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

Effectiveness of a game-based high-intensity interval training on executive function and other health indicators of children with ADHD: A three-arm partially-blinded randomized controlled trial

Background

Children with ADHD demand for effective intervention with minimum side effect to improve executive function (EF) and health well-being.

Method

This study used a three-arm partially-blinded randomized controlled trial to test the effects of two different kinds of 8-week game-based training programs (game-based HIIT program, GameHIIT; and game-based structured aerobic exercise program, GameSAE) on EF and other health indicators of children with ADHD, which was compared with a non-treatment control group.

Results

A total of 49 children with ADHD completed the program. Analyses of EF tests and parental survey indicated that (i) there is no significant intragroup difference among all measures between pre-/post-intervention tests for two game-based intervention groups. The only significant intergroup difference was observed in self-monitor score of parent-reported child's EF between GameSAE group and the control (large effect). Similarly, cerebral hemodynamic responses also found no significant group effect for all EF tests. However, the time effects were observed in several channels in the GameHIIT group in two EF tests (Color Words Stroop Test and Tower of London Test). No significant change of participants' overall ADHD symptoms was found in the pre-/post-tests for three groups. Nonetheless, further analyses revealed that both of two game-based training programs exhibited the significant positive effects on child's PA levels and the large effects on levels of physical fitness, when they were compared to the control.

Conclusion

By this study, a significant enhancement in physical fitness and PA levels were found in both game-based PA interventions when they were compared with control group. However, the effectiveness of game-based PA interventions on improving EF or reducing ADHD symptoms remains unclear. This implies that a larger intervention dosage or a tailored intervention design may be warranted to improve the EF of children with ADHD.

Perspectives of pharmacy staff on provision of self-care and minor ailment education in primary schools: a qualitative study

BACKGROUND

Pharmacy professionals, given their health expertise, can play a role in enhancing health education within their communities and among patients. The potential of the pharmacy workforce to enhance health education among primary school children is underexplored.

AIM

This study aimed to investigate the perspectives of pharmacy staff on the provision of education regarding self-care and treatment of minor ailments to primary school-aged children and to identify roles that pharmacists could play in this regard.

METHOD

Qualitative semi-structured interviews were conducted online with frontline pharmacy staff in the UK who had patient facing roles with primary school-aged children and parents. Interviews were audio-recorded and transcribed verbatim. Thematic data analysis was applied to the transcripts.

RESULTS

A total of 17 participants were recruited. Participants included 12 pharmacists, two pharmacy technicians and three pharmacy dispensers. All participants worked within community, hospital or primary care facilities. Five themes emerged from the data analysis: sources of health knowledge accessed by children and parents; a perceived lack of knowledge regarding self-care and treatments for minor ailments among children and parents; a perceived positive impact of education on self-care; barriers to health education; and the potential role of pharmacy staff in self-care education in schools.

CONCLUSION

Pharmacy staff recognise the value of integrating health education into primary school curricula. A collaborative approach with educational institutions could bridge the gap in knowledge regarding self-care and treatment of minor ailments, and could empower children and reduce unnecessary use of healthcare resources.

Understanding bidirectional and transactional processes of child eating behaviours and parental feeding practices explaining poor health outcomes across infancy and early childhood in Australia: protocol for the Longitudinal Assessment of Children's Eating (LACE) study

INTRODUCTION

Child eating behaviours develop through interactions between the child's characteristics, psychological factors and the child's social environment and this affects the child's diet and weight. To examine the currently existing birth cohort studies examining child eating behaviours, a review was conducted. There are currently no birth cohorts that concurrently examine child eating behaviours, dietary intake, growth and parental feeding practices from birth into early childhood. Therefore, the primary objective of the Longitudinal Assessment of Children's Eating (LACE) study is to examine the bidirectional and transactional processes of child eating behaviours and parental feeding practices explaining poor dietary intake and excess weight across infancy and early childhood.

METHODS AND ANALYSIS

The LACE study will be a prospective, longitudinal parent-reported study following infants from younger than 4 months of age across nine waves of data collection: younger than 4 months, 4 months, 6 months, 9 months, 12 months, 18 months, 2 years, 3 years and 5 years. Participants will be included if they are parents of infants younger than 4 months, 18 years or older, fluent in English and living in Australia at baseline. A sample size of 1210 is proposed. Participants will be recruited online via paid social media (Facebook and Instagram) advertisements. The study will examine child eating behaviours, body mass index Z-score, dietary intake, screen time, temperament, parent feeding practices and styles, and demographics. The data will be obtained using the online survey software Qualtrics. Data analyses will be conducted using Stata.

ETHICS AND DISSEMINATION

Ethical approval was granted by the Deakin University Human Ethics Advisory Group, Faculty of Health (HEAG-H 120_2022). The findings from this study will be disseminated via presentations at scientific conferences and published manuscripts in peer-reviewed journals. Findings will be disseminated to the general public via mainstream media and to participants of the study with a summary of the findings.

Effect of a Web-Based Nutritional and Physical Activity Intervention With Email Support (the EDDY Program) on Primary School Children's BMI Z-Score During the COVID-19 Pandemic: Intervention Study

Background

COVID-19 mitigation measures enhanced increases in children's weight and BMI due to decreased physical activity and increased energy intake. Overweight and obesity were major worldwide problems before the pandemic, and COVID-19 increased their severity even more. High BMI directly correlates with health disadvantages including cardiovascular diseases, musculoskeletal disorders, and mental health diseases. Therefore, it is vitally important to develop counteracting interventions to maintain children's health during exceptional situations like pandemics. However, worldwide data from such interventions are limited, and to our knowledge, no suitable study has been carried out during the pandemic in Austria.

Objective

This study was conducted to examine a 15-week web-based intervention with email support, the EDDY (Effect of Sports and Diet Trainings to Prevent Obesity and Secondary Diseases and to Influence Young Children's Lifestyle) program and the effect of nutritional education and physical activity on children's BMI z-score during the COVID-19 pandemic in Vienna, Austria.

Methods

The intervention consisted of 3 weekly videos-2 physical activity and 1 nutritional education video, respectively-and a biweekly email newsletter for the parents. This study was conducted in a Viennese primary school from February to June 2021 by a team of physicians, nutritionists, and sports scientists, including both professionals and students. The study population included an intervention group (who received web-based nutritional and physical activity training) and a control group (who received no intervention), comprising in total 125 children aged 8 to 11 years. Due to COVID-19 mitigation measures, the control group was a comparative group observed during the prior school year (2019-2020). Anthropometric measurements were obtained before and after the intervention in both groups.

Results

Due to a high dropout rate (n=57, 45.6%) because of the mitigation measures, there were 41 children in the intervention group and 27 in the control group. At baseline, the BMI z-score was 1.0 (SD 1.1) in the intervention group and 0.6 (SD 1.2) in the control group (P=.17). After the study period, the BMI z-score decreased by 0.06 (SD 0.21) in the intervention group, whereas it increased by 0.17 (SD 0.34) in the control group (P<.001). Comparing the change in BMI z-scores within BMI categories in the intervention group and control group revealed a statistically significant difference in the normal-weight children (P=.006). Further results showed that the decrease in BMI z-score was significant in the intervention group among both boys (P=.004) and girls (P=.01).

Conclusions

A web-based intervention with combined nutritional education and physical activity training might be an adequate tool to lessen the enhanced increase in body weight during a pandemic. Therefore, additional studies with greater sample sizes and different locations are needed. As the implementation of such intervention programs is essential, further studies need to be established rapidly.

Enhancing nutritional knowledge and self-regulation among adolescents: efficacy of a multifaceted food literacy intervention

This health literacy intervention study, conducted on adolescent students, aimed to evaluate the impact of a comprehensive educational program on promoting healthy eating habits. The intervention sought to enhance adolescents' knowledge about nutrition, foster self-regulation skills, and ultimately improve their overall health, including their body mass index (BMI). Through a multi-component approach that combined theoretical learning with practical activities and the integration of digital tools such as the MyFitnessPal app, the study targeted improvements in food literacy, which encompasses nutrition knowledge, food label interpretation skills, and cooking abilities. These elements are critical in influencing adolescents' food choices and eating behaviors, with a focus on increasing the consumption of fruits and vegetables while reducing the intake of fast food and processed snacks. The intervention was structured around a series of educational workshops and interactive sessions, facilitated by professionals experienced in nutrition. These sessions covered topics such as food composition, the importance of a balanced diet, and strategies for avoiding excessive consumption of processed and high-energy-density foods. A distinctive feature of the program was its use of digital tools to enhance engagement and allow for the practical application of learned concepts through food tracking and activity monitoring. Preliminary results indicate positive outcomes in terms of increased food knowledge and improved dietary habits among participants. Notably, there was a significant improvement in adolescents' BMI, highlighting the potential of food literacy interventions to contribute to better physical health outcomes. The study underscores the importance of adopting multidisciplinary and technology-enhanced approaches in educational programs aimed at promoting healthy eating among adolescents. The study's findings suggest that well-structured food education programs, tailored to address the specific needs of adolescents, can facilitate positive changes in eating behavior. This highlights the critical role of food literacy in adolescents' health and wellbeing and points to the need for continued investment in research and development to optimize intervention strategies. The integration of digital technologies and a focus on self-regulation strategies are identified as promising avenues for future research and educational practice, reinforcing the call for innovative investments in food education and health promotion among the youth.

Development and evaluation of the Capability, Opportunity, and Motivation to deliver Physical Activity in School Scale (COM-PASS)

BACKGROUND

Teachers are recognized as 'key agents' for the delivery of physical activity programs and policies in schools. The aim of our study was to develop and evaluate a tool to assess teachers' capability, opportunity, and motivation to deliver school-based physical activity interventions.

METHODS

The development and evaluation of the Capability, Opportunity, and Motivation to deliver Physical Activity in School Scale (COM-PASS) involved three phases. In Phase 1, we invited academic experts to participate in a Delphi study to rate, provide recommendations, and achieve consensus on questionnaire items that were based on the Capability, Opportunity, and Motivation Behavior (COM-B) model. Each item was ranked on the degree to which it matched the content of the COM-B model, using a 5-point scale ranging from '1 = Poor match' to '5 = Excellent match'. In Phase 2, we interviewed primary and secondary school teachers using a 'think-aloud' approach to assess their understanding of the items. In Phase 3, teachers (n = 196) completed the COM-PASS to assess structural validity using confirmatory factor analysis (CFA).

RESULTS

Thirty-eight academic experts from 14 countries completed three rounds of the Delphi study. In the first round, items had an average rating score of 4.04, in the second round 4.51, and in the third (final) round 4.78. The final tool included 14 items, which related to the six constructs of the COM-B model: physical capability, psychological capability, physical opportunity, social opportunity, reflective motivation, and automatic motivation. In Phase 2, ten teachers shared their interpretation of COM-PASS via a 20-min interview, which resulted in minor changes. In Phase 3, CFA of the 3-factor model (i.e., capability, opportunity, and motivation) revealed an adequate fit to the data (χ2 = 122.6, p < .001, CFI = .945, TLI = .924, RMSEA = .066). The internal consistencies of the three subscale scores were acceptable (i.e., capability: α = .75, opportunity: α = .75, motivation: α = .81).

CONCLUSION

COM-PASS is a valid and reliable tool for assessing teachers' capability, opportunity, and motivation to deliver physical activity interventions in schools. Further studies examining additional psychometric properties of the COM-PASS are warranted.

Identifying cost-based quality and performance indicators for home care: a modified delphi method study

BACKGROUND

This study, part of a multi-study program, aimed to identify a core set of cost-based quality and performance indicators using a modified Delphi research approach. Conceptually, this core set of cost-based indicators is intended for use within a broader health system performance framework for evaluating home care programming in Canada.

METHODS

This study used findings from a recently published scoping review identifying 34 cost-focused home care program PQIs. A purposive and snowball technique was employed to recruit a national panel of system-level operational and content experts in home care. We collected data through progressive surveys and engagement sessions. In the first round of surveying, the panel scored each indicator on Importance, Actionable, and Interpretable criteria. The panel set the second round of ranking the remaining indicators' consensus criteria. The panel ranked by importance their top five indicators from operational and system perspectives. Indicators selected by over 50% of the panel were accepted as consensus.

RESULTS

We identified 13 panellists. 12 completed the first round which identified that 30 met the predetermined inclusion criteria. Eight completed the ranking exercise, with one of the eight completing one of two components. The second round resulted in three PQIs meeting the consensus criteria: one operational and two systems-policy-focused. The PQIs: "Average cost per day per home care client," "Home care service cost (mean) per home care client 1y, 3y and 7y per health authority and provincially and nationally", and "Home care funding as a percent of overall health care expenditures."

CONCLUSIONS

The findings from this study offer a crucial foundation for assessing operational and health system outcomes. Notably, this research pioneers identifying key cost-based PQIs through a national expert panel and modified Delphi methodology. This study contributes to the literature on PQIs for home care and provides a basis for future research and practice. These selected PQIs should be applied to future research to test their applicability and validity within home care programming and outcomes. Researchers should apply these selected PQIs in future studies to evaluate their applicability and validity within home care programming and outcomes.

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

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.

Community-Based Participatory Obesity Prevention Interventions in Rural Communities: A Scoping Review

Child obesity is a worldwide public health concern. In America, children from rural areas have greater odds of obesity in comparison to those from urban areas. Community-engaged research is important for all communities, particularly under-represented communities. This paper reports the results of a scoping review investigating community-engaged research in obesity prevention programs tested with school-aged children in rural America. A literature search of Medline Ovid was conducted to identify interventions reporting the results of obesity prevention interventions that promoted a healthy diet or physical activity (PA) behaviors to school-age children in rural communities of the United States (US). After title and abstract review, potentially relevant citations were further examined by assessing the full text. Each stage of review was conducted by two independent reviewers. Twelve studies met the inclusionary criteria and are included in this review. Most of the studies focused on elementary school participants (n = 7) and improving both diet and PA (n = 9). Out of the twelve studies, only five included the target audience in intervention development or implementation. The most popular type of community engagement was community participation (n = 4). This review revealed that community-engaged research is under-utilized in obesity prevention interventions tested with school-aged children in rural US communities.

Epidaure Market-Effectiveness and transferability of a school-based intervention to improve healthy and sustainable food choices by schoolchildren: Protocol of a randomized controlled trial and qualitative study

CONTEXT

At least 40% of cancers are linked to environmental or behavioral factors, and dietary behavior appears to be a major lever. Epidaure Market is a prevention initiative developed using a method for co-constructing health promotion initiatives and prevention programs that stratifies evidence from the scientific literature and combines it with experiential knowledge (DEVA, TPB, BCT). It promotes a sustainable diet (i.e., healthy, ecological and ethical nutrition) among 5th and 4th grade students during the crucial period of adolescence, when these behaviors are often far from the recommendations.

METHOD

The protocol implemented was carried out in 72 middle school classes in the Montpellier and Dijon academies. The intervention included teaching sessions and a virtual supermarket game, integrated into the school curriculum and delivered by science teachers. Effectiveness is tested in a cluster randomized controlled trial with 3 evaluation times (pre- and post-intervention and 1 follow-up). The study also includes an implementation assessment, with process analysis and implementation elements, as well as a transferability assessment based on key functions (FIC model and Astaire grid).

EXPECTED OUTCOMES

The study is still underway within the school. The primary expected outcome is a positive influence on the motives underlying food choices to move towards a sustainable diet. Secondary expectations involve changes in variables such as self-efficacy and perceived social norms, as well as an increase in knowledge about healthy eating. We also expect the qualitative approaches to provide information on the deployment process in the new territories.

DISCUSSION

The study aims not only to demonstrate the effectiveness of Epidaure Market, but also to identify the optimal conditions for its nationwide implementation in France's middle schools. Ultimately, the initiative aims to help reduce the incidence of cancer by promoting healthier eating habits among teenagers.

Effectiveness of Participatory Research Interventions on Obesity and Obesity-Related Behaviors in Adolescents: A Systematic Review and Meta-analysis

CONTEXT

Adolescence is an optimal period to promote healthy lifestyles because behavior patterns are established in this stage. It has been suggested that engaging youth increases the effectiveness of interventions, but an overview is lacking.

OBJECTIVE

This study aims to evaluate the effectiveness of participatory research (PR) interventions, where adolescents (11-18 years old) from high-income countries had a significant role in the intervention development and/or delivery, compared with no (PR) intervention control groups on obesity-related outcomes and healthy lifestyle behaviors (HLBs).

DATA SOURCES

Eight databases (Embase, Medline ALL, Web of Science Core Collection, PsycINFO, ERIC, CINAHL, Scopus, and Cochrane Central Register of Controlled Trials) and Google Scholar were searched from 1990 to 2024 for randomized controlled trials (RCTs) and non-RCTs (in English).

DATA EXTRACTION

Two researchers independently performed the data extraction and risk-of-bias assessment.

DATA ANALYSIS

Sixteen studies were included and outcomes have been narratively described. Seven studies evaluated youth-led interventions, 3 studies evaluated co-created interventions, and 6 studies evaluated the combination of both. Six studies focused on physical activity (PA), 2 on nutrition, and 8 on a combination of PA, nutrition, and/or obesity-related outcomes. Ten studies presented at least 1 significant effect on PA, nutrition, or obesity-related outcomes in favor of the intervention group. Additionally, 12 studies were pooled in a meta-analysis. Whereas a small desired effect was found for fruit consumption, a small undesired effect was found for vegetable consumption. The pooled analysis found no significant effects on moderate-vigorous PA, total PA, and PA self-efficacy.

CONCLUSION

We found some evidence that youth empowerment in research may have positive effects on obesity-related HLBs, specifically an increased fruit consumption. However, the overall evidence was inconclusive due to limited studies and the heterogeneity of the studies included. This overview may guide future public health interventions that aim to engage and empower adolescents.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration Nº CRD42021254135.

Pragmatic Adaptations to Kids SIPsmartER's Implementation Protocol Supported Its Delivery During the COVID-19 Pandemic

OBJECTIVE

Describe the adaptation, implementation, and perceptions of Kids SIPsmartER's classroom component during the coronavirus disease-impacted 2020-2021 school year.

DESIGN

Mixed methods process evaluation.

SETTING

Seven rural Appalachian middle schools (US).

PARTICIPANTS

Middle-school teachers (n = 14) and principals (n = 6).

INTERVENTION

Kids SIPsmartER was a multilevel, school-based intervention designed to decrease sugar-sweetened beverage intake. The 12-lesson classroom component was supported by an implementation protocol.

MEASURES

Implementation protocol adaptations, program perceptions, and the school context were assessed using teacher and principal interviews, teacher-completed fidelity checklists, and researcher-maintained field notes. Adaptations were mapped to the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME).

ANALYSIS

Qualitative data were content coded. Quantitative data were summarized using descriptive statistics.

RESULTS

All schools maintained Kids SIPsmartER and delivered 100% of lessons. Ten adaptations were made to the implementation protocol. Schools used adapted delivery approaches to meet individual needs. Teachers and principals identified more benefits than barriers to implementing the program.

CONCLUSIONS AND IMPLICATIONS

Using a strategically adapted implementation protocol that was flexible to schools' individual needs allowed all middle schools to deliver Kids SIPsmartER during the 2020-2021 school year. Findings identify adaptation considerations that other school-based evidence-based interventions could incorporate to facilitate delivery during high-stress times.

Region of Murcia's 2022 report card on physical activity for children and youth

Objective

The aim of this review was to summarize the process and results of the Region of Murcia's 2022 Report Card on Physical Activity for Children and Youth.

Methods

Indicators from the Global Matrix initiative (Overall Physical Activity, Organized Sport & Physical Activity, Physical Fitness, Active Play, Active Transport, Sedentary Behaviors, Family & Peers, School, Community & Environment, and Government) were evaluated based on the best available data in the Region of Murcia.

Results

Active play was the indicator with the highest grade (B+), followed by Organized Sport & Physical Activity (B) and Active Play (B). School and Family and Peers indicators obtained a C+ and C grade, respectively. Both Community and Environment and Sedentary Behaviors indicators received a D+ grade. The grade for Overall Physical Activity and Government indicators was D. Physical Fitness was the indicator with the lowest grade of this Report Card (D-). None of the indicators received an incomplete grade (INC) because of a lack of available information.

Conclusions

The present Report Card offers evidence highlighting the low level of physical activity in Spanish children and adolescents living in the Region of Murcia. Further studies and surveillance efforts are urgently needed for most of the indicators analyzed, which should be addressed by researchers and the Region of Murcia's Government for this specific population. A strong commitment from the Government of the Region of Murcia is needed at all levels to promote a cultural change that will lead children and young people in this region to improve the current situation.

A school-based food and nutrition education intervention increases nutrition-related knowledge and fruit consumption among primary school children in northern Ghana

BACKGROUND

Providing children with the opportunity to learn about nutrition is critical in helping them establish a healthy lifestyle and eating behaviours that would remain with them till adulthood. We determined the effect of a school-based food and nutrition education (SFNE) intervention on the nutrition-related knowledge, attitudes, dietary habits, physical activity levels and the anthropometric indices (BMI-for-age z scores, %Body fat and waist circumference) of school-age children in northern Ghana.

METHODS

Following a controlled before-and-after study design, we recruited school-age children in primary 4 and 5 from public and private schools and assigned them non-randomly to intervention and control groups (4 schools total). A SFNE intervention called 'Eat Healthy, Grow Healthy (EHGH)' was implemented in intervention schools. Components of the intervention included children, teachers, school officials, and the school environment. Nutrition education didactic sessions, active discussions, nutrition games, charades, art work, and physical activity sessions were among the teaching and learning activities implemented. At 0 and 6 months, primary (anthropometry) and secondary (fruit, vegetable, and breakfast consumption) outcomes were obtained.

RESULTS

Mean BMI-for-age z-scores did not differ significantly between intervention and control groups (F1,261 = 0.45, P = 0.503, η2 = 0.01). However, significantly greater nutrition-related knowledge scores were recorded in the intervention group than in the control group at post-intervention (M = 6.07 SD = 2.17 vs. M = 5.22 SD = 1.92; p = 0.002). Mean number of days intervention children consumed fruits differed across time (F1, 263 = 33.04, p = 0.002, η2 = 0.04) but not between the control and intervention groups (F1, 263 = 0.28, p = 0.60, η2 = 0.00).

CONCLUSIONS

The EHGH intervention had positive effects on the nutrition-related knowledge and the consumption of fruits among children although it did not impact their anthropometric indices.

Adolescent mental health interventions: a narrative review of the positive effects of physical activity and implementation strategies

Introduction

The psychological well-being of adolescents is a global concern due to increasing societal pressures and mental health issues. Physical activity is known to enhance physical health and has potential benefits for mental health, including reducing symptoms of anxiety and depression, boosting self-esteem, and improving social skills. This narrative review explores how physical activity can serve as an intervention to help adolescents manage psychological stress and prevent mental health issues.

Methods

An extensive literature search was conducted using databases such as PubMed, PsycINFO, Web of Science, and Scopus. Keywords included "adolescent mental health," "physical activity," "psychological intervention," "types of exercise," "anxiety," "depression," "self-esteem," "social skills," and "emotional regulation." Studies were included based on relevance, peer-reviewed status, and involvement of adolescent populations. Data were extracted and analyzed qualitatively, focusing on the psychological impacts of different types of physical activity. Sixty one articles were eventually included.

Results and conclusion

The review identified multiple studies highlighting the positive effects of various physical activities on adolescent mental health. Aerobic exercises were found to improve mood and cognitive function, strength training reduced depressive symptoms and increased self-efficacy, team sports enhanced social skills and a sense of community, and mind-body practices like yoga and tai chi improved stress management and emotional regulation. The findings suggest that physical activity can play a significant role in promoting adolescent mental health. Implementation strategies in school and community settings, including integrating physical activity into school curricula, offering diverse activity options, training professional instructors, encouraging family and community involvement, and regular monitoring and evaluation, are recommended. Future research should address limitations such as sample diversity and long-term effects. This narrative review underscores the importance of physical activity in enhancing adolescent mental health. Effective implementation strategies and multi-sector collaboration are essential for maximizing the benefits of physical activity interventions.

Creating a healthy and sustainable food environment to promote plant-based food consumption: clear barriers and a gradual transition

BACKGROUND

A shift away from diets high in animal-based foods towards diets high in plant-based foods is desirable considering human health, environmental sustainability, and animal welfare. As the food environment plays a crucial role in shaping consumption patterns, understanding of how changes in the food environment can facilitate plant-based consumption is crucial for the so-called protein transition. The current study aims to garner insight into barriers and facilitators for food outlet managers to take action to stimulate plant-based consumption within a local food environment.

METHODS

Using a maximum-variation sample approach, we examined possible barriers and facilitators to promote plant-based consumption across different types of food outlets located within a geographically shared food environment (a city in the Netherlands). We conducted in-depth semi-structured interviews among food outlet managers and applied multi-stage thematic analysis to the interview transcripts.

RESULTS

Most managers underscored the urgency of shifting towards more plant-based diets, and perceived a growing demand for plant-based products. However, three barriers hindered most of them from taking decisive action: Managers' perception of low consumer demand for plant-based food options; fear of consumer resistance when stimulating plant-based food options; and limited behavioral agency to offer attractive plant-based food options. The few managers who made changes, or intend to make changes, are individuals with high intrinsic motivation, knowledge and skills.

CONCLUSIONS

The present work suggests the key for change towards a food environment stimulating plant-based consumption lies in addressing three (perceived) barriers shared among diverse outlets. These are partly different from barriers for stimulating healthy consumption in general. Furthermore, current changes appear to be driven incidentally by individuals who are motivated and able to stimulate more plant-based purchases among a small targeted group of consumers.

An SMS chatbot digital educational program to increase healthy eating behaviors in adolescence: A multifactorial randomized controlled trial among 7,890 participants in the Danish National Birth Cohort

BACKGROUND

Few cost-effective strategies to shift dietary habits of populations in a healthier direction have been identified. We examined if participating in a chatbot health education program transmitted by Short Messages Service ("SMS-program") could improve adolescent dietary behaviors and body weight trajectories. We also explored possible added effects of maternal or peer involvement.

METHODS AND FINDINGS

We conducted a randomized controlled trial (RCT) among adolescents from the Danish National Birth Cohort (DNBC). Eligible were adolescents who during 2015 to 2016 at age 14 years had completed a questionnaire assessing height, weight, and dietary habits. Two thirds were offered participation in an SMS-program, whereas 1/3 ("non-SMS group") received no offer. The SMS program aimed to improve 3 key dietary intake behaviors: sugar-sweetened beverages (SSBs), fruit and vegetables (FV), and fish. The offered programs had 3 factorially randomized schemes; the aims of these were to test effect of asking the mother or a friend to also participate in the health promotion program, and to test the effect of a 4-week individually tailored SMS program against the full 12-week SMS program targeting all 3 dietary factors. Height and weight and intakes of SSB, FV, and fish were assessed twice by a smartphone-based abbreviated dietary questionnaire completed at 6 months (m) and 18 m follow-up. Main outcome measures were (1) body mass index (BMI) z-score; and (2) an abbreviated Healthy Eating Index (mini-HEI, 1 m window, as mean of z-scores for SSB, FV, and fish). Among the 7,890 randomized adolescents, 5,260 were assigned to any SMS program; 63% (3,338) joined the offered program. Among the 7,890 randomized, 74% (5,853) and 68% (5,370) responded to follow-ups at 6 m and 18 m, respectively. Effects were estimated by intention-to-treat (ITT) analyses and inverse probability weighted per-protocol (IPW-PP) analyses excluding adolescents who did not join the program. Mean (standard deviation (SD)) mini-HEI at baseline, 6 m and 18 m was -0.01 (0.64), 0.01 (0.59), and -0.01 (0.59), respectively. In ITT-analyses, no effects were observed, at any time point, in those who had received any SMS program compared to the non-SMS group, on BMI z-score (6 m: -0.010 [95% confidence interval (CI) -0.035, 0.015]; p = 0.442, 18 m: 0.002 [95% CI -0.029, 0.033]; p = 0.901) or mini-HEI (6 m: 0.016 [95% CI -0.011, 0.043]; p = 0.253, 18m: -0.016 [95% CI -0.045, 0.013]; p = 0.286). In IPW-PP analyses, at 6 m, a small decrease in BMI z-score (-0.030 [95% CI -0.057, -0.003]; p = 0.032) was observed, whereas no significant effect was observed in mini-HEI (0.027 [95% CI -0.002, 0.056]; p = 0.072), among those who had received any SMS program compared to the non-SMS group. At 18 m, no associations were observed (BMI z-score: -0.006 [95% CI -0.039, 0.027]; p = 0.724, and mini-HEI: -0.005 [95% CI -0.036, 0.026]; p = 0.755). The main limitations of the study were that DNBC participants, though derived from the general population, tend to have higher socioeconomic status than average, and that outcome measures were self-reported.

CONCLUSIONS

In this study, a chatbot health education program delivered through an SMS program had no effect on dietary habits or weight trajectories in ITT analyses. However, IPW-PP-analyses, based on those 63% who had joined the offered SMS program, suggested modest improvements in weight development at 6 m, which had faded at 18 m. Future research should focus on developing gender-specific messaging programs including "booster" messages to obtain sustained engagement.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02809196 https://clinicaltrials.gov/study/NCT02809196.

Weekend physical activity profiles and their relationship with quality of life: The SOPHYA cohort of Swiss children and adolescents

INTRODUCTION

Quality of life (QoL) is an important health indicator among children and adolescents. Evidence on the effect of physical activity (PA)-related behaviors on QoL among youth remains inconsistent. Conventional accelerometer-derived PA metrics and guidelines with a focus on whole weeks may not adequately characterize QoL relevant PA behavior.

OBJECTIVE

This study aims to a) identify clusters of accelerometer-derived PA profiles during weekend days among children and adolescents living in Switzerland, b) assess their cross-sectional and predictive association with overall QoL and its dimensions, and c) investigate whether the associations of QoL with the newly identified clusters persist upon adjustment for the commonly used PA metrics moderate-to-vigorous physical activity (MVPA) and time spent in sedentary behavior (SB).

METHODS

The population-based Swiss children's Objectively measured PHYsical Activity (SOPHYA) cohort among children and adolescents aged 6 to 16 years was initiated at baseline in 2013. PA and QoL information was obtained twice over a five-year follow-up period. The primary endpoint is the overall QoL score and its six dimension scores obtained by KINDL® questionnaire. The primary predictor is the cluster membership of accelerometer-derived weekend PA profile. Clusters were obtained by applying the k-medoid algorithm to the distance matrix of profiles obtained by pairwise alignments of PA time series using the Dynamic Time Warping (DTW) algorithm. Secondary predictors are accelerometer-derived conventional PA metrics MVPA and SB from two combined weekend days. Linear regression models were applied to assess a) the cross-sectional association between PA cluster membership and QoL at baseline and b) the predictive association between PA cluster membership at baseline and QoL at follow-up, adjusting for baseline QoL.

RESULTS

The study sample for deriving PA profile clusters consisted of 51.4% girls and had an average age of 10.9 [SD 2.5] years). The elbow and silhouette methods indicated that weekend PA profiles are best classified in two or four clusters. The most differentiating characteristic for the two-clusters classification ("lower activity" and "high activity"), and the four-clusters classification ("inactive", "low activity", "medium activity", and "high activity"), respectively was the participant's mean counts per 15-seconds epoch. Participants assigned to high activity clusters were younger and more often male. Neither the clustered PA profiles nor MVPA or SB were cross-sectionally or predictively associated with overall QoL. The only association of a conventional PA metrics with QoL while adjusting for cluster membership was observed between MVPA during the weekend days and social well-being with a mean score difference of 2.4 (95%CI: 0.3 to 4.5; p = 0.025).

CONCLUSION

The absence of strong associations of PA metrics for the weekend with QoL, except for the positive association between MVPA during the weekend days and social well-being, is in line with results from two randomized studies not showing efficacy of PA interventions on youth QoL. But because PA decreases with age, its promotion and relevance to QoL remain important research topics. Larger longitudinal study samples with more than two follow-up time points of children and adolescents are needed to derive new novel accelerometer-derived PA profiles and to associate them with QoL dimensions.

Interventions to prevent obesity in children aged 12 to 18 years old

BACKGROUND

Prevention of obesity in adolescents is an international public health priority. The prevalence of overweight and obesity is over 25% in North and South America, Australia, most of Europe, and the Gulf region. Interventions that aim to prevent obesity involve strategies that promote healthy diets or 'activity' levels (physical activity, sedentary behaviour and/or sleep) or both, and work by reducing energy intake and/or increasing energy expenditure, respectively. There is uncertainty over which approaches are more effective, and numerous new studies have been published over the last five years since the previous version of this Cochrane Review.

OBJECTIVES

To assess the effects of interventions that aim to prevent obesity in adolescents by modifying dietary intake or 'activity' levels, or a combination of both, on changes in BMI, zBMI score and serious adverse events.

SEARCH METHODS

We used standard, extensive Cochrane search methods. The latest search date was February 2023.

SELECTION CRITERIA

Randomised controlled trials in adolescents (mean age 12 years and above but less than 19 years), comparing diet or 'activity' interventions (or both) to prevent obesity with no intervention, usual care, or with another eligible intervention, in any setting. Studies had to measure outcomes at a minimum of 12 weeks post baseline. We excluded interventions designed primarily to improve sporting performance.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methods. Our outcomes were BMI, zBMI score and serious adverse events, assessed at short- (12 weeks to < 9 months from baseline), medium- (9 months to < 15 months) and long-term (≥ 15 months) follow-up. We used GRADE to assess the certainty of the evidence for each outcome.

MAIN RESULTS

This review includes 74 studies (83,407 participants); 54 studies (46,358 participants) were included in meta-analyses. Sixty studies were based in high-income countries. The main setting for intervention delivery was schools (57 studies), followed by home (nine studies), the community (five studies) and a primary care setting (three studies). Fifty-one interventions were implemented for less than nine months; the shortest was conducted over one visit and the longest over 28 months. Sixty-two studies declared non-industry funding; five were funded in part by industry. Dietary interventions versus control The evidence is very uncertain about the effects of dietary interventions on body mass index (BMI) at short-term follow-up (mean difference (MD) -0.18, 95% confidence interval (CI) -0.41 to 0.06; 3 studies, 605 participants), medium-term follow-up (MD -0.65, 95% CI -1.18 to -0.11; 3 studies, 900 participants), and standardised BMI (zBMI) at long-term follow-up (MD -0.14, 95% CI -0.38 to 0.10; 2 studies, 1089 participants); all very low-certainty evidence. Compared with control, dietary interventions may have little to no effect on BMI at long-term follow-up (MD -0.30, 95% CI -1.67 to 1.07; 1 study, 44 participants); zBMI at short-term (MD -0.06, 95% CI -0.12 to 0.01; 5 studies, 3154 participants); and zBMI at medium-term (MD 0.02, 95% CI -0.17 to 0.21; 1 study, 112 participants) follow-up; all low-certainty evidence. Dietary interventions may have little to no effect on serious adverse events (two studies, 377 participants; low-certainty evidence). Activity interventions versus control Compared with control, activity interventions do not reduce BMI at short-term follow-up (MD -0.64, 95% CI -1.86 to 0.58; 6 studies, 1780 participants; low-certainty evidence) and probably do not reduce zBMI at medium- (MD 0, 95% CI -0.04 to 0.05; 6 studies, 5335 participants) or long-term (MD -0.05, 95% CI -0.12 to 0.02; 1 study, 985 participants) follow-up; both moderate-certainty evidence. Activity interventions do not reduce zBMI at short-term follow-up (MD 0.02, 95% CI -0.01 to 0.05; 7 studies, 4718 participants; high-certainty evidence), but may reduce BMI slightly at medium-term (MD -0.32, 95% CI -0.53 to -0.11; 3 studies, 2143 participants) and long-term (MD -0.28, 95% CI -0.51 to -0.05; 1 study, 985 participants) follow-up; both low-certainty evidence. Seven studies (5428 participants; low-certainty evidence) reported data on serious adverse events: two reported injuries relating to the exercise component of the intervention and five reported no effect of intervention on reported serious adverse events. Dietary and activity interventions versus control Dietary and activity interventions, compared with control, do not reduce BMI at short-term follow-up (MD 0.03, 95% CI -0.07 to 0.13; 11 studies, 3429 participants; high-certainty evidence), and probably do not reduce BMI at medium-term (MD 0.01, 95% CI -0.09 to 0.11; 8 studies, 5612 participants; moderate-certainty evidence) or long-term (MD 0.06, 95% CI -0.04 to 0.16; 6 studies, 8736 participants; moderate-certainty evidence) follow-up. They may have little to no effect on zBMI in the short term, but the evidence is very uncertain (MD -0.09, 95% CI -0.2 to 0.02; 3 studies, 515 participants; very low-certainty evidence), and they may not reduce zBMI at medium-term (MD -0.05, 95% CI -0.1 to 0.01; 6 studies, 3511 participants; low-certainty evidence) or long-term (MD -0.02, 95% CI -0.05 to 0.01; 7 studies, 8430 participants; low-certainty evidence) follow-up. Four studies (2394 participants) reported data on serious adverse events (very low-certainty evidence): one reported an increase in weight concern in a few adolescents and three reported no effect.

AUTHORS' CONCLUSIONS

The evidence demonstrates that dietary interventions may have little to no effect on obesity in adolescents. There is low-certainty evidence that activity interventions may have a small beneficial effect on BMI at medium- and long-term follow-up. Diet plus activity interventions may result in little to no difference. Importantly, this updated review also suggests that interventions to prevent obesity in this age group may result in little to no difference in serious adverse effects. Limitations of the evidence include inconsistent results across studies, lack of methodological rigour in some studies and small sample sizes. Further research is justified to investigate the effects of diet and activity interventions to prevent childhood obesity in community settings, and in young people with disabilities, since very few ongoing studies are likely to address these. Further randomised trials to address the remaining uncertainty about the effects of diet, activity interventions, or both, to prevent childhood obesity in schools (ideally with zBMI as the measured outcome) would need to have larger samples.

Schools as Hubs of Health: A Comprehensive Supplemental Nutrition Assistance Program-Education Model for Promoting Wellness in Low-Income Communities

Research indicates that health interventions are most effective when they address multiple social determinants of health to support positive behavior. Schools as Hubs of Health, a comprehensive model of nutrition and physical activity education, was developed to support wellness within school communities defined as low-income by the national Supplemental Nutrition Assistance Program Education (SNAP-Ed). Components of the model include the following: classroom education; garden education; youth engagement; staff training; parent and community engagement; and policies, systems, and environments. Findings over the last decade indicate positive outcomes in nutrition and physical activity behaviors, youth leadership and engagement, and systems and environmental changes that support health and wellness.

The cost-effectiveness of school-based interventions for chronic diseases: a systematic review

BACKGROUND

Chronic diseases, or non-communicable diseases (NCD), are conditions of long duration and often influenced and contributed by complex interactions of several variables, including genetic, physiological, environmental, and behavioral factors. These conditions contribute to death, disability, and subsequent health care costs. Primary and secondary school settings provide an opportunity to deliver relatively low cost and effective interventions to improve public health outcomes. However, there lacks systematic evidence on the cost-effectiveness of these interventions.

METHODS

We systematically searched four databases (PubMed/Medline, Cochrane, Embase, and Web of Science) for published studies on the cost-effectiveness of chronic-disease interventions in school settings. Studies were eligible for inclusion if they assessed interventions of any chronic or non-communicable disease, were conducted in a school setting, undertook a full cost-effectiveness analysis and were available in English, Spanish, or French.

RESULTS

Our review identified 1029 articles during our initial search of the databases, and after screening, 33 studies were included in our final analysis. The most used effectiveness outcome measures were summary effectiveness units such as quality-adjusted life years (QALYs) (22 articles; 67%) or disability-adjusted life years (DALYs) (4 articles; 12%). The most common health condition for which an intervention targets is overweight and obesity. Almost all school-based interventions were found to be cost-effective (30 articles; 81%).

CONCLUSION

Our review found evidence to support a number of cost-effective school-based interventions targeting NCDs focused on vaccination, routine physical activity, and supplement delivery interventions. Conversely, many classroom-based cognitive behavioral therapy for mental health and certain multi-component interventions for obesity were not found to be cost-effective.

The influence of physical activity on internet addiction among Chinese college students: the mediating role of self-esteem and the moderating role of gender

OBJECTIVES

The significance of self-esteem in the relationship between physical activity and Internet addiction among college students cannot be over, as it lays a solid foundation for the prevention and control of Internet addiction.

METHODS

A total of 950 college students were surveyed using the Physical Activity Rating Scale (PARS-3), Rosenberg Self-Esteem Scale (SES), and Chinese Internet Addiction Scale (CIAS-R) through a cluster random sampling method. Descriptive statistics, independent sample t-test, partial correlation analysis, mediation effect, moderation effect, and Bootstrap testing were conducted on the collected data to analyze and interpret the results.

RESULTS

(1) Significant gender differences were found in the amount of physical activity and the degree of Internet addiction among college students(P&& lt;0.001); (2) Physical activity was significantly and positively correlated with self-esteem (r = 0.26, P < 0.001), but significantly and negatively correlated with Internet addiction (r=-0.23, P < 0.001); Meanwhile, self-esteem and Internet addiction were significantly and negatively related to self-esteem (r=-0.22, P < 0.001). (3) Mediating effect analyses showed that self-esteem played a partial mediating role in physical activity and Internet addiction among college students, accounting for a portion of 78.95%. (4) A moderating effect of gender on the relationship between physical activity and Internet addiction was discovered.

CONCLUSION

The physical activity level of male students is significantly higher than that of female students, while the degree of internet addiction among female students is notably higher than that of male students. Physical activity can not only directly improve the issue of internet addiction among college students, but also indirectly improve it through self-esteem, with gender playing a moderating role in this process. This conclusion has practical reference significance for preventing and controlling internet addiction among college students, and provides evidence support for using physical activity as a reference solution in clinical applications. Additionally, it suggests that gender should be taken into account when preventing and intervening in internet addiction among college students, and different strategies and methods should be adopted for male and female students. Male students should be encouraged to participate more in physical activities, gradually increasing the frequency, duration, and intensity of their participation, in order to divert their attention and enhance their sense of achievement in sports, thereby reducing their use of mobile phones. For female students, on the other hand, it is important to strengthen real-life communication, change the form of sports participation, engage in group, collaborative, and different situational sports activities, and enhance their focus and attention in sports, in order to reduce their internet dependency, better guide them to use the internet reasonably, and enable them to achieve emotional release through sports.

Effectiveness of a smartphone app (Drink Less) versus usual digital care for reducing alcohol consumption among increasing-and-higher-risk adult drinkers in the UK: a two-arm, parallel-group, double-blind, randomised controlled trial

Background

Digital interventions, including apps and websites, can be effective for reducing alcohol consumption. However, many are not evidence- or theory-informed and have not been evaluated. We tested the effectiveness of the Drink Less app for reducing alcohol consumption compared with usual digital care in the UK.

Methods

In this two-arm, parallel group, double-blind, randomised controlled trial, we enrolled increasing-and-higher-risk drinkers (AUDIT ≥ 8) in the UK, who were motivated to reduce their alcohol consumption and willing to use a digital intervention to do so, via online methods. Participants were randomly assigned (1:1), using an online algorithm, to receive a web link to download the Drink Less app (intervention) or to the NHS alcohol advice webpage (usual digital care). Researchers were masked to group allocation. Participants were followed up at one, three and six months. The primary outcome was self-reported weekly alcohol consumption at six months, adjusting for baseline consumption. The full analytic sample was used in most analyses, though missing data was treated in different ways. The primary, pre-registered intention-to-treat analysis assumed baseline-carried-forwards. Secondary pre-registered analyses also focused on the full analytic sample and used alternatives including multiple imputation and last observation carried forwards. This trial is registered with the ISRCTN registry, ISRCTN64052601.

Findings

Between 07/13/2020 and 03/29/2022, 5602 people were randomly assigned to the Drink Less app (n = 2788) or comparator (n = 2814) groups. Six-month follow-up rates were 79% and 80%, respectively. The primary pre-registered conservative intention-to-treat approach assuming non-responders were drinking at baseline levels of consumption, found a non-significant greater reduction of 0.98 units in weekly alcohol consumption in the intervention group at 6-month follow-up (95% CI -2.67 to 0.70). The data were insensitive to detect the hypothesised effect (Bayes factor = 1.17). Data were not missing completely at random, with 6-month follow-up rates differing in terms of education, occupation, and income. We therefore conducted the pre-registered sensitivity analysis using multiple imputation, showing that the Drink Less app resulted in a 2.00-unit greater weekly reduction at 6-month follow-up compared with the NHS alcohol advice webpage (95% CI -3.76 to -0.24). Fewer than 0.1% of participants in both arms who responded to one, three or six-month follow-up reported adverse events linked to participation in the trial.

Interpretation

The Drink Less app may be effective in reducing the alcohol consumption in increasing-and-higher-risk drinkers motivated to reduce their consumption.

Funding

NIHR Public Health Research Programme.

The Effectiveness of a Telenutrition Intervention to Improve Dietary Behavior and Physical Activity Among Adolescents With Obesity: Protocol for a Systematic Review

BACKGROUND

The global obesity pandemic among adolescents is becoming a public health issue throughout the world. Telehealth use has significantly increased during and after the COVID-19 pandemic, including its application in adolescent obesity prevention and treatment.

OBJECTIVE

This review aims to synthesize the evidence on the effectiveness of telenutrition in improving dietary behavior and physical activity in adolescents with obesity.

METHODS

The PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols) guideline will be used to structure this protocol. The focus of the systematic review is guided by the population, intervention, comparator, and outcome (PICO) framework. A systematic search of Science Direct, PubMed, Cochrane, Embase, JMIR, ProQuest, and Google scholar databases will be conducted. Two authors will screen the titles and abstracts of identified studies independently and select studies according to the eligibility criteria. The full-text reading will be done independently by 2 reviewers to assess final eligibility. Any discrepancies will then be discussed and resolved. The Cochrane Collaboration Risk of Bias tool was used to assess the risk of bias; a descriptive analysis will summarize the effectiveness of the telenutrition or any type of telehealth intervention used.

RESULTS

The systematic review is expected to be completed by the end of March 2024. The ongoing screening and review of the articles are currently being conducted.

CONCLUSIONS

This systematic review aims to summarize the effectiveness, features, design process, usability, and coherence of a telenutrition intervention using behavior change theory to improve dietary patterns and physical activity among adolescents with obesity. It will identify areas for improvement and best practices, informing the development of more useful and engaging telenutrition interventions for adolescents.

TRIAL REGISTRATION

PROSPERO CRD42023458336; http://tinyurl.com/cp46fjj9.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/53282.

Healthy together Victoria and childhood obesity study: effects of a large scale, community-based cluster randomised trial of a systems thinking approach for the prevention of childhood obesity among secondary school students 2014-2016

BACKGROUND

Healthy Together Victoria (HTV) was a Victorian Government initiative that sought to reduce the prevalence of overweight and obesity through targeting chronic disease risk factors including physical activity, poor diet quality, smoking, and harmful alcohol use. The intervention involved a boosted workforce of > 170 local-level staff in 12 communities; employed to deliver system activation around health and wellbeing for individuals, families and communities. A cluster randomised trial (CRT) of a systems thinking approach to obesity prevention was embedded within HTV. We present the two-year changes in overweight and obesity and associated behaviours among secondary school students across Victoria, Australia.

METHODS

Twenty-three geographically bounded areas were randomised to intervention (12 communities) or comparison (11 communities). Randomly selected secondary schools within each community were invited to participate in the trial in 2014 and 2016. Students in Grade 8 (aged approximately 13-15 years) and Grade 10 (aged approximately 15-16 years) at participating schools were recruited using an opt-out approach across July-September 2014 and 2016. Primary outcomes were body mass index (BMI) and waist circumference. Secondary outcomes were physical activity, sedentary behaviour, diet quality, health-related quality of life, and depressive symptoms. Linear mixed models were fit to estimate the intervention effect adjusting for child/school characteristics.

RESULTS

There were 4242 intervention children and 2999 control children in the final analysis. For boys, the two-year change showed improvement in intervention versus control for waist circumference (difference in change: - 2.5 cm; 95% confidence interval [CI]: - 4.6, - 0.5) and consumption of sugar-sweetened beverages per day (< 1 serve: 8.5 percentage points; 95% CI: 0.6, 16.5). For girls, there were no statistically significant differences between conditions.

CONCLUSIONS

HTV seemed to produce favourable changes in waist circumference and sugar-sweetened beverage consumption for boys, however, no effect on BMI was observed. Although the HTV intervention was cut short, and the period between data collection points was relatively short, the changes observed in HTV contribute to the growing evidence of whole-of-community interventions targeting childhood obesity.

TRIAL REGISTRATION

This trial is unregistered. The intervention itself was a policy setting delivered by government and our role was the collection of data to evaluate the effect of this natural experiment. That is, this study was not a trial from the classical point of view and we were not responsible for the intervention.

Obesity-Related Knowledge and Practice Among the Healthcare Professions Students in Saudi Arabia

Objective

The objectives of this study are to identify the prevalence and the factors behind overweight and obesity among the healthcare profession's students.

Methods

A well-structured and validated questionnaire was distributed to a heterogeneous purposive sample of the healthcare profession's students in Saudi Arabia.

Results

About 21.0% and 15.5% were overweight and obese, respectively. The average knowledge score was 70.6% and increased with age and among obese participants. The average attitude score was 74.8% with no variation within age, body mass index (BMI), and gender. The average practice score was only 36.7%. There was a significant variation of the practice within the different age groups (P = 0.021). There was a significant association between the participant's knowledge and attitude, and practice.

Conclusion

The average practice score was poor. Despite their good knowledge and positive attitude, the students are exposed to heavy junk food marketing, which encourages overconsumption by instilling positive emotional associations with the junk food. They are mostly physically inactive, anxious and sleep deprived, which can lead to poor eating habits. For this group, various strategies and motivators will likely be needed.

Compensatory behavior of physical activity in adolescents - a qualitative analysis of the underlying mechanisms and influencing factors

INTRODUCTION

Compensatory behavior of physical activity (PA) based on the ActivityStat hypothesis in adolescents is scarcely investigated, and existing studies showed inconclusive results. Understanding the compensatory behavior in a holistic way is important as this can help to improve intervention outcomes and thus, increase the PA levels in adolescents. Thus, the aim of the present study is to investigate the occurrence, direction, timeframe, and ratio of habitual activity compensation in adolescents. Furthermore, we want to identify the awareness of compensation and factors that influence compensatory behavior.

METHODS

The present qualitative study used a mixed methods crossover analysis design. Participants (N = 15, 8 boys and 7 girls) were adolescents aged 11-15 years (mean age 13.04 ± 1.28). They provided a habitual weekly schedule with habitual/regular activities and their intensity. Participants then kept an activity diary over one week to capture their actual behavior. After that, data were compared and deviations > ±20% were considered as compensation opportunities. On this basis, deviations were descriptively analyzed for compensatory behavior and were coded as positive and negative compensatory behavior. Further, for each compensation, the ratio of compensation (MET-minutes of the compensating activity/MET-minutes of the activity that was compensated) was calculated. Additionally, interviews were conducted to explore perceptions and influencing factors for (no) compensation.

RESULTS

Overall, 198 compensation opportunities were identified with deviations greater ± 20%. Of these, 109 opportunities were compensated overall (69 within-day, 40 between-day). Negative compensation took place in 57 opportunities and 52 opportunities were compensated positively. Most of the deviations were overcompensated (compensation/deviation > 100%). About half of the adolescents (N = 8) were not aware about their compensatory behavior, and only one boy was aware of all his compensatory behavior. The most mentioned influence for positive compensation were social support by friends and good weather. As influencing factors for negative compensation, tiredness as well as no need for movement were mentioned predominantly. No negative compensation occurred because adolescents wanted to stick to their routines or participated in hedonistic activities.

DISCUSSION

Summarizing the findings, the present study delivered new insights into the field of compensatory behavior in adolescents. Nevertheless, compensatory behavior was not consistently observed regarding the occurrence of compensation, direction, timeframe and ratio. However, social support appears to be an important factor to compensate positively or to avoid a negative compensatory behavior. Further, it seems to be helpful to support individuals in their search for hedonistic activities as well as in the establishment of routines.

The Effectiveness of Teaching the Teacher Interventions in Improving the Physical Activity among Adolescents in Schools: A Scoping Review

Physical inactivity is a leading risk factor for global mortality as it increases the risk of non-communicable diseases and decreases overall health. Therefore, increasing physical activity (PA) is strongly recommended, particularly in adolescents. The Teaching the Teachers (TTT) approach is a prominent example of an intervention that could enhance PA levels in adolescents. However, available evidence on the efficacy of TTT interventions in promoting PA among adolescents is either limited or inconclusive. Therefore, a scoping review was conducted to provide an overview of the current state of knowledge regarding the effectiveness of TTT interventions in improving the PA of adolescent students. The PRISMA-Scoping methodology was employed, and articles in the Medline database were searched. We screened 2357 articles for inclusion, and finally included 16 articles. Most articles were conducted in European countries. The TTT interventions appeared to positively affect various aspects of PA. These aspects include support for personal autonomy, intent to engage in PA, improvements in body composition and fitness level, social support, enjoyment of Physical Education (PE), and positive attitudes towards PE. Consequently, policymakers could utilize TTT interventions to improve the physical activity of adolescents, which may reduce the burden of non-communicable diseases and foster healthier societies.

Assessing the impact of message relevance and frequency on physical activity change: A secondary data analysis from the random AIM trial

Text messages are widely used to deliver intervention content; however, sending more intensive messages may not always improve behavioral outcomes. This study investigated whether message frequency was associated with daily physical activity, either by itself or in interaction with message content relevance. Healthy but insufficiently active young adults (aged 18-29 years) wore Fitbit activity trackers and received text messages for 180 days. Message frequencies varied daily at random, and messages were sent from three content libraries (40% Move More, 40% Sit Less, 20% Inspirational Quotes). Contrary to expectations, the results revealed a null association between total daily text message frequency and physical activity, both for daily step counts and moderate-to-vigorous physical activity (MVPA) duration. Additional analyses revealed that the daily frequency of messages with relevant content (i.e. Move More, Sit Less) was not associated with physical activity, but the daily frequency of messages with irrelevant content (i.e. Inspirational Quotes) was negatively associated with physical activity. We concluded that the effectiveness of text messages in promoting physical activity is impacted by the combination of content relevance and frequency, with frequent irrelevant messages potentially decreasing activity levels. This study suggests that irrelevant message frequency can negatively impact physical activity, highlighting the risks of delivering irrelevant content in digital health interventions.

A systematic review of educational nutrition interventions based on behavioral theories in school adolescents

The purpose of this study was to summarize the evidence from studies conducted on adolescents, evaluating educational nutrition interventions for the modification of food consumption through controlled trials based on behavior change theories or models and implemented in school settings. A systematic search was carried out through PubMed and ERIC databases between November and December 2020, and updated in February 2023; English-language keywords were used, and no publication date limits were applied. Two authors independently performed the search, data extraction, data synthesis and risk of bias assessment. Twelve studies meeting the inclusion criteria were included. The interventions were based on different theories; the most used was the Social Cognitive Theory. Eleven of the twelve studies showed favorable modifications in the consumption of at least two of the food groups. Most studies were at low risk of bias, and only one was classified as high risk. It is concluded that educational nutrition interventions based on behavior change theories/models and implemented in the school setting influence positive changes in adolescents eating behavior.

Influence of Food Habits and Participation in a National Extracurricular Athletics Program on Body Weight within a Pair-Matched Sample of Polish Adolescents after One Year of Intervention-#goathletics Study

The COVID-19 pandemic reduced the physical activity level and commitment in adolescents, which has resulted in a body weight increase, and the World Health Organization (WHO) emphasizes that this negative trend must be now counteracted. The aim of this study was to assess the influence of food habits and participation in a national extracurricular athletics program (Athletics for All) on body weight within a pair-matched sample of Polish adolescents after one year of intervention. The #goathletics Study was conducted in a population of Polish adolescents within two pair-matched groups: 506 adolescents aged 10-14, including 281 female and 225 male adolescents, regularly participating in Athletics for All program for at least 9 months (one school year) (intervention group), and a pair-matched control group (matched taking into account city, gender, and age). The #goathletics Study included the assessment of the body weight, which was conducted based on the growth reference charts for Body Mass Index (BMI), and waist circumference to verify central fatness. Athletics for All participation and food habits were verified as determinants of body weight, while food habits were assessed using the validated Adolescents' Food Habits Checklist (AFHC). While compared the intervention group and control group, statistically significant differences were observed for body weight, BMI, and waist circumference, both for crude and relative values, with adolescents participating in the Athletics for All program presenting a lower risk of excessive body weight and central fatness (p < 0.05), while, compared to sub-groups stratified by AFHC score, no statistically significant differences in general anthropometric characteristics were observed (p > 0.05). While the body weight centile, height centile, BMI centile and waist-to-height ratio (WHtR) were assessed as the resultant variables, it was revealed that participation in the Athletics for All program is the only influencing factor in multi-factor analysis of variance (ANOVA) for body weight centile (F = 21.44; p < 0.0001) and BMI centile (F = 47.98; p < 0.0001), but for height centile and WHtR, none of the assessed factors influenced these variables. It was concluded that regularly participating in the Athletics for All program for at least 9 months was the only determinant of a lower risk of excessive body weight in adolescents, with declared food habits and gender not being significant.

Efficacy of a school-based education intervention on the consumption of fruits, vegetables and carbonated soft drinks among adolescents

OBJECTIVES

To evaluate the efficacy of a school-based education intervention on the consumption of fruit, vegetables and carbonated soft drinks among adolescents.

DESIGN

Cluster-randomised controlled trial.

SETTING

Eight secondary schools from Dhaka, Bangladesh, participated in this trial and were randomly allocated to intervention (n 160) and control groups (n 160).

PARTICIPANTS

A total of 320 students from 8th to 9th grades participated and completed the self-reported questionnaires at baseline, and at 8 and 12 weeks. The intervention included weekly classroom-based nutrition education sessions for students and healthy eating materials for students and parents. Repeated measures ANCOVA was used to assess the effects of the intervention.

RESULTS

Daily fresh fruit intake was more frequent in the intervention (26 %) compared to the control group (3 %) at 12 weeks (p = 0·006). Participants from the intervention group also reported a significantly (P < 0·001) higher (49 %) proportion of fresh vegetable intake compared to the control group (2 %) at 12 weeks. Frequency of daily carbonated soft drinks intake decreased (25 %) in the intervention group at 12 weeks compared to baseline, while it remained unchanged in the control group; the interaction effect was observed significant (P = 0·002).

CONCLUSION

Our school-based education intervention increased the daily frequency of fresh vegetables and fruit intake and decreased carbonated soft drink consumption among adolescents in the intervention group. There is a need for scaling up the intervention to engage students and empower them to develop healthy dietary habits.

Age-Specific Quantification of Overweight/Obesity Risk Factors From Infancy to Adolescence and Differences by Educational Level of Parents

Objectives: To explore the age-dependent associations between 26 risk factors and BMI in early life, and differences by parental educational level. Methods: Data of 10,310 children (24,155 measurements) aged 2-16 years participating in a multi-centre European cohort from 2007 to 2014 were utilized. Trajectories of overweight/obesity risk factors and their age-specific associations with BMI were estimated using polynomial mixed-effects models. Results: Exposure to most unfavourable factors was higher in the low/medium compared to the high education group, e.g., for PC/TV time (12.6 vs. 10.6 h/week). Trajectories of various risk factors markedly changed at an age of 9-11 years. Having a family history of obesity, maternal BMI, pregnancy weight gain and birth weight were positively associated with BMI trajectories throughout childhood/adolescence in both education groups; associations of behavioural factors with BMI were small. Parental unemployment and migrant background were positively associated with BMI in the low/medium education group. Conclusion: Associations of risk factors with BMI trajectories did not essentially differ by parental education except for social vulnerabilities. The age period of 9-11 years may be a sensitive period for adopting unfavourable behaviours.

Lifestyle interventions to change trajectories of obesity-related cardiovascular risk from childhood onset to manifestation in adulthood: a joint scientific statement of the task force for childhood health of the European Association of Preventive Cardiology and the European Childhood Obesity Group

There is an immediate need to optimize cardiovascular (CV) risk management and primary prevention of childhood obesity to timely and more effectively combat the health hazard and socioeconomic burden of CV disease from childhood development to adulthood manifestation. Optimizing screening programs and risk management strategies for obesity-related CV risk in childhood has high potential to change disease trajectories into adulthood. Building on a holistic view on the aetiology of childhood obesity, this document reviews current concepts in primary prevention and risk management strategies by lifestyle interventions. As an additional objective, this scientific statement addresses the high potential for reversibility of CV risk in childhood and comments on the use of modern surrogate markers beyond monitoring weight and body composition. This scientific statement also highlights the clinical importance of quantifying CV risk trajectories and discusses the remaining research gaps and challenges to better promote childhood health in a population-based approach. Finally, this document provides an overview on the lessons to be learned from the presented evidence and identifies key barriers to be targeted by researchers, clinicians, and policymakers to put into practice more effective primary prevention strategies for childhood obesity early in life to combat the burden of CV disease later in life.

Gender differences in the distribution of children's physical activity: evidence from nine countries

BACKGROUND

Physical activity in childhood is thought to influences health and development. Previous studies have found that boys are typically more active than girls, yet the focus has largely been on differences in average levels or proportions above a threshold rather than the full distribution of activity across all intensities. We thus examined differences in the distribution of physical activity between girls and boys in a multi-national sample of children.

METHODS

We used the harmonised International Children Accelerometry Database (ICAD), including waist-worn accelerometry data from 15,461 individuals (Boys: 48.3%) from 9 countries. Employing Generalised Additive Models of Location, Shape, and Scale (GAMLSS) we investigated gender differences in the distribution of individuals, including comparisons of variability (SD) and average physical activity levels (mean and median) and skewness. We conducted this analysis for each activity intensity (Sedentary, Light, and Moderate-to-Vigorous (MVPA)) and a summary measure (counts per minute (CPM)).

RESULTS

Sizable gender differences in the distribution of activity were found for moderate to vigorous activity and counts per minute, with boys having higher average levels (38% higher mean volumes of MVPA, 20% higher CPM), yet substantially more between-person variability (30% higher standard deviation (SD) for MVPA, 17% higher SD for CPM); boys' distributions were less positively skewed than girls. Conversely, there was little to no difference between girls and boys in the distribution of sedentary or light-intensity activity.

CONCLUSIONS

Inequality in activity between girls and boys was driven by MVPA. The higher mean volumes of MVPA in boys occurred alongside greater variability. This suggests a need to consider the underlying distribution of activity in future research; for example, interventions which target gender inequality in MVPA may inadvertently lead to increased inequality within girls.

COVID-19 and campus users: A longitudinal and place-based study of university mobilities in Texas

The COVID-19 pandemic has disrupted people's daily routines, including travel behaviors, social interactions, and work-related activities. However, the potential impacts of COVID-19 on the use of campus locations in higher education such as libraries, food courts, sports facilities, and other destinations are still unknown. Focusing on three largest universities in Texas (Texas A&M university, the University of Texas at Austin, and Texas Tech University), this study compares changes in campus destination visitations between pre and post COVID-19 outbreak (2019 Fall and 2021 Fall semesters, respectively) using the mobility data from SafeGraph. It also examines the potential moderation effects of walkable distance (i.e. 1 km) and greenery (i.e. NDVI value). The results presented the significant effects of COVID-19 on decreasing visitations to various campus places. The visitation decreased more significantly for people living within 1 km (defined as a walkable distance) of campus and for the food, eating, and drinking places and the sports, recreation, and sightseeing places. This finding suggests that those living near campus (mostly students) decreased their reliance on campus destinations, especially for eating/drinking and recreation purposes. The level of greeneries at/around campus destinations did not moderate campus visitations after COVID-19. Policy implications on campus health and urban planning were discussed.

Effectiveness of school-based nutrition interventions promoted in the League of Arab States: a systematic review

Arab countries are doubly burdened with undernutrition as well as overweight and obesity. To provide guidance to those looking to address concerns of obesity and overweight among children in this region, the current review bridges an existing knowledge gap and systematically characterizes and evaluates the available scientific evidence pertaining to school-based nutrition interventions completed to date across the Arab world. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and relevant keywords, terms and phrases, a search of the literature across 14 databases for school-based nutrition interventions implemented in this region was conducted. Out of 1568 articles from 14 databases, 38 full-text articles meeting the inclusion criteria were retrieved. Further assessment for eligibility excluded 23 articles and included one article from hand-searching references, leaving 16 articles in the final analysis. Most articles (n = 7) with the implementation of 5 months or longer found strong positive and significant impacts on limiting sweets consumption, increased dietary knowledge, self-efficacy, breakfast and fruit and vegetable consumption, among others. We also found evidence (n = 5) that teachers trained by experts such as dietitians and pediatricians can effectively implement nutrition interventions that achieve the intended outcomes. Training teachers to implement theory-based nutrition and health promotion curricula serves as a potential solution to improving nutrition knowledge, health behaviors and dietary practices among children living in Arab countries. Appropriately designed and implemented nutrition interventions can positively impact nutrition knowledge, health and diet-related behaviors in children and adolescents in this region.

The influence of neighborhood built environment on school-age children's outdoor leisure activities and obesity: a case study of Shanghai central city in China

Objective

The aim of this study was to examine the influencing pathways of the neighborhood built environment on children's outdoor leisure activities and obesity.

Methods

A total of 378 elementary school students from 10 schools in central Shanghai were selected by a convenient sampling method for questionnaire survey and accelerometer tracking.

Results

1) The neighborhood built environment could affect children's obesity not only through direct effect (β = 0.15, p < 0.05), but also through the mediating effect of outdoor leisure activities (β = 0.19, p < 0.05). 2) For boys, the neighborhood built environment could affect children's obesity not only through direct effect (β = 0.17, p < 0.05), but also through the mediating effect of outdoor leisure activities (β = 0.26, p < 0.05). For girls, the neighborhood built environment could affect children's obesity only through the mediating effect of outdoor leisure activities (β = 0.13, p < 0.05).

Conclusion

The neighborhood built environment and outdoor leisure activities are important influencing factors in children's obesity. The neighborhood built environment and outdoor leisure activities could have direct and indirect effects on children's obesity, while there are gender differences in the influencing pathways of the neighborhood built environment on children's obesity. This study suggests that improving the neighborhood built environment and promoting outdoor leisure activities in children have important value for influencing children's obesity.

Australian parental perceptions of genomic newborn screening for non-communicable diseases

Background: Newborn bloodspot screening (NBS) programs have improved neonatal healthcare since the 1960s. Genomic sequencing now offers potential to generate polygenic risk score (PRS) that could be incorporated into NBS programs, shifting the focus from treatment to prevention of future noncommunicable disease (NCD). However, Australian parents' knowledge and attitudes regarding PRS for NBS is currently unknown. Methods: Parents with at least one Australian-born child under 18 years were invited via social media platforms to complete an online questionnaire aimed at examining parents' knowledge of NCDs, PRS, and precision medicine, their opinions on receiving PRS for their child, and considerations of early-intervention strategies to prevent the onset of disease. Results: Of 126 participants, 90.5% had heard the term "non-communicable disease or chronic condition," but only 31.8% and 34.4% were aware of the terms "polygenic risk score" and "precision medicine" respectively. A large proportion of participants said they would consider screening their newborn to receive a PRS for allergies (77.9%), asthma (81.0%), cancer (64.8%), cardiovascular disease (65.7%), mental illness (56.7%), obesity (49.5%), and type 2 diabetes (66.7%). Additionally, participants would primarily consider diet and exercise as interventions for specific NCDs. Discussion: The results from this study will inform future policy for genomic NBS, including expected rate of uptake and interventions that parents would consider employing to prevent the onset of disease.

Experiences, Perspectives, and Barriers to Physical Activity Parenting Practices for Chinese Early Adolescents

BACKGROUND

Parents play an important role in shaping youth's lifestyle behaviors. This study aimed to investigate physical activity parenting practices (PAPP) for Chinese early adolescents and compare reporting discrepancies between parents and adolescent boys and girls.

METHODS

Fifty-five adolescent-parent dyads participated in 16 paired focus group interviews, and an additional 122 dyads completed questionnaire surveys with open-ended questions. Participants were recruited from 3 public middle schools in Suzhou, China. Qualitative data were analyzed inductively using an open-coding scheme. Frequencies of codes were compared by parent-child role and adolescent gender using chi-square tests.

RESULTS

Eighteen types of PAPP were identified and grouped into 6 categories: goals/control, structure, parental physical activity participation, communication, support, and discipline. These PAPP were viewed as promotive, preventive, or ineffective. Participants had mixed opinions on the effects of 11 PAPP and identified parental, adolescent, and environmental barriers for parents to promote youth physical activity. Compared with parents, adolescents were more likely to value the effects of setting expectation, scheduling, and coparticipation as well as dislike pressuring, restriction, and punishment. Girls were more likely to favor coparticipation and were more sensitive about negative communication than boys. Parents paid more attention to environmental barriers, whereas adolescents, especially girls, focused more on personal issues.

CONCLUSIONS

Future studies need to address both positive and negative PAPP as well as perception discrepancies by child-parent role and adolescent gender to generate more evidence to promote parents as favorable socialization agents of youth physical activity.

Interpersonal- and Community-Level Risk Factors for Adolescent Obesity: An Examination of Sexual Identity, School Violence, and School Climate in a Large Sample of Urban Adolescents

Sexual minority adolescents are more likely to have obesity compared to their heterosexual peers, but little is known about potential contributors to this disparity that lie outside of individual-level health behaviors, such as diet and exercise. One possible contributor is school violence victimization, a factor associated with overweight/obesity in adolescence. Another possible contributor is school climate, which is associated with feelings of safety and connectedness that can lower the likelihood of school violence victimization. Moreover, even less is known about relationships among all these factors among sexual minority adolescents. This gap in the literature was addressed by analyzing CDC's district-level data from the Youth Risk Behavior Survey and School Health Profiles (N = 60,625; 50.9% female, M_age = 16 years, 84.7% heterosexual, 15.3% sexual minority). Using multilevel mixed effects logistic regression models and controlling for covariates, it was found that among females and males, those with 2+ counts of last 12-month school violence victimization had higher odds of obesity than those with no school violence victimization (AOR = 1.33; AOR = 1.24). Furthermore, females and males in more positive LGBTQ school climates had lower odds of obesity than those in less positive school climates (AOR = 0.84; AOR = 0.85). There were no sexual identity differences in these models. Findings support the careful consideration of school violence victimization and LGBTQ school climate in future obesity prevention initiatives.

"You Measure Us and You Depress Us": Healthism and the Subjective Impact of Body Measurements on Secondary School Students

This study explores adolescents' subjective experiences when facing body measurements at school, performed to evaluate the effects of a school-based intervention to promote physical activity. Three semi-structured interviews (n = 3) and two focus groups (n = 7 and 3) were conducted with adolescents after measuring some variables related to their weight and adiposity. Observational data (n = 88) collected by the two researchers in charge of the measurements were also obtained. Findings derived from our thematic analysis question the suitability of body measurements as social contexts where the core ideas of healthism emerge. Some adolescents lived body measurements as negative social experiences, promoting body dissatisfaction, social comparison, embarrassment, and simplistic associations between health and body shape, which could hinder their adherence to healthy habits. We emphasize the role of qualitative research when evaluating pre/posttests of school-based intervention studies, not just the interventions themselves, to generate knowledge to improve research protocols and prevent unwanted psychological outcomes in participants.

Association Between 24-Hour Movement Guideline and Physical, Verbal, and Relational Forms of Bullying Among Chinese Adolescents

The Canadian 24-Hour Movement Guidelines for Children and Youth recommends specific guidance in physical activity, screen time, and sleep duration. The current research will further explore potential exposures between healthy movement and being involved in a bullying incident as a bully or a victim in a representative sample of adolescents in China. A total of 67 821 Chinese students (response rate = 98.4%) were included in this study (mean age = 13.04 years). The results showed that meeting sleep recommendation only, meeting screen time recommendation only, and meeting both these two recommendations might be protective factors against being bullied or bullying others. Meeting moderate-to-vigorous physical activity (MVPA) recommendation only reported higher odds of being victims in all forms of bullying while meeting both MVPA and another combination of the guideline would relate to lower odds of being a bully and a bully-victim in all forms of bullying involvement.

The effectiveness of school-based run/walk programmes to develop physical literacy and physical activity components in primary school children: A systematic review

The objectives of this review were to systematically review the research on school-based run/walk programmes and their measurements of physical literacy (PL) and physical activity (PA)-related components and to assess the different intervention methods and their impact on encouraging PL and PA. To be included in the review, studies had to satisfy all inclusion criteria. An electronic search was conducted on six databases, the last date search was 25 April 2022. All outcome measures were grouped using the Shearer et al. (2021) PL checklist and additional PA related outcomes. Ten studies were included in the final review. Five different run/walk interventions were identified and six studies followed or referred to The Daily Mile (TDM) protocol. Outcomes relating to the physical domain were most commonly explored, and no studies explored the cognitive domain. Four studies reported significant differences in cardiovascular endurance measures. Positive findings were also reported for outcomes relating to motivation and self-perception/self-esteem in the affective domain. Overall, run/walk programmes appear to provide promising results in favour of physical and affective development in PL. However, further high-quality studies are needed to draw firm conclusions. This review highlights the popularity of TDM and its potential to contribute to PL development.

Factors related to the implementation and scale-up of physical activity interventions in Ireland: a qualitative study with policy makers, funders, researchers and practitioners

BACKGROUND

Current literature reports a gap between development of effective interventions to promote physical activity and the systematic uptake into real-world settings. Factors relating to implementation and scale-up of physical activity interventions have been examined, however the perspectives of multiple stakeholders from different domains are not well researched. The purpose of this study was to examine the perceived factors related to physical activity intervention implementation and scale-up in different domains from different stakeholders on the island of Ireland.

METHODS

Practitioners, researchers, funders and policy makers in Ireland were invited to take part in a semi-structured interview exploring factors related to the implementation and scale-up of eleven different physical activity interventions. A thematic analysis was conducted to identify factors related to the implementation and scale-up of the included interventions. The data collection and analysis were guided by the Consolidated Framework for Implementation Research.

RESULTS

Thirty-eight participants took part in the interviews which identified factors related to 1) intervention planning and practical considerations; 2) organisational structures, staffing and resources related to delivery; 3) reflection, evaluation and updating of the intervention; and 4) practical consideration related to scale-up. Furthermore, participants referred to the ongoing commitment, engagement, and support needed throughout the implementation process.

CONCLUSIONS

Future research and practice needs to consider how different factors are experienced at different implementation stages and by the different stakeholder groups involved. The findings highlight multiple inter-related factors that influence the implementation and scale-up of physical activity interventions, but also identifies many strategies that can be utilised to aid future successes.

Nutritional status of school-age children and adolescents in low- and middle-income countries across seven global regions: a synthesis of scoping reviews

OBJECTIVE

To summarise available evidence on the nutritional status of school-age children and adolescents (5-19 years) from seven global regions and on interventions implemented to improve malnutrition in this population.

SETTING

Global.

DESIGN

Findings were compiled from seven scoping literature reviews, including data from low- and middle-income countries within the following UNICEF-defined global regions: East Asia and Pacific; Europe and Central Asia; South Asia; West and Central Africa; Eastern and Southern Africa; Middle East and North Africa and Latin America and the Caribbean.

RESULTS

A double burden of malnutrition was evident across the world regions reviewed: stunting, thinness, anaemia and other micronutrient deficiencies persisted, alongside rising overweight and obesity prevalence. Transitions towards diets increasingly high in energy-dense, processed and micronutrient-poor foods were observed. Evidence from intervention studies was limited, but suggested that providing multiple micronutrient-fortified foods or beverages at school may effectively target micronutrient deficiencies and facilitate weight gain in undernourished populations. Interventions to prevent or manage overweight and obesity were even more limited. There was minimal evidence of using novel technological approaches to engage school-age children and adolescents, or of involving them in designing interventions.

CONCLUSION

The limited data available on nutrition of school-age children and adolescents are neither standardised nor comparable. Consensus on methods for assessing nutritional status and its determinants for this age group is urgently needed to set targets and monitor progress. Additionally, strategies are required to ensure that nutritious, safe and sustainable diets are available, affordable and appealing.

Factors Related to High-School Students’ Odds of Having Overweight or Obesity

This study used data the Youth Risk Behavior Surveillance System ( N = 7,088) to examine factors associated with the odds of overweight/obesity. Overweight/obese was defined as a body mass index ≥85th percentile, based on age- and sex-specific growth charts. Participants were categorized into meeting/not meeting guidelines for: sleep, moderate-to-vigorous PA (MVPA), muscle strengthening PA, screen time, breakfast eating, fruit and vegetable consumption, and soda and milk consumption. Logistic regression analyses determined whether meeting guidelines for each health behavior was associated with the odds of students having overweight/obesity in the total group and stratified by sex. Meeting MVPA guidelines was the only behavior associated with having a lower odds of overweight/obesity in both sexes. For females, meeting recommendations for breakfast eating and strength training were also associated with lower odds of having overweight/obesity, whereas for boys, getting the recommended amount of sleep was associated with having lower odds of overweight/obesity. Interventions to reduce the prevalence of overweight/obesity in youth should be implemented inside and outside of the school environment and should include components addressing physical activity, diet, and sleep. Such interventions should address barriers to healthy behaviors that are unique to adolescents already affected by overweight/obesity.

Effects of nutritional intervention strategies in the primary prevention of overweight and obesity in school settings: systematic review and network meta-analysis

Objective

To examine the effects of different nutritional intervention strategies in the school setting on anthropometric and quality of diet outcomes by comparing and ranking outcomes in a network meta-analysis.

Design

Systematic review and network meta-analysis.

Data sources

PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Education Resources Information Centre (ERIC), PsycInfo, CAB Abstracts, Campbell Library, Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre) BiblioMap, Australian Education Index, Joanna Briggs Institute Evidence-Based Practice (JBI EBP) database, Practice-based Evidence in Nutrition (PEN) database, ClinicalTrials.gov, Current Controlled Trials, and World Health Organization International Clinical Trials Registry Platform.

Eligibility criteria for selecting studies

A systematic literature search was performed from inception to 2 May 2022. Cluster randomised controlled trials meeting these study criteria were included: generally healthy school students aged 4-18 years; intervention with ≥1 nutritional components in a school setting; and studies that assessed anthropometric measures (eg, body mass index, body fat) or measures related to the quality of diet (eg, intake of fruit and vegetables), or both. Random effects pairwise meta-analyses and network meta-analyses were performed with a frequentist approach. P scores, a frequentist analogue to surface under the cumulative ranking curve, ranging from 0 to 1 (indicating worst and best ranked interventions, respectively) were calculated. Risk of bias was assessed with Cochrane's RoB 2 tool. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was used to rate the certainty of evidence.

Results

51 cluster randomised controlled trials involving 75 954 participants and seven intervention nodes were included. Inconsistency could not be assessed (except for intake of fruit and vegetables) because the network meta-analyses were based mainly on star shaped networks with no direct evidence for specific pairs of nutritional interventions. Overall, little or no evidence was found to support a difference in body mass index, body weight, body fat, or waist circumference and moderate improvements in intake of fruit and vegetables with nutritional interventions in a school setting. Low to moderate certainty of evidence further suggested that multicomponent nutritional interventions likely reduced the prevalence (odds ratio 0.66, 95% confidence interval 0.55 to 0.80) and incidence (0.67, 0.47 to 0.96) of overweight compared with a control group. Based on low certainty of evidence, nutrition education and multicomponent interventions may be more effective than a control group (ie, usual practice) for increasing intake of fruit and vegetables. Multicomponent nutritional interventions were ranked the most effective for reducing body mass index (P score 0.76) and intake of fat (0.82). Nutrition education was ranked as best for body mass index z score (0.99), intake of fruit and vegetables (0.82), intake of fruit (0.92), and intake of vegetables (0.88).

Conclusions

The findings suggest that nutritional interventions in school settings may improve anthropometric and quality of diet measures, potentially contributing to the prevention of overweight and obesity in childhood and adolescence. The findings should be interpreted with caution because the certainty of evidence was often rated as low. The results of the network meta-analysis could be used by policy makers in developing and implementing effective, evidence based nutritional intervention strategies in the school setting.

Systematic review registration

PROSPERO CRD42020220451.

Compensation of overall physical activity in (pre)adolescent girls - the CReActivity project

BACKGROUND

According to the ActivityStat hypothesis more physical activity (PA) in one timespan is compensated by increased sedentary time (ST) in the following timespan and vice versa to maintain an overall stable PA level. Until now, existing literature revealed inconsistent results regarding compensatory behaviour across children and adolescents. Thus, the aim of the present study is (1) to investigate whether ST in the morning is compensated by active behaviour in the afternoon and (2) whether ST during the week is compensated by active behaviour during the weekend in (pre)adolescent girls. Additionally, we aimed to differentiate between positive and negative compensatory behaviour and examine whether it is moderated by socioeconomic status (SES), age or weight status.

METHODS

The participants were 370 sixth grade school girls (mean age 11.6 years) from Munich that participated in the CReActivity study, a school based intervention study aiming to identify the mechanisms of behavioural changes in PA among girls. ST and PA were measured over seven consecutive days using accelerometery. Descriptive determination of compensatory behaviour, as well as Bayesian multivariate multilevel analysis were conducted with data clustered on the individual (ID), class and school level.

RESULTS

Descriptive analysis revealed rather constant compensatory behaviour of about 60% for after-school days and weekends over all observation points. However, regarding all girls, compensation was predominantly negative. Differentiated analysis indicated that all girls with low ST levels in the morning or on weekdays, compensated for this behaviour with lower PA levels in the afternoon or on weekends. Multilevel covariate analysis indicated great variability between the participants. Furthermore, differences in compensatory behaviour can also be seen on class and school levels. Interestingly, PA compensatory behaviour is not associated with age, weight status or SES.

CONCLUSION

Our findings could neither confirm nor reject the ActivityStat Hypothesis. Overall, due to the great variability across the girls, it seems that compensation depends on individual factors. In the future, to prevent negative compensation, school-based interventions that have the potential to provide opportunities to be physically active, should not neglect (pre)adolescents' leisure time behaviour.

TRIAL REGISTRATION

DRKS00015723 (date of registration: 2018/10/22 retrospectively registered).

Implementation and Evaluation of a School-Based Educational Program Targeting Healthy Diet and Exercise (DIEX) for Greek High School Students

The present study examined the effectiveness of a school-based health education program promoting healthy diet and exercise, named DIEX, implemented on adolescents. The program is based on the Theory of Planned Behavior (TPB) and is supported by life skills training. The recipients of the program were high school students (n = 367; 168 boys and 199 girls) from 14 schools in Greece who attended 10 1 h sessions implemented by their schoolteachers. Data were collected before and after the program implementation through online questionnaires for: a. attitude, intention, subjective norms, and PBC toward healthy eating; b. knowledge about healthy eating; c. exercise behavior and attitude toward the DIEX program; and d. satisfaction with the DIEX program (only post-program). The results showed that there were significant differences among the pre- and post-measures of students' knowledge and behavior about healthy diet, as well as attitudes and satisfaction toward the program's application. The results show that the DIEX program may have improved nutrition behavior variables. Conclusively, a theory-based behavioral intervention with skills training may result in positive behavioral changes for young students during health education in school settings with the assistance of new technologies.