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Patterson E, Nyberg G, Norman Å, Schäfer Elinder L. Universal healthy school start intervention reduced the body mass index of young children with obesity. Acta Paediatr 2024; 113:2119-2125. [PMID: 38381539 DOI: 10.1111/apa.17164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 01/25/2024] [Accepted: 02/13/2024] [Indexed: 02/23/2024]
Abstract
AIM To evaluate the effect of a universal, school-based family support programme on body mass index (BMI) of children aged 5-7 years, using pooled data from three trials. METHODS The programme has three to four components and is delivered during the first school year. It aims to promote healthy dietary and physical activity behaviours, and secondarily prevent unhealthy weight gain. Three cluster-randomised controlled trials were conducted between 2010 and 2018 in low and mixed socioeconomic status areas in Sweden. Weight and height were measured. Multiple mixed linear regression analysis was performed on the pooled data. RESULTS In total, 961 children were included (50% girls, mean age 6.3 years). The post-intervention effect on BMI z-score in all children was small, but in those with obesity at baseline, we observed a significant, clinically relevant, decrease in BMI z-score (-0.21). This was most pronounced in children with a non-Nordic born parent (-0.24). Five to six months after the intervention, decreases were no longer statistically significant. CONCLUSION The intervention resulted in changes in BMI comparable to obesity treatment programmes focusing on behaviour change. However, the effect attenuated with time suggesting the programme should be sustained and evaluated for a longer time.
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Affiliation(s)
- Emma Patterson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Division for Risk and Benefit Assessment, Swedish Food Agency, Uppsala, Sweden
| | - Gisela Nyberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- The Swedish School of Sport and Health Sciences (GIH), Stockholm, Sweden
| | - Åsa Norman
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Liselotte Schäfer Elinder
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
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Moeller NC, Oestergaard L, Rasmussen MGB, Schmidt-Persson J, Larsen KT, Juhl CB. How to get children moving? The effectiveness of school-based interventions promoting physical activity in children and adolescents - A systematic review and meta-analysis of randomized controlled- and controlled studies. Health Place 2024; 89:103333. [PMID: 39163765 DOI: 10.1016/j.healthplace.2024.103333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 06/06/2024] [Accepted: 07/31/2024] [Indexed: 08/22/2024]
Abstract
This systematic review and meta-analysis summarizes the effectiveness of school-based physical activity (PA) interventions on children's and adolescents' PA. As no robust empirical evidence exists regarding what seems to characterize the school-based PA interventions that are most effective, we further aimed to map key factors of particular importance when trying to increase PA in early stages of life through school-based strategies. Intervention effects were calculated as standardized between-group (i.e., intervention vs. control) mean differences (SMD) in PA from baseline to follow-up. In total, 189 publications were included. Few studies (7%) were of high quality. Our results demonstrate that school-based interventions only have a small positive effect on children's and adolescents' PA levels. Compared to the effect observed during total day (SMD = 0.27, p < 0.001), a slightly larger effect was observed during school hours (SMD = 0.37, p < 0.001), while no intervention effect was observed during leisure time (SMD = 0.07, p = 0.20). There was a tendency for interventions to be more effective if theoretical frameworks for behavior changes were used in the design phase. The largest effect size was observed when experts from outside school delivered the program (SMD = 0.56, p = 0.01), but training of personnel involved in delivery was the determining factor for program effectiveness as no effect was observed if interventions were delivered primarily by schools' untrained staff (SMD = 0.06, p = 0.61). Intervention effects where larger if parents were involved in the intervention program (parents involved: SMD = 0.35, p < 0.001; parents not involved: SMD = 0.16, p = 0.02). Small positive intervention effects were sustained at long-term follow-up after end of intervention. Overall, the certainty of the evidence of the findings is rated as low.
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Affiliation(s)
- Niels Christian Moeller
- Department of Sports Science and Clinical Biomechanics, Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.
| | - Lars Oestergaard
- Department of Sports Science and Clinical Biomechanics, Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.
| | - Martin Gillies Banke Rasmussen
- Department of Sports Science and Clinical Biomechanics, Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.
| | - Jesper Schmidt-Persson
- Department of Sports Science and Clinical Biomechanics, Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.
| | - Kristian Traberg Larsen
- Department of Sports Science and Clinical Biomechanics, Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.
| | - Carsten Bogh Juhl
- Department of Sports Science and Clinical Biomechanics, Research Unit for Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark; Department of Occupational Therapy and Physiotherapy, Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark.
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O'Byrne Y, Dinneen J, Coppinger T. Methodology for evaluation of complex school-based health promotion interventions. J Public Health Policy 2024:10.1057/s41271-024-00510-4. [PMID: 39128967 DOI: 10.1057/s41271-024-00510-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2024] [Indexed: 08/13/2024]
Abstract
There is a need for careful examination of large volumes of collected (structured and unstructured) information related to school-based evaluation. There is also no published, comprehensive framework/s for evaluating complex interventions in Irish primary schools. The aim of this paper is to outline a methodology for process evaluation of an Irish primary school-based physical activity (PA) and nutrition intervention. Evaluation followed the three themes outlined by the British Medical Research Council: implementation, context, and mechanism of impact that we further divided into six dimensions. Methodological tools included questionnaires, PA logs, reflective journals, write and draw, and semi-structured interviews. We triangulated findings across these multiple tools to assess each dimension. We designed a unique framework to enable comparisons and offer researchers a template for evaluating complex health promotion interventions in primary schools. We present a methodology for evaluating a complex school-based health promotion intervention. The framework we propose integrates process and outcome data. It aims to enhance future result interpretation and facilitate informed comparisons among intervention schools.
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Affiliation(s)
- Yvonne O'Byrne
- Sport, Leisure & Childhood Studies, Munster Technological University, Rossa Avenue, Bishopstown, County Cork, T12 P928, Ireland
| | - J Dinneen
- Sport, Leisure & Childhood Studies, Munster Technological University, Rossa Avenue, Bishopstown, County Cork, T12 P928, Ireland
| | - T Coppinger
- Sport, Leisure & Childhood Studies, Munster Technological University, Rossa Avenue, Bishopstown, County Cork, T12 P928, Ireland.
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Alalawi A, Blank L, Goyder E. Umbrella review of international evidence for the effectiveness of school-based physical activity interventions. PLoS One 2024; 19:e0304513. [PMID: 38870155 PMCID: PMC11175402 DOI: 10.1371/journal.pone.0304513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 05/14/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Obesity and physical inactivity among children and young people are public health concerns. Despite the wide variety of interventions available to promote physical activity, little is known about which interventions are most effective. This review aimed to evaluate the existing literature on school-based interventions that aim to increase physical activity among children and young people aged 6 to 18 years. METHODS A systematic review of reviews was undertaken. We searched for systematic reviews and meta-analyses published between December 2017 and January 2024 using databases such as PubMed, Scopus, and CINAHL. Titles and abstracts were independently screened by two reviewers, who also conducted data extraction and quality assessments. We focused on outcomes like changes in physical activity levels and body mass index to assess the effectiveness of the interventions. RESULTS A total of 23 reviews examining school-based physical activity interventions met the inclusion criteria, comprising 15 systematic reviews and 8 meta-analyses. All reviews (N = 23) were implemented in the school setting: three in primary schools, seven in secondary schools, and thirteen targeted both primary and secondary schools. The findings demonstrated that six reviews reported a statistical increase in physical activity levels among the target population, and one review found a decrease in body mass index. The most promising interventions focused on physical activity included within the school curriculum and were characterised as long-term interventions. 20 out of 23 reviews assessed the quality of primary studies. CONCLUSION Some interventions were promising in promoting physical activity among school-aged children and young people such as Daily Mile, Active Break, and Active transport while multi-component interventions seem to be positively effective in reducing BMI. Future efforts should focus on long-term, theory-driven programmes to ensure sustainable increases in physical activity.
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Affiliation(s)
- Abdullah Alalawi
- Health and Related Research, University of Sheffield, Sheffield, United Kingdom
- Al Qunfudah Health Sciences College, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Lindsay Blank
- Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Elizabeth Goyder
- Health and Related Research, University of Sheffield, Sheffield, United Kingdom
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Mohamad RMA, Alhawiti WM, Alshehri WA, Alhaj Ali RM, Alhakami ST, Alatawi MM, Almutairi AA, Al Atawi ES, Alkhaibari DG, Saleh RM, Awaji HH. Assessment of Adolescents' Overweight and Obesity Risk Factors Among Alabnaa Schools in Tabuk City, Saudi Arabia. Cureus 2024; 16:e61533. [PMID: 38957243 PMCID: PMC11218896 DOI: 10.7759/cureus.61533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND The prevalence of overweight and obesity among adolescents in Saudi Arabia has been progressively increasing. Obesity is associated with an increased risk of various morbidities and mortality. Identifying the factors that contribute to obesity in this age group is crucial for implementing targeted prevention measures. AIM The aim of this study was to identify risk factors for overweight and obesity among adolescents aged nine to 17 years residing in Tabuk City, Saudi Arabia. METHODS A case-control study was conducted during the 2021-2022 academic year at Alabnaa Schools in Tabuk City, Saudi Arabia. The study included overweight/obese individuals (cases, n = 125) and normal-weight individuals (controls, n = 201) who were selected based on their body mass index and classified according to the World Health Organization's reference for defining overweight and obesity in individuals aged five to 19 years. Data were collected from both groups using a self-administered questionnaire. RESULTS The study analyzed 125 overweight/obese students and 201 normal-weight students who were matched for sex and age (p > 0.05). Logistic regression analysis identified several risk factors for overweight or obesity among adolescents. A family history of obesity was found to be associated with a 5.735 times increased likelihood of obesity (95% CI: 3.318-9.912, p < 0.001). Another significant contributing risk factor for obesity was frequent consumption of four or more meals per day (adjusted odds ratio: 3.091, 95% CI: 1.094-8.736, p = 0.033). Students who used electronic devices for more than five hours were 2.422 times more likely to exhibit obesity (p = 0.006). CONCLUSIONS Certain factors may increase the risk of overweight or obesity in adolescents aged nine to 17 years. These factors include frequent eating, prolonged use of electronic devices, family history of obesity, and the misconception that obesity is not an illness. Tailored school health programs are needed to improve students' healthy lifestyles and eating behaviors, minimize sedentary entertainment and use of electronic devices, and engage children in physical activity.
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Affiliation(s)
| | | | - Waheed Ali Alshehri
- Preventive Medicine Department, King Salman Armed Forces Hospital, Tabuk, SAU
| | | | | | | | | | - Eman Saeed Al Atawi
- Preventive Medicine Department, King Salman Armed Forces Hospital, Tabuk, SAU
| | | | - Rakan Mahmoud Saleh
- Preventive Medicine Department, King Salman Armed Forces Hospital, Tabuk, SAU
| | - Hosam Hadi Awaji
- Preventive Medicine Department, King Salman Armed Forces Hospital, Tabuk, SAU
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Pedersen NH, Grøntved A, Møller NC, Debrabant B, Larsen KT, Brønd JC, Troelsen J, Brage S, Hjelmborg JVB, Wedderkopp N, Christiansen LB, Mortensen SR, Egebæk HK, Toftager M, Heidemann MS, Kristensen PL. Impact of a nationwide school policy on body mass index in Danish school children: An interrupted time series analysis. PUBLIC HEALTH IN PRACTICE 2024; 7:100510. [PMID: 38826636 PMCID: PMC11141446 DOI: 10.1016/j.puhip.2024.100510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 05/08/2024] [Indexed: 06/04/2024] Open
Abstract
Objectives A new school policy mandating 45 min physical activity daily during school was introduced in Denmark in 2014. We aimed to evaluate the effect of this policy on BMI in school-aged children. It was hypothesized that the school policy would decrease BMI, especially in the obese fraction of the population (90th percentile BMI). Study design This register-based study was conducted as a natural experiment. Methods Analyses were based on data from The National Child Health Register that contains nationwide data on height and weight from mandatory preventive health examinations completed by school nurses or medical doctors during pre-preparatory classes (0th-3rd grade) and lower secondary education (7th-9th grade). A total of 401,517 children were included in the analyses with annual repeated cross-sectional data covering the period from 2012 to 2018. The effect of the school policy was evaluated using an interrupted time series approach comparing pre- and post-policy slopes in BMI, stratified by sex and age-group. Results In boys, no significant differences were observed in mean BMI slopes from pre-to post-policy in either age-group. In girls, post-policy slopes were significantly higher compared to pre-policy in both age-groups (0th-3rd grade: β:0·034 kg/m2, 95%-CI: (0·024; 0·043), p-value: <0·001; 7th-9th grade: β:0·066 kg/m2, 95%-CI: (0·028; 0·103), p-value: 0·001). No significant differences in slopes were observed in BMI at the 90th percentile from pre-to post-policy for both sexes and across both age-groups. Adjustment for leisure-time physical activity as a potential time-varying confounder did not alter the findings. Conclusions In conclusion, we did not detect a significant decrease in BMI levels among school-aged children following the introduction of a nationwide school policy specifying daily physical activity in school. If anything, a small positive change in BMI was observed in girls. More research is needed to understand whether structural changes similar to this requirement are able to prevent overweight and obesity in children and adolescents.
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Affiliation(s)
- Natascha H. Pedersen
- Centre of Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Anders Grøntved
- Centre of Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Niels C. Møller
- Centre of Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Birgit Debrabant
- Data Science and Statistics, Department of Mathematics and Computer Science, University of Southern Denmark, Odense, Denmark
- Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Odense, Denmark
| | - Kristian T. Larsen
- Centre of Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jan C. Brønd
- Centre of Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jens Troelsen
- Research Unit for Active Living, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Søren Brage
- Centre of Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- MRC Epidemiology Unit, University of Cambridge, Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Jacob v B. Hjelmborg
- Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Odense, Denmark
| | - Niels Wedderkopp
- Centre of Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Lars B. Christiansen
- Research Unit for Active Living, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Sofie R. Mortensen
- Centre of Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Naestved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
| | - Heidi K. Egebæk
- Centre of Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Mette Toftager
- Research Unit for Active Living, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Malene S. Heidemann
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Peter L. Kristensen
- Centre of Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Spiga F, Davies AL, Tomlinson E, Moore TH, Dawson S, Breheny K, Savović J, Gao Y, Phillips SM, Hillier-Brown F, Hodder RK, Wolfenden L, Higgins JP, Summerbell CD. Interventions to prevent obesity in children aged 5 to 11 years old. Cochrane Database Syst Rev 2024; 5:CD015328. [PMID: 38763517 PMCID: PMC11102828 DOI: 10.1002/14651858.cd015328.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
BACKGROUND Prevention of obesity in children is an international public health priority given the prevalence of the condition (and its significant impact on health, development and well-being). Interventions that aim to prevent obesity involve behavioural change strategies that promote healthy eating 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 children 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 children (mean age 5 years and above but less than 12 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 body mass index (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 172 studies (189,707 participants); 149 studies (160,267 participants) were included in meta-analyses. One hundred forty-six studies were based in high-income countries. The main setting for intervention delivery was schools (111 studies), followed by the community (15 studies), the home (eight studies) and a clinical setting (seven studies); one intervention was conducted by telehealth and 31 studies were conducted in more than one setting. Eighty-six interventions were implemented for less than nine months; the shortest was conducted over one visit and the longest over four years. Non-industry funding was declared by 132 studies; 24 studies were funded in part or wholly by industry. Dietary interventions versus control Dietary interventions, compared with control, may have little to no effect on BMI at short-term follow-up (mean difference (MD) 0, 95% confidence interval (CI) -0.10 to 0.10; 5 studies, 2107 participants; low-certainty evidence) and at medium-term follow-up (MD -0.01, 95% CI -0.15 to 0.12; 9 studies, 6815 participants; low-certainty evidence) or zBMI at long-term follow-up (MD -0.05, 95% CI -0.10 to 0.01; 7 studies, 5285 participants; low-certainty evidence). Dietary interventions, compared with control, probably have little to no effect on BMI at long-term follow-up (MD -0.17, 95% CI -0.48 to 0.13; 2 studies, 945 participants; moderate-certainty evidence) and zBMI at short- or medium-term follow-up (MD -0.06, 95% CI -0.13 to 0.01; 8 studies, 3695 participants; MD -0.04, 95% CI -0.10 to 0.02; 9 studies, 7048 participants; moderate-certainty evidence). Five studies (1913 participants; very low-certainty evidence) reported data on serious adverse events: one reported serious adverse events (e.g. allergy, behavioural problems and abdominal discomfort) that may have occurred as a result of the intervention; four reported no effect. Activity interventions versus control Activity interventions, compared with control, may have little to no effect on BMI and zBMI at short-term or long-term follow-up (BMI short-term: MD -0.02, 95% CI -0.17 to 0.13; 14 studies, 4069 participants; zBMI short-term: MD -0.02, 95% CI -0.07 to 0.02; 6 studies, 3580 participants; low-certainty evidence; BMI long-term: MD -0.07, 95% CI -0.24 to 0.10; 8 studies, 8302 participants; zBMI long-term: MD -0.02, 95% CI -0.09 to 0.04; 6 studies, 6940 participants; low-certainty evidence). Activity interventions likely result in a slight reduction of BMI and zBMI at medium-term follow-up (BMI: MD -0.11, 95% CI -0.18 to -0.05; 16 studies, 21,286 participants; zBMI: MD -0.05, 95% CI -0.09 to -0.02; 13 studies, 20,600 participants; moderate-certainty evidence). Eleven studies (21,278 participants; low-certainty evidence) reported data on serious adverse events; one study reported two minor ankle sprains and one study reported the incident rate of adverse events (e.g. musculoskeletal injuries) that may have occurred as a result of the intervention; nine studies reported no effect. Dietary and activity interventions versus control Dietary and activity interventions, compared with control, may result in a slight reduction in BMI and zBMI at short-term follow-up (BMI: MD -0.11, 95% CI -0.21 to -0.01; 27 studies, 16,066 participants; zBMI: MD -0.03, 95% CI -0.06 to 0.00; 26 studies, 12,784 participants; low-certainty evidence) and likely result in a reduction of BMI and zBMI at medium-term follow-up (BMI: MD -0.11, 95% CI -0.21 to 0.00; 21 studies, 17,547 participants; zBMI: MD -0.05, 95% CI -0.07 to -0.02; 24 studies, 20,998 participants; moderate-certainty evidence). Dietary and activity interventions compared with control may result in little to no difference in BMI and zBMI at long-term follow-up (BMI: MD 0.03, 95% CI -0.11 to 0.16; 16 studies, 22,098 participants; zBMI: MD -0.02, 95% CI -0.06 to 0.01; 22 studies, 23,594 participants; low-certainty evidence). Nineteen studies (27,882 participants; low-certainty evidence) reported data on serious adverse events: four studies reported occurrence of serious adverse events (e.g. injuries, low levels of extreme dieting behaviour); 15 studies reported no effect. Heterogeneity was apparent in the results for all outcomes at the three follow-up times, which could not be explained by the main setting of the interventions (school, home, school and home, other), country income status (high-income versus non-high-income), participants' socioeconomic status (low versus mixed) and duration of the intervention. Most studies excluded children with a mental or physical disability. AUTHORS' CONCLUSIONS The body of evidence in this review demonstrates that a range of school-based 'activity' interventions, alone or in combination with dietary interventions, may have a modest beneficial effect on obesity in childhood at short- and medium-term, but not at long-term follow-up. Dietary interventions alone may result in little to no difference. Limited evidence of low quality was identified on the effect of dietary and/or activity interventions on severe adverse events and health inequalities; exploratory analyses of these data suggest no meaningful impact. We identified a dearth of evidence for home and community-based settings (e.g. delivered through local youth groups), for children living with disabilities and indicators of health inequities.
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Affiliation(s)
- Francesca Spiga
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Annabel L Davies
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Eve Tomlinson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Theresa Hm Moore
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Sarah Dawson
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Katie Breheny
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jelena Savović
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Yang Gao
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon, Hong Kong
| | - Sophie M Phillips
- Department of Sport and Exercise Science, Durham University, Durham, UK
- Fuse - Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- Child Health and Physical Activity Laboratory, School of Occupational Therapy, Western University, London, Ontario, Canada
| | - Frances Hillier-Brown
- Fuse - Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- Human Nutrition Research Centre and Population Health Sciences Institute, University of Newcastle, Newcastle, UK
| | - Rebecca K Hodder
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton, Australia
- National Centre of Implementation Science, The University of Newcastle, Callaghan, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
| | - Julian Pt Higgins
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- NIHR Bristol Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Carolyn D Summerbell
- Department of Sport and Exercise Science, Durham University, Durham, UK
- Fuse - Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
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8
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Basto-Abreu A, Carnalla M, Reyes-Sánchez F, Reyes-García A, Haby MM, Junquera-Badilla I, Sartoris-Ayala L, Rivera JA, Popkin BM, Barrientos-Gutiérrez T. Predicted impact of banning nonessential, energy-dense food and beverages in schools in Mexico: A microsimulation study. PLoS Med 2024; 21:e1004394. [PMID: 38728236 PMCID: PMC11086919 DOI: 10.1371/journal.pmed.1004394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 04/02/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Childhood obesity is a growing concern worldwide. School-based interventions have been proposed as effective means to improve nutritional knowledge and prevent obesity. In 2023, Mexico approved a reform to the General Education Law to strengthen the ban of sales and advertising of nonessential energy-dense food and beverages (NEDFBs) in schools and surroundings. We aimed to predict the expected one-year change in total caloric intake and obesity prevalence by introducing the ban of NEDFBs sales in schools, among school-aged children and adolescents (6 to 17 years old) in Mexico. METHODS AND FINDINGS We used age-specific equations to predict baseline fat-free mass (FFM) and fat mass (FM) and then estimated total energy intake (TEI) per day. The TEI after the intervention was estimated under 4 scenarios: (1) using national data to inform the intervention effect; (2) varying law compliance; (3) using meta-analytic data to inform the intervention effect size on calories; and (4) using national data to inform the intervention effect by sex and socioeconomic status (SES). We used Hall's microsimulation model to estimate the potential impact on body weight and obesity prevalence of children and adolescents 1 year after implementing the intervention in Mexican schools. We found that children could reduce their daily energy intake by 33 kcal/day/person (uncertainty interval, UI, [25, 42] kcal/day/person), reducing on average 0.8 kg/person (UI [0.6, 1.0] kg/person) and 1.5 percentage points (pp) in obesity (UI [1.1, 1.9] pp) 1 year after implementing the law. We showed that compliance will be key to the success of this intervention: considering a 50% compliance the intervention effect could reduce 0.4 kg/person (UI [0.3, 0.5] kg/person). Our sensitivity analysis showed that the ban could reduce body weight by 1.3 kg/person (UI [0.8, 1.8] kg/person) and up to 5.4 kg/person (UI [3.4, 7.5] kg/person) in the best-case scenario. Study limitations include assuming that obesity and the contribution of NEDFBs consumed at school remain constant over time, assuming full compliance, and not considering the potential effect of banning NEDFBs in stores near schools. CONCLUSIONS Even in the most conservative scenario, banning sales of NEDFBs in schools is expected to significantly reduce obesity, but achieving high compliance will be key to its success. WHY WAS THIS STUDY DONE? - School-based interventions have been recognized as effective means to improve nutritional knowledge and prevent obesity-related diseases.- In December 2023, the Chamber of Representatives of Mexico approved an amendment that strengthens and updates the General Education Law (Article 75) and nutritional guidelines to ban the sales and advertising of nonessential energy-dense food and beverages (NEDFBs) in schools. WHAT DID THE RESEARCHERS DO AND FIND? - We used age-specific equations to predict baseline fat-free mass (FFM) and fat mass (FM) and total energy intake (TEI) per day.- We used microsimulation modeling to predict body weight and obesity prevalence of children and adolescents 1 year after implementing the intervention in Mexican schools.- Our modeling study suggests that an important impact on obesity prevalence can be expected if the law is implemented and enforced as intended. WHAT DO THESE FINDINGS MEAN? - If successful, this law could serve as an example beyond Mexico on how to achieve changes in body weight through school food regulation.- An important limitation of our main scenario is that we assumed full compliance of schools with the law, yet lower compliance will reduce its impact. We also did not consider historical trends on obesity or NEDFBs consumed in schools during our 1 year simulation, and we considered only the ban impact inside schools, excluding effects near and outside schools.
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Affiliation(s)
- Ana Basto-Abreu
- National Institute of Public Health, Center for Population Health Research, Mexico
| | - Martha Carnalla
- National Institute of Public Health, Center for Population Health Research, Mexico
| | | | - Alan Reyes-García
- National Institute of Public Health, Center for Population Health Research, Mexico
| | - Michelle M. Haby
- Division of Biological and Health Sciences, Department of Chemical and Biological Sciences, University of Sonora, Hermosillo, Mexico
| | | | | | - Juan A. Rivera
- National Institute of Public Health, Center for Population Health Research, Mexico
| | - Barry M. Popkin
- Department of Nutrition, Gillings School of Global Public Health, and the Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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Lin G, Werner K, Alqunaiebet A, Hamza MM, Alkanhal N, Alsukait RF, Alruwaily A, Rakic S, Cetinkaya V, Herbst CH, Lin TK. The cost-effectiveness of school-based interventions for chronic diseases: a systematic review. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2024; 22:26. [PMID: 38605333 PMCID: PMC11008027 DOI: 10.1186/s12962-024-00511-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 01/02/2024] [Indexed: 04/13/2024] Open
Abstract
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.
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Affiliation(s)
- George Lin
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Kalin Werner
- Institute for Health & Aging, Department of Social and Behavioral Sciences, University of California, San Francisco, CA, USA
| | | | - Mariam M Hamza
- Health, Nutrition and Population Global Practice, The World Bank, Washington, DC, USA
| | - Norah Alkanhal
- Saudi Public Health Authority, Riyadh, KSA, Saudi Arabia
| | - Reem F Alsukait
- College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | | | - Severin Rakic
- Health, Nutrition and Population Global Practice, The World Bank, Washington, DC, USA
| | - Volkan Cetinkaya
- Health, Nutrition and Population Global Practice, The World Bank, Washington, DC, USA
| | - Christopher H Herbst
- Health, Nutrition and Population Global Practice, The World Bank, Washington, DC, USA
| | - Tracy Kuo Lin
- Institute for Health & Aging, Department of Social and Behavioral Sciences, University of California, San Francisco, CA, USA.
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10
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Daas MC, Gebremariam MK, Poelman MP, Andersen LF, Klepp KI, Bjelland M, Lien N. Mediators and moderators of the effects of a school-based intervention on adolescents' fruit and vegetable consumption: the HEIA study. Public Health Nutr 2024; 27:e50. [PMID: 38269621 PMCID: PMC10882531 DOI: 10.1017/s1368980024000260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
OBJECTIVE To examine whether targeted determinants mediated the effects of the HEalth In Adolescents (HEIA) intervention on fruit and vegetable (FV) consumption and explore if these mediating effects were moderated by sex, parental education or weight status. DESIGN Cluster-randomised controlled trial. SETTING The HEIA study (2007-2009) was a Norwegian 20-month multi-component school-based intervention to promote healthy weight development. FV consumption and targeted determinants were self-reported at baseline, mid-way (8 months) and post-intervention (20 months). PARTICIPANTS Adolescents (11-13-year-old) in twenty-five control schools (n 746) and twelve intervention schools (n 375). RESULTS At post-intervention, more adolescents in the intervention group compared with the control group had knowledge of the FV recommendations (OR: 1·4, 95 % CI 1·1, 1·9) and reported a decreased availability of vegetables at home (β: -0·1, 95 % CI -0·2, 0·0). Availability/accessibility of FV at home, availability of vegetables at dinner, taste preferences for different types of FV and knowledge of the FV recommendations were positively associated with the consumption of FV. However, none of the post-intervention determinants significantly mediated the intervention effects on FV consumption. Although no moderating influences by sex, parental education or weights status were observed on the mediating effects, exploratory analyses revealed significant moderations in the b-paths. CONCLUSIONS Since none of the targeted determinants could explain the increase in FV consumption, it remains unclear why the intervention was effective. Reporting on a wide range of mediators and moderators in school-based interventions is needed to reveal the pathways through which intervention effects are achieved.
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Affiliation(s)
- Merel Celine Daas
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo0317, Norway
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen6700 AA, The Netherlands
| | - Mekdes Kebede Gebremariam
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo0318, Norway
| | - Maartje P Poelman
- Department of Social Sciences, Chair Group Consumption and Healthy Lifestyles, Wageningen University & Research, Wageningen6700 EW, The Netherlands
| | - Lene Frost Andersen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo0317, Norway
| | - Knut-Inge Klepp
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo0213, Norway
| | - Mona Bjelland
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo0317, Norway
| | - Nanna Lien
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo0317, Norway
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11
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Busch V, Steenkamer I, van Nassau F, van Opdorp P, van Houtum L, Verhoeff A, Twisk J. The Effects of the Jump-In Whole-School Intervention on the Weight Development of Children in Amsterdam, the Netherlands. THE JOURNAL OF SCHOOL HEALTH 2024; 94:37-46. [PMID: 37518834 DOI: 10.1111/josh.13363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 06/13/2023] [Accepted: 06/22/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND This study assessed the effects of the "Jump-in" whole-school intervention in Amsterdam, the Netherlands, on children's weight development by comparing children exposed to the intervention and controls from 3 other large Dutch cities. Jump-in is a comprehensive intervention that aims to stimulate healthy nutrition and physical activity in children at primary schools in Amsterdam. In addition, the relationship between the intervention's implementation degree and its effectiveness was studied. METHODS Demographic and anthropometric data, collected by youth health care professionals via routine health checks at T0 (2014) and T1 (2019), were used to analyze possible intervention effects by comparing the weight development of children exposed to the Jump-in intervention versus unexposed controls. Implementation logs from health promotion professionals were used to determine intervention effects per implementation degree. Multilevel regression analyses were used for all analyses. RESULTS In total, 4299 children were included mean age ± 5.5 years (T0), 10.6 years (T1), and ≈50% boys/girls at both times. Receiving the fully implemented intervention resulted in a decline in standardized body-mass index (zBMI) compared to the controls (-0.23, confidence interval [CI] -0.33, -0.13). It also led to higher odds to move into a healthier weight category over time (odds ratio [OR] 1.36, CI 1.06, 1.74), yet no statistically significant shift towards a healthy weight was found. CONCLUSIONS Relative to the controls, children exposed to the intervention showed positive zBMI developments, with stronger effects when the implementation degree was higher. Despite positive results, creating more impact might require the further integration of school-based programs into whole-systems approaches that include other energy-balance behaviors.
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Affiliation(s)
- Vincent Busch
- Sarphati Amsterdam, Department of Healthy Living, Public Health Service (GGD) Amsterdam, City of Amsterdam, Nieuwe Achtergracht 100, 1018 WT, Amsterdam, The Netherlands
| | - Ilona Steenkamer
- Department of Healthy Living, Public Health Service (GGD), Nieuwe Achtergracht 100, 1018 WT, Amsterdam, The Netherlands
| | - Femke van Nassau
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centre, Vrije Universiteit, De Boelelaan 1089a, 1081 HV Amsterdam, Amsterdam, The Netherlands
| | - Paul van Opdorp
- Department of Healthy Living, Public Health Service (GGD) Amsterdam, City of Amsterdam, Nieuwe Achtergracht 100, 1018 WT, Amsterdam, The Netherlands
| | - Lieke van Houtum
- Sarphati Amsterdam, Department of Healthy Living, Public Health Service (GGD) Amsterdam, City of Amsterdam, Nieuwe Achtergracht 100, 1018 WT, Amsterdam, The Netherlands
| | - Arnoud Verhoeff
- Department of Sociology, University of Amsterdam, Nieuwe Achtergracht 166, 1018WV, Amsterdam, the Netherlands; Director, Sarphati Amsterdam, Department of Healthy Living, Public Health Service (GGD) Amsterdam, City of Amsterdam, Nieuwe Achtergracht 100, 1018WT, Amsterdam, The Netherlands
- Department of Sociology, University of Amsterdam. Nieuwe Achtergracht 166, 1018 WV, Amsterdam, The Netherlands
| | - Jos Twisk
- Department of Epidemiology and Data Science, Amsterdam UMC, De Boelelaan 1089a, 1081 HV, Amsterdam, The Netherlands
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12
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Rozga M, Handu D. Nutrition Interventions for Pediatric Obesity Prevention: An Umbrella Review of Systematic Reviews. Nutrients 2023; 15:5097. [PMID: 38140356 PMCID: PMC10745722 DOI: 10.3390/nu15245097] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/01/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
Nutrition interventions to prevent pediatric obesity can help to establish healthy habits to improve current and future health. The objective of this umbrella review of systematic reviews (SRs) is to examine the impact of obesity prevention interventions with a nutrition component on body mass index measures, overweight/obesity prevalence, and cost-effectiveness in participants 2-17 years old. Grading of Recommendations Assessment, Development and Evaluation (GRADE) methods were used, and this umbrella review was registered on PROSPERO (CRD42023443033). Included SRs were required to search ≥2 databases and to assess the risk of bias (RoB) of primary studies, and they were published 2017-June 2023. Database searches identified 4776 articles, and 31 SRs were included. In all age groups combined, interventions with both nutrition and physical activity were effective and cost-effective in all settings combined, and in the community setting specifically. In children ≤5 years old, interventions in the home and family, community, and healthcare settings demonstrated some efficacy, whereas in children 6-12 years old, school interventions were most effective. Evidence with individuals 13-17 years was limited. The certainty of evidence was generally low due to RoB in included studies, inconsistency, and imprecision. Pediatric obesity prevention interventions with nutrition should be tailored to the developmental stage to ensure appropriateness and efficacy.
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Affiliation(s)
- Mary Rozga
- Academy of Nutrition and Dietetics, 120 S. Riverside Plaza, Suite 2190, Chicago, IL 60606-6995, USA;
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Ginell K, Henschel B, Golzarri-Arroyo L, Jamshidi-Naeini Y, Brown AW, Allison DB. Unreliable Findings Due to Miscalculations and Errors. Comment on Nally et al. The Effectiveness of School-Based Interventions on Obesity-Related Behaviours in Primary School Children: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Children 2021, 8, 489. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1660. [PMID: 37892323 PMCID: PMC10605774 DOI: 10.3390/children10101660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 08/18/2023] [Accepted: 09/20/2023] [Indexed: 10/29/2023]
Abstract
Nally et al. [...].
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Affiliation(s)
- Keara Ginell
- Department of Cognitive Science, Vassar College, Poughkeepsie, NY 12604, USA
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN 47405, USA
| | - Beate Henschel
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN 47405, USA
| | - Lilian Golzarri-Arroyo
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN 47405, USA
| | - Yasaman Jamshidi-Naeini
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN 47405, USA
| | - Andrew W. Brown
- Department of Applied Health Science, Indiana University School of Public Health-Bloomington, Bloomington, IN 47405, USA
- Arkansas Children’s Research Institute, Little Rock, AR 72202, USA
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - David B. Allison
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN 47405, USA
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Donnelly S, Buchan DS, McLellan G, Roberts R, Arthur R. Exploring the feasibility of a cluster pilot randomised control trial to improve children's 24-hour movement behaviours and dietary intake: Happy homework. J Sports Sci 2023; 41:1787-1800. [PMID: 38219248 DOI: 10.1080/02640414.2023.2300562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 12/21/2023] [Indexed: 01/16/2024]
Abstract
We aimed to explore the feasibility, acceptability, and potential efficacy of Happy Homework (HH); an 8-week home-focussed intervention, with the purpose of encouraging children's positive dietary behaviours and engagement in positive physical activity (PA) and sleep behaviours. We randomised four Scottish schools (n = 71 participants; 5 classrooms) to either the HH intervention (n = 2) or usual curriculum control group (n = 2). HH consisted of movement and dietary-focused parent and child tasks. Primary outcome measures were intervention feasibility, acceptability, and potential efficacy. Secondary outcomes were objectively measured PA via ActiGraph GT3X+, sedentary behaviours (SBs) and sleep duration via activPAL4™ accelerometers and dietary behaviours, fruit and vegetable consumption and screen-time via questionnaires. After controlling for pre-test levels, post intervention stepping time and sleep duration were significantly greater for the HH group in comparison to the control group. The HH group reported eating more fruit and vegetables at post-test than the control group. Participants also reported the intervention to be enjoyable and motivating. These findings provide promising evidence that given a greater sample size, better retention and the prioritisation of health and wellbeing homework, HH could enhance children's health and wellbeing.
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Affiliation(s)
- Samantha Donnelly
- School of Health and Life Science, University of the West of Scotland, South Lanarkshire, UK
| | - Duncan S Buchan
- School of Health and Life Science, University of the West of Scotland, South Lanarkshire, UK
| | - Gillian McLellan
- School of Health and Life Science, University of the West of Scotland, South Lanarkshire, UK
| | - Ross Roberts
- Institute for the Psychology of Elite Performance, School of Human and Behavioural Sciences, Bangor University, Bangor, UK
| | - Rosie Arthur
- School of Health and Life Science, University of the West of Scotland, South Lanarkshire, UK
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15
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Wong JP, Bachman J, Griggs S, Hartz J. Decreasing Sedentary Behaviors in Youth to Prevent and Manage Childhood Obesity: Is It Realistic? Curr Atheroscler Rep 2023; 25:479-485. [PMID: 37378698 DOI: 10.1007/s11883-023-01121-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 06/29/2023]
Abstract
PURPOSE OF REVIEW Decreasing sedentary behaviors has been proposed as one approach to reduce the rate of obesity in youth. This review summarizes the contemporary literature examining the efficacy of these interventions in the school and community along with an additional focus on the role of socioeconomic status in these interventions. RECENT FINDINGS Studies that focus on decreasing sedentary behavior have utilized a wide variety of strategies in a number of settings. The effects of these interventions are often hindered by non-standard outcome measures, study infidelity, and subjective measures of sedentary time. However, interventions that incorporate engaged stakeholders and include younger subjects appear to be the most likely to succeed. Promising interventions to decrease sedentary behaviors have been shown in recent clinical trials; however, replicating and sustaining these results is challenging. From the available literature, school-based interventions have the potential of reaching the largest group of children. In contrast, interventions in younger children, particularly those with invested parents, seem to be the most effective.
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Affiliation(s)
- Jonathan P Wong
- Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Jennifer Bachman
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Suzanne Griggs
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Jacob Hartz
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA.
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Jones W, Sobers N, Brown-Perry A, Bristol L, Samuels TA. Revising primary and secondary school curricula in the Caribbean to enhance education on the risks for noncommunicable diseases. Rev Panam Salud Publica 2023; 47:e97. [PMID: 37405120 PMCID: PMC10317247 DOI: 10.26633/rpsp.2023.97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/09/2023] [Indexed: 07/06/2023] Open
Abstract
In the English-speaking Caribbean, an estimated 46% of men and 61% of women are currently overweight or obese, and 8% of children younger than 5 years are also overweight. To combat this worsening epidemic, driven by unhealthy dietary patterns, the Heads of Government of the Caribbean Community (CARICOM) issued the 2007 Port-of-Spain Declaration, which included mandates on the provision of healthy school meals, promotion of healthy dietary patterns, and reintroduction of physical education in schools. These mandates are aligned with evidence-based approaches used in childhood obesity prevention programs. School-based interventions, including curriculum revisions, are part of a multipronged approach to improve nutrition in children and are designed to complement and reinforce other interventions in schools. However, formal evaluation of the Port-of-Spain Declaration showed that most CARICOM member countries had difficulty implementing the mandates related to schools and diet. The Improving Household Nutrition Security and Public Health in the CARICOM project, in collaboration with regional institutions, the CARICOM Secretariat, and the Caribbean Examinations Council, sought to enhance nutrition education through revision of region-wide primary and secondary school curricula to increase the focus on prevention of noncommunicable diseases. This paper describes the process of revising the Caribbean Examinations Council's Human and Social Biology syllabus for secondary schools and the CARICOM Health and Family Life Education Regional Curriculum Framework for primary schools, which was achieved through multisectoral collaboration. We used the Framework for Reporting Adaptations and Modifications-Enhanced model to describe the process through which the modifications were made.
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Affiliation(s)
- Waneisha Jones
- The Faculty of Medical SciencesThe University of the West IndiesCave Hill CampusBarbadosThe Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Barbados.
| | - Natasha Sobers
- The George Alleyne Chronic Disease Research Centrea unit of the Caribbean Institute for Health ResearchThe University of the West IndiesBridgetownBarbadosThe George Alleyne Chronic Disease Research Centre, a unit of the Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, Barbados.
| | - Alsian Brown-Perry
- Caribbean Examinations CouncilKingstonJamaicaCaribbean Examinations Council, Kingston, Jamaica (retired).
| | - Laurette Bristol
- Human Resource DevelopmentCARICOM SecretariatTurkeyenGeorgetownGuyanaHuman Resource Development, CARICOM Secretariat, Turkeyen, Georgetown, Guyana.
| | - T. Alafia Samuels
- Epidemiology Research UnitCaribbean Institute for Health ResearchThe University of the West IndiesKingstonJamaicaEpidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica.
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Weyers S, Rigó M. Child health and development in the course of the COVID-19 pandemic: are there social inequalities? Eur J Pediatr 2023; 182:1173-1181. [PMID: 36604347 PMCID: PMC9816013 DOI: 10.1007/s00431-022-04799-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 12/21/2022] [Accepted: 12/29/2022] [Indexed: 01/07/2023]
Abstract
COVID-19 pandemic lockdowns and closures have influenced all children's health and development (HAD). We aimed to examine whether this differs by social circumstances. We hypothesised that socially disadvantaged children experienced more pronounced deterioration in their HAD compared with better-off children. In our trend study, we included five cohorts of school enrolment medical screening (school entrance 2018-2022) in the city of Dusseldorf, Germany. To compensate for selection bias due to the limited number of examinations in pandemic months, we chose the first 800 examinations of each cohort. We computed predicted prevalences of overweight, coordination and language problems as indicators of HAD. Neighbourhood deprivation, single-parent families and non-German nationality were used as indicators of social disadvantage. All groups of children experienced a deterioration in their HAD. Its magnitude is comparable between children with different social circumstances. For instance, between 2018 and 2021, prevalence of overweight increased from 19.2 to 24.2% in children from deprived neighbourhoods, and from 8.1 to 16.5% in children from well-off neighbourhoods. Prevalence of language problems (prepositions) increased from 49.9 to 72.1% among non-German children, and from 14.4 to 39.1% among German children. Conclusion: Results only partly confirmed our hypothesis. However, since the pre-pandemic prevalences of HAD problems among disadvantaged children were already higher, further deterioration - regardless of its magnitude - has led to their particularly poor situation. For those children, overweight and language development should be priorities of prevention. Generally, important settings for child HAD such as kindergartens or leisure facilities should remain open in future pandemics. What is known: • The COVID-19 pandemic has had a negative impact on general child health and development. • Before the pandemic, social inequalities in child health and development were a common phenomenon. What is new: • Children in all social groups experienced a deterioration in their health and development over the course of the pandemic. • Over the course of the pandemic, children from deprived neighbourhoods have demonstrated a particularly high prevalence of overweight. Language problems are particularly prevalent among non-German children.
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Affiliation(s)
- Simone Weyers
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany.
| | - Mariann Rigó
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
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Rodrigo-Sanjoaquín J, Corral-Abós A, Aibar Solana A, Zaragoza Casterad J, Lhuisset L, Bois JE. Effectiveness of school-based interventions targeting physical activity and sedentary time among children: a systematic review and meta-analysis of accelerometer-assessed controlled trials. Public Health 2022; 213:147-156. [PMID: 36413822 DOI: 10.1016/j.puhe.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/06/2022] [Accepted: 10/11/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To date, no meta-analysis has examined the influence of specific intervention characteristics in the overall effectiveness of school-based interventions measured only with accelerometer devices. Thus, the main purpose of this systematic review and meta-analysis was to evaluate the overall and specific variables of the effectiveness of school-based interventions assessed with accelerometer devices among children aged 5-12 years. STUDY DESIGN A systematic review and meta-analysis to assess the effectiveness of school-based interventions. METHODS Studies published in English, French and Spanish from five electronic databases between January 2010 and December 2021 were identified. Intervention designs with control group measure that assessed daily moderate-to-vigorous physical activity (MVPA) and sedentary time (ST) with accelerometer devices in children aged 5-12 years were included. PROSPERO ID CRD42022326859. RESULTS A total of 24 trials comprising of 19,487 children (51.3% girls) were included. Intervention studies were ineffective for improving daily MVPA (Hedges' g = 0.07, 95% confidence interval [CI] -0.03 to 0.17; I2 = 84.80%) but were effective for reducing ST (g = -0.08, 95% CI -0.12 to -0.03; I2 = 20.94%). Also, subgroup analyses for MVPA revealed that when studies had two intervention components (g = 0.21, 95% CI 0.06-0.36; I2 = 77.67%), and high quality (g = 0.12, 95% CI 0.01-0.22; I2 = 88.30%) they were effective. CONCLUSION School-based interventions have been effective to reduce children's daily time spent in ST. There is no evidence of overall effectiveness of school-based interventions for enhancing daily MVPA in children. Nevertheless, improving the quality of interventions and interventions with two components are effective to increase students' daily MVPA.
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Affiliation(s)
- J Rodrigo-Sanjoaquín
- Département Sciences et Techniques des Activités Physiques et Sportives (STAPS), Université de Pau et des Pays de l'Adour, Tarbes, Occitanie, France; Departamento de Didáctica de la Expresión Corporal, Universidad de Zaragoza, Huesca, Aragón, Spain.
| | - A Corral-Abós
- Departamento de Didáctica de la Expresión Corporal, Universidad de Zaragoza, Huesca, Aragón, Spain
| | - A Aibar Solana
- Departamento de Didáctica de la Expresión Corporal, Universidad de Zaragoza, Huesca, Aragón, Spain
| | - J Zaragoza Casterad
- Departamento de Didáctica de la Expresión Corporal, Universidad de Zaragoza, Huesca, Aragón, Spain
| | - L Lhuisset
- Département Sciences et Techniques des Activités Physiques et Sportives (STAPS), Université de Pau et des Pays de l'Adour, Tarbes, Occitanie, France
| | - J E Bois
- Département Sciences et Techniques des Activités Physiques et Sportives (STAPS), Université de Pau et des Pays de l'Adour, Tarbes, Occitanie, France
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19
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Klepp KI, Helleve A, Fismen AS, Rutter H. Improving the health of adolescents: the Nordic countries can help fill the evidence gap. Scand J Public Health 2022; 50:887-891. [PMID: 36245404 DOI: 10.1177/14034948221124675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
While in the Nordic countries we have well-developed welfare policies and several structural, statutory measures in place aiming to promote public health, studies from these countries are often absent from systematic reviews of research literature assessing the effects of policy measures designed to promote health. Using adolescent health promotion and efforts related to primary prevention of obesity as an example, this short commentary aims to illustrate the paucity of well-designed studies investigating the effects of public health policies affecting adolescents. This paper argues that the Nordic research community is in a good position to help fill this gap, and to contribute more widely to the international literature on evaluation of policy interventions.
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Affiliation(s)
- Knut-Inge Klepp
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway.,Department of Nutrition, University of Oslo, Oslo, Norway
| | - Arnfinn Helleve
- Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Oslo, Norway
| | - Anne-Siri Fismen
- Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Oslo, Norway.,Department of Health Promotion and Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Bergen, Norway
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, UK.,Centre for Lifecourse Nutrition, University of Agder, Kristiansand, Norway
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20
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Nally S, Ridgers ND, Gallagher AM, Murphy MH, Salmon J, Carlin A. “When You Move You Have Fun”: Perceived Barriers, and Facilitators of Physical Activity From a Child's Perspective. Front Sports Act Living 2022; 4:789259. [PMID: 35321521 PMCID: PMC8937021 DOI: 10.3389/fspor.2022.789259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 02/01/2022] [Indexed: 11/14/2022] Open
Abstract
In Northern Ireland (NI), many children do not meet the recommended levels of physical activity (PA). To reduce the prevalence of physical inactivity and associated health conditions, it is important to understand the influences on children's PA, which in turn has the potential to inform future intervention design. The purpose of this formative study was to examine the current views, barriers, facilitators, experiences, and perceptions of children in relation to PA in the classroom, school, and home environments, and to assess the acceptability of components for a school-based intervention. Write and draw tasks and semi-structured focus groups (n = 10) were conducted with 50 children aged 7–9 years (22 boys, 28 girls) from six primary schools. Focus groups were recorded, transcribed, and analyzed thematically. Pen profiles were constructed from the transcripts in a deductive manner and represent key emergent themes. Results indicated that children's perception and knowledge of PA was mainly structured and sport-based, while some referred to fun, play and health. Fun, social support and outdoor activity were identified as key facilitators. Barriers included parental restrictions, lack of time and space in the different environments. The acceptability of intervention components was examined, children recognized the potential benefits of additional movement in the classroom, but opinions differed on the sit-to-stand desks. Findings contribute to a more detailed understanding of children's perceptions of context specific PA, the barriers they face, in addition to factors that support them to lead a physically active lifestyle, which may inform future PA promotion strategies.
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Affiliation(s)
- Sarah Nally
- Centre for Exercise Medicine, Physical Activity and Health, Sports and Exercise Sciences Research Institute, Ulster University, Newtownabbey, United Kingdom
- *Correspondence: Sarah Nally
| | - Nicola D. Ridgers
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
| | - Alison M. Gallagher
- Nutrition Innovation Centre for Food and Health (NICHE), Biomedical Sciences Research Institute, University of Ulster, Coleraine, United Kingdom
| | - Marie H. Murphy
- Centre for Exercise Medicine, Physical Activity and Health, Sports and Exercise Sciences Research Institute, Ulster University, Newtownabbey, United Kingdom
| | - Jo Salmon
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
| | - Angela Carlin
- Centre for Exercise Medicine, Physical Activity and Health, Sports and Exercise Sciences Research Institute, Ulster University, Newtownabbey, United Kingdom
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21
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Nury E, Stadelmaier J, Morze J, Nagavci B, Grummich K, Schwarzer G, Hoffmann G, Angele CM, Steinacker JM, Wendt J, Conrad J, Schmid D, Meerpohl JJ, Schwingshackl L. Effects of nutritional intervention strategies in the primary prevention of overweight and obesity in school settings: systematic review and network meta-analysis. BMJ MEDICINE 2022; 1:e000346. [PMID: 36936562 PMCID: PMC9951385 DOI: 10.1136/bmjmed-2022-000346] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/04/2022] [Indexed: 12/25/2022]
Abstract
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.
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Affiliation(s)
- Edris Nury
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Stadelmaier
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jakub Morze
- Department of Cardiology and Internal Diseases, University of Warmia and Mazury, Olsztyn, Poland
- Department of Human Nutrition, University of Warmia and Mazury, Olsztyn, Poland
| | - Blin Nagavci
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kathrin Grummich
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
- Institute of Medical Biometry and Statistics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Guido Schwarzer
- Institute of Medical Biometry and Statistics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Georg Hoffmann
- Department of Nutritional Sciences, University of Vienna, Vienna, Austria
| | - Claudia M Angele
- Department of Nutritional Sciences, University of Vienna, Vienna, Austria
- Centre for Teacher Education, University of Vienna, Vienna, Austria
| | - Jürgen M Steinacker
- Division of Sports and Rehabilitation Medicine, Ulm University Hospital, Ulm, Germany
| | - Janine Wendt
- Division of Sports and Rehabilitation Medicine, Ulm University Hospital, Ulm, Germany
| | - Johanna Conrad
- Science Department, German Nutrition Society, Bonn, Germany
| | - Daniela Schmid
- Division for Quantitative Methods in Public Health and Health Services Research, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Hall in Tyrol, Austria
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
| | - Lukas Schwingshackl
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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22
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O’Brien KM, Barnes C, Yoong S, Campbell E, Wyse R, Delaney T, Brown A, Stacey F, Davies L, Lorien S, Hodder RK. School-Based Nutrition Interventions in Children Aged 6 to 18 Years: An Umbrella Review of Systematic Reviews. Nutrients 2021; 13:4113. [PMID: 34836368 PMCID: PMC8618558 DOI: 10.3390/nu13114113] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/12/2021] [Accepted: 11/15/2021] [Indexed: 01/08/2023] Open
Abstract
Schools are identified as a key setting to influence children's and adolescents' healthy eating. This umbrella review synthesised evidence from systematic reviews of school-based nutrition interventions designed to improve dietary intake outcomes in children aged 6 to 18 years. We undertook a systematic search of six electronic databases and grey literature to identify relevant reviews of randomized controlled trials. The review findings were categorised for synthesis by intervention type according to the World Health Organisation Health Promoting Schools (HPS) framework domains: nutrition education; food environment; all three HPS framework domains; or other (not aligned to HPS framework domain). Thirteen systematic reviews were included. Overall, the findings suggest that school-based nutrition interventions, including nutrition education, food environment, those based on all three domains of the HPS framework, and eHealth interventions, can have a positive effect on some dietary outcomes, including fruit, fruit and vegetables combined, and fat intake. These results should be interpreted with caution, however, as the quality of the reviews was poor. Though these results support continued public health investment in school-based nutrition interventions to improve child dietary intake, the limitations of this umbrella review also highlight the need for a comprehensive and high quality systematic review of primary studies.
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Affiliation(s)
- Kate M. O’Brien
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, Newcastle, NSW 2308, Australia; (C.B.); (S.Y.); (E.C.); (R.W.); (T.D.); (A.B.); (S.L.); (R.K.H.)
- Priority Research Centre in Health and Behaviour, University of Newcastle, University Drive, Callaghan, Newcastle, NSW 2308, Australia;
- Hunter New England Population Health, Longworth Avenue Wallsend, Newcastle, NSW 2287, Australia;
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, Newcastle, NSW 2305, Australia
- National Centre of Implementation Science, University of Newcastle, University Drive, Callaghan, Newcastle, NSW 2308, Australia
| | - Courtney Barnes
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, Newcastle, NSW 2308, Australia; (C.B.); (S.Y.); (E.C.); (R.W.); (T.D.); (A.B.); (S.L.); (R.K.H.)
- Priority Research Centre in Health and Behaviour, University of Newcastle, University Drive, Callaghan, Newcastle, NSW 2308, Australia;
- Hunter New England Population Health, Longworth Avenue Wallsend, Newcastle, NSW 2287, Australia;
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, Newcastle, NSW 2305, Australia
| | - Serene Yoong
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, Newcastle, NSW 2308, Australia; (C.B.); (S.Y.); (E.C.); (R.W.); (T.D.); (A.B.); (S.L.); (R.K.H.)
- Priority Research Centre in Health and Behaviour, University of Newcastle, University Drive, Callaghan, Newcastle, NSW 2308, Australia;
- Hunter New England Population Health, Longworth Avenue Wallsend, Newcastle, NSW 2287, Australia;
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, Newcastle, NSW 2305, Australia
- National Centre of Implementation Science, University of Newcastle, University Drive, Callaghan, Newcastle, NSW 2308, Australia
- Faculty of Health, Arts and Design, Swinburne University of Technology, John Street, Hawthorn, VIC 3122, Australia
| | - Elizabeth Campbell
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, Newcastle, NSW 2308, Australia; (C.B.); (S.Y.); (E.C.); (R.W.); (T.D.); (A.B.); (S.L.); (R.K.H.)
- Priority Research Centre in Health and Behaviour, University of Newcastle, University Drive, Callaghan, Newcastle, NSW 2308, Australia;
- Hunter New England Population Health, Longworth Avenue Wallsend, Newcastle, NSW 2287, Australia;
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, Newcastle, NSW 2305, Australia
| | - Rebecca Wyse
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, Newcastle, NSW 2308, Australia; (C.B.); (S.Y.); (E.C.); (R.W.); (T.D.); (A.B.); (S.L.); (R.K.H.)
- Priority Research Centre in Health and Behaviour, University of Newcastle, University Drive, Callaghan, Newcastle, NSW 2308, Australia;
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, Newcastle, NSW 2305, Australia
| | - Tessa Delaney
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, Newcastle, NSW 2308, Australia; (C.B.); (S.Y.); (E.C.); (R.W.); (T.D.); (A.B.); (S.L.); (R.K.H.)
- Priority Research Centre in Health and Behaviour, University of Newcastle, University Drive, Callaghan, Newcastle, NSW 2308, Australia;
- Hunter New England Population Health, Longworth Avenue Wallsend, Newcastle, NSW 2287, Australia;
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, Newcastle, NSW 2305, Australia
| | - Alison Brown
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, Newcastle, NSW 2308, Australia; (C.B.); (S.Y.); (E.C.); (R.W.); (T.D.); (A.B.); (S.L.); (R.K.H.)
- Priority Research Centre in Health and Behaviour, University of Newcastle, University Drive, Callaghan, Newcastle, NSW 2308, Australia;
- Hunter New England Population Health, Longworth Avenue Wallsend, Newcastle, NSW 2287, Australia;
- National Centre of Implementation Science, University of Newcastle, University Drive, Callaghan, Newcastle, NSW 2308, Australia
| | - Fiona Stacey
- Priority Research Centre in Health and Behaviour, University of Newcastle, University Drive, Callaghan, Newcastle, NSW 2308, Australia;
- Hunter New England Population Health, Longworth Avenue Wallsend, Newcastle, NSW 2287, Australia;
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, Newcastle, NSW 2305, Australia
| | - Lynda Davies
- Hunter New England Population Health, Longworth Avenue Wallsend, Newcastle, NSW 2287, Australia;
| | - Sasha Lorien
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, Newcastle, NSW 2308, Australia; (C.B.); (S.Y.); (E.C.); (R.W.); (T.D.); (A.B.); (S.L.); (R.K.H.)
- Priority Research Centre in Health and Behaviour, University of Newcastle, University Drive, Callaghan, Newcastle, NSW 2308, Australia;
- Hunter New England Population Health, Longworth Avenue Wallsend, Newcastle, NSW 2287, Australia;
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, Newcastle, NSW 2305, Australia
- National Centre of Implementation Science, University of Newcastle, University Drive, Callaghan, Newcastle, NSW 2308, Australia
| | - Rebecca K. Hodder
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, Newcastle, NSW 2308, Australia; (C.B.); (S.Y.); (E.C.); (R.W.); (T.D.); (A.B.); (S.L.); (R.K.H.)
- Priority Research Centre in Health and Behaviour, University of Newcastle, University Drive, Callaghan, Newcastle, NSW 2308, Australia;
- Hunter New England Population Health, Longworth Avenue Wallsend, Newcastle, NSW 2287, Australia;
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, Newcastle, NSW 2305, Australia
- National Centre of Implementation Science, University of Newcastle, University Drive, Callaghan, Newcastle, NSW 2308, Australia
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23
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Jones A, Armstrong B, Weaver RG, Parker H, von Klinggraeff L, Beets MW. Identifying effective intervention strategies to reduce children's screen time: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 2021; 18:126. [PMID: 34530867 PMCID: PMC8447784 DOI: 10.1186/s12966-021-01189-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/12/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Excessive screen time ([Formula: see text] 2 h per day) is associated with childhood overweight and obesity, physical inactivity, increased sedentary time, unfavorable dietary behaviors, and disrupted sleep. Previous reviews suggest intervening on screen time is associated with reductions in screen time and improvements in other obesogenic behaviors. However, it is unclear what study characteristics and behavior change techniques are potential mechanisms underlying the effectiveness of behavioral interventions. The purpose of this meta-analysis was to identify the behavior change techniques and study characteristics associated with effectiveness in behavioral interventions to reduce children's (0-18 years) screen time. METHODS A literature search of four databases (Ebscohost, Web of Science, EMBASE, and PubMed) was executed between January and February 2020 and updated during July 2021. Behavioral interventions targeting reductions in children's (0-18 years) screen time were included. Information on study characteristics (e.g., sample size, duration) and behavior change techniques (e.g., information, goal-setting) were extracted. Data on randomization, allocation concealment, and blinding was extracted and used to assess risk of bias. Meta-regressions were used to explore whether intervention effectiveness was associated with the presence of behavior change techniques and study characteristics. RESULTS The search identified 15,529 articles, of which 10,714 were screened for relevancy and 680 were retained for full-text screening. Of these, 204 studies provided quantitative data in the meta-analysis. The overall summary of random effects showed a small, beneficial impact of screen time interventions compared to controls (SDM = 0.116, 95CI 0.08 to 0.15). Inclusion of the Goals, Feedback, and Planning behavioral techniques were associated with a positive impact on intervention effectiveness (SDM = 0.145, 95CI 0.11 to 0.18). Interventions with smaller sample sizes (n < 95) delivered over short durations (< 52 weeks) were associated with larger effects compared to studies with larger sample sizes delivered over longer durations. In the presence of the Goals, Feedback, and Planning behavioral techniques, intervention effectiveness diminished as sample size increased. CONCLUSIONS Both intervention content and context are important to consider when designing interventions to reduce children's screen time. As interventions are scaled, determining the active ingredients to optimize interventions along the translational continuum will be crucial to maximize reductions in children's screen time.
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Affiliation(s)
- Alexis Jones
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - Bridget Armstrong
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - R. Glenn Weaver
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - Hannah Parker
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - Lauren von Klinggraeff
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - M. W. Beets
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
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