title: Impact of school policies on non-communicable disease risk factors - a systematic review.
abstract: Globally, non-communicable diseases (NCDs) are identified as one of the leading causes of mortality. NCDs have several modifiable risk factors including unhealthy diet, physical inactivity, tobacco use and alcohol abuse. Schools provide ideal settings for health promotion, but the effectiveness of school policies in the reduction of risk factors for NCD is not clear. This study reviewed the literature on the impact of school policies on major NCD risk factors.
  
  
  
  A systematic review was conducted to identify, collate and synthesize evidence on the effectiveness of school policies on reduction of NCD risk factors. A search strategy was developed to identify the relevant studies on effectiveness of NCD policies in schools for children between the age of 6 to 18 years in Ovid Medline, EMBASE, and Web of Science. Data extraction was conducted using pre-piloted forms. Studies included in the review were assessed for methodological quality using the Effective Public Health Practice Project (EPHPP) quality assessment tool. A narrative synthesis according to the types of outcomes was conducted to present the evidence on the effectiveness of school policies.
  
  
  
  Overall, 27 out of 2633 identified studies were included in the review. School policies were comparatively more effective in reducing unhealthy diet, tobacco use, physical inactivity and inflammatory biomarkers as opposed to anthropometric measures, overweight/obesity, and alcohol use. In total, for 103 outcomes independently evaluated within these studies, 48 outcomes (46%) had significant desirable changes when exposed to the school policies. Based on the quality assessment, 18 studies were categorized as weak, six as moderate and three as having strong methodological quality.
  
  
  
  Mixed findings were observed concerning effectiveness of school policies in reducing NCD risk factors. The findings demonstrate that schools can be a good setting for initiating positive changes in reducing NCD risk factors, but more research is required with long-term follow up to study the sustainability of such changes.
authors.affiliation: Australian Research Centre for Population Oral Health (ARCPOH), Adelaide Dental School, The University of Adelaide, Adelaide, Australia.
authors.forename: Ankur
authors.initials: A
authors.lastname: Singh
authors.affiliation: Health Promotion Division, Public Health Foundation of India (PHFI), Plot No. 47, Sector 44, Gurgaon, Haryana, 122002, India.
authors.forename: Shalini
authors.initials: S
authors.lastname: Bassi
authors.affiliation: Health Promotion Division, Public Health Foundation of India (PHFI), Plot No. 47, Sector 44, Gurgaon, Haryana, 122002, India.
authors.forename: Gaurang P
authors.initials: GP
authors.lastname: Nazar
authors.affiliation: Health Promotion Division, Public Health Foundation of India (PHFI), Plot No. 47, Sector 44, Gurgaon, Haryana, 122002, India.
authors.forename: Kiran
authors.initials: K
authors.lastname: Saluja
authors.affiliation: Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: MinHae
authors.initials: M
authors.lastname: Park
authors.affiliation: Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Kinra
authors.affiliation: Health Promotion Division, Public Health Foundation of India (PHFI), Plot No. 47, Sector 44, Gurgaon, Haryana, 122002, India. monika.arora@phfi.org.
authors.forename: Monika
authors.identifier: 0000-0001-9987-3933
authors.initials: M
authors.lastname: Arora
mesh_terms: D000293:Adolescent; D000428:Alcohol Drinking / Q000517:prevention & control; D002648:Child; D002908:Chronic Disease / Q000453:epidemiology*; D004032:Diet; D015444:Exercise; D006266:Health Education / Q000706:statistics & numerical data*; D006293:Health Promotion / Q000706:statistics & numerical data*; D006801:Humans; D009765:Obesity / Q000517:prevention & control; D050177:Overweight; D057766:Policy; D012307:Risk Factors; D012574:Schools / Q000458:organization & administration*; D000074606:Smoking Prevention
keywords: NCD risk factor; Non-communicable disease; School policy; Systematic review