Effect of a Multicomponent Intervention on Lifestyle Factors among Brazilian Adolescents from Low Human Development Index Areas: A Cluster-Randomized Controlled Trial

Valter Cordeiro Barbosa Filho, Alexsandra da Silva Bandeira, Giseli Minatto, Jair Gomes Linard, Jaqueline Aragoni da Silva, Rafael Martins da Costa, Sofia Wolker Manta, Soraya Anita Mendes de Sá, Thiago Sousa Matias, Kelly Samara da Silva, Valter Cordeiro Barbosa Filho, Alexsandra da Silva Bandeira, Giseli Minatto, Jair Gomes Linard, Jaqueline Aragoni da Silva, Rafael Martins da Costa, Sofia Wolker Manta, Soraya Anita Mendes de Sá, Thiago Sousa Matias, Kelly Samara da Silva

Abstract

Promoting healthy lifestyle factors (e.g., physical activity, healthy eating, less screen time) among young people is a relevant and challenging step toward reducing non-communicable diseases. This study aimed to evaluate the effect of a multicomponent intervention on lifestyle factors among adolescents from schools in low Human Development Index (HDI < 0.500) areas. The Fortaleça sua Saúde program was conducted with 548 adolescents aged 11⁻18 years old in the intervention group and 537 in the control group. The four-month intervention included strategies focused on training teachers, new opportunities for physical activity in the school environment, and health education strategies for the school community (including parents). Moderate- to-vigorous physical activity level (≥420 min/week), TV watching and computer use/gaming (<2 h/day), daily consumption of fruit juice, fruit, vegetables, soft drinks, savory foods and sweets, and current alcohol and tobacco use were measured before and after intervention. McNemar's test and logistic regression (odds ratio [OR] and a 95% confidence interval [95% CI]) were used, considering p < 0.05. In the intervention schools, a significant increase occurred in the number of adolescents who met physical activity guidelines (5.3%; 95% CI = 0.8; 9.8) and who reported using computer for <2 h a day (8.6%; 95% CI = 3.8; 13.4) after intervention. No changes were observed in the control schools. At the end of the intervention, adolescents from intervention schools were more likely to practice physical activity at recommended levels (OR = 1.44; 95% CI = 1.00; 2.08) than adolescents from control schools. No significant change was observed for the other lifestyle factors. In conclusion, this multicomponent intervention was effective in promoting physical activity among adolescents from vulnerable areas. However, other lifestyle factors showed no significant change after intervention. This study is registered at Clinicaltrials.gov NCT02439827.

Keywords: childhood behaviors; chronic disease; social vulnerability.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Logistic Regression (Odds Ratio and 95% Confidence Interval) of Intervention Group Adolescents (vs. Control Group Adolescents) Adopting Healthy Lifestyle Factors after Follow-up of the Fortaleça sua Saúde Program, 2014. Note: MVPA: moderate-to-vigorous physical activity. Logistic regression adjusted by gender, age, socioeconomic status and lifestyle factor at baseline and clustering by school.

References

    1. World Health Organization . Noncommunicable Diseases Progress Monitor 2017. World Health Organization; Geneva, Switzerland: 2017.
    1. Ding D., Rogers K., van der Ploeg H., Stamatakis E., Bauman A.E. Traditional and Emerging Lifestyle Risk Behaviors and All-Cause Mortality in Middle-Aged and Older Adults: Evidence from a Large Population-Based Australian Cohort. PLoS Med. 2015;12:e1001917. doi: 10.1371/journal.pmed.1001917.
    1. World Health Organization . World Health Statistics 2017: Monitoring Health for the Sustainable Development Goals SDGs. World Health Organization; Geneva, Switzerland: 2017.
    1. Organisation mondiale de la santé . Global Status Report on Noncommunicable Diseases 2014: Attaining the Nine Global Noncommunicable Diseases Targets; a Shared Responsibility. World Health Organization; Geneva, Switzerland: 2014.
    1. Sawyer S.M., Afifi R.A., Bearinger L.H., Blakemore S.-J., Dick B., Ezeh A.C., Patton G.C. Adolescence: A foundation for future health. Lancet. 2012;379:1630–1640. doi: 10.1016/S0140-6736(12)60072-5.
    1. World Health Organization . Preventing Chronic Diseases Designing and Implementing Effective Policy. World Health Organization; Geneva, Switzerland: 2014.
    1. Gore F.M., Bloem P.J., Patton G.C., Ferguson J., Joseph V., Coffey C., Sawyer S.M., Mathers C.D. Global burden of disease in young people aged 10–24 years: A systematic analysis. Lancet. 2011;377:2093–2102. doi: 10.1016/S0140-6736(11)60512-6.
    1. Kann L., Mcmanus T., Harris W.A., Shanklin S., Flint K.H., Hawkins J., Queen B., Lowry R., Olsen E.O., Chyen D., et al. Youth Risk Behavior Surveillance—United States, 2015. MMWR Surveill. Summ. 2016;65:1–174. doi: 10.15585/mmwr.ss6506a1.
    1. World Health Organization . Interventions on Diet and Physical Activity: What Works: Summary Report. World Health Organization; Geneva, Switzerland: 2009.
    1. Dobbins M., Husson H., DeCorby K., LaRocca R.L. School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18. Cochrane Database Syst. Rev. 2013 doi: 10.1002/14651858.CD007651.pub2.
    1. Hayman L.L. Preventive Cardiovascular Health in Schools: Current Status. Curr. Cardiovasc. Risk Rep. 2017;11:24. doi: 10.1007/s12170-017-0549-2.
    1. Langford R., Bonell C., Komro K., Murphy S., Magnus D., Waters E., Gibbs L., Campbell R. The Health Promoting Schools Framework: Known Unknowns and an Agenda for Future Research. Health Educ. Behav. 2017;44:463–475. doi: 10.1177/1090198116673800.
    1. Busch V., de Leeuw J.R.J., de Harder A., Schrijvers A.J.P. Changing Multiple Adolescent Health Behaviors Through School-Based Interventions: A Review of the Literature. J. School Health. 2013;83:514–523. doi: 10.1111/josh.12060.
    1. Champion K.E., Newton N.C., Spring B., Wafford Q.E., Parmenter B.J., Teesson M. A systematic review of school-based eHealth interventions targeting alcohol use, smoking, physical inactivity, diet, sedentary behaviour and sleep among adolescents: A review protocol. Syst. Rev. 2017;6:246. doi: 10.1186/s13643-017-0645-x.
    1. Havranek E.P., Mujahid M.S., Barr D.A., Blair I.V., Cohen M.S., Cruz-Flores S., Davey-Smith G., Dennison-Himmelfarb C.R., Lauer M.S., Lockwood D.W., et al. Social Determinants of Risk and Outcomes for Cardiovascular Disease: A Scientific Statement from the American Heart Association. Circulation. 2015;132:873–898. doi: 10.1161/CIR.0000000000000228.
    1. Jepson R.G., Harris F.M., Platt S., Tannahill C. The effectiveness of interventions to change six health behaviours: A review of reviews. BMC Public Health. 2010;10:538. doi: 10.1186/1471-2458-10-538.
    1. Craike M., Wiesner G., Hilland T.A., Bengoechea E.G. Interventions to improve physical activity among socioeconomically disadvantaged groups: An umbrella review. Int. J. Behav. Nutr. Phys. Act. 2018;15:43. doi: 10.1186/s12966-018-0676-2.
    1. Love R.E., Adams J., van Sluijs E.M.F. Equity effects of children’s physical activity interventions: A systematic scoping review. Int. J. Behav. Nutr. Phys. Act. 2017;14:134. doi: 10.1186/s12966-017-0586-8.
    1. Niessen L.W., Mohan D., Akuoku J.K., Mirelman A.J., Ahmed S., Koehlmoos T.P., Trujillo A., Khan J., Peters D.H. Tackling socioeconomic inequalities and non-communicable diseases in low-income and middle-income countries under the Sustainable Development agenda. Lancet. 2018;391:2036–2046. doi: 10.1016/S0140-6736(18)30482-3.
    1. Barbosa Filho V.C., da Silva Lopes A., Lima A.B., de Souza E.A., do Amaral Gubert F., Silva K.S., Vieira N.F.C., Trompieri Filho N., de Araújo T.S., de Bruin P.F.C., et al. Rationale and methods of a cluster-randomized controlled trial to promote active and healthy lifestyles among Brazilian adolescents: The “Fortaleça sua Saúde” program. BMC Public Health. 2015;15:1212. doi: 10.1186/s12889-015-2543-2.
    1. Barbosa Filho V.C., da Silva K.S., Mota J., Beck C., da Silva Lopes A. A physical activity intervention for Brazilian adolescents from low human development index areas: A cluster-randomized controlled trial. J. Phys. Act. Health. 2016;13:1174–1182. doi: 10.1123/jpah.2016-0113.
    1. Bronfenbrenner U. Ecological models of human development. Int. Encycl. Educ. 1994;3:37–43.
    1. Bandura A. Health promotion by social cognitive means. Health Educ. Behav. 2004;31:143–164. doi: 10.1177/1090198104263660.
    1. Guedes D.P., Lopes C.C. Validação da versão brasileira do Youth Risk Behavior Survey 2007. Revista de Saúde Pública. 2010;44:840–850. doi: 10.1590/S0034-89102010000500009.
    1. de Farias Júnior J.C., Lopes A.D.S., Mota J., Santos M.P., Ribeiro J.C., Hallal P.C. Validade e reprodutibilidade de um questionário para medida de atividade física em adolescentes: Uma adaptação do Self-Administered Physical Activity Checklist. Rev. Bras. Epidemiol. 2012;15:198–210. doi: 10.1590/S1415-790X2012000100018.
    1. World Health Organization . Global Recommendations on Physical Activity for Health. World Health Organization; Geneva, Switzerland: 2010.
    1. Tremblay M.S., LeBlanc A.G., Janssen I., Kho M.E., Hicks A., Murumets K., Colley R.C., Duggan M. Canadian Sedentary Behaviour Guidelines for Children and Youth. Appl. Physiol. Nutr. Metab. 2011;36:59–64. doi: 10.1139/H11-012.
    1. Nahas M.V., de Barros M.V.G., de Assis M.A.A., Hallal P.C., Florindo A.A., Konrad L. Methods and Participant Characteristics of a Randomized Intervention to Promote Physical Activity and Healthy Eating among Brazilian High School Adolescents: The Saude na Boa Project. J. Phys. Act. Health. 2009;6:153–162. doi: 10.1123/jpah.6.2.153.
    1. Silva K.S.D., Lopes A.D.S., Hoefelmann L.P., Cabral L.G.D.A., De Bem M.F.L., Barros M.V.G.D., Nahas M.V. Projeto COMPAC (comportamentos dos adolescentes catarinenses): Aspectos. Revista Brasileira de Cineantropometria e Desempenho Humano. 2013;15 doi: 10.5007/1980-0037.2013v15n1p1.
    1. Associação Brasileira de Empresas de Pesquisa—Critério de Classificação Econômica Brasil. 2012. Pesquisa Google. [(accessed on 24 October 2018)]; Available online: .
    1. De Barros M.V.G., Nahas M.V., Hallal P.C., de Farias Júnior J.C., Florindo A.A., de Barros S.S.H. Effectiveness of a school-based intervention on physical activity for high school adolescents in Brazil: The Saude na Boa project. J. Phys. Act. Health. 2009;6:163–169. doi: 10.1123/jpah.6.2.163.
    1. Ribeiro R.Q., Alves L. Comparison of two school-based programmes for health behaviour change: The Belo Horizonte Heart Study randomized trial. Public Health Nutr. 2014;17:1195–1204. doi: 10.1017/S1368980013000189.
    1. Verstraeten R., Roberfroid D., Lachat C., Leroy J.L., Holdsworth M., Maes L., Kolsteren P.W. Effectiveness of preventive school-based obesity interventions in low- and middle-income countries: A systematic review. Am. J. Clin. Nutr. 2012;96:415–438. doi: 10.3945/ajcn.112.035378.
    1. Cui Z., Shah S., Yan L., Pan Y., Gao A., Shi X., Wu Y., Dibley M.J. Effect of a school-based peer education intervention on physical activity and sedentary behaviour in Chinese adolescents: A pilot study. BMJ Open. 2012;2:e000721. doi: 10.1136/bmjopen-2011-000721.
    1. Contento I.R., Koch P.A., Lee H., Calabrese-Barton A. Adolescents Demonstrate Improvement in Obesity Risk Behaviors after Completion of Choice, Control & Change, a Curriculum Addressing Personal Agency and Autonomous Motivation. J. Am. Diet. Assoc. 2010;110:1830–1839. doi: 10.1016/j.jada.2010.09.015.
    1. Costa C.D.S., Flores T.R., Wendt A., Neves R.G., Assunção M.C.F., Santos I.S. Comportamento sedentário e consumo de alimentos ultraprocessados entre adolescentes brasileiros: Pesquisa Nacional de Saúde do Escolar (PeNSE), 2015. Cadernos de Saúde Pública. 2018;34 doi: 10.1590/0102-311x00021017.
    1. De Rezende L.F.M., Rodrigues Lopes M., Rey-López J.P., Matsudo V.K.R., Luiz O.D.C. Sedentary Behavior and Health Outcomes: An Overview of Systematic Reviews. PLoS ONE. 2014;9:e105620. doi: 10.1371/journal.pone.0105620.
    1. Xu F., Ware R.S., Leslie E., Tse L.A., Wang Z., Li J., Wang Y. Effectiveness of a Randomized Controlled Lifestyle Intervention to Prevent Obesity among Chinese Primary School Adolescents: CLICK-Obesity Study. PLoS ONE. 2015;10:e0141421. doi: 10.1371/journal.pone.0141421.
    1. Chawla N., Panza A., Sirikulchayanonta C., Kumar R., Taneepanichskul S. Effectiveness of a school-based multicomponent intervention on children nutritional status among primary school children in bangkok, thailand. J. Ayub Med. Coll. Abbottabad. 2017;29:13–20.
    1. Habib-Mourad C., Ghandour L.A., Moore H.J., Nabhani-Zeidan M., Adetayo K., Hwalla N., Summerbell C. Promoting healthy eating and physical activity among school children: Findings from Health-E-PALS, the first pilot intervention from Lebanon. BMC Public Health. 2014;14:940. doi: 10.1186/1471-2458-14-940.
    1. Hale D.R., Fitzgerald-Yau N., Viner R.M. A Systematic Review of Effective Interventions for Reducing Multiple Health Risk Behaviors in Adolescence. Am. J. Public Health. 2014;104:e19–e41. doi: 10.2105/AJPH.2014.301874.
    1. Tomita A., Manuel J.I. Evidence on the association between cigarette smoking and incident depression from the South African National Income Dynamics Study 2008–2014: Mental health implications for a resource-limited setting. Nicotine Tobacco Res. 2018 doi: 10.1093/ntr/nty163.
    1. Murphy C.M., Janssen T., Colby S.M., Jackson K.M. Low Self-Esteem for Physical Appearance Mediates the Effect of Body Mass Index on Smoking Initiation Among Adolescents. J. Pediatr. Psychol. 2018 doi: 10.1093/jpepsy/jsy070.
    1. Granville-Garcia A.F., Clementino M.A., Gomes M.D.N.C., Firmino R.T., Ribeiro G.L.A., Siqueira M.B.L.D. Alcohol consumption among adolescents. Ciência Saúde Coletiva. 2014;19:7–16. doi: 10.1590/1413-81232014191.1989.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren