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      Development of a Web-Based School Support System Within the AVATAR Project for Psychosocial Well-being in Adolescents: Pilot Feasibility Study

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          Abstract

          Background

          Health and well-being promotions are key points of educational programs for adolescents within schools. There are several health education programs mainly based on lifestyle habit changes; however, social and emotional dimensions should be considered within these educational strategies.

          Objective

          This study aimed to (1) develop a new web-based school support system to assess and analyze individual, classroom, and scholastic institute data on lifestyle habits, social context, emotional status, and scholastic performance; (2) create a web tool for managing the well-being of adolescents through a dynamic and personalized interface that provides immediate feedback that allows the school to monitor progress; and (3) evaluate, in a pilot study, the feasibility of this web-based school support system in order to build health programs that are specific to the needs of the studied population.

          Methods

          The AVATAR (a new purpose for the promotion and evaluation of health and well-being among healthy teenagers) method consists of integrating the information coming from different questionnaires. In particular, to allow planning didactic and educational actions based on the results obtained, the AVATAR approach allows subdivision of the results of the different observed variables and the 4 components into the following 3 percentile categories: modify, improve, and maintain. The AVATAR web platform was designed to collect data on lifestyle, emotional status, and social context from junior high schools in terms of the fundamental aspects of adolescent daily life, with free use by the scholastic community (scholars, teachers, and parents). In this pilot/feasibility study, data from 331 students were acquired between 2018 and 2019 at the beginning of the scholastic year (pre) and at the end following the school-based program (post).

          Results

          Preliminary results showed that after school planning and specific program implementation, defined after AVATAR feedback, students reported better well-being perception characterized by higher perception in psychological well-being ( P=.001), mood ( P=.001), self-perception ( P=.006), and autonomy ( P=.001), and an increase in the perception of financial resources ( P=.001), which helped in developing healthy lifestyle habits ( P=.007). In the social context assessment, students reported stronger relationships with family ( P=.02) and peers ( P=.001), and a lower perception of bullying ( P=.001).

          Conclusions

          The AVATAR web-based platform is a feasible and flexible tool for the health and well-being management of adolescents from epidemiological, preventive, and educational points of view. In particular, it can be used to (1) promote information campaigns aimed at modifying risk behaviors in the student population, (2) sensitize students and put them at the center of their growth path, (3) inform institutions about the health and well-being of the school population, (4) ensure health programs are acceptable and feasible to users before launching on a large scale, and (5) improve the relationship of users (school) and educational agencies with research groups.

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          Most cited references26

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          Development of a WHO growth reference for school-aged children and adolescents

          OBJECTIVE: To construct growth curves for school-aged children and adolescents that accord with the WHO Child Growth Standards for preschool children and the body mass index (BMI) cut-offs for adults. METHODS: Data from the 1977 National Center for Health Statistics (NCHS)/WHO growth reference (1-24 years) were merged with data from the under-fives growth standards' cross-sectional sample (18-71 months) to smooth the transition between the two samples. State-of-the-art statistical methods used to construct the WHO Child Growth Standards (0-5 years), i.e. the Box-Cox power exponential (BCPE) method with appropriate diagnostic tools for the selection of best models, were applied to this combined sample. FINDINGS: The merged data sets resulted in a smooth transition at 5 years for height-for-age, weight-for-age and BMI-for-age. For BMI-for-age across all centiles the magnitude of the difference between the two curves at age 5 years is mostly 0.0 kg/m² to 0.1 kg/m². At 19 years, the new BMI values at +1 standard deviation (SD) are 25.4 kg/m² for boys and 25.0 kg/m² for girls. These values are equivalent to the overweight cut-off for adults (> 25.0 kg/m²). Similarly, the +2 SD value (29.7 kg/m² for both sexes) compares closely with the cut-off for obesity (> 30.0 kg/m²). CONCLUSION: The new curves are closely aligned with the WHO Child Growth Standards at 5 years, and the recommended adult cut-offs for overweight and obesity at 19 years. They fill the gap in growth curves and provide an appropriate reference for the 5 to 19 years age group.
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            Our future: a Lancet commission on adolescent health and wellbeing

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              Food, youth and the Mediterranean diet in Spain. Development of KIDMED, Mediterranean Diet Quality Index in children and adolescents.

              To evaluate dietary habits in Spanish children and adolescents based on a Mediterranean Diet Quality Index tool, which considers certain principles sustaining and challenging traditional healthy Mediterranean dietary patterns. Observational population-based cross-sectional study. A 16-item Mediterranean Diet Quality Index was included in data gathered for the EnKid study (in which two 24-hour recalls, a quantitative 169-item food-frequency questionnaire and a general questionnaire about socio-economic, demographic and lifestyle items were administered). Spain. In total, 3850 children and youths aged 2-24 years residing in Spain. Of the sample, 4.2% showed very low KIDMED index results, 49.4% had intermediate values and 46.4% had high index results. Important geographical differences were seen, with subjects from the Northeast showing the most favourable outcomes (52% with elevated scores vs. 37.5% of those from the North). Lower percentages of high diet quality were observed in low socio-economic groups, compared with middle and upper income cohorts (42.8%, 47.6% and 54.9%, respectively). Large cities had more positive results and only slight variations were seen for gender and age. The KIDMED index, the first to evaluate the adequacy of Mediterranean dietary patterns in children and youth, confirms that this collective is undergoing important changes, which makes them a priority target for nutrition interventions. Results challenge certain commonly perceived notions tied to income level, population size and diet quality.
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                Author and article information

                Contributors
                Journal
                JMIR Form Res
                JMIR Form Res
                JFR
                JMIR Formative Research
                JMIR Publications (Toronto, Canada )
                2561-326X
                December 2021
                2 December 2021
                : 5
                : 12
                : e24840
                Affiliations
                [1 ] Clinical Physiology Institute Consiglio Nazionale delle Ricerche Area della Ricerca di Pisa (CNR) Pisa Italy
                [2 ] Department of Information Engineering University of Pisa Pisa Italy
                [3 ] Fondazione Toscana Gabriele Monasterio Pisa Italy
                Author notes
                Corresponding Author: Alessandro Pingitore pingi@ 123456ifc.cnr.it
                Author information
                https://orcid.org/0000-0002-9415-3715
                https://orcid.org/0000-0003-2774-9161
                https://orcid.org/0000-0002-8342-8736
                https://orcid.org/0000-0001-7964-6338
                https://orcid.org/0000-0001-9996-4982
                https://orcid.org/0000-0003-3467-7362
                https://orcid.org/0000-0002-5130-2231
                https://orcid.org/0000-0003-3438-6450
                https://orcid.org/0000-0002-4049-184X
                Article
                v5i12e24840
                10.2196/24840
                8686459
                34860668
                3e463a34-71e1-452c-b2b6-015340eba7df
                ©Francesca Mastorci, Paolo Piaggi, Gabriele Trivellini, Cristina Doveri, Anselmo Casu, Luca Bastiani, Irene Marinaro, Cristina Vassalle, Alessandro Pingitore. Originally published in JMIR Formative Research (https://formative.jmir.org), 02.12.2021.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Formative Research, is properly cited. The complete bibliographic information, a link to the original publication on https://formative.jmir.org, as well as this copyright and license information must be included.

                History
                : 8 October 2020
                : 26 February 2021
                : 31 May 2021
                : 6 July 2021
                Categories
                Original Paper
                Original Paper

                adolescent,well-being management,schools,web tool,health promotion

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