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Rationale
There is an increasing trend towards unhealthy eating habits, body dissatisfaction, and inactivity among Canada’s youth. These unhealthy attitudes and behaviours in childhood correlate with an increased risk for future health problems, including conditions along the continuum of disordered eating (e.g. obesity, anorexia nervosa, bulimia nervosa), and/or complications resulting from these conditions (e.g. diabetes, cardiac disease, hypertension, osteoporosis). It is generally agreed that interventions focused on improving “healthy living” are needed to help reduce the incidence of physical and mental health problems associated with an unhealthy lifestyle.
Children spend a significant amount of time at school. Therefore school is, together with home, a great place to learn about and practice a healthy lifestyle. Unfortunately, because of funding issues, many schools have had to unwillingly decrease the number of hours spent on physical activity. As well, there has been an increase in the selection of unhealthy food choices in vending machines and the expansion of fast food restaurants and convenience stores nearby schools. Increased access by children to “junk” foods can act against the promotion of a healthy lifestyle.
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Funding was obtained from the Sick Kids Foundation National Grant Program for the design, implementation, and evaluation of a comprehensive, peer-assisted, school-based healthy living program now known as Healthy Buddies™. Grant: XG 03-024 School-Based Healthy Living Intervention Project: Children Teaching Children(top)
PHASE ONE - Program Development (Jan-Sept 2003): In the first nine months of the grant project elementary school educator Valerie Ryden was brought on to help our medical team design a comprehensive health promotion program for elementary school use, combining classroom lessons with regular physical activity sessions. The goals of the program were to improve attitudes and behaviours about nutrition, physical activity, and body image among participating students. Valerie and Dr. Sue Stock developed 21 different (weekly) lessons to be implemented over the course of one school year, and ideally, with full school participation. The lessons were designed such that the older students (grades 4, 5, 6, & 7) would receive the healthy living lesson for the week, taught by their classroom teacher. These students would then act as peer educators (buddies), assisting younger students (Kindergarten, grades 1, 2, 3) in a paired class with their learning of the same healthy living lesson. Valerie also designed structured aerobic fitness circuit sessions known as Fitness Loops. The Fitness Loops were developed so that paired intermediate and primary classes can utilize gym and outdoor recreational space simultaneously. Older and younger buddies learn about and practice exercising together in a safe, fun, and effective way.
PHASE TWO - Program Implementation & Evaluation (Sept 2003-June 2004): Two elementary schools on the Sunshine Coast of British Columbia were recruited for a randomized, controlled prospective study of the program. The Healthy Buddies™ program was implemented in one school. Valerie taught the 21 healthy living lessons over the course of the school year to all intermediate students. Each week, intermediate/primary paired classes got together so that older buddies could teach their younger buddies about healthy living. Classroom lessons focused on one of the three program themes: moving your body, fueling your body or feeling good about yourself and your body. Valerie also facilitated the Fitness Loop sessions with all the students. Additionally, there were school-wide functions and activities such as a themed “Healthy Living Days”. Students also participated in year-end celebrations involving student presentations about health and health promotion. (top)Research QuestionsThe investigators sought to answer the questions:1. Can older children effectively teach their younger peers about health promotion?2. Could the peer-teaching dynamic result in improved their health knowledge, behaviours and attitudes in BOTH groups of kids? (top)Outcome MeasuresStudents in the two evaluation schools (control and intervention) were measured at the beginning and end of the school year. Height, weight, BMI, blood pressure, and heart rate were collected. Students also completed a questionnaire battery assessing health related knowledge and behaviours, self esteem and healthy habits and attitudes. (top)Results SummaryWhen compared to the control school, students in the intervention school showed improved knowledge, behaviours and attitudes pertaining to health. As well, students who participated in the Healthy Buddies™ program had a decreased BMI velocity compared to non-program students across the study period; intervention students also showed a decrease in blood pressure. (top)Peer Reviewed PublicationS Stock, C Miranda, S Evans, S Plessis, J Ridley, S Yeh, J-P Chanoine. 2007. Healthy Buddies: A novel, peer-led health promotion program for the prevention of obesity and eating disorders in children in elementary school. Pediatrics, 120, 4, e1059-e1068. Available for download at http://www.pediatrics.org/cgi/content/full/120/4/e1059.PEDIATRICS is the official journal of the American Academy of Pediatrics. Online ISSN: 1098-4275.(top)
We wish to thank the Sick Kids Foundation, National Grant Program for funding the pilot study.We wish to thank Stewart Hercus, Superintendent of School District #46 (Sunshine Coast) for his support and endorsement. We wish to thank the principals and staff at the two pilot study schools for their support and involvement.We wish to thank the students at Chatelech Secondary School for assisting with the fitness run assessment.We wish to thank UBC medical student Ryan Ishkanian for his involvement in recruiting and training for, as well as coordinating, all endpoint assessments. Ryan was also instrumental in coordination of baseline and endpoint questionnaire scoring and verification of scores. We wish to thank the numerous UBC Psychology undergraduates who volunteered with the assessment administration. We also wish to thank Cork, Ireland medical student Riley Senft and UBC psychology student Jason Gronsdahl for their participation in the follow up assessments and for spending their Summer of 04 scoring questionnaires! We also wish to thank the three UBC medical students involved in the data analysis: Suzanne Plessis, Julia Ridley & Sophia Yeh.(top)Future DirectionsImplementation:The Healthy Buddies™ program has been awarded a competitive grant through the Provincial Health Services Authority, Prevention, Promotion, Protection program. To find out more about the current implementation plans and this grant, click here. Program Evaluation:In conjuction with limited implementation, grant requirements stipulate program evaluation. This is key to evidence-based practice. An assessment of the cost effectiveness of the program and determination of sustainability will be conducted along with a thorough evaluation of the program's health improvement effects when implemented in various students populations and when taught by existing school staff. To find out more about the current evaluation plans under this grant, click here. (top)