Background
Methods
Search strategy and study selection criteria
Inclusion Criteria | Exclusion Criteria |
---|---|
Population Children or adolescents between the age-group of 6 – 18 years. | Population Children or adolescents not in the specified age-group and studies conducted on animal models. |
Intervention Policies that modify the four identified risk factors (unhealthy diet, physical inactivity, alcohol and tobacco use) and associated health related behaviors amongst the students either alone or as part of any intervention program. | Intervention Policy components those are insufficiently described to enable replication. School policies focusing on differently abled students. |
Context Schools as a setting. | Context Community, pre-schools and clinical settings. |
Outcome Prevalence of health related behaviors identified as risk factors for NCDs. | Study design Editorials, library thesis, opinions and letters, papers with insufficient methodological details reported to allow critical appraisal of study quality, studies not in English language. Studies published before 1990. |
Study Design Any experimental or observational study design (randomized controlled trial controlled before-after study, quasi-experimental, interrupted time series, cohort study or cross-sectional study). |
Data extraction
Quality assessment
Synthesis of evidence
Results
S/No | Study | Year | Country | Study Design | Sample size (n) | Participant Inclusion Criteria | Policy/ Policy Intervention | Outcome/s measured | Quality |
---|---|---|---|---|---|---|---|---|---|
1 | Anthamatten et al. | 2011 | USA | Observational study; case-control |
n = 3688 | Participation in Learning Landscape Program; recent schoolyard renovation, the size of the school, and the social and demographic characteristics of the school population. | Physical Activity (learning landscape program)(Renovation of school grounds) | Utilization of school yards for Physical Activity | Weak |
2 | Blum et al. | 2008 | USA | Quasi-experimental |
n = 456 students from 7 schools; | Students from grade 9-11 | Elimination from SSB (Diet) and other junk food in schools food policy | Change in students beverage servings/day | Weak |
3 | Covelli et al. | 2008 | USA | Quasi-experimental - Repeated Measures |
n = 48 (Intervention = 31; control = 17) | (1) be of African-American ethnicity, (2) be between 14 and 17 years old, (3) be able to read and write in English, (4) have obtained a signed parental/guardian consent form, and (5) have signed a participant assent form. | Integration of health promotion in existing curriculum (Provision of cognitive behavioral components of health knowledge, health promotion concepts, nutrition, and exercise). | Health promotion knowledge, behaviors related to fruit and vegetable intake and exercise; blood pressure | Weak |
4 | Evans-Whipp et al. | 2010 | USA | Cross-sectional |
n = 3466 from 285 schools | One class per school was invited to take part in the study. Selected classes were from three-year levels: Grade 5 (age 10), Year 7 (age 12) and Year 9 (age 14). | Existing School tobacco policies (Washington and Victoria) - Comprehensive smoking bans, policy orientation towards abstinence and harm minimization principles, possession of tobacco products among students | Current tobacco use; daily tobacco use; students perception about school smoking | Moderate |
5 | Evans-Whipp et al. | 2013 | USA and Australia | Cross-sectional |
n = 1848 | Students from grade 5,7 or 9 | School alcohol policies (IYDS) | Current alcohol use; alcohol use in schools ground | Moderate |
6 | Foster et al. | 2008 | USA | RCT |
n = 10 schools; n = 1349 students | Not mentioned | School self-assessment; nutrition education; nutrition policy; social marketing; and parent outreach. | Sales of lower-fat à la carte foods; lower fat food choices; fruit and vegetable intake; Environmental and behavioral perceptions | Strong |
7 | French et al. | 2004 | USA | RCT |
n = 20 schools | Presence of an à la carte area in the school cafeteria operated by the school food service; a food service director and principal willing to take part in the study for two school years; an informed consent | School nutrition policy initiative | BMI-SD, height, overweight, obese | Weak |
8 | Fung et al. | 2013 | Canada | Cross-sectional |
n = 5215(in 2003); n = 5508(in 2011) | All public schools were invited to participate | School food and nutrition policy (Children’s Lifestyle and School Performance Study-CLASS) | Dietary Status, Nutrient Intake, and Weight Status | Moderate |
9 | Gibson et al. | 2008 | USA | RCT |
n = 4905 children (Intervention = 2505 and control = 2400) | Not mentioned | Physical Activity Across the Curriculum(PACC) - 90 mins moderate intensity physical activity delivered as part of academic instruction | Physical activity level | Weak |
10 | Hamilton et al. | 2005 | Australia | RCT |
n = 4636 adolescents from 30 government high schools | Not mentioned | School-based smoking intervention(The Smoking Cessation for Youth Project-SCYP) - Curricular, parent, nurse counselling cessation support and policy components | The primary outcome variable was regular smoking(smoking on 4 or more days in the previous week) and the more traditional measure of ‘current smoking’ within the last 30 days was used for secondary analyses | Strong |
11 | Llargues et al. | 2011 | Spain | RCT | 509 (Control: 237, Intervention: 272) | All the children born in 2000 who attended any of the schools in Granollers were eligible to participate | Teacher Training, Develop activities related to food habits and/or physical activity | Primary outcome: Difference in BMI progression Secondary outcomes: changes in eating habits and in physical activity | Strong |
12 | Knox et al. | 2012 | Australia | Quasi-experimental | 182 pupils attending year (n = 115 Inter; 77 control) | Not mentioned | Physical Activity - Brisk Walking Lessons | Adiposity variables, BP, lipids, lipoproteins, glucose, insulin, high sensitivity C-reactive protein, high molecular weight adenopectin, aerobic fitness, physical activity behavior and diet | Weak |
13 | Jhonson et al. | 2009 | USA | Cross-sectional |
n = 9151 students from 64 middle schools | All public schools that enroll seventh-grade students and participate in USDA school meal programs were eligible to participate | School district SSB policies | exposure of SSB and student consumption of SSB during the school days; school district policies about SSB and exposure to SSB in schools | Moderate |
14 | Lovato et al. | 2006 | USA | Cross-sectional |
n = 522,318 students from 81 secondary schools | Not mentioned | School/ District tobacco control policies - scale for prohibition, strength, and characteristics of enforcement. Seven policy components: developing, overseeing and communicating the policy, purpose, and goals, prohibition, strength of enforcement, tobacco use prevention education and assistance to overcome tobacco addictions (Perception of policy) | Student smoking | Weak |
15 | Manios et al. | 1999 | Greece | RCT |
n = 4171 students (Intervention); n = 1510 students (control) | All students in the first grade of selected schools | Multicomponent workbooks covering dietary issues, physical activity and fitness, dental health hygiene, smoking and accident prevention | Health Knowledge, Dietary, Physical Activity, Fitness, Anthropometric Measurements, Biochemical Indices | Moderate |
16 | Moore and Tapper | 2008 | UK | Randomized controlled trial | 43 primary schools | The school was excluded if existing tuck shop, selling any food | Fruit Truck Shops | Purchase and Intake of Fruits | Moderate |
17 | Murnaghan et al. | 2008 | Canada | Cross-Sectional |
n = 4709 grade 10 students | Not mentioned | Policy banning smoking in school property participated in provincially directed school-based smoking prevention program | Occasional and Current Smoking | Weak |
18 | O Brien et al. | 2010 | USA | Cross-Sectional |
n = 80,428 students in 328 schools across the state of Maine. n = 123 intervention;205 non-intervention schools | Not mentioned | Comprehensive school health education, physical education and physical activity, school nutrition and food services, health promotion and wellness, school counselling physical and behavioral health services, school climate, physical environment, youth, parent, family and community involvement | Behavior change: physical activity, nutrition, and tobacco use | Weak |
19 | Paek et al. | 2013 | USA | Cross-Sectional |
n = 983; 14 schools | All regular public schools containing grades 9, 10, 11, or 12 were included in the sampling frame | Tobacco-free school policy | Frequency of smoking | Weak |
20 | Patel et al. | 2012 | India | Cross-Sectional |
n = 172 students from 2 schools | Male adolescents (aged 13-15 yrs.) not meeting the age criteria were excluded | Tobacco promotion and availability around schools | Current smoking and smokeless tobacco use | Weak |
21 | Schwartz et al. | 2009 | USA | Quasi- Experimental | Not mentioned | Removal of snacks of low nutritional value | Intake of beverages, salty snacks and sweet snacks | Weak | |
22 | Spence et al. | 2013 | UK | Natural Experiment |
n = 385 [2003–4]; n = 632 [2008–9] | Not mentioned | Nutrient-based standards | Mean daily intakes of macro & micro nutrients in school lunch packed lunch and total diet | Weak |
23 | Vandongen et al. | 1995 | USA | Cross-Sectional | 1147 students from 30 schools | Not mentioned | Fitness, fitness + school nutrition, school-based nutrition, school + home nutrition, home-based nutrition | BP, Dietary Intake, 1.6 km run and Leger shuttle run, anthropometric measurements (subscapular skinfold) BMI, percentage fat | Weak |
24 | Raczynski et al. | 2009 | Australia | RCT |
n = 2202 | Not mentioned | Comprehensive legislation to combat obesity | BMI | Weak |
25 | Harris et al. | 1997 | USA | Quasi- Experimental |
n = 170 | Not mentioned | Modified school lunches, Enhanced nutrition education and increased opportunities for physical activities | Calorie intake, Physical fitness assessment, Knowledge, skills and attitudes related to nutrition and physical fitness | Weak |
26 | Holt et al. | 2013 | USA | Quasi- Experimental | Four elementary schools(grade k-5; 68 classroom teachers; 1284 students | Not mentioned | District mandated Physical Activity Policy (20 min) | The level of intensity of physical activity | Weak |
27 | Jaenke et al. | 2012 | Australia | Quasi- Experimental |
n = 127 children (11-12 years) | Eligibility for participation in the study was for students to be enrolled in school Grades 5 or 6. | Nutrition education, gardening program | Food preference assessment, fruit and vegetable intake | Weak |
Physical and anthropometric measures
Study | Design | Policy | Outcomes | Specific outcome | Impact (+) Favorable and significant change (=) No change | Strength of Association |
---|---|---|---|---|---|---|
Physical and Anthropometric measurements
| ||||||
Foster et al., 2008 [14] | RCT | School self-assessment; nutrition education; nutrition policy; social marketing; and parent outreach. | BMI, Overweight, Obesity | BMI | = | Control (Baseline: 20.76 kg/m2; Follow up: 23.06 kg/m2) Intervention (Baseline 21.07 kg/m2; Follow up 23.06 kg/m2) p-value 0.71 |
Overweight (BMI for age from the 85th to 94.9th percentile) | + | Adjusted Odds for Incidence:- 0.67 (0.47–0.96) | ||||
Obesity (BMI for age _95th percentile) | = | Adjusted Odds for Incidence:- 1.00 (0.66–1.52) | ||||
Fung et al., 2013 [21] | Cross-sectional | School based nutrition policy | Overweight and Obesity (BMI measurements) | Overweight | = | Overweight (Prevalence ratio, adjusted change: 1.03 (0.94, 1.12) |
Obesity | + | Obesity (Prevalence ratio, adjusted change: 1.26 (1.08, 1.48)) | ||||
Knox et al., 2012 [22] | Quasi-experimental | Brisk walking lessons | Waist circumference, Systolic Blood Pressure | Waist circumference | + | Prevalence of elevated waist circumference: Control:- 9.8% Intervention:- 6.9 |
Systolic Blood pressure | + | Prevalence of elevated BP: Control:- 3.3% Intervention:- 0% | ||||
Llargues et al., 2011 [23] | RCT | Teacher trainings, Activities around food habits and physical activity | BMI progression after two years | BMI | + | Control (Baseline: 16.5 kg/m2 (16.7 kg/m2 to 17.5 kg/m2) Follow up: 18.3 kg/m2 (17.9 kg/m2 to 18.7 kg/m2)) Intervention (Baseline: 17.1 kg/m2 (16.7 kg/m2 to 17.5 kg/m2) Follow up: 17.9 kg/m2 (17.4 kg/m2to 18.4 kg/m2) |
Manios et al., 1999 [24] | RCT | Multi-component workbooks – National policy for health education | BMI Progression | BMI | + | Control (Baseline: 24.4 kg/m2 Follow up: 32.8 kg/m2) Intervention (Baseline: 16.2 kg/m2 Follow up: 16.3 kg/m2) p = 0.001 |
Raczynski et al., 2009 [25] | RCT | Comprehensive legislation | BMI | BMI | = | Mean BMI: (Baseline: 28.8 kg/m2; 1 year follow up: 23.2 kg/m2; 2 year follow up: 25.7 kg/m2; 3 year follow up: 26.9 kg/m2) p value non-significant. |
Vandongen et al., 1995 [26] | Cross Sectional | Guidance around fitness and nutrition (Fitness, Fitness + School Nutrition, School nutrition, School and home nutrition, home nutrition, All groups together) | BMI, Systolic blood pressure, Percentage body fat, Triceps skinfold, Subscapular skinfold | BMI | = | Means: BMI (Intervention Baseline: 18.0 kg/m2 (95% CI 17.8 kg/m2, 18.3 kg/m2) Follow up: 18.5 kg/m2 (18.0 kg/m2, 18.5 kg/m2) Control Baseline: 17.6 kg/m2 (16.9 kg/m2, 18.3 kg/m2) Follow up: 18.2 kg/m2 (17.4 kg/m2, 18.9 kg/m2) |
Systolic blood pressure | = | Systolic blood pressure (Intervention Baseline: 104.8 mm/Hg (104.0 mm/Hg, 105.9 mm/Hg) Follow up: 102.2 mm/Hg (101.4 mm/Hg, 104.9 mm/Hg) Control Baseline: 105.9 mm/Hg (104.1 mm/Hg, 107.7 mm/Hg) Follow up: 103.1 mm/Hg (101.3 mm/Hg, 106.5 mm/Hg) | ||||
Percentage body fat | = | Percentage body fat (Intervention Baseline: 22.4% (21.9%, 23.0%) Follow up: 23.1% (22.5%, 23.7%) Control Baseline: 21.2% (19.6%, 22.8%) Follow up: 21.9%(20.3%, 23.6%) | ||||
Triceps skinfold | + | Triceps skinfold (Intervention Baseline: 14.5 mm (14.0 mm, 14.9 mm) Follow up: 15.1 mm (14.5 mm, 15.6 mm) Control Baseline: 13.0 mm (11.9 mm, 14.1 mm) Follow up: 14.2 mm (12.6 mm, 15.7 mm)) | ||||
Subscapular skinfold | = | Subscapular skinfold (Intervention Baseline: 10.3 mm (9.8 mm, 10.8 mm) Follow up: 11.1 mm (10.5 mm, 11.6 mm) Control Baseline: 10.2 mm (8.7 mm, 10.8 mm) Follow up: 10.7 mm(9.1 mm, 12.2 mm)) | ||||
Covelli, 2008 [27] | Quasi-experimental - Repeated Measures | Integration of health promotion into curriculum | Maintenance of blood pressure | Blood pressure | = | SBP: Intervention (Baseline 119.7 mm/Hg Follow up 116.2 mm/Hg) Control (Baseline 119.2 mm/Hg Follow up 119.1 mm/Hg; p = 0.56) |
DBP: Intervention (Baseline 66.2 mm/Hg Follow up 67.2 mm/Hg) Control (Baseline 66.8 mm/Hg Follow up 68.0 mm/Hg; p = 0.97) | ||||||
Biomarkers
| ||||||
Knox et al., 2012 [22] | Quasi-experimental | Brisk walking lessons | Blood levels of triglycerides, high density lipoprotein cholesterol, high density lipoprotein: total cholesterol, glucose | Triglycerides | + | Elevated Triglycerides (Control: - 2.5%; Intervention:-1.2%) |
High density lipoprotein cholesterol | + | Elevated high density lipoprotein cholesterol (Control: - 3. 7% vs. Intervention:-1.2%2.7%) | ||||
High density lipoprotein: total cholesterol | + | High density lipoprotein cholesterol to total cholesterol ratio (mean + − SD: 2% ± 4% [confidence interval (CI)o.o5 = 1% to 2%>], t80 = −3.5, p = .001) | ||||
Glucose | + | Glucose (−.1 ± .4 mmol/L p = .002) | ||||
Manios et al., 1999 [24] | RCT | Multi-component workbooks – National policy for health education | Serum level lipid changes | Total Serum Cholesterol | + | Intervention (Baseline 187.4 mg/dl Follow up 173.7 mg/dl) Control (Baseline 177.3 mg/dl Follow up 190.6 mg/dl; p = 0.001) |
Biomarkers
Unhealthy diet
Study | Design | Policy | Outcomes | Specific outcome | Impact (+) Favorable and significant change (=) No change | Strength of Association |
---|---|---|---|---|---|---|
Blum et al., 2008 [28] | Quasi-experimental | Elimination from SSB (Diet) and other junk food in schools food policy | Sugar-sweetened beverages consumption | SSB | = | Consumption of SSB decreased in both intervention and control boys (F = 53.69, P < .05) and girls (F = 22.87, P < .05). Intervention girls decreased diet soda consumption as compared to control girls (F = 6.57, P < .05) |
Diet soda | = | |||||
Juice | = | |||||
Johnson et al., 2009 [29] | Cross-sectional | School district SSB policies | Sugar-sweetened beverages consumption | SSBs | + | β = − 9.50, p < .0002 |
Schwartz et al., 2009 [30] | Quasi- Experimental | Removal of snacks of low nutritional value | Consumption of beverages, salty snack, and sweet snack | Beverages | + | β = −.23, p < .05 |
Salty snack | + | β = −.30, p < .05 | ||||
Sweet snack | = | Not reported | ||||
French et al., 2004 [31] | RCT | School nutrition policy initiative: Food availability in à la carte areas; Peer promotions | Lower-fat food choices, Added fats score, Fruit and vegetable score | Lower-fat food choices | = | % Yes: Intervention (Baseline 0.29 First year 0.28 Second year 0.28) Control (Baseline 0.23 First year 0.26 Second year 0.24; p = 0.62) |
Added fats score | = | % Yes: Intervention (Baseline 2.5 First year 2.6 Second year 2.4) Control (Baseline 2.6 First year 2.7 Second year 2.5; p = 0.97) | ||||
Fruit and vegetable score | = | % Yes: Intervention (Baseline 2.7 First year 2.9 Second year 2.9) Control (Baseline 2.8 First year 3.1 Second year 3.1; p = 0.95) | ||||
Foster et al., 2008 [14] | RCT | School self-assessment; nutrition education; nutrition policy; social marketing; and parent outreach. | Total energy consumed (kilo- joules), fat consumption (grams), and the number of fruit and vegetable servings | Energy | = | Adjusted difference: −104.27 (−234.28, 25.73) p = 0.12 |
Fat consumption | = | Adjusted difference: −3.78 (−8.59, 1.02) p = 0.12 | ||||
Fruit and vegetable servings | = | Adjusted difference: −0.04 (−0.37, 0.3) p = 0.82 | ||||
Fung et al., 2013 [21] | Cross-sectional | School food and nutrition policy (Children’s Lifestyle and School Performance Study-CLASS) | Fruit/vegetable, grain products, milk products, meat and alternatives, soda intake, SSBs, | Fruit/vegetable | = | β = −0.08 (−0.27, 0.19) |
Grain products | + | β = 0.26 (0.17, 0.34) | ||||
Milk products | + | β = 0.24 (0.18, 0.31) | ||||
Meat and alternatives | + | β = 0.06 (0.03, 0.09) | ||||
Soda intake | + | β = −0.09 (−0.11, −0.06) | ||||
SSBs | + | β = −0.20 (−0.27, −0.12) | ||||
Moore and Tapper, 2008 [32] | RCT | Fruit Truck Shops | Consumption of fruit and sweet and savoury snacks | Fruits | = | β = 0.06 (−0.1, −0.21) |
Sweets, Chocolates, Biscuits | = | β = −0.1 (−0.3, 0.01) | ||||
Crisps | = | β = −0.05 (−0.2, 0.06) | ||||
Jaenke et al., 2012 [33] | Quasi- Experimental | Nutrition education, gardening program | Fruit and vegetable intake | Fruits | = |
P = 0.93 |
Vegetables | + |
P = 0.67 | ||||
Knox et al., 2012 [22] | RCT | Brisk Walking Lessons | Consumption of total fat, saturated fat, carbohydrates, proteins, fiber, and total calories | Consumption of total fat, saturated fat, carbohydrates, proteins, fiber, and total calories | = | Non-significant changes, effect, estimates not reported |
Covelli, 2008 [27] | Quasi-experimental - Repeated Measures | Integration of health promotion in existing curriculum (Provision of cognitive behavioral components of health knowledge, health promotion concepts, nutrition, and exercise). | Fruits/vegetables per day | Fruits/vegetables per day | + | Fruits/vegetables per week: Intervention (Baseline 2.6 Follow up 4.9) Control (Baseline 2.7 Follow up 2.5; p = 0.0001) |
Llargues et al., 2011 [23] | RCT | Teacher Training, Develop activities related to food habits and/or physical activity | Fruits, vegetables, SSBs, Sweets, Fizzy drinks | Fruits | = | No changes: Intervention 84.2% (p = 0.36) Control 80.0% (0.18) |
Vegetables | = | No changes: Intervention 73.1% (p = 0.58) Control 81.4% (0.84) | ||||
Sweets | = | No changes: Intervention 93.7% (p = 1.0) Control 94.3% (0.7) | ||||
Fizzy drinks | = | No changes: Intervention 87.9% (p = 1.0) Control 89.2% (0.12) | ||||
Vandongen et al., 1995 [26] | Cross-Sectional | Guidance around fitness and nutrition (Fitness, Fitness + School Nutrition, School Nutrition, School and home nutrition, home nutrition, All groups together | Fat, sugar and protein | Fat | Boys =Girls + | Fat % energy (Intervention Baseline: 33.1 (32.7, 33.7) Follow up: 33.7 (33.1, 34.3) Control Baseline: 33.2 (32.7, 33.7) Follow up: 33.2 (31.5, 34.9) |
Sugar | Boys + Girls = | Sugar % energy (Intervention Baseline: 22.8 (22.1, 23.5) Follow up: 21.9 (21.2, 22.7) Control Baseline: 21.7 (20.0, 23.3) Follow up: 23.3 (21.4, 25.3) | ||||
Protein | Boys + Girls + | Protein (% energy) Intervention Baseline: 15.5 (15.3, 15.8) Follow up: 15.6 (15.2, 15.9) Control Baseline: 15.8 (15.1, 16.4) Follow up: 14.7 (13.9, 15.4) | ||||
Harris et al., 1997 [34] | Quasi- Experimental | Modified school lunches, Enhanced nutrition education and increased opportunities for physical activities | Knowledge and awareness regarding nutrition | Awareness levels | + | (t [33] = −6.64, p < .0001) |
O’Brien et al., 2010 [35] | Cross-Sectional | Comprehensive school health education, physical education and physical activity, school nutrition and food services, health promotion and wellness, school counselling physical and behavioral health services, school climate, physical environment, youth, parent, family and community involvement | SSB consumption | Two or more sodas/week | + | OR: 0.83 (p = .023) |
Spence et al., 2013 [36] | Natural Experiment | Nutrient-based standards | Non-milk extrinsic sugar | % energy NMES | = | Mean difference: −2.6 (−3.2, −1.9) (p < 0.001) |
Tobacco and alcohol use
Study | Design | Policy | Outcomes | Specific outcome | Impact (+) Favorable and significant change (=) No change | Strength of Association |
---|---|---|---|---|---|---|
Tobacco use
| ||||||
Evans-Whipp et al., 2010 [37] | Cross-sectional | Comprehensive smoking bans, policy orientation towards abstinence and harm minimization principles, possession of tobacco products among students | Current tobacco use, Daily smoking, Perception of smoking in school campus | Smoking ban – current smoking | = | OR (95% CI): 0.86 (0.59, 1.25) |
Harm minimization – current smoking | = | OR (95% CI): 1.09 (0.99, 1.21) | ||||
Strict enforcement – current smoking | = | OR (95% CI): 0.78 (0.57, 1.05) | ||||
Smoking ban – daily smoking | = | OR (95% CI): 0.95 (0.53, 1.69) | ||||
Harm minimization – daily smoking | = | OR (95% CI): 1.01 (0.85, 1.20) | ||||
Strict enforcement – daily smoking | = | OR (95% CI): 0.70 (0.44, 1.12) | ||||
Smoking ban – perception | = | OR (95% CI): 1.39 (0.67, 2.89) | ||||
Harm minimization – perception | = | OR (95% CI): 1.18 (0.97, 1.43) | ||||
Strict enforcement – perception | + | OR (95% CI): 0.45 (0.25, 0.82) | ||||
Hamilton et al., 2005 [38] | RCT | School-based harm minimization smoking intervention | Regular smoking, smoking within previous month | Regular smoking | + | Intervention vs comparison OR (95% CI): Baseline 0.74 (0.45, 1.22) Post-intervention: 0.50 (0.33, 0.74) |
Smoking within previous month | + | Intervention vs comparison OR (95% CI): Baseline 0 0.95 (0.71, 1.28) Post-intervention: 0.69 (0.53, 0.91) | ||||
Lovato et al., 2007 [39] | Cross sectional | School/ District tobacco control policies – policy intention (written policy), policy implementation, perception of policy enforcement | Prevalence of smoking | Policy intention – smoking prevalence | + | β = −0.11 (R2 = 0.27) (P < 0.05) |
Policy implementation – smoking prevalence | + | β = −0.04 (R2 = 0.21) (P < 0.05) | ||||
Policy perception – smoking prevalence | + | β = −0.55 (R2 = 0.62) (P < 0.05) | ||||
Murnaghan et al., 2008 [40] | Cross-sectional | Policy banning smoking in school property participated in provincially directed school-based smoking prevention program | Current smoking, Occasional smoking and Regular smoking | Occasional vs nonsmoker | = | OR (95% CI): 1.54 (0.79, 3.01) |
Regular vs occasional smoker | = | OR (95% CI): 0.92 (0.69, 1.23) | ||||
O’Brien et al., 2010 [35] | Cross-Sectional | Tobacco control school-based policy – Teacher shared information of consequences of smoking | Frequency of smoking in past month | Average cigarettes smoked/day | = | Not reported |
Paek et al., 2013 [41] | Cross-sectional | Tobacco-free school policy | Frequency of smoking | Frequency of smoking | + | β = −0.56 (P < 0.05) |
Patel et al., 2012 [20] | Cross-sectional | Avoiding tobacco promotion | Tobacco use | Tobacco use | + |
P < 0.05 |
Alcohol use
| ||||||
Evans-Whipp et al., 2013 [42] | Cross-sectional | Low policy enforcement, Abstinence alcohol message, Harm minimization alcohol message | Alcohol use: alcohol use on school grounds, current alcohol use. Binge drinking, student alcohol harm | Low policy enforcement - Use on school grounds | + | OR (95% CI): 1.48 (1.07, 2.05) |
Low policy enforcement - Current alcohol use | = | OR (95% CI): 1.12 (0.95, 1.32) | ||||
Low policy enforcement - Binge drinking | = | OR (95% CI): 1.14 (0.94, 1.38) | ||||
Low policy enforcement - Student alcohol harm | = | OR (95% CI): 1.02 (0.84, 1.25) | ||||
Abstinence alcohol message - Use on school grounds | = | OR (95% CI): 0.85 (0.66, 1.10) | ||||
Abstinence alcohol message - Current alcohol use | = | OR (95% CI): 0.90 (0.78, 1.04) | ||||
Abstinence alcohol message - Binge drinking | = | OR (95% CI): 0.84 (0.59, 1.25) | ||||
Abstinence alcohol message - Student alcohol harm | = | OR (95% CI): 0.86 (0.71, 1.04) | ||||
Harm minimization alcohol message - Use on school grounds | = | OR (95% CI): 0.90 (0.73, 1.10) | ||||
Harm minimization alcohol message - Current alcohol use | = | OR (95% CI): 0.92 (0.83, 1.02) | ||||
Harm minimization alcohol message - Binge drinking | = | OR (95% CI): 0.82 (0.72, 1.92) | ||||
Harm minimization alcohol message - Student alcohol harm | + | OR (95% CI): 0.83 (0.71, 0.96) |
Physical inactivity
Study | Design | Policy | Outcomes | Specific outcome | Impact (+) Favorable and significant change (=) No change | Strength of Association |
---|---|---|---|---|---|---|
Anthamatten et al., 2011 [43] | Case-control | Physical Activity (learning landscape program) (Renovation of school grounds) | Utilization of school yards for Physical Activity | Overall utilization of school yards | + | Mean difference: 7.0 p = 0.003 |
Covelli, 2008 [27] | Quasi-experimental | Integration of health promotion in existing curriculum (Provision of cognitive behavioral components of health knowledge, health promotion concepts, nutrition, and exercise). | Exercise | Exercise per week | + | Intervention group: Mean Baseline (2.6 (SE:0.9) Follow up 4.5 (SE: 1.4)) |
Control group: Mean Baseline (2.1 (SE(0.8) Follow up 2.2 (SE 0.1)) p = 0.001 | ||||||
Gibson et al., 2008 [44] | RCT | Physical Activity Across the Curriculum (PACC) - 90 mins moderate intensity physical activity delivered as part of academic instruction | Physical activity | Levels of physical activity | + | Intervention students 3.40 ± 0.02 vs control students 2.17 ± 0.03, p < 0.0001 |
Harris et al., 1997 [34] | Quasi-experimental | Modified school lunches, Enhanced nutrition education and increased opportunities for physical activities | Physical activity | Fitness levels | = | Pretest (18%) to post-test (29%) (p = 0.29) |
Holt et al., 2013 [45] | Quasi-experimental | District mandated Physical Activity Policy (20 min) | Physical activity: Walk/run, Movement activity | Walk/run | + | Not reported |
Movement | = | Not reported | ||||
Llargues et al., 2011 [23] | RCT | Teacher Training, Develop activities related to food habits and/or physical activity | Physical activity | Walking to school | + | No changes: Control 83% Intervention: 73.4% p < 0.05 |
Exercise | + | No changes: Control 74.2% Intervention: 76.4% p < 0.05 | ||||
Manios et al., 1999 [24] | RCT | Multicomponent workbooks covering dietary issues, physical activity and fitness, dental health hygiene, smoking and accident prevention | Leisure time physical activity | Leisure-time MVPA | + | Intervention (Baseline 0.9) (Follow up 2.8) Control (Baseline 1.4) (Follow up 2.0) |
O’Brien et al., 2010 [35] | Cross-sectional | Comprehensive school health education, physical education and physical activity, school nutrition and food services, health promotion and wellness, school counselling physical and behavioral health services, school climate, physical environment, youth, parent, family and community involvement | Physical activity | TV viewing >2 h/day | + | Odds ratio: 0.95 p = 0.28 |
Vandongen et al., 1995 [26] | Cross-sectional | Fitness, fitness + school nutrition, school based nutrition, school + home nutrition, home based nutrition | Fitness | Leger score | + | Means: Leger score (Intervention Baseline: 43.2 (41.9, 44.4) Follow up: 44.7 (43.2, 46.2) Control Baseline: 42.2 (38.6, 45.7) Follow up: 41.0 (37.2, 44.9) |
Run time (minutes) | + | Means: Run time (Intervention Baseline: 9.9 (9.8, 10.1) Follow up: 9.6 (9.4, 9.8) Control Baseline: 10.4 (9.9, 10.7) Follow up: 9.9 (9.4, 10.4) |