A cluster randomised controlled trial of a sugar-sweetened beverage intervention in secondary schools.

Schools allocated to the intervention group will implement a program to reduce sugar-sweetened beverage (SSB) consumption in students, using a whole schools approach by adopting strategies across the three arms of the Health Promoting Schools Framework. The intervention will run for two school terms from Term 2 to Term 3 2018 (one school term runs for approximately 10 weeks). Curriculum and teaching: Students will participate in two nutrition education lessons relating to SSB, incorporated into the schools’ Personal Development, Health and Physical Education (PDHPE) classes to be delivered by the school PDHPE teacher. Lesson plans will cover SSB sugar content awareness, adverse health effects of excessive SSB consumption, healthier drink alternatives, and semi-individualised feedback and goal setting to monitoring their own SSB consumption. Students will receive six fortnightly notifications in the second term via the school’s electronic communication channel to students. These will provide advice on reducing their SSB consumption, healthier drink alternatives, and reminders of adverse health effects of excessive SSB consumption. A school-based month-long challenge to encourage students to reduce SSB from their diets will be planned, led and carried out by a student committee in each school. Funding and resources will be provided by the research team on the completion of a grant application by the student committee. Strategies and activities will focus on increasing awareness and motivation, creating a presence on social media platforms, and fostering peer support to reduce SSB consumption. Ethos and environment: Guiding principles will be discussed with schools to fit into the school’s management plan and local procedures that contain the key messages of the intervention. The school environment will be modified to reduce the appeal of SSB to students. Specifically: i) Canteens and vending machines will be advised to lower the availability of SSB in the canteen by decreasing SSB options. ii) Drinks will be classified by a dietitian as Everyday, Occasional and Should Not Be Sold as per the NSW Healthy School Canteen Strategy. SSB that are still sold in canteens will be removed from display and concealed under the counter. Placement of drinks in the vending machine will be altered so that Everyday drinks appear at the top of the vending machine around eye level, followed by Occasional, and finally Should Not Be Sold. iii) SSB will also receive an increased price mark-up of at least 20% compared to their selling price at baseline. Occasional drinks will be encouraged to be sold at a price at least 10% above their selling price at baseline, while ensuring that all Should Not Be Sold drinks (including SSB) are more expensive than Occasional drinks, and all Occasional drinks are more expensive than Everyday drinks. iv) Promotion of SSB will be advised not to promote SSB, and healthier drink alternatives will be promoted to students via meal deals and posters. The goal by the end of the intervention is to remove all SSB from sale in the school as per the strategy. Two water bottle refill stations (with flow meters for monitoring) will be placed on school grounds to encourage water consumption with the aim to displace SSB. Partnerships and services: Parents will receive six fortnightly notifications in the second term via the school’s electronic communication channel. Notifications will provide advice on reducing their own SSB consumption and availability in the home environment, suggestions of healthier drink alternatives and role modelling. Adverse health effects of excessive SSB consumption, and tips on how to monitor and reduce the parent’s own SSB consumption will also be included. Six notifications will be sent to parents at the same time as the notification to students, with coinciding key message themes. A short snippet will be included in the school newsletter at the start of each school term to provide updates on the intervention. A total of two newsletter snippets will be drafted by the research team and sent to the school administration at the start of each intervention school term. Summarised results of the study will also be published in the newsletters. Five support strategies will be used to increase adoption of the intervention components by schools. These strategies have been effective in facilitating the adoption of other school based nutrition interventions. Executive leadership and school committees: Once a school is allocated to the intervention group, a meeting with the key stakeholders including the principal, canteen manager and school champion will be arranged to brief the school on the key intervention components such as the guidelines, canteen strategies and lesson plans. Peer-led planning and collaboration has been shown to be an effective support strategy to increase interest and adoption of the intervention in adolescent-based interventions. A teacher school champion and a student committee will be elected for each school and will serve as change agents by actively supporting and advocating the key messages of the intervention. Audit and feedback: To assist with the changes to the canteen and vending machines, a trained dietitian experienced in reviewing school canteen menus will audit the school’s drinks menu at the start of the intervention. Feedback will be provided via written reports to intervention schools. The report will contain personalised advice on reducing the sale of SSB and a meeting will be arranged with the canteen staff to discuss the feedback and their time will be reimbursed. One further feedback report will be provided at the intervention midpoint to help canteens work towards the end goal. Resources: Resources and promotional incentives such as lesson plans, canteen and vending machine pictograms, kitchen equipment (blender and recipe cards), water refill stations and water bottles will be provided to the schools. Other promotional material such as posters, newsletter snippets and notifications will also be prepared and sent to schools over the course of the intervention. Staff professional learning: Secondary school staff will be informed about the intervention via a short 20-minute presentation delivered by the research team within a usual staff meeting before the commencement of the intervention. An online staff professional development session will also be offered to equip Personal Development, Health and Physical Education (PDHPE) teachers with the skills and understanding to deliver the student lesson plans and provide positive role modelling and guidance for students. The session will take approximately ten minutes to complete and will be hosted on the program website. Communication and marketing: Research indicates that communication and marketing can increase awareness of key health messages leading to improved intervention endorsement and adoption. This will be achieved via school newsletter snippets, posters and notifications using the school’s electronic communication channel. The program will also have an attractive name (switchURsip), chosen through feedback from adolescents, for marketing and promotion on traditional and digital platforms to appeal to adolescents. A switchURsip website will be created for the school, students and parents. This website will contain all the resources under the appropriate tabs for school staff, students and parents and will be hosted on the Good for Kids. Good for Life website. This will provide easy access of intervention components for schools involved in the study. Control schools will have limited access to the website using passwords and will only be given access to the website at the end of the intervention period.