Promoting Physical Activity and Healthy Eating in Brazilian High Schools

Transcrição

1 Promoting Physical Activity and Healthy Eating in Brazilian High Schools A Cross-cultural l Randomized d Intervention ti Study Markus V. Nahas - UFSC Mauro V. G. de Barros - UPE Maria Alice A. de Assis UFSC Saúde na Boa! Nahas et al.

2 Excess Body Weight in Brazil (% adults) % BMI Estudo Nacional da Despesa Familiar Pesquisa Nacional sobre Saúde e Nutrição IBGE / POF Saúde na Boa! Nahas et al.

3 Programs that work: School-based Large number of people involved Low cost Evidences of efficacy and effectiveness (Ex. CATCH) Include: PE curriculum; Cafeteria; Health Education; Personnel training; and community partnerships 3

4 High school in Brazil 50% of students have a job; 50% attend night-time time classes 30% over 18 years of age Inactivity increases during the transition from adolescence to adulthood (15-24 years of age) Risk behaviors more prevalent among night-time students 4

5 Youth: Dificulties for Health Promotion Youth belief that they are away from behavior- related health problems Even when well informed, many ignore risks Value life factors other than their own health Dicotomy: Healthy behaviors and Fun 5

6 Health can be fun! A weight gain prevention focused on promoting physical activity, reducing sedentary behavior, and improving eating habits for youth in Brazilian High Schools. 6

7 The Logic Model of the intervention The Problem Youth in High Schools > 1/3 insuficiently active 50% poor eating habits. Students attending evening classes are at higher risk. Saúde na Boa! Nahas et al.

8 Intermediate outcomes in the Logic Model Primary outcome Physical activity: - days/wk doing >60 min MVPA - Inactivity (% of students reporting zero days/wk) Secondary outcome Eating behavior: - days per week consuming fruit and vegetable - soft drinks - sweets and fi fried/fatty snacks Saúde na Boa! Nahas et al.

9 Goal Plan Implement Evaluate the effectiveness Recife, PE Florianópolis, SC 9

10 Study Population Public high school students from Florianopolis (S) and Recife (NE) Attending evening classes Both genders; 15 to 24 years of age 10

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12 Elements of the Intervention - Introductory presentation to the school community - Posters, newsletters, web site - PE teachers training i and curriculum modification - Bike rack - Fruit Day - Events (trails, tournaments) 12

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16 Overview of the Intervention Period and Assessments: Formative Evaluation Major assessments Secondary (seasonal) assessments Baseline Mid - term Post - intervention Follow - up March 2006 June September December 2006 June 2007 Process Evaluation INTERVENTION PERIOD Final Report Sept 2007 Saúde na Boa! Nahas et al.

17 Flowchart Florianópolis, SC students Recife, PE students 25 Schools 114 Schools 10 Schools 10 Schools 5 Control 5 Intervention 5 Control 5 Intervention n=564 n=592 Baseline n=532 n=467 n=296 n=330 Losses n=285 n=255 n=268 n=262 Post-intervention n=247 n=212 17

18 Sample at Baseline (n=2,155) Intervention Control p Valid questionnaires i (n) ,096 % Girls <.01 Mean age (s) 18.5 (2.3) 18.2 (2.4) <.01 Work (% yes) Live with family (%) Skin color (% white) % Insufficiently active Low consumption of fruits Excess Body Weight

19 Impact: Days/wk 60 min MVPA overall Baseline p=0.11 Post-intervention p= Intervention Control 19

20 Days/wk 60 min MVPA by gender Baseline Intervention p=0.51 p=0.002 p=0.14 p= Post-intervention Control 20

21 Impact: prevalence of physical inactivity (0 days/wk MVPA) % p=0,001; Teste de McNemar p <

22 Impact: Low consumption of fruits (<3 days/wk) % p=0,007; Teste de McNemar p <

23 Impact: High consumption of soft drinks (5+ days/week) % p<0,001; Teste de McNemar p <

24 Conclusions The process Support of school administrators i t and students Fruit Day low cost, great visibility and impact Difficult to engage and train PE Teachers & Canteen personnel Continuation depends upon incentives and leadership engagement 24

25 Conclusions - Impact No positive changes in BMI Reduction of inactivity Reduction of soft drinks consumption Reduction in the prevalence of low consumption of fruits and vegetables Reduction in the consumption o of fried / fatty snacks Saúde na Boa! Nahas et al. 25

26 Limitations / Difficulties Teachers Strike High drop out rates (close to 50%!) Resistance to change Phys Ed lack of planning Lack of perspectives perceived by night- time students 26

27 Recife Thank you! Florianopolis li 27

28 Contact for publications (4): Acknowledgement: CNPq 28

29 Revista Brasileira de Atividade Física & Saúde, 2008(3),

30 Journal of Physical Activity and Health, 2009, 6,

31 Journal of Physical Activity and Health, 2009, 6,

32 Brazilian Journal of Epidemiology, 2009,12(2),