Percepções de escolares e merendeiras sobre alimentação escolar: uma análise por grupos focais / Perceptions of schoolchildren and lunch ladies about school meals: a focus groups analysis

Resumo Introdução: O Programa Nacional de Alimentação Escolar (PNAE) destaca-se por ser um dos maiores programas do mundo de alimentação escolar, contemplando o Direito Humano à Alimentação Adequada a estudantes brasileiros. Entretanto, alguns estudos têm observado baixa aceitabilidade e adesão à alimentação escolar. Objetivo: Analisar a percepção de merendeiras e escolares acerca da aceitabilidade e adesão à alimentação escolar. Metodologia: Pesquisa qualitativa realizada através de grupos focais com merendeiras de três escolas e escolares do sexto ao nono ano de escola pública de Sumidouro, Rio de Janeiro, Brasil. Os grupos focais foram realizados utilizando-se roteiros semiestruturados e gravados em áudio e vídeo, posteriormente transcritos e analisados por Análise de Conteúdo. Resultados: Foram identificados seis temas: autoconhecimento, adesão, aceitabilidade, preparo e distribuição da alimentação escolar, cardápio e ambiente. Conclusão: O emprego de esforços na melhoria da infraestrutura e aspecto do ambiente alimentar, com a aquisição de utensílios adequados, alteração no modelo de serviço de distribuição e no modo de preparo das refeições, resultando em cardápios variados, são estratégias que podem contribuir para melhorar a adesão e aceitabilidade à alimentação escolar. Essas mudanças favorecem a promoção de saúde no espaço escolar, com foco em políticas públicas saudáveis.

Abstract Introduction: National School Feeding Program (PNAE) stands out for being one of the largest school feeding programs in the world, contemplating the Human Right to Adequate Food for Brazilian students. However, some research works have observed low acceptability and adherence to school meals. Objective: To analyze the perception of school lunch ladies and students about acceptability and adherence to school meals. Methodology: Qualitative research carried out through focus groups with lunch ladies from three schools and students from the sixth to the ninth grade of a public school in Sumidouro, Rio de Janeiro state, Brazil. The focus groups were carried out using semi-structured scripts and recorded in audio and video, later transcribed and analyzed by Content Analysis. Results: Six themes were identified: self-knowledge, adherence, acceptability, preparation and distribution of school meals, menu and environment. Conclusion: The use of efforts to improve the infrastructure and aspect of the food environment, with the acquisition of adequate utensils, change in the distribution service model and in the way of preparing meals, resulting in varied menus, are strategies that can contribute to improve adherence and acceptability to school meals. These changes favor the promotion of health in the school environment, focusing on healthy public policies.

Environment modification at school to promote physical activity among adolescents: a cluster randomized controlled trial.

OBJECTIVE: To assess the effect of modifications of the school environment on physical activity in Brazilian adolescent students. METHODS: Seven public schools in Duque de Caxias (Brazil) were randomized into control and intervention groups. The intervention group underwent modifications in the school environment (painting of hopscotch and school courts) and the provision of sports equipment (balls, basketball table, soccer goalpost, volleyball nets, and others) to stimulate physical activity. Additionally, footsteps towards the court and materials were painted, and a superhero character called Super Active was introduced. Total physical activity was measured using a validated questionnaire for adolescents. Generalized linear models were used to evaluate the effect of the intervention, adjusted by sex. RESULTS: The sample consisted of 975 adolescents, with a mean age of 11.52 years (standard deviation - SD 1.43), and 56.7% were boys. After the one-month intervention, both groups' total physical activity time increased. The estimated changes from baseline were not different between the intervention and control groups (Δ=102.75 and Δ=99.76, respectively; p=0.52). CONCLUSION: The painting, supply of equipment and other strategies to encourage physical activity in the school environment did not promote a positive effect on improving physical activity among adolescents. Future research is necessary to evaluate the effect of the intervention in the long-term period, particularly in other population contexts in middle-income countries.

Environment modification at school to promote physical activity among adolescents: a cluster randomized controlled trial / Modificação do ambiente para a promoção da atividade física em adolescentes brasileiros: ensaio controlado randomizado em cluster

ABSTRACT: Objective: To assess the effect of modifications of the school environment on physical activity in Brazilian adolescent students. Methods: Seven public schools in Duque de Caxias (Brazil) were randomized into control and intervention groups. The intervention group underwent modifications in the school environment (painting of hopscotch and school courts) and the provision of sports equipment (balls, basketball table, soccer goalpost, volleyball nets, and others) to stimulate physical activity. Additionally, footsteps towards the court and materials were painted, and a superhero character called Super Active was introduced. Total physical activity was measured using a validated questionnaire for adolescents. Generalized linear models were used to evaluate the effect of the intervention, adjusted by sex. Results: The sample consisted of 975 adolescents, with a mean age of 11.52 years (standard deviation — SD 1.43), and 56.7% were boys. After the one-month intervention, both groups' total physical activity time increased. The estimated changes from baseline were not different between the intervention and control groups (Δ=102.75 and Δ=99.76, respectively; p=0.52). Conclusion: The painting, supply of equipment and other strategies to encourage physical activity in the school environment did not promote a positive effect on improving physical activity among adolescents. Future research is necessary to evaluate the effect of the intervention in the long-term period, particularly in other population contexts in middle-income countries.

RESUMO: Objetivo: Avaliar o efeito da modificação do ambiente escolar sobre a atividade física em estudantes adolescentes brasileiros. Métodos: Sete escolas públicas em Duque de Caxias (Brasil) foram aleatorizadas em grupos controle e intervenção. O grupo de intervenção sofreu modificações no ambiente escolar (pintura de quadra esportiva e amarelinhas) e no fornecimento de equipamento esportivo (bolas, tabela de basquete, gol, rede para vôlei e outros) para estimular a atividade física. Além disso, foram pintados passos em direção à quadra e materiais, e foi introduzida uma personagem de super-herói chamada Super Ativa. A atividade física total foi medida com o uso de um questionário validado para adolescentes. Foram utilizados modelos lineares generalizados para avaliar o efeito da intervenção, ajustados por sexo. Resultados: A amostra consistiu em 975 adolescentes, com idade média de 11,52 anos (desvio padrão — DP 1,43) e 56,7% eram meninos. Após a intervenção de um mês, o tempo total de atividade física aumentou em ambos os grupos. Contudo, as mudanças estimadas em relação à linha de base não foram diferentes entre os grupos de intervenção e controle (Δ=102,75 e Δ=99,76, respectivamente; p=0,52). Conclusão: A pintura, o fornecimento de equipamentos e as demais estratégias de estímulo à prática de atividade física no ambiente escolar não promoveram efeito positivo na melhoria da atividade física entre os adolescentes. São necessários estudos futuros para avaliar o efeito da intervenção em longo prazo, particularmente em outros contextos populacionais, em países de média renda.

Effectiveness of a school-based randomized controlled trial aimed at increasing physical activity time in adolescents.

BACKGROUND: This study aimed to evaluate the effectiveness of obesity prevention educational activities, isolated or combined with the modification of the school environment on total physical activity time. METHODS: This is a school-based randomized controlled trial, conducted with 2511 students from fifth and sixth-grade in Brazil, that employed a parallel, three-group experimental arms: control group (CG), PAAPPAS group (PG) and PAAPPAS-environment group (PEG). During the 2016 school year, the PG received educational activities in the classroom, providing a general basis for a healthy lifestyle. The PEG received the same educational activities and also modifications in the school environment to stimulate physical activity practice during one month. Physical activity was evaluated through a validated physical activity questionnaire. Intention-to-treat analysis was performed to evaluate the rate of change of physical activity time between groups using PROC GENMOD procedure. All analyses were performed using SAS. RESULTS: Total physical activity time increased by 22% in PEG compared with CG (P = 0.003). No difference was observed between PEG and PG (Δ = 60.20 vs. 36.37, respectively; P = 0.27) and between PG and CG (Δ = 36.37 vs. 9.70, respectively; P = 0.23). The proportion of individuals who attended at least 150 min week-1 of physical activity increased in PEG compared with PG (P = 0.04); however, no difference was observed between PEG and CG (P = 0.19) and between PG and CG (P = 0.26). For 300 min week-1, no difference was observed between groups. CONCLUSION: A school-based multi-component intervention including modification of the school environment was effective for increasing physical activity time among adolescents.

Arquitetura de escolhas como estratégia para promoção da atividade física em adolescentes: um ensaio comunitário randomizado / Choices architecture as a strategy to promote physical activity in students adolescents: a randomized community trial

O tempo gasto em atividade física pelos adolescentes em diferentes países é menor do que o recomendado. Considerando que o hábito da inatividade física tende a perdurar ao longo da vida e sendo também um dos principais fatores de risco ligado a diversas doenças crônicas na fase adulta, estratégias têm sido elaboradas com o objetivo de promover a atividade física. O tempo que destinamos a atividade física é diretamente influenciado pelo ambiente físico que frequentamos. Diante do exposto, o objetivo desse estudo consistiu em verificar o efeito de uma intervenção de modificação de ambiente para promoção de atividade física em adolescentes escolares. Trata-se de um ensaio randomizado controlado de base escolar com 7 escolas estaduais do município de Duque de Caxias, região metropolitana do Rio de Janeiro. Participaram do estudo os alunos do 5º e 6º ano dessas escolas. As escolas foram randomizadas em dois grupos: um grupo controle (3 escolas) e um grupo intervenção (4 escolas). Nas escolas intervenção o ambiente foi alterado durante o recesso escolar visando promover aumento de atividade física no retorno às aulas. Material esportivo foi exposto aos alunos e demarcação de quadra para prática de atividade física foi feito nas escolas intervenção. A variável de desfecho foi o tempo gasto em atividade física durante a semana aferido através de questionário validado para escolares. As informações foram coletadas na linha de base no início do ano letivo e no final do ano letivo. Modelos lineares de efeitos mistos foram usados para avaliar o efeito da intervenção no tempo gasto em atividade física. Participaram do estudo 975 crianças (56,7% meninos), com idade média de 11.52 (DP 1.43). Nas turmas de 6º ano, meninos do grupo intervenção apresentaram maior chance de aumentarem o tempo gasto em atividade física após intervenção, com um OR: 1,45 (IC 95% = 1,11 - 1,89.), para os meninos comparados aos meninos do grupo controle. Entre as meninas esse valor foi de OR: 1,44 (IC 95% = 1,06 ­ 1,97). Nas turmas do 5º ano, os meninos do grupo experimental tiveram menor chance de aumentarem o tempo gasto em atividade física que o grupo controle OR: 0,56 (IC 95% = 0,42 ­ 0,76), entre as meninas não foi observada associação. Conclui-se que melhorar as condições do meio ambiente para promoção de atividade física foi eficaz para os adolescentes mais velhos. Trata-se de uma estratégia simples e barata que deve ser melhor explorada nos futuros estudos para promover o tempo gasto em atividade física em escolares. Estudos futuros devem avaliar que tipo de atividade pode ser promovida para os mais jovens

The time spent on physical activity by adolescents in different countries is lower than recommended. Considering that the habit of physical inactivity tends to last throughout life and is also one of the main risk factors linked to several chronic diseases in adulthood, strategies have been elaborated with the objective of promoting physical activity. The time we allocate to physical activity is directly influenced by the physical environment we attend. In view of the above, the objective of this study was to verify the effect of an environment modification intervention to promote physical activity in school adolescents. It is a randomized controlled trial of school base with 7 state schools in the municipality of Duque de Caxias, metropolitan region of Rio de Janeiro. The students in the 5th and 6th years of these schools participated in the study. The schools were randomized into two groups: one control group (3 schools) and one intervention group (4 schools). In the intervention schools, the environment was changed during school recess, aiming to increase physical activity in the return to class. Sports material was exposed to the students and demarcation of court for physical activity practice was done in intervention schools. The outcome variable was the time spent in physical activity during the week measured through a questionnaire validated for schoolchildren. Information was collected at the baseline at the beginning of the school year and at the end of the school year. Linear models of mixed effects were used to evaluate the effect of the intervention on the time spent in physical activity. A total of 975 children (56.7% boys) participated in the study, with a mean age of 11.52 (SD 1.43). In the 6th grade groups, boys in the intervention group had a greater chance of increasing the time spent on physical activity after intervention, with an OR: 1.45 (95% CI = 1.11 - 1.89) for boys compared to the control group. Among girls, this value was OR: 1.44 (95% CI = 1.06 - 1.97). In the 5th grade, the boys in the experimental group had a lower chance of increasing the time spent in physical activity than the control group: OR 0.56 (95% CI = 0.42-0.76); observed association. It was concluded that improving the conditions of the environment for promoting physical activity was effective for older adolescents. It is a simple and inexpensive strategy that should be better explored in future studies to promote the time spent on physical activity in schoolchildren. Future studies should assess what type of activity can be promoted for younger people