Abstract
BackgroundPrevious studies have shown that multicomponent interventions may improve meal frequency and eating habits in children, but evidence among young people is limited. This study evaluated the effect of the Healthy High School (HHS) intervention on daily intake of breakfast, lunch, water, fruit, and vegetables at 9-month follow-up.MethodsThe study included first-year students (≈16 years) attending high school in Denmark. Participating schools were randomized into the HHS intervention (N = 15) or control group (operating as usual) (N = 15). The intervention was designed to promote well-being (primary outcome) by focusing on healthy habits including meals, stress prevention, and strong peer relations. It included a curriculum, structural and organisational initiatives, a workshop, and a smartphone application. Students completed self-administered online questionnaires at the beginning of the school year and nine months later. To account for clustering of data, we used multilevel logistic regression analyses to estimate odds ratios (OR). We applied an intention-to-treat approach with multiple imputations of missing data.ResultsAt baseline 4577 of 5201 students answered the questionnaire and 4512 at follow-up. In both groups the proportion of students eating breakfast decreased from approximately 50% to 40% from baseline to follow-up, and lunch frequency decreased from approximately 50% to 47%. Daily water intake, intake of fresh fruit and intake of vegetables remained unchanged from baseline to follow-up. There were no significant between group differences on any of the outcomes at first follow-up: breakfast: OR = 0.85 (95% CI: 0.65;1.10), lunch: OR = 0.96 (95% CI: 0.75;1.22), water intake: OR = 1.14 (95% CI: 0.92;1.40), intake of fresh fruit: (OR = 1.07, 95% CI: 0.84;1.37), vegetables: (OR = 1.01, 95% CI: 0.77;1.33).ConclusionNo evidence of an effect of the HHS intervention was found for any of the outcomes. Future studies are warranted to explore how health promoting interventions can be integrated in further education to support educational goals. Moreover, how to fit interventions to the lives and wishes of young people, by also including systems outside of the school setting.Trial registrationISRCTN, ISRCTN43284296. Registered 28 April 2017 - retrospectively registered.
Highlights
Eating patterns among Danish high school students (≈15–20 years old) are, as among most young people in western countries, characterized by more frequent meal skipping than in younger children [1, 2] and a low intake of water [3, 4], fruit, and vegetables [1,2,3, 5]
This paper aims to examine the effect of the multibehavioural multicomponent Healthy High School (HHS) intervention on meal frequencies and eating habits among first-year high school students (≈16 years old) at the end of the school year, in which the intervention was implemented
Larger proportions of students had breakfast daily during weekends compared to school days (MondayFriday), while smaller proportions had lunch daily during the weekend
Summary
Eating patterns among Danish high school students (≈15–20 years old) are, as among most young people in western countries, characterized by more frequent meal skipping than in younger children [1, 2] and a low intake of water [3, 4], fruit, and vegetables [1,2,3, 5]. Children and young people of low socioeconomic position report a lower intake of fruit and vegetables [1, 9] and to skip breakfast [1, 12, 13] and lunch [12, 13] more often than children and young people of high socioeconomic position. This study evaluated the effect of the Healthy High School (HHS) intervention on daily intake of breakfast, lunch, water, fruit, and vegetables at 9-month follow-up
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