Abstract
Objectives
To assess the impact of multicomponent intervention on knowledge and practice of health behaviors among school children. The secondary objective was to assess mean change in cardiometabolic risk factors such as anthropometric measurements and biochemical profile.
Methods
A cluster-randomized, controlled trial was conducted among adolescents aged 13–18 y from government and private senior secondary schools in Shimla city. Multicomponent health behavioral intervention was delivered through teachers. Subjective and objective measures of knowledge and health behaviors were the primary outcomes.
Results
There was no significant effect of intervention on nutrition knowledge adjusted mean difference (aMD) 2.4 (95% CI: −3.7 to 8.7; p = 0.43), and the dietary habits adjusted mean difference 2.9 (95% CI: −0.3 to 6.2; p = 0.08) between the intervention and control group. However, significant improvement in odds of dietary practices 2.4 (95% CI: 1.1 to 5.0; p = 0.03) and decreased odds of consumption of junk food 3.8 (95% CI: 1.6 to 9.3; p = 0.003) was observed. There was no effect on physical activity odds 2.9 (95% CI: 0.8 to 11.6; p = 0.12) or screen time with aMD 0.9 (95% CI: 0.7 to 1.2; p = 0.52). Anthropometric measurements and biochemical profile also did not differ except low-density lipoprotein cholesterol which had significantly lower aMD: −7.2 (95% CI: −13.6 to −1.0; p = 0.02). There was no change in alcohol and tobacco consumption with odds 0.8 (95% CI: 0.6 to 1.2; p = 0.33) and 1.0 (95% CI: 0.7 to 1.5; p = 0.87), respectively after intervention.
Conclusions
Multipronged interventions targeting lifestyle behaviors of adolescents at multilevels are vital to curb rising trends of noncommunicable diseases. This quintessentially calls for wider support across multiple sectors and creation of sustained enabling macro- and micro-environment.
The trial is registered in the Clinical Trial Registry of India under the registration number CTRI/2018/01/011312 dated 12/01/2018 Registered, retrospectively.
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References
Non-communicable diseases and adolescents: an opportunity for action. Available at: http://www.jhsph.edu/research/centers-and-institutes/center-for-adolescent-health/_includes/_pre-redesign/az/noncommunicable.pdf. Accessed on 13 Aug 2020.
WHO Noncommunicable diseases fact sheet June 2017. Available at: http://www.who.int/mediacentre/factsheets/fs355/en/. Accessed on 12 Jul 2020.
Booth SL, Sallis JF, Ritenbaugh C, et al. Environmental and societal factors affect food choice and physical activity: rationale, influences, and leverage points. Nutr Rev. 2001;59:S21–65.
Stokols D, Allen J, Bellingham RL. The social ecology of health promotion: implications for research and practice. Am J Health Promot. 1996;10:247–51.
Guidelines for school and community programs to promote lifelong physical activity among young people. Centre for Disease Control and Prevention. MMWR Recomm Rep. 1997;46:1–36.
Flynn MA, McNeil DA, Maloff B, et al. Reducing obesity and related chronic disease risk in children and youth: a synthesis of evidence with 'best practice’ recommendations. Obes Rev. 2006;7:S7–66.
Kliemann N, Wardle J, Johnson F, Croker H. Reliability and validity of a revised version of the general nutrition knowledge questionnaire. Eur J Clin Nutr. 2016;70:1174–80.
Johnson F, Wardle J, Griffith J. The adolescent food habits checklist: reliability and validity of a measure of healthy eating behaviour in adolescents. Eur J Clin Nutr. 2002;56:644–9.
The WHO STEP wise approach to chronic disease risk factor surveillance (STEPS). Available at: http://www.who.int/chp/steps. Accessed on 2 May 2019.
Pandey VK, Aggarwal P, Kakkar R. Modified BG Prasad’s socio-economic Classification-2018: the need of an update in the present scenario. Indian J Comm Health. 2018;30:82–4.
de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ. 2007;85:660–7.
Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents; National Heart, Lung, and Blood Institute. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report. Pediatrics. 2011;128:S213–56.
ISAK, The International Society for the Advancement of Kinanthropometry, 1986. Available at: http://www.isakonline.com. Accessed on 12 May 2019.
Langford R, Bonell CP, Jones HE, et al. 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.
Patton GC, Sawyer SM, Santelli JS, et al. Our future: a lancet commission on adolescent health and wellbeing. Lancet. 2016;387:2423–78.
Government of India. District Census 2011. Census Organization of India, New Delhi, India. 2011.
Reducing global poverty through universal primary and secondary education. UNESCO Institute for Statistics. Available at: http://unesdoc.unesco.org/images/0025/002503/250392E.pdf. Accessed on 20 May 2020.
Eather N, Morgan P, Lubans D. Improving the fitness and physical activity levels of primary school children: results of the Fit-4-fun group randomized controlled trial. Prev Med. 2013;56:12–9.
Lloyd J, Creanor S, Logan S, et al. Effectiveness of the healthy lifestyles programme (HeLP) to prevent obesity in UK primary-school children: a cluster randomised controlled trial. Lancet Child Adolesc Health. 2018;2:35–45.
Llargues E, Franco R, Recasens A, et al. Assessment of a school-based intervention in eating habits and physical activity in school children: the AVall study. J Epidemiol Community Health. 2011;65:896–901.
Adab P, Pallan MJ, Lancashire ER, et al. Effectiveness of a childhood obesity prevention programme delivered through schools, targeting 6- and 7-year olds: cluster randomised controlled trial (WAVES study). BMJ. 2018;360:k211.
Hamilton G, Cross D, Resnicow K, Hall M. A school-based harm minimization smoking intervention trial: outcome results. Addiction. 2005;100:689–700.
Crespo NC, Elder JP, Ayala GX, et al. Results of a multi-level intervention to prevent and control childhood obesity among Latino children: the Aventuras Para Niños study. Ann Behav Med. 2012;43:84–100.
Grydeland M, Bergh IH, Bjelland M, et al. Intervention effects on physical activity: the HEIA study - a cluster randomized controlled trial. Int J Behav Nutr Phys Act. 2013;10:17.
Foster GD, Sherman S, Borradaile KE, et al. A policy-based school intervention to prevent overweight and obesity. Pediatrics. 2008;121:e794–802.
Saraf DS, Gupta SK, Pandav CS, et al. Effectiveness of a school based intervention for prevention of non-communicable diseases in middle school children of rural North India: a randomized controlled trial. Indian J Pediatr. 2015;82:354–62.
Sutherland R, Campbell E, McLaughlin M, et al. Scale-up of the physical activity 4 everyone (PA4E1) intervention in secondary schools: 12-month implementation outcomes from a cluster randomized controlled trial. Int J Behav Nutr Phys Act. 2020;17:100.
Shinde S, Weiss HA, Khandeparkar P, et al. A multicomponent secondary school health promotion intervention and adolescent health: an extension of the SEHER cluster randomised controlled trial in Bihar, India. PLoS Med. 2020;17:e1003021.
Shinde S, Weiss HA, Varghese B, et al. Promoting school climate and health outcomes with the SEHER multi-component secondary school intervention in Bihar, India: a cluster-randomised controlled trial. Lancet. 2018;392:2465–77.
Acknowledgements
The authors thank the entire survey staff, all the students, teachers, and staff of the 12 secondary schools who participated in the study.
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PCN, AM: Conceptualization, methodology, interpretation, analysis; DS, NG: Supervision, interpretation; AM, PCN: Writing, reviewing, editing; DS, SG: Validation. Dr. Anmol Gupta, Professor, Department of Community Medicine, Indira Gandhi Medical College, Shimla, is the guarantor for the paper.
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Institutional Ethics Committee, Indira Gandhi Medical College, Shimla, dated 7/6/14 vide order No.HFW(MS)G-5(ETHIC)/2014–7155.
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Department of Health Research, New Delhi, India
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Mahajan, A., Negi, P.C., Gandhi, S. et al. Impact of School-Based Health Behavioral Intervention on Awareness, Practice Pattern of Healthy Lifestyle, and Cardiometabolic Risk Factors among School Children of Shimla: A Cluster-Randomized, Intervention Study. Indian J Pediatr 89, 343–350 (2022). https://doi.org/10.1007/s12098-021-03786-6
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DOI: https://doi.org/10.1007/s12098-021-03786-6