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Rahman A. Editorial: Equity/inequality, diversity and inclusion in child and adolescent mental health - a perspective from the South Asian region. Child Adolesc Ment Health 2024; 29:197-199. [PMID: 38634295 DOI: 10.1111/camh.12702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2024] [Indexed: 04/19/2024]
Abstract
Over 1.8 billion people, about a quarter of the world's population live in the seven countries of South Asia: Afghanistan, Bangladesh, Bhutan, India, Nepal, Pakistan, and Sri Lanka. The population is characterized by a significant demographic youth bulge, with over 40% under the age of 18. This young population poses challenges related to ensuring their well-being and development. Issues such as poverty, undernutrition, lack of early stimulation, limited access to quality education and health care, and gender disparities persist in large parts of South Asia, affecting the lives of many children and adolescents. The promotion of child and adolescent mental health remains a challenge. Accumulating evidence suggests that early interventions can provide long-term health and socioeconomic benefits by prevention of the onset of mental health problems and their development into chronic disorders. This needs to be coupled with specialist services that can cater to the needs of children with greater needs, and support the community and schools-based non-specialist led services. Addressing child and adolescent mental health in South Asia presents a window of opportunity, because this regional youth bulge can contribute significantly to the global economy of the future.
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Affiliation(s)
- Atif Rahman
- Institute of Population Health, University of Liverpool, Liverpool, UK
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Ponsford R, Melendez-Torres GJ, Miners A, Falconer J, Bonell C. Whole-school interventions promoting student commitment to school to prevent substance use and violence, and improve educational attainment: a systematic review. PUBLIC HEALTH RESEARCH 2024; 12:1-290. [PMID: 38356404 DOI: 10.3310/dwtr3299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Background Whole-school interventions modify the school environment to promote health. A subset of these interventions promotes student commitment to school to prevent substance (tobacco, alcohol, other drugs) use and/or violence. A previous review identified the theory of human functioning and school organisation as a comprehensive theory of such interventions, and found evidence that these interventions reduce substance use and/or violence. Objectives The objectives were to search for, appraise and synthesise evidence to address the following questions: (1) What whole-school interventions promoting student commitment to school to prevent substance use and/or violence have been evaluated, what intervention subtypes are apparent and how closely do these align with the theory of human functioning and school organisation? (2) What factors relating to setting, population and intervention affect implementation? (3) What are the effects on student substance use, violence and educational attainment? (4) What is the cost-effectiveness of such interventions? (5) Are intervention effects mediated by student commitment to school or moderated by setting or population? Data sources A total of 56 information sources were searched (in January 2020), then an updated search of 48 of these was carried out (in May 2021). Reference lists were also searched and experts were contacted. Review methods Eligible studies were process/outcome evaluations of whole-school interventions to reduce student violence or substance use among students aged 5-18 years attending schools, via actions aligning with the theory of human functioning and school organisation: modifying teaching to increase engagement, enhancing student-staff relationships, revising school policies, encouraging volunteering or increasing parental involvement. Data extraction and quality assessments used existing tools. Theory and process reports were synthesised qualitatively. Outcome and economic data were synthesised narratively; outcome data were meta-analysed. Results Searches retrieved 63 eligible reports on 27 studies of 22 interventions. We identified four intervention subtypes focused on student participation in school-wide decisions, improving staff-student relationships, increasing engagement in learning and involving parents. The theories of change of most intervention subtypes aligned closely with the theory of human functioning and school organisation, and informed refinement of an intervention theory of change. Theories of change for interventions increasing learning engagement did not align with this theory, aiming instead to increase school commitment primarily via social skills curricula. Factors influencing the implementation included whether or not interventions were tailorable, workable and well explained. Interventions with action groups comprising staff/students, etc. and providing local data were well implemented. Implementation was also affected by whether or not schools accepted the need for change and staff had the resources for delivery. Meta-analyses suggest small, but significant, intervention effects in preventing violence victimisation and perpetration, and substance use. There was sparse and inconsistent evidence of moderation and some evidence of mediation by student commitment to school. Two economic evaluations suggested that there is the potential for the interventions to be cost-effective. Limitations The quality of the studies was variable and the economic synthesis was limited to two studies. Conclusions Whole-school interventions aiming to promote student commitment to school share similar theories of change and factors affecting implementation. They have the potential to contribute to preventing violence and substance use among young people. Future trials should aim to optimise intervention effectiveness by better theorisation, and assess implementation and effect moderators and mediators. Study registration This study is registered as PROSPERO CRD42019154334. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: 17/151/05) and is published in full in Public Health Research; Vol. 12, No. 2. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Ruth Ponsford
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Alec Miners
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Jane Falconer
- Library & Archives Service, London School of Hygiene & Tropical Medicine, London, UK
| | - Chris Bonell
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
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Prince SA, Lancione S, Lang JJ, Amankwah N, de Groh M, Jaramillo Garcia A, Merucci K, Geneau R. Examining the state, quality and strength of the evidence in the research on built environments and physical activity among children and youth: An overview of reviews from high income countries. Health Place 2022; 76:102828. [PMID: 35700605 DOI: 10.1016/j.healthplace.2022.102828] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 05/13/2022] [Accepted: 05/16/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND Built environments have shown to be associated with health, with physical activity (PA) considered one of the critical pathways for achieving benefits. Navigating available evidence on the built environment and PA is challenging given the number of reviews. OBJECTIVE Examine the current state and quality of research looking at associations between built environments and total PA and domains of PA (i.e., leisure/recreation, transportation, school) among children and youth (1-18 years). METHODS We systematically searched the grey literature and six bibliographic databases from January 2000 to May 2020. Review quality was assessed using the AMSTAR2. Results by age group were synthesized using narrative syntheses and harvest plots, and certainty of the evidence was assessed using a modified GRADE approach. RESULTS This overview included 65 reviews. Most reviews were of very low-to-low quality. High certainty was found for positive associations between transportation PA and walking/cycling/active transportation (AT) infrastructure. There was high certainty for positive associations between streets/play streets and total PA, alongside lower certainty for transportation and leisure PA. Very low-to-moderate certainty supports schoolyards designed to promote PA were positively associated with total PA, but mixed for school PA (except children). Less consistent positive associations were found for forests/trees, greenspace/open space, recreation facilities, street lighting, traffic safety, population/residential density, proximity/access to destinations, neighbourhood characteristics, and home environments. There is very low-to-moderate certainty for negative associations between greater distance to school and traffic volume and domains of PA. Generally, null or mixed associations were observed for aesthetics, parks, AT comfort infrastructure, land-use mix, street connectivity, urban/rural status, and public transit. DISCUSSION There remains a need for high quality systematic reviews and studies to evaluate the effects of environmental changes across the pediatric age spectrum and using a PA domain approach. Given the global physical inactivity crisis the built environment remains and important means to promote PA among children/youth.
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Affiliation(s)
- Stephanie A Prince
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada.
| | - Samantha Lancione
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Justin J Lang
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada; School of Mathematics and Statistics, Faculty of Science, Carleton University, Ottawa, Canada
| | - Nana Amankwah
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Canada
| | - Margaret de Groh
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Canada
| | | | | | - Robert Geneau
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Canada
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Moor I, Bieber J, Niederschuh L, Winter K. Die Bedeutung schulischer Gesundheitsförderung für die Erhöhung gesundheitlicher Chancengleichheit. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2022; 65:749-757. [PMID: 35657386 PMCID: PMC9164180 DOI: 10.1007/s00103-022-03551-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/25/2022] [Indexed: 11/26/2022]
Abstract
ZusammenfassungSozioökonomisch bedingte Ungleichheiten in der Gesundheit sind ein wichtiges Public-Health-Handlungsfeld und deren Reduzierung eines ihrer wichtigsten Ziele. Bislang ist es jedoch kaum gelungen, gesundheitliche Ungleichheiten zu verringern, was zugleich auch auf ein großes Forschungsdefizit hinweist. Auch im Kindes- und Jugendalter lassen sich bereits Ungleichheiten in der Gesundheit und dem Gesundheitsverhalten feststellen, wobei jene mit einem niedrigen sozioökonomischen Status verglichen mit sozial privilegierteren Gleichaltrigen oftmals mehr Risikofaktoren und gleichzeitig weniger Ressourcen aufweisen. Obwohl Gesundheitsförderung auf gesundheitliche Chancengleichheit abzielt, berücksichtigen Interventionen nur selten den sozioökonomischen Status und können entsprechend wenig Evidenz über sozioökonomisch differenzierte Interventionseffekte liefern. Wie kann es daher gelingen, allen Heranwachsenden die gleichen Chancen auf ein gesundes Aufwachsen zu ermöglichen?Um der Beantwortung dieser Frage näherzukommen, ist es zum einen das Ziel des Beitrags, einen Überblick über gesundheitliche Ungleichheiten im Kindes- und Jugendalter zu geben und die Rolle von Gesundheitsförderung sowie aktuelle Forschungsdefizite in diesem Zusammenhang aufzuzeigen. Zum anderen soll die Bedeutung der Schule und schulischer Gesundheitsförderungsmaßnahmen bei der Verringerung gesundheitlicher Ungleichheiten und der Erhöhung gesundheitlicher Chancengleichheit herausgestellt werden. Die Schule ist nicht nur ein Ort, an dem Heranwachsende unabhängig von ihrer sozialen Herkunft stets erreicht werden können, sondern hat das Potenzial, gesundheitliche Ungleichheiten sowohl zu verschärfen als auch zu reduzieren.
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Affiliation(s)
- Irene Moor
- Institut für Medizinische Soziologie, Martin-Luther-Universität Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle/Saale, Deutschland.
| | - Janis Bieber
- Institut für Medizinische Soziologie, Martin-Luther-Universität Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle/Saale, Deutschland
| | - Liska Niederschuh
- Institut für Medizinische Soziologie, Martin-Luther-Universität Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle/Saale, Deutschland
| | - Kristina Winter
- Institut für Medizinische Soziologie, Martin-Luther-Universität Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle/Saale, Deutschland
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Sadjadi M, Blanchard L, Brülle R, Bonell C. Barriers and facilitators to the implementation of Health-Promoting School programmes targeting bullying and violence: a systematic review. HEALTH EDUCATION RESEARCH 2022; 36:581-599. [PMID: 34312670 DOI: 10.1093/her/cyab029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/20/2021] [Accepted: 06/24/2021] [Indexed: 06/13/2023]
Abstract
Health-Promoting School (HPS) interventions aim to reduce bullying and violence via curriculum, environmental and family/community-engagement components. Despite evidence of their effectiveness, factors influencing the implementation of such interventions are poorly understood. This systematic review aims to examine such factors by assessing qualitative process evaluations of HPS interventions aiming to reduce bullying, aggression or violence. A comprehensive systematic search of 12 databases was carried out, and 20 reports from 17 studies were included. Thematic synthesis was used to identify factors affecting implementation. Factors that enable implementation were related to programme characteristics and stakeholder buy-in, including support from leadership, teachers, students and parents. Good communication and staff climate were important. Interventions were better implemented when they framed health promotion as a core school business, were supported by a national policy, used local data to show need and effectiveness and provided high-quality, pragmatic and accessible staff training. The results of this review can serve to guide and facilitate the design and implementation of future bullying and violence prevention programmes. Since there is significant overlap in terms of the important pillars and guiding principles for all interventions guided by the HPS framework, the findings may apply to outcomes beyond bullying and violence.
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Leurent B, Dodd M, Allen E, Viner R, Scott S, Bonell C. Is positive school climate associated with better adolescent mental health? Longitudinal study of young people in England. SSM - MENTAL HEALTH 2021; 1:None. [PMID: 34957422 PMCID: PMC8654679 DOI: 10.1016/j.ssmmh.2021.100033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/18/2021] [Accepted: 10/18/2021] [Indexed: 11/19/2022] Open
Abstract
Background and objectives Studies suggest that individual student-reported connection to school is associated with better mental health. However, there is less evidence for associations between schools’ overall school climate and the mental health of their students. This may reflect limitations in which mental health outcomes have been examined. We conducted a large longitudinal study in schools, hypothesising that we would find associations at both the student and school levels between student-reported positive school climate, and reduced student conduct and emotional problems and improved mental wellbeing. Methods We tracked students in 20 English secondary schools from near the end of the first year of secondary school (age 11/12) over 3 years using reliable measures of school climate and mental health. Results We found associations between student-level reports of positive school climate at baseline, and reduced conduct and emotional problems and better mental wellbeing at 3-year follow-up adjusting for various potential confounders. We also found some evidence of adjusted associations between baseline school-level measures of overall positive climate and better student mental health at follow-up. However, these student- and school-level associations reduced considerably when also adjusting for baseline mental health. Conclusions Our findings suggest that there are associations between school climate and student mental health at both the student and school level but these associations are complex and not necessarily causal. Previous studies provide little evidence that mental health differ between schools or is influenced by school climate. These studies' ability to identify school effects may have been undermined by choice of outcomes. Our study suggests that mental health may be better in schools with more student belonging.
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Affiliation(s)
- Baptiste Leurent
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Matthew Dodd
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Elizabeth Allen
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Russell Viner
- Institute of Child Health, University College London, 30 Guilford St, London, WC1N 1EH, UK
| | - Stephen Scott
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Chris Bonell
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, UK
- Corresponding author. Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
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Arthur K, Christofides N, Nelson G. Process evaluation of a pre-adolescent transdisciplinary health intervention for inter-generational outcomes. PLoS One 2021; 16:e0261632. [PMID: 34941911 PMCID: PMC8699635 DOI: 10.1371/journal.pone.0261632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 12/06/2021] [Indexed: 11/18/2022] Open
Abstract
Background The CIrCLE of Life Initiative was implemented to 537 grade 6 learners and their parents, in five Government-run South African primary schools. The transdisciplinary intervention was intended to increase knowledge and skills on HIV and obesity. The study aim was to assess and report on the implementation process. Methods Data was collected on an adapted Proctor’s taxonomy of implementation outcomes, and to assess participants’ experiences. Qualitative and quantitative data were collected through educator logbooks, researcher observations, and learner-parent workbooks. Results Differentiations between the various school contexts were observed. The process evaluation revealed high learner penetration (97.2%), but lower learner and parent exposure (44.3% and 55.5%, respectively). All educators thought that the intervention was a fit for both rural and urban schools, different socio-economic groups, and people of different ethnic and cultural backgrounds. The intervention was perceived to be sustainable, and there were recommendations for adoption into the school curriculum and scale-up if found to be effective. Conclusion The process evaluation facilitated the assessment of the implementation outcomes, described its processes, and acknowledged fundamental characteristics that could justify variability in the intervention impact and outcomes. The value of process evaluations and their benefit to the science of implementation were demonstrated.
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Affiliation(s)
- Keshni Arthur
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
| | - Nicola Christofides
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gill Nelson
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- UCL Institute for Global Health, University College London, London, United Kingdom
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McHugh C, Lloyd J, Logan S, Wyatt K. Implementing a set of health promoting processes in English secondary schools: A comparative case study. PUBLIC HEALTH IN PRACTICE 2021; 2:100214. [PMID: 36101576 PMCID: PMC9461601 DOI: 10.1016/j.puhip.2021.100214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 09/24/2021] [Accepted: 10/26/2021] [Indexed: 10/27/2022] Open
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Martínez García L, Samsó Jofra L, Alonso-Coello P, Ansuategi E, Asso Mistral L, Ballesteros M, Canelo-Aybar C, Casino G, Gallego Iborra A, Niño de Guzmán Quispe EP, Requeijo C, Roqué I Figuls M, Salas K, Ubeda M, Urreta I, Rosenbaum S. Teaching and learning how to make informed health choices: Protocol for a context analysis in Spanish primary schools. F1000Res 2021; 10:312. [PMID: 34631019 PMCID: PMC8474100 DOI: 10.12688/f1000research.51961.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/06/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction The Informed Health Choices (IHC) project developed learning resources to teach primary school children (10 to 12-year-olds) to assess treatment claims and make informed health choices. The aim of our study is to explore the educational context for teaching and learning critical thinking about health in Spanish primary schools. Methods During the 2020-2021 school year, we will conduct 1) a systematic assessment of educational documents and resources, and 2) semi-structured interviews with key education and health stakeholders. In the systematic assessment of educational documents and resources, we will include state and autonomous communities' curriculums, school educational projects, and commonly used textbooks and other health teaching materials. In the semi-structured interviews, we will involve education and health policy makers, developers of learning resources, developers of health promotion and educational interventions, head teachers, teachers, families, and paediatric primary care providers. We will design and pilot a data extraction form and a semi-structured interview guide to collect the data. We will perform a quantitative and a qualitative analysis of the data to explore how critical thinking about health is being taught and learned in Spanish primary schools. Conclusion We will identify opportunities for and barriers to teaching and learning critical thinking about health in Spanish primary schools. We will formulate recommendations-for both practice and research purposes-on how to use, adapt (if needed), and implement the IHC resources in this context.
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Affiliation(s)
- Laura Martínez García
- Iberoamerican Cochrane Centre (IbCC) - Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Laura Samsó Jofra
- Epidemiology and Public Health Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre (IbCC) - Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Eukane Ansuategi
- CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain.,Osakidetza, OSI Donostialdea, University Hospital of Donostia, Library Service, Donostia, Spain
| | - Laia Asso Mistral
- Maternal and Child Health Service, General Subdirectorate of Health Promotion, Public Health Agency of Catalonia, Barcelona, Spain
| | - Monica Ballesteros
- Iberoamerican Cochrane Centre (IbCC) - Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
| | - Carlos Canelo-Aybar
- Iberoamerican Cochrane Centre (IbCC) - Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Gonzalo Casino
- Iberoamerican Cochrane Centre (IbCC) - Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
| | | | | | - Carolina Requeijo
- Epidemiology and Public Health Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Marta Roqué I Figuls
- Iberoamerican Cochrane Centre (IbCC) - Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
| | - Karla Salas
- Health Services Research Group - Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.,Vall d'Hebron University Hospital, Barcelona, Spain
| | - Mar Ubeda
- Osakidetza, OSI Donostialdea, University Hospital of Donostia, Library Service, Donostia, Spain
| | - Iratxe Urreta
- CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain.,Clinical Epidemiology and Research Unit, University Hospital of Donostia, Donostia, Spain
| | - Sarah Rosenbaum
- Centre for Informed Health Choices, Norwegian Institute of Public Health, Oslo, Norway
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Long KQ, Ngoc-Anh HT, Phuong NH, Tuyet-Hanh TT, Park K, Takeuchi M, Lam NT, Nga PTQ, Phuong-Anh L, Van Tuan L, Bao TQ, Thinh OP, Van Huy N, Lan VTH, Van Minh H. Clustering Lifestyle Risk Behaviors among Vietnamese Adolescents and Roles of School: A Bayesian Multilevel Analysis of Global School-Based Student Health Survey 2019. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2021; 15:100225. [PMID: 34528007 PMCID: PMC8342779 DOI: 10.1016/j.lanwpc.2021.100225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/10/2021] [Accepted: 07/07/2021] [Indexed: 11/17/2022]
Abstract
Background Adolescence is a vulnerable period for many lifestyle risk behaviors. In this study, we aimed to 1) examine a clustering pattern of lifestyle risk behaviors; 2) investigate roles of the school health promotion programs on this pattern among adolescents in Vietnam. Methods We analyzed data of 7,541 adolescents aged 13–17 years from the 2019 nationally representative Global School-based Student Health Survey, conducted in 20 provinces and cities in Vietnam. We applied the latent class analysis to identify groups of clustering and used Bayesian 2-level logistic regressions to evaluate the correlation of school health promotion programs on these clusters. We reassessed the school effect size by incorporating different informative priors to the Bayesian models. Findings The most frequent lifestyle risk behavior among Vietnamese adolescents was physical inactivity, followed by unhealthy diet, and sedentary behavior. Most of students had a cluster of at least two risk factors and nearly a half with at least three risk factors. Latent class analysis detected 23% males and 18% females being at higher risk of lifestyle behaviors. Consistent through different priors, high quality of health promotion programs associated with lower the odds of lifestyle risk behaviors (highest quality schools vs. lowest quality schools; males: Odds ratio (OR) = 0·67, 95% Highest Density Interval (HDI): 0·46 – 0·93; females: OR = 0·69, 95% HDI: 0·47 – 0·98). Interpretation Our findings demonstrated the clustering of specific lifestyle risk behaviors among Vietnamese in-school adolescents. School-based interventions separated for males and females might reduce multiple health risk behaviors in adolescence. Funding The 2019 Global School-based Student Health Survey was conducted with financial support from the World Health Organization. The authors received no funding for the data analysis, data interpretation, manuscript writing, authorship, and/or publication of this article.
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Affiliation(s)
| | | | - Nguyen Hong Phuong
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC 20006
| | | | - Kidong Park
- World Health Organization, Country Office for Vietnam, Hanoi, 100000, Vietnam
| | - Momoe Takeuchi
- World Health Organization, Country Office for Vietnam, Hanoi, 100000, Vietnam
| | - Nguyen Tuan Lam
- World Health Organization, Country Office for Vietnam, Hanoi, 100000, Vietnam
| | - Pham Thi Quynh Nga
- World Health Organization, Country Office for Vietnam, Hanoi, 100000, Vietnam
| | - Le Phuong-Anh
- World Health Organization, Country Office for Vietnam, Hanoi, 100000, Vietnam
| | - Le Van Tuan
- Vietnam Ministry of Education and Training, Hanoi, 100000, Vietnam
| | - Tran Quoc Bao
- General Department of Preventive Medicine, Ministry of Health, Hanoi, 100000, Vietnam
| | - Ong Phuc Thinh
- Hanoi University of Public Health, Hanoi, 100000, Vietnam
| | - Nguyen Van Huy
- Health Innovation and Transformation Centre, Federation University, Victoria, 3353, Australia.,Graduate School of Public Health, St. Luke's International University, Tokyo, 104-0044, Japan
| | | | - Hoang Van Minh
- Hanoi University of Public Health, Hanoi, 100000, Vietnam
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Shoari N, Ezzati M, Doyle YG, Wolfe I, Brauer M, Bennett J, Fecht D. Nowhere to Play: Available Open and Green Space in Greater London Schools. J Urban Health 2021; 98:375-384. [PMID: 33742376 PMCID: PMC8190412 DOI: 10.1007/s11524-021-00527-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/05/2021] [Indexed: 12/01/2022]
Abstract
Experiencing outdoor space, especially natural space, during childhood and adolescence has beneficial physical and mental health effects, including improved cognitive and motor skills and a lower risk of obesity. Since school-age children typically spend 35-40 hours per week at schools, we quantified their access to open (non-built-up) space and green space at schools in Greater London. We linked land use information from the UK Ordnance Survey with school characteristics from the Department for Education (DfE) for schools in Greater London. We estimated open space by isolating land and water features within school boundaries and, as a subset of open space, green space defined as open space covered by vegetation. We examined the relationship of both school open and green space with distance to Central London, whether the school was fee-paying, and the percentage of pupils eligible for free school meals (as a school-level indicator of socioeconomic status). Almost 400,000 pupils (30% of all pupils in London) attended schools with less than ten square metre per pupil of open space-the minimum recommended area by DfE-and 800,000 pupils attended schools with less than ten square metre per pupil of green space. Of the latter, 70% did not have any public parks in the immediate vicinity of their schools. School green space increased with distance from Central London. There was a weak association between the school-level socioeconomic indicator and the amount of open and green space. Fee-paying schools provided less open space compared to non-fee-paying schools in central parts of London, but the provision became comparable in suburban London. Many London schools do not provide enough open and green space. There is a need to ensure regular contact with green space through safeguarding school grounds from sales, financially supporting disadvantaged schools to increase their outdoor space and providing access to off-site facilities such as sharing outdoor space with other schools.
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Affiliation(s)
- Niloofar Shoari
- MRC Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Majid Ezzati
- MRC Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | | | - Ingrid Wolfe
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Michael Brauer
- School of Population and Public Health, The University of British Columbia, Vancouver, Canada
| | - James Bennett
- MRC Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Daniela Fecht
- MRC Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
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12
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Guz S, Kattari SK, Atteberry-Ash B, Klemmer CL, Call J, Kattari L. Depression and Suicide Risk at the Cross-Section of Sexual Orientation and Gender Identity for Youth. J Adolesc Health 2021; 68:317-323. [PMID: 32680801 DOI: 10.1016/j.jadohealth.2020.06.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 05/23/2020] [Accepted: 06/02/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE Adolescence is a developmental phase in which young people begin to explore their identity and seek to understand how their identity fits into the larger society. Although this is a developmental task for all adolescents, it is especially salient for sexual and gender minority youth. Owing to oppressive social structures and stigmatized identities, adolescents who identify as nonheterosexual or noncisgender are vulnerable to experiencing disproportionate adverse health outcomes. METHODS To further the literature on adolescent mental health among sexual and gender minority youth, this study analyzed a representative statewide sample of high school students (ages 14-18) to analyze how sexual orientation and gender identity are associated with depression and suicidality. RESULTS Results aligned with previous research demonstrating that sexual and gender minority youth were all at a heightened risk for depression. However, transgender youth and youth questioning their sexuality or gender were at especially heightened risk for experiencing depression and suicidality. CONCLUSION The findings of this study indicate a need to target or adapt direct services and programming for sexual and gender minority adolescents.
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Affiliation(s)
- Samantha Guz
- University of Chicago School of Social Service Administration, Chicago, Illinois.
| | - Shanna K Kattari
- University of Michigan School of Social Work, Ann Arbor, Michigan
| | | | - Cary L Klemmer
- University of Southern California Dworak-Peck School of Social Work, Los Angeles, California
| | - Jarrod Call
- University of Denver Graduate School of Social Work, Denver, Colorado
| | - Leonardo Kattari
- University of Michigan School of Social Work, Ann Arbor, Michigan
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13
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Bergling E, Farewell C, Puma J. Development of a Dissemination and Implementation Framework for an Early Childhood Obesity Prevention Program. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2020; 52:1160-1165. [PMID: 33008744 DOI: 10.1016/j.jneb.2020.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 08/20/2020] [Accepted: 08/25/2020] [Indexed: 06/11/2023]
Abstract
Dissemination and implementation (D&I) science addresses the disconnect between evidence-based research and practical application in community settings. Early childhood education settings are ideal for the application of D&I research because of their widespread use for implementing health promotion interventions. A D&I framework was applied to the Culture of Wellness in Preschools program, a comprehensive early childhood obesity prevention program. The development and application of the Culture of Wellness in Preschools D&I framework can lead to a more comprehensive approach to program evaluation and quality improvement and can contribute more broadly to the body of evidence of nutrition-related health promotion programs.
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Affiliation(s)
- Emily Bergling
- Rocky Mountain Prevention Research Center, Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO.
| | - Charlotte Farewell
- Rocky Mountain Prevention Research Center, Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Jini Puma
- Rocky Mountain Prevention Research Center, Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
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14
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Šouláková B, Kasal A, Butzer B, Winkler P. Meta-Review on the Effectiveness of Classroom-Based Psychological Interventions Aimed at Improving Student Mental Health and Well-Being, and Preventing Mental Illness. J Prim Prev 2020; 40:255-278. [PMID: 31140100 DOI: 10.1007/s10935-019-00552-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This meta-review summarizes existing evidence from systematic reviews and meta-analyses on the effectiveness of school-based psychological interventions aimed at improving student mental health and well-being, and preventing mental illness. Systematic reviews and meta-analyses were identified via the electronic databases PsycINFO, Web of Knowledge, Medline, Embase, and HMIC (Health Management Information Consortium). Ten systematic reviews and meta-analysis were eligible for inclusion in the final analyses. These systematic reviews and meta-analyses evaluated the effects of five types of school-based psychological interventions: Mindfulness, Social Emotional Learning, Cognitive Behavioral Therapy, Yoga, and Body-Image. Overall effectiveness reported in the included studies was significant for the most part, and ranging from small to large with respect to the effect size. The authors of all of the studies emphasized the need for additional high-quality trials to further examine the effectiveness of school-based psychological interventions aimed at improving student mental health and well-being, and preventing mental illness.
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Affiliation(s)
- Barbora Šouláková
- Department of Social Psychiatry, National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic.
| | - Alexandr Kasal
- Department of Social Psychiatry, National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic.,Faculty of Social Sciences, Charles University in Prague, Prague, Czech Republic
| | - Bethany Butzer
- Department of Social Psychiatry, National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic.,School of Psychology, University of New York in Prague, Prague, Czech Republic
| | - Petr Winkler
- Department of Social Psychiatry, National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic.,Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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15
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Pauli LA, Correa MB, Demarco FF, Goettems ML. The school social environment and oral health-related quality of life in children: a multilevel analysis. Eur J Oral Sci 2020; 128:153-159. [PMID: 31999873 DOI: 10.1111/eos.12679] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2019] [Indexed: 11/27/2022]
Abstract
This study aimed to explore the association between schoolchildren's oral health-related quality of life (OHRQoL) and the school-related social environment (contextual factors). A cross-sectional study was performed with 1,211 children, aged 8-12 yr, from 20 private and public schools. Sociodemographic information was collected from a questionnaire given to parents, and children were interviewed using the Child Perceptions Questionnaire (CPQ) and examined for oral health conditions. Contextual variables were obtained from school coordinators regarding the social environment. Data analysis was performed through multilevel Poisson regression. A high negative impact on OHRQoL was found for participants who were girls, older, had very severe malocclusion, had dental trauma and caries, and had mothers with less schooling. A negative impact on OHRQoL was also found for children who attended schools in which police security was required (rate ratios [RR] = 1.11; 95% CI: 1.01-1.22) and in which violence among students occurred in the last year (RR = 1.17; 95% CI: 1.02-1.35). The need for police security was associated with a negative impact on the emotional well-being domain, and violence among students was associated with negative impact on the oral symptoms, functional limitations, and social well-being domains. Children in healthier environments have better OHRQoL.
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Affiliation(s)
- Laís A Pauli
- Post-Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, Brazil
| | - Marcos B Correa
- Post-Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, Brazil
| | - Flávio F Demarco
- Post-Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, Brazil.,Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Marília L Goettems
- Post-Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, Brazil
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16
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García-Moya I, Brooks FM, Spencer NH. School-level factors associated with teacher connectedness: a multilevel analysis of the structural and relational school determinants of young people's health. J Public Health (Oxf) 2019; 40:366-374. [PMID: 28985417 PMCID: PMC6051442 DOI: 10.1093/pubmed/fdx089] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Indexed: 11/13/2022] Open
Abstract
Background Conducting research on the antecedents of teacher connectedness (TC) is key to inform intervention and policy that can leverage the public health potential of teachers for young people’s well-being. As part of the EU-funded Teacher Connectedness Project, this study aims to examine the contribution of a variety of school-level factors (including type of school, school size, student–teacher ratio, students per class and teacher gender). Methods Sample consisted of 5335 adolescents aged 11, 13 and 15 years that had participated in the HBSC study in England. Multilevel multinomial regression was used to examine the contributions of sociodemographic and school-level factors to TC. Results TC was lower in older adolescents and those from less affluent families, but similar in boys and girls. Regarding school-level factors, it was not the size of the school but the ratio of students per teacher which was significantly associated to TC, with higher student–teacher ratio being significantly associated with lower odds of medium-to-high TC. Some differences between mixed and all-girls schools were also found. Conclusions Health promotion strategies targeting student–teacher relationships need to consider how TC changes by age and SES and give attention to school-level factors, in particular the student–teacher ratio.
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Affiliation(s)
- I García-Moya
- CRIPACC, School of Health and Social Work, University of Hertfordshire, College Lane Campus, Hatfield, Hertfordshire, UK
| | - F M Brooks
- CRIPACC, School of Health and Social Work, University of Hertfordshire, College Lane Campus, Hatfield, Hertfordshire, UK.,Faculty of Health, University of Technology Sydney, PO Box 123 Broadway, Sydney, NSW, Australia
| | - N H Spencer
- Hertfordshire Business School, University of Hertfordshire, de Havilland Campus, Hatfield, Hertfordshire, UK
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17
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Nery NG, Jordão LMR, Freire MDCM. School environment and oral health promotion: the National Survey of School Health (PeNSE). Rev Saude Publica 2019; 53:93. [PMID: 31644772 PMCID: PMC6802948 DOI: 10.11606/s1518-8787.2019053001376] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 03/11/2019] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To evaluate the potential support of schools for oral health promotion and associated factors in Brazilian capitals. METHODS Data from 1,339 public and private schools of the 27 Brazilian capitals were obtained from the National Survey of School Health (PeNSE) 2015. Data from the capitals were obtained from the United Nations Development Program and the Department of Informatics of the Brazilian Unified Health System (Datasus). The indicator “ ambiente escolar promotor de saúde bucal ” (AEPSB – oral health promoting school environment) was designed from 21 variables of the school environment with possible influence on students’ oral health employing the categorical principal components analysis (CATPCA). Associations between the AEPSB and characteristics of schools, capitals and regions were tested (bivariate analysis). RESULTS Ten variables comprised CAPTCA, after excluding those with low correlation or high multicollinearity. The analysis resulted in a model with three dimensions: D1. Within-school aspects (sales of food with added sugar in the canteen and health promotion actions), D2. Aspects of the area around the school (sales of food with added sugar in alternative points) and D3. prohibitive policies at school (prohibition of alcohol and tobacco consumption). The sum of the scores of the dimensions generated the AEPSB indicator, dichotomized by the median. From the total of schools studied, 51.2% (95%CI 48.5–53.8) presented a more favorable environment for oral health (higher AEPSB). In the capitals, this percentage ranged from 36.6% (95%CI 23.4–52.2) in Rio Branco to 80.4% (95%CI 67.2–89.1) in Florianópolis. Among the Brazilian regions, it ranged from 45.5% (95%CI 40.0–51.2) in the North to 67.6% (95%CI 59.4–74.9) in the South. Higher percentages of schools with higher AEPSB were found in public schools [58.1% (95%CI 54.9–61.2)] and in capitals and regions with higher Human Development Index [61.0% (95%IC 55.8–66.0) and 57.4% (95%CI 53.2–61.4), respectively] and lower Gini index [55.7% (95%CI 51.2–60.0) and 52.8 (95%CI 49.8–55.8), respectively]. CONCLUSIONS The potential to support oral health promotion in schools in Brazilian capitals, assessed by the AEPSB indicator, was associated with contextual factors of schools, capitals and Brazilian regions.
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Affiliation(s)
- Newillames Gonçalves Nery
- Secretaria Municipal de Saúde de Goiânia. Goiânia, GO, Brasil.,Universidade Federal de Goiás. Faculdade de Odontologia. Programa de Pós-Graduação em Odontologia. Goiânia, GO, Brasil
| | - Lidia Moraes Ribeiro Jordão
- Universidade Federal de Goiás. Faculdade de Odontologia. Programa de Pós-Graduação em Odontologia. Goiânia, GO, Brasil
| | - Maria do Carmo Matias Freire
- Universidade Federal de Goiás. Faculdade de Odontologia. Programa de Pós-Graduação em Odontologia. Goiânia, GO, Brasil
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18
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Bonell C, Allen E, Warren E, McGowan J, Bevilacqua L, Jamal F, Sadique Z, Legood R, Wiggins M, Opondo C, Mathiot A, Sturgess J, Paparini S, Fletcher A, Perry M, West G, Tancred T, Scott S, Elbourne D, Christie D, Bond L, Viner RM. Modifying the secondary school environment to reduce bullying and aggression: the INCLUSIVE cluster RCT. PUBLIC HEALTH RESEARCH 2019. [DOI: 10.3310/phr07180] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundBullying, aggression and violence among children and young people are some of the most consequential public mental health problems.ObjectivesThe INCLUSIVE (initiating change locally in bullying and aggression through the school environment) trial evaluated the Learning Together intervention, which involved students in efforts to modify their school environment using restorative approaches and to develop social and emotional skills. We hypothesised that in schools receiving Learning Together there would be lower rates of self-reported bullying and perpetration of aggression and improved student biopsychosocial health at follow-up than in control schools.DesignINCLUSIVE was a cluster randomised trial with integral economic and process evaluations.SettingForty secondary schools in south-east England took part. Schools were randomly assigned to implement the Learning Together intervention over 3 years or to continue standard practice (controls).ParticipantsA total of 6667 (93.6%) students participated at baseline and 5960 (83.3%) students participated at final follow-up. No schools withdrew from the study.InterventionSchools were provided with (1) a social and emotional curriculum, (2) all-staff training in restorative approaches, (3) an external facilitator to help convene an action group to revise rules and policies and to oversee intervention delivery and (4) information on local needs to inform decisions.Main outcome measuresSelf-reported experience of bullying victimisation (Gatehouse Bullying Scale) and perpetration of aggression (Edinburgh Study of Youth Transitions and Crime school misbehaviour subscale) measured at 36 months. Intention-to-treat analysis using longitudinal mixed-effects models.ResultsPrimary outcomes – Gatehouse Bullying Scale scores were significantly lower among intervention schools than among control schools at 36 months (adjusted mean difference –0.03, 95% confidence interval –0.06 to 0.00). There was no evidence of a difference in Edinburgh Study of Youth Transitions and Crime scores. Secondary outcomes – students in intervention schools had higher quality of life (adjusted mean difference 1.44, 95% confidence interval 0.07 to 2.17) and psychological well-being scores (adjusted mean difference 0.33, 95% confidence interval 0.00 to 0.66), lower psychological total difficulties (Strengths and Difficulties Questionnaire) score (adjusted mean difference –0.54, 95% confidence interval –0.83 to –0.25), and lower odds of having smoked (odds ratio 0.58, 95% confidence interval 0.43 to 0.80), drunk alcohol (odds ratio 0.72, 95% confidence interval 0.56 to 0.92), been offered or tried illicit drugs (odds ratio 0.51, 95% confidence interval 0.36 to 0.73) and been in contact with police in the previous 12 months (odds ratio 0.74, 95% confidence interval 0.56 to 0.97). The total numbers of reported serious adverse events were similar in each arm. There were no changes for staff outcomes. Process evaluation – fidelity was variable, with a reduction in year 3. Over half of the staff were aware that the school was taking steps to reduce bullying and aggression. Economic evaluation – mean (standard deviation) total education sector-related costs were £116 (£47) per pupil in the control arm compared with £163 (£69) in the intervention arm over the first two facilitated years, and £63 (£33) and £74 (£37) per pupil, respectively, in the final, unfacilitated, year. Overall, the intervention was associated with higher costs, but the mean gain in students’ health-related quality of life was slightly higher in the intervention arm. The incremental cost per quality-adjusted life year was £13,284 (95% confidence interval –£32,175 to £58,743) and £1875 (95% confidence interval –£12,945 to £16,695) at 2 and 3 years, respectively.LimitationsOur trial was carried out in urban and periurban settings in the counties around London. The large number of secondary outcomes investigated necessitated multiple statistical testing. Fidelity of implementation of Learning Together was variable.ConclusionsLearning Together is effective across a very broad range of key public health targets for adolescents.Future workFurther studies are required to assess refined versions of this intervention in other settings.Trial registrationCurrent Controlled Trials ISRCTN10751359.FundingThis project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full inPublic Health Research; Vol. 7, No. 18. See the NIHR Journals Library website for further project information. Additional funding was provided by the Educational Endowment Foundation.
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Affiliation(s)
- Chris Bonell
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Elizabeth Allen
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Emily Warren
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Jennifer McGowan
- Institute of Child Health, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Leonardo Bevilacqua
- Institute of Child Health, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Farah Jamal
- Department of Social Science, University College London Institute of Education, London, UK
| | - Zia Sadique
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Rosa Legood
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Meg Wiggins
- Department of Social Science, University College London Institute of Education, London, UK
| | - Charles Opondo
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Anne Mathiot
- Institute of Child Health, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Joanna Sturgess
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Sara Paparini
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Adam Fletcher
- School of Social Sciences, Cardiff University, Cardiff, UK
| | | | - Grace West
- Institute of Child Health, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Tara Tancred
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Stephen Scott
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Diana Elbourne
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Deborah Christie
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Lyndal Bond
- College of Health and Biomedicine, Victoria University, Melbourne, VIC, Australia
| | - Russell M Viner
- Institute of Child Health, University College London Great Ormond Street Institute of Child Health, London, UK
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19
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Bonell C, Blakemore SJ, Fletcher A, Patton G. Role theory of schools and adolescent health. THE LANCET CHILD & ADOLESCENT HEALTH 2019; 3:742-748. [DOI: 10.1016/s2352-4642(19)30183-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/14/2019] [Accepted: 05/15/2019] [Indexed: 10/26/2022]
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20
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Peterson AJ, Donze M, Allen E, Bonell C. Effects of Interventions Addressing School Environments or Educational Assets on Adolescent Sexual Health: Systematic Review and Meta-analysis. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2019; 51:91-107. [PMID: 31108026 DOI: 10.1363/psrh.12102] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 01/07/2019] [Accepted: 01/23/2019] [Indexed: 06/09/2023]
Abstract
CONTEXT School-based interventions that aim to modify sexual health knowledge, attitudes and behaviors have mixed and often unsustained effects on adolescent sexual health outcomes. However, observational evidence suggests that broader school-related factors, such as school climate and academic attainment, can influence outcomes. METHODS Nine databases were searched in July 2017 for randomized and quasi-experimental evaluations of interventions addressing school-level environment or student-level educational assets, to examine whether such interventions can promote young people's sexual health. Searches were limited to studies published since 1990 but were not restricted by language. Studies were assessed for risk of bias and synthesized narratively and meta-analytically. RESULTS Searches yielded 11 evaluations, published from 1999 to 2016, of interventions related to school-level environment or student-level educational assets. Because of inconsistent reporting, the risk of bias was not clear for most studies, and meta-analysis was possible for only one outcome. The meta-analysis of three randomized trials provided some evidence that school-environment interventions may delay sexual debut (pooled odds ratio, 0.5). Narrative synthesis of the remaining outcomes found mixed results, but suggests that interventions addressing school-level environment may delay sexual debut and that those addressing student-level educational assets may reduce risk of pregnancy and STDs. CONCLUSIONS Additional and more rigorous evidence is needed to assess the probability that interventions addressing school-related factors are effective and to provide better understanding of the mechanisms by which they may work to improve adolescent sexual health.
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Affiliation(s)
- Amy J Peterson
- Program Manager, ETR, Scotts Valley, CA
- Doctoral Degree Candidate, Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London
| | - Melissa Donze
- City Research Scientist, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York
| | - Elizabeth Allen
- Professor, Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London
| | - Chris Bonell
- Professor, Department of Public Health Sociology, London School of Hygiene and Tropical Medicine, London
- Head, Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London
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21
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Ponsford R, Thompson C, Paparini S. We need a renewed focus on primary prevention to tackle youth knife violence. BMJ 2019; 365:l1769. [PMID: 30992272 DOI: 10.1136/bmj.l1769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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22
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Carlson P. Declining alcohol consumption among adolescents and schools in Stockholm, 2010-2016. NORDIC STUDIES ON ALCOHOL AND DRUGS 2019; 36:344-356. [PMID: 32934572 PMCID: PMC7434179 DOI: 10.1177/1455072519835710] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 02/14/2019] [Indexed: 11/22/2022] Open
Abstract
Aims: The principle aim of this study was to investigate changes in alcohol consumption among adolescents in Stockholm from 2010 to 2016. A further aim was to investigate whether there are divergent or similar trends in alcohol consumption among elementary schools in Stockholm from 2010 to 2016 and, if there are diverging trends, to examine how the differences might be explained. Methods: Data were analysed using multilevel mixed effects linear regression, in which individual students represented one level and schools the second level. Data: Student-level data were derived from the Stockholm School Survey for the years 2010, 2012, 2014 and 2016 (n = 15481). School-level data (n = 132) were derived from registries of the Swedish National Agency for Education. Results: The results showed that there was an almost 45% decline in total alcohol consumption among ninth-grade students in Stockholm between 2010 and 2016. The decline was similar among all analysed consumption groups. Two factors were found to statistically explain some of the general decline: more restrictive parental attitudes towards alcohol and, more importantly, decreasing alcohol consumption among the students’ peers. The downward trends among schools between 2010 and 2016 were universal but not identical, but when parental attitudes towards alcohol and peers’ alcohol behaviour were controlled for, the diverging school trends in alcohol consumption were considerably more equal. Conclusions: School constitutes a social context for the student of which both parents and peers are important parts, and the diverging changes may be due to the norms and behaviours, influenced by parents and peers, characterising these schools.
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Bonell C, Allen E, Warren E, McGowan J, Bevilacqua L, Jamal F, Legood R, Wiggins M, Opondo C, Mathiot A, Sturgess J, Fletcher A, Sadique Z, Elbourne D, Christie D, Bond L, Scott S, Viner RM. Effects of the Learning Together intervention on bullying and aggression in English secondary schools (INCLUSIVE): a cluster randomised controlled trial. Lancet 2018; 392:2452-2464. [PMID: 30473366 PMCID: PMC6286420 DOI: 10.1016/s0140-6736(18)31782-3] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 07/26/2018] [Accepted: 07/27/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Bullying, aggression, and violence among children and young people are some of the most consequential public mental health problems. We tested the Learning Together intervention, which involved students in efforts to modify their school environment using restorative practice and by developing social and emotional skills. METHODS We did a cluster randomised trial, with economic and process evaluations, of the Learning Together intervention compared with standard practice (controls) over 3 years in secondary schools in south-east England. Learning Together consisted of staff training in restorative practice; convening and facilitating a school action group; and a student social and emotional skills curriculum. Primary outcomes were self-reported experience of bullying victimisation (Gatehouse Bullying Scale; GBS) and perpetration of aggression (Edinburgh Study of Youth Transitions and Crime (ESYTC) school misbehaviour subscale) measured at 36 months. We analysed data using intention-to-treat longitudinal mixed-effects models. This trial was registered with the ISRCTN registry (10751359). FINDINGS We included 40 schools (20 in each group); no schools withdrew. 6667 (93·6%) of 7121 students participated at baseline and 5960 (83·3%) of 7154 at 36 months. Mean GBS bullying score at 36 months was 0·34 (SE 0·02) in the control group versus 0·29 (SE 0·02) in the intervention group, with a significant adjusted mean difference (-0·03, 95% CI -0·06 to -0·001; adjusted effect size -0·08). Mean ESYTC score at 36 months was 4·33 (SE 0·20) in the control group versus 4·04 (0·21) in the intervention group, with no evidence of a difference between groups (adjusted difference -0·13, 95% CI -0·43 to 0·18; adjusted effect size -0·03). Costs were an additional £58 per pupil in intervention schools than in control schools. INTERPRETATION Learning Together had small but significant effects on bullying, which could be important for public health, but no effect on aggression. Interventions to promote student health by modifying the whole-school environment are likely to be one of the most feasible and efficient ways of addressing closely related risk and health outcomes in children and young people. FUNDING National Institute for Health Research, Educational Endowment Foundation.
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Affiliation(s)
- Chris Bonell
- London School of Hygiene & Tropical Medicine, London, UK.
| | | | - Emily Warren
- London School of Hygiene & Tropical Medicine, London, UK
| | - Jennifer McGowan
- University College London Great Ormond St Institute of Child Health, London, UK
| | - Leonardo Bevilacqua
- University College London Great Ormond St Institute of Child Health, London, UK
| | - Farah Jamal
- University College London Institute of Education, London, UK
| | - Rosa Legood
- London School of Hygiene & Tropical Medicine, London, UK
| | - Meg Wiggins
- University College London Institute of Education, London, UK
| | - Charles Opondo
- London School of Hygiene & Tropical Medicine, London, UK
| | - Anne Mathiot
- University College London Great Ormond St Institute of Child Health, London, UK
| | - Jo Sturgess
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Zia Sadique
- London School of Hygiene & Tropical Medicine, London, UK
| | - Diana Elbourne
- London School of Hygiene & Tropical Medicine, London, UK; Victoria University, Melbourne, VIC, Australia
| | | | - Lyndal Bond
- Victoria University, Melbourne, VIC, Australia
| | - Stephen Scott
- Institute of Psychiatry Psychology & Neurology, London, UK
| | - Russell M Viner
- University College London Great Ormond St Institute of Child Health, London, UK.
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Pearson R, Howe J. Pupil participation and playground design: listening and responding to children’s views. EDUCATIONAL PSYCHOLOGY IN PRACTICE 2017. [DOI: 10.1080/02667363.2017.1326375] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Julia Howe
- School of Education, University of Birmingham, Birmingham, UK
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Yazdi Feyzabadi V, Keshavarz Mohammadi N, Omidvar N, Karimi-Shahanjarini A, Nedjat S, Rashidian A. Factors Associated With Unhealthy Snacks Consumption Among Adolescents in Iran's Schools. Int J Health Policy Manag 2017; 6:519-528. [PMID: 28949464 PMCID: PMC5582438 DOI: 10.15171/ijhpm.2017.09] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 01/18/2017] [Indexed: 12/03/2022] Open
Abstract
Background: Well-informed interventions are needed if school-based health promotion is to be effective. Among other aims, the Iranian Health Promoting School (IHPS) program that was launched in 2011, has an important aim
of promoting dietary behaviors of adolescents. The present study, therefore, aimed to investigate the factors affecting
unhealthy snacking of adolescents and provide evidence for a more effective IHPS program.
Methods: In a cross-sectional study design, 1320 students from 40 schools in Kerman city were selected using a
proportional stratified random sampling method. A modified qualitative Food Frequency Questionnaire (FFQ) was
used to gather data about unhealthy snacking behavior. Data about intrapersonal and environmental factors were
obtained using a validated and reliable questionnaire. A mixed-effects negative-binomial regression model was used
to analyze the data.
Results: Taste and sensory perception (prevalence rate ratio [PRR]=1.18; 95% CI: 1.09-1.27), being a male (PRR=1.20;
95% CI: 1.05-1.38) and lower nutritional knowledge (PRR=0.96; 95% CI: 0.91-0.99) were associated with higher weekly
unhealthy snaking. Perceived self-efficacy (PRR=0.95; 95% CI: 0.91-1.00) negatively influenced the frequency of
unhealthy snaking, with this approaching significance (P<.06). In case of environmental factors, high socio-economic
status (SES) level (PRR=1.45; 95% CI: 1.26-1.67), single-parent family (PRR=1.14; 95% CI: 1.01-1.30), more social
norms pressure (PRR=1.08; 95% CI: 1.01-1.17), pocket money allowance (PRR=1.21; 95% CI: 1.09-1.34), easy
accessibility (PRR=1.06; 95% CI:1.01-1.11), and less perceived parental control (PRR=0.96; 95% CI: 0.92-0.99) all had
a role in higher consumption of unhealthy snacks. Interestingly, larger school size was associated with less unhealthy
snacking (PRR=0.79; 95% CI: 0.68-0.92).
Conclusion: Unhealthy snacking behavior is influenced by individual, socio-cultural and physical-environmental
influences, namely by factors relating to poor parenting practices, high SES level, family characteristics, improper social
norms pressure, and less knowledge and self-efficacy of students. This evidence can be used to inform a more evidencebased
IHPS program through focusing on supportive strategies at the home, school, and local community levels.
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Affiliation(s)
- Vahid Yazdi Feyzabadi
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Nasrin Omidvar
- Department of Community Nutrition, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Akram Karimi-Shahanjarini
- Social Determinants of Health Research Center and Department of Public Health, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Saharnaz Nedjat
- Epidemiology and Biostatistics Department, School of Public Health, Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Rashidian
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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26
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Mansoor OD, Ali R, Richards R. Regional survey supports national initiative for ‘water-only’ schools in New Zealand. Aust N Z J Public Health 2017; 41:508-511. [DOI: 10.1111/1753-6405.12705] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 03/01/2017] [Accepted: 05/01/2017] [Indexed: 12/26/2022] Open
Affiliation(s)
| | - Rukhsana Ali
- Regional Public Health; Hutt Hospital Campus; New Zealand
| | - Ruth Richards
- Regional Public Health; Hutt Hospital Campus; New Zealand
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27
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Lester S, Lawrence C, Ward CL. What do we know about preventing school violence? A systematic review of systematic reviews. PSYCHOL HEALTH MED 2017; 22:187-223. [PMID: 28132514 DOI: 10.1080/13548506.2017.1282616] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Many children across the world are exposed to school violence, which undermines their right to education and adversely affects their development. Studies of interventions for school violence suggest that it can be prevented. However, this evidence base is challenging to navigate. We completed a systematic review of interventions to reduce four types of school violence: (a) peer violence; (b) corporal punishment; (c) student-on-teacher violence and (d) teacher-on-student violence. Reviewers independently searched databases and journals. Included studies were published between 2005 and 2015; in English; considered school-based interventions for children and measured violence as an outcome. Many systematic reviews were found, thus we completed a systematic review of systematic reviews. Only systematic reviews on interventions for intimate partner violence (IPV) and peer aggression were found. These reviews were generally of moderate quality. Research on both types of violence was largely completed in North America. Only a handful of programmes demonstrate promise in preventing IPV. Cognitive behavioral, social-emotional and peer mentoring/mediation programmes showed promise in reducing the levels of perpetration of peer aggression. Further research needs to determine the long-term effects of interventions, potential moderators and mediators of program effects, program effects across different contexts and key intervention components.
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Affiliation(s)
- Soraya Lester
- a Department of Psychology , University of Cape Town , Cape Town , South Africa
| | - Cayleigh Lawrence
- a Department of Psychology , University of Cape Town , Cape Town , South Africa
| | - Catherine L Ward
- a Department of Psychology , University of Cape Town , Cape Town , South Africa.,b Safety and Violence Initiative , University of Cape Town , Cape Town , South Africa
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28
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Svensson AC, Stjernschantz Forsberg J, Seblova D, Lager A. Residential area and physical activity: A multi-level study of 68,000 adults in Stockholm County. Scand J Public Health 2016; 45:25-32. [DOI: 10.1177/1403494816682377] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim: To determine whether there are systematic differences in physical activity between residential areas after extensive control for sociodemographic factors at the individual level. Methods: Multi-level regressions of walking/bicycling, sedentary activities, household work and exercise were carried out in a representative sample of 68,303 adults in 39 residential areas in Stockholm County, first adjusting at the individual level for country of birth, sex, age, education, occupational class and income. The type of housing was then considered at the individual level or, for walking/bicycling and exercise, at both the individual and area levels (as a measure of area density). Results: After adjustment for sociodemographic factors, differences between residential areas remained in walking/bicycling, corresponding to 0.27 SD, or 50 min/week between the most and least active areas. Forty per cent of this difference could be explained by the type of housing at the area level. For sedentary activities and household work, respectively, much of the variation that remained after adjustment for sociodemographic factors was, in turn, explained by the type of housing at the individual level, leaving a difference of 0.16 SD (80 min/week) and 0.13 SD (60 min/week), respectively. For exercise, the corresponding difference was 0.11 SD (11 min/week, not sensitive to housing). Conclusions: Area level factors may influence walking/bicycling. High area density was associated with more activity. However, high density also comes with a type of housing (apartments) that is associated with less household work and, surprisingly, more sedentary activities, introducing a challenging trade-off. The differences in exercise were smaller than for all other types of activities.
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Affiliation(s)
- Anna C. Svensson
- Department of Public Health Sciences, Karolinska Institutet, Sweden
| | - Joanna Stjernschantz Forsberg
- Centre for Epidemiology and Community Medicine, Stockholm County Council, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Sweden
| | - Dominika Seblova
- Department of Public Health Sciences, Karolinska Institutet, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm County Council, Sweden
| | - Anton Lager
- Department of Public Health Sciences, Karolinska Institutet, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm County Council, Sweden
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29
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Hallingberg B, Fletcher A, Murphy S, Morgan K, Littlecott HJ, Roberts C, Moore GF. Do stronger school smoking policies make a difference? Analysis of the health behaviour in school-aged children survey. Eur J Public Health 2016; 26:964-968. [PMID: 27335332 PMCID: PMC5172489 DOI: 10.1093/eurpub/ckw093] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background: Associations of the strength of school smoking policies with
cigarette, e-cigarette and cannabis use in Wales were examined. Methods:
Nationally representative cross-sectional survey of pupils aged 11–16 years
(N=7376) in Wales. Senior management team members from 67
schools completed questionnaires about school smoking policies, substance use
education and tobacco cessation initiatives. Multi-level, logistic regression
analyses investigated self-reported cigarette, e-cigarette and cannabis use, for all
students and those aged 15–16 years. Results: Prevalence of
current smoking, e-cigarette use and cannabis use in the past month were 5.3%,
11.5% and 2.9%, respectively. Of schools that provided details about
smoking policies (66/67), 39.4% were strong (written policy applied to
everyone in all locations), 43.9% were moderate (written policy not applied to
everyone in all locations) and 16.7% had no written policy. There was no
evidence of an association of school smoking policies with pupils’ tobacco or
e-cigarette use. However, students from schools with a moderate policy [OR =
0.47; 95% (confidence interval) CI: 0.26–0.84] were less likely to have
used cannabis in the past month compared to schools with no written policy. This
trend was stronger for students aged 15–16 years (moderate policy: OR =
0.42; 95% CI: 0.22–0.80; strong policy: OR = 0.45; 95% CI:
0.23–0.87). Conclusions: School smoking policies may exert less
influence on young people’s smoking behaviours than they did during times of
higher adolescent smoking prevalence. Longitudinal studies are needed to examine the
potential influence of school smoking policies on cannabis use and mechanisms
explaining this association.
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Affiliation(s)
- B Hallingberg
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, School of Social Sciences, Cardiff University, Cardiff, United Kingdom
| | - A Fletcher
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, School of Social Sciences, Cardiff University, Cardiff, United Kingdom
| | - S Murphy
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, School of Social Sciences, Cardiff University, Cardiff, United Kingdom
| | - K Morgan
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, School of Social Sciences, Cardiff University, Cardiff, United Kingdom
| | - H J Littlecott
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, School of Social Sciences, Cardiff University, Cardiff, United Kingdom
| | - C Roberts
- Social Research and Information Division, Cathays Park, Cardiff, United Kingdom
| | - G F Moore
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, School of Social Sciences, Cardiff University, Cardiff, United Kingdom
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Bonell C, Fletcher A, Jamal F, Aveyard P, Markham W. Where next with theory and research on how the school environment influences young people's substance use? Health Place 2016; 40:91-7. [PMID: 27232064 DOI: 10.1016/j.healthplace.2016.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 05/04/2016] [Accepted: 05/12/2016] [Indexed: 11/28/2022]
Abstract
Substance use (smoking, drinking and illicit drug use) remains, a serious problem for young people living in industrialised countries. There is increasing interest in interventions to modify the school, environment, addressing the multiple upstream determinants of young, people's health. This article provides an overview of current theory, about how secondary school environments influence young people's, substance use before focusing on the Theory of Human Functioning and, School Organisation. It critically examines the extent to which this, theory is substantiated by quantitative and qualitative evidence and, considers how the theory might be elaborated to better inform future, empirical research.
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Affiliation(s)
- Chris Bonell
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
| | - Adam Fletcher
- Cardiff School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff CF10 3BD, UK
| | - Farah Jamal
- Department of Social Science, UCL Institute of Education, Department of Social Science, 18 Woburn Square, London WC1H 0NR
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, New Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK
| | - Wolfgang Markham
- University of Warwick, Warwick Medical School, Coventry CV4 7AL, UK
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31
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Bonell C, Harden A, Fletcher A, Viner R. In memoriam: the contributions to public health research of Farah Jamal, BA, MSc, PhD. J Epidemiol Community Health 2016; 70:329-30. [PMID: 26838125 DOI: 10.1136/jech-2016-207197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Chris Bonell
- Department of Social Science, University College London Institute of Education, London, UK
| | - Angela Harden
- Institute for Health and Human Development, University of East London, London, UK
| | - Adam Fletcher
- School of Social Sciences, Cardiff University, Cardiff, UK
| | - Russell Viner
- Institute of Child Health, University College London, London, UK
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Morton KL, Atkin AJ, Corder K, Suhrcke M, van Sluijs EMF. The school environment and adolescent physical activity and sedentary behaviour: a mixed-studies systematic review. Obes Rev 2016; 17:142-58. [PMID: 26680609 PMCID: PMC4914929 DOI: 10.1111/obr.12352] [Citation(s) in RCA: 146] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 09/04/2015] [Accepted: 10/07/2015] [Indexed: 12/21/2022]
Abstract
There is increasing academic and policy interest in interventions aiming to promote young people's health by ensuring that the school environment supports healthy behaviours. The purpose of this review was to summarize the current evidence on school-based policy, physical and social-environmental influences on adolescent physical activity and sedentary behaviour. Electronic databases were searched to identify studies that (1) involved healthy adolescents (11-18 years old), (2) investigated school-environmental influences and (3) reported a physical activity and/or sedentary behaviour outcome or theme. Findings were synthesized using a non-quantitative synthesis and thematic analysis. Ninety-three papers of mixed methodological quality were included. A range of school-based policy (e.g. break time length), physical (e.g. facilities) and social-environmental (e.g. teacher behaviours) factors were associated with adolescent physical activity, with limited research on sedentary behaviour. The mixed-studies synthesis revealed the importance of specific activity settings (type and location) and intramural sport opportunities for all students. Important physical education-related factors were a mastery-oriented motivational climate and autonomy supportive teaching behaviours. Qualitative evidence highlighted the influence of the wider school climate and shed light on complexities of the associations observed in the quantitative literature. This review identifies future research needs and discusses potential intervention approaches to be considered.
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Affiliation(s)
- K L Morton
- UKCRC Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - A J Atkin
- UKCRC Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - K Corder
- UKCRC Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - M Suhrcke
- Centre for Health Economics, University of York, York, UK
| | - E M F van Sluijs
- UKCRC Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
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Du SS, Jiang YS, Chen Y, Li Z, Zhang YF, Sun CH, Feng RN. Development and Applicability of an Internet-Based Diet and Lifestyle Questionnaire for College Students in China: A Cross-Sectional Study. Medicine (Baltimore) 2015; 94:e2130. [PMID: 26656341 PMCID: PMC5008486 DOI: 10.1097/md.0000000000002130] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Diet contributes to the increasing incidence of chronic diseases. Thus, fast, accurate, and convenient dietary assessment tools are in demand. We designed an internet-based diet and lifestyle questionnaire for Chinese (IDQC). The objective of this study was to validate its applicability and assess the dietary habits of Chinese college students.Six hundred forty-four college students from northern China were recruited and asked to complete the IDQC for the last 4 months (135 food items) and 3-day diet records (3DDRs). Food and nutrient intakes recorded in the IDQC were validated against those in the 3DDRs using the Wilcoxon matched-pairs t test, correlation analysis, and cross-classification. The Student t and χ tests were used in the dietary assessment.There were significantly positive correlations in the dietary intakes of 9 food groups and 23 nutrients between the IDQC and 3DDRs. All participants consumed low levels of fruits, vegetables, legumes, dairy, and certain micronutrients (ie, vitamin A, vitamin B1, vitamin B2, folic acid, vitamin C, calcium, selenium, and iodine), and high levels of iron and manganese. Male students consumed higher intakes of the food groups and nutrients than female students.The IDQC represents an accurate and convenient dietary assessment tool that can be used in large populations. Inadequate and excessive nutrition co-existed in college students, and more fruits, vegetables, legumes, dairy, and various vitamins and minerals were needed in this population's daily diet. The IDQC is free of access at www.yyjy365.org/diet.
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Affiliation(s)
- Shan-Shan Du
- From the Department of Nutrition and Food Hygiene, School of Public Health (S-SD, Y-C, Z-L, Y-FZ, C-HS, R-NF); and College of Bioinformatics Science and Technology, Harbin Medical University, Harbin, China (Y-SJ)
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Kite J, Indig D, Mihrshahi S, Milat A, Bauman A. Assessing the usefulness of systematic reviews for policymakers in public health: A case study of overweight and obesity prevention interventions. Prev Med 2015; 81:99-107. [PMID: 26303371 DOI: 10.1016/j.ypmed.2015.08.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 08/12/2015] [Accepted: 08/13/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Systematic reviews (SRs) should include policy-relevant information in order to more readily inform policy and practice. We investigated whether SRs of overweight and obesity prevention interventions are framed in such a way that maximises their usefulness for policymakers. METHOD We conducted a systematic review of SRs of overweight and obesity prevention interventions published in 4 databases any time up to December 2014. We analysed the SRs for their usefulness to policymakers, using a coding frame developed based on literature around what policymakers want and need from systematic reviews. Systematic reviews were assessed for a) policy links and framing; b) quality assessment and conflict of interest statements: and c) discussion of policy implications. RESULTS Of the 153 SRs that met the inclusion criteria, very few (7%) had authors from policy-based organisations, 48% had funding from such organisations, and almost a third (31%) framed their introduction or aims around policy. Most (69%) discussed issues affecting generalisability of the SR findings but only a quarter (24%) discussed cost or cost-effectiveness of the intervention under investigation. Less than a third (29%) of SRs discussed the policy implications of their findings. SRs that were policy-framed were significantly more likely to discuss costs (PR=1.8, 95%CI 1.0-3.0) and policy implications (PR=2.5, 95%CI 1.5-4.0). CONCLUSION SRs should discuss the policy and practice implications of their findings to maximise the influence of SRs on policy making. It is recommended that SR guidelines are updated to include generalisability and discussion of policy and practice implications as a requirement.
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Affiliation(s)
- James Kite
- Prevention Research Collaboration, School of Public Health, University of Sydney, NSW, Australia.
| | - Devon Indig
- Prevention Research Collaboration, School of Public Health, University of Sydney, NSW, Australia.
| | - Seema Mihrshahi
- Prevention Research Collaboration, School of Public Health, University of Sydney, NSW, Australia.
| | - Andrew Milat
- NSW Ministry of Health, 73 Miller St, North Sydney, NSW, Australia.
| | - Adrian Bauman
- Prevention Research Collaboration, School of Public Health, University of Sydney, NSW, Australia.
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35
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Pearson M, Chilton R, Wyatt K, Abraham C, Ford T, Woods HB, Anderson R. Implementing health promotion programmes in schools: a realist systematic review of research and experience in the United Kingdom. Implement Sci 2015; 10:149. [PMID: 26510493 PMCID: PMC4625879 DOI: 10.1186/s13012-015-0338-6] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 10/14/2015] [Indexed: 11/16/2022] Open
Abstract
Background Schools have long been viewed as a good setting in which to encourage healthy lifestyles amongst children, and schools in many countries aspire to more comprehensive, integrated approaches to health promotion. Recent reviews have identified evidence of the effects of school health promotion on children’s and young people’s health. However, understanding of how such programmes can be implemented in schools is more limited. Methods We conducted a realist review to identify the conditions and actions which lead to the successful implementation of health promotion programmes in schools. We used the international literature to develop programme theories which were then tested using evaluations of school health promotion programmes conducted in the United Kingdom (UK). Iterative searching and screening was conducted to identify sources and clear criteria applied for appraisal of included sources. A review advisory group comprising educational and public health practitioners, commissioners, and academics was established at the outset. Results In consultation with the review advisory group, we developed four programme theories (preparing for implementation, initial implementation, embedding into routine practice, adaptation and evolution); these were then refined using the UK evaluations in the review. This enabled us to identify transferable mechanisms and enabling and constraining contexts and investigate how the operation of mechanisms differed in different contexts. We also identified steps that should be taken at a senior level in relation to preparing for implementation (which revolved around negotiation about programme delivery) and initial implementation (which centred on facilitation, support, and reciprocity—the latter for both programme deliverers and pupils). However, the depth and rigour of evidence concerning embedding into routine practice and adaptation and evolution was limited. Conclusions Our findings provide guidance for the design, implementation, and evaluation of health promotion in schools and identify the areas where further research is needed. Electronic supplementary material The online version of this article (doi:10.1186/s13012-015-0338-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M Pearson
- Institute of Health Research, University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - R Chilton
- Institute of Health Research, University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - K Wyatt
- Institute of Health Research, University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - C Abraham
- Institute of Health Research, University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - T Ford
- Institute of Health Research, University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - H B Woods
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - R Anderson
- Institute of Health Research, University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK.
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Pearson M, Chilton R, Wyatt K, Abraham C, Ford T, Woods HB, Anderson R. Implementing health promotion programmes in schools: a realist systematic review of research and experience in the United Kingdom. Implement Sci 2015. [PMID: 26510493 DOI: 10.1186/s13012–015–0338–6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Schools have long been viewed as a good setting in which to encourage healthy lifestyles amongst children, and schools in many countries aspire to more comprehensive, integrated approaches to health promotion. Recent reviews have identified evidence of the effects of school health promotion on children's and young people's health. However, understanding of how such programmes can be implemented in schools is more limited. METHODS We conducted a realist review to identify the conditions and actions which lead to the successful implementation of health promotion programmes in schools. We used the international literature to develop programme theories which were then tested using evaluations of school health promotion programmes conducted in the United Kingdom (UK). Iterative searching and screening was conducted to identify sources and clear criteria applied for appraisal of included sources. A review advisory group comprising educational and public health practitioners, commissioners, and academics was established at the outset. RESULTS In consultation with the review advisory group, we developed four programme theories (preparing for implementation, initial implementation, embedding into routine practice, adaptation and evolution); these were then refined using the UK evaluations in the review. This enabled us to identify transferable mechanisms and enabling and constraining contexts and investigate how the operation of mechanisms differed in different contexts. We also identified steps that should be taken at a senior level in relation to preparing for implementation (which revolved around negotiation about programme delivery) and initial implementation (which centred on facilitation, support, and reciprocity-the latter for both programme deliverers and pupils). However, the depth and rigour of evidence concerning embedding into routine practice and adaptation and evolution was limited. CONCLUSIONS Our findings provide guidance for the design, implementation, and evaluation of health promotion in schools and identify the areas where further research is needed.
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Affiliation(s)
- M Pearson
- Institute of Health Research, University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - R Chilton
- Institute of Health Research, University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - K Wyatt
- Institute of Health Research, University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - C Abraham
- Institute of Health Research, University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - T Ford
- Institute of Health Research, University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - H B Woods
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - R Anderson
- Institute of Health Research, University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK.
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Bush PL, García Bengoechea E. What do we know about how to promote physical activity to adolescents? A mapping review. HEALTH EDUCATION RESEARCH 2015; 30:756-772. [PMID: 26330018 DOI: 10.1093/her/cyv036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 08/06/2015] [Indexed: 06/05/2023]
Abstract
To date, adolescent physical activity (PA) intervention research has focused on the school setting and suggests a need to extend interventions beyond this setting to influence teenagers' overall level of PA. But, the relative effectiveness of PA promotion strategies that can be part of such multi-setting interventions remains unknown. We completed a mapping review of PA intervention research that focused on increasing adolescents' level of PA to describe the sum of what has been learned in this area and to expose research and knowledge gaps. We searched data bases from 1993 to September 2014, included PA promotion intervention studies targeting 12- to 17-year-old youth and assessing changes in their level of PA, and used ecological and capacity building frameworks to review this research. The 46 included studies suggest that little is known about strategies targeting the interpersonal, organizational, community or policy levels of teenagers' PA behavior influences; our current knowledge remains concentrated in the intrapersonal domain and the school setting. We suggest avenues for researchers as well as practitioners who design and implement adolescent PA programs such that we further develop our research and practice knowledge base and develop programs to positively impact adolescents' PA behavior.
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Affiliation(s)
- Paula Louise Bush
- Department of Family Medicine, McGill University, 5858 ch. de la Côte-des-Neiges, Montreal, QC H3S 1Z1, Canada and
| | - Enrique García Bengoechea
- School of Science and Health, University of Western Sydney, Locked Bag 1797, Penrith, NSW 2751, Australia and Participatory Research at McGill (PRAM), Department of Family Medicine, McGill University, 5858 ch. de la Côte-des-Neiges, Montreal, QC H3S 1Z1, Canada
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Busching R, Krahé B. The girls set the tone: gendered classroom norms and the development of aggression in adolescence. PERSONALITY AND SOCIAL PSYCHOLOGY BULLETIN 2015; 41:659-76. [PMID: 25742920 DOI: 10.1177/0146167215573212] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 01/24/2015] [Indexed: 11/16/2022]
Abstract
In a four-wave longitudinal study with N = 1,321 adolescents in Germany, we examined the impact of class-level normative beliefs about aggression on aggressive norms and behavior at the individual level over the course of 3 years. At each data wave, participants indicated their normative acceptance of aggressive behavior and provided self-reports of physical and relational aggression. Multilevel analyses revealed significant cross-level interactions between class-level and individual-level normative beliefs at T1 on individual differences in physical aggression at T2, and the indirect interactive effects were significant up to T4. Normative approval of aggression at the class level, especially girls' normative beliefs, defined the boundary conditions for the expression of individual differences in aggressive norms and their impact on physically and relationally aggressive behavior for both girls and boys. The findings demonstrate the moderating effect of social norms on the pathways from individual normative beliefs to aggressive behavior in adolescence.
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Abstract
Even as mental health has become increasingly recognized as a key issue in global health, child mental health has largely remained in its shadows. This is possibly because many interventions for child mental health lie outside the realm of narrowly defined biomedical interventions and platforms, with the majority of interventions targeting psychological and social mechanisms and a strong emphasis on prevention. This situation must change, however, as child mental health interventions have potentially the greatest impact on the burden of mental disorders, and other health and social outcomes, than at any other time in the life course. There is now a growing body of evidence that indicates which interventions are ready for scale-up or show sufficient promise for further research and refinement. These are primarily delivered in community or school platforms through nonspecialist workers in partnership with parents and teachers. They include interventions to promote early child development, parenting interventions through childhood into adolescence, school interventions aimed at reengineering school environments and strengthening life skills, and interventions for the early detection and management of neurodevelopmental disorders and mental health problems through trans-diagnostic interventions based on impairments. Above all, what is needed is a population-based approach, which emphasizes the goal of coverage of evidence-based interventions for all children; with a particular focus on disadvantaged children; with seamless coordination of preventive and treatment interventions across platforms of care; and utilizing collaborative, stepped-care delivery paradigms.
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Affiliation(s)
- Vikram Patel
- London School of Hygiene & Tropical Medicine, London, UK.,Public Health Foundation of India, New Delhi, India.,Sangath, Goa, India
| | - Atif Rahman
- University of Liverpool, Liverpool, UK.,Human Development Research Foundation, Rawalpindi, Pakistan
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Jamal F, Langford R, Daniels P, Thomas J, Harden A, Bonell C. Consulting with young people to inform systematic reviews: an example from a review on the effects of schools on health. Health Expect 2014; 18:3225-35. [PMID: 25470115 DOI: 10.1111/hex.12312] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND There has been increasing interest in involving the public in systematic reviews as they provide a shortcut to the evidence and arguably have greater influence over policy decisions and ultimately people's lives. Case examples of this involvement are rare, especially for reviews focused on children and young people. This study describes the process and impact of consulting with a young people's advisory group to inform decision making in a systematic review on the effects of schools and school environment interventions on children and young people's health. METHODS Consultations were conducted with a pre-existing group of young people brought together to advise on public health research. Their views were sought at two key stages: (i) at the beginning when general views relating to the policy problem under study were elicited; and (ii) half-way through to advise on how to focus the review on key priorities. RESULTS Young people's involvement in our review ensured that the scope of our review was appropriate and that issues which were important to young people were considered. The group was especially valuable in terms of prioritizing in a relevant and meaningful way. A crucial additional impact of involvement was young people providing 'early signals' of key themes for the synthesis.
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Affiliation(s)
- Farah Jamal
- Institute for Health and Human Development, UH250, Stratford Campus, University of East London, London, UK
| | - Rebecca Langford
- University of Bristol, School of Social and Community Medicine, Bristol, UK
| | - Philip Daniels
- Public Health Registrar Office, West Midlands Deanery, Birmingham, UK
| | - James Thomas
- Institute of Education, University of London, London, UK
| | - Angela Harden
- Institute for Health and Human Development, UH250, Stratford Campus, University of East London, London, UK
| | - Chris Bonell
- Institute of Education, University of London, London, UK
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Driessen CE, Cameron AJ, Thornton LE, Lai SK, Barnett LM. Effect of changes to the school food environment on eating behaviours and/or body weight in children: a systematic review. Obes Rev 2014; 15:968-82. [PMID: 25266705 DOI: 10.1111/obr.12224] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 08/13/2014] [Accepted: 08/14/2014] [Indexed: 12/18/2022]
Abstract
Previous school obesity-prevention reviews have included multi-component interventions. Here, we aimed to review the evidence for the effect of isolated food environment interventions on both eating behaviours (including food purchasing) and/or body weight. Five electronic databases were searched (last updated 30 November 2013). Of the 1,002 unique papers identified, 55 reported on school food environment changes, based on a review of titles and abstracts. Thirty-seven further papers were excluded, for not meeting the inclusion criteria. The final selection consisted of 18 papers (14 United States, 4 United Kingdom). Two studies had a body mass index (BMI) outcome, 14 assessed purchasing or eating behaviours and two studies assessed both weight and behaviour. Seventeen of 18 papers reported a positive outcome on either BMI (or change in BMI) or the healthfulness of food sold or consumed. Two studies were rated as strong quality and 11 as weak. Only three studies included a control group. A school environment supportive of healthy eating is essential to combat heavy marketing of unhealthy food. Modification of the school food environment (including high-level policy changes at state or national level) can have a positive impact on eating behaviours. A need exists, however, for further high-quality studies.
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Affiliation(s)
- C E Driessen
- School of Health and Social Development, Deakin University, Burwood, Australia
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