School Health Promotion, the Body Mass Index z-Score, and Psychosocial Health in Primary Schools of the Netherlands
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Study Population
Measurements
2.2. Statistical Analyses
3. Results
3.1. Descriptive Statistics
3.2. Differences in the BMI z-Score
3.3. Differences in Psychosocial Health
4. Discussion
Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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BMI z-Score (N = 7077 2) | SDQ Score (N = 2826 2) | |||||
---|---|---|---|---|---|---|
Certified Schools 1 (N = 1415 2) | Non-Certified Schools 1 (N = 5662 2) | Subsample Certified Schools 1 (N = 951 2) | Certified Schools 1 (N = 750 2) | Non-Certified Schools 1 (N = 2076 2) | Subsample Certified Schools 1 (N = 476 2) | |
Schools (N) | 332 | 1366 | 210 | 202 | 639 | 106 |
Students (N) | 52,650 | 226,128 | 33,645 | 32,373 | 94,966 | 19,679 |
BMI z-score (Mean (SD))/SDQ score 3 (Mean (SD)) | −0.14 (1.02) | −0.18 (0.98) * | −0.15 (1.00) | 5.80 (4.70) | 5.57 (4.60) * | 5.89 (4.73) |
School health promotion | ||||||
No. of years Healthy School (Mean (SD)) | 1.76 (1.67) | - * | 1.08 (1.23) * | 1.93 (1.76) | - * | 1.04 (1.21) * |
Healthy School topic certificates (yes) (%) | ||||||
Nutrition | 26.50 | - * | 23.97 | 30.53 | - * | 25.00 * |
Physical activity | 27.92 | - * | 20.19 * | 28.80 | - * | 21.22 * |
Well-being | 25.44 | - * | 18.19 * | 24.67 | - * | 15.55 * |
Relationships and sexuality | 3.25 | - * | 2.00 | 3.73 | - * | 2.94 |
Environment and nature | 1.34 | - * | 4 | 4 | - | 4 |
General school characteristics | ||||||
Urbanicity school area (%) | ||||||
High | 30.88 | 28.24 | 25.55 * | 37.60 | 39.93 | 36.55 |
Medium | 19.65 | 20.22 | 21.35 | 18.40 | 17.34 | 23.53 * |
Low | 49.47 | 51.54 | 53.10 | 44.00 | 42.73 | 39.92 |
School size (no. of students) (Mean (SD)) | 214 (116) | 206 (116) * | 207 (110) | 217 (125) | 221 (135) | 207 (108) |
School type (%) | ||||||
Public | 28.27 | 25.42 * | 25.24 | 29.07 | 25.39 | 26.05 |
Independent non-denominational | 3.75 | 3.30 | 4 | 4 | 5.30 | 4 |
Catholic | 43.18 | 36.28 * | 44.69 | 52.67 | 41.52 * | 60.50 * |
Protestant | 23.53 | 31.91 * | 24.40 | 13.47 | 24.86 * | 9.03 * |
Other | 1.27 | 3.09 * | 4 | 4 | 2.94 | 4 |
School population characteristics (Mean (SD)) | ||||||
Age in months | 101.19 (17.78) | 97.77 (16.87) * | 101.86 (18.16) | 99.41 (13.54) | 99.50 (12.48) | 99.99 (13.80) |
Gender (proportion boy) | 0.50 (0.11) | 0.50 (0.11) * | 0.50 (0.11) | 0.49 (0.10) | 0.50 (0.10) * | 0.49 (0.10) |
Proportion disadvantaged students | 0.11 (0.11) | 0.08 (0.09) * | 0.10 (0.11) * | 0.13 (0.12) | 0.08 (0.10) * | 0.13 (0.12) |
Proportion high parental educational attainment 5 | 0.54 (0.20) | 0.60 (0.18) * | 0.55 (0.20) | 0.53 (0.22) | 0.61 (0.19) * | 0.51 (0.22) |
Proportion high household income 5,6 | 0.47 (0.20) | 0.54 (0.18) * | 0.48 (0.19) | 0.45 (0.21) | 0.55 (0.19) * | 0.44 (0.22) |
Proportion low household income 5,6 | 0.03 (0.05) | 0.04 (0.05) * | 0.04 (0.05) | 0.04 (0.06) | 0.03 (0.05) * | 0.05 (0.06) |
Proportion first-generation migration background 5,6 | 0.04 (0.06) | 0.03 (0.06) * | 0.03 (0.06) | 0.05 (0.07) | 0.04 (0.06) * | 0.04 (0.07) |
Proportion second-generation migration background 5,6 | 0.17 (0.18) | 0.13 (0.15) * | 0.15 (0.17) * | 0.20 (0.19) | 0.15 (0.14) * | 0.19 (0.18) |
Proportion high urbanicity (home) area | 0.30 (0.41) | 0.26 (0.39) * | 0.25 (0.39) * | 0.38 (0.43) | 0.37 (0.43) | 0.38 (0.42) |
Proportion low urbanicity (home) area | 0.51 (0.46) | 0.56 (0.46) * | 0.54 (0.46) | 0.44 (0.46) | 0.48 (0.46) * | 0.41 (0.46) |
Proportion overweight and underweight 7 | - | - | - | 0.19 (0.11) | 0.17 (0.11) * | 0.20 (0.12) |
BMI z-Score (N = 7077 1) | SDQ Score (N = 2826 1) | |||
---|---|---|---|---|
ICC School-Level (%) | ICC School Year Level (%) | ICC School-Level (%) | ICC School Year Level (%) | |
0 model | 2.41 | 0.62 | 2.45 | 0.45 |
School health promotion | ||||
Healthy School | 2.40 | 0.62 | 2.43 | 0.45 |
Healthy School ever | 2.38 | 0.62 | 2.40 | 0.45 |
Number of years Healthy School | 2.40 | 0.62 | 2.43 | 0.45 |
Healthy School topic certificates | ||||
Nutrition | 2.41 | 0.62 | 2.43 | 0.45 |
Physical activity | 2.38 | 0.63 | 2.42 | 0.45 |
Well-being | 2.41 | 0.62 | 2.45 | 0.45 |
Relationships and sexuality | 2.41 | 0.62 | 2.45 | 0.45 |
Environment and nature | 2.41 | 0.62 | - 2 | - 2 |
General school characteristics | ||||
School size | 2.28 | 0.63 | 2.31 | 0.46 |
School type | 2.36 | 0.62 | 2.39 | 0.45 |
Urbanicity school area 3 | 2.40 | 0.62 | 2.42 | 0.45 |
School population characteristics | ||||
Disadvantaged students | 1.18 * | 0.65 | 1.49 * | 0.45 |
High parental educational attainment 3 | 0.90 * | 0.77 | 1.18 * | 0.58 |
Household income 3 | 1.42 * | 0.72 | 1.42 * | 0.56 |
Migration background 3 | 1.77 * | 0.68 | 2.03 * | 0.47 |
Urbanicity home area 3,4 | 2.33 | 0.63 | 2.36 | 0.45 |
Overweight and underweight 4 | - | - | 1.96 * | 0.50 |
All significant variables multivariately 5 | 0.83 | - | 1.12 | - |
BMI z-Score (N = 951 1) | SDQ Score (N = 476 1) | |||
---|---|---|---|---|
B | 95% CI | B | 95% CI | |
Model 1: Intercept | −0.03 | (−0.14, 0.08) | 6.89 | (6.16, 7.62) * |
HS | −0.03 | (−0.06, −0.01) * | −0.06 | (−0.23, 0.11) |
Model 2: Intercept | −0.04 | (−0.15, 0.07) | 6.88 | (6.15, 7.61) * |
Number of years HS | −0.01 | (−0.02, 0.00) | −0.01 | (−0.09, 0.06) |
Model 3: Intercept 2 | −0.07 | (−0.19, 0.04) | - | - |
No HS | 0.04 | (0.01, 0.07) * | - | - |
HS, but no nutrition/physical activity certificate | 0.04 | (−0.01, 0.08) | - | - |
Model 4: Intercept 3 | - | - | 6.60 | (5.82, 7.39) * |
No HS | - | - | 0.25 | (−0.02, 0.52) |
HS, but no well-being certificate | - | - | 0.27 | (−0.02, 0.56) |
BMI z-Score (N = 951 1) | SDQ Score (N = 476 1) | |||
---|---|---|---|---|
B | 95% CI | B | 95% CI | |
Model 1: | ||||
Intercept | −0.03 | (−0.14, 0.09) | 6.82 | (6.09, 7.56) * |
Disadvantaged students | 0.67 | (0.36, 0.99) * | 3.10 | (1.12, 5.07) * |
HS | −0.06 | (−0.10, −0.03) * | 0.08 | (−0.17; 0.32) |
HS × disadvantaged students | 0.31 | (0.05, 0.58) * | −1.20 | (−2.83; 0.44) |
Model 2: | ||||
Intercept | −0.07 | (−0.19, 0.06) | 7.03 | (6.25, 7.80) * |
High parental educational attainment | −0.18 | (−0.35, −0.01) * | −0.46 | (−1.56, 0.64) |
HS | 0.02 | (−0.06, 0.11) | −0.31 | (−0.80, 0.19) |
HS × high parental educational attainment | −0.10 | (−0.24, 0.04) | 0.46 | (−0.40, 1.31) |
Model 3: | ||||
Intercept | −0.08 | (−0.20, 0.05) | 7.12 | (6.31, 7.93) * |
Low household income | 0.09 | (−0.42, 0.59) | −2.29 | (−5.20, 0.62) |
High household income | 0.10 | (−0.06, 0.25) | −1.64 | (−2.73, −0.56) * |
HS | 0.05 | (−0.05, 0.14) | −0.47 | (−1.10, 0.15) |
HS × low household income | 0.02 | (−0.64, 0.67) | 1.82 | (−2.18, 5.82) |
HS × high household income | −0.16 | (−0.32, 0.00) * | 0.72 | (−0.32, 1.77) |
Model 4: | ||||
Intercept | −0.03 | (−0.15, 0.08) | 6.82 | (6.07, 7.57) * |
First-generation migration background | 0.30 | (−0.16, 0.76) | 0.64 | (−1.89, 3.17) |
Second-generation migration background | −0.16 | (−0.31, 0.02) | 0.41 | (−0.62, 1.44) |
HS | −0.04 | (−0.08, −0.01) * | 0.09 | (−0.18, 0.37) |
HS × first-generation migration background | −0.44 | (−0.99, 0.11) | −0.44 | (−3.44, 2.57) |
HS × second-generation migration background | 0.17 | (0.01, 0.33) * | −0.75 | (−1.96, 0.47) |
Model 5: | ||||
Intercept | - | - | 6.92 | (6.15, 7.69) * |
Overweight and underweight | - | - | 0.24 | (−1.73, 2.20) |
HS | - | - | −0.10 | (−0.55, 0.34) |
HS × overweight and underweight | - | - | 0.25 | (−2.09, 2.59) |
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Vonk, L.; Eekhout, I.; Huijts, T.; Levels, M.; Jansen, M. School Health Promotion, the Body Mass Index z-Score, and Psychosocial Health in Primary Schools of the Netherlands. Int. J. Environ. Res. Public Health 2024, 21, 1073. https://doi.org/10.3390/ijerph21081073
Vonk L, Eekhout I, Huijts T, Levels M, Jansen M. School Health Promotion, the Body Mass Index z-Score, and Psychosocial Health in Primary Schools of the Netherlands. International Journal of Environmental Research and Public Health. 2024; 21(8):1073. https://doi.org/10.3390/ijerph21081073
Chicago/Turabian StyleVonk, Lisanne, Iris Eekhout, Tim Huijts, Mark Levels, and Maria Jansen. 2024. "School Health Promotion, the Body Mass Index z-Score, and Psychosocial Health in Primary Schools of the Netherlands" International Journal of Environmental Research and Public Health 21, no. 8: 1073. https://doi.org/10.3390/ijerph21081073