IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0172332.html
   My bibliography  Save this article

Costs and effects of a state-wide health promotion program in primary schools in Germany – the Baden-Württemberg Study: A cluster-randomized, controlled trial

Author

Listed:
  • Dorothea Kesztyüs
  • Romy Lauer
  • Tibor Kesztyüs
  • Reinhold Kilian
  • Jürgen M Steinacker
  • on behalf of the “Join the Healthy Boat” Study Group

Abstract

Aim: To evaluate the cost-effectiveness of the state-wide implementation of the health promotion program “Join the Healthy Boat” in primary schools in Germany. Methods: Cluster-randomized intervention trial with wait-list control group. Anthropometric data of 1733 participating children (7.1 ± 0.6 years) were taken by trained staff before and after a one year intervention period in the academic year 2010/11. Parents provided information about the health status, and the health behaviour of their children and themselves, parental anthropometrics, and socio-economic background variables. Incidence of abdominal obesity, defined as waist-to-height ratio (WHtR) ≥ 0.5, was determined. Generalized linear models were applied to account for the clustering of data within schools, and to adjust for baseline-values. Losses to follow-up and missing data were analysed. From a societal perspective, the overall costs, costs per pupil, and incremental cost-effectiveness ratio (ICER) to identify the costs per case of averted abdominal obesity were calculated. Results: The final regression model for the incidence of abdominal obesity shows lower odds for the intervention group after an adjustment for grade, gender, baseline WHtR, and breakfast habits (odds ratio = 0.48, 95% CI [0.25; 0.94]). The intervention costs per child/year were €25.04. The costs per incidental case of averted abdominal obesity varied between €1515 and €1993, depending on the different dimensions of the target group. Conclusion: This study demonstrates the positive effects of state-wide, school-based health promotion on incidental abdominal obesity, at affordable costs and with proven cost-effectiveness. These results should support allocative decisions of policymakers. An early start to the prevention of abdominal obesity is of particular importance because of its close relationship to non-communicable diseases. Trial registration: German Clinical Trials Register (DRKS), Freiburg University, Germany, DRKS-ID: DRKS00000494.

Suggested Citation

  • Dorothea Kesztyüs & Romy Lauer & Tibor Kesztyüs & Reinhold Kilian & Jürgen M Steinacker & on behalf of the “Join the Healthy Boat” Study Group, 2017. "Costs and effects of a state-wide health promotion program in primary schools in Germany – the Baden-Württemberg Study: A cluster-randomized, controlled trial," PLOS ONE, Public Library of Science, vol. 12(2), pages 1-18, February.
    • Handle: RePEc:plo:pone00:0172332
    DOI: 10.1371/journal.pone.0172332
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0172332
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0172332&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0172332?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Dorothea Kesztyüs & Romy Lauer & Anja Schreiber & Tibor Kesztyüs & Reinhold Kilian & Jürgen Steinacker, 2014. "Parents’ willingness to pay for the prevention of childhood overweight and obesity," Health Economics Review, Springer, vol. 4(1), pages 1-8, December.
    2. Jean-Pierre Després & Isabelle Lemieux, 2006. "Abdominal obesity and metabolic syndrome," Nature, Nature, vol. 444(7121), pages 881-887, December.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Hsin-Han Chen & Hui-Ling Chen & Yi-Tien Lin & Chaou-Wen Lin & Chien-Chang Ho & Hsueh-Yi Lin & Po-Fu Lee, 2020. "The Associations between Functional Fitness Test Performance and Abdominal Obesity in Healthy Elderly People: Results from the National Physical Fitness Examination Survey in Taiwan," IJERPH, MDPI, vol. 18(1), pages 1-14, December.
    2. Saaket Agrawal & Marcus D. R. Klarqvist & Nathaniel Diamant & Takara L. Stanley & Patrick T. Ellinor & Nehal N. Mehta & Anthony Philippakis & Kenney Ng & Melina Claussnitzer & Steven K. Grinspoon & Pu, 2023. "BMI-adjusted adipose tissue volumes exhibit depot-specific and divergent associations with cardiometabolic diseases," Nature Communications, Nature, vol. 14(1), pages 1-10, December.
    3. Dionysios V Chartoumpekis & Apostolos Zaravinos & Panos G Ziros & Ralitsa P Iskrenova & Agathoklis I Psyrogiannis & Venetsana E Kyriazopoulou & Ioannis G Habeos, 2012. "Differential Expression of MicroRNAs in Adipose Tissue after Long-Term High-Fat Diet-Induced Obesity in Mice," PLOS ONE, Public Library of Science, vol. 7(4), pages 1-13, April.
    4. Kang Chen & Lai Yee Cheong & Yuan Gao & Yaming Zhang & Tianshi Feng & Qin Wang & Leigang Jin & Eric Honoré & Karen S. L. Lam & Weiping Wang & Xiaoyan Hui & Aimin Xu, 2022. "Adipose-targeted triiodothyronine therapy counteracts obesity-related metabolic complications and atherosclerosis with negligible side effects," Nature Communications, Nature, vol. 13(1), pages 1-20, December.
    5. Purificación Gómez-Abellán & Antoni Díez-Noguera & Juan A Madrid & Juan A Luján & José M Ordovás & Marta Garaulet, 2012. "Glucocorticoids Affect 24 h Clock Genes Expression in Human Adipose Tissue Explant Cultures," PLOS ONE, Public Library of Science, vol. 7(12), pages 1-10, December.
    6. Sofia I I Kring & Claus Holst & Esther Zimmermann & Tine Jess & Tina Berentzen & Søren Toubro & Torben Hansen & Arne Astrup & Oluf Pedersen & Thorkild I A Sørensen, 2008. "FTO Gene Associated Fatness in Relation to Body Fat Distribution and Metabolic Traits throughout a Broad Range of Fatness," PLOS ONE, Public Library of Science, vol. 3(8), pages 1-7, August.
    7. Ming Zhao & Hongbo Lin & Yanyan Yuan & Fuyan Wang & Yang Xi & Li Ming Wen & Peng Shen & Shizhong Bu, 2016. "Prevalence of Pre-Diabetes and Its Associated Risk Factors in Rural Areas of Ningbo, China," IJERPH, MDPI, vol. 13(8), pages 1-13, August.
    8. Katharina Ruettger & Stacy A. Clemes & Yu-Ling Chen & Charlotte L. Edwardson & Amber Guest & Nicholas D. Gilson & Laura J. Gray & Vicki Johnson & Nicola J. Paine & Aron P. Sherry & Mohsen Sayyah & Jac, 2022. "Drivers with and without Obesity Respond Differently to a Multi-Component Health Intervention in Heavy Goods Vehicle Drivers," IJERPH, MDPI, vol. 19(23), pages 1-12, November.
    9. Shih-Chang Chen & Chaou-Wen Lin & Po-Fu Lee & Hui-Ling Chen & Chien-Chang Ho, 2021. "Anthropometric Characteristics in Taiwanese Adults: Age and Gender Differences," IJERPH, MDPI, vol. 18(14), pages 1-13, July.
    10. Aimee M. Deaton & Aditi Dubey & Lucas D. Ward & Peter Dornbos & Jason Flannick & Elaine Yee & Simina Ticau & Leila Noetzli & Margaret M. Parker & Rachel A. Hoffing & Carissa Willis & Mollie E. Plekan , 2022. "Rare loss of function variants in the hepatokine gene INHBE protect from abdominal obesity," Nature Communications, Nature, vol. 13(1), pages 1-12, December.
    11. Ashley Beckett & Jake Riley Scott & Angel Marie Chater & Louise Ferrandino & Jeffrey William Frederick Aldous, 2023. "The Prevalence of Metabolic Syndrome and Its Components in Firefighters: A Systematic Review and Meta-Analysis," IJERPH, MDPI, vol. 20(19), pages 1-14, September.
    12. Müller, Nathalie & Fallucchi, Francesco & Suhrcke, Marc, 2024. "Peer effects in weight-related behaviours of young people: A systematic literature review," Economics & Human Biology, Elsevier, vol. 53(C).
    13. Vincenzo Sicari & Irene Maria Grazia Custureri & Rosa Tundis & Monica Rosa Loizzo, 2023. "Comparison of Physicochemical Characteristics and Bioactivity of Olive Oil Mill Wastewaters from Traditional and Water-Saving ARA-Controlled Three-Phase Decanter," Sustainability, MDPI, vol. 15(5), pages 1-11, February.
    14. Shamim Shaikh Mohiuddin, 2019. "A Mini Review on Diagnostic Criteria of Metabolic Syndrome Associated with Chronic Obesity in Children and Adolescent," Current Research in Diabetes & Obesity Journal, Juniper Publishers Inc., vol. 9(3), pages 72-77, January.
    15. Hicken, Margaret T. & Lee, Hedwig & Hing, Anna K., 2018. "The weight of racism: Vigilance and racial inequalities in weight-related measures," Social Science & Medicine, Elsevier, vol. 199(C), pages 157-166.
    16. Ha-Jin Jang & Hannah Oh, 2021. "Trends and Inequalities in Overall and Abdominal Obesity by Sociodemographic Factors in Korean Adults, 1998–2018," IJERPH, MDPI, vol. 18(8), pages 1-19, April.
    17. Furong Xu & Jacob E. Earp & Alessandra Adami & Ingrid E. Lofgren & Matthew J. Delmonico & Geoffrey W. Greene & Deborah Riebe, 2022. "The Sex and Race/Ethnicity-Specific Relationships of Abdominal Fat Distribution and Anthropometric Indices in US Adults," IJERPH, MDPI, vol. 19(23), pages 1-12, November.
    18. Gregory E. Bigford & Luisa F. Betancourt & Susan Charlifue & Mark S. Nash, 2023. "Therapeutic Lifestyle Intervention Targeting Enhanced Cardiometabolic Health and Function for Persons with Chronic Spinal Cord Injury in Caregiver/Care-Receiver Co-Treatment: A Study Protocol of a Mul," IJERPH, MDPI, vol. 20(19), pages 1-22, September.
    19. Po-Fu Lee & Chien-Chang Ho & Nai-Wen Kan & Ding-Peng Yeh & Yun-Chi Chang & Yu-Jui Li & Ching-Yu Tseng & Xin-Yu Hsieh & Chih-Hui Chiu, 2020. "The Association between Physical Fitness Performance and Abdominal Obesity Risk among Taiwanese Adults: A Cross-Sectional Study," IJERPH, MDPI, vol. 17(5), pages 1-10, March.
    20. Koichiro Irie & Tatsuo Yamamoto & Tetsuji Azuma & Komei Iwai & Takatoshi Yonenaga & Takaaki Tomofuji, 2023. "Association between Periodontal Condition and Fat Distribution in Japanese Adults: A Cross-Sectional Study Using Check-Up Data," IJERPH, MDPI, vol. 20(3), pages 1-10, January.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0172332. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.