Can school efforts really persuade kids not to smoke, spur teens to exercise and get little ones to eat more fruits and veggies? Yes, if these efforts are part of a schoolwide program that promotes healthy behaviors on multiple fronts, according to the results of the most comprehensive study on the effects of these programs completed to date.
"Traditionally we have had health education in schools, but the result of those efforts has been disappointing," said Kelli Komro, a professor of health outcomes and policy in the University of Florida College of Medicine and associate director of UF's Institute for Child Health Policy. "It is not only the curriculum that helps, but it also takes changing the school environment and the social environment so that it supports health-promoting behaviors, and linking all of this to families and communities to ensure there are coordinated messages."
The international team of researchers, which included Komro, reviewed data from 67 studies examining schools using the World Health Organization's health-promoting schools program. Health-promoting schools deploy multiple techniques to promote healthy behavior in children and staff members, such as adopting healthier cooking methods in the cafeteria, expanding time for physical fitness, getting parents involved through homework assignments that promote health and inviting the community in for demonstrations related to health.
They found that schools with these types of programs were successful at reducing children's body mass index, increasing physical activity and consumption of fruits and vegetables, and decreasing cigarette use and bullying. The results were published online in The Cochrane Library, a database of systematic reviews on human health studies.
The researchers began reviewing data in 2011, initially culling information from more than 78,000 studies. They whittled this down to just 67 large, randomized, controlled trials - the most rigorous types of studies. The final data included findings from 1,345 schools and 98 school districts, mostly in the United States.
"There are multiple interventions that were being examined in these studies," Komro said. "All of them meet the framework for a health-promoting school, which includes three main components - educating students, creating healthy social and physical environments and reaching out to families and communities."
The schools involved in these programs use a variety of different tactics tailored to their specific school and community to meet these goals, Komro said. Often, some of the techniques are simple fixes that improve health, such as teaching kitchen staff healthier cooking techniques or pairing kids with buddies so they don't get bullied.
"For school leaders, it is thinking 'What changes can be made to make the school environment more health promoting?'" Komro said. "These behaviors track into adulthood, so if you think of it from a societal perspective, it pays off to get these kids on a healthy trajectory early in life.
"These are health changes at a population level that are anticipated to have long-term benefits."
In some categories, such as drug and alcohol use, the researchers found no evidence that these health-promoting interventions made a difference, but Komro said this is largely because they did not find enough data. More studies are needed to come to a conclusion, she said.
"Overall, I think the results of the study are promising," Komro said. "When prevention efforts are coordinated and comprehensive, prevention works."