title: Is an ecological school-based nutrition intervention effective to improve adolescents' nutrition-related knowledge, attitudes and behaviour in rural areas of China?
abstract: OBJECTIVE
  The purpose of this article is to examine the effect of a school-based nutrition intervention using an ecological approach to improve adolescents' nutrition-related knowledge, attitudes and behaviour in rural China.
  
  
  METHODS
  A cluster-randomised intervention trial design was employed. Two middle schools were randomly selected and assigned to the school that was conducting a holistic school-based intervention using health-promoting school (HPS) framework, 'HPS School', or to the 'Control School' in Mi Yun County, Beijing. From each school we randomly selected 65 seventh-grade students to participate in the study. Their nutrition-related knowledge, attitudes and behaviour were measured by pre- and post-intervention surveys with the same instrument. The nutrition intervention lasted for six months.
  
  
  RESULTS
  Adolescents in the intervention school were more likely to know the nutrition knowledge items, with an odds ratio (OR) ranging from 1.86 (95% confidence interval (CI): 1.11-3.09) to 6.34 (95% CI: 3.83-10.47); more likely to think nutrition is very important to health, developing healthy dietary habits is very important, and that expired foods should be thrown away, with ORs of 3.03 (95% CI: 1.60-5.76), 2.76 (95% CI: 1.66-4.59) and 2.35 (95% CI: 1.33-4.17) respectively, and more likely to consume no soft drinks, desserts or fried food, and to eat vegetables every day of the last week, with ORs of 1.99 (95% CI: 1.31-3.04), 3.96 (95% CI: 2.43-6.46), 3.63 (95% CI: 2.26-5.85), and 2.51 (95% CI: 1.41-4.48) respectively, as compared with those in the control school after interventions.
  
  
  CONCLUSIONS
  Our intervention using the HPS framework, an ecological approach, was an appropriate model to promote nutrition among adolescents in rural China and its use should be advocated in future school-based nutrition promotion programmes for adolescents.
authors.affiliation: 1. Research School of Population Health, Australian National University, Canberra, ACT, Australia.
authors.forename: Dongxu
authors.initials: D
authors.lastname: Wang
authors.affiliation: 2. School of Medicine, Griffith University, Brisbane, QLD, Australia.
authors.forename: Donald
authors.initials: D
authors.lastname: Stewart
authors.affiliation: 3. School of Public Health, Peking University, Beijing, China.
authors.forename: Chun
authors.initials: C
authors.lastname: Chang
mesh_terms: D000293:Adolescent; D017195:Adolescent Nutritional Physiological Phenomena; D002648:Child; D002681:China; D005247:Feeding Behavior; D005260:Female; D015438:Health Behavior; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D015397:Program Evaluation; D011897:Random Allocation; D012424:Rural Population; D012572:School Health Services; D013334:Students / Q000523:psychology*
keywords: China; adolescents; ecology; health promotion; health-promoting school; nutrition; nutrition programme; rural education; school programmes