Academic Collaborative Center for Public Health Limburg, Public Health Service South Limburg, P.O. Box 33, 6400 AA, Heerlen, The Netherlands.
Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
BMC Public Health. 2023 Jul 5;23(1):1296. doi: 10.1186/s12889-023-16123-7.
Overweight among adolescents remains a serious concern worldwide and can have major health consequences in later life, such as cardiovascular diseases and cancer. Still, 33% of secondary school adolescents in the Netherlands consume sugar-sweetened beverages daily and over 26% do not consume water every day. The Dutch Healthy School program was developed to support schools in stimulating healthier lifestyles by focusing on health education, school environments, identifying students' health problems, and school policy. We examined the variation between secondary schools regarding the daily consumption of water and sugar-sweetened beverages and whether this variation can be explained by differences between schools regarding Healthy School certification, general school characteristics, and the school population.
We performed a cross-sectional multilevel study. We used data from the national Youth Health Monitor of 2019 on secondary schools (grades 8 and 10, age range about 12 to 18 years) of seven Public Health Services and combined these with information regarding Healthy School certification and general school- and school population characteristics. Our outcomes were daily consumption of water and sugar-sweetened beverages. In total, data from 51,901 adolescents from 191 schools were analysed. We calculated the intraclass correlation to examine the variation between schools regarding our outcomes. Thereafter, we examined whether we could explain this variation by the included characteristics.
The school-level explained 4.53% of the variation in the consumption of water and 2.33% of the variation in the consumption of sugar-sweetened beverages. This small variation in water and sugar-sweetened consumption could not be explained by Healthy School certification, yet some general school- and school population characteristics did: the proportion of the school population with at least one parent with high educational attainment, the educational track of the adolescents, urbanicity (only for water consumption) and school type (only for sugar-sweetened beverages consumption).
The low percentages of explained variation indicate that school-level characteristics in general (including Healthy School certification) do not matter substantially for the daily consumption of water and sugar-sweetened beverages. Future research should examine whether school health promotion can contribute to healthier lifestyles, and if so, under which level of implementation and school conditions.
超重青少年仍然是全球范围内一个严重的问题，可能会对以后的生活造成重大健康后果，如心血管疾病和癌症。尽管如此，荷兰仍有 33%的中学生每天饮用含糖饮料，超过 26%的学生每天不饮水。荷兰健康学校计划旨在通过关注健康教育、学校环境、发现学生健康问题和学校政策，支持学校培养更健康的生活方式。我们调查了中学之间在日常饮水和含糖饮料消费方面的差异，以及这种差异是否可以通过学校的健康学校认证、一般学校特征和学校人群的差异来解释。
我们进行了一项横断面多水平研究。我们使用了 2019 年全国青年健康监测的数据，涉及来自七个公共卫生服务的中学（8 年级和 10 年级，年龄约为 12 至 18 岁），并将这些数据与健康学校认证以及一般学校和学校人群特征的信息相结合。我们的结果是每日水和含糖饮料的摄入量。总共分析了来自 191 所学校的 51901 名青少年的数据。我们计算了组内相关系数，以检查我们的结果在学校之间的差异。之后，我们检查了是否可以通过纳入的特征来解释这种差异。
学校层面解释了水摄入量变化的 4.53%和含糖饮料摄入量变化的 2.33%。水和含糖饮料摄入量的这种小变化不能用健康学校认证来解释，但一些一般学校和学校人群特征可以解释：具有高学历父母的学生比例、青少年的教育轨道、城市性（仅适用于水摄入量）和学校类型（仅适用于含糖饮料摄入量）。
解释变化的低百分比表明，一般来说，学校层面的特征（包括健康学校认证）对水和含糖饮料的日常摄入量没有实质性影响。未来的研究应探讨学校健康促进是否有助于更健康的生活方式，如果是，在何种实施水平和学校条件下如此。
