Students' perceptions of school sugar-free, food and exercise environments enhance healthy eating and physical activity

Moving towards health promoting schools: effectiveness of an educational intervention to improve knowledge, attitude and beliefs regarding heart attack, and CPR knowledge in high school students in Lebanon

Background

Health promoting schools (HPS) prioritize the health of students and community. One important target of HPS is noncommunicable diseases (NCDs), including prevention of heart attacks, due to their burden on healthcare.

Objective

This study assesses the effectiveness of an educational intervention to promote knowledge of signs and symptoms, beliefs and attitudes towards heart attack, and promote knowledge of Cardiopulmonary resuscitation (CPR).

Methods

The intervention consisted of a 6-minute educational video between a pre-and post-survey. Among other questions, the survey included the Calgary Charter on Health literacy scale, the acute coronary syndrome response index questionnaire, and items assessing knowledge of CPR.

Results

A total of 401 high school students participated (58.9% females). Few students had adequate baseline knowledge of heart attack symptoms (22%) and CPR (7%). The sample showed moderate level of health literacy (12 ± 2.7). Chest pain was the most identified symptom (95%) while abdominal pain was the least identified (14.25%). The intervention significantly increased knowledge, beliefs and attitudes towards heart attack, and knowledge of CPR (p < 0.001). Following the intervention, 83.2% of students demonstrated sufficient knowledge of heart attack symptoms, and 45% exhibited adequate knowledge of CPR. Variables predictive of better attitude, in other words higher confidence in recognizing and reacting to symptoms of heart attack, included having higher health literacy and prior knowledge of risk factors (p < 0.05). Needing help reading medical instructions sometimes predicted worse belief in their capacity to act if they experienced or witnessed a heart attack [score (p < 0.05)]. It was also predictive of worse attitude towards heart attack (OR = 0.18).

Conclusion

High school students in Lebanon lack appropriate knowledge, attitudes, and beliefs toward heart attack, and lack CPR qualifications. Scale up of this educational initiative, along with training of teachers and school personnel, can be used as part of a holistic HPS program aimed at raising awareness of heart attack and first responder preparedness.

The impact of perceived school climate on exercise behavior engagement among obese adolescents: a dual mediation effect test of exercise benefits and perseverance qualities

Introduction

This study explores the relationship between perceived school climate and exercise behavior among obese adolescents, as well as the multiple mediating effects of perseverance qualities and exercise benefits.

Methods

A survey was conducted on 586 obese adolescents in Beijing, with an age range of 13-18 years old and an average age of 15.40 ± 1.824, among who 337 were male, 249 were female, 303 were high school students and 238 were middle school students. A standard scale was used to evaluate perceived school climate, exercise benefits, perseverance qualities, and exercise behaviors. The data was analyzed by independent samples t-test, bivariate correlation analysis, descriptive statistical analysis, and structural equation model (SEM).

Results

(1) Perceived school climate among obese adolescents positively predicted exercise behavior (Z = 2.870, p < 0.01), perseverance qualities (Z = 3.107, p < 0.01) and exercise benefits (Z = 4.290, p < 0.001); perseverance qualities positively predicted exercise behavior in obese adolescents (Z = 4.431, p < 0.001); exercise benefits positively predicted the obese adolescents' exercise behavior (Z = 4.267, p < 0.001). (2) Perseverance qualities (Z = 2.282, 95% CI [0.032, 0.191], [0.028, 0.179]) and exercise benefits (Z = 2.518, 95% CI [0.060, 0.287], [0.053, 0.271]) play a mediating role in the obese adolescents' perceived school climate and exercise behavior, respectively. These two factors have parallel multiple mediating effects between obese adolescents' perceived school climate and exercise behavior, with mediating effects accounting for 16 and 25%, respectively. The mediating effect of exercise benefits is greater than that of perseverance qualities. (3) There is no difference in the specific indirect effects of perseverance qualities and exercise benefits (Z = -0.800, 95% CI [- 0.198, 0.064], [-0.190, 0.068]).

Conclusion

Obese adolescents' perception of school climate can effectively enhance their motivation to participate in exercise behavior and indirectly influence exercise behavior through exercise benefits and perseverance qualities, cultivate good physical exercise behavior among obese adolescents, and effectively prevent and intervene in the occurrence of obesity.