Smoke-free-school-hours at vocational education and training schools in Denmark: attitudes among managers and teaching staff - a national cross-sectional study

Developing and Evaluating a Data-Driven and Systems Approach to Health Promotion Among Vocational Students: Protocol for the Data Health Study

BACKGROUND

Vocational school students exhibit significant risk behaviors in terms of poor diet, frequent use of nicotine products, inadequate fruit and vegetable intake, low levels of physical activity, and poor mental health. This makes vocational students vulnerable to the development of noncommunicable diseases. Therefore, effective health promotion programs targeting vocational students are required.

OBJECTIVE

The Danish study "Data-driven and Systems Approach to Health Promotion Among Vocational Students" (Data Health) aims to develop, implement, and evaluate a systems approach to support vocational schools, municipalities, and local communities in implementing locally relevant health promotion actions among and for vocational students. This paper describes the Data Health program and how implementation and preliminary effectiveness will be evaluated.

METHODS

The Data Health program offers an iterative 5-step process to develop changes in the systems that shape health behavior and well-being among vocational students. The program will be implemented and evaluated in 8 Danish vocational schools in 4 municipalities. The implementation of the process and actions will be explored using a systems-based evaluation design that assesses contextual differences and the mechanisms through which the program leads to changes in the systems. Preliminary effectiveness at the individual level (students' self-reported health behavior and well-being) and organizational level (school organizational readiness reported by school staff) will be assessed using a quasi-experimental design, and cross-sectional data will be collected at all 8 schools simultaneously 4 times during the 2-year study period.

RESULTS

This study was launched in 2021, and data collection is expected to be completed in June 2024. The first results are expected to be submitted for publication in January 2024.

CONCLUSIONS

We expect that the Data Health study will make significant contributions to complex intervention research by contributing to the paucity of research studies that have used systems approaches in school settings. The study will also provide evidence of successful elements for systems change and effectiveness to determine whether a national scale-up can be recommended.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05308459; https://clinicaltrials.gov/study/NCT05308459.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/52571.

Are Perceptions of Health Dependant on Social Class? Studying Soft Power and Symbolic Violence in a Health Promotion Program among Young Men at Vocational Schools

Health behaviour among young people has a social gradient, and tends to be skewed in terms of gender as well. Young men in vocational educational settings are an example where the inequality in health is apparent. Addressing this problem requires an understanding of health behaviour and its determinants in the target group in order to be able to develop interventions that can address the problem. The aim of the paper is to investigate to what extent a multicomponent intervention based on the Whole School Approach, targeting the risk behaviours, smoking, eating and physical activity that have an impact on health behaviour among male students in a disadvantaged educational setting. The paper uses self-reported longitudinal data on risk behaviours from the “Gearing up the Body” 1-year intervention program that was implemented among students at a Danish vocational school. For the analysis, we created a score model to categorise students and behaviour. Analyses suggest that interventions had only a modest impact and what evidence there is shows that the interventions reduced the health behaviour scores by 0.03 points. More specifically, we find that symbolic violence reduces the health behaviour score of the healthy types by 0.20 points, whereas soft power increases the health behaviour of the unhealthy type by 0.05 points. An explanation for the disappointing results of the “Gearing up the Body” program is tension between different understanding of what is “right” and “wrong” health behaviour. We find that the ideas of soft power and symbolic violence can contribute to a better understanding of why health and health behaviour is understood differently among vocational students. Thus, the finding demonstrates that one needs to apply a participatory approach rather than a normative approach addressing the health behaviour of disadvantaged individuals.

Are Danish vocational schools ready to implement "smoke-free school hours"? A qualitative study informed by the theory of organizational readiness for change

BACKGROUND

The smoking prevalence is high among students enrolled in vocational education and training, which is considered a lower level of education. The school tobacco policy regarding smoke-free school hours stipulates that students and staff are not allowed to smoke during school hours-inside or outside school premises-and it might be an effective intervention for reducing smoking in vocational schools. For school tobacco policies to be effective, they must be appropriately implemented. A primary predictor for successful implementation is organizational readiness for change. This study seeks to identify and understand the barriers to and facilitators for developing organizational readiness to implement smoke-free school hours in Danish vocational schools.

METHODS

Semi-structured interviews and focus groups were carried out with managers and teachers (n = 22 participants) from six vocational schools. The interview guides were informed by "A theory of organizational readiness for change" developed by Weiner, which was also used as a framework to analyze the data.

RESULTS

We identified 13 facilitators and barriers. Nine factors acted as facilitators, including the following: believing that health promotion is a school role and duty; believing that society and workplaces are becoming more smoke-free, and believing that smoke-free school hours is a beneficial strategy to achieve fewer educational interruptions. Additional facilitators include establishing clear rules for sanctioning and enforcement, developing a joint understanding about smoke-free school hours, developing skills to deal with student responses to smoke-free school hours, establishing social alternatives to smoking, offering smoking cessation help, and mandating smoke-free school hours by law. Four organizational norms, practices, or discourses acted as barriers: believing that smoke-free school hours violate personal freedom, believing that students have more important problems than smoking, believing that it is difficult to administer the level of enforcement, and believing that the enforcement of smoke-free school hours negatively influences student-teacher relations.

DISCUSSION

Our results suggest that developing organizational readiness before adopting a comprehensive tobacco policy such as smoke-free school hours is important for successful implementation. Further research should investigate how to strengthen the facilitators for and counter the barriers to developing readiness for implementing smoke-free school hours.

Programme theory and realist evaluation of the 'Smoke-Free Vocational Schools' research and intervention project: a study protocol

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.

Dropout at Danish vocational schools: does the school's health promotion capacity play a role? A survey- and register-based prospective study

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.

Health Literacy is Associated with Health Behaviors in Students from Vocational Education and Training Schools: A Danish Population-Based Survey

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.