Impact of school-based health promotion interventions aimed at different behavioral domains: a systematic review
Abstract
Objective: Given that lifestyleshave similar determinants and that school-based interventions are usually targeted at all the risks that affect adolescents, the objective of this systematic review was to summarize the characteristics and effects of school-based interventions acting on different behavioral domains of adolescent health promotion. Methods: The review process was conducted by two independent reviewers who searched PubMed, Scopus, PsycINFO, and ERIC databases for experimental or observational studies with at least two measures of results published from 2007 to 2011, given that the research information available doubles every 5 years. Methodological quality was assessed with a standardized tool. Results: Information was extracted from 35 studies aiming to prevent risk behaviors and promote healthy nutrition, physical activity, and mental and holistic health. Activities were based on theoretical models and were classified into interactive lessons, peer mediation, environmental changes, parents’ and community activities, and tailored messages by computer-assisted training or other resources, usually including multiple components. In some cases, we identified some moderate to large, short- and long-term effects on behavioral and intermediate variable. Conclusions: This exhaustive review found that well-implemented interventions can promote adolescent health. These findings are consistent with recent reviews. Implications for practice, public health, and research are discussed.
Full text
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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