title: A Controlled Health Promoting School Study in the Netherlands: Effects After 1 and 2 Years of Intervention.
abstract: OBJECTIVE
  Many unhealthy behavioral habits often originate in adolescence. In the literature, the school-based whole school approach is stated be the most promising way to promote healthy behavior. Herein, interventions are evidence based and integrated into the curriculum, while embedded in complementary healthy school policies and environment. This study evaluates the effects of such an intervention on Dutch high schools.
  
  
  METHODS
  Two Dutch high schools and two controls were followed to evaluate the intervention's effects on health behaviors, body mass index, and psychosocial problems after 1 year (N = 969) and 2 years (N = 605). Outcomes were measured via self-report surveys and analyzed with mixed methods regression analyses. To complement information on intervention effects, structured interviews were held with a representative sample of teachers per intervention school to map their respective whole school approach implementation success.
  
  
  RESULTS
  After 2 years, one intervention school showed significant improvements: Body mass index and excessive screen time use were reduced. In the other intervention school, priority targets did not improve. These findings reflected their respective success in intervention implementation, for example, differences in intervention integration and tailoring.
  
  
  CONCLUSIONS
  This study shows that it is feasible for schools to implement a comprehensive Health Promoting School intervention themselves and that, when successful, effects in terms of improving behaviors and health outcomes are promising. The process evaluation helped understand these findings in context.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands v.busch@umcutrecht.nl.
authors.forename: Vincent
authors.initials: V
authors.lastname: Busch
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: Johannes Rob Josephus
authors.initials: JR
authors.lastname: De Leeuw
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: Nicolaas P A
authors.initials: NP
authors.lastname: Zuithoff
authors.affiliation: Faculty of Behavioral and Social Sciences, State University of Groningen, Groningen, Netherlands.
authors.forename: Tom Albert
authors.initials: TA
authors.lastname: Van Yperen
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: Augustinus Jacobus Petrus
authors.initials: AJ
authors.lastname: Schrijvers
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D000428:Alcohol Drinking / Q000517:prevention & control; D015992:Body Mass Index; D058445:Bullying / Q000517:prevention & control; D003479:Curriculum; D015438:Health Behavior; D006292:Health Priorities; D006293:Health Promotion / Q000379:methods*; D006306:Health Surveys; D006801:Humans; D020407:Internet; D007407:Interviews as Topic; D009426:Netherlands; D012044:Regression Analysis; D012572:School Health Services; D012574:Schools; D057185:Sedentary Behavior; D000074606:Smoking Prevention; D012940:Social Problems
keywords: behavior change; health promotion; school health