1
|
Fuentealba-Urra S, Rubio A, González-Carrasco M, Oyanedel JC, Céspedes-Carreno C. Mediation effect of emotional self-regulation in the relationship between physical activity and subjective well-being in Chilean adolescents. Sci Rep 2023; 13:13386. [PMID: 37591897 PMCID: PMC10435534 DOI: 10.1038/s41598-023-39843-7] [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: 04/07/2023] [Accepted: 07/31/2023] [Indexed: 08/19/2023] Open
Abstract
Adolescents' subjective well-being and physical activity have been found to be correlated in previous studies. However, the underlying mechanisms of this relationship, especially the potential contribution of emotional self-regulation, have received little attention. This study aims to investigate the extent to which emotional self-regulation mediates the association between adolescent physical activity habits and their subjective well-being. The study involved 9585 adolescents who completed a cross-sectional survey. Participants were aged between 10 and 19 years old and attended primary and secondary schools in all 16 regions of Chile. The survey utilized a self-report questionnaire to measure physical activity habits, subjective well-being, and emotional self-regulation. Sociodemographic variables, such as age, gender, and socioeconomic level, were also considered in the analysis. The results showed that physical activity habits, emotional regulation, and subjective well-being were positively correlated. Among these factors, the strongest association was found between subjective well-being and emotional self-regulation. The mediation analysis revealed a partial mediation effect of emotional self-regulation between physical activity habits and subjective well-being. In other words, physical activity habits affect subjective well-being to the extent that these habits affect emotional self-regulation. These findings provide valuable insights into the mechanisms underlying the link between physical activity habits and subjective well-being among adolescents. They also offer useful information for the development of public programs and policies aimed at promoting physical activity habits and subjective well-being in young people.
Collapse
Affiliation(s)
- Sergio Fuentealba-Urra
- Facultad de Educación y Ciencias Sociales, Universidad Andres Bello, 4030000, Concepción, Chile.
| | - Andrés Rubio
- Facultad de Economia y Negocios, Universidad Andres Bello, Fernandez Concha 700, Las Condes, Santiago, Chile
- Facultad de Psicología, Universidad Diego Portales, Santiago, Chile
| | | | - Juan Carlos Oyanedel
- Facultad de Educación y Ciencias Sociales, Universidad Andres Bello, 4030000, Concepción, Chile
| | | |
Collapse
|
2
|
Guthold R, Kann L, Bhatti L, Abduvahobov P, Ansong J, Atkinson U, Baltag V, Caffe S, Caixeta R, Diallo CB, Fouad H, Haddad S, Hachri H, Jaggi JA, Joshi P, Karna P, Louazani SA, Mbola Mbassi S, Mehta R, Mudgal Y, Nigg CR, Okely AD, Ondarsuhu D, Ouaourir T, Trhari FZ, Riley LM. Effectiveness of a participatory approach to develop school health interventions in four low resource cities: study protocol of the 'empowering adolescents to lead change using health data' cluster randomised controlled trial. BMJ Open 2023; 13:e071353. [PMID: 37407059 PMCID: PMC10335517 DOI: 10.1136/bmjopen-2022-071353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 06/14/2023] [Indexed: 07/07/2023] Open
Abstract
INTRODUCTION Comprehensive local data on adolescent health are often lacking, particularly in lower resource settings. Furthermore, there are knowledge gaps around which interventions are effective to support healthy behaviours. This study generates health information for students from cities in four middle-income countries to plan, implement and subsequently evaluate a package of interventions to improve health outcomes. METHODS AND ANALYSIS We will conduct a cluster randomised controlled trial in schools in Fez, Morocco; Jaipur, India; Saint Catherine Parish, Jamaica; and Sekondi-Takoradi, Ghana. In each city, approximately 30 schools will be randomly selected and assigned to the control or intervention arm. Baseline data collection includes three components. First, a Global School Health Policies and Practices Survey (G-SHPPS) to be completed by principals of all selected schools. Second, a Global School-based Student Health Survey (GSHS) to be administered to a target sample of n=3153 13-17 years old students of randomly selected classes of these schools, including questions on alcohol, tobacco and drug use, diet, hygiene, mental health, physical activity, protective factors, sexual behaviours, violence and injury. Third, a study validating the GSHS physical activity questions against wrist-worn accelerometry in one randomly selected class in each control school (n approximately 300 students per city). Intervention schools will develop a suite of interventions using a participatory approach driven by students and involving parents/guardians, teachers and community stakeholders. Interventions will aim to change existing structures and policies at schools to positively influence students' behaviour, using the collected data and guided by the framework for Making Every School a Health Promoting School. Outcomes will be assessed for differential change after a 2-year follow-up. ETHICS AND DISSEMINATION The study was approved by WHO's Research Ethics Review Committee; by the Jodhpur School of Public Health's Institutional Review Board for Jaipur, India; by the Noguchi Memorial Institute for Medical Research Institutional Review Board for Sekondi-Takoradi, Ghana; by the Ministry of Health and Wellness' Advisory Panel on Ethics and Medico-Legal Affairs for St Catherine Parish, Jamaica, and by the Comité d'éthique pour la recherche biomédicale of the Université Mohammed V of Rabat for Fez, Morocco. Findings will be shared through open access publications and conferences. TRIAL REGISTRATION NUMBER NCT04963426.
Collapse
Affiliation(s)
- Regina Guthold
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, WHO, Geneva, Switzerland
| | - Laura Kann
- Noncommunicable Diseases Department, WHO, Geneva, Switzerland
| | - Lubna Bhatti
- Noncommunicable Diseases Department, WHO, Geneva, Switzerland
| | - Parviz Abduvahobov
- Health and Education Section, Division for Peace and Sustainable Development, Education Sector, UNESCO, Paris, France
| | | | - Uki Atkinson
- National Council on Drug Abuse, Kingston, Jamaica
| | - Valentina Baltag
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, WHO, Geneva, Switzerland
| | - Sonja Caffe
- Family, Health Promotion and Life Course, PAHO, Washington, Columbia, USA
| | - Roberta Caixeta
- Noncommunicable Diseases and Mental Health Department, PAHO, Washington, Columbia, USA
| | - Cheick Bady Diallo
- Universal Health Coverage/Communicable and Noncommunicable Diseases, WHO Regional Office for Africa, Brazzaville, Congo
| | - Heba Fouad
- Noncommunicable Diseases and Mental Health Department, WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Sally Haddad
- Department of Health Science, Institute of Sport Science, University of Bern, Bern, Switzerland
| | | | - Jeannine A Jaggi
- Department of Health Science, Institute of Sport Science, University of Bern, Bern, Switzerland
| | | | - Priya Karna
- WHO Country Office for India, New Delhi, India
| | | | - Symplice Mbola Mbassi
- Universal Health Coverage/Life Course, WHO Regional Office for Africa, Brazzaville, Congo
| | - Rajesh Mehta
- WHO Regional Office for South-East Asia, New Delhi, India
| | | | - Claudio R Nigg
- Department of Health Science, Institute of Sport Science, University of Bern, Bern, Switzerland
| | - Anthony D Okely
- School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Dolores Ondarsuhu
- Noncommunicable Diseases and Mental Health Department, PAHO, Washington, Columbia, USA
| | - Tahar Ouaourir
- Population Department, Ministry of Health, Rabat, Morocco
| | | | - Leanne M Riley
- Noncommunicable Diseases Department, WHO, Geneva, Switzerland
| |
Collapse
|
3
|
Vakili M, Mirzadeh M, Mirzaei M, Modarresi M, Raei R, Karimi R, Aghakoochak A, Imani AA. Sex differences in high-risk health behaviors among school-going adolescents in Yazd, Iran; a cross-sectional study. Heliyon 2023; 9:e16404. [PMID: 37303572 PMCID: PMC10250580 DOI: 10.1016/j.heliyon.2023.e16404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/14/2023] [Accepted: 05/15/2023] [Indexed: 06/13/2023] Open
Abstract
Objective Adolescents are exposed to a wide range of high-risk health behaviors. This study aimed to investigate the high-risk health behaviors of adolescents in an Iranian adolescent population and gender differences. Method This cross-sectional descriptive study recruited high school students in Yazd city in center of Iran. Schools were randomly selected. In each school, all selected classes were included. Sampling in each class was census. The study investigated self-reported high-risk health behaviors. Students completed the Global School-based Student Health Survey (GSHS), an anonymous, validated questionnaire. Results 2420 students participated in this study (52.5% male). The age range was 12-19 years. Daily consumption of ≥1 serving of fruit and vegetables per day was reported by 77.4% and 49.5% of respondents, respectively. Adequate physical activity was reported by only 18.4% of adolescents, and significantly less frequently by girls than boys (p < 0.001). 11.8% were current smokers (M/F ratio: 2.6), and 20.5% (M/F ratio: 1.5) were ever used hookah. The prevalence of ever alcohol and substance abuse was 15.5% and 8.8%, respectively. The prevalence of tobacco and substance use was significantly higher in participants' boys than in girls (p < 0.001). Males were over twice more likely to report frequent fighting in the past 12 months than girls. Overall, girls reported more parental supervision than boys (82.1% vs. 73.4%) and parental monitoring (90.6% vs. 86.8%), while boys reported higher levels of awareness over leisure activities than girls (65.8% vs. 58.4%). Conclusions High-risk health behaviors are more common in boys than girls. Health policymakers should use these results in prioritizing and designing health interventions to promote youth health. Further studies are recommended to identify the factors influencing the prevalence of these behaviors.
Collapse
Affiliation(s)
- Mahmood Vakili
- Health Monitoring Research Center, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mahboobahsadat Mirzadeh
- Department of Internal Medicine, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohsen Mirzaei
- Accident Prevention and Crisis Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mozhgan Modarresi
- Yazd Cardiovascular Research Center, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Reihaneh Raei
- Health Monitoring Research Center, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Reihaneh Karimi
- Health Monitoring Research Center, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Arezoo Aghakoochak
- Health Monitoring Research Center, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | |
Collapse
|
4
|
Kjeld SG, Glenstrup S, Andersen S, Bast LS. From a teacher and school leader perspective: What happened with smoking rules and practices during a three-year smoking preventive intervention? - Findings from the X:IT II study. EVALUATION AND PROGRAM PLANNING 2023; 97:102236. [PMID: 36645953 DOI: 10.1016/j.evalprogplan.2023.102236] [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: 03/02/2021] [Revised: 08/16/2022] [Accepted: 01/11/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND School-based smoking preventive interventions are most effective if they consist of multiple components; one of them being strict anti-smoking rules, i.e., no smoking by anyone at any location during school hours. However, there is a lack of in-depth knowledge about how smoking practices and rules about smoking actually change over time. Therefore, the purpose of this study was to examine how smoking practices changed during a three-year period in which a smoking preventive intervention with strict anti-smoking rules was implemented at schools. METHODS We used data from 46 Danish schools that were enrolled in the evaluation of the X:IT II study - a smoking preventive intervention with three main components: one of them being strict anti-smoking rules. We collected questionnaire data among school employees at four timepoints from the autumn of 2017 until April 2020. The questionnaire covered topics regarding students' and employees' tobacco patterns at the school, control with smoking, and aspects of the intervention delivery. RESULTS Over time, student smoking rules got stricter; from three out of four at baseline to almost all schools having rules about no student smoking during school hours three years later. Employee smoking rules also changed, although not as much as student rules. Overall, smoking at school grounds seemed to decline - however, student smoking at other locations increased, hence, violating the rule about no smoking during school hours. Enforcement of smoking rules also increased over time. CONCLUSION Although implementing and enforcing new rules in a school setting may be difficult, it seemed that most schools in the X:IT II study changed their rules and smoking practices for both students and employees over the three-year intervention period. It seemed, however, that students relocated their smoking to other places than the school or just outside school grounds. Implications of these findings are important to consider in future interventions, i.e., students leaving school during school hours to smoke and the physical separation between those who smoke and those who do not.
Collapse
Affiliation(s)
- S G Kjeld
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455 Copenhagen, Denmark
| | - S Glenstrup
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455 Copenhagen, Denmark
| | - S Andersen
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455 Copenhagen, Denmark
| | - L S Bast
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455 Copenhagen, Denmark.
| |
Collapse
|
5
|
Bonnesen CT, Thygesen LC, Rod NH, Toftager M, Madsen KR, Jensen MP, Rosing JA, Wehner SK, Due P, Krølner RF. Preventing Stress among High School Students in Denmark through the Multicomponent Healthy High School Intervention-The Effectiveness at First Follow-Up. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1754. [PMID: 36767122 PMCID: PMC9914335 DOI: 10.3390/ijerph20031754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/13/2023] [Accepted: 01/15/2023] [Indexed: 06/18/2023]
Abstract
Stress is a widespread phenomenon and young people especially are experiencing high levels of stress. School-related factors are the most frequently self-reported stressors among adolescents, but few interventions have targeted the school environment. This study evaluated the effectiveness of the Healthy High School (HHS) intervention on stress at a 9-month follow-up. The study included 5201 first-year high school students (~16 years) in Denmark. Participating schools were randomized into the HHS intervention (N = 15) or control group (N = 15). Baseline measurements were conducted in August 2016 and the follow-up was conducted in May 2017. The intervention was designed to promote well-being (primary outcome) by focusing on physical activity, meals, sleep, sense of security, and stress (secondary outcomes). The intervention comprised: structural initiatives at the school level; a teaching material; peer-led innovation workshops; and a smartphone app. The 10-item Perceived Stress Scale was used to measure stress. Intervention effects on perceived stress were estimated using an intention-to-treat approach with multiple imputations of missing data and multilevel general linear regression modelling. A total of 4577 students answered the baseline questionnaire. No statistically significant difference was found in stress between students at intervention and control schools at the follow-up (mean score: 16.7 versus 16.7, adjusted b = 0.42, 95% CI: -0.16;1.00). The HHS Study is one of the first large randomized controlled trials targeting school environmental stressors. Potential implementation failures and the failures of the program theory are discussed.
Collapse
Affiliation(s)
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, 1455 Copenhagen, Denmark
| | - Naja Hulvej Rod
- Section of Epidemiology, Department of Public Health, University of Copenhagen, 1014 Copenhagen, Denmark
| | - Mette Toftager
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense, Denmark
| | - Katrine Rich Madsen
- National Institute of Public Health, University of Southern Denmark, 1455 Copenhagen, Denmark
| | - Marie Pil Jensen
- National Institute of Public Health, University of Southern Denmark, 1455 Copenhagen, Denmark
| | - Johanne Aviaja Rosing
- National Institute of Public Health, University of Southern Denmark, 1455 Copenhagen, Denmark
| | - Stine Kjær Wehner
- National Institute of Public Health, University of Southern Denmark, 1455 Copenhagen, Denmark
| | - Pernille Due
- National Institute of Public Health, University of Southern Denmark, 1455 Copenhagen, Denmark
| | | |
Collapse
|
6
|
Nannsen AØ, Kristensen K, Johansen LB, Iken MK, Madsen M, Pilgaard KA, Grabowski D, Hangaard S, Schou AJ, Andersen A. Management of Diabetes during School Hours: A Cross-Sectional Questionnaire Study in Denmark. Healthcare (Basel) 2023; 11:healthcare11020251. [PMID: 36673619 PMCID: PMC9859616 DOI: 10.3390/healthcare11020251] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/06/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023] Open
Abstract
Managing diabetes is complicated for many children. It often requires support from an adult during the school day. In Denmark, most children spend 30-35 h a week at school. Nevertheless, diabetes management in schools remains largely uninvestigated. This study aimed to examine the characteristics and organization of diabetes management in Danish primary schools from the personnel's perspective. All primary schools in Denmark were invited to participate in the study (n = 2129), and 525 schools were included. A questionnaire was constructed and sent by email. Questionnaire data are presented in the descriptive statistics and compared with the ISPAD guidelines. According to 77.2% of respondents, school personnel had received training in diabetes management, and 78.5% of the schools had at least one person available for diabetes support every day. Respondents felt prepared to help the students with counting carbohydrates (38.9%), dosing insulin (39.1%), and helping the students during high (52.1%) or low (60.3%) blood sugar levels, insulin chock (35.2%), or during activities (36.3%). Yet, diabetes management was a challenging task. Only 61.7% had an action plan for diabetes management, 37.4% had face-to-face information meetings with the parents, and 55.1% of respondents reported having sufficient time to cooperate with the parents.
Collapse
Affiliation(s)
- Anne Østergaard Nannsen
- Steno Diabetes Center Aarhus (SDCA), Aarhus University Hospital, 8200 Aarhus N, Denmark
- Correspondence:
| | - Kurt Kristensen
- Steno Diabetes Center Aarhus (SDCA), Aarhus University Hospital, 8200 Aarhus N, Denmark
- Department of Pediatrics, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Lise Bro Johansen
- Steno Diabetes Center Copenhagen (SDCC), Department of Research, Copenhagen University Hospital, 2730 Herlev, Denmark
| | | | - Mette Madsen
- Steno Diabetes Center North Denmark (SDCN), 9000 Aalborg, Denmark
- Department of Pediatrics and Adolescent Medicine, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Kasper Ascanius Pilgaard
- Steno Diabetes Center Copenhagen (SDCC), Department of Research, Copenhagen University Hospital, 2730 Herlev, Denmark
- Department of Pediatrics, Copenhagen University Hospital, 2730 Herlev, Denmark
| | - Dan Grabowski
- Steno Diabetes Center Copenhagen (SDCC), Department of Research, Copenhagen University Hospital, 2730 Herlev, Denmark
| | - Stine Hangaard
- Steno Diabetes Center North Denmark (SDCN), 9000 Aalborg, Denmark
| | - Anders Jørgen Schou
- Steno Diabetes Center Odense (SDCO), 5000 Odense, Denmark
- Pediatric Research Unit, Odense University Hospital, 5000 Odense, Denmark
| | - Anette Andersen
- Steno Diabetes Center Aarhus (SDCA), Aarhus University Hospital, 8200 Aarhus N, Denmark
| |
Collapse
|
7
|
Wehner SK, Tjørnhøj-Thomsen T, Bonnesen CT, Madsen KR, Jensen MP, Krølner RF. Peer mentors' role in school-based health promotion: qualitative findings from the Young & Active study. Health Promot Int 2022; 37:daab089. [PMID: 34339490 PMCID: PMC9067443 DOI: 10.1093/heapro/daab089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Peer-led interventions are highlighted as promising strategies to promote health among adolescents, but little is known about the mechanisms underlying this approach. To better understand the role of peer mentors (PMs) as implementers in school-based health promotion, we combined participant observations, focus group interviews and video recordings to explore high school students' reception of a peer-led intervention component (Young & Active). Young & Active aimed to increase well-being among first-year high school students (∼16 years of age) through the promotion of movement and sense of community and was implemented during the school year 2016-2017 in a larger school-based intervention study, the Healthy High School study in Denmark. The Healthy High School study was designed as a cluster-randomized controlled trial with 15 intervention schools and 15 control schools. At each intervention school, university students in Sports Science and Health (members of the research group) facilitated an innovation workshop aiming at inspiring all first-year students to initiate movement activities at schools. The findings illustrate potentials and challenges implied in the PM role. The peer mentors' profound commitment, as well as their response and sensibility to situational contingencies, were found to be significant for the students' reception and experience of the intervention. In conclusion, the specific job of PMs as implementers seems to consist of simultaneously following a manual and situationally adjusting in an emerging context balancing commitment and identification to the target group and the intervention project.
Collapse
Affiliation(s)
- Stine Kjær Wehner
- Department of Health and social context, National
Institute of Public Health, University of Southern Denmark,
Studiestræde 6, 1455 Copenhagen K, Denmark
| | - Tine Tjørnhøj-Thomsen
- Department of Health and social context, National
Institute of Public Health, University of Southern Denmark,
Studiestræde 6, 1455 Copenhagen K, Denmark
| | - Camilla Thørring Bonnesen
- Department of Health and social context, National
Institute of Public Health, University of Southern Denmark,
Studiestræde 6, 1455 Copenhagen K, Denmark
| | - Katrine Rich Madsen
- Department of Health and social context, National
Institute of Public Health, University of Southern Denmark,
Studiestræde 6, 1455 Copenhagen K, Denmark
| | - Marie Pil Jensen
- Department of Health and social context, National
Institute of Public Health, University of Southern Denmark,
Studiestræde 6, 1455 Copenhagen K, Denmark
| | - Rikke Fredenslund Krølner
- Department of Health and social context, National
Institute of Public Health, University of Southern Denmark,
Studiestræde 6, 1455 Copenhagen K, Denmark
| |
Collapse
|
8
|
Duus KS, Bonnesen CT, Rosing JA, Madsen KR, Pedersen TP, Toftager M, Thygesen LC, Krølner RF. Effect of the multicomponent healthy high school intervention on meal frequency and eating habits among high school students in Denmark: a cluster randomized controlled trial. Int J Behav Nutr Phys Act 2022; 19:12. [PMID: 35120544 PMCID: PMC8815150 DOI: 10.1186/s12966-021-01228-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 11/10/2021] [Indexed: 12/03/2022] Open
Abstract
Background Previous studies have shown that multicomponent interventions may improve meal frequency and eating habits in children, but evidence among young people is limited. This study evaluated the effect of the Healthy High School (HHS) intervention on daily intake of breakfast, lunch, water, fruit, and vegetables at 9-month follow-up. Methods The study included first-year students (≈16 years) attending high school in Denmark. Participating schools were randomized into the HHS intervention (N = 15) or control group (operating as usual) (N = 15). The intervention was designed to promote well-being (primary outcome) by focusing on healthy habits including meals, stress prevention, and strong peer relations. It included a curriculum, structural and organisational initiatives, a workshop, and a smartphone application. Students completed self-administered online questionnaires at the beginning of the school year and nine months later. To account for clustering of data, we used multilevel logistic regression analyses to estimate odds ratios (OR). We applied an intention-to-treat approach with multiple imputations of missing data. Results At baseline 4577 of 5201 students answered the questionnaire and 4512 at follow-up. In both groups the proportion of students eating breakfast decreased from approximately 50% to 40% from baseline to follow-up, and lunch frequency decreased from approximately 50% to 47%. Daily water intake, intake of fresh fruit and intake of vegetables remained unchanged from baseline to follow-up. There were no significant between group differences on any of the outcomes at first follow-up: breakfast: OR = 0.85 (95% CI: 0.65;1.10), lunch: OR = 0.96 (95% CI: 0.75;1.22), water intake: OR = 1.14 (95% CI: 0.92;1.40), intake of fresh fruit: (OR = 1.07, 95% CI: 0.84;1.37), vegetables: (OR = 1.01, 95% CI: 0.77;1.33). Conclusion No evidence of an effect of the HHS intervention was found for any of the outcomes. Future studies are warranted to explore how health promoting interventions can be integrated in further education to support educational goals. Moreover, how to fit interventions to the lives and wishes of young people, by also including systems outside of the school setting. Trial registration ISRCTN, ISRCTN43284296. Registered 28 April 2017 - retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-021-01228-2.
Collapse
Affiliation(s)
- Katrine Sidenius Duus
- National Institute of Public Health, University of Southern Denmark (SDU), Studiestræde 6, 1455 Copenhagen K, Copenhagen, Denmark.
| | - Camilla Thørring Bonnesen
- National Institute of Public Health, University of Southern Denmark (SDU), Studiestræde 6, 1455 Copenhagen K, Copenhagen, Denmark
| | - Johanne Aviaja Rosing
- National Institute of Public Health, University of Southern Denmark (SDU), Studiestræde 6, 1455 Copenhagen K, Copenhagen, Denmark
| | - Katrine Rich Madsen
- National Institute of Public Health, University of Southern Denmark (SDU), Studiestræde 6, 1455 Copenhagen K, Copenhagen, Denmark
| | - Trine Pagh Pedersen
- National Institute of Public Health, University of Southern Denmark (SDU), Studiestræde 6, 1455 Copenhagen K, Copenhagen, Denmark
| | - Mette Toftager
- National Institute of Public Health, University of Southern Denmark (SDU), Studiestræde 6, 1455 Copenhagen K, Copenhagen, Denmark
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark (SDU), Studiestræde 6, 1455 Copenhagen K, Copenhagen, Denmark
| | - Rikke Fredenslund Krølner
- National Institute of Public Health, University of Southern Denmark (SDU), Studiestræde 6, 1455 Copenhagen K, Copenhagen, Denmark
| |
Collapse
|
9
|
The Moderating Role of Sociodemographic Factors in the Relationship between Physical Activity and Subjective Well-Being in Chilean Children and Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111190. [PMID: 34769709 PMCID: PMC8583316 DOI: 10.3390/ijerph182111190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 01/01/2023]
Abstract
Background: The relationship between physical activity habits and well-being is widely recognized; however, the interaction that these variables have with sociodemographic factors throughout life is only partially addressed in the literature, particularly in children and adolescents. The aim of this article is to analyze the moderating effect of sociodemographic factors and the possible interaction of these moderations in the relationship between physical activity and subjective well-being in children and adolescents. Methods: This cross-sectional study considered a sample of 9572 children and adolescents from 10 to 19 years of age, students of primary and secondary schools in all regions of Chile. Subjective well-being and physical activity habits were measured using self-report questionnaires. Socioeconomic level was established from the school vulnerability index (SVI) of each student’s school. Results: Simple moderation analyses revealed that the higher the age and the lower the SVI, the stronger the relationship between physical activity habits and subjective well-being. From a double moderation analysis, it could be observed that the age of the subjects is the most relevant moderator in the relationship between physical activity habits and perceived well-being in young people. Conclusions: This study highlights the importance of considering these factors and their interaction when generating programs or public policies to improve physical activity habits and well-being in children and adolescents.
Collapse
|
10
|
Wehner SK, Tjørnhøj-Thomsen T, Duus KS, Brautsch LAS, Jørgensen A, Bonnesen CT, Krølner RF. Adaptation, Student Participation and Gradual Withdrawal by Researchers as Sustainability Strategies in the High School-Based Young and Active Intervention: School Coordinators' Perspectives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10557. [PMID: 34639854 PMCID: PMC8508229 DOI: 10.3390/ijerph181910557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/01/2021] [Accepted: 10/07/2021] [Indexed: 11/16/2022]
Abstract
Ensuring the sustainability of school-based public health intervention activities remains a challenge. The Young and Active (Y&A) intervention used peer-led workshops to promote movement and strengthen students' sense of community in 16 Danish high schools. Peer mentors inspired first-year students to implement movement activities. To support sustainability, we applied a three-year stepwise implementation strategy using university students as peer mentors in year 1 and senior high school students in the following two years. This study explores the sustainability potential of Y&A, focusing on school coordinators' reflections on the intervention's fit to their schools and the student-driven approach, and we assess the three-step implementation strategy. The study is based on telephone interviews with coordinators (n = 7) from schools that participated in all three years and participant observations of four workshops (a total of approximately 250 participating students). Results were generated through an abductive analysis. Seven schools continued the intervention throughout the three years and adapted it to fit their priorities. The student-driven approach was perceived to be valuable, but few student-driven activities were initiated. Teacher support seemed crucial to support students in starting up activities and acting as peer mentors in workshops. The three-step implementation strategy proved valuable due to the peer-approach and the possibility of gradual adaptation. In future similar initiatives, it is important to address how the adequate staff support of students can be facilitated.
Collapse
Affiliation(s)
- Stine Kjær Wehner
- National Institute of Public Health, University of Southern Denmark, 1455 Copenhagen, Denmark; (T.T.-T.); (K.S.D.); (L.A.S.B.); (A.J.); (C.T.B.); (R.F.K.)
| | | | | | | | | | | | | |
Collapse
|
11
|
Thørring Bonnesen C, Aviaja Rosing J, Pil Jensen M, Kjær Wehner S, Rich Madsen K, Toftager M, Due P, Fredenslund Krølner R. What characterizes schools and students participating in health promoting school-based intervention studies? Findings from the healthy high school study. Prev Med Rep 2021; 23:101491. [PMID: 34354905 PMCID: PMC8322433 DOI: 10.1016/j.pmedr.2021.101491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 07/03/2021] [Accepted: 07/10/2021] [Indexed: 11/11/2022] Open
Abstract
The Healthy High School (HHS) intervention was developed to promote well-being among first-year high school students (~16 years of age) in Denmark by targeting stress, physical activity, meal habits, sleep, and sense of community. Thirty-one schools were randomly allocated to intervention (16 schools) or control (15 schools) groups in a cluster-randomized controlled trial. The purpose of this short communication was to compare characteristics of students and schools between 1) schools accepting to participate in the HHS study and non-participating schools using national survey data and 2) intervention and control schools using HHS baseline data. We included cross-sectional data from the Danish National Youth Study 2014 on 119 schools and 22,935 first-year students to characterize participating schools and students. At baseline (August 2016), students (n = 4577; 88.0%) and principals (n = 29; 96.7%) completed online questionnaires. Compared to non-participating schools, fewer HHS schools perceived their school as being popular and offered weekly sport activities outside school hours. More HHS schools had teachers engaged in health promotion activities and focused on stress prevention. The characteristics of HHS students did not differ markedly from non-participating high school students. There were no socio-demographic, outcome or contextual differences between the study arms. To ensure successful recruitment of schools it is important that the intervention meets the need of the schools and that the advantages of participation are explicit. This underlines the need for a thorough needs assessment prior to intervention development, co-creation of intervention activities with school staff, and a well-planned recruitment strategy.
Collapse
Affiliation(s)
- Camilla Thørring Bonnesen
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, Copenhagen DK-1455, Denmark
| | - Johanne Aviaja Rosing
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, Copenhagen DK-1455, Denmark
| | - Marie Pil Jensen
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, Copenhagen DK-1455, Denmark
| | - Stine Kjær Wehner
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, Copenhagen DK-1455, Denmark
| | - Katrine Rich Madsen
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, Copenhagen DK-1455, Denmark
| | - Mette Toftager
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, Copenhagen DK-1455, Denmark
| | - Pernille Due
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, Copenhagen DK-1455, Denmark
| | - Rikke Fredenslund Krølner
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, Copenhagen DK-1455, Denmark
| |
Collapse
|
12
|
Bast LS, Andersen HB, Andersen A, Lauemøller SG, Bonnesen CT, Krølner RF. School Coordinators' Perceptions of Organizational Readiness Is Associated with Implementation Fidelity in a Smoking Prevention Program: Findings from the X:IT II Study. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 22:312-323. [PMID: 33404969 PMCID: PMC8032573 DOI: 10.1007/s11121-020-01197-1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2020] [Indexed: 11/30/2022]
Abstract
School organizational readiness to implement interventions may play an important role for the actual obtained implementation level, and knowledge about organizational readiness prior to intervention start can help pinpoint how to optimize support to the schools. In this study, we applied a novel heuristic, R = MC2 to assess school organizational readiness prior to implementation of a multicomponent smoking prevention program. Furthermore, we examined the association to actual implementation after the first year of study. We used questionnaire data from school coordinators at 40 schools in Denmark who had accepted to implement the multi-component smoking prevention intervention-X:IT II-in the school year 2017-2018 including three main components: (1) Rules on smoke-free school time, (2) A smoke-free curriculum, and (3) Parental involvement. On behalf of the school, a school coordinator answered a baseline questionnaire about the organizational readiness and a follow-up questionnaire about implementation of the three components after first year of study. Readiness was measured by summing aspects of motivation (relative advantage, compatibility, complexity, and priority), general capacity (culture, climate, and staff capacity), and innovation-specific capacity (knowledge, skills, and abilities). Based on school coordinators' perceptions, almost all schools had good general capacity while the other two areas of readiness varied across schools; overall, 56.8% of schools (N = 25) had good motivation for implementing the X:IT II intervention and 61.3% (N = 27) had high innovation-specific capacity. Half of the schools had high overall readiness defined as high motivation and high innovation-specific capacity. Schools with high overall readiness implemented the rules on smoke-free school time, smoke-free curriculum, and parental involvement to a higher degree than schools with low overall readiness. All participating schools possessed sufficient levels of general capacity, e.g., a well-functioning organizational culture and sufficient staff capacity. High levels of motivation and innovation-specific capacity were positively associated with the schools' actual implementation of the main intervention components. This way of conceptualizing and measuring organizational readiness may be useful in future studies, i.e., in studies where enhancing readiness is a main objective.
Collapse
|
13
|
Rigney G, Watson A, Gazmararian J, Blunden S. Update on school-based sleep education programs: how far have we come and what has Australia contributed to the field? Sleep Med 2021; 80:134-157. [PMID: 33607553 DOI: 10.1016/j.sleep.2021.01.061] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE School-based sleep education programs help to promote sleep health information to many children and adolescents. The aim of this systematic review was to identify and describe school-based sleep education programs, to update previous reviews and identify recent advances and improvements in this field worldwide. METHODS Four electronic databases were searched. Eligibility criteria included children aged 5-18 years, sleep education intervention conducted in a school setting, and at least one pre-post-measure of a sleep variable. RESULTS A total of 32 articles met eligibility criteria with Australian sleep researchers constituting ∼ one quarter of these studies. Studies dated from 2007 to 2020 with sample sizes ranging from 9 to 3713 students. The majority of participants were high school students and predominantly female. Education programs generally took 4-6 weeks and content was consistent across studies. Overall, exposure to sleep education increased sleep knowledge, however changes in sleep behaviour variables and secondary outcome variables (eg, mental health; cognitive function; sleep hygiene practices) presented varied results. Studies conducted since 2015 were more likely to be randomised controlled trials and to include more interactive, online designs utilising innovative content such as mindfulness. CONCLUSIONS An exponential growth in school sleep education programs was identified since 2016. Future studies should consider utilising objective sleep measures, longer-term follow-ups, innovative delivery methods, and stronger attempts at implementing a knowledge-to-action approach for more sustainable programs.
Collapse
Affiliation(s)
- Gabrielle Rigney
- Central Queensland University, Appleton Institute, Adelaide, SA, Australia
| | - Autumn Watson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Julie Gazmararian
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sarah Blunden
- Central Queensland University, Appleton Institute, Adelaide, SA, Australia.
| |
Collapse
|
14
|
Bonnesen CT, Jensen MP, Madsen KR, Toftager M, Rosing JA, Krølner RF. Implementation of initiatives to prevent student stress: process evaluation findings from the Healthy High School study. HEALTH EDUCATION RESEARCH 2020; 35:195-215. [PMID: 32219401 PMCID: PMC7243719 DOI: 10.1093/her/cyaa003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 02/06/2020] [Indexed: 06/10/2023]
Abstract
Process evaluation of public health interventions is important for understanding intervention results and can help explain why interventions succeed or fail. This study evaluated implementation of a school-based intervention combining educational and environmental strategies to prevent stress among Danish high school students. We investigated dose delivered, dose received, fidelity, appreciation, barriers and facilitators at the 15 intervention schools using mixed methods and multiple data sources: questionnaires among students, teachers and school coordinators; semi-structured interviews with school coordinators; telephone interviews with student counsellors; and focus group interviews with students and teachers. Implementation varied by schools and classes. Half of the intervention schools delivered the environmental strategies. For the educational strategies, dose delivered differed according to intervention provider. Students reported a lower dose received compared with dose delivered reported by school staff. Overall, student counsellors, school coordinators and students-especially those with low perceived stress-were satisfied with the stress preventive initiatives while teacher satisfaction varied. Five main barriers and three facilitators for implementation were identified. The use of multiple data sources and data methods created new knowledge of the implementation process which is important for the interpretation of effect evaluation and development of future interventions.
Collapse
Affiliation(s)
- Camilla Thørring Bonnesen
- Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen K, Denmark
| | - Marie P Jensen
- Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen K, Denmark
| | - Katrine R Madsen
- Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen K, Denmark
| | - Mette Toftager
- Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen K, Denmark
| | - Johanne A Rosing
- Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen K, Denmark
| | - Rikke F Krølner
- Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen K, Denmark
| |
Collapse
|