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Arellano-Gómez LP, Chávez-Palencia C, Ramos-García CO, Orozco-Hernández RP, Rodríguez-Preciado SI, Ochoa-González H, Balderas-Arteaga N, González-Rocha A, Denova-Gutiérrez E. Participatory intervention to improve nutrition and physical activity of school-age children in Mexico. Contemp Clin Trials 2023; 127:107138. [PMID: 36868348 DOI: 10.1016/j.cct.2023.107138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/08/2023] [Accepted: 02/25/2023] [Indexed: 03/04/2023]
Abstract
Obesity is one of the major public health problems of the 21st century, affecting every country in the world. In Mexico, the prevalence of overweight and obesity in children (5 to 11 years) was 35.5%. Childhood obesity is a chronic disease itself; and is associated with other chronic conditions. OBJECTIVE To assess the effect and feasibility of a participatory intervention to improve nutrition and physical activity within the school environment in children in public elementary schools in Mexico. METHODS The present study is a cluster trial. The intervention focused on; changes in food offered, training the schools' food service staff, promoting water consumption and physical activity at the community level, implementing healthy spaces inside the school, improving the quality of physical education within schools, among others. The main outcomes will focus on rate of weight gain, time devoted to physical activity, sedentary behaviors, diet quality and response feeding behaviors. We also will assess the time and personnel involved in the intervention development, maintenance, and dissemination. CONCLUSION Findings from this trial will generate new translational knowledge in Mexico; if the results are positive, this participatory intervention could serve as a basis for designing multidimensional interventions that could be scaled up at the national level.
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Affiliation(s)
- Laura Patricia Arellano-Gómez
- Departamento de Psicología, Educación y Salud. Instituto Tecnológico de Estudios Superiores de Occidente (ITESO), Universidad Jesuita de Guadalajara, Anillo Periférico Sur Manuel Gómez Morín 8585, San Pedro Tlaquepaque, Jalisco 45604, Mexico.
| | - Clío Chávez-Palencia
- División de Ciencias de la Salud, Centro Universitario de Tonalá, Universidad de Guadalajara, Av. Nuevo Periférico 555 Ejido San José Tatepozco, Tonalá, Jalisco 45425, Mexico.
| | - César Octavio Ramos-García
- División de Ciencias de la Salud, Centro Universitario de Tonalá, Universidad de Guadalajara, Av. Nuevo Periférico 555 Ejido San José Tatepozco, Tonalá, Jalisco 45425, Mexico.
| | - Roberto Paulo Orozco-Hernández
- Departamento de Psicología, Educación y Salud. Instituto Tecnológico de Estudios Superiores de Occidente (ITESO), Universidad Jesuita de Guadalajara, Anillo Periférico Sur Manuel Gómez Morín 8585, San Pedro Tlaquepaque, Jalisco 45604, Mexico.
| | - Salvador Iván Rodríguez-Preciado
- Departamento de Psicología, Educación y Salud. Instituto Tecnológico de Estudios Superiores de Occidente (ITESO), Universidad Jesuita de Guadalajara, Anillo Periférico Sur Manuel Gómez Morín 8585, San Pedro Tlaquepaque, Jalisco 45604, Mexico.
| | - Héctor Ochoa-González
- Departamento de Psicología, Educación y Salud. Instituto Tecnológico de Estudios Superiores de Occidente (ITESO), Universidad Jesuita de Guadalajara, Anillo Periférico Sur Manuel Gómez Morín 8585, San Pedro Tlaquepaque, Jalisco 45604, Mexico.
| | - Nydia Balderas-Arteaga
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Universidad 655 Colonia Santa María Ahuacatitlán, Cuernavaca, Morelos 62100, Mexico.
| | - Alejandra González-Rocha
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Universidad 655 Colonia Santa María Ahuacatitlán, Cuernavaca, Morelos 62100, Mexico
| | - Edgar Denova-Gutiérrez
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Universidad 655 Colonia Santa María Ahuacatitlán, Cuernavaca, Morelos 62100, Mexico.
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Aceves-Martins M, López-Cruz L, García-Botello M, Gutierrez-Gómez YY, Moreno-García CF. Interventions to Prevent Obesity in Mexican Children and Adolescents: Systematic Review. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 23:563-586. [PMID: 34725762 PMCID: PMC9072495 DOI: 10.1007/s11121-021-01316-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2021] [Indexed: 10/26/2022]
Abstract
The prevalence of overweight and obesity has been rising among Mexican children and adolescents in the last decades. To systematically review obesity prevention interventions delivered to Mexican children and adolescents. Thirteen databases and one search engine were searched for evidence from 1995 to 2021. Searches were done in English and Spanish to capture relevant information. Studies with experimental designs, delivered in any setting (e.g., schools or clinics) or digital domains (e.g., social media campaigns) targeting Mexican children or adolescents (≤ 18 years) and reporting weight outcomes, were included in this review. In addition, the risk of bias was appraised with the Effective Public Health Practice Project Quality Assessment Tool. Twenty-nine studies with 19,136 participants (3-17 years old) were included. The prevalence of overweight and obesity at baseline ranged from 21 to 69%. Most of the studies (89.6%) were delivered in school settings. The duration ranged from 2 days to 3 school years, and the number of sessions also varied from 2 to 200 sessions at different intensities. Overall, anthropometric changes varied across studies. Thus, the efficacy of the included studies is heterogeneous and inconclusive among studies. Current evidence is heterogeneous and inconclusive about the efficacy of interventions to prevent obesity in Mexican children and adolescents. Interventions should not be limited to educational activities and should include different components, such as multi-settings delivery, family inclusion, and longer-term implementations. Mixed-method evaluations (including robust quantitative and qualitative approaches) could provide a deeper understanding of the effectiveness and best practices.
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Affiliation(s)
- Magaly Aceves-Martins
- The Rowett Institute of Nutrition and Health, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK.
| | - Lizet López-Cruz
- Universidad Europea del Atlántico, Parque Científico Y Tecnológico de Cantabria, C/Isabel Torres 21, 39011, Santander, Spain
| | - Marcela García-Botello
- Universidad de Monterrey, Zona Valle Poniente, Av. Ignacio Morones Prieto 4500, 66238, San Pedro Garza García, N.L, Mexico
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Jáuregui A, Pacheco-Miranda S, Argumedo-García G, Marrón-Ponce JA, G.-Olvera A, Vargas-Meza J, Ayvar-Gama YY, Velázquez D, David Quezada A, Bonvecchio-Arenas A. Comprehensive evaluation of Salud Escolar a health school program in Mexico: Rationale, design and methods. Prev Med Rep 2022; 25:101662. [PMID: 35127349 PMCID: PMC8800016 DOI: 10.1016/j.pmedr.2021.101662] [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: 03/08/2021] [Revised: 10/04/2021] [Accepted: 12/07/2021] [Indexed: 11/04/2022] Open
Abstract
The prevalence of obesity and overweight in Mexican children and adolescents is high (greater than 30%) and lifestyle behaviors are far from achieving health recommendations. Salud Escolar is a complex cross-sectoral multi-level policy-based program in Mexico aiming to support schoolchildren healthy behaviors. We describe the rationale, design and methods for the comprehensive evaluation of Salud Escolar during its first phase of implementation. Using a mixed-methods approach and the logic model of Salud Escolar as a guide, a comprehensive evaluation involving 3 types of evaluations was designed: 1) A design evaluation before program implementation, to determine the consistency between the design of Salud Escolar and the problem to be addressed (i.e., childhood obesity), 2) An implementation evaluation to assess potential execution bottlenecks, and 3) An outcomes evaluation, to measure short-term (i.e., knowledge, attitudes and practices related to healthy eating, drinking plain water and doing regular physical activity) and intermediate outcomes (i.e., fruit and vegetable intake, water consumption and daily moderate to vigorous physical activity). This evaluation will provide essential knowledge about program design and implementation processes, which are vital for drawing robust conclusions about the effectiveness of the program. Results and lessons learned from this comprehensive evaluation will provide evidence to improve Salud Escolar program and facilitate its upscaling process and may provide relevant information for school-based programs in other places sharing socio-contextual conditions.
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Key Words
- BMI, Body mass index
- GEE, Generalized Estimating Equations
- HR, Hour
- IS, Implementation Science
- ISAT, ISCOLE School Audit Tool
- LMIC, Low-Middle Income Countries
- MIR, Results Indicators Matrix
- MVPA, Moderate-to-vigorous physical activity
- Obesity
- PA, Physical activity
- Program evaluation
- SOFIT, System for Observing Fitness Time
- SSBs, Sugar sweetened beverages
- School-based intervention
- Schoolchildren
- TRM, Terms of Reference Model
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Affiliation(s)
- Alejandra Jáuregui
- Center for Health and Nutrition Research, National Institute of Public Health, Mexico. Universidad 655, Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, 62100 Cuernavaca, Morelos, Mexico
| | - Selene Pacheco-Miranda
- Center for Health and Nutrition Research, National Institute of Public Health, Mexico. Universidad 655, Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, 62100 Cuernavaca, Morelos, Mexico
| | - Gabriela Argumedo-García
- Center for Health and Nutrition Research, National Institute of Public Health, Mexico. Universidad 655, Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, 62100 Cuernavaca, Morelos, Mexico
| | - Joaquín A Marrón-Ponce
- Center for Health and Nutrition Research, National Institute of Public Health, Mexico. Universidad 655, Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, 62100 Cuernavaca, Morelos, Mexico
| | - Armando G.-Olvera
- Center for Health and Nutrition Research, National Institute of Public Health, Mexico. Universidad 655, Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, 62100 Cuernavaca, Morelos, Mexico
| | - Jorge Vargas-Meza
- Center for Health and Nutrition Research, National Institute of Public Health, Mexico. Universidad 655, Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, 62100 Cuernavaca, Morelos, Mexico
| | - Ylenia Yatziri Ayvar-Gama
- Center for Health and Nutrition Research, National Institute of Public Health, Mexico. Universidad 655, Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, 62100 Cuernavaca, Morelos, Mexico
| | - Daniel Velázquez
- Center for Health and Nutrition Research, National Institute of Public Health, Mexico. Universidad 655, Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, 62100 Cuernavaca, Morelos, Mexico
| | - Amado David Quezada
- Center for Evaluation and Surveys, Research National Institute of Public Health, Mexico. Universidad 655, Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, 62100 Cuernavaca, Morelos, Mexico
| | - Anabelle Bonvecchio-Arenas
- Center for Health and Nutrition Research, National Institute of Public Health, Mexico. Universidad 655, Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, 62100 Cuernavaca, Morelos, Mexico
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Nutritional Characteristics, Sites of Origin, and Cost of Foods Consumed during School Hours and Their Relationship to Nutritional Status of Schoolchildren in Mexico City. Life (Basel) 2021; 11:life11050439. [PMID: 34068865 PMCID: PMC8153579 DOI: 10.3390/life11050439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/09/2021] [Accepted: 05/10/2021] [Indexed: 11/17/2022] Open
Abstract
Access, nutritional characteristics, preferences, and cost can affect food intake at school. A cross-sectional study was performed to determine the nutritional characteristics, sites of origin, and cost of foods consumed during school hours. Three hundred and sixty-nine children from five public elementary schools in Mexico City participated. The children gave information about the foods that they consumed five days out of the week during school hours, including the place of acquisition, cost of the food, and portion size. Anthropometric measurements of height and weight of the children were taken. Caloric consumption and percentage of recommended daily energy intake from food during school hours was determined. Children were 10.9 ± 0.9 years old; 55.6% were girls, 26% were overweight, 23% were obese, and 3.3% were of low height for age. The average calorie intake was 515 kilocalories (kcal) (boys, 535 kcal; girls, 476 kcal, p = 0.051); calorie intake was higher when school meal intakes included foods from home, school, and outside of school. No significant differences were found in calorie intake by children’s nutritional status. The cost in Mexican pesos per 100 kcal consumed showed differences according to the nutritional status of the children; it was 4.0 Mexican pesos for children with normal weight and 4.2 and 3.8 pesos in children who were overweight or obese, respectively. The information obtained in this study should be used to provide nutritional guidance. The food portion size intake during school hours should be reduced, and the food should come from one or at most two sites, because each extra food represents an increase in the total kilocalorie intake.
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Danielli S, Coffey T, Ashrafian H, Darzi A. Systematic review into city interventions to address obesity. EClinicalMedicine 2021; 32:100710. [PMID: 33681735 PMCID: PMC7910670 DOI: 10.1016/j.eclinm.2020.100710] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/11/2020] [Accepted: 12/22/2020] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Obesity threatens to undo the improvements that have been made in life expectancy over the last two centuries. It disproportionately affects lower socioeconomic and ethnic minority groups and has become one of the most important global health challenges of the 21stcentury. Whilst obesity is not confined to city populations, cities are home to more than half of the world's population with concentrated groups at high risk of obesity. Cities have also long been the forefront of social and technological change that has led to our current obesogenic environment. The aim of this study was to systematically identify city-wide interventions to address obesity, from which recommendations for policy makers, health system leaders and political leaders in cities could be made. METHODS Systematic review, conducted according to PRISMA guidelines, examining Embase, Ovid Medline, Central, Scopus, Campbell Library, CINALH, Health Business Elite; Health Management Information Consortium (HMIC), PyschINFO and Prospero. No restrictions on article type, date range or geographic location were applied. Along with classic academic sources, books and policy white papers were sought and reviewed. Studies that described a city-wide intervention to reduce obesity were included, irrespective of study design or perceived methodological quality. Only studies in English language were included. The primary outcome indicators that were sought and extracted were: reduction in obesity, reduction in weight and/or reduction in BMI. Where a primary outcome indicator was not stated, any other secondary impact measure was identified and recorded. This manuscript represents thematic analysis of a sub-set of data from the Prospero study, registration number: CRD42020166210. FINDINGS Our search yielded 42,137 original citations of which 1614 met the inclusion criteria and 96 were coded as relating to obesity. The 96 citations, ranging in year of publication 1997 to 2019, were conducted in 36 cities, with 13 citations either not stating a city or covering multiple cities, across 5 continents. The highest proportion of publications were from North America (59 / 96) and in particular the USA (56/96) and New York City (23/96). Primary outcome indicators were only stated in one quarter of the identified studies (24/96). Overall, there was heterogeneity of study design, descriptive methodologies and publication types, with a majority being descriptive texts using qualitative instruments of assessment. INTERPRETATION Multi-level and multi-component interventions, at the individual, community and city level, done in concert, are needed to address obesity. A composite of interventions that cities can utilise to address obesity is provided. These interventions will also be beneficial to the environment and make the case that personal health and planetary health are inextricably linked and should be considered as one. FUNDING None.
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Affiliation(s)
- Shaun Danielli
- Imperial College, Exhibition Rd, London, United Kingdom
- Corresponding author.
| | - Tom Coffey
- London Mayoral Health Advisor, London, United Kingdom
| | | | - Ara Darzi
- Imperial College, Exhibition Rd, London, United Kingdom
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Assessing the Relationship between District and State Policies and School Nutrition Promotion-Related Practices in the United States. Nutrients 2020; 12:nu12082356. [PMID: 32784595 PMCID: PMC7468700 DOI: 10.3390/nu12082356] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/29/2020] [Accepted: 07/31/2020] [Indexed: 12/20/2022] Open
Abstract
School environments are an optimal setting to promote healthy student diets, yet it is unclear what role state and district policies play in shaping school contexts. This study examined how state and district policies are associated with school-reported practices for promoting student participation in school lunch programs. School nutrition manager data were obtained from the School Nutrition and Meal Cost Study’s (SNMCS) sample of 1210 schools in 46 states and the District of Columbia (DC) during school year 2014–2015. Relevant state laws and district policies were compiled and coded. Multivariable logistic and Poisson regressions, controlling for school characteristics, examined the relationship between state/district laws/policies and school practices. Compared to schools in districts or states with no policies/laws, respectively, schools were more likely to provide nutritional information on school meals (AOR = 2.59, 95% CI = 1.33, 5.05) in districts with strong policies, and to promote school meals at school events (AOR = 1.93, CI = 1.07, 3.46) in states with strong laws. Schools in states with any laws related to strategies to increase participation in school meals were more likely to seek student involvement in menu planning (AOR = 2.02, CI = 1.24, 3.31) and vegetable offerings (AOR = 2.00, CI = 1.23, 3.24). The findings support the association of laws/policies with school practices.
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Carducci B, Oh C, Keats EC, Roth DE, Bhutta ZA. Effect of Food Environment Interventions on Anthropometric Outcomes in School-Aged Children and Adolescents in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis. Curr Dev Nutr 2020; 4:nzaa098. [PMID: 32666031 PMCID: PMC7340483 DOI: 10.1093/cdn/nzaa098] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 04/29/2020] [Accepted: 05/21/2020] [Indexed: 12/28/2022] Open
Abstract
Food environments may promote access to unhealthy foods, contributing to noncommunicable diseases in low- and middle- income countries (LMICs). This review assessed published evidence on the effects of food environment interventions on anthropometric (BMI and weight status) outcomes in school-aged children (5-9 y) and adolescents (10-19 y) (SACA) in LMICs. We summarized randomized controlled trials (RCTs) and quasi-experimental studies (QES) published since 2000 to August 2019 in the peer-reviewed and gray literature that assessed the effects of food-related behavioral and environmental interventions on diet-related health outcomes in SACA in LMICs. Electronic databases (MEDLINE, Embase, PsycINFO, Cochrane Library) were searched using appropriate keywords, Medical Subject Headings, and free text terms. Eleven RCTs and 6 QES met the inclusion criteria, testing multicomponent behavioral and environmental interventions in schools. Analysis of 6 RCTs (n = 17,054) suggested an overall effect on change in BMI [mean difference (MD): -0.11, 95% CI: -0.19 , -0.03], whereas there was no observed effect in 5 studies using endline BMI (n = 17,371) (MD: 0.05, 95% CI: -0.32, 0.21). There was no significant pooled effect among the 3 QES (n = 5,023) that reported differences in change in BMI or endline (MD: -0.37, 95% CI: -0.95, 0.22). There is limited evidence to support the modification of diet-related health outcomes through school-based food environment interventions in SACA in LMICs. Further studies are needed to understand the impact of school and community-based food environment interventions on nutritional status in this population.
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Affiliation(s)
- Bianca Carducci
- Centre for Global Child Health, Hospital for Sick Children; Peter Gilgan Centre for Research, and Learning (PGCRL), Toronto, ON, Canada
- Department of Nutritional Sciences, University of Toronto, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Christina Oh
- Centre for Global Child Health, Hospital for Sick Children; Peter Gilgan Centre for Research, and Learning (PGCRL), Toronto, ON, Canada
| | - Emily C Keats
- Centre for Global Child Health, Hospital for Sick Children; Peter Gilgan Centre for Research, and Learning (PGCRL), Toronto, ON, Canada
| | - Daniel E Roth
- Centre for Global Child Health, Hospital for Sick Children; Peter Gilgan Centre for Research, and Learning (PGCRL), Toronto, ON, Canada
- Department of Nutritional Sciences, University of Toronto, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children; Peter Gilgan Centre for Research, and Learning (PGCRL), Toronto, ON, Canada
- Department of Nutritional Sciences, University of Toronto, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
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Medeiros ERD, Rebouças DGDC, Paiva ACDS, Nascimento CPAD, Silva SYBE, Pinto ESG. Studies evaluating of health interventions at schools: an integrative literature review. Rev Lat Am Enfermagem 2018; 26:e3008. [PMID: 30020339 PMCID: PMC6053286 DOI: 10.1590/1518-8345.2463.3008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 01/04/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to identify and analyze the available evidence on the strategies used in the studies evaluating health interventions at school. METHOD this is an integrative review searching in LILACS, CINAHL, CUIDEN, ScienceDirect, and PubMed. From the pre-defined inclusion and exclusion criteria, there were 121 articles chosen to compose the sample. RESULTS english studies (97.5%), with a quantitative approach (80.2%), related to the interventions carried out in the Region of the Americas (54.6%) and the European Region (23.1%) predominated. For the most part, they are interventions as programs (70.2%), interested in evaluating results (73.5%) from the value judgment (83.4%). Prevalence of interventions focused on efficacy, effects or impact, and activities carried out on interventions were focused on physical activity, healthy eating, sexual and reproductive health, mental health, and use of tobacco, alcohol, and other drugs. They are worked through activities of clinical monitoring, health promotion and disease prevention. CONCLUSION the evidence indicates that the evaluations of health interventions in the school focus the results produced in programs through the judgment of value. The topics most addressed were healthy eating, physical activity, prevention of alcohol and other drugs, among others.
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Affiliation(s)
- Eliabe Rodrigues de Medeiros
- Doctoral student, Departamento de Enfermagem, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil. Bolsista do Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil
| | - Danielle Gonçalves da Cruz Rebouças
- Cardiology and Hemodynamics Specialist, Specialization student in Public Health: Oncology Nursing, Escola da Assembleia Legislativa do Rio Grande do Norte, Natal, RN, Brazil
| | - Alany Carla de Sousa Paiva
- Occupational Health Nursing Specialist, Specialization student in Higher Education Teaching, Escola de Saúde, Universidade Potiguar, Natal, RN, Brazil
| | - Camila Priscila Abdias do Nascimento
- Emergency and Trauma Nursing Specialist, Specialization student in Public Health, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Erika Simone Galvão Pinto
- PhD, Professor Adjunto, Departamento de Enfermagem, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
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Lessons learned and insights from the implementation of a food and physical activity policy to prevent obesity in Mexican schools: An analysis of nationally representative survey results. PLoS One 2018; 13:e0198585. [PMID: 29944659 PMCID: PMC6019747 DOI: 10.1371/journal.pone.0198585] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 05/22/2018] [Indexed: 11/19/2022] Open
Abstract
Obesity is a serious problem among children in Mexico. In 2010, the government implemented a national food and physical activity policy in elementary schools, to prevent obesity. The goal of this study is to assess the implementation of this policy, using the logic model from a descriptive survey with national representativeness at the elementary school level and based on a stratified cluster design. We used a systematic random sampling of schools (n = 122), stratified into public and private. We administered questionnaires to 116 principals, 165 members of the Food and Physical Activity Committees, 132 food school food vendors, 119 teachers, 348 parents. This study evidences a significant deviation in implementation from what had been planned. Our lessons learned are the importance to: base the design/implementation of the policy on a theoretical framework, make programs appealing to stakeholders, select concrete and measurable objective or goals, and support stakeholders during the implementation process.
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Calderón-Garcidueñas L, de la Monte SM. Apolipoprotein E4, Gender, Body Mass Index, Inflammation, Insulin Resistance, and Air Pollution Interactions: Recipe for Alzheimer's Disease Development in Mexico City Young Females. J Alzheimers Dis 2017; 58:613-630. [PMID: 28527212 PMCID: PMC9996388 DOI: 10.3233/jad-161299] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Given the epidemiological trends of increasing Alzheimer's disease (AD) and growing evidence that exposure and lifestyle factors contribute to AD risk and pathogenesis, attention should be paid to variables such as air pollution, in order to reduce rates of cognitive decline and dementia. Exposure to fine particulate matter (PM2.5) and ozone (O3) above the US EPA standards is associated with AD risk. Mexico City children experienced pre- and postnatal high exposures to PM2.5, O3, combustion-derived iron-rich nanoparticles, metals, polycyclic aromatic hydrocarbons, and endotoxins. Exposures are associated with early brain gene imbalance in oxidative stress, inflammation, innate and adaptive immune responses, along with epigenetic changes, accumulation of misfolded proteins, cognitive deficits, and brain structural and metabolic changes. The Apolipoprotein E (APOE) 4 allele, the most prevalent genetic risk for AD, plays a key role in the response to air pollution in young girls. APOE 4 heterozygous females with >75% to <94% BMI percentiles are at the highest risk of severe cognitive deficits (1.5-2 SD from average IQ). This review focused on the relationships between gender, BMI, systemic and neural inflammation, insulin resistance, hyperleptinemia, dyslipidemia, vascular risk factors, and central nervous system involvement in APOE4 urbanites exposed to PM2.5 and magnetite combustion-derived iron-rich nanoparticles that can reach the brain. APOE4 young female heterozygous carriers constitute a high-risk group for a fatal disease: AD. Multidisciplinary intervention strategies could be critical for prevention or amelioration of cognitive deficits and long-term AD progression in young individuals at high risk.
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Ewart-Pierce E, Mejía Ruiz MJ, Gittelsohn J. "Whole-of-Community" Obesity Prevention: A Review of Challenges and Opportunities in Multilevel, Multicomponent Interventions. Curr Obes Rep 2016; 5:361-74. [PMID: 27379620 PMCID: PMC5962013 DOI: 10.1007/s13679-016-0226-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The causes of obesity worldwide are complex and multilevel, including changing food environments, physical activity levels, policies, and food production systems. This intricate context requires multilevel and multicomponent (MLMC) interventions to improve health outcomes. We conducted a literature review of MLMC interventions for obesity prevention and mitigation; 14 studies meeting search criteria were identified. We found examples of successes in preventing obesity, reducing overweight, improving healthful behaviors, and enhancing some psychosocial indicators. Of eight studies that reported health and behavioral results, five showed no significant impact and three showed reductions in obesity. Four studies showed significant improvement in dietary behavior, and five reported significant desirable effects in physical activity or screen time. Five studies reported psychosocial impacts, and three of these showed significant improvements. MLMC approaches show promising results, particularly when they are able to integrate components at the policy, community, and interpersonal levels.
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Affiliation(s)
- Ella Ewart-Pierce
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA.
| | - María José Mejía Ruiz
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
| | - Joel Gittelsohn
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
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Safdie M, Cargo M, Richard L, Lévesque L. An ecological and theoretical deconstruction of a school-based obesity prevention program in Mexico. Int J Behav Nutr Phys Act 2014; 11:103. [PMID: 25108611 PMCID: PMC4423771 DOI: 10.1186/s12966-014-0103-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 07/30/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ecological intervention programs are recommended to prevent overweight and obesity in children. The National Institute of Public Health (INSP) in Mexico implemented a successful ecological intervention program to promote healthy lifestyle behaviors in school age children. This study assessed the integration of ecological principles and Social Cognitive Theory (SCT) constructs in this effective school-based obesity prevention program implemented in 15 elementary schools in Mexico City. METHODS Two coders applied the Intervention Analysis Procedure (IAP) to "map" the program's integration of ecological principles. A checklist gauged the use of SCT theory in program activities. RESULTS Thirty-two distinct intervention strategies were implemented in one setting (i.e., school) to engage four different target-groups (students, parents, school representatives, government) across two domains (Nutrition and Physical Activity). Overall, 47.5% of the strategies targeted the school infrastructure and/or personnel; 37.5% of strategies targeted a key political actor, the Public Education Secretariat while fewer strategies targeted parents (12.5%) and children (3%). More strategies were implemented in the Nutrition domain (69%) than Physical Activity (31%). The most frequently used SCT construct within both intervention domains was Reciprocal Determinism (e.g., where changes to the environment influence changes in behavior and these behavioral changes influence further changes to the environment); no significant differences were observed in the use of SCT constructs across domains. CONCLUSIONS Findings provide insight into a promising combination of strategies and theoretical constructs that can be used to implement a school-based obesity prevention program. Strategies emphasized school-level infrastructure/personnel change and strong political engagement and were most commonly underpinned by Reciprocal Determinism for both Nutrition and Physical Activity.
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Affiliation(s)
- Margarita Safdie
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Av. Universidad 655, Sta. Ma. Ahuacatitlán, Cuernavaca, Morelos, 62508, México.
- School of Kinesiology and Health Studies, Queen's University, 28 Division Street, Kingston, Ontario, Canada.
| | - Margaret Cargo
- School of Population Health, University of South Australia, 160 Currie Street, GPO Box 2471, Adelaide, South Australia, 5000, Australia.
| | - Lucie Richard
- Faculty of Nursing and IRSPUM, Université de Montréal, Station Centre-ville, PO Box 6128, H3C3J7, Montréal, Quebec, Canada.
| | - Lucie Lévesque
- School of Kinesiology and Health Studies, Queen's University, 28 Division Street, Kingston, Ontario, Canada.
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