School-based Health Promotion Program Research Articles

Health Promotion in a Low-income Primary School: Children with and Without DCD Benefit, but Differently

ABSTRACTPoor motor performance and reduced physical fitness are characteristic of children with Developmental Coordination Disorder (DCD). These features have also been identified more frequently among children living in low socio-economic circumstances. Aims: To evaluate the outcomes of a nine-week health promotion program (HPP) on the motor performance and fitness levels of children (6–10 years) with and without DCD attending a low-income primary school. Methods: The HPP was designed and implemented by undergraduate physiotherapy students using guidelines from the World Health Organization School Health Initiative and their physiotherapy curriculum. Children with DCD (n = 22) and a control group without DCD (n = 19) participated in the evaluation. Motor skill, functional strength, aerobic capacity, and anaerobic power were measured at baseline and after nine weeks. Results: Both groups of children improved on all measures at the conclusion of the HPP. Children with DCD showed greater improvement than the control group in motor performance and the control group showed greater improvement on one of the anaerobic fitness outcomes. Conclusions: A school-based HPP that focuses on increasing opportunities for physical activity may be effective in improving motor performance in children with DCD and can increase fitness levels in general.

Turn 2 Us: Outcomes of an Urban Elementary School-based Mental Health Promotion and Prevention Program Serving Ethnic Minority Youths

Many school-age children in the United States with social, emotional, and behavioral problems do not receive mental health services. These problems negatively affect their social and behavioral functioning and academic achievement. This is particularly a problem for Latino youths, who represent the largest ethnic minority group in the United States and the largest group with unmet need for mental health services. School-based mental health promotion and prevention programs (SBMH-PPs) can mitigate such problems. This article describes such a program, located in an underserved area of northern Manhattan, New York City. A study was conducted to examine the effects of this SBMH-PP, which served 174 predominantly Latino at-risk students from two urban elementary schools during the 2008-2009 school year. Pre and post teacher reports, attendance rates, and academic scores were used to analyze the effects of the SBMH-PP on these students. RESULTS demonstrated increased prosocial behavior and classroom compliance, as well as improved academic achievement. Improvement was also found in attendance when compared with a control group of similar students not served by the program. The outcomes of this study provide further evidence for the effectiveness of SBMH-PPs that serve minority youths in elementary schools. Language: en

Rationale and study protocol to evaluate the SunSmart policy intervention: a cluster randomised controlled trial of a primary school-based health promotion program.

BackgroundPrevious evaluations of the SunSmart Program have supported the link between a written sun protection policy and improved sun protection behaviours in New South Wales (NSW) primary schools. However these evaluations have relied on self-reported data and research suggests that direct observations are required to better represent schools’ usual sun protective practices.Methods/DesignData will be collected in the summer months of 2014, 2015, and 2016 as part of an 18-month cluster-controlled trial in NSW primary schools (n = 20). Researchers will conduct three direct observations to record students’ hat use and teachers’ use of sun protective measures during recess and lunch periods in each school. Researchers will also record the volume of sunscreen that the Year 6 classes in each school utilise over the term. At the conclusion of baseline data collection, five schools will be randomised into an intervention group that will work with researchers to develop a policy-driven intervention to improve sun safety behaviour in NSW primary schools.DiscussionAn initial review of relevant Australian and New Zealand literature suggests that provision of policy support is likely to improve school sun protection practices; however there is no suggested model for this support. This will be the first objective analysis of sun safe behaviours leading to a policy-driven intervention conducted in Australian primary schools since the 1990s, and will inform the future direction of sun safety in our schools.Trial registrationAustralian and New Zealand Clinical Trials Register ACTRN12614000926639 Registered 28th August 2014.

34. A School-based Health Promotion Program to Promote Physical Activity Among Young Adolescents in Hong Kong

Despite the strong evidence for the benefits of physical activity on the health and development of young people, the majority of the Hong Kong adolescents have sedentary lifestyles. A recent study found that less than 10% of teens engaged in 60 minutes or more of physical activity per day. There are tremendous barriers to promoting physical activity among students in Hong Kong, including pressure to perform well academically and lack of open space. In addition, students with low socioeconomic background may have limited opportunities to engage in regular physical activity.

Effects of a Health Promotion Program on Elementary Students’ Physical and Mental Health

Many health promotion programs have been implemented to prevent obesity and mental health problems among school-aged children. However, only a few programs included both physical and psychological measures to assess the effects of the program. The present study was designed to test the effects of a 6-week health promotion program on physical and mental health among school-aged children using physiological and psychological measures. A total of 74 elementary school students (4th and 5th grade) recruited from urban (n = 51) and rural areas (n = 23) participated in the study. We used the Korean version of the Kovacs’ Children’s Depression Inventory and the Conners-Wells’ Adolescent Self-Report Scale-Short Form (CASS-S) to measure levels of depression and hyperactivity, respectively. To assess children’s physical health, we measured body mass index (BMI), body fat percentage, and heart rate variability. In addition, children’s health-related behaviors (e.g., eating and exercise habits) were assessed using the health promotion behavior scale. A total of 63 students (13 in the experimental and 50 in the control group) who completed both physiological and psychological measures were included in the final analysis. Compared to children in the control group, children in the experimental group showed a significant decrease in their level of hyperactivity (t = -2.01, p = 0.049) and increase in heart rate variability (t = -2.35, p = 0.022). No significant group differences were noted for depression, BMI, body fat percentage, and health promotion behaviors between the two groups. Findings of this study provided preliminary evidence of the effectiveness of a 6-week school-based health promotion program for improving emotional health among school-aged children living in a rural area. Future studies testing the effects of health promotion programs with longer sessions and programs focusing on social-emotional skill development are needed.

Leadership skills are associated with health behaviours among Canadian children.

Life skills development is a core area for action in the Ottawa Charter for Health Promotion. The role of life skills in influencing health behaviours among children has received little attention in research. The purpose of this cross-sectional study was to investigate the relationship between self-leadership, as a model of life skills, and diet quality, physical activity, sleep duration and body weight. A provincially representative sample of 2328 grade 5 students (aged 10-11 years) was surveyed in Alberta, Canada. Self-leadership skills were assessed based on student responses indicating frequency of performing various leadership traits. Diet quality was based on responses to the Harvard Youth/Adolescent Food Frequency Questionnaire and physical activity on responses to the Physical Activity Questionnaire for Children. Sleep duration was assessed based on parent survey responses, and body mass index determined based on measured height and weight. Random effects regression models with children nested within schools were used to determine the associations. Higher self-leadership was associated with better diet quality (P < 0.01) and more physical activity (P < 0.01). Although not statistically significant, higher self-leadership was suggestive of healthier body weight status (OR = 0.91, 95% CI = 0.66, 1.27). No association of self-leadership with sleep duration was found. The incorporation of leadership skill development may enhance the effectiveness of school-based health promotion programs. This study reinforces the importance of leadership skill promotion in the promotion of healthy eating and active living, which may help curb the obesity epidemic in the short term, and prevention of chronic diseases and mounting healthcare costs in the long term.

Life course impact of school-based promotion of healthy eating and active living to prevent childhood obesity.

BackgroundThe Alberta Project Promoting active Living and healthy Eating in Schools (APPLE Schools) is a comprehensive school health program that is proven feasible and effective in preventing obesity among school aged children. To support decision making on expanding this program, evidence on its long-term health and economic impacts is particularly critical. In the present study we estimate the life course impact of the APPLE Schools programs in terms of future body weights and avoided health care costs.MethodWe modeled growth rates of body mass index (BMI) using longitudinal data from the National Population Health Survey collected between 1996–2008. These growth rate characteristics were used to project BMI trajectories for students that attended APPLE Schools and for students who attended control schools (141 randomly selected schools) in the Canadian province of Alberta.ResultsThroughout the life course, the prevalence of overweight (including obesity) was 1.2% to 2.8% (1.7 on average) less among students attending APPLE Schools relative to their peers attending control schools. The life course prevalence of obesity was 0.4% to 1.4% (0.8% on average) less among APPLE Schools students. If the APPLE Schools program were to be scaled up, the potential cost savings would be $33 to 82 million per year for the province of Alberta, or $150 to 330 million per year for Canada.ConclusionsThese projected health and economic benefits seem to support broader implementation of school-based health promotion programs.

Exploring determinants of completeness of implementation and continuation of a Dutch school-based healthy diet promotion programme

Strategies to promote implementation of school-based health promotion (HP) programmes should be designed to suit determinants of implementation and continuation. This study explored determinants of completeness of teachers' implementation of a healthy diet promotion programme and of their intention to continue the programme. Strategies for promoting complete and continued implementation of school-based HP programmes should be designed to suit such determinants. Teacher logbooks were used to assess completeness. Additionally, the teachers completed questionnaires before and after implementation on user-, programme-, context- and dissemination strategy-related determinants and their intention to continue the programme in the next school year. Non-parametric tests and logistic regressions were used to assess baseline-posttest changes in determinants and differences in determinants between teachers with levels of completeness and of intention to continue the programme. Variability in teachers' completeness of using the programme was best predicted by their perception of ‘relative advantage’ and ‘compatibility’ of the intervention programme. Teachers' intention to continue could be explained by ‘perceived personal benefits’, their perception of ‘programme outcome feasibility’ and on ‘subjective norm from students’. Our explorative study indicates that HP professionals should target various user-, programme- and context-related determinants in their implementation strategy to improve completeness of programme implementation and continuation. Close collaboration with the users and members of the target group during the programme development phase is essential.

Long Live Love. The implementation of a school-based sex-education program in The Netherlands.

Implementation of health education programs is often inadequately considered or not considered at all in planning, developing and evaluating interventions. With the focus being predominantly on the adoption stage, little is known about the factors influencing the implementation and continuation stages of the diffusion process. This study contributes to the understanding of factors that promote or impede each stage of the diffusion process in the school setting using the sex education program Long Live Love (LLL) as an example. A survey integrating different diffusion-related concepts was completed by 130 teachers. Results showed that teacher curriculum-related beliefs were associated with all stages in the diffusion process. Although adoption of LLL was predominantly related to teacher curriculum-related beliefs, implementation completeness and fidelity and continued use of LLL were also enhanced by contextual factors, namely teacher training and interactive context variables (school policy, governing body support and student response), respectively. The results of this study can be used to optimize the adoption, implementation and continuation of school-based (sexual) health promotion programs.

Evaluation of a School-Based Health Education Program for Urban Indigenous Young People in Australia

The aim of this study was to investigate the effectiveness of a school-based health promotion and education program in improving knowledge, attitudes, self-efficacy and behaviours of urban Indigenous young people regarding chronic disease and associated risk factors. A mixed methods approach was adopted for this evaluation; however, this paper will focus on the quantitative aspect of the study. The Deadly Choices? health education program was delivered weekly at six education facilities in Brisbane, Australia to participants from years seven to 12 over seven weeks. One school that received the Deadly Choices program the following term acted as the control group. Questionnaire data was collected immediately pre and post intervention to assess program impact. As self-reported by participants there were mostly significant improvements over time for questions relating to knowledge, attitudes and self-efficacy regarding leadership, chronic disease and risk factors within the intervention group. There were also significant changes within the intervention group regarding breakfast frequency (P = 0.002), physical activity frequency (P ≤ 0.001), fruit (P = 0.004) and vegetable (P ≤ 0.001) intake. Overall, there were few significant differences between the control and intervention groups regarding health attitudes and behaviours; however, there were considerably more improvements relating to self-efficacy and knowledge of chronic disease and associated risk factors between groups. The program also facilitated 30 Aboriginal and Torres Strait Islander health checks for participants. Deadly Choices is an innovative and comprehensive school-based program which has great potential to improve the health outcomes of Indigenous young people in urban areas by providing education in leadership and chronic disease prevention; engaging students in physical activity participation; and collaborating with health services to facilitate health checks.

Intervention effects of a school-based health promotion programme on obesity related behavioural outcomes.

Studies have shown preventive effects of an active lifestyle during childhood on later life; therefore, health promotion has to start early. The programme “Join the Healthy Boat” promotes a healthy lifestyle in primary school children. In order to evaluate it, children's behaviours in respect of increased physical activity (PA), a decrease in screen media use (SMU), more regular breakfast, and a reduction of the consumption of soft drinks (SDC) were investigated. 1943 children (7.1 ± 0.6 years) participated in the cluster-randomised study and were assessed at baseline and 1736 of them at follow-up. Teachers delivered lessons, which included behavioural contracting and budgeting of SMU and SDC. Daily SMU, PA behaviours, SDC, and breakfast patterns were assessed via parental questionnaire. After one-year intervention, significant effects were found in the intervention group for SMU of girls, children without migration background, and children with parents having a low education level. In the control group, second grade children skipped breakfast significantly more often. Tendencies but no significant differences were found for PA and SDC. This intervention seems to affect groups, which are usually hard to reach, such as children of parents with low education levels, which shows that active parental involvement is vital for successful interventions.

Does Youth Net Decrease Mental Illness Stigma in High School Students?

This study examined whether stigma toward mental illness decreased for youth after participating in focus groups in a school-based mental health promotion program called Youth Net (YN FGs). A total of 294 students from 6 high schools participated in a randomized controlled trial, completing questionnaires that measured stigma and depression. Stigma decreased for participants in the intervention group in low-need schools only. Study findings suggest continuing with YN FGs in low-need schools and working collaboratively with community partners to provide evidence of the effectiveness of mental health promotion with youth.

Effects of Positive Action on the Emotional Health of Urban Youth: A Cluster-Randomized Trial

We examined the effects of Positive Action (PA), a school-based social-emotional learning and health promotion program, on the emotional health of predominately low-income and ethnic minority urban youth. The study was a matched-pair, cluster-randomized controlled trial involving 14 Chicago public schools. Outcomes were assessed over a 6-year period of program implementation for a cohort of youth in each school, followed from grades 3 to 8. Youth reported on their emotional health (positive affect, life satisfaction, depression, anxiety) and social-emotional and character development. Growth-curve and structural-equation modeling analyses assessed overall program effects on the emotional health outcomes as well as mediation of these effects via the program's impact on youths' social-emotional and character development. Students in PA schools, compared with those in control schools, had more favorable change over the course of the study in positive affect (standardized mean difference effect size [ES]= .17) and life satisfaction (ES= .13) as well as significantly lower depression (ES=-.14) and anxiety (ES=-.26) at study end point. Program effects for positive affect, depression, and anxiety were mediated by more favorable change over time in social-emotional and character development for students in PA schools. Results suggest that universal, school-based programs can benefit the emotional health of youth in low-income, urban settings. The modest magnitude of effects over an extended period of program implementation, however, reflects the challenges of both mounting interventions and offsetting formidable risks for mental health problems in such environments.

Development of a health promotion questionnaire index (HPQI) to measure doktor muda (junior doctor) programme impact on schoolchildren’s oral health knowledge, attitudes and behaviour

Long term evaluations of impacts of community based health promotion programmes are not an easy or straightforward task to do due to lack of validated and reliable indices. Objective: To develop and test an index to measure schoolchildren?s oral health knowledge, attitudes, and behaviour as a result of a school-based health promotion programme in Malaysia called the Doktor Muda (Junior Doctor) Programme (DMP). Materials and Methods: The index was developed in English based on the DMP module and translated into Malay. The Malay version was tested on 174, 11-12 year old schoolchildren. Psychometric analysis of the index involved content and face validity tests as well as factor analysis, internal and test-retest reliability. Results: Factor analysis yielded 3 factors with groups of items viz. oral health knowledge (OHK), oral health attitudes (OHA) and oral health behaviour (OHB). The Cronbach?s alpha coefficients of the three factors were 0.61, 0.73, and 0.64, respectively. The Kappa coefficients were 0.70, 0.77 and 0.73, respectively (intraclass correlation coefficients = 0.72, 0.70 and 0.78). The final questionnaire comprised 33 items, namely; OHK 11 items, OHA 15 items, and OHB 7 items. Conclusion: The Health Promotion Questionnaire Index (HPQI) to measure the DMP impact on schoolchildren?s oral health knowledge, attitudes, and behaviours was empirically verified to be valid and reliable for use among 11-12 year old Malaysian schoolchildren.

Problem Behavior and Urban, Low-Income Youth

Youth problem behaviors remain a public health issue. Youth in low-income, urban areas are particularly at risk for engaging in aggressive, violent, and disruptive behaviors. To evaluate the effects of a school-based social-emotional learning and health promotion program on problem behaviors and related attitudes among low-income, urban youth. A matched-pair, cluster RCT. Participants were drawn from 14 Chicago Public Schools over a 6-year period of program delivery with outcomes assessed for a cohort of youth followed from Grades 3 to 8. Data were collected from Fall 2004 to Spring 2010, and analyzed in Spring 2012. The Positive Action program includes a scoped and sequenced K-12 classroom curriculum with six components: self-concept, social and emotional positive actions for managing oneself responsibly, and positive actions directed toward physical and mental health, honesty, getting along with others, and continually improving oneself. The program also includes teacher, counselor, family, and community training as well as activities directed toward schoolwide climate development. Youth reported on their normative beliefs in support of aggression and on their bullying, disruptive, and violent behaviors; parents rated youths' bullying behaviors and conduct problems; schoolwide data on disciplinary referrals and suspensions were obtained from school records. Multilevel growth-curve modeling analyses conducted on completion of the trial indicated that Positive Action mitigated increases over time in (1) youth reports of normative beliefs supporting aggressive behaviors and of engaging in disruptive behavior and bullying (girls only) and (2) parent reports of youth bullying behaviors (boys only). At study end-point, students in Positive Action schools also reported a lower rate of violence-related behavior than students in control schools. Schoolwide findings indicated positive program effects on both disciplinary referrals and suspensions. Program effect sizes ranged from -0.26 to -0.68. These results extend evidence of the effectiveness of the Positive Action program to low-income, minority, urban school settings, and to middle school-aged youth.

Take Home Messages on Sustainable Food: Surveying Parent Perceptions of the Effects of a Primary School Programme

Aims: Parents are important stakeholders in school-based health promotion programmes. This study aimed to understand the perceptions of parents of a primary school-based healthy and sustainable food programme. It specifically sought to examine the perceived effects of the programme on the home environment and on parental engagement with schools. Study Design: A cross-sectional parent survey and a before-and-after school activity survey. Place and Duration of Study: Primary schools in England taking part in the Food for Life Partnership programme, between January 2008 and January 2011. Methodology: In 35 schools a pre-programme enrolment survey on parental involvement was completed and repeated at 18-24 months. In the same schools 740 parents responded to a cross-sectional survey on perceptions and effects of sustainable food education. Results: Parental involvement increased across a number of areas of food-related school

Effects of a health-promotion programme in sixth grade German students' physical education

The aim of the study was to assess the effects of a school-based health-promotion programme in physical education (PE) on sixth grade German students' motor performance, BMI and health-related quality of life (HRQOL). In a quasi-experimental design, 516 students (54.7% girls) were assigned to either the intervention group (IG) that received eight 90-minute health-promoting PE lessons or the control group (CG), which continued regular PE. Outcome variables were assessed at baseline, immediately after, and three months after the intervention in order to explore significant short- and middle-term intervention effects, respectively. The intervention programme had gender specific effects in motor performance with girls reaching higher levels. Positive short-term intervention effects were found in girls' sideways jumps (η 2=0.17) and negative effects were measured in the 20-meter sprints (η 2=0.05) and the standing long jump (η 2=0.04). Positive middle-term effects were measured on the motor performance score (η 2=0.05), sideways jumps (η 2=0.08) and stand-and-reach flexibility (η 2=0.04). In boys, short-term positive intervention effects were found in 20-meter sprints (η 2=0.04). In the middle-term, differences in favour of the CG were found in press-ups (η 2=0.03) and sideways jumps (η 2=0.06). Concerning BMI the IG had significantly lower levels compared to the CG in the short-term (η 2=0.04) and in the middle-term (η 2=0.03), respectively. There were no significant differences between the groups in HRQOL. In conclusion, the results demonstrate the feasibility of promoting health related parameters in PE, but also raise the question whether gender-specific tailored interventions would result in higher intervention effects concerning motor performance especially in boys.

Attitudes of adolescents regarding health: evaluation of a school-based health promotion program in Seville, Spain.

The study examined differences in attitudes regarding health within students in their fourth year of mandatory secondary school in Seville, Spain. The students were divided into two groups according to their participation in the "Forma Joven" health promotion program. A descriptive and bivariate analysis was conducted. As there were no significant differences in the socio-demographic characteristics of the two groups, the groups were considered homogeneous. Attitudes were also similar in both groups. Statistically significant differences were only found in the level of danger assigned to two of the thirteen transit situations explored: "not using a seatbelt" and "entering a vehicle when the driver has been drinking," with the lower level of risk corresponding to the group of students participating in the program. These findings are consistent with the results of previous studies and invites reflection upon the effectiveness of such programs. In the case of the "Forma Joven" program, the ineffectiveness could be attributable to a lack of systematization in the program's implementation. In the future, interventions to increase the effectiveness of the program should be proposed.

Anthropometric outcomes associated with a primary school-based health promotion programme in the Italian city of Parma

The City Council of Parma and allied partners launched a programme based on professionally guided physical exercise and nutritional education in all primary schools of the metropolitan area, with a total of 7,000 children involved, ranging from 6 to 10 years of age. One scientific end-point of the programme was the definition of the parameter(s) most associated with increased physical activity and potential modification of eating habits. To this purpose we studied in a cohort of 2,151 9-year-old children the associations among BMI, fat mass (FM), breakfast eating and the amount of physical activity, the most relevant variables that characterize lifestyle. There was a consistent significant inverse correlation between FM and physical activity and a significant correlation between FM and breakfast skipping. When sorted by BMI, an inverse significant correlation was found between FM and physical activity in boys, except in those underweight. In girls, a significant correlation was found in those of normal weight, but not in those overweight or obese. The number of sports practised was related to FM only in overweight and obese boys. Breakfast skipping was significantly correlated with FM only in underweight girls. Taken together, our data show that FM can be used to accurately evaluate physical activity and eating habits in children, and suggest that, in preventive health programmes, the fundamental parameter to pay attention to is the amount rather than the type of physical activity.

Optimizing school-based health-promotion programmes: Lessons from a qualitative study of fluoridated milk schemes in the UK

Background and objective: Some districts in the United Kingdom (UK), where the level of child dental caries is high and water fluoridation has not been possible, implement school-based fluoridated milk (FM) schemes. However, process variables, such as consent to drink FM and loss of children as they mature, impede the effectiveness of these schemes. The aim of this study was to investigate the views of lay participants in FM schemes on the barriers and potential solutions to optimizing schemes and understand how this may inform the implementation of other school-based health-promotion programmes. Design and setting: A qualitative study based on semi-structured interviews and focus groups was carried out in schools participating in FM schemes in the north west of England. Findings: Grounded theory analysis on interview data revealed that the overarching potential solution for optimizing schemes was the need for engagement by schools in the scheme. The degree of engagement with the scheme was related to (the interrelated categories of) acceptability and understanding of FM by the school community. Conclusion: The concept of the need for engagement by schools in health-promotion programmes may be useful for sensitizing health planners to the needs of the school community when developing strategies for the implementation of fluoridated-milk schemes and other school-based health-promotion programmes.