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The present study aimed to evaluate the effect of the school-based educational intervention “FOODcamp” on dietary habits among 6th–7th graders (aged 11–13 years), focusing on the food groups: fruits and vegetables, fish, meat, discretionary food, and sugar-sweetened beverages. In this cluster-based quasi-experimental controlled intervention study, 16 intervention classes (322 children) and 16 control classes (267 children) from nine schools were recruited during the school year 2019–2020. The children were asked to record their food intake for four consecutive days (Wednesday to Saturday) before (baseline) and after (follow-up) attending FOODcamp, using a validated self-administered web-based dietary record. Eligible dietary intake registrations from 124 and 118 children from the control and interventions classes, respectively, were included in the final statistical analysis. Hierarchical mixed model analysis was used to evaluate the effect of the intervention. No statistically significant effects of participating in FOODcamp were found on the average food intake of the food groups eaten regularly (vegetables, fruit, vegetables/fruit/juice combined, or meat) (p > 0.05). Among the food groups not eaten regularly (fish, discretionary foods, and sugar-sweetened beverages), a non-significant tendency to lower odds of consuming sugar-sweetened beverages from baseline to follow-up (OR = 0.512; 95% CI: 0.261–1.003; p = 0.0510) was seen among FOODcamp participants compared to control participants. In conclusion, this study found no effect of the educational intervention FOODcamp on the dietary intake of vegetables, fruit, vegetable/fruit/juice combined, meat, fish, or sugar-sweetened beverages. The intake frequency of sugar-sweetened beverages tended to decrease among FOODcamp participants.

Strategies are needed to improve the dietary habits of children. The aim of the present study was to evaluate the effect of implementing a school food programme on the dietary quality of lunches consumed by school children aged 7-13 years compared with packed lunches brought from home. A secondary objective was to investigate if a possible effect would differ between the younger children and the older. A quasi-experimental study design with four intervention schools and four matched control schools was conducted. In total, 984 school children participated. Data on packed lunches were collected at baseline. At the 1st follow-up the children in the intervention schools were offered free school meals and at the 2nd follow-up children paid for their school meals. The control group had packed lunches at all measurements. A digital photographic method combined with a Meal Index of dietary Quality (Meal IQ) was used for dietary assessment. Multilevel modelling was employed for data analyses. The quality of dietary intake was improved when free school meals were offered (P = 0·004); if the school meals were paid for the use was limited and no difference in change in dietary quality was found (P = 0·343). The school food programme had no difference in effect according to age (P = 0·083). In conclusion, offering a free school meal had a positive effect on dietary quality of the lunches consumed by school children aged 7-13 years. No effect was measured when the school meals were not provided for free. The dietary effect did not depend on age.

Healthy food and meal habits can help promote and maintain good health throughout life. Only few 4-18-year-olds follow official Danish dietary recommendations, leaving room for improvement, notably among 13-18-year-old adolescents and children and adolescents of parents with short-term education. Specific focus areas for all families with children may help limit intake of sugary foods and beverages on weekends. Promotion of healthy food and meal habits among children and adolescents call for a comprehensive and well-coordinated approach with participation of main stakeholders in the field.

Strategies are needed to improve the dietary habits of children. The aim of the present study was to evaluate the effect of implementing a school food programme on the dietary quality of lunches consumed by school children aged 7-13 years compared with packed lunches brought from home. A secondary objective was to investigate if a possible effect would differ between the younger children and the older. A quasi-experimental study design with four intervention schools and four matched control schools was conducted. In total, 984 school children participated. Data on packed lunches were collected at baseline. At the 1st follow-up the children in the intervention schools were offered free school meals and at the 2nd follow-up children paid for their school meals. The control group had packed lunches at all measurements. A digital photographic method combined with a Meal Index of dietary Quality (Meal IQ) was used for dietary assessment. Multilevel modelling was employed for data analyses. The quality of dietary intake was improved when free school meals were offered (P = 0·004); if the school meals were paid for the use was limited and no difference in change in dietary quality was found (P = 0·343). The school food programme had no difference in effect according to age (P = 0·083). In conclusion, offering a free school meal had a positive effect on dietary quality of the lunches consumed by school children aged 7-13 years. No effect was measured when the school meals were not provided for free. The dietary effect did not depend on age.

Strategies to improve health behaviour and well-being of children are needed. A multicomponent intervention “We Act – together for health” was developed with the aim to improve the dietary habits, physical activity, well-being and social capital among school children aged 10-12 years by increasing their health competences and promoting a healthy school environment. This paper describes the theoretical frame for the project, the development of the We Act intervention and the design and methods used in the efficacy study. We Act builds upon the health promoting school approach and the IVAC model. The intervention included three components: 1) An educational component compromising: a) Lunch meal habits integrated into science and Danish (“IEAT”), and physical activity integrated into maths (“IMOVE”); b) Vision workshop integrated primarily in Danish, and; c) Action and Change process at class and school level. 2) A school component including a workshop to develop teachers’ competencies, and 3) A parental component: including homepage, an APP, a Facebook-group and a handout produced by their child. A quasi-experimental study with 4 intervention schools and 4 matched control schools was conducted. In total 656 school children participated. The intervention was carried out in between the baseline and follow up measurements and a process evaluation was carried out to study implementation fidelity. Dietary intake during the school day was measured using a digital photographic method, pedometers registered physical activity, and an electronic questionnaire was used to assess well-being and social capital among the pupils. We Act will provide new knowledge on the implementation and effectiveness of a multicomponent school based intervention targeting school children, teachers, school management and parents to promote dietary habits, physical activity, and well-being among school children. An important part of the evaluation will be to sum up the various intervention component

Social capital has been found to be positively associated with various health and well-being outcomes amongst children. Less is known about how social capital may be generated and specifically in relation to children in the school setting. Drawing on the social cohesion approach and the democratic health educational methodology IVAC (Investigation - Vision - Action - Change) the aim of this study was to examine the effect of the Health Promoting School intervention 'We Act - Together for Health' on children's cognitive social capital. A quasi-experimental controlled pre- and post-intervention study design was conducted with 548 participants (mean age 11.7 years). Cognitive social capital was measured as: horizontal social capital (trust and support in pupils); vertical social capital (trust and support in teachers); and a sense of belonging in the school using questions derived from the Health Behaviour in School Children study. A series of multilevel ordinal logistic regression analyses was performed for each outcome to estimate the effect of the intervention. The analyses showed no overall significant effect from the intervention on horizontal social capital or vertical social capital at the six-month follow-up. A negative effect was found on the sense of belonging in the school. Gender and grade appeared to be important for horizontal social capital, while grade was important for sense of belonging in the school. The results are discussed in relation to We Act's implementation process, our conceptual framework and methodological issues and can be used to direct future research in the field. The study finds that child participation in health education can affect the children's sense of belonging in the school, though without sufficient management support, this may have a negative effect. With low implementation fidelity regarding the Action and Change dimension of the intervention at both the school and class level, and with measurement issues regarding the concep

Background: Strategies to improve health behavior and wellbeing of Danish children are needed. A multicomponent intervention “WeAct – together for health” was developed to improve the dietary habits, physical activity and wellbeing among school children aged 10-12 years by increasing their health competences and promoting a healthy school environment. This paper describes the development and evaluation of the intervention guided by theory and adjustment to real life setting. Methods: The intervention builds upon the health promoting school approach and the IVAC model. The settings are the school and the family. Three educational components targeted the school: 1) Lunch meal habits integrated into science and Danish (“IEAT”) and physical activity integrated into maths (“IMOVE”), 2) Vision workshop integrated primarily into Danish, and 3) the Action and Change process at class and school level. Teachers participated in a course to develop competencies regarding the holistic health concept, active involvement of school children and the IVAC approach. Components developed for parental support included a homepage, an APP, a Facebook-group and a handout produced by their child. A quasi-experimental study design with 4 intervention schools and 4 matched control schools was conducted. In total 658 school children participated. The baseline data were collected in October/November 2015 and the follow-up in May/June 2016 with the intervention in between the measurements. The quality of dietary intake during the school day was measured using a digital photographic method, physical activity was registered by pedometers and an electronic questionnaire was used to assess wellbeing among the pupils. A process evaluation was done. Results and conclusion: The recruitment of schools for the full health promoting school process was demanding due to the context of the school reform and the present pressure on schools. In total 27 municipalities and 256 schools were contact

Introduction: Research has suggested various school health policy models aimed at promoting children’s health through policy processes. The models present some overall phases in the process, but also different barriers calling for more in-depth qualitative studies (1). With education as the school’s prime objective, barriers potentially prevail if models do not consider the existing structures of the school. As part of the on-going project - Healthy Kids -, this presentation introduces a school health policy model, developed as an ‘add-in’ to the school curriculum and organisational practices. Methods The presented model works at two levels - the classroom and the organizational level – and is based on four phases, namely: Investigation – Vision – Action – Change, viewed as an iterative process. Pupil perspectives and learning is the basis in all four phases based on a set of health education programmes. Simultaneously a staff health team is formed from existing organisational structures, integrating local knowledge and building support for school policy making based on the pupils’ visions. A pilot study - applying the model in one Danish elementary school - has been conducted as an action research process, combined with interviews and participatory observation with teachers, school nurses, and the pupils, with the purpose of exploring the applicability and value of the model. Hereafter the model will be tested at four interventions schools based on qualitative studies. Results Pupils enjoyed having a voice in school matters and to deal with real life during health education. Teachers were very positive towards the integration of school health policy work into teaching the curriculum in Danish, Maths and Biology. However, the transferring from the classroom to the organizational levels was weakhindering sustainable health changes. Conclusion Findings indicate that integrating school policy processes into the teaching of

BACKGROUND: It is a challenge to assess children's dietary intake. The digital photographic method (DPM) may be an objective method that can overcome some of these challenges.OBJECTIVE: The aim of this study was to evaluate the validity and reliability of a DPM to assess the quality of dietary intake from school lunch sandwiches brought from home among children aged 7-13 years.DESIGN: School lunch sandwiches (n=191) were prepared to represent randomly selected school lunch sandwiches from a large database. All components were weighed to provide an objective measure of the composition. The lunches were photographed using a standardised DPM. From the digital images, the dietary components were estimated by a trained image analyst using weights or household measures and the dietary quality was assessed using a validated Meal Index of Dietary Quality (Meal IQ). The dietary components and the Meal IQ obtained from the digital images were validated against the objective weighed foods of the school lunch sandwiches. To determine interrater reliability, the digital images were evaluated by a second image analyst.RESULTS: Correlation coefficients between the DPM and the weighed foods ranged from 0.89 to 0.97. The proportion of meals classified in the same or an adjacent quartile ranged from 98% (starch) to 100% (fruits, vegetables, fish, whole grain, and Meal IQ). There was no statistical difference between fish, fat, starch, whole grains, and Meal IQ using the two methods. Differences were found for fruits and vegetables; Bland-Altman analyses showed a tendency to underestimate high amounts of these variables using the DPM. For interrater reliability, kappa statistics ranged from 0.59 to 0.82 across the dietary components and Meal IQ.CONCLUSIONS: The standardised DPM is a valid and reliable method for assessing the dietary quality of school lunch sandwiches brought from home.

Background: It is a challenge to assess children’s dietary intake. The digital photographic method (DPM) may be an objective method that can overcome some of these challenges. Objective: The aim of this study was to evaluate the validity and reliability of a DPM to assess the quality of dietary intake from school lunch sandwiches brought from home among children aged 7-13 years. Design: School lunch sandwiches (n=191) were prepared to represent randomly selected school lunch sandwiches from a large database. All components were weighed to provide an objective measure of the composition. The lunches were photographed using a standardised DPM. From the digital images, the dietary components were estimated by a trained image analyst using weights or household measures and the dietary quality was assessed using a validated Meal Index of Dietary Quality (Meal IQ). The dietary components and the Meal IQ obtained from the digital images were validated against the objective weighed foods of the school lunch sandwiches. To determine interrater reliability, the digital images were evaluated by a second image analyst. Results: Correlation coefficients between the DPM and the weighed foods ranged from 0.89 to 0.97. The proportion of meals classified in the same or an adjacent quartile ranged from 98% (starch) to 100% (fruits, vegetables, fish, whole grain, and Meal IQ). There was no statistical difference between fish, fat, starch, whole grains, and Meal IQ using the two methods. Differences were found for fruits and vegetables; BlandAltman analyses showed a tendency to underestimate high amounts of these variables using the DPM. For interrater reliability, kappa statistics ranged from 0.59 to 0.82 across the dietary components and Meal IQ. Conclusions: The standardised DPM is a valid and reliable method for assessing the dietary quality of school lunch sandwiches brought from home.

OBJECTIVE: School lunch programmes are one strategy to promote healthier dietary habits in children, but better evaluation tools for assessing the dietary quality of such programmes are needed. The aim of the present study was to develop and validate a simple index to assess the dietary quality of school lunches for children aged 7-13 years.DESIGN: A Meal Index of dietary Quality (Meal IQ) was developed to consist of seven components (nutrients and food groups) based on dietary issues for children aged 7-13 years, which were identified in a national dietary survey. The Meal IQ was validated against calculated nutrient contents of school lunches both provided by the school and brought from home.SETTING: At eight public schools from all over Denmark, data were collected on 191 individual lunches brought from home (which is most common in Denmark) and thirty-one lunches provided as part of a school food programme. In addition thirty-two lunches provided at eighteen other public schools were included.SUBJECTS: A total of 254 school lunches.RESULTS: A higher Meal IQ score was associated with a higher overall dietary quality, including lower contents of fat, saturated fat and added sugars, higher contents of fibre, various vitamins and minerals, and more fruits, vegetables and fish.CONCLUSIONS: The Meal IQ is a valid and useful evaluation tool for assessing the dietary quality of lunches provided by schools or brought to school from home.

Objective: To explore motivation and perceived barriers towards weight loss among Danish men. Design: The study was of an explorative nature, using qualitative focus group interviews as a method. Setting: Copenhagen, Denmark. Subjects: Twenty-two overweight men, at the age of 25-44 years and motivated for weight loss, were recruited and distributed into four focus groups. The men were primarily unskilled workers. Overall 13 men participated and each group contained three or four participants. Intervention: The interview guide was partly structured, partly unstructured and the themes of the interviews were motives and perceived barriers towards weight loss. Results: Main barriers for losing weight appeared to be lack of motivation and the perception of the slimming diet. The men had a desire to have a lean appearance and avoid illness, but in all the interviews it appeared that the strongest motive for losing weight was a strong desire to become more effective and a greater asset for one's workplace. Overweight subjects were considered less effective and attractive for the labour market. Conclusion: This study indicates that if men from lower socioeconomic backgrounds are to be motivated to weight loss the focus should not be on leanness and good health but rather on increased effectiveness and performance, and the arena should include the working place. Sponsorship: The Royal Veterinary and Agricultural University supplied the necessary equipment and conference rooms.