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Wolfenden L, McCrabb S, Barnes C, O'Brien KM, Ng KW, Nathan NK, Sutherland R, Hodder RK, Tzelepis F, Nolan E, Williams CM, Yoong SL. Strategies for enhancing the implementation of school-based policies or practices targeting diet, physical activity, obesity, tobacco or alcohol use. Cochrane Database Syst Rev 2022; 8:CD011677. [PMID: 36036664 PMCID: PMC9422950 DOI: 10.1002/14651858.cd011677.pub3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Several school-based interventions are effective in improving child diet and physical activity, and preventing excessive weight gain, and tobacco or harmful alcohol use. However, schools are frequently unsuccessful in implementing such evidence-based interventions. OBJECTIVES 1. To evaluate the benefits and harms of strategies aiming to improve school implementation of interventions to address student diet, physical activity, tobacco or alcohol use, and obesity. 2. To evaluate the benefits and harms of strategies to improve intervention implementation on measures of student diet, physical activity, obesity, tobacco use or alcohol use; describe their cost or cost-effectiveness; and any harms of strategies on schools, school staff or students. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search was between 1 September 2016 and 30 April 2021 to identify any relevant trials published since the last published review. SELECTION CRITERIA We defined 'Implementation' as the use of strategies to adopt and integrate evidence-based health interventions and to change practice patterns within specific settings. We included any trial (randomised controlled trial (RCT) or non-randomised controlled trial (non-RCT)) conducted at any scale, with a parallel control group that compared a strategy to implement policies or practices to address diet, physical activity, overweight or obesity, tobacco or alcohol use by students to 'no intervention', 'usual' practice or a different implementation strategy. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Given the large number of outcomes reported, we selected and included the effects of a single outcome measure for each trial for the primary (implementation) and secondary (student health behaviour and obesity) outcomes using a decision hierarchy. Where possible, we calculated standardised mean differences (SMDs) to account for variable outcome measures with 95% confidence intervals (CI). For RCTs, we conducted meta-analyses of primary and secondary outcomes using a random-effects model, or in instances where there were between two and five studies, a fixed-effect model. The synthesis of the effects for non-randomised studies followed the 'Synthesis without meta-analysis' (SWiM) guidelines. MAIN RESULTS We included an additional 11 trials in this update bringing the total number of included studies in the review to 38. Of these, 22 were conducted in the USA. Twenty-six studies used RCT designs. Seventeen trials tested strategies to implement healthy eating, 12 physical activity and six a combination of risk factors. Just one trial sought to increase the implementation of interventions to delay initiation or reduce the consumption of alcohol. All trials used multiple implementation strategies, the most common being educational materials, educational outreach and educational meetings. The overall certainty of evidence was low and ranged from very low to moderate for secondary review outcomes. Pooled analyses of RCTs found, relative to a control, the use of implementation strategies may result in a large increase in the implementation of interventions in schools (SMD 1.04, 95% CI 0.74 to 1.34; 22 RCTs, 1917 participants; low-certainty evidence). For secondary outcomes we found, relative to control, the use of implementation strategies to support intervention implementation may result in a slight improvement on measures of student diet (SMD 0.08, 95% CI 0.02 to 0.15; 11 RCTs, 16,649 participants; low-certainty evidence) and physical activity (SMD 0.09, 95% CI -0.02 to 0.19; 9 RCTs, 16,389 participants; low-certainty evidence). The effects on obesity probably suggest little to no difference (SMD -0.02, 95% CI -0.05 to 0.02; 8 RCTs, 18,618 participants; moderate-certainty evidence). The effects on tobacco use are very uncertain (SMD -0.03, 95% CIs -0.23 to 0.18; 3 RCTs, 3635 participants; very low-certainty evidence). One RCT assessed measures of student alcohol use and found strategies to support implementation may result in a slight increase in use (odds ratio 1.10, 95% CI 0.77 to 1.56; P = 0.60; 2105 participants). Few trials reported the economic evaluations of implementation strategies, the methods of which were heterogeneous and evidence graded as very uncertain. A lack of consistent terminology describing implementation strategies was an important limitation of the review. AUTHORS' CONCLUSIONS The use of implementation strategies may result in large increases in implementation of interventions, and slight improvements in measures of student diet, and physical activity. Further research is required to assess the impact of implementation strategies on such behavioural- and obesity-related outcomes, including on measures of alcohol use, where the findings of one trial suggest it may slightly increase student risk. Given the low certainty of the available evidence for most measures further research is required to guide efforts to facilitate the translation of evidence into practice in this setting.
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Affiliation(s)
- Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
| | - Sam McCrabb
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Courtney Barnes
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Kate M O'Brien
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Kwok W Ng
- Physical Activity for Health Research Cluster, Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensu, Finland
| | - Nicole K Nathan
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
| | - Rachel Sutherland
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
| | - Rebecca K Hodder
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
| | - Flora Tzelepis
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Erin Nolan
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Christopher M Williams
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
- Musculoskeletal Division, The George Institute for Global Health, Sydney, NSW, Australia
| | - Sze Lin Yoong
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
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An R, Li D, Cole M, Park K, Lyon AR, White NH. Implementation of School Diabetes Care in the United States: A Scoping Review. J Sch Nurs 2022; 38:61-73. [PMID: 34184953 PMCID: PMC9924139 DOI: 10.1177/10598405211026328] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Diabetes management at school demands close collaboration of multiple stakeholders, including students with diabetes and parents, school nurses, teachers/staff, and local health care providers. This scoping review identified and synthesized evidence concerning factors that contributed to the quality and effectiveness of diabetes care implementation in U.S. K-12 schools. Forty-six studies met the eligibility criteria and were included. Five common factors emerged surrounding training and experiences, communications, parent engagement, resource allocations, and school environment. Complex interactions between multiple stakeholders jointly determined the quality of school diabetes care. A conceptual model was established to elucidate the complex interactions between multiple stakeholders and the relevant facilitators and barriers. Future research should improve sample representativeness, contrast school diabetes care practices to the national guidelines, and assess the impact of the social, economic, and political environment at federal, state, local/district levels on school diabetes care implementation.
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Affiliation(s)
- Ruopeng An
- Brown School, 7548Washington University, St. Louis, MO, USA
| | - Danyi Li
- Brown School, 7548Washington University, St. Louis, MO, USA
| | - Marjorie Cole
- Missouri Department of Health & Senior Services, Jefferson City, MO, USA
| | | | - Aaron R Lyon
- Department of Psychiatry and Behavioral Sciences, 7284University of Washington, Seattle, WA, USA
| | - Neil H White
- School of Medicine, Washington University, St. Louis, MO, USA
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Mandoh M, Redfern J, Mihrshahi S, Cheng HL, Phongsavan P, Partridge SR. Shifting From Tokenism to Meaningful Adolescent Participation in Research for Obesity Prevention: A Systematic Scoping Review. Front Public Health 2022; 9:789535. [PMID: 35004591 PMCID: PMC8734426 DOI: 10.3389/fpubh.2021.789535] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/30/2021] [Indexed: 12/21/2022] Open
Abstract
Background: Traditionally, adolescent participation in research has been tokenistic. Adolescents are rarely afforded the opportunity to influence decision-making in research designed to prevent obesity. Engaging adolescents in meaningful decision-making may enhance research translation. This review aimed to analyze the current modes and nature of adolescent participation in obesity prevention research decision-making. Methods: A systematic scoping review was conducted using Arksey and O'Malley's six-stage framework. Six major databases were searched for peer-reviewed primary research studies with adolescent participation related to obesity, physical activity, and diet. Modes of adolescent participation were categorized based on the Lansdown-UNICEF conceptual framework for measuring outcomes of adolescent participation. The framework outlines three modes of meaningful participation: (i) consultative, which involves taking opinions and needs into consideration; (ii) collaborative, where adolescents are partners in the decision-making process; and (iii) adolescent-led participation where adolescents have the capacity to influence the process and outcomes. The degree of involvement in research cycles was classified based on the National Health and Medical Research Council consumer engagement framework. Five stages of the research cycle were determined: identify, design and develop, conduct, analyze and disseminate. Results: In total, 126 papers describing 71 unique studies were identified. Of these, 69% (49/71) took place in the USA, and 85% (52/61) were conducted in minority or underserved communities, while males were more likely to be under-represented. In 49% (35/71) of studies, participation was consultative and 9% (6/71) of studies involved an adolescent-led approach. Furthermore, 87% (62/71) of studies incorporated adolescent participation in one or more of the research cycle's formative phases, which involve eliciting views, opinions and idea generation. Only 11% of studies engaged adolescents in all five stages of the research cycle where adolescents could have more influence over the research process. Conclusion: Meaningful adolescent participation in the obesity prevention research cycle is limited. Empowering and mobilizing equal partnership with adolescents should be at the forefront of all adolescent-related obesity prevention research.
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Affiliation(s)
- Mariam Mandoh
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Julie Redfern
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,The George Institute for Global Health, The University of New South Wales, Camperdown, NSW, Australia
| | - Seema Mihrshahi
- Department of Health Systems and Populations, Macquarie University, Sydney, NSW, Australia.,Prevention Research Collaboration, Charles Perkins Centre, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Hoi Lun Cheng
- Sydney Medical School, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia.,The Children's Hospital at Westmead, Academic Department of Adolescent Medicine, Sydney, NSW, Australia
| | - Philayrath Phongsavan
- Prevention Research Collaboration, Charles Perkins Centre, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Stephanie R Partridge
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Prevention Research Collaboration, Charles Perkins Centre, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
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Arthur K, Christofides N, Nelson G. Effectiveness of a pre-adolescent inter-generational intervention to address HIV and obesity in South Africa, using a pretest-posttest design. BMC Public Health 2021; 21:2251. [PMID: 34895196 PMCID: PMC8665511 DOI: 10.1186/s12889-021-12228-z] [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: 09/16/2020] [Accepted: 11/13/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Strengthening pre-adolescents knowledge and skills through an age- and culturally-appropriate intervention could prevent health issues later in life. Early interventions could influence the trajectory of future risky behaviour, and may influence health behaviour amongst their parents. The CIrCLE of Life Initiative was developed to address HIV and obesity. We evaluated whether the combined intervention increased knowledge, enhanced skills, and/or promoted healthy behaviour among students (9-12 years old) and their parents. METHODS The study was conducted from May to December 2018. Trained educators delivered 30-min lessons over ten consecutive weeks with 537 Grade 6 students at five government-run schools, in a district, in South Africa. Schools were purposively selected based on socioeconomic status and urban-rural classification. Students communicated with parents through shared homework activities. A pretest-posttest study design was used, with a 3-month follow up. Both groups completed self-administered paper-based questionnaires. A score of subscales was used in analysis. The pretest and posttest scores were compared for students and parents using a dependent t-test. Differences in outcomes by school quintile were compared using one-way ANOVA. RESULTS Response rates were high for both students (80.6%) and their parents (83.4%). Statistically significant differences were observed in HIV knowledge in students pretest (mean 8.04, SD 3.10) and posttest scores (mean 10.1, SD 2.70; p < 0.01), and their parents (mean 10.32, SD 2.80 vs 11.0, SD 2.50; p < 0.01). For both students and parents, pre- and post-test obesity awareness mean scores were similar, 1.93, SD 0.92 and 2.78, SD 0.57; p < 0.01, for students; and 2.47, SD 0.82 and 2.81, SD 0.54; p < 0.01, for parents. In the posttest, statistically significant changes were also observed in both groups, enhancing skills in measuring body mass index and pulse rate, and interpreting food labels. Students had a high intention to share gained knowledge with parents who had a high intention to receive it (89.4 and 89.5%, respectively). CONCLUSION The intervention increased knowledge about HIV and obesity-related awareness, and it enhanced skills in selected outcomes among pre-adolescents and parents. Accurate messages and enhanced communication skills could support inter-generational knowledge transfer. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04307966 retrospectively registered on 12 March 2020.
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Affiliation(s)
- Keshni Arthur
- School of Public Health, University of the Witwatersrand, 27 St Andrews Road, Parktown, Johannesburg, 2193 South Africa
| | - Nicola Christofides
- School of Public Health, University of the Witwatersrand, 27 St Andrews Road, Parktown, Johannesburg, 2193 South Africa
| | - Gill Nelson
- School of Public Health, University of the Witwatersrand, 27 St Andrews Road, Parktown, Johannesburg, 2193 South Africa
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Hildrey R, Karner H, Serrao J, Lin CA, Shanley E, Duffy VB. Pediatric Adapted Liking Survey (PALS) with Tailored Nutrition Education Messages: Application to a Middle School Setting. Foods 2021; 10:579. [PMID: 33801962 PMCID: PMC8001433 DOI: 10.3390/foods10030579] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 02/23/2021] [Accepted: 03/08/2021] [Indexed: 12/14/2022] Open
Abstract
We tested the feasibility of a school-based, liking-based behavioral screener (Pediatric Adapted Liking Survey (PALS)) and message program to motivate healthy diet and activity behaviors. Students, recruited from middle- (n = 195) or low-income (n = 310) schools, online-reported: likes/dislikes of foods/beverages and physical/sedentary activities, scored into healthy behavior indexes (HBI); perceived food insecurity; and sleep indicators. Students received tailored motivating or reinforcing messages (aligned with behavior change theories) and indicated their willingness to improve target behaviors as well as program feasibility (acceptability; usefulness). Although HBIs averaged lower in the lower versus middle-income school, frequencies of food insecurity were similar (39-44% of students). Students in both schools reported sleep concerns (middle-income school-43% reported insufficient hours of sleep/night; low-income school-55% reported excessive daytime sleepiness). Students across both schools confirmed the PALS acceptability (>85% agreement to answering questions quickly and completion without help) and usefulness (≥73% agreed PALS got them thinking about their behaviors) as well as the tailored message acceptability (≥73% reported the messages as helpful; learning new information; wanting to receive more messages) and usefulness (73% reported "liking" to try one behavioral improvement). Neither message type nor response varied significantly by food insecurity or sleep measures. Thus, this program feasibly delivered students acceptable and useful messages to motivate healthier behaviors and identified areas for school-wide health promotion.
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Affiliation(s)
- Rachel Hildrey
- Department of Allied Health Sciences, University of CT, Storrs, CT 06269-1101, USA; (R.H.); (H.K.); (J.S.); (E.S.)
| | - Heidi Karner
- Department of Allied Health Sciences, University of CT, Storrs, CT 06269-1101, USA; (R.H.); (H.K.); (J.S.); (E.S.)
| | - Jessica Serrao
- Department of Allied Health Sciences, University of CT, Storrs, CT 06269-1101, USA; (R.H.); (H.K.); (J.S.); (E.S.)
| | - Carolyn A. Lin
- Communications Department, University of CT, Storrs, CT 06269-1101, USA;
| | - Ellen Shanley
- Department of Allied Health Sciences, University of CT, Storrs, CT 06269-1101, USA; (R.H.); (H.K.); (J.S.); (E.S.)
| | - Valerie B. Duffy
- Department of Allied Health Sciences, University of CT, Storrs, CT 06269-1101, USA; (R.H.); (H.K.); (J.S.); (E.S.)
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Wolfenden L, Nathan NK, Sutherland R, Yoong SL, Hodder RK, Wyse RJ, Delaney T, Grady A, Fielding A, Tzelepis F, Clinton‐McHarg T, Parmenter B, Butler P, Wiggers J, Bauman A, Milat A, Booth D, Williams CM. Strategies for enhancing the implementation of school-based policies or practices targeting risk factors for chronic disease. Cochrane Database Syst Rev 2017; 11:CD011677. [PMID: 29185627 PMCID: PMC6486103 DOI: 10.1002/14651858.cd011677.pub2] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND A number of school-based policies or practices have been found to be effective in improving child diet and physical activity, and preventing excessive weight gain, tobacco or harmful alcohol use. Schools, however, frequently fail to implement such evidence-based interventions. OBJECTIVES The primary aims of the review are to examine the effectiveness of strategies aiming to improve the implementation of school-based policies, programs or practices to address child diet, physical activity, obesity, tobacco or alcohol use.Secondary objectives of the review are to: Examine the effectiveness of implementation strategies on health behaviour (e.g. fruit and vegetable consumption) and anthropometric outcomes (e.g. BMI, weight); describe the impact of such strategies on the knowledge, skills or attitudes of school staff involved in implementing health-promoting policies, programs or practices; describe the cost or cost-effectiveness of such strategies; and describe any unintended adverse effects of strategies on schools, school staff or children. SEARCH METHODS All electronic databases were searched on 16 July 2017 for studies published up to 31 August 2016. We searched the following electronic databases: Cochrane Library including the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; MEDLINE In-Process & Other Non-Indexed Citations; Embase Classic and Embase; PsycINFO; Education Resource Information Center (ERIC); Cumulative Index to Nursing and Allied Health Literature (CINAHL); Dissertations and Theses; and SCOPUS. We screened reference lists of all included trials for citations of other potentially relevant trials. We handsearched all publications between 2011 and 2016 in two specialty journals (Implementation Science and Journal of Translational Behavioral Medicine) and conducted searches of the WHO International Clinical Trials Registry Platform (ICTRP) (http://apps.who.int/trialsearch/) as well as the US National Institutes of Health registry (https://clinicaltrials.gov). We consulted with experts in the field to identify other relevant research. SELECTION CRITERIA 'Implementation' was defined as the use of strategies to adopt and integrate evidence-based health interventions and to change practice patterns within specific settings. We included any trial (randomised or non-randomised) conducted at any scale, with a parallel control group that compared a strategy to implement policies or practices to address diet, physical activity, overweight or obesity, tobacco or alcohol use by school staff to 'no intervention', 'usual' practice or a different implementation strategy. DATA COLLECTION AND ANALYSIS Citation screening, data extraction and assessment of risk of bias was performed by review authors in pairs. Disagreements between review authors were resolved via consensus, or if required, by a third author. Considerable trial heterogeneity precluded meta-analysis. We narratively synthesised trial findings by describing the effect size of the primary outcome measure for policy or practice implementation (or the median of such measures where a single primary outcome was not stated). MAIN RESULTS We included 27 trials, 18 of which were conducted in the USA. Nineteen studies employed randomised controlled trial (RCT) designs. Fifteen trials tested strategies to implement healthy eating policies, practice or programs; six trials tested strategies targeting physical activity policies or practices; and three trials targeted tobacco policies or practices. Three trials targeted a combination of risk factors. None of the included trials sought to increase the implementation of interventions to delay initiation or reduce the consumption of alcohol. All trials examined multi-strategic implementation strategies and no two trials examined the same combinations of implementation strategies. The most common implementation strategies included educational materials, educational outreach and educational meetings. For all outcomes, the overall quality of evidence was very low and the risk of bias was high for the majority of trials for detection and performance bias.Among 13 trials reporting dichotomous implementation outcomes-the proportion of schools or school staff (e.g. classes) implementing a targeted policy or practice-the median unadjusted (improvement) effect sizes ranged from 8.5% to 66.6%. Of seven trials reporting the percentage of a practice, program or policy that had been implemented, the median unadjusted effect (improvement), relative to the control ranged from -8% to 43%. The effect, relative to control, reported in two trials assessing the impact of implementation strategies on the time per week teachers spent delivering targeted policies or practices ranged from 26.6 to 54.9 minutes per week. Among trials reporting other continuous implementation outcomes, findings were mixed. Four trials were conducted of strategies that sought to achieve implementation 'at scale', that is, across samples of at least 50 schools, of which improvements in implementation were reported in three trials.The impact of interventions on student health behaviour or weight status were mixed. Three of the eight trials with physical activity outcomes reported no significant improvements. Two trials reported reductions in tobacco use among intervention relative to control. Seven of nine trials reported no between-group differences on student overweight, obesity or adiposity. Positive improvements in child dietary intake were generally reported among trials reporting these outcomes. Three trials assessed the impact of implementation strategies on the attitudes of school staff and found mixed effects. Two trials specified in the study methods an assessment of potential unintended adverse effects, of which, they reported none. One trial reported implementation support did not significantly increase school revenue or expenses and another, conducted a formal economic evaluation, reporting the intervention to be cost-effective. Trial heterogeneity, and the lack of consistent terminology describing implementation strategies, were important limitations of the review. AUTHORS' CONCLUSIONS Given the very low quality of the available evidence, it is uncertain whether the strategies tested improve implementation of the targeted school-based policies or practices, student health behaviours, or the knowledge or attitudes of school staff. It is also uncertain if strategies to improve implementation are cost-effective or if they result in unintended adverse consequences. Further research is required to guide efforts to facilitate the translation of evidence into practice in this setting.
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Coates VE, Horigan G, Davies M, Davies MT. Exploring why young people with Type 1 diabetes decline structured education with a view to overcoming barriers. Diabet Med 2017; 34:1092-1099. [PMID: 28430377 DOI: 10.1111/dme.13368] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2017] [Indexed: 12/13/2022]
Abstract
AIMS To identify factors that influence lack of engagement of young adults with Type 1 diabetes (aged 13-21 years) with structured diabetes education (SDE) to inform and broaden the reach of future SDE. METHODS A quantitative, cross-sectional survey was undertaken of 227 young people with Type 1 diabetes drawn from 11 health trusts across Northern Ireland and England, deemed to be representative of the wider population. Participants were asked to complete a questionnaire exploring non-attendance, along with the Diabetes Care Profile, the Diabetes Empowerment Scale (Short Form), the Diabetes Knowledge Test and the 12-item General Health Questionnaire. Demographic, health and diabetes-specific variables including HbA1c were also collected. RESULTS The five most commonly cited reasons for non-attendance were 'Had other things to do' (68.3%), 'No time' (62.2%), 'Could not get time off school/college or work' (60.8%), 'Learnt about diabetes from other sources' (55.5%) and 'Feel able to cope on own' (52.9%). CONCLUSIONS Greater emphasis is required on communication with young people about the benefits of SDE. In addition, efforts need to be directed to making diabetes education more accessible without losing the quality of structured programmes.
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Affiliation(s)
- V E Coates
- School of Nursing, Ulster University, and Western Health and Social Care Trust, Londonderry
| | - G Horigan
- School of Nursing, Ulster University, and Western Health and Social Care Trust, Londonderry
| | - M Davies
- Diabetes Research Centre, Leicester Diabetes Centre, University of Leicester, Leicester
| | - M T Davies
- Clinical Psychology Department, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, UK
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Huhman M, Kelly RP, Edgar T. Social Marketing as a Framework for Youth Physical Activity Initiatives: a 10-Year Retrospective on the Legacy of CDC's VERB Campaign. Curr Obes Rep 2017; 6:101-107. [PMID: 28421471 DOI: 10.1007/s13679-017-0252-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE OF REVIEW In 2002, the U.S. Centers for Disease Control and Prevention (CDC) launched the VERB. It's what you do! campaign to increase physical activity among tweens and concomitantly respond to the rise in childhood obesity. This retrospective study summarizes the history of the VERB campaign's social marketing approach and its effectiveness in promoting behavior change in the targeted population. RECENT FINDINGS The legacy of VERB, which ended in 2006, is discussed, with an emphasis on examining initiatives over the last decade and the degree to which they followed (or did not follow) the structural and thematic lead of the campaign. The article ends with suggestions for how VERB still has the potential to inform other social marketing campaigns going forward.
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Affiliation(s)
- Marian Huhman
- Department of Communication, University of Illinois at Urbana-Champaign, 3001 Lincoln Hall, 702 S. Wright Street, MC 456, Urbana, IL, 61801, USA.
| | - Ryan P Kelly
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA
| | - Timothy Edgar
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA
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Novel measures of inflammation and insulin resistance are related to obesity and fitness in a diverse sample of 11-14 year olds: The HEALTHY Study. Int J Obes (Lond) 2016; 40:1157-63. [PMID: 27143035 PMCID: PMC4935612 DOI: 10.1038/ijo.2016.84] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 03/01/2016] [Accepted: 04/19/2016] [Indexed: 12/25/2022]
Abstract
Background GlycA is a novel serum marker of systemic inflammation. There is no information on GlycA in pediatric populations, how it differs by gender or its association with body mass index (BMI) or fitness. LP-IR is a serum measure of insulin resistance which is related to changes in BMI group in adolescents, but its relationship with fitness is unknown. The current study examined the independent associations between fitness and BMI with GlycA and LP-IR among US adolescents. Methods Participants were 1664 US adolescents from the HEALTHY study with complete 6th and 8th grade BMI, fitness and blood data. GlycA and LP-IR were measured by NMR spectroscopy. Three BMI groups and three fitness groups were created. Linear mixed models examined associations between GlycA, LP-IR, fitness and BMI. Results LP-IR decreased between 6th and 8th grade. GlycA increased among girls but decreased among boys. At 8th grade, median GlycA values were 27 (7.6%) μmol/L higher (381 versus 354) for girls than boys. Median GlycA 6th grade values were 9% higher in obese girls than healthy weight girls. Overall there was strong evidence (p<0.001) that GlycA was higher in higher BMI groups. Fitness was negatively associated with GlycA (r = −0.37 and −0.35) and LP-IR (r = −0.34 and − 0.18) at the 6th and 8th grade assessments. As BMI category increased and fitness category decreased, GlycA and LP-IR levels increased. Lowest GlycA was found in the low BMI/high fitness group. Conclusions GlycA was associated with BMI and fitness among in US adolescents. These findings suggest that there are independent effects for BMI and fitness group with both GlycA and LP-IR. Future studies should validate the role of GlycA and LP-IR to evaluate the effects of interventions to modify obesity and fitness in order to improve systemic inflammation and insulin resistance.
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Vieth A, Woodrow J, Murphy-Goodridge J, O'Neil C, Roebothan B. The Ability of Posters to Enhance the Comfort Level with Breastfeeding in a Public Venue in Rural Newfoundland and Labrador. J Hum Lact 2016; 32:174-81. [PMID: 26151965 DOI: 10.1177/0890334415593944] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 05/26/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND The acceptance and support of breastfeeding in public venues can influence breastfeeding practices and, ultimately, the health of the population. OBJECTIVE The primary aim of this study was to investigate whether posters targeted at the general public could improve acceptability of breastfeeding in public places. METHODS A convenience sample of 255 participants was surveyed at shopping centers in 2 rural communities of Newfoundland and Labrador. Experimentally, questions were posed to 117 participants pre- and post-exposure to 2 specific posters designed to promote public acceptance of breastfeeding in public. RESULTS Initially, we surveyed that only 51.9% of participants indicated that they were comfortable with a woman breastfeeding anywhere in public. However, context played a role, whereby a doctor's office (84.5%) or park (81.4%) were the most acceptable public places for breastfeeding, but least acceptable was a business office environment (66.7%). Of participants, 35.4% indicated previously viewing specific posters. We used a visual analog scale to test poster viewing on the acceptability of public breastfeeding in the context of a doctor's office and a restaurant. Results of pre- versus post-viewing of the promotional posters indicated significant improvements in both scenarios: in a doctor's office (P = .035) and in a restaurant (P = .021). CONCLUSION Nearly 50% of the surveyed population indicated discomfort with a mother breastfeeding in public. Both cross-sectional and interventional evidence showed that posters significantly improved the reported level of comfort toward seeing breastfeeding in public.
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Affiliation(s)
- Alissa Vieth
- Memorial University of Newfoundland, St John's, NF, Canada
| | - Janine Woodrow
- Memorial University of Newfoundland, St John's, NF, Canada
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Kohlstadt IC, Steeves ETA, Rice K, Gittelsohn J, Summerfield LM, Gadhoke P. Youth peers put the "invent" into NutriBee's online intervention. Nutr J 2015; 14:60. [PMID: 26077664 PMCID: PMC4470038 DOI: 10.1186/s12937-015-0031-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 04/27/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Early adolescents perceive peers as credible and relatable. Peers therefore have a unique conduit to engage early adolescents in positive health behaviors through nutrition learning such as that recommended by the U.S. Institute of Medicine (IOM). PURPOSE We developed an online, peer leader component to an existing in-person preventive nutrition intervention called NutriBee. We reasoned that youth ages 13-18 could create intervention materials that could remain engaging, credible and relatable to younger peers ages 10-12 online. Peer leaders could potentially derive health benefits from their service-learning experience. METHODS From 2013-2014 youth could apply online to relate a personal interest to nutrition, an opportunity promoted at NutriBee pilot sites and through social media. The peer leaders with diverse backgrounds honed original ideas into tangible projects with the support of adult subject-matter experts chosen by the youth. Nutrition expertise was provided by NutriBee staff who then also converted the youth-invented projects from various media into an online curriculum. RESULTS 19 of 27 (70%) of selected youth from 12 states and diverse backgrounds, created an online curriculum comprising 10% of NutriBee's 20-hour intervention. All 19 online projects modeled 1 or more of NutriBee's 10 positive health behaviors; 8 evoked the chemosenses; 6 conveyed food texture; and 13 provided social context. Peer leaders perceived career advancement and service learning benefits. The dose, pedagogic approach, and project content align with the IOM recommendation. CONCLUSIONS Youth created intervention materials which communicate positive health behaviors online in ways peers can adopt. In a customarily sight-sound digital platform, youth leveraged the senses of smell, taste and touch and social context important for food selection. Peer leaders derived health benefit, as indirectly assessed by IOM criteria.
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Affiliation(s)
- Ingrid C Kohlstadt
- Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, 198 Prince George St., Annapolis, Baltimore, 21401, MD, USA.
| | - Elizabeth T Anderson Steeves
- Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, 198 Prince George St., Annapolis, Baltimore, 21401, MD, USA.
- University of Wisconsin, Milwaukee, WI, USA.
| | - Kerry Rice
- Boise State University, Department of Educational Technology, Boise, ID, USA.
| | - Joel Gittelsohn
- Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, 198 Prince George St., Annapolis, Baltimore, 21401, MD, USA.
| | | | - Preety Gadhoke
- St. John's University, College of Pharmacy and Health Sciences, New York, USA.
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Carins JE, Rundle-Thiele SR. Eating for the better: a social marketing review (2000-2012). Public Health Nutr 2014; 17:1628-39. [PMID: 23711161 PMCID: PMC10282391 DOI: 10.1017/s1368980013001365] [Citation(s) in RCA: 164] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 02/19/2013] [Accepted: 04/04/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The present study sought to identify both the ingredients for success and the potential impediments to social marketing effectiveness for healthy eating behaviour, focusing on studies conducted over the last 10 years. DESIGN A comprehensive literature review was undertaken examining seventeen databases to identify studies reporting the use of social marketing to address healthy eating. Thirty-four empirical studies were analysed to examine the effectiveness of social marketing interventions to improve healthy eating behaviour using Andreasen's (2002) social marketing benchmark criteria. Statistical analysis was undertaken to quantitatively evaluate whether effectiveness varied between study categories (subsets). SETTING Healthy eating empirical studies published from 2000 onwards. SUBJECTS Empirical studies that self-identified as social marketing. RESULTS Sixteen social marketing studies (subset 1) were identified in the review. These were systematic studies which sought to change behaviour through tailored solutions (e.g. use of marketing tools beyond communication was clearly evident) that delivered value to the target audience. For these sixteen studies, the mean number of criteria identified was five. Six studies met all six criteria. Positive change to healthy eating behaviour was found in fourteen of sixteen studies. The sixteen studies that met the definition of social marketing used significantly more of Andreasen's (2002) criteria and were more effective in achieving behavioural change than the eighteen studies in subset 2. CONCLUSIONS Social marketing is an involved process and it is important that studies identifying as social marketing adopt social marketing benchmark criteria. Social marketing when employed to its full extent offers the potential to change healthy eating.
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Affiliation(s)
- Julia E Carins
- Griffith Business School, Griffith University, Nathan, Queensland, Australia
- Population and Social Health Research Program, Griffith University, Nathan, Queensland, Australia
- Defence Science and Technology Organisation (DSTO), 74 George Street, Scottsdale, Tasmania 7260, Australia
| | - Sharyn R Rundle-Thiele
- Griffith Business School, Griffith University, Nathan, Queensland, Australia
- Population and Social Health Research Program, Griffith University, Nathan, Queensland, Australia
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School factors as barriers to and facilitators of a preventive intervention for pediatric type 2 diabetes. Transl Behav Med 2014; 4:131-40. [PMID: 24904696 DOI: 10.1007/s13142-013-0226-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
School-based interventions are essential to prevent pediatric obesity and type 2 diabetes. School environmental factors influence implementation of these interventions. This article examines how school factors acted as barriers to and facilitators of the HEALTHY intervention. The HEALTHY study was a cluster-randomized trial of a multicomponent intervention implemented in 21 schools. Interview data were analyzed to identify barriers and facilitators. Barriers included teacher frustration that intervention activities detracted from tested subjects, student resistance and misbehavior, classroom management problems, communication equipment problems, lack of teacher/staff engagement, high cost and limited availability of nutritious products, inadequate facility space, and large class sizes. Facilitators included teacher/staff engagement, effective classroom management, student engagement, schools with direct control over food service, support from school leaders, and adequate facilities and equipment. Contextual barriers and facilitators must be taken into account in the design and implementation of school-based health interventions.
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Jago R, Drews KL, Otvos JD, Foster GD, Marcus MD, Buse JB, Mietus-Snyder M, Willi SM. Effect of relative weight group change on nuclear magnetic resonance spectroscopy derived lipoprotein particle size and concentrations among adolescents. J Pediatr 2014; 164:1091-1098.e3. [PMID: 24508445 PMCID: PMC3992168 DOI: 10.1016/j.jpeds.2013.12.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 10/24/2013] [Accepted: 12/13/2013] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To examine whether longitudinal changes in relative weight category (as indicated by change in body mass index [BMI] classification group) were associated with changes in nuclear magnetic resonance (NMR)-derived lipoprotein particles among US youth. STUDY DESIGN Secondary analysis of data from a clustered randomized controlled trial. BMI and fasting blood samples were obtained from 2069 participants at the start of the 6th grade and end of the 8th grade. BMI was categorized as normal weight, overweight, or obese at both time points. Lipoprotein particle profiles were measured with NMR spectroscopy at both time points. Regression models were used to examine changes in relative weight group and change in lipoprotein variables. RESULTS A total of 38% of participants changed relative weight category (BMI group) during the 2.5-year study period. Low-density lipoprotein (LDL) cholesterol and non-high-density lipoprotein (HDL) cholesterol decreased almost universally, but more with improved BMI category. There were adverse effects on LDL size and total LDL particles, HDL size, and cholesterol for participants who remained obese or whose relative weight group worsened. Changes in relative category had no impact on HDL particles. CONCLUSION Improvement in relative weight group from 6th to 8th grade was associated with favorable changes in non-HDL cholesterol, very low-density lipoprotein size, LDL size, HDL size, and LDL particles but had no effect on HDL particles. Findings indicate that an improvement in relative weight group between 6th and 8th grade had an effect on NMR-derived particles sizes and concentrations among a large group of adolescents, which overrepresented low-income minorities.
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Affiliation(s)
- Russell Jago
- Center for Exercise, Nutrition & Health, School for Policy Studies, University of Bristol, Bristol, United Kingdom.
| | | | | | - Gary D. Foster
- Center for Obesity Research and Education, Temple University
| | | | | | - Michele Mietus-Snyder
- George Washington University School of Medicine & Health Sciences & Children’s National Medical Center
| | - Steven M. Willi
- Children’s Hospital of Philadelphia & Perelman School of Medicine of the University of Pennsylvania
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Langford R, Bonell CP, Jones HE, Pouliou T, Murphy SM, Waters E, Komro KA, Gibbs LF, Magnus D, Campbell R. The WHO Health Promoting School framework for improving the health and well-being of students and their academic achievement. Cochrane Database Syst Rev 2014; 2014:CD008958. [PMID: 24737131 PMCID: PMC11214127 DOI: 10.1002/14651858.cd008958.pub2] [Citation(s) in RCA: 272] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The World Health Organization's (WHO's) Health Promoting Schools (HPS) framework is an holistic, settings-based approach to promoting health and educational attainment in school. The effectiveness of this approach has not been previously rigorously reviewed. OBJECTIVES To assess the effectiveness of the Health Promoting Schools (HPS) framework in improving the health and well-being of students and their academic achievement. SEARCH METHODS We searched the following electronic databases in January 2011 and again in March and April 2013: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, CINAHL, Campbell Library, ASSIA, BiblioMap, CAB Abstracts, IBSS, Social Science Citation Index, Sociological Abstracts, TRoPHI, Global Health Database, SIGLE, Australian Education Index, British Education Index, Education Resources Information Centre, Database of Education Research, Dissertation Express, Index to Theses in Great Britain and Ireland, ClinicalTrials.gov, Current controlled trials, and WHO International Clinical Trials Registry Platform. We also searched relevant websites, handsearched reference lists, and used citation tracking to identify other relevant articles. SELECTION CRITERIA We included cluster-randomised controlled trials where randomisation took place at the level of school, district or other geographical area. Participants were children and young people aged four to 18 years, attending schools or colleges. In this review, we define HPS interventions as comprising the following three elements: input to the curriculum; changes to the school's ethos or environment or both; and engagement with families or communities, or both. We compared this intervention against schools that implemented either no intervention or continued with their usual practice, or any programme that included just one or two of the above mentioned HPS elements. DATA COLLECTION AND ANALYSIS At least two review authors identified relevant trials, extracted data, and assessed risk of bias in the trials. We grouped different types of interventions according to the health topic targeted or the approach used, or both. Where data permitted, we performed random-effects meta-analyses to provide a summary of results across studies. MAIN RESULTS We included 67 eligible cluster trials, randomising 1443 schools or districts. This is made up of 1345 schools and 98 districts. The studies tackled a range of health issues: physical activity (4), nutrition (12), physical activity and nutrition combined (18), bullying (7), tobacco (5), alcohol (2), sexual health (2), violence (2), mental health (2), hand-washing (2), multiple risk behaviours (7), cycle-helmet use (1), eating disorders (1), sun protection (1), and oral health (1). The quality of evidence overall was low to moderate as determined by the GRADE approach. 'Risk of bias' assessments identified methodological limitations, including heavy reliance on self-reported data and high attrition rates for some studies. In addition, there was a lack of long-term follow-up data for most studies.We found positive effects for some interventions for: body mass index (BMI), physical activity, physical fitness, fruit and vegetable intake, tobacco use, and being bullied. Intervention effects were generally small but have the potential to produce public health benefits at the population level. We found little evidence of effectiveness for standardised body mass index (zBMI) and no evidence of effectiveness for fat intake, alcohol use, drug use, mental health, violence and bullying others; however, only a small number of studies focused on these latter outcomes. It was not possible to meta-analyse data on other health outcomes due to lack of data. Few studies provided details on adverse events or outcomes related to the interventions. In addition, few studies included any academic, attendance or school-related outcomes. We therefore cannot draw any clear conclusions as to the effectiveness of this approach for improving academic achievement. AUTHORS' CONCLUSIONS The results of this review provide evidence for the effectiveness of some interventions based on the HPS framework for improving certain health outcomes but not others. More well-designed research is required to establish the effectiveness of this approach for other health topics and academic achievement.
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Affiliation(s)
- Rebecca Langford
- University of BristolSchool of Social and Community MedicineCanynge Hall39 Whatley RoadBristolUKBS8 2PS
| | - Christopher P Bonell
- Institute of Education, University of LondonSocial Science Research Unit18 Woburn SquareLondonLondonUKWC1H 0NR
| | - Hayley E Jones
- University of BristolSchool of Social and Community MedicineCanynge Hall39 Whatley RoadBristolUKBS8 2PS
| | - Theodora Pouliou
- University of BristolSchool of Social and Community MedicineCanynge Hall39 Whatley RoadBristolUKBS8 2PS
| | - Simon M Murphy
- Cardiff UniversityCardiff School of Social Sciences1‐3 Museum PlaceCardiffSouth GlamorganUKCF10 3BD
| | - Elizabeth Waters
- The University of MelbourneJack Brockhoff Child Health and Wellbeing Program, Melbourne School of Population and Global HealthLevel 5/207 Bouverie StParkvilleVICAustralia3052
| | - Kelli A Komro
- University of FloridaHealth Outcomes and Policy and Institute for Child Health PolicyPO Box 100177GainesvilleFloridaUSA32610‐0177
| | - Lisa F Gibbs
- The University of MelbourneJack Brockhoff Child Health and Wellbeing Program, Melbourne School of Population and Global HealthLevel 5/207 Bouverie StParkvilleVICAustralia3052
| | - Daniel Magnus
- University of BristolSchool of Social and Community MedicineCanynge Hall39 Whatley RoadBristolUKBS8 2PS
| | - Rona Campbell
- University of BristolSchool of Social and Community MedicineCanynge Hall39 Whatley RoadBristolUKBS8 2PS
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Marcus MD, Foster GD, ghormli LE. Stability of relative weight category and cardiometabolic risk factors among moderately and severely obese middle school youth. Obesity (Silver Spring) 2014; 22:1118-25. [PMID: 24376009 PMCID: PMC3968217 DOI: 10.1002/oby.20688] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 12/17/2013] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To examine the stability of severe pediatric obesity relative to moderate obesity and associated changes in cardiometabolic risk from the beginning of 6th to the end of 8th grade. METHODS Participants in HEALTHY, a multi-site, cluster randomized school-based study designed to mitigate risk for type 2 diabetes, completed standardized assessments of height, weight, glucose, insulin, lipids, and blood pressure at the beginning of 6th grade and the end of 8th grade. Youth were classified as moderately obese (100-119% of the 95th percentile of BMI for age and gender) or severely obese (≥120% of the 95th percentile of BMI for age and gender). Generalized linear mixed models (GLMM) that controlled for relevant covariables were used to examine the relation between baseline demographic and cardiometabolic risk factors and BMI status, as well as changes in relative weight category and risk factors during middle school. RESULTS Severe obesity was more likely to endure over the course of middle school than was moderate obesity, and was associated with significantly higher levels of cardiometabolic risk. CONCLUSIONS Research with a specific focus on understanding, preventing, and treating severe obesity in children is warranted.
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Affiliation(s)
- Marsha D. Marcus
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Gary D. Foster
- Center for Obesity Research and Education, Temple University
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Volpe SL, Hall WJ, Steckler A, Schneider M, Thompson D, Mobley C, Pham T, El ghormli L. Process evaluation results from the HEALTHY nutrition intervention to modify the total school food environment. HEALTH EDUCATION RESEARCH 2013; 28:970-978. [PMID: 24107856 PMCID: PMC3888190 DOI: 10.1093/her/cyt096] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 09/10/2013] [Indexed: 06/02/2023]
Abstract
The process evaluation of HEALTHY, a large multi-center trial to decrease type 2 diabetes mellitus in middle school children, monitored the implementation of the intervention to ascertain the extent that components were delivered and received as intended. The purpose of this article is to report the process evaluation findings concerning the extent to which the HEALTHY nutrition intervention was implemented during the HEALTHY trial. Overall, the observed fidelity of implementing nutrition strategies improved from baseline to the end of the study. By the last semester, all but two nutrition process evaluation goals were met. The most challenging goal to implement was serving high fiber foods, including grain-based foods and legumes. The easiest goals to implement were lowering the fat content of foods offered and offering healthier beverages. The most challenging barriers experienced by research dietitians and food service staff were costs, availability of foods and student acceptance. Forming strong relationships between the research dietitians and food service staff was identified as a key strategy to meet HEALTHY nutrition goals.
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Affiliation(s)
- S. L. Volpe
- Department of Nutrition Sciences, College of Nursing and Health Professions, Drexel University, PA 19102, School of Nursing, Health Behavior Department, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, Department of Planning, Policy and Design, School of Social Ecology, University of California at Irvine, Irvine, CA 92697, USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX 77030, Department of Biomedical Sciences, School of Dental Medicine, University of Nevada Las Vegas, Las Vegas, NV 89154 and Biostatistics Center, The George Washington University, Rockville, MD 20852, USA
| | - W. J. Hall
- Department of Nutrition Sciences, College of Nursing and Health Professions, Drexel University, PA 19102, School of Nursing, Health Behavior Department, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, Department of Planning, Policy and Design, School of Social Ecology, University of California at Irvine, Irvine, CA 92697, USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX 77030, Department of Biomedical Sciences, School of Dental Medicine, University of Nevada Las Vegas, Las Vegas, NV 89154 and Biostatistics Center, The George Washington University, Rockville, MD 20852, USA
| | - A. Steckler
- Department of Nutrition Sciences, College of Nursing and Health Professions, Drexel University, PA 19102, School of Nursing, Health Behavior Department, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, Department of Planning, Policy and Design, School of Social Ecology, University of California at Irvine, Irvine, CA 92697, USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX 77030, Department of Biomedical Sciences, School of Dental Medicine, University of Nevada Las Vegas, Las Vegas, NV 89154 and Biostatistics Center, The George Washington University, Rockville, MD 20852, USA
| | - M. Schneider
- Department of Nutrition Sciences, College of Nursing and Health Professions, Drexel University, PA 19102, School of Nursing, Health Behavior Department, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, Department of Planning, Policy and Design, School of Social Ecology, University of California at Irvine, Irvine, CA 92697, USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX 77030, Department of Biomedical Sciences, School of Dental Medicine, University of Nevada Las Vegas, Las Vegas, NV 89154 and Biostatistics Center, The George Washington University, Rockville, MD 20852, USA
| | - D. Thompson
- Department of Nutrition Sciences, College of Nursing and Health Professions, Drexel University, PA 19102, School of Nursing, Health Behavior Department, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, Department of Planning, Policy and Design, School of Social Ecology, University of California at Irvine, Irvine, CA 92697, USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX 77030, Department of Biomedical Sciences, School of Dental Medicine, University of Nevada Las Vegas, Las Vegas, NV 89154 and Biostatistics Center, The George Washington University, Rockville, MD 20852, USA
| | - C. Mobley
- Department of Nutrition Sciences, College of Nursing and Health Professions, Drexel University, PA 19102, School of Nursing, Health Behavior Department, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, Department of Planning, Policy and Design, School of Social Ecology, University of California at Irvine, Irvine, CA 92697, USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX 77030, Department of Biomedical Sciences, School of Dental Medicine, University of Nevada Las Vegas, Las Vegas, NV 89154 and Biostatistics Center, The George Washington University, Rockville, MD 20852, USA
| | - T. Pham
- Department of Nutrition Sciences, College of Nursing and Health Professions, Drexel University, PA 19102, School of Nursing, Health Behavior Department, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, Department of Planning, Policy and Design, School of Social Ecology, University of California at Irvine, Irvine, CA 92697, USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX 77030, Department of Biomedical Sciences, School of Dental Medicine, University of Nevada Las Vegas, Las Vegas, NV 89154 and Biostatistics Center, The George Washington University, Rockville, MD 20852, USA
| | - L. El ghormli
- Department of Nutrition Sciences, College of Nursing and Health Professions, Drexel University, PA 19102, School of Nursing, Health Behavior Department, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, Department of Planning, Policy and Design, School of Social Ecology, University of California at Irvine, Irvine, CA 92697, USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX 77030, Department of Biomedical Sciences, School of Dental Medicine, University of Nevada Las Vegas, Las Vegas, NV 89154 and Biostatistics Center, The George Washington University, Rockville, MD 20852, USA
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Hernandez AE, Marcus MD, Hirst K, Faith MS, Goldberg L, Treviño RP. Impact of implementation and conduct of the HEALTHY primary prevention trial on student performance. Am J Health Promot 2013; 29:55-8. [PMID: 24200256 DOI: 10.4278/ajhp.130131-arb-53] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To determine whether a school-wide intervention program to reduce risk factors for type 2 diabetes (T2D) affected student achievement, rates of disciplinary actions, and attendance rates. DESIGN The HEALTHY primary prevention trial was designed to evaluate a comprehensive school-based intervention to reduce factors for T2D, especially overweight and obesity. Students were followed up from beginning of sixth grade (Fall 2006) through end of eighth grade (Spring 2009). SETTING Forty-two middle schools at seven U.S. sites. SUBJECTS Schools were randomized in equal numbers at each site to intervention (21 schools, 2307 students) or control (21 schools, 2296 students). Intervention . An integrated school-wide program that focused on (1) foods and beverages, (2) physical education, (3) classroom-based behavior change and education, and (4) social marketing communication and promotional campaigns. MEASURES Aggregate (grade- and school-wide) test performance (passing rate), attendance, and referrals for disciplinary actions. ANALYSIS Descriptive statistics and tests of intervention versus control using mixed linear models methods to adjust for the clustering of students within schools. RESULTS There were no differences between intervention and control schools in test performance for mathematics (p = .7835) or reading (p = .6387), attendance (p = .5819), or referrals for disciplinary action (p = .8671). CONCLUSION The comprehensive HEALTHY intervention and associated research procedures did not negatively impact student achievement test scores, attendance, or referrals for disciplinary action.
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Bell AC, Wolfenden L, Sutherland R, Coggan L, Young K, Fitzgerald M, Hodder R, Orr N, Milat AJ, Wiggers J. Harnessing the power of advertising to prevent childhood obesity. Int J Behav Nutr Phys Act 2013; 10:114. [PMID: 24090174 PMCID: PMC3852185 DOI: 10.1186/1479-5868-10-114] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 09/23/2013] [Indexed: 11/17/2022] Open
Abstract
Background Social marketing integrates communication campaigns with behavioural and environmental change strategies. Childhood obesity programs could benefit significantly from social marketing but communication campaigns on this issue tend to be stand-alone. Methods A large-scale multi-setting child obesity prevention program was implemented in the Hunter New England (HNE) region of New South Wales (NSW), Australia from 2005–2010. The program included a series of communication campaigns promoting the program and its key messages: drinking water; getting physically active and; eating more vegetables and fruit. Pre-post telephone surveys (n = 9) were undertaken to evaluate awareness of the campaigns among parents of children aged 2–15 years using repeat cross-sections of randomly selected cohorts. A total of 1,367 parents (HNE = 748, NSW = 619) participated. Results At each survey post baseline, HNE parents were significantly more likely to have seen, read or heard about the program and its messages in the media than parents in the remainder of the state (p < 0.001). Further, there was a significant increase in awareness of the program and each of its messages over time in HNE compared to no change over time in NSW (p < 0.001). Awareness was significantly higher (p < 0.05) in HNE compared to NSW after each specific campaign (except the vegetable one) and significantly higher awareness levels were sustained for each campaign until the end of the program. At the end of the program participants without a tertiary education were significantly more likely (p = 0.04) to be aware of the brand campaign (31%) than those with (20%) but there were no other statistically significant socio-demographic differences in awareness. Conclusions The Good for Kids communication campaigns increased and maintained awareness of childhood obesity prevention messages. Moreover, messages were delivered equitably to diverse socio-demographic groups within the region.
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Affiliation(s)
- Andrew Colin Bell
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.
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Schneider M, DeBar L, Calingo A, Hall W, Hindes K, Sleigh A, Thompson D, Volpe SL, Zeveloff A, Pham T, Steckler A. The effect of a communications campaign on middle school students' nutrition and physical activity: results of the HEALTHY study. JOURNAL OF HEALTH COMMUNICATION 2013; 18:649-667. [PMID: 23409792 PMCID: PMC3669645 DOI: 10.1080/10810730.2012.743627] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The HEALTHY Study was a 3-year school-based intervention designed to change the behaviors of middle school students to reduce their risk for developing type 2 diabetes mellitus. This report examines the relation between exposure to communications campaign materials and behavior change among students in the HEALTHY intervention schools. Using data from campaign tracking logs and student interviews, the authors examined communications campaign implementation and exposure to the communications campaign as well as health behavior change. Campaign tracking documents revealed variability across schools in the quantity of communications materials disseminated. Student interviews confirmed that there was variability in the proportion of students who reported receiving information from the communication campaign elements. Correlations and regression analysis controlling for semester examined the association between campaign exposure and behavior change across schools. There was a significant association between the proportion of students exposed to the campaign and the proportion of students who made changes in health behavior commensurate with study goals. The results suggest that, in the context of a multifaceted school-based health promotion intervention, schools that achieve a higher rate of exposure to communication campaign materials among the students may stimulate greater health behavior change.
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Marcus MD, Hirst K, Kaufman F, Foster GD, Baranowski T. Lessons learned from the HEALTHY primary prevention trial of risk factors for type 2 diabetes in middle school youth. Curr Diab Rep 2013; 13:63-71. [PMID: 23065367 PMCID: PMC3544993 DOI: 10.1007/s11892-012-0333-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The HEALTHY trial was designed to take a primary prevention approach to risk factors for type 2 diabetes in youth, primarily obesity. The study involved over 6,000 students at 42 middle schools across the U.S. Half received an integrated intervention program of components addressing the school food environment, physical education, lifestyle behaviors, and promotional messaging. The intervention was designed to be more comprehensive than previous efforts, and the research was amply funded. Although the primary objective of reducing the percentage of overweight and obesity in schools that received the intervention program, as compared with control schools, was not obtained, key secondary outcomes indicated an intervention effect. In retrospect, senior investigators involved in the study's design, conduct, and analysis discuss weaknesses and strengths and offer recommendations for future research efforts that address prevention of childhood obesity from a public health perspective.
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Affiliation(s)
- Marsha D. Marcus
- University of Pittsburgh School of Medicine, 3811 O’Hara Street, Pittsburgh PA 15213, (o) 412-246-6371, (f) 412-246-6370,
| | - Kathryn Hirst
- George Washington University Biostatistics Center, 6110 Executive Boulevard, Suite 750, Rockville MD 02852, (o) 301-881-9260, (f) 301-881-3767,
| | - Francine Kaufman
- Children’s Hospital Los Angeles, 4650 Sunset Boulevard, MS 61, Los Angeles CA 90027, (o) 323-361-5489, (f) 323-361-1350,
| | - Gary D. Foster
- Temple University Center for Obesity Research and Education, 3223 North Broad Street, Philadelphia PA 19140, (o) 215-707-8632, (f) 215-707-6475,
| | - Tom Baranowski
- Baylor College of Medicine Children's Nutrition Research Center, 1100 Bates Street, Houston TX 77030, (o) 713-798-6762, (f) 713-798-7098,
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Willi SM, Hirst K, Jago R, Buse J, Kaufman F, El ghormli L, Bassin S, Elliot D, Hale DE. Cardiovascular risk factors in multi-ethnic middle school students: the HEALTHY primary prevention trial. Pediatr Obes 2012; 7:230-9. [PMID: 22461375 PMCID: PMC3348358 DOI: 10.1111/j.2047-6310.2011.00042.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Revised: 10/24/2011] [Accepted: 12/09/2011] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The objective of this study was to examine the effects of an integrated, multi-component, school-based intervention programme on cardiovascular disease (CVD) risk factors among a multi-ethnic cohort of middle school students. METHODS HEALTHY was a cluster randomized, controlled, primary prevention trial. Middle school was the unit of randomization and intervention. Half of the schools were assigned to an intervention programme consisting of changes in the total school food environment and physical education classes, enhanced by educational outreach and behaviour change activities and promoted by a social marketing campaign consisting of reinforcing messages and images. Outcome data reported (anthropometrics, blood pressure and fasting lipid levels) were collected on a cohort of students enrolled at the start of 6th grade (∼11-12 years old) and followed to end of 8th grade (∼13-14 years old). RESULTS Forty-two middle schools were enrolled at seven field centres; 4363 students provided both informed consent and CVD data at baseline and end of study. The sample was 52.7% female, 54.5% Hispanic, 17.6% non-Hispanic Black, 19.4% non-Hispanic White and 8.5% other racial/ethnic combinations, and 49.6% were categorized as overweight or obese (body mass index ≥ 85th percentile) at baseline. A significant intervention effect was detected in the prevalence of hypertension in non-Hispanic Black and White males. The intervention produced no significant changes in lipid levels. CONCLUSIONS The prevalence of some CVD risk factors is high in minority middle school youth, particularly males. A multi-component, school-based programme achieved only modest reductions in these risk factors; however, promising findings occurred in non-Hispanic Black and White males with hypertension.
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Affiliation(s)
- S. M. Willi
- Deparment of Endocrinology/Diabetes; Children's Hospital of Philadelphia; Philadelphia; PA; USA
| | - K. Hirst
- Biostatistics Center; George Washington University; Rockville; MD; USA
| | - R. Jago
- Deparment of Exercise; Nutrition and Health; University of Bristol; Bristol; UK
| | - J. Buse
- School of Medicine; University of North Carolina; Chapel Hill; NC; USA
| | - F. Kaufman
- University of Southern California; Children's Hospital Los Angeles; Los Angeles; CA; USA
| | - L. El ghormli
- Biostatistics Center; George Washington University; Rockville; MD; USA
| | - S. Bassin
- University of California; Irvine; CA; USA
| | - D. Elliot
- Health Promotion and Sports Medicine; Oregon Health & Science University; Portland; OR; USA
| | - D. E. Hale
- Deparment of Pediatrics; University of Texas Health Science Center; San Antonio; TX; USA
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Ewing LA, Karvonen-Gutierrez CA, Noonan D, Duffy SA. Development of the Tobacco Tactics logo: From thumb prints to press. Tob Induc Dis 2012; 10:6. [PMID: 22515268 PMCID: PMC3464712 DOI: 10.1186/1617-9625-10-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 03/29/2012] [Indexed: 12/02/2022] Open
Abstract
Background The purpose of this study was to describe the development and evaluation of the image-based Veterans Affairs (VA) Tobacco Tactics program logo and campaign character using principles of social marketing. Methods Four cross-sectional surveys with open- and closed-ended questions were used to gather participant demographic information, smoking behavior, and feedback on the development and evaluation of the Tobacco Tactics program logo and campaign character. The first 3 surveys were conducted with 229 veterans, visitors, and staff to obtain feedback for the final logo and character choice. The fourth survey was conducted with 47 inpatient veteran smokers to evaluate the Tobacco Tactics manual which was illustrated with the logo and campaign character. Descriptive statistics and bivariate analyses comparing demographic characteristics and tobacco use variables to opinions about the pictures for each round of testing were computed. Results After three rounds of testing to modify the logo and character choices based on participant feedback and survey data, the bulldog logo was chosen to represent the VA Tobacco Tactics program as it was viewed as strong and tough by the majority of participants. About 80% of the participants rated the manual highly on items such as logo, color, and pictures/illustrations. Almost 90% said they would recommend the manual to someone trying to quit smoking. Conclusion Social marketing techniques that include consumer feedback to develop appealing tobacco cessation campaigns can increase consumer engagement and enhance the development of compelling tobacco cessation campaigns to compete with the influential marketing of tobacco companies.
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Affiliation(s)
- Lee A Ewing
- Ann Arbor VA Center for Clinical Management Research, Health Services Research and Development, and the University of Michigan, School of Nursing, Departments of Otolaryngology and Psychiatry, 2215 Fuller Rd, Ann Arbor, MI, 48105, USA.
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Hall WJ, Zeveloff A, Steckler A, Schneider M, Thompson D, Pham T, Volpe SL, Hindes K, Sleigh A, McMurray RG. Process evaluation results from the HEALTHY physical education intervention. HEALTH EDUCATION RESEARCH 2012; 27:307-18. [PMID: 22156231 PMCID: PMC3303206 DOI: 10.1093/her/cyr107] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Accepted: 11/07/2011] [Indexed: 05/31/2023]
Abstract
Process evaluation is an assessment of the implementation of an intervention. A process evaluation component was embedded in the HEALTHY study, a primary prevention trial for Type 2 diabetes implemented over 3 years in 21 middle schools across the United States. The HEALTHY physical education (PE) intervention aimed at maximizing student engagement in moderate-to-vigorous physical activity through delivery of structured lesson plans by PE teachers. Process evaluation data collected via class observations and interventionist interviews assessed fidelity, dose delivered, implementor participation, dose received and barriers. Process evaluation results indicate a high level of fidelity in implementing HEALTHY PE activities and offering 225 min of PE every 10 school days. Concerning dose delivered, students were active for approximately 33 min of class, representing an average of 61% of the class time. Results also indicate that PE teachers were generally engaged in implementing the HEALTHY PE curriculum. Data on dose received showed that students were highly engaged with the PE intervention; however, student misbehavior was the most common barrier observed during classes. Other barriers included teacher disengagement, large classes, limited gym space and poor classroom management. Findings suggest that the PE intervention was generally implemented and received as intended despite several barriers.
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Affiliation(s)
- William J Hall
- School of Nursing.chool of Social Work, University of North Carolina, Chapel Hill, NC 27599, USA.
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Laberge S, Bush PL, Chagnon M. Effects of a Culturally Tailored Physical Activity Promotion Program on Selected Self-Regulation Skills and Attitudes in Adolescents of an Underserved, Multiethnic Milieu. Am J Health Promot 2012; 26:e105-15. [DOI: 10.4278/ajhp.090625-quan-202] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. To implement a culturally tailored physical activity (PA) promotion program (FunAction) and to assess its impact on five self-regulation skills and attitudes in adolescents. Design. The design and implementation of the FunAction program were informed by social marketing principles. The study used a quasi-experimental approach to assess the impact of the program on specific outcome variables. Setting. A multiethnic, underserved middle school in Montreal, Quebec, Canada. Subjects. The intervention group was made up of grade 8 students (n = 165) and the control group was made up of grade 7 students (n = 137). Intervention. During the 16-week intervention, adolescents were able to choose from a variety of 45-minute cardiovascular PAs offered daily during their school lunch period. Adolescents participated in the activities on a voluntary basis. Measures. A self-report questionnaire was administered preintervention and postintervention to measure adolescents' scores on the following self-regulation skills and attitudes: self control, self-esteem, attention/concentration, social competence, and interethnic relationships. Analysis. Three-way repeated measures analyses of variance and correlational analyses were used. Results. A significant improvement was observed only in attention/concentration. Girls' attention/concentration scores improved significantly in the intervention group compared to the control group (F1,127 = 16.26, p < .001). The improvement in attention/concentration scores for boys in the intervention group was correlated with their frequency of participation in the program PAs (r = .24, p = .008). Conclusion. Using social marketing principles can help encourage adolescents from underserved, multiethnic milieus to participate in PA during their school lunch hour. Furthermore, voluntary participation in a culturally tailored PA program can improve youths' attention/concentration.
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Affiliation(s)
- Suzanne Laberge
- Suzanne Laberge, PhD, is with the Department of Kinesiology, and Miguel Chagnon, MSc, is with the Department of Mathematics and Statistics, University of Montreal, Montreal, Quebec, Canada. Paula Louise Bush, MSc, is with the Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
| | - Paula Louise Bush
- Suzanne Laberge, PhD, is with the Department of Kinesiology, and Miguel Chagnon, MSc, is with the Department of Mathematics and Statistics, University of Montreal, Montreal, Quebec, Canada. Paula Louise Bush, MSc, is with the Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
| | - Miguel Chagnon
- Suzanne Laberge, PhD, is with the Department of Kinesiology, and Miguel Chagnon, MSc, is with the Department of Mathematics and Statistics, University of Montreal, Montreal, Quebec, Canada. Paula Louise Bush, MSc, is with the Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
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Aschemann-Witzel J, Perez-Cueto FJA, Niedzwiedzka B, Verbeke W, Bech-Larsen T. Lessons for public health campaigns from analysing commercial food marketing success factors: a case study. BMC Public Health 2012; 12:139. [PMID: 22353342 PMCID: PMC3297499 DOI: 10.1186/1471-2458-12-139] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 02/21/2012] [Indexed: 11/10/2022] Open
Abstract
Background Commercial food marketing has considerably shaped consumer food choice behaviour. Meanwhile, public health campaigns for healthier eating have had limited impact to date. Social marketing suggests that successful commercial food marketing campaigns can provide useful lessons for public sector activities. The aim of the present study was to empirically identify food marketing success factors that, using the social marketing approach, could help improve public health campaigns to promote healthy eating. Methods In this case-study analysis, 27 recent and successful commercial food and beverage marketing cases were purposively sampled from different European countries. The cases involved different consumer target groups, product categories, company sizes and marketing techniques. The analysis focused on cases of relatively healthy food types, and nutrition and health-related aspects in the communication related to the food. Visual as well as written material was gathered, complemented by semi-structured interviews with 12 food market trend experts and 19 representatives of food companies and advertising agencies. Success factors were identified by a group of experts who reached consensus through discussion structured by a card sorting method. Results Six clusters of success factors emerged from the analysis and were labelled as "data and knowledge", "emotions", "endorsement", "media", "community" and "why and how". Each cluster subsumes two or three success factors and is illustrated by examples. In total, 16 factors were identified. It is argued that the factors "nutritional evidence", "trend awareness", "vertical endorsement", "simple naturalness" and "common values" are of particular importance in the communication of health with regard to food. Conclusions The present study identified critical factors for the success of commercial food marketing campaigns related to the issue of nutrition and health, which are possibly transferable to the public health sector. Whether or not a particular factor contributes to future success depends on the specific context of use, the combination of factors and the environment. Consideration of the specific applicability of the success factors identified in this study during the design of marketing activities could benefit public sector food and health-related campaigns.
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Affiliation(s)
- Jessica Aschemann-Witzel
- MAPP-Centre, Aarhus School of Business, Aarhus University, Haslegaardsvej 10, 8210 Aarhus, Denmark.
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27
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Mobley CC, Stadler DD, Staten MA, ghormli LE, Gillis B, Hartstein J, Siega-Riz AM, Virus A. Effect of nutrition changes on foods selected by students in a middle school-based diabetes prevention intervention program: the HEALTHY experience. THE JOURNAL OF SCHOOL HEALTH 2012; 82:82-90. [PMID: 22239133 PMCID: PMC3261591 DOI: 10.1111/j.1746-1561.2011.00670.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND The HEALTHY primary prevention trial developed an integrated multicomponent intervention program to moderate risk factors for type 2 diabetes in middle schools. The nutrition component aimed to improve the quality of foods and beverages served to students. Changes in the School Breakfast Program (SBP), National School Lunch Program (NSLP), and à la carte venues are compared to the experience of control schools. METHODS The intervention was implemented in 21 middle schools from winter 2007 through spring 2009 (following a cohort of students from sixth through eighth grades); 21 schools acted as observed controls. The nutrition component targeted school food service environmental change. Data identifying foods and nutrients served (selected by students for consumption) were collected over a 20-day period at baseline and end of study. Analysis compared end of study values for intervention versus control schools. RESULTS Intervention schools more successfully limited dessert and snack food portion size in NSLP and à la carte and lowered fat content of foods served. Servings of high-fiber grain-based foods and/or legumes were improved in SBP but not NSLP. Intervention and control schools eliminated >1% fat milk and added-sugar beverages in SBP, but intervention schools were more successful in NSLP and à la carte. CONCLUSION The HEALTHY program demonstrated significant changes in the nutritional quality of foods and beverages served in the SBP, NSLP, and à la carte venues, as part of an effort to decrease childhood obesity and support beneficial effects in some secondary HEALTHY study outcomes.
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Affiliation(s)
- Connie C. Mobley
- Associate Dean of Research and Professor of Nutrition, University of Nevada Las Vegas, 1001 Shadow Lane MS 7425, Las Vegas, NV 89106, Phone: 702-774-2643, FAX: 7027742647
| | - Diane D. Stadler
- Assistant Professor, Division of Health Promotion & Sports Medicine, Director of Graduate Programs in Human Nutrition, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, CR110, Portland, Oregon 97239, Phone: 503-494-0168, FAX: 503-494-1310
| | - Myrlene A Staten
- Senior Advisor, Diabetes Translational Research, National Institutes of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 6707 Democracy Blvd, Rm 6107, Bethesda, MD 20892, Phone: 301-402-7886, FAX: 301-480-3503
| | - Laure El ghormli
- Senior Research Associate, Biostatistics Center, George Washington University, 6110 Executive Blvd, Suite 750, Rockville, MD 20852, Phone: 301-231-6804, Fax: 301-881-3767
| | - Bonnie Gillis
- Senior Manager, Scientific Content Development, Health Promotion Department, University of Pittsburgh Medical Center Health Plan, Two Chatham Center, 112 Washington Place, Pittsburgh, PA 15219, Phone: 412-454-5658, FAX: 412-454-2942
| | - Jill Hartstein
- Nutritionist, University of California, Irvine, 620 University Tower, 4199 Campus Drive, Irvine, CA 92697, Phone: 949-285-4626, Fax: 949-824-8849
| | - Anna Maria Siega-Riz
- Professor of Epidemiology and Nutrition, Associate Chair of Epidemiology, 2105-A McGavran Greenberg Bld, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, Phone: 919-962-8410
| | - Amy Virus
- Center for Obesity Research & Education, Temple University, 3223 North Broad Street, Suite 175, Philadelphia PA 19140, Phone: 215-707-8669, FAX: 215-707-6475
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Cochran G, Montgomery KL, Bell H. Translating evidence-based practices into policy: a case study in Texas. SOCIAL WORK IN HEALTH CARE 2012; 51:383-401. [PMID: 22583026 DOI: 10.1080/00981389.2012.660568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Screening and brief intervention (SBI) in health care settings is an evidence-based practice for substance misuse. The Uniform Accident and Sickness Policy Provision Law (UPPL) discourages providers from carrying out SBI by allowing insurers in 26 states to refuse coverage for injuries resulting from intoxication. This project used a qualitative case study methodology to understand how policy-advocacy communication may have impacted the success of UPPL repeal efforts in Texas. Results showed bill progress could have been impeded due to less-effective communication from advocates. These findings suggest the quality of communication may influence the success of evidence-based policy-advocacy for UPPL repeal.
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Affiliation(s)
- Gerald Cochran
- School of Social Work, The University of Texas at Austin, Austin, TX 78712, USA.
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29
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DeBar LL, Schneider M, Drews KL, Ford EG, Stadler DD, Moe EL, White M, Hernandez AE, Solomon S, Jessup A, Venditti EM. Student public commitment in a school-based diabetes prevention project: impact on physical health and health behavior. BMC Public Health 2011; 11:711. [PMID: 21933431 PMCID: PMC3189889 DOI: 10.1186/1471-2458-11-711] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 09/20/2011] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND As concern about youth obesity continues to mount, there is increasing consideration of widespread policy changes to support improved nutritional and enhanced physical activity offerings in schools. A critical element in the success of such programs may be to involve students as spokespeople for the program. Making such a public commitment to healthy lifestyle program targets (improved nutrition and enhanced physical activity) may potentiate healthy behavior changes among such students and provide a model for their peers. This paper examines whether student's "public commitment"--voluntary participation as a peer communicator or in student-generated media opportunities--in a school-based intervention to prevent diabetes and reduce obesity predicted improved study outcomes including reduced obesity and improved health behaviors. METHODS Secondary analysis of data from a 3-year randomized controlled trial conducted in 42 middle schools examining the impact of a multi-component school-based program on body mass index (BMI) and student health behaviors. A total of 4603 students were assessed at the beginning of sixth grade and the end of eighth grade. Process evaluation data were collected throughout the course of the intervention. All analyses were adjusted for students' baseline values. For this paper, the students in the schools randomized to receive the intervention were further divided into two groups: those who participated in public commitment activities and those who did not. Students from comparable schools randomized to the assessment condition constituted the control group. RESULTS We found a lower percentage of obesity (greater than or equal to the 95th percentile for BMI) at the end of the study among the group participating in public commitment activities compared to the control group (21.5% vs. 26.6%, p = 0.02). The difference in obesity rates at the end of the study was even greater among the subgroup of students who were overweight or obese at baseline; 44.6% for the "public commitment" group, versus 53.2% for the control group (p = 0.01). There was no difference in obesity rates between the group not participating in public commitment activities and the control group (26.4% vs. 26.6%). CONCLUSIONS Participating in public commitment activities during the HEALTHY study may have potentiated the changes promoted by the behavioral, nutrition, and physical activity intervention components. TRIAL REGISTRATION ClinicalTrials.gov number, NCT00458029.
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Affiliation(s)
- Lynn L DeBar
- Kaiser Permanente Center for Health Research, 3800 North Interstate Ave, Portland, OR 97227, USA
| | - Margaret Schneider
- Department of Planning, Policy, and Design, University of California at Irvine, 258 Social Ecology I, Irvine, CA 92697, USA
| | - Kimberly L Drews
- The George Washington University Biostatistics Center, 6110 Executive Blvd, Suite 750, Rockville, MD 20852, USA
| | - Eileen G Ford
- The Children's Hospital of Philadelphia, Department of Pediatrics, 3535 Market Street, Suite 1572, Philadelphia, PA 19104, USA
| | - Diane D Stadler
- Division of Health Promotion and Sports Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, CR110, Portland, OR 97239, USA
| | - Esther L Moe
- Division of Health Promotion and Sports Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, CR110, Portland, OR 97239, USA
| | - Mamie White
- Children's Nutrition Research Center, Baylor College of Medicine, 1100 Bates Street #2033, Houston, TX 77030, USA
| | - Arthur E Hernandez
- College of Education, Texas A&M University, Corpus Christi, 6300 Ocean Drive, Unit 5818, Corpus Christi, TX 78412, USA
| | - Sara Solomon
- City of Philadelphia Department of Public Health, 1101 Market Street, Floor 9, Philadelphia, PA 19102, USA
| | - Ann Jessup
- School of Nursing, The University of North Carolina at Chapel Hill, Carrington Hall, CB #7460, Chapel Hill, NC 27599-7460, USA
| | - Elizabeth M Venditti
- University of Pittsburgh, Western Psychiatric Institute and Clinic, 3811 O'Hara St., Pittsburgh, PA 15213, USA
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Abstract
The HEALTHY study was a multi-site randomized trial designed to determine whether a 3-year school-based intervention targeting nutrition and physical activity behaviors could effectively reduce risk factors associated with type 2 diabetes in middle school children. Pilot and formative studies were conducted to inform the development of the intervention components and the process evaluation methods for the main trial. During the main trial, both qualitative and quantitative assessments monitored the fidelity of the intervention and motivated modifications to improve intervention delivery. Structured observations of physical education classes, total school food environments, classroom-based educational modules, and communications and promotional campaigns provided verification that the intervention was delivered as intended. Interviews and focus groups yielded a multidimensional assessment of how the intervention was delivered and received, as well as identifying the barriers to and facilitators of the intervention across and within participating schools. Interim summaries of process evaluation data were presented to the study group as a means of ensuring standardization and quality of the intervention across the seven participating centers. Process evaluation methods and procedures documented the fidelity with which the HEALTHY study was implemented across 21 intervention schools and identified ways in which the intervention delivery might be enhanced throughout the study.
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Rationale, design and methods of the HEALTHY study physical education intervention component. Int J Obes (Lond) 2010; 33 Suppl 4:S37-43. [PMID: 19623187 DOI: 10.1038/ijo.2009.115] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The HEALTHY primary prevention trial was designed to reduce risk factors for type 2 diabetes in middle school students. Middle schools at seven centers across the United States participated in the 3-year study. Half of them were randomized to receive a multi-component intervention. The intervention integrated nutrition, physical education (PE) and behavior changes with a communications strategy of promotional and educational materials and activities. The PE intervention component was developed over a series of pilot studies to maximize student participation and the time (in minutes) spent in moderate-to-vigorous physical activity (MVPA), while meeting state-mandated PE guidelines. The goal of the PE intervention component was to achieve > or =150 min of MVPA in PE classes every 10 school days with the expectation that it would provide a direct effect on adiposity and insulin resistance, subsequently reducing the risk of type 2 diabetes in youth. The PE intervention component curriculum used standard lesson plans to provide a comprehensive approach to middle school PE. Equipment and PE teacher assistants were provided for each school. An expert in PE at each center trained the PE teachers and assistants, monitored delivery of the intervention and provided ongoing feedback and guidance.
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Venditti EM, Elliot DL, Faith MS, Firrell LS, Giles CM, Goldberg L, Marcus MD, Schneider M, Solomon S, Thompson D, Yin Z. Rationale, design and methods of the HEALTHY study behavior intervention component. Int J Obes (Lond) 2010; 33 Suppl 4:S44-51. [PMID: 19623189 DOI: 10.1038/ijo.2009.116] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
HEALTHY was a multi-center primary prevention trial designed to reduce risk factors for type 2 diabetes in adolescents. Seven centers each recruited six middle schools that were randomized to either intervention or control. The HEALTHY intervention integrated multiple components in nutrition, physical education, behavior change and communications and promotion. The conceptual rationale as well as the design and development of the behavior intervention component are described. Pilot study data informed the development of the behavior intervention component. Principles of social learning and health-related behavior change were incorporated. One element of the behavior intervention component was a sequence of peer-led, teacher-facilitated learning activities known as FLASH (Fun Learning Activities for Student Health). Five FLASH modules were implemented over five semesters of the HEALTHY study, with the first module delivered in the second semester of the sixth grade and the last module in the second semester of the eighth grade. Each module contained sessions that were designed to be delivered on a weekly basis to foster self-awareness, knowledge, decision-making skills and peer involvement for health behavior change. FLASH behavioral practice incorporated individual and group self-monitoring challenges for eating and activity. Another element of the behavior intervention component was the family outreach strategy for extending changes in physical activity and healthy eating beyond the school day and for supporting the student's lifestyle change choices. Family outreach strategies included the delivery of newsletters and supplemental packages with materials to promote healthy behavior in the home environment during school summer and winter holiday breaks. In conclusion, the HEALTHY behavior intervention component, when integrated with total school food and physical education environmental changes enhanced by communications and promotional campaigns, is a feasible and acceptable mechanism for delivering age-appropriate social learning for healthy eating and physical activity among an ethnically diverse group of middle school students across the United States.
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Affiliation(s)
- E M Venditti
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
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Foster GD, Linder B, Baranowski T, Cooper DM, Goldberg L, Harrell JS, Kaufman F, Marcus MD, Treviño RP, Hirst K. A school-based intervention for diabetes risk reduction. N Engl J Med 2010; 363:443-53. [PMID: 20581420 PMCID: PMC2924187 DOI: 10.1056/nejmoa1001933] [Citation(s) in RCA: 255] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND We examined the effects of a multicomponent, school-based program addressing risk factors for diabetes among children whose race or ethnic group and socioeconomic status placed them at high risk for obesity and type 2 diabetes. METHODS Using a cluster design, we randomly assigned 42 schools to either a multicomponent school-based intervention (21 schools) or assessment only (control, 21 schools). A total of 4603 students participated (mean [+/- SD] age, 11.3 [+/- 0.6 years; 54.2% Hispanic and 18.0% black; 52.7% girls). At the beginning of 6th grade and the end of 8th grade, students underwent measurements of body-mass index (BMI), waist circumference, and fasting glucose and insulin levels. RESULTS There was a decrease in the primary outcome--the combined prevalence of overweight and obesity--in both the intervention and control schools, with no significant difference between the school groups. The intervention schools had greater reductions in the secondary outcomes of BMI z score, percentage of students with waist circumference at or above the 90th percentile, fasting insulin levels (P=0.04 for all comparisons), and prevalence of obesity (P=0.05). Similar findings were observed among students who were at or above the 85th percentile for BMI at baseline. Less than 3% of the students who were screened had an adverse event; the proportions were nearly equivalent in the intervention and control schools. CONCLUSIONS Our comprehensive school-based program did not result in greater decreases in the combined prevalence of overweight and obesity than those that occurred in control schools. However, the intervention did result in significantly greater reductions in various indexes of adiposity. These changes may reduce the risk of childhood-onset type 2 diabetes. (Funded by the National Institutes of Health and the American Diabetes Association; ClinicalTrials.gov number, NCT00458029.)
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Marko M, Fogel J, Mykerezi E, Van Voorhees BW. Adolescent Internet Depression Prevention: Preferences for Intervention and Predictors of Intentions and Adherence. JOURNAL OF CYBER THERAPY AND REHABILITATION 2010; 3:9-30. [PMID: 30631378 PMCID: PMC6324738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Adolescents in primary care with sub-threshold depression (not reaching criteria for disorder) symptoms may be candidates for early intervention to prevent onset of major depressive disorder. However, we know little about their attitudes toward such interventions or what may predict motivation or adherence for preventive interventions. We also describe preferences for different types of interventions and conduct exploratory analyses to identify predictors of motivation to prevent depression and subsequent adherence to an Internet-based intervention. Adolescents with sub-threshold depressed mood favored novel behavioral treatment approaches, such as Internet-based models for depression prevention. Adolescent beliefs about the intervention and perceived social norms predicted intention to participate in depression prevention. The most important significant predictors of adherence were beliefs about the intervention. Careful attention to the specific beliefs and attitudes of users toward intervention should be incorporated into intervention design as well as evolving public health strategies to prevent depressive disorders.
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Affiliation(s)
- Monika Marko
- Department of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - Joshua Fogel
- Department of Economics, Brooklyn College of the City University of New York, Brooklyn, New York, USA
| | - Elton Mykerezi
- Department of Applied Economics, University of Minnesota, Twin Cities, St. Paul, MN, USA
| | - Benjamin W Van Voorhees
- Department of Medicine, The University of Chicago, Chicago, Illinois, USA
- Department of Psychiatry, The University of Chicago, Chicago, Illinois, USA
- Department of Pediatrics, The University of Chicago, Chicago, Illinois, USA
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Gillis B, Mobley C, Stadler DD, Hartstein J, Virus A, Volpe SL, El ghormli L, Staten MA, Bridgman J, McCormick S. Rationale, design and methods of the HEALTHY study nutrition intervention component. Int J Obes (Lond) 2009; 33 Suppl 4:S29-36. [PMID: 19623185 PMCID: PMC2754734 DOI: 10.1038/ijo.2009.114] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The HEALTHY study was a randomized, controlled, multicenter and middle school-based, multifaceted intervention designed to reduce risk factors for the development of type 2 diabetes. The study randomized 42 middle schools to intervention or control, and followed students from the sixth to the eighth grades. Here we describe the design of the HEALTHY nutrition intervention component that was developed to modify the total school food environment, defined to include the following: federal breakfast, lunch, after school snack and supper programs; a la carte venues, including snack bars and school stores; vending machines; fundraisers; and classroom parties and celebrations. Study staff implemented the intervention using core and toolbox strategies to achieve and maintain the following five intervention goals: (1) lower the average fat content of foods, (2) increase the availability and variety of fruits and vegetables, (3) limit the portion sizes and energy content of dessert and snack foods, (4) eliminate whole and 2% milk and all added sugar beverages, with the exception of low fat or nonfat flavored milk, and limit 100% fruit juice to breakfast in small portions and (5) increase the availability of higher fiber grain-based foods and legumes. Other nutrition intervention component elements were taste tests, cafeteria enhancements, cafeteria line messages and other messages about healthy eating, cafeteria learning laboratory (CLL) activities, twice-yearly training of food service staff, weekly meetings with food service managers, incentives for food service departments, and twice yearly local meetings and three national summits with district food service directors. Strengths of the intervention design were the integration of nutrition with the other HEALTHY intervention components (physical education, behavior change and communications), and the collaboration and rapport between the nutrition intervention study staff members and food service personnel at both school and district levels.
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Affiliation(s)
- B Gillis
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
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Hirst K, Baranowski T, DeBar L, Foster GD, Kaufman F, Kennel P, Linder B, Schneider M, Venditti EM, Yin Z. HEALTHY study rationale, design and methods: moderating risk of type 2 diabetes in multi-ethnic middle school students. Int J Obes (Lond) 2009; 33 Suppl 4:S4-20. [PMID: 19623188 PMCID: PMC2782907 DOI: 10.1038/ijo.2009.112] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The HEALTHY primary prevention trial was designed and implemented in response to the growing numbers of children and adolescents being diagnosed with type 2 diabetes. The objective was to moderate risk factors for type 2 diabetes. Modifiable risk factors measured were indicators of adiposity and glycemic dysregulation: body mass index > or =85th percentile, fasting glucose > or =5.55 mmol l(-1) (100 mg per 100 ml) and fasting insulin > or =180 pmol l(-1) (30 microU ml(-1)). A series of pilot studies established the feasibility of performing data collection procedures and tested the development of an intervention consisting of four integrated components: (1) changes in the quantity and nutritional quality of food and beverage offerings throughout the total school food environment; (2) physical education class lesson plans and accompanying equipment to increase both participation and number of minutes spent in moderate-to-vigorous physical activity; (3) brief classroom activities and family outreach vehicles to increase knowledge, enhance decision-making skills and support and reinforce youth in accomplishing goals; and (4) communications and social marketing strategies to enhance and promote changes through messages, images, events and activities. Expert study staff provided training, assistance, materials and guidance for school faculty and staff to implement the intervention components. A cohort of students were enrolled in sixth grade and followed to end of eighth grade. They attended a health screening data collection at baseline and end of study that involved measurement of height, weight, blood pressure, waist circumference and a fasting blood draw. Height and weight were also collected at the end of the seventh grade. The study was conducted in 42 middle schools, six at each of seven locations across the country, with 21 schools randomized to receive the intervention and 21 to act as controls (data collection activities only). Middle school was the unit of sample size and power computation, randomization, intervention and primary analysis.
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