One- and Two-Year Effects of the Healthy Primary School of the Future on Children's Dietary and Physical Activity Behaviours: A Quasi-Experimental Study

Nina H M Bartelink, Patricia van Assema, Stef P J Kremers, Hans H C M Savelberg, Marije Oosterhoff, Maartje Willeboordse, Onno C P van Schayck, Bjorn Winkens, Maria W J Jansen, Nina H M Bartelink, Patricia van Assema, Stef P J Kremers, Hans H C M Savelberg, Marije Oosterhoff, Maartje Willeboordse, Onno C P van Schayck, Bjorn Winkens, Maria W J Jansen

Abstract

Schools can help to improve children's health. The 'Healthy Primary School of the Future' (HPSF) aims to sustainably integrate health and well-being into the school system. This study examined the effects of HPSF on children's dietary and physical activity (PA) behaviours after 1 and 2 years' follow-up. The study (n = 1676 children) has a quasi-experimental design with four intervention schools, i.e., two full HPSF (focus: nutrition and PA) and two partial HPSF (focus: PA), and four control schools. Accelerometers and child- and parent-reported questionnaires were used at baseline, after 1 (T1) and 2 (T2) years. Mixed-model analyses showed significant favourable effects for the full HPSF versus control schools for, among others, school water consumption (effect size (ES) = 1.03 (T1), 1.14 (T2)), lunch intake of vegetables (odds ratio (OR) = 3.17 (T1), 4.39 (T2)) and dairy products (OR = 4.43 (T1), 4.52 (T2)), sedentary time (ES = -0.23 (T2)) and light PA (ES = 0.22 (T2)). Almost no significant favourable effects were found for partial HPSF compared to control schools. We conclude that the full HPSF is effective in promoting children's health behaviours at T1 and T2 compared with control schools. Focusing on both nutrition and PA components seems to be more effective in promoting healthy behaviours than focusing exclusively on PA.

Keywords: behaviour; effect evaluation; follow-up; health-promoting schools; nutrition; physical activity.

Conflict of interest statement

The authors declare no conflicts of interests. None of the funding bodies had a role in the design of the study or the writing of this manuscript, nor a role in the data collection, analysis, interpretation of data, and writing of publications.

References

    1. Gubbels J.S., van Assema P., Kremers S.P. Physical activity, sedentary behavior, and dietary patterns among children. Curr. Nutr. Rep. 2013;2:105–112. doi: 10.1007/s13668-013-0042-6.
    1. Sahoo K., Sahoo B., Choudhury A.K., Sofi N.Y., Kumar R., Bhadoria A.S. Childhood obesity: Causes and consequences. J. Fam. Med. Prim. Care. 2015;4:187.
    1. CBS. RIVM. The Netherlands Nutrition Centre Kinderen Eten te Weinig Fruit, Groente en vis [Children Eat to Less Fruit, Vegetables and Fish] [(accessed on 17 December 2018)]; Available online: .
    1. Beweeggedrag Kinderen [Physical Activity Behaviour of Children] [(accessed on 12 January 2018)]; Available online: .
    1. Schönbeck Y., Talma H., van Dommelen P., Bakker B., Buitendijk S.E., HiraSing R.A., van Buuren S. Increase in prevalence of overweight in Dutch children and adolescents: A comparison of nationwide growth studies in 1980, 1997 and 2009. PLoS ONE. 2011;6:e27608. doi: 10.1371/journal.pone.0027608.
    1. Craigie A.M., Lake A.A., Kelly S.A., Adamson A.J., Mathers J.C. Tracking of obesity-related behaviours from childhood to adulthood: A systematic review. Maturitas. 2011;70:266–284. doi: 10.1016/j.maturitas.2011.08.005.
    1. Han E., Norton E.C., Powell L.M. Direct and indirect effects of body weight on adult wages. Econ. Hum. Biol. 2011;9:381–392. doi: 10.1016/j.ehb.2011.07.002.
    1. Stein D., Weinberger-Litman S.L., Latzer Y. Psychosocial perspectives and the issue of prevention in childhood obesity. Front. Public Health. 2014;2:104. doi: 10.3389/fpubh.2014.00104.
    1. Kelsey M.M., Zaepfel A., Bjornstad P., Nadeau K.J. Age-related consequences of childhood obesity. Gerontology. 2014;60:222–228. doi: 10.1159/000356023.
    1. Mohammadi N.K. Complexity Science, Schools and Health: Applications for Management of Change in Schools to Promote Health and Education. Lambert Academic Publishing; Saarbrucken, Germany: 2010.
    1. Lynch J.W., Kaplan G.A., Salonen J.T. Why do poor people behave poorly? Variation in adult health behaviours and psychosocial characteristics by stages of the socioeconomic lifecourse. Soc. Sci. Med. 1997;44:809–819. doi: 10.1016/S0277-9536(96)00191-8.
    1. Pampel F.C., Krueger P.M., Denney J.T. Socioeconomic disparities in health behaviors. Annu. Rev. Sociol. 2010;36:349–370. doi: 10.1146/annurev.soc.012809.102529.
    1. Dooris M., Poland B., Kolbe L., De Leeuw E., McCall D.S., Wharf-Higgins J. Global Perspectives on Health Promotion Effectiveness. Springer; Berlin, Germany: 2007. Healthy settings; pp. 327–352.
    1. Verrotti A., Penta L., Zenzeri L., Agostinelli S., De Feo P. Childhood obesity: Prevention and strategies of intervention. A systematic review of school-based interventions in primary schools. J. Endocrinol. Investig. 2014;37:1155–1164. doi: 10.1007/s40618-014-0153-y.
    1. Leurs M.T., Schaalma H.P., Jansen M.W., Mur-Veeman I.M., St. Leger L.H., De Vries N. Development of a collaborative model to improve school health promotion in the Netherlands. Health Promot. Int. 2005;20:296–305. doi: 10.1093/heapro/dai004.
    1. WHO . Promoting Health Through Schools: Report of a WHO Expert Committee on Comprehensive School Health Education and Promotion. WHO; Geneva, Switzerland: 1997.
    1. WHO . Health Promoting Schools: A Framework for Action. World Health Organization Western Pacific Region; Manila, Philippines: 2009.
    1. Langford R., Bonell C., Jones H., Pouliou T., Murphy S., Waters E., Komro K., Gibbs L., Magnus D., Campbell R. The World Health Organization’s Health Promoting Schools framework: A Cochrane systematic review and meta-analysis. BMC Public Health. 2015;15:130. doi: 10.1186/s12889-015-1360-y.
    1. Young I., St Leger L., Buijs G. School Health Promotion: Evidence for Effective Action. CBO; Utrecht, The Netherlands: 2013.
    1. Lister-Sharp D., Chapman S., Stewart-Brown S., Sowden A. Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] Centre for Reviews and Dissemination; London, UK: 1999. Health promoting schools and health promotion in schools: Two systematic reviews.
    1. Langford R., Bonell C.P., Jones H.E., Pouliou T., Murphy S.M., Waters E., Komro K.A., Gibbs L.F., Magnus D., Campbell R. The WHO Health Promoting School framework for improving the health and well-being of students and their academic achievement. Cochrane Database Syst. Rev. 2014;4:CD008958. doi: 10.1002/14651858.CD008958.pub2.
    1. Deschesnes M., Martin C., Hill A.J. Comprehensive approaches to school health promotion: How to achieve broader implementation? Health Promot. Int. 2003;18:387–396. doi: 10.1093/heapro/dag410.
    1. Lee A. Health-promoting schools. Appl. Health Econ. Health Policy. 2009;7:11–17. doi: 10.1007/BF03256138.
    1. Shiell A., Hawe P., Gold L. Complex interventions or complex systems? Implications for health economic evaluation. BMJ Br. Med. J. 2008;336:1281. doi: 10.1136/.
    1. Keshavarz N., Nutbeam D., Rowling L., Khavarpour F. Schools as social complex adaptive systems: A new way to understand the challenges of introducing the health promoting schools concept. Soc. Sci. Med. 2010;70:1467–1474. doi: 10.1016/j.socscimed.2010.01.034.
    1. Darlington E.J., Violon N., Jourdan D. Implementation of health promotion programmes in schools: An approach to understand the influence of contextual factors on the process? BMC Public Health. 2018;18:163. doi: 10.1186/s12889-017-5011-3.
    1. Moore G.F., Audrey S., Barker M., Bond L., Bonell C., Hardeman W., Moore L., O’Cathain A., Tinati T., Wight D. Process evaluation of complex interventions: Medical Research Council guidance. BMJ. 2015;350:h1258. doi: 10.1136/bmj.h1258.
    1. Hawe P., Shiell A., Riley T. Theorising interventions as events in systems. Am. J. Commun. Psychol. 2009;43:267–276. doi: 10.1007/s10464-009-9229-9.
    1. Bartelink N., van Assema P., Jansen M., Savelberg H., Willeboordse M., Kremers S. The Healthy Primary School of the Future: A Contextual Action-Oriented Research Approach. Int. J. Environ. Res. Public Health. 2018;15:2243. doi: 10.3390/ijerph15102243.
    1. Willeboordse M., Jansen M., van den Heijkant S., Simons A., Winkens B., de Groot R., Bartelink N., Kremers S., van Assema P., Savelberg H. The Healthy Primary School of the Future: Study protocol of a quasi-experimental study. BMC Public Health. 2016;16:1. doi: 10.1186/s12889-016-3301-9.
    1. Bartelink N.H., van Assema P., Kremers S.P., Savelberg H.H., Oosterhoff M., Willeboordse M., van Schayck C.P., Winkens B., Jansen M.W. Can the Healthy Primary School of the Future offer perspective in the on-going obesity epidemic in young children?—A quasi-experimental study. (Under Review)
    1. Schulz D.N., Kremers S.P., van Osch L.A., Schneider F., van Adrichem M.J., de Vries H. Testing a Dutch web-based tailored lifestyle programme among adults: A study protocol. BMC Public Health. 2011;11:108. doi: 10.1186/1471-2458-11-108.
    1. Mata J., Silva M., Vieira P., Coutinho S., Andrade A., Teixeira P. Healthy spill-over: Increased exercise motivation improves eating self-regulation during behavioral obesity treatment in women. Health Psychol. 2009;28:709–716. doi: 10.1037/a0016764.
    1. Jungbluth P. De Opbrengst van Basisscholen in Zuid-Limburg in 2009 en 2010. [The Proceeds of Primary Schools in South Limburg in 2009 and 2010] Maastricht University; Maastricht, The Netherlands: 2011.
    1. Vermeer A.J.M.B.N., Hesdahl M.H., Janssen-Goffin M.J.H., Linssen E.C.A.J., Rutten N., Hajema K.J. Lokale rapporten Volksgezondheid Toekomst Verkenning: Een Nieuwe kijk op Gezondheid in Heerlen, Kerkrade, Landgraaf en Brunssum; [Local Reports on Public Health Development: A New Perspective on Health in Heerlen, Kerkrade, Landgraaf and Brunssum] GGD Zuid Limburg; Geleen, The Netherlands: 2014.
    1. Bentsen P., Bonde A.H., Schneller M.B., Danielsen D., Bruselius-Jensen M., Aagaard-Hansen J. Danish ‘add-in’school-based health promotion: Integrating health in curriculum time. Health Promot. Int. 2018 doi: 10.1093/heapro/day095.
    1. Pluye P., Potvin L., Denis J.-L., Pelletier J. Program sustainability: Focus on organizational routines. Health Promot. Int. 2004;19:489–500. doi: 10.1093/heapro/dah411.
    1. Vermeer A.J.M. Duurzaamheid van Wijkgerichte Gezondheidsbevordering: Een Praktijkgericht Onderzoek naar de Factoren die van Invloed Zijn op Duurzaamheid van Zuid-Limburgse Wijkgerichte Gezondheidsbevordering. [Sustainability of Community Health Promotion: A Practice-Based Study into the Factors that Influence the Sustainability of Community Health Promotion in the Dutch Southern Limburg Region] Maastricht University; Maastricht, The Netherlands: 2013.
    1. Gezondheidsraad . Dutch Dietary Guidelines 2015. Health Council of the Netherlands; Hague, The Netherlands: 2015.
    1. Bartelink N.H., van Assema P., Jansen M.W., Savelberg H.H., Moore G.F., Hawkins J., Kremers S.P. Process evaluation of the Healthy Primary School of the Future: The key learning points. (submitted)
    1. Lokale en Nationale Monitor Jeugdgezondheid [Local and National Youth Health Monitor] Standaardvraagstelling Bewegen [Standard Questionnaire Physical Activity] [(accessed on 16 March 2015)]; Available online: .
    1. Craig C.L., Marshall A.L., Sjorstrom M., Bauman A.E., Booth M.L., Ainsworth B.E., Pratt M., Ekelund U., Yngve A., Sallis J.F. International physical activity questionnaire: 12-country reliability and validity. Med. Sci. Sports Exerc. 2003;35:1381–1395. doi: 10.1249/01.MSS.0000078924.61453.FB.
    1. Lokale en Nationale Monitor Jeugdgezondheid [Local and National Youth Health Monitor] Standaardvraagstelling Voeding [Standard Questionnaire Nutrition] [(accessed on 16 March 2015)]; Available online: .
    1. Van Assema P., Brug J., Ronda G., Steenhuis I. The relative validity of a short Dutch questionnaire as a means to categorize adults and adolescents to total and saturated fat intake. J. Hum. Nutr. Diet. 2001;14:377–390. doi: 10.1046/j.1365-277X.2001.00310.x.
    1. Brink L., Postma-Smeets A., Stafleu A., Wolvers D. Richtlijnen Schijf van Vijf [Wheel of Five Guidlines] Netherlands Nutrition Centre; Hague, The Netherlands: 2016.
    1. Shavers V.L. Measurement of socioeconomic status in health disparities research. J. Nat. Med. Assoc. 2007;99:1013.
    1. Keij I. Hoe doet het CBS dat nou? Standaarddefinitie allochtonen [How does Statistics Netherlands do this? Standard definition of emigrants] Index Feiten Cijfers Over Onze Samenleving. 2000;10:24–25.
    1. Choi L., Liu Z., Matthews C.E., Buchowski M.S. Validation of accelerometer wear and nonwear time classification algorithm. Med. Sci. Sports Exerc. 2011;43:357. doi: 10.1249/MSS.0b013e3181ed61a3.
    1. Jago R., Sebire S.J., Turner K.M., Bentley G.F., Goodred J.K., Fox K.R., Stewart-Brown S., Lucas P.J. Feasibility trial evaluation of a physical activity and screen-viewing course for parents of 6 to 8 year-old children: Teamplay. Int. J. Behav. Nutr. Phys. Act. 2013;10:31. doi: 10.1186/1479-5868-10-31.
    1. Dössegger A., Ruch N., Jimmy G., Braun-Fahrländer C., Mäder U., Hänggi J., Hofmann H., Puder J.J., Kriemler S., Bringolf-Isler B. Reactivity to accelerometer measurement of children and adolescents. Med. Sci. Sports Exerc. 2014;46:1140. doi: 10.1249/MSS.0000000000000215.
    1. Migueles J.H., Cadenas-Sanchez C., Ekelund U., Nyström C.D., Mora-Gonzalez J., Löf M., Labayen I., Ruiz J.R., Ortega F.B. Accelerometer data collection and processing criteria to assess physical activity and other outcomes: A systematic review and practical considerations. Sports Med. 2017;47:1821–1845. doi: 10.1007/s40279-017-0716-0.
    1. Evenson K.R., Catellier D.J., Gill K., Ondrak K.S., McMurray R.G. Calibration of two objective measures of physical activity for children. J. Sports Sci. 2008;26:1557–1565. doi: 10.1080/02640410802334196.
    1. Lipsey M.W. Design Sensitivity: Statistical Power for Experimental Research. Volume 19 Sage; Pugey, France: 1990.
    1. Metcalf B., Henley W., Wilkin T. Effectiveness of intervention on physical activity of children: Systematic review and meta-analysis of controlled trials with objectively measured outcomes (EarlyBird 54) BMJ. 2012;345:e5888. doi: 10.1136/bmj.e5888.
    1. Van Kann D., Kremers S., De Vries N., De Vries S., Jansen M. The effect of a school-centered multicomponent intervention on daily physical activity and sedentary behavior in primary school children: The Active Living study. Prev. Med. 2016;89:64–69. doi: 10.1016/j.ypmed.2016.05.022.
    1. Shephard R.J. Limits to the measurement of habitual physical activity by questionnaires. Br. J. Sports Med. 2003;37:197–206. doi: 10.1136/bjsm.37.3.197.
    1. Rowland T.W. The biological basis of physical activity. Med. Sci. Sports Exerc. 1998;30:392–399. doi: 10.1097/00005768-199803000-00009.
    1. Brink E.J., Postma-Smeets A., Stafleu A.D.W. The Wheel of Five: Factsheet. The Netherlands Nutrition Centre; Hague, The Netherlands: 2017.
    1. Kremers S.P., De Bruijn G.-J., Visscher T.L., Van Mechelen W., De Vries N.K., Brug J. Environmental influences on energy balance-related behaviors: A dual-process view. Int. J. Behav. Nutr. Phys. Act. 2006;3:9. doi: 10.1186/1479-5868-3-9.
    1. Hill J.O., Wyatt H.R., Melanson E.L. Genetic and environmental contributions to obesity. Med. Clin. N. Am. 2000;84:333–346. doi: 10.1016/S0025-7125(05)70224-8.
    1. Nederhof A.J. Methods of coping with social desirability bias: A review. Eur. J. Soc. Psychol. 1985;15:263–280. doi: 10.1002/ejsp.2420150303.
    1. Riley A.W. Evidence that school-age children can self-report on their health. Ambul. Pediatr. 2004;4:371–376. doi: 10.1367/A03-178R.1.

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