Scientific Publications

APPLE Schools is nationally and internationally recognized as an exemplary school health promotion project. The prestigious National Cancer Institute has listed APPLE Schools on its Research-Tested Intervention Programs (RTIP) database webpage. 

All scientific publications posted on this webpage have been conducted by researchers from the University of Alberta School of Public health. Download the list of publications here

“It trickles into the community”: A case study of the transfer of health promoting practices from school to community in Canada

Discover how APPLE Schools’ intervention extends beyond the classroom in our latest research paper. Focused on a community in Alberta, Canada, this study investigates the broader impact of our holistic approach to children’s health. Through interviews and document analysis, we explore how APPLE Schools fosters a healthier community environment by bridging school and community efforts.

Delivering Health Promotion During School Closures in Public Health Emergencies: Building Consensus among Canadian Experts

APPLE Schools is renowned for its innovation in education and worked to continue to innovate its strategies during the COVID-19 pandemic when schools were closed. These innovative activities are now recognized as effective practices that can support schools during public health emergencies and natural disasters.

Learn more about the research by clicking the link below, or check out the list of activities on Beyond School Walls!

Parental Perspectives of Sleep in the Home: Shaping Home-School Partnerships in School-Based Sleep Promotion Initiatives

We know that sleep is critical to child health and preventing chronic disease. This study found that parents strongly value healthy sleep practices and support school-based sleep promotion. To be effective, sleep promotion efforts should include resources that engage parents in the activities, and must consider parent-reported barriers to developing healthy practices for their children. Find out more

Want to encourage families in your community to prioritize sleep? Check out our Dream Team home challenge!

It takes a community: Exploring APPLE Schools’ impact within and beyond school walls in Canada

This latest research explores the influence of APPLE Schools on the school and community environments. Four themes were identified: 1) APPLE Schools looks different 2) APPLE Schools builds champions 3) APPLE Schools builds community partnerships 4) APPLE Schools honours community culture. Health promotion practice in school was uniquely adapted based on strengths and needs of each school and was broadly influenced by the community outside of school walls. 

In summary, the study found that school-based health promotion reaches beyond school walls and can influence the broader community environment. 

Perceived changes in lifestyle behaviours and in mental health and wellbeing of elementary school children during the first COVID-19 lockdown in Canada

This study brings children’s perspectives about the effects of school closures on their health to the conversation about lockdowns. Children reported considerable declines in lifestyle behaviours, leading to the conclusion that with the already high burden of unhealthy lifestyles pre-COVID, this generation of children is at an increased risk for future chronic disease. These findings will guide APPLE Schools to shape implementation moving forward to help combat the negative trends. 

It’s Very Stressful for Children”: Elementary School-Aged Children’s Psychological Wellbeing During COVID-19 in Canada

Children and their parents provided insight into how the lockdown affected them and how they coped with the changes. They reported that the changes were sudden and stressful on children and that the disruptions led to feelings of boredom and lack of purpose. Many turned to screens to connect with peers in an effort to combat feelings of loneliness. Results underscore the need to resilience building and the promotion of positive coping strategies to help school-aged children thrive in the event of future health crises or natural disasters. 

Mental Health and Wellbeing of 9-12-year-old children in Northern Canada Before the COVID-19 Pandemic and After the First Lockdown

This study compared the mental health and wellbeing of APPLE school students two years before the COVID-19 pandemic started and after school reopened post lockdown in fall of 2020. Researchers surveyed 476 grade 4-6 students in 11 schools in northern Alberta and saw no negative trends in students’ responses regarding their mental health and wellbeing between pre-pandemic and post-lockdown. These positive results may be due to the work of APPLE Schools continuing active programming and intensifying mental health support throughout the pandemic. 

“Sleep is healthy for your body and your brain.” Use of student-centred photovoice to explore the translation of sleep promotion at school to sleep behaviour at home 

Researchers explored students’ perceptions of sleep behaviour within the context of APPLE Schools’ approach to improving health behaviours. They found that school-based sleep promotion interventions that are grounded in the CSH approach hold promise for successfully shaping student sleep behaviour. To promote health and academic success in children, future interventions should include home-school based partnerships that address child sleep across many learning environments. Check out the corresponding infographic

Cost-effectiveness and return on investment of school-based health promotion programmes for chronic disease prevention

This study considered feasibility, acceptability, sustainability, new methodologies, and all relevant scientific evidence to optimally inform public health decision makers on school-based health promotion.

The study revealed that the comprehensive school health (CSH) approach, which APPLE Schools uses, is the most effective and cost effective approach. Every $1 spent by APPLE Schools will reduce future health care costs by $3.20 because fewer APPLE Schools graduates will develop chronic diseases. And every $1 spent by APPLE Schools will save society $8.60 when considering productivity and longevity, which economists would refer to as an 860% return on investment – an extraordinarily high benefit! Check out the corresponding infographic

A Social Network Analysis of Interactions About Physical Activity and Nutrition Among APPLE Schools Staff

The latest research highlights the importance of all school staff in promoting health using the comprehensive school health approach, and the value of collective action through distributed leadership. School health champions and others were found to be key sources of physical activity or nutrition advice in their school networks. As well, principals, educational assistants, teachers and an accounts clerk play a central role within school advice networks. 

An Enhanced Approach for Economic Evaluation of Long-Term Benefits of School-Based Health Promotion Programs

This research developed a new method for economic evaluations of health promotion programs, as existing methods of evaluations are based only on changes in body weight. This new approach is more complex as it considers behavioural change in terms of physical activity, and fruit and vegetable consumption, in addition to changes in body weight. This research revealed that existing studies have underestimated the real economic benefits of health promotion.

What this means for APPLE Schools is that the program is more cost effective and has a higher return on investment as was previously estimated.

Adherence to Lifestyle Recommendations and ADHD: A Population-Based Study of Children Aged 10-11 Years

A healthy lifestyle may help prevent the development and severity of ADHD in children and youth. This research looked at nine existing lifestyle recommendations that are issued to ensure healthy development and prevention of overweight and chronic diseases. Of these recommendations, meeting those for fruit and vegetables, meat and alternatives, saturated fat, added sugar, and physical activity were associated with less ADHD. In fact, children who met 7-9 recommendations had substantially lower incidences of ADHD and fewer doctor visits related to ADHD, relative to children who met fewer recommendations.

The association between the cost and quality of diets of children in Canada

Diets of better quality are more expensive.  For low-income households, this may lead to a genuine barrier to healthy eating. However, reducing the purchase of unhealthy foods may create the financial space for households to purchase pricier healthier options. Such initiatives may also alleviate future health care costs.

Translation of school-learned health behaviours into the home: student insights through photovoice

An exciting new study that illustrates students’ abilities to positively impact the home environment. Their influence in the home is the result of their involvement with the comprehensive school health approach to health promotion. 

Lifestyle Behaviour and Mental Health in Early Adolescence 

Mental health in adolescence is directly linked with childhood lifestyle. A new study by Kara Loewen at the U of A School of Public health examined the associations of meeting established recommendations for diet, physical activity, sleep, and sedentary behaviour in childhood with mental illness in adolescence. Check out the video to get the details

Associations of friendship and children’s physical activity during and outside of school: A social network study

Children spend a lot of time with their friends in and out of school. As a result, friends may influence the behaviour and choices of one another. This study was undertaken in elementary schools within Edmonton and Fort McMurray to understand how friendships may influence the physical activity participation of children. 

Stay in or play out? The influence of weather condition on physical activity of grade 5 children in Canada.

This research conducted in APPLE schools suggest that daily weather condition can affect physical activity (PA) in school children, particularly outside school hours, and should be considered when evaluating PA levels or designing interventions to promote PA. Findings provide support for increased investment toward creating weather-appropriate physical activity opportunities.

Long-term effects of comprehensive school health on health-related knowledge, attitudes, self-efficacy, health behaviours and weight status of adolescents

The effects of APPLE Schools on elementary students continue when they move into adolescence or a new school environment. This paper suggests that APPLE Schools may have an equalizing effect on students as they reach the levels of their peers in non-APPLE schools. An important take-away is that lifestyle practices are adopted throughout childhood and adolesence and the school environment has an important influence on development, so we should consider extending comprehensive school health initiatives into junior high and high schools. 

Cost-effectiveness of a school-based health promotion program in
Canada: A life-course modeling approach

This research examines APPLE Schools as a cost-effective intervention for preventing obesity and reducing chronic disease risk over the lifetime. Allocating resources towards school-based programs like APPLE Schools, is likely to reduce the public health burden of obesity and chronic diseases.

Essential conditions for the implementation of comprehensive school health to achieve changes in school culture and improvements in health behaviours of students

This research contributes to the evidence base of CSH implementation, ultimately helping to shape its optimization by providing school communities with a set of understandable essential conditions for CSH implementation. This is important as it helps to support and bolster the CSH framework that has been shown to improve the education, health, and well-being of school-aged children. 

The Role of the Comprehensive School Health Principal in Knowledge Sharing and Use

This study compares the extent of knowledge-sharing and use of evaluation data by principals in CSH schools and other randomly selected schools in Alberta. Results showed that CSH principals had statistically significant higher odds of both sharing and using the data in general, including outside of the school and with parents.  

Does School-Based Health Promotion Affect Physical Activity on Weekends?

Exposure to health promotion projects in schools such as those implementing APPLE Schools may reduce physical activity inequalities for overweight/obese and socioeconomically disadvantaged children outside of school hours. Investments in school-based health promotion lead to behaviour modification beyond the school environment.

Preparing School Health Facilitators: Competence and Confidence Building for a New Role

The development and evaluation of a training program for school health facilitators working with school communities to implement Comprehensive School Health (CSH) has resulted in recommendations outlined in this article. Analyses revealed that the implementation and processes used in training were equally as important as the content, and that training positively affected confidence.

Implementing Comprehensive School Health in Alberta, Canada: The Principal’s Role

The role of the principal in the implementation of CSH is key to implementation of APPLE Schools. This research provides recommendations to help establish effective leadership practices in schools, conducive to creating a healthy school culture. See Story Catcher 7 to read about a school’s journey through the five stages of principal support. 

Leadership skills are associated with health behaviours among Canadian children

This study shows that leadership is strongly associated with better diet quality and more physical activity among students in Alberta.

Teaching leadership skills is a mostly overlooked health promotion strategy. However, APPLE Schools teaches leadership skills and promotes healthy eating and active living. This approach has been shown to be effective in preventing overweight in the short term, and will result in better health in the long-term.

Do school-based physical activity interventions increase or reduce inequalities in health?

This study compared the two-year change in physical activity among 10 to11 year-old children attending schools with APPLE Schools and schools without health promotion programs. CSH programs implemented in socioeconomically disadvantaged neighbourhoods reduced inequalities in physical activity. See APPLE Schools’ Story Catcher 2 and Story Catcher 5 for in-school examples of physical activity practice which led to these research results.

School-based health promotion and physical activity during and after school hours

The two-year change in physical activity during and after-school among students in APPLE Schools is examined here. The findings provide evidence of the effectiveness of APPLE Schools to affect children’s physical activity during and outside of school.

Life Course Impact of School-Based Promotion of Healthy Eating and Active Living to Prevent Childhood Obesity  

To support decision making on expanding the APPLE Schools program, evidence on its long-term health and economic impacts is critical. Throughout the life course, the prevalence of overweight (including obesity) was less among students attending APPLE Schools relative to their peers attending control schools. If the APPLE Schools program were to expand, the potential cost savings would be $33 to $82 million per year for the province of Alberta, or $150 to $330 million per year for Canada. The APPLE Schools Story Catcher 3 provides samples of activities that contributed to this research. 

The Sustainability of APPLE Schools: Teachers’ Perceptions

There is a lack of understanding of teachers’ perceptions of school-based health promotion, specifically on the sustainability of these programs. Teachers’ perceptions on the sustainability of CSH programs were not previously well understood. This study provides insight on ways to improve the likelihood of project sustainability and future programming. See APPLE Schools’ Story Catcher 6 for in-school examples of this research in action.

From “best practice” to “next practice”: school-based health promotion Improves healthy eating and physical activity  

In 2010 relative to 2008, students attending APPLE Schools were eating more fruits and vegetables, consuming fewer calories, were more physically active and were less likely to be obese. These changes contrasted changes observed among students elsewhere in the province. These findings provide evidence on the effectiveness of CSH in improving health behaviours. The findings show that an example of “best practice” may lead to success in another setting. This study provides the evidence that investments in the broader implementation of health promotion in schools are justified. See APPLE Schools’ Story Catcher 1 and Story Catcher 5 for in-school examples of this research in action.

Physical Activity among Canadian Children on School Days and Non-School Days

The average daily step count of grade five students in APPLE Schools was higher on school days than non-school days. More steps were also taken during school hours than non-school hours. Activity levels of children are below Canadian recommended levels for optimal growth and health. Health promotion should emphasize physical activity particularly among girls, outside school hours, and weekends.

Parent and Student support for school policies that
promote healthy eating and active living

Parents overwhelmingly support schools limiting the availability of unhealthy foods. Of all parents of grade five students in Alberta, 93.7% agree or strongly agree with limiting the availability of unhealthy foods in school. The present study shows that parents overwhelmingly support school policies that promote healthy eating and active living. APPLE Schools’ Story Catcher 4 presents quotes from parents expressing their support for healthy school.

Implementing Comprehensive School Health. Teachers’ perceptions of APPLE Schools

The purpose of this study was to examine teachers’ perceptions of the implementation of CSH in APPLE Schools. Themes that affected implementation included: a) building support; b) defining roles; c) leadership; d) embedding in school culture; and e) engaging stakeholders. Teachers were very supportive of APPLE Schools and had a clear sense of facilitating factors, barriers and solutions to enhance implementation. 

Tailoring and Implementing Comprehensive School Health: APPLE Schools

School Health Facilitators tailored strategies in ten elementary schools to successfully implement customized health promotion strategies that acknowledge the unique needs and barriers to healthy living in schools.