Effects of statewide health promotion in primary schools on children’s sick days, visits to a physician and parental absence from work: a cluster-randomized trial

Abstract

BackgroundBased on the World Health Organization’s global school health initiative we investigate intervention effects of statewide health promotion in schools on the numbers of children’s sick days and visits to a physician, and parental days off work due to child illness.MethodsCluster-randomized trial with 1-year follow-up in primary schools in the state of Baden-Württemberg, Germany. Anthropometric measurements of first and second grade school children were taken by trained staff. Parents filled in questionnaires for information about socio-demographics, health-related variables, numbers of children’s sick days, visits to a physician, and days parents had to stay off work to care for a sick child. Longitudinal differences in the outcome variables were calculated between baseline and follow-up. Intraclass correlation coefficients were determined to quantify a possible clustering of data in schools. Accordingly, linear models and linear mixed models were applied to identify relationships and ascertain significances.ResultsData from 1943 children (1st grade n = 1024, 6.6 ± 0.4 years old; 2nd grade n = 919, 7.6 ± 0.4 years old) were available at baseline. Unadjusted differences regarding both grades were found between mean longitudinal changes in intervention and control group in children’s sick days (−3.2 ± 7.1 vs. -2.3 ± 5.6, p = 0.013), and maternal days off work (−0.9 ± 2.4 vs. -0.5 ± 2.8, p = 0.019). The intervention effect on sick days was adjusted in a linear regression for baseline values, gender and migration background and confirmed for first grade children (B = −0.83, p = 0.003). The intervention effect on maternal days off work lost its significance after adjusting for baseline values. No significant differences were detected in the numbers of children’s visits to a physician and paternal days off work.ConclusionsSchool-based health promotion slightly reduces sick days in first grade children. Subsequently, parents may not need to stay off work themselves. Small individual effects add up to larger benefits in a statewide implementation of health promotion. Additionally, health promotion may also positively contribute to school success.Trial RegistrationThe study was registered on the German Clinical Trials Register (DRKS), Freiburg University, Germany, under the DRKS-ID: DRKS00000494. Registered: 25 August 2010.

Global Alliance for the Promotion of Physical Activity: the Hamburg Declaration

“…Studies have been demonstrating that population health is influenced by the environment in the broadest sense,37 38 54 including economic factors,55 access to green spaces, water and air quality,54 56 employment, access to medical care,57 the availability of safe non-motorised transportation (eg, walking, cycling) systems,30 54 58 as well as education 35 55 59. In this framework, individual behaviour reflects individuals’ personal responsibility through health-promoting behaviours and choices - of which PA is one of the most important 13 21 59 60. Heritability affects the likelihood of developing a particular NCD 8 26 61.…”

“…A systematic global interaction is needed among all participants, including individuals, organisations and communities with a direct interest in the process and outcomes of projects, research or policy 38 44. This work should target the sport, school, health and medicine sectors and focus on successfully implementing PA and exercise promotion measures 30 59. Policies should create an ecosystem that promotes healthy lifestyles, reduces sedentary behaviour and integrates PA and exercise as medicine in the daily care of patients 37 55 68 69.…”