Multi-component School-based Intervention Research Articles

Effect of a multicomponent school-based intervention with parental involvement on socioeconomic inequalities in smoking initiation: equity impact analysis of the TOPAS study

BackgroundAs prevalence of tobacco use falls, socioeconomic inequalities in tobacco use are increasing in many high-income countries. Evidence is lacking on the effect of preventive interventions on socioeconomic inequalities in...

An examination of the predictors of change in BMI among 38026 school students in Makkah, Saudi Arabia.

The prevalence of childhood obesity has substantially increased in the Gulf Cooperation Council countries, including Saudi Arabia. The Rashaka initiative is a Saudi national school-based multicomponent intervention that was introduced in the school year 2016-2017 to address childhood overweight and obesity. This study aims to examine the effect of the Rashaka initiative on students' body mass index (BMI) for two academic years (2016-2017 and 2018-2019) and to analyse predictors of BMI change. Secondary data for this pre-post study was provided by the Ministry of Health for 38026 students from 89 intermediate and secondary schools that implemented the initiative in Makkah City, Saudi Arabia. It was analysed using non-parametric tests and multiple regressions at a 5% level of significance. Over 2y of implementation, BMI was reduced significantly across the schools (p < 0.001). Based on the regression modelling, school gender and education stage were found to be the only significant predictors of BMI change. Girls and intermediate schools had greater BMI reductions than boys and secondary schools (p < 0.001 and p = 0.031). This study provides tentative evidence for the effectiveness of the Rashaka intervention in Makkah City. In addition, our study has identified that the Rashaka initiative may require modification to improve its effect on boys and students in secondary schools.

Promoting hEalthy Diet and Active Lifestyle (PEDAL): a protocol for the development and feasibility study of a multicomponent intervention among primary school children in Singapore

BackgroundSetting healthy lifestyle habits during the formative years of childhood is critical as habits can track to adulthood and help prevent obesity and chronic disease risks in later life. While multicomponent interventions have been shown to be effective in changing the lifestyle behaviours of children, there is a limited understanding of the feasibility of such interventions in primary schools in Singapore. A multiphase mixed method study was conducted to develop and examine the feasibility of a theory-based multicomponent school-based intervention—Promoting hEatlthy Eating and Active Lifestyle (PEDAL).MethodsUnderpinned by Kincaid’s ideation model, the PEDAL intervention was developed to increase fruit and vegetable consumption and decrease sedentary behaviours among children. This study consists of three phases. Phase 1 details the development of PEDAL, which consists of four components: (A) a series of interactive health education lessons, (B) actionable home activities to support habit formation, (C) parental/guardian engagement, and (D) optimising the school environment. In Phase 2, components A and B of PEDAL were implemented in two public, co-educational primary schools among Primary 5 students (aged 10–12 years) in Singapore. Data was collected quantitatively using questionnaires and qualitatively using focus group discussions (FGDs) with students and teachers. The feasibility dimensions of components A and B, including recruitment capability, data collection, social validity, and practicality were examined, and ideation on healthy eating and physical activity was explored. In Phase 3, the full PEDAL intervention was pilot-tested in two other public, co-education primary schools with the same target population, using a concurrent mixed method quasi-experimental study design. Feasibility dimensions and potential effectiveness of the intervention will be assessed.DiscussionThis study will provide insights into the feasibility of PEDAL and inform its refinement. Findings from the pilot test will guide the planning of a larger-scale definitive trial.Trial registrationRegistered with ISRCTN registry (ISRCTN16114046) on 16 October 2022.

The Secret Sauce? Taking the Mystery Out of Scaling-Up School-Based Physical Activity Interventions.

Over the last 4 decades, physical activity researchers have invested heavily in determining "what works" to promote healthy behaviors in schools. Single and multicomponent school-based interventions that target physical education, active transportation, and/or classroom activity breaks effectively increased physical activity among children and youth. Yet, few of these interventions are ever scaled-up and implemented under real-world conditions and in diverse populations. To achieve population-level health benefits, there is a need to design school-based health-promoting interventions for scalability and to consider key aspects of the scale-up process. In this opinion piece, we aim to identify challenges and advance knowledge and action toward scaling-up school-based physical activity interventions. We highlight the key roles of planning for scale-up at the outset, scale-up pathways, trust among partners and program support, program adaptation, evaluation of scale-up, and barriers and facilitators to scaling-up. We draw upon our experience scaling-up effective school-based interventions and provide a solid foundation from which others can work toward bridging the implementation-to-scale-up gap.

Mediators and moderators of the effects of a school-based intervention on adolescents' fruit and vegetable consumption: the HEIA study.

To examine whether targeted determinants mediated the effects of the HEalth In Adolescents (HEIA) intervention on fruit and vegetable (FV) consumption and explore if these mediating effects were moderated by sex, parental education or weight status. Cluster-randomised controlled trial. The HEIA study (2007-2009) was a Norwegian 20-month multi-component school-based intervention to promote healthy weight development. FV consumption and targeted determinants were self-reported at baseline, mid-way (8 months) and post-intervention (20 months). Adolescents (11-13-year-old) in twenty-five control schools (n 746) and twelve intervention schools (n 375). At post-intervention, more adolescents in the intervention group compared with the control group had knowledge of the FV recommendations (OR: 1·4, 95 % CI 1·1, 1·9) and reported a decreased availability of vegetables at home (β: -0·1, 95 % CI -0·2, 0·0). Availability/accessibility of FV at home, availability of vegetables at dinner, taste preferences for different types of FV and knowledge of the FV recommendations were positively associated with the consumption of FV. However, none of the post-intervention determinants significantly mediated the intervention effects on FV consumption. Although no moderating influences by sex, parental education or weights status were observed on the mediating effects, exploratory analyses revealed significant moderations in the b-paths. Since none of the targeted determinants could explain the increase in FV consumption, it remains unclear why the intervention was effective. Reporting on a wide range of mediators and moderators in school-based interventions is needed to reveal the pathways through which intervention effects are achieved.

From awareness to action: Effects of a schoolbased intervention on TV viewing behavior stages and screen time guidelines knowledge in Brazilian adolescents

The aims of the study were to verify the effect of an intervention on the stage of behavior change for TV viewing and to identify the possible mediating role of knowledge on screen time guidelines among Brazilian students. This study is a multicomponent school-based intervention conducted with 727 students (54.3% female, 13 years; 427 in the intervention group and 300 in the control group). The intervention was performed in 2017 with baseline and post-intervention assessments (over one academic year). Teacher training was carried out at the beginning of the intervention along with environmental improvements, while educational curriculum such as the delivery of folders and posters were performed throughout the year. The stages of behavior change for TV viewing and knowledge of screen time guidelines were measured by a self-reported questionnaire and the structural equation modeling approach was performed. The intervention had no significant effects on stages of behavior change for TV (p = 0.744) nor did it result in significant changes on knowledge of screen time guidelines (p = 0.741). While there was no mediation between knowledge of screen time guidelines and the effect of the intervention on stages of behavior change for TV (95%CI: -0.45;0.63), an association was found between knowledge of screen time guidelines and stages of behavior change for TV (p&lt;0.001). In conclusion, intervention had no significant effect on the stages of behavior change for TV and no mediating effect was observed. However, enhancing awareness on screen time guidelines may positively impact the adolescent’s intention to reduce TV time.

Adoption of a multicomponent intervention to improve HPV vaccination in France: a mixed methods study

Abstract Background HPV vaccine coverage (VC) in France has always been lower than in most high-income countries. As part of the PrevHPV project, we developed and evaluated a school-based multicomponent intervention to improve HPV VC among French adolescents. We assessed the adoption of the PrevHPV intervention among secondary schools and its associated factors. Methods We carried out a pragmatic cluster randomized controlled trial (April 2021-June 2022) in 14/25 French school districts. The cluster was the municipality. Municipalities were eligible if there was only one secondary school and most inhabitants aged 11-14 years attended this school. We then contacted the head of the school to ask him/her to participate in the study. Based on the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework, we described municipalities’ exclusions, schools participation and associated factors (Chi2, t-tests). We also used qualitative data from six focus groups with participating school staff to explore facilitators and barriers to adoption at the school level. Results Compared to non-eligible municipalities (n = 2658), eligible ones (n = 1205) were smaller, less urban and deprived, with lower accessibility to general practitioners. Out of 346 randomly selected municipalities, 91 (26%) accepted to participate. Participating schools were smaller and located in more deprived municipalities than non-participating ones. During the trial, 31/91 (34%) schools discontinued intervention; we did not identify any characteristic associated with discontinuation. Qualitative data showed that several contextual factors can influence adoption at the school-level: human resources (school staff availability, turnover and attitudes towards vaccination, especially for school nurses); material (e.g. computer equipment) and financial resources; parents’ attitudes towards vaccination. Conclusions These results can guide policy making on school-based HPV vaccine promotion in France and Europe. Key messages • The PrevHPV project is supported by the French health authorities and conducted by a multidisciplinary consortium to tackle a long-lasting public health concern in France. • Should the intervention prove effective, these results are expected to help stakeholders scale-up the school-based PrevHPV intervention in France and other European countries.

Adolescents' experiences of a school-based health promotion intervention in socioeconomically advantaged and disadvantaged areas in Sweden: a qualitative process evaluation study.

Adolescence is a transition period in which positive experiences of physical activity have the potential to last into later adulthood. These experiences are influenced by socioeconomic determinants, leading to health inequalities. This study aims to explore adolescents' experiences and participation in a multi-component school-based intervention in schools located in socioeconomically advantaged and disadvantaged areas in Sweden. A qualitative design was used to evaluate how participants experienced the intervention. The intervention was a multi-component school-based intervention. It was conducted in six schools (four control and two intervention schools) with a total of 193 students and lasted one school year. It was teacher-led and consisted of three 60-minute group sessions per week: varied physical activities, homework support with activity breaks, and walks while listening to audiobooks. In total, 23 participant observations were conducted over eight months and 27 students participated in focus groups. A content analysis was conducted. The results describe a main category 'Engaging in activities depending on socioeconomic status' and three generic categories: 1. Variations in participation in PA together with classmates and teachers; 2. Variations in engagement in PA after school; and 3. Differences in time and place allocated to do homework and listen to audiobooks. These categories illustrate how participants looked forward to the physical activities but used the time spent during the walks and homework support differently depending on how busy they were after school. Frequently, those who were busiest after school were also those from the advantaged area, and those who had little to do after school were from the disadvantaged area. Socioeconomic factors influence participants' possibilities to engage in the intervention activities as well as how they use their time in the activities. This study showed that it is crucial to support adolescents' participation in physical activities by providing structure and engaging well-known teachers in the activities, especially in schools located in disadvantaged areas.

Effectiveness of the multi-component intervention ‘Focus’ on reducing smoking among students in the vocational education setting: a cluster randomized controlled trial

BackgroundSocial inequality in smoking remains an important public health issue. Upper secondary schools offering vocational education and training (VET) comprise more students from lower socioeconomic backgrounds and have higher smoking prevalence than general high schools. This study examined the effects of a school-based multi-component intervention on students’ smoking.MethodsA cluster randomized controlled trial. Eligible participants were schools offering VET basic courses or preparatory basic education in Denmark, and their students. Schools were stratified by subject area and eight schools were randomly allocated to intervention (1,160 invited students; 844 analyzed) and six schools to control (1,093 invited students; 815 analyzed). The intervention program comprised smoke-free school hours, class-based activities, and access to smoking cessation support. The control group was encouraged to continue with normal practice. Primary outcomes were daily cigarette consumption and daily smoking status at student level. Secondary outcomes were determinants expected to impact smoking behavior. Outcomes were assessed in students at five-month follow-up. Analyses were by intention-to-treat and per protocol (i.e., whether the intervention was delivered as intended), adjusted for covariates measured at baseline. Moreover, subgroup analyses defined by school type, gender, age, and smoking status at baseline were performed. Multilevel regression models were used to account for the cluster design. Missing data were imputed using multiple imputations. Participants and the research team were not blinded to allocation.ResultsIntention-to-treat analyses showed no intervention effect on daily cigarette consumption and daily smoking. Pre-planned subgroup analyses showed statistically significant reduction in daily smoking among girls compared with their counterparts in the control group (OR = 0.39, 95% CI: 0.16, 0.98). Per-protocol analysis suggested that schools with full intervention had higher benefits compared with the control group (daily smoking: OR = 0.44, 95% CI: 0.19, 1.02), while no marked differences were seen among schools with partial intervention.ConclusionThis study was among the first to test whether a complex, multicomponent intervention could reduce smoking in schools with high smoking risk. Results showed no overall effects. There is a great need to develop programs for this target group and it is important that they are fully implemented if an effect is to be achieved.Trial registrationhttps://www.isrctn.com/ISRCTN16455577, date of registration 14/06/2018.

The effect of a multi-component school-based social network intervention on children’s body mass index: a four-arm intervention study

Objective: Schools are considered an important setting for stimulating healthy weight. The current study is unique in examining effects of a multi-component school-based social network intervention on children’s body mass index z-scores (zBMI). Methods: Four schools were randomly allocated to one of four conditions: a social network intervention using influence agents focusing on water consumption, physical activity, a combination of the two, or a passive control condition. Participants included a total of 201 6- to-11-year-old children (53.7% girls; M age = 8.51, SD age = 0.93). At baseline, 149 (76.0%) participants had a healthy weight, 29 (14.8%) had overweight and 18 (9.2%) had obesity. Results: Linear mixed effect models indicated that a multi-component school-based social network intervention targeting both water consumption and physical activity was most effective in decreasing children’s zBMI. Conclusion: This study suggests that schools can contribute to the intervention of childhood obesity—even without involving the parents—by targeting both children’s water consumption and physical activity through influential peers, but more research is needed to identify mechanisms of change.

The Effects of a Multi-Component School-Based Nutrition Education Intervention on Children's Determinants of Fruit and Vegetable Intake.

Evidence suggests that multi-component school-based health-promoting interventions have great potential to improve children’s fruit and vegetable intake. However, interventions that combine classroom-based curricula with experiential learning strategies (e.g., cooking) are relatively seldom described. This study investigates the short-term and longer-term effects of a multi-component school-based nutrition education intervention combining classroom-based and experiential learning strategies on children’s determinants of their fruit and vegetable intake (knowledge, taste preferences, attitudes, and intention). Using a comparative quasi-experimental study design, data were collected, via child-reported questionnaires, at the baseline, directly after the intervention, and three months after the intervention from 4 control and 15 intervention classes from Dutch primary schools. A total of 192 children in grades three and four (aged 8–10 years) constituted the participants. After correction for the baseline, sex, age, and the fruit or vegetable product assessed in the questionnaire; the intervention group showed a significant increase in knowledge (p = 0.001; standardized effect size (ES = 0.60), taste preference (p = 0.002; ES = 0.52), attitude towards the assessed fruit or vegetable product (p = 0.004; ES = 0.48), and general attitude towards healthy products (p = 0.01; ES = 0.39) over the short term, when compared to the control group. The effects of the intervention did not continue to be significant over the longer term. The findings implicate short-term intervention success, although more research and intervention adaptations are recommended to increase the impact of such programs, especially over the long term.

Increasing Fruit and Vegetable Intake of Primary School Children in a Quasi-Randomized Trial: Evaluation of the Three-Year School-Based Multicomponent Intervention.

Insufficient consumption of fruit and vegetables was found in primary school children. To address this problem, a three-year school-based multicomponent intervention was conducted in 14 primary schools in the City of Zagreb. The aim of the study was therefore to evaluate one of the primary goals of the intervention—the increase in fruit and vegetable intake among primary school children. A total of 681 children were allocated to the intervention (n = 300 in the control group and n = 381 in the intervention group). The intervention included 23 interactive classroom workshops, 10 cross-curricular activities, 13 homework challenges, visual exposure with educational posters in classrooms, parent education via the website, and the implementation of new dishes into the school food system. Fruit and vegetable intake was assessed using a semi-quantitative food frequency questionnaire at baseline and after the intervention. Data were analyzed by per-protocol analysis. The study involved 259 children (50.2% girls; age 7.7 ± 0.4 years; n = 116 in the control group and n = 143 in the intervention group) who completed a food intake frequency questionnaire at both time points. Children in the intervention group showed a significant increase (p < 0.001) in total daily fruit and vegetable intake (before: 332.1 ± 164.9 g; after: 430.1 ± 186.7 g) compared to the control group (before: 350.2 ± 187.5; after: 382.6 ± 196.8) after the intervention. The increase in fruit and vegetable intake was achieved in 89% of children, while 25% more children reached the daily recommendation of 400 g. The use of the multicomponent intervention showed potential to increase fruit and vegetable intake in primary school children.

Menstrual health interventions, schooling, and mental health problems among Ugandan students (MENISCUS): study protocol for a school-based cluster-randomised trial

BackgroundMenstrual health is an increasingly recognised public health issue, defined as complete physical, mental, and social well-being in relation to the menstrual cycle. The MENISCUS trial aims to assess whether a multi-component intervention addressing physical and emotional aspects of menstrual health improves educational attainment, mental health problems, menstrual management, self-efficacy, and quality of life among girls in secondary school in Uganda.MethodsThe study is a parallel-arm cluster-randomised controlled trial with 60 schools (clusters) in Wakiso and Kalungu districts, with a mixed-methods process evaluation to assess intervention fidelity and acceptability and economic and policy analyses. The schools will be randomised 1:1 to immediate intervention or to optimised usual care with delayed intervention delivery. The intervention includes creation of a Menstrual Health Action Group at schools and NGO-led training of trainers on puberty education, development of a drama skit, delivery of a menstrual health kit including reusable pads and menstrual cups, access to pain management strategies including analgesics, and basic improvements to school water, sanitation, and hygiene facilities. Baseline data will be collected from secondary 2 students in 2022 (median age ~15.5 years), with endline after 1 year of intervention delivery (~3600 females and a random sample of ~900 males).The primary outcomes assessed in girls are (i) examination performance based on the Mathematics, English, and Biology curriculum taught during the intervention delivery (independently assessed by the Uganda National Examinations Board) and (ii) mental health problems using the Total Difficulties Scale of the Strengths and Difficulties 25-item questionnaire. Secondary outcomes are menstrual knowledge and attitudes in girls and boys and, in girls only, menstrual practices, self-efficacy in managing menstruation, quality of life and happiness, prevalence of urogenital infections, school and class attendance using a self-completed menstrual daily diary, and confidence in maths and science.DiscussionThe trial is innovative in evaluating a multi-component school-based menstrual health intervention addressing both physical and emotional aspects of menstrual health and using a “training of trainers” model designed to be sustainable within schools. If found to be cost-effective and acceptable, the intervention will have the potential for national and regional scale-up.Trial registrationISRCTN 45461276. Registered on 16 September 2021

P02-01 Promoting Physical Activity in Secondary School for Health, a collaborative European project

IssueThe 2PASS-4Health project (Promoting Physical Activity in Secondary School for Health) was founded by the Erasmus+ Sport programme of the European Union to improve the participation in sport and physical activity (PA). This project aims at examining examples of PA promotion interventions in secondary school, identifying good practices as well as the main barriers and difficulties linked to the design, implementation and evaluation of such interventions in order to improve their quality and sustainability. This project targets both the scientific community and various stakeholders involved in school-based PA promotion for adolescents to provide them with clear knowledge and usable tools. The overall design of this project will be presented as well as the first results and deliverables created to implement the interventions.DescriptionIn order to fill the existing gap between theory and practice by identifying evidence-based practices that work we are translating recent scientific knowledge into accessible information and tools that meet the needs of the stakeholders in the field. Furthermore, using a co-design approach involving several internationally recognised experts, stakeholders, and end-users, we developed some adapted and ready-to-use contents and we designed an optimised multicomponent school-based intervention that has been implemented in France and Spain. We evaluated these interventions not only in terms of outcomes related to PA and sedentary time, but also in relation to other important domains like implementation or maintenance based on the RE-AIM framework.ResultsWe are producing: (1) a white paper geared towards professionals and policy makers, and a consensus statement intended for the scientific community; (2) two handbooks on the implementation of the intervention and its evaluation, accompanied by two scientific publications; (3) an educational toolkit to support PA promotion in schools; and (4) articles on the evaluation of the interventions held in France and Spain.LessonsSystem approach seems needed to implement a sustainable multilevel whole-of-school intervention co-constructed with the different stakeholders and end-users involved.

P139 Three-year School-based Intervention May Change Primary School Children's Preferences for Fruit and Vegetable Dishes

<h3>Objective</h3> Evaluation of the three-year school-based multicomponent intervention "Nutri-školica" in terms of changing children's preferences for fruit and vegetable dishes from the school menus. <h3>Use of Theory or Research</h3> Preference, as one of the biological characteristics according to Bronfenbrenner's Ecological Systems Theory, may be the trigger for children's consumption of fruit and vegetable dishes. With appropriate educational, sensory, and exposure-based intervention, it could be modified to increase children's acceptance of fruit and vegetable dishes. <h3>Target Audience</h3> Primary school children (7-10 years old). <h3>Program Description</h3> "Nutri-školica" is a three-year (school years 2018/2019-2020/2021) school-based multicomponent intervention aimed at increasing the acceptance and consumption of fruit and vegetables among primary school children. The intervention was implemented in 14 elementary school in the city of Zagreb, with children within the schools divided into an intervention and a control group. <h3>Evaluation Methods</h3> To assess the impact of the intervention on children's preferences for fruit and vegetable dishes, a two-way analysis of variance with repeated measures was conducted to compare pre- and post-intervention changes in the intervention and control groups. Children's preferences were assessed during school lunch two weeks before and after the intervention. After the children finished their school lunch, they rated the meal items, which included fruit or vegetables, using a taste-and-rate method on a 5-point smiley-face scale (5 represents "most liked"). The analysis was conducted with 70 children who ate school lunch and rated the meals before and after the intervention. <h3>Results</h3> Children in the intervention group (before: 4.19 ± 1.12; after: 4.29 ± 0.83) showed a significant increase (<i>P =</i> 0.018) in preference for fruit and vegetable dishes served at school after the three-year intervention compared to the control group (before: 4.29 ± 0.92; after: 3.28 ± 1.07). <h3>Conclusions</h3> The intervention "Nutri-školica" has proven successful in changing children's preferences for fruit and vegetable dishes. <h3>Funding</h3> European Commission – Horizon 2020 (Call H2020-SFS-2015-2, Topic: SFS-20-2015, Type of action: RIA, Proposal Number: 678024-2); Croatian Science Foundation - Young researchers' career development project: training of doctoral students (DOK-01-2018 - funded by the European Social Fund)

A Multi-Country Study of Risk and Protective Factors for Emotional and Behavioral Problems Among Early Adolescents

PurposeEarly adolescence (ages 10–14) is a critical period for psychosocial development, but few studies have focused on risk and protective factors for emergent psychosocial challenges among youth living in low- and middle-income countries. This study explored the contribution of social environmental factors to patterns of emotional and behavioral problems among early adolescents across four low- and middle-income countries. MethodsParticipants were drawn from the Global Early Adolescent Study, and included 10,437 early adolescents from six low-resource urban settings in the Democratic Republic of Congo, Malawi, Indonesia, and China. Multivariate latent class regression was used to examine the associations between distinct patterns of emotional and behavioral problems and risk and protective factors across the family, peer, school, and neighborhood levels. ResultsAcross countries, childhood adversity, peer bullying behaviors, and a perceived lack of school safety were consistently associated with emotional and behavioral problems. With some contextual variability, peer substance use and a perceived lack of neighborhood safety also emerged as significant risk factors. The magnitude of these associations was generally greatest among a subgroup of early adolescents with co-occurring emotional and behavioral problems. DiscussionThe overall consistency of findings across countries is suggestive of the generalizability of risk factors in early adolescence and indicates that interventions bolstering psychosocial adjustment among this age group may have applicability in diverse cross-national settings. Given the significance of peer bullying behaviors and school safety, multicomponent school-based interventions may be an especially applicable approach.

Adolescent Self-Efficacy for Diet and Exercise Following a School-Based Multicomponent Lifestyle Intervention.

Self-efficacy is perhaps the most important parameter associated with behavioral changes. The main aim of this study was to provide insight into the diet and exercise self-efficacy of Greek adolescents and how they could be modified via a multilevel multicomponent school-based lifestyle intervention. Secondary aims were to study the associations of students’ dietary and exercise self-efficacy indices with their anthropometric and sociodemographic parameters. A representative sample of the adolescent population in Attica, consisting of 1610 adolescents aged 12–17 years, recruited from 23 public high schools in three municipalities of the Attica area in Greece, received a three-component lifestyle educational intervention for health promotion and underwent screening for characteristics of metabolic syndrome with the use of portable telemedicine. All assessments and anthropometric measurements were performed at baseline and after the 6-month intervention. Anthropometric measurements included body mass index, waist circumference (WC), waist-to-height ratio (WHtR) and waist-to-hip ratio (WHR). Assessment tools included the Self-efficacy for Diet and the Self-efficacy for Exercise questionnaires, as well as the Mediterranean Diet Quality Index in Children and Adolescents (KIDMED). Analysis included 1020 adolescent students (421 males and 599 females), who completed the self-efficacy questionnaires pre- and post-intervention. Overall, the dietary (p < 0.001) and exercise (p < 0.001) self-efficacy increased significantly post-intervention. Post-intervention, all adolescents decreased their abdominal obesity indices (WC, WHtR, WHR), and this improvement was even more pronounced and significant (p = 0.019, p = 0.019, p = 0.023 respectively) in the adolescents with overweight/obesity. Post-intervention, the proportion of adolescents with normal weight increased from 73.9% to 78.6%, whereas the proportion of adolescents with overweight and obesity decreased from 20.4% to 15.9% and from 5.7% to 5.5%, respectively. Abdominal obesity also decreased from 10.4% to 9.0%. Female adolescents achieved significantly (p = 0.010) higher changes in diet self-efficacy than males. Other sociodemographic characteristics such as family structure, parental age, parental educational level and family income showed non-significant differences. Adolescents with higher KIDMED scores manifested significantly higher dietary and exercise self-efficacy than those with lower KIDMED scores. Both adolescents with normal weight and overweight/obesity manifested a reciprocal relation between diet and exercise self-efficacy. Multicomponent lifestyle interventions in the school environment may provide a first step in students’ behavior changes and provide grounds for future prevention programs in youth.

Changes in Dietary Magnesium Intake and Risk of Type 2 Diabetes Mellitus in Middle School Students: Using Data from the HEALTHY Study

BackgroundThe HEALTHY Study was a multicomponent school-based intervention, designed to prevent type 2 diabetes mellitus (T2DM) in middle-school students. ObjectivesWe examined whether the difference in dietary magnesium intake, BMI percentile, and plasma glucose and insulin concentrations from 6th to 8th grade were related in the intervention schools and in the control schools that participated in the HEALTHY Study. MethodsA total of 2181 ethnically diverse students, from 11.3 to 13.7 y of age, with completed dietary records, BMI percentile, and plasma glucose and insulin concentrations at 6th and 8th grades were included. Dietary magnesium intake was self-reported using the Block Kids FFQ. A hierarchical multiple regression model was used to determine whether the differences in dietary magnesium intake, BMI percentile, and plasma glucose and insulin concentrations from 6th to 8th grades were related, while adjusting for dietary calcium intake and total energy intake. ResultsThe difference in dietary magnesium intake was significantly related to changes in BMI percentile from 6th to 8th grade in intervention and in control schools [intervention: β: −0.07; 95% CI: −0.58, −0.02; P = 0.03; R2 (regression coefficient effect size): 0.14; 95% CI for R2: 0.10, 0.17; control: β: −0.08; 95% CI: −0.63, −0.09; P = 0.01; R2: 0.12; 95% CI for R2: 0.08, 0.15]. The difference in dietary magnesium intake was not related to plasma glucose and insulin concentrations in intervention and in control schools. ConclusionsWe conclude that a multicomponent intervention was associated with reduced risk of T2DM, and that this association may be modulated, in part, by magnesium. The differences in dietary magnesium intake from 6th to 8th grade were negatively related to changes in BMI percentile among middle-school students.

Effectiveness of a school-based intervention on physical activity and screen time among adolescents

ObjectivesTo evaluate the effectiveness of a multi-component school-based intervention on physical activity (PA) and screen time (ST) among urban adolescents in Bangladesh. DesignCluster-randomised controlled trial. MethodsEight high schools were randomly assigned to either intervention group (IG) or control group (CG). Participants (n = 160 per group, 40 school) were in grades 8–9. A 12-week multi-component intervention was developed based on the WHO's Health-Promoting Schools framework. The IG received weekly supervised circuit exercise (30 min/week), health education session (10 min/week) with health educational materials, and lunchtime sports activities (20 min/week). The main outcome measures included self-reported PA, ST, knowledge on PA and SB, which were assessed at baseline, 8 and 12 weeks. Repeated measures ANCOVA was used to evaluate the intervention effects. ResultsTotal PA (MET-min/week) was increased from baseline to 8 and 12 weeks in the IG (3%–5%) but decreased in the CG (5%–3%) and significantly improved in the IG compared to the CG (p < 0.001) over time. Average ST (min/day) reduced from baseline to 8 and 12 weeks in the IG (28%–35%), while remained unchanged in the CG (6%–5%). The IG had a significantly lower average ST than the CG at 12 weeks. The average knowledge scores on PA and SB were significantly higher in the IG than the CG at 12 weeks (p < 0.001). ConclusionsOur intervention has demonstrated some promising effects on increasing PA, reducing ST, and improving PA and SB knowledge. This study underscores the need for a scaled-up evaluation in other locations including rural settings.

Effectiveness and moderators of a multicomponent school-based intervention on screen time devices: the Movimente cluster-randomized controlled trial

BackgroundInterventions targeting reduce screen time in adolescents are urgently needed, mainly in low and middle-income countries because of the lack of evidence. Thus, the aims of the study were to examine the effect of a cluster-randomized controlled trial on screen time (ST) devices among Brazilian adolescents and to identify possible moderators.MethodsMovimente was a multicomponent school-based intervention that was performed in 2017 and consisted of teacher training, education curriculum, and environmental improvements. Baseline and post-intervention assessments (over one academic year) were conducted with students aged 10–16 years at baseline (baseline n = 921, [n = 538 intervention group; n = 383 control group]). A self-report questionnaire was used to measure daily minutes of device specific screen time (TV, computer, video games and smartphone) and demographic variables. Linear mixed models were used to examine intervention effects and an exploratory moderation analysis (sex, grade and socioeconomic status) was performed.ResultsThe intervention had no significant effects on TV time (β = − 6.4, 95% CI: − 6.1;13.4), game time (β = − 8.2, 95% CI: − 7.2;10.8), computer time (β = 1.1, 95% CI: − 6.3;18.5), smartphone time (β = − 10.2, 95% CI: − 32.5;12.1), screen time (β = − 12.8, 95% CI: − 50.5;24.8), meeting screen time guidelines (OR: 1.29, 95% CI: 0.65,2.57) and meeting screen time guidelines with smartphone (OR: 1.66, 95% CI: 0.37,7.40). There was a significant intervention effect on reducing TV time (β = − 37.1, 95% CI: − 73.0, − 1.3) among 8th grade students only.ConclusionsThe Movimente intervention was effective only for TV time among 8th grade students. Understanding how school-based interventions can improve adolescents’ device specific screen time across age groups is needed. Future strategies should cover all screen-based devices. Further, there is a need for more studies in low- and-middle income countries to assist in the development of effective strategies.Trial registrationClinicaltrials.gov identifier NCT02944318 (25/10/2016).