Yazdi-Feyzabadi Vahid, Omidvar Nasrin, Keshavarz Mohammadi Nastaran, Nedjat Saharnaz, Karimi-Shahanjarini Akram, Rashidian Arash
Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Health Promot Int. 2018 Dec 1;33(6):1010-1021. doi: 10.1093/heapro/dax045.
The Iranian Health Promoting Schools (IHPS) program was first piloted and then formally established in Iran in 2011 as a framework to promote healthy environment and behaviors such as proper dietary practice among adolescents. This study examined the role of IHPS in improving the school food environment and snacking behaviors among adolescents. In this cross-sectional study, 1320 eighth grade students from 40 middle schools with IHPS and non-IHPS program were selected using a proportional stratified random sampling method. A modified 55-item qualitative Food Frequency Questionnaire was used to assess the frequency of consumption of healthy and unhealthy snacks in the studied adolescents. Mixed effect negative binomial regression models were used to analyze the data. The association was also adjusted for individual variables, including gender, socio-economic status, pocket money, family structure and nutritional knowledge level. No significant difference was observed between the average of healthy and unhealthy snack items in IHPS and non-IHPS schools (p > 0.05). On the basis of adjusted analysis, being from/in IHPS was not associated with weekly frequency consumption of unhealthy [prevalence rate ratio (PRR) = 0.99; 95% CI: 0.85-1.16] and healthy (PRR = 1.08; 95% CI: 0.96-1.2) snacks among the adolescents. There was no difference regarding school food environment and snacking behaviors in IHPS and non-IHPS schools. This might indicate that there has been a weakness in institutionalizing the comprehensive concepts of the HPS approach in the studied schools. Addressing the proper understanding of HPS approach and the need for development of HPS through matching and adaptability with health promotion actions to reach defined standards, is necessary.
伊朗健康促进学校（IHPS）项目于2011年在伊朗首次进行试点，随后正式设立，作为促进健康环境以及青少年适当饮食习惯等行为的框架。本研究探讨了IHPS在改善青少年学校饮食环境和零食消费行为方面的作用。在这项横断面研究中，采用比例分层随机抽样方法，从40所设有和未设IHPS项目的中学选取了1320名八年级学生。使用一份经过修改的包含55个条目的定性食物频率问卷，评估所研究青少年食用健康和不健康零食的频率。采用混合效应负二项回归模型分析数据。该关联还针对个体变量进行了调整，包括性别、社会经济地位、零花钱、家庭结构和营养知识水平。在设有IHPS和未设IHPS的学校中，健康和不健康零食项目的平均数量之间未观察到显著差异（p>0.05）。基于调整后的分析，就读于设有IHPS项目学校的青少年与不健康零食（患病率比（PRR）=0.99；95%置信区间：0.85 - 1.16）和健康零食（PRR = 1.08；95%置信区间：0.96 - 1.2）的每周消费频率无关。设有IHPS和未设IHPS的学校在学校饮食环境和零食消费行为方面没有差异。这可能表明在所研究的学校中，将健康促进学校方法的综合概念制度化存在不足。有必要通过与健康促进行动相匹配和适应以达到既定标准，来正确理解健康促进学校方法以及发展健康促进学校的必要性。
