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Jongenelis MI, Budden T, Christian H, Coall DA, Jackson B, Nathan A, Glassenbury E. The Role of Grandparents in Facilitating Children's Physical Activity. J Phys Act Health 2024; 21:1037-1045. [PMID: 39187252 DOI: 10.1123/jpah.2024-0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 06/21/2024] [Accepted: 06/29/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND Research suggests there is considerable opportunity to improve children's movement behaviors while they are being cared for by their grandparents. An understanding of the extent to which grandparent practices facilitate children's engagement in physical activity is critical to the development of health interventions targeting grandparent caregivers. This study examined the activity-related beliefs and practices of grandparents and their association with grandchildren's engagement in various movement behaviors while in grandparental care. METHODS Australian grandparents (N = 1190; 60% women) who provided regular care to a grandchild aged 3-14 years were recruited via a web panel provider to complete an online survey. The survey assessed grandparents' physical activity-related beliefs (eg, perceived importance) and practices (eg, support and social control) and their grandchildren's engagement in physical activity (unstructured, structured, and outdoor play) and screen-based activities while in grandparental care. RESULTS The importance of grandchildren's physical activity was rated highly by grandparents. Grandparents' support for their grandchildren's physical activity was positively associated with their grandchildren's engagement in structured physical activity, unstructured physical activity, and outdoor play. Negative social control was associated with greater engagement in screen-based activities. Other correlates of grandchildren's physical activity and screen-based activities included grandparents' own engagement in these activities. CONCLUSIONS Findings highlight the importance of reinforcing the beliefs and practices that positively influence children's movement behaviors and addressing those that have unintended consequences. Encouraging grandparents to support their grandchildren's physical activity and discouraging forms of negative social control are likely to be important in efforts to promote physical activity in children.
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Affiliation(s)
- Michelle I Jongenelis
- Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Timothy Budden
- Telethon Kids Institute, The University of Western Australia, Nedlands, WA, Australia
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Crawley, WA, Australia
| | - Hayley Christian
- Telethon Kids Institute, The University of Western Australia, Nedlands, WA, Australia
- School of Population and Global Health, The University of Western Australia, Crawley, WA, Australia
| | - David A Coall
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Ben Jackson
- Telethon Kids Institute, The University of Western Australia, Nedlands, WA, Australia
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Crawley, WA, Australia
| | - Andrea Nathan
- Telethon Kids Institute, The University of Western Australia, Nedlands, WA, Australia
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Gefter L, Morioka-Douglas N, Srivastava A, Jiang CA, Lewis M, Sanders L, Rodriguez E. Assessing health behavior change and comparing remote, hybrid and in-person implementation of a school-based health promotion and coaching program for adolescents from low-income communities. HEALTH EDUCATION RESEARCH 2024; 39:297-312. [PMID: 38687641 DOI: 10.1093/her/cyae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 03/07/2024] [Accepted: 03/26/2024] [Indexed: 05/02/2024]
Abstract
To assess the impact of a school-based health intervention on adolescents' health knowledge, psychosocial assets and health behaviors, including comparisons of implementation mode: remote, hybrid or in-person. The Stanford Youth Diabetes Coaches Program, an 8-week, school-based health promotion and coaching skills program, was offered to adolescents (ages 14-18 years) from four low-income US communities. Mode of program implementation was remote, hybrid or in-person. Participants completed online pre- and postsurveys. Analysis included paired t-tests, linear regression and qualitative coding. From Fall 2020 to Fall 2021, 262 adolescents enrolled and 179 finished the program and completed pre- and postsurveys. Of the 179, 80% were female, with a mean age of 15.9 years; 22% were Asian; 8% were Black or African American; 25% were White; and 40% were Hispanic. About 115 participants were remote, 25 were hybrid and 39 were in-person. Across all participants, significant improvements (P < 0.01) were reported in health knowledge, psychosocial assets (self-esteem, self-efficacy and problem-solving) and health behaviors (physical activity, nutrition and stress reduction). After adjusting for sex and age, these improvements were roughly equivalent across the three modes of delivery. Participation was associated with significant improvements in adolescent health behaviors. Furthermore, remote mode of instruction was just as effective as in-person and hybrid modes.
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Affiliation(s)
- Liana Gefter
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, 1265 Welch Road, Stanford, CA 94305, USA
| | - Nancy Morioka-Douglas
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, 1265 Welch Road, Stanford, CA 94305, USA
| | - Ashini Srivastava
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, 1265 Welch Road, Stanford, CA 94305, USA
| | - Can Angela Jiang
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, 1265 Welch Road, Stanford, CA 94305, USA
| | - Meredith Lewis
- UAB Medicine Huntsville, Family Medicine Center, UAB Medicine, Huntsville Regional Medical Campus, 301 Governors Dr SW, Huntsville, AL 35801, USA
| | - Lee Sanders
- Division of General Pediatrics, Department of Pediatrics, Stanford University School of Medicine, 453 Quarry Road, Stanford, CA 94305, USA
| | - Eunice Rodriguez
- Division of General Pediatrics, Department of Pediatrics, Stanford University School of Medicine, 453 Quarry Road, Stanford, CA 94305, USA
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Budden T, Coall DA, Jackson B, Christian H, Nathan A, Jongenelis MI. Barriers and enablers to promoting grandchildren's physical activity and reducing screen time: a qualitative study with Australian grandparents. BMC Public Health 2024; 24:1670. [PMID: 38909205 PMCID: PMC11193900 DOI: 10.1186/s12889-024-19178-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 06/18/2024] [Indexed: 06/24/2024] Open
Abstract
BACKGROUND With an increasing number of grandparents providing care to their grandchildren, calls have been made for these caregivers to be considered important stakeholders in encouraging children's engagement in health-promoting behaviors, such as physical activity. Understanding the perspectives of grandparents who provide care is crucial to informing efforts that aim to increase children's physical activity, yet little is understood about their perceptions of specific barriers and enablers to promoting children's physical activity and reducing screen time. The present study sought to explore these perceptions. METHODS Semi-structured focus groups and individual interviews were conducted with grandparents who reported providing care to a grandchild aged 3 to 14 years. A total of 20 grandparents were sampled (mean age = 67.8 years). Data were subjected to reflexive thematic analysis. RESULTS Key reported barriers to physical activity included (i) the effort (physical and logistical) and financial cost associated with organizing physical activities, (ii) grandparents' age and mobility issues (e.g., due to injury or illness), (iii) caring for children of different ages (e.g., older children having different physical activity interests than younger children), and (iv) a local environment that is not conducive to physical activity (e.g., lack of appropriate facilities). Barriers to reducing screen time included (i) parents sending children to care with electronic devices and (ii) children's fear of missing out on social connection that occurs electronically. Strategies and enablers of physical activity included (i) integrating activity into caregiving routines (e.g., walking the dog), (ii) involving grandchildren in decision making (e.g., asking them in which physical activities they wish to engage), (iii) encouraging grandchildren to engage in activity with other children, and (iv) creating a physical and social environment that supports activity (e.g., owning play equipment). A common strategy for reducing screen time was the creation of a home environment that is not conducive to this activity (e.g., removing electronic devices from view). CONCLUSIONS Findings suggest that grandparents may benefit from resources that assist them to identify activities that are inexpensive and require minimal effort to organize. Activities that account for grandparents' age and health status, as well as any environmental barriers, are likely to be well-received.
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Affiliation(s)
- Timothy Budden
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, 35 Stirling Highway, Nedlands, WA, 6009, Australia
- Telethon Kids Institute, The University of Western Australia, 15 Hospital Avenue, Nedlands, WA, 6009, Australia
| | - David A Coall
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
| | - Ben Jackson
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, 35 Stirling Highway, Nedlands, WA, 6009, Australia
- Telethon Kids Institute, The University of Western Australia, 15 Hospital Avenue, Nedlands, WA, 6009, Australia
| | - Hayley Christian
- Telethon Kids Institute, The University of Western Australia, 15 Hospital Avenue, Nedlands, WA, 6009, Australia
- School of Population and Global Health, The University of Western Australia, 35 Stirling Highway, Nedlands, WA, 6009, Australia
| | - Andrea Nathan
- Telethon Kids Institute, The University of Western Australia, 15 Hospital Avenue, Nedlands, WA, 6009, Australia
| | - Michelle I Jongenelis
- Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences, The University of Melbourne, Grattan St, Melbourne, VIC, 3010, Australia.
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Carducci B, Dominguez G, Kidd E, Oh C, Jain R, Khan A, Bhutta ZA. Promoting healthy school food environments and nutrition in Canada: a systematic review of interventions, policies, and programs. Nutr Rev 2024:nuae030. [PMID: 38767979 DOI: 10.1093/nutrit/nuae030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
CONTEXT The school food environment is a critical interface for child and adolescent nutrition, and there is a need to understand existing literature on Canadian school food environments to identify equity gaps and opportunities, and empower decision-makers to plan for future action. OBJECTIVE Literature on Canadian school food and nutrition interventions, policies, programs, and their effects on diets and nutritional status are synthesized and appraised in this systematic review. DATA SOURCES A search strategy was developed for each database used (Medline, Embase, PsycINFO, ERIC, Cochrane Collaboration, Canadian Electronic Library, BiblioMap), with a combination of free text and controlled vocabulary, for articles published from 1990 to 2021. Unpublished data and grey literature were also searched. DATA EXTRACTION Quantitative and qualitative studies with an observational or intervention study design, reviews, or program evaluations conducted in Canadian schools with participants aged 5-19.9 years were included. Key study characteristics and risk of bias were extracted independently by 2 investigators using a standardized tool. DATA ANALYSIS A total of 298 articles were included (n = 192 peer reviewed and 106 from the grey literature), which were mostly conducted in Ontario (n = 52), British Columbia (n = 43), and Nova Scotia (n = 28). Twenty-four interventions, 5 nonevaluated programs, and 1 policy involved Indigenous populations. Overall, 86 articles measured and reported on effectiveness outcomes, including dietary intake; anthropometry; knowledge, attitudes, and practices; and physical activity. The literature remains largely heterogenous and primarily focused on nutrition education programs that use subjective assessments to infer changes in nutrition. A key facilitator to implementation and sustainability was community engagement, whereas key barriers were staff capacity, access to resources and funding, and consistent leadership. CONCLUSIONS This review provides insight into Canadian school food and nutrition interventions, programs, and policies and uncovers important evidence gaps that require careful examination for future evaluations. Governments must create supportive environments that optimize nutrition for children and adolescents through equitable policies and programs. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42022303255.
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Affiliation(s)
- Bianca Carducci
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research, and Learning, Toronto, ON, Canada
- Department of Nutritional Sciences, University of Toronto, Faculty of Medicine, University of Toronto, Medical Sciences Building, Toronto, ON, Canada
| | - Georgia Dominguez
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research, and Learning, Toronto, ON, Canada
| | - Emily Kidd
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research, and Learning, Toronto, ON, Canada
| | - Christina Oh
- Western University, Schulich School of Medicine and Dentistry, London, ON, Canada
| | - Reena Jain
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research, and Learning, Toronto, ON, Canada
| | - Amira Khan
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research, and Learning, Toronto, ON, Canada
- Department of Nutritional Sciences, University of Toronto, Faculty of Medicine, University of Toronto, Medical Sciences Building, Toronto, ON, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research, and Learning, Toronto, ON, Canada
- Department of Nutritional Sciences, University of Toronto, Faculty of Medicine, University of Toronto, Medical Sciences Building, Toronto, ON, Canada
- Centre of Excellence in Women, and Child Health, Aga Khan University, Karachi, Pakistan
- Dalla Lana School of Public, Health University of Toronto Health Sciences Building, Toronto, ON, Canada
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Wellman RJ, O'Loughlin EK, Maximova K, Kalubi J, Riglea T, O'Loughlin J. School- and intervention-related factors associated with institutionalization of health promotion interventions in elementary schools. Health Promot Chronic Dis Prev Can 2024; 44:166-178. [PMID: 38597805 PMCID: PMC11097743 DOI: 10.24095/hpcdp.44.4.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
INTRODUCTION Long-term availability of health-promoting interventions (HPIs) in school settings can translate into health benefits for children. However, little is known about factors associated with HPI institutionalization in schools. In this study, we identified correlates of the institutionalization of HPIs offered in elementary schools in Quebec, Canada. METHODS In two-part, structured telephone interviews over three academic years (2016-2019), elementary school principals (or their designees) throughout Quebec identified an index HPI offered at least once in their school during the previous three years, and were asked whether it was institutionalized (i.e. explicitly written in the school's educational project, e.g. in the form of educational objectives and means of achieving them). We examined associations between institutionalization and 10 school-related and 16 HPI-related characteristics in univariable and multivariable logistic regression analyses. RESULTS School key informants (n = 163) reported on 147 different HPIs that had been available in their schools in the past three years, 56% of which were institutionalized. Three aspects of school culture-parent/community engagement with the school, school/teacher commitment to student health and school physical environment-were positively associated with HPI institutionalization. HPI-related characteristics positively associated with HPI institutionalization included number of competencies addressed by the HPI, number of teaching strategies employed, modifications made to the HPI prior to or during implementation and perceived success of the HPI. Inviting families or community groups to participate in the HPI was inversely associated with institutionalization. CONCLUSION Better understanding of factors associated with HPI institutionalization may inform the development of school-based HPIs that have the potential for sustainability.
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Affiliation(s)
- Robert J Wellman
- Department of Population and Quantitative Health Sciences, Division of Preventive and Behavioral Medicine, UMass Chan Medical School, Worcester, Massachusetts, United States
| | - Erin K O'Loughlin
- Centre de recherche du Centre hospitalier de l'Université de Montréal CRCHUM, Montréal, Quebec, Canada
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Katerina Maximova
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jodi Kalubi
- Centre de recherche du Centre hospitalier de l'Université de Montréal CRCHUM, Montréal, Quebec, Canada
- Department of Social and Preventive Medicine, Université de Montréal, Montréal, Quebec, Canada
- Centre de recherche en santé publique (CReSP), Université de Montréal, and CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Quebec, Canada
| | - Teodora Riglea
- Centre de recherche du Centre hospitalier de l'Université de Montréal CRCHUM, Montréal, Quebec, Canada
- Department of Social and Preventive Medicine, Université de Montréal, Montréal, Quebec, Canada
| | - Jennifer O'Loughlin
- Centre de recherche du Centre hospitalier de l'Université de Montréal CRCHUM, Montréal, Quebec, Canada
- Department of Social and Preventive Medicine, Université de Montréal, Montréal, Quebec, Canada
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Nayakarathna R, Patel N, Currie C, Faulkner G, Riazi N, Tremblay MS, Trudeau F, Larouche R. Correlates of Physical Activity in Children from Families Speaking Non-official Languages at Home: a Multi-site Canadian Study. J Racial Ethn Health Disparities 2024; 11:815-825. [PMID: 36913115 DOI: 10.1007/s40615-023-01563-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/22/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Children from families speaking a non-official language at home may be particularly at risk for low physical activity (PA), underscoring a need to investigate correlates of PA in this subpopulation. METHODS We recruited 478 children in 37 schools stratified by area-level socioeconomic status (SES) and type of urbanization within three regions of Canada. Steps/day were measured using SC-StepRx pedometers. We assessed potential social-ecological correlates with child and parent surveys. We used gender-stratified linear mixed models to examine the correlates of steps/day. RESULTS Outdoor time was the strongest correlate of boys' and girls' PA. Lower area-level SES was associated with less PA among boys, but outdoor time attenuated this difference. The strength of association between outdoor time and PA decreased with age in boys and increased with age in girls. DISCUSSION Outdoor time was the most consistent correlate of PA. Future interventions should promote outdoor time and address socioeconomic disparities.
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Affiliation(s)
| | - Nimesh Patel
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB, Canada
| | - Cheryl Currie
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB, Canada
| | - Guy Faulkner
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - Negin Riazi
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - Mark S Tremblay
- Healthy Active Living and Obesity Research Group, CHEO Research Institute, Ottawa, ON, Canada
| | - François Trudeau
- Département des Sciences de l'Activité Physique, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Richard Larouche
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB, Canada.
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Dabravolskaj J, Veugelers PJ, Mandour BA, Flynn J, Maximova K. Delivering health promotion during school closures in public health emergencies: building consensus among Canadian experts. Health Promot Int 2023; 38:daad172. [PMID: 38091618 PMCID: PMC10716908 DOI: 10.1093/heapro/daad172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
School-based health promotion is drastically disrupted by school closures during public health emergencies or natural disasters. Climate change will likely accelerate the frequency of these events and hence school closures. We identified innovative health promotion practices delivered during COVID-19 school closures and sought consensus among education experts on their future utility. Fifteen health promotion practices delivered in 87 schools across Alberta, Canada during COVID-19 school closures in Spring 2020, were grouped into: 'awareness of healthy lifestyle behaviours and mental wellness', 'virtual events', 'tangible supports' and 'school-student-family connectedness'. Two expert panels (23 school-level practitioners and 20 decision-makers at the school board and provincial levels) rated practices on feasibility, acceptability, reach, effectiveness, cost-effectiveness and other criteria in three rounds of online Delphi surveys. Consensus was reached if 70% or more participants (strongly) agreed with a statement, (strongly) disagreed or neither. Participants agreed all practices require planning, preparation and training before implementation and additional staff time and most require external support or partnerships. Participants rated 'awareness of healthy lifestyle behaviours and mental wellness' and 'virtual events' as easy and quick to implement, effective and cost-effective, sustainable, easy to integrate into curriculum, well received by students and teachers, benefit school culture and require no additional funding/resources. 'Tangible supports' (equipment, food) and 'school-student-family connectedness' were rated as most likely to reach vulnerable students and families. Health promotion practices presented herein can inform emergency preparedness plans and are critical to ensuring health remains a priority during public health emergencies and natural disasters.
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Affiliation(s)
- Julia Dabravolskaj
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria St, Toronto, ON M5B 1T8, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St Room 500, Toronto, ON M5T 3M7, Canada
| | - Paul J Veugelers
- School of Public Health, University of Alberta, 3-50E University Terrace, 8303 112 Street NW, Edmonton, AB T6G 1K4, Canada
| | - Boshra A Mandour
- School of Public Health, University of Alberta, 3-50E University Terrace, 8303 112 Street NW, Edmonton, AB T6G 1K4, Canada
| | - Jenn Flynn
- APPLE Schools, 206-A, 12227 – 107 Ave NW, Edmonton, AB T5M 1Y9, Canada
| | - Katerina Maximova
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria St, Toronto, ON M5B 1T8, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St Room 500, Toronto, ON M5T 3M7, Canada
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Phetla MC, Skaal L. Scanning for Obesogenicity of Primary School Environments in Tshwane, Gauteng, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6889. [PMID: 37835158 PMCID: PMC10572655 DOI: 10.3390/ijerph20196889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/18/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023]
Abstract
The purpose of this study was to scan for the obesogenicity of primary school environments in Tshwane, Gauteng, South Africa. This study was carried out in ten public primary schools in the Tshwane West district of the Gauteng province. An observational design was used to collect the data. Data collection was conducted using an observational checklist guided by the Analysis Grid for Environments Linked to Obesity (ANGELO) framework. The findings revealed that although a nutrition policy was available in most schools, few schools were communicating the policy. Despite all the schools having sports fields, children were not exercising. Most schools also had a school nutrition programme. Most primary schoolchildren's lunchboxes contained sweets, sugar-sweetened beverages, and snacks. A few lunchboxes contained fruits and vegetables. Primary schools in Tshwane West did not comply with most aspects of the school mapping environment, indicating that the school environments were obesogenic. It is therefore essential to scan for obesogenicity in all South African schools so that tailor-made interventions can be implemented to rectify and further prevent obesogenic school environments.
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Affiliation(s)
- Morentho Cornelia Phetla
- Department of Human Nutrition & Dietetics, Sefako Makgatho Health Sciences University, Pretoria 0001, South Africa
| | - Linda Skaal
- Faculty of Health Sciences, Durban University of Technology, Durban 4001, South Africa;
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Maximova K, Wu X, Khan MK, Dabravolskaj J, Sim S, Mandour B, Pabayo R, Veugelers PJ. The impact of the COVID-19 pandemic on inequalities in lifestyle behaviours and mental health and wellbeing of elementary school children in northern Canada. SSM Popul Health 2023; 23:101454. [PMID: 37334330 PMCID: PMC10260266 DOI: 10.1016/j.ssmph.2023.101454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 06/11/2023] [Indexed: 06/20/2023] Open
Abstract
Objectives The COVID-19 pandemic has negatively affected children's lifestyle behaviours and mental health and wellbeing, and concerns have been raised that COVID-19 has also increased health inequalities. No study to date has quantified the impact of COVID-19 on health inequalities among children. We compared pre-pandemic vs. post-lockdown inequalities in lifestyle behaviours and mental health and wellbeing among children living in rural and remote northern communities. Methods We surveyed 473 grade 4-6 students (9-12 years of age) from 11 schools in rural and remote communities in northern Canada in 2018 (pre-pandemic), and 443 grade 4-6 students from the same schools in 2020 (post-lockdown). The surveys included questions on sedentary behaviours, physical activity, dietary intake, and mental health and wellbeing. We measured inequality in these behaviors using the Gini coefficient, a unitless measure ranging from 0 to 1 with a higher value indicating greater inequality. We used temporal changes (2020 vs. 2018) in Gini coefficients to assess the impact of COVID-19 on inequalities in lifestyle behaviours and mental health and wellbeing separately among girls and boys. Results Inequalities in all examined lifestyle behaviours increased between 2018 and 2020. Inequalities in watching TV, playing video games, and using a cell phone increased among girls, while inequalities in playing video games, using computers and tablets, and consumption of sugar, salt, saturated fat and total fat increased among boys. Changes in inequalities in mental health and wellbeing were small and not statistically significant. Conclusion The findings suggest that the COVID-19 pandemic has exacerbated inequalities in lifestyle behaviours among children living in rural and remote northern communities. If not addressed, these differences may translate into exacerbated inequalities in future health. The findings further suggest that school health programs can help mitigate the negative impact of the pandemic on lifestyle behaviours and mental health and wellbeing.
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Affiliation(s)
- Katerina Maximova
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria St, Toronto, Ontario, M5B 1T8, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St Room 500, Toronto, Ontario, M5T 3M7, Canada
| | - Xiuyun Wu
- School of Public Health, University of Alberta, 3-50E University Terrace, 8303 112 Street NW, Edmonton, Alberta, T6G 1K4, Canada
| | - Mohammed K.A. Khan
- Dalla Lana School of Public Health, University of Toronto, 155 College St Room 500, Toronto, Ontario, M5T 3M7, Canada
| | - Julia Dabravolskaj
- School of Public Health, University of Alberta, 3-50E University Terrace, 8303 112 Street NW, Edmonton, Alberta, T6G 1K4, Canada
| | - Shannon Sim
- School of Public Health, University of Alberta, 3-50E University Terrace, 8303 112 Street NW, Edmonton, Alberta, T6G 1K4, Canada
| | - Boshra Mandour
- School of Public Health, University of Alberta, 3-50E University Terrace, 8303 112 Street NW, Edmonton, Alberta, T6G 1K4, Canada
| | - Roman Pabayo
- School of Public Health, University of Alberta, 3-50E University Terrace, 8303 112 Street NW, Edmonton, Alberta, T6G 1K4, Canada
| | - Paul J. Veugelers
- School of Public Health, University of Alberta, 3-50E University Terrace, 8303 112 Street NW, Edmonton, Alberta, T6G 1K4, Canada
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Börnhorst C, Pigeot I, De Henauw S, Formisano A, Lissner L, Molnár D, Moreno LA, Tornaritis M, Veidebaum T, Vrijkotte T, Didelez V, Wolters M. The effects of hypothetical behavioral interventions on the 13-year incidence of overweight/obesity in children and adolescents. Int J Behav Nutr Phys Act 2023; 20:100. [PMID: 37620898 PMCID: PMC10463721 DOI: 10.1186/s12966-023-01501-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 08/07/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND In view of the high burden of childhood overweight/obesity (OW/OB), it is important to identify targets for interventions that may have the greatest effects on preventing OW/OB in early life. Using methods of causal inference, we studied the effects of sustained behavioral interventions on the long-term risk of developing OW/OB based on a large European cohort. METHODS Our sample comprised 10 877 children aged 2 to < 10 years at baseline who participated in the well-phenotyped IDEFICS/I.Family cohort. Children were followed from 2007/08 to 2020/21. Applying the parametric g-formula, the 13-year risk of developing OW/OB was estimated under various sustained hypothetical interventions on physical activity, screen time, dietary intake and sleep duration. Interventions imposing adherence to recommendations (e.g. maximum 2 h/day screen time) as well as interventions 'shifting' the behavior by a specified amount (e.g. decreasing screen time by 30 min/day) were compared to 'no intervention' (i.e. maintaining the usual or so-called natural behavior). Separately, the effectiveness of these interventions in vulnerable groups was assessed. RESULTS The 13-year risk of developing OW/OB was 30.7% under no intervention and 25.4% when multiple interventions were imposed jointly. Meeting screen time and moderate-to-vigorous physical activity (MVPA) recommendations were found to be most effective, reducing the incidence of OW/OB by -2.2 [-4.4;-0.7] and -2.1 [-3.7;-0.8] percentage points (risk difference [95% confidence interval]), respectively. Meeting sleep recommendations (-0.6 [-1.1;-0.3]) had a similar effect as increasing sleep duration by 30 min/day (-0.6 [-0.9;-0.3]). The most effective intervention in children of parents with low/medium educational level was being member in a sports club; for children of mothers with OW/OB, meeting screen time recommendations and membership in a sports club had the largest effects. CONCLUSIONS While the effects of single behavioral interventions sustained over 13 years were rather small, a joint intervention on multiple behaviors resulted in a relative reduction of the 13-year OW/OB risk by between 10 to 26%. Individually, meeting MVPA and screen time recommendations were most effective. Nevertheless, even under the joint intervention the absolute OW/OB risk remained at a high level of 25.4% suggesting that further strategies to better prevent OW/OB are required.
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Affiliation(s)
- C Börnhorst
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstr 30, 28359, Bremen, Germany.
| | - I Pigeot
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstr 30, 28359, Bremen, Germany
- Institute of Statistics, Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany
| | - S De Henauw
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - A Formisano
- Institute of Food Sciences, National Research Council, Avellino, Italy
| | - L Lissner
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - D Molnár
- Department of Pediatrics, Medical School, University of Pécs, Pécs, Hungary
| | - L A Moreno
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, Faculty of Health Sciences, Universidad de Zaragoza, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria Aragón (IIS Aragón), Saragossa, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de La Obesidad Y Nutrición (CIBERObn), Madrid, Spain
| | - M Tornaritis
- Research and Education Institute of Child Health, Strovolos, Cyprus
| | - T Veidebaum
- National Institute for Health Development, Estonian Centre of Behavioral and Health Sciences, Tallinn, Estonia
| | - T Vrijkotte
- Department of Public and Occupational Health, Amsterdam University Medical Center (Amsterdam UMC), University of Amsterdam, Amsterdam, The Netherlands
| | - V Didelez
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstr 30, 28359, Bremen, Germany
- Institute of Statistics, Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany
| | - M Wolters
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstr 30, 28359, Bremen, Germany
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11
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Hank I, Rossiter MD, Finch S. Influence of the 2019 Canada's Food Guide on the Food Environment in Childcare and Early Learning Centres. CAN J DIET PRACT RES 2023; 84:93-97. [PMID: 36866836 DOI: 10.3148/cjdpr-2022-035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Purpose: This study investigated the potential influence of the 2019 Canada's Food Guide (CFG) on the eating environment and food provided in early learning and childcare centres across Canada.Methods: Directors of childcare centres were invited to complete an online survey about their awareness and adoption of the 2019 CFG and submit their menus for analysis.Results: Twenty-five directors completed the survey, and eighteen cycle menus were analyzed. Frequency and the types of foods offered in childcare centres were assessed. Ninety-two percent reported being aware of the changes in the food guide. Many challenges including the lack of support and resources, cost of food, and food reluctance could affect their ability to apply the changes, especially the incorporation of plant-based protein and the uncertainty around the amount of dairy products to provide. Menu analysis indicated frequency of offering items from the various food groups. Vegetables were mostly offered during lunchtime with an average offering rate of 4.83 ± 0.24 times per week.Conclusion: Representatives of early learning and childcare centres identified having difficulties in interpreting and applying the changes in the 2019 CFG. Dietitians have the knowledge and skills required to support childcare centres through training opportunities, workshops, toolkits, and advocacy.
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Affiliation(s)
- Imene Hank
- Applied Human Sciences, University of Prince Edward Island, Charlottetown, PEI, Canada
| | - Melissa D Rossiter
- Applied Human Sciences, University of Prince Edward Island, Charlottetown, PEI, Canada
| | - Sarah Finch
- Applied Human Sciences, University of Prince Edward Island, Charlottetown, PEI, Canada
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12
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Bryant M, Burton W, O'Kane N, Woodside JV, Ahern S, Garnett P, Spence S, Sharif A, Rutter H, Baker T, Evans CEL. Understanding school food systems to support the development and implementation of food based policies and interventions. Int J Behav Nutr Phys Act 2023; 20:29. [PMID: 36907879 PMCID: PMC10009978 DOI: 10.1186/s12966-023-01432-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/02/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Schools provide opportunities to improve the quality of children's diet, whilst reducing inequalities in childhood diet and health. Evidence supports whole school approaches, including consistency in food quality, eating culture and food education. However, such approaches are often poorly implemented due to the highly complex environments in which schools operate. We aimed to develop a school food systems map using a systems thinking approach to help identify the key factors influencing primary school children's dietary choice. METHODS Eight workshops were conducted with 80 children (from schools from varying locations (region of England/UK; urban/rural), deprivation levels and prioritisation of school food policies)) and 11 workshops were held with 82 adult stakeholders across the UK (principals, teachers, caterers, school governors, parents, and local and voluntary sector organisations) to identify factors that influence food choice in children across a school day and their inter-relationships. Initial exploratory workshops started with a 'blank canvas' using a group model building approach. Later workshops consolidated findings and supported a wider discussion of factors, relationships and influences within the systems map. Strengths of the relationship between factors/nodes were agreed by stakeholders and individually depicted on the map. We facilitated an additional eight interactive, in-person workshops with children to map their activities across a whole school day to enable the production of a journey map which was shared with stakeholders in workshops to facilitate discussion. RESULTS The final 'CONNECTS-Food' systems map included 202 factors that were grouped into 27 nodes. Thematic analysis identified four key themes: leadership and curriculum; child food preference; home environment; and school food environment. Network analysis highlighted key factors that influence child diet across a school day, which were largely in keeping with the thematic analysis; including: 'available funds/resources', 'awareness of initiatives and resources', 'child food preference and intake', 'eligibility of free school meals', 'family circumstances and eating behaviours', 'peer/social norms', 'priorities of head teachers and senior leaders'. CONCLUSIONS Our systems map demonstrates the need to consider factors external to schools and their food environments. The map supports the identification of potential actions, interventions and policies to facilitate a systems-wide positive impact on children's diets.
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Affiliation(s)
- Maria Bryant
- Department of Health Sciences, University of York, York, YO150DD, UK
- Hull York Medical School, University of York, York, YO150DD, UK
| | - Wendy Burton
- Department of Health Sciences, University of York, York, YO150DD, UK
| | - Niamh O'Kane
- Centre for Public Health, Queen's University Belfast, Belfast, BT12 6BJ, UK
| | - Jayne V Woodside
- Centre for Public Health, Queen's University Belfast, Belfast, BT12 6BJ, UK.
| | - Sara Ahern
- Bradford Institute of Health Research, Bradford Royal Infirmary, Bradford, BD9 6RJ, UK
| | - Phillip Garnett
- School for Business and Society, University of York, York, YO10 5DD, UK
| | - Suzanne Spence
- Human Nutrition Exercise Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Amir Sharif
- Faculty of Management, Law and Social Sciences, University of Bradford, Bradford, BD7, 1DP, UK
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, BA2 7AY, UK
| | - Tim Baker
- Charlton Manor Primary School, Indus Road, Charlton, London, SE7 7EF, UK
| | - Charlotte E L Evans
- School of Food Science and Nutrition, University of Leeds, Leeds, LS2 9JT, UK
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13
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The importance of eating patterns for health-related quality of life among children aged 10-11 years in Alberta of Canada. Sci Rep 2022; 12:20885. [PMID: 36463245 PMCID: PMC9719497 DOI: 10.1038/s41598-022-23707-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 11/03/2022] [Indexed: 12/04/2022] Open
Abstract
Children with unhealthy eating behaviours are more likely to experience poor physical and mental health. Few studies have investigated the importance of eating patterns for health-related quality of life (HRQoL) among children. This study aimed to identify common eating patterns, and their associations with HRQoL among Canadian children. Data were collected from 9150 grade five students (aged 10-11 years) in repeat cross-sectional population-based surveys in Alberta, Canada. Students' eating behaviours were analyzed using latent class analysis to identify the eating patterns. We applied multilevel multivariable logistic regression to examine the association of the eating patterns with HRQoL. We identified three groups of children with distinct eating patterns: eating healthy (52%), less healthy (31%) and unhealthy (17%). The first group had a higher proportion of students engaged in healthy eating behaviours. The unhealthy pattern group (third group) included a higher proportion of students with poor eating behaviours. Students' eating behaviours in the second group were healthier than the third group but less healthy than the first group. Children with unhealthy and less healthy patterns were more likely to experience lower HRQoL than children with the healthy pattern. Health promotion programs effective in improving healthy eating patterns may not only reduce the risk for chronic diseases in the long term, but also improve the HRQoL in the short term.
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Camp-Spivey LJ, Newman SD, Stevens RN, Nichols M. Survey of South Carolina Public School Personnel Perspectives on Barriers and Facilitators to Regular Physical Activity and Healthy Eating Behaviors in Schools. THE JOURNAL OF SCHOOL HEALTH 2022; 92:1062-1073. [PMID: 35962619 DOI: 10.1111/josh.13228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 05/06/2022] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND In South Carolina (SC), 42% of youth are overweight or obese. Two sets of modifiable behaviors contributing to obesity are physical activity (PA) and dietary habits. School-based interventions have successfully improved these behaviors. The purpose of this study was to identify SC public school personnel perspectives on the most common barriers and facilitators to regular PA and healthy eating behaviors in schools. METHODS A needs assessment survey was conducted with school personnel statewide. There were 17 questions on the survey that addressed: (1) demographic information about participants' educational backgrounds, (2) barriers to regular PA and healthy eating behaviors in schools, and (3) facilitators to regular PA and healthy eating behaviors in schools. Univariate and bivariate descriptive statistical analyses were performed using IBM SPSS Statistics 27. RESULTS Participants (N = 1311) indicated insufficient time for regular PA (n = 514, 39.2%) and limited access to healthy foods for healthy eating (n = 271, 20.7%) as main barriers. The primary facilitators were support from administrators for regular PA (n = 264, 20.1%) and support from cafeteria staff for healthy eating (n = 234, 17.8%). Further analyses explored how factors compared based on roles in schools, academic levels, and school district classifications. CONCLUSIONS Results suggest that overarching barriers and facilitators to school-based interventions addressing childhood obesity exist, so common strategies to mitigate challenges and maximize supports can be used in schools. Future studies are needed to examine how decreasing barriers and enhancing facilitators affect the implementation and outcomes of these school-based interventions.
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Affiliation(s)
- Logan J Camp-Spivey
- Mary Black College of Nursing, University of South Carolina Upstate, Spartanburg, SC, 29303
| | - Susan D Newman
- College of Nursing, Medical University of South Carolina, Charleston, SC, 29425
| | - Robert N Stevens
- South Carolina Clinical & Translational Research Institute, Medical University of South Carolina, Charleston, SC, 29425, USA; Co-Chair, Southeastern School Behavioral Health Conference, University of South Carolina, Columbia, SC, 29208, USA; Consultant, South Carolina Department of Education, Columbia, SC, 29211, USA; Consultant, South Carolina Department of Mental Health, Columbia, SC, 29202, USA; Investigator, STAR Clinical Research Network, Vanderbilt University, Nashville, TN, 37235, USA, Multiple
| | - Michelle Nichols
- College of Nursing, Medical University of South Carolina, Charleston, SC, 29425, USA; President, Mixed Methods International Research Association, Indianapolis, IN, 46230, USA, Multiple
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15
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O'Loughlin EK, Kalubi J, Riglea T, Pelekanakis A, O'Loughlin JL. Correlates of perceived success of health-promoting interventions in elementary school. Health Promot Chronic Dis Prev Can 2022; 42:398-407. [PMID: 36165766 PMCID: PMC9559196 DOI: 10.24095/hpcdp.42.9.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
INTRODUCTION School-based health-promoting interventions (HPIs) aim to support youth development and positively influence modifiable lifestyle behaviours. Identifying factors that contribute to or hinder the perceived success of HPIs could facilitate their adaptation, improve implementation and contribute to HPI sustainability. The objective of this study was to identify factors in three domains (school characteristics, characteristics of the HPI and factors related to planning and implementing the HPI) associated with perceived success of HPIs among school principals in elementary schools. METHODS Data were drawn from Project PromeSS, a cross-sectional survey of school principals and/or nominated staff members in a convenience sample of 171 public elementary schools in Quebec, Canada. School board and school recruitment spanned three academic school years (2016-2019). Data on school and participant characteristics, HPI characteristics, variables related to HPI planning and implementation and perceived success of the HPI were collected in two-part, structured telephone interviews. Descriptive statistics were used to characterize schools and study participants. Twenty-eight potential correlates of perceived HPI success were investigated separately in multivariable linear regression modelling. RESULTS Participants generally perceived HPIs as highly successful. After controlling for number of students, language of instruction, school neighbourhood and school deprivation, we identified five correlates of perceived success, including lower teacher turnover, higher scores for school physical environment, school/teacher commitment to student health, principal leadership and school being a developer (vs. adopter) of the HPI. CONCLUSION If replicated, these factors should be considered by HPI developers and school personnel when planning and implementing HPIs in elementary schools.
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Affiliation(s)
- Erin K O'Loughlin
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
- Carrefour de l'innovation et de l'évaluation en santé, Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Jodi Kalubi
- Carrefour de l'innovation et de l'évaluation en santé, Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
- Département de médecine sociale et préventive, Université de Montréal, Montréal, Québec, Canada
- Centre de recherche en santé publique (CReSP), Université de Montréal and CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Québec, Canada
| | - Teodora Riglea
- Carrefour de l'innovation et de l'évaluation en santé, Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Annie Pelekanakis
- Carrefour de l'innovation et de l'évaluation en santé, Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Jennifer L O'Loughlin
- Carrefour de l'innovation et de l'évaluation en santé, Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
- Département de médecine sociale et préventive, Université de Montréal, Montréal, Québec, Canada
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16
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Veugelers PJ, Dabravolskaj J, Khan MKA, Tran TT, Flynn J, Maximova K. From best practice to next practice: implementing Comprehensive School Health in rural and remote northern communities. Health Promot Chronic Dis Prev Can 2022; 42:344-352. [PMID: 35993604 PMCID: PMC9514208 DOI: 10.24095/hpcdp.42.8.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Northern communities in Canada experience a disproportionate burden of chronic diseases including mental illness. To mitigate the growing health inequalities, an ongoing Comprehensive School Health program promoting healthy lifestyle behaviours and mental health and well-being was expanded to rural and remote northern communities. We report on the program's impact on knowledge, attitudes, lifestyle behaviours (healthy eating, physical activity, screen time), weight status and the mental health and well-being of elementary school students during the first four years of implementation. METHODS Following a repeated cross-sectional design, we surveyed 440, 352 and 384 Grade 4 to 6 students (9-12 years old) from eight schools in 2016, 2018 and 2020/21, respectively. Students were approximately equally represented by girls and boys. RESULTS Between 2016 and 2018, students reported modest increases in vegetable and fruit consumption and dietary variety; declines in screen time; no changes in physical activity; and declines in attitudes toward healthy lifestyle and in mental health and well-being. Between 2018 and 2020/21, lifestyle behaviours deteriorated substantially, while attitudes and mental health and well-being continued to decline. CONCLUSION A program that was successful in socioeconomically disadvantaged urban neighbourhoods had a favourable, though modest, impact on selected lifestyle behaviours, but not on attitudes and mental health and well-being, in rural and remote northern communities. In light of cultural differences and logistical challenges in Canada's North, systematic and proactive adaptations to local contexts, increased intensity, and longer program delivery are essential to facilitate sustainable improvements in lifestyle behaviours and mental health and well-being.
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Affiliation(s)
- Paul J Veugelers
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Julia Dabravolskaj
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Mohammad K A Khan
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- >Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Truc Trudy Tran
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- >Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jenn Flynn
- The APPLE Schools Foundation, Edmonton, Alberta, Canada
| | - Katerina Maximova
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- >Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Camp-Spivey LJ, Newman SD, Stevens RN, Nichols M. Describing South Carolina Public School Administrators' Perceptions and Experiences Related to School-Based Interventions and Strategies to Promote Healthy Physical Activity and Eating Behaviors: A Qualitative Study. THE JOURNAL OF SCHOOL HEALTH 2022; 92:581-593. [PMID: 35355265 DOI: 10.1111/josh.13164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 01/14/2022] [Accepted: 01/26/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND School-based interventions and strategies targeting physical activity (PA) and eating patterns have successfully addressed unhealthy behaviors contributing to excess weight in school-age children. The purpose of this study was to investigate South Carolina (SC) public school administrators' perceptions of and experiences with weight-related issues in schools and associated barriers and facilitators to awareness, selection, and implementation of school-based healthy PA and eating interventions and strategies. METHODS This qualitative descriptive study, guided by the Social Ecological Model and the Steps in Quality Intervention Development Model, involved semistructured interviews with SC public school administrators from all academic levels (N = 28). Data were analyzed using thematic analysis. RESULTS Four themes were identified from interviews (N = 28): weight-related terminology or stigma, experiences with school-based healthy PA and eating interventions and strategies, barriers to school-based healthy PA and eating interventions and strategies, and facilitators to school-based healthy PA and eating interventions and strategies. CONCLUSIONS Schools are well-positioned to provide interventions and strategies to improve PA and dietary habits leading to childhood obesity. School administrators, while knowledgeable and experienced with weight-related issues and school-based interventions and strategies, encounter barriers and facilitators that impact offerings and delivery. Understanding these challenges and supports is important in the development, adaptation, and implementation of school-based interventions and strategies focused on healthy PA and eating behaviors.
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Affiliation(s)
- Logan J Camp-Spivey
- Mary Black School of Nursing, University of South Carolina Upstate, Spartanburg, SC, 29303
| | - Susan D Newman
- College of Nursing, Medical University of South Carolina, Charleston, SC, 29425
| | - Robert N Stevens
- South Carolina Clinical & Translational Research Institute, Medical University of South Carolina, Charleston, SC, 29425
- Co-Chair, Southeastern School Behavioral Health Conference, University of South Carolina, Columbia, SC, 29208
- Consultant, South Carolina Department of Education, Columbia, SC, 29211
- Consultant, South Carolina Department of Mental Health, Columbia, SC, 29202
- Investigator, STAR Clinical Research Network, Vanderbilt University, Nashville, TN, 37235
| | - Michelle Nichols
- College of Nursing, Medical University of South Carolina, Charleston, SC, 29425
- President, Mixed Methods International Research Association, Indianapolis, IN, 46230
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Kontak JC, Caldwell HAT, Kay-Arora M, Hancock Friesen CL, Kirk SFL. Peering in: youth perspectives on Health Promoting Schools and youth engagement in Nova Scotia, Canada. Health Promot Int 2022; 37:6648071. [PMID: 35862775 PMCID: PMC9302890 DOI: 10.1093/heapro/daac081] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Health Promoting Schools (HPS) is a whole-school approach that shapes the conditions necessary to support student health and well-being. Youth engagement is recognized as key to HPS implementation, yet research related to the involvement of youth voice in school health promotion initiatives is limited. The purpose of this study was to understand youth perspectives on HPS and school youth engagement. Ten youth (grades 9–10, ages 14–16) were trained as peer researchers using a Youth Participatory Action Research approach. The peer researchers interviewed 23 of their peers (grades 7–10, ages 12–16) on perspectives related to HPS and school youth engagement. All interviews were audio-recorded, transcribed and data were analysed using inductive ‘codebook’ thematic analysis. Themes related to a healthy school community were mapped onto the pillars of HPS: (i) Social and Physical Environment, (ii) Teaching and Learning, (iii) Partnerships and Services and (iv) School Policies. Participants placed more importance on the social and physical environment of the school including respect, inclusivity, supportive relationships and the design of spaces. Key factors for youth engagement were: (i) safe and supportive spaces, (ii) passion and interest, (iii) using their voice, (iv) power dynamics, (v) accessibility and (vi) awareness. With recognition that youth engagement is a crucial part of HPS, this work provides relevant and applicable information on areas of the healthy school community that are important to youth, and if/how they are meaningfully engaged in school decision-making.
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Affiliation(s)
- Julia C Kontak
- Faculty of Health, Dalhousie University, Dalhousie University, 5968 College Street, PO Box 15000, Halifax, NS B3H 4R2, Canada.,Healthy Populations Institute, Dalhousie University, 1318 Robie Street, Halifax, NS B3H 3E2, Canada
| | - Hilary A T Caldwell
- Healthy Populations Institute, Dalhousie University, 1318 Robie Street, Halifax, NS B3H 3E2, Canada
| | - Margaret Kay-Arora
- Healthy Populations Institute, Dalhousie University, 1318 Robie Street, Halifax, NS B3H 3E2, Canada
| | - Camille L Hancock Friesen
- Healthy Populations Institute, Dalhousie University, 1318 Robie Street, Halifax, NS B3H 3E2, Canada.,Division of Pediatric Cardiothoracic Surgery, Children's Health and Medical Centre, University of Nebraska Medical Center, 8200 Dodge Street, Omaha, NE 68114, USA
| | - Sara F L Kirk
- Healthy Populations Institute, Dalhousie University, 1318 Robie Street, Halifax, NS B3H 3E2, Canada.,School of Health and Human Performance, Dalhousie University, PO Box 15000, Halifax, NS B3H 4R2, Canada
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Reagan R, Woodruff SJ, Seabrook JA, Gilliland J. A randomized control trial of a Canadian-based school food program on the home food environment. Health Promot Int 2022; 37:6648070. [PMID: 35862774 DOI: 10.1093/heapro/daac087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Research provides evidence of take-home effects in school-based nutrition interventions, citing children as important influencers of family nutrition, acting as agents of change in the household and potentially influencing family food consumption. Therefore, the purpose of this randomized control trial was to examine whether implementation of a centrally procured school food program would produce changes in children's home food environment, including fruit and/or vegetable availability and parental modelling of fruit and/or vegetable consumption. A secondary objective was to investigate whether children's fruit and/or vegetable intake predicted their parent's fruit and/or vegetable intake. A total of 60 schools participated in the evaluation, including 2443 students (and their parents) in grades 5-8. Findings indicated that the intervention did not produce take-home effects on children's home availability of fruit (p = 0.52) and vegetables (p = 0.67) or parental modelling of fruit (p = 0.26) and vegetable consumption (p = 0.78), which may be related to the fact that only food provisions were given. However, children's fruit and vegetable consumption predicted parents' fruit and vegetable consumption (p < 0.001), thereby indicating that children may possess the capacity to influence home nutrition. Future school-based nutrition interventions are recommended to be multi-component (e.g. experiential learning, parent involvement) and that encourage nutrition leadership opportunities for children in the home context.
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Affiliation(s)
- Rebecca Reagan
- Department of Kinesiology, University of Windsor, 401 Sunset Ave, Windsor, ON, N9B 3P4, Canada
| | - Sarah J Woodruff
- Department of Kinesiology, University of Windsor, 401 Sunset Ave, Windsor, ON, N9B 3P4, Canada
| | - Jamie A Seabrook
- School of Food and Nutritional Sciences, Brescia University College at Western University, 1285 Western Rd, London, ON, N6G 1H2, Canada.,Department of Paediatrics, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada.,Department of Epidemiology & Biostatistics, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada
| | - Jason Gilliland
- Department of Paediatrics, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada.,Department of Epidemiology & Biostatistics, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada.,Department of Geography, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada.,School of Health Studies, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada
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Klassen D, Champion C, Montemurro G, Flynn J, Raine K, Storey K. It takes a community: exploring APPLE Schools' impact within and beyond school walls in Canada. Health Promot Int 2022:6576067. [PMID: 35486099 DOI: 10.1093/heapro/daac050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Childhood is a critical stage to develop healthy behaviours, and the school years are an important developmental period in which children are learning and growing. School-based health promotion interventions are increasingly using the comprehensive school health (CSH) approach that has been found effective at improving health behaviours, while adapting to the school and community context to create and sustain a healthy school culture. The interconnected environments of school, home and community are key to the CSH approach, however, there is minimal research that has been conducted to determine the impact at the community-level. This research used a qualitative multiple case study design to explore the influence of a school-based health promotion intervention, APPLE Schools, on the school and community environments from the perspectives of school staff in Alberta, Canada. Twenty-two participants participated in walking interviews in five schools. The walking interview approach combined interviewing and field observation and empowered participants to share their local expertise and knowledge within the context of school and community environments. Interviews were transcribed and analysed using an inductive thematic approach. Four themes were identified: APPLE schools look different, APPLE Schools build champions, APPLE Schools builds community partnerships and APPLE Schools honours community culture. Health promotion practice in schools was uniquely adapted based on strengths and needs of each school and was broadly influenced by the community outside of school walls. In sum, it was found that school-based health promotion reaches beyond school walls and can influence the broader community environment.
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Affiliation(s)
- Danielle Klassen
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB T6G 1C9, Canada
| | - Claudine Champion
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB T6G 1C9, Canada
| | - Genevieve Montemurro
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB T6G 1C9, Canada
| | - Jenn Flynn
- APPLE Schools Foundation, 3-50 University Terrace, 8303-112 Street, Edmonton, AB T6G 2T4, Canada
| | - Kim Raine
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB T6G 1C9, Canada
| | - Kate Storey
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB T6G 1C9, Canada
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Gillies C, Blanchet R, Gokiert R, Farmer A, Willows ND. Comprehensive Nutrition Interventions in First Nation-Operated Schools in Canada. CAN J DIET PRACT RES 2022; 83:128-132. [PMID: 35014557 DOI: 10.3148/cjdpr-2021-039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Comprehensive school-based nutrition interventions offer a promising strategy to support healthy eating for First Nations children. A targeted strategic review was performed to identify nutrition interventions in 514 First Nation-operated schools across Canada through their websites. Directed content analysis was used to describe if interventions used 1 or more of the 4 components of the Comprehensive School Health (CSH) framework. Sixty schools had interventions. Nearly all (n = 56, 93%) schools offered breakfast, snack, and (or) lunch programs (social and physical environment). About one-third provided opportunities for students to learn about traditional healthy Indigenous foods and food procurement methods (n = 18, 30%) (teaching and learning) or facilitated connections between the school and students' families or the community (n = 16, 27%) (partnerships and services). Few schools (n = 10, 17%) had a nutrition policy outlining permitted foods (school policy). Less than 1% (n = 3) of interventions included all 4 CSH components. Results suggest that most First Nation-operated schools provide children with food, but few have nutrition interventions that include multiple CSH components. First Nation-operated schools may require additional financial and (or) logistical support to implement comprehensive school-based nutrition interventions, which have greater potential to support long-term health outcomes for children than single approaches.
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Affiliation(s)
- Christina Gillies
- Department of Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, AB.,Department of Social Sciences, Wageningen University & Research, Wageningen, The Netherlands
| | - Rosanne Blanchet
- Department of Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, AB
| | - Rebecca Gokiert
- School of Public Health, University of Alberta, Edmonton, AB
| | - Anna Farmer
- Department of Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, AB
| | - Noreen D Willows
- Department of Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, AB
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Maximova K, Khan MKA, Dabravolskaj J, Maunula L, Ohinmaa A, Veugelers PJ. Perceived changes in lifestyle behaviours and in mental health and wellbeing of elementary school children during the first COVID-19 lockdown in Canada. Public Health 2022; 202:35-42. [PMID: 34879321 PMCID: PMC8645293 DOI: 10.1016/j.puhe.2021.10.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/21/2021] [Accepted: 10/09/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The closure of schools to prevent the spread of COVID-19 prompted concerns of deteriorating lifestyle behaviours, mental health, and wellbeing of children, particularly those in socioeconomically disadvantaged settings. We assessed changes in lifestyle behaviours (physical activity, screen time, eating habits and bed/wake-up times), mental health and wellbeing during the first lockdown in Spring 2020 as perceived by school children from disadvantaged settings, and examined determinants of these changes. STUDY DESIGN Cross-sectional study. METHODS We surveyed 1095 grade 4 to 6 students (age 9-12 years) from 20 schools in socioeconomically disadvantaged communities in northern Canada. Students reported on changes in lifestyle behaviours, mental health and wellbeing during the lockdown. Determinants of these perceived changes were examined in multivariable regression models. RESULTS A majority of students reported declines in physical activity, having late bed/wake-up times, and modest improvements in mental health and wellbeing. Many students reported increases rather than decreases in screen time and snacking. Positive attitudes toward being active, eating healthy, going to sleep on time and being healthy were strongly associated with maintaining healthy lifestyle behaviours during the lockdown. Positive attitudes toward active and healthy living and healthy lifestyle behaviours were associated with maintaining positive mental health and wellbeing during the lockdown. CONCLUSIONS The considerable changes in lifestyle behaviors, superimposed on the pre-existing burden of unhealthy lifestyle behaviours, put this generation of children at increased risk for future chronic disease. Findings call for effective health promotion of active and healthy lifestyles to benefit both physical and mental health.
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Affiliation(s)
- Katerina Maximova
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria St, M5B 1T8, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College St Room 500, M5T 3M7, Toronto, Ontario, Canada; School of Public Health, University of Alberta, 3-50E University Terrace, 8303 112 Street NW, T6G 1K4, Edmonton, Alberta, Canada
| | - Mohammad K A Khan
- Dalla Lana School of Public Health, University of Toronto, 155 College St Room 500, M5T 3M7, Toronto, Ontario, Canada
| | - Julia Dabravolskaj
- School of Public Health, University of Alberta, 3-50E University Terrace, 8303 112 Street NW, T6G 1K4, Edmonton, Alberta, Canada
| | - Laena Maunula
- School of Public Health, University of Alberta, 3-50E University Terrace, 8303 112 Street NW, T6G 1K4, Edmonton, Alberta, Canada
| | - Arto Ohinmaa
- School of Public Health, University of Alberta, 3-50E University Terrace, 8303 112 Street NW, T6G 1K4, Edmonton, Alberta, Canada
| | - Paul J Veugelers
- School of Public Health, University of Alberta, 3-50E University Terrace, 8303 112 Street NW, T6G 1K4, Edmonton, Alberta, Canada.
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23
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Maunula L, Dabravolskaj J, Maximova K, Sim S, Willows N, Newton AS, Veugelers PJ. "It's Very Stressful for Children": Elementary School-Aged Children's Psychological Wellbeing during COVID-19 in Canada. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8121185. [PMID: 34943381 PMCID: PMC8700526 DOI: 10.3390/children8121185] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/06/2021] [Accepted: 12/12/2021] [Indexed: 12/14/2022]
Abstract
Emerging evidence suggests that the COVID-19 pandemic and associated public health measures, including lockdowns and school closures, have been negatively affecting school-aged children’s psychological wellbeing. To identify supports required to mitigate the negative impacts of the COVID-19 pandemic, we gathered in-depth information on school-aged children’s and parents’ lived experiences of COVID-19 and perceptions of its impact on psychological wellbeing in grade 4–6 students in Canada. In this qualitative study, we conducted telephone-based semi-structured interviews with parents (n = 15) and their children (n = 16) from six schools in small and mid-sized northern prairie communities in Canada. Interviews were analyzed through thematic analysis. Three interrelated themes have emerged. First, the start of COVID-19 brought sudden and stressful changes to children’s lives. Second, disruptions to daily life led to feelings of boredom and lack of purpose. Third, limited opportunities for social interaction led to loneliness and an increase in screen time to seek social connection with peers. Results underscore the need for resilience building and the promotion of positive coping strategies to help school-aged children thrive in the event of future health crises or natural disasters.
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Affiliation(s)
- Laena Maunula
- School of Public Health, University of Alberta, 3-50E University Terrace, 8303 112 Street NW, Edmonton, AB T6G 1K4, Canada; (L.M.); (J.D.); (S.S.); (P.J.V.)
| | - Julia Dabravolskaj
- School of Public Health, University of Alberta, 3-50E University Terrace, 8303 112 Street NW, Edmonton, AB T6G 1K4, Canada; (L.M.); (J.D.); (S.S.); (P.J.V.)
| | - Katerina Maximova
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, Toronto, ON M5B 1T8, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St Room 500, Toronto, ON M5T 3M7, Canada
- Correspondence: ; Tel.: +1-416-360-4000
| | - Shannon Sim
- School of Public Health, University of Alberta, 3-50E University Terrace, 8303 112 Street NW, Edmonton, AB T6G 1K4, Canada; (L.M.); (J.D.); (S.S.); (P.J.V.)
| | - Noreen Willows
- Department of Agricultural, Food & Nutritional Science, Faculty of Agricultural, Life & Environmental Sciences, University of Alberta, Edmonton, AB T6G 2P5, Canada;
| | - Amanda S. Newton
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 1C9, Canada;
| | - Paul J. Veugelers
- School of Public Health, University of Alberta, 3-50E University Terrace, 8303 112 Street NW, Edmonton, AB T6G 1K4, Canada; (L.M.); (J.D.); (S.S.); (P.J.V.)
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Camp-Spivey LJ, Newman SD, Stevens RN, Nichols M. "We've Had to Build the Plane as We Flew It.": Impacts of the COVID-19 Pandemic on School-Based Weight Management Interventions. Child Obes 2021; 17:497-506. [PMID: 34197215 DOI: 10.1089/chi.2021.0037] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: In response to the coronavirus disease 2019 (COVID-19) pandemic, elementary and secondary schools in the United States transitioned to remote learning to slow viral spread and protect students and school officials. This move interrupted academic education and school-based health interventions focused on physical activity (PA) and healthy eating behaviors to help combat childhood obesity. Little is known on how these interventions were affected by COVID-19. Methods: This concurrent multimethodological study incorporated two independent components: qualitative descriptive semistructured interviews with public school administrators and quantitative descriptive cross-sectional needs assessment survey of public school personnel. Results: Three themes were identified from interviews with school administrators (N = 28): changes in school-based interventions addressing PA and healthy eating behaviors, changes in academic delivery affecting PA and healthy eating behaviors, and needs of school administrators. From the survey (N = 1311), 635 (48.4%) participants indicated that schools' abilities to address PA and healthy eating behaviors were negatively impacted by COVID-19. The majority (n = 876, 66.8%) of participants strongly agreed or agreed that the pandemic would affect future school-based interventions related to PA and healthy eating behaviors. Conclusions: While schools are prime locations for delivering school-based weight management interventions related to childhood obesity, participants reported the pandemic had overall negative impacts on interventions addressing PA and healthy eating behaviors. Understanding these impacts is essential to adapting school-based interventions to changes from COVID-19 so students may receive health information and access health promotion interventions in remote learning environments and during social distancing.
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Affiliation(s)
- Logan J Camp-Spivey
- Medical University of South Carolina, College of Nursing, Charleston, SC, USA
| | - Susan D Newman
- Medical University of South Carolina, College of Nursing, Charleston, SC, USA
| | - Robert N Stevens
- South Carolina Department of Education and South Carolina Department of Mental Health, School Behavioral Health, Columbia, SC, USA
| | - Michelle Nichols
- Medical University of South Carolina, College of Nursing, Charleston, SC, USA
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Ekwaru JP, Ohinmaa A, Dabravolskaj J, Maximova K, Veugelers PJ. Cost-effectiveness and return on investment of school-based health promotion programmes for chronic disease prevention. Eur J Public Health 2021; 31:1183-1189. [PMID: 34355754 PMCID: PMC8643402 DOI: 10.1093/eurpub/ckab130] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND While school-based health prevention programmes are effective in addressing unhealthy diet and physical inactivity, little is known about their economic implications. We conducted an economic evaluation of the programmes that were previously identified as feasible, acceptable, and sustainable in the Canadian context. METHODS This study builds on a meta-analysis of the effectiveness of feasible, acceptable, and sustainable school-based health promotion programmes. A micro-simulation model incorporated intervention effects on multiple risk factors to estimate incremental cost-effectiveness and return on investment (ROI) of comprehensive school health (CSH), multicomponent, and physical education (PE) curriculum modification programmes. Cost-effectiveness was expressed as the programme costs below which the programme would be cost-effective at a CA$50 000 threshold level. RESULTS The estimated costs below which interventions were cost-effective per quality-adjusted life year gained were CA$682, CA$444, and CA$416 per student for CSH, multicomponent, and PE curriculum modification programmes, respectively. CSH programmes remained cost-effective per year of chronic disease prevented for costs of up to CA$3384 per student, compared to CA$1911 and CA$1987 for multicomponent and PE curriculum modification interventions, respectively. If the interventions were implemented at total discounted intervention costs of CA$100 per student, ROI through the avoidance of direct healthcare costs related to the treatment and management of chronic diseases would be 824% for CSH, 465% for multicomponent interventions, and 484% for PE curriculum modification interventions. CONCLUSIONS Whereas each examined intervention types showed favourable economic benefits, CSH programmes appeared to be the most cost-effective and to have the highest ROI.
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Affiliation(s)
- John P Ekwaru
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Arto Ohinmaa
- School of Public Health, University of Alberta, Edmonton, Canada
| | | | - Katerina Maximova
- School of Public Health, University of Alberta, Edmonton, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Paul J Veugelers
- School of Public Health, University of Alberta, Edmonton, Canada
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26
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Exploring Factors Contributing to the Implementation of Ontario's Healthy Kids Community Challenge: Surveys and Key Stakeholder Interviews with Program Providers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111108. [PMID: 34769628 PMCID: PMC8583105 DOI: 10.3390/ijerph182111108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/13/2021] [Accepted: 10/19/2021] [Indexed: 12/04/2022]
Abstract
(1) Background: To explore factors contributing to the Healthy Kids Community Challenge (HKCC) program implementation; (2) Methods: Data were collected through a quantitative survey (n = 124) and in-depth telephone interviews (n = 16) with program providers. Interviews were recorded and transcribed for thematic analysis using NVivo; (3) Results: Provincial funding and in-kind support from community partners were key. Initiatives were feasible to implement, and key messages were well-received by communities. Specific practices and process were commonly discussed, and strong local program leadership was crucial to implementation; (4) Conclusions: Results have implications for planning and implementing future multi-component, community-based health promotion programs that include similar partnerships.
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Long KQ, Ngoc-Anh HT, Phuong NH, Tuyet-Hanh TT, Park K, Takeuchi M, Lam NT, Nga PTQ, Phuong-Anh L, Van Tuan L, Bao TQ, Thinh OP, Van Huy N, Lan VTH, Van Minh H. Clustering Lifestyle Risk Behaviors among Vietnamese Adolescents and Roles of School: A Bayesian Multilevel Analysis of Global School-Based Student Health Survey 2019. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2021; 15:100225. [PMID: 34528007 PMCID: PMC8342779 DOI: 10.1016/j.lanwpc.2021.100225] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/10/2021] [Accepted: 07/07/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Adolescence is a vulnerable period for many lifestyle risk behaviors. In this study, we aimed to 1) examine a clustering pattern of lifestyle risk behaviors; 2) investigate roles of the school health promotion programs on this pattern among adolescents in Vietnam. METHODS We analyzed data of 7,541 adolescents aged 13-17 years from the 2019 nationally representative Global School-based Student Health Survey, conducted in 20 provinces and cities in Vietnam. We applied the latent class analysis to identify groups of clustering and used Bayesian 2-level logistic regressions to evaluate the correlation of school health promotion programs on these clusters. We reassessed the school effect size by incorporating different informative priors to the Bayesian models. FINDINGS The most frequent lifestyle risk behavior among Vietnamese adolescents was physical inactivity, followed by unhealthy diet, and sedentary behavior. Most of students had a cluster of at least two risk factors and nearly a half with at least three risk factors. Latent class analysis detected 23% males and 18% females being at higher risk of lifestyle behaviors. Consistent through different priors, high quality of health promotion programs associated with lower the odds of lifestyle risk behaviors (highest quality schools vs. lowest quality schools; males: Odds ratio (OR) = 0·67, 95% Highest Density Interval (HDI): 0·46 - 0·93; females: OR = 0·69, 95% HDI: 0·47 - 0·98). INTERPRETATION Our findings demonstrated the clustering of specific lifestyle risk behaviors among Vietnamese in-school adolescents. School-based interventions separated for males and females might reduce multiple health risk behaviors in adolescence. FUNDING The 2019 Global School-based Student Health Survey was conducted with financial support from the World Health Organization. The authors received no funding for the data analysis, data interpretation, manuscript writing, authorship, and/or publication of this article.
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Affiliation(s)
| | | | - Nguyen Hong Phuong
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC 20006
| | | | - Kidong Park
- World Health Organization, Country Office for Vietnam, Hanoi, 100000, Vietnam
| | - Momoe Takeuchi
- World Health Organization, Country Office for Vietnam, Hanoi, 100000, Vietnam
| | - Nguyen Tuan Lam
- World Health Organization, Country Office for Vietnam, Hanoi, 100000, Vietnam
| | - Pham Thi Quynh Nga
- World Health Organization, Country Office for Vietnam, Hanoi, 100000, Vietnam
| | - Le Phuong-Anh
- World Health Organization, Country Office for Vietnam, Hanoi, 100000, Vietnam
| | - Le Van Tuan
- Vietnam Ministry of Education and Training, Hanoi, 100000, Vietnam
| | - Tran Quoc Bao
- General Department of Preventive Medicine, Ministry of Health, Hanoi, 100000, Vietnam
| | - Ong Phuc Thinh
- Hanoi University of Public Health, Hanoi, 100000, Vietnam
| | - Nguyen Van Huy
- Health Innovation and Transformation Centre, Federation University, Victoria, 3353, Australia
- Graduate School of Public Health, St. Luke's International University, Tokyo, 104-0044, Japan
| | | | - Hoang Van Minh
- Hanoi University of Public Health, Hanoi, 100000, Vietnam
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Dabravolskaj J, Khan MKA, Veugelers PJ, Maximova K. Mental Health and Wellbeing of 9-12-year-old Children in Northern Canada Before the COVID-19 Pandemic and After the First Lockdown. Int J Public Health 2021; 66:1604219. [PMID: 34539323 PMCID: PMC8441596 DOI: 10.3389/ijph.2021.1604219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/17/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Children’s mental health and wellbeing declined during the first COVID-19 lockdown (Spring 2020), particularly among those from disadvantaged settings. We compared mental health and wellbeing of school-aged children observed pre-pandemic in 2018 and after the first lockdown was lifted and schools reopened in Fall 2020. Methods: In 2018, we surveyed 476 grade 4–6 students (9–12 years old) from 11 schools in socioeconomically disadvantaged communities in Northern Canada that participate in a school-based health promotion program targeting healthy lifestyle behaviours and mental wellbeing. In November-December 2020, we surveyed 467 grade 4–6 students in the same schools. The 12 questions in the mental health and wellbeing domain were grouped based on correlation and examined using multivariable logistic regression. Results: There were no notable changes pre-pandemic vs. post-lockdown in responses to each of the 12 questions or any of the sub-groupings. Conclusion: Supporting schools to implement health promotion programs may help mitigate the impact of the pandemic on children’s mental health and wellbeing. The findings align with recent calls for schools to remain open as long as possible during the pandemic response.
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Affiliation(s)
| | - Mohammed K A Khan
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Paul J Veugelers
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Katerina Maximova
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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The Use of a Nonrefundable Tax Credit to Increase Children's Participation in Physical Activity in Alberta, Canada. J Phys Act Health 2021; 18:1067-1073. [PMID: 34186513 DOI: 10.1123/jpah.2020-0217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 04/05/2021] [Accepted: 05/04/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Potential income disparities were examined in the (1) awareness and uptake of the Children's Fitness Tax Credit (CFTC), and (2) physical activity (PA) of children from families who did and did not claim the credit in Alberta, Canada in 2012 and 2014. METHODS Secondary analyses of 3 cross-sectional data sets of grade 5 students (10-11 y) were performed, including Alberta Project Promoting healthy Living for Everyone Schools 2012 (N = 1037), and Raising healthy Eating and Active Living Kids Alberta 2012 (N = 2676), and 2014 (N = 3125). Parents reported whether they claimed the CFTC in the previous year, their education and household income, and their child's gender and PA. Children self-reported their PA from the previous 7 days. In Alberta Project Promoting healthy Living for Everyone Schools, children also wore pedometers. Analyses adjusted for clustering within schools and demographic factors. RESULTS Higher income families (≥$50,000/y) were more likely to be aware of and to have claimed the CFTC compared with low-income families (<$50,000/y). The CFTC was associated with organized PA with larger associations for higher-income families (odds ratio = 9.03-9.32, Ps < .001) compared with lower-income families (odds ratio = 3.27-4.05, Ps < .01). No associations existed for overall PA or pedometer steps with the CFTC. CONCLUSIONS Income disparities exist in the awareness, uptake, and potential impact of the CFTC. Tax credits are not effective in promoting overall PA.
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Identifying dietary patterns in Irish schoolchildren and their association with nutritional knowledge and markers of health before and after intervention. Br J Nutr 2021; 126:383-391. [PMID: 33054881 DOI: 10.1017/s0007114520004043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The aim of the study was to identify dietary patterns (DP) and examine differences in anthropometric measures, blood pressure (BP), cardiorespiratory fitness and nutritional knowledge of 6- and 10-year-old children at baseline and following a nutrition and physical activity intervention, with respect to DP and treatment group. This is a longitudinal study. Food diary, nutritional knowledge questionnaire and 550-m walk/run test measured dietary intake, nutritional knowledge and cardiorespiratory fitness, respectively. BP, weight, height and waist circumference were also measured and BMI and waist-to-height ratio (WHtR) were derived. All measurements were performed at baseline and following intervention. Two primary schools (one intervention, one control) in Cork, Ireland, were selected. Participants were 6- (n 39, age 5·9 (sd 0·6) years) and 10- (n 49, age 9·8 (sd 0·5) years)-year-olds. Two DP were identified, using k-means cluster analysis, for both 6- (unhealthy and nutrient-dense) and 10-year-olds (processed and Western diet) at baseline. DP derived post-intervention were (1) plant-based and (2) processed foods for 6-year-olds and (1) nutrient-dense and (2) unhealthy for 10-year-olds. There was no statistically significant difference in DP for 6- and 10-year-olds at baseline and post-intervention (P > 0·05). Following the intervention, a multivariate ANOVA showed there were no statistically significant differences in nutritional knowledge, BMI, WHtR, cardiorespiratory fitness and BP based on DP and intervention/control group for both age groups (P > 0·05). Three out of four dietary patterns identified for 6- and 10-year-olds were unfavourable. While no statistically significant evidence of intervention impact was found on DP, a positive trend was emerging among 10-year-olds.
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"Sleep is healthy for your body and brain." Use of student-centered photovoice to explore the translation of sleep promotion at school to sleep behavior at home. Sleep Health 2021; 7:588-595. [PMID: 34301526 DOI: 10.1016/j.sleh.2021.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 05/01/2021] [Accepted: 05/08/2021] [Indexed: 11/20/2022]
Abstract
STUDY OBJECTIVES Schools are an important setting to teach and reinforce positive health behaviors such as sleep, however, research that incorporates the student perspective of school-based sleep promotion initiatives is limited. This study explored student's perceptions of sleep behavior (how they understood and valued positive and negative sleep behaviors) and determined if and how students translate school-based sleep promotion to the home. METHODS Forty-five grade 4 and 5 children (aged 9-11 years) were purposefully sampled from 3 schools participating in the Alberta Project Promoting healthy Living for Everyone in schools (APPLE) in Edmonton, Canada. Using focused ethnography as the method and photovoice as a data generating strategy, qualitative in-depth information was generated through photo-taking and one-on-one interviews. Data were analyzed in an iterative, cyclical process using latent content analysis techniques. RESULTS Four themes related to students' perception of sleep behavior within the context of a school-based sleep promotion initiative were identified: sleep is "healthy for your body and brain," sleep habits are rooted in the home environment, school experiences shape positive sleep habits at home, and students translate sleep promotion home if they think it is useful or would be acceptable to the family. CONCLUSION AND IMPLICATIONS School-based sleep promotion interventions that are grounded in the comprehensive school health (CSH) approach hold promise for successfully shaping student sleep behavior. To promote health and academic success in children, future interventions should include home-school partnerships that address child sleep across multiple critical learning environments.
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Storey KE, Stearns JA, McLeod N, Montemurro G. A social network analysis of interactions about physical activity and nutrition among APPLE schools staff. SSM Popul Health 2021; 14:100763. [PMID: 33748390 PMCID: PMC7966860 DOI: 10.1016/j.ssmph.2021.100763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/16/2021] [Accepted: 02/20/2021] [Indexed: 11/27/2022] Open
Abstract
Comprehensive school health (CSH) is a holistic approach to school-based health promotion that involves active participation and buy-in of school community members, including school staff (e.g., support staff, teachers, school health champions, principals). Implementation and sustainability of CSH builds on complex relationships within the school that support school-level health promoting changes and understanding the social relationships that exist in a school setting is critical. Thus, the purpose of this study was to conduct a social network analysis to examine adviceseeking networks of staff within three schools involved with a CSH program called APPLE Schools (A Project Promoting healthy Living for Everyone in Schools) project approach. The degree to which school staff were central in the network (i.e., gave or sought physical activity or nutrition advice, were connected or disconnected to others; indegree/outdegree centrality and betweenness centrality) and the overall structure of the networks were assessed (i.e., optimal levels of density and centralization). School health champions and several other individuals in the network were shown to be key sources of physical activity or nutrition advice and were identified as central players in the network. Whole networks across schools had low density and betweenness centralization, with optimal levels of out-centralization, and low to optimal levels of incentralization. This research allowed us to gain an understanding of network structures and relationship patterns in CSH schools, with specific attention to the coordinating role of school health champions, and other central players within the network. These findings increase our understanding of advice relationships that exist in a school setting and how these relationships may support CSH implementation and sustainability.
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Affiliation(s)
- Kate E. Storey
- School of Public Health, University of Alberta, 3-50 University Terrace, 8303-112 Street, Edmonton, Alberta, T6G 2T4, Canada
| | - Jodie A. Stearns
- School of Public Health, University of Alberta, 3-50 University Terrace, 8303-112 Street, Edmonton, Alberta, T6G 2T4, Canada
- Division of Preventive Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, 1902 College Plaza, 8215 -112 St, Edmonton, AB, T6G 2C8, Canada
| | - Nicole McLeod
- School of Public Health, University of Alberta, 3-50 University Terrace, 8303-112 Street, Edmonton, Alberta, T6G 2T4, Canada
| | - Genevieve Montemurro
- School of Public Health, University of Alberta, 3-50 University Terrace, 8303-112 Street, Edmonton, Alberta, T6G 2T4, Canada
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Nutrition across the curriculum: a scoping review exploring the integration of nutrition education within primary schools. Nutr Res Rev 2021; 35:181-196. [PMID: 33926596 DOI: 10.1017/s0954422421000111] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Primary schools contribute to promoting healthy eating behaviour and preventing overweight and obesity by providing nutrition education. Research highlights the importance of improving teachers' programme implementation to enhance intervention effectiveness. An integrative approach has been suggested to reduce time barriers that teachers currently experience in teaching nutrition. This scoping review explores use and effectiveness of integrative teaching in primary-school-based nutrition education programmes. Six databases were searched for primary-school-based interventions on nutrition education. Papers reporting on integration of nutrition topics within core curriculum were included. Abstracts and full texts of potentially relevant articles were screened to determine eligibility. Next, data were extracted and tabulated. Findings were collated and summarised to describe intervention characteristics, subject integration and effectiveness of the included programmes. Data describing integration of nutrition into the primary school curriculum were extracted from 39 eligible papers. Nutrition education programmes often involve lessons about food groups and are frequently embedded within the mathematics, science or literacy syllabus. Although articles report on the integration of nutrition, the use of this approach was not commonly described in detail. Only seven papers discussed student outcomes related to the integration of nutrition education within core subjects. The ability to draw strong conclusions about school-based nutrition intervention effectiveness is limited by the current lack of programme description and methodological issues. Hence, more research is warranted to inform evidence on effectiveness of integrative nutrition education for both teacher and student outcomes. Future studies that include greater detail regarding the integrative approach are needed.
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Burns KE, Chaurasia A, Carson V, Leatherdale ST. A quasi-experimental examination of how changes in school-level intramurals are associated with physical activity among a sample of Canadian secondary school students from the COMPASS study. SSM Popul Health 2021; 14:100805. [PMID: 33997250 PMCID: PMC8105658 DOI: 10.1016/j.ssmph.2021.100805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/05/2021] [Accepted: 04/16/2021] [Indexed: 12/17/2022] Open
Abstract
Introduction Intramurals in schools may encourage physical activity among youth. Schools are continuously making changes to these intramurals, yet it is not well understood how these changes impact youth physical activity. The main objective of this research was to examine if changes in the number of intramurals were associated with youth physical activity over time with a secondary objective to explore the association between sport participation and physical activity among youth over time. Methods This study used three years of linked longitudinal school- and student-level data from Ontario schools in year 5 (Y5: 2016–2017), year 6 (Y6: 2017–2018) and year 7 (Y7: 2018–2019) of the COMPASS study. Data on intramurals from 55 schools were collected from the School Programs and Policies questionnaire to determine intramural changes that were made from Y5 to Y6. Using the COMPASS Student Questionnaire, baseline demographics were collected and data on physical activity and sport participation were measured at Y5, Y6 and Y7 on 4417 students. Hierarchical linear mixed regression models were used to estimate how changes in intramurals were associated with youth physical activity over time. Results Changes in school-specific intramurals were not significantly associated with physical activity over time. Intramural, varsity and community sport participation were all positively and significantly associated with youth physical activity among female and males. Conclusions Intramural, varsity and community sport participation are important opportunities for youth physical activity. Schools should offer a variety of intramural and varsity sports to encourage physical activity. Although adding intramurals may not be effective at increasing youth physical activity, they may be effective when used in combination with other strategies to increase physical activity. The use of an indicator variable in multi-level modeling is a novel method to evaluate a natural experiment. Intramural, varsity and community sport participation were positively associated with youth physical activity. Intramural changes were not associated with youth physical activity over time. Intramurals may be a useful part of a more comprehensive approach to increasing youth physical activity.
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Affiliation(s)
- Kathleen E Burns
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Ashok Chaurasia
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Valerie Carson
- Faculty of Kinesiology, Sport, And Recreation, University of Alberta, Edmonton, AB, Canada
| | - Scott T Leatherdale
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
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Colley P, Miller L, Seabrook JA, Woodruff SJ, Gilliland J. Children's perceptions of a Centrally Procured School Food Program in southwestern Ontario, Canada. HEALTH PROMOTION AND CHRONIC DISEASE PREVENTION IN CANADA-RESEARCH POLICY AND PRACTICE 2021; 41:131-137. [PMID: 33851812 DOI: 10.24095/hpcdp.41.4.02] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION This qualitative study investigates children's perceptions of the influences of a Centrally Procured School Food Program on their dietary behaviours and their recommendations on how to improve the program. METHODS The observations of 208 students aged 9 to 14 years (Grades 5-8) at 21 elementary schools were collected through focus groups in 2017/18. The larger intervention consisted of a 10-week program offering daily snacks (i.e. fruit, vegetables, whole grains, dairy, meat alternatives) for elementary school children in southwestern Ontario, Canada. RESULTS The participants' overall impressions of the program were positive. They noted reduced hunger, increased energy and improved nutrition. Many children felt that the program changed their dietary patterns at home as well as at school, particularly in terms of eating more fruit and vegetables. The snack program also enabled children to try healthy foods. CONCLUSION Most participants considered the program to be beneficial in promoting healthy eating. Participants recommended adding educational activities, expanding the variety of foods and increasing child involvement in selecting and preparing foods.
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Affiliation(s)
| | | | - Jamie A Seabrook
- Western University, London, Ontario, Canada.,Brescia University College, London, Ontario, Canada
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Riglea T, Kalubi J, Sylvestre MP, Maximova K, Dutczak H, Gariépy G, O'Loughlin J. Social inequalities in availability of health-promoting interventions in Québec elementary schools. Health Promot Int 2021; 37:6184835. [PMID: 33760062 DOI: 10.1093/heapro/daab023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Availability of health-promoting interventions (HPIs) may vary across schools serving students with different socioeconomic backgrounds. Our objectives were to describe social inequalities across elementary schools in: (i) level of importance that school principals attribute to 13 common health-related issues among students in their school; (ii) availability of HPIs within their school addressing eight health topics and (iii) (mis)alignment between perceived importance and HPI availability. Data were collected in telephone interviews with school principals in a convenience sample of 171 elementary schools (59% of 291 schools contacted). Schools were categorized as serving very advantaged, moderately advantaged or disadvantaged students. Principals reported how important 13 health issues were among students in their schools and provided data on HPI availability for 8 health issues, 4 of which required school action under government mandates. Higher proportions of principals in schools serving disadvantaged students (36% of all 171 schools) perceived most health issues as important. The mean number of HPIs in the past year was 12.0, 12.1 and 11.7 in schools serving very advantaged, moderately advantaged and disadvantaged students, respectively. Only availability of mental health HPIs differed by school deprivation (60, 43 and 30% in very, moderately and disadvantaged, respectively). Although most schools offered oral health HPIs, dental problems were not perceived as important. Smoking was perceived as not important and smoking-related HPIs were relatively rare (9%). Given rapid evolution in public health priorities, (mis)alignment between perceived importance of specific health issues and HPI availability in elementary schools warrants ongoing reflection.
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Affiliation(s)
- Teodora Riglea
- Centre de recherche du centre hospitalier de l'Université de Montréal (CRCHUM), 850 rue Saint-Denis, Montréal, QC H2X 0A9, Canada
| | - Jodi Kalubi
- Centre de recherche du centre hospitalier de l'Université de Montréal (CRCHUM), 850 rue Saint-Denis, Montréal, QC H2X 0A9, Canada.,Department of Social and Preventive Medicine, Université de Montréal, 7101 avenue du Parc, Montréal, QC H3N 1X9, Canada.,Centre de recherche en santé publique (CReSP), Université de Montréal & CIUSSS du Centre-Sud-de-l'Île-de-Montréal, 7101 avenue du Parc, Montréal, QC H3N 1X9, Canada
| | - Marie-Pierre Sylvestre
- Centre de recherche du centre hospitalier de l'Université de Montréal (CRCHUM), 850 rue Saint-Denis, Montréal, QC H2X 0A9, Canada.,Department of Social and Preventive Medicine, Université de Montréal, 7101 avenue du Parc, Montréal, QC H3N 1X9, Canada
| | - Katerina Maximova
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7, Canada.,MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada
| | - Hartley Dutczak
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Geneviève Gariépy
- Department of Social and Preventive Medicine, Université de Montréal, 7101 avenue du Parc, Montréal, QC H3N 1X9, Canada.,Montréal Mental Health University Institute, 7401 Rue Hochelaga, Montréal, QC H1N 3M5, Canada
| | - Jennifer O'Loughlin
- Centre de recherche du centre hospitalier de l'Université de Montréal (CRCHUM), 850 rue Saint-Denis, Montréal, QC H2X 0A9, Canada.,Department of Social and Preventive Medicine, Université de Montréal, 7101 avenue du Parc, Montréal, QC H3N 1X9, Canada
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Burns KE, Chaurasia A, Carson V, Leatherdale ST. Examining If Changes in the Type of School-Based Intramural Programs Affect Youth Physical Activity over Time: A Natural Experiment Evaluation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2752. [PMID: 33803119 PMCID: PMC7967481 DOI: 10.3390/ijerph18052752] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 02/26/2021] [Accepted: 03/03/2021] [Indexed: 11/16/2022]
Abstract
(1) School-based physical activity programs such as intramurals provide youth with inclusive opportunities to be physically active, yet we know little about how types of intramurals (e.g., team and individual sports) may contribute to youth MVPA. This research aims to evaluate how real-world changes in types of intramurals available in schools impact youth physical activity over time. (2) This study used three years of longitudinal school- and student-level data from Ontario schools participating in year 5 (2016-2017), year 6 (2017-2018) and year 7 (2018-2019) of the COMPASS study. Data on types of intramural programs from 55 schools were obtained, baseline demographic characteristics were measured and data on physical activity and sport participation were collected on a sample of 4417 students. Hierarchical linear mixed regression models were used to estimate how changes in the type of intramurals associate with youth MVPA over time. (3) Regardless of participation, adding individual and team intramurals was significantly and positively associated with female MVPA in Y6. (4) The indirect, but positive relationship between adding individual and team intramurals and female MVPA may be explained by other characteristics of the school environment that are conducive to female MVPA.
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Affiliation(s)
- Kathleen E. Burns
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (A.C.); (S.T.L.)
| | - Ashok Chaurasia
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (A.C.); (S.T.L.)
| | - Valerie Carson
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB T6G 2R3, Canada;
| | - Scott T. Leatherdale
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (A.C.); (S.T.L.)
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Dadaczynski K, Hering T. Health Promoting Schools in Germany. Mapping the Implementation of Holistic Strategies to Tackle NCDs and Promote Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2623. [PMID: 33807890 PMCID: PMC7967522 DOI: 10.3390/ijerph18052623] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/23/2021] [Accepted: 03/01/2021] [Indexed: 11/25/2022]
Abstract
Noncommunicable diseases (NCDs) and their underlying risk factors are seen as major public health problems that threaten health and welfare systems worldwide. The holistic and resource oriented Health Promoting School (HPS) approach can serve as an appropriate framework for the prevention and control of NCDs. The paper aimed to map the implementation of HPS activities in German schools and to examine associations with potential influencing factors. A series of cross-sectional online studies including five federal states and 5006 school principals (40.2% males, 50.8% females) from primary and secondary public schools was conducted from 2013 to 2018. Principal component analysis (PCA) resulted in two factors of HPS implementation (F1: concrete HPS action, F2: capacity building for HPS). Comparing both factors, a lower implementation level could be identified for HPS capacity building with lowest mean values found for regular teacher training and intersectoral collaboration. Multiple binary regression analyses revealed significant associations between low HPS implementation and male gender (OR: 1.36 to 1.42), younger age (OR: 1.47 to 1.90), secondary school (OR: 1.78 to 3.13) and federal state (Lower Saxony = OR: 1.27 to 1.45; Schleswig-Holstein = OR: 1.95 to 2.46). Moreover, low access to resources, decision-latitude and perceived educational benefits were independently associated with both factors of HPS implementation. Based on the results of this study, there is a need to support schools in their capacity building for health (e.g., regular teacher training, cooperation with local health services). Moreover, considering the core mission of schools, more evidence of the educational impact of health promotion and its translation into the language of education is needed for secondary schools in particular.
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Affiliation(s)
- Kevin Dadaczynski
- Department of Nursing and Health Science, Fulda University of Applied Sciences, 36037 Fulda, Germany
- Centre for Applied Health Science, Leuphana University Lueneburg, 21337 Lueneburg, Germany
| | - Thomas Hering
- Department of Applied Human Sciences, Magdeburg-Stendal University of Applied Sciences, 39676 Stendal, Germany;
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Carins J, Pang B, Willmott T, Knox K, Storr R, Robertson D, Rundle-Thiele S, Pettigrew S. Creating supportive eating places: a systematic review of food service initiatives. Health Promot Int 2021; 36:1368-1392. [PMID: 33538304 DOI: 10.1093/heapro/daaa155] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Obesity and diet-related health problems are complex, multi-factorial issues. Individual food choices are shaped by the wider context, and food environment level change is needed to support individual behaviour change. The food service sector can play an integral role, changing aspects of the food environment and contributing to improved consumer health. This systematic review aimed to analyse food service schemes that aimed to improve consumer health. Ten electronic databases were systematically searched to identify articles, supplemented with checking of reference lists from similar reviews and forward and backward searches to identify articles describing food service sector schemes. Sixteen schemes were identified, documented in 36 articles/reports. The schemes aimed to improve consumer health through one of three approaches-informing, enabling or engineering. In this order, these approaches involved increasing levels of effort from food services, corresponding with decreasing levels of effort for consumers. Half the schemes were informing, relying on an informed consumer to make a healthy choice. Most informing schemes had been evaluated to determine their impact on consumer choice and/or health, the evidence showed these schemes were generally ineffective. The effect of the enabling or engineering schemes on consumer choice and health had not been measured. Instead, evaluations focussed on process or business engagement rather than behavioural change assessments. This review indicates the food sector has the potential to contribute to consumer health through enabling and engineering; however, detailed outcome assessments are needed to draw definitive conclusions.
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Affiliation(s)
- Julia Carins
- Social Marketing @ Griffith, Department of Marketing, Griffith University, 170 Kessels Road, Nathan, Brisbane, Queensland 4111, Australia
| | - Bo Pang
- Social Marketing @ Griffith, Department of Marketing, Griffith University, 170 Kessels Road, Nathan, Brisbane, Queensland 4111, Australia
| | - Taylor Willmott
- Social Marketing @ Griffith, Department of Marketing, Griffith University, 170 Kessels Road, Nathan, Brisbane, Queensland 4111, Australia
| | - Kathy Knox
- Social Marketing @ Griffith, Department of Marketing, Griffith University, 170 Kessels Road, Nathan, Brisbane, Queensland 4111, Australia
| | - Ryan Storr
- Social Marketing @ Griffith, Department of Marketing, Griffith University, 170 Kessels Road, Nathan, Brisbane, Queensland 4111, Australia
| | - Dianne Robertson
- Social Marketing @ Griffith, Department of Marketing, Griffith University, 170 Kessels Road, Nathan, Brisbane, Queensland 4111, Australia
| | - Sharyn Rundle-Thiele
- Social Marketing @ Griffith, Department of Marketing, Griffith University, 170 Kessels Road, Nathan, Brisbane, Queensland 4111, Australia
| | - Simone Pettigrew
- Food Policy Division, George Institute for Global Health, 1 King St, Newtown, Sydney, New South Wales 2042, Australia
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Dong Y, Zou Z, Wang H, Dong B, Hu P, Ma Y, Song Y, Ma J. National School-Based Health Lifestyles Intervention in Chinese Children and Adolescents on Obesity and Hypertension. Front Pediatr 2021; 9:615283. [PMID: 34123956 PMCID: PMC8192970 DOI: 10.3389/fped.2021.615283] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 04/15/2021] [Indexed: 12/28/2022] Open
Abstract
Introduction: This study aimed to examine the effectiveness of the national school-based intervention on both obesity and high blood pressure in Chinese children and adolescents aged 6-18 years. Methods: The national school-based cluster non-randomized controlled trial was done in seven provinces from September 2013 to February 2014. A total of 23,175 children and adolescents in the control group and 25,702 in the intervention group were included in this trial with a mean follow-up of 6.7 ± 0.9 months. Mixed-effects regression models were used to evaluate the effect of the interventions on body weight and blood pressure (BP). Results: A significant upward in the body mass index (BMI) levels but downward in systolic BP (SBP), diastolic BP (DBP), BMI Z-scores, SBP Z-scores, and DBP Z-scores were witnessed in the intervention group compared to those in the control group (<0.001). Subgroup analyses presented significant intervention effects in children aged 6-12 years for BMI, SBP, DBP, and their standardized values Z-scores, but no effective results were found in adolescents aged 13-18 years. Stratification analyses based on the dynamic weight changes presented non-differential HBP, SHBP, and DHBP prevalence gaps between the control and intervention groups. Children aged 6-12 years with higher BMI percentiles at baseline presented obvious declines in SBP and DBP standardized values Z-scores. Conclusion: A mean 6-month multi-centered school-based comprehensive obesity intervention in China yields a small to null effect on obesity and hypertension with increasing age; the early age before 12 years may be the key period for interventions, and the younger, the better. Precise and high-intensity interventions targeting the population at different stages of childhood and adolescence are urgently needed to be developed. Clinical Trial Registration: https://www.clinicaltrials.gov/, identifier: NCT02343588.
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Affiliation(s)
- Yanhui Dong
- School of Public Health, Institute of Child and Adolescent Health, Peking University, Beijing, China
| | - Zhiyong Zou
- School of Public Health, Institute of Child and Adolescent Health, Peking University, Beijing, China
| | - Haijun Wang
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Bin Dong
- School of Public Health, Institute of Child and Adolescent Health, Peking University, Beijing, China
| | - Peijin Hu
- School of Public Health, Institute of Child and Adolescent Health, Peking University, Beijing, China
| | - Yinghua Ma
- School of Public Health, Institute of Child and Adolescent Health, Peking University, Beijing, China
| | - Yi Song
- School of Public Health, Institute of Child and Adolescent Health, Peking University, Beijing, China
| | - Jun Ma
- School of Public Health, Institute of Child and Adolescent Health, Peking University, Beijing, China
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Neely KC, Montemurro GR, Storey KE. A Canadian-wide perspective on the essential conditions for taking a comprehensive school health approach. BMC Public Health 2020; 20:1907. [PMID: 33317496 PMCID: PMC7734767 DOI: 10.1186/s12889-020-09987-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 11/29/2020] [Indexed: 12/22/2022] Open
Abstract
Background The primary purpose of this research was to explore Comprehensive School Health (CSH) stakeholders’ perceptions of the essential conditions for taking a CSH approach in other contexts across Canada. The secondary purpose was to examine the need for and development of an evaluative tool or resource to assess the implementation of the essential conditions. Methods Data were generated through individual semi-structured interviews (n = 38) and small group interviews (n = 3) with 45 participants across Canada involved in implementing policies or programs which take a CSH approach. Interviews were subjected to content analysis. Results There was positive support for the essential conditions and results indicated the essential conditions are relevant across Canada. Findings revealed the necessity for a new essential condition that reflected support and leadership from the school district and/or provincial/territorial governing bodies. Modifications to the description of each of the essential conditions were also suggested to provide clarity. Results also indicated that an evaluative tool that was concise, meaningful, and provided immediate feedback would be useful to school communities to establish readiness, assess, and improve ongoing implementation of CSH approaches. Conclusions This research contributes to the evidence-base of CSH by providing school communities across Canada with a set of refined and understandable essential conditions that support successful implementation. Further, the development of an evaluation tool will support school health champions, researchers, and policymakers in the optimization and implementation of policies or programs which take a CSH approach, ultimately supporting healthier school communities across the country.
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Affiliation(s)
- Kacey C Neely
- Faculty of Health Sciences and Sport, J12 Pathfoot, University of Stirling, Stirling, FK9 4LA, UK.
| | - Genevieve R Montemurro
- School of Public Health, University of Alberta, 3-50 University Terrace, 8303-112 Street, Edmonton, AB, T6G 2T4, Canada
| | - Kate E Storey
- School of Public Health, University of Alberta, 3-50 University Terrace, 8303-112 Street, Edmonton, AB, T6G 2T4, Canada
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Fruit and Vegetable Lesson Plan Pilot Intervention for Grade 5 Students from Southwestern Ontario. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228422. [PMID: 33203027 PMCID: PMC7697685 DOI: 10.3390/ijerph17228422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 10/28/2020] [Accepted: 11/12/2020] [Indexed: 12/15/2022]
Abstract
The purpose was to create and assess the impact of food literacy curriculum alongside a centrally procured school snack program among grade five students in Southwestern Ontario, Canada. Grade five students (N = 287) from five intervention and three controls schools participated in an 8-week food delivery program. In addition to the food delivery program, intervention schools received a resource kit and access to 42 multidisciplinary food literacy lesson plans using the produce delivered as part of the food delivery program. Participants completed matched pre- and post-test online surveys to assess fruit and vegetable intake, knowledge, preferences, and attitudes. Descriptive analyses and changes in scores between the intervention and control schools were assessed using one-way ANOVAs, paired samples t-tests, and McNemar’s tests. In total, there were 220 participants that completed both the pre- and post-test surveys. There was a significant improvement in fruit and vegetable intake (p = 0.038), yet no differences in knowledge of the recommended number of food group servings, knowledge of food groups, or fruit and vegetable preferences or attitudes were observed. Integrating nutrition lesson plans within core curricula classes (e.g., math, science, and literacy) can lead to modest increases in fruit and vegetable intake.
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Habib-Mourad C, Ghandour LA, Maliha C, Dagher M, Kharroubi S, Hwalla N. Impact of a Three-Year Obesity Prevention Study on Healthy Behaviors and BMI among Lebanese Schoolchildren: Findings from Ajyal Salima Program. Nutrients 2020; 12:E2687. [PMID: 32899135 PMCID: PMC7551295 DOI: 10.3390/nu12092687] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/11/2020] [Accepted: 08/14/2020] [Indexed: 12/11/2022] Open
Abstract
Most school-based obesity prevention programs in low- to middle-income countries are of short duration, and few undertake follow-up analyses after the termination of the project. The aims of the current study are to investigate (1) the long-term effects of a school-based intervention program when implemented over two years on body mass index (BMI), healthy dietary behaviors, and physical activity (PA); and (2) whether the effects are sustained after one-year washout. The study is a cluster-randomized trial; 36 public and private schools were randomized into either intervention or control groups. Students (8-12 years) completed pre-and post-assessment anthropometric measurements and questionnaires about their eating and physical activity habits. Students in the intervention groups received the program components for two consecutive years. Multiple logistic regression models were used to examine the effect of the intervention on BMI and healthy behaviors. Students in the intervention groups were less likely to be overweight at washout, only in public schools. The number of children reporting change in dietary behaviors significantly increased in intervention groups, with a sustained effect only in public schools. Policies aiming at securing a positive nutrition environment in schools, and adoption of nutrition programs, are needed for achieving sustained behavior and prompting BMI changes in children.
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Affiliation(s)
- Carla Habib-Mourad
- Department of Nutrition and Food Sciences, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut 11-0236, Lebanon; (C.H.-M.); (C.M.); (M.D.); (S.K.)
| | - Lilian A. Ghandour
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut 11-0236, Lebanon;
| | - Carla Maliha
- Department of Nutrition and Food Sciences, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut 11-0236, Lebanon; (C.H.-M.); (C.M.); (M.D.); (S.K.)
| | - Michèle Dagher
- Department of Nutrition and Food Sciences, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut 11-0236, Lebanon; (C.H.-M.); (C.M.); (M.D.); (S.K.)
| | - Samer Kharroubi
- Department of Nutrition and Food Sciences, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut 11-0236, Lebanon; (C.H.-M.); (C.M.); (M.D.); (S.K.)
| | - Nahla Hwalla
- Department of Nutrition and Food Sciences, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut 11-0236, Lebanon; (C.H.-M.); (C.M.); (M.D.); (S.K.)
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Zhang T, Lu G, Wu XY. Associations between physical activity, sedentary behaviour and self-rated health among the general population of children and adolescents: a systematic review and meta-analysis. BMC Public Health 2020; 20:1343. [PMID: 32883275 PMCID: PMC7650260 DOI: 10.1186/s12889-020-09447-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 08/25/2020] [Indexed: 01/02/2023] Open
Abstract
Background Self-rated health (SRH) is an indicator that captures a person’s perception of their overall health status. The relationship between physical activity (PA), sedentary behaviour (SB) and SRH has been investigated in systematic reviews among adult and elderly populations. No systematic review to date has synthesized the relationship between PA, SB and SRH among children and adolescents. The purpose of this systematic review and meta-analysis was to synthesize the associations between PA, SB and SRH in the general population of children and adolescents and to investigate the dose-response relationship between PA, SB and SRH. Methods We conducted a computer search for English language studies in the databases of MEDLINE, EMBASE and PSYCINFO that were published between 1946 and 2019. We searched PubMed, Google Scholar, and the references of the identified publications for additional studies. A meta-analysis was employed to synthesize the associations between PA, SB respectively and SRH. The dose-response association was tested using a random effects meta-regression model. The review was reported following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Results Sixty-eight published articles were included in the final review, including 59 cross-sectional and nine longitudinal studies. We found evidence that PA was associated with better SRH, and SB was associated with lower SRH among children and adolescents. A dose-response relationship between PA and SRH was observed, where a higher level of PA was associated with better SRH than a lower level of PA. The relationship between PA, SB and SRH was observed in both boys and girls, and did not show a significant gender difference. Conclusions The findings in the systematic review suggest that health intervention programmes targeting promoting PA and reducing SB among children and adolescents may enhance their overall health status. Future research is needed to expand prospective cohort and intervention studies to address directionality and causality in the relationships between PA, SB and SRH among children and youth. Trial registration PROSPERO - CRD42019142244. Registered on October 18, 2019.
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Affiliation(s)
- Tong Zhang
- School of Public Health, Weifang Medical University, 7166 Baotong West Street, Weifang, 261053, Shandong, China
| | - Guohua Lu
- School of Public Health, Weifang Medical University, 7166 Baotong West Street, Weifang, 261053, Shandong, China
| | - Xiu Yun Wu
- School of Public Health, Weifang Medical University, 7166 Baotong West Street, Weifang, 261053, Shandong, China.
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Elias PH, Montemurro G, Sulz L, Torrance B, Storey KE. Canadian after-school care providers' perceived role promoting healthy lifestyles: a focused ethnography. BMC Public Health 2020; 20:1279. [PMID: 32842998 PMCID: PMC7445905 DOI: 10.1186/s12889-020-09369-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 08/10/2020] [Indexed: 11/20/2023] Open
Abstract
BACKGROUND After-school care programs have garnered interest in recent years as the hours of 3:00-6:00 p.m. are an opportune time for children to engage in healthy behaviours, specifically healthy eating and physical activity. Care providers are major influencers within the after-school care setting, impacting health promoting opportunities for children. However, little is known regarding the role care providers play in health promotion interventions in the after-school care setting, specifically those using comprehensive approaches. The purpose of this research was to explore care providers' role and experience promoting healthy eating and physical activity through the after-school care health promotion intervention School's Out … Let's Move (SOLMo). SOLMo was guided by the evidence-based comprehensive school health framework. SOLMo had two main goals: [1] to serve a healthy snack with vegetable or fruit, and milk or water as the drink; [2] to include 30 min of moderate to vigorous physical activity. The intervention included resources and coaching for care providers to promote healthy eating and physical activity for children and took place in four after-school sites over a six-month period. Three of four sites were located in a school. The primary researcher was engaged with the sites over 22-months. METHODS This research was guided by the qualitative method focused ethnography. Semi-structured interviews with care providers (n = 13) taking part in SOLMo were conducted. Participant observation was included as part of data generation to further understand care provider roles. Latent content analysis was utilized iteratively and concurrently throughout data generation. RESULTS Overall, care providers were supportive of promoting health behaviours in the after-school setting. Through analysis, five themes and eight subthemes emerged related to care providers' role and experience promoting healthy eating and physical activity through SOLMo: 1) enhanced awareness; 2) improved programming; 3) strong relationships; 4) collaborative approach; and 5) role tension. CONCLUSIONS As major influencers, care providers play a crucial role in promoting healthy lifestyle behaviours for children. This research provides valuable insight into this role and the implementation of comprehensive health promotion approaches in the after-school setting. Findings contribute to the implementation knowledge base and help inform the promotion of healthy lifestyle behaviours for children.
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Affiliation(s)
- Pierrette H Elias
- School of Public Health, University of Alberta, 3-50 University Terrace, 8303-112 Street, Edmonton, AB, T6G 2T4, Canada
| | - Genevieve Montemurro
- School of Public Health, University of Alberta, 3-50 University Terrace, 8303-112 Street, Edmonton, AB, T6G 2T4, Canada
| | - Lauren Sulz
- Department of Secondary Education, Faculty of Education, University of Alberta, 350 Education Centre South, 11210 - 87 Ave, Edmonton, Alberta, T6G 2G5, Canada
| | - Brian Torrance
- Ever Active Schools, 11759 Groat Road, Edmonton, Alberta, T5M 3K6, Canada
| | - Kate E Storey
- School of Public Health, University of Alberta, 3-50 University Terrace, 8303-112 Street, Edmonton, AB, T6G 2T4, Canada.
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Verjans-Janssen SRB, Gerards SMPL, Kremers SPJ, Vos SB, Jansen MWJ, Van Kann DHH. Effects of the KEIGAAF intervention on the BMI z-score and energy balance-related behaviors of primary school-aged children. Int J Behav Nutr Phys Act 2020; 17:105. [PMID: 32807194 PMCID: PMC7433155 DOI: 10.1186/s12966-020-01012-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 08/10/2020] [Indexed: 01/22/2023] Open
Abstract
The aim of the current study was to evaluate the one- and two-year effectiveness of the KEIGAAF intervention, a school-based mutual adaptation intervention, on the BMI z-score (primary outcome), and energy balance-related behaviors (secondary outcomes) of children aged 7-10 years.A quasi-experimental study was conducted including eight intervention schools and three control schools located in low socioeconomic neighborhoods in the Netherlands. Baseline measurements were conducted in March and April 2017 and repeated after one and 2 years. Data were collected on children's BMI z-score, sedentary behavior (SB), physical activity (PA) behavior, and nutrition behavior through the use of anthropometric measurements, accelerometers, and questionnaires, respectively. All data were supplemented with demographics, and weather conditions data was added to the PA data. Based on the comprehensiveness of implemented physical activities, intervention schools were divided into schools having a comprehensive PA approach and schools having a less comprehensive approach. Intervention effects on continuous outcomes were analyzed using multiple linear mixed models and on binary outcome measures using generalized estimating equations. Intervention and control schools were compared, as well as comprehensive PA schools, less comprehensive PA schools, and control schools. Effect sizes (Cohen's d) were calculated.In total, 523 children participated. Children were on average 8.5 years old and 54% were girls. After 2 years, intervention children's BMI z-score decreased (B = -0.05, 95% CI -0.11;0.01) significantly compared to the control group (B = 0.20, 95% CI 0.09;0.31). Additionally, the intervention prevented an age-related decline in moderate-to-vigorous PA (MVPA) (%MVPA: B = 0.95, 95% CI 0.13;1.76). Negative intervention effects were seen on sugar-sweetened beverages and water consumption at school, due to larger favorable changes in the control group compared to the intervention group. After 2 years, the comprehensive PA schools showed more favorable effects on BMI z-score, SB, and MVPA compared to the other two conditions.This study shows that the KEIGAAF intervention is effective in improving children's MVPA during school days and BMI z-score, especially in vulnerable children. Additionally, we advocate the implementation of a comprehensive approach to promote a healthy weight status, to stimulate children's PA levels, and to prevent children from spending excessive time on sedentary behaviors.Trial registrationNetherlands Trial Register, NTR6716 ( NL6528 ), Registered 27 June 2017 - retrospectively registered.
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Affiliation(s)
- Sacha R B Verjans-Janssen
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6229, HA, Maastricht, The Netherlands.
| | - Sanne M P L Gerards
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6229, HA, Maastricht, The Netherlands
| | - Stef P J Kremers
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6229, HA, Maastricht, The Netherlands
| | - Steven B Vos
- Department of Industrial Design, Eindhoven University of Technology, 5612, AZ, Eindhoven, The Netherlands.,School of Sport Studies, Fontys University of Applied Sciences, 5644, HZ, Eindhoven, The Netherlands
| | - Maria W J Jansen
- Academic Collaborative Center for Public Health, Public Health Service South-Limburg, 6400, AA, Heerlen, The Netherlands.,Department of Health Services Research, Maastricht University, CAPHRI Care and Public Health Research Institute, 6229, GT, Maastricht, The Netherlands
| | - Dave H H Van Kann
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6229, HA, Maastricht, The Netherlands.,School of Sport Studies, Fontys University of Applied Sciences, 5644, HZ, Eindhoven, The Netherlands
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Dabravolskaj J, Montemurro G, Ekwaru JP, Wu XY, Storey K, Campbell S, Veugelers PJ, Ohinmaa A. Effectiveness of school-based health promotion interventions prioritized by stakeholders from health and education sectors: A systematic review and meta-analysis. Prev Med Rep 2020; 19:101138. [PMID: 32612906 PMCID: PMC7322344 DOI: 10.1016/j.pmedr.2020.101138] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/15/2020] [Accepted: 05/23/2020] [Indexed: 01/28/2023] Open
Abstract
Childhood obesity and associated modifiable risk factors exert significant burden on the health care system. The goal of this systematic review and meta-analysis was to examine the effectiveness of school-based intervention types perceived by Canadian stakeholders in health and education as feasible, acceptable and sustainable in terms of improving physical activity (PA), fruit and vegetable intake, and body weight. We searched multiple databases for studies that evaluated school-based interventions to prevent obesity and associated risk factors (i.e., unhealthy diet, physical inactivity, sedentary behaviour) in children aged 4–18 years from January 1, 2012 to January 28, 2020. From 10,871 identified records, we included 83 and 80 studies in our systematic review and meta-analysis, respectively. Comprehensive School Health (CSH) and interventions which focused on modifications to school nutrition policies showed statistically significant positive effects on fruit intake of 0.13 (95% CI: 0.04, 0.23) and 0.30 (95% CI: 0.1, 0.51) servings per day, respectively. No intervention types showed statistically significant effect on vegetable intake. CSH, modifications to physical education (PE) curriculum, and multicomponent interventions showed statistically significant difference in BMI of −0.26 (95% CI: −0.40, −0.12), −0.16 (95% CI: −0.3, −0.02), and −0.18 (95% CI: −0.29, −0.07), respectively. CSH interventions showed positive effect on step-count per day, but no other types of interventions showed significant effect on any of PA outcome measures. Thus, the results of this systematic review and meta-analysis suggest that decision-makers should carefully consider CSH, multicomponent interventions, modifications to PE curricula and school nutrition policies to prevent childhood obesity.
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Key Words
- BMI, body mass index
- CI, confidence interval
- CSH, Comprehensive School Health
- Childhood obesity prevention
- FV, fruit and vegetable
- HSAT, Healthy School Action Tools
- Health promotion
- MVPA, moderate to vigorous physical activity
- Meta-analysis
- PA, physical activity
- PE, physical education
- PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses
- RCT, randomized controlled trial
- SES, socioeconomic status
- School-based interventions
- Systematic review
- UK, United Kingdom
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Affiliation(s)
| | | | - John Paul Ekwaru
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Xiu Yun Wu
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Kate Storey
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Sandra Campbell
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, Canada
| | - Paul J Veugelers
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Arto Ohinmaa
- School of Public Health, University of Alberta, Edmonton, Canada
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Ekwaru JP, Ohinmaa A, Veugelers PJ. An Enhanced Approach for Economic Evaluation of Long-Term Benefits of School-Based Health Promotion Programs. Nutrients 2020; 12:nu12041101. [PMID: 32316099 PMCID: PMC7230436 DOI: 10.3390/nu12041101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/10/2020] [Accepted: 04/12/2020] [Indexed: 12/22/2022] Open
Abstract
Chronic diseases constitute a tremendous public health burden globally. Poor nutrition, inactive lifestyles, and obesity are established independent risk factors for chronic diseases. Public health decision-makers are in desperate need of effective and cost-effective programs that prevent chronic diseases. To date, most economic evaluations consider the effect of these programs on body weight, without considering their effects on other risk factors (nutrition and physical activity). We propose an economic evaluation approach that considers program effects on multiple risk factors rather than on a single risk factor. For demonstration, we developed an enhanced model that incorporates health promotion program effects on four risk factors (weight status, physical activity, and fruit and vegetable consumption). Relative to this enhanced model, a model that considered only the effect on weight status produced incremental cost-effectiveness ratio (ICER) estimates for quality-adjusted life years that were 1% to 43% higher, and ICER estimates for years with chronic disease prevented that were 1% to 26% higher. The corresponding estimates for return on investment were 1% to 20% lower. To avoid an underestimation of the economic benefits of chronic disease prevention programs, we recommend economic evaluations consider program effects on multiple risk factors.
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Choukem SP, Tochie JN, Sibetcheu AT, Nansseu JR, Hamilton-Shield JP. Overweight/obesity and associated cardiovascular risk factors in sub-Saharan African children and adolescents: a scoping review. INTERNATIONAL JOURNAL OF PEDIATRIC ENDOCRINOLOGY 2020; 2020:6. [PMID: 32211050 PMCID: PMC7092532 DOI: 10.1186/s13633-020-0076-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 02/13/2020] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Recently, childhood and adolescence overweight/obesity has increased disproportionately in developing countries, with estimates predicting a parallel increase in future cardiovascular disease (CVD) burden identifiable in childhood and adolescence. Identifying cardiovascular risk factors (CVRF) associated with childhood and adolescence overweight/obesity is pivotal in tailoring preventive interventions for CVD. Whilst this has been examined extensively in high-income countries, there is scant consistent or representative data from sub-Saharan Africa (SSA). OBJECTIVE This scoping review synthesises contemporary studies on CVRF associated with overweight and obesity in SSA children and adolescents to provide evidence on the current burden of overweight/obesity and CVD in this population. METHODS We searched MEDLINE and Google Scholar up to July 31, 2019 for observational and experimental studies and systematic reviews addressing childhood and adolescence overweight/obesity and CVRF in SSA without language restriction. Four investigators working in four pairs, independently selected and extracted the relevant data. The methodological quality of all included studies was assessed. RESULTS We included 88 studies with a total of 86,637children and adolescents from 20 SSA countries. The risk of bias was low in 62 (70.5%), moderate 18 (20.5%), and high in eight (9%) studies. Overweight/obesity in SSA children and adolescents is rising at an alarming rate. Its main associations include physical inactivity, unhealthy diets, high socio-economic status, gender and high maternal body mass index. Identified CVRF in overweight/obese SSA children and adolescents are mainly metabolic syndrome, hypertension, dyslipidaemia, diabetes and glucose intolerance. There is a dearth of guidelines or consensus on the management of either childhood overweight/obesity or CVRF in overweight/obese SSA children and adolescents. CONCLUSION The current findings suggest an urgent need to review current health policies in SSA countries. Health education and transforming the current obesogenic environment of the SSA child and adolescent into one which promotes physical activity and healthy dietary habits is required.
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Affiliation(s)
- Simeon-Pierre Choukem
- Department of Clinical Sciences, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Health and Human Development (2HD) Research Network, Douala, Cameroon
- Diabetes and Endocrine Unit, Department of Internal Medicine, Douala General Hospital, Douala, Cameroon
| | - Joel Noutakdie Tochie
- Health and Human Development (2HD) Research Network, Douala, Cameroon
- Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Aurelie T. Sibetcheu
- Health and Human Development (2HD) Research Network, Douala, Cameroon
- Department of Pediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Jobert Richie Nansseu
- Health and Human Development (2HD) Research Network, Douala, Cameroon
- Disease, Epidemics and Pandemics Control, Ministry of Public Health, Yaoundé, Cameroon
| | - Julian P. Hamilton-Shield
- Bristol Biomedical Research Centre (Nutrition Theme), University of Bristol and University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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The Role of School Leaders' Health Literacy for the Implementation of Health Promoting Schools. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17061855. [PMID: 32178457 PMCID: PMC7142764 DOI: 10.3390/ijerph17061855] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/04/2020] [Accepted: 03/11/2020] [Indexed: 01/12/2023]
Abstract
Background: The promotion of health literacy is seen as an urgent goal in public health and education and, hence, should be integrated in the school context as a component of the holistic health promoting school (HPS) approach. However, only limited empirical studies have addressed health literacy of school staff so far. Hence, this study aimed to examine the level of health literacy among school leaders and its association with the extent of HPS implementation. Methods: A cross-sectional study with n = 680 school principals and members of the school management board from Germany was carried out at the end of 2018. Individual health literacy, attitudes, and competencies towards HPS and occupational self-efficacy served as independent variables and the level of HPS implementation was the dependent variable. Data were analyzed using univariate and bivariate analysis as well as multiple binary logistic regression. Results: 29.3% of school leaders show a limited health literacy with significantly higher values found for male respondents. Regression analyses revealed that male gender (OR: 1.91, 95% CI: 1.22–2.99), HPS attitudes (OR: 3.17, 95% CI: 2.13–4.72), and HPS competencies (OR: 3.66, 95% CI: 2.43–5.50) were associated with a lower level of HPS implementation. Furthermore, regression analyses differentiated by gender showed that limited health literacy is associated with a low level of HPS implementation for male school leaders only (OR: 2.81, 95% CI: 1.22–6.45). Conclusions: The promotion of health literacy especially for male leaders would not only result in positive effects on an individual level but also could contribute to a stronger implementation of activities on school health promotion. We suggest integrating health literacy, HPS attitudes, and competencies more strongly into the qualification and in further training of school leaders.
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