Introduction: Childhood obesity is associated with increased cardiovascular disease risk and is a major health issue in the United States. Previous studies show higher rates of obesity in low socioeconomic status (SES) communities. The efficacy of school-based interventions in these communities is not as well documented. Hypothesis: We hypothesized that low SES would be less healthy at baseline and show greater improvement than high SES. Methods: Project Healthy Schools (PHS) is a school-based intervention targeted at middle-school students in lower Michigan. We studied body mass index (BMI), blood pressure (BP), lipid profiles, resting and recovery heart rate (HR), and behavioral characteristics in 3147 middle-school students. Students were stratified into 2 groups: high SES and low SES. Ann Arbor (median family income=$53,377) students were included in the high SES cohort (n=1840) while Ypsilanti ($33,699) and Detroit ($27,862) were considered low SES (n=1307). Chi-square, Wilcoxon, and t-tests were conducted to compare baseline and baseline-to-follow-up data. Median household income was based on US Census Bureau data. Results: At baseline, those students in the low SES cohort performed significantly worse than the students in the high SES cohort in nearly every category, most notably: BMI, systolic and diastolic BP, resting and recovery HR, fried food consumption, exercise, and screen time. Upon follow-up, post-intervention examination, low SES improved recovery HR, screen time, fried meat and snacks, and sugary beverages significantly more than high SES. High SES improved fruit, BP, and total cholesterol significantly more than low SES. Conclusions: The PHS intervention was more efficacious in a number of categories in higher-risk, low SES communities. This suggests a need for the implementation of similar school-based programs in low SES areas.
The purpose of this study was to evaluate the effectiveness of environmental activities in a school-based health program among 6th grade students (N = 2315).Students enrolled in Project Healthy Schools, a school-based health program designed to reduce childhood obesity and improve cardiovascular health, completed a health questionnaire on recent lifestyle choices including diet, physical activity, and sedentary behaviors. Baseline and follow-up data were compared between students who received educational lessons and students who received educational lessons and additional activities in the schools' environment. We calculated descriptive and one-way ANOVA statistics.Students at schools with educational lessons and environmental activities reported more fruit intake (p = .046), fewer sugary beverages (p = .054) and servings of fatty/sugary foods (p = .002), and more moderate physical activity (p = .009) compared to students with educational lessons only. No beneficial effect was observed in decreasing TV viewing time. Mobile device time increased in both groups.The present study suggests school-based health programs combining educational lessons and additional environmental activities may improve diet and physical activity in middle school children to a greater degree than educational lessons alone.
Introduction: Millions of children consume school lunches daily. Children from low-income families are eligible for free or reduced-price school meals. While studies show improvement in the nutritional quality of school lunches, the effect of school lunch or lunch brought from home on cardiovascular risk factors among children is unknown. Hypothesis: We hypothesized that frequently consuming school lunch is associated with increased cardiovascular risk factors when compared with lunch brought from home. Methods: All 15,742 sixth graders enrolled in Project Healthy Schools, a school-based wellness intervention, were included in this cross-sectional study (2004-2015). We examined 10,169 behavioral surveys and 1,845 physiological screenings. We compared self-reported diet, physical activity (PA), sedentary behaviors and physiologic parameters (height, weight, blood pressure (BP) and heart rate) in 2 groups, children who reported eating school lunch daily and those who eat home-prepared lunch daily. The groups were further stratified by socioeconomic status (SES); low SES (<$35,000) or high SES (>$50,000) based on the median household income of the school region. Students in the middle SES range ($35,000-$50,000) were excluded from analysis (n=4230). Results: School lunch students were associated with less healthy behaviors (PA, diet [fruit/vegetable servings, meat and sugary beverage intake], and sedentary activities) and physiologic measures (percent of overweight/obesity, systolic BP and recovery heart rate) compared with students bringing lunch from home in low and high SES groups (Table 1). Conclusions: In this large cohort of children, we observed frequent school lunch consumption, even after adjustment for SES, was associated with less healthy behaviors and physiologic parameters. Further research is warranted to determine whether healthier school lunches would improve cardiovascular health characteristics and health behaviors in middle-school students.
