Efficacy of school-based interventions aimed at decreasing sugar-sweetened beverage consumption among adolescents: a systematic review
Open accessAbstract
Objective: To verify the efficacy of school-based interventions aimed at reducing sugar-sweetened beverage (SSB) consumption among adolescents in order to develop or improve public health interventions. Design: Systematic review of interventions targeting adolescents and/or the school environment. Setting: The following databases were investigated: MEDLINE/PubMed, PsycINFO, CINAHL and EMBASE. Proquest Dissertations and Theses was also investigated for unpublished trials. Subjects: Adolescents were defined as individuals between the ages of 12 and 17 years. Results: A total of thirty-six studies detailing thirty-six different interventions tested among independent samples (n 152 001) were included in the review. Twenty interventions were classified as educational/behavioural and ten were classified as legislative/environmental interventions. Only six interventions targeted both individuals and their environment. Over 70 % of all interventions, regardless of whether they targeted individuals, their environment or both, were effective in decreasing SSB consumption. Legislative/environmental studies had the highest success rate (90·0 %). Educational/behavioural interventions only and interventions that combined educational/behavioural and legislative/environmental approaches were almost equally effective in reducing SSB consumption with success rates of 65·0 and 66·7 %, respectively. Among the interventions that had an educational/behavioural component, 61·5 % were theory-based. The behaviour change techniques most frequently used in interventions were providing information about the health consequences of performing the behaviour (72·2 %), restructuring the physical environment (47·2 %), behavioural goal setting (36·1 %), self-monitoring of behaviour (33·3 %), threat to health (30·6 %) and providing general social support (30·6 %). Conclusions: School-based interventions show promising results to reduce SSB consumption among adolescents. A number of recommendations are made to improve future studies.
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According to the JBI critical appraisal tool, 14 reviews scored high, two reviews scored moderate, and only one review scored low in terms of methodological quality.
“According to the JBI critical appraisal tool, 14 reviews scored high [30–32, 34–41, 43–45], two reviews scored moderate [33, 42], and only one review scored low [29] in terms of methodological quality (Table 2).”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [35]
Majority of the reviews (n = 14) evaluated multi-component interventions while three reviews evaluated only health education interventions.
“Majority of the reviews (n = 14) evaluated multi-component interventions [30–32, 34–40, 42–45] while three reviews evaluated only health education interventions [29, 33, 41].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [35]
Fifteen of the reviews used narrative synthesis and two included both meta-analysis and narrative synthesis.
“Fifteen of the reviews used narrative synthesis [29–43] and two included both meta-analysis and narrative synthesis [44, 45].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [35]
These reviews mostly included studies based in HICs; eight reviews among these 14 included primary studies based in five LMICs.
“These reviews mostly included studies based in HICs. Eight reviews among these 14 included primary studies based in five LMICs [30, 35–38, 42, 43, 45].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [35]
All the reviews included studies based in HICs, and only eight reviews included a few studies based in five LMICs.
“All the reviews included studies based in HICs, and only eight reviews included a few studies based in five LMICs [30, 35–38, 42, 43, 45].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [35]
The primary outcomes for the reviews reporting promising effects were intake of FV, processed snacks, SSB, fat, protein, fibre and vitamins, frequency of regular meals, recommended calorie intake, healthy eating knowledge, and staying in school for having healthy lunch.
“The primary outcomes for these reviews were intake of FV [30, 32, 36–38, 42, 45], processed snacks [30, 36–38, 45], SSB [30, 35, 37], fat [37, 42], protein, fibre and vitamins [37], frequency of regular meals [30, 37, 38], recommended calorie intake [37, 42], healthy eating knowledge [30, 36], and staying in school for having healthy lunch [38].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [35]
Seven high-quality and one moderate-quality reviews (including 192 unique studies) reported promising effects of multi-component interventions on healthy eating behaviour.
“There were promising effects of multi-component interventions on healthy eating behaviour reported in seven high-quality [30, 32, 35–38, 45] and one moderate-quality reviews [42] (including 192 unique studies) [30, 32, 35–38, 42, 45].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [35]
The contents of healthy eating education components involved lessons on healthy eating, food labelling, healthy cooking, consequences of SSB intake, nutrition, food safety farmers' visits on healthy food cultivation, menu planning, healthy eating goal setting and self-monitoring, healthy food as rewards, and food tasting.
“The contents involved lessons on healthy eating [32, 37, 38, 42, 45], food labelling, healthy cooking [30, 36], consequences of SSB intake [35], nutrition, food safety farmers’ visits on healthy food cultivation [36], menu planning, healthy eating goal setting and self-monitoring, healthy food as rewards, and food tasting [38].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [35]
The contents of school environment change components involved increased availability of milk and protein and fresh fruits, free or subsidised FV, replacing SSB with healthier alternatives in vending machines, chef and staff consultations on healthy culinary lessons, and healthy eating posters around school.
“The contents involved increased availability of milk and protein [32, 35–38, 45] and fresh fruits [30], free or subsidised FV [35], replacing SSB with healthier alternatives (milk, water, juice) in vending machines [35], chef, staff consultations on healthy culinary lessons [36], and healthy eating posters around school [45].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [35]
These reviews mainly focused on interventions in HICs, with only 11 primary studies from LMICs (Ethiopia, India, Iran, Kenya, and Tunisia).
“These reviews mainly focused on interventions in HICs - only 11 primary studies were from LMICs (Ethiopia, India, Iran, Kenya, and Tunisia) [30, 35–38, 42, 45].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [35]
The family involvement components at the system level included communicating with families via newsletters, leaflets, emails, booklets, brochures and texts, organising parents' meetings, in-school learning sessions, food coupons and social support groups, and providing parents recipe guides.
“The family involvement components at the system level included communicating with families via newsletters [30, 32, 35, 37, 38], leaflets [30, 45], emails [35, 37], booklets [30], brochures [30] and texts [37], organising parents’ meetings [35, 45], in-school learning sessions, food coupons [37] and social support groups [35], and providing parents recipe guides [30].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [35]
The contents of family involvement components involved information on healthy eating knowledge, healthy cooking, feeding healthy foods to children at home, nutritional guidelines, coupons to purchase healthy foods, offering FV and free healthy foods.
“The contents involved information on healthy eating knowledge [30, 32, 35, 38, 42, 45], healthy cooking, feeding healthy foods to children at home [37], nutritional guidelines [38], coupons to purchase healthy foods [37], offering FV and free healthy foods [45].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [35]
The outcomes in the studies were measured by FFQ, 24 h dietary recalls, food diary, KAP survey, cognitive and attitudinal assessments, FV recall, number of days stayed, bought, ate healthy lunch at schools, snack scale, and 7-day recall, or 5-day food recall.
“The outcomes were measured by FFQ [32, 35–38, 42, 45], 24 h dietary recalls [32, 35–38, 45], food diary [38, 42], knowledge attitude practice (KAP) survey [32, 45], cognitive and attitudinal assessments [38], FV recall, number of days stayed, bought, ate healthy lunch at schools, snack scale [38], and 7-day recall [45], or 5-day food recall [42].”
From School-based healthy eating interventions for adolescents aged 10–19 years: an umbrella review (2024) · cites this paper as [35]
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- Authors
- Vézina-Im, L.-A., Beaulieu, D., Bélanger-Gravel, A., Boucher, D., Sirois, C., Dugas, M., & Provencher, V.
- Affiliations
- Université du Québec à Rimouski (CA)
- Quebec Research and Development Centre (CA)
- Université Laval (CA)
- Venue
- Public Health Nutrition
- Publisher
- Cambridge University Press (CUP)
- Published
- 2017-02-08
- Volume
- 20
- Issue
- 13
- Pages
- 2416-2431
- ISSN
- 1368-9800 (ISSN-L)
- 1475-2727
- PMC
- PMC10261378
- OpenAlex
- W2586227688
- Cited by
- 106
- References
- 137
- Citations by year
- 2026: 12 · 2025: 15 · 2024: 11 · 2023: 9 · 2022: 14 · 2021: 13 · 2020: 12 · 2019: 9 · 2018: 8 · 2017: 3
- FWCI
- 1.42
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Public Health Nutrition (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Corpus Université Laval (Université Laval) (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Health Professions › Speech and Hearing › School Health and Nursing Education
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Keywords
- sugar-sweetened beverages, school-based intervention, adolescents, health education, behaviour change techniques, environmental interventions, legislation, theory-based intervention, self-monitoring, goal setting
- MeSH terms
- Healthy Lifestyle, Diet, Healthy, Dietary Sugars, Adolescent, Adolescent Behavior, Beverages, Child, Child Behavior, Child Nutritional Physiological Phenomena, Choice Behavior, Humans, Patient Compliance, Schools, Adolescent Nutritional Physiological Phenomena, Evidence-Based Medicine
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