Systematic Review and Meta-Analysis of Health Promotion Interventions for Children and Adolescents Using an Ecological Framework

OBJECTIVE: To evaluate and quantify the evidence for health promotion interventions in children and adolescents. METHOD: 96 independent samples of smoking, physical activity, and diet studies were included. Outcomes included both objective and self-reports of health behavior, as well as proxy measures such as fitness. RESULTS: The aggregated effect was significant (g = .20, 95% confidence interval [CI] = 0.08-0.32, n = 96). A significant effect of intervention was observed at approximately 1-year follow-up (g = .07, 95% CI = 0.02-0.14, n = 20). The greatest risk of bias was failure to blind outcome assessment, which occurred in 21% of studies. Most studies lacked sufficient detail to determine the quality of their randomization sequence (58%). Additional concerns about risk of bias for individual studies were minimal. Overall, the quality of this finding was moderate using the Grading of Recommendations Assessment, Development, and Evaluation criteria. CONCLUSION: Health promotion interventions are effective for modifying health behavior; however, effect sizes are small.