Implementation and evaluation of the HEROES initiative: a tri-state coordinated school health program to reduce childhood obesity.

This article describes the design, implementation, and evaluative findings of the HEROES (Healthy, Energetic, Ready, Outstanding, Enthusiastic, Schools) Initiative, a school-based multilevel childhood obesity prevention intervention. Based on the Centers for Disease Control and Prevention's recommended coordinated school health approach, the HEROES Initiative works to alleviate the burden of childhood obesity in Southern Indiana, Northwestern Kentucky, and Southeastern Illinois in the United States. Process evaluation was conducted with the 17 participating schools in spring 2012 based on interviews with school personnel and observation of the school environment. Findings showed that despite some variability, schools were generally able to implement the intervention with fidelity. School-level outcome evaluation was also based on observation of the school environment, and revealed that schools had implemented a number of new practices to encourage physical activity and healthy eating. Assessment of student-level outcomes was based on professionally collected physiological measurements and self-reported behavioral data collected over an 18-month period of time, last collected in spring 2012. Findings demonstrated that the HEROES Initiative has been successful in reducing the percentage of overweight children in participating schools and healthfully modifying their dietary, physical activity, and sedentary behaviors. Strategies that have facilitated success and challenges related to the intervention are discussed.

Predictors for moderate- and vigorous-intensity physical activity during an 18-month coordinated school health intervention.

OBJECTIVE: To evaluate if the HEROES Initiative, a school-based childhood obesity prevention program based on the U. S. Centers for Disease Control and Prevention (CDC)'s coordinated school health approach was able to effectively increase physical activity among elementary and middle school students who were exposed to the program for 18 months and to determine student and school-level predictors of success. METHOD: Students who participated in physiological data collection were invited to participate in a survey at baseline, 6 months, and 18 months (N=1091, 8 schools). The dropout rate at 18 months was 39.1% when graduates were counted. Data was analyzed using generalized estimating equations. RESULTS: A significant increase (p=.0067) was observed in vigorous-intensity physical activity (VPA) but a non-significant increase (p=.1753) was observed in moderate-intensity physical activity (MPA). Each school's implementation fidelity score was also only associated with VPA increases. Students' screen time and vegetable/fruit intake were independently associated with both VPA and MPA increases. Body mass index of students was not predictive of VPA or MPA changes. CONCLUSION: An 18-month school-based intervention that employs the CDC's coordinated school health approach appears to be effective in increasing physical activity among elementary and middle school children.

The Impact of Family Rules on Children's Eating Habits, Sedentary Behaviors, and Weight Status.

BACKGROUND: Family rules may be influential in helping children to modify their dietary and sedentary behaviors, which are important modifiable risk factors for childhood obesity. However, data examining family rules in relation to children's health behaviors and weight status are limited. METHODS: This cross-sectional study examined differences in family rules by demographic characteristics of students enrolled in the HEROES (Healthy, Energetic, Ready, Outstanding, Enthusiastic Schools) Initiative, a school-based childhood obesity prevention program. It also investigated the relationship between eating and screen time family rules and six eating and screen time behaviors: fast food consumption; soft drink consumption; fruit and vegetable intake; television viewing; computer use; and video game use, in addition to the association between family rules and children's weight status. Measures included self-reported behavioral data and anthropometric data from students in fourth to eighth grade at 16 schools (N=2819) in a tri-state area of the United States in spring 2012. RESULTS: Approximately one-third of students had each of the family rules examined. Whereas the profile of students who had specific rules varied, in general, younger, female, white, and low socioeconomic status students were more likely to have rules than their counterparts. Family rules were associated with healthier outcomes for each of the six behaviors examined (p<0.001), even after controlling for demographics (p<0.001). However, family rules were not associated with children's weight status. CONCLUSIONS: This study demonstrates that family rules are an underutilized strategy to promote healthier eating habits and reduce children's screen time hours and may serve as an intermediary mechanism to curb childhood obesity.

The relationship between school-level characteristics and implementation fidelity of a coordinated school health childhood obesity prevention intervention.

BACKGROUND: Curtailing childhood obesity is a public health imperative. Although multicomponent school-based programs reduce obesity among children, less is known about the implementation fidelity of these interventions. This study examines process evaluation findings for the Healthy, Energetic Ready, Outstanding, Enthusiastic, Schools (HEROES) Initiative, a tri-state school-based childhood obesity prevention intervention based on the coordinated school health (CSH) model. METHODS: Site visits were conducted that included key stakeholder interviews, observation, and document review. Scores were given for 8 domains, and a total implementation score was calculated. Two-way analyses of variance were conducted to examine the relationship of 4 school-level characteristics: elementary vs. middle/high schools, public vs. private schools, district vs. building level implementation, and socioeconomic status on each implementation area. RESULTS: Overall, schools had high fidelity scores, although some domains were implemented more successfully than others. Three school-level characteristics were associated with 1 or more domains, with elementary schools and schools implementing at the building level consistently having higher implementation scores than their counterparts. CONCLUSIONS: Process evaluation findings provide insight into successes and challenges schools implementing the CSH approach may encounter. Although preliminary, these findings on school-level characteristics establish a new area of research related to school-based childhood obesity prevention programs' implementation fidelity.

Predictors for Persistent Overweight, Deteriorated Weight Status, and Improved Weight Status During 18 Months in a School-Based Longitudinal Cohort.

PURPOSE: To examine predictors for persistent overweight/obesity, deteriorated weight status, and improved weight status among students who participated in a school-based obesity prevention intervention from fall 2009 to spring 2011. DESIGN: Longitudinal assessment of a school-based cohort was conducted to determine the characteristics of students who remained overweight/obese, improved their weight status, or showed deteriorated weight status during an 18-month period. SETTING: Eleven schools in southern Indiana, northwestern Kentucky, and southeastern Illinois. SUBJECTS: N = 5309 students in 4th through 12th grade. MEASURES: Weight, height, and self-reported physical activity and nutrition behaviors of students were measured at baseline and 6, 12, and 18 months. ANALYSIS: SAS 9.3 was employed to examine predictors for the three different weight categories using logistic regression. RESULTS: Low socioeconomic status (SES) (adjusted odds ratio [AOR] = 1.56 and p < .001, AOR = 1.35 and p = .0069, respectively) and higher soda intake (AOR = 1.07 and p = .0016, AOR = 1.08 and p = .0278, respectively) increased the odds of belonging to persistent overweight/obesity (30.6%) and deteriorated weight status (6.9%), compared to the persistent nonoverweight status group. CONCLUSION: While SES is an important determinant of weight category change, students' screen time and soda consumption may be important factors. Schools and families may be able to successfully focus on these modifiable risk factors, decreasing the burden of childhood obesity.

Long-term predictors of blood pressure among adolescents during an 18-month school-based obesity prevention intervention.

PURPOSE: To evaluate the effectiveness of the HEROES (Healthy, Energetic, Ready, Outstanding, Enthusiastic Schools) initiative, a multicomponent school-based obesity prevention intervention based on the Centers for Disease Control and Prevention's coordinated school health approach, on the improvement of blood pressure (BP) and to determine long-term predictors of systolic and diastolic BP changes among high school students who were exposed to the intervention. METHODS: Biometric and behavioral data from high school students were analyzed at baseline, 6, 12, and 18 months (N = 847, three schools). The attrition rate at 18 months was 26.1%. Sequential generalized estimating equation models were fit to the data using SAS 9.3, taking into account clustering effects within the same school and correlations within repeated measures. RESULTS: A significant downward trend was observed in systolic BP (p = .0006) and diastolic BP (p < .0001) among the students who were exposed to the HEROES initiative. The prevalence of hypertension decreased from 17.1% at baseline to 12.8% at 6 months (p < .0001), 12.0% at 12 months (p < .0001), and 15.0% (p = .0024) at 18 months. Baseline body mass index, increases in body mass index percentiles, and increases of television-viewing hours were associated with BP increases. Increases in frequencies of eating french fries or chips, skipping breakfast, and consuming supersize meals when eating fast food were predictive of systolic BP changes, not of diastolic BP changes. CONCLUSIONS: An 18-month multicomponent school-based obesity intervention program may be effectively used to decrease rates of high BP among adolescents.