Commitment to a healthy lifestyle among rural schoolchildren before and after preventive intervention

Introduction: Behavioral models of a healthy lifestyle emerge at school age and determine the health status in adulthood. Schools are considered the best environment for building commitment to a healthy lifestyle.

Objective: To assess adherence to a healthy lifestyle in rural schoolchildren before and after preventive intervention.

Materials and methods: Students attending six schools in the Bekovsky district of the Penza Region were anonymously surveyed twice using the international Health Behavior in School-aged Children questionnaire. In the years 2015 and 2022, 617 and 596 fifth to eleventh graders aged 11 to 17 were interviewed, respectively. We have developed a method for integral assessment of the commitment of children and adolescents to a healthy lifestyle, based on the cumulative adherence of schoolchildren to its six components with four options of adherence distinguished. The adherence index is defined as the proportion of people committed to a specific number of healthy lifestyle components out of the total number of respondents and is expressed as a percentage.

Results: Prior to preventive intervention in health education started in 2009, 12.7 % of boys and 7.2 % of girls in grades 5 to 8 and 28.1 % of male and 16.4 % of female ninth to eleventh graders smoked or tried to smoke. During the first phase of the intervention (2008–2015), a significant reduction in the number of smoking schoolchildren was achieved. As a result of the second stage of intervention launched in the district schools in 2015, we observed an increase in the number of daily fruit eaters (OR: 1.45; 95 % CI: 1.06–1.99) and a decrease in the number of smokers (OR: 0.22; 95 % CI: 0.07–0.66) and alcohol drinkers (OR: 0.25; 95 % CI: 0.08–0.76) among 11–14-year-old schoolchildren. Among schoolchildren aged 15–17, we detected an increase in the number of those eating fruit (OR: 0.049; 95 % CI: 1.49–1.06) and vegetables (OR: 1.78; 95 % CI: 1.16–2.73) on a daily basis, having sufficient physical activity (OR: 1.9; 95 % CI: 1.26–2.87), neither smoking (OR: 0.45; 95 % CI: 0.21–0.96) nor drinking alcohol (OR: 0.29, 95 % CI: 0.11–0.8). The index of adherence to healthy lifestyle among students in grades 5–8 increased from 1.54 (95 % CI: 0.8; 2.28) in 2015 to 3.98 % (95 % CI: 2.76; 5.2) (p < 0.05) in 2022, and from 1.76 (95 % CI: 1.21; 2.31) to 1.83 (95 % CI: 1.21; 2.45) among the ninth to eleventh graders.

Conclusions: A two-stage preventive intervention in health education in rural schools realized without additional expenditures contributed to raising commitment to a healthy lifestyle among students in grades 5–8.

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