Top

Published in:

Open Access 01-12-2018 | Research article

Long-term effects of comprehensive school health on health-related knowledge, attitudes, self-efficacy, health behaviours and weight status of adolescents

Authors: Nicole Naadu Ofosu, John Paul Ekwaru, Kerry Ann Bastian, Sarah A. Loehr, Kate Storey, John C. Spence, Paul J. Veugelers

Published in: BMC Public Health | Issue 1/2018

Abstract

Background

APPLE Schools is a Comprehensive School Health (CSH) project, started in schools in socioeconomically disadvantaged areas where dietary habits are poor, physical activity (PA) levels are low, and obesity rates are high. Earlier research showed program effects whereby energy intake, PA and weight status of students in APPLE Schools had reached similar levels as that of students in other schools. However, it is unknown whether the effects of CSH are sustained when children grow into adolescents. Effects of APPLE Schools on health-related knowledge, attitudes, self-efficacy, diet, PA, and weight status, seven years after the start of the project, when students were in junior high and high school were assessed. We hypothesised that APPLE School graduates and comparison school graduates will remain at similar levels for these indicators.

Methods

In the 2015/16 school year, junior high and high school graduates (grades 7–12) in Northern Alberta, Canada participated in a Youth Health Survey. Participants included graduates from APPLE elementary schools (n = 202) and comparison elementary schools (n = 338). Health-related knowledge, attitudes, self-efficacy, diet (24-h dietary recall), PA (pedometer step count) and weight status were assessed. Mixed effects regression was employed to assess differences in these outcomes between APPLE School graduates and comparison school graduates. Comparisons between elementary school (2008/09) and junior high/high school (2015/16) of self-efficacy, PA and weight status were also conducted.

Results

APPLE School graduates did not significantly differ from comparison school graduates on any outcomes (i.e. knowledge, attitudes, self-efficacy, diet, PA, and weight status). Additionally, no significant differences existed in the comparisons between 2008/09 and 2015/16.

Conclusion

Our findings of no difference between the APPLE School graduates and comparison school graduates suggest that the effects of APPLE Schools may continue into adolescence or the new school environment may have an equalizing effect on the students. Since lifestyle practices are adopted throughout childhood and adolescence, and the school environment has an important influence on development, an extension of CSH initiatives into junior high/high schools should be considered. This will help to consolidate and support the continuance of healthy lifestyle messages and practices throughout childhood and adolescence.

Choudhry S, McClinton-Powell L, Solomon M, Davis D, Lipton R, Darukhanavala A, Steenes A, Selvaraj K, Gielissen K, Love L, et al. Power-up: a collaborative after-school program to prevent obesity in African American children. Prog Community Health Partnersh. 2011;5(4):363–73.PubMedCentralPubMed

Foster GD, Sherman S, Borradaile KE, Grundy KM, Vander Veur SS, Nachmani J, Karpyn A, Kumanyika S, Shults J. A policy-based school intervention to prevent overweight and obesity. Pediatrics. 2008;121(4):e794–802. https://doi.org/10.1542/peds.2007-1365.CrossRefPubMed

Lobstein T, Baur L, Uauy R, TaskForce IIO. Obesity in children and young people: a crisis in public health. Obes Rev. 2004;5(Suppl 1):4–104. https://doi.org/10.1111/j.1467-789X.2004.00133.x.CrossRefPubMed

Veugelers PJ, Fitzgerald AL. Effectiveness of school programs in preventing childhood obesity: A multilevel comparison. Am J Public Health. 2005;95(3):432–5. https://doi.org/10.2105/Ajph.2004.045898.CrossRefPubMedCentralPubMed

Faught EL, Ekwaru JP, Gleddie D, Storey KE, Asbridge M, Veugelers PJ. The combined impact of diet, physical activity, sleep and screen time on academic achievement: a prospective study of elementary school students in Nova Scotia, Canada. Int J Behav Nutr Phys Act. 2017;14(1):29. https://doi.org/10.1186/s12966-017-0476-0.CrossRefPubMedCentralPubMed

Joint Consortium for School Health. Internet: http://www.jcsh-cces.ca/index.php/about/comprehensive-school-health (Accessed 13 June 2016).

Veugelers PJ, Schwartz ME. Comprehensive School Health in Canada; 2010. p. S5.

Rose G. Sick individuals and sick populations. Int J Epidemiol. 2001;30(3):427–32. https://doi.org/10.1093/ije/30.3.427.CrossRefPubMed

Alberta Project Promoting active Living and healthy Eating. APPLE Schools 2016:2.

10.

Fung C, Kuhle S, Lu C, Purcell M, Schwartz M, Storey K, Veugelers PJ. From “best practice” to “next practice”: the effectiveness of school-based health promotion in improving healthy eating and physical activity and preventing childhood obesity. Int J Behav Nutr Phys Act. 2012;9:27.CrossRefPubMedCentralPubMed

11.

Vander Ploeg KA, Maximova K, McGavock J, Davis W, Veugelers P. Do school-based physical activity interventions increase or reduce inequalities in health? Soc Sci Med. 2014;112:80–7. https://doi.org/10.1016/j.socscimed.2014.04.032.CrossRefPubMed

12.

Vander Ploeg KA, McGavock J, Maximova K, Veugelers PJ. School-based health promotion and physical activity during and after school hours. Pediatrics. 2014;133(2):E371–E8. https://doi.org/10.1542/peds.2013-2383. CrossRefPubMed

13.

Lai SK, Costigan SA, Morgan PJ, Lubans DR, Stodden DF, Salmon J, Barnett LM. Do School-based interventions focusing on physical activity, fitness, or fundamental movement skill competency produce a sustained impact in these outcomes in children and adolescents? A systematic review of follow-up studies. Sports Med. 2014;44(1):67–79. https://doi.org/10.1007/s40279-013-0099-9.CrossRefPubMed

14.

Tarro L, Llaurado E, Morina D, Sola R, Giralt M. Follow-up of a healthy lifestyle education program (the Educacio en Alimentacio study): 2 years after cessation of intervention. J Adolescent Health. 2014;55(6):782–9. https://doi.org/10.1016/j.jadohealth.2014.06.020.CrossRef

15.

DiStefano C, Zhu M, Mindrila D. Understanding and Using Factor Scores: Considerations for the Applied Researcher. Practical Assessment, Research & Evaluation. 2009;14(20):2.

16.

Hanning RM. The web-based food behaviour questionnaire (Fbq): a valid and popular approach to school-based dietary assessment in Canada. Ann Nutr Metab. 2009;55:342.

17.

Hanning RM, Royall D, Toews JE, Blashill L, Wegener J, Driezen P. Web-based food behaviour questionnaire: validation with grades six to eight students. Can J Diet Pract Res. 2009;70(4):172–8. https://doi.org/10.3148/70.4.2009.172.CrossRefPubMed

18.

PeaceWorks Technology Solutions P. Internet: https://peaceworks.ca/web-q (accessed 30 June 2016).

19.

Storey KE, McCargar LJ. Reliability and validity of web-SPAN, a web-based method for assessing weight status, diet and physical activity in youth. J Hum Nutr Diet. 2012;25(1):59–68. https://doi.org/10.1111/j.1365-277X.2011.01181.x.CrossRefPubMed

20.

Health Canada H. December 21, 2015. Internet: http://www.hc-sc.gc.ca/fn-an/nutrition/fiche-nutri-data/cnf_aboutus-aproposdenous_fcen-eng.php (accessed Sept 30 2016).

21.

Crouter SE, Schneider PL, Karabulut M, Bassett DR, Jr. Validity of 10 electronic pedometers for measuring steps, distance, and energy cost. Med Sci Sports Exerc 2003;35(8):1455–1460. doi: https://doi.org/10.1249/01.MSS.0000078932.61440.A2.

22.

Tudor-Locke C, Williams JE, Reis JP, Pluto D. Utility of pedometers for assessing physical activity: convergent validity. Sports Med. 2002;32(12):795–808.CrossRefPubMed

23.

Cole TJ, Lobstein T. Extended international (IOTF) body mass index cut-offs for thinness, overweight and obesity. Pediatr Obes. 2012;7(4):284–94. https://doi.org/10.1111/j.2047-6310.2012.000064.x. CrossRefPubMed

24.

StataCorp. Stata/IC 14.0 for Mac. College Station, TX, USA. StataCorp LP, 2011, 2015:Stata Statistical Software: Release 12.

25.

Collings PJ, Wijndaele K, Corder K, Westgate K, Ridgway CL, Sharp SJ, Dunn V, Goodyer I, Ekelund U, Brage S. Magnitude and determinants of change in objectively-measured physical activity, sedentary time and sleep duration from ages 15 to 17.5y in UK adolescents: the ROOTS study. Int J Behav Nutr Phys Act. 2015;12:61. https://doi.org/10.1186/s12966-015-0222-4.CrossRefPubMedCentralPubMed

26.

Corder K, Sharp SJ, Atkin AJ, Griffin SJ, Jones AP, Ekelund U, van Sluijs EM. Change in objectively measured physical activity during the transition to adolescence. Br J Sports Med. 2015;49(11):730–6. https://doi.org/10.1136/bjsports-2013-093190.CrossRefPubMed

27.

Matton L, Thomis M, Wijndaele K, Duvigneaud N, Beunen G, Claessens AL, Vanreusel B, Philippaerts R, Lefevre J. Tracking of physical fitness and physical activity from youth to adulthood in females. Med Sci Sports Exerc. 2006;38(6):1114–20. https://doi.org/10.1249/01.mss.0000222840.58767.40.CrossRefPubMed

28.

Malina RM. Adherence to physical activity from childhood to adulthood: a perspective from tracking studies. Quest. 2001;53(3):346–55.CrossRef

29.

Milanovic Z, Pantelic S, Trajkovic N, Sporis G, Kostic R, James N. Age-related decrease in physical activity and functional fitness among elderly men and women. Clin Interv Aging. 2013;8 https://doi.org/10.2147/Cia.S44112.

30.

Tuna HD, Edeer AO, Malkoc M, Aksakoglu G. Effect of age and physical activity level on functional fitness in older adults. Eur Rev Aging Phys A. 2009;6(2):99–106. https://doi.org/10.1007/s11556-009-0051-z.CrossRef

31.

Kelder SH, Perry CL, Klepp KI, Lytle LL. Longitudinal Tracking of Adolescent Smoking, Physical-Activity, and Food Choice Behaviors. Am J Public Health. 1994;84(7):1121–6. https://doi.org/10.2105/Ajph.84.7.1121.CrossRefPubMedCentralPubMed

32.

Viner RM, Ozer EM, Denny S, Marmot M, Resnick M, Fatusi A. Currie C. Adolescent Health 2: Adolescence and the social determinants of health. Lancet. 2012;379(9826):1641–52. https://doi.org/10.1016/S0140-6736(12)60149-4.CrossRefPubMed

33.

Lake A, Townshend T. Obesogenic environments: exploring the built and food environments. J R Soc Promo Health. 2006;126(6):262–7. https://doi.org/10.1177/1466424006070487.CrossRef

34.

Lister-Sharp D, Chapman S, Stewart-Brown S, Sowden A. Health promoting schools and health promotion in schools: two systematic reviews. Health Technol Assess. 1999;3(22):1–207.PubMed

35.

Morton KL, Atkin AJ, Corder K, Suhrcke M, van Sluijs EM. The school environment and adolescent physical activity and sedentary behaviour: a mixed-studies systematic review. Obes Rev. 2016;17(2):142–58. https://doi.org/10.1111/obr.12352.CrossRefPubMed

36.

Nader PR, Stone EJ, Lytle LA, Perry CL, Osganian SK, Kelder S, Webber LS, Elder JP, Montgomery D, Feldman HA, et al. Three-year maintenance of improved diet and physical activity - the CATCH cohort. Arch Pediat Adol Med. 1999;153(7):695–704.CrossRef

37.

Meyer U, Schindler C, Zahner L, Ernst D, Hebestreit H, van Mechelen W, Brunner-La Rocca HP, Probst-Hensch N, Puder JJ, Kriemler S. Long-term effect of a school-based physical activity program (KISS) on fitness and adiposity in children: a cluster-randomized controlled trial. PLoS One. 2014;9(2):e87929. https://doi.org/10.1371/journal.pone.0087929.CrossRefPubMedCentralPubMed

38.

Dobbins M, Husson H, Dc K, LaRocca RL. School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18. Cochrane Database of Syst Rev. 2013;2:1361–6137.

39.

Langford R, Bonell C, Jones H, Pouliou T, Murphy S, Waters E, Komro K, Gibbs L, Magnus D, Campbell R. The World Health Organization's health promoting schools framework: a Cochrane systematic review and meta-analysis. BMC Public Health. 2015;15:130. https://doi.org/10.1186/s12889-015-1360-y.CrossRefPubMedCentralPubMed

40.

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? Health Evidence Network report. Copenhagen: WHO Regional Office for Europe; 2006.

Title: Long-term effects of comprehensive school health on health-related knowledge, attitudes, self-efficacy, health behaviours and weight status of adolescents
Authors: Nicole Naadu Ofosu
John Paul Ekwaru
Kerry Ann Bastian
Sarah A. Loehr
Kate Storey
John C. Spence
Paul J. Veugelers
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Public Health / Issue 1/2018
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/s12889-018-5427-4

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Long-term effects of comprehensive school health on health-related knowledge, attitudes, self-efficacy, health behaviours and weight status of adolescents

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2018

Liquor licences issued to Australian schools

Assessing the social climate of physical (in)activity in Canada

Community influences on modern contraceptive use among young women in low and middle-income countries: a cross-sectional multi-country analysis

Dairy product consumption and risk of hip fracture: a systematic review and meta-analysis

Washing with hope: evidence of improved handwashing among children in South Africa from a pilot study of a novel soap technology

Do supportive family behaviors promote diabetes self-management in resource limited urban settings? A cross sectional study