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      School-based Intervention to Promote Healthy Lifestyles in Sousse, Tunisia

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          Abstract

          Background:

          Integrated actions against selected risk factors (i.e. smoking, physical inactivity, and unhealthy diet) can lead to the reduction of major chronic diseases.

          Objective:

          To implement and evaluate a school-based intervention program to prevent cardiovascular risk factors among children.

          Materials and Methods:
          Design:

          Pre- test post-test quasi experimental design with a control group.

          Setting:

          Four secondary schools in Sousse, Tunisia.

          Intervention:

          The overall intervention program lasted for a school year and incorporated educative actions concerning tobacco use, physical activity, and healthy diet.

          Results:

          Globally, knowledge, behaviors, and intentions concerning smoking improved in both groups between baseline and the end of the study, particularly in the intervention group. Nutrition knowledge, behaviors, and intentions improved in both groups between baseline and final stage, particularly in the intervention group. At the final stage, there was an increase in the proportion of children walking to and from school in the intervention group. There was also an increase in the percentage of children with intention of practicing sport in the future particularly in the intervention group. There were no significant differences in BMI after the intervention neither in intervention nor in control groups. At the end of the study, the incidence of overweight and obesity was similar to that at baseline.

          Conclusions:

          This pilot study has demonstrated the potential of school as a suitable setting for the promotion of healthy lifestyles in children. The study resulted in substantial improvements concerning knowledge, behaviors, and intentions in the intervention group.

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          Most cited references22

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          Joining together to combat poverty. Everybody welcome and needed.

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            Tracking of serum lipids and lipoproteins from childhood to adulthood. The Bogalusa Heart Study.

            Serum lipids (total cholesterol and triglycerides) and lipoprotein cholesterol fractions (low density lipoprotein (LDL) cholesterol, very low density lipoprotein (VLDL) cholesterol, and high density lipoprotein (HDL) cholesterol) have been measured approximately every 3 years on children and young adults since 1973-1974 in Bogalusa, Louisiana, a community of approximately 22,000 individuals, one-third of whom are black and two-thirds of whom are white. A total of 1,586 children were examined both at baseline (1973-1974) and at the most recent survey (1984-1986), providing 12 years of follow-up. The decreases in levels noted during puberty for total cholesterol and LDL cholesterol, primarily for boys, were followed by a rise until age 26 years. HDL cholesterol levels, particularly for white boys, continued to drop after age 14 years, yielding increasingly high LDL cholesterol/HDL cholesterol ratios. Tracking, as measured by both correlation coefficients and persistence at extreme quartiles, was evident for all of the lipids and lipoproteins. The 12-year correlation coefficients were greatest for LDL cholesterol and no trend in the magnitude of the correlation coefficients with age was noted. Tracking for HDL cholesterol was better after age 9 years, particularly for white males. Approximately 50% of those children who had total cholesterol levels or LDL cholesterol levels above the 75th percentile at baseline remained elevated 12 years later. For HDL cholesterol, a trend with age was noted for white boys: 42% of those aged 9-14 years in the lower most quartile persisted in this rank 12 years later. The best predictor of follow-up lipid or lipoprotein level was baseline level. The next best predictor was increase in weight as defined by weight/height, an index of obesity. That serum lipid and lipoprotein levels continue to track from childhood into young adulthood points to the necessity of measurement early in life and, where indicated, the introduction of preventive and interventional programs aimed at developing healthy lifestyles.
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              Serum cholesterol, blood pressure, and mortality: implications from a cohort of 361,662 men.

              The risks associated with various levels of serum cholesterol were determined by analysis of 6-year mortality in 361,662 men aged 35-57. Above the 20th percentile for serum cholesterol (greater than 181 mg/dl, greater than 4.68 mmol/l), coronary heart disease (CHD) mortality increased progressively; the relative risk was large (3.8) in the men with cholesterol levels above the 85th percentile (greater than 253 mg/dl, greater than 6.54 mmol/l). When men below the 20th cholesterol percentile were used as the baseline risk group, half of all CHD deaths were associated with raised serum cholesterol concentrations; half of these excess deaths were in men with cholesterol levels above the 85th percentile. For both CHD and total mortality, serum cholesterol was similar to diastolic blood pressure in the shape of the risk curve and in the size of the high-risk group. This new evidence supports the policy of a moderate fat intake for the general population and intensive treatment for those at high risk. There is a striking analogy between serum cholesterol and blood pressure in the epidemiological basis for identifying a large segment of the population (10-15%) for intensive treatment.
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                Author and article information

                Journal
                Indian J Community Med
                IJCM
                Indian Journal of Community Medicine : Official Publication of Indian Association of Preventive & Social Medicine
                Medknow Publications (India )
                0970-0218
                1998-3581
                January 2010
                : 35
                : 1
                : 94-99
                Affiliations
                Service of Epidemiology and Biostatistics, University Hospital Farhat Hached - 4000 Sousse, Tunisia
                Author notes
                Address for correspondence: Dr. Imed Harrabi, Service of Epidemiology and Biostatistics, University Hospital Farhat Hached, 4000 Sousse, Tunisia. E-mail: imed_harrabi@ 123456yahoo.fr
                Article
                IJCM-35-94
                10.4103/0970-0218.62581
                2888378
                20606930
                833ddada-7a55-483b-8cb3-f2cfbf7fac5d
                © Indian Journal of Community Medicine

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 15 August 2008
                : 30 October 2009
                Categories
                Original Article

                Public health
                child and adolescent health,community health,risk behaviours
                Public health
                child and adolescent health, community health, risk behaviours

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