Introduction: Healthier school environments can benefit students, and school wellness policies may result in meaningful enhancements. Schools participating in federal child nutrition programs must implement wellness policies as mandated by law. The primary study objective is to assess effectiveness of implementing school-based nutrition and physical activity policies on student BMI trajectories. Study design: Cluster randomized trial using 2 x 2 factorial design. Setting/participants: Twelve randomly selected schools in an urban district. Students were followed for 3 years through middle school, fifth to eighth grades (2011-2015, n=595 students, 92.3% participation, 85.2% retention). Intervention: Specific to randomized condition, support was provided for implementation of nutrition policies (e.g., alternatives to food-based rewards/celebrations) and physical activity policies (e.g., opportunities for physical activity during/after school). Main outcome measures: Sex-/age-adjusted BMI percentile and BMI z-score; behavioral indicators. Data collected via standardized protocols. Results: Analyses followed intention-to-treat principles, with planned secondary analyses (conducted 2016-2018). Students at schools randomized to receive support for nutrition policy implementation had healthier BMI trajectories over time (F=3.20, p=0.02), with a greater magnitude over time and cumulatively significant effects 3 years post-intervention (beta=-2.40, p=0.04). Overall, students at schools randomized to receive the nutrition intervention had an increase in BMI percentile of <1%, compared with students in other conditions, whereas BMI percentile increased 3%-4%. There was no difference in student BMI between those in schools with and without physical activity policy implementation. Examining behavioral correlates in eighth grade, students at schools randomized to the nutrition condition consumed fewer unhealthy foods and sugar-sweetened beverages, and ate less frequently at fast-food restaurants (all p<0.03). Conclusions: This cluster randomized trial demonstrated effectiveness of providing support for implementation of school-based nutrition policies, but not physical activity policies, to limit BMI increases among middle school students. Results can guide future school interventions. (C) 2019 Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine.
机构:Plymouth University Peninsula Schools of Medicine and Dentistry (formerly Peninsula College of Medicine and Dentistry),Peninsula Clinical Trials Unit and Medical Statistics Group
Siobhan Creanor
Jenny Lloyd
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机构:Plymouth University Peninsula Schools of Medicine and Dentistry (formerly Peninsula College of Medicine and Dentistry),Peninsula Clinical Trials Unit and Medical Statistics Group
Jenny Lloyd
Melvyn Hillsdon
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Melvyn Hillsdon
Sarah Dean
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Sarah Dean
Colin Green
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Colin Green
Rod S. Taylor
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Rod S. Taylor
Emma Ryan
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Emma Ryan
Katrina Wyatt
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机构:Plymouth University Peninsula Schools of Medicine and Dentistry (formerly Peninsula College of Medicine and Dentistry),Peninsula Clinical Trials Unit and Medical Statistics Group
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Univ Laval, Fac Sci Infirmieres, Pavillon Ferdinand Vandry,Local 3453, Quebec City, PQ G1K 7P4, Canada
Univ Libanaise, Fac Sante Publ, Saraya St, Saida 714, Saida, LebanonUniv Laval, Fac Sci Infirmieres, Pavillon Ferdinand Vandry,Local 3453, Quebec City, PQ G1K 7P4, Canada
Santina, Tania
Beaulieu, Dominique
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Univ Quebec Rimouski, Campus Levis, Levis, PQ, CanadaUniv Laval, Fac Sci Infirmieres, Pavillon Ferdinand Vandry,Local 3453, Quebec City, PQ G1K 7P4, Canada
Beaulieu, Dominique
Gagne, Camille
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Univ Laval, Fac Sci Infirmieres, Pavillon Ferdinand Vandry,Local 3453, Quebec City, PQ G1K 7P4, CanadaUniv Laval, Fac Sci Infirmieres, Pavillon Ferdinand Vandry,Local 3453, Quebec City, PQ G1K 7P4, Canada
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Univ Rhode Isl, Dept Kinesiol, Kingston, RI 02881 USAUniv Rhode Isl, Dept Kinesiol, Kingston, RI 02881 USA
Greaney, Mary L.
Hardwick, Cary K.
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Commonwealth Community Care, Springfield, MA USAUniv Rhode Isl, Dept Kinesiol, Kingston, RI 02881 USA
Hardwick, Cary K.
Spadano-Gasbarro, Jennifer L.
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Harvard Univ, Sch Publ Hlth, Dept Nutr, Boston, MA 02115 USAUniv Rhode Isl, Dept Kinesiol, Kingston, RI 02881 USA
Spadano-Gasbarro, Jennifer L.
Mezgebu, Solomon
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Massachusetts Dept Publ Hlth, Div Hlth Promot & Dis Prevent, Boston, MA USAUniv Rhode Isl, Dept Kinesiol, Kingston, RI 02881 USA
Mezgebu, Solomon
Horan, Christine M.
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Harvard Pilgrim Hlth Care Inst, Dept Populat Med, Boston, MA USAUniv Rhode Isl, Dept Kinesiol, Kingston, RI 02881 USA
Horan, Christine M.
Schlotterbeck, Sara
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Brown Univ, Alpert Med Sch, Providence, RI 02912 USAUniv Rhode Isl, Dept Kinesiol, Kingston, RI 02881 USA
Schlotterbeck, Sara
Austin, S. Bryn
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Boston Childrens Hosp, Div Adolescent & Young Adult Med, Boston, MA USA
Harvard Univ, Sch Publ Hlth, Dept Social & Behav Sci, Boston, MA 02115 USAUniv Rhode Isl, Dept Kinesiol, Kingston, RI 02881 USA
Austin, S. Bryn
Peterson, Karen E.
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Harvard Univ, Sch Publ Hlth, Dept Nutr, Boston, MA 02115 USA
Univ Michigan, Sch Publ Hlth, Human Nutr Program, Ann Arbor, MI 48109 USAUniv Rhode Isl, Dept Kinesiol, Kingston, RI 02881 USA
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Univ Utah, Dept Dermatol, 30 N Mario Capecchi Dr, Salt Lake City, UT 84112 USA
Univ Utah, Huntsman Canc Inst, 2000 Circle Hope Dr, Salt Lake City, UT 84112 USAUniv Utah, Dept Dermatol, 30 N Mario Capecchi Dr, Salt Lake City, UT 84112 USA
Wu, Yelena P.
Stump, Tammy K.
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Univ Utah, Dept Dermatol, 30 N Mario Capecchi Dr, Salt Lake City, UT 84112 USA
Univ Utah, Huntsman Canc Inst, 2000 Circle Hope Dr, Salt Lake City, UT 84112 USAUniv Utah, Dept Dermatol, 30 N Mario Capecchi Dr, Salt Lake City, UT 84112 USA
Stump, Tammy K.
Hay, Jennifer L.
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Mem Sloan Kettering Canc Ctr, Dept Psychiat & Behav Sci, 1275 York Ave, New York, NY 10021 USAUniv Utah, Dept Dermatol, 30 N Mario Capecchi Dr, Salt Lake City, UT 84112 USA
Hay, Jennifer L.
Buller, David B.
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Klein Buendel Inc, 1667 Cole Blvd,Suite 220, Golden, CO 80401 USAUniv Utah, Dept Dermatol, 30 N Mario Capecchi Dr, Salt Lake City, UT 84112 USA
Buller, David B.
Jensen, Jakob D.
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Univ Utah, Huntsman Canc Inst, 2000 Circle Hope Dr, Salt Lake City, UT 84112 USA
Univ Utah, Dept Commun, Salt Lake City, UT USAUniv Utah, Dept Dermatol, 30 N Mario Capecchi Dr, Salt Lake City, UT 84112 USA
Jensen, Jakob D.
Grossman, Douglas
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Univ Utah, Dept Dermatol, 30 N Mario Capecchi Dr, Salt Lake City, UT 84112 USA
Univ Utah, Huntsman Canc Inst, 2000 Circle Hope Dr, Salt Lake City, UT 84112 USAUniv Utah, Dept Dermatol, 30 N Mario Capecchi Dr, Salt Lake City, UT 84112 USA
Grossman, Douglas
Shen, Jincheng
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Univ Utah, Huntsman Canc Inst, 2000 Circle Hope Dr, Salt Lake City, UT 84112 USA
Univ Utah, Dept Populat Hlth Sci, Salt Lake City, UT USAUniv Utah, Dept Dermatol, 30 N Mario Capecchi Dr, Salt Lake City, UT 84112 USA
Shen, Jincheng
Haaland, Benjamin A.
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Univ Utah, Huntsman Canc Inst, 2000 Circle Hope Dr, Salt Lake City, UT 84112 USA
Univ Utah, Dept Populat Hlth Sci, Salt Lake City, UT USAUniv Utah, Dept Dermatol, 30 N Mario Capecchi Dr, Salt Lake City, UT 84112 USA
Haaland, Benjamin A.
Jones, Jacey
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Univ Utah, Huntsman Canc Inst, 2000 Circle Hope Dr, Salt Lake City, UT 84112 USAUniv Utah, Dept Dermatol, 30 N Mario Capecchi Dr, Salt Lake City, UT 84112 USA
Jones, Jacey
Tercyak, Kenneth P.
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Georgetown Univ, Georgetown Lombardi Canc Ctr, Washington, DC USAUniv Utah, Dept Dermatol, 30 N Mario Capecchi Dr, Salt Lake City, UT 84112 USA
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Umm Al Qura Univ, Dept Community Med & Pilgrims, Makkah Al Mukarrama 7607, Saudi ArabiaFed Postgrad Med Inst, Dept Oral Hlth Sci, Lahore 54600, Pakistan