From

International Journal of Behavioral Nutrition and Physical Activity

Paul J Veugelers¹  Kate Storey¹  Marg Schwartz¹  Megan Purcell¹  Connie Lu¹  Stefan Kuhle¹  Christina Fung¹ 

[1] School of Public Health, University of Alberta, 6-50 University Terrace, 8303 - 112 St, Edmonton, AB T6G 2 T4, Canada

关键词: Health policy;    Program evaluation;    Health promotion;    Comprehensive school health;    Children;    Obesity;    Physical activity;    Nutrition;    School health;    Public health;   

Others  :  828331
DOI  :  10.1186/1479-5868-9-27

 received in 2011-07-22, accepted in 2012-03-13,  发布年份 2012

【 摘 要 】

Background

In 2005, we reported on the success of Comprehensive School Health (CSH) in improving diets, activity levels, and body weights. The successful program was recognized as a "best practice" and has inspired the development of the Alberta Project Promoting active Living and healthy Eating (APPLE) Schools. The project includes 10 schools, most of which are located in socioeconomically disadvantaged areas. The present study examines the effectiveness of a CSH program adopted from a "best practice" example in another setting by evaluating temporal changes in diets, activity levels and body weight.

Methods

In 2008 and 2010, we surveyed grade 5 students from approximately 150 randomly selected schools from the Canadian province of Alberta and students from 10 APPLE Schools. Students completed the Harvard Youth/Adolescent Food Frequency Questionnaire, questions on physical activity, and had their height and weight measured. Multilevel regression methods were used to analyze changes in diets, activity levels, and body weight between 2008 and 2010.

Results

In 2010 relative to 2008, students attending APPLE Schools were eating more fruits and vegetables, consuming fewer calories, were more physically active and were less likely obese. These changes contrasted changes observed among students elsewhere in the province.

Conclusions

These findings provide evidence on the effectiveness of CSH in improving health behaviors. They show that an example of "best practice" may lead to success in another setting. Herewith the study provides the evidence that investments for broader program implementation based on "best practice" are justified.

【 授权许可】

   
2012 Fung et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Ebbeling CB, Pawlak DB, Ludwig DS: Childhood obesity: public-health crisis, common sense cure. Lancet 2002, 360:473-482.
• [2]Lobstein T, Baur L, Uauy R: Obesity in children and young people: a crisis in public health. Obes Rev 2004, 5:4-85.
• [3]Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM: Prevalence of high body mass index in US children and adolescents, 2007-2008. JAMA 2010, 303:242-249.
• [4]Ogden CL, Carroll MD: Prevalence of Obesity Among Children and Adolescents: United States, Trends 1963-1965 Through 2007-2008. [http:/ / www.cdc.gov/ nchs/ data/ hestat/ obesity_child_07_08/ obesity_child_07_08.htm] webcite
• [5]Statistics Canada: Canadian Health Measures Survey: Cycle 1 Data Tables. 2007 to 2009, no. 2. [http:/ / www.statcan.gc.ca/ bsolc/ olc-cel/ olc-cel?catno=82-623-XIE&lang=eng#f ormatdisp] webcite
• [6]Shields M: Overweight and obesity among children and youth. Health Rep 2006, 17:27-42.
• [7]Wang F, Veugelers PJ: Self-esteem and cognitive development in the era of the childhood obesity epidemic. Obes Rev 2008, 9:615-623.
• [8]Dietz WH: Overweight in childhood and adolescence. N Engl J Med 2004, 350:855-857.
• [9]Manson JE, Bassuk SS: Obesity in the United States: a fresh look at its high toll. JAMA 2003, 289:229-230.
• [10]Must A, Strauss RS: Risks and consequences of childhood and adolescent obesity. Int J Obes Relat Metab Disord 1999, 23(Supp 2):s2-s11.
• [11]Andersen RE: The spread of the childhood obesity epidemic. CMAJ 2000, 163:1461-1462.
• [12]Hill JO, Wyatt HR, Reed GW, Peters JC: Obesity and the environment: Where do we go from here? Science 2003, 299:853-855.
• [13]Swinburn BA, Caterson I, Seidell JC, James WP: Diet, nutrition and the prevention of excess weight gain and obesity. Public Health Nutr 2004, 7:123-146.
• [14]Brown T, Summerbell C: Systematic review of school-based interventions that focus on changing dietary intake and physical activity levels to prevent childhood obesity: an update to the obesity guidance produced by the National Institute for Health and Clinical Excellence. Obes Rev 2009, 10:110-141.
• [15]Katz DL: School-based interventions for health promotion and weight control: not just waiting on the world to change. Annu Rev Public Health 2009, 30:253-272.
• [16]Booth M, O'Brodovich H, Finegood D: Addressing Childhood Obesity: The Evidence for Action. [http://publications.gc.ca/pub?id=329477&sl=0] webcite
• [17]Stewart-Brown S: What is the evidence on school health promotion in improving health or preventing disease and, specifically, what is the effectiveness of the health promoting schools approach? [http://www.euro.who.int/__data/assets/pdf_file/0007/74653/E88185.pdf] webcite
• [18]Story M, Kaphingst KM, French S: The role of schools in obesity prevention. The Future of Children 2006, 16:109-142.
• [19]Organization WH: Ottawa charter for health promotion. Can J Public Health 1986, 77:425-430.
• [20]Joint Consortium for School Health: What is Comprehensive School Health? [http://jcsh-cces.ca/index.php?option=com_content&view=article&id=40&Itemid=62] webcite
• [21]CDC: Coordinated School Health. [http://www.cdc.gov/healthyyouth/cshp/] webcite
• [22]Deschesnes M, Martin C, Hill AJ: Comprehensive approaches to school health promotion: how to achieve broader implementation? Health Promot Int 2003, 18:387-396.
• [23]Veugelers PJ, Schwartz ME: Comprehensive school health in Canada. Can J Public Health 2010, 101(Suppl 2):S5-S8.
• [24]Murray NG, Low BJ, Hollis C, Cross AW, Davis SM: Coordinated school health programs and academic achievement: a systematic review of the literature. J Sch Health 2007, 77:589-600.
• [25]Lister-Sharp D, Chapman S, Stewart-Brown S, Sowden A: Health promoting schools and health promotion in schools: two systematic reviews. Health Technol Assessment 1999, 3:1-207.
• [26]Wanjirũ M, Flisher AJ: Evaluations of health promoting schools: a review of nine studies. Health Promot Int 2004, 19:357-368.
• [27]Veugelers PJ, Fitzgerald AL: Effectiveness of school programs in preventing childhood obesity: a multilevel comparison. Am J Public Health 2005, 95:432-435.
• [28]Public Health Agency of Canada: Canadian Best Practices Portal [http://cbpp-pcpe.phac-aspc.gc.ca/] webcite
• [29]Swinburn B, Gill T, Kumanyika S: Obesity prevention: a proposed framework for translating evidence into action. Obes Rev 2005, 6:23-33.
• [30]APPLE Schools: Alberta Project Promoting active Living & healthy Eating (APPLE) Schools. [http://www.appleschools.ca/] webcite
• [31]REAL Kids Alberta: Raising healthy Eating and Active Living Kids in Alberta. [http://www.realkidsalberta.ca/] webcite
• [32]Alberta Education: Student population by grade, school and authority, Alberta 2006/07 school year. [http:/ / education.alberta.ca/ apps/ eireports/ pdf_files/ eis1004_2007/ eis1004_2007.pdf] webcite
• [33]Rockett HRH, Breitenbach M, Frazier AL, Witschi J, Wolf AM, Field AE, Colditz GA: Validation of a youth/adolescent food frequency questionnaire. Prev Med 1997, 26:808-816.
• [34]Rockett HRH, Wolf AM, Colditz GA: Development and reproducibility of a food frequency questionnaire to assess diets of older children and adolescents. J Am Diet Assoc 1995, 95:336-340.
• [35]Government of Canada: The Canadian Nutrient File. [http:/ / www.hc-sc.gc.ca/ fn-an/ nutrition/ fiche-nutri-data/ cnf_aboutus-aproposdenous_fcen-eng. php] webcite
• [36]Kant AK: Indexes of overall diet quality: a review. J Am Diet Assoc 1996, 96:785-791.
• [37]Kim S, Haines PS, Siega-Riz AM, Popkin BM: The Diet Quality Index-International (DQI-I) provides an effective tool for cross-national comparison of diet quality as illustrated by China and the United States. J Nutr 2003, 133:3476-3484.
• [38]Crocker PR, Bailey DA, Faulkner RA, Kowalski KC, McGrath R: Measuring general levels of physical activity: preliminary evidence for the Physical Activity Questionnaire for Older Children. Med Sci Sports Exerc 1997, 29:1344-1349.
• [39]Kowalski KC, Crocker PRE, Faulkner RA: Validation of the physical activity questionnaire for older children. Pediatr Exerc Sci 1997, 9:174-Äì186.
• [40]Cole TJ, Bellizzi MC, Flegal KM, Dietz WH: Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 2000, 320:1240.
• [41]Rao JNK, Scott AJ: The analysis of categorical data from complex sample surveys: Chi-squared tests for goodness of Fit and independence in Two-Way tables. J Am Statist Assoc 1981, 76:221-230.
• [42]Rao JNK, Scott AJ: On Chi-squared tests for multiway contingency tables with cell proportions estimated from survey data. Ann Statist 1984, 12:46-60.
• [43]Willett W: Nutritional Epidemiology. 2nd edition. New York: Oxford University Press; 1998.
• [44]Wang S, Moss JR, Hiller JE: Applicability and transferability of interventions in evidence-based public health. Health Promot Int 2006, 21:76-83.
• [45]Day ME, Strange KS, McKay HA, Naylor PJ: Action schools! BC-Healthy Eating: effects of a whole-school model to modifying eating behaviours of elementary school children. Can J Public Health 2008, 99:328-331.
• [46]Wang MC, Rauzon S, Studer N, Martin AC, Craig L, Merlo C, Fung K, Kursunoglu D, Shannguan M, Crawford P: Exposure to a Comprehensive School Intervention Increases Vegetable Consumption. J Adolesc Health 2010, 47:74-82.
• [47]Kuhle S, Kirk S, Ohinmaa A, Yasui Y, Allen AC, Veugelers PJ: Use and cost of health services among overweight and obese Canadian children. Int J Pediatr Obes 2011, 6(2):142-148.
• [48]Troiano RP, Berrigan D, Dodd KW, Masse LC, Tilert T, McDowell M: Physical activity in the United States measured by accelerometer. Med Sci Sports Exerc 2008, 40:181-188.
• [49]Livingstone MB, Black AE: Markers of the validity of reported energy intake. J Nutr 2003, 133(Suppl 3):895S-920S.