Results of a 3-year, nutrition and physical activity intervention for children in rural, low-socioeconomic status elementary schools

Coordinated Approach: Comprehensive Policy and Action Planning

BACKGROUND

Schools play a vital role in student health, and a collaborative approach may affect health factors such as physical activity (PA) and nutrition. There is a lack of recent literature synthesizing collaborative approaches in K-12 settings. We present updated evidence about interventions that used a coordinated school health approach to support K-12 student PA and nutrition in the United States.

METHODS

A 2-phase literature review search included a search of systematic reviews for individual qualifying studies (2010-2018), followed by a search for individual articles (2010-2020) that evaluated a coordinated approach or use of school wellness councils, committees, or teams to address PA and/or nutrition.

RESULTS

We identified 35 articles describing 30 studies and grouped them by intervention type. Interventions demonstrated promising findings for environmental changes and student dietary and PA behaviors.

IMPLICATIONS

Coordinated and multicomponent interventions demonstrated significant improvements or null results, indicating that implementation of programs and/or policies to promote healthier eating and PA practices may support and do not appear to hinder environmental or behavioral outcomes.

CONCLUSIONS

Schools can use a coordinated approach to implement opportunities for PA and nutrition; this may influence students' PA and dietary behaviors.

Scoping Review of Family and Community Engagement Strategies Used in School-Based Interventions to Promote Healthy Behaviors

BACKGROUND

School efforts to promote health among students are more successful when families and community members are involved.

METHODS

We conducted a scoping review to summarize and categorize family and community engagement strategies used in US school and out-of-school time (OST) interventions to address physical activity (PA) and nutrition in kindergarten through 12th grade students.

RESULTS

The National Network of Partnership Schools' Six Keys to Success framework was useful in organizing the types of family and community engagement strategies used in included interventions. Many interventions used multiple family and community engagement strategies, with the most common being communicating with families and community members; providing support or education to families; and collaborations among school/OST program and community to support students and their families.

CONCLUSIONS

This review identified six common family and community engagement strategies used in school and OST interventions for PA and nutrition. Including family and community engagement strategies in school and OST interventions could play an important role in maximizing support, resources, and expertise to promote healthy behaviors among all students.

The banana project: a qualitative study of caregivers' and teachers' experiences of preschool children participating in a free banana school fruit scheme in rural Tanzania

Introduction

Good nutrition is the foundation of sustainable growth and development among children. The United Nations aims to achieve food security and improve nutrition through its Sustainable Development Goal 2 - Zero Hunger. In close collaboration with local communities and authorities, the Tanga International Competence Centre, Tanzania, supports projects aimed at achieving the United Nations Sustainable Development Goals. One of their initiatives, The Banana Project, which is a free school fruit scheme, started in 2011 based on a recognised need for nutritional support among preschool children at a rural school in Tanga District. In the interest of improving nutrition, the free school fruit scheme provides one banana 5 school days a week to each child in the class. This study aimed to explore caregivers' (parents and/or guardians) and teachers' experiences with preschool children's participation in the project, with a specific focus on nutrition and health.

Methods

This qualitative study was performed in 2017. A total of 16 semistructured indepth interviews with 14 caregivers and 2 teachers of the preschool children participating in the project were conducted. Data were analysed using a hermeneutic perspective.

Results

Caregivers and teachers of the preschool children participating in the intervention experienced that bananas (1) reduced children's hunger and nutritional deficiency, (2) increased fruit intake and improved their appetite for other foods, (3) improved their physical health and provided energy, and (4) supported cognitive and socioemotional development.

Conclusion

These findings indicate that the banana intervention has several benefits to preschool children and has an impact on their families. To improve health and reduce the risk of malnutrition of children in rural Tanzania, The Banana Project can be an recommended as a simple, cost-effective and sustainable health and nutrition promotion initiatives.

Characterizing Middle School Students' Physical Literacy Development: A Self-Determination Theory-Based Pilot Intervention in Physical Education

Purpose: Positive youth development (PYD) can be achieved through effective and purposeful instructions in physical education (PE) and other relevant experiences both in and beyond schools. Students' PYD is associated with their physical literacy (PL) development, which has become a primary emphasis of PE, especially in the United States, in recent years. This study aimed to (a) characterize middle school students' physical literacy (PL) and (b) capture their PL developing trajectories in light of receiving a self-determination theory (SDT)-based pedagogical workshop, with the long-term vision on PYD.

Methods: Participants (N = 226) completed the Canadian Assessment of Physical Literacy (CAPL-2) in physical education (PE). A subsample (n = 49) received four workshop sessions over 8 weeks; and completed the CAPL-2 and participated in focus group interviews before and after the workshop.

Results: Both boys and girls' CAPL-2 scores were in the “progressing” stage. Significant differences in PL and PL domains were observed by gender, grade, socioeconomic status (SES), body mass index (BMI), and race/ethnicity. The low PL group showed improvements in PL and PL domains. Interview data delineated positive PL developing trajectories for physical activity (PA) type, frequency, and intensity; perceived motives; and participation barriers.

Conclusion: PL is a dynamic state that can be improved through purposeful PE. Future work should examine the effect (and implementation) of opportunities in (e.g., PE) and beyond schools (e.g., youth sports programs) to ultimately advance PYD.

School-based physical activity interventions in rural and urban/suburban communities: A systematic review and meta-analysis

Disparities in physical activity and health outcomes exist between urban and rural youth. School settings can be utilized to promote physical activity in youth regardless of urban-rural status. This systematic review and meta-analysis aimed to assess and compare the effect of rural and urban/suburban school-based physical activity programs on total physical activity in youth. A search of five databases was conducted. A total of 33 studies remained after the exclusion process, 28 of which took place in urban/suburban schools and five of which took place in rural schools. The DerSimonian and Laird random effects model was employed with the estimates of heterogeneity taken from the inverse-variance fixed-effect model. For rural studies, the Hartung-Knapp-Sidak-Jonkman method was used to obtain error estimates. Results from the total sample indicated a significant but small pooled increase in daily physical activity (Hedge's g = 0.12, 95% confidence interval [CI]: 0.06-0.18), which held for interventions conducted in urban/suburban schools (Hedge's g = 0.12, 95% CI: 0.06-0.19). For rural school-based interventions, there was no significant pooled effect (Hedge's g = 0.06, 95% CI: -0.50 to 0.61). This meta-analysis provides evidence that school-based interventions can be marginally effective for increasing daily physical activity in children and adolescents; however, no effect was observed for interventions implemented in rural settings.

Effects of an Intervention to Promote Physical Activity and Reduce Sedentary Time in Disadvantaged Children: Randomized Trial

BACKGROUND

In our society, children are particularly vulnerable to physical inactivity and excessive sedentary time (ST). The aim of this study was to evaluate the effectiveness of a school-based intervention designed to promote physical activity (PA) and reduce ST in 6- to 10-years-old children from a disadvantaged neighborhood.

METHODS

The first intervention of this randomized trial was carried out in School 1 in 2017/2018 and 2018/2019, School 2 benefited from the same intervention in 2018/2019. Baseline assessments were realized using accelerometers prior to the intervention (T1-T2), after the first intervention (T3) and after the second intervention (T4). School-based actions targeted children, parents, teachers, physical, and organizational environment of school and politics. The chi-square test of independence was used to analyze the evolution of the moderate and vigorous physical activity (MVPA) and ST.

RESULTS

For School 1, an increase in the percentage of very active children (over 40 minutes MVPA/day) and of having a very low ST (less 240 minutes/day) (p = .00) was found. No further evolution was revealed during the intervention (T2-T3) and 1 year after (T3-T4). For School 2, similar effects on PA and ST were found at T3 (p < .05).

CONCLUSIONS

Positive effects occurred before the intervention in each school and then remained stable.

Intergenerational Comparison of Food Parenting of Home Eating Behaviors of Schoolchildren

OBJECTIVE

To explore intergenerational differences on key factors of food parenting practices (FPPs) related to home eating behavior of schoolchildren.

DESIGN

In-depth interviews with social recognition theory-based semistructured interviews conducted from December 2016 to January 2017.

PARTICIPANTS

Primary caregivers of elementary schoolchildren from 23 households (16 parents, 14 grandparents) in 4 remote areas of Hualien, Taiwan.

PHENOMENON OF INTEREST

Factors related to FPPs hindering micronutrient-dense food group consumption by schoolchildren in a remote area.

SETTING

In-depth interviews were conducted at participants' houses.

ANALYSIS

Interviews were audiorecorded and transcribed verbatim. Inductive thematic analysis was performed to elicit studied phenomenon.

RESULTS

Routine family meals provided adequate staple, protein, and vegetables but inadequate whole grains, dairy, fruits, and nuts. More parents provided breakfast composed of pan-fried and semiprocessed products made of refined flour and sugary beverages. Both parents and grandparents had ambiguous nutrition concepts and inconsistent FPPs but in different aspects. They both reflected expectations for assistance from local schools for nutrition and FPPs education to shape up healthy eating behavior of children.

CONCLUSIONS AND IMPLICATIONS

Study findings pinpoint the strength and barriers of FPPs for primary caregivers. Implementing integrated nutrition education programs tailored for empowering nutrition literacy and FPPs is suggested to enhance the healthy eating behavior of schoolchildren in a remote area.

A Systematic Review and Qualitative Synthesis Resulting in a Typology of Elementary Classroom Movement Integration Interventions

Background/Objective

Movement integration (MI) involves infusing physical activity into normal classroom time. A wide range of MI interventions have succeeded in increasing children’s participation in physical activity. However, no previous research has attempted to unpack the various MI intervention approaches. Therefore, this study aimed to systematically review, qualitatively analyze, and develop a typology of MI interventions conducted in primary/elementary school settings.

Subjects/Methods

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to identify published MI interventions. Irrelevant records were removed first by title, then by abstract, and finally by full texts of articles, resulting in 72 studies being retained for qualitative analysis. A deductive approach, using previous MI research as an a priori analytic framework, alongside inductive techniques were used to analyze the data.

Results

Four types of MI interventions were identified and labeled based on their design: student-driven, teacher-driven, researcher-teacher collaboration, and researcher-driven. Each type was further refined based on the MI strategies (movement breaks, active lessons, other: opening activity, transitions, reward, awareness), the level of intrapersonal and institutional support (training, resources), and the delivery (dose, intensity, type, fidelity). Nearly half of the interventions were researcher-driven, which may undermine the sustainability of MI as a routine practice by teachers in schools. An imbalance is evident on the MI strategies, with transitions, opening and awareness activities, and rewards being limitedly studied. Delivery should be further examined with a strong focus on reporting fidelity.

Conclusions

There are distinct approaches that are most often employed to promote the use of MI and these approaches may often lack a minimum standard for reporting MI intervention details. This typology may be useful to effectively translate the evidence into practice in real-life settings to better understand and study MI interventions.

A mixed-studies systematic review and meta-analysis of school-based interventions to promote physical activity and/or reduce sedentary time in children

PURPOSE

The aim of this mixed-studies systematic review was to ascertain the effectiveness of school-based interventions in increasing physical activity (PA) and/or reducing sedentary time (ST) in children aged 5-11 years, as well as to explore their effectiveness in relation to categories of the theory of expanded, extended, and enhanced opportunity (TEO).

METHODS

Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 5 databases were searched using predefined search terms. Following title and abstract screening of 1115 records, the removal of duplicates (n = 584) and articles that did not meet the inclusion criteria agreed to a priori (n = 419) resulted in 112 records that were full-text screened. Two independent reviewers subsequently used the mixed-methods appraisal tool to assess the methodological quality of 57 full-text studies that met the inclusion criteria after full-text screening. The interventions were summarised using the TIDierR checklist and TEO. The strength of evidence was determined using a 5-level rating system utilising a published decision tree.

RESULTS

Overall evidence ratings for interventions implemented within school settings were: no evidence of effects on moderate-to-vigorous physical activity (MVPA) and inconclusive evidence of effects on sedentary time. In relation to the TEO, expansion of PA appeared to be the most promising intervention type for MVPA, with moderate evidence of effect, whereas extension and enhancement of PA opportunity demonstrated no evidence of effect. A critical issue of possible compensatory behavior was identified by analysis of intervention effect in relation to PA measurement duration; when studies measured changes in PA during the actual intervention, there was moderate evidence of effect, whereas those that measured changes in PA during the school day presented inconclusive evidence of effect, and those that measured changes in PA over a whole day yielded no evidence of effect. Two meta-analyses of those studies using a whole-day accelerometer measure for MVPA or ST showed a significant but moderate effect for MVPA (effect size = 0.51; 95% confidence interval (CI): 0.02-0.99) and a large but nonsignificant effect for ST (effect size = 1.15; 95%CI: -1.03 to 3.33); both meta-analyses demonstrated low precision, considerable inconsistency, and high heterogeneity.

CONCLUSION

The findings have important implications for future intervention research in terms of intervention design, implementation, and evaluation.

Promoting physical activity in upper elementary children using multi-theory model (MTM) of health behavior change

Background

Physical activity and exercise offer numerous benefits to children and Centers for Disease Control and Prevention guidelines require that school children engage in at least 60 minutes of moderate to vigorous physical activity every day. Unfortunately, up to 30% elementary students do not meet these requirements and 79% elementary schools do not provide students with physical education classes every day. The transition from elementary to secondary school is particularly deleterious for levels of physical activity. Therefore, there is a need to develop educational interventions for upper elementary school children to promote physical activity. A new theory multi-theory model (MTM) of health behavior change can be utilized to develop such interventions.

Objectives

The purpose of this article was to develop and introduce an instrument based on MTM for physical activity change in upper elementary school children and propose an approach for changing this behavior among sedentary students.

Methods

A review of literature in MEDLINE, CINAHL, Google Scholar, and ERIC databases was conducted for physical activity in upper elementary children and multi-theory model of health behavior change to prepare this article.

Results

An instrument with Flesch-Kincaid Grade level of 5.4 and the Flesch Reading Ease of 68 making it suitable for administration with upper elementary school children was developed. An approach utilizing the constructs of participatory dialogue, behavioral confidence and changes in physical environment to initiate physical activity and reifying the constructs of emotional transformation, practice for change and changes in social environment to sustain physical activity in upper elementary school children is presented.

Conclusions

MTM offers potential to augment current educational efforts to promote physical activity in upper elementary school children.

Determinants of Physical Activity for Latino and White Middle School-Aged Children

BACKGROUND

Physical activity (PA) has long been acknowledged to contribute health benefits among children. However, research has consistently shown that PA declines as children grow older. Thus, this study examined the factors which are associated to children's PA in order to identify potential barriers to PA.

METHODS

Using data from the KidQuest Program, we conducted bivariate and multivariate analyses on survey data collected from fifth to seventh grade students in a small Midwestern city.

RESULTS

We found that food knowledge, eating breakfast, and talking with family about eating healthy foods, are positively related to PA. On the other hand, screen time is negatively related to PA. In addition, our results evinced differences between ethnicities and found that Latino children's screen time affects their PA levels more than their white counterpart.

CONCLUSIONS

There are different factors which can be tapped to increase PA among middle school-aged children. Given the differences between the Latino and white samples especially in screen time, schools should consider individualized intervention, rather than a "one size fits all" program, to increase PA participation.

Prevalence of metabolic syndrome among university students: A systematic review

Introduction: Metabolic syndrome (MS) is defined as a set of conditions including high blood pressure, dyslipidemia, glucose intolerance and visceral obesity. In recent years, an increase of obesity in university students has been observed, although the accurate prevalence of MS is unknown.Objective: To determine the prevalence of MS in university students between January 2000 and January 2016.Materials and methods: A systematic review of studies published in the PubMed, LILACS, ScienceDirect, UpToDate, Imbiomed, SciELO and Google Scholar databases was performed. To ensure the highest number of papers, different combinations of words related to MS were used in Spanish, English, and Portuguese.Results: A total of 16 studies met the inclusion criteria. Students from different health, social and human sciences careers from America, Asia and Europe participated in said studies. The prevalence of MS ranged from 0 to 19.2% according to NCEP-ATP III.Conclusions: The prevalence of MS varies widely across studies. It is important to expand MS research, as this would allow designing specific interventions for high-risk groups in the university context.

NutriBee Intervention Improves Diet and Psychosocial Outcomes by Engaging Early Adolescents from Diverse and Disadvantaged Communities

OBJECTIVE

NutriBee was the first clinical nutrition intervention designed to bring the Institute of Medicine recommendations for 20 hours of experiential nutrition-themed learning to grades 4-7 into club and camp settings. We piloted NutriBee to assess acceptability and impact among early adolescents in diverse and disadvantaged communities in order to evaluate its future potential as a group medical nutrition intervention.

METHODS

Nine communities across Guam, Maryland, Michigan, and New Mexico representing South Pacific Island, American Indian, urban African American, recently immigrated Hispanic, and rural Caucasian ethnic groups piloted NutriBee in nonclinical settings (clubs, schools, camps). The 6 club and camp pilots administered consenting NutriBee participants a 41-question pre-post survey assessing impact on food selection and the psychosocial parameters of intentions, outcome expectations, self-efficacy, and knowledge. Process measures included dose, fidelity, and acceptability questions.

RESULTS

Pre- and postsurveys were completed by 170 of 179 (95%) consenting, eligible participants. Impact scores increased significantly (p < 0.001): Food selection behavior (+9.3%), intentions (+19.1%), outcome expectations (+15.1%), self-efficacy (+7.4%), and knowledge (+17.6%). Each pilot (n = 6) demonstrated significant (p < 0.001) impact, a mean dose delivered of 80% (16 hours) or higher, and an acceptability score of at least 74%. Girls participating in girl-only programs (n = 72) shared greater impact than girls in coed programs (n = 41; 13.6% vs. 10.4% mean score increase, p = 0.05).

CONCLUSIONS

NutriBee successfully extended the impact of an IOM-aligned intervention to club and camp settings to which clinicians can refer at-risk early adolescents.

Physical Activity-Related Policy and Environmental Strategies to Prevent Obesity in Rural Communities: A Systematic Review of the Literature, 2002-2013

INTRODUCTION

Health disparities exist between rural and urban residents; in particular, rural residents have higher rates of chronic diseases and obesity. Evidence supports the effectiveness of policy and environmental strategies to prevent obesity and promote health equity. In 2009, the Centers for Disease Control and Prevention recommended 24 policy and environmental strategies for use by local communities: the Common Community Measures for Obesity Prevention (COCOMO); 12 strategies focus on physical activity. This review was conducted to synthesize evidence on the implementation, relevance, and effectiveness of physical activity-related policy and environmental strategies for obesity prevention in rural communities.

METHODS

A literature search was conducted in PubMed, PsycINFO, Web of Science, CINHAL, and PAIS databases for articles published from 2002 through May 2013 that reported findings from physical activity-related policy or environmental interventions conducted in the United States or Canada. Each article was extracted independently by 2 researchers.

RESULTS

Of 2,002 articles, 30 articles representing 26 distinct studies met inclusion criteria. Schools were the most common setting (n = 18 studies). COCOMO strategies were applied in rural communities in 22 studies; the 2 most common COCOMO strategies were "enhance infrastructure supporting walking" (n = 11) and "increase opportunities for extracurricular physical activity" (n = 9). Most studies (n = 21) applied at least one of 8 non-COCOMO strategies; the most common was increasing physical activity opportunities at school outside of physical education (n = 8). Only 14 studies measured or reported physical activity outcomes (10 studies solely used self-report); 10 reported positive changes.

CONCLUSION

Seven of the 12 COCOMO physical activity-related strategies were successfully implemented in 2 or more studies, suggesting that these 7 strategies are relevant in rural communities and the other 5 might be less applicable in rural communities. Further research using robust study designs and measurement is needed to better ascertain implementation success and effectiveness of COCOMO and non-COCOMO strategies in rural communities.