Adolescents are high consumers of sugar-sweetened beverages (SSB), which contribute to overweight and obesity – a significant public health issue. Evidence suggests that replacing SSB with water and school-based interventions can reduce consumption. This study examines the acceptability of a previously trialled intervention (Thirsty? Choose Water!) in regional and remote secondary schools.

An open-label randomised controlled trial using a two-by-two factorial design tested the outcomes of a behavioural and/or environmental intervention on SSB and water consumption.

Regional and remote secondary schools (public, catholic and independent) within the boundaries of two regional Local Health Districts within New South Wales.

Twenty-four schools participated in the study. The target group was year 7 students (n 1640) – 72 % of eligible students completed baseline data. The study followed students into year 8 (n 1188) – 52 % of eligible students completed post-intervention data. Forty teachers undertook training to deliver the intervention.

Interventions showed high levels of acceptability. Students demonstrated changes in knowledge, attitudes and consumption behaviours. Multivariable ordinal logression analysis demonstrated that all interventions increased the odds of students increasing their water consumption (though not statistically significant). Conversely, the combined (OR: 0·75; 95 % CI: 0·59, 0·97) or environmental intervention (OR: 0·68; 95 % CI: 0·51, 0·90) had greater odds of reducing SSB consumption and was statistically significant.

This study builds on recent Australian evidence regarding the impact of school-based interventions on water and SSB consumption. In this study, despite a minor intervention change, and the impacts of fires, floods and COVID-19 on study implementation, the interventions were highly regarded by the school communities with positive outcomes.

To evaluate implementation and effectiveness of nutrition promotion programmes using the health-promoting schools (HPS) approach, to indicate areas where further research is needed and to make recommendations for practice in this field.

The searched electronic databases included: CINAHL, Cochrane Library, Health Reference Center, Informit Search, MEDLINE, ProQuest, PsycINFO, PubMed, ScienceDirect, Scopus, Social Services Abstracts and Web of Science. Inclusion criteria were: (i) controlled or before-and-after studies evaluating a nutrition intervention and involving the HPS approach, either fully or in part; (ii) provision of information about components and delivery of the intervention; and (iii) report on all evaluated outcomes.

Schools.

Students, parents and school staff.

All included studies described intervention delivery and six reported on process evaluation. In intervention schools school environment and ethos were more supportive, appropriate curriculum was delivered and parents and/or the community were more engaged and involved. Students participated in interventions at differing levels, but the majority was satisfied with the intervention. The evidence indicates that nutrition promotion programmes using the HPS approach can increase participants’ consumption of high-fibre foods, healthier snacks, water, milk, fruit and vegetables. It can also reduce participants’ ‘breakfast skipping’, as well as reduce intakes of red food, low-nutrient dense foods, fatty and cream foods, sweet drinks consumption and eating disorders. It can help to develop hygienic habits and improved food safety behaviours.

More professional training for teachers in the HPS approach, further qualitative studies, longer intervention periods, improved follow-up evaluations and adequate funding are required for future school-based nutrition promotion programmes.

Although teachers are the key participants in health-promoting schools (HPS) programme delivery, it is still unknown whether teachers are appropriate health information resources and role models for students with respect to healthy diets. The present study aimed to investigate the effects of implementing HPS programmes on teachers’ nutrition knowledge and diets.

One HPS programme aiming at dietary intervention (HP-D) and one HPS not aiming at dietary intervention (HP-ND) were selected, along with two non-health-promoting (NHP) schools matched for school size and urbanization level with the two HPS. All 361 teachers in the four schools were invited to participate, yielding a 78·4 % overall valid response rate. A structured, self-reported questionnaire was administered, with regression models used for statistical analysis.

Teachers in the HP-D group had a mean score of 21·1 on a range of 0–30 for nutrition knowledge, which was significantly higher than the mean scores of 18·5 in the HP-ND group and 19·1 in the NHP group (P < 0·001). Better dietary behaviours were also observed among HP-D teachers. Further, being a ‘health education’ course instructor was associated with significantly higher scores on nutrition knowledge (β = 2·6, P < 0·001) and vegetable and fruit consumption (β = 1·4, P = 0·02) in the HP-D group than in the NHP group. The HP-ND and NHP groups exhibited similar patterns of non-significant differences compared with the HP-D group.

Implementation of a coordinated HPS framework on nutrition and diet was positively correlated with schoolteachers’ nutrition knowledge and dietary intake.