title: Changing multiple adolescent health behaviors through school-based interventions: a review of the literature.
abstract: BACKGROUND
  In approaches to health promotion in adolescents, unhealthy behaviors are no longer regarded as independent processes, but as interrelated. This article presents a systematic literature review of school-based interventions targeting multiple adolescent behaviors simultaneously.
  
  
  METHODS
  A systematic literature search was performed using PubMed, Science Direct, and PsychInfo. Only papers written in English and describing original research were included.
  
  
  RESULTS
  Of 33 papers included, 23 focused on quantitative behavioral changes, and 10 on the evaluation of intervention development, implementation, and/or institutionalization. Parental and community involvement in the intervention seemed to be positively associated with effective changes in student health behaviors, whereas creating a healthy school environment and/or policies were less strongly associated with intervention effectiveness. Findings indicated that, for adequate implementation, an intervention should be integrated in pre-existent school settings, fine-tuned to its target population or environment, involve family and the community, and be led by the school itself, with there being a "healthy school coordinator" to coordinate the program.
  
  
  CONCLUSIONS
  A multi-behavior, multi-actor approach would appear to be the most effective way to promote, at school, healthy behaviors among adolescents.
authors.affiliation: University Medical Center Utrecht, Room Str. 5.122, P.O. Box 85500, Stratenum 6.131, Universiteitsweg 100, 3508 GA, Utrecht, The Netherlands. v.busch@umcutrecht.nl
authors.forename: Vincent
authors.initials: V
authors.lastname: Busch
authors.forename: Johannes Rob Josephus
authors.initials: JR
authors.lastname: de Leeuw
authors.forename: Alinda
authors.initials: A
authors.lastname: de Harder
authors.forename: Augustinus Jacobus Petrus
authors.initials: AJ
authors.lastname: Schrijvers
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D001521:Behavior Therapy / Q000379:methods*; D003299:Cooperative Behavior; D005178:Faculty; D005260:Female; D015438:Health Behavior; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D010290:Parents; D012574:Schools; D013334:Students / Q000523:psychology*; D013663:Teaching / Q000379:methods*