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The study’s purpose was to evaluate an intervention to reduce fruit and vegetable food neophobia and influence attitudes and behaviors among children using a four-month, non-experimental, before-and-after intervention. Participants were children aged 5–11 years in an intervention school (IS) and a control school (CS). Children were offered fruit or vegetable samples weekly utilizing school-specific psychosocial and educational practices to encourage participation. The outcomes of interest included attitudes measured using a written survey-based food neophobia scale (FNS), behavioral observations, and an oral survey. The post-intervention IS FNS score was significantly lower compared to pre-intervention (p = 0.04). Repeated-measures ANOVA revealed a statistically significant overall effect of time (p = 0.006). School type-time interaction was not significant (p = 0.57). Pre-intervention observational data showed the proportions finishing and taking another fruit and vegetable sample were higher in the CS (p &lt, 0.001 for both). Post-intervention, the proportions taking the vegetable (p = 0.007) and the fruit (p &lt, 0.001) were higher in the IS. The percentage tasting the vegetable was higher in the CS (p = 0.009). Offering samples of produce in school lunchrooms may reduce food neophobia. This intervention is an inexpensive program that volunteers can quickly implement.

Ensuring the sustainability of school-based public health intervention activities remains a challenge. The Young and Active (Y&amp, A) intervention used peer-led workshops to promote movement and strengthen students’ sense of community in 16 Danish high schools. Peer mentors inspired first-year students to implement movement activities. To support sustainability, we applied a three-year stepwise implementation strategy using university students as peer mentors in year 1 and senior high school students in the following two years. This study explores the sustainability potential of Y&amp, A, focusing on school coordinators’ reflections on the intervention’s fit to their schools and the student-driven approach, and we assess the three-step implementation strategy. The study is based on telephone interviews with coordinators (n = 7) from schools that participated in all three years and participant observations of four workshops (a total of approximately 250 participating students). Results were generated through an abductive analysis. Seven schools continued the intervention throughout the three years and adapted it to fit their priorities. The student-driven approach was perceived to be valuable, but few student-driven activities were initiated. Teacher support seemed crucial to support students in starting up activities and acting as peer mentors in workshops. The three-step implementation strategy proved valuable due to the peer-approach and the possibility of gradual adaptation. In future similar initiatives, it is important to address how the adequate staff support of students can be facilitated.

This pilot study used accelerometers to investigate the effectiveness of a multiple recess school intervention on physical activity patterns in younger elementary children using a post-test only with nonequivalent groups design. First and second grade students (N = 157) participating in a larger study, the LiiNK Project&reg, (Let&rsquo, s inspire innovation &lsquo, N Kids), wore accelerometers for the duration of the school day for two weeks to measure physical activity intensity and number of steps taken daily. Students attended either an intervention school (N = 90), participating in four 15-min unstructured, outdoor recesses and one 15-min character development lesson daily, or a control school (N = 67), participating in two 15-min unstructured, outdoor recesses daily and no character development program. The intervention students, grades 1 and 2, took more steps (p &lt, 0.001) and time spent in moderate (p &lt, 0.001) and vigorous (p &lt, 0.001) physical activity (MVPA) than the control school students. Intervention students averaged approximately 900 more steps per day than the control school students. These results show young children given 60 min of recess daily continue to increase physical activity patterns over those with 30 min of recess daily. Next steps are to evaluate if children demonstrate healthier body fat levels as a result of these higher patterns of MVPA daily.

Background: Parental involvement is one of the important factors in pupils’ academic achievement. Aim: The study sought to assess whether an intervention to enhance the interaction of parents with Grade 4 learners (aged 10–15 years) in homework would improve the learners performance in Chitonga and Mathematics. Setting: This study was conducted with two rural primary schools in the Kalomo District of Southern Province, Zambia. Methods: The participants were Grade 4 learners and their parents. A total of 168 participants were enlisted (84 learners and 84 parents). Elementary tests in Mathematics and Chitonga, the quality of parent–child interaction in homework, the quality and frequency of parent–school communication in homework, and the use of home resources in the instruction of children to increase Chitonga and Mathematics skills were assessed. One school served as a control while the other was the target of intervention. Parents in the intervention group received a 10-week programme of sensitisation on how to support their children in homework using available local resources and on parent–child interactions. Questionnaires and interviews were sent to collect data from parents while tests in Mathematics and Chitonga, systematically developed by the national regulatory body, were set to assess the learners’ performance. Results: Post-test scores of learners in Mathematics and Chitonga in the intervention school were significantly higher, in addition to increased parent–child interaction and the use of home resources in instruction. Conclusion: The authors conclude that interventions which empower parents with knowledge and skills for greater involvement in their children’s homework can be effective in improving the learners’ performance.

The aim of this pilot study was to assess whether the installation of ultraviolet radiation (UVR) meters in secondary schools has the potential to improve adolescents&rsquo, sun protection-related knowledge, attitudes, and behaviours and reduce their exposure to UVR during school hours. Data were collected from students at two schools via online pre- and post-intervention surveys, measurement of sunscreen usage, polysulfone UVR exposure badges, and photographs of the schoolyards to assess hat and shade use. Several operational issues limited the quantity and quality of data that could be collected, and findings were mixed. While there were no significant changes in either self-reported or observed sun protection behaviours, there were significant improvements in UVR knowledge among students at the intervention school, and reactions to the meter were highly favourable. Students reported consulting the meter regularly and using it to make decisions about their sun protection behaviours. Overall, the study results offer some support for the use of UVR meters in areas frequented by adolescents and provide insights into the process issues that are likely to need to be addressed when attempting to trial sun protection interventions in schools.

Objective Sports activities is broadly utilized to support well-being of youth after a disaster or conflict. However, scientific validation of programs have not been conducted. The Mastery Approach to Coaching (MAC) is a coaching-education program on sports activities. The MAC reported to have a positive effect on youngsters’ self-esteem. As self-esteem is generally known to be beneficial for mental status, we tested the effect of a MAC program on students’ self-esteem in a disaster-affected area: Leyte, Philippines. We recruited 10th grade students from three schools; one school was allocated to the MAC intervention and the two schools to the control group. All schools were encouraged to involve students in volleyball from January to February 2015. In January 2015, MAC workshop was conducted in the intervention school before the sports activity. Results A total of 293 students completed the questionnaires. The intervention school (n = 51) showed a significant change in self-esteem, with the mean score increasing from 20.2 to 21.1 (p = 0.02). Neither school in the control group showed the significant change. The result showed the feasibility and a positive effect of sports activity with the MAC. However, further investigation should be conducted. Trial registration UMIN Clinical Trials Registry ID: UMIN000033197 on June 30th 2018. Retrospectively registered

Objective: A school tobacco policy (STP) commonly is used to reduce smoking among adoles-cents, but the effectiveness of such programs is unclear. We evaluated the impact of an STP on tobacco use in 4 schools. Methods: The study included 4 intervention and 4 control schools, located in the inner city of Stockholm, Sweden. Schools self-selected for assignment to either an intervention program or a comparison group. In total, the study was comprised of 2671 students in grades 9 and 11, ages 15 to 18, and 1998 students (75%) responded to the questionnaire. We used a repeated cross-sectional design with assessment of tobacco use prevalence before im-plementation of the STP in 2016 and after 2 years under the program, in 2018. Results: Two years after the STP, the intervention school in grade 9 showed a lower prevalence (13.5% vs 1.6%) in the proportion of students who reported smoking (χ2 = 4.54; p < .05) whereas the proportion reporting snus use was practically unchanged. We found no statistically significant impact of the STP for grade 11. Conclusions: The results are promising with regard to smoking, when the STP is implemented in early adolescence. (Less)

Objective Compare the effectiveness of community-based HPV-related education and onsite school-based vaccination versus community-based education only for increasing HPV vaccine uptake in a rural, medically underserved area. Methods Our cohort included 2307 Rio Grande City Consolidated Independent School District (RGCISD) middle school students from 3 schools enrolled in August 2016 and followed until April 2018. Using a quasi-experimental design, this study implemented an onsite school-based vaccination program and physician-led education on HPV and HPV vaccines for parents/guardians, school nurses/staff, and pediatric/family providers in the surrounding community (15-mile radius of RGCCISD) at 1 middle school (“intervention school”), and education-only for the remaining 2 schools (“comparison schools”). The Centers for Disease Control and Prevention's HPV-related educational materials supplemented the education. HPV vaccine status was obtained from school immunization records and the project's contracted vaccine vendor. HPV vaccine initiation and completion rates were compared pre and post intervention and between the intervention and comparison schools. Logistic regression was used to compare the odds of newly initiating/completing vaccination between the intervention and comparison schools. Results At baseline, the intervention school had lower HPV vaccine initiation and completion rates than the comparison schools (20.00% and 8.70% vs 28.97% and 14.56%). Post intervention, the intervention school had higher initiation and completion rates than the comparison schools (53.67% and 28.36% vs 41.56% and 20.53%). Students from the intervention school were over 3.6-times more likely to newly initiate/complete the HPV vaccinations than students from the comparison schools. Conclusion The school with on-site vaccination events and community-based education had a higher adolescent HPV vaccination rate compared to schools that received community-based education only., Highlights • Our study implemented the first school-based vaccination program in a rural, medically underserved area in Texas. • School-based vaccinations and community education increased the HPV vaccination rate at a greater rate than education only. • Our work demonstrates that middle schools provide feasible and effective settings for increasing HPV vaccination rates.

Background: Modern-day technology is appealing to children. Few studies, however, have conducted longitudinal analyses of a school-based exergaming program&rsquo, s effect on physical activity (PA) behaviors and fitness in children. Therefore, this study examined the longitudinal effect of an 8-month school-based exergaming intervention on children&rsquo, s objectively-measured PA and cardiorespiratory fitness (CRF). Materials and Methods: Eighty-one fourth grade students (X̅age = 9.23 &plusmn, 0.62, 39 girls, 54.3% African American, 30.9% Non-Hispanic White, 14.8% other) participated in this study from 2014&ndash, 2015. The intervention school&rsquo, s children participated in a once-weekly 50-minute exergaming intervention during recess throughout the school year, while the control school continued regular recess. Children&rsquo, s in-school PA and sedentary behavior (SB) were measured with ActiGraphGT3X+ accelerometers, with CRF assessed via the half-mile run. All measurements were taken at baseline, mid-intervention (four months) and post-intervention (eight months). Repeated-measures two-way ANCOVAs using age and race as covariates were conducted to examine between-school differences over time for SB, light PA (LPA), moderate-to-vigorous PA (MVPA), and CRF. Results: Significant time by group interactions were observed for LPA, F(1, 79) = 7.82, &eta, 2 = 0.09, p &lt, 0.01, and MVPA, F(1, 79) = 4.58, &eta, 2 = 0.06, p &lt, 0.05, as LPA increased among the control group, while MVPA increased among intervention group. Children in both groups experienced decreased SB during the intervention (intervention: &minus, 7.63 minutes, control: &minus, 17.59 minutes), but demonstrated lower CRF over time (intervention: +46.73 seconds, control: +61.60 seconds). Conclusions: Observations suggested that school-based exergaming implementation may be effective in increasing children&rsquo, s MVPA and decreasing their SB over the course an academic year (i.e., ~eight months). More research is needed, however, to discern how modifications to school-based exergaming might also promote improved CRF in children.

The present study adopted a quasi-experimental mixed method approach to investigate the influence of an improved school ground on children’s academic performance. In total, 123 children from two (intervention and control) primary schools in Bangladesh participated. In the intervention school, a barren school ground was redesigned with several behavior settings (e.g., gardens and amphitheater) for teaching and learning. Treatment group children ( n = 29) received math and science classes outdoors, while a comparison group ( n = 32) received usual indoor classes. A control school with no changes to the outdoor environment was included ( n = 62). The redesigned school ground was associated with higher levels of academic attainment. Furthermore, all intervention schoolchildren perceived more opportunities to explore in the redesigned school ground. Qualitative insights suggest the diverse settings provided more opportunities to explore, experiment, and work collaboratively. These results highlight the potential for school ground design to contribute to improvement of children’s academic attainment in developing countries.

Purpose– The purpose of this paper is to examine the effectiveness of a holistic school-based nutrition programme using the health-promoting school (HPS) approach, on teachers’ knowledge, attitudes and behaviour in relation to nutrition in rural China.Design/methodology/approach– A cluster-randomised intervention trial design was employed. Two middle schools were randomly selected and assigned to either the intervention school using the HPS framework (HPS School), or to the Control School, in Miyun County, Beijing. From each school 20 teachers were randomly selected to complete the survey. Nutrition-related knowledge, attitudes and behaviour were measured at pre- and post-intervention surveys with the same instrument. The nutrition intervention last for six months.Findings– The holistic school-based nutrition programme using the HPS framework had no statistical impact on improving teacher’s knowledge, attitudes and behaviour in relation to nutrition (p> 0.05).Practical implications– Future holistic school-based nutrition programmes targeting adolescents should also design and implement longer and more intensive interventions for teachers focusing on how to equip them with the awareness and ability to disseminate their knowledge, positive attitudes and role model behaviours to students, rather than on how to teach them basic knowledge and skills.Originality/value– Although teachers play a critical role in the HPS framework, there is very limited published research investigating the change in teachers’ nutrition-related knowledge, attitudes and behaviour as a result of a nutrition promotion programme.

Objectives: To evaluate the effectiveness of a one-year teaching intervention to increase moderate to vigorous physical activity (MVPA) during primary school physical education (PE). Methods: A quasi-experimental, non-equivalent group design involving four classes from two primary schools in the West Midlands, UK. In March 2014 schools were selected through purposive sampling to match schools in terms of size and demographics (baseline, n = 111: post-intervention, n = 95); data were collected from children in school years 3 and 4 (aged 7 to 9 years). The intervention involved developing teacher effectiveness through the SHARP Principles Model which was grounded in the Self Determination Theory (SDT), the Social Ecological Model (SEM) and three key ingredients from the Behaviour Change Taxonomy (BCT). MVPA was assessed at baseline and four weeks post-intervention using the System for Observing Fitness and Instruction Time (SOFIT). Four individual teacher interviews were conducted with the intervention school, to explore teachers' perceptions of the intervention. Results: A two-way ANOVA (Analysis of Variance) indicated large interaction effect sizes for time spent in MVPA (F(1, 27) = 11.07, p = 0.003, ηp2 = .316) and vigorous activity (VPA) (F = (1,27) = 8.557, p = .007, ηp2 = .263). PA in the intervention school increased significantly whereas in the control school MVPA remained relatively constant and VPA decreased. The qualitative findings revealed two main emergent themes: a paradigm shift and teacher's developing pedagogy. Conclusions: The intervention was effective in increasing MVPA in PE. Recommendations based on this evaluation would be for the SHARP Principles Model to be replicated and evaluated on a wider scale across a variety of contexts., Highlights • We designed and evaluated a primary PE teaching strategy intervention. • The intervention yielded a large effect size, and increased children's MVPA by 30%. • The SHARP Principles Model re-directed the school's approach to primary PE. • Qualitative data suggested a paradigm shift in the teacher's thinking towards PE. • Mixed methods assisted in understanding the effectiveness of the intervention.

Objective: Use a school-based food garden as an instrument to improve healthy dietary consumption, habits, and practices among children from the third to fifth grade in public schools in Chile. Design: Quasi-experimental, six-month intervention with an evaluation of dietary consumption, habits, and practices and use of the school-based food garden among the 3rd to 5th grade students. Setting: Two municipal schools in a low-middle income district in Santiago de Chile; one with a school garden intervention and a control school without a garden. Subjects: 155 third to fifth grade children, 63 in the intervention school and 92 in the control school (average age 10 years old, 58% boys). Results: In the intervened school, there was a significant improvement in the children’s dietary habits, such as peeling and slicing fruit (p Conclusions: The school-based food garden was effective in achieving change in dietary habits and practices among the third to fifth grade children. The project should be carried out for a longer period of time, so that the changes will be reflected in the students’ food consumption and nutritional status.

Infectious diseases are common among schoolchildren as a result of their poor hand hygiene, especially in those who have developmental disabilities.A quasi-experimental study using a pre- to post-test design with a control group was used to test the feasibility and sustainability of simplified 5-step handwashing techniques to measure the hand hygiene outcome for students with mild intellectual disability. Sickness-related school absenteeism was compared.The intervention group experienced a significant increase in the rating of their handwashing quality in both hands from pre- to post-test: left dorsum (+1.05, P .001); right dorsum (+1.00, P .001); left palm (+0.98, P .001); and right palm (+1.09, P .001). The pre- to post-test difference in the intervention group (+1.03, P .001) was significantly greater than the difference in the control group (+0.34, P = .001). There were no differences between the post-test and the sustainability assessment in the intervention group. The intervention school experienced a significantly lower absenteeism rate (0.0167) than the control group in the same year (0.028, P = .04).Students in this study showed better performance in simplified handwashing techniques and experienced lower absenteeism than those using usual practice in special education school settings.The simplified 5-step hand hygiene technique has been proven effective in reducing the spread of infectious diseases.

Our purpose for this quasi-experimental study was to evaluate the short-term and maintenance effects of the self-regulated strategy development writing instructional model by Graham and Harris with 7th-grade students in an urban, ethnically diverse Title I middle school. We compared the writing skills of our intervention students with those of students in a control school. For 5 weeks, we coached teachers at the intervention school in a strategy for persuasive writing. Teachers at the control school also taught persuasive writing but used traditional instruction. We used a pre/posttest design to measure short-term growth, and we collected a maintenance writing score 2 months after the intervention. We used gain scores from pretest to posttest and from posttest to maintenance in a hierarchical linear modeling analysis. We found no differences between the 2 groups from pretest to posttest; however, scores between posttest and maintenance showed that the self-regulated strategy development students scored si...

Aim: This study assessed whether a Swedish school-based exercise intervention programme could increase total physical activity. Methods: We followed up 228 children who started school in 1998-2000 seven years later, when they had reached a mean age of 14.8. The 152 children (59% boys) at the intervention school did 200 minutes of physical education per week during that period, and the 76 children (50% boys) in the three control schools did the standard 60 minutes. Questionnaires assessed the durations of total and leisure-time physical activity and screen-time activity at baseline and after five and seven years. Results: Physical activity and screen-time activity were similar between the two groups before the study started. The intervention group then achieved higher durations of total physical activity than the controls (p < 0.001) and these levels remained in the sex-specific evaluations. There were no differences between the groups in the durations of leisure-time activity (p 0.08-0.77) or screen-time activity (p 0.31-0.91). Conclusion: A school-based exercise intervention programme increased the total duration of physical activity in both sexes without any compensatory increase in screen-time activity. The findings contradict the activity-stat theory, which stated that the duration of physical activity in children is constant. (Less)

The purpose of this study was to explore the physical activity patterns and emotional states differences among elementary school students at two private schools with differently structured school days. Students at one school received the LiiNK Project® pilot intervention, which included an additional two 15-minute recess breaks (unstructured outdoor play) throughout the school day and a 15-minute character development lesson three to four times weekly. Students at the comparison school received only one 30-minute recess daily and no additional character development curriculum. Grades K-2 children from two schools (N=262) wore pedometers for one school week and were observed for emotional expressions during recess. A univariate ANOVA revealed that intervention school students took significantly more steps on average than comparison school students, F(1, 260)=0.784, p, {"references":["Centers for Disease Control and Prevention. School health policies and practices study: 2014 Overview. Atlanta, GA: U.S. HHS 2015.","Tremblay MS, LeBlanc AG, Kho ME, Saunders TJ, Larouche R, Colley RC, et al. Systematic review of sedentary behaviour and health indicators in school-aged children and youth. Int J Behav Nutr Phys Act 2011; 8(98): 1-22. https://doi.org/10.1186/1479-5868-8-98","Olshansky SJ, Passaro DJ, Hershow RC, Layden J, Carnes BA, Broday J, et al. A potential decline in life expectancy in the United States in the 21st century. N Engl J Med 2005; 352(11): 1138-45."]}

Purpose Misuse and/or lack of booster seat use are often associated with high rates of injury and death among school-aged children. This pilot study examined the efficacy and the potential effectiveness of a booster seat intervention in the classroom. Methods Two elementary schools participated (randomly assigned as one intervention school and one control school). At the intervention school, a certified car seat specialist and a police officer held an interactive booster seat session. The height and age for each child were recorded. Children received a certificate indicating whether they met the requirements for booster seat use and a postcard with car seat restraint specifications. Children in the control school received a brochure on car seat safety. Pre- and post-intervention self-reports were collected and booster seat use was observed. Results Observational findings showed a decline in booster seat use at the control school and an increase in use at the intervention school. Self-reports of booster seat use indicated a decline at both schools; however, cell sizes were too small to permit statistical analyses. Conclusion Anecdotally researchers found the sessions were easy to conduct and were well received by the children and could be easily integrated into programming in schools. Classroom sessions may have the potential to positively influence booster seat use among 6- to 8-year-olds.

BackgroundMany children do not meet physical activity (PA) guidelines. One strategy that may enhance PA is to increase active transport to school (ATS) rates.PurposeTo assess the effects of an ATS intervention.MethodsA quasi-experimental design was used to compare ATS and vehicle traffic rates at a school that participated in a statewide event (Nevada Moves Day [NMD]) with those of a control school. Schools were matched on enrollment, ethnicity, socioeconomic status, and neighborhood street patterns. Data collection occurred one week before, on NMD, and one week later. Children using ATS and motor vehicles were counted by university students.ResultsPre-intervention ATS rates were statistically similar at the intervention (10.3%) and control schools (7.8%; P>.05). On the NMD, ATS increased to 17.9% at the intervention school and was 7.0% (P

We assessed whether supplying soap to primary schools on a regular basis increased pupil hand washing and decreased Escherichia coli hand contamination. Multiple rounds of structured observations of hand washing events after latrine use were conducted in 60 Kenyan schools, and hand rinse samples were collected one time in a subset of schools. The proportion of pupils observed practicing hand washing with soap (HWWS) events was significantly higher in schools that received a soap provision intervention (32%) and schools that received soap and latrine cleaning materials (38%) compared with controls (3%). Girls and boys had similar hand washing rates. There were non-significant reductions in E. coli contamination among intervention school pupils compared with controls. Removing the barrier of soap procurement can significantly increase availability of soap and hand washing among pupils; however, we discuss limitations in the enabling policy and institutional environment that may have prevented reaching desired levels of HWWS.

Background: Primary schools are increasingly used as arenas for public health initiatives. The aim of this study was to assess a primary school-based food intervention. Methods: The intervention comprised timetabled kitchen classroom sessions (90 min, fortnightly). Pupils prepared and cooked food, which they then ate together. Children's relationship with food, including food enjoyment, experience and food neophobia, were addressed at the intervention school (baseline n = 154; follow-up n = 164) and at a matched control school (baseline n = 171; follow-up n = 174). Results: Pupils at the intervention school scored significantly higher (M = 3.90, SD = 1.81) for scores on Kitchen Equipment, compared to the control school (M = 3.06, SD = 2.12); and again scored significantly higher (M = 9.34, SD = 3.79) for the overall Cooking Experience Score compared to the control school (M = 7.98, SD = 4.57). Shifts accompanying the intervention in three outcome measures for pupils (taste description, liking for cooking and helping with cooking at home) were also revealed. No main intervention effect for food neophobia and fussiness was found; a close to significant time by intervention interaction (P = 0.053) was evident. Conclusions: The study indicates limited but encouraging changes, and contributes to the growing literature regarding school-based food initiatives.

Summary Background: Schools provide a prime environment for interventions that attempt to increase physical activity and prevent obesity. Objective: This study examined the effect of a 30-min, structured recess using 22 games of known energy expenditure on moderate-to-vigorous physical activity when compared to free play implemented with third graders from two elementary schools over 9 weeks. Methods: Moderate-to-vigorous physical activity and other cardiovascular risk factors were assessed pre- and post-intervention in 27 children. Results: Moderate-to-vigorous physical activity during recess increased significantly in intervention school children from 6.9 0.8 to 14.9 0.9 min pre- and post-intervention, respectively (adjusted mean change 8.0 1.1; P < 0.0001), with no differences by gender or body mass index (BMI). In-school, moderate-tovigorous physical activity also increased significantly more for intervention compared to control children (adjusted mean change 14 4 min vs. 3 3 min; P = 0.014, respectively). Conclusion: There was no significant difference in BMI and cardiovascular risk factors. A structured recess is feasible to implement and can significantly increase moderate-to-vigorous physical activity.

The aim of the study was to determine the effectiveness of a school-initiated cognitive and behavioral program to reduce childhood obesity. Height, weight, body mass index (BMI), and BMI z scores were obtained at the beginning and end of the school year at an intervention school (n = 1022) and at a control school (n = 692). The prevalence of overweight and obesity was 18.9% and 30.4% versus 19% and 30.2%, respectively, in the intervention and control schools. The incidence of overweight increased in the control school, but the incidence of obesity, weight, and BMI z scores increased significantly in the intervention school, suggesting that implementation of any school-based obesity intervention programs requires careful planning to achieve goals.

Background Elementary schools represent both a source of childhood sun exposure and a setting for educational interventions. Methods Sun Protection of Florida's Children was a cluster randomized trial promoting hat use at (primary outcome) and outside of schools among fourth-grade students during August 8, 2006, through May 22, 2007. Twenty-two schools were randomly assigned to the intervention (1115 students) or control group (1376 students). Intervention schools received classroom sessions targeting sun protection attitudes and social norms. Each student attending an intervention school received two free wide-brimmed hats. Hat use at school was measured by direct observation and hat use outside of school was measured by self-report. A subgroup of 378 students (178 in the intervention group and 200 in the control group) underwent serial measurements of skin pigmentation to explore potential physiological effects of the intervention. Generalized linear mixed models were used to evaluate the intervention effect by accounting for the cluster randomized trial design. All P values were two-sided and were claimed as statistically significant at a level of .05. Results The percentage of students observed wearing hats at control schools remained essentially unchanged during the school year (baseline = 2%, fall = 0%, and spring = 1 %) but increased statistically significantly at intervention schools (baseline = 2%, fall = 30%, and spring = 41%) (P < .001 for intervention effect comparing the change in rate of hat use over time at intervention vs control schools). Self-reported use of hats outside of school did not change statistically significantly during the study (control: baseline = 14%, fall = 14%, and spring = 11%; intervention: baseline = 24%, fall = 24%, and spring = 23%) nor did measures of skin pigmentation. Conclusions The intervention increased use of hats among fourth-grade students at school but had no effect on self-reported wide-brimmed hat use outside of school or on measures of skin pigmentation.

This study evaluated a physical activity intervention for children that comprised peer-modelling, pedometer step goals and tangible rewards. A version of the intervention without the reward component was also tested. Participants (n = 386) were from three primary schools, which were randomly assigned to one of three conditions: (i) full intervention, where children received "Fit 'n' Fun Dude" peer-modelling materials and were given daily pedometer goals to receive rewards, (ii) no-rewards intervention, where children received peer-modelling materials and pedometer goals but rewards were not used and (iii) control, where children wore pedometers with no further intervention. Physical activity was measured at baseline, intervention and at the end of a 14-week 'taper' phase. During the intervention, the full intervention school showed the largest increase in physical activity relative to baseline (+2456 steps per day, p < 0.001). There was a smaller increase in the no-rewards school (+1033 steps per day, p < 0.03), and no significant change in the control. At the end of the taper phase, physical activity in the no-rewards school continued to increase (+2030 steps per day, p < 0.001) but had returned to baseline in the full intervention school. The intervention that used only peer-modelling and pedometer goals produced better effects over time.

Low fruit and vegetable intake may be associated with overweight. The United States Department of Agriculture implemented the Fresh Fruit and Vegetable Program in 2006-2007. One Houston-area high school was selected and received funding to provide baskets of fresh fruits and vegetables daily for each classroom during this period. This study assessed the impact of the program on students' fruit and vegetable intake. At program end (May 2007), fruit and vegetable intake surveys were distributed to students at the intervention school as well as at a comparison high school that did not receive the program. Surveys, which were completed anonymously, were received from 34% of intervention and 42% of comparison school students. The students were classified as to whether they met the recommended daily intake of fruit, 100% fruit juice, and vegetables. The probability of meeting the recommendations was assessed with logistic regression analyses, controlling for sex, age, and ethnicity. Compared with the comparison control school students, intervention school students were more likely to report eating fruit and drinking 100% fruit juice at least two times per day (39.3% vs 27.3%; P

Low fruit and vegetable (FV) intakes are associated with excess body weight. The United States Department of Agriculture sponsors a Free Fruit and Vegetable Program in schools whereby students receive free FV snacks daily. This study assessed whether the program improved student exposure to and preferences for FV in a Houston high school in 2006-2007. Anonymous, post-intervention only FV exposure and preference surveys were completed by 2000 intervention school students and 1600 students in a comparison school during May, 2007. Differences in FV exposure and preferences were assessed, as well as differences in preferences between those students who tasted the item for the first time at school compared to those who had tasted the item before. The comparison school average scores for prior FV exposure and vegetable preferences were significantly higher than the intervention school scores. Intervention school students who had tasted the item previously reported significantly higher preferences than students who had tasted it for the first time at school. Access to the Free Fruit and Vegetable Program did not appear to improve high school student reported FV exposure and preferences. Future research should investigate the connection between food exposure, preferences and consumption in adolescents.

Longitudinal studies have been conducted to evaluate correlates of stage of change movement among adult smokers but no studies were found to be conducted among adolescent smokers. This study used longitudinal data to examine adolescents' abstinence self-efficacy over 10-week and six-month periods and determined whether stage transitions were associated with concomitant changes or baseline values in perceived abstinence self-efficacy, nicotine dependence and motivation to quit. From baseline to 10-weeks results showed a change in motivation to quit and baseline stage were significantly associated with stage progression and regression. Additionally, intervention school status was significantly associated with stage progression. On the other hand, baseline score for nicotine dependence predicted stage regression not progression. Adolescents' becoming more or less 'ready' to quit smoking are influenced by their nicotine dependence and motivation to quit.

In looking for new strategies to promote physical activity (PA), the purpose of this study was to determine whether providing equipment, playground markings, and a physical education (PE)-based intervention effectively increases PA levels during school recess. A total of 223 children (mean age = 7.10 years ± 0.6; 45.3% female) from three schools participated in this study in 2012. In the first intervention school (G1; n = 75) six previous PE classes teaching games for recess were performed and playground markings and game equipment were provided. In the second intervention school (G2; n = 68) only playground markings and game equipment were provided. The third school served as the control group (GC; n = 80). PA was assessed with pedometers. The increase in mean steps after intervention in G2 was higher than the G1 and GC ( P < 0.001). No differences between G1 and GC were observed at post-intervention ( P = 0.05). The effects did not vary by gender or BMI. Providing game equipment and playground marks may increase children PA in recess. Nevertheless, additional PE-based intervention did not imply an improvement, and was not effective in increasing PA. Normal 0 21 false false false ES X-NONE X-NONE

The process of a life skills-based nutrition education program and impact on upper grade students in elementary schools were evaluated with regard to their knowledge, attitude, behavior while eating snacks and breakfast, and self-esteem. The subjects for this study were students from two elementary schools in Osaka prefecture. The students in the intervention school participated in a nutrition education program between the second trimester of the fifth grade and the first trimester of the sixth grade that focused on eating healthier snacks and eating breakfast every day. Questionnaires were completed by the students in the intervention and control schools before and after the program. A total of 160 students (88 in the intervention school and 72 in the control school) participated in the survey. A chi-square test, t-test, McNemar test, and Wilcoxon signed-ranks test were used to examine the effects of the program. The statistical significance level was 0.05.Although the teachers could implement well the program for eating healthier snacks, they pointed out the need to reexamine the process and worksheets of the program for eating breakfast. The overall program had a positive effect on nutritional and behavioral knowledge and on the self-control of students in selecting healthy snacks. However, it did not change to the expected extent the intake of oily snacks, attitude and behavior toward eating breakfast, and self-esteem. These results suggest that the program should be revised to improve life skills including decision-making and goal-setting abilities among elementary school students, and to strengthen the relationship between schools and families.

Objective To use the Analysis Grid for Environments Linked to Obesity (ANGELO) framework to determine the barriers and promoters of healthy eating and physical activity in children aged 5-12 years, as a basis for the development of a pilot community-based programme for preventing obesity in children (APPLE project: A Pilot Programme for Lifestyle and Exercise). Methods Semi-structured interviews were held with nine community stakeholders including doctors, school staff and food outlet operators. This information was used to develop a telephone-administered questionnaire to 101 parents of children in the intervention communities. Finally, structured interviews were undertaken with intervention school principals (n=4) regarding the school environment pertaining to physical activity and healthy eating. Results Major barriers to physical activity identified included lack of facilities, coaches and equipment. Work commitments prevented 40 per cent of parents being physically active with their children. Shared transport would increase opportunities for activity. Socio-cultural influences included family support for sport, lack of initiative to instigate activities and preference for more sedentary options; 70 per cent of parents thought their child preferred TV or computers over sport/games. Cost prevented one-third of children being involved in activity and 45 per cent of parents buying healthier foods. Political barriers to healthy eating included the absence of parental rules regarding purchasing less healthy food options, using treat foods to coerce children to behave and the lack of fruit and vegetable advertising. Over two-thirds of parents thought banning particular foods would have a positive effect on eating habits. One third of parents said their children didn’t like healthy foods and 25 per cent thought it did not matter what their child ate as long as they were growing properly. Conclusions The ANGELO framework used in this assessment identified potential environmental barriers to healthy eating and physical activity in children and provides the basis for an obesity prevention programme in youngsters aged 5-12 years.

Evidence for adverse effects of screen media exposure has led to recommendations to limit children's screen time. This paper describes a randomized controlled trial of SMART (Student Media Awareness to Reduce Television), an 18-lesson, theory-based classroom curriculum to reduce screen time among third and fourth grade children in two matched public elementary schools (n = 181). Intervention school children significantly reduced their weekday television viewing and weekday and Saturday video game playing compared to controls. Greater effects were found among boys and more adult-supervised children. Mothers, fathers, and siblings and other children in intervention school households also reduced their television viewing. The findings demonstrate the efficacy of a classroom intervention to reduce screen time among elementary school children and their family/household members.

Back pain in adolescence is an increasingly common problem. The objective of this study was to assess the effects of a change in seating position for students suffering from back pain. Volunteer students between the ages of 16 and 18 years were recruited from two schools. Students completed pain diaries on a twice daily basis. After the first week, the intervention school students were given a high density foam wedge to use on normal school chairs. In total, 48 students took part in the study: 26 in the control and 22 in the intervention school. Use of the wedge was associated with a significant reduction in both intensity and frequency of back pain recorded in the intervention school (P

Objectives To determine if intervention school students who received skills-based breast self-exam (BSE)/testicular self-exam (TSE) training were more likely than control school students to report higher intentions to perform BSE/TSE, greater BSE/TSE self-efficacy, and actual performance of BSE/TSE. Methods BSE/TSE behaviors, intentions, and self-efficacy were assessed in a high school-based trial (N = 6 schools; 3 schools randomized/condition) using self-reported data at 3 time points (N = 1058, 9 th grade students). Results At follow-up, intervention students had greater BSE/TSE intentions and self-efficacy than control students. Intervention students were more likely than control students to report monthly BSE (54.8% vs 27.2%, p = .031) and TSE (81.5% vs 31.4%, p = .010). Conclusions Skills-based interventions with goal setting affect teenagers' self-examination behaviors, intentions, and self-efficacy. Teaching self-screening may empower teenagers to become more engaged in their preventive health, which may lead to improved health as they age.

To investigate changes in student food selection and consumption in response to the new National School Lunch Program meal patterns during fall 2011.Eight elementary and four intermediate schools in one Houston area school district were matched on free/reduced-price meal eligibility and randomized into control or intervention conditions.Both intervention and control school cafeterias served the same menu. The intervention school cafeterias posted the new meal pattern daily; students could select one fruit and two vegetable servings per reimbursable meal. Control school students could only select the previous meal pattern: a total of two fruit and vegetable servings per meal.Students were observed during lunch: student sex and foods selected/consumed were recorded. Diet analysis software was used to calculate energy/food groups selected/consumed.Cochran-Mantel-Haenszel χ² tests examined differences in the percent of students selecting each meal component by condition, controlling for sex, grade, and school free/reduced-price meal eligibility. Analysis of covariance assessed differences in amount of energy/food groups selected and consumed, and differences in percent of food groups consumed.Observations were conducted for 1,149 elementary and 427 intermediate students. Compared with students in the control schools, significantly more intervention elementary and intermediate school students selected total (P0.001, P0.05) and starchy vegetables (P0.001, P0.01); more intervention intermediate school students selected fruit (P0.001), legumes (P0.05), and protein foods (P0.01). There were significantly greater amounts of these foods selected and consumed, but no differences in the proportion of the foods consumed by condition. Fewer calories were consumed by elementary and intermediate school intervention students.More intervention students selected fruit and vegetables at lunch and consumed them compared with control condition students. Future studies with larger and more diverse student populations are warranted.

Adolescents do not consume the recommended daily amount of whole fruit. As part of the effort to improve the dietary choices of adolescents, traditional nutrition education alone has not been successful. School cafeterias are a strategic place to focus efforts to promote positive behavior change at the site of students’ food selection and consumption. Garden-based sustainability programs correlate with the state-mandated science standards taught in the middle school classroom and have been effective at increasing fruit consumption in children. This study measured the effect of a vermicomposting model on whole fruit consumption in the middle school lunch room. Students were introduced to the concept of vermicomposting in the classroom through a lesson plan. Students were invited to participate in the vermicomposting process by contributing their fruit scraps to a worm bin that was placed in the school cafeteria for the duration of the study. A significant increase in familiarity with the topic of vermicomposting was observed after implementation of the lesson plan. Compared to baseline, the control school experienced an overall increase in fully consumed and partially consumed fruit, while the intervention school experienced a simultaneous decrease in consumption. No significant changes in fruit selection were observed.

El principal objetivo de este trabajo se ha centrado en poner de relieve cómo los distintos contextos o escenarios en los que se desarrolla la vida del niño de seis a doce años (familia, escuela y comunidad próxima), pueden contribuir a su educación para la salud y en concreto, a la formación en él de estilos de vida saludables. El segundo objetivo ha sido sensibilizar a futuros educadores (maestros de educación primaria en segundo curso de formación) sobre la importancia de la educación para la salud, e incrementar su conocimiento sobre los estilos de vida de sus futuros alumnos, así como sobre formas de intervención de la escuela en este sentido, en colaboración con las familias y la comunidad. Para conseguir estos dos grandes objetivos se ha realizado una actualización conceptual en la primera parte del trabajo y una aproximación empírica en la segunda, mediante la recogida de datos sobre los estilos de vida de diez niños/as de seis a doce años y la reflexión, en el contexto de clases interactivas, sobre características de los mismos y de la intervención de diversos agentes educativos.http://dx.doi.org/10.15304/ie.24.2047

Background An emerging public health strategy is to enhance children’s opportunities to be physically active during school break periods. The aim of this study was to evaluate the effects of the Lunchtime Enjoyment Activity and Play (LEAP) school playground intervention on primary school children’s quality of life (QOL), enjoyment and participation in physical activity (PA). Methods This study consisted of a movable/recycled materials intervention that included baseline, a 7-week post-test and an 8-month follow-up data collection phase. Children within an intervention school (n = 123) and a matched control school (n = 152) aged 5-to-12-years-old were recruited for the study. Children’s PA was measured using a combination of pedometers and direct observation (SOPLAY). Quality of life, enjoyment of PA and enjoyment of lunchtime activities were assessed in the 8-12year children. A multi-level mixed effect linear regression model was applied in STATA (version 12.0) using thextmixedcommand to fit linear mixed models to each of the variables to examine whether there was a significant difference (p  Results Significant overall interaction effects (group × time) were identified for children’s mean steps and distance (pedometers) in the intervention school compared to the control school. Intervention school children also spent significantly higher proportions within specified target areas engaged in higher PA intensities in comparison to the control school at both the 7-week post-test and 8-month follow-up. A short-term treatment effect was revealed after 7-weeks for children’s physical health scale QOL, enjoyment of PA and enjoyment of intra-personal play activities. Conclusions Examining the effects of this school playground intervention over a school year suggested that the introduction of movable/recycled materials can have a significant, positive long-term intervention effect on children’s PA. The implications from this simple, low-cost intervention provide impetus for schools to consider introducing the concept of a movable/recycled materials intervention on a wider scale within primary school settings. Trial registration Australian and New Zealand Clinical Trials Registration Number:ACTRN12613001155785.

Previous attempts to reduce the effects of television advertising on children's purchase requests have had little success. Therefore, we tested the effects of a classroom intervention to reduce television, videotape, and video game use on children's toy purchase requests, in a school-based randomized controlled trial. Third- and fourth-grade children (mean age, 8.9 years) in two sociodemographically and scholastically matched public elementary schools were eligible to participate. Children in one randomly selected elementary school received an 18-lesson, 6-month classroom curriculum to reduce television, videotape, and video game use. In both schools, in September (before intervention) and April (after intervention) of a single school year, children and parents reported children's prior week's purchase requests for toys seen on television. After intervention, children in the intervention school were significantly less likely to report toy purchase requests than children in the control school, with adjusting for baseline purchase requests, gender, and age (odds ratio, 0.29; 95% confidence interval, 0.12-0.69). Among intervention school children, reductions in self-reported purchase requests were also associated with reductions in television viewing. There was no significant difference between schools in parent reports of children's requests for toy purchases. These findings suggest that reducing television viewing is a promising approach to reducing the influences of advertising on children's behavior.

This article describes some of the approaches used and challenges encountered conducting nutrition education research in junior high schools. The Teens Eating for Energy and Nutrition at School (TEENS) study recruited 16 schools and over 3800 seventh graders to participate in an intervention to increase students' intakes of fruits, vegetables, and lower fat foods for the purpose of reducing their future risk of cancer. The TEENS intervention included a classroom curriculum as well as a school environment and family component. This article describes some of the issues faced in the design and implementation of the study including recruiting schools and teens, maximizing the number of students within each intervention school exposed to all components of the intervention, and implementing elements of nutrition education in a classroom setting. The methods used to meet these challenges and the success of the methods attempted are described.

Preventing children's thermal injuries requires changes to both the home environment and the behaviour of family members. Two pilot studies were undertaken of a school-based programme that taught children aged 7-11 years about burns and scalds hazards, and encouraged changes to the home environment and family practices through a take-home exercise. Both studies took place at ethnically diverse schools from low/middle-income areas of Waitakere City, New Zealand. Study 1 involved 55 children who received the programme, and Study 2 involved 64 children who received the programme and 71 children from a control school. The children's ability to identify the burns and scalds hazards illustrated in a series of pictures was measured before and after the programme. Children who received the programme showed considerable improvement in hazard identification at the post-test, while children at the control school showed minimal improvement. The take-home exercise was completed by 85% of the children and their families in Study 1, and 61% of the participants from the intervention school in Study 2. In both studies families reported positive safety changes as a result of the programme. The programme appeared equally effective with all the ethnic groups involved. Future development of the programme is discussed.

Objective The purpose of this pilot study was to examine the effectiveness of two interventions on children's physical activity during the 20-min school break. Methods Children from three schools participated in this study. In the first intervention school ( n = 89) the school's courts were allocated to different children on alternate days of the week, playground markings were painted in the school's yard and jump ropes were provided. In the second intervention school ( n = 89) the school's courts were just allocated to different children on alternate days of the week. The third school served as the control group ( n = 69). Physical activity was measured with a pedometer during the 20-min break (09:05–09:25) and during the after school period (13:05 till bed time). Data were collected in Cyprus, between January/April of 2007. Results A significant time by group interaction indicated a change in break-time activity. Four weeks after the intervention, mean steps in the first (1427 ± 499) and second (1331 ± 651) intervention schools were significantly higher than steps in the control school (1053 ± 447). Non-significant increases were observed in the after-school activity of children in the intervention schools. Conclusions Implementing simple, low-cost interventions during break periods could help increase children's activity.