Creating smoke-free environments in recreational settings

Local government venues' sponsorship and signage policies to limit the promotion of harmful products: A Western Australian public health audit

OBJECTIVE

Identify and assess publicly available local government sponsorship and signage policies related to harmful products in Western Australia (WA).

METHODS

An audit of WA Local Government Authority (LGAs) websites (n=139) was conducted. Sponsorship, signage, venue hire and community grants' policies were located and assessed against set criterion. Policies were scored for the inclusion of statements regarding the display and promotion of harmful commodities (alcohol, tobacco, gambling products, unhealthy food and beverages).

RESULTS

Across WA local governments, 477 relevant policies were identified. Six percent (n=28) included statements restricting the promotion of at least one harmful commodity via sponsorships, signage, venue hire, and sporting and/or community grants policy. Twenty-three local governments had at least one policy that restricted unhealthy signage or sponsorship.

CONCLUSIONS

Most WA local governments do not have publicly available policies that specifically limit the advertising and promotion of harmful commodities in their government-owned facilities.

IMPLICATIONS FOR PUBLIC HEALTH

There is a dearth of research identifying LGA interventions addressing advertising of harmful commodities within council-owned sporting venues. This research indicates opportunities for West Australian LGAs to develop and implement policy to protect public health by restricting the promotion of harmful commodities to their communities, improving the healthfulness of environments.

Adolescents' beliefs, attitudes and social norms with regard to smoking and sports: a qualitative study

OBJECTIVES

The aim of this study is to explore the beliefs, attitudes and social norms of Dutch adolescents with regard to smoking and sports. In addition, we examine whether there are differences between adolescents at sports clubs with versus without an outdoor smoke-free policy (SFP).

DESIGN

Qualitative design in the form of focus group interviews.

SETTING

Focus group interviews (n=27) were conducted at 16 sports clubs in the Netherlands. Soccer, tennis, field hockey and korfball clubs were included. Focus group discussions were transcribed verbatim and analysed thematically using MAXQDA.

PARTICIPANTS

180 adolescents aged 13-18 years old were included in the study. All participants signed an informed consent form. For participants younger than 16 years, parental consent was required.

RESULTS

With respect to smoking in relation to sports, participants had mostly negative beliefs (ie, smoking has a negative effect on health and sports performance), attitudes (ie, sports and smoking are activities that do not fit together; at sports clubs smoking is not appropriate), and social norms (ie, it is not normal to smoke at sports clubs). The same beliefs, attitudes and social norms were expressed by participants at both sports clubs with and without an outdoor SFP. However, argumentation against smoking was more detailed and more consistent among participants at sports clubs with an outdoor SFP.

CONCLUSION

Adolescents have negative beliefs, attitudes and social norms with regard to smoking in relationship to sports. Outdoor SFP at sports clubs might reinforce these negative associations. These findings point to the potential importance of sports in the prevention of adolescent smoking.

Critical success factors of public health sponsorship in Australia

Public health sponsorship is a unique phenomenon in Australia. The current research examines the critical success factors of Western Australian Health Promotion Foundation's (Healthway) sponsorship program, Australia's largest public health sponsorship program. Using stakeholder interviews and expert observational studies, two studies present five key success factors: (i) effective segmentation and targeting of health messages; (ii) collaboration between Healthway and partnering organization to leverage sponsored events; (iii) displacement of unhealth sponsorship; (iv) use of leveraging strategies to raise awareness of health messages; and (v) environmental changes that facilitate behavioural change. The current research provides insights into how and why sponsorship is an effective public health promotion tool.

The Adoption, Implementation, and Impact of Smoke-Free Policies among Gaelic Athletic Association Clubs in Ireland: A Qualitative Study

The Gaelic Athletic Association (GAA) is a major stakeholder in promoting smoke-free policies in Ireland. Several GAA clubs have adopted smoke-free policies, and there is a growing interest among other GAA clubs to also become smoke-free. As such, the purpose of this study is to explore the process of how GAA clubs adopt, implement, and enforce smoke-free policies in order to discover best practices that other clubs could replicate. Representatives from 15 smoke-free clubs were interviewed regarding how their club became smoke-free. Interview data were analyzed, in which four major themes emerged: (1) process (planning a smoke-free policy, communicating the policy to the community, providing smoking cessation resources), (2) barriers (opinions and behaviors of club members who smoke, bars connected to club houses, policy exceptions, visitors and umpires who were unaware of the policy), (3) enforcement (community-based style of enforcement, non-confrontational approach, non-enforcement), and (4) impact (observation of policy compliance and decrease in cigarette litter). The study's findings indicate a general ease of becoming smoke-free with minimal barriers. As such, the GAA should urge each club to become smoke-free and to use the effective methods used by current smoke-free clubs for communicating and enforcing smoke-free policies.

Increasing the Health Promotive Capacity of Human Environments

This article offers an integration of two different perspectives on health promotion research and practice: one emphasizing the concept of community capacity for health improvement and the other focusing on the notion of health supportive environments. These two approaches generally have emphasized different kinds of community assets for health promotion. Specifically, community capacity research has focused on the cultivation of human resources (e.g., collaborative coalitions, participatory decision-making, health education strategies) for health promotion, whereas environmentally oriented research has underscored the influence of material resources (e.g., the built environment, natural resources, technological infrastructure) on important health behaviors and outcomes. Combining these two streams of health promotion research yields a broader understanding of the health promotive capacity of human environments and suggests several “best process” guidelines for enhancing health promotion practice.

Unhealthy product sponsorship of Australian national and state sports organisations

ISSUE ADDRESSED

Marketing of products harmful to the health of children has been found to be prolific, and occurs across multiple media platforms and in several settings, including organised sport, thus potentially undermining the health benefits inherent in sports participation. Through website audits, this study investigated the nature and extent of unhealthy food, beverage, alcohol and gambling sponsorship across peak Australian sporting organisations.

METHODS

A structured survey tool identified and assessed sponsoring companies and products displayed on the websites of the 53 national and state/territory sport governing bodies in Australia receiving government funding. Identified products were categorised as healthy or unhealthy, based on criteria developed by health experts.

RESULTS

There was a total of 413 websites operated by the 53 sports, with 1975 company or product sponsors identified. Overall, 39 sports had at least one unhealthy sponsor, and 10% of all sponsors were rated as unhealthy. Cricket had the highest percent of unhealthy sponsors (27%) and the highest number of unhealthy food and beverage sponsors (n=19). Rugby Union (n=16) and Australian Football (n=4) had the highest numbers of alcohol and gambling sponsors respectively.

CONCLUSIONS

Sponsorship of Australian sport governing bodies by companies promoting unhealthy food and beverage, alcohol and gambling products is prevalent at the state/territory and national level. SO WHAT?: Regulatory guidelines should be established to limit such sponsorship and ensure that it is not translated into promotions that may reach and influence children.

Sports clubs as settings for health promotion: fundamentals and an overview to research

This paper explores the efficacy and value of sports clubs as a setting for health promotion. Sports clubs for children and adolescents are the primary focus of the paper, and the aims are two-fold.

AIMS

Firstly, the paper aims to review the basis for and elements of the health promoting sports club (HPSC) concept. Secondly, the aim is to overview the international evolution of the HPSC concept and its usefulness in the research. The settings-based health promotion approach forms the basis for the HPSC concept and it is introduced first. Thereafter, both obligating and prospecting factors, to justify the importance for sports clubs to address health promotion, are expressed. Major prospecting factors relate to the facts that sports club activities reach a lot of children and adolescents, and that its educational nature is informal due to voluntary participation. The paper also presents multilevel structure of sports clubs, as well as the determinants affecting the settings-based work. The research concerning health promotion in sports-related settings is evolving worldwide, and Nordic countries are in the front line of this new-wave of settings-based health promotion. Indeed, it has been claimed that, for the settings approach to assimilate to current societal challenges, there is a need to widen the reach of the approach to non-traditional, non-institutional settings, like sports clubs.

Maintaining relevance: an evaluation of health message sponsorship at Australian community sport and arts events

Background

Health message sponsorship at community sport and arts events is an established component of a health promotion settings approach. Recent increases in commercial sponsorship of sport and community events has swelled competition for consumer attention and potentially reduced the impact of health message sponsorship. The purpose of this study was to evaluate awareness, understandings and behavioural intentions of health messages promoted at sponsored community sport and arts events.

Methods

Interview and self-administered surveys were completed by 2259 adults attending one of 29 sport and arts events held in Western Australia between 2008 and 2013. The surveys measured participant awareness of the health message promoted at the event, as well as comprehension, acceptance and behavioural intention as a result of exposure to health messages.

Results

Awareness of the sponsored health message was 58% across all sponsored events, with high levels of comprehension (74%) and acceptance (92%) among those aware of the health message. Forming behavioural intentions was significantly related to the type of sponsored message promoted at the event, being female and over 40 years of age. Messages about sun protection and promoting mental health were the most likely to result in behavioural intention.

Conclusions

Health message sponsorship, at least within a comprehensive sponsorship program, appears to remain an effective health promotion strategy for generating awareness and behavioural intention among people attending sport and arts events. Remaining relevant within a modern sponsorship environment appears closely aligned to selecting health messages that promote behavioural action relevant to the sponsored event that are also supported by broader health promotion campaigns.

Health in arts: are arts settings better than sports settings for promoting anti-smoking messages?

AIM

Tobacco smoking is a leading cause of preventable mortality and morbidity. Since 1991, the Western Australian Health Promotion Foundation (Healthway) has sponsored the arts and sport in exchange for cigarette smoke-free events, smoke-free policies and the promotion of anti-smoking messages (e.g. Quit, Smoke Free or Smarter than Smoking). As health promoters often look for innovative and effective settings to advocate health, and as the approach of sponsoring the arts to promote health to the general population is uncommon, the purpose of this study was to evaluate the effectiveness of 'health in arts' by measuring the cognitive impact (message awareness, comprehension, acceptance and intention) of promoting anti-smoking messages at arts events, and comparing findings to sports events, a more traditional health promotion setting.

METHOD

A secondary analysis of the 2004-2009 Healthway Sponsorship Monitor data was conducted. A total of 12 arts events (n = 592 respondents) and 9 sports events (n = 420 respondents) sponsored by Healthway to promote an anti-smoking message were evaluated. The study was cross-sectional in design. Participants were residents of Western Australia aged 15 years or above and attended events as part of an audience or as a spectator. Descriptive and regression analyses were conducted.

RESULTS

After adjustment for demographic variables, smoking status and clustering, arts events were found to be as effective in promoting anti-smoking message awareness, comprehension and acceptance and twice as effective on intention to act (p = .03) compared with sports events.

CONCLUSION

This study provides evidence of the effectiveness of arts sponsorship to promote health to the general population, that is, health in arts. Promoting an anti-smoking message in arts settings was as, or more, effective than in sports settings. Results suggest that the arts should be utilised to communicate and reinforce anti-smoking messages to the general population. The suitability of the arts to promote other types of health messages should be investigated further.

Young adult perceptions of smoking in outdoor park areas

PURPOSE

Smoking restrictions in recreational settings are established to promote anti-smoking norms and reduce exposure to secondhand smoke. Outdoor smoke-free policies are increasing, yet little is known about the perceptions of such restrictions.

METHODS

Data were collected from a population-based sample of young adults (n=2289) in upper Midwestern United States. Cross-sectional multivariate logistic regression was used to assess predictors of the perceived difficulty to smoke in outdoor park areas.

RESULTS

Living in an area with a smoke-free park policy was associated with a 1.4 times higher odds of perceiving difficulty to smoke compared to those living in an area without such a policy, after controlling for past month smoking, physical activity, age, and gender. Both smokers and non-smokers living in an area with a smoke-free park policy had higher odds of perceiving difficulty to smoking in park areas (OR=1.6 and 1.3 respectively) compared to smokers and non-smokers living in areas without such policies.

CONCLUSION

Banning smoking in park areas was associated with a heightened perception of difficulty in smoking for young adult smokers and non-smokers.

Measuring compliance with tobacco-free campus policy

OBJECTIVE

The purpose is to describe psychometric testing and feasibility of the Tobacco-Free Compliance Assessment Tool (TF-CAT) to measure tobacco-free policy compliance at a public university and medical center. The aims are to (1) investigate concurrent validity by comparing the number of cigarette butts in areas covered by the policy with those on adjacent sidewalks; (2) evaluate the interrater reliability of the TF-CAT; and (3) describe the feasibility of using the TF-CAT.

METHODS

Phase I was a pilot study on the health care campus. Phase II was baseline of an intervention study on the main campus. Cigarette butts and smokers were counted in hot spots. Validity was assessed using Mann-Whitney U and Geographical Information System Analysis methods.

RESULTS

There was some support for the validity and high interrater reliability. Data collectors spent 1 hour per week for 8 weeks during Phase I, and 31 hours in 1 week during Phase II.

CONCLUSION

TF-CAT is a feasible, time-intensive method to measure tobacco-free policy compliance.

The behavioral ecology of secondhand smoke exposure: A pathway to complete tobacco control

INTRODUCTION

This article outlines a theoretical framework for research concerning secondhand smoke exposure (SHSe) prevention as a means to curtail the tobacco industry.

METHODS

The Behavioral Ecological Model (BEM) assumes interlocking social contingencies of reinforcement (i.e., rewards or punishments) from the highest level of society (e.g., taxing cigarette sales) to physiological reactions to nicotine that influence smoking and SHSe. We review selected research concerning both policy and clinical efforts to restrict smoking and/or SHSe.

RESULTS

Research to date has focused on smoking cessation with modest to weak effects. The BEM and empirical evidence suggest that cultural contingencies of reinforcement should be emphasized to protect people from SHSe, especially vulnerable children, pregnant women, the ill, the elderly, and low-income adults who have not "elected" to smoke. Doing so will protect vulnerable populations from industry-produced SHSe and may yield more and longer-lasting cessation.

CONCLUSIONS

Interventions that reduce SHSe may serve as a Trojan horse to counter the tobacco industry. Future studies should: (a) guide policies to restrict SHSe; (b) develop powerful community and clinical interventions to reduce SHSe; (c) test the degree to which policies and other contexts enhance the effects of clinical interventions (e.g., media programs disclosing the disingenuous marketing by the industry); and (d) investigate the effects of all health care providers' ability to reduce SHSe and generate an antitobacco culture, by advising all clients to avoid starting to smoke, to protect their children from SHSe, and to quit smoking.

Encouraging Young Western Australians to Be Smarter than Smoking

Purpose.

Smarter than Smoking is a multistrategy statewide youth smoking intervention. This article describes key strategies and results from its inception in 1995 to 2005.

Design.

Comprehensive evaluation included formative research and baseline and follow-up surveys. Triennial national surveys provided independent monitoring of adolescent smoking prevalence.

Setting.

Western Australia.

Subjects.

10- to 15-year-olds.

Intervention.

A multipronged strategy mix, including mass media, the Internet, sponsorship, school initiatives, publications, and advocacy.

Measures.

Smoking prevalence, media awareness, and attitudes toward smoking and campaign messages.

Analysis.

Trend comparisons across the first decade of the project, along with descriptive statistics.

Results.

Significant attitudinal and behavioral shifts were observed following media waves and over time. There was a steady increase in the proportion who had never smoked (from 40% in 1996 to 61 % in 2005). Results also showed a significant decrease in smoking prevalence from 1996 to 2005, down from 28% to 7% among 14-year-olds and from 43% to 14% among 15-year-olds.

Conclusions.

Smarter than Smoking was effective in achieving positive shifts in awareness, attitudes, intentions, and behavior. Effectiveness appeared to have been enhanced by sustained long-term funding youth involvement in strategy development, and a strong research and evaluation base.

At the frontier of tobacco control: a brief review of public attitudes toward smoke-free outdoor places

INTRODUCTION

Outdoor smoke-free areas have been adopted increasingly in North America, Britain, Ireland, Australasia, and elsewhere. Their use appears to be one of the frontier areas of tobacco control development. We briefly reviewed the available reports on public attitudes about smoke-free public outdoor areas.

METHODS

We included surveys of the general population or of users of public outdoor locations, reported in English language publications to September 2008.

RESULTS

We identified 16 relevant reports that used surveys from 1988 to 2007. Although the evidence remains limited, this research indicates that, in a number of jurisdictions, the majority of the public supports restricting smoking in various outdoor settings. Support for smoke-free outdoor public places appears to be increasing over time. Among respondents' reasons for support were the following: litter control, establishing positive smoke-free role models for youth, reducing youth opportunities to smoke, and avoiding exposure to secondhand smoke.

DISCUSSION

Given the recent increase in outdoor smoking restrictions in many developed countries and the growing recognition of the importance of reducing smoking role models for children, this area needs further research related to attitudes and policy evaluation. Given the levels of public support, policy makers in some jurisdictions appear to have an opportunity to establish smoke-free outdoor public places, at least in areas frequented by children.

Policy interventions implemented through sporting organisations for promoting healthy behaviour change

BACKGROUND

Sporting organisations provide an important setting for health promotion strategies that involve policies, communication of healthy messages and creation of health promoting environments. The introduction of policy interventions within sporting organisations is one strategy to target high risk behaviours such as smoking, alcohol consumption, excess sun exposure, unhealthy eating and discrimination.

OBJECTIVES

To update a review of all controlled studies evaluating policy interventions organised through sporting settings to increase healthy behaviour (related to smoking, alcohol, healthy eating, sun protection, discrimination, safety and access).

SEARCH STRATEGY

We updated the original (2004) searches in May 2007. We searched: the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2 2007); MEDLINE and MEDLINE In-Process and Other Non-Indexed Citations (2004 to Week 3 April 2007); EMBASE (2004 to Week 17 2007); PsyclNFO (2004 to April Week 1 2007); CINAHL (2004 to Week 1 May 2007); SPORTDiscus (2004 to April 2007); Sociological Abstracts (2004 to 2007); Dissertation Abstracts (2004 to May 2007), ERIC (2000 to 2007), freely available online health promotion and sports-related databases hosted by leading agencies, and the internet using sport and policy-related key words.

SELECTION CRITERIA

Controlled studies evaluating any policy intervention implemented through sporting organisations to instigate and/or sustain healthy behaviour change, intention to change behaviour, or changes in attitudes, knowledge or awareness of healthy behaviour, in people of all ages. Policies must address any of the following: smoking, alcohol, healthy eating, sun protection, access for disadvantaged groups, physical safety (not including injuries), and social and emotional health (e.g. anti-vilification, anti-discrimination). Uncontrolled studies which met the other inclusion criteria were to be reported in an annex to the review.

DATA COLLECTION AND ANALYSIS

We assessed whether identified citations met the inclusion criteria. Abstracts were inspected independently by two review authors and full papers were obtained where necessary. As we located no controlled evaluation studies, we did not undertake data collection or analysis. We found no uncontrolled studies meeting other inclusion criteria, and therefore present no annex to the review.

MAIN RESULTS

We found no rigorous studies evaluating the effectiveness of policy interventions organised through sporting organisations to increase healthy behaviours, attitudes, knowledge or the inclusion of health-oriented policies within the organisations.

AUTHORS' CONCLUSIONS

We found no controlled studies to guide the use of policy interventions used in sporting settings. The original (2004) searches identified a number of case studies with anecdotal reporting of outcomes. We strongly recommend that rigorous evaluation techniques are employed more commonly in this field to illuminate the impact of health promoting policy on outcomes, and the contexts and processes which are likely to be effective in reducing harmful behaviours.

Policy interventions implemented through sporting organisations for promoting healthy behaviour change

BACKGROUND

Sporting organisations provide an important setting for health promotion strategies that involve policies, communication of healthy messages and creation of health promoting environments. The introduction of policy interventions within sporting organisations is one strategy to target high risk behaviours such as smoking, alcohol consumption, excess sun exposure, unhealthy eating and discrimination.

OBJECTIVES

To update a review of all controlled studies evaluating policy interventions organised through sporting settings to increase healthy behaviour (related to smoking, alcohol, healthy eating, sun protection, discrimination, safety and access).

SEARCH STRATEGY

We updated the original (2004) searches in May 2007. We searched: the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2 2007); MEDLINE and MEDLINE In-Process and Other Non-Indexed Citations (2004 to Week 3 April 2007); EMBASE (2004 to Week 17 2007); PsyclNFO (2004 to April Week 1 2007); CINAHL (2004 to Week 1 May 2007); SPORTDiscus (2004 to April 2007); Sociological Abstracts (2004 to 2007); Dissertation Abstracts (2004 to May 2007), ERIC (2000 to 2007), freely available online health promotion and sports-related databases hosted by leading agencies, and the internet using sport and policy-related key words.

SELECTION CRITERIA

Controlled studies evaluating any policy intervention implemented through sporting organisations to instigate and/or sustain healthy behaviour change, intention to change behaviour, or changes in attitudes, knowledge or awareness of healthy behaviour, in people of all ages. Policies must address any of the following: smoking, alcohol, healthy eating, sun protection, access for disadvantaged groups, physical safety (not including injuries), and social and emotional health (e.g. anti-vilification, anti-discrimination). Uncontrolled studies which met the other inclusion criteria were to be reported in an annex to the review.

DATA COLLECTION AND ANALYSIS

We assessed whether identified citations met the inclusion criteria. Abstracts were inspected independently by two review authors and full papers were obtained where necessary. As we located no controlled evaluation studies, we did not undertake data collection or analysis. We found no uncontrolled studies meeting other inclusion criteria, and therefore present no annex to the review.

MAIN RESULTS

We found no rigorous studies evaluating the effectiveness of policy interventions organised through sporting organisations to increase healthy behaviours, attitudes, knowledge or the inclusion of health-oriented policies within the organisations.

AUTHORS' CONCLUSIONS

We found no controlled studies to guide the use of policy interventions used in sporting settings. The original (2004) searches identified a number of case studies with anecdotal reporting of outcomes. We strongly recommend that rigorous evaluation techniques are employed more commonly in this field to illuminate the impact of health promoting policy on outcomes, and the contexts and processes which are likely to be effective in reducing harmful behaviours.

The policies and practices of sports governing bodies in relation to assessing the safety of sports grounds

Sport is an important context for physical activity and it is critical that safe environments are provided for such activity. Sports safety is influenced by the presence of sports ground environmental hazards such as ground hardness, poorly maintained playing fields, surface irregularities and the presence of debris/rubbish. To reduce injury risk, sports governing bodies need to ensure regular assessment of grounds safety and the removal of identified hazards. This study describes sports ground safety guidelines and recommendations of a sample of sports governing bodies and provides recommendations for how they could be improved. Semi-structured key informant interviews were conducted with nominees of state governing bodies for Australian football, cricket, soccer and hockey. The use of matchday checklists to identify ground hazards, as mandated by insurance companies was widely promoted across all levels of play. Sports governing bodies had more direct involvement in assessing grounds used for higher level of play, than grounds used for community or junior sport. There was a general presumption that identified hazards on community grounds would be corrected by local councils or clubs before anyone played on them, but this was rarely monitored. Sports governing bodies run the risk of being negligent in their duty of care to sports participants if they do not formally monitor the implementation of their ground safety polices and guidelines. There is also further scope for sports bodies to work closely with insurers to develop ground safety assessment guidelines specific to their sport.

Policy interventions implemented through sporting organisations for promoting healthy behaviour change

BACKGROUND

Sporting organisations provide an important setting for health promotion strategies that involve policies, communication of healthy messages and creation of health promoting environments. The introduction of policy interventions within sporting organisations is one strategy to target high risk behaviours such as smoking, alcohol consumption, excess sun exposure, unhealthy eating and discrimination.

OBJECTIVES

To review all controlled evaluation studies of policy interventions organised through sporting settings to increase healthy behaviour (related to smoking, alcohol, healthy eating, sun protection, discrimination, safety and access).

SEARCH STRATEGY

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsyclNFO, CINAHL, SPORTDiscus, Sociological Abstracts, Dissertation Abstracts, freely available online health promotion and sports-related databases hosted by leading agencies, and the internet using sport and policy-related key words. We identified further studies in the bibliographies of articles and by contacting authors of key articles in the area.

SELECTION CRITERIA

We aimed to identify research that had used study designs that incorporated an evaluated intervention and comparison. Uncontrolled studies, meeting other inclusion criteria, were to be reported in an annex to the review. Types of studies: Studies in which sporting organisations were allocated to a policy intervention or control/comparison group. No minimum follow-up required.

TYPES OF PARTICIPANTS

People of all ages. Types of interventions: Any policy intervention implemented through sporting organisations to instigate and/or sustain healthy behaviour change, intention to change behaviour, or changes in attitudes, knowledge or awareness of healthy behaviour. Policies must address any of the following: smoking, alcohol, healthy eating, sun protection, access for disadvantaged groups, physical safety (not including injuries), and social and emotional health (e.g.. anti-vilification, anti-discrimination). Types of outcome measures: Behaviour change, intention to change behaviour, change in attitudes, knowledge or awareness of healthy behaviour, and policy presence.

DATA COLLECTION AND ANALYSIS

We assessed whether identified citations were controlled evaluation studies and investigated the use of policy implemented in sporting settings. Abstracts were independently inspected by two reviewers and full papers were obtained where necessary. As no controlled evaluation studies were located, no data collection or analysis was undertaken. No uncontrolled studies meeting other inclusion criteria were identified and therefore no annex is presented.

MAIN RESULTS

No rigorous studies were located to test the effectiveness of policy interventions organised through sporting organisations to increase healthy behaviours, attitudes, knowledge or inclusion of health oriented policies within the organisations.

AUTHORS' CONCLUSIONS

We were unable to find any controlled studies to guide the use of policy interventions used in sporting settings. The search process revealed a number of case studies with anecdotal reporting of outcomes. We strongly recommend that rigorous evaluation techniques are employed more commonly in this field to illuminate the impact of health promoting policy on outcomes, and the contexts and processes which are likely to be effective in reducing harmful behaviours.

Critical processes for creating health-promoting sporting environments in Australia

The reach of sporting organizations into the community makes them an ideal vehicle through which to promote health to the general population. There are now a number of documented examples demonstrating that sponsorship can lead to improvements in the health of the sporting environment, but relatively little is known as to why some sponsorships are more successful in achieving these structural changes than others in ostensibly similar sports. The purpose of this study was to identify the processes required for health promotion agencies and sporting organizations working in collaboration to implement structural changes in sporting settings such as smoke-free environments, provision of healthy food choices, responsible alcohol management and sun protection, along with the factors that facilitate and hinder this from being achieved. We conclude that such changes are difficult to achieve, especially in the absence of a programmatic approach to health promotion.

Smoke-free parks: a 12-year-old made it happen

This case study examines how a 12-year-old in the City of Grand Terrace, California was able to get the city council to adopt a resolution making city parks smoke-free/tobacco-free zones in his community. Over a three-month period of time, this 12-year-old (with tremendous support from his parents and sister) applied for and received a mini-grant from the Tri-County SOUTH Regional Tobacco-Free Project and implemented "The Terrace is GRAND with Smoke-Free Parks" activities. This young man recruited 11 youth and 9 adults, trained them in the basics of tobacco prevention called Tobacco 101, and collected 100 surveys and 809 petition signatures supporting smoke-free parks from residents in Grand Terrace. They also collected trash in their parks and separated it into two groups: tobacco-related trash and all other trash. This 12-year-old met with the mayor of Grand Terrace to ask for support for this issue and scheduled a time to present his group's findings to the city council. On June 22, 2000, the youths presented council members with the tobacco-trash collected, the petition signatures, taped end-to-end, that stretched across the council chambers, and asked the city council to make their parks smoke/tobacco-free. Council members acknowledged the excellent work implemented by these youths, adopted a resolution making all parks (except one senior park) tobacco-free, and agreed to place signage in the parks. On August 24, 2000, the city council presented him with his own "Tobacco-Free Zone" sign as an acknowledgment for his hard work in making parks safe places for youths in Grand Terrace.