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Special Issue "Promoting Nutrition and Physical Activity in Education and Care Settings"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Children's Health".

Deadline for manuscript submissions: closed (30 September 2021).

Special Issue Editors

Dr. Sze Lin (Serene) Yoong
E-Mail Website
Guest Editor
School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales 2308, Australia
Interests: implementation science; policy; early childhood; nutrition; obesity prevention; online interventions
Dr. Nicole Nathan
E-Mail Website
Guest Editor
Hunter New England Population Health, Wallsend, New South Wales 2287, Australia
Interests: scalable interventions; schools; physical activity; policy
Prof. Dr. Rebecca Golley
E-Mail Website
Assistant Guest Editor
Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, South Australia 5001, Australia
Interests: nutrition; early years; obesity prevention
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Lifestyle behaviors including nutrition and physical activity track from childhood into adulthood, increasing the risk of developing both long and short-term chronic morbidities. The World Health Organization has recommended that education and care settings, including schools and childcare centers, play a role in supporting the development of healthy eating and activity behaviors. 

This Special Issue seeks to focus on policy-relevant and pragmatic studies undertaken in these settings that are related to improving diet, physical activity, and sedentary behaviors. In particular, we are looking for studies that have broader external validity, and have considered issues related to implementation, scaling up and cost. We are considering a range of research papers, including systematic reviews, trial and cost outcomes of interventions and/or high quality descriptive research.

We look forward to receiving your excellent submissions.

Dr. Sze Lin (Serene) Yoong
Dr. Nicole Nathan
Prof. Dr. Rebecca Golley
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2300 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • nutrition
  • physical activity
  • schools
  • early childhood and education care
  • pragmatic studies

Published Papers (12 papers)

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Research

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Article
The Relationship between Physical Activity, Self-Regulation and Cognitive School Readiness in Preschool Children
Int. J. Environ. Res. Public Health 2021, 18(22), 11797; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph182211797 - 10 Nov 2021
Viewed by 360
Abstract
(1) Background: Limited research exists on the pathways through which physical activity influences cognitive development in the early years. This study examined the direct and indirect relationships between physical activity, self-regulation, and cognitive school readiness in preschool children. (2) Method: Participants (n [...] Read more.
(1) Background: Limited research exists on the pathways through which physical activity influences cognitive development in the early years. This study examined the direct and indirect relationships between physical activity, self-regulation, and cognitive school readiness in preschool children. (2) Method: Participants (n = 56) aged 3–5 years were recruited from the PLAYCE study, Perth, Western Australia. Physical activity was measured using 7-day accelerometry. Self-regulation was measured using the Head Toes Knees and Shoulders task and cognitive school readiness was assessed using the Bracken School Readiness Assessment. Baron and Kenny’s method was used for mediation analysis. (3) Results: After adjustment for socio-demographic factors, total physical activity was positively and significantly associated with cognitive school readiness (B = 0.16, SE = 0.07, p ≤ 0.05). Moderate-vigorous physical activity (MVPA) was positively and significantly associated with self-regulation (B = 0.3, SE = 0.13, p ≤ 0.05) and cognitive school readiness score (B = 0.20, SE = 0.09, p ≤ 0.05). Self-regulation was found to be a partial mediator of the relationship between MVPA and cognitive school readiness. (4) Conclusion: These findings highlight the direct and indirect association between preschool children’s physical activity, self-regulation, and cognitive school readiness. Further research is needed to determine the causal relationships between young children’s physical activity and cognitive development, over time. Full article
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Article
The Families and Schools for Health Project: A Longitudinal Cluster Randomized Controlled Trial Targeting Children with Overweight and Obesity
Int. J. Environ. Res. Public Health 2021, 18(16), 8744; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18168744 - 19 Aug 2021
Cited by 1 | Viewed by 970
Abstract
This cluster randomized controlled trial aimed at overweight and obese children compared three treatments. Two psychoeducation interventions for parents and children were conducted: Family Lifestyle (FL) focused on food and physical activity; Family Dynamics (FD) added parenting and healthy emotion management. A third [...] Read more.
This cluster randomized controlled trial aimed at overweight and obese children compared three treatments. Two psychoeducation interventions for parents and children were conducted: Family Lifestyle (FL) focused on food and physical activity; Family Dynamics (FD) added parenting and healthy emotion management. A third Peer Group (PG) intervention taught social acceptance to children. Crossing interventions yielded four conditions: FL, FL + PG, FL + FD, and FL + FD + PG—compared with the control. Longitudinal BMI data were collected to determine if family- and peer-based psychosocial components enhanced the Family Lifestyle approach. Participants were 1st graders with BMI%ile >75 (n = 538: 278 boys, 260 girls). Schools were randomly assigned to condition after stratifying for community size and percent American Indian. Anthropometric data were collected pre- and post-intervention in 1st grade and annually through 4th grade. Using a two-level random intercept growth model, intervention status predicted differences in growth in BMI or BMI-M% over three years. Children with obesity who received the FL + FD + PG intervention had lower BMI gains compared to controls for both raw BMI (B = −0.05) and BMI-M% (B = −2.36). Interventions to simultaneously improve parent, child, and peer-group behaviors related to physical and socioemotional health offer promise for long-term positive impact on child obesity. Full article
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Article
Scaling up Action Schools! BC: How Does Voltage Drop at Scale Affect Student Level Outcomes? A Cluster Randomized Controlled Trial
Int. J. Environ. Res. Public Health 2021, 18(10), 5182; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18105182 - 13 May 2021
Viewed by 918
Abstract
Action Schools! BC (AS! BC) was scaled-up from an efficacy trial to province-wide delivery across 11 years (2004–2015). In this study we: (1) describe strategies that supported implementation and scale-up; (2) evaluate implementation (teachers’ physical activity (PA) delivery) and student’s PA and cardiorespiratory [...] Read more.
Action Schools! BC (AS! BC) was scaled-up from an efficacy trial to province-wide delivery across 11 years (2004–2015). In this study we: (1) describe strategies that supported implementation and scale-up; (2) evaluate implementation (teachers’ physical activity (PA) delivery) and student’s PA and cardiorespiratory fitness (CRF) within a cluster randomized controlled trial during years 2 and 3 of scale-up; and (3) assess relationships between teacher-level implementation and student-level outcomes. We classified implementation strategies as process, capacity-building or scale-up strategies. Elementary schools (n = 30) were randomized to intervention (INT; 16 schools; 747 students) or usual practice (UP; 14 schools; 782 students). We measured teachers’ PA delivery (n = 179) using weekly logs; students’ PA by questionnaire (n = 30 schools) and accelerometry (n = 9 schools); and students’ CRF by 20-m shuttle run (n = 25 schools). INT teachers delivered more PA than UP teachers in year 1 (+33.8 min/week, 95% CI 12.7, 54.9) but not year 2 (+18.8 min/week, 95% CI −0.8, 38.3). Unadjusted change in CRF was 36% and 27% higher in INT girls and boys, respectively, compared with their UP peers (year 1; effect size 0.28–0.48). Total PA delivered was associated with change in children’s self-reported MVPA (year 1; r = 0.17, p = 0.02). Despite the ‘voltage drop’, scaling-up school-based PA models is feasible and may enhance children’s health. Stakeholders must conceive of new ways to effectively sustain scaled-up health promoting interventions if we are to improve the health of students at a population level. Clinical Trials registration: NCT01412203. Full article
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Article
Implementation of Physical Activity in US Elementary Schools: The Role of Administrative Support, Financial Resources, and Champions
Int. J. Environ. Res. Public Health 2021, 18(9), 4476; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18094476 - 23 Apr 2021
Viewed by 765
Abstract
The intentional integration of physical activity in elementary school classrooms—including brief instructional breaks for activity, or integration into lessons—can benefit children’s physical activity and education outcomes. Teachers are key implementation agents, but despite physical activity in the classroom being an evidence-informed practice, many [...] Read more.
The intentional integration of physical activity in elementary school classrooms—including brief instructional breaks for activity, or integration into lessons—can benefit children’s physical activity and education outcomes. Teachers are key implementation agents, but despite physical activity in the classroom being an evidence-informed practice, many teachers do not regularly implement it. The aim of this study was to obtain updated nationally representative prevalence estimates in United States public elementary schools, regarding four key outcomes: (1) school adoption of physically active lessons (PA lessons); (2) school adoption of physical-activity breaks (PA breaks); (3) penetration in the classroom, defined as ≥50% of teachers using PA breaks; and (4) dose, defined as an average of at least 50 min per week of PA breaks. We examined variations in outcomes by school demographic characteristics, and by three factors hypothesized to be implementation facilitators (administrative support, financial resources, and presence of a wellness champion at the school). In the 2019–20 school year, surveys were distributed to a nationally representative sample of 1010 public elementary schools in the US; responses were obtained from 559 (55.3%). The weighted prevalence of schools reporting adoption of PA lessons was 77.9% (95% CI = 73.9% to 81.9%), and adoption of PA breaks was nearly universal at 91.2% (95% CI = 88.4% to 94.1%). Few demographic differences emerged, although adoption of PA lessons was less prevalent at higher-poverty schools (73.9%) and medium-poverty schools (77.0%) as compared to schools with lower poverty levels (87.1%; p < 0.01). Across all four outcomes, associations emerged with facilitators in multivariable logistic regression models. The prevalence of adoption of PA lessons, adoption of PA breaks, and dose of PA breaks were all significantly higher at schools where administrative encouragement occurred more frequently. Financial support was associated with implementation outcomes, including adoption of PA lessons, and penetration and dose of PA breaks. Presence of a champion was associated with higher prevalence of reporting adoption of PA lessons. School leaders can play a crucial role in supporting teachers’ implementation of PA breaks and lessons in the classroom, through providing financial resources, encouragement, and supporting champions. Effective school-leadership practices have the potential to positively impact students at a large-scale population level by supporting implementation of PA lessons and breaks. Full article
Article
An Overview of Research Opportunities to Increase the Impact of Nutrition Intervention Research in Early Childhood and Education Care Settings According to the RE-AIM Framework
Int. J. Environ. Res. Public Health 2021, 18(5), 2745; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18052745 - 08 Mar 2021
Viewed by 1388
Abstract
Objective: To highlight opportunities for future nutrition intervention research within early childhood and education care (ECEC) settings, with a focus on generating evidence that has applicability to real-world policy and practice. Methods: An overview of opportunities to progress the field was developed by [...] Read more.
Objective: To highlight opportunities for future nutrition intervention research within early childhood and education care (ECEC) settings, with a focus on generating evidence that has applicability to real-world policy and practice. Methods: An overview of opportunities to progress the field was developed by the authors using a collaborative writing approach and informed by recent research in the field. The group developed a list of recommendations aligned with the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) framework. Pairs of authors drafted individual sections of the manuscript, which were then reviewed by a separate pair. The first and senior author consolidated all sections of the manuscript and sought critical input on the draft iterations of the manuscript. Results: Interventions that employ digital platforms (reach) in ECEC settings, as well as research in the family day care setting (effectiveness) were identified as areas of opportunities. Research understanding the determinants of and effective strategies for dissemination (adoption), the implementation of nutrition programs, in addition to de-implementation (implementation) of inappropriate nutrition practices, is warranted. For maintenance, there is a need to better understand sustainability and the sustainment of interventions, in addition to undertaking policy-relevant research. Conclusions: The ECEC setting is prime for innovative and practical nutrition intervention research. Full article
Article
Stakeholder Generated Ideas for Alternative School Food Provision Models in Australia Using the Nominal Group Technique
Int. J. Environ. Res. Public Health 2020, 17(21), 7935; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17217935 - 29 Oct 2020
Cited by 2 | Viewed by 1823
Abstract
Good nutrition is important for children’s learning, growth, and development, yet food intake during school hours does not align with recommendations. In Australia, most school children currently bring a packed lunch from home, but what if there was a different way? This project [...] Read more.
Good nutrition is important for children’s learning, growth, and development, yet food intake during school hours does not align with recommendations. In Australia, most school children currently bring a packed lunch from home, but what if there was a different way? This project aimed to engage a diverse range of stakeholders to (1) generate, refine and prioritize ideas for novel models of food provision to Australian children within school hours, and (2) to determine and rank the potential barriers and facilitators to changing the school food provision system. This study used nominal group technique virtual workshops—three idea generation workshops (n = 21 participants) and one consensus workshop (n = 11 participants). School lunch prepared onsite was the top ranked food provision model option based on impact and achievability. Potential barriers (n = 26) and facilitators (n = 28) to changing the school food system were generated. The top ranked barrier and facilitator related to government support. This study highlights that there is an opportunity to explore partnerships and utilize existing skills and infrastructure to introduce a universal school-provided lunch model in Australia. The next steps should focus on building the business case capturing the social value of investing in school lunches, including considering parent-paid and subsidized options. Full article
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Article
Childcare Food Provision Recommendations Vary across Australia: Jurisdictional Comparison and Nutrition Expert Perspectives
Int. J. Environ. Res. Public Health 2020, 17(18), 6793; https://doi.org/10.3390/ijerph17186793 - 17 Sep 2020
Cited by 3 | Viewed by 3937
Abstract
Early childhood is a critical stage for nutrition promotion, and childcare settings have the potential for wide-reaching impact on food intake. There are currently no Australian national guidelines for childcare food provision, and the comparability of existing guidelines across jurisdictions is unknown. This [...] Read more.
Early childhood is a critical stage for nutrition promotion, and childcare settings have the potential for wide-reaching impact on food intake. There are currently no Australian national guidelines for childcare food provision, and the comparability of existing guidelines across jurisdictions is unknown. This project aimed to map and compare childcare food provision guidelines and to explore perspectives amongst early childhood nutrition experts for alignment of jurisdictional childcare food provision guidelines with the Australian Dietary Guidelines (ADG). A desktop review was conducted and formed the basis of an online survey. A national convenience sample of childhood nutrition experts was surveyed. Existing guideline recommendations for food group serving quantities were similar across jurisdictions but contained many minor differences. Of the 49 survey respondents, most (84–100%) agreed with aligning food group provision recommendations to provide at least 50% of the recommended ADG serves for children. Most (94%) agreed that discretionary foods should be offered less than once per month or never. Jurisdictional childcare food provision guidelines do not currently align, raising challenges for national accreditation and the provision of support and resources for services across jurisdictions. Childhood nutrition experts support national alignment of food provision guidelines with the ADG. Full article
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Article
A Three-Arm Randomised Controlled Trial of High- and Low-Intensity Implementation Strategies to Support Centre-Based Childcare Service Implementation of Nutrition Guidelines: 12-Month Follow-Up
Int. J. Environ. Res. Public Health 2020, 17(13), 4664; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17134664 - 29 Jun 2020
Viewed by 901
Abstract
The study aimed to compare the effectiveness of a suite of implementation strategies of varying intensities on centre-based childcare service implementation of nutrition guideline recommendations at 12-month follow-up. A six-month three-arm parallel group randomised controlled trial was undertaken with 69 services, randomised to [...] Read more.
The study aimed to compare the effectiveness of a suite of implementation strategies of varying intensities on centre-based childcare service implementation of nutrition guideline recommendations at 12-month follow-up. A six-month three-arm parallel group randomised controlled trial was undertaken with 69 services, randomised to one of three arms: high-intensity strategies (executive support; group face-to-face training; provision of resources; multiple rounds of audit and feedback; ongoing face-to-face and phone support); low-intensity strategies (group face-to-face training; provision of resources; single round of audit and feedback); or usual care control. Across all study arms, only three high-intensity services were compliant with overall nutrition guidelines. A significant group interaction was found between the three arms for compliance with individual food groups. Relative to control, a significantly greater proportion of low-intensity services were compliant with dairy, and a significantly greater proportion of high-intensity services were compliant with fruit, vegetables, dairy, breads and cereals, and discretionary foods. No significant differences between the high- and low-intensity for individual food group compliance were found. High-intensity implementation strategies may be effective in supporting childcare service implementation of individual food group recommendations. Further research is warranted to identify strategies effective in increasing overall nutrition compliance. Full article
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Article
The Impact of a Gradual Healthier Assortment among Vocational Schools Participating in a School Canteen Programme: Evidence from Sales and Student Survey Data
Int. J. Environ. Res. Public Health 2020, 17(12), 4352; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17124352 - 17 Jun 2020
Cited by 1 | Viewed by 1495
Abstract
Many adolescents have poor eating habits. As a major part of their caloric intake takes place at school, the present study aims to examine the effect of increasing the availability of healthier foods in school canteens on sales, student attitude and self-reported behaviour. [...] Read more.
Many adolescents have poor eating habits. As a major part of their caloric intake takes place at school, the present study aims to examine the effect of increasing the availability of healthier foods in school canteens on sales, student attitude and self-reported behaviour. A quasi-experimental study was carried out at two vocational schools in the Netherlands over a 10-month period, where the visible share of healthier products was gradually or abruptly increased from 60% to 80%. Outcome measures were sales data for healthier and less healthy foods and drinks in the canteens, as well as surveys. The proportion of healthier products sold increased from 31.1% during the baseline period to 35.9% in the final period. A gradual increase led to higher relative sales of healthier products (40%) than an abrupt change (34.5%). Survey data showed that students’ moderate satisfaction remained insensitive to the changes over time. Overall, results suggest that increasing the availability of healthier products in school canteens leads to small positive changes in sales of products, particularly in the product groups beverages and sandwiches. A gradual introduction may ensure that students slowly get used to assortment changes. Full article
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Article
Knowledge, Attitudes and Practices of Australian Trainee Childcare Educators Regarding Their Role in the Feeding Behaviours of Young Children
Int. J. Environ. Res. Public Health 2020, 17(10), 3712; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17103712 - 25 May 2020
Cited by 5 | Viewed by 1401
Abstract
Background: Early childhood (2–5 years) is acknowledged as a critical time for the establishment of healthy behaviours. The increasing number of children and amount of time spent in childcare provides strong rationale to explore the important role that childcare services and childcare [...] Read more.
Background: Early childhood (2–5 years) is acknowledged as a critical time for the establishment of healthy behaviours. The increasing number of children and amount of time spent in childcare provides strong rationale to explore the important role that childcare services and childcare educators play in influencing healthy eating behaviours of young children in their care. Methods: This study used a qualitative exploratory approach to describe the knowledge, attitudes and practices of Australian childcare trainee educators’ regarding their role in the feeding of young children. Results: All participants agreed that feeding of young children was an important part of their role, but described challenges to the promotion of healthy eating and the adoption of responsive child feeding practices. These included personal beliefs and experiences with food, the bi-directional nature of child feeding, conflicting parental requests and/or unsupportive centre-based policies and procedures. Conclusion: Training about responsive child feeding practices within the childcare sector should include all childcare staff; aim to enhance relational efficacy and communication skills with parents; and empower childcare staff to lead organisational change. To support this, childcare centres need to provide coherent centre-based healthy eating policies inclusive of healthy food provision and desirable feeding practices. Full article

Review

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Review
Strategies for Teachers to Promote Physical Activity in Early Childhood Education Settings—A Scoping Review
Int. J. Environ. Res. Public Health 2021, 18(3), 867; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18030867 - 20 Jan 2021
Cited by 1 | Viewed by 1541
Abstract
Recent evidence has emphasized the importance of the early childhood years for developing lifelong physical activity patterns. As such, evidence-informed programs that create opportunities for young children to engage in physical activity are needed and education settings present an important context. This review [...] Read more.
Recent evidence has emphasized the importance of the early childhood years for developing lifelong physical activity patterns. As such, evidence-informed programs that create opportunities for young children to engage in physical activity are needed and education settings present an important context. This review aimed to identify strategies that are implemented by teachers to promote physical activity in early childhood education and care settings. This is a scoping review that followed the framework proposed by the Joanna Briggs Institute. Searches were conducted using the databases of PubMed, SCOPUS, PsycINFO, SPORT Discus, ERIC and Web of Science for publications up to September 2020. From a total of 8974 articles, 19 were deemed eligible. Ten types of strategies, performed by teachers with the intention to improve physical activity-related primary outcomes, were identified. Physical activity promotion by teachers in early childhood settings is recommended to take a multi-strategy approach, in conjunction with professional development training opportunities and continuous follow-up support for teachers. Future work is warranted to fill the evidence gap in other regions (e.g., Asia, Africa and South America) and strengthen the evidence base to establish best practice standards. Full article
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Review
The Efficacy of Workplace Interventions on Improving the Dietary, Physical Activity and Sleep Behaviours of School and Childcare Staff: A Systematic Review
Int. J. Environ. Res. Public Health 2020, 17(14), 4998; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17144998 - 11 Jul 2020
Cited by 2 | Viewed by 1596
Abstract
There is a need for effective interventions that improve the health and wellbeing of school and childcare staff. This review examined the efficacy of workplace interventions to improve the dietary, physical activity and/or sleep behaviours of school and childcare staff. A secondary aim [...] Read more.
There is a need for effective interventions that improve the health and wellbeing of school and childcare staff. This review examined the efficacy of workplace interventions to improve the dietary, physical activity and/or sleep behaviours of school and childcare staff. A secondary aim of the review was to assess changes in staff physical/mental health, productivity, and students’ health behaviours. Nine databases were searched for controlled trials including randomised and non-randomised controlled trials and quasi-experimental trials published in English up to October 2019. PRISMA guidelines informed screening and study selection procedures. Data were not suitable for quantitative pooling. Of 12,396 records screened, seven articles (based on six studies) were included. Most studies used multi-component interventions including educational resources, work-based wellness committees and planned group practice (e.g., walking groups). Multiple outcomes were assessed, findings were mixed and on average, there was moderate risk of bias. Between-group differences in dietary and physical activity behaviours (i.e., fruit/vegetable intake, leisure-time physical activity) favoured intervention groups, but were statistically non-significant for most outcomes. Some of the studies also showed differences favouring controls (i.e., nutrient intake, fatty food consumption). Additional robust studies testing the efficacy of workplace interventions to improve the health of educational staff are needed. Full article
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