Journal
INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH
Volume 11, Issue 11, Pages 11261-11285Publisher
MDPI
DOI: 10.3390/ijerph111111261
Keywords
school policy; monitoring; healthy school environment; nutrition; physical activity; overweight; primary schools; Europe
Funding
- Bulgaria: Ministry of Health
- Bulgaria: National Center of Public Health and Analyses
- Bulgaria: Regional Health Inspectorates
- Czech Republic: Internal Grant Agency of the Ministry of Health [IGA NS/9832-4]
- Greece: Hellenic Medical Association for Obesity
- Greece: Alexander Technological Educational Institute of Thessaloniki
- Hungary: National Institute for Food and Nutrition Science
- Hungary: Chamber of Hungarian Health Care Professionals
- Ireland: Health Service Executive
- Ireland: Department of Health
- Latvia: Centre for Disease Prevention and Control
- Lithuania: Lithuanian State Science and Studies Foundation
- Lithuania: Lithuanian University of Health Sciences
- Lithuania: Research Council of Lithuania [SIN-17/2012]
- Malta: Primary Health Care Department
- Norway: Norwegian Institute of Public Health
- Norway: Directorate of Health
- Portugal: Ministry of Health
- Portugal: Regional Health Directorates
- Slovenia: Ministry of Education, Science and Sport
- Sweden: Swedish Research Council for Health, Working Life and Welfare
- Sweden: Swedish Research Council
- General Health Directorate of Portugal
- National Health Institute Doutor Ricardo Jorge in Lisbon, Portugal
- National Institute of Health in Rome, Italy
- Norwegian Institute of Public Health in Oslo, Norway
- Hellenic Medical Association for Obesity in Athens, Greece
- Directorate-General for Health of France
- Karolinska Institute in Huddinge, Sweden
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Background: Schools are important settings for the promotion of a healthy diet and sufficient physical activity and thus overweight prevention. Objective: To assess differences in school nutrition environment and body mass index (BMI) in primary schools between and within 12 European countries. Methods: Data from the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative (COSI) were used (1831 and 2045 schools in 2007/2008 and 2009/2010, respectively). School personnel provided information on 18 school environmental characteristics on nutrition and physical activity. A school nutrition environment score was calculated using five nutrition-related characteristics whereby higher scores correspond to higher support for a healthy school nutrition environment. Trained field workers measured children's weight and height; BMI-for-age (BMI/A) Z-scores were computed using the 2007 WHO growth reference and, for each school, the mean of the children's BMI/A Z-scores was calculated. Results: Large between-country differences were found in the availability of food items on the premises (e.g., fresh fruit could be obtained in 12%. 95% of schools) and school nutrition environment scores (range: 0.30. 0.93). Low-score countries (Bulgaria, Czech Republic, Greece, Hungary, Latvia and Lithuania) graded less than three characteristics as supportive. High-score (>= 0.70) countries were Ireland, Malta, Norway, Portugal, Slovenia and Sweden. The combined absence of cold drinks containing sugar, sweet snacks and salted snacks were more observed in high-score countries than in low-score countries. Largest within-country school nutrition environment scores were found in Bulgaria, Czech Republic, Greece, Hungary, Latvia and Lithuania. All country-level BMI/A Z-scores were positive (range: 0.20. 1.02), indicating higher BMI values than the 2007 WHO growth reference. With the exception of Norway and Sweden, a country-specific association between the school nutrition environment score and the school BMI/A Z-score was not observed. Conclusions: Some European countries have implemented more school policies that are supportive to a healthy nutrition environment than others. However, most countries with low school nutrition environment scores also host schools with supportive school environment policies, suggesting that a uniform school policy to tackle the unhealthy school nutrition environment has not been implemented at the same level throughout a country and may underline the need for harmonized school policies.
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