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Kjeld SG, Homberg T, Andersen S. Relationship between smoking and mental health in educational settings with high smoking rates: a cohort study among Danish youth. Scand J Public Health 2024:14034948241227305. [PMID: 38342989 DOI: 10.1177/14034948241227305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2024]
Abstract
BACKGROUND Smoking and poor mental health in youth represent important public health priorities. This study aimed to (i) compare tobacco-related behaviors and mental health in two educational settings with high smoking rates: vocational education and training (VET) schools and preparatory basic education (PBE) schools, and (ii) examine associations between smoking at school start and mental health 5 months later. METHODS Data were obtained from baseline (N = 1843) and follow-up (N = 1039) assessments conducted as part of a school-based trial in two rounds (baseline in August 2018 and August 2019). Students' characteristics were presented by adjusted prevalences. Logistic regression analyses assessed associations between smoking and measures of mental health: school-related well-being, overall loneliness, and stress. RESULTS More PBE students than VET students reported daily smoking (40% vs. 27%), nicotine dependence, perceived benefits of smoking (e.g., stress reduction: 41% vs. 33%), low smoking-related self-efficacy (e.g., ability to resist smoking if offered by a friend: 20% vs. 32%), school-related loneliness, and low school connectedness (25% vs. 11%). Daily smokers at VET and PBE schools had lower odds of school-related loneliness (AOR = 0.51, 95% CI: 0.35-0.74) and higher odds of stress (AOR = 2.75, 95% CI: 2.00-3.80). Smoking was associated with better classmate relations in VET schools but not in PBE schools. CONCLUSIONS Our study suggested that students in PBE schools constitute a more vulnerable group in terms of smoking and mental health compared with students in VET schools. Smoking seemed to prevent loneliness in school but was associated with heightened stress levels.
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Affiliation(s)
- Simone G Kjeld
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | - Susan Andersen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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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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Frank VA, Herold MD. Pushing boundaries or adding a gimmick to the party? Young people's experiences of nitrous oxide use in Denmark. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023:104020. [PMID: 37032283 DOI: 10.1016/j.drugpo.2023.104020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/26/2023] [Accepted: 03/27/2023] [Indexed: 04/11/2023]
Abstract
Nitrous oxide (N2O) use for intoxication among young people has increased in many parts of the Western world, including Denmark. The literature, however, primarily focusses on harms related to N2O use, and not on other aspects, for example modes of administration or effects such as different forms of pleasure or fun. Therefore, despite this increase, we still know very little about how and why young people use nitrous oxide for intoxication, including their experiences of N2O intoxication. Based on 45 qualitative interviews with young Danes age 18-25 years, who all were former or present N2O users, we explore their experiences of N2O intoxication. We do this by analyzing in-depth descriptions of where, how and with whom they use N2O. When analyzing these descriptions in relation to different modes of administration, intensity of use, combination with other substances (e.g. alcohol, cannabis), and use in different settings, we argue that N2O intoxication is experienced differently by the young participants. Some of the participants also searched for particular intoxication experiences with N2O. We unfold the participants' various descriptions of intoxication by differentiating between moderate and intensive use. Overall, our study shows that these differences in N2O use for intoxication are not equally risky or harmful. In general, young people's own perspectives and experiences with (illegal) drug use is increasingly emphasized as important to include when developing preventive interventions. Our analysis of the young participants' differing experiences with N2O for intoxication can inform future prevention initiatives in relation to harms of N2O intoxication.
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Affiliation(s)
- Vibeke A Frank
- Research Centre for Management, Organisation and Social Sciences, VIA University College, Aarhus N, Denmark.
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Danielsen D, Jensen TS, Kjeld SG, Bast LS, Andersen S. Context matters in smoking prevention: evaluating smoke-free school hours in Danish vocational schools. Health Promot Int 2023; 38:7143326. [PMID: 37099679 PMCID: PMC10132565 DOI: 10.1093/heapro/daad030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
Youth is a crucial period for smoking preventive interventions. School-based interventions targeting the policy level and the sociocultural processes of smoking show promising effects in reducing smoking uptake and prevalence. This study presents findings from the qualitative process evaluation of a smoking preventive intervention, Focus, in the vocational school (VET) setting. Specifically, the study focused on contextual factors affecting the implementation of smoke-free school hours (SFSH). Participant observations and focus groups were conducted in four VETs during the implementation period October-December 2018. The data encompass participant observation field notes (n = 21 school days), student focus groups (n = 8) (aged 16-20), teacher focus groups (n = 5) and semi-structured individual interviews with VET leaders (n = 3). The study found that SFSH was not clearly communicated to students due to the educational structure and chaotic rhythm of the school days, ambivalent attitudes among teachers toward enforcement of smoking rules and lack of clear managerial support. The interplay of these factors counteracted the implementation of SFSH in the VET context. The presented contextual factors are important when interpreting the effectiveness of the Focus intervention and for informing future preventive efforts aiming to reduce smoking among youth in high risk of smoking cigarettes.
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Affiliation(s)
- Dina Danielsen
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, Kobenhavn 1455, Denmark
| | - Tina S Jensen
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, Kobenhavn 1455, Denmark
| | - Simone G Kjeld
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, Kobenhavn 1455, Denmark
| | - Lotus S Bast
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, Kobenhavn 1455, Denmark
| | - Susan Andersen
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, Kobenhavn 1455, Denmark
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Hjort AV, Christiansen TB, Stage M, Rasmussen KH, Pisinger C, Tjørnhøj-Thomsen T, Klinker CD. Programme theory and realist evaluation of the 'Smoke-Free Vocational Schools' research and intervention project: a study protocol. BMJ Open 2021; 11:e042728. [PMID: 33542044 PMCID: PMC7925872 DOI: 10.1136/bmjopen-2020-042728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Smoke-free school hours (SFSHs) entails a smoking ban during school hours and might be an effective intervention to reduce the high smoking prevalence in vocational schools. For SFSH to be effective, the policy must be adequately implemented and enforced; this challenge for schools constitutes a research gap. The 'Smoke-Free Vocational Schools' research and intervention project has been developed to facilitate schools' implementation of SFSH. It is scheduled to run from 2018 to 2022, with SFSH being implemented in 11 Danish vocational schools. This study protocol describes the intervention project and evaluation design of the research and intervention project. METHODS AND ANALYSIS The intervention project aims to develop an evidence-based model for implementing SFSH in vocational schools and similar settings. The project is developed in a collaboration between research and practice. Two public health NGOs are responsible for delivering the intervention activities in schools, while the research partner evaluates what works, for whom, and under what circumstances. The intervention lasts one year per school, targeting different socioecological levels. During the first 6 months, activities are delivered to stimulate organisational readiness to implement SFSH. Then, SFSH is established, and during the next 6 months, activities are delivered to stimulate implementation of SFSH into routine practice. The epistemological foundation is realistic evaluation. The evaluation focuses on both implementation and outcomes. Process evaluation will determine the level of implementation and explore what hinders or enables SFSH becoming part of routine practice using qualitative and quantitative methods. Outcomes evaluation will quantitively assess the intervention's effectiveness, with the primary outcome measure being changes in smoking during school hours. ETHICS AND DISSEMINATION Informed consent will be obtained from study participants according to the General Data Protection Regulation (GDPR) and Danish data protection law. The study adheres to Danish ethics procedures. Study findings will be disseminated at conferences and further published in open-access peer-reviewed journals.
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Affiliation(s)
- Anneke Vang Hjort
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | - Maria Stage
- Cancer Prevention & Information, Danish Cancer Society, Copenhagen, Denmark
| | | | - Charlotta Pisinger
- Prevention, Danish Heart Foundation, Copenhagen, Denmark
- Center for Clinical Research and Prevention, University of Copenhagen, Frederiksberg, Denmark
| | - Tine Tjørnhøj-Thomsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Dropout at Danish vocational schools: does the school's health promotion capacity play a role? A survey- and register-based prospective study. BMC Public Health 2020; 20:786. [PMID: 32456701 PMCID: PMC7249319 DOI: 10.1186/s12889-020-08955-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 05/19/2020] [Indexed: 11/10/2022] Open
Abstract
Background School dropout rates and risky health behavior is common among students in vocational education and training (VET) schools. Students with poor physical and mental health are more likely to drop out, and as such VET schools may be an important setting for health promotion initiatives, not only to support a healthy lifestyle, but also to assure completion of education. A common feature of successful health promotion at VET schools is a high health promotion capacity at the school level. This study aimed to investigate the association between VET school’s health promotion capacity and later student dropout rates. Secondary, we explored other school characteristics associated with student dropout rates. Methods This prospective study comprised 58 Danish VET schools offering basic programs. Health promotion capacity was assessed using questionnaire data from 2017 from school managers and teachers, and this was combined with register-based data on student dropouts the following year. Health promotion capacity was assessed using six scales, representing six underlying domains, and managers and teachers’ ratings of these were compared using t-test. Associations between health promotion capacity and student dropout rates as well as associations between school characteristics and student dropout rates were analyzed using multiple linear regression. Results No associations between VET schools’ health promotion capacity and student dropout rates were observed, neither for the schools’ overall health promotion capacity or for any of the six underlying domains (p = 0.17–0.84). School managers assessed health promotion capacity significantly higher than teachers overall and within all domains (p < 0.05). Moreover, student dropout rates were significantly lower at schools with a higher proportion of ethnic Danish students, VET-students at higher educational level and schools located in the Western part of Denmark (p < 0.05). Conclusion No associations between VET schools’ health promotion capacity and student dropout rates were observed. This may be due to a relatively short follow-up time in our study and future research may reveal if VET school health promotion capacity may affect dropout rates over a longer time period. Moreover, more work is needed to further develop instruments for measuring health promotion capacity in a VET school context as well as other contexts.
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Klinker CD, Aaby A, Ringgaard LW, Hjort AV, Hawkins M, Maindal HT. Health Literacy is Associated with Health Behaviors in Students from Vocational Education and Training Schools: A Danish Population-Based Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020671. [PMID: 31968667 PMCID: PMC7014204 DOI: 10.3390/ijerph17020671] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/17/2020] [Accepted: 01/19/2020] [Indexed: 01/16/2023]
Abstract
Health literacy has been identified as an important and changeable intermediary determinant of health equity. Vocational education and training (VET) schools are a relevant setting for health behavior interventions seeking to diminish health inequities because many VET students come from low socio-economic status backgrounds. This study examines VET students’ health literacy and its association with health behavior based on a cross-sectional survey among 6119 students from 58 VET schools in Denmark in 2019. Two scales from the Health Literacy Questionnaire was used to assess domains of health literacy. Data were analyzed using Anova and logistic regression. The study population consisted of 43.4% female, and mean age was 24.2 years (range 15.8–64.0). The health literacy domain ‘Actively managing my health’ mean was 2.51, SD 0.66, and ‘Appraisal of health information’ mean was 2.37, SD 0.65. For both domains, being female, older age, attending the VET educational program Care-health-pedagogy, and higher self-rated health were associated with higher scale scores. In the adjusted analyses, lower scale scores were associated with less frequent breakfast, daily smoking, high-risk alcohol behavior and moderate-to-low physical activity. Our results show that low health literacy is associated with unhealthy behaviors in this population. Our results support and inform health literacy research and practice in educational institutions and services.
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Affiliation(s)
- Charlotte Demant Klinker
- Steno Diabetes Center Copenhagen, Health Promotion, Niels Steensens vej 6, 2820 Gentofte, Denmark
- Correspondence: ; Tel.: +45-30-91-29-68
| | - Anna Aaby
- Department of Public Health, Bartholins Alle 2, Aarhus University, 8000 Aarhus, Denmark
| | - Lene Winther Ringgaard
- Steno Diabetes Center Copenhagen, Health Promotion, Niels Steensens vej 6, 2820 Gentofte, Denmark
| | - Anneke Vang Hjort
- Steno Diabetes Center Copenhagen, Health Promotion, Niels Steensens vej 6, 2820 Gentofte, Denmark
| | - Melanie Hawkins
- School of Health and Social Development, Deakin University, Geelong, VIC 3220, Australia
| | - Helle Terkildsen Maindal
- Steno Diabetes Center Copenhagen, Health Promotion, Niels Steensens vej 6, 2820 Gentofte, Denmark
- Department of Public Health, Bartholins Alle 2, Aarhus University, 8000 Aarhus, Denmark
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Croot L, O’Cathain A, Sworn K, Yardley L, Turner K, Duncan E, Hoddinott P. Developing interventions to improve health: a systematic mapping review of international practice between 2015 and 2016. Pilot Feasibility Stud 2019; 5:127. [PMID: 31720005 PMCID: PMC6839208 DOI: 10.1186/s40814-019-0512-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 10/15/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Researchers publish the processes they use to develop interventions to improve health. Reflecting on this endeavour may help future developers to improve their practice. METHODS Our aim was to collate, describe, and analyse the actions developers take when developing complex interventions to improve health. We carried out a systematic mapping review of empirical research studies that report the development of complex interventions to improve health. A search was undertaken of five databases over 2015-2016 using the term 'intervention dev*'. Eighty-seven journal articles reporting the process of intervention development were identified. A purposive subset of 30 articles, using a range of published approaches to developing interventions, was selected for in-depth analysis using principles of realist synthesis to identify the actions of intervention development and rationales underpinning those actions. RESULTS The 87 articles were from the USA (39/87), the UK (32/87), continental Europe (6/87), and the rest of the world (10/87). These mainly took a pragmatic self-selected approach (n = 43); a theory- and evidence-based approach, e.g. Intervention Mapping, Behaviour Change Wheel (n = 22); or a partnership approach, e.g. community-based participatory research, co-design (n = 10). Ten actions of intervention development were identified from the subset of 30 articles, including identifying a need for an intervention, selecting the intervention development approach to follow, considering the needs of the target population, reviewing published evidence, involving stakeholders, drawing or generating theory, and designing and refining the intervention. Rationales for these actions were that they would produce more engaging, acceptable, feasible, and effective interventions. CONCLUSIONS Developers take a variety of approaches to the international endeavour of complex intervention development. We have identified and described a set of actions taken within this endeavour regardless of whether developers follow a published approach or not. Future developers can use these actions and the rationales that underpin them to help them make decisions about the process of intervention development. TRIAL REGISTRATION PROSPERO, CRD42017080545.
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Affiliation(s)
- Liz Croot
- Medical Care Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Alicia O’Cathain
- Medical Care Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Katie Sworn
- Medical Care Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Lucy Yardley
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Katrina Turner
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Edward Duncan
- NMAHP Research Unit, University of Stirling, Stirling, UK
| | - Pat Hoddinott
- NMAHP Research Unit, University of Stirling, Stirling, UK
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Aho H, Koivisto A, Paavilainen E, Joronen K. The relationship between peer relations, self-rated health and smoking behaviour in secondary vocational schools. Nurs Open 2019; 6:754-764. [PMID: 31367397 PMCID: PMC6650760 DOI: 10.1002/nop2.260] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 10/01/2018] [Accepted: 10/16/2018] [Indexed: 11/20/2022] Open
Abstract
AIMS To examine the association between peer relations, self-rated health and smoking behaviour in vocational school setting. BACKGROUND Smoking in adolescence causes health and socioeconomic inequality in adulthood. There is evidence that smokers are physically less active, have lower academic aspirations and perceive poorer health than non-smokers. METHOD The study was conducted in spring 2013 and involved 34,776 vocational students who took part in the School Health Promotion Study in Finland. The associations between adolescent smoking habits and peer relations and smokers' self-rated health were studied adjusting for the respondents' age, parental education and family type. RESULTS A substantial proportion of the respondents, 37% of the girls and 36% of the boys, reported smoking daily, 15% of the girls and 14% boys smoked occasionally with a further 15% of the girls and 13% of the boys stating that they were ex-smokers. Of the girls, 33% and 38% of the boys were non-smokers. Adjusted multinomial regression revealed that having a close friend or friends predicted smoking among girls and boys. Additionally, the adjusted model indicated that being a bully and/or a bully + bully-victim was associated with smoking behaviour in boys only. Boys and girls who rated their health as moderate or poor were more often daily smokers; in girls, this was also the case in occasional smokers. CONCLUSION Smoking prevention aimed at vocational schools should take into consideration the norms and expectations related to peer relations which strongly influence adolescents' smoking habits.
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Affiliation(s)
- Hanna Aho
- Faculty of Social Science, Health SciencesUniversity of TampereTampereFinland
- Department of Musclosceletal DiseasesTampere University HospitalTampereFinland
- Tampere University of Applied SciencesTampereFinland
| | - Anna‐Maija Koivisto
- Faculty of Social Science, Health SciencesUniversity of TampereTampereFinland
| | - Eija Paavilainen
- Faculty of Social Science, Health SciencesUniversity of TampereTampereFinland
| | - Katja Joronen
- Faculty of Social Science, Health SciencesUniversity of TampereTampereFinland
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Heinze C, Hjort AV, Elsborg P, Maindal HT, Klinker CD. Smoke-free-school-hours at vocational education and training schools in Denmark: attitudes among managers and teaching staff - a national cross-sectional study. BMC Public Health 2019; 19:813. [PMID: 31234822 PMCID: PMC6591894 DOI: 10.1186/s12889-019-7188-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/17/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tobacco is the main cause of non-communicable disease and premature death globally. Implementing restrictive school tobacco policies such as smoke-free-school-hours (SFSH) may have the potential to reduce smoking among Vocational Education and Training (VET) school students. To be effective, school tobacco policies that largely involve strict and consistent enforcement by both managers and teaching teaching staff must be implemented. This study investigated the attitudes towards the implementation of SFSH among the managers and teaching staff at Danish VET schools. METHODS The analyses were based on cross-sectional survey data collected with an online survey among managers and teaching staff at Danish VET schools. The data was collected from March to June 2017. RESULTS Managers and teaching staff (n = 571) from 71 out of 87 Danish VET schools (81.6%) took part in the survey. In the adjusted analysis, teaching staff were twice as likely as managers to have a favourable attitude towards SFSH. Furthermore, being female and of increasing age correlated with having a favourable attitude. A trend towards schools in favour of SFSH having more health promotion facilities, policy and practice, was identified. CONCLUSION AND IMPLICATIONS Existing health promotion facilities and activities at the schools were associated with a favorable attitude among the management towards implementing SFSH. Thus, implementing other health promotion activities and policies might be an important first step to establish readiness to implement SFSH.
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Affiliation(s)
- Clara Heinze
- Health Promotion, Steno Diabetes Center Copenhagen, Niels Steensens vej 6, 2820, Gentofte, Denmark.
| | - Anneke Vang Hjort
- Health Promotion, Steno Diabetes Center Copenhagen, Niels Steensens vej 6, 2820, Gentofte, Denmark
| | - Peter Elsborg
- Health Promotion, Steno Diabetes Center Copenhagen, Niels Steensens vej 6, 2820, Gentofte, Denmark
| | - Helle Terkildsen Maindal
- Health Promotion, Steno Diabetes Center Copenhagen, Niels Steensens vej 6, 2820, Gentofte, Denmark.,Department of Public Health, Aarhus University, Bartholins Alle 2, 8000, Aarhus, Denmark
| | - Charlotte Demant Klinker
- Health Promotion, Steno Diabetes Center Copenhagen, Niels Steensens vej 6, 2820, Gentofte, Denmark
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Andersen S, Rod MH, Holmberg T, Ingholt L, Ersbøll AK, Tolstrup JS. Effectiveness of the settings-based intervention Shaping the Social on preventing dropout from vocational education: a Danish non-randomized controlled trial. BMC Psychol 2018; 6:45. [PMID: 30208956 PMCID: PMC6134754 DOI: 10.1186/s40359-018-0258-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 09/05/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lack of formal education is an important social determinant of health inequality and represents a public health problem. School dropout is particularly common in vocational education; however few prevention programs targeting dropout in the vocational school setting have been evaluated. The purpose of the present study was to test the effect on school dropout of a settings-based intervention program (named Shaping the Social) that targeted the school organization in order to create social and supportive learning environments. METHODS A non-randomized controlled design including four large intervention schools and six matched-control schools was used. The target population was students in technical and agricultural vocational education, which is provided to students from age 16. Students were enrolled at school start. Register-based data (n = 10,190) was used to assess the effect on school dropout during a 2-year period. Odds ratios (OR) and 95% confidence intervals (CI) were calculated in logistic regression models, adjusting for age, sex, ethnicity, parental income, prior school dropout and type of basic course. Student survey (n = 2396) at 10-week follow-up was used to examine wellbeing at school (four subscales: school connectedness, student support, teacher relatedness, and valuing the profession) which was the hypothesized proximal intervention effect. As a secondary aim, we examined how the student wellbeing factors were associated with school dropout, independently of the intervention, and we explored whether the student wellbeing factors were potential mediators. RESULTS The present study showed an intervention effect on school dropout with dropout rates lower in intervention schools (36%) than control schools (40%) (OR = 0.86, 95% CI: 0.74, 0.99). We had no attrition on the dropout outcome. School connectedness mediated the intervention effect; no significant mediation effects were found for student support, teacher relatedness, and valuing the profession. Independently of the intervention, each student wellbeing factor prevented dropout. CONCLUSIONS Findings from this study suggest that a comprehensive, multicomponent school-based intervention could prevent dropout from vocational education by promoting school connectedness; nevertheless, the dropout rate remained high. Our results point to the need to explore how to further improve the wellbeing at school among young people in vocational education. TRIALS REGISTRATION ISRCTN, ISRCTN57822968 . Registered 16 January 2013 (retrospective registered).
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Affiliation(s)
- Susan Andersen
- Centre for Intervention Research in Health Promotion and Disease, National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455, Copenhagen K, Denmark.
| | - Morten Hulvej Rod
- National Research Centre for Disadvantaged Children and Youth, Kronprinsesse Sofies Vej 35, Frederiksberg, Denmark
| | - Teresa Holmberg
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455, Copenhagen, Denmark
| | - Liselotte Ingholt
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455, Copenhagen, Denmark
| | - Annette Kjær Ersbøll
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455, Copenhagen, Denmark
| | - Janne Schurmann Tolstrup
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455, Copenhagen, Denmark
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Jarlstrup NS, Juel K, Pisinger CH, Grønbæk M, Holm S, Andersen S. International Approaches to Tobacco Use Cessation Programs and Policy in Adolescents and Young Adults: Denmark. CURRENT ADDICTION REPORTS 2018. [DOI: 10.1007/s40429-018-0187-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Andersen S, Rod MH, Ersbøll AK, Stock C, Johansen C, Holmberg T, Zinckernagel L, Ingholt L, Sørensen BB, Tolstrup JS. Effects of a settings-based intervention to promote student wellbeing and reduce smoking in vocational schools: A non-randomized controlled study. Soc Sci Med 2016; 161:195-203. [PMID: 27319278 DOI: 10.1016/j.socscimed.2016.06.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 06/06/2016] [Accepted: 06/09/2016] [Indexed: 11/17/2022]
Abstract
RATIONALE School dropout and health risk behavior such as cigarette smoking represent major problems among students attending upper secondary vocational education. Modifications to the social environment may promote educational attainment as well as health and wellbeing of young people. However, there is a need for more evidence-based intervention programs. OBJECTIVE The aim of this study was to assess the effectiveness of an intervention targeting the socio-environmental setting at vocational schools on student wellbeing and smoking. METHODS We conducted a non-randomized controlled trial of 5794 students (mean age 21 years; 81% male) in 10 (four intervention and six comparison) large vocational schools in Denmark. The intervention involved changes in everyday school practices focusing on four themes: (i) introduction activities, (ii) daily class meetings, (iii) scheduled breaks and (iv) pleasant non-smoking environment. Outcomes were student wellbeing (four subscales: school connectedness, student support, teacher relatedness, positive valuing of the profession) and daily smoking measured at 10-week follow-up. RESULTS We found statistically significant between-group difference in school connectedness, but not in student support, teacher relatedness and valuing the profession. The intervention had no effect on daily smoking. However, we found a statistically significant interaction between baseline smoking status and condition. This interaction suggested that baseline occasional smokers in the intervention group had significantly reduced odds ratio (OR) of becoming a daily smoker compared to baseline occasional smokers in the control group (8% versus 16%; OR = 0.44). CONCLUSION The positive effects on school connectedness and in preventing occasional smokers becoming daily smokers indicate that it is possible to tackle school-related wellbeing and smoking in a high risk population through settings-based interventions.
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Affiliation(s)
- Susan Andersen
- Centre for Intervention Research in Health Promotion and Disease, National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, DK-1353 Copenhagen, Denmark.
| | - Morten Hulvej Rod
- Centre for Intervention Research in Health Promotion and Disease, National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, DK-1353 Copenhagen, Denmark.
| | - Annette Kjær Ersbøll
- Centre for Intervention Research in Health Promotion and Disease, National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, DK-1353 Copenhagen, Denmark.
| | - Christiane Stock
- Institute of Public Health, University of Southern Denmark, Niels Bohrs Vej 9, DK-6700 Esbjerg, Denmark.
| | - Christoffer Johansen
- The Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Denmark.
| | - Teresa Holmberg
- Centre for Intervention Research in Health Promotion and Disease, National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, DK-1353 Copenhagen, Denmark.
| | - Line Zinckernagel
- Centre for Intervention Research in Health Promotion and Disease, National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, DK-1353 Copenhagen, Denmark.
| | - Liselotte Ingholt
- Centre for Intervention Research in Health Promotion and Disease, National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, DK-1353 Copenhagen, Denmark.
| | - Betina Bang Sørensen
- Centre for Intervention Research in Health Promotion and Disease, National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, DK-1353 Copenhagen, Denmark.
| | - Janne Schurmann Tolstrup
- Centre for Intervention Research in Health Promotion and Disease, National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, DK-1353 Copenhagen, Denmark.
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Andersen S, Tolstrup JS, Rod MH, Ersbøll AK, Sørensen BB, Holmberg T, Johansen C, Stock C, Laursen B, Zinckernagel L, Øllgaard AL, Ingholt L. Shaping the Social: design of a settings-based intervention study to improve well-being and reduce smoking and dropout in Danish vocational schools. BMC Public Health 2015; 15:568. [PMID: 26088693 PMCID: PMC4474364 DOI: 10.1186/s12889-015-1936-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 06/12/2015] [Indexed: 11/15/2022] Open
Abstract
Background The social environment at schools is an important setting to promote educational attainment, and health and well-being of young people. However, within upper secondary education there is a need for evidence-based school intervention programmes. The Shaping the Social intervention is a comprehensive programme integrating social and educational activities to promote student well-being and reduce smoking and dropout in upper secondary vocational education. The evaluation design is reported here. Methods/design The evaluation employed a non-randomised cluster controlled design, and schools were selected to either implement the intervention or continue with normal practice for comparison. In the baseline survey conducted 2011–2012, 2,329 students from four intervention schools and 3,371 students from six comparison schools answered a computer-based questionnaire during class, representing 73 % and 81 % of eligible students, and 22 % of all technical/agricultural vocational schools in Denmark. Follow-up assessment was conducted 10 weeks after baseline and at the same time teachers of the intervention classes answered a questionnaire about implementation. School dropout rates will be tracked via national education registers through a 2-year follow-up period. Discussion Shaping the Social was designed to address that students at Danish vocational schools constitute a high risk population concerning health behaviour as well as school dropout by modifying the school environment, alongside developing appropriate evaluation strategies. To address difficulties in implementing settings-based interventions, as highlighted in prior research, the strategy was to involve intervention schools in the development of the intervention. Baseline differences will be included in the effectiveness analysis, so will the impact of likely mediators and moderators of the intervention. Trials registration ISRCTN57822968. Date of registration: 16/01/2013
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Affiliation(s)
- Susan Andersen
- Centre for Intervention Research in Health Promotion and Disease, National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, DK-1353, Copenhagen, Denmark.
| | - Janne Schurmann Tolstrup
- National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, DK-1353, Copenhagen, Denmark.
| | - Morten Hulvej Rod
- National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, DK-1353, Copenhagen, Denmark.
| | - Annette Kjær Ersbøll
- National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, DK-1353, Copenhagen, Denmark.
| | - Betina Bang Sørensen
- National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, DK-1353, Copenhagen, Denmark.
| | - Teresa Holmberg
- National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, DK-1353, Copenhagen, Denmark.
| | - Christoffer Johansen
- The Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100, Copenhagen, Denmark.
| | - Christiane Stock
- Institute of Public Health, University of Southern Denmark, Niels Bohrs Vej 9, DK-6700, Esbjerg, Denmark.
| | - Bjarne Laursen
- National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, DK-1353, Copenhagen, Denmark.
| | - Line Zinckernagel
- National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, DK-1353, Copenhagen, Denmark.
| | - Anne Louise Øllgaard
- National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, DK-1353, Copenhagen, Denmark.
| | - Liselotte Ingholt
- National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, DK-1353, Copenhagen, Denmark.
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