School-based interventions to promote adolescent health: A systematic review in low- and middle-income countries of WHO Western Pacific Region

Any better? A follow-up content analysis of adolescent sexual and reproductive health inclusion in Global Financing Facility country planning documents

BACKGROUND

The Global Financing Facility (GFF) supports national reproductive, maternal, newborn, child, adolescent health, and nutrition needs. Previous analysis examined how adolescent sexual and reproductive health was represented in GFF national planning documents for 11 GFF partner countries.

OBJECTIVES

This paper furthers that analysis for 16 GFF partner countries as part of a Special Series.

METHODS

Content analysis was conducted on publicly available GFF planning documents for Afghanistan, Burkina Faso, Cambodia, CAR, Côte d'Ivoire, Guinea, Haiti, Indonesia, Madagascar, Malawi, Mali, Rwanda, Senegal, Sierra Leone, Tajikistan, Vietnam. Analysis considered adolescent health content (mindset), indicators (measure) and funding (money) relative to adolescent sexual and reproductive health needs, using a tracer indicator.

RESULTS

Countries with higher rates of adolescent pregnancy had more content relating to adolescent reproductive health, with exceptions in fragile contexts. Investment cases had more adolescent content than project appraisal documents. Content gradually weakened from mindset to measures to money. Related conditions, such as fistula, abortion, and mental health, were insufficiently addressed. Documents from Burkina Faso and Malawi demonstrated it is possible to include adolescent programming even within a context of shifting or selective priorities.

CONCLUSION

Tracing prioritisation and translation of commitments into plans provides a foundation for discussing global funding for adolescents. We highlight positive aspects of programming and areas for strengthening and suggest broadening the perspective of adolescent health beyond the reproductive health to encompass issues, such as mental health. This paper forms part of a growing body of accountability literature, supporting advocacy work for adolescent programming and funding.

A Provider-Focused Intervention to Increase Universal HIV Testing among Adolescents in School-Based Health Centers

We describe a provider-focused intervention to increase universal HIV testing among adolescent users in a network of School-Based Health Centers (SBHC) and compare the rate of HIV test offer and acceptance for SBHCs with and without the HIV testing intervention. The intervention was implemented at the six largest SBHCs in the 12-site network and included system- and staff-level initiatives, including an implementation coach to support SBHC associates. Rates of HIV test offer and acceptance at six sites in the Intervention Cohort were compared to that at the six sites in a Non-Intervention Cohort which was not randomly selected but had comparable distributions by age, gender and race/ethnicity. The model showed an intervention effect for universal HIV test offer, but no overall effect for test acceptance. Analyzing the intervention effect by whether a patient had a history of sexual activity, the intervention was very effective early in its implementation at increasing test offer to those with no history of sexual activity, and late in its implementation at increasing test acceptance for those with no or unknown sexual activity. Increasing and sustaining universal HIV testing in SBHCs may benefit from using Implementation Science frameworks to guide adaptation of the intervention.

Effects of Performance-Based Financing on Availability, Quality, and Use of Family Planning Services in the Democratic Republic of Congo: An Impact Evaluation

Access to high-quality family planning services remains limited in many low- and middle-income countries, resulting in a high burden of unintended pregnancies and adverse health outcomes. We used data from a large randomized controlled trial in the Democratic Republic of Congo to test whether performance-based financing (PBF) can increase the availability, quality, and use of family planning services. Starting at the end of 2016, 30 health zones were randomly assigned to a PBF program, in which health facilities received financing conditional on the quantity and quality of offered services. Twenty-eight health zones were assigned to a control group in which health facilities received unconditional financing of a similar magnitude. Follow-up data collection took place in 2021-2022 and included 346 health facility assessments, 476 direct clinical observations of family planning consultations, and 9,585 household surveys. Findings from multivariable regression models show that the PBF program had strong positive impacts on the availability and quality of family planning services. Specifically, the program increased the likelihood that health facilities offered any family planning services by 20 percentage points and increased the likelihood that health facilities had contraceptive pills, injectables, and implants available by 23, 24, and 20 percentage points, respectively. The program also improved the process quality of family planning consultations by 0.59 standard deviations. Despite these improvements, and in addition to reductions in service fees, the program had a modest impact on contraceptive use, increasing the modern method use among sexually active women of reproductive age by 4 percentage points (equivalent to a 37 percent increase), with no significant impact on adolescent contraceptive use. These results suggest that although PBF can be an effective approach for improving the supply of family planning services, complementary demand-side interventions are likely needed in a setting with very low baseline utilization.

Is Spending More Time Outdoors Able to Prevent and Control Myopia in Children and Adolescents? A Meta-Analysis

INTRODUCTION

Spending more time outdoors was treated as a safe and cost-effective method to prevent and control myopia. While prior research has established an inverse association between outdoor time and the risk of myopia onset, the effect of increasing outdoor time in delaying the progression of myopia remains a subject of debate. The present meta-analysis aimed to assess the relationship between outdoor time and the myopia onset, and further examine whether there is a dose-response relationship between outdoor time and the risk of myopia onset. Meanwhile, perform whether the outdoor time is related to delaying the progression of myopia.

METHODS

Studies were retrieved from PubMed, Web of Science, Embase, Medline, and the Cochrane Database, spanning from their inception to February 2023. Three cohort studies and 5 prospective intervention studies were included, with a total of 12,922 participants aged 6-16 years.

RESULTS

Comparing the highest with the lowest exposure levels of time spent outdoors, the highest outdoor time was strongly associated with a reduced risk of myopia onset (odds ratio [OR]: 0.53; 95% confidence interval [CI]: 0.34, 0.82). A nonlinear dose-response relationship was found between outdoor time and myopia onset risk. Compared to 3.5 h of outdoor time per week, an increase to 7, 16.3, and 27 h per week corresponded with a respective reduction in the risk of myopia onset by 20%, 53%, and 69%. Among children and adolescents who were not myopic, spending more time outdoors significantly slowed down the speed of change in spherical equivalent refractive (weighted mean difference [WMD] = 0.10D, 95% CI: 0.07, 0.14) and axial length (WMD = -0.05 mm, 95% CI: -0.06, -0.03). Among children and adolescents who were already myopic, spending more time outdoors did not slow myopia progression.

CONCLUSIONS

Overall, spending more time outdoors can prevent the onset of myopia, but it does not seem to slow its progression. Further studies are needed to better understand these trends.

Multi-country case study on school health policy and its implementation in relation to COVID-19 control in Micronesia Small Islands Developing States

INTRODUCTION

The COVID-19 pandemic caused school closures and rises in mental illness and non-communicable disease among school children worldwide. The Pacific Small Islands Developing States (SIDS) were also affected, but school health activities, which can effectively reduce negative effects of COVID-19, were not widely implemented compared to other Asia-Pacific countries. This study examined current school health implementation and related policies at national, local, and school levels in the Micronesia SIDS according to phases of COVID-19 control.

METHODS

Multi-country case study targeted the Federated States of Micronesia (FSM), Republic of the Marshall Islands (RMI), and Republic of Palau (ROP). These studies focused on school health implementation periods according to the PPR (Prevention, Preparedness, and Response) concept: Phase #1: prevention/preparedness, #2: early phase response, and #3: chronic phase response/recovery phase. Data were collected through policy document reviews that identified school health policies related to COVID-19 controls in the three phases and key informant interviews (KIIs) with 44 key informants (FSM, n = 14; RMI, n = 18; ROP, n = 12) whose work related to school health. The collected data were analyzed using content analysis methods according to the conceptual framework in this study.

RESULTS

This study identified three factors of school health implementation related to COVID-19 controls: promotion of decentralized education (FSM), implementation of COVID-19 controls in the school community (RMI), and disaster management for the protection of students including response to infectious disease (ROP). In Phase #1, no country had established a school health policy. In Phase #2, three enablers were identified in FSM and ROP, as reflected in COVID-19 controls by the education and health sectors. In Phase #3, RMI implemented COVID-19 controls in the school community. Documents on youth policy and disaster management in ROP were updated to reflect the chronic phase response and response to future public health crises.

CONCLUSIONS

A decentralized education was instrumental in immediately implementing COVID-19 control measures in schools at national and local levels for coordination between education and health sectors. Despite each county's multi-sectoral approach to engage COVID-19 controls in schools, local government organization requires strengthening and implementation of the formulated school health policy. In preparation for the next public health crisis, school health should be promoted that is integrated into both infection control and disaster management.

Analysis of the nutritional composition and organization of school meals in the province of Kadiogo in Burkina Faso: challenges and prospects

Background

In the face of food shortages and precariousness, school meals are an effective means of encouraging pupils to attend and stay in school, and of combating nutritional deficiencies. Unfortunately, there are bottlenecks to be identified and resolved.

Objective

Analyzing the composition of meals served to school-age children in primary schools in the province of Kadiogo, while assessing the opinion of school staff on these meals (Burkina Faso).

Methods

A descriptive cross-sectional survey about school meals was carried out during the period from April to May 2019 among school stakeholders in primary schools in five (05) municipalities of the province of Kadiogo.

Results

Insufficient quantity and quality of rations served were recorded in primary schools. The endogenous initiative canteens represented 46.4% of the registered canteens. The promotion of Health-Hygiene-Nutrition (H-H-N) activities in schools encountered difficulties in covering the sanitary needs of school-aged children because unavailability of socio-sanitary infrastructures. School meals consisted of starchy foods and legumes in rural schools and more diversified meals consisting of fruits and vegetables as well as meat and fish in urban schools. In rural municipalities, school meals were insufficient in quantity and quality, while in the urban municipality, macronutrient intakes were in excess with micronutrient intakes largely deficient.

Conclusion

Despite the shortcomings, school officials specified that school meals cover lunch rations, increase school enrolment, and improve school-aged children' learning capacity.

Impact of the Japanese Government's 'General Principles of Suicide Prevention Policy' on youth suicide from 2007 to 2022

BACKGROUND

The Japanese Government programme 'General Principles of Suicide Prevention Policy' (GPSPP) contributed to decreasing suicide mortality rates (SMRs) before the COVID-19 pandemic, but they increased after the pandemic.

AIMS

To identify risk factors for youth suicide and the impact of GPSPP on youth suicide.

METHOD

Annual suicide numbers during 2007-2022 were obtained from government databases. SMRs of student and non-student youths were analysed with a linear mixed-effects model. Interrupted time-series analysis was conducted to investigate temporal relations between three GPSPP periods and SMRs with 52 suicide motives among high school, special vocational school and university students. Multiple regression analysis was conducted to investigate the influence of grade repetition on university student SMRs.

RESULTS

Non-student youth SMRs were higher than student SMRs. School-related (worrying about the future/underachievement), health-related (mainly mental illness) and family-related (conflict with parent and severe verbal reprimands) motives were major motives for student SMRs. During the first GPSPP period (2007-2012), no student SMRs decreased. During the second period (2012-2017), university and special vocational school student SMRs increased, but high school student SMRs were unchanged. In contrast, during the third period (2017-2022), with the exception of male special vocational school students, all SMRs increased. Unexpectedly, long-term grade repetition was negatively associated with health-related SMRs.

CONCLUSIONS

These findings suggest that GPSPP-supported programmes in schools partially contributed to student suicide prevention. To suppress increasing student SMRs, social/life support specialists should participate in in-school support services to bolster the social standing and lives of students who repeat grades or experience setbacks.

Effectiveness of an educational intervention to promote psychosocial well-being of school-going adolescents in Sri Lanka

BACKGROUND

One-fifth of the Sri Lankan population consists of adolescents, with 71% of them schooling. An extreme need exists in the country for the introduction of evidence-based interventions for the psychosocial well-being of adolescents. The present study assessed the effectiveness of an educational intervention to promote the psychosocial well-being of school-going adolescents in grade nine in Western Province, Sri Lanka.

MATERIALS AND METHODS

A quasi-experimental study was conducted among grade nine students in Western Province in 2019. Panadura Medical Officer of Health (MOH) area was selected as the interventional area (IA), and Kelaniya MOH area was identified as the control area (CA). Teachers at schools in the IA received training on psychosocial health promotion of adolescents. They delivered the activity-based educational intervention package to the grade nine students as 20-min classroom sessions for three months. Pre- and post-intervention assessments of attitudes and practices related to the psychosocial well-being of adolescents were conducted using an interviewer-administered questionnaire. Categorical data were compared using Chi-Square or Fisher's exact test. Mann-Whitney U test was applied to determine the difference between the medians of the pre-and post-intervention scores on attitude and practices for psychosocial well-being.

RESULTS

A total of 1040 grade nine students were enrolled. There was a statistically significant increase in median score on attitudes [81.8 (IQR:75.5-85.5) to 82.3(IQR:78.6-87.2] and practices [81.7(IQR: 76.1-85.7) to 83.1(IQR: 79.1-86.9)] in the IA while there was no significant difference in the CA. The proportion of bullied adolescents in the past 30 days reduced significantly from 14.8% (n = 38) to 7.9% (n = 20) in IA(p = .03), whereas there was a slight reduction from 17.1% (n = 44) to 11.3% (n = 26) in CA (p = .17).

CONCLUSIONS

The present psychosocial intervention is effective in improving the psychosocial well-being of school adolescents, though long-term effectiveness was not assessed. It is recommended to utilise study findings in deciding to introduce the present intervention to basic and in-service teacher training packages and school curricula with necessary modifications.

Effectiveness of school-based nutrition interventions promoted in the League of Arab States: a systematic review

Arab countries are doubly burdened with undernutrition as well as overweight and obesity. To provide guidance to those looking to address concerns of obesity and overweight among children in this region, the current review bridges an existing knowledge gap and systematically characterizes and evaluates the available scientific evidence pertaining to school-based nutrition interventions completed to date across the Arab world. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and relevant keywords, terms and phrases, a search of the literature across 14 databases for school-based nutrition interventions implemented in this region was conducted. Out of 1568 articles from 14 databases, 38 full-text articles meeting the inclusion criteria were retrieved. Further assessment for eligibility excluded 23 articles and included one article from hand-searching references, leaving 16 articles in the final analysis. Most articles (n = 7) with the implementation of 5 months or longer found strong positive and significant impacts on limiting sweets consumption, increased dietary knowledge, self-efficacy, breakfast and fruit and vegetable consumption, among others. We also found evidence (n = 5) that teachers trained by experts such as dietitians and pediatricians can effectively implement nutrition interventions that achieve the intended outcomes. Training teachers to implement theory-based nutrition and health promotion curricula serves as a potential solution to improving nutrition knowledge, health behaviors and dietary practices among children living in Arab countries. Appropriately designed and implemented nutrition interventions can positively impact nutrition knowledge, health and diet-related behaviors in children and adolescents in this region.

Effectiveness of Life Skills Intervention on Depression, Anxiety and Stress among Children and Adolescents: A Systematic Review

Children and adolescents are at a significantly high risk of mental health problems during their lifetime, among which are depression and anxiety, which are the most common. Life skills education is one of the intervention programmes designed to improve mental well-being and strengthen their ability to cope with the daily stresses of life. This review aimed to identify and evaluate the effect of life skills intervention on the reduction of depression, anxiety and stress among children and adolescents. Following the Population, Intervention, Comparison and Outcome (PICO) model and the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2009 checklist, eight databases (Academic Search Complete, CINAHL, Cochrane, MEDLINE, Psychology and Behavioural Sciences Collection, PubMed, Scopus and Web of Science) were systematically reviewed from 2012 to 2020. The search was limited to English papers only. It included published experimental and quasi-experimental studies addressing the effect of life skills interventions on the reduction of at least one of the following mental health disorders: depression, anxiety and stress among children and adolescents (from the age of 5 years old to 18 years old). We used the Joanna Briggs Institute checklist for experimental and quasi-experimental studies to evaluate the quality of the included studies. This study was registered in PROSPERO [CRD42021256603]. The search identified only 10 studies (three experimental and seven quasi-experimental) from 2,160 articles. The number of the participants was 6,714 aged between 10 years old and 19 years old. Three studies in this review focused on depression and anxiety, whereas one study investigated depression and the other anxiety. Three studies targeted only stress and two examined the three outcomes, namely, depression, anxiety and stress. Almost in all studies, the life skills intervention positively impacted mental disorders, considering the differences among males and females. The overall methodological quality of the findings was deemed to be moderate to high. Our results clearly indicated the advantages of life skills programmes among adolescents in different settings and contexts. Nonetheless, the results highlight some important policy implications by emphasising the crucial roles of developers and policymakers in the implementation of appropriate modules and activities. Further research examining life skills intervention with a cultural, gender perspective, age-appropriate and long-term effect is recommended.

Correlates of condom use among male university students from eastern China who engage in casual sex

Consistent condom use with casual partners is critical for preventing the transmission of human immunodeficiency virus (HIV) among male university students. This study aimed to determine the level of consistent condom use and explore the correlates of condom use consistency in male university students in eastern China. A descriptive cross-sectional survey was conducted in 13 universities in Zhejiang Province, which involved the recruitment of 31,674 students by stratified random sampling. Among them, 545 male students who engaged in casual sex in the year prior to this study were included. Adjusted and unadjusted logistic regression models were used to examine the correlates associated with consistent condom use. Among the 545 male university students, only 205 (37.6%) consistently used condoms in the previous year. The following correlates were associated with higher rates of consistent condom use: 1) Knowledge, specifically, the number of correct answers to "HIV infection can be determined by appearance" (AOR: 2.06, 95% CI: 1.21-3.49); 2) never finding casual partners on the internet during the past over the prior year (AOR: 0.63; 95% CI: 0.40-0.99); 3) never drinking alcohol before casual sex during the last over the prior year (AOR: 0.30; 95% CI: 0.20-0.46); 4) never engaging in commercial sex (AOR: 0.57; 95% CI: 0.34-0.96); and 5) high condom self-efficacy score (AOR: 2.55; 95% CI: 1.44-4.49). The study found a low level of consistent condom use among male university students. Promoting condom self-efficacy, reducing web-based casual sex, drinking before sex, and commercial sex are essential to improving the level of consistent condom use among male university students to reduce the transmission of HIV.

Increasing urban health awareness in adolescents using an interactive approach: evidence from a school-based pre-post pilot study in Rome, Italy

BACKGROUND

Cities contribute to and are affected by the climate crisis, determining significant health issues in urban settings. Educational institutions have a privileged position to contribute to achieving the transformations needed for a healthier future, so Urban Health education is fundamental to empowering the health of the youth living in cities. This study aims to measure and raise the awareness of Urban Health among students attending a high school in Rome (Italy).

METHODS

An interactive educational intervention, consisting of four sessions, was conducted in a Roman high school during spring 2022. Overall, 319 students aged between 13 and 18 attended the sessions and were asked to complete a 11-items questionnaire before and another after the interventions. Data was gathered anonymously and analyzed using descriptive and inferential statistics.

RESULTS

Fifty-eight percent of respondents improved their post-intervention questionnaire score, while 15% did not improve and 27% got worse. The mean score significantly improved after the intervention (p < 0.001; Cohen's d = 0.39).

CONCLUSIONS

The results suggest that school-based interventions using interactive approaches on Urban Health could be effective in increasing students' awareness and promoting health especially in urban settings.

Investigating the health status of primary school children in Tonga: Lessons learnt and reflections on field work in the Pacific Islands

Globally, the child health focus has been on reducing under-5-year mortality, with large populations in low-resource regions prioritised. Children in older age groups, particularly in less populated regions such as the Pacific, have received limited attention. Child health research in the Pacific region has been lacking, and research approaches for the region have historically been from Western biomedical paradigms. We completed the study of primary school children's health over a period of 5 years. Firstly, we conducted a literature review, then we completed an audit of hospital admissions of primary school children, then we completed a two-round Delphi process and finally, we piloted the survey in three primary schools. Our results found there were high levels of oral health problems, ear health, obesity and exposure to violence and poverty impacting on the quality of health of primary school-age children. Identifying these indicators was made possible by the partnerships and trust established by the study team and provides specific and measurable targets for future work to improve the quality of child health outcomes. This paper describes key field work lessons learnt for research in the Pacific region. It must: (i) be on the platform of relationship, cultural safety and local ownership; (ii) include consideration of holistic Pacific paradigms of health; (iii) be adaptive to the context and environment; and (iv) be committed to long-term partnership and work.

Content analysis of health-related subjects in the K12 school curricula of Japan, Indonesia, Philippines, Guam, Micronesia, Marshall Islands, Palau, and Fiji

BACKGROUND

As a component of health promoting school, a school curriculum for health education was considered a fundamental. This survey aimed to identify the components of health-related topics and in which subjects were they taught.

METHODS

Four topics were chosen: (i) hygiene, (ii) mental health, (iii) nutrition-oral Health, and (iv) environmental education related to global warming in Education for Sustainable Development (ESD). Before gathering the curricula from partner countries, school health specialists were gathered to discuss the appropriate components of a curriculum that required evaluation. The survey sheet was distributed to and answered by our partner in each country.

RESULTS

About hygiene, individual practices or items that improve health-related were widely covered. However, items that imparted health-related education from an environmental perspective were not widely covered. About mental health, two types of country groups were identified. The first group included countries that taught mental health topics mainly as part of morals or religion; the second group included countries that imparted mental health topics mainly as part of health. The first group focused mainly on communication skills or coping methods. The second group focused not only on communication and coping skill but also on basic knowledge of mental health. About nutrition-oral education, three types of country groups were identified. One group imparted nutrition-oral education mainly in terms of health or nutrition. Another group imparted this topic mainly in terms of morals, home economics, and social science. The third group was the intermediate group. About ESD, a solid structure for this topic was not identified in any country. Many items were taught as part of science, while some were taught as part of social studies. Climate change was the most commonly taught item across all countries. The items related to environment were relatively limited compared to those related to natural disasters.

CONCLUSIONS

Overall, two different approaches were identified: the cultural-based approach, which promotes healthy behaviors as moral codes or community-friendly behaviors and the science-based approach, which promotes children's health through scientific perspectives. Policymakers should initially  consider the findings of this study while making decisions on which approach should be taken.

Teachers' conflicts in implementing comprehensive sexuality education: a qualitative systematic review and meta-synthesis

INTRODUCTION

Comprehensive sexuality education (CSE) enables children and young people to learn about the cognitive, emotional, physical, and social characteristics of sexuality. Teachers experience conflicts in teaching CSE due to different cultural and religious backgrounds. This qualitative systematic review aimed to describe the conflicts experienced by teachers in the implementation of CSE in schools. Furthermore, this study aimed to identify the causes of conflict among teachers in implementing CSE.

METHODS

This article focused on teachers' conflicts in implementing CSE from 2010 to 2022. Online bibliographic databases, such as PubMed, Web of Science, and ERIC, were used to search for relevant articles. The following search term was used: Teacher, Comprehensive Sexuality Education, and Conflict.

RESULTS

A total of 11 studies were included in the review. All 11 studies were conducted in countries with a predominantly Christian population. The majority of the studies were conducted in Africa. The study respondents included teachers, school principals, and school coordinators. The studies identified that CSE implementation is related to multiple conflicts, depending on the context of the country. Five themes on the causes of conflict emerged from the thematic meta-synthesis: (1) Hesitancy in talking about sex education among teachers due to the cultural and religious context; (2) non-integration of traditional sex education into comprehensive sexuality education, (3) fostering effective facilitation of CSE among teachers, (4) determining the appropriate age to start sex education, and (5) roles of stakeholders outside the school.

CONCLUSIONS

This qualitative systematic review and thematic meta-synthesis highlighted several conflicts among teachers in CSE implementation. Despite the teachers having a perception that sex education should be provided, traditional sex education has not yet transformed to CSE. The study findings also emphasize the need to identify the teacher's role in CSE implementation. The thematic meta-synthesis also strongly reflected the context of Christianity in Europe and Africa; thus, further research on the religious context in other regions is needed.

The associations between social environment and adolescents’ psychosomatic health: An ecological perspective

Objectives

It has been known that social environments are associated with adolescents’ health. However, the complex relationship between diverse types of social environments and adolescents’ psychosomatic heath remained unclear. Thus, using an ecological perspective, the current study aimed to examine the associations between social environment and adolescents’ psychosomatic health.

Methods

We used the data from the Health Behavior in School-aged Children (HBSC) project conducted in the Czech Republic in 2018. A total of 13377 observations were included.

Results

The region, as a macrosystem, could not explain the variance in adolescents’ psychological and somatic health. The quality of neighborhood environment (exosystem) was significantly related to adolescents’ psychological and somatic health. At the microsystem level, teacher support had stronger, family support had weaker, and peer support had no association with psychological and somatic health. At the mesosystem level, the interactions between family, teacher, and friend support were negligible for adolescents’ psychological and somatic health.

Conclusions

The results underscore the importance of teachers’ support and neighborhood environment for adolescents’ psychosomatic health. Therefore, the findings suggest the need to improve teacher-adolescent relationships and the neighborhood community quality.

Toward the upscaling of school nutrition programs in Dubai: An exploratory study

Background

School nutrition programs impact the intellectual, social, and emotional development of school children, as well as their future risk of developing Non-Communicable Diseases. While many stakeholders are involved in the development, implementation, and evaluation of school nutrition programs in Dubai, United Arab Emirates, little is known about the complementarity among those stakeholders, and the means to upscale school nutrition programs while ensuring effective, efficient, and equitable implementation. Accordingly, this study aims at exploring the perceptions of a diverse group of stakeholders, positioned at differing levels of the public health and education ecosystems in the United Arab Emirates, in relation to current guidelines and practices around the planning, implementation, and evaluation of school nutrition programs in Dubai, United Arab Emirates.

Methods

The current study relied on a qualitative design, based on semi-structured key informant interviews. A total of 29 interviews were carried out. Those interviewees included leaders and directors from different institutions, decision- and policy- makers, nutritionists and dieticians, school nurses and nurse managers, and school principals and vice principals. All stakeholders were interviewed by the research team. Data was transcribed, and then thematically analyzed using the health systems' model as an analytic framework.

Results

The thematic analysis of interview data identified five interrelated themes. The first theme relates to the limited coordination across regulatory local and federal entities, and the multiplicity of guidelines issued by the different stakeholders. The challenges around the human and financial resourcing of school nutrition programs constituted the second theme. The third theme was the weakly coordinated implementation efforts. The fourth theme was the need for better performance measurement, and the fifth theme flagged the need for improved inclusiveness for health needs and cultural preferences of the diverse student body in Dubai (given that there are citizens from more than 200 nationalities co-existing in Dubai).

Conclusion

This study emphasizes that all the involved stakeholders need to better collaborate to upscale the school nutrition program in Dubai. This will require the formation of a unified governing body, which would identify and develop a single stream of resources, and sets in place a reliable, all encapsulating and equitable implementation plan along with an overarching monitoring and evaluation framework.

Can Students Learn from Their Co-Students About Tuberculosis? Outcomes from Student-Friendly Quasi-Experimental Intervention Study in India

Background

The World Health Organization's "End TB Strategy" aims to end global tuberculosis (TB) epidemic through a holistic combination of health and social interventions placing the patients and communities at the heart of the response. This study aimed to assess the effectiveness of utilizing school children as ambassadors in TB advocacy.

Materials and Methods

We adopted a quasi-experimental intervention design where students' awareness level was assessed before and after the intervention. A total of 185 student ambassadors were trained to conduct interventions in schools, and 920 students were randomly selected to assess the impact of the ambassador's intervention. A structured questionnaire was used to assess the correct and incorrect knowledge on specific aspects of TB. This intervention study was implemented in a phased manner which involved a participatory formative phase. A student-friendly and culturally relevant educational materials and activities for providing TB knowledge for the study student population were developed. Data collected from the baseline and end-line evaluation surveys were analyzed using STAT Ver. 16.0.- Stata Corp., June 2016, USA.

Results

A significant increase (>80%; P < 0.05) in the correct knowledge on diagnosis and prevention for TB was noted among sampled students (n = 818) before and after intervention. Reduction in incorrect knowledge, like understanding TB as hereditary disease, was found to be less (50%; P < 0.05).

Conclusions

School students lead intervention could significantly improve correct knowledge on TB and could be replicated.

Adolescent Health Promotion Interventions Using Well-Care Visits and a Smartphone Cognitive Behavioral Therapy App: Randomized Controlled Trial

Background

Adolescent health promotion is important in preventing risk behaviors and improving mental health. Health promotion during adolescence has been shown to contribute to the prevention of late onset of the mental health disease. However, scalable interventions have not been established yet.

Objective

This study was designed to test the efficacy of two adolescent health promotion interventions: a well-care visit (WCV) with a risk assessment interview and counseling and self-monitoring with a smartphone cognitive behavioral therapy (CBT) app. Our hypothesis was that participants who had received both WCV and the CBT app would have better outcomes than those who had received only WCV or those who had not received any intervention. We conducted a prospective multi-institutional randomized controlled trial.

Methods

Participants were 217 adolescents aged 13-18 years. They were randomly divided into two intervention groups (WCV group and WCV with CBT app group) and a nonintervention group. WCV comprised a standardized physical examination along with a structured interview and counseling for youth risk assessment, which was designed with reference to the Guideline for Health Supervision of Adolescents of Bright Futures. A smartphone-based CBT program was developed based on the CBT approach. The CBT app comprised a 1-week psychoeducation component and a 1-week self-monitoring component. During the CBT program, participants created several self-monitoring sheets based on the CBT model with five window panels: event, thoughts, feelings, body response, and actions. The primary outcome was the change in scores for depressive symptoms. Secondary outcomes included changes in scores for self-esteem, quality of life, self-monitoring, and an adolescent health promotion scale. These outcomes were evaluated at baseline and at 1, 2, and 4 months after baseline. The exploratory outcome was the presence of suicidal ideation during the observation period. Intervention effects were estimated using mixed effect models.

Results

In total, 94% (204/217) of the participants completed the 4-month evaluation. Both intervention groups showed a significant effect in the form of reduced scores for depressive symptoms at 1 month in high school students; however, these effects were not observed at 2 and 4 months. The intervention effect was significantly more predominant in those scoring above cutoff for depressive symptoms. There was significantly less suicidal ideation in the intervention groups. As for secondary outcomes, there was significant increase in health promotion scale scores at the 4-month follow-up among junior high school students in the WCV group. Moreover, the CBT app was significantly effective in terms of obtaining self-monitoring skills and reducing depressive symptoms.

Conclusions

Although adolescent health promotion interventions may have short-term benefits, the frequency of WCV and further revision of the CBT app should be considered to evaluate long-term effectiveness.

Trial Registration

University Hospital Medical Information Network Clinical Trials Registry UMIN 000036343; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000041246

Surviving versus thriving: The wellbeing of primary school aged children in Tonga

AIM

To enable improvements in global child health, the focus must move beyond child survival to child wellbeing. In the Pacific Islands, the wellbeing of children has received little attention. This study aimed to investigate the wellbeing of children from three primary schools in Tonga.

METHODS

A cross-sectional survey was completed in three primary schools in Nuku'alofa with children aged 5-15 years. The study participants (256 children, 143 caregivers) completed the Child Health and Illness Profile - Child Edition, CHIP-CE (Version 1.0).

RESULTS

On average, >70% of children and caregivers described home and school environments as positive. From the children's reports, boys had significantly lower scores for risk avoidance than girls (3.40 vs. 3.73, P < 0.001). Children aged 5-7 versus 8-15 years had significantly lower scores for satisfaction (3.63 vs. 3.92, P = 0.002), resilience (3.34 vs. 3.56, P = 0.016) and achievement (3.25 vs. 3.62, P = 0.002). From the caregivers' report, girls had significantly lower scores for academic performance than boys (3.60 vs. 3.81, P = 0.04). Boys had significantly lower scores for individual risk association compared to girls (3.93 vs. 4.29, P = 0.01). Overall CHIP-CE scores were lower than those of comparable populations in the West, while at the same time protective factors were documented.

CONCLUSIONS

Understanding child wellbeing in the Pacific is critical for strengthening protective factors known to mitigate poor child health outcomes. Continuing to base global child health success on child survival alone misses opportunities for improving the wellbeing of nations.

The 'big four' health risk behaviors among Vietnamese adolescents: co-occurrence and socio-cultural risk factors

Background

Health Risk Behaviors (HRBs) represent significant health threats for adolescents. However, there has been relatively little research on multiple HRBs in low-and-middle-income countries (LMIC), where the majority of the world’s youth reside. This study’s objective was to investigate common HRB, their co-occurrence, and socio-demographic risk and protective factors among Vietnamese adolescents.

Methods

A cross-sectional self-report survey examined four major HRBs (tobacco use, alcohol consumption, physical inactivity, unhealthy diet) among 431 adolescents aged 15–17 years in five Vietnam provinces. Key HRB risk and protective factors assessed included perceived social norms, parental monitoring of adolescents’ behavior, and health behavior literacy.

Results

Forty-one percent of participants reported no HRB, 39% reported one, and 20% reported two or more HRBs. The four HRBs appeared to be independent, with an exploratory factor analysis indicating no common factors. The most prevalent HRB was unhealthy diet (45%), the least prevalent smoking (1%). The most frequent co-occurring HRBs were unhealthy diet and physical inactivity. Adolescents’ perceptions of norms regarding HRBs and related healthy behaviors were the most consistent risk factor for the HRB. Diet was the HRB most influenced by the social variables perceived norms, monitoring, and health literacy.

Conclusions

Results highlight the importance of future research identifying the temporal order of co-occurrence of multiple HRB, how differing conceptualizations of socio-cultural roles impact on HRB, and health-related effects of HRB co-occurrence. Such information will be useful for maximizing the efficiency and effectiveness of prevention and intervention programs in LMIC.

Effectiveness of a neuroscience-based, harm reduction program for older adolescents: A cluster randomised controlled trial of the Illicit Project

The prevention of risky adolescent substance use is critical. Limited age-appropriate, school-based programs target adolescents aged 16-19 years, despite this representing the age of initiation and escalation of substance use. The Illicit Project is a neuroscience-based, harm reduction program targeting late adolescents, designed to address this gap. The current study aims to evaluate the program's effectiveness in reducing risky substance use and related harms among late adolescents. A cluster randomised controlled trial was conducted involving 950 students (Mage = 15.9 years SD = 0.68; 60% Female) from eight secondary schools in Australia. Five schools received The Illicit Project program, and three schools were randomised into the active control group (health education as usual). All students completed a self-report survey at baseline and 6-months post-baseline and intervention students completed a program evaluation survey. Outcomes include alcohol and substance use, alcohol related harms and drug literacy levels (knowledge and skills). At 6-months post baseline, individuals in the intervention group were less likely to engage in weekly binge drinking (OR = 0.56), high monthly alcohol consumption (OR = 0.56), early onset cannabis use (OR = 0.35), risky single occasion cannabis use (OR = 0.48), MDMA use (OR = 0.16) or nicotine product use (OR = 0.59) compared to the control group. Students in the intervention group were less likely to have experience alcohol related harms (OR = 0.57) and more likely to have higher drug literacy scores (β = 2.44) at follow-up. These preliminary results support the effectiveness of The Illicit Project. Further follow-up is required to determine the durability of the results over time.

Status of school health programs in Asia: National policy and implementation

BACKGROUND

The WHO's Health Promoting Schools (HPS) framework is based on an understanding of the reciprocal relationship between health and education, and the need to take a holistic approach to health promotion in schools. We aim to clarify the degree to which the HPS framework is reflected in the national policies of eight target countries and the issues surrounding its successful implementation.

METHODS

Date were collected through two expert workshops with participants from eight Asian countries: Cambodia, China, Japan, Korea, Lao PDR, Nepal, the Philippines, and Thailand. In the first workshop, data collected on national policy were mapped against the HPS framework. From this, key issues were identified, and follow-up data collection was conducted in each country for a second workshop.

RESULTS

We identified a policy shift toward the HPS framework in six out of the eight countries. Neither Japan nor Korea had changed their national policy frameworks to reflect an HPS approach; however, in the latter, model programs had been introduced at a local level. We identified various barriers to successful implementation, especially in relation to mental health and wellbeing.

CONCLUSION

Given the recent shift toward the HPS approach in six out of the eight countries in this study, there is a need to conduct research to assess the impact of this framework on the health and wellbeing of students and school staff. At the same time, we call for more dialog in the context of Japan to explore the possible benefits of introducing the HPS framework into schools.

Development of a Web-Based School Support System Within the AVATAR Project for Psychosocial Well-being in Adolescents: Pilot Feasibility Study

BACKGROUND

Health and well-being promotions are key points of educational programs for adolescents within schools. There are several health education programs mainly based on lifestyle habit changes; however, social and emotional dimensions should be considered within these educational strategies.

OBJECTIVE

This study aimed to (1) develop a new web-based school support system to assess and analyze individual, classroom, and scholastic institute data on lifestyle habits, social context, emotional status, and scholastic performance; (2) create a web tool for managing the well-being of adolescents through a dynamic and personalized interface that provides immediate feedback that allows the school to monitor progress; and (3) evaluate, in a pilot study, the feasibility of this web-based school support system in order to build health programs that are specific to the needs of the studied population.

METHODS

The AVATAR (a new purpose for the promotion and evaluation of health and well-being among healthy teenagers) method consists of integrating the information coming from different questionnaires. In particular, to allow planning didactic and educational actions based on the results obtained, the AVATAR approach allows subdivision of the results of the different observed variables and the 4 components into the following 3 percentile categories: modify, improve, and maintain. The AVATAR web platform was designed to collect data on lifestyle, emotional status, and social context from junior high schools in terms of the fundamental aspects of adolescent daily life, with free use by the scholastic community (scholars, teachers, and parents). In this pilot/feasibility study, data from 331 students were acquired between 2018 and 2019 at the beginning of the scholastic year (pre) and at the end following the school-based program (post).

RESULTS

Preliminary results showed that after school planning and specific program implementation, defined after AVATAR feedback, students reported better well-being perception characterized by higher perception in psychological well-being (P=.001), mood (P=.001), self-perception (P=.006), and autonomy (P=.001), and an increase in the perception of financial resources (P=.001), which helped in developing healthy lifestyle habits (P=.007). In the social context assessment, students reported stronger relationships with family (P=.02) and peers (P=.001), and a lower perception of bullying (P=.001).

CONCLUSIONS

The AVATAR web-based platform is a feasible and flexible tool for the health and well-being management of adolescents from epidemiological, preventive, and educational points of view. In particular, it can be used to (1) promote information campaigns aimed at modifying risk behaviors in the student population, (2) sensitize students and put them at the center of their growth path, (3) inform institutions about the health and well-being of the school population, (4) ensure health programs are acceptable and feasible to users before launching on a large scale, and (5) improve the relationship of users (school) and educational agencies with research groups.

Predictors of mental health worsening among children and adolescents during the coronavirus disease 2019 pandemic

PURPOSE OF REVIEW

Restrictions put in place to contain the spread of coronavirus disease 2019 (COVID-19) have significantly affected the lives of children and adolescents worldwide. School closure, home confinement and social distancing have the potential to negatively impact the mental health of this population. Several risk factors seem to contribute to worsening mental health of children and adolescents, with an increase of anxiety and depression symptoms. This review aims at exploring research available on risk factors that may worsen the mental health among children and adolescents during the pandemic.

RECENT FINDINGS

Some of these predictors in worsening the effects are social isolation, screen time and excessive social media use, parental stress and poor parent-child relationship, low socioeconomic status, preexisting mental health conditions and/or disabilities.

SUMMARY

Further research is needed in order to understand mental health effects of the COVID-19 pandemic, as well as risk factors associated with negative consequences. New findings will help in targeting evidence-based interventions to prevent and mitigate the negative effects of COVID-19 on the mental health of children and adolescents.

School-based interventions targeting double burden of malnutrition and educational outcomes of adolescents in low- and middle-income countries: protocol for a systematic review

BACKGROUND

Adolescence is a period of rapid physical growth and transition between childhood to adulthood. However, in many developing countries, nutritional and epidemiological transitions are contributing to surging overnutrition, which, together with prevalent undernutrition, is resulting in the double burden of malnutrition (DBM) among adolescents. Schools as social systems have tremendous but mostly underutilized capacity to facilitate change and address a range of nutritional and associated educational concerns of adolescents and young people. The main objective of this systematic review will be to describe school-based interventions that address the multiple forms of malnutrition, and synthesize their effects on nutrition and educational outcomes among adolescents (10 - 19 - years - old) from low- and middle-income countries (LMICs).

METHODS

Comprehensive literature searches will be conducted in multiple electronic databases, including Medline (through PubMed), Embase, CENTRAL (through Cochrane Library), CINAHL, and Google Scholar. We will include randomized controlled trials (RCTs), non-RCTs including controlled before-after studies, examining the effects of nutrition interventions on nutrition and educational outcomes among adolescents in LMICs. Two reviewers will independently screen all citations and full-text articles and abstract data. The quality of the included studies will be assessed with the Cochrane Collaboration's revised tool for assessing the risk of bias for RCTs and the Risk Of Bias In Non-randomized Studies of Interventions tool for controlled before-after studies and non-randomized controlled trials.

DISCUSSION

To maximize the power of schools as a platform to reinforce the mutually beneficial relationship between adolescent nutrition and education, it is imperative to develop and implement integrated interventions connecting schools, adolescents, parents, communities, and the health care system. The results of this systematic review may provide a comprehensive state of current knowledge on the effectiveness of school-based interventions to enable future research that maximizes the impact and efficiency of integrated approaches to tackle multiple forms of malnutrition among school-going and out-of-school adolescents.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO ID: CRD42020211109.

A systematic review of school health policy measurement tools: implementation determinants and outcomes

BACKGROUND

Governments in some countries or states/provinces mandate school-based policies intended to improve the health and well-being of primary and secondary students and in some cases the health of school staff. Examples include mandating a minimum time spent per week in programmed physical activity, mandating provision of healthy foods and limiting fat content of school meals, and banning tobacco products or use on school campuses. Although school health researchers have studied whether schools, districts, or states/provinces are meeting requirements, it is unclear to what extent implementation processes and determinants are assessed. The purposes of the present systematic review of quantitative measures of school policy implementation were to (1) identify quantitative school health policy measurement tools developed to measure implementation at the school, district, or state/provincial levels; (2) describe the policy implementation outcomes and determinants assessed and identify the trends in measurement; and (3) assess pragmatic and psychometric properties of identified implementation measures to understand their quality and suitability for broader application.

METHODS

Peer-reviewed journal articles published 1995-2020 were included if they (1) had multiple-item quantitative measures of school policy implementation and (2) addressed overall wellness, tobacco, physical activity, nutrition, obesity prevention, or mental health/bullying/social-emotional learning. The final sample comprised 86 measurement tools from 67 peer-review articles. We extracted study characteristics, such as psychometric and pragmatic measure properties, from included articles based on three frameworks: (1) Implementation Outcomes Framework, (2) Consolidated Framework for Implementation Research, and (3) Policy Implementation Determinants Framework.

RESULTS

Most implementation tools were developed to measure overall wellness policies which combined multiple policy topics (n = 35, 40%) and were in survey form (n = 75, 87%). Fidelity was the most frequently prevalent implementation outcome (n = 70, 81%), followed by adoption (n = 32, 81%). The implementation determinants most assessed were readiness for implementation, including resources (n = 43, 50%), leadership (n = 42, 49%), and policy communication (n = 41, 48%). Overall, measures were low-cost and had easy readability. However, lengthy tools and lack of reported validity/reliability data indicate low transferability.

CONCLUSIONS

Implementation science can contribute to more complete and rigorous assessment of school health policy implementation processes, which can improve implementation strategies and ultimately the intended health benefits. Several high-quality measures of implementation determinants and implementation outcomes can be applied to school health policy implementation assessment. Dissemination and implementation science researchers can also benefit from measurement experiences of school health researchers.

Injury Prevention, Safety Education and Violence in Relation to the Risk of Tooth Fracture among Korean Adolescents

This study aimed to determine the injury prevention-, safety education-, and violence-related factors pertaining to tooth fracture experience (TFE) in Korean adolescents. We used data from the 14th Korea Youth Risk Behavior Survey (KYRBS) in 2018. The 60,040 participants were selected using a complex sampling design from middle and high schools. The participants completed a self-administered questionnaire. The explanatory variables, including school safety education and violence, were assessed in relation to prevention of traumatic injuries. Complex-samples multivariable logistic regression models were applied to explain the factors related to TFE over the past 12 months. The overall prevalence of TFE was 11.4%. Risk factors related to tooth fractures were not wearing a seatbelt on an express bus, not wearing helmets while riding motorcycles and bicycles, clinical treatment due to injuries at school, injuries associated with earphone/smartphones use, and lack of school safety education such as danger evacuation training. The top risk factor was injuries associated with earphone/smartphone usage, followed by lack of familiarity with school safety education. Thus, to prevent tooth fractures among adolescents, schools should strengthen their safety education, including education regarding mobile device usage, and wearing a seatbelt and wearing a helmet. Care should be taken to manage facilities around the school and to prevent injury related to tooth fracture. Further studies on various risk factors related to tooth fractures are warranted.

A Case for Girl-child Education to Prevent and Curb the Impact of Emerging Infectious Diseases Epidemics

Not only do epidemics such as HIV/AIDS, Ebola Virus Disease (EVD), and the current Coronavirus Disease (COVID-19) cause the loss of millions of lives, but they also cost the global economy billions of dollars. Consequently, there is an urgent need to formulate interventions that will help control their spread and impact when they emerge. The education of young girls and women is one such historical approach. They are usually the vulnerable targets of disease outbreaks - they are most likely to be vehicles for the spread of epidemics due to their assigned traditional roles in resource-limited countries. Based on our work and the work of others on educational interventions, we propose six critical components of a cost-effective and sustainable response to promote girl-child education in resource-limited settings.

Systematic Review: Effect of Health Education Intervention on Improving Knowledge, Attitudes and Practices of Adolescents on Malnutrition

Adolescence is a phase in the life cycle of human beings. Adequate knowledge, attitudes and practices towards malnutrition are necessary for proper growth and development and for their future children. This systematic review aimed to determine the effect of health education intervention to improve the knowledge, attitudes and practices of adolescents on malnutrition. PubMed, Scopus, clinical trials, CINAHL, SAGE, Science Direct and Medline were searched according to Preferred Reporting Item for Systematic Reviews and Meat-analysis (PRISMA) guidelines to identified published studies from January 2013 to December 2019 based on the inclusion and exclusion criteria. A total of eight studies were included in this review. Data extraction was done based on randomized controlled trial only. Three out of the eight studies had low risk of bias, the overall evidence of the study was moderate. Findings from this study suggest that health education intervention among adolescents have significantly improved their knowledge, attitudes and practices. More specific interventions should be conducted in low and middle income countries since they bear more of the burden of malnutrition globally.

The Relationship between Weight Status, Health-Related Quality of Life, and Life Satisfaction in a Sample of Spanish Adolescents

Excess weight has been associated with numerous psychosocial problems and is considered to be one of the most important health problems of today. The aim of this study is to analyze the relationship between weight status, which is evaluated by means of the body mass index (BMI), and the health-related quality of life (HRQoL) and life satisfaction (LS) variables in Spanish adolescents, as well as to examine whether gender influences this interrelationship. A total of 1197 subjects studying in their 1st and 4th years of high school (mean age: 14.4 years, SD: 1.69) participated in the study by completing the Health Behavior in School-Aged Children (HBSC) questionnaire. Then, the participants were grouped into the following categories: underweight, normal weight, overweight, and obese. The results show that boys have significantly higher HRQoL as well as higher levels of LS. On the other hand, only the obese group shows significantly lower scores in both HRQoL and LS than those in the normal-weight group. The interaction of weight category and gender does not have a significant impact on the variables that have been analyzed (HRQoL or LS).