Objectives: Coordinated School Health (CSH) is a systematic approach to improving the health and well-being of school-age children. It is recommended for its potential to promote healthy weight in adolescents through strategic programming. Resources and programming for adolescent obesity prevention varies among schools, thereby limiting the intended benefits of CSH. The purpose of this study was to understand gaps in schools approaches to healthy weight promotion and support for overweight/obese students. We evaluated perceptions of adolescent obesity and environmental factors and programs facilitating healthy weight in high schools in Appalachian Tennessee. Methods: In 2012, 17 key school personnel from 5 randomly selected high schools were interviewed. Questions addressed their perceptions of adolescent obesity, school-based physical activity and nutrition programming, and support available to overweight/obese students. Thematic analysis was conducted to identify emerging themes. Results: Participants consistently identified adolescent obesity and/ or associated risk factors as major health problems within their schools. Barriers to physical activity and healthful eating were identified at multiple levels. Because of the sensitivity surrounding overweight/obesity, no particular programs or curricula targeted overweight/obese adolescents specifically, but they were available to all students. Support is not explicitly available; therefore, overweight/ obese students must seek out these resources. Conclusions: Findings suggest that although school personnel are concerned about the impact of adolescent obesity on health outcomes, there is wide variation across schools on the types and quality of programming available to address the issue. Results can be used to encourage school-based strengths and identify gaps in the CSH infrastructure in school systems.

Approximately one-third of children in the United States are overweight or obese with increased risks for numerous physical and psychosocial comorbidities. Schools are ideal environments to address this serious health crisis and school nurses are uniquely positioned qualified healthcare providers to actively participate in childhood obesity prevention (COP). A review of the literature provided findings to identify a gap in the knowledge regarding the association between school nurse COP perceptions and practices. A modified theoretical framework based on Bandura’s health promotion by social cognitive theory guided this study. The purpose of this study was to identify the key perceptions (self-efficacy, perceived benefits and perceived barriers) influencing school nurse participation in COP practices and determine associations between school nurse characteristics and COP perceptions and practices. Preliminary research was conducted to determine content validity for modified perception scales, clarity of instructions and questions, data collection and retrieval procedures, and refinement of recruitment strategies. Adequate reliability and validity was determined for modified scales measuring school nurse self-efficacy, perceived benefits, perceived barriers, and COP practices targeting individual children (child-level) and the entire school population (school-level). Florida RN school nurses (n = 171) completed self-administered anonymous questionnaires from an emailed weblink or a paper version offered at two Florida Association of School Nurses conferences. School nurses with characteristics reflecting more education engaged in more COP practices (p < .05) than those without education-related characteristics. School nurses with > 8 hours of COP education reported higher COP self-efficacy than those with none (p < .01). Linear regressions showed that a model comprised of self-efficacy, perceived benefits, and perceived barriers significantly explained 12.0% of the variance in child-level practices (p < iv .001) and 9.1% of school-level practices (p < .001). Self-efficacy explained the most variance of school nurse child-level and school-level practices (p < .001), and perceived barriers were inversely associated with child-level practices (p < .05). Four series of regressions showed that only perceived barriers partially mediated the influence of self-efficacy on child-level practices. Data analyses indicated self-efficacy and perceived barriers were key determinants of school nurse COP practices. Therefore, policy changes and educational interventions to increase selfefficacy and reduce perceived barriers may be effective in mobilizing school nurses to actively engage in COP practices

The prevalence rate of childhood obesity has increased rapidly worldwide. The childhood obesity epidemic is associated with many adverse health consequences in children as well as a financial burden for a nation’s economy. A meta-analysis was conducted to investigate the effectiveness of school-based childhood obesity prevention programs in preventing childhood obesity. The objectives of this study were to 1) identify the most effective childhood obesity prevention programs through effect size comparison, and 2) identify important program components that affect the effectiveness of the intervention through subgroup analysis. The Comprehensive Meta-Analysis (CMA) program was used for all statistical analyses. Results of the meta-analysis demonstrated that the summary effect size was small (d = 0.039, 95% confidence interval). The school-based program identified in the meta-analysis as the most effective had a d value of 0.368. Subgroup analyses were performed because this meta-analysis study was heterogeneous (Q = 167.774, p = 0.001) with an I2 value of 68.410%. The subgroup moderators were length of program duration, age of participants, nutrition, physical activity, parental involvement, specialist involvement, and theory based versus non-theory based intervention programs. Subgroup analyses demonstrated that significant differences (p < 0.05) occurred among the moderator components. Programs that targeted younger children less than ten years old and programs that were theory based were more effective. The meta-analysis study contained publication bias because the funnel plot was skewed and smaller studies were missing. To further explore the publication bias problem, Classic fail-safe N and Duval and Tweedie’s trim and fill analyses were performed. Classic fail-safe N indicated that two programs were missing from the present study to achieve a non-biased result. The Duval and Tweedie’s trim and fill analysis demonstrated that a small mean effect size difference was detected between the present observed studies and the unbiased effect size. The small mean effect size difference indicated that the results and the reported effect sizes in this meta-analysis study were valid.

Overweight and obesity in Mexican children substantiates the need to identify effective strategies and policies to address this problem. Instituto Nacional de Salud Publica (INSP) designed and implemented a randomized control trial (RCT) to assess an ecologically-based intervention program to modify the school environment to promote healthy lifestyle behaviours in children. The objectives of this thesis are to describe the design and impact of this RCT, to examine the program content through an ecological approach, and to examine policy activities that have been informed by the RCT findings. Four manuscripts address these objectives. Manuscript one is Promoting a Healthful Diet and Physical Activity in the Mexican School System for the Prevention of Obesity in Children: Rationale, Design and Methods. It describes the rationale, design, and methods of the two-year INSP-Secretaria de Educacion Publica (Secretary of Public Education, SEP) RCT. Manuscript two is Impact of a School-based Intervention Program on Obesity Risk Factors in Mexican Children. It reports on the environmental impact of the INSP-SEP intervention by comparing 16 intervention schools with 11 non-intervention schools. Results showed increased availability and food intake of healthy foods with a concomitant decrease in unhealthy food availability in intervention schools/children. Manuscript three is An Ecological and Theoretical Deconstruction of a School-based Obesity Prevention Program in Mexico. It reports on an assessment of the integration of ecological principles and theoretical constructs in the school-based behavioural change/obesity prevention intervention carried out by the INSP-SEP. Results showed that 32 intervention strategies were implemented in the school setting to engage target-groups; the most used SCT construct was Reciprocal Determinism. Manuscript four is titled Quality and Implementation of the Nutrition and Physical Activity School Policy Guidelines in Mexico City. It assesses the quality and implementation conditions of a policy and reports on the implementation and the uptake of the national school policy to prevent obesity in Mexico city through a policy analysis, WHO School Policy Framework (SPF) and indicators informed by the national policy. Findings showed that not all of the 10 implementation pre-conditions were met; School Guidelines mostly complied with SPF but were not fully implemented within our sample. / Thesis (Ph.D, Kinesiology & Health Studies) -- Queen's University, 2013-09-30 17:05:33.787

Public health campaigns might not be universally helpful and could have detrimental consequences. The current investigation explored the effects of obesity prevention campaigns. Their impact was assessed using an experiment in which participants were randomized to view either weight focused obesity prevention campaigns or obesity prevention campaigns that did not use weight related terms. Results demonstrated that compared with campaigns without weight related terminology, weight focused campaigns increased negative perceptions of obesity and decreased self-efficacy for health behavior change. No differences in body satisfaction, thin-ideal internalization, state anxiety, or frequency of positive health behaviors were found based on the type of campaign viewed. Finally, exposure to both types of campaigns increased internalization of the thin-ideal. This study demonstrates that weight focused prevention messages pose serious public health consequences. Obesity prevention campaigns should refrain from using weight-related terminology and instead emphasize the positive health consequences of a healthy diet and physical activity.

The current study explored the high school health promotion environment with regards to physical activity, nutrition, and sedentary behaviors from the perspective of high school health and physical education teachers and administrators. Specifically, potential strategies for a prevention program to promote student physical activity participation and healthy eating, and decrease student sedentary time were explored. Individual semi-structured interviews were conducted with physical education teachers to explore potential strategies to promote student health behaviors. Next, interviews were conducted with high school administrators to determine the feasibility of recommended strategies. Teachers and administrators in the current study expressed a need for strategies that target student health at the high school level; however, educators felt taxed and overburdened, and cited the current state of public education as a barrier to implementing strategies. Additional barriers to implementing health-based strategies included funding, transportation, supervision, facilities, and logistics or regulations. Participants explained the school lunch program has improved, with schools now offering healthier food. Unfortunately, the perceived number of students buying lunches has decreased and educators still feel the lunch options could be improved. Although there were many barriers to implementing the extracurricular initiatives discussed, the following strategies were considered the most feasible by teachers and administrators in the current study: intramurals, open gym times, fitness classes or group exercise classes, fitness apps, and improving the school lunches. Teachers and administrators held mixed views about policy changes that have the greatest potential to influence student health behaviors. Educators called for parent and community partnerships to help overcome the hurdles associated with implementing extracurricular school-based health activities. Findings illustrated the necessity of a multi-faceted approach to implementing health-based strategies at the high school level.

Thesis advisor: Maureen E. Kenny / Childhood obesity is one of the most significant threats to the health development of children in the United States. A relationship has been found between mental health conditions, such as depression, and obesity development. Obesity prevention initiatives frequently target children's health behaviors due to their important role in the development of childhood obesity. Yet despite their importance, relatively little is known about the association between mental health factors and children's health behaviors. In addition, self-efficacy and self-regulation, cognitive factors which have been found to have a prominent role in behavior change, may also be correlated with children's health behaviors. These cognitive factors may also interact with mental health factors to predict children's health behaviors. The current study sought to investigate whether or not internalizing behaviors, self-efficacy, and self-regulation significantly predicted healthy eating behavior, unhealthy eating behavior, and physical activity behavior in preadolescent children. The study was a secondary data analysis of the Study of Early Child Care and Youth Development (SECCYD) Phase II-III data. Internalizing behaviors were found to have a significant relationship with unhealthy eating behaviors for both boys and girls, however, the relationship was positive for girls and negative for boys. Among the cognitive factors, sports self-efficacy and self-regulation, sports self-efficacy was found to be a significant predictor of physical activity behavior for both boys and girls. In addition, the moderating relationship between internalizing behaviors and self-regulation as a predictor of physical activity behavior was supported for boys. Findings from the study indicate individual psychological factors, such as mental health and self-efficacy may have a significant influence on children's health behaviors. Results also suggest factors at the psychological level may be interacting with one another, along with factors at the biological and social levels of development, to influence health behaviors. The current study highlights that investigating the psychological factors influencing health behaviors may yield an important contribution towards understanding obesity development. These findings have implications both for identifying children at risk for developing obesity, as well as, the design and implementation of obesity prevention initiatives. / Thesis (PhD) — Boston College, 2012. / Submitted to: Boston College. Lynch School of Education. / Discipline: Counseling, Developmental, and Educational Psychology.

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The effectiveness of an eight-week nutrition and physical activity intervention at a summer camp to prevent obesity, and promote healthy eating habits and physical activity among children in Kuwait was studied. Two summer camps were recruited for intervention and comparison groups. Convenient sampling was used (N= 79). Pre-test/post-test assessment were used for the participants in the intervention and comparison groups. Modified Healthy Habits Survey (HHS) was used to measure children’s knowledge, behavior and attitude about nutrition, screen time and physical activities, BMI-for age percentile were collected. Statistical analysis included independent t-test, paired t-test, chi-squared test, McNemar's test, and multiple regression. Results indicated that there was a significant increase in nutrition knowledge score (Pp= 0.013, p = 0.007, p = 0.002, and p = 0.012, respectively). There was no significant decrease in the number of servings of unhealthy foods for french-fries and chips, fruit flavored drinks or soft drinks. The only significant decrease in the unhealthy food intake was seen in the number of servings of sweets and candies. Thirty-three-point-three percent of participants in the intervention group decreased their consumption of sweets and candies to 1 time or less per day (P=0.001). There was a significant increase in the intervention group in both physical activity and screen time knowledge (Pp