title: Effectiveness of a universal parental support programme to promote healthy dietary habits and physical activity and to prevent overweight and obesity in 6-year-old children: the Healthy School Start Study, a cluster-randomised controlled trial.
abstract: OBJECTIVE
  To develop and evaluate the effectiveness of a parental support programme to promote healthy dietary and physical activity habits and to prevent overweight and obesity in Swedish children.
  
  
  METHODS
  A cluster-randomised controlled trial was carried out in areas with low to medium socio-economic status. Participants were six-year-old children (n = 243) and their parents. Fourteen pre-school classes were randomly assigned to intervention (n = 7) and control groups (n = 7). The intervention lasted for 6 months and included: 1) Health information for parents, 2) Motivational Interviewing with parents and 3) Teacher-led classroom activities with children. Physical activity was measured by accelerometry, dietary and physical activity habits and parental self-efficacy through a questionnaire. Body weight and height were measured and BMI standard deviation score was calculated. Measurements were conducted at baseline, post-intervention and at 6-months follow-up. Group differences were examined using analysis of covariance and Poisson regression, adjusted for gender and baseline values.
  
  
  RESULTS
  There was no significant intervention effect in the primary outcome physical activity. Sub-group analyses showed a significant gender-group interaction in total physical activity (TPA), with girls in the intervention group demonstrating higher TPA during weekends (p = 0.04), as well as in sedentary time, with boys showing more sedentary time in the intervention group (p = 0.03). There was a significantly higher vegetable intake (0.26 servings) in the intervention group compared to the control group (p = 0.003). At follow-up, sub-group analyses showed a sustained effect for boys. The intervention did not affect the prevalence of overweight or obesity.
  
  
  CONCLUSIONS
  It is possible to influence vegetable intake in children and girls' physical activity through a parental support programme. The programme needs to be intensified in order to increase effectiveness and sustain the effects long-term. These findings are an important contribution to the further development of evidence-based parental support programmes to prevent overweight and obesity in children.
  
  
  BACKGROUND
  Controlled-trials.com ISRCTN32750699.
authors: Karolinska Institutet, Department of Public Health Sciences, Tomtebodavägen 18 A, 171 65 Solna, Sweden; Centre for Epidemiology and Community Medicine, Stockholm County Council, Box 1497, 171 29 Solna, Sweden.
authors: Gisela
authors: G
authors: Nyberg
authors: Karolinska Institutet, Department of Public Health Sciences, Tomtebodavägen 18 A, 171 65 Solna, Sweden; Centre for Epidemiology and Community Medicine, Stockholm County Council, Box 1497, 171 29 Solna, Sweden.
authors: Elinor
authors: E
authors: Sundblom
authors: Karolinska Institutet, Department of Public Health Sciences, Tomtebodavägen 18 A, 171 65 Solna, Sweden.
authors: Åsa
authors: Å
authors: Norman
authors: Karolinska Institutet, Department of Clinical Neuroscience, Nobels väg 9, 171 65 Solna, Sweden.
authors: Benjamin
authors: B
authors: Bohman
authors: Karolinska Institutet, Institute of Environmental Medicine, Box 210, 171 77 Stockholm, Sweden.
authors: Jan
authors: J
authors: Hagberg
authors: Karolinska Institutet, Department of Public Health Sciences, Tomtebodavägen 18 A, 171 65 Solna, Sweden; Centre for Epidemiology and Community Medicine, Stockholm County Council, Box 1497, 171 29 Solna, Sweden.
authors: Liselotte Schäfer
authors: LS
authors: Elinder
mesh_terms: D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D005247:Feeding Behavior; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D009043:Motor Activity; D009765:Obesity / Q000517:prevention & control*; D017063:Outcome Assessment, Health Care; D010290:Parents; D012572:School Health Services; D012944:Social Support