also suggests that interventions to prevent childhood obesity do not appear to result in adverse effects or health inequalities.The review will not be updated in its current form. To manage the growth in RCTs of child obesity prevention interventions, in future, this review will be split into three separate reviews based on child age.
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Affiliation(s)
- Tamara Brown
- Durham UniversityDepartment of Sport and Exercise SciencesDurhamUK
- Fuse, the NIHR Centre for Translational Research in Public HealthDurhamUK
| | - Theresa HM Moore
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge HallBristolUKBS8 2PS
- NIHR CLAHRC West at University Hospitals Bristol NHS Foundation TrustBristol‐ None ‐UKBS1 2NT
| | - Lee Hooper
- University of East AngliaNorwich Medical SchoolNorwich Research ParkNorwichNorfolkUKNR4 7TJ
| | - Yang Gao
- Hong Kong Baptist UniversityDepartment of Sport and Physical EducationKowloonHong Kong
| | - Amir Zayegh
- The Royal Children's HospitalGeneral MedicineMelbourneVictoriaAustralia3052
| | - Sharea Ijaz
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge HallBristolUKBS8 2PS
- NIHR CLAHRC West at University Hospitals Bristol NHS Foundation TrustBristol‐ None ‐UKBS1 2NT
| | - Martha Elwenspoek
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge HallBristolUKBS8 2PS
- NIHR CLAHRC West at University Hospitals Bristol NHS Foundation TrustBristol‐ None ‐UKBS1 2NT
| | - Sophie C Foxen
- Royal Air Force High WycombeDefence Medical ServicesNaphillBucksUKHP14 4UE
| | - Lucia Magee
- Royal United HospitalMedical DepartmentBathUK
| | - Claire O'Malley
- Durham UniversityDepartment of Sport and Exercise SciencesDurhamUK
- Fuse, the NIHR Centre for Translational Research in Public HealthDurhamUK
| | | | - Carolyn D Summerbell
- Durham UniversityDepartment of Sport and Exercise SciencesDurhamUK
- Fuse, the NIHR Centre for Translational Research in Public HealthDurhamUK
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8
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McCullogh N, Boyle SE, Fothergill M, Defeyter MA. 'A really good balance': Thematic analysis of stakeholders' views on classroom- and games-based positive choices interventions for primary school children. PLoS One 2019; 14:e0219503. [PMID: 31287843 PMCID: PMC6615601 DOI: 10.1371/journal.pone.0219503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 06/25/2019] [Indexed: 12/02/2022] Open
Abstract
This study explores the views of children, parents, school staff and intervention staff regarding interventions designed to promote healthy lifestyles and positive choices in primary schools in the North East of England, United Kingdom. The interventions consisted of six weekly sessions in which classroom learning was followed by physically active games. Focus groups and semi-structured interviews were conducted with a total of 45 participants and thematic analysis was performed on the resultant 26 transcripts to identify themes relating to the role of physical activity, facilitators and barriers to children’s engagement in the sessions and the perceived outcomes of intervention participation. Results indicated that participants across the four groups felt the inclusion of classroom learning and physical activity made the interventions suitable for a range of children, with the games reinforcing classroom messages and acting as a reward for their work. Central to children’s active engagement was their enjoyment, and they were felt to benefit in terms of psychosocial wellbeing and–especially when the topic of the intervention was fitness and nutrition–physical wellbeing. Overall, combined classroom- and games-based interventions were valued methods for communicating healthy lifestyle and positive choices messages to a primary school audience, though research into intervention outcomes is currently limited.
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Affiliation(s)
- Nicola McCullogh
- Department of Sport, Exercise and Rehabilitation, Northumbria University, United Kingdom
- * E-mail:
| | - Spencer E. Boyle
- Department of Sport, Exercise and Rehabilitation, Northumbria University, United Kingdom
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9
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Kim SY. Health Related Nutritional Knowledge and Dietary Behavior Regarding Caffeine Intake among High School Students in Yongin Region. Osong Public Health Res Perspect 2018; 9:299-308. [PMID: 30584493 PMCID: PMC6296809 DOI: 10.24171/j.phrp.2018.9.6.03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objectives We aimed to examine health-related nutritional knowledge and dietary behavior related to caffeine intake among high school students (n = 310) in the Yongin region of Korea. Methods Data were collected using a face-to-face survey, and analyzed using chi-square test, t- test, and logistic regression analysis. Results The level of caffeine intake in respondents was divided into low (< 30 mg/d; n = 208) and high caffeine intake groups (> 30 mg/d; n = 102). Total nutritional knowledge related to bone disease was higher in the low intake group (score 2.75) than the high intake group (score 2.39; p < 0.05). The high intake group had lower scores for nutritional knowledge (score 0.70; p < 0.05) related to how caffeinated beverages affect sleep and for dietary behavior (score 3.25; p < 0.001), based on “I avoid caffeinated foods before sleep,” than the low intake group (nutritional knowledge score, 0.80; dietary behavior score, 3.76). Conclusion In the overall analysis, the low caffeine intake group had better nutritional knowledge related to bone and sleep health, and healthier dietary behavior related to sleep health compared with the high intake group.
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Affiliation(s)
- Seong Yeong Kim
- Nutrition Education, Graduate School of Education, Kyonggi University, Suwon, Korea
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10
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Whelan J, Love P, Millar L, Allender S, Bell C. Sustaining obesity prevention in communities: a systematic narrative synthesis review. Obes Rev 2018; 19:839-851. [PMID: 29603583 DOI: 10.1111/obr.12675] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 01/04/2018] [Accepted: 01/09/2018] [Indexed: 01/01/2023]
Abstract
Obesity is a global problem for which sustainable solutions are yet to be realized. Community-based interventions have improved obesity-related behaviours and obesity in the short term. Few papers have explored how to make the interventions and their intended outcomes sustainable. The aim of this paper is to identify factors that contribute to the sustainability of community-based obesity prevention interventions and their intended outcomes. A systematic narrative synthesis review was conducted of published community-based obesity prevention interventions to identify factors contributing to intervention sustainability. Data extracted were included study authors' perspectives of intervention success and sustainability. Eighty-one papers met the inclusion criteria, and from these we identified ten factors that contribute to sustainability: resourcing, leadership, workforce development, community engagement, partnerships, policy, communications, adaptability, evaluation and governance. This review of community-based obesity prevention interventions gives rise to optimism that sustainable change is possible. We propose a framework to help practitioners build sustainability into their interventions and report on them so that others can also benefit.
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Affiliation(s)
- J Whelan
- Deakin University, Geelong, Australia, Global Obesity Centre, School of Medicine
| | - P Love
- Deakin University, Geelong, Australia, School of Exercise and Nutrition Sciences
| | - L Millar
- Victoria University, Melbourne, Australia, Australian Health Policy Collaboration
| | - S Allender
- Deakin University, Geelong, Australia, Global Obesity Centre, School of Health and Social Development
| | - C Bell
- Deakin University, Geelong, Australia, Global Obesity Centre, School of Medicine
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11
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Kelley GA, Kelley KS, Pate RR. Exercise and adiposity in overweight and obese children and adolescents: protocol for a systematic review and network meta-analysis of randomised trials. BMJ Open 2017; 7:e019512. [PMID: 29288191 PMCID: PMC5770943 DOI: 10.1136/bmjopen-2017-019512] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Overweight and obesity is a worldwide public health problem among children and adolescents. However, the magnitude of effect, as well as hierarchy of exercise interventions (aerobic, strength training or both), on selected measures of adiposity is not well established despite numerous trials on this issue. The primary purposes of this study are to use the network meta-analytical approach to determine the effects and hierarchy of exercise interventions on selected measures of adiposity in overweight and obese children and adolescents. METHODS AND ANALYSIS Randomised exercise intervention trials >4 weeks, available in any language up to 31 August 2017 and which include direct and/or indirect evidence, will be included. Studies will be located by searching seven electronic databases, cross-referencing and expert review. Dual selection and abstraction of data will occur. The primary outcomes will be changes in body mass index (in kg/m2), fat mass and percent body fat. Risk of bias will be assessed using the Cochrane Risk of Bias assessment instrument while confidence in the cumulative evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation instrument for network meta-analysis. Network meta-analysis will be performed using multivariate random-effects meta-regression models. The surface under the cumulative ranking curve will be used to provide a hierarchy of exercise treatments (aerobic, strength or both). ETHICS AND DISSEMINATION This study does not require ethics approval. Findings will be presented at a professional conference and published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD 42017073103 .
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Affiliation(s)
- George A Kelley
- Department of Biostatistics, School of Public Health, West Virginia University, Morgantown, West Virginia, USA
| | - Kristi S Kelley
- Department of Biostatistics, School of Public Health, West Virginia University, Morgantown, West Virginia, USA
| | - Russell R Pate
- Department of Exercise Science, University of South Carolina, Columbia, South Carolina, USA
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12
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Matsumoto M, Ikemoto S. The Necessary Items for Inclusion in a Questionnaire for Assessing the Nutrition Knowledge of Young Japanese Children. J Nutr Sci Vitaminol (Tokyo) 2017; 63:8-14. [PMID: 28367929 DOI: 10.3177/jnsv.63.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
It is well known nutrition education for 3- to 5-y-old children is important, and it is necessary to assess their nutrition knowledge before and after nutrition education to evaluate the effectiveness of an educational program. This study aimed to determine the necessary questions for inclusion in a questionnaire designed to assess the nutrition knowledge of young Japanese children in order to assess the effectiveness of the Shokuiku nutrition education program. Eighty and 124 children from 9 nursery schools in Japan participated in the intervention and control groups, respectively. A 15-item questionnaire was completed by the intervention group before and after total of 16 nutrition education lessons. The control group completed the questionnaire only once. The necessary questions for inclusion in the questionnaire were evaluated by comparing the frequency of correct answers given by the pre- and post-intervention groups using McNemar and Wilcoxon's signed rank sum tests, and by the post-intervention and control groups using Chi-square and Mann-Whitney tests. The frequency of correct answers given to questions in all categories except "Breakfast and life rhythm" significantly differed between the pre- and post-intervention groups (p<0.05). The frequency of correct answers given by the post-intervention group was significantly higher than that of the control group only in the category of "Three colors food groups" (p<0.05). The results suggest that it is necessary to include questions about functions of food and nutrients such as the role of food groups to assess the nutrition knowledge of young Japanese children in order to evaluate the effectiveness of the Shokuiku program.
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13
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Haghani S, Shahnazi H, Hassanzadeh A. Effects of Tailored Health Education Program on Overweight Elementary School Students' Obesity-Related Lifestyle: A School-Based Interventional Study. Oman Med J 2017; 32:140-147. [PMID: 28439385 PMCID: PMC5397082 DOI: 10.5001/omj.2017.25] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 10/01/2016] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Overweight and obesity are regarded as one of the most serious health and nutrition issues worldwide. This is immediately recognizable in both children and adolescents. In this study, we aimed to determine the effects of tailored education on lifestyle modification in elementary school students in Isfahan. METHODS In a quasi-experimental study, two elementary schools in Isfahan District 3, Iran, were randomly selected to determine the intervention and comparison groups. Subsequently, 32 students from each school, 64 in total, were chosen arbitrarily and included in the study. They filled out the standardized questionnaire of physical activity and dietary behaviors before the intervention. Following one and four months' educational intervention, they were asked to complete the questionnaires once more. RESULTS The average general lifestyle score, one and four months after education, was significantly different between the groups (p < 0.001). However, this difference was not significant before the intervention
(p = 0.660). Furthermore, the average lifestyle scores related to nutrition and physical activity one and four months after education showed a significant difference between the groups (p < 0.001). CONCLUSIONS Providing overweight elementary school students with education about a healthy lifestyle improves their general lifestyle and reduces weight. Therefore, it is recommended that such interventions are applied to prevent complications associated with being overweight in children.
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Affiliation(s)
- Sharareh Haghani
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hossein Shahnazi
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Akbar Hassanzadeh
- Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
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14
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Speroni KG, Earley C, Atherton M. Evaluating the Effectiveness of the Kids Living Fit™Program: A Comparative Study. J Sch Nurs 2016; 23:329-36. [DOI: 10.1177/10598405070230060501] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
After-school programs can be implemented by school nurses to facilitate healthy lifestyle choices in children with the goal of decreasing obesity. Kids Living Fit™(KLF), an after-school program designed by community hospital nurses, was implemented in elementary schools and focused on best lifestyle choices regarding foods consumed and activities chosen for children in grades 2 through 5. Study measures included comparison of body mass index (BMI) percentiles for age and gender and waist circumference between two self-selected groups composing a total sample size of 185 participants: the KLF intervention group ( n =80) and the no-intervention/ contrast group ( n =105). The 12-week intervention included a weekly fitness program and monthly dietitian presentations. Participants completed food and activity diaries and wore pedometers. In pairwise comparisons, the KLF group had a significant decrease in BMI percentile between baseline and follow-up (−2.3%) compared with the contrast group. The KLF group also demonstrated a smaller increase in waist circumference than the contrast group.
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Affiliation(s)
- Karen Gabel Speroni
- Karen Gabel Speroni, RN, PhD, is the director of nursing research in Patient Care Services, Inova Loudoun Hospital, Leesburg, VA
| | - Cynthia Earley
- Cynthia Earley, RN, BSN, is a research nurse intern at Inova Loudoun Hospital, Leesburg, VA
| | - Martin Atherton
- Martin Atherton, DrPH, is an adjunct professor at George Mason University, Fairfax, VA
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15
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Rosi A, Dall'Asta M, Brighenti F, Del Rio D, Volta E, Baroni I, Nalin M, Coti Zelati M, Sanna A, Scazzina F. The use of new technologies for nutritional education in primary schools: a pilot study. Public Health 2016; 140:50-55. [PMID: 27756495 DOI: 10.1016/j.puhe.2016.08.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 08/03/2016] [Accepted: 08/22/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The aim of this study was evaluating if the presence of a humanoid robot could improve the efficacy of a game-based, nutritional education intervention. STUDY DESIGN This was a controlled, school-based pilot intervention carried out on fourth-grade school children (8-10 years old). A total of 112 children underwent a game-based nutritional educational lesson on the importance of carbohydrates. For one group (n = 58), the lesson was carried out by a nutritional educator, the Master of Taste (MT), whereas for another group, (n = 54) the Master of Taste was supported by a humanoid robot (MT + NAO). A third group of children (n = 33) served as control not receiving any lesson. METHODS The intervention efficacy was evaluated by questionnaires administered at the beginning and at the end of each intervention. The nutritional knowledge level was evaluated by the cultural-nutritional awareness factor (AF) score. RESULTS A total of 290 questionnaires were analyzed. Both MT and MT + NAO interventions significantly increased nutritional knowledge. At the end of the study, children in the MT and MT + NAO group showed similar AF scores, and the AF scores of both intervention groups were significantly higher than the AF score of the control group. CONCLUSIONS This study showed a significant increase in the nutritional knowledge of children involved in a game-based, single-lesson, educational intervention performed by a figure that has a background in food science. However, the presence of a humanoid robot to support this figure's teaching activity did not result in any significant learning improvement.
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Affiliation(s)
- A Rosi
- Department of Food Science, University of Parma, Parma, Italy; eServices for Life and Health, Fondazione Centro San Raffaele, Milano, Italy
| | - M Dall'Asta
- Department of Food Science, University of Parma, Parma, Italy
| | - F Brighenti
- Department of Food Science, University of Parma, Parma, Italy
| | - D Del Rio
- Department of Food Science, University of Parma, Parma, Italy; The Need for Nutrition Education/Innovation Programme (NNEdPro), Cambridge, UK
| | - E Volta
- Giocampus Steering Committee, Parma, Italy
| | - I Baroni
- eServices for Life and Health, Fondazione Centro San Raffaele, Milano, Italy
| | - M Nalin
- eServices for Life and Health, Fondazione Centro San Raffaele, Milano, Italy
| | - M Coti Zelati
- eServices for Life and Health, Fondazione Centro San Raffaele, Milano, Italy
| | - A Sanna
- eServices for Life and Health, Fondazione Centro San Raffaele, Milano, Italy
| | - F Scazzina
- Department of Food Science, University of Parma, Parma, Italy; The Need for Nutrition Education/Innovation Programme (NNEdPro), Cambridge, UK.
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16
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Thakur JS, Bharti B, Tripathy JP, Dhawan V, Bhansali A. Impact of 20 Week Lifestyle Intervention Package on Anthropometric Biochemical and Behavioral Characteristics of Schoolchildren in North India. J Trop Pediatr 2016; 62:368-76. [PMID: 27105646 PMCID: PMC5040831 DOI: 10.1093/tropej/fmw020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Childhood obesity is a public health problem worldwide. There is convincing evidence that school-based interventions are effective in managing childhood obesity. However, the nature of interventions, its impact on prevention of obesity and how they work remain poorly understood. The primary objective of this study was to examine the impact of a multicomponent lifestyle intervention on weight and body mass index (BMI) of children in a school-based setting. METHODS It is a cluster randomized trial where four schools were randomly selected and allocated to intervention and control arm equally. Of the 462 schoolchildren selected, 201 were assigned to the intervention group and 261 belonged to the control group. Children in the intervention arm received a multicomponent lifestyle package. Primary outcome measures included anthropometric measurements (weight, BMI, skinfold thickness and waist and hip circumference), whereas secondary outcomes were biochemical parameters, physical activity and dietary intake. RESULTS Compared with controls and adjusting for age, sex and clustering within classes, children in the intervention group showed decrease in the weight by - 0.08 (-0.15 to - 0.00, p = 0.048) z-score units, waist circumference by - 0.14 (-0.25 to - 0.03, p = 0.01) and triceps thickness by - 0.35 (-0.47 to - 0.22, p < 0.001) z-score units; however, BMI showed no significant decrease. There was significant reduction in intake of energy, protein and fat but no to minimal reduction in biochemical parameters. CONCLUSION A school-based lifestyle intervention package favorably affected anthropometric (weight, waist circumference and triceps and biceps thickness) and behavioral parameters. At least 20 weeks of healthy lifestyle promoting intervention package should be included in school curriculum in each academic year for sustainable impact and behavioral change to reduce the burden of lifestyle disorders.
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Affiliation(s)
- J. S. Thakur
- Department of Community Medicine, School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhavneet Bharti
- Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jaya Prasad Tripathy
- International Union against Tuberculosis and Lung Disease, The Union South East Asia Office, New Delhi, India
| | - Veena Dhawan
- Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical, Education and Research, Chandigarh, India
| | - Anil Bhansali
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Racey M, Machmueller D, Field D, Kulak V, Newton GS. Perceptions and use of sources of health knowledge by young adolescents. Int J Adolesc Med Health 2016; 30:/j/ijamh.ahead-of-print/ijamh-2016-0002/ijamh-2016-0002.xml. [PMID: 27299195 DOI: 10.1515/ijamh-2016-0002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 04/30/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Understanding how adolescents acquire health knowledge and where they currently seek answers to health-related questions may facilitate the development of interventions that will be both engaging and effective, and may help to improve health over the short- and long-term. OBJECTIVE The present study sought to investigate the perception and use of sources of health knowledge by young adolescents as stratified by gender. METHODS Thirty 50-min long focus groups were conducted with 143 participants. Focus group questions were built around the following three main categories: sources of knowledge, including preferred sources, sources accessed for general health, and sources accessed for personal/sensitive health; health information and behaviour change, including characteristics of health knowledge presentation that have influenced behaviour change; and learning preferences to promote behaviour change. Content analysis of focus group transcripts was performed. RESULTS The use of sources of health knowledge was similar between genders, with some differences noted between sources accessed for general as compared to personal health questions. As well, motivation appeared to be the primary influence of health behaviour change, with knowledge being reported as both as positive and neutral influence, most notably in the areas of diet and exercise. Lastly, adolescents reported several characteristics of health knowledge presentation that they felt would motivate positive behaviour change, including engaging and participatory activities. CONCLUSION These results should be considered in the development of interventions to improve health-related behaviour in adolescents, although future research to quantify the use of sources of health knowledge by this population is recommended.
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Affiliation(s)
- Megan Racey
- University of Guelph, Department of Human Health and Nutritional Science, 50 Stone Rd. E., Guelph, ON, N1G 2W1, Canada
| | - David Machmueller
- University of Guelph, Department of Human Health and Nutritional Science, 50 Stone Rd. E., Guelph, ON, N1G 2W1, Canada
| | - David Field
- University of Guelph, Department of Human Health and Nutritional Science, 50 Stone Rd. E., Guelph, ON, N1G 2W1, Canada
| | - Verena Kulak
- University of Guelph, Department of Human Health and Nutritional Science, 50 Stone Rd. E., Guelph, ON, N1G 2W1, Canada
| | - Genevieve S Newton
- University of Guelph, Department of Human Health and Nutritional Science, 50 Stone Rd. E., Guelph, ON, N1G 2W1, Canada, Phone: +519-824-4120 ext. 56822, Fax: +519-763-5902
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Racey M, O'Brien C, Douglas S, Marquez O, Hendrie G, Newton G. Systematic Review of School-Based Interventions to Modify Dietary Behavior: Does Intervention Intensity Impact Effectiveness? THE JOURNAL OF SCHOOL HEALTH 2016; 86:452-63. [PMID: 27122145 DOI: 10.1111/josh.12396] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 11/03/2015] [Accepted: 01/09/2016] [Indexed: 05/21/2023]
Abstract
BACKGROUND Owing to the associations between diet and health, it is important that effective health promotion strategies establish healthful eating behaviors from an early age. We reviewed the intensity of school-based interventions aimed to modify dietary behavior in preadolescent and adolescents and related intervention characteristics to effectiveness. METHODS Our systematic literature search of 8 databases sought to identify interventions measuring dietary intake in school settings to students aged 9 to 18. We evaluated these studies for effectiveness, intensity, intervention category, and follow-up measures. RESULTS Of the 105 interventions 81 were found to be effective immediately postintervention, irrespective of intensity. Studies that were 6 weeks to 5 months in duration, targeted students' environment or group (alone or in combination), and reached students only in schools were more effective. Only one-fifth of interventions conducted a follow-up measure, and a majority showed a loss of effectiveness from postintervention to follow-up. CONCLUSIONS We identified characteristics of effective interventions. These findings may inform the development of future interventions targeting dietary behavior in preadolescents and adolescents in the school-based setting.
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Affiliation(s)
- Megan Racey
- University of Guelph, Department of Human Health & Nutritional Science, Guelph, ON N1G 2W1, Canada.
| | - Charlene O'Brien
- University of Guelph, Department of Human Health & Nutritional Science, Guelph, ON N1G 2W1, Canada.
| | - Sabrina Douglas
- University of Guelph, Department of Human Health & Nutritional Science, Guelph, ON N1G 2W1, Canada.
| | - Olivia Marquez
- University of Guelph, Department of Human Health & Nutritional Science, Guelph, ON N1G 2W1, Canada.
| | - Gilly Hendrie
- CSIRO Food and Nutritional Sciences, PO BOX 10041, Adelaide 5000, South Australia.
| | - Genevieve Newton
- University of Guelph, Department of Human Health & Nutritional Science, Guelph, ON N1G 2W1, Canada.
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Ramsey Buchanan L, Rooks-Peck CR, Finnie RKC, Wethington HR, Jacob V, Fulton JE, Johnson DB, Kahwati LC, Pratt CA, Ramirez G, Mercer SL, Glanz K. Reducing Recreational Sedentary Screen Time: A Community Guide Systematic Review. Am J Prev Med 2016; 50:402-415. [PMID: 26897342 PMCID: PMC9664246 DOI: 10.1016/j.amepre.2015.09.030] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 09/03/2015] [Accepted: 09/03/2015] [Indexed: 11/15/2022]
Abstract
CONTEXT Sedentary time spent with screen media is associated with obesity among children and adults. Obesity has potentially serious health consequences, such as heart disease and diabetes. This Community Guide systematic review examined the effectiveness and economic efficiency of behavioral interventions aimed at reducing recreational (i.e., neither school- nor work-related) sedentary screen time, as measured by screen time, physical activity, diet, and weight-related outcomes. EVIDENCE ACQUISITION For this review, an earlier ("original") review (search period, 1966 through July 2007) was combined with updated evidence (search period, April 2007 through June 2013) to assess effectiveness of behavioral interventions aimed at reducing recreational sedentary screen time. Existing Community Guide systematic review methods were used. Analyses were conducted in 2013-2014. EVIDENCE SYNTHESIS The review included 49 studies. Two types of behavioral interventions were evaluated that either (1) focus on reducing recreational sedentary screen time only (12 studies); or (2) focus equally on reducing recreational sedentary screen time and improving physical activity or diet (37 studies). Most studies targeted children aged ≤13 years. Children's composite screen time (TV viewing plus other forms of recreational sedentary screen time) decreased 26.4 (interquartile interval= -74.4, -12.0) minutes/day and obesity prevalence decreased 2.3 (interquartile interval= -4.5, -1.2) percentage points versus a comparison group. Improvements in physical activity and diet were reported. Three study arms among adults found composite screen time decreased by 130.2 minutes/day. CONCLUSIONS Among children, these interventions demonstrated reduced screen time, increased physical activity, and improved diet- and weight-related outcomes. More research is needed among adolescents and adults.
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Affiliation(s)
- Leigh Ramsey Buchanan
- Community Guide Branch, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, CDC, Atlanta, Georgia
| | - Cherie R Rooks-Peck
- Community Guide Branch, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, CDC, Atlanta, Georgia
| | - Ramona K C Finnie
- Community Guide Branch, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, CDC, Atlanta, Georgia
| | - Holly R Wethington
- Community Guide Branch, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, CDC, Atlanta, Georgia.
| | - Verughese Jacob
- Community Guide Branch, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, CDC, Atlanta, Georgia
| | - Janet E Fulton
- Physical Activity and Health Branch, Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Donna B Johnson
- Center for Public Health Nutrition, University of Washington, Seattle, Washington
| | | | - Charlotte A Pratt
- Clinical Applications and Prevention Branch, Prevention and Population Sciences Program, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | | | - Shawna L Mercer
- Community Guide Branch, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, CDC, Atlanta, Georgia
| | - Karen Glanz
- Schools of Medicine and Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
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Evaluation of physical activity interventions in children via the reach, efficacy/effectiveness, adoption, implementation, and maintenance (RE-AIM) framework: A systematic review of randomized and non-randomized trials. Prev Med 2016; 82:8-19. [PMID: 26582207 DOI: 10.1016/j.ypmed.2015.11.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 11/01/2015] [Accepted: 11/05/2015] [Indexed: 01/28/2023]
Abstract
CONTEXT Existing reviews of physical activity (PA) interventions designed to increase PA behavior exclusively in children (ages 5 to 11years) focus primarily on the efficacy (e.g., internal validity) of the interventions without addressing the applicability of the results in terms of generalizability and translatability (e.g., external validity). OBJECTIVE This review used the RE-AIM (Reach, Efficacy/Effectiveness, Adoption, Implementation, Maintenance) framework to measure the degree to which randomized and non-randomized PA interventions in children report on internal and external validity factors. METHODS AND RESULTS A systematic search for controlled interventions conducted within the past 12years identified 78 studies that met the inclusion criteria. Based on the RE-AIM criteria, most of the studies focused on elements of internal validity (e.g., sample size, intervention location and efficacy/effectiveness) with minimal reporting of external validity indicators (e.g., representativeness of participants, start-up costs, protocol fidelity and sustainability). CONCLUSIONS Results of this RE-AIM review emphasize the need for future PA interventions in children to report on real-world challenges and limitations, and to highlight considerations for translating evidence-based results into health promotion practice.
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Pearson M, Chilton R, Wyatt K, Abraham C, Ford T, Woods HB, Anderson R. Implementing health promotion programmes in schools: a realist systematic review of research and experience in the United Kingdom. Implement Sci 2015; 10:149. [PMID: 26510493 PMCID: PMC4625879 DOI: 10.1186/s13012-015-0338-6] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 10/14/2015] [Indexed: 11/16/2022] Open
Abstract
Background Schools have long been viewed as a good setting in which to encourage healthy lifestyles amongst children, and schools in many countries aspire to more comprehensive, integrated approaches to health promotion. Recent reviews have identified evidence of the effects of school health promotion on children’s and young people’s health. However, understanding of how such programmes can be implemented in schools is more limited. Methods We conducted a realist review to identify the conditions and actions which lead to the successful implementation of health promotion programmes in schools. We used the international literature to develop programme theories which were then tested using evaluations of school health promotion programmes conducted in the United Kingdom (UK). Iterative searching and screening was conducted to identify sources and clear criteria applied for appraisal of included sources. A review advisory group comprising educational and public health practitioners, commissioners, and academics was established at the outset. Results In consultation with the review advisory group, we developed four programme theories (preparing for implementation, initial implementation, embedding into routine practice, adaptation and evolution); these were then refined using the UK evaluations in the review. This enabled us to identify transferable mechanisms and enabling and constraining contexts and investigate how the operation of mechanisms differed in different contexts. We also identified steps that should be taken at a senior level in relation to preparing for implementation (which revolved around negotiation about programme delivery) and initial implementation (which centred on facilitation, support, and reciprocity—the latter for both programme deliverers and pupils). However, the depth and rigour of evidence concerning embedding into routine practice and adaptation and evolution was limited. Conclusions Our findings provide guidance for the design, implementation, and evaluation of health promotion in schools and identify the areas where further research is needed. Electronic supplementary material The online version of this article (doi:10.1186/s13012-015-0338-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M Pearson
- Institute of Health Research, University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - R Chilton
- Institute of Health Research, University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - K Wyatt
- Institute of Health Research, University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - C Abraham
- Institute of Health Research, University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - T Ford
- Institute of Health Research, University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - H B Woods
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - R Anderson
- Institute of Health Research, University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK.
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Pearson M, Chilton R, Wyatt K, Abraham C, Ford T, Woods HB, Anderson R. Implementing health promotion programmes in schools: a realist systematic review of research and experience in the United Kingdom. Implement Sci 2015. [PMID: 26510493 DOI: 10.1186/s13012–015–0338–6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Schools have long been viewed as a good setting in which to encourage healthy lifestyles amongst children, and schools in many countries aspire to more comprehensive, integrated approaches to health promotion. Recent reviews have identified evidence of the effects of school health promotion on children's and young people's health. However, understanding of how such programmes can be implemented in schools is more limited. METHODS We conducted a realist review to identify the conditions and actions which lead to the successful implementation of health promotion programmes in schools. We used the international literature to develop programme theories which were then tested using evaluations of school health promotion programmes conducted in the United Kingdom (UK). Iterative searching and screening was conducted to identify sources and clear criteria applied for appraisal of included sources. A review advisory group comprising educational and public health practitioners, commissioners, and academics was established at the outset. RESULTS In consultation with the review advisory group, we developed four programme theories (preparing for implementation, initial implementation, embedding into routine practice, adaptation and evolution); these were then refined using the UK evaluations in the review. This enabled us to identify transferable mechanisms and enabling and constraining contexts and investigate how the operation of mechanisms differed in different contexts. We also identified steps that should be taken at a senior level in relation to preparing for implementation (which revolved around negotiation about programme delivery) and initial implementation (which centred on facilitation, support, and reciprocity-the latter for both programme deliverers and pupils). However, the depth and rigour of evidence concerning embedding into routine practice and adaptation and evolution was limited. CONCLUSIONS Our findings provide guidance for the design, implementation, and evaluation of health promotion in schools and identify the areas where further research is needed.
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Affiliation(s)
- M Pearson
- Institute of Health Research, University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - R Chilton
- Institute of Health Research, University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - K Wyatt
- Institute of Health Research, University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - C Abraham
- Institute of Health Research, University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - T Ford
- Institute of Health Research, University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - H B Woods
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - R Anderson
- Institute of Health Research, University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK.
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Kelishadi R, Motlagh ME, Bahreynian M, Gharavi MJ, Kabir K, Ardalan G, Safari O, Qorbani M. Methodology and Early Findings of the Assessment of Determinants of Weight Disorders among Iranian Children and Adolescents: The Childhood and Adolescence Surveillance and PreventIon of Adult Noncommunicable Disease-IV Study. Int J Prev Med 2015; 6:77. [PMID: 26425332 PMCID: PMC4564901 DOI: 10.4103/2008-7802.162953] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 07/08/2015] [Indexed: 11/21/2022] Open
Abstract
Background: This paper presents the methodology and primary findings of a national project on determinants of weight disorders among Iranian children and adolescents at national and sub-national levels. Methods: This nationwide study was conducted in 2011–2012 in Iran as part of the fourth phase of a national surveillance program entitled Childhood and Adolescence Surveillance and PreventIon of Adult Noncommunicable disease-IV study. It had two phases of qualitative and quantitative study. This multicentric study was conducted among 25,000 students aged 6–18 years, living in urban and rural areas of 30 provinces of Iran. Students were selected by multistage cluster sampling method. Data regarding weight disorders including sociodemographic variables, perinatal factors, lifestyle factors, family and student dietary habits, quality of life, and family history of chronic diseases as well as body image were gathered via validated questionnaires. Results: Overall, 23043 students completed the survey (participation rate: 92.17%). The mean age of participants was 12.55 ± 3.31 years; 50.8% were boys, and 73.4% were from urban areas. Underweight was found in 10.4% of boys and 9.2% of girls, the corresponding figure for overweight and obesity was 21% and 18.3%. Abdominal obesity was found in 17.6% of students. Among parents, obesity was more frequent than other weight disorders, with higher prevalence in parents of girls than boys (24.5% vs. 21.5%, respectively, P < 0.001). Overweight and obesity were more prevalent in urban than in rural parents (66.7% vs. 59.7%, respectively, P < 0.001). Conclusions: This survey serves as confirmatory evidence on the prevalence of dual burden of weight disorders in Iran. Its findings on determinants of weight disorders would help policymakers to implement relevant programs at national and sub-national levels.
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Affiliation(s)
- Roya Kelishadi
- Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Noncommunicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Maryam Bahreynian
- Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Noncommunicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Javad Gharavi
- Department of Medical Parasitology, Deputy of Researches and Technologies, Alborz University of Medical Sciences, Karaj, Iran ; Department of Medical Parasitology, Faculty of Allied Medicine, Iran, University of Medical Sciences, Tehran, Iran
| | - Kourosh Kabir
- Department of Community Medicine, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Gelayol Ardalan
- Department of School Health, Bureau of Population, Family and School Health, Ministry of Health and Medical Education, Tehran, Iran
| | - Omid Safari
- Department of Pediatrics, Alborz University of Medical Sciences, Karaj, Iran
| | - Mostafa Qorbani
- Department of Community Medicine, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran ; Depatment of Epidemiology, Noncommunicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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24
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Wang Y, Cai L, Wu Y, Wilson RF, Weston C, Fawole O, Bleich SN, Cheskin LJ, Showell NN, Lau BD, Chiu DT, Zhang A, Segal J. What childhood obesity prevention programmes work? A systematic review and meta-analysis. Obes Rev 2015; 16:547-65. [PMID: 25893796 PMCID: PMC4561621 DOI: 10.1111/obr.12277] [Citation(s) in RCA: 366] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 02/11/2015] [Accepted: 02/13/2015] [Indexed: 01/28/2023]
Abstract
Previous reviews of childhood obesity prevention have focused largely on schools and findings have been inconsistent. Funded by the US Agency for Healthcare Research and Quality (AHRQ) and the National Institutes of Health, we systematically evaluated the effectiveness of childhood obesity prevention programmes conducted in high-income countries and implemented in various settings. We searched MEDLINE®, Embase, PsycINFO, CINAHL®, ClinicalTrials.gov and the Cochrane Library from inception through 22 April 2013 for relevant studies, including randomized controlled trials, quasi-experimental studies and natural experiments, targeting diet, physical activity or both, and conducted in children aged 2-18 in high-income countries. Two reviewers independently abstracted the data. The strength of evidence (SOE) supporting interventions was graded for each study setting (e.g. home, school). Meta-analyses were performed on studies judged sufficiently similar and appropriate to pool using random effect models. This paper reported our findings on various adiposity-related outcomes. We identified 147 articles (139 intervention studies) of which 115 studies were primarily school based, although other settings could have been involved. Most were conducted in the United States and within the past decade. SOE was high for physical activity-only interventions delivered in schools with home involvement or combined diet-physical activity interventions delivered in schools with both home and community components. SOE was moderate for school-based interventions targeting either diet or physical activity, combined interventions delivered in schools with home or community components or combined interventions delivered in the community with a school component. SOE was low for combined interventions in childcare or home settings. Evidence was insufficient for other interventions. In conclusion, at least moderately strong evidence supports the effectiveness of school-based interventions for preventing childhood obesity. More research is needed to evaluate programmes in other settings or of other design types, especially environmental, policy and consumer health informatics-oriented interventions.
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Affiliation(s)
- Y Wang
- Department of Epidemiology and Environmental Health (formerly the Department of Social and Preventive Medicine), School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, NY, USA
- Johns Hopkins Global Center on Childhood Obesity, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - L Cai
- Johns Hopkins Global Center on Childhood Obesity, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Maternal and Child Health, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Y Wu
- Johns Hopkins Global Center on Childhood Obesity, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - R F Wilson
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - C Weston
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - O Fawole
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - S N Bleich
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - L J Cheskin
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - N N Showell
- Division of General Pediatrics and Adolescent Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - B D Lau
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - D T Chiu
- Johns Hopkins Global Center on Childhood Obesity, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - A Zhang
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - J Segal
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Edwardson CL, Harrington DM, Yates T, Bodicoat DH, Khunti K, Gorely T, Sherar LB, Edwards RT, Wright C, Harrington K, Davies MJ. A cluster randomised controlled trial to investigate the effectiveness and cost effectiveness of the 'Girls Active' intervention: a study protocol. BMC Public Health 2015; 15:526. [PMID: 26036965 PMCID: PMC4453020 DOI: 10.1186/s12889-015-1886-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 05/29/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Despite the health benefits of physical activity, data from the UK suggest that a large proportion of adolescents do not meet the recommended levels of moderate-to-vigorous physical activity (MVPA). This is particularly evident in girls, who are less active than boys across all ages and may display a faster rate of decline in physical activity throughout adolescence. The 'Girls Active' intervention has been designed by the Youth Sport Trust to target the lower participation rates observed in adolescent girls. 'Girls Active' uses peer leadership and marketing to empower girls to influence decision making in their school, develop as role models and promote physical activity to other girls. Schools are provided with training and resources to review their physical activity, sport and PE provision, culture and practices to ensure they are relevant and attractive to adolescent girls. METHODS/DESIGN This study is a two-arm cluster randomised controlled trial (RCT) aiming to recruit 20 secondary schools. Clusters will be randomised at the school level (stratified by school size and proportion of Black and Minority Ethnic (BME) pupils) to receive either the 'Girls Active' intervention or carry on with usual practice (1:1). The 20 secondary schools will be recruited from state secondary schools within the Midlands area. We aim to recruit 80 girls aged 11-14 years in each school. Data will be collected at three time points; baseline and seven and 14 months after baseline. Our primary aim is to investigate whether 'Girls Active' leads to higher objectively measured (GENEActiv) moderate-to-vigorous physical activity in adolescent girls at 14 months after baseline assessment compared to the control group. Secondary outcomes include other objectively measured physical activity variables, adiposity, physical activity-related psychological factors and the cost-effectiveness of the 'Girls Active' intervention. A thorough process evaluation will be conducted during the course of the intervention delivery. DISCUSSION The findings of this study will provide valuable information on whether this type of school-based approach to increasing physical activity in adolescent girls is both effective and cost-effective in the UK. TRIAL REGISTRATION ISRCTN10688342. Registered 12 January 2015.
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Affiliation(s)
- C L Edwardson
- Diabetes Research Centre, University of Leicester, Leicester, UK. .,NIHR Leicester-Loughborough Diet, Lifestyle, and Physical Activity Biomedical Research Unit, Leicester, UK.
| | - D M Harrington
- Diabetes Research Centre, University of Leicester, Leicester, UK. .,NIHR Leicester-Loughborough Diet, Lifestyle, and Physical Activity Biomedical Research Unit, Leicester, UK.
| | - T Yates
- Diabetes Research Centre, University of Leicester, Leicester, UK. .,NIHR Leicester-Loughborough Diet, Lifestyle, and Physical Activity Biomedical Research Unit, Leicester, UK.
| | - D H Bodicoat
- Diabetes Research Centre, University of Leicester, Leicester, UK. .,NIHR Leicester-Loughborough Diet, Lifestyle, and Physical Activity Biomedical Research Unit, Leicester, UK.
| | - K Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK. .,NIHR Leicester-Loughborough Diet, Lifestyle, and Physical Activity Biomedical Research Unit, Leicester, UK.
| | - T Gorely
- School of Sport, University of Stirling, Scotland, UK.
| | - L B Sherar
- NIHR Leicester-Loughborough Diet, Lifestyle, and Physical Activity Biomedical Research Unit, Leicester, UK. .,School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, UK.
| | - R T Edwards
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK.
| | - C Wright
- Youth Sport Trust, Leicestershire, UK.
| | - K Harrington
- Diabetes Research Centre, University of Leicester, Leicester, UK.
| | - M J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK. .,NIHR Leicester-Loughborough Diet, Lifestyle, and Physical Activity Biomedical Research Unit, Leicester, UK.
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Yavuz HM, van Ijzendoorn MH, Mesman J, van der Veek S. Interventions aimed at reducing obesity in early childhood: a meta-analysis of programs that involve parents. J Child Psychol Psychiatry 2015; 56:677-92. [PMID: 25292319 DOI: 10.1111/jcpp.12330] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/14/2014] [Indexed: 01/13/2023]
Abstract
BACKGROUND Obesity is a growing problem even in very young childhood, resulting in high costs for individuals and society. As a response, numerous obesity prevention and intervention programs have been developed. Previous research has shown that early intervention programs are more effective when parents are involved, but the effectiveness of specific aspects of programs with parental involvement has not been investigated. This meta-analysis aims to investigate the features related to the effectiveness of different types of obesity intervention programs involving parents and targeting young children (0-6-year-olds). METHODS The Web of Science, PubMed, PsycInfo, CINAHL, and ERIC databases were searched for childhood obesity prevention and intervention programs involving parents. Data were analyzed using the Comprehensive Meta-analysis (CMA) software. RESULTS Fifty studies with effect sizes measured at short-term follow-up (within 3 months from the end of the intervention) and 26 studies with effect sizes measured at long-term follow-up (all reported in a total of 49 publications) were identified. The combined effect size of interventions was small but significant at short-term follow-up (d = .08, p < .01). The results suggested the presence of a potential publication bias in studies providing results at long-term follow-up, with a nonsignificant adjusted effect size (d = .02), which indicated that obesity interventions were not effective at long-term follow-up. Multivariate meta-regression analyses showed that interventions were more effective when including either interactive sessions or educational materials as opposed to those including both interactive sessions and noninteractive educational materials. No other moderators regarding sample characteristics, study design, or methodological quality were significant. CONCLUSION Interventions targeting young children that require parental involvement are effective at short-term follow-up, specifically when interventions include one mode of intervention rather than two. However, results were not retained in the long run.
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Affiliation(s)
- H Melis Yavuz
- Department of Psycholog, Koc University, Istanbul, Turkey
| | | | - Judi Mesman
- Department of Psycholog, Koc University, Istanbul, Turkey
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Peckham S, Falconer J, Gillam S, Hann A, Kendall S, Nanchahal K, Ritchie B, Rogers R, Wallace A. The organisation and delivery of health improvement in general practice and primary care: a scoping study. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03290] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundThis project examines the organisation and delivery of health improvement activities by and within general practice and the primary health-care team. The project was designed to examine who delivers these interventions, where they are located, what approaches are developed in practices, how individual practices and the primary health-care team organise such public health activities, and how these contribute to health improvement. Our focus was on health promotion and ill-health prevention activities.AimsThe aim of this scoping exercise was to identify the current extent of knowledge about the health improvement activities in general practice and the wider primary health-care team. The key objectives were to provide an overview of the range and type of health improvement activities, identify gaps in knowledge and areas for further empirical research. Our specific research objectives were to map the range and type of health improvement activity undertaken by general practice staff and the primary health-care team based within general practice; to scope the literature on health improvement in general practice or undertaken by health-care staff based in general practice and identify gaps in the evidence base; to synthesise the literature and identify effective approaches to the delivery and organisation of health improvement interventions in a general practice setting; and to identify the priority areas for research as defined by those working in general practice.MethodsWe undertook a comprehensive search of the literature. We followed a staged selection process involving reviews of titles and abstracts. This resulted in the identification of 1140 papers for data extraction, with 658 of these papers selected for inclusion in the review, of which 347 were included in the evidence synthesis. We also undertook 45 individual and two group interviews with primary health-care staff.FindingsMany of the research studies reviewed had some details about the type, process or location, or who provided the intervention. Generally, however, little attention is paid in the literature to examining the impact of the organisational context on the way services are delivered or how this affects the effectiveness of health improvement interventions in general practice. We found that the focus of attention is mainly on individual prevention approaches, with practices engaging in both primary and secondary prevention. The range of activities suggests that general practitioners do not take a population approach but focus on individual patients. However, it is clear that many general practitioners see health promotion as an integral part of practice, whether as individual approaches to primary or secondary health improvement or as a practice-based approach to improving the health of their patients. Our key conclusion is that there is currently insufficient good evidence to support many of the health improvement interventions undertaken in general practice and primary care more widely.Future ResearchFuture research on health improvement in general practice and by the primary health-care team needs to move beyond clinical research to include delivery systems and be conducted in a primary care setting. More research needs to examine areas where there are chronic disease burdens – cancer, dementia and other disabilities of old age. Reviews should be commissioned that examine the whole prevention pathway for health problems that are managed within primary care drawing together research from general practice, pharmacy, community engagement, etc.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Stephen Peckham
- Centre for Health Services Studies, University of Kent, Kent, UK
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Jane Falconer
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Steve Gillam
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Alison Hann
- Public Health and Policy Studies, Swansea University, Swansea, UK
| | - Sally Kendall
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hertfordshire, UK
| | - Kiran Nanchahal
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Benjamin Ritchie
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Rebecca Rogers
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Andrew Wallace
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Department of Social Policy, University of Lincoln, Lincoln, UK
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Effect of the Dutch school-based education programme ‘Taste Lessons’ on behavioural determinants of taste acceptance and healthy eating: a quasi-experimental study. Public Health Nutr 2014; 18:2231-41. [DOI: 10.1017/s1368980014003012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveTo assess the effect of the Dutch school-based education programme ‘Taste Lessons’ on children’s behavioural determinants towards tasting unfamiliar foods and eating healthy and a variety of foods.DesignIn a quasi-experimental study design, data on behavioural determinants were collected at baseline, four weeks and six months after the intervention in both the intervention and control group. Children completed consecutively three questionnaires in which knowledge, awareness, skills, attitude, emotion, subjective norm and intention towards the two target behaviours were assessed. Teachers implemented on average a third of the programme activities. Multilevel regression analyses were conducted to compare individual changes in the determinants in the intervention group with those in the control group, corrected for children’s gender and age. Effect sizes were expressed as Cohen’s d.SettingDutch elementary schools.SubjectsForty-nine classes (1183 children, 9–12 years old) in grades 5–8 of twenty-one elementary schools.ResultsThe intervention group showed a higher increase in knowledge (d=0·26, P<0·01), which persisted after six months (d=0·23, P<0·05). After four weeks, the intervention group showed a higher increase in number of foods known (d=0·22, P<0·05) and tasted (d=0·21, P<0·05), subjective norm of the teacher (d=0·17, P<0·05) and intention (d=0·16, P<0·05) towards the target behaviours.ConclusionsPartial implementation of Taste Lessons during one school year showed small short-term effects on increasing behavioural determinants in relation to tasting unfamiliar foods and eating healthy and a variety of foods. Full and repeated implementation of Taste Lessons in subsequent years might result in larger effects.
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Verrotti A, Penta L, Zenzeri L, Agostinelli S, De Feo P. Childhood obesity: prevention and strategies of intervention. A systematic review of school-based interventions in primary schools. J Endocrinol Invest 2014; 37:1155-64. [PMID: 25200996 DOI: 10.1007/s40618-014-0153-y] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 08/06/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Two crucial aspects of obesity prevention are early childhood and school-based interventions. The main purpose of this systematic review wass to evaluate the efficacy and the feasibility of school-based interventions performed in primary schools. METHODS All pertinent data from the literature have been critically examined and reviewed to evaluate the efficacy and the feasibility of different strategies of interventions. In particular, many studies have been performed in school-aged children. RESULTS Data from literature suggest that educational interventions toward healthy eating habits and physical activity at school could be a key strategy in the prevention of obesity, because it has been shown that is difficult to treat obesity in adults through changes in the lifestyle rather than during childhood. Recent advances in technology, especially web-based interventions, have been used to provide a specific content addressing healthy lifestyle with regard diet and exercise. These data suggest the opportunity to use web-interactive programs as a new challenging technique of communication in order to promote healthy behaviors. CONCLUSIONS The early detection and treatment of obesity in children may be the best approach to prevent future increases in morbidity, as well as healthcare costs that will likely occur as overweight and obese children age.
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Affiliation(s)
- A Verrotti
- Department of Pediatrics, University of Perugia, Perugia, Italy,
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Temple M, Robinson JC. A systematic review of interventions to promote physical activity in the preschool setting. J SPEC PEDIATR NURS 2014; 19:274-84. [PMID: 24888784 DOI: 10.1111/jspn.12081] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 02/19/2014] [Accepted: 04/11/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE Conduct a systematic review of school-based interventions to promote physical activity in preschoolers. DESIGN AND METHODS A systematic search of literature between 2002 and 2014 in nine electronic databases and reference lists was conducted using the terms physical activity combined with environment, children, or interventions. RESULTS Fourteen articles were identified. Interventions were environmental, cognitive/behavioral, or a combination. Positive interventions involving preschool children included manipulation of the playground with the number of children playing at one time, markings, or equipment, and goal setting and reinforcement. PRACTICE IMPLICATIONS More research is needed to determine interventions to promote physical activity in preschool children.
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Affiliation(s)
- Melissa Temple
- School of Nursing, University of Mississippi Medical Center, Jackson, Mississippi, USA
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van de Gaar VM, Jansen W, van Grieken A, Borsboom GJJM, Kremers S, Raat H. Effects of an intervention aimed at reducing the intake of sugar-sweetened beverages in primary school children: a controlled trial. Int J Behav Nutr Phys Act 2014; 11:98. [PMID: 25060113 PMCID: PMC4222660 DOI: 10.1186/s12966-014-0098-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 07/15/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since sugar-sweetened beverages (SSB) may contribute to the development of overweight in children, effective interventions to reduce their consumption are needed. Here we evaluated the effect of a combined school- and community-based intervention aimed at reducing children's SSB consumption by promoting the intake of water. Favourable intervention effects on children's SSB consumption were hypothesized. METHODS In 2011-2012, a controlled trial was conducted among four primary schools, comprising 1288 children aged 6-12 years who lived in multi-ethnic, socially deprived neighbourhoods in Rotterdam, the Netherlands. Intervention schools adopted the 'water campaign', an intervention developed using social marketing. Control schools continued with their regular health promotion programme. Primary outcome was children's SSB consumption, measured using parent and child questionnaires and through observations at school, both at baseline and after one year of intervention. RESULTS Significant positive intervention effects were found for average SSB consumption (B -0.19 litres, 95% CI -0.28;-0.10; parent report), average SSB servings (B -0.54 servings, 95% CI -0.82;-0.26; parent report) and bringing SSB to school (OR 0.51, 95% CI 0.36;0.72; observation report). CONCLUSIONS This study supports the effectiveness of the water campaign intervention in reducing children's SSB consumption. Further studies are needed to replicate our findings. TRIAL REGISTRATION Current Controlled Trials: NTR3400.
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Quelly SB. Childhood obesity prevention: a review of school nurse perceptions and practices. J SPEC PEDIATR NURS 2014; 19:198-209. [PMID: 24612520 DOI: 10.1111/jspn.12071] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 01/24/2014] [Accepted: 01/28/2014] [Indexed: 12/01/2022]
Abstract
PURPOSE The purpose of this review is to examine key school nurse perceptions that may promote or deter school nurse involvement in childhood obesity prevention (COP) practices. CONCLUSIONS Ten research articles were identified through a systematic review of the literature. School nurse participation in COP is inconsistent, and this variation is not well understood. Some variations in COP practices may be explained by differences in self-efficacy, perceived benefits, and perceived barriers. PRACTICE IMPLICATIONS Efforts are needed to develop and implement interventions and policies to modify those perceptions that may promote school nurse active engagement in COP practices.
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Affiliation(s)
- Susan B Quelly
- College of Nursing, University of Central Florida, Orlando, Florida, USA
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Toruner EK, Ayaz S, Altay N, Citak EA, Sahin S. Efficacy of a School-Based Healthy Life Program in Turkey. CHILDRENS HEALTH CARE 2014. [DOI: 10.1080/02739615.2014.880918] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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van Koperen MT, van der Kleij RM, Renders CC, Crone MM, Hendriks AMA, Jansen MM, van de Gaar VV, Raat HJ, Ruiter EE, Molleman GG, Schuit JA, Seidell JJ. Design of CIAO, a research program to support the development of an integrated approach to prevent overweight and obesity in the Netherlands. BMC OBESITY 2014. [PMID: 26217497 PMCID: PMC4472617 DOI: 10.1186/2052-9538-1-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The aim of this paper is to describe the research aims, concepts and methods of the research Consortium Integrated Approach of Overweight (CIAO). CIAO is a concerted action of five Academic Collaborative Centres, local collaborations between academic institutions, regional public health services, local authorities and other relevant sectors in the Netherlands. Prior research revealed lacunas in knowledge of and skills related to five elements of the integrated approach of overweight prevention in children (based upon the French EPODE approach), namely political support, parental education, implementation, social marketing and evaluation. CIAO aims to gain theoretical and practical insight of these elements through five sub-studies and to develop, based on these data, a framework for monitoring and evaluation. METHODS/DESIGN For this research program, mixed methods are used in all the five sub-studies. First, problem specification through literature research and consultation of stakeholders, experts, health promotion specialists, parents and policy makers will be carried out. Based on this information, models, theoretical frameworks and practical instruments will be developed, tested and evaluated in the communities that implement the integrated approach to prevent overweight in children. Knowledge obtained from these studies and insights from experts and stakeholders will be combined to create an evaluation framework to evaluate the integrated approach at central, local and individual levels that will be applicable to daily practice. DISCUSSION This innovative research program stimulates sub-studies to collaborate with local stakeholders and to share and integrate their knowledge, methodology and results. Therefore, the output of this program (both knowledge and practical tools) will be matched and form building blocks of a blueprint for a local evidence- and practice-based integrated approach towards prevention of overweight in children. The output will then support various communities to further optimize the implementation and subsequently the effects of this approach.
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Affiliation(s)
- Marije Tm van Koperen
- Faculty of Earth and Life Sciences, Institute of Health Sciences, VU University Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
| | - Rianne Mjj van der Kleij
- Department of Public Health & Primary Care, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Carry Cm Renders
- Faculty of Earth and Life Sciences, Institute of Health Sciences, VU University Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
| | - Matty Mr Crone
- Department of Public Health & Primary Care, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, The Netherlands
| | | | - Maria M Jansen
- Caphri research School for Public Health and Primary care, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Vivian Vm van de Gaar
- Public Health, Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Hein Jh Raat
- Erasmus University Medical Center, child and adolescent public health, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Emilie Elm Ruiter
- Department of Primary and Community Care, Academic Collaborative Center AMPHI Integrated Health Policy, Radboud University Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Gerard Grm Molleman
- Department of Primary and Community Care, Academic Collaborative Center AMPHI Integrated Health Policy, Radboud University Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Jantine Aj Schuit
- National Institute for Public Health and the Environment (RIVM), PO Box 1 3720, BA Bilthoven, The Netherlands
| | - Jacob Jc Seidell
- Faculty of Earth and Life Sciences, Institute of Health Sciences, VU University Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
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Are dietary interventions effective at increasing fruit and vegetable consumption among overweight children? A systematic review. J Epidemiol Community Health 2014; 68:485-90. [DOI: 10.1136/jech-2013-203238] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Taylor NJ, Sahota P, Sargent J, Barber S, Loach J, Louch G, Wright J. Using intervention mapping to develop a culturally appropriate intervention to prevent childhood obesity: the HAPPY (Healthy and Active Parenting Programme for Early Years) study. Int J Behav Nutr Phys Act 2013; 10:142. [PMID: 24373301 PMCID: PMC3895739 DOI: 10.1186/1479-5868-10-142] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 11/28/2013] [Indexed: 11/10/2022] Open
Abstract
Introduction Interventions that make extensive use of theory tend to have larger effects on behaviour. The Intervention Mapping (IM) framework incorporates theory into intervention design, implementation and evaluation, and was applied to the development of a community-based childhood obesity prevention intervention for a multi-ethnic population. Methods IM was applied as follows: 1) Needs assessment of the community and culture; consideration of evidence-base, policy and practice; 2) Identification of desired outcomes and change objectives following identification of barriers to behaviour change mapped alongside psychological determinants (e.g. knowledge, self-efficacy, intention); 3) Selection of theory-based methods and practical applications to address barriers to behaviour change (e.g., strategies for responsive feeding); 4) Design of the intervention by developing evidence-based interactive activities and resources (e.g., visual aids to show babies stomach size). The activities were integrated into an existing parenting programme; 5) Adoption and implementation: parenting practitioners were trained by healthcare professionals to deliver the programme within Children Centres. Results HAPPY (Healthy and Active Parenting Programme for Early Years) is aimed at overweight and obese pregnant women (BMI > 25); consists of 12 × 2.5 hr. sessions (6 ante-natal from 24 weeks; 6 postnatal up to 9 months); it addresses mother’s diet and physical activity, breast or bottle feeding, infant diet and parental feeding practices, and infant physical activity. Conclusion We have demonstrated that IM is a feasible and helpful method for providing an evidence based and theoretical structure to a complex health behaviour change intervention. The next stage will be to assess the impact of the intervention on behaviour change and clinical factors associated with childhood obesity. The HAPPY programme is currently being tested as part of a randomised controlled feasibility trial.
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Affiliation(s)
- Natalie J Taylor
- Bradford Institute of Health Research, Bradford Teaching Hospitals NHS Trust, Bradford BD9 6RJ, UK.
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Fairclough SJ, Hackett AF, Davies IG, Gobbi R, Mackintosh KA, Warburton GL, Stratton G, van Sluijs EMF, Boddy LM. Promoting healthy weight in primary school children through physical activity and nutrition education: a pragmatic evaluation of the CHANGE! randomised intervention study. BMC Public Health 2013; 13:626. [PMID: 23819701 PMCID: PMC3733685 DOI: 10.1186/1471-2458-13-626] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 06/28/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This pragmatic evaluation investigated the effectiveness of the Children's Health, Activity and Nutrition: Get Educated! (CHANGE!) Project, a cluster randomised intervention to promote healthy weight using an educational focus on physical activity and healthy eating. METHODS Participants (n = 318, aged 10-11 years) from 6 Intervention and 6 Comparison schools took part in the 20 weeks intervention between November 2010 and March/April 2011. This consisted of a teacher-led curriculum, learning resources, and homework tasks. Primary outcome measures were waist circumference, body mass index (BMI), and BMI z-scores. Secondary outcomes were objectively-assessed physical activity and sedentary time, and food intake. Outcomes were assessed at baseline, at post-intervention (20 weeks), and at follow-up (30 weeks). Data were analysed using 2-level multi-level modelling (levels: school, student) and adjusted for baseline values of the outcomes and potential confounders. Differences in intervention effect by subgroup (sex, weight status, socio-economic status) were explored using statistical interaction. RESULTS Significant between-group effects were observed for waist circumference at post-intervention (β for intervention effect =-1.63 (95% CI = -2.20, -1.07) cm, p<0.001) and for BMI z-score at follow-up (β=-0.24 (95% CI = -0.48, -0.003), p=0.04). At follow-up there was also a significant intervention effect for light intensity physical activity (β=25.97 (95% CI = 8.04, 43.89) min, p=0.01). Interaction analyses revealed that the intervention was most effective for overweight/obese participants (waist circumference: β=-2.82 (95% CI = -4.06, -1.58) cm, p<0.001), girls (BMI: β=-0.39 (95% CI = -0.81, 0.03) kg/m2, p=0.07), and participants with higher family socioeconomic status (breakfast consumption: β=8.82 (95% CI = 6.47, 11.16), p=0.07). CONCLUSIONS The CHANGE! intervention positively influenced body size outcomes and light physical activity, and most effectively influenced body size outcomes among overweight and obese children and girls. The findings add support for the effectiveness of combined school-based physical activity and nutrition interventions. Additional work is required to test intervention fidelity and the sustained effectiveness of this intervention in the medium and long term. TRIAL REGISTRATION Current Controlled Trials ISRCTN03863885.
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Affiliation(s)
- Stuart J Fairclough
- Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, 62, Great Crosshall Street, Liverpool, UK.
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Morris JG, Gorely T, Sedgwick MJ, Nevill A, Nevill ME. Effect of the Great Activity Programme on healthy lifestyle behaviours in 7–11 year olds. J Sports Sci 2013; 31:1280-93. [DOI: 10.1080/02640414.2013.781665] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- John G. Morris
- a Institute of Youth Sport, School of Sport, Exercise and Health Sciences , Loughborough University , Loughborough , LE11 3TU , United Kingdom
| | - Trish Gorely
- a Institute of Youth Sport, School of Sport, Exercise and Health Sciences , Loughborough University , Loughborough , LE11 3TU , United Kingdom
| | - Matthew J. Sedgwick
- a Institute of Youth Sport, School of Sport, Exercise and Health Sciences , Loughborough University , Loughborough , LE11 3TU , United Kingdom
| | - Alan Nevill
- b University of Wolverhampton, School of Sport , Performing Arts and Leisure , Walsall Campus, Gorway Road, Walsall , WS1 3BD , United Kingdom
| | - Mary E. Nevill
- a Institute of Youth Sport, School of Sport, Exercise and Health Sciences , Loughborough University , Loughborough , LE11 3TU , United Kingdom
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Madden AM, Harrex R, Radalowicz J, Boaden DC, Lim J, Ash R. A kitchen-based intervention to improve nutritional intake from school lunches in children aged 12-16 years. J Hum Nutr Diet 2013; 26:243-51. [DOI: 10.1111/jhn.12037] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A. M. Madden
- Department of Human and Environmental Sciences; University of Hertfordshire; Hatfield UK
| | - R. Harrex
- Oxford Health NHS Foundation Trust; East Oxford Health Centre; Oxford UK
| | - J. Radalowicz
- Department of Nutrition and Dietetics; Royal Gwent Hospital; Newport UK
| | | | - J. Lim
- Public Health Directorate; NHS South East London; London UK
| | - R. Ash
- School of Human Sciences; London Metropolitan University; London UK
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Dobbins M, Husson H, DeCorby K, LaRocca RL. School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18. Cochrane Database Syst Rev 2013; 2013:CD007651. [PMID: 23450577 PMCID: PMC7197501 DOI: 10.1002/14651858.cd007651.pub2] [Citation(s) in RCA: 422] [Impact Index Per Article: 38.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The World Health Organization (WHO) estimates that 1.9 million deaths worldwide are attributable to physical inactivity and at least 2.6 million deaths are a result of being overweight or obese. In addition, WHO estimates that physical inactivity causes 10% to 16% of cases each of breast cancer, colon, and rectal cancers as well as type 2 diabetes, and 22% of coronary heart disease and the burden of these and other chronic diseases has rapidly increased in recent decades. OBJECTIVES The purpose of this systematic review was to summarize the evidence of the effectiveness of school-based interventions in promoting physical activity and fitness in children and adolescents. SEARCH METHODS The search strategy included searching several databases to October 2011. In addition, reference lists of included articles and background papers were reviewed for potentially relevant studies, as well as references from relevant Cochrane reviews. Primary authors of included studies were contacted as needed for additional information. SELECTION CRITERIA To be included, the intervention had to be relevant to public health practice (focused on health promotion activities), not conducted by physicians, implemented, facilitated, or promoted by staff in local public health units, implemented in a school setting and aimed at increasing physical activity, included all school-attending children, and be implemented for a minimum of 12 weeks. In addition, the review was limited to randomized controlled trials and those that reported on outcomes for children and adolescents (aged 6 to 18 years). Primary outcomes included: rates of moderate to vigorous physical activity during the school day, time engaged in moderate to vigorous physical activity during the school day, and time spent watching television. Secondary outcomes related to physical health status measures including: systolic and diastolic blood pressure, blood cholesterol, body mass index (BMI), maximal oxygen uptake (VO2max), and pulse rate. DATA COLLECTION AND ANALYSIS Standardized tools were used by two independent reviewers to assess each study for relevance and for data extraction. In addition, each study was assessed for risk of bias as specified in the Cochrane Handbook for Systematic Reviews of Interventions. Where discrepancies existed, discussion occurred until consensus was reached. The results were summarized narratively due to wide variations in the populations, interventions evaluated, and outcomes measured. MAIN RESULTS In the original review, 13,841 records were identified and screened, 302 studies were assessed for eligibility, and 26 studies were included in the review. There was some evidence that school-based physical activity interventions had a positive impact on four of the nine outcome measures. Specifically positive effects were observed for duration of physical activity, television viewing, VO2 max, and blood cholesterol. Generally, school-based interventions had little effect on physical activity rates, systolic and diastolic blood pressure, BMI, and pulse rate. At a minimum, a combination of printed educational materials and changes to the school curriculum that promote physical activity resulted in positive effects.In this update, given the addition of three new inclusion criteria (randomized design, all school-attending children invited to participate, minimum 12-week intervention) 12 of the original 26 studies were excluded. In addition, studies published between July 2007 and October 2011 evaluating the effectiveness of school-based physical interventions were identified and if relevant included. In total an additional 2378 titles were screened of which 285 unique studies were deemed potentially relevant. Of those 30 met all relevance criteria and have been included in this update. This update includes 44 studies and represents complete data for 36,593 study participants. Duration of interventions ranged from 12 weeks to six years.Generally, the majority of studies included in this update, despite being randomized controlled trials, are, at a minimum, at moderate risk of bias. The results therefore must be interpreted with caution. Few changes in outcomes were observed in this update with the exception of blood cholesterol and physical activity rates. For example blood cholesterol was no longer positively impacted upon by school-based physical activity interventions. However, there was some evidence to suggest that school-based physical activity interventions led to an improvement in the proportion of children who engaged in moderate to vigorous physical activity during school hours (odds ratio (OR) 2.74, 95% confidence interval (CI), 2.01 to 3.75). Improvements in physical activity rates were not observed in the original review. Children and adolescents exposed to the intervention also spent more time engaged in moderate to vigorous physical activity (with results across studies ranging from five to 45 min more), spent less time watching television (results range from five to 60 min less per day), and had improved VO2max (results across studies ranged from 1.6 to 3.7 mL/kg per min). However, the overall conclusions of this update do not differ significantly from those reported in the original review. AUTHORS' CONCLUSIONS The evidence suggests the ongoing implementation of school-based physical activity interventions at this time, given the positive effects on behavior and one physical health status measure. However, given these studies are at a minimum of moderate risk of bias, and the magnitude of effect is generally small, these results should be interpreted cautiously. Additional research on the long-term impact of these interventions is needed.
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Olvera NN, Knox B, Scherer R, Maldonado G, Sharma SV, Alastuey L, Bush JA. A Healthy Lifestyle Program for Latino Daughters and Mothers. AMERICAN JOURNAL OF HEALTH EDUCATION 2013. [DOI: 10.1080/19325037.2008.10599052] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Norma N. Olvera
- a Department of Health and Human Performance , University of Houston , Garrison Room 104, Houston , TX , 77204
| | - Brook Knox
- b Department of Health and Human Performance , University of Houston , Garrison Room 104, Houston , TX , 77204
| | - Rhonda Scherer
- c Department of Health and Human Performance , University of Houston , Garrison Room 104, Houston , TX , 77204
| | - Gabriela Maldonado
- d Department of Health and Human Performance , University of Houston , Garrison Room 104, Houston , TX , 77204
| | - Shreela V. Sharma
- e Health Sciences Center , University of Texas at Houston, School of Public Health , RAS E-603, 1200 Herman Pressler, Houston , TX , 77030
| | - Lisa Alastuey
- f Department of Health and Human Performance , University of Houston , Garrison Room 104, Houston , TX , 77204
| | - Jill A. Bush
- g Department of Health and Human Performance , University of Houston , Garrison Room 104, Houston , TX , 77204
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Ganann R, Fitzpatrick-Lewis D, Ciliska D, Peirson L. Community-based interventions for enhancing access to or consumption of fruit and vegetables among five to 18-year olds: a scoping review. BMC Public Health 2012; 12:711. [PMID: 22931474 PMCID: PMC3505745 DOI: 10.1186/1471-2458-12-711] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 08/23/2012] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Low fruit and vegetable ( FV) consumption is a key risk factor for morbidity and mortality. Consumption of FV is limited by a lack of access to FV. Enhanced understanding of interventions and their impact on both access to and consumption of FV can provide guidance to public health decision-makers. The purpose of this scoping review is to identify and map literature that has evaluated effects of community-based interventions designed to increase FV access or consumption among five to 18-year olds. METHODS The search included 21 electronic bibliographic databases, grey literature, targeted organization websites, and 15 key journals for relevant studies published up to May 2011. Retrieved citations were screened in duplicate for relevance. Data extracted from included studies covered: year, country, study design, target audience, intervention setting, intervention strategies, interventionists, and reported outcomes. RESULTS The search located 19,607 unique citations. Full text relevance screening was conducted on 1,908 studies. The final 289 unique studies included 30 knowledge syntheses, 27 randomized controlled trials, 55 quasi-experimental studies, 113 cluster controlled studies, 60 before-after studies, one mixed method study, and three controlled time series studies. Of these studies, 46 included access outcomes and 278 included consumption outcomes. In terms of target population, 110 studies focused on five to seven year olds, 175 targeted eight to 10 year olds, 192 targeted 11 to 14 year olds, 73 targeted 15 to 18 year olds, 55 targeted parents, and 30 targeted teachers, other service providers, or the general public. The most common intervention locations included schools, communities or community centres, and homes. Most studies implemented multi-faceted intervention strategies to increase FV access or consumption. CONCLUSIONS While consumption measures were commonly reported, this review identified a small yet important subset of literature examining access to FV. This is a critically important issue since consumption is contingent upon access. Future research should examine the impact of interventions on direct outcome measures of FV access and a focused systematic review that examines these interventions is also needed. In addition, research on interventions in low- and middle-income countries is warranted based on a limited existing knowledge base.
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Affiliation(s)
- Rebecca Ganann
- Effective Public Health Practice Project, McMaster University, Hamilton, ON, Canada
| | | | - Donna Ciliska
- Effective Public Health Practice Project, McMaster University, Hamilton, ON, Canada
| | - Leslea Peirson
- Effective Public Health Practice Project, McMaster University, Hamilton, ON, Canada
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Nutrition knowledge and other determinants of food intake and lifestyle habits in children and young adolescents living in a rural area of Sicily, South Italy. Public Health Nutr 2012; 16:1827-36. [PMID: 22931967 DOI: 10.1017/s1368980012003965] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The study aimed to test the reliability of a nutrition questionnaire and to assess potential associations between nutrition knowledge, food consumption and lifestyle behaviours, controlling for sociodemographic factors. DESIGN Cross-sectional survey. SETTING Comprehensive school in the municipality of Butera, a rural area of Sicily, South Italy. SUBJECTS The survey was conducted between March and May 2010 on 445 students (4-16 years). RESULTS All constructs of the questionnaire had statistically significant Cronbach's a and Pearson's correlation coefficients, showing good internal consistency and temporal stability. After controlling for covariates, nutrition knowledge was positively associated with pasta/rice, fish, vegetable and fruit intakes, and negatively with sweets, snacks, fried foods and sugary drinks consumption. Moreover, students whose parents were in the highest educational and occupational categories reported eating significantly more fruits and vegetables and less meat, sweets, snacks, fried foods and sugary drinks. Students with higher nutrition knowledge scores were less likely to have two or more snacks daily and to spend more than 3 h in sedentary activities daily (OR=0.89, 95% CI 0.83, 0.97 and OR=0.92, 95% CI 0.86, 0.99, respectively). High parental education was associated with less frequent snacking and more frequent weekly physical activity, compared with lower categories, whereas high parental occupational category was associated with daily breakfast. CONCLUSIONS Improving nutrition knowledge in children and young adolescents may translate into educating them in good dietary habits. Moreover, nutrition intervention programmes should also involve parents to improve dietary quality and nutritional habits of the entire family.
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Dick M, Lee A, Bright M, Turner K, Edwards R, Dawson J, Miller J. Evaluation of implementation of a healthy food and drink supply strategy throughout the whole school environment in Queensland state schools, Australia. Eur J Clin Nutr 2012; 66:1124-9. [DOI: 10.1038/ejcn.2012.108] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Moreno L, Gracia-Marco L. Prevención de la obesidad desde la actividad física: del discurso teórico a la práctica. An Pediatr (Barc) 2012; 77:136.e1-6. [DOI: 10.1016/j.anpedi.2012.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 04/24/2012] [Indexed: 10/28/2022] Open
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Werner D, Teufel J, Holtgrave PL, Brown SL. Active generations: an intergenerational approach to preventing childhood obesity. THE JOURNAL OF SCHOOL HEALTH 2012; 82:380-6. [PMID: 22712675 DOI: 10.1111/j.1746-1561.2012.00713.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND Over the last 3 decades, US obesity rates have increased dramatically as more children and more adults become obese. This study explores an innovative program, Active Generations, an intergenerational nutrition education and activity program implemented in out-of-school environments (after school and summer camps). It utilizes older adult volunteers to implement a version of the evidence-based childhood obesity prevention program, Coordinated Approach to Child Health, in 8 US cities. METHODS Approximately 760 children in third- to fifth-grade participated in Active Generations, a 10-lesson, intergenerational, childhood obesity prevention program. Children completed an age-appropriate survey instrument, the Active Generations survey (AGS). The AGS is a valid and reliable, self-administered, self-report, paper-and-pencil survey designed to assess knowledge, attitudes, and behaviors. It was administered by trained volunteers on the first day and last day of the program. Constructs assessed included physical activity, nutrition, and media use. RESULTS Students significantly increased their reported fruit and vegetable consumption post-program. For example, the percentage of students reporting eating 3 or more servings of vegetables per day was 16% greater post-program. Students were more likely to report reading food labels and greater confidence that they could participate in physical activity. They also significantly decreased their daily screen time. CONCLUSIONS Active Generations is a promising childhood obesity prevention program.
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Affiliation(s)
- Danilea Werner
- Auburn University, 7018 Haley Center, Auburn, AL 36849-5256, USA.
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One-year change in energy and macronutrient intakes of overweight and obese inner-city African American children: effect of community-based Taking Action Together type 2 diabetes prevention program. Eat Behav 2012; 13:271-4. [PMID: 22664410 DOI: 10.1016/j.eatbeh.2012.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 02/29/2012] [Accepted: 03/21/2012] [Indexed: 01/09/2023]
Abstract
Taking Action Together (TAT) was a controlled community-based intervention protocol developed to reduce risk of T2DM among low-income, high BMI, 9-10 year old African American children. A secondary hypothesis of this study was that there would be greater improvements in the treatment group in dietary intakes and physical activity. To evaluate the primary study objectives, multiple linear regression models were employed, with 1 year change in dietary variables as dependent variables. Intervention group status was the independent variable of interest and BMIz was included as a covariate in all analyses to adjust for group differences in baseline obesity status of the children. The findings from this analysis suggest that 1 year change in dietary intakes in boys was associated with group intervention status, with boys in the treatment group reducing their intakes of energy and fat to a significantly greater extent than boys in the control group. Differences in energy intakes were not significant, however, for girls. Based on the differences in gender response to our comprehensive TAT intervention, we conclude that interventions designed for and delivered only to African American girls might be more successful than those delivered in mixed gender settings.
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van Grieken A, Ezendam NPM, Paulis WD, van der Wouden JC, Raat H. Primary prevention of overweight in children and adolescents: a meta-analysis of the effectiveness of interventions aiming to decrease sedentary behaviour. Int J Behav Nutr Phys Act 2012; 9:61. [PMID: 22640437 PMCID: PMC3462110 DOI: 10.1186/1479-5868-9-61] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 05/02/2012] [Indexed: 01/04/2023] Open
Abstract
The objectives of this meta-analysis were to provide an overview of the evidence regarding the effects of interventions, implemented in the school- and general population setting, aiming to prevent excessive sedentary behaviour in children and adolescents on (1) the amount of sedentary behaviour and (2) BMI. Differences in effects on sedentary behaviour and BMI between single health behaviour interventions (sedentary behaviour only) and multiple health behaviour interventions were explored. A literature search was conducted in PubMed, EMBASE, Web of Science, PsycINFO and Cochrane Database of Systematic Reviews. Thirty-four (R)CT studies evaluating 33 general population interventions, published between 1990 and April 2011, aiming to decrease sedentary behaviour in normal weight children or adolescents (0–18 years) were included. Intervention duration ranged from 7 days to 4 years. Mean change in sedentary behaviour and BMI from baseline to post-intervention was calculated using a random effects model. Results showed significant decreases for the amount of sedentary behaviour and BMI. For sedentary behaviour the post-intervention mean difference was −17.95 min/day (95%CI:-26.61;–9.28); the change-from-baseline mean difference was −20.44 min/day (95%CI:-30.69;–10.20). For BMI the post-intervention mean difference was −0.25 kg/m² (95%CI:-0.40;–0.09); the change-from-baseline mean difference was −0.14 kg/m² (95%CI:-0.23;–0.05). No differences were found between single and multiple health behaviour interventions. Interventions in the school- and general population setting aiming to reduce only sedentary behaviour and interventions targeting multiple health behaviours can result in significant decreases in sedentary behaviour. Studies need to increase follow-up time to estimate the sustainability of the intervention effects found.
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Affiliation(s)
- Amy van Grieken
- Department of Public Health, Erasmus MC, University Medical Center, P,O, Box 2040, 3000 CA, Rotterdam, The Netherlands
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Kruseman M, Berchtold A, Truan J, Duboule L, Faurie H, Emonet E, Volery M. Développement et validation d’un questionnaire permettant d’évaluer les connaissances alimentaires (QuesCA) auprès de jeunes de 9 à 15ans. Arch Pediatr 2012; 19:456-66. [DOI: 10.1016/j.arcped.2012.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 10/15/2011] [Accepted: 02/09/2012] [Indexed: 11/28/2022]
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Cahill JM, Freeland-Graves JH, Shah BS, Lu H, Pepper MR. Determinants of Weight Loss after an Intervention in Low-Income Women in Early Postpartum. J Am Coll Nutr 2012; 31:133-43. [DOI: 10.1080/07315724.2012.10720019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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