Abstract
We aimed to identify, describe and analyse school environment assessment (SEA) tools that address behavioural risk factors (unhealthy diet, physical inactivity, tobacco and alcohol consumption) for non-communicable diseases (NCD). We searched in MEDLINE and Web of Science, hand-searched reference lists and contacted experts. Basic characteristics, measures assessed and measurement properties (validity, reliability, usability) of identified tools were extracted. We narratively synthesized the data and used content analysis to develop a list of measures used in the SEA tools.Twenty-four SEA tools were identified, mostly from developed countries. Out of these, 15 were questionnaire based, 8 were checklists or observation based tools and one tool used a combined checklist/observation based and telephonic questionnaire approach. Only 1 SEA tool had components related to all the four NCD risk factors, 2 SEA tools has assessed three NCD risk factors (diet/nutrition, physical activity, tobacco), 10 SEA tools has assessed two NCD risk factors (diet/nutrition and physical activity) and 11 SEA tools has assessed only one of the NCD risk factor. Several measures were used in the tools to assess the four NCD risk factors, but tobacco and alcohol was sparingly included. Measurement properties were reported for 14 tools.The review provides a comprehensive list of measures used in SEA tools which could be a valuable resource to guide future development of such tools. A valid and reliable SEA tool which could simultaneously evaluate all NCD risk factors, that has been tested in different settings with varying resource availability is needed.
Highlights
The shift from United Nation's Millennium Development Goals to the Sustainable Development Goals (SDG) reflects a paradigm shift in terms of strategies to reduce premature mortality due to non-communicable diseases (NCDs) (UN, 2016)
Describe and analyse school environment assessment (SEA) tools that address behavioural risk factors for non-communicable diseases
Monitoring and evaluating school environment and policies is vital to optimize the availability of healthier food options in and around schools, promote healthy eating and physical activity in schools, restrict initiation and limit current tobacco and alcohol use by adolescents, and to identify major challenges in acquiring healthy behaviours among students (Sallis and Glanz, 2009)
Summary
The shift from United Nation's Millennium Development Goals to the Sustainable Development Goals (SDG) reflects a paradigm shift in terms of strategies to reduce premature mortality due to non-communicable diseases (NCDs) (UN, 2016). Physical inactivity, unhealthy diet and harmful alcohol use are the key behavioural risk factors responsible for significant mortality and morbidity due to NCDs (GBD 2015 DALYs and HALE Collaborators, 2016). These behaviours become established in childhood and adolescence (WHO, 2009) and contribute to overweight/obesity, raised blood pressure, raised blood glucose and dyslipidaemia (Li et al, 2013), which are precursors to adult chronic diseases. The WHO's voluntary global NCD targets aim to achieve country specific reductions in NCD risk behaviours and halt the rise of obesity and diabetes among adolescents and adults (WHO, 2014) Achieving these goals could substantially prevent premature heart disease, premature stroke, type 2 diabetes and cancer (WHO, 2005). It is necessary to establish healthy behaviours earlier in life to prevent NCDs throughout the life-course
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