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Abstract Background Sustainment has been defined as the sustained use or delivery of an intervention in practice following cessation of external implementation support. This review aimed to identify and synthesise factors (barriers and facilitators) that influence the sustainment of interventions (policies, practices, or programmes) in schools and childcare services that address the leading risk factors of chronic disease. Methods Seven electronic databases and relevant reference lists were searched for articles, of any design, published in English, from inception to March 2020. Articles were included if they qualitatively and/or quantitatively reported on school or childcare stakeholders’ (including teachers, principals, administrators, or managers) perceived barriers or facilitators to the sustainment of interventions addressing poor diet/nutrition, physical inactivity, obesity, tobacco smoking, or harmful alcohol use. Two independent reviewers screened texts, and extracted and coded data guided by the Integrated Sustainability Framework, an existing multi-level sustainability-specific framework that assesses factors of sustainment. Results Of the 13,158 articles identified, 31 articles met the inclusion criteria (8 quantitative, 12 qualitative, 10 mixed-methods, and 1 summary article). Overall, 29 articles were undertaken in schools (elementary n=17, middle n=3, secondary n=4, or a combination n=5) and two in childcare settings. The main health behaviours targeted included physical activity (n=9), diet (n=3), both diet and physical activity (n=15), and smoking (n=4), either independently (n=1) or combined with other health behaviours (n=3). Findings suggest that the majority of the 59 barriers and 74 facilitators identified to impact on intervention sustainment were similar across school and childcare settings. Factors predominantly relating to the ‘inner contextual factors’ of the organisation including: availability of facilities or equipment, continued executive or leadership support present, and team cohesion, support, or teamwork were perceived by stakeholders as influential to intervention sustainment. Conclusions Identifying strategies to improve the sustainment of health behaviour interventions in these settings requires a comprehensive understanding of factors that may impede or promote their ongoing delivery. This review identified multi-level factors that can be addressed by strategies to improve the sustainment of such interventions, and suggests how future research might address gaps in the evidence base. Trial registration This review was prospectively registered on PROSPERO: CRD42020127869, Jan. 2020.

To describe physical activity (PA) and inactivity levels of Filipino youth aged 14-16 y.PA type and patterns were assessed in an adolescent cohort enrolled in the Cebu Longitudinal Health and Nutrition Survey.A total of 1053 males (aged 15.6+/-0.5 y; body mass index (BMI)=18.6+/-2.6 kg/m(2)) and 990 females (aged 14.6+/-0.5 y; BMI=18.8+/-2.4 kg/m(2)).PA was assessed by (1) self-reported usual PA (questionnaire); (2) 24-h objective monitoring (Caltrac accelerometer); and (3) 24 h recalls of PA during the objectively monitored time frame.As measured by Caltrac, males expended 378.0+/-164.5 kcal and females 271.0+/-105.4 kcal. The measurement approaches employed agreed in expected ways, given the limitations of each. Together the approaches used indicated that the primary sources of PA for this population are chores and active commuting. In all, 40% of the sample walked to school, less than 1% rode a bicycle, 22% rode in/on motorized transport, and 37% used some combination of walking and motorized transport. Further, gender differences exist for type, frequency, and duration of physical activities performed by Filipino youth. Specifically, females report engaging in few leisure-time physical activities and more household chores. In total, 48% of Filipino youth report watching > or =2 h/day of television; relatively few youth (7%) report watching >4 h/day at this time. An 18% of males report no vigorous activities compared to 87% of females.Clear gender differences in PA patterns and levels exist in Filipino adolescents. Nonsport/exercise type activities (eg chores and active commuting) currently provide a large proportion of daily activity for both males and females, however. It is anticipated that as modernization and technological advancement continue in this developing country, these primary sources of PA will decrease.

Adolescent travel mode choices to/from school vary in their physical activity (PA) component and environmental sustainability. Research has typically focussed on correlates of active travel, the most healthy and sustainable mode, in comparison to other modes combined. Under the premise that a small shift from less to more healthy/sustainable modes may be a more feasible than a shift to 'pure' active travel (e.g., walking), we examined potential correlates of the odds of undertaking more vs. less healthy/sustainable modes.Hong Kong adolescents attending secondary school and a parent/caregiver (n = 1299 dyads) participated in this cross-sectional study. Latent profile analyses identified groups of adolescents with different transport mode profiles to/from school. Profiles were ranked based on relative PA/sustainability outcomes. Multilevel logistic regression identified environmental, social and psychological factors associated with more vs. less PA/sustainable transport mode profiles to/from school.Most frequent transport modes were walking and public transport. Latent profile analysis resulted in a 7-profile model (walk (n = 430); walk & public transport (n = 93); public transport (n = 486); bicycle, car & taxi (n = 60); school bus to & public transport from school (n = 54); school bus (n = 106); car to & car/public transport from school (n = 70)). All profile comparisons were associated with at least one environmental variable. School proximity, access to services and parent transport-related PA were generally associated with higher odds of healthier-more sustainable transport modes. Adolescent-perceived distance and effort barriers to walking and cycling were generally associated with lower odds of more healthy/sustainable modes.Most adolescents engaged in relatively healthy/sustainable travel modes to/from school. Public transport to walking and school bus to public transport mode shifts are likely to have the biggest impact towards more healthy/sustainable modes. Encouraging parent-related transport PA may positively influence adolescent mode choice. Relatively dense, destination-rich neighbourhoods may encourage more healthy/sustainable transport modes to/from school by providing easy access to schools and services.Government policy encouraging enrolment in the closest local school and private school encouragement of public transport rather than school buses may have the greatest impact on shifts to more healthy/sustainable transport modes to/from school in Hong Kong adolescents.