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Scoping Review of Family and Community Engagement Strategies Used in School-Based Interventions to Promote Healthy Behaviors
Abstract
Background:
School efforts to promote health among students are more successful when families and community members are involved.
Methods:
We conducted a scoping review to summarize and categorize family and community engagement strategies used in US school and out-of-school time (OST) interventions to address physical activity (PA) and nutrition in kindergarten through 12th grade students.
Results:
The National Network of Partnership Schools' Six Keys to Success framework was useful in organizing the types of family and community engagement strategies used in included interventions. Many interventions used multiple family and community engagement strategies, with the most common being communicating with families and community members; providing support or education to families; and collaborations among school/OST program and community to support students and their families.
Conclusions:
This review identified six common family and community engagement strategies used in school and OST interventions for PA and nutrition. Including family and community engagement strategies in school and OST interventions could play an important role in maximizing support, resources, and expertise to promote healthy behaviors among all students.
... Many interventions that reported positive results for at least 1 PA or nutrition outcome provided implementationfocused professional development or technical assistance and/or engaged family or community members frequently as part of a coordinated approach. [16][17][18]22,32 Family and community engagement strategies to support and promote PA and nutrition in school and OST settings included communicating with families and community members; providing classes and support for families; offering volunteer opportunities for family and community members; involving families and community members in decision making; reinforcing health knowledge and practices in the home and community; and promoting collaborations among school and community to support students and their families. 32 Few studies evaluated school-based employee health and well-being programs. ...
... [16][17][18]22,32 Family and community engagement strategies to support and promote PA and nutrition in school and OST settings included communicating with families and community members; providing classes and support for families; offering volunteer opportunities for family and community members; involving families and community members in decision making; reinforcing health knowledge and practices in the home and community; and promoting collaborations among school and community to support students and their families. 32 Few studies evaluated school-based employee health and well-being programs. 21 This left us to extrapolate from the broader employee health and well-being literature, which finds that multicomponent health and well-being programs that include educational, behavioral, and environmental PA and nutrition strategies can improve employees' KAP, PA and dietary behaviors, anthropometric outcomes, and some indicators of mental health. ...
... Several recent review articles have highlighted qualities of school-based nutrition and physical activity programs that improve health behaviors or outcomes. These include coordinated approaches (school wellness councils, committees, or teams to address physical activity and/or nutrition) [25]; professional development or technical assistance [24,26]; family, parental, or community engagement [26][27][28]; physical activity policies; improvements to physical education and recess interventions [29]; and experiential nutrition education to improve skills (cooking, gardening, taste-testing, etc.) combined with other strategies [27]. ...
Research indicates that health interventions are most effective when they address multiple social determinants of health to support positive behavior. Schools as Hubs of Health, a comprehensive model of nutrition and physical activity education, was developed to support wellness within school communities defined as low-income by the national Supplemental Nutrition Assistance Program Education (SNAP-Ed). Components of the model include the following: classroom education; garden education; youth engagement; staff training; parent and community engagement; and policies, systems, and environments. Findings over the last decade indicate positive outcomes in nutrition and physical activity behaviors, youth leadership and engagement, and systems and environmental changes that support health and wellness.
... Adequate and balanced nutrition in the preschool period aims to ensure growth and development, support cognitive development, prevent health problems (anemia, dental caries, malnutrition, obesity, etc.), and protect against nutrition-related chronic diseases (type 2 diabetes, hypertension, cardiovascular diseases, some types of cancer, etc.) that may occur in adulthood (Michael et al., 2023;Weihrauch-Blüher & Wiegand, 2018). The World Health Organization (WHO) Commission to Ending Childhood Obesity has reported that "healthy food consumption," "weight management," "increasing physical activity," "a healthy," "nutritious and active school environment," and "healthy nutrition and physical activity at an early age" are key components and targets in the prevention of childhood obesity (Ongan et al., 2023). ...
Healthy societies are formed by learning and maintaining sustainable healthy eating behaviors from childhood. The aim of this study was to determine the effect of short‐term sustainable nutrition education on growth and development parameters of preschool children. This study is an experimental design with pretest–posttest control group. This study was carried out in two kindergartens between February 2022 and June 2023 in Turkey. The education group received 4 months of dietary behavior training. The dietary scale and anthropometric measurements were administered at the first and last meetings. Data were analyzed with 95% confidence interval. The study was completed with 174 children. A statistically significant difference was found, especially in body weight (p < 0.05) and body weight percentile values (p < 0.05) in the posttest of the education group. A statistically significant difference (p < 0.05) was found between the groups in the eating behavior scale posttest score. Nutrition education in schools is important in promoting healthy eating habits. Nutrition education improves eating behavior positively. To maintain healthy eating behaviors, however, the continuity of education is necessary. In addition, as growth and development are physical processes, it is recognized that growth and development cannot be assessed by nutrition alone.
... 24 Another manuscript in this special issue offers a robust description of parent/community engagement strategies. 88 CPSTF recommends park infrastructure improvements with additional activities, like structured programming for increasing PA. 89 CPSTF finds the economic benefits exceed the cost for park infrastructure interventions to increase physical activity and use. ...
Background:
This systematic review aims to identify out-of-school time (OST) interventions (eg, programming, policies) that increased opportunities for physical activity (PA) and healthy eating and/or improved youth PA and dietary behaviors.
Methods:
We searched for articles within systematic reviews that met our criteria (2010-2018) and for individual articles (2010-2020). Reviewer pairs screened articles, double-extracted data, assessed risk of bias (RoB), and achieved consensus. We included 71 articles (55 studies, 60 intervention arms).
Results:
Health (n = 3) and nutrition education (n = 7) interventions showed promising results, but most used weak designs and had high RoB. PA-focused interventions (n = 23) were largely consistent in improving fitness and moderate to vigorous PA during programming. Programmatic interventions that improved both PA and nutrition outcomes engaged family or community members (n = 4/13). Most organizational policy interventions improved the nutrition environment and student PA during OST.
Conclusions:
Organization-level policy and programmatic interventions can improve environmental supports and youth behaviors during OST programming, complementing school-day efforts to address student PA and dietary intake. To maximize their potential impact, OST programs need to be accessible to families. Administrators can consider actions to reduce participation barriers.
Background:
The school environment, consisting of the physical environment and social-emotional climate (SEC), plays a crucial role in both student and employee health; however, there is a lack of recent literature synthesizing school environment interventions in K-12 settings. We describe updated evidence about school environment interventions to support K-12 student and employee health in the United States.
Methods:
A 2-phase search included a review of reviews (2010-2018), followed by a search for individual articles (2010-2020) that targeted school physical environment and/or SEC to address physical activity (PA) and/or nutrition. We also investigated how nutrition and PA interventions with an SEC component improves social-emotional and/or mental health outcomes. Because research on dietary and PA behaviors for school employees is limited; we included studies on other worksites (eg, hospitals and offices) to provide insight for school employees.
Findings:
We identified 40 articles describing 40 unique studies and 45 interventions and grouped them by intervention type. Physical environment interventions demonstrated significant and positive nutrition and PA behavioral outcomes for students; outcomes among employees were mixed. Interventions with SEC components reported improvements in some mental health outcomes.
Implications:
The school environment can affect dietary and PA behaviors as well as mental health for students and employees.
Conclusions:
Establishing healthy school environments can support student and employee PA, dietary behaviors, and mental health.
Background:
Schools play a vital role in student health, and a collaborative approach may affect health factors such as physical activity (PA) and nutrition. There is a lack of recent literature synthesizing collaborative approaches in K-12 settings. We present updated evidence about interventions that used a coordinated school health approach to support K-12 student PA and nutrition in the United States.
Methods:
A 2-phase literature review search included a search of systematic reviews for individual qualifying studies (2010-2018), followed by a search for individual articles (2010-2020) that evaluated a coordinated approach or use of school wellness councils, committees, or teams to address PA and/or nutrition.
Results:
We identified 35 articles describing 30 studies and grouped them by intervention type. Interventions demonstrated promising findings for environmental changes and student dietary and PA behaviors.
Implications:
Coordinated and multicomponent interventions demonstrated significant improvements or null results, indicating that implementation of programs and/or policies to promote healthier eating and PA practices may support and do not appear to hinder environmental or behavioral outcomes.
Conclusions:
Schools can use a coordinated approach to implement opportunities for PA and nutrition; this may influence students' PA and dietary behaviors.
The Dietary Guidelines for Americans, 2020–2025 was issued jointly by the US Departments of Agriculture and of Health and Human Services in December 2020. It is the ninth edition of the Dietary Guidelines and is the first to provide recommendations by life stage, from birth to older adulthood. The Dietary Guidelines is grounded in the current body of scientific evidence on diet and health outcomes and aims to promote health and prevent chronic diseases. The process to develop the Dietary Guidelines involved 4 steps: (1) identifying the topics and supporting scientific questions, (2) appointing a Dietary Guidelines Advisory Committee (Committee) to review current scientific evidence, (3) developing the new edition of the Dietary Guidelines, and (4) implementing the Dietary Guidelines. The 2020-2025 edition provides 4 overarching guidelines and supporting key recommendations that encourage healthy dietary patterns across the life span. The foods and beverages that people consume have a profound impact on health, and it is never too late or too early to eat healthfully.
Parents substantially influence children’s diet and physical activity behaviors, which consequently impact childhood obesity risk. Given this influence of parents, the objective of this umbrella review was to synthesize evidence on effects of parent involvement in diet and physical activity treatment and prevention interventions on obesity risk among children aged 3–12 years old. Ovid/MEDLINE, Elsevier/Embase, Wiley/Cochrane Library, Clarivate/Web of Science, EBSCO/CINAHL, EBSCO/PsycInfo, and Epistemonikos.org were searched from their inception through January 2020. Abstract screening, full-text review, quality assessment, and data extraction were conducted independently by at least two authors. Systematic reviews and meta-analyses of diet and physical activity interventions that described parent involvement, included a comparator/control, and measured child weight/weight status as a primary outcome among children aged 3–12 years old were included. Data were extracted at the level of the systematic review/meta-analysis, and findings were narratively synthesized. Of 4158 references identified, 14 systematic reviews and/or meta-analyses (eight treatment focused and six prevention focused) were included and ranged in quality from very low to very high. Our findings support the inclusion of a parent component in both treatment and prevention interventions to improve child weight/weight status outcomes. Of note, all prevention-focused reviews included a school-based component. Evidence to define optimal parent involvement type and duration and to define the best methods of involving parents across multiple environments (e.g., home, preschool, school) was inadequate and warrants further research. PROSPERO registration: CRD42018095360.
Establishing healthy dietary and physical activity patterns among youths is an important public health strategy for improving health and preventing chronic diseases; however, few adolescents meet U.S. government recommendations for dietary or physical activity behaviors, and disparities by sex and race/ethnicity exist. CDC analyzed data from the 2019 Youth Risk Behavior Survey to update estimates of dietary and physical activity behaviors among U.S. high school students overall and by sex and race/ethnicity. In addition, 2-year comparisons (2017 and 2019) and trends in prevalence of these behaviors during 2009-2019 were examined. In 2019, overall, during the 7 days before the survey, 41.8% of students had eaten fruit or drunk 100% fruit juices <1 time/day; 40.7% had eaten vegetables <1 time/day; and 16.7% had not eaten breakfast on all 7 days. Moreover, although 57.4% of students had played on ≥1 sports team during the 12 months before the survey, less than half of students had been physically active for ≥60 minutes/day on all 7 days (23.2%), had exercised to strengthen or tone their muscles on ≥3 days/week (49.5%), had met both aerobic and muscle-strengthening physical activity guidelines (16.5%), or had attended physical education classes on all 5 days in an average school week (25.9%). Trend data indicate limited progress in shifting dietary and physical activity behaviors. That is, with the exception of decreases in the percentage of students who had consumed soda ≥1 time/day (2009: 29.2%; 2019: 15.1%), sports drinks ≥1 time/day (2015: 13.8%; 2019: 10.6%), and <3 glasses/day of plain water (2015: 50.5%; 2019: 44.6%), high school students' dietary and physical activity behaviors have not improved and, in certain cases, have worsened. These findings support the need for multicomponent approaches, including policy and environmental changes, and opportunities for adolescents to learn about and practice making healthy choices.
Introduction:
LiveWell Greenville, a multi-organization community coalition, launched an initiative in 2011 to help afterschool programs promote environments that decrease the risk of obesity among children and adolescents. The objective of this study was to describe changes in nutrition and physical activity environments, policies, and practices among 37 afterschool programs after their participation in the LiveWell Greenville Afterschool Initiative.
Methods:
The study used a nonexperimental, pre- and postsurvey design. The survey was based on the Nutrition and Physical Activity Self-Assessment for Child Care questionnaire and modified for afterschool settings. Items addressed sedentary time, physical activity time, availability of sugar-sweetened beverages, sweet and salty snack consumption, fruit consumption, staff behaviors, and policies that support nutrition and physical activity practices. The self-assessment survey was completed by an afterschool program supervisor at each site. The 9-month intervention consisted of program staff members' completing the pre-assessment and goal-setting worksheet, receiving technical support and training from LiveWell Greenville staff, attending networking meetings about nutrition and physical activity promotion strategies, and completing a postassessment.
Results:
We found significant positive changes in afterschool environments in the type and frequency of snacks offered, duration of children's sedentary time, staff behaviors that supported healthy nutrition and physical activity practices, and education provided to staff, children, and parents.
Conclusion:
We found the LiveWell Greenville Afterschool Initiative, which involved self-assessment, goal setting and technical support, to be a successful strategy to change nutrition and physical activity environments in afterschool settings.
Background
The aims of this systematic review were to study the effectiveness of primary school-based physical activity, sedentary behavior and nutrition interventions with direct parental involvement on children’s BMI or BMI z-score, physical activity, sedentary behavior and nutrition behavior and categorize intervention components into targeted socio-cognitive determinants and environmental types using the Environmental Research framework for weight Gain prevention.
Methods
In March 2018, a systematic search was conducted in four electronic literature databases. Articles written in English about effectiveness studies on school-based interventions with direct parental involvement targeting 4–12 year olds were included. Interventions with indirect parental involvement, interventions not targeting the school environment, and pilot studies were excluded. Study and intervention characteristics were extracted. Study quality and study effectiveness were assessed and effect sizes (Cohen’s d) were calculated for the outcome measures. Types of socio-cognitive factors and environmental types targeted were distinguished.
Results
In total, 25 studies were included. Most studies on BMI or BMI z-score, physical activity and sedentary behavior found favorable results: 61.1%, 81.1% and 75%, respectively. Results regarding nutrition behavior were inconclusive. Methodological study quality varied. All interventions targeted multiple environmental types in the school and family environment. Five targeted socio-cognitive determinants (knowledge, awareness, attitude, self-efficacy and intrinsic motivation) of the children were identified. No consistent pattern was found between either type of environment targeted, number of type of environment targeted, or the child’s targeted socio-cognitive determinants and intervention effectiveness.
Discussion
School-based interventions with direct parental involvement have the potential to improve children’s weight status, physical activity and sedentary behavior. Based on the results, it is recommended that school-based interventions with direct parental involvement target more than one EBRB, last at least one year, and focus particularly on the physical and social environment within both the school and the family environment.
Scoping reviews, a type of knowledge synthesis, follow a systematic approach to map evidence on a topic and identify main concepts, theories, sources, and knowledge gaps. Although more scoping reviews are being done, their methodological and reporting quality need improvement. This document presents the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) checklist and explanation. The checklist was developed by a 24-member expert panel and 2 research leads following published guidance from the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Network. The final checklist contains 20 essential reporting items and 2 optional items. The authors provide a rationale and an example of good reporting for each item. The intent of the PRISMA-ScR is to help readers (including researchers, publishers, commissioners, policymakers, health care providers, guideline developers, and patients or consumers) develop a greater understanding of relevant terminology, core concepts, and key items to report for scoping reviews.
Background:
Afterschool interventions have been found to improve the nutritional quality of snacks served. However, there is limited evidence on how these interventions affect children's snacking behaviors.
Objective:
Our aim was to determine the impact of an afterschool intervention focused at the school district, site, family, and child levels on dietary consumption of foods and beverages served at snack.
Design:
This was a secondary analysis of a group-randomized controlled trial.
Participants/setting:
Data were collected from 400 children at 20 afterschool sites in Boston, MA before (fall 2010) and after (spring 2011) intervention implementation.
Intervention:
The Out-of-School Nutrition and Physical Activity intervention aimed to promote fruits, vegetables, whole grains, and water, while limiting sugary drinks and trans fats. Researchers worked with district foodservice staff to change snack foods and beverages. Teams of afterschool staff participated in three 3-hour learning collaborative sessions to build skills and created action plans for changing site practices. The intervention included family and child nutrition education.
Main outcome measures:
Research assistants observed dietary snack consumption using a validated measure on 2 days per site at baseline and follow-up.
Statistical analyses performed:
This study used multivariable regression models, accounting for clustering of observations, to assess the intervention effect, and conducted post-hoc stratified analyses by foodservice type.
Results:
Children in intervention sites had greater decreases in consumption of juice (-0.61 oz/snack, 95% CI -1.11 to -0.12), beverage calories (-29.1 kcal/snack, 95% CI -40.2 to 18.0), foods with trans fats (-0.12 servings/snack, 95% CI -0.19 to -0.04), total calories (-47.7 kcal/snack, 95% CI -68.2 to -27.2), and increases in consumption of whole grains (0.10 servings/snack, 95% CI 0.02 to 0.18) compared to controls. In post-hoc analyses, sites with on-site foodservice had significant improvements for all outcomes (P<0.001), with no effect for sites with satellite foodservice.
Conclusions:
Results demonstrate that an afterschool intervention can improve children's dietary snack consumption, particularly at sites with on-site foodservice.
Positive parent-child attachment can be determined by opportunities for the child to interact with his/her parent and can influence a child's physical activity (PA) behavior. Therefore, an intervention that provides children and their parent more time to interact positively could impact children's PA. We examined the efficacy of a 12-week mother-daughter intervention on African-American girls' PA levels. In Spring of 2013 and 2014, mother-daughter dyads (n = 76) from Springfield, MA, were randomly assigned to one of three groups [child-mother (CH-M, n = 28), child alone (CH, n = 25), or control (CON, n = 23)] that participated in an afterschool culturally-tailored dance intervention (60 min/day, 3 days/week, 12 weeks). Girls in the CH-M group participated in the intervention with their maternal figure, while girls in the CH group participated in the intervention alone. CON group participants received weekly health-related newsletters. PA was assessed with accelerometers for seven days at baseline, 6-weeks, and 12-weeks. Hierarchical linear modeling was used to examine rates of change in PA. During the afterschool intervention time, girls in the CH-M group displayed a significantly steeper rate of increase in their percent time spent in vigorous PA compared to both the CON (γ = 0.80, p < 0.001) and the CH group (χ² (1)=13.01, p < 0.001). Mothers in the CH-M group displayed a significantly steeper rate of increase in their percent time spent in total daily moderate-to-vigorous PA compared to CH group's mothers (γ = 0.07, p = 0.01). This culturally-tailored mother-daughter afterschool intervention influenced African-American girls' afterschool hour PA levels, but not total daily PA.
Trial Registration: Study is registered at www.clinicaltrials.govNCT01588379.
Correction:
Following the publication of the original article [1], it was brought to our attention that author Judith Wylie-Rosett was erroneously included as Judith Wylie.
Adolescent obesity is a major health issue facing today’s youth. This may be the first generation to have a lower life expectancy than their parents. The Youth Empowerment Implementation Project’s (YEIP) goal was to increase fruit and vegetable intake, lower junk food consumption, and increase physical activity among low-income African-American youth living in the Midwest. Thirty middle school aged youth participated in an evidenced-based program (i.e., Botvin’s Life Skills Training) and were engaged in health education and physical activities. The results from baseline to follow-up demonstrated a reduction in junk food intake for participants and an increase in fruit and vegetable intake but not for physical activity. The health behaviors of participants improved for three out of four indicators following the intervention. Limitations, future research, and implications for future programs are also discussed.
Since the release of Equality of Educational Opportunity, researchers have emphasized the importance of applying the results of research to policies for school improvement. Policies tell educators to do something, but not how to enact specific laws. This study analyzes data from 347 schools in 21 districts to identify variables that support the enactment of policies for parental engagement. We address research questions on how school and district practices affect the quality of school-based partnership programs. Our results indicate that a policy on parental involvement may be a good first step, but other factors—principals' support for family and community engagement and active facilitation of research-based structures and processes by district leaders—are important for establishing a basic partnership program. These factors promote programs that engage all students' families. Schools that take these steps have higher percentages of engaged families and report higher rates of average daily attendance among their students.
Introduction:
US legislation requires that schools offer free drinking water where meals are served. However, little information is available about what types of water delivery systems schools should install to meet such requirements. The study objective was to examine the efficacy and cost of 2 water delivery systems (water dispensers and bottleless water coolers) in increasing students' lunchtime intake of water in low-income middle schools.
Methods:
In 2013, twelve middle schools in the San Francisco Bay Area participated in a cluster randomized controlled trial in which they received 6 weeks of promotional activities, received provision of cups, and were assigned to 1 of 2 cafeteria water delivery systems: water dispensers or bottleless water coolers (or schools served as a control). Student surveys (n = 595) and observations examined the interventions' effect on students' beverage intake and staff surveys and public data assessed intervention cost.
Results:
Analysis occurred from 2013 through 2015. Mixed-effects logistic regression, accounting for clustering and adjustment for student sociodemographic characteristics, demonstrated a significant increase in the odds of students drinking water in schools with promotion plus water dispensers and cups (adjusted odds ratio = 3.1; 95% confidence interval, 1.4-6.7; P = .004) compared with schools with traditional drinking fountains and no cups or promotion. The cost of dispenser and bottleless water cooler programs was similar ($0.04 per student per day).
Conclusion:
Instead of relying on traditional drinking fountains, schools should consider installing water sources, such as plastic dispensers with cups, as a low-cost, effective means for increasing students' water intake.
Background:
Most schools have not fully implemented wellness policies, and those that have rarely incorporate meaningful student participation. The aim of the Fuel Up to Play 60 (FUTP60) program is to help schools implement wellness policies by engaging students in activities to improve access to healthful, good tasting food and drinks, and increase the number and type of opportunities for students to be physically active. The aim of this paper is to present initial student-level results from an implementation of FUTP60 in 72 schools, grades 6-9.
Methods:
The study used a non-controlled pretest/posttest with serial cross-sectional data. School process data and student-level data were collected in fall 2009 (pre-intervention) and spring 2010 (post-intervention). School wellness practices were captured during a baseline needs assessment survey. Validated self-administered questionnaires assessing dietary and physical activity (PA) behaviors were administered to students in grades 6-9 in the 72 pilot schools. Mixed-effects logistic regression controlling for clustering of schools and demographics was used to calculate odds ratios and confidence intervals to evaluate changes pre- and post- intervention.
Results:
All 72 schools implemented FUTP60 during the 2009-2010 school year. Action strategies most frequently chosen by the schools included increasing breakfast participation and new activities before and after school. Positive and significant changes in students' behaviors (n = 32,482 at pretest and 29,839 at post-test) were noted for dairy, whole grains, fruit, and vegetable consumption and PA levels pre- and post-intervention (OR 1.05 to 1.27). Students aware of the program at post-test were significantly more likely to report healthier eating and PA behaviors than students unaware of the program (OR 1.1 to 1.34).
Conclusions:
FUTP60 pilot findings indicate that a low intensity program focused on wellness policy implementation is associated with small positive changes in student behaviors, especially when students were aware of the program. Although these initial results are promising, a more rigorous controlled study is warranted as a next step.
Background
Many programmes for children that involve gardening and nutrition components exist; however, none include experimental designs allowing more rigorous evaluation of their impact on obesity.
Objectives
The objective of this study is to explore the effects of a novel 12‐week gardening, nutrition and cooking intervention {‘LA Sprouts’} on dietary intake, obesity parameters and metabolic disease risk among low‐income, primarily Hispanic/Latino youth in Los Angeles..
Methods
This study used a randomized control trial involving four elementary schools [two randomized to intervention {172, 3rd–5th grade students}; two randomized to control {147, 3rd–5th grade students}]. Classes were taught in 90‐min sessions once per week for 12 weeks. Data collected at pre‐intervention and post‐intervention included dietary intake via food frequency questionnaire, anthropometric measures {body mass index, waist circumference}, body fat, and fasting blood samples.
Results
LA Sprouts participants compared with controls had significantly greater reductions in body mass index z‐scores {−0.1 vs. −0.04, respectively; p = 0.01} and waist circumference {−1.2 vs. 0.1 cm; p < 0.001}. Fewer LA Sprouts participants had the metabolic syndrome after the intervention than before, while controls with metabolic syndrome increased. LA Sprouts participants compared with controls increased dietary fiber intake {+3.4% vs. −16.5%; p = 0.04}. All participants decreased vegetable intake, but decreases were less in LA Sprouts than controls {−3.7% vs. −26.1%; p = 0.04}. Change in fruit intake did not differ between LA Sprouts and controls.
Conclusions
LA Sprouts was effective in reducing obesity and metabolic risk; however, additional larger and longer‐term studies are warranted.
BACKGROUND
While it is a national priority to support the health and education of students, these sectors must better align, integrate, and collaborate to achieve this priority. This article summarizes the literature on the connection between health and academic achievement using the Whole School, Whole Community, and Whole Child (WSCC) framework as a way to address health-related barriers to learning.METHODSA literature review was conducted on the association between student health and academic achievement.RESULTSMost of the evidence examined the association between student health behaviors and academic achievement, with physical activity having the most published studies and consistent findings. The evidence supports the need for school health services by demonstrating the association between chronic conditions and decreased achievement. Safe and positive school environments were associated with improved health behaviors and achievement. Engaging families and community members in schools also had a positive effect on students' health and achievement.CONCLUSIONS
Schools can improve the health and learning of students by supporting opportunities to learn about and practice healthy behaviors, providing school health services, creating safe and positive school environments, and engaging families and community. This evidence supports WSCC as a potential framework for achieving national educational and health goals.
Background:
The Whole Child approach and the coordinated school health (CSH) approach both address the physical and emotional needs of students. However, a unified approach acceptable to both the health and education communities is needed to assure that students are healthy and ready to learn.
Methods:
During spring 2013, the ASCD (formerly known as the Association for Supervision and Curriculum Development) and the US Centers for Disease Control and Prevention (CDC) convened experts from the field of education and health to discuss lessons learned from implementation of the CSH and Whole Child approaches and to explore the development of a new model that would incorporate the knowledge gained through implementation to date.
Results:
As a result of multiple discussions and review, the Whole School, Whole Community, Whole Child (WSCC) approach was developed. The WSCC approach builds upon the traditional CSH model and ASCD's Whole Child approach to learning and promotes greater alignment between health and educational outcomes.
Conclusion:
By focusing on children and youth as students, addressing critical education and health outcomes, organizing collaborative actions and initiatives that support students, and strongly engaging community resources, the WSCC approach offers important opportunities that will improve educational attainment and healthy development for students.
Background:
The Whole School, Whole Community, Whole Child (WSCC) model calls for greater collaboration across the community, school, and health sectors to meet the needs and support the full potential of each child. This article reports on how 3 states and 2 local school districts have implemented aspects of the WSCC model through collaboration, leadership and policy creation, alignment, and implementation.
Methods:
We searched state health and education department websites, local school district websites, state legislative databases, and sources of peer-reviewed and gray literature to identify materials demonstrating adoption and implementation of coordinated school health, the WSCC model, and associated policies and practices in identified states and districts. We conducted informal interviews in each state and district to reinforce the document review.
Results:
States and local school districts have been able to strategically increase collaboration, integration, and alignment of health and education through the adoption and implementation of policy and practice supporting the WSCC model. Successful utilization of the WSCC model has led to substantial positive changes in school health environments, policies, and practices.
Conclusions:
Collaboration among health and education sectors to integrate and align services may lead to improved efficiencies and better health and education outcomes for students.
Reviews of primary research are becoming more common as evidence-based practice gains recognition as the benchmark for care, and the number of, and access to, primary research sources has grown. One of the newer review types is the 'scoping review'. In general, scoping reviews are commonly used for 'reconnaissance' - to clarify working definitions and conceptual boundaries of a topic or field. Scoping reviews are therefore particularly useful when a body of literature has not yet been comprehensively reviewed, or exhibits a complex or heterogeneous nature not amenable to a more precise systematic review of the evidence. While scoping reviews may be conducted to determine the value and probable scope of a full systematic review, they may also be undertaken as exercises in and of themselves to summarize and disseminate research findings, to identify research gaps, and to make recommendations for the future research. This article briefly introduces the reader to scoping reviews, how they are different to systematic reviews, and why they might be conducted. The methodology and guidance for the conduct of systematic scoping reviews outlined below was developed by members of the Joanna Briggs Institute and members of five Joanna Briggs Collaborating Centres.
This article describes a framework and empirical evidence to support the argument that educational programs and policies are crucial public health interventions. Concepts of education and health are developed and linked, and we review a wide range of empirical studies to clarify pathways of linkage and explore implications. Basic educational expertise and skills, including fundamental knowledge, reasoning ability, emotional self-regulation, and interactional abilities, are critical components of health. Moreover, education is a fundamental social determinant of health - an upstream cause of health. Programs that close gaps in educational outcomes between low-income or racial and ethnic minority populations and higher-income or majority populations are needed to promote health equity. Public health policy makers, health practitioners and educators, and departments of health and education can collaborate to implement educational programs and policies for which systematic evidence indicates clear public health benefits.
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Background : Every school day, over 31 million U.S. children eat school lunches. Unfortunately, students often do not choose the healthy options in the school cafeteria. This paper describes outcome results of a pilot study using “nudges” to improve elementary school students’ fruits and vegetables selections. Methods : A pilot study was conducted from January to May 2012, in six intervention schools and 2 control schools. A behavioral economics-based intervention was conducted using “nudges” or cues from the cafeteria (staff encouragement to select fruit and vegetables, food labels, “Harvest of the Month” posters), school (morning announcement messages, prompts regarding cafeteria food selections), and parents (school newsletter articles, parent listserve messages) to promote students’ selection of fruits and vegetables in the school cafeteria. The serving data from the point-of-service machine provided fruits and vegetables served per student per day. Results : There were no significant differences in the number of servings of fruits and vegetables served per student per day, averaged over the study period. Process data revealed low implementation of the intervention components, which may partially explain results. Conclusions : Low implementation of nudges led to non-significant results in this pilot study. However, providing environmental cues are important and warrant further research with full implementation. Starting 2012, the new meal pattern includes two vegetables and a fruit serving for lunch; and two fruit servings for breakfast. Minimal cost interventions should be explored to facilitate successful implementation of new school meal guidelines.
Project FIT was a two-year multi-component nutrition and physical activity intervention delivered in ethnically-diverse low-income elementary schools in Grand Rapids, MI. This paper reports effects on children's nutrition outcomes and process evaluation of the school component. A quasi-experimental design was utilized. 3rd, 4th and 5th-grade students (Yr 1 baseline: N = 410; Yr 2 baseline: N = 405; age range: 7.5-12.6 years) were measured in the fall and spring over the two-year intervention. Ordinal logistic, mixed effect models and generalized estimating equations were fitted, and the robust standard errors were utilized. Primary outcomes favoring the intervention students were found regarding consumption of fruits, vegetables and whole grain bread during year 2. Process evaluation revealed that implementation of most intervention components increased during year 2. Project FIT resulted in small but beneficial effects on consumption of fruits, vegetables, and whole grain bread in ethnically diverse low-income elementary school children.
The impact of Comprehensive School Physical Activity Programs (CSPAPs) on urban children’s, educators’, and parents’ physical activity (PA) is relatively unknown. The purpose of this study was to explore overall changes in student, educator, and parent PA after an 8-month CSPAP-based program. This longitudinal, exploratory study implemented a CSPAP in 20 urban elementary schools, with six randomized for research. In-school PA was measured prepost for all fourth grade students using accelerometers. Parent and educator PA was self-reported using the IPAQ. RM-ANOVAs revealed significant prepost increases in minutes of student MVPA (P < .001). Parents significantly increased PA (P < .01) and although educators’ reported change in PA, it was not statistically significant (P = .50). This study provides unique information about the potential influence of one CSPAP on students’ overall PA, PA by individual context within the school, the differential PA patterns by race, and PA changes for educators and parents.
Obesity prevention programs that are delivered in after-school programs are needed as a focus on curriculum can make it difficult to include this health programming during the school day. The current study examined the implementation of 2 pilot programs in different after-school programs for young children. There were 36 children in the intervention groups and 18 children in comparison groups. Children learned about healthy eating and increasing involvement in physical activity. Lessons were based on the Traffic Light Diet. Results indicated improvement in children's reports of their eating habits. Activity levels improved in 1 school, but not in the other. Parents and children were satisfied with the program and children demonstrated good knowledge of the interventions to promote healthy eating. Future studies should include larger sample sizes and evaluation of the effectiveness of different components of the intervention. Nurses can play a key role in disseminating information and designing and leading after-school programs to improve child knowledge about healthy eating and exercise. Nursing students may also benefit from assisting with conducting these types of programs to improve their experience in health prevention programming.
Objective:
Afterschool programs can be health-promoting environments for children. Written policies positively influence nutrition and physical activity (PA) environments, but effective strategies for building staff capacity to write such policies have not been evaluated. This study measures the comprehensiveness of written nutrition, PA, and screen time policies in afterschool programs and assesses impact of the Out of School Nutrition and Physical Activity (OSNAP) intervention on key policies.
Methods:
Twenty afterschool programs in Boston, MA participated in a group-randomized, controlled trial from September 2010 to June 2011. Intervention program staff attended learning collaboratives focused on practice and policy change. The Out-of-School Time (OST) Policy Assessment Index evaluated written policies. Inter-rater reliability and construct validity of the measure and impact of the intervention on written policies were assessed.
Results:
The measure demonstrated moderate to excellent inter-rater reliability (Spearman's r=0.53 to 0.97) and construct validity. OSNAP was associated with significant increases in standards-based policy statements surrounding snacks (+2.6, p=0.003), beverages (+2.3, p=0.008), screen time (+0.8, p=0.046), family communication (+2.2, p=0.002), and a summary index of OSNAP goals (+3.3, p=0.02).
Conclusions:
OSNAP demonstrated success in building staff capacity to write health-promoting policy statements. Future research should focus on determining policy change impact on practices.
Objective
To compare changes in nutrient levels of school meals before and after implementation of nutrition interventions at five school districts in two, large U.S. counties. School menu changes were compared against national school meal recommendations.
Methods
A large urban school district in Los Angeles County, California (LAC) and four school districts in suburban Cook County, Illinois (SCC) implemented school meal nutrition interventions. Nutrition analyses were conducted for school breakfast and lunch before and after changes were made to the meal programs. Means, % change, and net calories (kilocalories or kcals) offered as a result of the nutrition interventions were calculated.
Results
School districts in both counties made district-wide changes in their school breakfast and lunch menus. Menu changes resulted in a net reduction of calories, sugar, and sodium content offered in the meals. Net fewer calories offered as a result of the nutrition interventions was estimated to be about 64,075 kcals per student per year for LAC and 22,887 kcals per student per year for SCC.
Conclusions
Nutrition interventions can have broad reach through changes in menu offerings to school-aged children and adolescents. However, further research is needed to examine how these changes affect student food selection and consumption.
Tobacco use, obesity, and physical inactivity among Louisiana's youth pose a serious public health problem. Given the potential of school environments to affect student well-being, the Louisiana Tobacco Control Program developed and tested a pilot program, Schools Putting Prevention to Work. The objective was to assist school districts in developing a comprehensive school wellness policy and engaging their school community to generate environments that support healthful choices and behaviors.
The pilot was implemented in 27 school districts, reaching an estimated 325,000 people across the state. Demographics of participating students were similar to all Louisiana's public school students.
A school wellness project state team advised project development. A subgroup that included contractors and partners implemented and modified the pilot. Sites were selected though an application process. Site representatives received trainings, technical assistance, and funding to organize school-based support-building activities and coordinate a school health advisory council to develop policy and sustain healthy school environments. Project sites reported progress monthly; evaluation included data from sites and project administrators.
Twenty-five comprehensive school wellness policies (covering 100% tobacco-free schools and daily physical activity and healthier cafeteria items) were approved by school boards. Environmental changes such as physical activity breaks, healthier vending options, and tobacco-free campuses were adopted.
This pilot demonstrated a successful approach to achieving policy and environmental change. The state team engaged and guided school districts to motivate students, parents, faculty/staff/administration, and businesses to establish and maintain opportunities to improve lifestyle health.
Background:
We introduce the Whole School, Whole Community, Whole Child approach to supporting student and school staff physical activity and nutrition and describe the methods used to generate the evidence synthesized across the special issue articles.
Methods:
A 2-phase literature review search included a search of systematic reviews (2010-2018) for individual qualifying articles (Phase 1) and a search for individual articles on topics not addressed by a review (2010-2020) or that needed an update because they were in a review that was older (2010-2016) or showed insufficient evidence (Phase 2). Research librarians developed search strategies. In each phase, pairs of subject matter experts applied criteria to review abstracts and full-text articles and extracted data using standardized forms. We included 314 articles, describing 293 studies.
Findings:
Most of the included studies looked at elementary or secondary school level interventions; 51% were rated poor quality, and few took place in a rural setting.
Implications for school health policy, practice, and equity:
Most of the identified studies engaged majority minority or racially/ethnically diverse schools, suggesting that these interventions are feasible in a variety of settings.
Conclusions:
This collection of 10 articles identifies evidence-based interventions, gaps in research, and implications for health equity.
The main goal of this study is to synthesize the results of past meta-analyses including studies published over the past 50 years examining the relation between parental involvement and student academic achievement for school-age children (grades K-12) in naturally occurring and intervention studies. Based on a total of 23 meta-analyses examining the relation between parental involvement and achievement encompassing 1,177 primary studies, we conclude that there is a positive association between parental involvement and achievement. The random effects’ mean effect size was 0.18 for observational studies and 0.16 for intervention studies. We note that both naturally occurring and intervention PI studies found null effects for homework involvement. As for type of involvement, our results were consistent with Wilder (2014), pointing to the strongest effect for parent expectations and aspirations and mixed results for homework help.
Objective:
To determine the preliminary impact of the Brighter Bites nutrition intervention on decreasing fruit and vegetable (F&V) waste at school lunches among fourth- and fifth-grade children.
Method:
This was a nonrandomized pre-post-controlled study in Houston and Dallas, TX. Two schools received the Brighter Bites intervention (n = 76), and 1 comparison school (n = 39), during the 2017-2018 school year. Brighter Bites is a 16-week school-based nutrition intervention providing weekly distribution of fresh F&V plus nutrition education. Main outcome measures were direct observation and weights to measure the number of F&V dishes selected at school lunches, amount of F&V wasted (gm), and related nutrient waste (4 time points/child). Mixed-effects linear regression analysis was used to determine change in F&V selection and waste over time.
Results:
There was a significant decrease over time in proportion of F&V selected among those in the comparison school, but not the intervention schools (P < .001). Compared with children in the comparison group, those receiving Brighter Bites showed a significant decrease in the amount of F&V wasted at each meal (P < .001) and per item (P < .05) at the end of both 8 and 16 weeks of intervention. There were significant decreases in waste of energy (kcal); dietary fiber (gm); vitamins B1, B3, and B6 (mg); total folate (µg); and B12 (µg) among those receiving Brighter Bites (P < .05).
Conclusions and implications:
Although absolute food or nutrient changes were small even when significant, programs such as Brighter Bites may contribute to a healthy intake. Future studies are warranted that include a larger sample size with a stringent, cluster-randomized control trial design and consideration for other covariates.
Childhood obesity is a pressing public health issue, especially in the Hispanic community. Two pilot studies were performed; Study 1 was performed to assess the effect of a nutrition education intervention on the nutrition-related knowledge, attitudes, and behaviors of Hispanic children in an after-school program. Nutrition educational lessons were administered 1 h per week. Evaluation was conducted as a baseline Pre-test, a Post-test (following the last session) and a 4-month follow-up. Children showed a significant decrease in the consumption of less-healthy foods from the time of the Pre-test to the Post-test measure (P < .05) and could identify healthy foods. Study 2 was performed to assess the effect of a nutrition education intervention on Hispanic children's caregivers' willingness to engage in healthy behaviors. Caregivers increased their willingness to engage in healthy behaviors (P < .05). This indicates that knowledge and attitudes about foods can be altered, and that caregiver education is needed so to ensure that healthy foods are available in a child's diet and to reinforce positive attitudes about foods.
In this paper the author introduces a very practical model to guide school leaders/managers into supporting parental -involvement and -engagement in their schools. The model is called the Dual Navigation Approach (DNA). This rubric is based on six meta-analyses that he conducted over the last fifteen years. What is presented therefore is a data based paradigm of parental –involvement and -engagement, which will help school leaders and managers understand what how these programmes in their schools can become considerably enhanced. The DNA model more fully distinguishes and develops the two primary branches of parental -involvement and -engagement, i.e. the school-based component and the home-based aspects. According to the author, when these two components of parental –involvement and -engagement work together student education outcomes can be greatly enhanced. The practical significance of these findings is discussed.
Let's Move! Active Schools (LMAS), now Active Schools, is a national initiative in the United States (US) that aims to engage schools to increase students' opportunities to be physically active. This evaluation describes changes in school-level practices related to physical education (PE) and physical activity (PA) among schools that received an LMAS-partner grant from ChildObesity180 or Fuel Up to Play 60 (FUTP60). ChildObesity180 and FUTP60 asked grantee schools to complete nine common questions, between October 2013 and August 2014, before and after receiving the grants to assess progress in implementing practices for PE and PA. "Yes" responses indicated presence of PE/PA-supportive practices. For schools with complete pre and post data (n=972), frequencies of "yes" responses were calculated for each practice at pre/post. Schools receiving a FUTP60 partner grant reported statistically significant improvements from pre to post across five practices for PE and PA, and ChildObesity180 grantees reported significant increases on all practices except daily recess, which was already in place at 95% of schools at pre-survey. Schools across both grant programs reported the largest increases for promoting PA via messaging, implementing classroom PA breaks, and providing PA before and after school. Schools in both programs reported smaller, but statistically significant, increases in requiring the recommended minutes of PE. This study illustrates the feasibility of offering small grants, at a national scale, for schools to make changes that support PA throughout the day. Results suggest that schools can shift PA policies and practices over the course of a school year.
Objectives:
The objectives of this study were to (1) determine the impact of a 1-year elementary school physical activity intervention on changes in teacher-reported school-based physical activity time and (2) assess the relationship between these changes and changes in student aerobic capacity.
Methods:
HealthMPowers, a nonprofit organization, provided a multicomponent physical activity intervention to 3479 students in 39 schools in Georgia during 2013-2014. HealthMPowers administered a survey to faculty members before (August 2013) and after (May 2014) the intervention to measure student physical activity times. The organization collected pre- and post-intervention Progressive Aerobic Cardiovascular Endurance Run (PACER) laps (a measure of aerobic capacity that awards 1 lap for each completed 20-meter lap) for 2342 fourth-grade students. We performed linear regression to determine the relationship between school-level changes in teacher-reported school-based physical activity time and student aerobic capacity.
Results:
The weekly estimated teacher-reported time in physical activity increased by 39 minutes from pre- to post-intervention: 21 minutes for recess, 17 minutes for classroom, and 1 minute for physical education. The mean number of student PACER laps increased by 3 laps from pre- to post-intervention, and 1515 of 2342 (65%) students increased the number of PACER laps completed. We observed a positive association between school-level changes in school-based physical activity time and school-level changes in PACER laps ( r = 0.38; 95% confidence interval, 0.29-0.46).
Conclusions:
These findings highlight the need for more prospective research into multicomponent physical activity interventions. Rigorous testing, including randomized controlled trials of large-scale implementations, is needed to examine how these school-based interventions might be used to improve the physical activity and fitness of larger populations of children.
The study purpose was to examine the impact of the Harvest of the Month (HOTM) program on fruit and vegetable (FV) consumption, FV preferences, other eating behaviors, physical activity and other variables related to healthy eating. A clustered randomized controlled trial was employed in 28 elementary schools. After parental consent was obtained, students in grades 4-6 were randomly assigned to treatment and control conditions (Intervention=127, Control=148). Students in the intervention group participated in HOTM, a widely used school-based nutrition promotion and obesity prevention program. Control group schools continued their usual practice. Participants completed baseline and follow-up surveys measuring fruit and vegetable (FV) consumption, FV preferences, other eating behaviors, physical activity, FV knowledge and self-efficacy to eat, prepare and ask for FV. No impacts of HOTM were found for FV consumption or other nutritional behaviors, physical activity, FV knowledge, or self-efficacy. A positive impact of the program was only found for FV preferences. This study suggests that the HOTM program did not affect eating behaviors or physical activity behaviors. The evidence base regarding school-based nutrition education programs including HOTM could be strengthened by the use of more rigorous impact evaluations to examine their effectiveness prior to widespread use.
Objectives:
This study examined the long-term effects on BMI of a randomized controlled trial of Students for Nutrition and Exercise, a 5-week, middle school-based obesity prevention intervention combining school-wide environmental changes, encouragement to eat healthy school cafeteria foods, and peer-led education and marketing.
Methods:
We randomly selected schools from the Los Angeles Unified School District and assigned 5 to the intervention group and 5 to a wait-list control group. Of the 4022 seventh-graders across schools, a total of 1368 students had their height and weight assessed at baseline and 2 years' postintervention.
Results:
A multivariable linear regression was used to predict BMI percentile at ninth grade by using BMI percentile at seventh grade, school indicators, and sociodemographic characteristics (child gender, age, Latino race/ethnicity, US-born status, and National School Lunch Program eligibility [as a proxy for low-income status]). Although the Students for Nutrition and Exercise intervention did not exhibit significant effects on BMI percentile overall, intervention students who were classified as obese at baseline (in seventh grade) showed significant reductions in BMI percentile in ninth grade (b = -2.33 percentiles; SE, 0.83; P = .005) compared with control students. This outcome translated into ∼9 pounds (∼4.1 kg) lower expected body weight after 2 years for an obese student in the intervention school at the mean height and age of the sample at baseline.
Conclusions:
Multilevel school-based interventions can have long-term effects on BMI among students who are obese. Future research should examine the mechanisms by which school-based obesity interventions can affect BMI over time.
Background:
HealthCorps provides school wellness programming using curricula to promote changes in nutrition, mental health, and physical activity behaviors. The research objective was to evaluate effects of implementing its curricula on nutrition, mental health, and physical activity knowledge and behavior.
Methods:
Pre- and postsurvey data were collected (N = 2255) during the 2012-2013 academic year from 14 New York City public high schools. An 18-item knowledge questionnaire addressed 3 domains; 26 behavioral items were analyzed by factor analysis to identify 6 behavior domains, breakfast being a seventh 1-item domain. We examined the effects stratified by sex, applying mixed-effects models to take into account clustering effects of schools and participants adjusted for age.
Results:
The HealthCorps program significantly increased all 3 knowledge domains (p < .05), and significantly changed several key behavioral domains. Boys significantly increased fruits/vegetables intake (p = .03). Girls increased acceptance of new fruits/vegetables (p = .03) and breakfast consumption (p = .04), and decreased sugar-sweetened beverages and energy dense food intake (p = .03). The associations between knowledge and behavior were stronger in boys than girls.
Conclusion:
The HealthCorps program significantly increased participants' knowledge on nutrition, mental health, and physical activity. It also improved several key behavioral domains, which are targets of the 2010 Dietary Guidelines to address obesity in youth.
Over one third of U.S. youth are overweight or obese. Treatments typically have had unreliable effects, inconsistently incorporating behavior-change theory. After-school care might be a viable setting for health behavior-change programs. We evaluated effects of two consecutive 12-week segments of a revised self-efficacy/social cognitive theory-based physical activity and nutrition treatment on fitness levels, body mass index (BMI), and targeted psychosocial factors in after-school care participants, ages 5–8 years. Changes in physiological measures, exercise self-efficacy (ESE), and physical self-concept over 9 months were contrasted in experimental (n = 72) vs. typical-care (n = 42) groups. Mediation of the group–BMI change relationship by the psychosocial factors was also assessed. Improvements in physiological measures and ESE were significantly greater in the experimental group. ESE change completely mediated the association of treatment type with BMI change. The experimental group demonstrated significantly greater improvements in the physiological measures, with its treatment’s theoretical basis and application within after-school care supported.
Background:
Schools play a role in addressing childhood obesity by implementing healthy eating and physical activity strategies. The primary aim of this case study was to describe prevalence of overweight and obesity among elementary school students in a rural Mid-western community between 2006 and 2012. The secondary aim was to use a novel approach called "population dose" to retrospectively evaluate the impact dose of each strategy implemented and its estimated potential population level impact on changes in overweight and obesity.
Methods:
Weight and height were directly measured annually beginning in January 2006 to assess weight status, using BMI (kg/m(2)), for all kindergarten to fifth-grade students (N ≈ 2400 per year). Multiple evidence-based strategies were implemented in nine schools to increase physical activity and healthy eating behaviors. BMI reporting and revised school meal programs were implemented districtwide. Comprehensive school physical activity programs, school food environment, and supportive/promotional strategies were implemented at individual schools.
Results:
The absolute change in prevalence of obesity (BMI ≥95th percentile) decreased from 16.4% to 13.9%, indicating a 15.2% relative change in prevalence of obesity in 6 years. There was an inverse relationship between the number of strategies implemented and prevalence of overweight and obesity over time.
Conclusions:
District and school-level approaches have the potential to impact childhood obesity. Schools can successfully implement strategies to address overweight and obesity, but the extent of implementation between schools may vary. Population dose analysis can be used to estimate impact of clusters of strategies to address overweight/obesity.
Purpose:
To compare two intensity levels (standard vs. enhanced) of a nutrition and physical activity intervention vs. a control (usual programs) on nutrition knowledge, body mass index, fitness, academic performance, behavior, and medication use among elementary school students.
Design:
Quasi-experimental with three arms.
Setting:
Elementary schools, students' homes, and a supermarket.
Subjects:
A total of 1487 third-grade students.
Intervention:
The standard intervention (SI) provided daily physical activity in classrooms and a program on making healthful foods, using food labels. The enhanced intervention (EI) provided these plus additional components for students and their families.
Measures:
Body mass index (zBMI), food label literacy, physical fitness, academic performance, behavior, and medication use for asthma or attention-deficit hyperactivity disorder (ADHD).
Analysis:
Multivariable generalized linear model and logistic regression to assess change in outcome measures.
Results:
Both the SI and EI groups gained less weight than the control (p < .001), but zBMI did not differ between groups (p = 1.00). There were no apparent effects on physical fitness or academic performance. Both intervention groups improved significantly but similarly in food label literacy (p = .36). Asthma medication use was reduced significantly in the SI group, and nonsignificantly (p = .10) in the EI group. Use of ADHD medication remained unchanged (p = .34).
Conclusion:
The standard intervention may improve food label literacy and reduce asthma medication use in elementary school children, but an enhanced version provides no further benefit.
Improving children's nutrition and physical activity have become priorities in the United States. This quasi-experimental study evaluated the longitudinal effects of a 3-year, school-based, health promotion intervention (i.e. nutrition and physical education, classroom physical activity, professional development and health promotion for teachers and families, and strengthening wellness policies and family/community partnerships) on children's health behaviors in four, rural, low-socioeconomic status elementary schools. A total of 999 kindergarten to third-grade children participated in data collection consisting of 4-day pedometer tracking and previous-day fruits and vegetables consumption recall from baseline in January, 2011 through 12 follow-up assessments ending May, 2013. The mixed-effects regression models showed that children's nutrition and physical activity behaviors significantly improved over the 3-year intervention. The percentages of children who met the nutrition recommendation increased from 11 to 23% for girls and 12 to 23% for boys, while the percent who met the physical activity recommendation increased from 1 to 16% for girls and 3 to 7% for boys. Further, children's age and their school impacted certain intervention effects. This school-based intervention could be disseminated to promote healthy behaviors among rural disadvantaged children. Engaging parents and community partnerships is recommended to expand the traditional, children-focused education interventions.
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This study describes the Food and Fitness Fun Education Program (FFFEP), which was implemented in an after-school child care program in California. FFFEP consisted of 16 weeks of lessons and activities. Changes in healthy eating and physical activity in children and their parents were analyzed using pre- and posttests for children and a parent survey. In all, 1,810 children in kindergarten through fifth grades participated in the program. Testing of the children took place at the beginning and end of the program. A sample of parents in the 48 sites participated in surveys at the end of the program. Seventy-two percent of the children in the program were Hispanic. Children and parents reported healthier eating and an increase in physical activity as a result of the children’s participation.
BACKGROUND
Policies call on after-school programs (ASPs) to serve more nutritious snacks. A major barrier for improving snack quality is cost. This study describes the impact on snack quality and expenditures from a community partnership between ASPs and local grocery stores.METHODS
Four large-scale ASPs (serving ˜500 children, aged 6-12 years, each day) and a single local grocery store chain participated in this study. The nutritional quality of snacks served was recorded preintervention (18 weeks spring/fall 2011) and postintervention (7 weeks spring 2012) via direct observation, along with cost/child/snack/day.RESULTSPreintervention snacks were low-nutrient-density salty snacks (eg, chips, 3.0 servings/week), sugar-sweetened beverages (eg, powdered-lemonade, 1.9 servings/week), and desserts (eg, cookies, 2.1 servings/week), with only 0.4 servings/week of fruits and no vegetables. By postintervention, fruits (3.5 servings/week) and vegetables (1.2 servings/week) were increased, whereas sugar-sweetened beverages and desserts were eliminated. Snack expenditures were $0.26 versus $0.24 from preintervention to postintervention. Partnership savings versus purchasing snacks at full retail cost was 24.5% or $0.25/serving versus $0.34/serving.CONCLUSIONS
This innovative partnership can serve as a model in communities where ASPs seek to identify low-cost alternatives to providing nutritious snacks.
To increase fruit and vegetable (FV) consumption of youth in Body Quest: Food of the Warrior (BQ), a childhood obesity prevention program.
Quasi-experimental.
Supplemental Nutrition Assistance Program-Education eligible schools (n = 60).
Third-grade students (n = 2,477).
Treatment groups (n = 1,674) self-reported foods consumed through the School Lunch Program for 17 weekly assessments; they participated in BQ curriculum, iPad app education, and weekly FV tastings. Control groups (n = 803) completed only pre- and post-assessments.
Weekly FV consumed through School Lunch Program.
ANCOVA and growth modeling.
From before to after the program, the treatment group demonstrated significant, moderate increases in fruit (P < .01) and vegetable (P < .001) consumptions, increasing from 7 to 8 weekly FV servings. After the program, the treatment group consumed significantly (P < .001) more FV than the control group. Fruit and vegetable consumption increased to class 10 and then stabilized. From before to after the program, all FV predictors were significantly higher and included gender (vegetables), race (FV), and free/reduced lunch (fruit).
Nutrition programs can increase FV intake. Even moderate increases in FV intake can be an initial step for the prevention of chronic disease.
In 2011, the U.S. Young Men's Christian Association (YMCA) adopted activity standards recommending that afterschool programs (ASPs) ensure all children engage in a minimum of 30 minutes of moderate to vigorous physical activity (MVPA) daily during the ASP. ASPs decide how to accomplish this standard, for which few effective strategies exist.
To evaluate strategies designed to help ASPs meet the MVPA standard.
Single group intervention with pretest and three follow-up measures repeated-cross-sectional design with a subsample cohort.
Four large-scale YMCA ASPs, serving approximately 500 children each day.
Community-based participatory development of strategies focused on modification of program schedules, professional development training, and weekly checklists to evaluate activity opportunities.
Accelerometry-derived MVPA classified as meet or fail-to-meet the 30 minutes' MVPA/day standard collected over a minimum of 4 nonconsecutive days at baseline (fall 2011) and three follow-up assessments (spring 2012, fall 2012, spring 2013). Random intercept logistic regression models evaluated the probability of meeting the standard for boys and girls, separately (analyzed summer 2013).
A total of 895 children (aged 5-12 years, 48.4% girls) representing 3654 daily measures were collected across the four assessments. The percentage of girls and boys meeting the MVPA standard at baseline was 13.3% and 28.0%, respectively. By spring 2013, this increased to 29.3% and 49.6%. These changes represented an increase in the odds of meeting the 30 minutes' MVPA/day standard by 1.5 (95% CI=1.1, 2.0) and 2.4 (95% CI=1.2, 4.8) for girls and boys, respectively.
The strategies developed herein represent an effective approach to enhancing current practice within YMCA ASPs to achieve existing MVPA standards. Additional work is necessary to evaluate the scalability of the strategies in a larger sample of ASPs.
To compare effects of the Cooking With Kids (CWK) cooking and tasting curriculum (CWK-CT) with a less-intense, tasting-only curriculum (CWK-T) and to conduct a non-treatment comparison on fourth graders' cooking self-efficacy (SE), cooking attitudes (AT), and fruit and vegetable preferences (FVP).
Pre-post, quasi-experimental, 2 cohorts.
Eleven low-income public schools in a Southwestern city.
Fourth-grade students, 50% female and 84% Hispanic.
School-based experiential nutrition education program of 5 2-hour cooking and/or 5 1-hour fruit and vegetable tasting lessons throughout the school year.
Cooking self-efficacy, AT, and FVP were assessed with 3 tested, validated scales administered in a 37-item survey pre- and post-classroom intervention.
General linear modeling with gender and prior cooking experience were fixed factors.
Among 961 students, CWK positively affected FVP, especially in CWK-CT students and males (P = .045 and .033, respectively); vegetable preference drove this outcome. Independent of treatment, students without cooking experience (61% male) had more than twice the gains in cooking self-efficacy (P = .004) and an improved AT response (P = .003).
Cooking With Kids increased FVP, especially with vegetables. Greatest gains in preferences and self-efficacy were seen in boys without prior cooking experience. For fourth graders, experiential nutrition education improved cognitive behaviors that may mediate healthful food choices.
To evaluate a community partnership between after-school programs (ASPs) and grocery stores to provide discounted pricing on snacks to meet the National Afterschool Association Healthy Eating Standards that call for serving a fruit or vegetable (FV) daily while eliminating sugar-based foods and beverages.
A single-group, pretest with multiple posttest design (spring, 2011-2013) in 4 large-scale ASPs serving 500 children/d was used, along with direct observation of snacks served, consumed, and cost.
At baseline, FV, sugar-sweetened beverages, and desserts were served 0.1 ± 0.5, 1.7 ± 2.0, and 2.0 ± 1.4 d/wk. By spring, 2013, FV increased to 5.0 ± 0.0 d/wk, whereas sugar-sweetened beverages and desserts were eliminated. A total of 84% of children consumed the fruit; 59% consumed the vegetables. Cost associated with purchasing snacks resulted in a $2,000-$3,000 savings over a standard 180-day school year.
This partnership can serve as a model for successfully meeting nutrition policies established for ASP snacks.