A School- and Home-Based Intervention to Improve Adolescents' Physical Activity and Healthy Eating: A Pilot Study

Organized Physical Activity Program Participation, Physical Activity, and Related Psychosocial Factors Among Urban Adolescents

The study purpose was to examine whether adolescents who participated in organized physical activity (PA) programs differed from nonparticipants in motivation, social support, and self-efficacy related to PA; PA (min/hr); and sedentary screen time behavior. Thirty-nine 5th-7th grade adolescents participated in organized PA programs; 41 did not. Approximately 56.3% were Black, and 52.5% had annual family incomes <$20,000. Compared to nonparticipants, those who participated reported significantly higher social support (M = 2.32 vs. 3.13, p < .001) and fewer hours watching television or movies on a usual weekend day (M = 2.49 vs. 1.59, p = .016); and had higher accelerometer-measured vigorous PA (M = 0.58 vs. 1.04, p = .009) and moderate-to-vigorous PA (M = 2.48 vs. 3.45, p = .035). Involving adolescents in organized PA programs may be important for improving their moderate-to-vigorous PA, vigorous PA, and related psychosocial factors, as well as reducing sedentary screen time behavior.

Effects of out-of-school physical activity interventions based on self-determination theory in children and adolescents: A systematic review and meta-analysis

OBJECTIVE

This systematic review and meta-analysis aimed to examine the effects of out-of-school physical activity (PA) interventions, based on Self-Determination Theory (SDT), on basic psychological needs (BPN), motivation toward PA, and PA levels in youths.

DESIGN

Systematic review and meta-analyses.

METHOD

We searched for intervention studies examining the effects of PA interventions based on SDT implemented outside the school published in English and Spanish in six electronic databases up to January 2022.

RESULTS

Outcomes of interest were BPN, motivation, and PA levels. In total, nine studies were included in this review. Seven individual meta-analyses were conducted for each variable, revealing nonsignificant clustered effects for the outcomes autonomy satisfaction (g = 0.12, 95% CI [-0.31, 0.55]), competence satisfaction (g = 0.02, 95% CI [-0.28, 0.32]), relatedness satisfaction (g = 0.13, 95% CI [-0.43, 0.68]), autonomous motivation (g = 0.15, 95% CI [-0.38, 0.67]), controlled motivation (g = 0.12, 95% CI [-0.32, 0.55]), amotivation (g = -0.36, 95% CI [-0.88, 0.16]), and PA behavior (g = 0.02, 95% CI [-0.08, 0.12]).

CONCLUSION

Meta-analyses suggest that out-of-school PA interventions based on SDT are not effective in increasing levels of needs satisfaction, types of motivation, and PA levels.

School Health Education Program in Pakistan (SHEPP): findings from a feasibility trial in pre-adolescent school children from a lower middle-income country

BACKGROUND

The school environment plays an essential role in promoting health education and physical activity for children and adolescents. We aim to assess the feasibility of threefold health education program in children and its potential efficacy on physical activity and diet and cardiometabolic risk factors including blood pressure, body mass index (BMI), and waist circumference.

METHODS

The SHEPP was a parallel group feasibility intervention trial conducted in two schools over 23 months. All children aged 9-11 years enrolled in the schools were included. The SHEPP intervention comprised of health education on healthy lifestyle and physical activity sessions for children, training of teachers, and awareness sessions for parents conducted over 10 months. One school received the intervention of SHEPP while the other school continued routine activity. The primary outcome was the feasibility of SHEPP in terms of recruitment, retention, and treatment fidelity. Secondary outcomes were physical activity levels, dietary intake (of fruits and vegetables), and cardiometabolic risk factors (blood pressure, BMI, and waist circumference (WC)).

RESULTS

A total of 1280 preadolescent children were assessed for eligibility and 1191 were found eligible. The overall recruitment n (%) was 982/1191(82.5%) with 505(51.4) from SHEPP intervention school and 477(48.6) in routine activity school. The overall retention rate n (%) at 10-month follow-up was 912/982(92.8), with 465/505(92) in SHEPP intervention school and 447/477(93.7) in routine activity school. In treatment fidelity, 132/144(92) %). Physical activity sessions and all (100%) health education sessions were conducted for each of the twelve classes. Mean (SD) Seven-day Physical activity increased by 134 (196) min in the SHEPP intervention school v 29.8(177) in the routine activity school (P value < 0.001) from baseline to follow-up. Overall, there was an increase in vegetable intake (> 3 serving /day) in SHEPP intervention school of 5.5 to 21.4% from baseline to follow-up compared to 7.5 to 14.9% in routine activity school. The mean change (SD) in systolic blood pressure was 1.3(12) mmHg, 2.2(19.0) mm Hg in in diastolic blood pressure, - 0.09(5.4) kg/m² in BMI and 6.2 cm in waist circumference in the intervention arm versus - 3.4(11.1) mm Hg in SBP, - 4.3(9.9) mm Hg in DBP, - 0.04((4.6) kg/m² in BMI, and 3.8 cm in WC in the control arm.

CONCLUSION

We found that intervention using SHEPP is feasible in schools and may help children to adopt a healthy lifestyle as they age by increasing physical activity. However, the potentially beneficial effect on diet, MI, and BP needs further exploration and a longer follow-up, more specifically at the juncture of teenage and adulthood.

TRIAL REGISTRATION

NCT03303287.

School-Based Family-Oriented Health Interventions to Promote Physical Activity in Children and Adolescents: A Systematic Review

OBJECTIVE

This study aimed to systematically review and analyse intervention programs in a school context centred on the family, focused on increasing youths' physical activity.

DATA SOURCE

The research was carried out in the PubMed, Scopus and Web of Science databases.

STUDY INCLUSION CRITERIA

Studies were included if participants were children or adolescents, focusing on school-based intervention studies with parental involvement and physical activity, sedentary behaviour or physical fitness outcomes.

DATA EXTRACTION

The search was performed according to the PRISMA protocol. A total of 416 articles were identified. After being considered for eligibility and duplicates, 22 studies were identified as relevant for inclusion.

DATA SYNTHESIS

Sample and intervention characteristics, objective, the role of the family, outcomes measures, main findings regarding the outcomes and risk of bias.

RESULTS

Ten studies reported improvements in physical activity, 6 in sedentary behaviour and 9 in the components of physical fitness and/or skills related to healthy behaviours and lifestyles. Most of the interventions adopted a multidisciplinary and multi-component approach.

CONCLUSIONS

Most interventions employed a school's multidisciplinary/multi-component approach to promoting physical activity, nutrition, and general education for healthier lifestyle behaviours. The impact of school-based interventions involving families on youth's physical activity levels is still a relatively emerging theme. Further research is needed given the diversity of the intervention's characteristics and the disparity in the results' efficacy.

Improving Obesogenic Dietary Behaviors among Adolescents: A Systematic Review of Randomized Controlled Trials

The overweight and obesity epidemic persists, and over 340 million children and adolescents aged 5–19 were classified as overweight or obese worldwide in 2020. Obesity intervention becomes crucial during the adolescent years due to the increased autonomy and adolescent motivation to oversee one’s own behaviors and lifestyle-related decisions. The objective of the current study was to conduct a systematic review of randomized controlled trials aimed at improving dietary intake and behaviors among adolescents. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were utilized. The key terms used in the searches referred to the study population and the topic of interest and included words and phrases such as “obesity or overweight and adolescents”, “dietary behaviors and adolescents”, “dietary intake and adolescents”, and “dietary habits and adolescents.” A tertiary screening process was employed, and the National Heart, Lung, and Blood Institute Quality Assessment of Controlled Intervention Studies quality scoring tool was utilized to assess the quality of research articles independently by n = 2 researchers. A total of 7441 articles were identified through the database search, and 36 were included in the current systematic review. The most common outcomes explored included dietary behaviors, anthropometric or biometric outcomes, and physical activity. Approximately half of the studies demonstrated significant improvements in the primary outcomes investigated. The majority of the high-impact studies where significant improvements in primary outcomes were demonstrated were conducted in school settings or were multicomponent or multilevel in nature. Thus, interventions targeting dietary behaviors in adolescents that are delivered in the school setting and are multicomponent or multilevel in nature are the most effective in terms of impact on dietary intake, anthropometric or biometric outcomes, and physical activity.

Considerations for a Social Media Physical Activity Program: Exploratory Study

BACKGROUND

Social media may be a powerful platform to combat parents' and children's low physical activity levels.

OBJECTIVE

This study surveyed parents' beliefs about physical activity in order to expand the extant literature concerning the interest in and the design of an effective and feasible social media physical activity (SMPA) program.

METHODS

Primary caregivers (n=250; 215 [86%] mothers, 164 [65.6%] White) of children aged 6-12 years completed an online questionnaire. Interest was examined through responses on the questionnaire; beliefs (ie, perceptions, knowledge, and support) about physical activity were examined using Spearman correlations; and to support the SMPA program design, researchers examined a combination of multiple-choice and free-response questions. For the free-response questions, the researchers performed open coding related to perceived benefits, barriers, and motivators.

RESULTS

Parent respondents (n=215, 86%) were interested in a SMPA program tailored for families. Regarding beliefs, parents exhibited a monotonic relationship between 2 questions related to perceptions of physical activity levels in their children (r_s(250)=.310, P<.001), knowledge about physical activity and motor skills (r_s(250)=.328, P<.001), and support of physical activity and motor skills (r_s(250)=.385, P<.001). Parents perceived benefits of a SMPA program, highlighting family time and health. Barriers included time constraints, a lack of motivation, and environmental factors.

CONCLUSIONS

Parents are interested in supporting healthy family behaviors using a SMPA program. An effective program should emphasize motor skill activities, be fun and family oriented, and incorporate incentives, goal setting, and advice and tips. SMPA also needs to address identified barriers, such as those regarding time and environment.

School nurses' engagement and care ethics in promoting adolescent health

Background:

The school is a key environment for establishing good health habits among pupils. School nurses play a prominent role in health promotion, since they meet with every single adolescent.

Research aim:

To describe care ethics in the context of school nurses’ health-promoting activities among adolescents in secondary schools.

Research design:

An explorative descriptive methodology in which semi-structured interviews were used to collect data and content analysis was performed.

Participants and research context:

Data were collected from eight school nurses in a municipality in Western Sweden.

Ethical considerations:

This study was conducted according to the ethical principles of the Swedish Research Council (2011), and the written informed consent of the participants was obtained.

Findings/discussion:

A caring relation, based on care ethics, is the basis for successful health-promoting activities among adolescents. The school nurses show strong engagement in and commitment to caring for and caring about adolescents by being attentive and listening to their expressed feelings and needs, both spoken and unspoken. Furthermore, the school nurses have a deep sense of responsibility in supporting and empowering adolescents to trust their own capabilities. To enhance health and well-being, school nurses emphasize low-threshold counselling, flexibility, openness, early intervention and continuity, as well as good collaboration with the health team at school and with parents.

Conclusion:

Strengthening person-centred healthcare can provide adolescents with the recognition and support they need to grow into healthy adults. For successful health promotion, all aspects of the ethics of care should be considered as part of an integrated whole based on the integrity of care.

A systematic review and meta-analysis of school-based interventions with health education to reduce body mass index in adolescents aged 10 to 19 years

BACKGROUND

Adolescents are increasingly susceptible to obesity, and thus at risk of later non-communicable diseases, due to changes in food choices, physical activity levels and exposure to an obesogenic environment. This review aimed to synthesize the literature investigating the effectiveness of health education interventions delivered in school settings to prevent overweight and obesity and/ or reduce BMI in adolescents, and to explore the key features of effectiveness.

METHODS

A systematic search of electronic databases including MEDLINE, CINAHL, PsychINFO and ERIC for papers published from Jan 2006 was carried out in 2020, following PRISMA guidelines. Studies that evaluated health education interventions in 10-19-year-olds delivered in schools in high-income countries, with a control group and reported BMI/BMI z-score were selected. Three researchers screened titles and abstracts, conducted data extraction and assessed quality of the full text publications. A third of the papers from each set were cross-checked by another reviewer. A meta-analysis of a sub-set of studies was conducted for BMI z-score.

RESULTS

Thirty-three interventions based on 39 publications were included in the review. Most studies evaluated multi-component interventions using health education to improve behaviours related to diet, physical activity and body composition measures. Fourteen interventions were associated with reduced BMI/BMI z-score. Most interventions (n = 22) were delivered by teachers in classroom settings, 19 of which trained teachers before the intervention. The multi-component interventions (n = 26) included strategies such as environment modifications (n = 10), digital interventions (n = 15) and parent involvement (n = 16). Fourteen studies had a low risk of bias, followed by 10 with medium and nine with a high risk of bias. Fourteen studies were included in a random-effects meta-analysis for BMI z-score. The pooled estimate of this meta-analysis showed a small difference between intervention and control in change in BMI z-score (- 0.06 [95% CI -0.10, - 0.03]). A funnel plot indicated that some degree of publication bias was operating, and hence the effect size might be inflated.

CONCLUSIONS

Findings from our review suggest that school-based health education interventions have the public health potential to lower BMI towards a healthier range in adolescents. Multi-component interventions involving key stakeholders such as teachers and parents and digital components are a promising strategy.