Cost‐Effectiveness of a School‐Based Obesity Prevention Program

BACKGROUND: A school‐based obesity prevention study (Medical College of Georgia FitKid Project) started in the fall of 2003 in 18 elementary schools. Half of the schools were randomized to an after‐school program that included moderate‐to‐vigorous physical activity, healthy snacks, homework assistance, and academic enrichment. All third graders were invited to enroll. The objective of this study was to assess the cost‐effectiveness (CE) of the first‐year intervention. METHODS: Standard CE analysis methods and a societal perspective were used. Program delivery costs incurred during the first‐year intervention and the usual after‐school care costs that would occur in the absence of the intervention were estimated (in 2003 dollars). Net intervention costs were calculated by subtracting the usual after‐school care costs from the intervention costs. The effectiveness of the intervention was measured as percent body fat (%BF) reduction compared with a control condition. The CE was assessed as the net intervention cost divided by the effectiveness of the intervention. RESULTS: The intervention costs totaled $174,070, $558/student, or $956/student who attended ≥40% of the intervention sessions. The usual after‐school care costs were estimated at $639/student. Students who attended ≥40% of the intervention reduced %BF by 0.76% (95% confidence interval: ?1.42 to ?0.09) at an additional cost of $317/student. CONCLUSIONS: Subjects who attended ≥40% of the intervention achieved a significant reduction in %BF at a relatively low cost. School‐based obesity prevention programs of this type are likely to be a cost‐effective use of public funds and warrant careful consideration by policy makers and program planners.     

The Influence of Organizational Culture on School‐Based Obesity Prevention Interventions: A Systematic Review of the Literature

BACKGROUND

Although the influence of organizational culture has been examined on a variety of student outcomes, few studies consider the influence that culture may have on school‐based obesity prevention interventions. We present a systematic review of the literature to examine how elements of organizational culture may affect the adoption, implementation, and sustainability of school‐based obesity prevention interventions.

METHODS

Fourteen studies examining the impact of organizational‐level characteristics on school‐based obesity prevention interventions were identified through the online databases EBSCO (CINAHL, ERIC, Agricola), Web of Science, Medline (PubMed), and Scopus.

RESULTS

Five themes were identified as elements of organizational culture that influence the adoption, implementation, and sustainability of school‐based obesity prevention interventions: organizational response to limited resources, value placed on staff training and professional development, internal support, organizational values, and school climate.

CONCLUSIONS

Organizational culture can greatly influence the success of school‐based obesity interventions. The collection of data related to organizational‐level factors may be used to identify strategies for creating and sustaining a supportive environment for obesity prevention interventions in the school setting.

     

Effects of a School‐Based Pedometer Intervention in Adolescents: 1‐Year Follow‐Up of a Cluster‐Randomized Controlled Trial

BACKGROUND

Physical activity (PA) is one of the most important health behaviors that may be modified by each individual. To foster PA in adolescents, a school‐based intervention was evaluated.

METHODS

A cluster‐randomized controlled trial with preassessment in 2014 and follow‐up assessment in 2015 included 29 schools with 1020 students (47.6% girls, mean age = 13.69 years). Intervention students received pedometers and monitored their steps for 12 weeks. Classes with the most steps were awarded. Primary outcomes included moderate‐to‐vigorous PA, out‐of‐school sports activities, active transport assessed through questionnaires, as well as cardiorespiratory fitness measured using the 20‐m shuttle‐run test and anthropometric data (weight, height, body fat, and waist circumference) assessed by study staff.

RESULTS

Significant interaction terms between group and time were found for all 3 indicators of PA; intervention students showed a higher increase of PA than control students. The same pattern was shown for cardiorespiratory fitness, but the effect missed significance. A more favorable development for the intervention students was shown for body fat and waist‐to‐height ratio, while there was no effect on body mass index percentile.

CONCLUSIONS

An easy way to administer school‐based PA program may enhance students' leisure‐time PA even 1 year after the intervention has ended.

     

Examining Time to Treatment and the Role of School‐Based Health Centers in a School‐Based Sexually Transmitted Infection Program

BACKGROUND

Barriers to health care service utilization contribute to the spread of sexually transmitted infections (STIs) among teens. School‐based STI screening programs reach adolescents outside of the clinic‐based health care model and schools with school‐based health centers (SBHCs) may expedite treatment because of their proximity to the population. This study examined whether students who tested positive for STIs in a school‐based screening program had differing times to treatment based on treatment location.

METHODS

All positive cases of chlamydia and gonorrhea from the 2012‐2013 school year in a Chicago Department of Public Health (CDPH) and Chicago Public Schools school‐based STI screening program were reviewed. Median time to treatment was compared for those treated at an SBHC versus those treated elsewhere (CDPH STI clinic, community health center, private physician).

RESULTS

Overall, 540 students had positive results. The median age was 17 years, 427 had chlamydia (79.1%), 59 had gonorrhea (10.9%), and 54 had dual infections (10.0%); 144 were tested in a school with a SBHC on site (26.7%). Of the 483 students who received treatment (89.4%), those treated at a SBHC had a faster time to treatment compared to CDPH STI clinics (median 17 days versus 28 days, respectively, p < .001).

CONCLUSIONS

For students testing positive in the Chicago school‐based STI program, time to treatment is accelerated in locations with SBHCs.

     

Training in Methods of Preventing Childhood Obesity Increases Self-Efficacy in Nurses in Child Health Services: A Randomized,Controlled Trial

ObjectiveTo evaluate the effects of training in methods of preventing childhood obesity on self-efficacy (SE) in nurses.MethodsIn a randomized, controlled trial conducted in child health services in Sweden, nurses in the intervention and control groups of the PRIMROSE prevention trial of childhood obesity were offered a 5-day workshop on dietary and physical activity interventions, and motivational interviewing. Self-efficacy for influencing parents to promote healthy dietary and physical activity behaviors in their children was measured using an 18-item instrument. Difference in SE between groups at post-assessment was analyzed using multiple linear regression analysis.ResultsCompared to control nurses (n = 38), intervention nurses (n = 22) demonstrated higher SE (β = 14.70, P < .001).Conclusions and ImplicationsTraining in methods of preventing childhood obesity increased SE in nurses. Self-efficacy should be included as a construct in evaluations of clinical training.