| Summary: | 碩士 === 國立陽明大學 === 公共衛生研究所 === 105 === Background: Childhood obesity is a major global public health issue. (1) To assess the efficacy of MX program on improving children’s knowledge, attitude, and practice of physical activities and healthy diet, and healthy growth in rural elementary schools. (2) To assess the sustainability of the health behaviors and health indicators after MX program ended. (3) To compare the pre-post changes in the health behaviors and health indicator between the intervention group and the control group. (4) To assess the efficacy of MX on the health behaviors and health indicators by school environment.
Methods: This study was a delayed-start, cluster randomized control trial. The intervention took place in the 1st semester of 2016 school year. Eight rural elementary schools at the north coast of Taiwan were participated. Schools were matched by school location and student number of 3rd and 4th grades, and the matched schools were randomly assigned to the intervention group and the control group. The intervention group received eight weeks MX program intervention and was followed up eight weeks later. The control group started the same program after the intervention group completed the program. The efficacy of the intervention was tested by the mixed effect model, using intention-to-treat analysis.
Results: About half of students in the intervention group and a third of students in the control group were overweight or obese at baseline. (1) Efficacy of intervention: compared to the control group, the intervention group had significantly increased in physical knowledge score (+0.91 vs. +0.25, p = 0.002), diet knowledge score (+0.62 vs. +0.17, p = 0.044), and the score of interests in NASA and space exploration (+0.34 vs. -0.07, p < 0.0001). Most of students stayed at the same stage of change for three health behaviors, while the intervention group (32.9%) had a higher percentage of improvement on exercise habit than the control group (27.6%). (2) Sustainability: KAP scores and perceived norm toward the health behaviors remained constant after the intervention. The interests in NASA and space exploration decreased after the end of intervention (-0.19, 95% CI = -0.06 – -0.33, p = 0.006). (3) Pre-post changes between two groups: significant differences of pre-post change between the intervention group and the control group were found in height (+1.36 vs. +0.48, p < 0.0001), height z-score (+0.07 vs. -0.07, p < 0.0001), weight (+0.82 vs. -0.06, p = 0.009), diet knowledge score (+0.62 vs. +0.15, p = 0.029), behavioral belief score (+0.28 vs. -0.10, p = 0.045), dietary behavior score (+2.68 vs. -0.42, p = 0.0002), and score of interest in NASA and space exploration (+0.34 vs. -0.08, p = 0.0006). (4) Environmental factor that modified the intervention efficacy: the models showed a significant interaction of monthly milk provision and intervention on children’s height (p = 0.012) and on behavior belief of “Drinking milk helps me grow taller” (p = 0.041).
Conclusion: The present study is the first to examine the effects of the NASA MX program, and our study demonstrated the efficacy in improving children’s knowledge of healthy eating and active living. The present study also demonstrated the feasibility and acceptability in Taiwan children population.
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