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      One- and Two-Year Effects of the Healthy Primary School of the Future on Children’s Dietary and Physical Activity Behaviours: A Quasi-Experimental Study

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          Abstract

          Schools can help to improve children’s health. The ‘Healthy Primary School of the Future’ (HPSF) aims to sustainably integrate health and well-being into the school system. This study examined the effects of HPSF on children’s dietary and physical activity (PA) behaviours after 1 and 2 years’ follow-up. The study ( n = 1676 children) has a quasi-experimental design with four intervention schools, i.e., two full HPSF (focus: nutrition and PA) and two partial HPSF (focus: PA), and four control schools. Accelerometers and child- and parent-reported questionnaires were used at baseline, after 1 (T1) and 2 (T2) years. Mixed-model analyses showed significant favourable effects for the full HPSF versus control schools for, among others, school water consumption (effect size (ES) = 1.03 (T1), 1.14 (T2)), lunch intake of vegetables (odds ratio (OR) = 3.17 (T1), 4.39 (T2)) and dairy products (OR = 4.43 (T1), 4.52 (T2)), sedentary time (ES = −0.23 (T2)) and light PA (ES = 0.22 (T2)). Almost no significant favourable effects were found for partial HPSF compared to control schools. We conclude that the full HPSF is effective in promoting children’s health behaviours at T1 and T2 compared with control schools. Focusing on both nutrition and PA components seems to be more effective in promoting healthy behaviours than focusing exclusively on PA.

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          Most cited references31

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          Socioeconomic Disparities in Health Behaviors.

          The inverse relationships between socioeconomic status (SES) and unhealthy behaviors such as tobacco use, physical inactivity, and poor nutrition have been well demonstrated empirically but encompass diverse underlying causal mechanisms. These mechanisms have special theoretical importance because disparities in health behaviors, unlike disparities in many other components of health, involve something more than the ability to use income to purchase good health. Based on a review of broad literatures in sociology, economics, and public health, we classify explanations of higher smoking, lower exercise, poorer diet, and excess weight among low-SES persons into nine broad groups that specify related but conceptually distinct mechanisms. The lack of clear support for any one explanation suggests that the literature on SES disparities in health and health behaviors can do more to design studies that better test for the importance of the varied mechanisms.
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            Methods of coping with social desirability bias: A review

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              Limits to the measurement of habitual physical activity by questionnaires.

              Despite extensive use over 40 years, physical activity questionnaires still show limited reliability and validity. Measurements have value in indicating conditions where an increase in physical activity would be beneficial and in monitoring changes in population activity. However, attempts at detailed interpretation in terms of exercise dosage and the extent of resulting health benefits seem premature. Such usage may become possible through the development of standardised instruments that will record the low intensity activities typical of sedentary societies, and will ascribe consistent biological meaning to terms such as light, moderate, and heavy exercise.
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                Author and article information

                Journal
                Nutrients
                Nutrients
                nutrients
                Nutrients
                MDPI
                2072-6643
                22 March 2019
                March 2019
                : 11
                : 3
                : 689
                Affiliations
                [1 ]Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; p.vanassema@ 123456maastrichtuniversity.nl
                [2 ]Department of Health Promotion, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; s.kremers@ 123456maastrichtuniversity.nl
                [3 ]Academic Collaborative Centre for Public Health Limburg, Public Health Services, P.O. Box 33, 6400 AA Heerlen, The Netherlands; maria.jansen@ 123456ggdzl.nl
                [4 ]Department of Nutrition and Movement Sciences, Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; hans.savelberg@ 123456maastrichtuniversity.nl
                [5 ]Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre MUMC+/ Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.; marije.oosterhoff@ 123456mumc.nl
                [6 ]Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.; maartje.willeboordse@ 123456maastrichtuniversity.nl (M.W.); onno.vanschayck@ 123456maastrichtuniversity.nl (O.C.P.v.S.)
                [7 ]Department of Methodology and Statistics, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; bjorn.winkens@ 123456maastrichtuniversity.nl
                [8 ]Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
                Author notes
                Author information
                https://orcid.org/0000-0002-8098-5289
                Article
                nutrients-11-00689
                10.3390/nu11030689
                6470547
                30909515
                e17d6606-2830-4f2f-a34a-191c4175ac1c
                © 2019 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 29 January 2019
                : 18 March 2019
                Categories
                Article

                Nutrition & Dietetics
                behaviour,nutrition,physical activity,effect evaluation,health-promoting schools,follow-up

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