Systematic Review and Meta-Analysis of Health Promotion Interventions for Children and Adolescents Using an Ecological Framework

Objective To evaluate and quantify the evidence for health promotion interventions in children and adolescents. Method 96 independent samples of smoking, physical activity, and diet studies were included. Outcomes included both objective and self-reports of health behavior, as well as proxy measures such as fitness. Results The aggregated effect was significant (g ¼ .20, 95% confidence interval [CI] ¼ 0.08–0.32, n ¼ 96). A significant effect of intervention was observed at approximately 1-year follow-up (g ¼ .07, 95% CI ¼ 0.02–0.14, n ¼ 20). The greatest risk of bias was failure to blind outcome assessment, which occurred in 21% of studies. Most studies lacked sufficient detail to determine the quality of their randomization sequence (58%). Additional concerns about risk of bias for individual studies were minimal. Overall, the quality of this finding was moderate using the Grading of Recommendations Assessment, Development, and Evaluation criteria. Conclusion Health promotion interventions are effective for modifying health behavior; however, effect sizes are small.