Gac
Sani .
2014;28(5):411–417
Re iew
Impac
o
school-based
heal h
p omo ion
in e en ions
aimed
a
di e en
beha io al
domains:
a
sys ema ic
e iew
Ma a
Lima-Se ano,
Joaquín
S.
Lima-Rod íguez∗
Nu sing
Depa men ,
Facul y
o
Nu sing,
Physio he apy
and
Podia y,
Uni e si y
o
Se illa,
Espa˜
na
a
i
c
l
e
i
n
o
A icle
his o y:
Recei ed
2
Feb ua y
2014
Accep ed
7
May
2014
A ailable
online
10
June
2014
Keywo ds:
Heal h
p omo ion
P og am
e alua ion
Li es yles
Risk
beha io
Adolescence
a
b
s
a
c
Objec i e:
Gi en
ha
li es ylesha e
simila
de e minan s
and
ha
school-based
in e en ions
a e
usually
a ge ed
a
all
he
isks
ha
a ec
adolescen s,
he
objec i e
o
his
sys ema ic
e iew
was
o
summa ize
he
cha ac e is ics
and
e ec s
o
school-based
in e en ions
ac ing
on
di e en
beha io al
domains
o
adolescen
heal h
p omo ion.
Me hods:
The
e iew
p ocess
was
conduc ed
by
wo
independen
e iewe s
who
sea ched
PubMed,
Sco-
pus,
PsycINFO,
and
ERIC
da abases
o
expe imen al
o
obse a ional
s udies
wi h
a
leas
wo
measu es
o
esul s
published
om
2007
o
2011,
gi en
ha
he
esea ch
in o ma ion
a ailable
doubles
e e y
5
yea s.
Me hodological
quali y
was
assessed
wi h
a
s anda dized
ool.
Resul s:
In o ma ion
was
ex ac ed
om
35
s udies
aiming
o
p e en
isk
beha io s
and
p omo e
heal hy
nu i ion,
physical
ac i i y,
and
men al
and
holis ic
heal h.
Ac i i ies
we e
based
on
heo e ical
models
and
we e
classified
in o
in e ac i e
lessons,
pee
media ion,
en i onmen al
changes,
pa en s’
and
commu-
ni y
ac i i ies,
and
ailo ed
messages
by
compu e -assis ed
aining
o
o he
esou ces,
usually
including
mul iple
componen s.
In
some
cases,
we
iden ified
some
mode a e
o
la ge,
sho -
and
long- e m
e ec s
on
beha io al
and
in e media e
a iable.
Conclusions:
This
exhaus i e
e iew
ound
ha
well-implemen ed
in e en ions
can
p omo e
adolescen
heal h.
These
findings
a e
consis en
wi h
ecen
e iews.
Implica ions
o
p ac ice,
public
heal h,
and
esea ch
a e
discussed.
©
2014
SESPAS.
Published
by
Else ie
España,
S.L.U.
All
igh s
ese ed.
Impac o
de
las
in e enciones
escola es
de
p omoción
de
la
salud
di igidas
a
di e en es
á eas
de
conduc a:
una
e isión
sis emá ica
Palab as
cla e:
P omoción
de
la
salud
E aluación
de
p og amas
y
p oyec os
de
salud
Es ilos
de
idas
Eompo amien os
de
iesgos
Adolescencia
e
s
u
m
e
n
Obje i o:
Dado
que
los
es ilos
de
ida
ienen
simila es
de e minan es,
y
las
in e enciones
escola es
suelen
es a
di igidas
a
odos
los
iesgos
que
apa ecen
du an e
la
adolescencia,
el
obje i o
de
es a
e isión
sis emá ica
ha
sido
esumi
las
ca ac e ís icas
y
los
e ec os
de
in e enciones
escola es
de
p omoción
de
la
salud
di igidas
a
di e en es
á eas
de
conduc a.
Mé odos:
La
e isión
se
ealizó
po
dos
e aluado es
que
independien emen e
ealiza on
una
búsqueda
en
las
bases
de
da os
PubMed,
Scopus,
PsycINFO,
y
ERIC,
de
es udios
obse acionales
y
expe imen ales
con
al
menos
dos
medidas
de
esul ados,
publicados
en e
2007
y
2011,
pues
la
in o mación
cien ífica
disponible
se
duplica
cada
cinco
a˜
nos.
La
calidad
me odológica
se
e aluó
con
he amien as
es anda izadas.
Resul ados:
Se
ecogió
in o mación
de
35
es udios
di igidos
a
p omo e
la
nu ición
saludable
y
la
ac i i-
dad
ísica,
p omo e
la
salud
men al
y
holís ica,y
p e eni
conduc as
de
iesgo.
Las
ac i idades
se
basa on
en
dis in os
modelos
eó icos
y
se
califica on
en
lecciones
in e ac i as,
mediación
po
pa es,
cambios
ambien ales,
ac i idades
con
pad es
y
comunidad,
a ención
“a
medida”
asis ida
po
el
o denado
u
o os
ecu sos,
con
ecuencia
incluye on
múl iples
componen es.
En
algunos
casos,
se
encon a on
de
mode ado
a
la gos
e ec os,
a
co o
y
la go
plazo
sob e
a iables
compo amen ales
e
in e medias.
Conclusiones:
La
o aleza
de
es a
e isión
es
que
se
ha
lle ado
a
cabo
de
modo
exhaus i o,
y
apun a
a
que
in e enciones
bien
implemen adas
pueden
p omo e
la
salud
adolescen e.
Los
hallazgos
son
con-
sis en es
con
e isiones
ecien es,
y
sus
implicaciones
pa a
la
p ác ica,
la
salud
pública,
y
la
in es igación
han
sido
discu idos.
©
2014
SESPAS.
Publicado
po
Else ie
España,
S.L.U.
Todos
los
de echos
ese ados.
∗Co esponding
au ho .
E-mail
add ess:
[email p o ec ed]
(J.S.
Lima-Rod íguez).
h p://dx.doi.o g/10.1016/j.gace a.2014.05.003
0213-9111/©
2014
SESPAS.
Published
by
Else ie
España,
S.L.U.
All
igh s
ese ed.
412
M.
Lima-Se ano,
J.S.
Lima-Rod íguez
/
Gac
Sani .
2014;28(5):411–417
In oduc ion
Bio-psycho-social
changes
may
lead
o
unheal hy
li es yles
in
adolescence,
which
end
o
co-occu
and
ha e
simila
de e mi-
nan s.
This
has
a
majo
impac
in
e ms
o
disease,
disabili y,
dea h,
and
high
cos s
o
amilies
and
communi y.1,2
Adolescence
has
been
associa ed
o
unheal hy
nu i ion
and
physical
ac i i y
is
educed
in
his
pe iod.3Obesi y
is
linked
o
body
image
diso de s
ha
a ec
men al
heal h
and
well-being.4In
2010
he
Heal h
Beha io
in
School-Aged
Child en
(HBSC)
in e na-
ional
s udy
ound
ha
14.3%
o
pa icipan s
we e
o e weigh .
The
ci ed
s udy
also
ound
ha
19%
o
15
yea -old’s
epo ed
smoking
a
leas
once
a
week,
26%
a
p e alence
o
weekly
alcohol
consump ion,
33%
ha ing
been
d unk
wice
o
mo e,
and
18%
using
cannabis
a
leas
once
in
li e.
Rega ding
sexuali y,
27%
o
15
yea -old’s
epo ed
ha ing
had
sexual
in e cou se.1In
addi ion,
a fic
inju y
is
he
lead-
ing
cause
o
dea h
among
15-19
yea -old’s
and
among
10–14
yea
old’s.5
In
o de
o
p e en
unheal hy
li es yles
heal h
p omo ion
p o-
g ammes
a e
pe o med
a
schools.
These
a e
app op ia e
con ex s
o
imp o e
public
heal h
ha
allow
access
o
highe
numbe s
o
adolescen s.6,7 Sys ema ic
e iews
ha e
been
pe o med
o
e alu-
a e
he
e ec
o
school-based
in e en ions
ega ding
nu i ion
and
physical
ac i i y,6,8 subs ance
use,9,10 o
iolence,11 which
ound
some
posi i e
e ec s
o
a iable
magni ude.
Pe e s
and
cols
pe -
o med
a
e iew
on
h ee
domains,
i.
e.,
nu i ion,
subs ance
use
and
sexuali y.7
This
is
a
sys ema ic
e iew
ac oss
di e en
beha iou al
domains
since
hey
ha e
simila
de e minan s,
and
school-based
in e -
en ions
usually
deal
wi h
all
isks
ha
a ec
adolescence.
We
ques ioned
¿Wha
a e
he
main
cha ac e is ics
o
ecen
school-
based
heal h
p omo ion
and
isk
p e en ion
in e en ions
a ge ed
o
adolescen s?
¿Wha
a e
hei
main
e ec s?
The
objec i e
was
o
summa ize
cha ac e is ics
and
e ec s
o
school-based
in e en-
ions
leading
o
beha iou s
such
as
nu i ion,
physical
ac i i y,
men al
and
holis ic
heal h,
and
isk
p e en ion
(ea ing
diso de s,
subs ance
use,
sexuali y,
iolence
and
oad
sa e y).
Me hods
In
Feb ua y
2012
a
sea ch
was
pe o med
in
PubMed,
PsycINFO,
ERIC
and
Scopus,
o
bo h
e iew
and
o iginal
a icles.
Re ised
da abases
include
ele an
in o ma ion
on
heal h,
psychology,
edu-
ca ion
and
mul idisciplina y
sciences.
Since
esea ch
in o ma ion
is
upda ed
e e y
fi e
yea s
and
p e ious
wo ks
become
obsole e,12,13
we
conside ed
a icles
published
om
2007.01.01
o
2011.12.31.
The
ollowing
sea ch
e ms:
adolescen ,
p og am
e alua ion,
heal h
p omo ion,
and
whene e
i
was
possible
he
hesau us
ool
we e
used
(complemen a y
ma e ial:
able
I).
We
conside ed
ge -
ing
in
ouch
wi h
au ho s
i
he e
we e
doub s
o
di ficul y
in
e ie ing
ull- ex .
Re e ence
lis s
o
bo h
o iginal
and
me a-analy ic
a icles
selec ed
we e
e ified
o
iden i y
addi ional
s udies
which
eached
inclusion
c i e ia.
These
we e
English,
Spanish,
and
Po uguese
lan-
guages,
wi h
abs ac ,
quan i a i e
expe imen al
o
obse a ional
s udies
in
which
an
in e en ion
g oup
was
compa ed
a
leas
wice
(p e es
and
pos es ),
in e en ions
aimed
a
heal hy
adolescen s
(11-17
yea s)
wi hou
specific
illness
o
isks
(such
as
subs ance
consume s,
men al
diso de s
o
obese),
he
p ima y
in e en ions
we e
conduc ed
a
school,
and
he
a icle
had
a
mode a e
o
s ong
sco e
in
quali y
assessmen .
In
he
final
sample,
exclusion
c i e ia
we e
di e en
o
o iginal
and
had
weak
quali y
sco es.
The
s anda dized
quali y
assessmen
ool
o
E ec i e
Public
Heal h
P ac ice
P ojec
was
used.14 Eigh
componen s
we e
sco ed
(weak/mode a e/s ong):
(1)
Selec ion
bias,
(2)
s udy
design,
(3)
con ounde s,
(4)
blinding,
(5)
da a
col-
lec ion,
(6)
wi hd awals
and
d op-ou s,
(7)
in e en ion
in eg i y,
and
(8)
analysis.
When
he e
we e
mul iple
publica ions
o
he
same
s udy
a
p ojec
accoun
was
c ea ed.
The
mos
impo an
in o ma ion
was
ex ac ed
and
summa ized
in
ables
a ending
he
ollow-
ing
ca ego ies:
heal h
nu i ion
and
physical
ac i i y,
men al
and
holis ic
heal h,
and
isk
p e en ion
in e en ions.
Rega ding
he
sus ainabili y,
we
conside ed
popula ion
and
se ing,
whe he
ou -
comes
we e
measu ed
o e
mul iple
ime
poin s
and
a
sho
o
long- e m.
Rega ding
he
applicabili y
we
also
e iewed
i
e ec
a ied
ac oss
di e en
popula ions
and
se ings.15 Whene e
i
was
possible,
he
ollowing
subca ego ies
we e
iden ified:
e e -
ence
(au ho ,
yea ),
s udy
cha ac e is ics
(design,
andomized
le el,
coun y,
popula ion,
ollow-ups,
numbe
o
a iables,
pa icipan s’
age),
in e en ion
cha ac e is ics
(se ing,
objec i es,
heo e ical
amewo k,
implemen a ion
cha ac e is ics),
main
e ec s
(only
hose
ha
p<.05).
When
i
was
possible,
Cohen’s
d
was
calcula ed.16
We
conside ed
0.2
low,
0.5
mode a e,
and
0.8
la ge
e ec .
When
o e ed,
we
used
odds
a io
(1.50
low,
3.50
mode a e,
9.00
la ge
e ec ),
and
R2(0.01
low,
0.06
mode a e,
0.14
la ge
e ec ).17 How-
e e ,
gi en
he
he e ogenei y
o
s udies
ega ding
in e en ions,
pa icipan s,
ou come
measu es,
no
pooled
e ec
sizes
we e
calcu-
la ed
bu
a
na a i e
sys ema ic
e iew
was
pe o med.
Two
independen
e iewe s
we e
in ol ed
in
e e y
s ep,
i.
e.,
sc eening
he
esul s
om
da abase
sea ches,
ca ying
ou
quali y
assessmen ,
ex ac ing
da a,
e iewing
d a s
and
he
final
epo .
Disag eemen s
we e
sol ed
by
discussion.
S anda dized
ools
we e
adap ed
and
used
independen ly.6
Resul s
Li e a u e
sea ch,
quali y
a ing,
and
cha ac e is ics
o
s udies
537
abs ac s
we e
iden ified.
Subsequen ly,
64
ull- ex
a icles
we e
e ie ed
(Fig.
1),
and
finally,
56
p ojec s
we e
selec ed.
The
easons
o
exclusion
we e:
pa icipan s
we e
no
11
o
17
yea s-
old,
in e en ions
we e
no
p ima y
based
on
school,
we e
aimed
o
illness
o
in
isk
adolescen s,
esul
measu es
we e
no
shown,
o
he e
was
only
one
measu e.
The
quali y
o
he
56
p ojec s
was
e alua ed
and
21
weak
ones
we e
excluded.
The
main
limi a ions
we e
small
sample
size
ha
was
inadequa ely
explained,
no
con ol
o
po en ially
con ounde s,
no
binding,
high
pe cen age
o
d op-ou s,
and
no
eliable
ins u-
men s.
Finally,
da a
we e
ex ac ed
om
35
p ojec s
(Table
1);
hey
we e
classified
in o
h ee
ca ego ies.
Thus
12
aimed
a
nu i ion
and
physical
ac i i y;
eigh
a
men al
and
holis ic
heal h;
and
15
a
p e en
isk
beha iou s
(supplemen a y
ma e ial:
Tables
II
o
IV).
Desc ip ion
o
s udies
The
p ojec s
we e
manly
conduc ed
in
Eu ope
(N
=
17),
and
he
Uni ed
S a es
(USA)
(N
=
12).
The
pa icipan s
we e
a ound
13
mean
o
age.
Specifically,
ou
s udies
we e
o ien a ed
o
emale
s uden s,
wo
o
u al
communi ies,
and
wo
o
A o-Ame ican
s uden s.
The
majo i y
we e
expe imen al
(N
=
24)
o
quasi-expe imen al
(N
=
10),
whe e
one
expe imen al
g oup
(EG)
was
compa ed
o
a
con ol
g oup
(CG)
ha
deli e ed
i s
habi ual
cu iculum
(N
=
28).
In
addi ion,
wo
s udies
applied
quali a i e
me hodology
in
o de
o
complemen
quan i a i e
esul s.
In
six
p ojec s
wo
measu es
we e
ca ied
ou ,
al hough
Shek
and
cols34 deli e ed
pos es
measu es
a e
wo
yea s
o
in e -
en ion.
15
p ojec s
had
h ee
measu es,
in
12
o
hem
we e
deli e ed
in
sho - e m
(10
weeks
o
12
mon hs),
while
in
he
es
in
M.
Lima-Se ano,
J.S.
Lima-Rod íguez
/
Gac
Sani .
2014;28(5):411–417
413
Elec onic da abase sea ch (537)
Scopus (214)
ERIC + PsycINFO (213)
Pubmed (110)
Po en ially ele an a icles (64)
Non- ele an base on i le and abs ac sc eening (473)
Mul iple publica ions om he same s udy combined
in p ojec accoun s
+ Rele an a icles om e e ences lis s
Quali y assessmen o ele an p ojec accoun s (56)
Weak p ojec accoun s emo ed (21)
Da a ex ac ion om 35 p ojec s (17 s ong, 18 mode a e)
Fig.
1.
Flow
cha
o
s udy
selec ion
p ocess.
long- e m
(mos ly
wo
yea s).
Nine
p ojec s
had
mo e
measu es,
whe e
he
la es
was
ca ied
in
long
e m
( wo/ h ee-yea
ollow-
up).
Popula ion
size
was
e y
a iable
be ween
48
pa icipan s22
and
11,748
pa icipan s55 a
p e es .
Cha ac e is ics
o
school-based
in e en ions.
All
in e en ions
had
as
main
ocus
s uden s
a
schools,
some
o
hem
we e
also
pe o med
in
o he
con ex s
such
as
amily
(N
=
11),20,21,23,25,31,32,39–42,51–54,56–58 and
communi y
(N
=
5).24,42,46,51–54,56
The
majo i y
we e
based
on
heo e ical
models
o
beha iou
change
(N
=
24),
i.e.,
social
cogni i e
heo y,19,24,25,27,40–43,49,51–54,58
ans- heo e ical
model,23,30,51–54 heo y
o
planned
beha iou ,39–41,51–54 sel - egula ion
and
planning
heo y,25
sel -de e mina ion
heo y,26 heal h
p omo ion
(Sidani
and
B aden’s,
Pende ’s,
Pe y’s
models),20–23,50,56 social
influence
models,46,48,51–54 ecological
models,18,24,42,46 psycho-social
aining,33,33,39,42 o
posi i e
you h
de elopmen ,34,36 among
o he s.
The
ac i i ies
we e
implemen ed
in o
six
a eas,
i.e.,
in e ac i e
lessons,
pee
media ion,
imp o ing
accessibili y
by
en i onmen
changes,
ac i i ies
wi h
pa en s,
ac i i ies
wi h
communi y,
and
ailo ed
message
by
compu e -assis ed
aining
o
o he
esou ces.
The
majo i y
(N
=
21)
pe o med
in e ac i e
lessons
o
a iable
leng h,
i.e.,
om
wo
lessons
in
o al42 o
one
lesson
pe
week
o e
he
yea .32The
mean
was
10
lessons.
These
we e
pe o med
mainly
in
he
class oom
by
p o esso s
o
p e iously
ained
heal h
p ac-
i ione s
( om
1-day
o
5-day
aining).
In
Jemmo
III
and
cols,
he
lessons
we e
deli e ed
du ing
a e school
by
communi y
co-
acili a o
ha
ecei ed
2.5-day
o
8-day
aining.40,41,49
Sca ce
in o ma ion
was
gi en
abou
ypes
o
in e ac i e
me hodologies,
bu
in
some
p ojec s
discussion,
consensus,
ole-
play,
modeling,
sol ing
p oblems,
aining
in
decision-making
p ocess,
games
o
film
analysis
we e
named.
In
addi ion,
some
p ojec s
added
physical
aining
o
in e ac i e
lessons.19,22–25,28,41
Pee
media ion
conduc ed
by
p e iously
ained
pee
lead-
e s
was
ca ied
ou
in
11
p ojec s,
mainly
hose
o
p e en ing
isk
beha iou
such
as
ea ing
diso de ,42 HIV/AIDS
p e en ion,48
subs ance
use,51–59 and
pee
iolence.46 They
ga e
in o ma ion
bo h
o mally,29 and
in o mally.51–57 In
McVey
and
cols,42 suppo
g oups
conduc ed
by
a
nu se
we e
pe o med.
Dzewal owski
and
cols27 and
Bonell
and
cols37 used
ac ion
eams
ha
led
en i on-
men
changes
such
as
school
policy
and
communi y
ac i i ies.
In
Bonell
and
cols37 hese
eams
also
in ol ed
school
pe sonal
and
pa en s.
Some
in e en ions
pe o med
media
campaigns
by
pee s
such
as
music
eco ds,48 o
media
announcemen s.46
En i onmen
changes
we e
pe o med
in
he
majo i y
o
physical
ac i i y
and
heal h
nu i ion
in e en ions
o
imp o e
accessibili y,
inc easing
hou s
o
physical
aining,
changing
meals
a
school
ca e e ias,
o
gi ing
ege ables
and
ui s,
among
o he s.18,20,21,24,27,28
Some
p ojec s
ca ied
ou
ac i i ies
wi h
pa en s
(N
=
11)
and
communi ies
(N
=
5).
The
pa en s’
ac i i ies
we e
based
on
homewo k
wi h
s uden s,31,32,40,41,51–54,56 and
pa en s’
lessons
o
in o ma ion
wi h
a iable
pa icipa ion.20,21,25,42,57,58 In
Taymoo y
y
cols,23 s uden s
and
hei
pa en s
we e
p oposed
o
do
exe -
cise
ou side.
Communi y
ac i i ies
in ol ed
o ganizing
wo kshops,
e en s
o
se ices,
mass
media
in o ma ion
o
a ending
ac i i ies
pe o med
by
communi y
membe s.24,42,46,51–54,56
Some
in e en ions
we e
ocus
in
ailo ed
message,
such
as
leafle s,47 compu e - ailo ed
aining,20,21,33 and
o he s
pe o med
on-line
lessons.33,38,60
Rega ding
applicabili y,
fi e
in e en ions
we e
based
on
p o-
g ams
p e iously
e alua ed
in
o he
con ex s.
Fo
ins ance,
Hampel
and
cols,31 ca ied
ou
an
in e en ion
p e iously
pe o med
in
a
414
M.
Lima-Se ano,
J.S.
Lima-Rod íguez
/
Gac
Sani .
2014;28(5):411–417
Table
1
Con ibu ions
abou
e ec i eness
e alua ion
o
school
heal h
p omo ion
p og ams.
Re e ence
S udy
cha ac e is ics:
coun y;
design;
popula ion;
age
g oup;
se ing;
heo y
18
No way;
Quasi-expe imen al
wo-g oup;
1,950;
6◦and
7◦g ade s;
School;
Ecological
Model.
19
USA;
Quasi-expe imen al
wo-g oup,
146;
Female
seconda y
s uden s;
School;
Social-cogni i e
heo y.
20,21
Belgium;
Expe imen al
h ee-g oup;
2,849;
7◦and
8◦g ade s;
School;
amily;
Heal h
p omo ion.
22
USA;
Quasi-expe imen al
one-g oup;
48;
14
o17
yea -old;
School;
Heal h
p omo ion
(Sidani
y
B aden).
23
I an;
Expe imen al
ou -g oup;
166;
Female
9◦and
10◦g ade s;
School,
amily;
Heal h
p omo ion
(Pende );
T ans- heo e ical
model.
24
USA;
Obse a ional
epea ed
measu es
one-g oup,
3,502;
Female
6◦ o
8◦g ade s;
School,
communi y;
Ope an
lea ning,
social
cogni i e,
ecological
heo ies.
25
Po ugal;
Expe imen al;
291;
6◦and
7◦g ade s;
School,
amily;
Social
cogni i e,
sel - egula ion
and
planning
heo ies.
26
England;
Expe imen al;
235;
14
o16
yea -old;
School;
Sel -de e mina ion
heo y.
27
USA;
Expe imen al;
2,311;
7◦and
8◦g ade s;
School;
Social-cogni i e,
pa icipa i e
ac ion
heo ies.
28
The
Ne he lands;
Expe imen al;
1,108;
12
o
14
yea -old;
School;
Theo y:
No
said.
29
USA;
Expe imen al;
2,120;
6◦g ade s;
School;
Theo y:
No
said.
30
USA;
Expe imen al;
1,800;
9◦ o
11◦g ade s;
School;
T ans- heo e ical
model.
31
Aus ia;
Quasi-expe imen al
wo-g oup;
458;
5◦ o
8◦g ade s;
School,
amily;
S ess
managemen
(Laza us
&
Meichenbaum)
heo y.
32
Sweden;
Quasi-expe imen al
ou -g oup;
1,003;
4◦ o
7◦g ade s;
School,
amily;
Social
and
emo ional
aining.
33
Ge many;
Quasi-expe imen al
ou -g oup:
904;
8◦and
9◦g ade s;
School.
Social
skills
aining.
34-36
China;
Expe imen al;
6,656;
7◦ o
10◦g ade s;
School;
Posi i e
de elopmen
heo y.
37
England;
Expe imen al;
614;
7◦g ade s;
School,
amily;
Theo y:
No
said.
38
USA;
Expe imen al;
190;
6◦g ade s;
School;
Theo y:
No
said.
39
The
Ne he lands;
Quasi-expe imen al
wo-g oup;
954;
13
o
17
yea -old;
School;
Social
lea ning,
a ional
emo i e
and
compe ence
lea ning.
40,41
Sou h
A ica;
Expe imen al;
1,057;
6◦g ade s;
School,
amily;
Theo y:
No
said
42
Canada;
Expe imen al;
1,438;
6
and
7◦g ade s;
School,
amily,
communi y;
Social
Cogni i e,
eminis ,
ecological
heo ies.
43
Spain;
Expe imen al;
323;
8◦ emale
g ade s;
School;
Social-cogni i e
heo y.
44
Aus alia;
Quasi-expe imen al
wo-g oup;
277;
7◦g ade s;
School;
Theo y:
No
said.
45
Ge many;
Quasi-expe imen al
wo-g oup;
887;
6◦ emale
g ade s;
School,
amily;
Theo y:
No
said.
46
USA;
Expe imen al;
1,492;
6◦&
7◦g ade s;
School,
communi y;
Social
influence,
ecological
heo ies.
47
England;
Expe imen al;
508;
6◦g ade s;
School;
Ta ge ed
cogni ions
and
p epa a o y
ac ions
o
skills.
48
USA;
Quasi-expe imen al
wo
g oups;
422;
Seconda y
s uden s;
School;
Social
influence
heo y.
49
USA;
Expe imen al
fi e-g oup;
662;
Seconda y
s uden s;
School;
Social
cogni i e,
planned
beha iou
easoned
ac ion
heo ies.
50
G eek;
Expe imen al;
741;
Seconda y
s uden s;
School;
Heal h
p omo ion.
51-54
Eu opean
Union;Quasi-expe imen al
wo-g oup;
19,034
7◦ o
9◦g ade s;
School,
amily,
communi y;
A i ude,
Social
Influence
and
Sel -e ficacy
model
55
England
and
Wales;
Expe imen al;
10,047;
12
o13
yea s-old;
School;
Social
influence
heo y.
56
USA;
Expe imen al;
4,259;
6◦g ade s;
School,
amily,
communi y;
Social
influence
heo y,
heal h
p omo ion
(Pe y).
57,58
Eu opean
Union;
Expe imen al;
7,079;
12
o
14
yea s-old;
School,
amily;
Social
influence
heo y.
59
India;
Quasi-expe imen al
wo-g oup;
11,748;
6◦and
8◦g ade s;
School;
Social
Cogni i e
heo y.
60
USA;
Expe imen al;
5,782;
7◦&
8◦g ade s;
School;
Theo y:
No
said.
clinical
en i onmen ;
Richa dson
and
cols44 adap ed
an
in e en-
ion
om
a
communi y
con ex
in
Uni ed
Kingdom
o
schools
in
Aus alia;
Jemmo
and
cols40,41,49 pe o med
a
simila
in e en-
ion
in
di e en
con ex s
(USA
A ican-Ame ican
and
Sou h-A ican
s uden s)
bu
did
no
compa e
hese;
Kom o56 and
cols
adap ed
an
in e en ion
om
a
u al
o
an
u ban
en i onmen ;
and
Campbel55
and
cols
adap ed
an
in e en ion
a ge ed
o
sexual
heal h
o
a
smoking
p e en ion
domain.
Subsequen ly,
Sheck
y
cols34–36 and
Wick
y
cols45 pe o med
dissemina ion
s udies
o
e alua e
in e -
en ions
p e iously
pilo ed
in
eal-se ings.
Finally,
Ge meni
y
cols50 and
De
V ies
and
cols51–54 pe o med
hei
in e en ions
in
di e en
se ings.
Ge meni
y
cols50 ca ied
ou
hei s
in
h ee
ypes
o
schools
(public,
p i a e
and
oca ional)
and
ound
ha
e ec
was
mo e
a ou able
a
oca ional
and
public
schools
han
a
p i a e
schools.
De
V ies
and
cols51–54 pe o med
hei
in e en ion
in
di -
e en
coun ies,
and
ound
some
di e ences
in
ou comes
ega ding
he
coun y
o
o igin.
Main
e ec s
Significan
e ec s
(p
<
0.05)
a e
shown
in
supplemen a y
ma e-
ial
( ables
II
o
IV).
The
majo i y
o
in e en ions
aimed
a
p omo ing
heal h
nu i ion
and
physical
ac i i y
ound
mod-
e a e
o
la ge
e ec s
such
as
Dun on
and
cols
on
physical
ac i i y
(d
=
0.58),19 Hae ens
and
cols
on
physical
ac i i y
o
ligh
in ensi y
(d
=
0.54)
and
pe cen
o
ene gy
om
a
(in
gi ls)
(d
=
1.56),20,21 Co elli
on
physical
ac i i y
(d
=
2.32),
ui
and
ege able
consump ion
(d
=
2.82),
and
knowledge
(d
=
4.37),22
Taymoo i
and
cols
on
all
measu es
o
physical
ac i i y
(R2=
0.29-
0.34)
in
pos es ,
and
in
physical
ac i i y
minu es
pe
week
(d
=
0.59)
in
ollow-up,23 Cha zisa an is&Hagge
on
in en ions
(d
=
0.73),
and
physical
ac i i y
(R2=
0.22),26 Dzewal owski
and
cols
on
physical
ac i i y
(d
=
1.24-1.88),
sel -e ficacy
(d
=
1.47-
3.25)
and
school
suppo
(d
=
2.29),27 and
Fo ne is
and
cols
on
physical
ac i i y
sel -e ficacy
(d
=
1.86-3,16)
and
knowledge
(d
=
1.92-2.37).29
Some
men al
and
holis ic
heal h
p omo ion
in e en ions
ound
mode a e
o
la ge
e ec s
such
as
Hampel
and
cols
on
s ess
coping
(R2=
0.73),31 F id ici&Lohaus
on
s ess
knowledge
and
coping
(R2=
0.10),33 Shek
and
cols
on
one
indica o
o
posi-
i e
de elopmen
(d
=
1.57),34–36 and
Jemmo
III
and
cols
on
knowledge
(d
=
1.03),
a i ude
(d
=
0.89)
and
in en ion
(d
=
0.81)
o
heal h
p omo ion.40,41 Those
ha
measu ed
beha iou s
ound
low
e ec s.32,40,41 In
wo
p ojec s
esul s
om
quali a i e
me hodology
poin ed
o
educe
isk
beha iou s.34–37 Finally,
some
in e en-
ions
aimed
a
p e en ing
isk
beha iou s
ound
mode a e
o
la ge
e ec s
such
as
McVey
and
cols
on
in e naliza ion
o
media
ideals
(d
=
0.73),
body
sa is ac ion
(d
=
0.81),
diso de ed
ea ing
a i-
ude
and
beha iou
(d
=
1.05)
in
isk
g oups,42 Raich
and
cols
on
nu i ion,
ea ing
a i udes
and
knowledge
(R2=
0.06)
in
ado-
lescen s
wi h
ea ly
mena che,43 Richa dson
and
cols
on
media
li e acy
(d
=
0.95),44 Swaim&
Kelly
on
iolen
in en ions
agains
pee s
(d
=
0.98),
physical
assaul
(d
=
3.29),
e bal
ic imiza ion
(d
=
2.90),
and
pe cei ed
school
sa e y
(d
=
4.04),46 Lemieux
and
cols
on
a i ude
(R2=
0.33),
and
social
no ma i e
suppo
o
abs i-
nence
(in
gi ls,
R2=
0.24)
in
HIV/AIDS
p e en ion,48 Hills
&
Ab aham
M.
Lima-Se ano,
J.S.
Lima-Rod íguez
/
Gac
Sani .
2014;28(5):411–417
415
on
in en ions
(d
=
0.98),
sel -e ficacy
condom
a ailabili y
(d
=
0.71-
1.82),
pu chased
(d
=
0.59)
and
ca ied
condoms
(d
=
0.62),47 De
V ies
and
cols
on
obacco
use
(d
=
0.06-0.08),51–54 and
Pe y
and
cols
on
in e media e
a iables
o
obacco
use
(d
=
2.80-13.5).59
Discussion
We
ha e
ound
good-quali y
p ojec s
in
physical
ac i i y,
heal h
nu i ion,
men al
and
holis ic
heal h,
and
isk
beha iou
p e en-
ion.
Implemen a ion
ac i i ies
we e
pe o med
in
six
a eas,
which
we e
classified
in
in e ac i e
lessons,
pee
media ion,
imp o ing
accessibili y
by
en i onmen
changes,
ac i i ies
wi h
pa en s,
wi h
communi y,
and
ailo ed
message;
and
hey
mainly
add essed
acili o s
and
ba ie s,
social
influences
(pee s,
amily,
school,
media
and
communi y),
cogni i e,
emo ional
and
beha iou al
skills,
and
including
mul iple
componen s.
Simila
ac i i ies
and
beha iou al
de e minan s
we e
app oached
in
in e en ions
ha
led
o
di e en
beha iou s,
his
poin
ha
in eg a i e
p og ams
add essing
mul iple
beha iou s
could
be
implemen ed
in
schools
by
using
hose
e ec i e
ac i i ies
and
elemen s.7In
addi ion,
he
majo i y
o
p ojec s
we e
based
on
heo e ical
models;
p e ious
au ho s
emphasized
ha
heo y-based
p og ams
p oduce
be e
e ec s.6,7,15
Some
p ojec s
ound
mode a e
o
la ge
sho
and
long- e m
e ec
and
some
o
hem
measu ed
ou comes
o e
mul iple
ime
poin s.
Mos
p ojec s
we e
ca ied
ou
in
“ eal
condi ions”,
in
a
wide
numbe
o
schools
wi h
la ge
samples,
and
in
some
cases
included
amily
and
communi y
con ex s,
hese
si ua ions
con ibu e
o
sus-
ainabili y
o
in e en ions.15
The
majo i y
o
he
p ojec s
conduc ed
o
p omo e
physical
ac i i y
and
heal h
nu i ion
ound
mode a e
o
la ge
e ec s
on
beha iou al
a iables.
Mos
o
hem
we e
based
on
heal h
p o-
mo ion
models,
bu
e ec s
we e
ound
in
sho
o
medium- e m
such
as
Hae ens
and
cols
ha
pe o med
en i onmen
changes
plus
ailo ed-compu e
aining
and
ac i i ies
wi h
pa en s,20,21
Dun on
and
cols19 and
Co elli22 ha
ca ied
ou
in e ac i e
lessons
plus
physical
ac i i y
aining,
o
Cha zisa an is&
Hagge 26
ha
changed
he
eaching
s yle
o
physical
educa ion
eache s
o
p o ided
au onomy
( eedback,
a ionale,
sense
o
choice
and
acknowledge
di ficul ies)
o
physical
ac i i y.
Howe e ,
Dzewal-
owski
and
cols’
in e en ion
ound
la ge
long- e m
e ec s
( wo
yea s).
This
was
based
on
social
cogni i e
heo y
and
ac ion
eams
imp o ed
accessibili y
o
physical
ac i i y
by
school-en i onmen
changes.27
Subsequen ly,
a
ew
p ojec s
aimed
a
men al
and
holis ic
heal h
ound
la ge
e ec s.
Some
o
hem
in
a
sho - e m,
such
as
Hampel
and
cols,
in
s ess
p e en ion,
ha
pe o med
in e -
ac i e
lessons
and
ac i i ies
wi h
pa en s,31 and
Jemmo
III
and
cols,
which
based
on
social-cogni i e
and
planned
beha iou
he-
o ies,
ca ied
ou
lessons
augh
by
communi y
co- acili a o s.40,41
Likewise,
Shek
and
cols
ha
pe o med
in e ac i e
lessons
ound
e ec
on
posi i e
de elopmen
a e
wo
yea s.34–36 Finally,
some
p ojec s
in ended
o
isk
p e en ion
ound
la ge
e ec s,
we
emphasize
hose
in
long- e m.
Fo
ins ance,
in
smoking
p e en-
ion,
De
V ies
and
cols,
who
based
on
social
influences
heo y,
pe o med
ac i e
lessons
combined
wi h
ac i i ies
wi h
pee s,
pa -
en s,
and
communi y,51–54 Pe y
and
cols,
who
based
on
social
cogni i e
heo y,
ca ied
ou
in e ac i e
lessons,
pee
media ion,
school
e en s,
and
pa en
in o ma ion.59 In
iolence
p e en ion,
Swaim&
Kelly
pe o med
ac i i ies
a
school
and
communi y
led
by
pee s,
based
on
social
influence
heo y
and
ecological
model.46
Rega ding
applicabili y,
al hough
mos
in e en ions
we e
pe o med
in
a
wide
numbe
o
schools
wi h
la ge
popula-
ions,
only
wo
s udies
compa ed
an
in e en ion
in
di e en
con ex s.
De
V ies
and
cols51–54,
compa ed
hei
p og am
in
di e -
en
coun ies
ac oss
Eu ope
and
ound
some
dispa i y
e ec s
ha
we e
explained
by
adminis a i e
di ficul ies,
design
limi a ions
( ega ding
esponse
a es
o
andom
assignmen ),
and
al hough
i
was
based
on
co e
objec i es
and
me hods
many
di e ences
appea ed
amongs
coun ies.51 Ge meni
y
cols50 also
ound
some
dispa i y
e ec
ac oss
school
ypes
ha
we e
explained
by
he
cha -
ac e is ics
o
he
popula ion,
and
o he
school- ela ed
ac o s.
Ou
e iew
poin s
o
well-implemen ed
p og ams
ha
may
p o-
mo e
heal hy
li es yles
in
adolescence.
Resul s
a e
consis en
wi h
hose
epo ed
in
ecen
e iews;6–11 and
since
isk
beha iou s
ha e
simila
de e minan s,
he
s eng h
o
his
a icle
is
he
e iew
has
been
conduc ed
ac oss
di e en
beha iou al
domains
ha
a ec
adolescence
and
a e
usually
add essed
in
school-based
in e -
en ions.
In
his
espec ,
p ac i ione s
and
esea che s
in
heal h
and
educa ion
can
use
hose
elemen s
ha
we e
e ec i e,
espe-
cially
hose
simila
ac oss
domains,
in
deli e ing
heal h
p omo ion
in e en ions.7
Rega ding
limi a ions,
al hough
da abases
included
we e
ele-
an
wi h
he
in e en ions
analyzed,
we
limi ed
he
sea ch
o
ou
da abases,
and
also
limi ed
he
ime
pe iod
(o e
las
fi e
yea s)
and
languages,
so
some
a icles
migh
be
missed.
The
he e ogenei y
conce ning
di e ences
in
in e en ions,
s udy
designs,
me hodolo-
gies
and
a iables
used
o
ou come
measu es
p ecludes
gi ing
a
syn hesis
o
esul s
and
pe o ming
a
me a-analysis.
In
he
u u e,
i
could
be
in e es ing
o
gene a e
sub-g oups
o
in e en ion
ypes
o
sol e
his
limi a ion.
Fu he mo e,
al hough
we
ha e
included
some
aspec s
ela ed
o
sus ainabili y
and
applicabili y,
fi s
i
was
no
easy
iden i ying
aspec s
ega ding
hese
c i e ia
in
all
he
p ojec s,
second
ou
s udy
was
mainly
o ien ed
o
summa ize
cha ac e is-
ics
and
e ec s
including
in e en ions.
Howe e ,
in
he
u u e
i
may
be
pe inen
o
analyze
hese
c i e ia
ho oughly.15
Conclusions
This
e iew
has
some
implica ions
o
p ac ice
and
esea ch.
Since
school-based
in e en ions
a e
associa ed
wi h
some
posi-
i e
e ec s,
should
be
con inued
and
encou aged
by
public
heal h
ins i u es;
and
heal h
p omo ion
con en s
would
be
included
mo e
equen ly
in
s uden
cu iculums.6The e
is
enough
e idence
o
encou age
deli e ing
school-based
in e en ions
based
on
heo-
ies
abou
beha iou al
change
o
heal h
p omo ion.
The e
is
some
e idence
ha
encou ages
pe o ming
in e en ions
ha
p omo e
en i onmen al
changes,
dealing
wi h
social
influence
and
imp o -
ing
cogni i e,
emo ional
and
beha iou al
skills.
Since
he
ac
ha
simila
domains
we e
ound
in
he
a eas
e iewed,
i
would
be
in e es ing
pe o ming
in eg a i e
in e en ions
aimed
a
whole
isks
ha
a ec
adolescence.
On
he
o he
hand,
assis ed
compu e
and
on-line
in e en ion
mus
be
s udied
mo e.
The e
a e
many
gaps
in
he
li e a u e
ha
may
be
esea ched.
I
is
necessa y
o
find
ou
which
he
main
a iables
a e
ha
influ-
ence
beha iou al
change
in
o de
o
de elop
heal h
p omo ion
p og ams
o
in e ene
in
said
a iables.
I
is
equi ed
bo h
o
imple-
men
and
e alua e
(p ocess
and
e ec )
in e en ions
ha
include
named
e idence
in
a
comp ehensi e
way,
and
pa icipa o y
ac ion
esea ch
may
be
use ul
in
his
kind
o
esea ch.
Thus,
since
i
is
e y
impo an
o
p omo e
heal h
and
p e en
isk
in
adolescence,
i
is
necessa y
o
ake
no ice
o
esea ch
ela ed
o
school-based
in e -
en ion
as
a
majo
p io i y
and
ecognize
he
need
o
und
p ojec s
in
his
esea ch
field.
Edi o
in
cha ge
o
he
a icle
MaFelici as
Domínguez-Be jón.

416
M.
Lima-Se ano,
J.S.
Lima-Rod íguez
/
Gac
Sani .
2014;28(5):411–417
Wha
is
known
abou
he
opic?
Heal h
p omo ion
p og ams
a e
pe o med
a
schools
o
p e en
unheal hy
li es yles
in
Adolescence.
Di e en
sys-
ema ic
e iews
ha e
been
ca ied
ou
o
e alua e
he
e ec
o
school
heal h
p omo ion
p og ams
ega ding
di e en
domains,
which
ound
some
posi i e
e ec s
o
a iable
mag-
ni ude.
Wha
does
his
s udy
add
o
he
li e a u e?
This
is
a
comp ehensi e
sys ema ic
e iew
ac oss
di e en
beha iou
domains
since
hey
ha e
simila
de e minan s,
and
school-based
in e en ions
deal
wi h
whole
isk
ha
a ec s
adolescence.
We
showed
he
main
e ec s
o
in e en ions
ega ding
o
physical
ac i i y,
nu i ion,
men al
and
holis ic
heal h,
and
isk
beha iou s.
I
poin s
o
well-implemen ed
p og ammes
may
educe
isks
in
adolescence.
Con ibu ions
o
au ho ship
We
decla e
ha
bo h
au ho sha e
made
subs an ial
con ib-
u ions
o
all
o
he
ollowing:
(1)
he
concep ion
and
design
o
he
s udy,
o
acquisi ion
o
da a,
o
analysis
and
in e p e a ion
o
da a,
(2)
d a ing
he
a icle
o
e ising
i
c i ically
o
impo an
in ellec-
ual
con en ,
(3)
he
final
app o al
o
he
e sion
o
be
submi ed.
Funding
The e
is
no
unding.
Conflic
o
in e es
We
ha e
no
conflic
o
in e es
Appendix
A.
Supplemen a y
da a
Supplemen a y
da a
associa ed
wi h
his
a icle
can
be
ound,
in
he
online
e sion,
a
doi:10.1016/j.gace a.2014.05.003.
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