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Padgett L, Stevens J, Summerbell C, Burton W, Stamp E, McLarty L, Schofield H, Bryant M. Childhood obesity prevention trials: A systematic review and meta-analysis on trial design and the impact of type 1 error. Obes Rev 2024; 25:e13736. [PMID: 38529530 DOI: 10.1111/obr.13736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/19/2023] [Accepted: 02/12/2024] [Indexed: 03/27/2024]
Abstract
Effect sizes from previously reported trials are often used to determine the meaningful change in weight in childhood obesity prevention interventions because information on clinically meaningful differences is lacking. Estimates from previous trials may be influenced by statistical significance; therefore, it is important that they have a low risk of type 1 error. A systematic review and meta-analysis were conducted to report on the design of child obesity prevention randomized controlled trials and effectiveness according to risk of type 1 error. Eighty-four randomized controlled trials were identified. A large range of assumptions were applied in the sample size calculations. The most common primary outcome was BMI, with detectable effect size differences used in sample size calculations ranging from 0.25 kg/m2 (followed up at 2 years) to 1.1 kg/m2 (at 9 months) and BMI z-score ranging from 0.1 (at 4 years) to 0.67 (at 3 years). There was no consistent relationship between low risk of type 1 error and reports of higher or lower effectiveness. Further clarity of the size of a meaningful difference in weight in childhood obesity prevention trials is required to support evaluation design and decision-making for intervention and policy. Type 1 error risk does not appear to impact effect sizes in a consistent direction.
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Affiliation(s)
- Louise Padgett
- Department of Health Sciences, University of York, York, UK
| | - June Stevens
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Carolyn Summerbell
- Department of Sport and Exercise Sciences, Durham University, Durham City, UK
| | - Wendy Burton
- Department of Health Sciences, University of York, York, UK
| | - Elizabeth Stamp
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Laura McLarty
- Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK
| | - Holly Schofield
- Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK
| | - Maria Bryant
- Department of Health Sciences and the Hull York Medical School, University of York, York, UK
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Balderas-Arteaga N, Mendez K, Gonzalez-Rocha A, Pacheco-Miranda S, Bonvecchio A, Denova-Gutiérrez E. Healthy lifestyle interventions within the curriculum in school-age children: systematic review and meta-analysis. Health Promot Int 2024; 39:daae020. [PMID: 38470184 DOI: 10.1093/heapro/daae020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024] Open
Abstract
Childhood obesity is a major public health challenge. Previous research has identified the impact of school-based interventions for preventing and treating obesity; we hypothesized that when curricular changes are integrated, results could be exponentiated. This study aimed to systematically review and conduct a meta-analysis of the published literature analyzing information about school-based interventions inserted in the curriculum. The Cochrane Handbook methodology was followed. An electronic search was conducted in five databases, with a specific design strategy per database. Randomized controlled trials or quasi-experimental studies of children with nutrition and physical activity (PA) interventions inserted into the school curricula were included. The risk of bias was assessed with the Risk of Bias tool. The mean differences were pooled using a fixed-effects model for the meta-analysis. The certainty of the evidence was evaluated according to the guidelines of the Grading of the Recommendations, Assessment, Development, and Evaluations working group (Protocol ID: CRD42021270557). After the screening and selection process, 12 studies were included. The interventions identified, based on the school curricula, include classroom activities and homework, among others. A meta-analysis with five intervention groups presented an overall mean difference of -0.14 body mass index (BMI) Z-score (95% CI: -0.25, -0.03) after this intervention with high certainty of the evidence. This systematic review and meta-analysis suggest that nutrition and PA lessons inserted into the curricula and supported with additional activities (i.e. homework, workshops, etc.) could increase nutrition knowledge and improve attitudes toward fruit, vegetables, and water consumption, and BMI Z-score reduction.
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Affiliation(s)
- Nydia Balderas-Arteaga
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Kenia Mendez
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Alejandra Gonzalez-Rocha
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Selene Pacheco-Miranda
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Anabelle Bonvecchio
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Edgar Denova-Gutiérrez
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
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Neri LDCL, Guglielmetti M, Fiorini S, Quintiero F, Tagliabue A, Ferraris C. Nutritional counseling in childhood and adolescence: a systematic review. Front Nutr 2024; 11:1270048. [PMID: 38362101 PMCID: PMC10867228 DOI: 10.3389/fnut.2024.1270048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/15/2024] [Indexed: 02/17/2024] Open
Abstract
Healthy eating habits are the basis for good health status, especially for children and adolescents, when growth and development are still ongoing. Nutrition educational programs are essential to prevent and treat chronic diseases. Nutritional counseling (NC), as a collaborative process between the counselor and the client process, could help to achieve better outcomes. This review aims to collect information about the utilization of NC during childhood and adolescence and to highlight its possible impact on adherence/compliance rates, nutrition knowledge, status and dietary intake. The methods applied in this systematic review followed the instruction of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search in PubMed/Medline, Scopus, Web of Science, LILACS, and Science Direct included observational or randomized studies. RoB 2.0 and Robins-I tools was used for the risk of bias assessment in randomized and non-randomized studies, respectively. The quality of evidence was checked by the Mixed Methods Appraisal Tool system. A total of 21 articles were selected, computing 4,345 individuals. 11 achieved at least 4 stars quality level. The highest risk of bias for randomized studies was related to the randomization process. 42.9% of non-randomized studies had some concerns of bias, mainly because of a lack of control of all confounding factors. Different strategies of NC were used in children and adolescents with positive results for health or diseases. NC strategies can be effectively used in children and adolescents. In general, NC showed benefits in pediatrics age for anthropometric or body composition parameters, dietary intake, nutrition knowledge and physical activity improvement. Performing NC in pediatrics is challenging due to the counseling strategies that must be adapted in their contents to the cognitive ability of each age. More structured research must be done focused on this population. Investments in healthy eating behaviors in pediatrics can lead to better health outcomes in the future population with substantial benefits to society. Systematic review registration [https://www.crd.york.ac.uk/prospero/#recordDetails], identifier [CRD42022374177].
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Affiliation(s)
- Lenycia de Cassya Lopes Neri
- Laboratory of Food Education and Sport Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
- Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Monica Guglielmetti
- Laboratory of Food Education and Sport Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
- Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Simona Fiorini
- Laboratory of Food Education and Sport Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
- Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Federica Quintiero
- Laboratory of Food Education and Sport Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
- Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Anna Tagliabue
- Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Cinzia Ferraris
- Laboratory of Food Education and Sport Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
- Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
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Beavers AW, Kennedy AO, Blake JP, Comstock SS. Development and evaluation of food preservation lessons for gardeners: application of the DESIGN process. Public Health Nutr 2023; 27:e23. [PMID: 38149788 PMCID: PMC10830356 DOI: 10.1017/s1368980023002926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 11/01/2023] [Accepted: 12/18/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVE This study presents the development and evaluation of food preservation lessons for gardeners. DESIGN Lessons were developed using the DESIGN process, a nutrition education program planning framework. This study examines the effectiveness of this curriculum at increasing knowledge of proper food preservation practices and increasing participants' confidence in home food preservation, identifies challenges participants experienced with home food preservation and assesses the perceived influence of home food preservation on vegetable intake and aspects of food security. We used the DESIGN process developed by Contento and Koch to develop the curricula and used social cognitive theory to guide the lesson development. Lessons on three types of food preservation (freezing, water bath canning and pressure canning) were developed and presented to adult gardeners. The evaluation consisted of post-lesson surveys and a follow-up survey several months after the lessons. SETTING Mid-Michigan, USA. PARTICIPANTS Adult gardeners. RESULTS Food preservation confidence increased following the lessons. At follow-up, 64 % of participants agreed or strongly agreed that they ate more fruit and vegetables because of preserving food, 57 % of respondents agreed or strongly agreed that they spend less money on food due to preserving, while 71 % reported being better able to provide food for themselves and their family. Lastly, 93 % reported feeling better about where their food comes from and wasting less food due to preserving. CONCLUSIONS This study provides evidence that home food preservation may be beneficial in promoting fruit and vegetable intake and food security among gardeners.
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Affiliation(s)
- Alyssa W Beavers
- Department of Nutrition and Food Science, Wayne State University, Detroit, MI48201, USA
| | - Allison O Kennedy
- Department of Nutrition and Food Science, Wayne State University, Detroit, MI48201, USA
| | - Jessica P Blake
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, USA
| | - Sarah S Comstock
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, USA
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Miller M, Barwood D, Devine A, Boston J, Smith S, Masek M. Rethinking Adolescent School Nutrition Education Through a Food Systems Lens. THE JOURNAL OF SCHOOL HEALTH 2023; 93:891-899. [PMID: 37254564 DOI: 10.1111/josh.13351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/24/2023] [Accepted: 05/21/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Obesity-driven nutrition education in schools does not appear to result in healthier adolescent food choices. This study explored food systems as an alternative pedagogical approach to engage students in nutrition education. METHODS After playing a food systems computer game, 250 13- to 16-year-old students in 5 Western Australian secondary schools, participated in group discussions to distinguish learning and interests in food systems. Discussion records were thematically coded using constant comparative analysis. RESULTS Students reported crop growth, food production and food waste, healthier food choices, and food systems as knowledge outcomes of game play. They requested additional content on food production, costing, handling, processing, and accessing local produce. Experiential activities were preferred pedagogical approaches. CONCLUSIONS Cross-curricular pedagogy which embraces human and planetary health through a food systems lens, can engage adolescents in nutrition education. Transformational computer games are effective to engage, educate and stimulate inquiry in food systems education.
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Affiliation(s)
- Margaret Miller
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, Perth, WA, 6027, Australia
| | - Donna Barwood
- School of Education, Edith Cowan University, 270 Joondalup Drive, Joondalup, Perth, WA, 6027, Australia
| | - Amanda Devine
- Public Health and Occupational Health & Safety, Edith Cowan University, 270 Joondalup Drive, Joondalup, Perth, WA, 6027, Australia
| | - Julie Boston
- School of Education, Edith Cowan University, 270 Joondalup Drive, Joondalup, Perth, WA, 6027, Australia
| | - Sandra Smith
- School of Education, Edith Cowan University, 270 Joondalup Drive, Joondalup, Perth, WA, 6027, Australia
| | - Martin Masek
- School of Science, Edith Cowan University, 270 Joondalup Drive, Joondalup, Perth, WA, 6027, Australia
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Lyu J, Wan Z, Liu Z, Zhou S, Feng X, Gao A, Lin Y, Zhang F, Wang H. Effect of a Multifaceted Intervention on Children's Body Image and the Mediating Role of Body Image in Changes in Adiposity Indicators. Nutrients 2023; 15:3951. [PMID: 37764735 PMCID: PMC10534561 DOI: 10.3390/nu15183951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Besides genetic factors and energy-related behaviors, psycho-cultural factors are also important in obesity etiology. Previous studies have suggested that improving body image might be an effective method for managing body weight. Thus, this study aimed to evaluate the effects of a multifaceted intervention on the body image of children and explore whether body image played a mediating role in changes in adiposity indicators. This study was embedded in a cluster randomized controlled trial, involving 1287 children from 24 primary schools in three cities in China (Beijing, Changzhi and Urumqi). The 9-month multifaceted intervention on childhood obesity included five components (three targeted children and two targeted environments), and randomization was performed by an independent person who was blinded to the schools. Two indicators (body size perception and body size expectation) were chosen to characterize body image and were measured by Ma figural stimuli at baseline and the end of the trial. Changes in body image indicators were classified as conducive to weight loss or not. Other anthropometric measures and self-reported behaviors were also collected at both time points. Generalized linear mixed models were used in the analyses. Compared to the controls (n = 648), the proportion of body size perception conducive to weight loss increased in the intervention group (n = 639), with an odds ratio of 2.42 (95%CI: 1.70~3.45, p < 0.001). The proportion of body size expectation conducive to weight loss also increased more in the intervention group than in the controls (OR = 1.74, 95%CI: 1.14~2.66, p = 0.010). In children whose baseline nutritional status was "normal weight with higher BMI" or "overweight/obese", the improvements in body size perception and body size expectation partly mediated the association between the intervention and changes in BMI, BMI Z score, waist circumference and body fat percentage (p < 0.05). This multifaceted study effectively improved the body image of children, which, in turn, led to beneficial changes in adiposity indicators. For the first time, body size perception and body size expectation have been confirmed to be important factors associated with the beneficial effect of a childhood obesity intervention, suggesting that body image components should be generalized in the future.
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Affiliation(s)
- Jinlang Lyu
- Department of Maternal and Child Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing 046000, China; (J.L.); (Z.W.); (Z.L.); (S.Z.)
- Peking University Health Science Center-Weifang Joint Research Center for Maternal and Child Health, Weifang 261000, China
| | - Zhongshang Wan
- Department of Maternal and Child Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing 046000, China; (J.L.); (Z.W.); (Z.L.); (S.Z.)
| | - Zheng Liu
- Department of Maternal and Child Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing 046000, China; (J.L.); (Z.W.); (Z.L.); (S.Z.)
| | - Shuang Zhou
- Department of Maternal and Child Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing 046000, China; (J.L.); (Z.W.); (Z.L.); (S.Z.)
| | | | - Aiyu Gao
- Dongcheng Primary and Secondary School Health Care Center, Beijing 236499, China;
| | - Yi Lin
- Urumqi Primary and Secondary School Health Care Center, Urumqi 830003, China
| | - Fang Zhang
- Mentougou Primary and Secondary School Health Care Center, Beijing 102300, China;
| | - Haijun Wang
- Department of Maternal and Child Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing 046000, China; (J.L.); (Z.W.); (Z.L.); (S.Z.)
- Peking University Health Science Center-Weifang Joint Research Center for Maternal and Child Health, Weifang 261000, China
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Cunningham-Sabo L, Lohse B, Clifford J, Burg A, Nigg C. Fuel for Fun Process Evaluation Reveals Strong Implementation and Approval with Varied Parent Engagement. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2023; 55:16-29. [PMID: 36621265 DOI: 10.1016/j.jneb.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 07/25/2022] [Accepted: 08/01/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To describe the implementation and process characteristics of Fuel for Fun: Cooking with Kids Plus Parents and Play (FFF). DESIGN Mixed methods. SETTING Elementary schools in 2 Northern Colorado school districts. PARTICIPANTS Fourth graders (aged 9-11 years), parents, school staff, and implementation researchers; measured over 2 consecutive years in 8 schools (851 students, 45 classrooms). INTERVENTION(S) Social Cognitive and active learning theory-based classroom cooking with tasting lessons, active recess games, cooking with tasting food promotion during school lunch, family nights, and take-home intervention reinforcements. A 7-month program delivered by a trained intervention team. MAIN OUTCOME MEASURE(S) Implementation measures (observations and debriefings) assessed context, reach, dose delivered, fidelity, and dose received; process measures (surveys) assessed student and parent perceptions and intervention participation. ANALYSIS Descriptive statistics for quantitative and themes for qualitative data. RESULTS Minor adjustments in program delivery plans were required to accommodate changes in school schedules and policies. Process measures demonstrated > 90% achievement of goals for nearly all child-centered activities. One-quarter of eligible families participated in evening events, with strong parent and student approval. Fifty out of 116 parents (43%) completing an online survey reported preparing ≥ 1 of 5 recipes with their child. Fifty-nine percent of eligible students completed >1 of 10 take-home activity sheets with their parents. CONCLUSIONS AND IMPLICATIONS Engagement and commitment of the intervention team and school staff supported strong implementation. Participant responses were positive, but improvement in parent engagement requires investigation.
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Affiliation(s)
- Leslie Cunningham-Sabo
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO.
| | - Barbara Lohse
- Wegmans School of Health and Nutrition, Rochester Institute of Technology, Rochester, NY
| | - Jessica Clifford
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO
| | - Alixanna Burg
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO
| | - Claudio Nigg
- Department of Health Science, Institute of Sport Science, University of Bern, Bern, Switzerland
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Camp-Spivey LJ, Newman SD, Stevens RN, Nichols M. Survey of South Carolina Public School Personnel Perspectives on Barriers and Facilitators to Regular Physical Activity and Healthy Eating Behaviors in Schools. THE JOURNAL OF SCHOOL HEALTH 2022; 92:1062-1073. [PMID: 35962619 DOI: 10.1111/josh.13228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 05/06/2022] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND In South Carolina (SC), 42% of youth are overweight or obese. Two sets of modifiable behaviors contributing to obesity are physical activity (PA) and dietary habits. School-based interventions have successfully improved these behaviors. The purpose of this study was to identify SC public school personnel perspectives on the most common barriers and facilitators to regular PA and healthy eating behaviors in schools. METHODS A needs assessment survey was conducted with school personnel statewide. There were 17 questions on the survey that addressed: (1) demographic information about participants' educational backgrounds, (2) barriers to regular PA and healthy eating behaviors in schools, and (3) facilitators to regular PA and healthy eating behaviors in schools. Univariate and bivariate descriptive statistical analyses were performed using IBM SPSS Statistics 27. RESULTS Participants (N = 1311) indicated insufficient time for regular PA (n = 514, 39.2%) and limited access to healthy foods for healthy eating (n = 271, 20.7%) as main barriers. The primary facilitators were support from administrators for regular PA (n = 264, 20.1%) and support from cafeteria staff for healthy eating (n = 234, 17.8%). Further analyses explored how factors compared based on roles in schools, academic levels, and school district classifications. CONCLUSIONS Results suggest that overarching barriers and facilitators to school-based interventions addressing childhood obesity exist, so common strategies to mitigate challenges and maximize supports can be used in schools. Future studies are needed to examine how decreasing barriers and enhancing facilitators affect the implementation and outcomes of these school-based interventions.
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Affiliation(s)
- Logan J Camp-Spivey
- Mary Black College of Nursing, University of South Carolina Upstate, Spartanburg, SC, 29303
| | - Susan D Newman
- College of Nursing, Medical University of South Carolina, Charleston, SC, 29425
| | - Robert N Stevens
- South Carolina Clinical & Translational Research Institute, Medical University of South Carolina, Charleston, SC, 29425, USA; Co-Chair, Southeastern School Behavioral Health Conference, University of South Carolina, Columbia, SC, 29208, USA; Consultant, South Carolina Department of Education, Columbia, SC, 29211, USA; Consultant, South Carolina Department of Mental Health, Columbia, SC, 29202, USA; Investigator, STAR Clinical Research Network, Vanderbilt University, Nashville, TN, 37235, USA, Multiple
| | - Michelle Nichols
- College of Nursing, Medical University of South Carolina, Charleston, SC, 29425, USA; President, Mixed Methods International Research Association, Indianapolis, IN, 46230, USA, Multiple
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Papadopoulos N, Mantilla A, Bussey K, Emonson C, Olive L, McGillivray J, Pesce C, Lewis S, Rinehart N. Understanding the Benefits of Brief Classroom-Based Physical Activity Interventions on Primary School-Aged Children's Enjoyment and Subjective Wellbeing: A Systematic Review. THE JOURNAL OF SCHOOL HEALTH 2022; 92:916-932. [PMID: 35607277 PMCID: PMC9545911 DOI: 10.1111/josh.13196] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/07/2022] [Accepted: 05/01/2022] [Indexed: 06/01/2023]
Abstract
BACKGROUND Engaging in classroom-based physical activity (PA) breaks may help increase children's subjective wellbeing and enjoyment of PA, important precursors for children to remain engaged in PA. We conducted a systematic review to investigate the effect of brief classroom-based PA interventions on primary school children's subjective wellbeing and enjoyment of PA. METHODS Databases were reviewed between the earliest date of records and April 2020. Eligibility criteria included peer-reviewed empirical quantitative or mixed methods studies reporting enjoyment of PA or wellbeing outcomes of participating in a brief classroom-based PA program. Fifteen papers were included. Interventions supported 7022 child participants enrolled at baseline and 6286 children analyzed in interventions across 148 schools. RESULTS Thirteen studies examined the effect of brief classroom-based PA interventions on subjective wellbeing. Four found a significant positive effect for children in the intervention group (specifically for children's self-efficacy in learning with video exercises, quality of life, and self-confidence). Eight studies examined the effect of brief classroom-based PA interventions on enjoyment of PA. Five studies reported a positive effect for children in the intervention group and only 1 study found a negative effect for 1 grade level of children in the intervention group. The remaining studies with wellbeing and/or enjoyment outcomes reported no significant effect. CONCLUSIONS Findings from these studies indicate that the integration of brief PA breaks may support PA enjoyment and specific self-beliefs and quality of life perceptions that contribute to children's subjective wellbeing. However, more research is needed to confirm this effect.
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Affiliation(s)
- Nicole Papadopoulos
- School of Educational Psychology & Counselling, Faculty of EducationMonash University19 Ancora Imparo WayClaytonVictoria3800Australia
| | - Ana Mantilla
- School of Educational Psychology & Counselling, Faculty of Education, Monash University19 Ancora Imparo WayClaytonVictoria3800Australia
| | - Katherine Bussey
- School of Educational Psychology & Counselling, Faculty of EducationMonash University19 Ancora Imparo WayClaytonVictoria3800Australia
| | - Chloe Emonson
- School of Educational Psychology & Counselling, Faculty of EducationMonash University19 Ancora Imparo WayClaytonVictoria3800Australia
| | - Lisa Olive
- School of Psychology, Deakin University1 Gheringhap StGeelongVictoria3220Australia
| | - Jane McGillivray
- School of PsychologyDeakin University1 Gheringhap StGeelongVictoria3220Australia
| | - Caterina Pesce
- Department of Movement, Human and Health SciencesUniversity of Rome“Foro Italico,” Rome00135Italy
| | - Samantha Lewis
- School of Educational Psychology & Counselling, Faculty of EducationMonash University19 Ancora Imparo WayClaytonVictoria3800Australia
| | - Nicole Rinehart
- School of Educational Psychology & Counselling, Faculty of EducationMonash University19 Ancora Imparo WayClaytonVictoria3800Australia
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Munusamy G, Shanmugam R. Prevention and Interventional Strategies of Adolescent Obesity / Overweight. CARDIOMETRY 2022. [DOI: 10.18137/cardiometry.2022.23.133147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Purpose: It’s a known factor that obesity and overweight among adolescentsare major emerging global health problems associated with morbidityand mortality throughout their life in developed and developing countries. There is evidence that reducing overweight and obesity by increasing awareness, self-efficacy, and contemplation to adopt a health-promoting lifestyle.The aim of this review how the theory and model used to reduce this burden through vicarious interventional activities among adolescence (10-19 years)in a school setting. Methods: A literature search was performed in four databases to identify published studies between January 2009 and December 2019. Randomized control trial exploring the multiple interventional effects on obesity and overweight by utilization of with or without theoretical constructs and outcome on body mass index. Results: Originally references searched were 2112 abstracts and full-text articles. The total population was 34,846 adolescents. Most of the multiple interventionshad little positive effect onphysical activity, dietary intake, and sedentary behavior changes directly on BMI. Only three studies show changes in behavior through theory. Minimal studies reported the involvement and motivation of parents, friends, and teachers for themselves and adolescents. Conclusion: The contemporary review to visualizemultiple interventions, and how models and theory focused on various pragmatic activities in the delivery and outcome in school settings among adolescents.
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Camp-Spivey LJ, Newman SD, Stevens RN, Nichols M. Describing South Carolina Public School Administrators' Perceptions and Experiences Related to School-Based Interventions and Strategies to Promote Healthy Physical Activity and Eating Behaviors: A Qualitative Study. THE JOURNAL OF SCHOOL HEALTH 2022; 92:581-593. [PMID: 35355265 DOI: 10.1111/josh.13164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 01/14/2022] [Accepted: 01/26/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND School-based interventions and strategies targeting physical activity (PA) and eating patterns have successfully addressed unhealthy behaviors contributing to excess weight in school-age children. The purpose of this study was to investigate South Carolina (SC) public school administrators' perceptions of and experiences with weight-related issues in schools and associated barriers and facilitators to awareness, selection, and implementation of school-based healthy PA and eating interventions and strategies. METHODS This qualitative descriptive study, guided by the Social Ecological Model and the Steps in Quality Intervention Development Model, involved semistructured interviews with SC public school administrators from all academic levels (N = 28). Data were analyzed using thematic analysis. RESULTS Four themes were identified from interviews (N = 28): weight-related terminology or stigma, experiences with school-based healthy PA and eating interventions and strategies, barriers to school-based healthy PA and eating interventions and strategies, and facilitators to school-based healthy PA and eating interventions and strategies. CONCLUSIONS Schools are well-positioned to provide interventions and strategies to improve PA and dietary habits leading to childhood obesity. School administrators, while knowledgeable and experienced with weight-related issues and school-based interventions and strategies, encounter barriers and facilitators that impact offerings and delivery. Understanding these challenges and supports is important in the development, adaptation, and implementation of school-based interventions and strategies focused on healthy PA and eating behaviors.
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Affiliation(s)
- Logan J Camp-Spivey
- Mary Black School of Nursing, University of South Carolina Upstate, Spartanburg, SC, 29303
| | - Susan D Newman
- College of Nursing, Medical University of South Carolina, Charleston, SC, 29425
| | - Robert N Stevens
- South Carolina Clinical & Translational Research Institute, Medical University of South Carolina, Charleston, SC, 29425
- Co-Chair, Southeastern School Behavioral Health Conference, University of South Carolina, Columbia, SC, 29208
- Consultant, South Carolina Department of Education, Columbia, SC, 29211
- Consultant, South Carolina Department of Mental Health, Columbia, SC, 29202
- Investigator, STAR Clinical Research Network, Vanderbilt University, Nashville, TN, 37235
| | - Michelle Nichols
- College of Nursing, Medical University of South Carolina, Charleston, SC, 29425
- President, Mixed Methods International Research Association, Indianapolis, IN, 46230
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Burgermaster M, Rodriguez VA. Psychosocial-Behavioral Phenotyping: A Novel Precision Health Approach to Modeling Behavioral, Psychological, and Social Determinants of Health Using Machine Learning. Ann Behav Med 2022; 56:1258-1271. [PMID: 35445699 DOI: 10.1093/abm/kaac012] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The context in which a behavioral intervention is delivered is an important source of variability and systematic approaches are needed to identify and quantify contextual factors that may influence intervention efficacy. Machine learning-based phenotyping methods can contribute to a new precision health paradigm by informing personalized behavior interventions. Two primary goals of precision health, identifying population subgroups and highlighting behavioral intervention targets, can be addressed with psychosocial-behavioral phenotypes. We propose a method for psychosocial-behavioral phenotyping that models social determinants of health in addition to individual-level psychological and behavioral factors. PURPOSE To demonstrate a novel application of machine learning for psychosocial-behavioral phenotyping, the identification of subgroups with similar combinations of psychosocial characteristics. METHODS In this secondary analysis of psychosocial and behavioral data from a community cohort (n = 5,883), we optimized a multichannel mixed membership model (MC3M) using Bayesian inference to identify psychosocial-behavioral phenotypes and used logistic regression to determine which phenotypes were associated with elevated weight status (BMI ≥ 25kg/m2). RESULTS We identified 20 psychosocial-behavioral phenotypes. Phenotypes were conceptually consistent as well as discriminative; most participants had only one active phenotype. Two phenotypes were significantly positively associated with elevated weight status; four phenotypes were significantly negatively associated. Each phenotype suggested different contextual considerations for intervention design. CONCLUSIONS By depicting the complexity of psychological and social determinants of health while also providing actionable insight about similarities and differences among members of the same community, psychosocial-behavioral phenotypes can identify potential intervention targets in context.
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Affiliation(s)
- Marissa Burgermaster
- Department of Nutritional Sciences, College of Natural Sciences, University of Texas at Austin, Austin, TX, USA.,Department of Population Health, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Victor A Rodriguez
- Department of Biomedical Informatics, Columbia University, New York, NY, USA.,College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
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Camp-Spivey LJ, Newman SD, Stevens RN, Nichols M. "We've Had to Build the Plane as We Flew It.": Impacts of the COVID-19 Pandemic on School-Based Weight Management Interventions. Child Obes 2021; 17:497-506. [PMID: 34197215 DOI: 10.1089/chi.2021.0037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: In response to the coronavirus disease 2019 (COVID-19) pandemic, elementary and secondary schools in the United States transitioned to remote learning to slow viral spread and protect students and school officials. This move interrupted academic education and school-based health interventions focused on physical activity (PA) and healthy eating behaviors to help combat childhood obesity. Little is known on how these interventions were affected by COVID-19. Methods: This concurrent multimethodological study incorporated two independent components: qualitative descriptive semistructured interviews with public school administrators and quantitative descriptive cross-sectional needs assessment survey of public school personnel. Results: Three themes were identified from interviews with school administrators (N = 28): changes in school-based interventions addressing PA and healthy eating behaviors, changes in academic delivery affecting PA and healthy eating behaviors, and needs of school administrators. From the survey (N = 1311), 635 (48.4%) participants indicated that schools' abilities to address PA and healthy eating behaviors were negatively impacted by COVID-19. The majority (n = 876, 66.8%) of participants strongly agreed or agreed that the pandemic would affect future school-based interventions related to PA and healthy eating behaviors. Conclusions: While schools are prime locations for delivering school-based weight management interventions related to childhood obesity, participants reported the pandemic had overall negative impacts on interventions addressing PA and healthy eating behaviors. Understanding these impacts is essential to adapting school-based interventions to changes from COVID-19 so students may receive health information and access health promotion interventions in remote learning environments and during social distancing.
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Affiliation(s)
- Logan J Camp-Spivey
- Medical University of South Carolina, College of Nursing, Charleston, SC, USA
| | - Susan D Newman
- Medical University of South Carolina, College of Nursing, Charleston, SC, USA
| | - Robert N Stevens
- South Carolina Department of Education and South Carolina Department of Mental Health, School Behavioral Health, Columbia, SC, USA
| | - Michelle Nichols
- Medical University of South Carolina, College of Nursing, Charleston, SC, USA
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Luo M, Allman-Farinelli M. Trends in the Number of Behavioural Theory-Based Healthy Eating Interventions Inclusive of Dietitians/Nutritionists in 2000-2020. Nutrients 2021; 13:nu13114161. [PMID: 34836417 PMCID: PMC8623843 DOI: 10.3390/nu13114161] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 11/06/2021] [Accepted: 11/10/2021] [Indexed: 01/08/2023] Open
Abstract
Nutrition interventions developed using behaviour theory may be more effective than those without theoretical underpinnings. This study aimed to document the number of theory-based healthy eating interventions, the involvement of dietitians/nutritionists and the behaviour theories employed from 2000 to 2020. We conducted a review of publications related to healthy eating interventions that used behaviour change theories. Interventional studies published in English between 2000 and 2020 were retrieved from searching Medline, Cinahl, Embase, Psycinfo and Cochrane Central. Citation, country of origin, presence or absence of dietitian/nutritionist authors, participants, dietary behaviours, outcomes, theories and any behaviour change techniques (BCTs) stated were extracted. The publication trends on a yearly basis were recorded. A total of 266 articles were included. The number of theory-based interventions increased over the two decades. The number of studies conducted by dietitians/nutritionists increased, but since 2012, increases have been driven by other researchers. Social cognitive theory was the most used behaviour theory. Dietitians/nutritionists contributed to growth in publication of theory-based healthy eating interventions, but the proportion of researchers from other professions engaged in this field increased markedly. The reasons for this growth in publications from other professions is unknown but conjectured to result from greater prominence of dietary behaviours within the context of an obesity epidemic.
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Affiliation(s)
- Man Luo
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2006, Australia;
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310020, China
| | - Margaret Allman-Farinelli
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2006, Australia;
- Correspondence: ; Tel.: +61-2-90367045
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Neil-Sztramko SE, Caldwell H, Dobbins M. School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18. Cochrane Database Syst Rev 2021; 9:CD007651. [PMID: 34555181 PMCID: PMC8459921 DOI: 10.1002/14651858.cd007651.pub3] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Physical activity among children and adolescents is associated with lower adiposity, improved cardio-metabolic health, and improved fitness. Worldwide, fewer than 30% of children and adolescents meet global physical activity recommendations of at least 60 minutes of moderate to vigorous physical activity per day. Schools may be ideal sites for interventions given that children and adolescents in most parts of the world spend a substantial amount of time in transit to and from school or attending school. OBJECTIVES The purpose of this review update is to summarise the evidence on effectiveness of school-based interventions in increasing moderate to vigorous physical activity and improving fitness among children and adolescents 6 to 18 years of age. Specific objectives are: • to evaluate the effects of school-based interventions on increasing physical activity and improving fitness among children and adolescents; • to evaluate the effects of school-based interventions on improving body composition; and • to determine whether certain combinations or components (or both) of school-based interventions are more effective than others in promoting physical activity and fitness in this target population. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, BIOSIS, SPORTDiscus, and Sociological Abstracts to 1 June 2020, without language restrictions. We screened reference lists of included articles and relevant systematic reviews. We contacted primary authors of studies to ask for additional information. SELECTION CRITERIA Eligible interventions were relevant to public health practice (i.e. were not delivered by a clinician), were implemented in the school setting, and aimed to increase physical activity among all school-attending children and adolescents (aged 6 to 18) for at least 12 weeks. The review was limited to randomised controlled trials. For this update, we have added two new criteria: the primary aim of the study was to increase physical activity or fitness, and the study used an objective measure of physical activity or fitness. Primary outcomes included proportion of participants meeting physical activity guidelines and duration of moderate to vigorous physical activity and sedentary time (new to this update). Secondary outcomes included measured body mass index (BMI), physical fitness, health-related quality of life (new to this update), and adverse events (new to this update). Television viewing time, blood cholesterol, and blood pressure have been removed from this update. DATA COLLECTION AND ANALYSIS: Two independent review authors used standardised forms to assess each study for relevance, to extract data, and to assess risk of bias. When discrepancies existed, discussion occurred until consensus was reached. Certainty of evidence was assessed according to GRADE. A random-effects meta-analysis based on the inverse variance method was conducted with participants stratified by age (children versus adolescents) when sufficient data were reported. Subgroup analyses explored effects by intervention type. MAIN RESULTS Based on the three new inclusion criteria, we excluded 16 of the 44 studies included in the previous version of this review. We screened an additional 9968 titles (search October 2011 to June 2020), of which 978 unique studies were potentially relevant and 61 met all criteria for this update. We included a total of 89 studies representing complete data for 66,752 study participants. Most studies included children only (n = 56), followed by adolescents only (n = 22), and both (n = 10); one study did not report student age. Multi-component interventions were most common (n = 40), followed by schooltime physical activity (n = 19), enhanced physical education (n = 15), and before and after school programmes (n = 14); one study explored both enhanced physical education and an after school programme. Lack of blinding of participants, personnel, and outcome assessors and loss to follow-up were the most common sources of bias. Results show that school-based physical activity interventions probably result in little to no increase in time engaged in moderate to vigorous physical activity (mean difference (MD) 0.73 minutes/d, 95% confidence interval (CI) 0.16 to 1.30; 33 studies; moderate-certainty evidence) and may lead to little to no decrease in sedentary time (MD -3.78 minutes/d, 95% CI -7.80 to 0.24; 16 studies; low-certainty evidence). School-based physical activity interventions may improve physical fitness reported as maximal oxygen uptake (VO₂max) (MD 1.19 mL/kg/min, 95% CI 0.57 to 1.82; 13 studies; low-certainty evidence). School-based physical activity interventions may result in a very small decrease in BMI z-scores (MD -0.06, 95% CI -0.09 to -0.02; 21 studies; low-certainty evidence) and may not impact BMI expressed as kg/m² (MD -0.07, 95% CI -0.15 to 0.01; 50 studies; low-certainty evidence). We are very uncertain whether school-based physical activity interventions impact health-related quality of life or adverse events. AUTHORS' CONCLUSIONS Given the variability of results and the overall small effects, school staff and public health professionals must give the matter considerable thought before implementing school-based physical activity interventions. Given the heterogeneity of effects, the risk of bias, and findings that the magnitude of effect is generally small, results should be interpreted cautiously.
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Affiliation(s)
| | - Hilary Caldwell
- Department of Kinesiology, Child Health & Exercise Medicine Program, McMaster University, Hamilton, Canada
| | - Maureen Dobbins
- School of Nursing, McMaster University, Hamilton, Canada
- National Collaborating Centre for Methods and Tools, Hamilton, Canada
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St. Pierre C, Guan W, Barry L, Dease G, Gottlieb S, Morris A, Merrill J, Sacheck JM. Themes in Train-the-Trainer Nutrition Education Interventions Targeting Middle School Students: A Systematic Review. Nutrients 2021; 13:2749. [PMID: 34444910 PMCID: PMC8398099 DOI: 10.3390/nu13082749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/04/2021] [Accepted: 08/05/2021] [Indexed: 11/24/2022] Open
Abstract
Context-appropriate nutrition education interventions targeting middle school students have the potential to promote healthy dietary patters that may help prevent unnecessary weight gain at a point in childhood development when youth experience increasing agency over their food choices. The aim of this review was to identify and synthesize themes in train-the-trainer approaches, intervention content and delivery, and youth receptivity across teacher, mentor, and peer-led nutrition education interventions that targeted middle school-age youth in urban, primarily low-income settings. A systematic, electronic literature search was conducted in seven electronic databases, PubMed/Medline, CINAHL, ERIC, PsycINFO, Scopus, SPORTDiscus, and Cochrane CENTRAL, using fixed inclusion and exclusion criteria. A total of 53 papers representing 39 unique interventions were selected for data extraction and quality assessment. A framework synthesis approach was used to organize the interventions into six categories and identify themes according to whether the intervention was classroom-based or out-of-school-based and whether adults, cross-age peers or same-age peers delivered the intervention. Ten of the interventions contained multiple components such that they were included in two of the categories. The review findings indicated that trainings should be interactive, include opportunities to role-play intervention scenarios and provide follow-up support throughout intervention delivery. Interventions targeting middle school youth should include positive messaging and empower youth to make healthy choices within their specific food environment context.
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Affiliation(s)
- Christine St. Pierre
- Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA; (G.D.); (J.M.S.)
| | - Win Guan
- Up2Us Sports, New York, NY 10018, USA; (W.G.); (J.M.)
| | - Leah Barry
- Department of Sociology, Tulane University, New Orleans, LA 70118, USA; (L.B.); (S.G.)
| | - Grace Dease
- Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA; (G.D.); (J.M.S.)
| | - Sydney Gottlieb
- Department of Sociology, Tulane University, New Orleans, LA 70118, USA; (L.B.); (S.G.)
| | - Arielle Morris
- School of Science & Engineering, Tulane University, New Orleans, LA 70118, USA;
| | | | - Jennifer M. Sacheck
- Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA; (G.D.); (J.M.S.)
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Nutrition across the curriculum: a scoping review exploring the integration of nutrition education within primary schools. Nutr Res Rev 2021; 35:181-196. [PMID: 33926596 DOI: 10.1017/s0954422421000111] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Primary schools contribute to promoting healthy eating behaviour and preventing overweight and obesity by providing nutrition education. Research highlights the importance of improving teachers' programme implementation to enhance intervention effectiveness. An integrative approach has been suggested to reduce time barriers that teachers currently experience in teaching nutrition. This scoping review explores use and effectiveness of integrative teaching in primary-school-based nutrition education programmes. Six databases were searched for primary-school-based interventions on nutrition education. Papers reporting on integration of nutrition topics within core curriculum were included. Abstracts and full texts of potentially relevant articles were screened to determine eligibility. Next, data were extracted and tabulated. Findings were collated and summarised to describe intervention characteristics, subject integration and effectiveness of the included programmes. Data describing integration of nutrition into the primary school curriculum were extracted from 39 eligible papers. Nutrition education programmes often involve lessons about food groups and are frequently embedded within the mathematics, science or literacy syllabus. Although articles report on the integration of nutrition, the use of this approach was not commonly described in detail. Only seven papers discussed student outcomes related to the integration of nutrition education within core subjects. The ability to draw strong conclusions about school-based nutrition intervention effectiveness is limited by the current lack of programme description and methodological issues. Hence, more research is warranted to inform evidence on effectiveness of integrative nutrition education for both teacher and student outcomes. Future studies that include greater detail regarding the integrative approach are needed.
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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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Chapman-Novakofski K. Congratulations and Thank You. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2020; 52:671. [PMID: 32646597 DOI: 10.1016/j.jneb.2020.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Chapman-Novakofski K. Chasing Technology. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2019; 51:1138. [PMID: 31706458 DOI: 10.1016/j.jneb.2019.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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