E. Bonsergent

Effect of gender on the association between weight status and health-related quality of life in adolescents.

BackgroundSome studies have investigated the association between body mass index (BMI) and health-related quality of life (HRQoL) among adolescents, but their results have been discrepant and few paid attention to the role of gender. The present investigation aimed to assess the relationship between weight status and HRQoL in adolescents and to verify whether it was similar in boys and girls.MethodsFive thousand two hundred and twenty six adolescents aged 14 to 18 years were included in the PRomotion de l’ALIMentation et de l’Activité Physique (PRALIMAP) trial, a 2x2x2 factorial cluster randomized trial performed in 24 high schools in France. Sociodemographic, anthropometric and HRQoL data were collected. BMI was categorized in four classes (thin, normal-weight, overweight, obese). Linear regression models were used to estimate the association between weight status and HRQoL, adjusting for confounders.ResultsThe mean age of adolescents was 15.7±0.6 years and their mean BMI was 21.6 ±3.5 kg/m2; 55% were girls. Boys were more often overweight and obese than were girls (overweight: 15.6% vs 14.2%, obese: 4.8% vs 3.3%), and girls were more likely to be thin (5.5% vs 4.5%, p=0.0042). All HRQoL scores were higher for boys (p=<0.0001). Weight status was not associated with physical and social scores neither in boys nor in girls. Conversely, it was associated with mental score, but differently in girls than boys. As compared with normal-weight girls, thin girls had better mental HRQoL (β=+6.17, p=0.0010), and overweight and obese girls had lower mental HRQoL (β=−3.89 and β=−5.90, respectively, p<0.001). Mental HRQoL was lower for thin, overweight and obese boys than for normal-weight boys (β= −4.97, β= −1.68 and β= −3.17, respectively, p<0.0001).ConclusionsGender can modify the association between weight status and HRQoL in adolescents. Body image could be an important target of public health programs to improve subjective health during adolescence.

Intervention dose estimation in health promotion programmes: a framework and a tool. Application to the diet and physical activity promotion PRALIMAP trial

BackgroundAlthough the outcomes of health promotion and prevention programmes may depend on the level of intervention, studies and trials often fail to take it into account. The objective of this work was to develop a framework within which to consider the implementation of interventions, and to propose a tool with which to measure the quantity and the quality of activities, whether planned or not, relevant to the intervention under investigation. The framework and the tool were applied to data from the diet and physical activity promotion PRALIMAP trial.MethodsA framework allowing for calculation of an intervention dose in any health promotion programme was developed. A literature reviews revealed several relevant concepts that were considered in greater detail by a multidisciplinary working group. A method was devised with which to calculate the dose of intervention planned and that is actually received (programme-driven activities dose), as well as the amount of non-planned intervention (non-programme-driven activities dose).ResultsIndicators cover the roles of all those involved (supervisors, anchor personnel as receivers and providers, targets), in each intervention-related groups (IRG: basic setting in which a given intervention is planned by the programme and may differ in implementation level) and for every intervention period. All indicators are described according to two domains (delivery, participation) in two declensions (quantity and quality). Application to PRALIMAP data revealed important inter- and intra-IRG variability in intervention dose.ConclusionsA literature analysis shows that the terminology in this area is not yet consolidated and that research is ongoing. The present work provides a methodological framework by specifying concepts, by defining new constructs and by developing multiple information synthesis methods which must be introduced from the programmes conception. Application to PRALIMAP underlined the feasibility of measuring the implementation level. The framework and the tool can be used in any complex programme evaluation. The intervention doses obtained could be particularly useful in comparative trials.Trial registrationPRALIMAP is registered at ClinicalTrials.gov under NCT00814554

Process evaluation of a school-based overweight and obesity screening strategy in adolescents

The PRALIMAP (PRomotion de l’ALIMentation et de l’Activité Physique) trial highlights the effectiveness of implementing a screening strategy in high schools to prevent overweight/obesity among adolescents. The strategy comprises three steps: i) body measurements to detect overweight/obese adolescents, ii) a medical interview with each adolescent identified to discuss the findings, and iii) an adapted care management consisting of seven group educational sessions. A process evaluation was conducted in the PRALIMAP trial to assess the effective implementation of the screening strategy activities, and the participation of adolescents and school professionals in them, from a qualitative and a quantitative point of view. The present paper describes the process and the implementation of the screening strategy as performed in the PRALIMAP trial, and discusses the feasibility of such an intervention in high school settings. The ability of nurses to explain the screening results improved with the addition of specialist support. The ability of adolescents to take part in the screening strategy improved when the adapted care management was conducted inside schools and could be increased even further if the waiting time between the three steps could be minimised.

Effectiveness of three overweight and obesity prevention strategies in high school adolescents: The PRALIMAP trial

| 163 Consortium for School Health was adopted to consider the following domains for HPS activities: social and physical environment, teaching and learning, healthy school policy, and partnerships and services. The rubric, a familiar assessment tool in educational settings, defines HPS best practices at different levels of implementation, and was developed in consultation with local stakeholders. The tool will be administered to all schools in Nova Scotia with Grade 5 students as part of a larger CIHR-funded research project (The Children’s Lifestyle and School Performance Study, CLASS II). A quantitative system will be developed to score schools according to their level of implementation. The findings will highlight the need to consider local policy contexts in the development and administration of tools, to accurately measure implementation of health promotion activities. Results will help advance future tool development and provide insight into what schools need to create a healthy school environment, thereby contributing to childhood obesity prevention.