Alberta Project Promoting Active Living and Healthy Eating in Schools (APPLE Schools)

The Effectiveness of a Comprehensive School Health Intervention in Improving Healthy Eating and Physical Activity and Preventing Childhood Obesity

The objectives were to 1) make students eat healthier and be more active; and 2) prevent overweight and obesity. Children will therefore be less likely overweight or obese. Beginning in January 2008, the Alberta Project Promoting active Living and healthy Eating in Schools (APPLE Schools) was implemented in 10 schools throughout the Canadian Province, Alberta. Full-time School Health Facilitators were placed in each of the schools to implement what is know in Canada as Comprehensive School Health (CSH). In the United States, CSH is more commonly referred to as "Coordinated School Health", while the synonymous term "Health Promoting Schools" is often used in Australia and Europe. The project was evaluated annually in the spring from 2008 to 2011 and as of 2009 evaluations included the use of time-stamped pedometers. The comparison group included approximately 150 schools that were randomly selected to reflect the population of Alberta, Canada. Twenty of these randomly selected schools also participated in data collection which involved the use of time-stamped pedometers.

Study Overview

• Status: Completed
• Conditions: Childhood Obesity
• Intervention / Treatment: Other: Comprehensive School Health (CSH)

Detailed Description

The Alberta Project Promoting active Living and healthy Eating in Schools (APPLE Schools) is a quasi-experimental pre-post trial with a non-equivalent parallel control group. The intervention began in January 2008 and lasted through June 2011 and was implemented school-wide. As out primary interest is to reduce the prevalence of overweight and obesity in schools, the essential comparisons were across grade five students in differing calendar years. At each survey all grade five students were invited to participate. The current design allowed intervention effects to be assessed over time at the school-level. Surveys were administered in the spring of 2008, 2009, 2010, and 2011 in intervention schools. And in the spring of 2008 and 2011 in control schools.

• Study Type: Interventional
• Enrollment (Actual): 8663
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Canada
  • Alberta
    • Edmonton, Alberta, Canada, T6G2T4
      • Population Health Intervention Research Unit

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 5 years to 14 years (Child)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

Intervention Schools:

• school located in a socioeconomically disadvantaged neighbourhood and a demonstrated need for health promotion
• Grade five students with parent consent, who also assented to participate were included in annual evaluations

Control Schools:

• Grade five students with parent consent, who also assented to participate were included in annual evaluations

Exclusion Criteria:

Intervention & Control Schools:

• Schools that did not receive jurisdictional approval to participate
• Grade five students who did not receive parent consent or did not provide their assent were not included in annual evaluations

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Comparison Schools; Regular health promotion activities
Experimental: Comprehensive School Health (CSH); Full time School Health Facilitator present in each school on a day-to-day basis for 3.5 years responsible for facilitating implementation of Comprehensive School Health	Other: Comprehensive School Health (CSH); APPLE Schools uses a CSH approach to health promotion which addresses health through four inter-related pillars 1) positive social and physical environments 2) teaching and learning 3) healthy school policy 4) partnerships and services. A key component of the APPLE Schools intervention was the placement of a full-time School Health Facilitator in each school. Their role was to facilitate the development and implementation of the project, to ensure that it met the schools' unique needs for health promotion, and that it aligned with the core principles of CSH.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Overweight and obesity	Students' body weight was measured to the nearest 0.1kg using calibrated digital scales and height was measured to the nearest 0.1cm. BMI was calculated as weight divided by height^2 (kg/m^2). Overweight and obesity were defined using the International Obesity Task Force age and sex specific body mass index (BMI) cut-off points.	24 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
physical activity	Children's physical activity was measured using time-stamped pedometers which were worn for 9 consecutive days. The Physical Activity Questionnaire for Older Children (PAQ-C) was also used to assess children's physical activity levels	24 months
Diet Quality	Students' diet quality was assessed through the use of the Harvard Youth/Adolescent Food Frequency Questionnaire.	24 months

Collaborators and Investigators

• Sponsor: University of Alberta
• Investigators: Principal Investigator: Paul J Veugelers, PhD, University of Alberta

Publications and helpful links

General Publications

• 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 Mar 13;9:27. doi: 10.1186/1479-5868-9-27.
• Bastian KA, Maximova K, McGavock J, Veugelers P. Does School-Based Health Promotion Affect Physical Activity on Weekends? And, Does It Reach Those Students Most in Need of Health Promotion? PLoS One. 2015 Oct 21;10(10):e0137987. doi: 10.1371/journal.pone.0137987. eCollection 2015.
• Vander Ploeg KA, McGavock J, Maximova K, Veugelers PJ. School-based health promotion and physical activity during and after school hours. Pediatrics. 2014 Feb;133(2):e371-8. doi: 10.1542/peds.2013-2383. Epub 2014 Jan 13.
• 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 Jul;112:80-7. doi: 10.1016/j.socscimed.2014.04.032. Epub 2014 Apr 29.
• Dube N, Khan K, Loehr S, Chu Y, Veugelers P. The use of entertainment and communication technologies before sleep could affect sleep and weight status: a population-based study among children. Int J Behav Nutr Phys Act. 2017 Jul 19;14(1):97. doi: 10.1186/s12966-017-0547-2.

Helpful Links

• Related Info

Study record dates

Study Major Dates

• Study Start: January 1, 2008
• Primary Completion (Actual): June 1, 2011
• Study Completion (Actual): June 1, 2011

Study Registration Dates

• First Submitted: July 31, 2013
• First Submitted That Met QC Criteria: July 31, 2013
• First Posted (Estimate): August 2, 2013

Study Record Updates

• Last Update Posted (Actual): March 25, 2020
• Last Update Submitted That Met QC Criteria: March 23, 2020
• Last Verified: July 1, 2013

More Information

Terms related to this study

• Keywords: Health Promotion; Nutrition; Physical activity; Childhood
• Additional Relevant MeSH Terms: Overnutrition; Nutrition Disorders; Overweight; Body Weight; Obesity; Pediatric Obesity
• Other Study ID Numbers: Pro00003800