The Effects of a Multi-Component, School-Based Intervention on the Health and Behaviors of Children
Authors:   , Duffine Abigail , Volpe Stella L. 
Published: July 2021

Problem: Childhood obesity affects nearly 17% of children in the United States, and children living with obesity have a 40% chance of developing more than one risk factor for cardiovascular disease as adults. Interventions addressing childhood obesity are best effective in the school environment, primarily due to the immense time children spend in school. Multi-component interventions that focus on several aspects of obesity interventions, including nutrition and physical activity, have shown to be more successful in influencing the behaviors and health outcomes of children. Although key components of effective school-based interventions have been identified, the frequency, type and duration of interventions provided have been inconsistent and have led to equivocal results, limiting the reproducibility and future application of effective obesity prevention interventions. Additionally, little information is known about the comparative effectiveness of school-based interventions across different School Types, such as Public, Charter and Parochial/Religious schools. The purpose of this study was to identify how a multi-component school-based obesity intervention affected the health outcomes and behaviors of children. Methods: Students were recruited from schools of the Greater Philadelphia area for a three-year study. Thirteen schools were provided nutrition, physical activity, and wellness interventions implemented by community partners. Schools were designated as Core, Level 1, or Control Schools. Core Schools received weekly interventions; Level 1 Schools received monthly interventions; and Control Schools received no interventions. Anthropometric and health behavior assessments were collected in the Fall and Spring of each year. Food preference assessments were collected throughout the study intervention. Linear mixed modeling was used to assess the influence of Level of Intervention, Sex, School, and School Type on the anthropometric outcomes of the students. Chi-square tests of independence were utilized to assess the influence of the Level of Intervention on the students' likelihood of meeting national fruit, vegetable, and physical activity recommendations. Chi-square tests of independence were also used to assess the influence of the Level of Intervention on the students' exposure to, preference for, and willingness to try new fruits and vegetables again. Results: Six linear mixed models were built to describe the influence of the Level of Intervention, Sex, School, and School Type on either Body mass index (BMI) z-score or waist circumference. Level of Intervention was significant (p=0.037) in predicting BMI z-score in all students. School Type was a significant predictor of BMI z-score in students who were overweight and/or obese (p=0.039). School Type was also a significant predictor of waist circumference in all students (p=0.001), students at low-risk for cardio-metabolic disease (<90th percentile) (p=0.011), and students at high-risk for cardio-metabolic disease (90th percentile) (p=0.041). For the health behaviors, significant (p<0.004) chi-square tests were reported in the Fall of Years 2 and 3 for having met the physical activity recommendations. Descriptive statistics indicated that higher proportions of students in the Core and Level 1 Schools reported meeting fruit, vegetable, and physical activity recommendations compared to students of the Control Schools. Finally, to assess the food preferences of children, students in Core Schools were 3.7 times more likely to have been exposed to a new fruit and vegetable (p<0.001) presented during in-class lessons, compared to students in Level 1 Schools during the Winter of Year 3. No other significant differences were found. However, there was an increase in the proportion of students who had exposure to, preference for, and willingness to try new foods throughout the final year of intervention. Conclusions: This is the first study to identify School Type as a significant predictor of anthropometric outcomes for students enrolled in a school-based intervention. Further, this multi-component school-based intervention may have been effective in changing the health behaviors and food preferences of children. Further research should focus on the different environmental factors across School Types and how they influence the health outcomes of children.