Health and Wellbeing of Primary School-aged Children
Conditions
Keywords
Nutrition, Physical activity, School, Children, Prevention, School Health
Brief summary
Rationale: In 2015-2020, the Dutch 'Healthy Primary School of the Future' intervention took place. Two schools became 'Healthy Primary Schools of the Future'; providing a healthy lunch and structured physical activity (PA) sessions. Two other 'Physical Activity Schools' only implemented the PA sessions. The intervention showed promising effects on children's BMI z-score and dietary and PA behaviours. Following these promising results, childcare centres of educational board Prisma have expressed their interest in implementing changes fitting the 'Healthy Primary School of the Future'. However, this is more complex than it seems to be, as budget to implement changes is lower and all childcare centres have a unique context. Therefore, there is a need to investigate how 'Healthy Primary School of the Future' can successfully be implemented in various, real-life school-settings. It is hypothesised that to maximise implementation and sustainability, each childcare centre will need to put together a set of changes and interventions which fit the context and needs of all stakeholders involved. No intervention is allocated in this study other than activities planned by childcare centres in accordance with wishes and needs of stakeholders. Objective: To study the implementation of 'Healthy Childcare Centre of the Future' in different school-contexts and develop guidelines that can be used to facilitate widespread dissemination of the initiative. Secondary objectives include evaluating the initiative's effects on children's BMI z-score, general health, dietary and PA behaviours and school well-being. To reach these objectives, a process evaluation, effect evaluation and cost-effectiveness evaluation will be executed. Data will be collected using questionnaires (parents, children, teachers, directors), anthropometric measures (children), interviews (teachers, directors), observations and analyses of minutes of meetings.
Detailed description
Rationale: From 2015-2020, the 'Healthy Primary School of the Future' intervention took place in Limburg, the Netherlands. The school environment of four primary schools changed. Two schools became 'Healthy Primary Schools of the Future'; providing their students with a healthy lunch and structured physical activity (PA) sessions during lunch time breaks. Two other 'Physical Activity Schools' only implemented the structured PA sessions. Interim analyses showed promising effects of the intervention; at two-year-follow-up, the study showed a significant decrease in BMI z-score of children in the 'Healthy Primary Schools of the Future' as compared with children in control schools. Also, positive intervention effects on dietary and PA behaviours were observed. Following these promising results, childcare centres of educational board Prisma have expressed their interest in implementing changes fitting the 'Healthy Primary School of the Future' initiative. However, this is more complex than it seems to be, as budget to implement changes is lower than in the original trial, and all childcare centres have a unique context. Therefore, there is a need to investigate how 'Healthy Primary School of the Future' can successfully be implemented in various, real-life school-settings. It is hypothesised that to maximise implementation and sustainability, each childcare centre will need to put together a set of changes and interventions which fit the context and needs of all stakeholders involved (e.g., the school board, teachers, parents and children). Objective: The main objective is to study the implementation process of 'Healthy Childcare Centre of the Future' in different school-contexts and develop guidelines that can be used to facilitate widespread dissemination of the initiative. Secondary objectives include evaluating the effects of the 'Healthy Childcare Centre of the Future' on children's BMI z-score, general health, dietary and PA behaviours and school well-being. To reach these objectives, a process evaluation, effect evaluation and cost-effectiveness evaluation will be executed. Study design: A non-randomised, non-controlled, observational study design. Study population: Children in study years four to six (at baseline) of twelve childcare centres located in Limburg, the Netherlands. Main parameters/endpoints: The main study parameter of the effect evaluation is the change in absolute BMI z-score, which will be compared between the childcare centres categorised based on their degree of implementation (using categories based on the Diffusion of Innovations Theory). Methods: Data will be collected in the form of questionnaires (parents, children, teachers/pedagogical employees, directors), anthropometric measurements (children), interviews (teachers/pedagogical employees, directors), observations and analyses of minutes of meetings. Nature and extend of the burden and risks associated with participation: No intervention is allocated in this study other than activities planned by childcare centres in accordance with wishes and needs of childcare centre staff and parents. All outcome measures are non-invasive. The measurement protocol was designed while taking into account both a minimal burden for participants and a relevant scientific output for stakeholders (e.g., school board, teachers, parents/caregivers and children). Burden of participants is minimalised by incorporating most measurements in the regular school day.
Interventions
BEHAVIORALVarious health-promoting initiatives
No intervention is allocated in this study other than activities planned by childcare centres in accordance with wishes and needs of childcare centre staff and parents.
Sponsors
Maastricht University Medical Center
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Healthy volunteers
Yes
Inclusion criteria
* Student from study years four to six (at baseline) at one of the the predetermined childcare centres
Exclusion criteria
* None
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| BMI Z-score | Two years | Children's Body Mass Index (BMI) was assessed by height and weight; age- and sex-specific BMI cut-off points were used to define overweight and obesity. BMI z-scores were calculated using Dutch reference values. A z-score of 0 represents the population mean. A z-score \> 0 means a BMI higher than the population mean, a z-score of \< 0 means a BMI lower than the population mean, both can pose specific health-related risks. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Child Physical Activity Behaviour (Child-reported) | Two years | Assessed using the validated Physical Activity Questionnaire for Children (PAQ-C).The PAQ-C is a self-administered,7-day recall instrument, which provides a summary physical activity score derived from eight items, each scored on a 5-point scale. Item 1 (spare time activity) from no activity = 1; 7 times or more = 5. Items 2 to 7 (PE, lunch, right after school, evening, weekends) from lowest activity response = 1 or highest activity response = 5. Item 8 (mean of all days of the week) from none = 1; very often = 5. Item 9 (identifies students who are unusual active during the previous week). By adding up all means of the first eight items in PAQ-C, a summative score of physical activity is obtained. A score of 1 indicates low physical activity level, whereas a score of 5 indicates high physical activity level. |
| Child Waist Circumference | Two years | Waist circumference is measured with a measuring tape to the nearest 0.1 cm, following the World Health Organisation's assessment protocol. |
| Mean Number of Days Per Week of Soft Drink Consumption | Two years | Soft drink consumption during the past week was derived from the parental questionnaire ranging from never (0) to every day (7). |
| Water Consumption During School Hours | Two years | Water consumption during school hours was derived from the child questionnaire ranging from never (0) to every day (3). |
| Fruit Consumption at Lunch | Two years | The child lunch questionnaire assessed children's consumption of certain food types during lunch. The items were summarised into six dichotomous (yes/no) food types: fruits, vegetables, grains (bread and cereals), dairy (milk/yoghurt and cheese), water, and butter. |
| Mean Number of Days Per Week of Healthy Dietary Behaviours | Two years | A composite score for healthy dietary behaviours was computed from four separate questions. This score was calculated by averaging the weekly consumption (ranging from never (0) to every day (7)) of breakfast consumption and intake of fruit, warm and raw vegetables, and water throughout the day, as reported in the parental questionnaire. |
| Grain Consumption at Lunch | Two years | The child lunch questionnaire assessed children's consumption of certain food types during lunch. The items were summarised into six dichotomous (yes/no) food types: fruits, vegetables, grains (bread and cereals), dairy (milk/yoghurt and cheese), water, and butter. |
| Dairy Consumption at Lunch | Two years | The child lunch questionnaire assessed children's consumption of certain food types during lunch. The items were summarised into six dichotomous (yes/no) food types: fruits, vegetables, grains (bread and cereals), dairy (milk/yoghurt and cheese), water, and butter. |
| Water Consumption at Lunch | Two years | The child lunch questionnaire assessed children's consumption of certain food types during lunch. The items were summarised into six dichotomous (yes/no) food types: fruits, vegetables, grains (bread and cereals), dairy (milk/yoghurt and cheese), water, and butter. |
| Butter Consumption at Lunch | Two years | The child lunch questionnaire assessed children's consumption of certain food types during lunch. The items were summarised into six dichotomous (yes/no) food types: fruits, vegetables, grains (bread and cereals), dairy (milk/yoghurt and cheese), water, and butter. |
| Consumption of at Least Two Healthy Food Groups During Lunch | Two years | The child lunch questionnaire assessed children's consumption of certain food types during lunch. The items were summarised into six dichotomous (yes/no) food types: fruits, vegetables, grains (bread and cereals), dairy (milk/yoghurt and cheese), water, and butter. To shed more light on the nutritional value of the children's lunches, the different food types consumed were summed, and a dichotomous variable was created indicating whether children consumed at least two of the food types during lunch. |
| Vegetable Consumption at Lunch | Two years | The child lunch questionnaire assessed children's consumption of certain food types during lunch. The items were summarised into six dichotomous (yes/no) food types: fruits, vegetables, grains (bread and cereals), dairy (milk/yoghurt and cheese), water, and butter. |
Countries
Netherlands
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Medium Implementers As the present study investigated the effectiveness of health-promoting activities under real-world conditions and all participating schools were free to implement activities of their choice, there were no intervention or control groups. Instead, schools were categorised on the basis of the implemented activities' intensity. This resulted in the formation of two groups: medium implementers (six schools) and low implementers (five schools). The project's effectiveness on various health outcomes was compared between these two groups. | 143 |
| Low Implementers As the present study investigated the effectiveness of health-promoting activities under real-world conditions and all participating schools were free to implement activities of their choice, there were no intervention or control groups. Instead, schools were categorised on the basis of the implemented activities' intensity. This resulted in the formation of two groups: medium implementers (six schools) and low implementers (five schools). The project's effectiveness on various health outcomes was compared between these two groups. | 172 |
| Total | 315 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Lost to Follow-up | 7 | 6 |
Baseline characteristics
| Characteristic | Medium Implementers | Low Implementers | Total |
|---|---|---|---|
| Age, Continuous | 9.21 years STANDARD_DEVIATION 1 | 9.17 years STANDARD_DEVIATION 0.96 | 9.19 years STANDARD_DEVIATION 0.98 |
| At least two healthy food groups at lunch %no | 18 Participants | 20 Participants | 38 Participants |
| At least two healthy food groups at lunch %yes | 125 Participants | 152 Participants | 277 Participants |
| BMI z-score | -0.15 Z-score STANDARD_DEVIATION 0.82 | -0.10 Z-score STANDARD_DEVIATION 0.94 | -0.13 Z-score STANDARD_DEVIATION 0.89 |
| Butter at lunch %no | 58 Participants | 65 Participants | 123 Participants |
| Butter at lunch %yes | 85 Participants | 107 Participants | 192 Participants |
| Dairy at lunch %no | 90 Participants | 114 Participants | 204 Participants |
| Dairy at lunch %yes | 53 Participants | 58 Participants | 111 Participants |
| Fruit at lunch %no | 94 Participants | 113 Participants | 207 Participants |
| Fruit at lunch %yes | 49 Participants | 59 Participants | 108 Participants |
| Grains at lunch %no | 11 Participants | 11 Participants | 22 Participants |
| Grains at lunch %yes | 132 Participants | 161 Participants | 293 Participants |
| Healthy dietary behaviours | 5.57 mean days/week STANDARD_DEVIATION 0.96 | 5.56 mean days/week STANDARD_DEVIATION 0.95 | 5.56 mean days/week STANDARD_DEVIATION 0.95 |
| Overweight/obese Normal weight | 100 Participants | 151 Participants | 251 Participants |
| Overweight/obese Overweight/obese | 43 Participants | 21 Participants | 64 Participants |
| Physical activity summary score | 3.04 units on a scale STANDARD_DEVIATION 0.64 | 2.94 units on a scale STANDARD_DEVIATION 0.67 | 2.98 units on a scale STANDARD_DEVIATION 0.66 |
| Race/Ethnicity, Customized Western/Non-Western Non-Western | 6 Participants | 3 Participants | 9 Participants |
| Race/Ethnicity, Customized Western/Non-Western Western | 125 Participants | 149 Participants | 274 Participants |
| School water consumption | 1.43 units on a scale STANDARD_DEVIATION 1.22 | 1.25 units on a scale STANDARD_DEVIATION 1.13 | 1.33 units on a scale STANDARD_DEVIATION 1.17 |
| Sex: Female, Male Female | 72 Participants | 105 Participants | 177 Participants |
| Sex: Female, Male Male | 71 Participants | 67 Participants | 138 Participants |
| Socioeconomic status Highest tertile | 60 Participants | 84 Participants | 144 Participants |
| Socioeconomic status Lowest tertile | 32 Participants | 22 Participants | 54 Participants |
| Socioeconomic status Middle tertile | 39 Participants | 47 Participants | 86 Participants |
| Soft drink consumption | 4.31 mean days/week STANDARD_DEVIATION 2.74 | 4.06 mean days/week STANDARD_DEVIATION 2.78 | 4.17 mean days/week STANDARD_DEVIATION 2.76 |
| Study year Five | 37 Participants | 62 Participants | 99 Participants |
| Study year Four | 48 Participants | 52 Participants | 100 Participants |
| Study year Six | 58 Participants | 58 Participants | 116 Participants |
| Vegetables at lunch %no | 108 Participants | 128 Participants | 236 Participants |
| Vegetables at lunch %yes | 35 Participants | 44 Participants | 79 Participants |
| Waist circumference | 56.84 centimeters STANDARD_DEVIATION 4.66 | 58.62 centimeters STANDARD_DEVIATION 6.77 | 57.81 centimeters STANDARD_DEVIATION 5.96 |
| Water at lunch %no | 96 Participants | 126 Participants | 222 Participants |
| Water at lunch %yes | 47 Participants | 46 Participants | 93 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 0 / 315 |
| other Total, other adverse events | 0 / 315 |
| serious Total, serious adverse events | 0 / 315 |
Outcome results
Primary
BMI Z-score
Children's Body Mass Index (BMI) was assessed by height and weight; age- and sex-specific BMI cut-off points were used to define overweight and obesity. BMI z-scores were calculated using Dutch reference values. A z-score of 0 represents the population mean. A z-score \> 0 means a BMI higher than the population mean, a z-score of \< 0 means a BMI lower than the population mean, both can pose specific health-related risks.
Time frame: Two years
Population: The number analysed at T1 and T2 corresponds to the number of participants that were not LOF at T1 and T2.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Medium implementers | BMI Z-score | T0 (baseline) | -0.15 Z-score | Standard Deviation 0.82 |
| Medium implementers | BMI Z-score | T1 (after one year) | -0.14 Z-score | Standard Deviation 0.83 |
| Medium implementers | BMI Z-score | T2 (after two years) | -0.10 Z-score | Standard Deviation 0.88 |
| Low implementers | BMI Z-score | T2 (after two years) | -0.05 Z-score | Standard Deviation 0.98 |
| Low implementers | BMI Z-score | T0 (baseline) | -0.10 Z-score | Standard Deviation 0.94 |
| Low implementers | BMI Z-score | T1 (after one year) | -0.03 Z-score | Standard Deviation 0.97 |
p-value: 0.21Mixed Models Analysis
Comparison: Linear mixed model analyses assessed longitudinal intervention effects on children's BMI z-score. A two-level model with measurements as first level and participants as second was used. The model's fixed part consisted of group (medium/low implementers), time (T0/T1/T2), interaction term of group with time, and covariates sex (boy/girl), study year at T0 (four/five/six), SES (low/middle/high), and children's weight status at T0 (underweight/normal weight/overweight). This analyses reports T2-T0.p-value: 0.793Mixed Models Analysis
Secondary
Butter Consumption at Lunch
The child lunch questionnaire assessed children's consumption of certain food types during lunch. The items were summarised into six dichotomous (yes/no) food types: fruits, vegetables, grains (bread and cereals), dairy (milk/yoghurt and cheese), water, and butter.
Time frame: Two years
Population: The number analysed at T1 and T2 corresponds to the number of participants that were not LOF at T1 and T2.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Medium implementers | Butter Consumption at Lunch | T0 (baseline) | 59.4 percentage of yes |
| Medium implementers | Butter Consumption at Lunch | T1 (after one year) | 59.1 percentage of yes |
| Medium implementers | Butter Consumption at Lunch | T2 (after two years) | 55.1 percentage of yes |
| Low implementers | Butter Consumption at Lunch | T0 (baseline) | 62.2 percentage of yes |
| Low implementers | Butter Consumption at Lunch | T1 (after one year) | 60.7 percentage of yes |
| Low implementers | Butter Consumption at Lunch | T2 (after two years) | 56.6 percentage of yes |
Comparison: Logistic mixed model analyses were used to assess longitudinal intervention effects on children's binary dietary behaviours. A two-level model with measurements as first level and participants as second level was used. The model's fixed part consisted of group (medium/low implementers), time (T0/T1/T2), interaction term of group with time, and covariates sex (boy/girl), study year at baseline (four/five/six), SES (low/middle/high), and children's BMI z-score at baseline. Analysis reports T1-T0.p-value: 0.766Mixed Models Analysis
Comparison: Logistic mixed model analyses were used to assess longitudinal intervention effects on children's binary dietary behaviours. A two-level model with measurements as first level and participants as second level was used. The model's fixed part consisted of group (medium/low implementers), time (T0/T1/T2), interaction term of group with time, and covariates sex (boy/girl), study year at baseline (four/five/six), SES (low/middle/high), and children's BMI z-score at baseline. Analysis reports T2-T0.p-value: 0.995Mixed Models Analysis
Secondary
Child Physical Activity Behaviour (Child-reported)
Assessed using the validated Physical Activity Questionnaire for Children (PAQ-C).The PAQ-C is a self-administered,7-day recall instrument, which provides a summary physical activity score derived from eight items, each scored on a 5-point scale. Item 1 (spare time activity) from no activity = 1; 7 times or more = 5. Items 2 to 7 (PE, lunch, right after school, evening, weekends) from lowest activity response = 1 or highest activity response = 5. Item 8 (mean of all days of the week) from none = 1; very often = 5. Item 9 (identifies students who are unusual active during the previous week). By adding up all means of the first eight items in PAQ-C, a summative score of physical activity is obtained. A score of 1 indicates low physical activity level, whereas a score of 5 indicates high physical activity level.
Time frame: Two years
Population: The number analysed at T1 and T2 corresponds to the number of participants that were not LOF at T1 and T2.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Medium implementers | Child Physical Activity Behaviour (Child-reported) | T0 (baseline) | 3.04 score on a scale | Standard Deviation 0.64 |
| Medium implementers | Child Physical Activity Behaviour (Child-reported) | T1 (after one year) | 3.19 score on a scale | Standard Deviation 0.58 |
| Medium implementers | Child Physical Activity Behaviour (Child-reported) | T2 (after two years) | 3.12 score on a scale | Standard Deviation 0.62 |
| Low implementers | Child Physical Activity Behaviour (Child-reported) | T0 (baseline) | 2.94 score on a scale | Standard Deviation 0.67 |
| Low implementers | Child Physical Activity Behaviour (Child-reported) | T1 (after one year) | 3.25 score on a scale | Standard Deviation 0.59 |
| Low implementers | Child Physical Activity Behaviour (Child-reported) | T2 (after two years) | 3.17 score on a scale | Standard Deviation 0.65 |
Comparison: Linear mixed model analyses were used to assess longitudinal intervention effects on children's PA score. A two-level model with measurements as first level and participants as second level was used. The model's fixed part consisted of group (medium/low implementers), time (T0/T1/T2), interaction term of group with time, and covariates sex (boy/girl), study year at baseline (four/five/six), SES (low/middle/high), and children's BMI z-score at baseline. This analysis reports T1-T0.p-value: 0.053Mixed Models Analysis
Comparison: Linear mixed model analyses were used to assess longitudinal intervention effects on children's PA score. A two-level model with measurements as first level and participants as second level was used. The model's fixed part consisted of group (medium/low implementers), time (T0/T1/T2), interaction term of group with time, and covariates sex (boy/girl), study year at baseline (four/five/six), SES (low/middle/high), and children's BMI z-score at baseline. This analysis reports T2-T0.p-value: 0.209Mixed Models Analysis
Secondary
Child Waist Circumference
Waist circumference is measured with a measuring tape to the nearest 0.1 cm, following the World Health Organisation's assessment protocol.
Time frame: Two years
Population: Number analysed at T1 and T2 corresponds to number of participants that were not LOF at T1 and T2.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Medium implementers | Child Waist Circumference | T0 (baseline) | 56.84 centimeters | Standard Deviation 4.66 |
| Medium implementers | Child Waist Circumference | T1 (after one year) | 58.49 centimeters | Standard Deviation 5.64 |
| Medium implementers | Child Waist Circumference | T2 (after two years) | 61.12 centimeters | Standard Deviation 5.94 |
| Low implementers | Child Waist Circumference | T0 (baseline) | 58.62 centimeters | Standard Deviation 6.77 |
| Low implementers | Child Waist Circumference | T1 (after one year) | 59.40 centimeters | Standard Deviation 6.68 |
| Low implementers | Child Waist Circumference | T2 (after two years) | 61.57 centimeters | Standard Deviation 7.11 |
Comparison: Linear mixed model analyses were used to assess longitudinal intervention effects on children's waist circumference. A two-level model with measurements as first level and participants as second level was used. The model's fixed part consisted of group (medium/low implementers), time (T0/T1/T2), interaction term of group with time, and covariates sex (boy/girl), study year at baseline (four/five/six), SES (low/middle/high), and children's BMI z-score at baseline. This analysis reports T1-T0.p-value: 0.003Mixed Models Analysis
Comparison: Linear mixed model analyses were used to assess longitudinal intervention effects on children's waist circumference. A two-level model with measurements as first level and participants as second level was used. The model's fixed part consisted of group (medium/low implementers), time (T0/T1/T2), interaction term of group with time, and covariates sex (boy/girl), study year at baseline (four/five/six), SES (low/middle/high), and children's BMI z-score at baseline. This analysis reports T2-T0.p-value: <0.001Mixed Models Analysis
Secondary
Consumption of at Least Two Healthy Food Groups During Lunch
The child lunch questionnaire assessed children's consumption of certain food types during lunch. The items were summarised into six dichotomous (yes/no) food types: fruits, vegetables, grains (bread and cereals), dairy (milk/yoghurt and cheese), water, and butter. To shed more light on the nutritional value of the children's lunches, the different food types consumed were summed, and a dichotomous variable was created indicating whether children consumed at least two of the food types during lunch.
Time frame: Two years
Population: The number analysed at T1 and T2 corresponds to the number of participants that were not LOF at T1 and T2.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Medium implementers | Consumption of at Least Two Healthy Food Groups During Lunch | T0 (baseline) | 87.4 percentage of yes |
| Medium implementers | Consumption of at Least Two Healthy Food Groups During Lunch | T1 (after one year) | 86.1 percentage of yes |
| Medium implementers | Consumption of at Least Two Healthy Food Groups During Lunch | T2 (after two years) | 89.7 percentage of yes |
| Low implementers | Consumption of at Least Two Healthy Food Groups During Lunch | T0 (baseline) | 88.4 percentage of yes |
| Low implementers | Consumption of at Least Two Healthy Food Groups During Lunch | T1 (after one year) | 88.7 percentage of yes |
| Low implementers | Consumption of at Least Two Healthy Food Groups During Lunch | T2 (after two years) | 86.7 percentage of yes |
Comparison: Logistic mixed model analyses were used to assess longitudinal intervention effects on children's binary dietary behaviours. A two-level model with measurements as first level and participants as second level was used. The model's fixed part consisted of group (medium/low implementers), time (T0/T1/T2), interaction term of group with time, and covariates sex (boy/girl), study year at baseline (four/five/six), SES (low/middle/high), and children's BMI z-score at baseline. Analysis reports T1-T0.p-value: 0.437Mixed Models Analysis
Comparison: Logistic mixed model analyses were used to assess longitudinal intervention effects on children's binary dietary behaviours. A two-level model with measurements as first level and participants as second level was used. The model's fixed part consisted of group (medium/low implementers), time (T0/T1/T2), interaction term of group with time, and covariates sex (boy/girl), study year at baseline (four/five/six), SES (low/middle/high), and children's BMI z-score at baseline. Analysis reports T1-T0.p-value: 0.798Mixed Models Analysis
Secondary
Dairy Consumption at Lunch
The child lunch questionnaire assessed children's consumption of certain food types during lunch. The items were summarised into six dichotomous (yes/no) food types: fruits, vegetables, grains (bread and cereals), dairy (milk/yoghurt and cheese), water, and butter.
Time frame: Two years
Population: The number analysed at T1 and T2 corresponds to the number of participants that were not LOF at T1 and T2.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Medium implementers | Dairy Consumption at Lunch | T0 (baseline) | 37.1 percentage of yes |
| Medium implementers | Dairy Consumption at Lunch | T1 (after one year) | 39.4 percentage of yes |
| Medium implementers | Dairy Consumption at Lunch | T2 (after two years) | 48.5 percentage of yes |
| Low implementers | Dairy Consumption at Lunch | T0 (baseline) | 33.7 percentage of yes |
| Low implementers | Dairy Consumption at Lunch | T1 (after one year) | 39.3 percentage of yes |
| Low implementers | Dairy Consumption at Lunch | T2 (after two years) | 38.0 percentage of yes |
Comparison: Logistic mixed model analyses were used to assess longitudinal intervention effects on children's binary dietary behaviours. A two-level model with measurements as first level and participants as second level was used. The model's fixed part consisted of group (medium/low implementers), time (T0/T1/T2), interaction term of group with time, and covariates sex (boy/girl), study year at baseline (four/five/six), SES (low/middle/high), and children's BMI z-score at baseline. Analysis reports T1-T0.p-value: 0.483Mixed Models Analysis
Comparison: Logistic mixed model analyses were used to assess longitudinal intervention effects on children's binary dietary behaviours. A two-level model with measurements as first level and participants as second level was used. The model's fixed part consisted of group (medium/low implementers), time (T0/T1/T2), interaction term of group with time, and covariates sex (boy/girl), study year at baseline (four/five/six), SES (low/middle/high), and children's BMI z-score at baseline. Analysis reports T2-T0.p-value: 0.626Mixed Models Analysis
Secondary
Fruit Consumption at Lunch
The child lunch questionnaire assessed children's consumption of certain food types during lunch. The items were summarised into six dichotomous (yes/no) food types: fruits, vegetables, grains (bread and cereals), dairy (milk/yoghurt and cheese), water, and butter.
Time frame: Two years
Population: The number analysed at T1 and T2 corresponds to the number of participants that were not LOF at T1 and T2.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Medium implementers | Fruit Consumption at Lunch | T0 (baseline) | 34.3 percentage of yes |
| Medium implementers | Fruit Consumption at Lunch | T1 (after one year) | 31.4 percentage of yes |
| Medium implementers | Fruit Consumption at Lunch | T2 (after two years) | 22.8 percentage of yes |
| Low implementers | Fruit Consumption at Lunch | T0 (baseline) | 34.3 percentage of yes |
| Low implementers | Fruit Consumption at Lunch | T1 (after one year) | 26.8 percentage of yes |
| Low implementers | Fruit Consumption at Lunch | T2 (after two years) | 23.5 percentage of yes |
Comparison: Logistic mixed model analyses were used to assess longitudinal intervention effects on children's binary dietary behaviours. A two-level model with measurements as first level and participants as second level was used. The model's fixed part consisted of group (medium/low implementers), time (T0/T1/T2), interaction term of group with time, and covariates sex (boy/girl), study year at baseline (four/five/six), SES (low/middle/high), and children's BMI z-score at baseline. Analysis reports T1-T0.p-value: 0.249Mixed Models Analysis
Comparison: Logistic mixed model analyses were used to assess longitudinal intervention effects on children's binary dietary behaviours. A two-level model with measurements as first level and participants as second level was used. The model's fixed part consisted of group (medium/low implementers), time (T0/T1/T2), interaction term of group with time, and covariates sex (boy/girl), study year at baseline (four/five/six), SES (low/middle/high), and children's BMI z-score at baseline. Analysis reports T2-T0.p-value: 0.803Mixed Models Analysis
Secondary
Grain Consumption at Lunch
The child lunch questionnaire assessed children's consumption of certain food types during lunch. The items were summarised into six dichotomous (yes/no) food types: fruits, vegetables, grains (bread and cereals), dairy (milk/yoghurt and cheese), water, and butter.
Time frame: Two years
Population: The number analysed at T1 and T2 corresponds to the number of participants that were not LOF at T1 and T2.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Medium implementers | Grain Consumption at Lunch | T0 (baseline) | 92.3 percentage of yes |
| Medium implementers | Grain Consumption at Lunch | T1 (after one year) | 94.2 percentage of yes |
| Medium implementers | Grain Consumption at Lunch | T2 (after two years) | 94.9 percentage of yes |
| Low implementers | Grain Consumption at Lunch | T0 (baseline) | 93.6 percentage of yes |
| Low implementers | Grain Consumption at Lunch | T1 (after one year) | 93.5 percentage of yes |
| Low implementers | Grain Consumption at Lunch | T2 (after two years) | 92.8 percentage of yes |
Comparison: Logistic mixed model analyses were used to assess longitudinal intervention effects on children's binary dietary behaviours. A two-level model with measurements as first level and participants as second level was used. The model's fixed part consisted of group (medium/low implementers), time (T0/T1/T2), interaction term of group with time, and covariates sex (boy/girl), study year at baseline (four/five/six), SES (low/middle/high), and children's BMI z-score at baseline. Analysis reports T1-T0.p-value: 0.742Mixed Models Analysis
Comparison: Logistic mixed model analyses were used to assess longitudinal intervention effects on children's binary dietary behaviours. A two-level model with measurements as first level and participants as second level was used. The model's fixed part consisted of group (medium/low implementers), time (T0/T1/T2), interaction term of group with time, and covariates sex (boy/girl), study year at baseline (four/five/six), SES (low/middle/high), and children's BMI z-score at baseline. Analysis reports T2-T0.p-value: 0.37Mixed Models Analysis
Secondary
Mean Number of Days Per Week of Healthy Dietary Behaviours
A composite score for healthy dietary behaviours was computed from four separate questions. This score was calculated by averaging the weekly consumption (ranging from never (0) to every day (7)) of breakfast consumption and intake of fruit, warm and raw vegetables, and water throughout the day, as reported in the parental questionnaire.
Time frame: Two years
Population: The number analysed at T1 and T2 corresponds to the number of participants that were not LOF at T1 and T2.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Medium implementers | Mean Number of Days Per Week of Healthy Dietary Behaviours | T0 (baseline) | 5.57 mean days/week | Standard Deviation 0.96 |
| Medium implementers | Mean Number of Days Per Week of Healthy Dietary Behaviours | T1 (after one year) | 5.38 mean days/week | Standard Deviation 0.94 |
| Medium implementers | Mean Number of Days Per Week of Healthy Dietary Behaviours | T2 (after two years) | 5.45 mean days/week | Standard Deviation 0.9 |
| Low implementers | Mean Number of Days Per Week of Healthy Dietary Behaviours | T0 (baseline) | 5.56 mean days/week | Standard Deviation 0.95 |
| Low implementers | Mean Number of Days Per Week of Healthy Dietary Behaviours | T1 (after one year) | 5.56 mean days/week | Standard Deviation 0.9 |
| Low implementers | Mean Number of Days Per Week of Healthy Dietary Behaviours | T2 (after two years) | 5.52 mean days/week | Standard Deviation 0.84 |
Comparison: Linear mixed model analyses were used to assess longitudinal intervention effects on children's dietary behaviours. A two-level model with measurements as first level and participants as second level was used. The model's fixed part consisted of group (medium/low implementers), time (T0/T1/T2), interaction term of group with time, and covariates sex (boy/girl), study year at baseline (four/five/six), SES (low/middle/high), and children's BMI z-score at baseline. This analysis reports T1-T0.p-value: 0.444Mixed Models Analysis
Comparison: Linear mixed model analyses were used to assess longitudinal intervention effects on children's dietary behaviours. A two-level model with measurements as first level and participants as second level was used. The model's fixed part consisted of group (medium/low implementers), time (T0/T1/T2), interaction term of group with time, and covariates sex (boy/girl), study year at baseline (four/five/six), SES (low/middle/high), and children's BMI z-score at baseline. This analysis reports T2-T0.p-value: 0.863Mixed Models Analysis
Secondary
Mean Number of Days Per Week of Soft Drink Consumption
Soft drink consumption during the past week was derived from the parental questionnaire ranging from never (0) to every day (7).
Time frame: Two years
Population: The number analysed at T1 and T2 corresponds to the number of participants that were not LOF at T1 and T2.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Medium implementers | Mean Number of Days Per Week of Soft Drink Consumption | T0 (baseline) | 4.31 mean days/week | Standard Deviation 2.74 |
| Medium implementers | Mean Number of Days Per Week of Soft Drink Consumption | T1 (after one year) | 4.07 mean days/week | Standard Deviation 2.67 |
| Medium implementers | Mean Number of Days Per Week of Soft Drink Consumption | T2 (after two years) | 3.35 mean days/week | Standard Deviation 2.61 |
| Low implementers | Mean Number of Days Per Week of Soft Drink Consumption | T0 (baseline) | 4.06 mean days/week | Standard Deviation 2.78 |
| Low implementers | Mean Number of Days Per Week of Soft Drink Consumption | T1 (after one year) | 3.63 mean days/week | Standard Deviation 2.88 |
| Low implementers | Mean Number of Days Per Week of Soft Drink Consumption | T2 (after two years) | 3.43 mean days/week | Standard Deviation 2.7 |
Comparison: Linear mixed model analyses were used to assess longitudinal intervention effects on children's dietary behaviours. A two-level model with measurements as first level and participants as second level was used. The model's fixed part consisted of group (medium/low implementers), time (T0/T1/T2), interaction term of group with time, and covariates sex (boy/girl), study year at baseline (four/five/six), SES (low/middle/high), and children's BMI z-score at baseline. This analysis reports T1-T0.p-value: 0.815Mixed Models Analysis
Comparison: Linear mixed model analyses were used to assess longitudinal intervention effects on children's dietary behaviours. A two-level model with measurements as first level and participants as second level was used. The model's fixed part consisted of group (medium/low implementers), time (T0/T1/T2), interaction term of group with time, and covariates sex (boy/girl), study year at baseline (four/five/six), SES (low/middle/high), and children's BMI z-score at baseline. This analysis reports T2-T0.p-value: 0.418Mixed Models Analysis
Secondary
Vegetable Consumption at Lunch
The child lunch questionnaire assessed children's consumption of certain food types during lunch. The items were summarised into six dichotomous (yes/no) food types: fruits, vegetables, grains (bread and cereals), dairy (milk/yoghurt and cheese), water, and butter.
Time frame: Two years
Population: The number analysed at T1 and T2 corresponds to the number of participants that were not LOF at T1 and T2.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Medium implementers | Vegetable Consumption at Lunch | T0 (baseline) | 24.5 percentage of yes |
| Medium implementers | Vegetable Consumption at Lunch | T1 (after one year) | 31.4 percentage of yes |
| Medium implementers | Vegetable Consumption at Lunch | T2 (after two years) | 19.9 percentage of yes |
| Low implementers | Vegetable Consumption at Lunch | T0 (baseline) | 25.6 percentage of yes |
| Low implementers | Vegetable Consumption at Lunch | T1 (after one year) | 26.8 percentage of yes |
| Low implementers | Vegetable Consumption at Lunch | T2 (after two years) | 19.9 percentage of yes |
Comparison: Logistic mixed model analyses were used to assess longitudinal intervention effects on children's binary dietary behaviours. A two-level model with measurements as first level and participants as second level was used. The model's fixed part consisted of group (medium/low implementers), time (T0/T1/T2), interaction term of group with time, and covariates sex (boy/girl), study year at baseline (four/five/six), SES (low/middle/high), and children's BMI z-score at baseline. Analysis reports T1-T0.p-value: 0.073Mixed Models Analysis
Comparison: Logistic mixed model analyses were used to assess longitudinal intervention effects on children's binary dietary behaviours. A two-level model with measurements as first level and participants as second level was used. The model's fixed part consisted of group (medium/low implementers), time (T0/T1/T2), interaction term of group with time, and covariates sex (boy/girl), study year at baseline (four/five/six), SES (low/middle/high), and children's BMI z-score at baseline. Analysis reports T2-T0.p-value: 0.658Mixed Models Analysis
Secondary
Water Consumption at Lunch
The child lunch questionnaire assessed children's consumption of certain food types during lunch. The items were summarised into six dichotomous (yes/no) food types: fruits, vegetables, grains (bread and cereals), dairy (milk/yoghurt and cheese), water, and butter.
Time frame: Two years
Population: The number analysed at T1 and T2 corresponds to the number of participants that were not LOF at T1 and T2.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Medium implementers | Water Consumption at Lunch | T0 (baseline) | 32.9 percentage of yes |
| Medium implementers | Water Consumption at Lunch | T1 (after one year) | 38.0 percentage of yes |
| Medium implementers | Water Consumption at Lunch | T2 (after two years) | 44.9 percentage of yes |
| Low implementers | Water Consumption at Lunch | T0 (baseline) | 26.7 percentage of yes |
| Low implementers | Water Consumption at Lunch | T1 (after one year) | 31.0 percentage of yes |
| Low implementers | Water Consumption at Lunch | T2 (after two years) | 38.6 percentage of yes |
Comparison: Logistic mixed model analyses were used to assess longitudinal intervention effects on children's binary dietary behaviours. A two-level model with measurements as first level and participants as second level was used. The model's fixed part consisted of group (medium/low implementers), time (T0/T1/T2), interaction term of group with time, and covariates sex (boy/girl), study year at baseline (four/five/six), SES (low/middle/high), and children's BMI z-score at baseline. Analysis reports T1-T0.p-value: 0.771Mixed Models Analysis
Comparison: Logistic mixed model analyses were used to assess longitudinal intervention effects on children's binary dietary behaviours. A two-level model with measurements as first level and participants as second level was used. The model's fixed part consisted of group (medium/low implementers), time (T0/T1/T2), interaction term of group with time, and covariates sex (boy/girl), study year at baseline (four/five/six), SES (low/middle/high), and children's BMI z-score at baseline. Analysis reports T1-T0.p-value: 0.861Mixed Models Analysis
Secondary
Water Consumption During School Hours
Water consumption during school hours was derived from the child questionnaire ranging from never (0) to every day (3).
Time frame: Two years
Population: The number analysed at T1 and T2 corresponds to the number of participants that were not LOF at T1 and T2.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Medium implementers | Water Consumption During School Hours | T0 (baseline) | 1.43 mean days/week | Standard Deviation 1.22 |
| Medium implementers | Water Consumption During School Hours | T1 (after one year) | 1.47 mean days/week | Standard Deviation 1.13 |
| Medium implementers | Water Consumption During School Hours | T2 (after two years) | 1.63 mean days/week | Standard Deviation 1.2 |
| Low implementers | Water Consumption During School Hours | T0 (baseline) | 1.25 mean days/week | Standard Deviation 1.13 |
| Low implementers | Water Consumption During School Hours | T1 (after one year) | 1.40 mean days/week | Standard Deviation 1.16 |
| Low implementers | Water Consumption During School Hours | T2 (after two years) | 1.73 mean days/week | Standard Deviation 1.17 |
Comparison: Linear mixed model analyses were used to assess longitudinal intervention effects on children's dietary behaviours. A two-level model with measurements as first level and participants as second level was used. The model's fixed part consisted of group (medium/low implementers), time (T0/T1/T2), interaction term of group with time, and covariates sex (boy/girl), study year at baseline (four/five/six), SES (low/middle/high), and children's BMI z-score at baseline. This analysis reports T1-T0.p-value: 0.307Mixed Models Analysis
Comparison: Linear mixed model analyses were used to assess longitudinal intervention effects on children's dietary behaviours. A two-level model with measurements as first level and participants as second level was used. The model's fixed part consisted of group (medium/low implementers), time (T0/T1/T2), interaction term of group with time, and covariates sex (boy/girl), study year at baseline (four/five/six), SES (low/middle/high), and children's BMI z-score at baseline. This analysis reports T2-T0.p-value: 0.263Mixed Models Analysis