Childhood overweight and obesity
Childhood obesity is a serious public health challenge in Australia, with approximately one in four (27.4%) children aged 5–17 years being overweight or obese [
1]. Compared to healthy weight range children, those above a healthy weight are more likely to develop chronic conditions including asthma, Type 2 diabetes, poor emotional wellbeing, poor academic performance [
2] and to become obese adults [
3].
Compelling evidence suggests sugar sweetened beverages (SSBs) are detrimental to health and contribute to obesity [
4]. Recent systematic reviews confirm the link between SSBs consumption and weight gain in both children and adults [
5,
6], and that reducing SSBs consumption reduces weight gain in children, particularly in those who are already overweight [
7]. During adolescence SSBs consumption increases, with nearly 25% of NSW children aged 12–17 years consuming SSBs at least 5 or more times per week [
8]. Substitution of SSBs with water has been associated with a reduction in BMI in early adolescence and increasing the consumption of water has been shown to decrease the incidence of overweight/obesity in children [
9]. At a population level, reducing consumption of SSBs is an important modifiable behaviour to address and in combination with other strategies can contribute to alleviating the problem of overweightness and obesity.
There is increasing evidence that addressing this issue in the school setting has merit. A recent systematic review [
10] examined 36 interventions in school settings that targeted the individual, the environment or both. This review demonstrated that 70% of these interventions were effective in decreasing SSB consumption, with effectiveness increasing for those interventions that targeted legislation or the environment. Moreover, a systematic review of educational and behavioural interventions to reduce SSB consumption in children and adolescents, found the trend toward reduction in SSB consumption approached statistical significance in those studies conducted within school-based settings (
p = .06) [
11].
Other evidence suggests school based education programs promoting increased water consumption can impact positively on SSBs consumption [
12] as can the provision of chilled water stations and water bottles [
13] which has been shown to increase water consumption in children and decrease the incidence of overweight in children [
13‐
15].
In view of this evidence, interventions using the health promoting schools framework to address SSB consumption holds promise, and is the basis of this study intervention. A recent Cochrane systematic review demonstrated modest positive intervention effects on range of health indicators for interventions that utilised the Health Promoting Schools Framework [
16].
This study is an expansion of an initial pilot project conducted on the NSW Central Coast. In 2016 Central Coast Local Health District piloted a component of the Thirsty? Choose Water! behavioural intervention (TCW-BI) targeting the partnership domain of the Health Promoting Schools Framework. Partnering with immunisation nurses, the post-immunisation waiting period was used to deliver messages that promoted water as a preferred drink, and generate discussion regarding SSBs. All year 7 students involved in the secondary school immunisation program were exposed to the intervention. Post-immunisation nurses directed students to participate in “Spouts and Straws” (snakes and ladders), a game which introduces messages about the benefits of water consumption and the negative health effects of SSBs. Preliminary findings suggested students’ knowledge and awareness regarding SSBs increased, with some changes in their water drinking habits. The evaluation indicated high levels of acceptability for students, teachers and immunisation staff and utilising the immunisation program as an opportunity to deliver health messages was considered practical and effective.
This current study expands on this pilot, examining the impact of a TCW-BI addressing all aspects of the health promoting schools framework and/or the installation of chilled water stations on Year 7 secondary school students’ knowledge, attitudes and behaviours regarding the consumption of SSBs and water.