title: Children at Risk: Risk Factors for Low Back Pain in the Elementary School Environment Variation in Back Pain Between Countries: The Example of Britain and Germany Harm minimization in school drug education: final results of the School Health and Alcohol Harm Reduction Project (SHAHRP). Low back pain in Australian adults: prevalence and associated disability. A 2-year prospective longitudinal study on low back pain in primary school children Personal risk factors for first-time low back pain. The effect of education on backpack wearing and posture in a middle school population. Evaluation of a Health Promoting Schools program to reduce smoking in Australian secondary schools. Nonspecific back pain in children. A search for associated factors in 14-year-old schoolchildren. Evaluation of a pilot school programme aimed at the prevention of obesity in children. Low Back Pain in the Young A Prospective Three‐Year Follow‐up Study of Subjects With and Without Low Back Pain Postural Hygiene Program to Prevent Low Back Pain Knowledge and perceptions about back education among elementary school students, teachers, and parents in Belgium. The Association of Backpack Use and Back Pain in Adolescents Back care education in elementary school: a pilot study investigating the complementary role of the class teacher.
abstract: Study Design . A prevalence survey of 101 r and omly selected elementary schools in the Israel Central District . Objectives . To identify and describe risk factors for  low back pain that exist in the elementary school environment . Summary of Background Data . Recent surveys report a high prevalence of low back pain in children and adolescents that increases with age , with a correlation between low back pain in adolescence and that experienced in adulthood . Environmental risk factors have been associated with the development of low back pain in children . Because of the significant amount of time children spend in their school environment , risk factors need to be identified in this environment . Methods . A question naire , completed by school nurses , measured risk factors among 10,000 children in elementary schools in Israel . These included backpack and student weight , the availability of storage facilities , the  appropriateness of chair and desk height to student height  ,  seating arrangements during frontal lessons  , and  physical activity at recess . Results . Between 30 % and 54 % of students carried > 15 % of their body weight . Nearly 15 % of the first grade rs and 20 % of sixth grade rs had inappropriate chairs . In 74 % of the classes , students sat with their side facing the teacher and in 35 % students sat with their backs . In 6 % of schools , no physical activity is offered at recess . Conclusions . Shortcomings were found in all areas investigated . There is an urgent need for health promotion programs to increase awareness and reduce risks in the school environment Study Design . Cross-sectional survey with personal interviews . Objective . To study national differences in subjective health , back pain , and self-perceived disability between the United Kingdom and Germany . Summary of Background Data . Back pain is a leading health problem in most Western population s , causing enormous costs to the national health systems . Different prevalence rates were reported from many countries , but rarely as a result of a direct comparison based on an identical study design . Methods . A total of 6,235 male and female participants 50 to 79 years of age ( population -based stratified r and om sample s ) were recruited in 6 British and 8 German study centers . The interviewer administered st and ardized question naire included a section about presence and severity of back pain . Results . Past and current back pain was more frequent among German participants and different between East and West German centers . The differences in back pain prevalence rates could not be explained by less favorable risk profiles among German respondents . Conclusions . Intercultural differences in perceiving or reporting back pain can be hypothesized as the most likely explanation of the markedly different prevalence rates of the disorder in the United Kingdom and East and West Germany AIMS The School Health and Alcohol Harm Reduction Project ( SHAHRP study ) aim ed to reduce alcohol-related harm in secondary school students . DESIGN The study used a quasi-experimental research design in which r and omly selected and allocated intervention and comparison groups were assessed at eight , 20 and 32 months after baseline . SETTING Metropolitan , government secondary schools in Perth , Western Australia . PARTICIPANTS The sample involved over 2300 students . The retention rate was 75.9 % over 32 months . INTERVENTION The evidence -based intervention , a curriculum programme with an explicit harm minimization goal , was conducted in two phases over a 2-year period . MEASURES Knowledge , attitude , total alcohol consumption , risky consumption , context of use , harm associated with own use and harm associated with other people 's use of alcohol . FINDINGS There were significant knowledge , attitude and behavioural effects early in the study , some of which were maintained for the duration of the study . The intervention group had significantly greater knowledge during the programme phases , and significantly safer alcohol-related attitudes to final follow-up , but both scores were converging by 32 months . Intervention students were significantly more likely to be non-drinkers or supervised drinkers than were comparison students . During the first and second programme phases , intervention students consumed 31.4 % and 31.7 % less alcohol . Differences were converging 17 months after programme delivery . Intervention students were 25.7 % , 33.8 % and 4.2 % less likely to drink to risky levels from first follow-up onwards . The intervention reduced the harm that young people reported associated with their own use of alcohol , with intervention students experiencing 32.7 % , 16.7 % and 22.9 % less harm from first follow-up onwards . There was no impact on the harm that students reported from other people 's use of alcohol . CONCLUSIONS The results of this study support the use of harm reduction goals and classroom approaches in school drug education OBJECTIVES To determine the prevalence ranges of  low back pain ( LBP )  together with any related disability in Australian adults . DESIGN A population -based survey . METHODS The survey was mailed in June 2001 to a stratified r and om sample of 3000 Australian adults selected from the Electoral Roll . Demographic variables of respondents were compared with the Australian population . Selective response bias was investigated using wave analysis . A range of prevalence data was derived , as were disability scores using the Chronic Pain Grade . RESULTS There was a 69 % response rate . There was little variation between the sample and the Australian adult population . There was no significant selective response bias found . The sample point prevalence was estimated at 25.6 % ( 95 % confidence interval [ CI ] , 23.6 - 27.5 ) , 12-month prevalence was 67.6 % ( 95 % CI , 65.5 - 69.7 ) , and lifetime prevalence was 79.2 % , ( 95 % CI , 77.3 - 81.0 ) . In the previous 6-month period , 42.6 % ( 95 % CI , 40.4 - 44.8 ) of the adult population had experienced low-intensity pain and low disability from it . Another 10.9 % ( 95 % CI , 9.6 - 12.3 ) had experienced high intensity-pain but still low disability from this pain . However , 10.5 % ( 95 % CI , 9.2 - 11.9 ) had experienced high-disability LBP . CONCLUSION LBP is a common problem in the Australian adult population , yet most of this is low-intensity and low-disability pain . Nevertheless , over 10 % had been significantly disabled by LBP in the past 6 months . Data from this study will provide a better underst and ing of the magnitude of the LBP problem in Australia , the need for access to health care re sources , and also strategic research directions Abstract . There is increasing evidence that non-specific low back pain ( LBP ) is common among children and adolescents , but there are few longitudinal studies on this subject . This is a longitudinal prospect i ve study aim ed at finding factors associated with the prediction of low back pain in schoolchildren aged 9–12 years , which is a younger age group than has previously been studied . This study was performed on school children in the city of Antwerp , Belgium . A total of 287 children filled out a question naire  and were examined at the beginning of the study ( T1 ) and 2 years later ( T2 ) . The question naire asked about back pain , general health , health perceptions , quality of life perceptions , sports , leisure , daily life , school life ( weight of satchel ... ) and some issues related to parents ( smoking , LBP ) . The question naire reliability was tested . Logistic regression was used to analyse the data . No predictors for LBP in children could be identified . Using logistic regression techniques , we analysed the children who reported no lifetime episode of LBP at both T1 and T2 , the children who did report a lifetime episode at both T1 and T2 and also those who reported a history of LBP at T2 only ( New LBP ) . At T2 there were 51 children ( 17.8 % ) reporting suffering at least one lifetime episode of LBP who had not reported such an episode at T1 . Only one parameter showed a statistical difference : New LBP was observed significantly more frequently in children who do not walk to school ( P<0.0001 ) . An interesting point of this study is that a number of children who had reported a history of LBP at T1 did not do so at T2 . It may be that LBP in children is so benign and its natural history so favourable that the memory of the episode fades away . It is extremely interesting to note that among the few significant variables , those related to general well-being and self-perception of health , are prominent . It appears , therefore , that psychological factors play a role in the experience of LBP in a similar way to what has been reported in adults . Poor self-perception of health ( health belief ) could be a factor behind the reporting of LBP . Some variables linked to consequences of LBP ( absence from school or from gym and visit to a doctor ) play a significant role in reporting LBP , which suggests that those " health care " factors may reinforce a feeling of disease severity STUDY DESIGN A prospect i ve study of personal risk factors for first-time low back pain . OBJECTIVES To construct and vali date a multivariate model to predict low back pain . SUMMARY OF BACKGROUND DATA Various physical and psychological factors have been reported to increase the risk of low back pain , but conflicting results may be attributable to inaccurate " clinical " measures and to poorly vali date d statistical models . METHODS A total of 403 health care workers aged 18 - 40 years volunteered for the study . None had any history of " serious " back pain requiring medical attention or time off work . The volunteers completed the following question naires : the modified somatic perception question naire , the Zung depression scale , and the Health Locus of Control .  Anthropometric factors were quantified using st and ard techniques . The 3Space Isotrak device ( Polhemus , VT ) was used to measure lumbar curvature and hip and lumbar spine mobility . Leg and back strength and back muscle fatiguability were measured in functional postures . Postal follow-up question naires , sent after 6 , 12 , 18 , 24 , 30 , and 36 months , inquired about back pain , and multivariate logistic regression was used to identify risk factors at each follow-up . RESULTS The response rate fell from 99 % at 12 months to 90 % at 36 months , at which time 90 volunteers reported " serious " back pain and 266 reported " any " back pain . The following were consistent predictors of serious back pain : reduced range of lumbar lateral bending , a long back , reduced lumbar lordosis , increased psychological distress , and previous nonserious low back pain . Only the latter three were consistent predictors of " any " back pain . Physical factors had the most influence in a sub- population of volunteers who were new to the job . CONCLUSIONS Personal risk factors explained up to 12 % of first-time low back pain PURPOSE The effect of education on proper wearing of a backpack was studied to determine whether or not a middle school population would improve posture during load carriage by maintaining a more natural posture and to determine if schoolchildren would comply with proper backpack wearing . METHOD 17 middle school children with a mean age of 12.7 years were r and omized into control and intervention groups . Participants were videotaped in four conditions from an anterior view and from a lateral view . Members of both groups participated in Sessions A and C , which consisted of videotaping of the four conditions . Intervention members additionally participated in Session B , consisting of education on how to wear a backpack properly . All participants were interviewed concerning their participation and its effect on how they wore their backpack . Video footage was analyzed to calculate the change in skeletal angles as a result of different methods of load carriage . Interview data was coded and analyzed . RESULTS No quantitative significance was found between control and intervention groups in regards to education on proper backpack wearing improving posture . Interviews revealed that intervention group members benefited from the education on proper wearing of a backpack . 87.5 % of the intervention group members proceeded to continue wearing the backpack properly after the education intervention . CONCLUSIONS Education regarding proper wearing of a backpack may impact the middle school aged child by improving quality of life as noted through decrease in reports of musculoskeletal pain by participants This r and omized controlled trial evaluated the effectiveness of a multicomponent Health Promoting Schools ( HPS ) intervention program in improving self-reported smoking outcomes among a cohort of adolescents in 22 public secondary schools in the Hunter Region of New South Wales , Australia .  Pre-test surveys were completed by students in the first 2 years of secondary school , with a 2-year post-test survey . Multivariate analyses examined intervention effect for the main outcome , post-test smoking behavior , controlling for pre-test smoking status , school and other confounders . The sample comprised the cohort of 1852 students who completed both surveys . The results demonstrated that the HPS program failed to improve smoking behavior over the 2 years ( equal increase of 10 % in both groups ) . The program was successful in improving smoking knowledge , but not attitudes , in intervention versus control group ( P < 0.001 ) . Independent predictors of post-test smoking included : pre-test smoking [ odds ratio ( OR ) = 5.44 ; 95 % confidence interval ( CI ) = 3.20 - 9.28 ] , being female ( OR = 0.55 ; CI = 0.35 - 0.87 ) , having more close friends who smoked ( OR = 1.42 ; CI = 1.33 - 1.52 ) , peer group having no clear opinion about smoking ( OR = 3.23 ; CI = 1.27 - 8.27 ) , having more positive and less negative attitudes towards smoking , and being less involved in school activities . We discuss method ological issues in multicomponent community-based interventions , and highlight the strengths and limitations of this study BACKGROUND Nonspecific back pain in children is nearly as common as in adults but is associated with a number of age-specific risk factors including female gender , a family history of low back pain , a high level of physical activity , and prolonged sitting . OBJECTIVE To investigate potential school-related risk factors for back pain in children , most notably schoolbag weight expressed as a percentage of body weight ( relative schoolbag weight ) , whether the schoolbag is carried by h and or by a shoulder harness , how the child travels to and from school , and sitting positions . PATIENTS AND METHODS 123 eighth- grade rs , 58 girls and 65 boys , with a mean age of 14 + /- 0.6 years , completed an anonymous self- question naire during a school day involving six hours of classes . Their schoolbag was weighed on the same day . RESULTS Most respondents traveled to and from school in a vehicle ( 70 % ) , made one trip in each direction each day ( 75 % ) , and carried their schoolbag by the shoulder harness ( 92 % ) . The prevalence of back pain on the study day was 27.6 % , whereas the cumulative prevalence for the last 12 months was 82.9 % with 16.3 % of respondents reporting a single episode of pain , 57.7 % recurrent pain , and 8.9 % chronic pain . A need for a physician visit for back pain was reported in 18.7 % of cases , and 14.6 % of respondents had missed school and /or sporting activities because of back pain . Female gender was associated with current back pain ( odds ratio [ OR ] , 2.7 ; 95 % confidence interval [ CI ] , 1.2 - 6.1 ) . A relative schoolbag weight of 20 % or more was associated with a history of back pain ( OR , 3.1 ; 95 % CI , 1.0 - 9.2 ) , and this effect was larger in children who traveled to and from school on foot and in those who carried their schoolbag in their h and . Sitting on the edge of the chair while completing the question naire was significantly associated with a history of a physician visit for back pain ( OR , 3.1 ; 95 % CI , 1.0 - 9.5 ) . Neither h and edness nor the position of the question naire on the table were significantly associated with back pain in our study population . CONCLUSIONS The findings from this cross-sectional study indicate a need for a longitudinal prospect i ve study design ed to identify etiologic and prognostic factors of back pain in adolescents , with the goal of devising preventive strategies likely to reduce the risk of low back pain in adulthood This paper describes the development , implementation and evaluation of a school- and family-based intervention to prevent obesity in children aged 5 - 7 years . In addition , the efficacy of three different intervention programmes was compared . Children aged 5 - 7 years ( n=213 ) were recruited from three primary schools in Oxford and r and omly allocated to a control group or one of three intervention groups : nutrition group , physical activity group , and combined nutrition and physical activity group . The setting for the interventions was lunchtime clubs , where an interactive and age-appropriate nutrition and /or physical activity curriculum was delivered . The intervention lasted for 20 weeks over four school terms ( approximately 14 months ) . Children 's growth , nutrition knowledge , diet and physical activity were assessed at baseline and at the end of the intervention . Significant improvements in nutrition knowledge were seen in all children ( p<0.01 ) between baseline and post-intervention , and results were highly significant in the nutrition and combined group ( p<0.001 ) . Overall , fruit and vegetable intake increased significantly ( p<0.01 and < 0.05 , respectively ) , with changes seen in fruit consumption in the nutrition group ( p<0.05 ) and the control group ( p<0.05 ) in particular . No significant changes in the rates of overweight and obesity were seen as a result of the intervention . Gender differences were not detected in the majority of assessment s and there was no clear effect of programme type per se . This pilot study has demonstrated that school may be a suitable setting for the promotion of healthy lifestyles in children , but requires replication in other social setting s. Future initiatives should be long-lasting , multi-faceted and sustainable , involving all children in a school , and should target the whole environment and be behaviourally focused . The ultimate goal of any such programme is to lead to positive behaviour change which will have a beneficial effect on long-term health . Successful targeting of the family remains a challenge to such interventions Study Design . This was a prospect i ve 3-year follow-up study of r and omized matched subgroups of 15-year-old school children with or without low back pain initially . Objective . In addition to low back pain and leisure time physical activity , spinal mobility , trunk muscle strength , and early degenerative findings of the lumbar spine were evaluated . Summary of Background Data . Reliable epidemiologic studies on the prevalence of low back pain and development of early degenerative changes of the lumbar spine in young persons have been sparse . Along with several other characteristics , the relationship of these changes to frequent low back pain in young persons is not known . Methods . After a question naire-based survey was administered , subjects with or without low back pain were examined initially and at follow-up with special reference to leisure time physical activity , anthropometry , spinal mobility , trunk muscle strength , and magnetic resonance imaging findings of the lumbar spine . Results . At baseline and at follow-up , those subjects with initial low back pain were characterized by a low frequency of physical activity and decreased spinal function . During follow-up , the occurrence of disc degeneration increased significantly more in the original group with low back pain than among asymptomatic subjects . Furthermore , disc degeneration at baseline significantly predicted future frequent low back pain . Initial disc protrusion also predicted future frequent low back pain . Conclusion . After the rapid physical growth period , there seemed to be a causal relationship between the early evolution of the degenerative processes of the lower lumbar discs and frequent low back pain in several subjects Study Design . A quasi-experimental study with 3 × 4 design was performed . Objective . To improve the level of knowledge and motor skills and thereby avert the development of painful symptoms . Summary of Background Data . Despite the fact that low back pain affects a high percentage of the population , little research has been carried out to prevent low back pain through health education . Methods . The participants in this study were 106 third- grade ( 9-year-old ) students . The program included 11 sessions . The teacher attended the placebo group sessions . No intervention was used with the control group . Results . The level of knowledge and motor skills in the experimental group showed a significant increase immediately after the intervention finished , and at 6- and 12-month intervals after completion of the postural hygiene program ( P = 0.00 ) . Some positive changes were generalized to natural situations ( P = 0.00 ) . In an independent health check carried out by the local school health services 4 years after application of the postural hygiene program , the results tended slightly to favor the experimental condition over the control conditions ( placebo + no intervention ) . A greater number of the control subjects required medical treatment for low back pain , although this difference was only marginally significant ( P = 0.07 ) . Conclusions . The findings from this study support the hypothesis that programs involving practice and motivating strategies impart health knowledge and habits more efficiently than those restricted to the mere transmission of information A back education program for Belgian elementary school children was evaluated using self-reported question naires before intervention and at three follow-up points during one year . Most children found the program interesting , important , and amusing . Intervention children ( n = 347 ) showed better back care knowledge than control  children ( n = 359 ) , and knowledge gained was retained over a period of one year . Back education did not result in increased fear-avoidance beliefs about physical activity , and intervention children reported more checking of their book bag weight than controls at all test moments . Self-reported behavior in relation to posture-related and back care related self-efficacy were affected only minimally by the program , possibly due to poor self-judgment . Involvement , fear-avoidance beliefs , and back care knowledge of teachers and parents of the intervention children showed low correlation with the children 's perceptions and knowledge . Sufficient promise exists to justify further development and evaluation of early back education Study Design . A cross-sectional study comprising the first phase of an ongoing , longitudinal prospect i ve study was conducted . Objective . To investigate the relation between backpack use  and back pain in adolescents . Summary of Background Data . The prevalence of nonspecific back pain increases dramatically during adolescence from less than 10 % in the pre – teen-age years up to 50 % in 15- to 16-year-olds . There is widespread concern that heavy backpacks carried by adolescents contribute to the development of back pain . Methods . A total of 1126 children , ages 12 to 18 years , participated by completing a question  naire about their health , activities , and backpack use . Each child ’s body weight , height , and backpack weight were measured . A child was classified as having back pain if one or more of the following were reported during the preceding month :  neck or back pain that had interfered with school or leisure ,  neck or back pain  with a severity rating of 2 or more on a scale 0 to 10 , a visit to a physician or therapist for neck or back pain , or exemption from physical education or sports because of neck or back pain . Results . Of 1122 backpack users , 74.4 % were classified as having back pain , vali date d by significantly poorer general health , more limited physical functioning , and more bodily pain . As compared with no or low use of backpacks at school , heavy use ( odds ratio , 1.98;P < 0.0001 ) was independently associated with back pain . Female gender and larger body mass index also were significantly associated with back pain . As compared with adolescents who had no back pain , adolescents with back pain carried significantly heavier backpacks that represented a significantly greater percentage of their body weights . Conclusion . The use of backpacks during the school day and backpack weights are independently associated with back pain This study investigated the efficacy of guidelines for a  motivated class teacher to enhance the application of back care principles , taught by a physical therapist , in fifth- grade elementary schoolchildren . Testing consisted of a practical test before and a practical test , knowledge test and c and i d camera evaluation 11 weeks after the program . Three groups were compared : an  intervention group of 38 pupils , with extra guidelines for the teacher , an  intervention group of 48 pupils , without extra guidelines and 34 controls . The intervention plus guidelines group , compared to the intervention group without extra teacher guidelines , obtained significantly higher posttest-pretest gain scores for five of the seven practical test items and scored significantly higher for seven of the nine items of the c and i d camera evaluation . Knowledge test scores did not differ significantly between the two intervention groups . Study results indicate that guidelines to a motivated class teacher improve efficacy of back care education in elementary schoolchildren
target: Results of these studies indicate that school-based spinal health interventions may be effective in increasing spinal care knowledge and decreasing the prevalence of spinal pain .
  However , overall the evidence is inconclusive regarding spinal care behaviors .
  The poor quality of the review ed studies limits the conclusions that can be made regarding the effectiveness of school-based spinal health interventions
background: OBJECTIVES To establish the effectiveness of  school-based spinal health interventions  in terms of : 1 ) improving knowledge about the spine/spinal care ; 2 ) changing spinal care behaviors ; and 3 ) decreasing the prevalence of spinal pain .
  SUMMARY OF BACKGROUND DATA Spinal pain is a significant problem in children and adolescents that has been addressed through school-based spinal health interventions .
  No systematic review has been carried out on this topic to date .