The study gives new information about the cost-effectiveness of structured health promotion embedded in daily routine at primary schools. Assuming a MWTP of euro35 the intervention is cost-effective with a positive NMB. This result may help decision makers in implementing programmes to prevent childhood overweight in school settings.

BackgroundIncreasing prevalences of overweight and obesity in children are known problems in industrialized countries. Early prevention is important as overweight and obesity persist over time and are related with health problems later in adulthood. "Komm mit in das gesunde Boot - Grundschule" is a school-based program to promote a healthier lifestyle. Main goals of the intervention are to increase physical activity, decrease the consumption of sugar-sweetened beverages, and to decrease time spent sedentary by promoting active choices for healthy lifestyle. The program to date is distributed by 34 project delivery consultants in the state of Baden-Württemberg and is currently implemented in 427 primary schools. The efficacy of this large scale intervention is examined via the Baden-Württemberg Study.Methods/DesignThe Baden-Württemberg Study is a prospective, stratified, cluster-randomized, and longitudinal study with two groups (intervention group and control group). Measurements were taken at the beginning of the academic years 2010/2011 and 2011/2012. Efficacy of the intervention is being assessed using three main outcomes: changes in waist circumference, skinfold thickness and 6 minutes run. Stratified cluster-randomization (according to class grade level) was performed for primary schools; pupils, teachers/principals, and parents were investigated. An approximately balanced number of classes in intervention group and control group could be reached by stratified randomization and was maintained at follow-up.DiscussionAt present, "Komm mit in das Gesunde Boot - Grundschule" is the largest school-based health promotion program in Germany. Comparative objective main outcomes are used for the evaluation of efficacy. Simulations showed sufficient power with the existing sample size. Therefore, the results will show whether the promotion of a healthier lifestyle in primary school children is possible using a relatively low effort within a school-based program involving children, teachers and parents. The research team anticipates that not only efficacy will be proven in this study but also expects many other positive effects of the program.Trial registrationGerman Clinical Trials Register (DRKS), DRKS-ID: DRKS00000494

Studies have shown preventive effects of an active lifestyle during childhood on later life; therefore, health promotion has to start early. The programme “Join the Healthy Boat” promotes a healthy lifestyle in primary school children. In order to evaluate it, children's behaviours in respect of increased physical activity (PA), a decrease in screen media use (SMU), more regular breakfast, and a reduction of the consumption of soft drinks (SDC) were investigated. 1943 children (7.1 ± 0.6 years) participated in the cluster-randomised study and were assessed at baseline and 1736 of them at follow-up. Teachers delivered lessons, which included behavioural contracting and budgeting of SMU and SDC. Daily SMU, PA behaviours, SDC, and breakfast patterns were assessed via parental questionnaire. After one-year intervention, significant effects were found in the intervention group for SMU of girls, children without migration background, and children with parents having a low education level. In the control group, second grade children skipped breakfast significantly more often. Tendencies but no significant differences were found for PA and SDC. This intervention seems to affect groups, which are usually hard to reach, such as children of parents with low education levels, which shows that active parental involvement is vital for successful interventions.

Obstructive lung disease is the major cause of morbidity and mortality in cystic fibrosis (CF). To identify risk factors contributing to FEV(1) decline in CF patients, we carried out a retrospective analysis of clinical and pulmonary function data in a population of CF patients followed up for 5 years and studied the correlation between clinical data and FEV(1) decline. Fifty-one adult CF patients were studied. The FEV(1) decline was related to the following clinical characteristics: CFTR genotype, age, gender, weight, height, age at diagnosis, baseline FEV(1), pancreatic function, presence of airway infection, pancreatic insufficiency and diabetes, number of exacerbations/year and intravenous (i.v.) antibiotic courses/year. Both the number of exacerbations/year and the number of i.v. antibiotic courses/year were strongly related to the FEV(1) decline. Patients with airway infection or with diabetes had significantly lower FEV(1) values during the study as compared with non-infected patients or patients without diabetes; however, both the presence of airway infection or diabetes did not affect the FEV(1) decline. These results suggest that the aggressive treatment of disease exacerbations is crucial for delaying lung function decline in CF.

BackgroundChildhood obesity and its consequences are a growing threat to national economies and health services. The aim of this study was to determine associations between waist-to-height ratio (WHtR) as a measure of central obesity, and health-related quality of life (HRQoL) and absenteeism of primary school children in the state of Baden-Württemberg, Germany.MethodsCross-sectional data from 1888 first and second grade children (7.1±0.6 years) participating in the baseline measurements of the Baden-Württemberg Study were analyzed. Parents completed questionnaires including a rating of their children’s HRQoL using KINDLR and EQ5D-Y VAS. Days of absence because of illness, and number of visits to a physician during the last year of school/kindergarten were asked, as well as the number of days parents took off work to care for their sick child. Anthropometric measurements were taken by trained staff. The Mann-Whitney-U test was used for statistical analysis of differences between WHtR groups. Logistic regression models were used to identify factors associated with sick days.ResultsA total of 158 (8.4%) children were centrally obese (WHtR ≥0.5). These children had significantly more sick days (9.05 vs. 6.84, p < 0.001) and visits to a physician (3.58 vs. 2.91, p < 0.05), but not days of parental absence than other children. According to regression analysis, sick days were also associated with age, migration status, physical activity pattern, maternal health awareness and family education level. Parent-rated HRQoL was significantly lower in centrally obese children for the EQ5D-Y VAS (88.1 vs. 91.6, p < 0.001), and the KINDLR subscales ’school’ (79.9 vs. 82.5, p < 0.05) and ’friends’ (75.4 vs. 78.3, p < 0.05), but not for the total score.ConclusionsCross-sectional results show higher rates of absence, more visits to a physician and lower HRQoL in children with central obesity. Each missed day at school implies a hazard to academic achievement and each additional visit to a physician is related to higher health care costs. Thus, the negative impact of central obesity is already measurable in primary school children, which emphasizes the urgent need for early delivery of health promotion and targeted prevention.

The objective of this study was to investigate the association of different cognitive abilities with children's body weight adjusted for further weight influencing sociodemographic, family, and lifestyle factors. Cross-sectional data of 498 primary school children (7.0 ± 0.6 years; 49.8% boys) participating in a health promotion programme in southwest Germany were used. Children performed a computer-based test battery (KiTAP) including an inhibitory control task (Go-Nogo paradigm), a cognitive flexibility task, and a sustained attention task. Height and weight were measured in a standardized manner and converted to BMI percentiles based on national standards. Sociodemographic features (migration background and parental education), family characteristics (parental body weight), and children's lifestyle (TV consumption, physical activity, consumption of sugar-sweetened beverages and breakfast habits) were assessed via parental questionnaire. A hierarchical regression analysis revealed inhibitory control and cognitive flexibility to be significant cognitive predictors for children's body weight. There was no association concerning sustained attention. The findings suggest that especially cognitive abilities known as executive functions (inhibitory control and cognitive flexibility) are associated with children's body weight. Future longitudinal and intervention studies are necessary to investigate the directionality of the association and the potential of integrating cognitive training in obesity prevention strategies. This trial is registered with ClinicalTrials.gov DRKS00000494.

ObjectiveTo determine parental willingness-to-pay (WTP) for childhood obesity prevention.MethodsCross-sectional data from the follow-up measurements (2011) of a health promotion programme in German primary schools. Data collection included anthropometric measurements of children and self-administered questionnaires for parents, including WTP assessment. Mann-Whitney U-Test was used for differences between groups, and regression analysis to identify factors associated with general WTP and amount of WTP.ResultsFrom 1 534 parents, 97.8% considered overweight/obesity to be serious public health problems. A general WTP to reduce the incidence of childhood overweight/obesity by half, was declared by 48.8%. Parents of overweight/obese children showed with 61.4%, significantly more frequently, their general WTP than the others with 47.2% (p = 0.001). Mean WTP was €23.04 (99% confidence interval (CI) [22.45; 23.75]) per month. Parents of centrally obese children showed significantly higher WTP than parents of the other children (p = 0.001). General WTP and the amount of WTP were associated with the central obesity of the child, migration status and household income. Additionally, general WTP was associated with maternal obesity.ConclusionsNearly half of the parents were willing to invest in prevention of obesity. The general WTP significantly occurs more often and with higher amount in affected parents.Electronic supplementary materialThe online version of this article (doi:10.1186/s13561-014-0020-8) contains supplementary material, which is available to authorized users.

AimPhysical activity (PA) and physical fitness (PF) are known to be closely connected. Various environmental and biological constraints have been shown to influence children’s PA with parents being among strong determinants of their children’s PA behaviour. However, little is known about parental influence on PF in children. Therefore, the purpose of this study was to identify the influence of parental health-related behaviours and attitudes on PF in boys and girls.Subjects and methodsBaseline data of 1,875 primary school children (7.1 ± 0.6 years; 50 % male) were included in the analyses. Lateral jumping performance was used as a proxy for whole-body coordination and the 6-min run for cardiovascular fitness. Parental health-related behaviours, attitudes and sociodemographic variables were assessed via questionnaire. Regression analyses, adjusting for age and BMI, were performed separately for boys and girls.ResultsThe final models of the regression analyses showed that children’s age and BMI are significantly related to PF. Mothers’ self-efficacy to encourage their children to be active is significantly associated with boys’ coordination and cardiovascular fitness and girls’ coordination. Mothers’ PA affects PF in boys, not in girls. Maternal smoking has a significantly negative effect on both boys’ and girls’ cardiovascular fitness.ConclusionThis study shows that parental health-related behaviours and self-efficacy to encourage their children to be active affect children’s PF. Influencing factors, however, differ in girls and boys, and mothers seem especially influential.