title: School-based intervention to enable school children to act as change agents on weight, physical activity and diet of their mothers: a cluster randomized controlled trial.
abstract: BACKGROUND
  School health promotion has been shown to improve the lifestyle of students, but it remains unclear whether school-based programs can influence family health. We developed an innovative program that enables school children to act as change agents in promoting healthy lifestyles of their mothers. The objective of this study was to examine the effect of the child-initiated intervention on weight, physical activity and dietary habit of their mothers.
  
  
  METHODS
  A 12-month cluster randomized trial was conducted, with school as a cluster. Participants were mothers with grade 8 students, aged around 13 years, of 20 schools in Homagama, Sri Lanka. Students of the intervention group were trained by facilitators to acquire the ability to assess noncommunicable disease risk factors in their homes and take action to address them, whereas those of the comparison group received no intervention. Body weight, step count and lifestyle of their mothers were assessed at baseline and post-intervention. Multi-level multivariable linear regression and logistic regression were used to assess the effects of intervention on continuous and binary outcomes, respectively.
  
  
  RESULTS
  Of 308 study participants, 261 completed the final assessment at 12 month. There was a significantly greater decrease of weight and increase of physical activity in the intervention group. The mean (95% confidence interval) difference comparing the intervention group with the control group was -2.49 (-3.38 to -1.60) kg for weight and -0.99 (-1.40 to -0.58) kg/m(2) for body mass index. The intervention group had a 3.25 (95% confidence interval 1.87-5.62) times higher odds of engaging in adequate physical activity than the control group, and the former showed a greater number of steps than the latter after intervention. The intervention group showed a greater reduction of household purchase of biscuits and ice cream.
  
  
  CONCLUSIONS
  A program to motivate students to act as change agents of family's lifestyle was effective in decreasing weight and increasing physical activity of their mothers.
  
  
  BACKGROUND
  Sri Lanka Clinical Trials Registry SLCTR/2013/011 .
authors.affiliation: Department of Community Medicine, University of Colombo, No.25, PO Box. 271, Kynsey Road, Colombo-08, Western Province, Sri Lanka.
authors.forename: Nalika
authors.initials: N
authors.lastname: Gunawardena
authors.affiliation: Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, Japan.
authors.forename: Kayo
authors.initials: K
authors.lastname: Kurotani
authors.affiliation: The Foundation for Health Promotion, No.21/1 Kahawita Road, Attidiya, Dehiwala, 10350, Western Province, Sri Lanka.
authors.forename: Susantha
authors.initials: S
authors.lastname: Indrawansa
authors.affiliation: Department of Global Health, School of Health Sciences, University of the Ryukyus, 1 Senbaru, Nishihara-cho, Nakagami-gun, Okinawa, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Nonaka
authors.affiliation: Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, Japan. mizoue@ri.ncgm.go.jp.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Mizoue
authors.affiliation: Department of Psychological Medicine, University of Colombo, Sri Lanka, No.25, PO Box. 271, Kynsey Road, Colombo-08, Western Province, Sri Lanka.
authors.forename: Diyanath
authors.initials: D
authors.lastname: Samarasinghe
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D001835:Body Weight; D002648:Child; D004032:Diet; D015444:Exercise; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D009034:Mother-Child Relations; D009035:Mothers; D009043:Motor Activity; D009765:Obesity / Q000517:prevention & control / Q000628:therapy; D015397:Program Evaluation; D012572:School Health Services; D012574:Schools; D013188:Sri Lanka; D013334:Students
keywords: Diet; Mother; Obesity; Physical activity; Randomized controlled trial; Sri Lanka; Student