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1 Paul J. Veugelers & Angela L. Fitzgerald American Journal of Public Health Mar 2005; Vol. 95, No. 03 Title: “ Effectiveness of School Programs in Preventing.

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Presentation on theme: "1 Paul J. Veugelers & Angela L. Fitzgerald American Journal of Public Health Mar 2005; Vol. 95, No. 03 Title: “ Effectiveness of School Programs in Preventing."— Presentation transcript:

1 1 Paul J. Veugelers & Angela L. Fitzgerald American Journal of Public Health Mar 2005; Vol. 95, No. 03 Title: “ Effectiveness of School Programs in Preventing Childhood Obesity: A Multilevel Comparison.” 1 Research Seminar: Presentation Presentation by, Asif Raza Khowaja January 30 th, 2010

2 2 Rationale  To highlight major public health crisis of pandemic increase in childhood obesity.  To emphasize potential health problem of developing countries.  Childhood obesity is preventable, therefore, proactive policies can be formed at Govt. / Local level.  Focusing health promotion through “School Health”.  Renowned Journal & subject relevant publication 2

3 3  Over past four decades, childhood obesity has remarkably increased in U.S, Canada, Australia & Europe  Childhood obesity is major cause of Hypertension, type 2 Diabetes, Cardiovascular diseases and Cancer problems which account for billions of dollars in healthcare spending  School health initiatives have excellent impact on preventing childhood obesity, however, effectiveness of such programs varies across countries. Background 3

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6 6 Introduction  Define Childhood obesity: The measurement of overweight and obesity in children is difficult due to maturation & growth rate. There has been recent international agreement on the need to use BMI to define obesity in children. Children / Youth having BMI 25-30 are overweight and BMI >30 are obese. BMI: Body Mass Index is a composition of body mass, calculated as weight in Kg divided by square of height in meters 4

7 7 Factors of Childhood Obesity 5

8 8 Introduction  Insufficient physical activity and poor nutrition due to the consumption of calorie-dense foods are acknowledged as primary factors of childhood excess body weight.  Physical activity and nutrition in School are primary foci of health promotion initiatives to prevent or reduce childhood obesity.  The Centers for Disease Control and Prevention (CDC) provides guidelines for school programs to promote physical activity and healthy eating. Continued… 6

9 9 CDC Guidelines Healthy Eating & Activity in Schools School Health Policies Curriculum Integration of food serv. Nutrition Education Family involvement Staff /Teachers training Introduction Continued… 7

10 10 Objectives To evaluate the effectiveness of school programs in regard to: Prevent Overweight & Obesity Increase Physical Activity Improve Dietary Quality 8

11 11 Methodology  Design :  Design : Population-based survey  Setting :  Setting : Homogenous Canadian province of Nova Scotia, where more than 95% of elementary school children attend similarly public funded schools.  Participants:  Participants: Enrolled 5517 children (5 th grade school children) 9

12 12  Inclusion criteria:  Children of 5 th grade in school.  Schools and Parents who voluntarily consented.  Resident of Canadian Province Nova Scotia. Methodology Continued… 10

13 13 (Comprising of School Prevention Program) School Children of 5 th grade Children’s Lifestyle & School Performance Study (CLASS) 291 Public Schools Invited 282 Public Schools Consented (96.9%) (51.1%) Methodology 5517 students participated after Parents’ Consent 73 Schools With Nutrition Program 07 Schools With AVHPSP Program 199 Schools Without Nutrition Program 2003 Survey 279 Public Schools Completed survey (99.9%) Continued… 11

14 14 Harvard Youth Adolescent Food Frequency Questionnaire Questionnaire Frequency & Kinds of Food Number of daily servings of fruits and vegetables Nutrients & Calorie Intake Percentage of calorie intake from dietary fats Overall Dietary Quality Dietary adequacy, variety, moderation & balance 5200 Completed (94%) Methodology Data Collection: 5517 Consented Continued… 12

15 15 Physical & Sedentary Activities Assessment Physical Activity Reported weekly number of engagements in organized sports and leisure time Physical activity. Sedentary Activity Reported daily number of hours watching television, Using computer, and Playing video games. 5197 Completed (94%) Methodology 5517 Consented Data Collection: Continued… 13

16 16 Overweight & Obesity Assessment Overweight The international body mass index cutoff points (more than 25 Kg/m2 ). Adjusted for age & gender Obesity The international body mass index cutoff points (more than 30 Kg/m2 ). Adjusted for age & gender 4298 Completed (78%) Methodology 5517 Consented Data Collection: Continued… 14

17 17 Statistical Analysis Descriptive :  Proportions Inferential :  Multi-level Logistic Regression Method  Beta Co-efficient  Odds ratio  95 % Confidence Interval 15

18 18 Results 5200 Children Completed YAQ 3656 (70.3%) Without Nutrition Program 1350 (26%) With Nutrition Program 133 (2.6%) With AVHPSP Program 16

19 19 Results Continued…

20 20 Results Summary of Table 1  Students in AVHPSP exhibit lower rates of overweight, obesity and have better dietary habits (higher consumption of fruits & vegetables, less caloric intake from fat) and higher dietary quality index score.  Students in AVHPSP reported more participation in physical activities and less participation in sedentary activities.  The characteristics of students from school without a nutrition program and with a nutrition program (other than the AVHPSP) were almost similar. Continued… 18

21 21 Results Non- significant Significant Continued…

22 22 Results  Rates of overweight & obesity are significantly lower among students in schools having AVHPSP than schools without nutrition program  Students in AVHPSP reported more consumption of fruits and vegetables & better dietary quality. (Statistically Significant findings).  Fats consumption is low among students in AVHPSP. But (Statistically Non-significant findings).  Students in AVHPSP reported more participation in physical activity & less in sedentary activities. But (Statistically Non-significant findings). Summary of Table 2 Continued… 20

23 23 Discussion  School-based healthy eating & physical activity programs provide greater opportunity to:  Enhance learning & provide social benefits  Enhance health during critical periods of growth  Lower risk for chronic diseases in adulthood  Help to establish health behaviors at an early age.  Author contends that limited number of studies have been conducted on “Effectiveness of school programs to prevent childhood obesity” and results of such studies are inconsistence. 21

24 24 Discussion  This study demonstrate effectiveness of some programs and the absence of effectiveness of others.  It creates evidence that schools with a program like AVHPSP, are consistence with the CDC recommendations for school-based healthy eating program.  Diet & activities were similar among students from schools with and without nutrition program, because:  Recently introduced School Nutritional Programs  Masking of possible benefits in schools Without Nutrition Program. Continued… 22

25 25 Strengths & Limitation Strengths & Limitation (by author)  High response rate & Adjustment for Non- response bias & potential confounders.  Use of measurement (Ht. & Wt.) to define overweight & obesity, prevent self-report bias.  Using validated modified YAQ questionnaire  Exactness of adjustment is difficult to verify.  Cannot exclude confounding of factors that were not considered.  Self reporting of YAQ questions are subject to error. 23

26 26 Conclusion  As a result of rapid recent increase in childhood obesity, prevention is a public health priority.  Broader implementation & investment in school programs preventing childhood obesity is justified, because, it has high potential to reduce childhood obesity and in the long term, reduce likelihood of comorbid conditions and health care spending. 24

27 27 Critique (by presenter)_  Title:  The concept of effectiveness of school programs in preventing childhood obesity is well discussed in the paper.  The title itself seems catchy, reflecting the notion of health promotion, focusing School Health.  Authors affiliation:  Both authors belong to Dept. of Community Health & Epidemiology Dalhousie University, Nova Scotia. 25

28 28 Critique  Abstract:  Well structured  Provides comprehensive information about the study.  Funding:  Canadian Population Health funds (Principal author won new investigator award) Continued… 26

29 29  Introduction:  Justifies the need for such study.  Thoroughly discussed all objectives of the study.  Presents guidelines of CDC & relate with study objectives.  The definition for “Childhood obesity” is required.  The reason for targeting 5th grade school children not mentioned. Critique Continued… 27

30 30 Critique: Methodology  Ethical Consideration:  Approval of Human Participant Protection was taken from Human Research Board, Dalhousie University Nova Scotia.  Informed consent was taken from parents before the participation of their children. Continued… 28

31 31  Validity: Internal Validity (A). Questionnaire & Physical Measurement  Using validated tools for data collection is appreciated.  Highlight high response rate in questionnaire completion, however, very poor response rate (51.1%) of parental consent on school level.  After parental consent, School children 317 (7%) not completed YAQ and 320 (6%) not completed Physical & Sedentary activity questionnaire, the reason for such non- completion not stated. Critique: Methodology Continued… 29

32 32  Validity: Internal Validity (A). Questionnaire & Physical Measurements.  Provided good reference of international cut-off points for obesity & overweight.  But fail to relate weight with standard cut-off for height.  How many representatives involved for data collection, their qualification, additional specific trainings, not stated.  Standardization of instruments used for height & weight, not stated.  The minimally required sample size not calculated / justified. Critique: Methodology Continued… 30

33 33  Validity: External Validity (B). Generalizability: Results are worth to generalize because of:  Rigor of research methodology  Reducing chance / bias  Considerably large sample size. Critique: Methodology Continued… 31

34 34  The results tables are simple to understand.  Use of sophisticated statistical analysis is appreciated.  Presents study analysis adjusted for gender, area of residence (urban & rural), parental education, & income.  Reduce the likelihood of Chance / Bias by controlling the effects of possible confounders on the findings. Critique: Result Continued… 32

35 35  Discussion:  Language is easy to understand.  Study strengths & limitations highlighted. Bibliography:Bibliography:  Considerable review of recent literature has been done. Critique Continued… 33

36 36 Policy Implication  Health-care workers and pediatricians should screen children for obesity and risk factors as part of "well-child" visits.  Health workers should provide counseling and educational information, and prescribe healthy diets and exercise for children. In order to prevent potential health problem of childhood obesity in developing countries, the National Health Policies need to be proactive in developing policies adhering to the health needs of children at state level. 34

37 37  Making school health program as an integral part of school academia.  Adapting and following the guidelines of CDC in school-based healthy eating programs.  Parents and other family members should act as positive role models, decreasing their own and the children's sedentary activities and planning more family activities.  The community in general should improve safety and encourage neighborhood designs to facilitate walking, biking and outdoor play. Policy Implication Continued… 35

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39 39 Thank you


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