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Healthier Choices in School Cafeterias: A Systematic Review of Cafeteria Interventions.
Gordon, K, Dynan, L, Siegel, R
The Journal of pediatrics. 2018;:273-279.e2
Abstract
OBJECTIVE To describe school cafeteria interventions in terms of a behavioral economics scheme and to assess which system is more likely to be effective in improving food selection or consumption. STUDY DESIGN With this systematic review, we categorize cafeteria interventions using the behavioral economics theory of Kahneman into system 1 (fast and intuitive thinking) and system 2 (slow and cognitively demanding) or mixed (having elements of system 1 and system 2). Pertinent studies were identified from review of the literature of interventions performed in school and cafeteria settings in children grades K-12 within the past 5 years (2012-2017) at time of search. RESULTS In all, 48 of 978 studies met inclusion criteria. By defining success as a 30% improvement in a desired outcome or statistically significant reduction in body mass index, 89% of system 1, 67% of mixed (had both system 1 and 2 elements), and only 33% of system 2 interventions were successful. CONCLUSIONS This review found successful system 1 type school cafeteria interventions to be more common than system 2 type interventions and system 2 type interventions are less effective than system 1.
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An exploratory trial of a health education programme to promote healthy lifestyles through social and emotional competence in young children: Study protocol.
Bermejo-Martins, E, López-Dicastillo, O, Mujika, A
Journal of advanced nursing. 2018;(1):211-222
Abstract
AIM: To implement and evaluate a health education programme based on the development of social and emotional competence in young children. BACKGROUND Children's social and emotional skills play a key role in the adoption and maintenance of their lifestyles. Currently, a more comprehensive perspective dealing with these aspects is needed to promote healthy habits in children and develop effective health education programmes. DESIGN An exploratory randomized controlled trial. METHODS A convenience sample of 30 children (5 and 6 years old) will be recruited from a public school in Spain, with 15 participants in the experimental group and 15 in the control group. Participants in the experimental group will receive the first unit of the programme, consisting of developing emotional knowledge skills around daily health habits (eating, hygiene, sleep and physical exercise) using different game-based dynamics and an emotional diary, while those in the control group will continue with their usual school routine. Outcome measures include emotional knowledge ability, basic social skills and children's health profile. The perceived impact of the intervention by parents, acceptability (by parents and children) and feasibility of the programme will be also assessed. Data will be collected at baseline, postintervention and at 7-month follow-up. DISCUSSION This study offers an innovative intervention aimed at improving children's healthy lifestyles from a holistic perspective by addressing social and emotional competence as one of the most influential aspects of children's development. This exploratory trial is an essential step to explore crucial aspects of the full-scale clinical trial.
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A Healthy School Start Plus for prevention of childhood overweight and obesity in disadvantaged areas through parental support in the school setting - study protocol for a parallel group cluster randomised trial.
Elinder, LS, Patterson, E, Nyberg, G, Norman, Å
BMC public health. 2018;(1):459
Abstract
BACKGROUND Systematic reviews conclude that interventions to prevent overweight and obesity in children obtain stronger effects when parents are involved. Parenting practices and parent-child interactions shape children's health-related behaviours. The Healthy School Start Plus intervention aims to promote healthy dietary habits and physical activity and prevent obesity in children through parental support in disadvantaged areas with increased health needs, delivered by teachers and school nurses. This protocol describes the design, outcome and process evaluation of the study. METHODS Effectiveness of the intervention is compared to standard care within school health services. The 6-month programme, based on Social Cognitive Theory, consists of four components: 1) Health information to parents regarding the child; 2) Motivational Interviewing with the parents by the school nurse concerning the child; 3) classroom activities for the children by teachers; and 4) a web-based self-test of type-2 diabetes risk by parents. Effects will be studied in a cluster randomised trial including 17 schools and 352 six-year old children. The primary outcome is dietary intake of indicator foods, and secondary outcomes are physical activity, sedentary behaviour and BMI. Outcomes will be measured at baseline, at 6 months directly after the intervention, and at follow-up 18 months post baseline. Statistical analysis will be by mixed-effect regression analysis according to intention to treat and per protocol. Mediation analysis will be performed with parental self-efficacy and parenting practices. Quantitative and qualitative methods will be used to study implementation in terms of dose, fidelity, feasibility and acceptability. The hypothesis is that the programme will be more effective than standard care and feasible to perform in the school context. DISCUSSION The programme is in line with the cumulated evidence regarding the prevention of childhood obesity: That schools should be a focal point of prevention efforts, interventions should involve multiple components, and include the home environment. If effective, it will fill a knowledge gap concerning evidence-based health promotion practice within school health services to prevent obesity, and in the long term reduce social inequalities in health. TRIAL REGISTRATION The trial was retrospectively registered on January 4, 2018 and available online at ClinicalTrials.gov : No. NCT03390725 .
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Together We STRIDE: A quasi-experimental trial testing the effectiveness of a multi-level obesity intervention for Hispanic children in rural communities.
Ko, LK, Rillamas-Sun, E, Bishop, S, Cisneros, O, Holte, S, Thompson, B
Contemporary clinical trials. 2018;:81-86
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Abstract
BACKGROUND Hispanic children are disproportionally overweight and obese compared to their non-Hispanic white counterparts in the US. Community-wide, multi-level interventions have been successful to promote healthier nutrition, increased physical activity (PA), and weight loss. Using community-based participatory approach (CBPR) that engages community members in rural Hispanic communities is a promising way to promote behavior change, and ultimately weight loss among Hispanic children. OBJECTIVES Led by a community-academic partnership, the Together We STRIDE (Strategizing Together Relevant Interventions for Diet and Exercise) aims to test the effectiveness of a community-wide, multi-level intervention to promote healthier diets, increased PA, and weight loss among Hispanic children. METHODS The Together We STRIDE is a parallel quasi-experimental trial with a goal of recruiting 900 children aged 8-12 years nested within two communities (one intervention and one comparison). Children will be recruited from their respective elementary schools. Components of the 2-year multi-level intervention include comic books (individual-level), multi-generational nutrition and PA classes (family-level), teacher-led PA breaks and media literacy education (school-level), family nights, a farmer's market and a community PA event (known as ciclovia) at the community-level. Children from the comparison community will receive two newsletters. Height and weight measures will be collected from children in both communities at three time points (baseline, 6-months, and 18-months). SUMMARY The Together We STRIDE study aims to promote healthier diet and increased PA to produce healthy weight among Hispanic children. The use of CBPR approach and the engagement of the community will springboard strategies for intervention' sustainability. Clinical Trials Registration Number: NCT02982759 Retrospectively registered.
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Systematic Review of Physical Education-Based Physical Activity Interventions Among Elementary School Children.
Errisuriz, VL, Golaszewski, NM, Born, K, Bartholomew, JB
The journal of primary prevention. 2018;(3):303-327
Abstract
Physical education (PE)-based interventions are a popular method to target children's physical activity (PA) and fitness; however, little is known about their effectiveness or what factors lead to successful interventions. This paper: (1) systematically reviews studies examining PE interventions designed to impact PA, fitness, and/or body composition; and (2) makes recommendations for new research directions based upon these findings. Our systematic review was limited to experimental and quasi-experimental studies conducted in elementary schools. We conducted literature searches using predetermined keywords in 3 databases, identified a total of 4964 potentially relevant studies, and screened their abstracts and full texts for eligibility. This resulted in 12 relevant studies. We used criteria established by Downs and Black (1998) to assess each study's methodological quality. PE interventions consistently showed increases in moderate-to-vigorous PA or vigorous PA during PE class but were less consistent in impacting leisure-time PA. PE interventions affected body composition differentially, depending on the assessment used (i.e., body mass index or skinfold thickness). Half of the studies assessing fitness did not show a significant impact; however, those that did were designed to influence fitness outcomes. Few studies assessed psychosocial determinants regarding PA, and no study demonstrated significant impacts on constructs other than knowledge. Interventions often contained multiple components (e.g., diet, family) implemented alongside PE interventions. Identifying effective intervention components was difficult due to lack of process evaluation. We identify the need for future research to use more objective and accurate PA measurements and adiposity, incorporate measurement of psychological constructs, expand interventions' theoretical basis, and include strong process evaluation.
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The Influence of Organizational Culture on School-Based Obesity Prevention Interventions: A Systematic Review of the Literature.
Fair, KN, Solari Williams, KD, Warren, J, McKyer, ELJ, Ory, MG
The Journal of school health. 2018;(6):462-473
Abstract
BACKGROUND Although the influence of organizational culture has been examined on a variety of student outcomes, few studies consider the influence that culture may have on school-based obesity prevention interventions. We present a systematic review of the literature to examine how elements of organizational culture may affect the adoption, implementation, and sustainability of school-based obesity prevention interventions. METHODS Fourteen studies examining the impact of organizational-level characteristics on school-based obesity prevention interventions were identified through the online databases EBSCO (CINAHL, ERIC, Agricola), Web of Science, Medline (PubMed), and Scopus. RESULTS Five themes were identified as elements of organizational culture that influence the adoption, implementation, and sustainability of school-based obesity prevention interventions: organizational response to limited resources, value placed on staff training and professional development, internal support, organizational values, and school climate. CONCLUSIONS Organizational culture can greatly influence the success of school-based obesity interventions. The collection of data related to organizational-level factors may be used to identify strategies for creating and sustaining a supportive environment for obesity prevention interventions in the school setting.
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[The importance of the process in evaluating the effectiveness of a childhood obesity campaign].
Lineros-González, C, Marcos-Marcos, J, Ariza, C, Hernán-García, M, ,
Gaceta sanitaria. 2017;(3):238-241
Abstract
The prevention of childhood obesity is one of the greatest public health challenges of modern times. This has triggered the generation of a wealth of scientific evidence, culminating in a body of knowledge concerning the essential components of campaigns implemented in the school setting. In this regard, a growing trend towards the evaluation of research results in terms of effectiveness has become apparent, while the fieldwork itself very rarely comes under the spotlight. By considering the implementation process description of a multicomponent campaign designed to prevent childhood obesity in boys and girls in the 3rd year of primary education in Spain (9-10 years of age), the aim of this paper is to influence the elements of this process by considering important aspects pertaining to its implementation, such as its plausibility and feasibility in the particular context.
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Health Promotion Intervention to Improve Diet Quality in Children.
Rosário, R, Araújo, A, Padrão, P, Lopes, O, Moreira, A, Pereira, B, Moreira, P
Health promotion practice. 2017;(2):253-262
Abstract
OBJECTIVE This study aims to evaluate the impact of an intervention program, taught by trained teachers, on foods and nutrients components of the Diet Quality Index-International among children in Grades 1 to 4. METHOD A total of 464 children (239 female, 6-12 years) from seven elementary Portuguese schools participated in this randomized trial. Three schools were allocated to the intervention, and four to the control group. The intervention program was based on the health promotion model and social cognitive theory. Teachers previously trained by researchers in nutrition, healthy eating, and healthy cooking implemented the intervention in the classroom from November 2008 to March 2009. Sociodemographic, anthropometric, physical activity, and dietary assessments were performed before (2007/2008) and at the end of the intervention (2009). Dietary intake was gathered by a 24-hour dietary recall and the components of Diet Quality Index-International were defined. RESULTS Children from the intervention schools reported a significantly higher adequacy in vegetable consumption (p = .018) and a significantly higher moderation in sodium consumption (p = .032) compared with the controllers. CONCLUSION Our study provides further support for the success of intervention programs that aim to enhance children's dietary intake. Implementing similar interventions can be promising to support vegetable consumption and moderate sodium intake.
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Design of a school randomized trial for nudging students towards healthy diet and physical activity to prevent obesity: PAAPAS Nudge study protocol.
Cunha, DB, Verly Junior, E, Paravidino, VB, Araújo, MC, Mediano, MFF, Sgambato, MR, de Souza, BDSN, Marques, ES, Baltar, VT, de Oliveira, ASD, et al
Medicine. 2017;(50):e8898
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Abstract
OBJECTIVE To evaluate the effectiveness of nudge activities at school on the students' body mass index (BMI). DESIGN School-based factorial randomized community trial. SETTING Eighteen public schools in the municipality of Duque de Caxias, metropolitan area of Rio de Janeiro, Brazil. PARTICIPANTS AND INTERVENTION The 18 schools will be randomized into 4 group arms: group 1-control (without any activity); group 2-will receive educational activities in the classroom; group 3-will receive changes in the school environment (nudge strategies); group 4-will receive educational activities and changes in the school environment. Activities will occur during the 2018 school-year. MAIN OUTCOME MEASURE(S): The primary (BMI) and secondary (body fat percentage) outcomes will be assessed at baseline and after the study using a portable electronic scale with a segmental body composition monitor. The height will be measured by a portable stadiometer. ANALYSIS Statistical analyses for each outcome will be conducted through linear mixed models that took into account the missing data and cluster effect of the schools.
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Process evaluation results of a cluster randomised controlled childhood obesity prevention trial: the WAVES study.
Griffin, TL, Clarke, JL, Lancashire, ER, Pallan, MJ, Adab, P, ,
BMC public health. 2017;(1):681
Abstract
BACKGROUND Increasing prevalence of childhood obesity and its related consequences emphasises the importance of developing and evaluating interventions aimed at prevention. The importance of process evaluation in health intervention research is increasingly recognised, assessing implementation and participant response, and how these may relate to intervention success or failure. A comprehensive process evaluation was designed and undertaken for the West Midlands ActiVe lifestyle and healthy Eating in School children (WAVES) study that tested the effectiveness of an obesity prevention programme for children aged 6-7 years, delivered in 24 UK schools. The four intervention components were: additional daily school-time physical activity (PA); cooking workshops for children and parents; Villa Vitality (VV), a 6-week healthy lifestyle promotion programme run by a local football club; and signposting to local PA opportunities. METHODS Data relating to six dimensions (Fidelity, Reach, Recruitment, Quality, Participant Responsiveness, Context) were collected via questionnaires, logbooks, direct observations, focus groups and interviews. Multiple data collection methods allowed for data triangulation and validation of methods, comparing research observations with teacher records. The 6-stage WAVES study model ((i) Data collection, (ii) Collation, (iii) Tabulation, (iv) Score allocation and discussion, (v) Consultation, (vi) Final score allocation) was developed to guide the collection, assimilation and analysis of process evaluation data. Two researchers independently allocated school scores on a 5-point Likert scale for each process evaluation dimension. Researchers then discussed school score allocations and reached a consensus. Schools were ranked by total score, and grouped to reflect low, medium or high intervention implementation. RESULTS The intervention was predominantly well-implemented and well-received by teachers, parents and children. The PA component was identified as the most challenging, VV the least. Median implementation score across schools was 56/75 (IQR, 51.0 - 60.8). Agreement between teacher logbooks and researcher observations was generally high, the main discrepancies occurred in session duration reporting where in some cases teachers' estimations tended to be higher than researchers'. CONCLUSIONS The WAVES study model provides a rigorous and replicable approach to undertaking and analysing a multi-component process evaluation. Challenges to implementing school-based obesity prevention interventions have been identified which can be used to inform future trials. TRIAL REGISTRATION ISRCTN97000586 . 19 May 2010.