A health promoting sports club framework: strategies from the field

The application of the settings-based approach to sports clubs requires a context-specific framework to develop and operationalize health promotion interventions. Incorporating top-down and bottom-up perspectives into interventions increases their efficiency, success and sustainability. In 2020, the health promoting sports club (HPSC) model and intervention framework were created, including strategies and intervention components. A subsequent concept mapping study generated 35 statements from sports club stakeholders highlighting their needs when developing health promotion initiatives. This commentary integrates the concept mapping results into the HPSC model and intervention framework. The process added new sports club levels, updated existing and developed new intervention components, then classified them into the framework. The revised HPSC model has seven levels while the revised intervention framework includes 13 strategies and 69 intervention components. This revised HPSC framework provides sports club stakeholders, public health experts and researchers a means to develop and implement targeted health promotion interventions.

The characteristics of organized sport and physical activity initiatives for older adults in Sweden

There is a common understanding that sport and physical activity can be important to address healthy aging. There are individual-level recommendations about how much physical activity people of different ages should engage in to gain health benefits, but at the same time there are no recommendations for how organizations should organize physical activities to suit as many people as possible for as long as possible. The purpose of this study was to explore the characteristics of sport and physical activity initiatives that older adults participate in. Different ongoing sport and physical activity initiatives that involve older adults were investigated regarding their focus, organization, intensity and organizer, and in relation to their costs, booking opportunities and recruitment. The study was conducted with a cross-sectional design using the Salutogenic Physical Activity Health Resources Questionnaire (SPAHRQ). The study included 27 different initiatives with 372 participants (60% women) ranging from 60 to 96 years of age. A health-promoting, salutogenic settings-based approach, and specifically the concepts drop-in, drop-through and drop-over were used in discussing recommendations for the organization of sport and physical activity for older adults. The main findings were that who organizes the sport and physical activity initiative seems to affect the characteristics of how it is organized and what characterizes the participants in it. Despite the differing characters of sport and physical activity initiatives, the majority of older adults are recruited by internal contacts like friends and family. Which older adults participate in which initiatives is explained mostly by the age and gender of the participants. In conclusion, to attract as many older adults as possible, organizations should work with lowering the thresholds, as well as within and between, organizations, and raise the threshold for dropping out of sports and physical activity.

Health promoting sports federations: theoretical foundations and guidelines

Background

Researchers and policy-makers have highlighted that the potential for organized sports to promote health has been underexploited. Sports clubs have limited capacity to promote health due to their voluntary nature and have called for support from their national sports federations. The present article provides guidelines, based on the theoretical principles of health promoting sports clubs and an analysis of practical tools and proven strategies, to support national sports federations to invest in health promotion (HP).

Methods

A qualitative iterative study was undertaken, based on five 2-h meetings of a group of 15 international researchers in HP in sports clubs. Notes and minutes from meetings, as well as shared outputs were analyzed based on the health promoting sports club framework.

Results

Guidelines developed for national sports federations to promote health includes a definition of a health promoting sports federation (HPSF), a description of how the settings-based approach to HP adapts to national sports federations, as well as practical applications of health promoting sports club's intervention strategies. The analysis of existing tools also demonstrated that most tools are centered on a single dimension of health (social, mental, physical, spiritual or community), and often on a specific health topic. Furthermore, they do not cover HP as a continuous long-lasting process, but are generally short-term programs. The HPSF clarifies theoretical concepts, their practical implementation via case studies and outlines intervention components and tools useful for sports federations in their implementation of HP.

Conclusion

The guidelines developed in this study are intended to facilitate national sports federations to acknowledge/understand, reinforce/underpin and foster current and further investment in HP.

Health promoting sports clubs: from theoretical model to logic model

A recent literature review indicated that the settings-based approach, as it is applied to sports clubs, is poorly understood and not well implemented. The current study builds on the health promoting sports clubs (HPSC) theoretical model as a basis for a settings-based approach in the sports setting and proposes a logic model to develop and evaluate HPSC in practice. The logic model was established through qualitative, iterative methods in the form of six meetings with eight experts in the field. Qualitative thematic coding was conducted on notes taken and contributions during and between meetings. The results describe a best-practice logic model of HPSC, including inputs, activities, outcomes and impacts at each HPSC level, while case studies illustrate the interactions between levels. Results indicate that a HPSC can have an impact at each level, from individual health to social and community capital. For a sports club, the logic model helps to define how the club's board or management committee can set the conditions for club managers and coaches to support members' health. External stakeholders to clubs are also recognized for their key responsibility in providing different types of resources to support sports clubs to be health promoting. Future research should focus on monitoring and evaluating at each level, including empirical testing system interactions as a whole and interactions across levels.

Health promoting sports clubs: from theory to intervention

INTRODUCTION

Beyond the contribution of sports clubs to physical activity, an important health determinant, sports clubs can embrace the settings-based approach to health promotion, acting as health promoting sports clubs (HPSC). Limited research links the HPSC concept with evidence-driven strategies to provide guidance to develop HPSC interventions.

METHODS

An intervention building a research system of the development of an HPSC intervention will be presented, including seven different studies, from literature review to intervention co-construction and evaluation. The different steps and their results will be presented as lessons learnt for settings-based intervention development.

RESULTS

First, the evidence base showed a poorly defined HPSC concept, but 14 evidence-driven strategies. Second, concept mapping identified 35 sports clubs needs in regard to HPSC. Third, the HPSC model and intervention framework were designed using a participative research approach. Fourth, a measurement tool for HPSC was validated psychometrically. Fifth, capitalization of experience from eight exemplar HPSC projects was realized to test the intervention theory. Sixth, program co-construction was realized by involving sports club actors. Seventh, intervention evaluation was built by the research team.

DISCUSSION

This HPSC intervention development is an example of building a health promotion program, implicating different types of stakeholders, and provide a HPSC theoretical model, HPSC intervention strategies, a program and toolkit, for sports clubs to implement health promotion and fully endorse their role in the community.

Development of the Health Promoting Sports Club - National Audit Tool

Background

Sports clubs have requested support from national governing authorities to invest in health promotion (HP), by developing policies, guidelines and dedicated funding. This manuscript outlines the development of a national audit tool to review policies development and implementation to support HP in sports clubs.

Methods

A 5-step process was undertaken by an international project team: (1) a rapid literature review to identify items assessing policies in physical activity, HP and sports, (2) a thematic analysis to categorize items, (3) a Delphi method to analyze item relevance, country specificity, reformulation, validation and organization, (4) face validity through an online survey and in-depth interviews with expert representatives on physical activity and sports and (5) audit tool finalization though project team consensus.

Results

Eight sources were reviewed with 269 items identified. Items were coded into 25 categories with three broad themes: policies, actors and settings-based approach. The Delphi study extracted and refined 50 items and categorized them into 10 sections. After revisions from 22 surveys and 8 interviews, consensus was reached by the international project team on 41 items categorized into 11 sections: Role of ministry or department; Policies; Communication; Implementation & Dissemination; Evaluation & Measurement methods; Sub-national level policies; Funding & Coordination; Participative approach; Actors & Stakeholders; National sporting events; Case studies and Implicated stakeholders.

Conclusions

To progress HP in the sports club context it is necessary to understand existing national level policies. This national audit tool will aid in monitoring and assessing national policies for health promoting sports clubs.

S07 How do sports clubs contribute to health? From theory to interventions

The symposium presents last findings on health promotion interventions in sports clubs. After a short introduction about the health promoting sports clubs (HPSC), five presentations (France, Sweden, Ireland, Finland and Netherlands) will reflect upon how sports clubs can be health promoting: in theory, from youth perspectives, by increasing physical activity level as outcome or enhancing sustainability of interventions, before opening the discussion with academic experts. Presentation 1 describes an iterative international process, implicating three groups (French sport students, French and Swedish experts) to create an intervention theory, based on the HPSC model. Presentation 2 focuses on a cross-sectional study investigating 123 Swedish youth's representation of sports clubs' role towards health promotion, identifying social dimension, environment, coaches, amount and ambition of practice as key factors. Presentation 3 is a longitudinal study among 366 adolescents, followed from age 15 to age 19, questioning the participation to organised sport practice and their orientation (leisure or competitive). Results have shown that by the age of 19, 33% of boys and 43% of girls have dropped out of organised sport, where 45% of boys and 26% of girls continued participation. Adolescents with a competitive goal orientation were more likely to continue participation. Presentation 4 is a longitudinal study among 131 youth measuring objective physical activity before and in the middle of a sport season. Principal results showed a significant change across time point, as well as differences between gender (a decrease in moderate to vigorous physical activity during games for boys and an increase for girls). Presentation 5 examined factors that influenced the sustainability of 14 Dutch sporting program aimed at increasing physical activity among inactive people 6.5 years after their implementation. Interviews with representatives of Dutch National Sports Federations and sports clubs helped to identify facilitating and impeding factors, like program adaptation, evaluation, financing and factors related to human resources. Question and Answer will be organised around the key ingredients and challenges facing the development of HPSC interventions, such as implementation of theoretical background, sport participants need consideration, complexity of outcomes evaluation of HPSC and program sustainability.

P04-08 The art of ageing well - a salutogenic study of physically active old adults

Background

People aged 60 years and over has doubled since 1980 and WHO predicts that this population will reach 2 billion by the year 2050. However, increases in life spans do not directly lead to increases in health. An aging population poses both challenges and opportunities for society and for individuals. In order to address this, scholars argue for the benefits of being physically active, especially in a group of peers. However, the relation between physical activity and health is often based on an understanding of what causes or prevents illness rather than what promotes health. The purpose of this study is thus to contribute to knowledge about which health resources older adults develop in their participation in organised physical activity initiatives. The study will consider to what extent older adults develop health resources, differences in demographic background and the relation between the health resources and Sense of coherence (SOC).

Methods

This is the first data collection in a longitudinal study. Participants were old adult men and women, 60 years and above. All participants were active in ongoing organised physical activity initiatives in different organisations on a voluntary basis. A survey included demographics, overall health, health resources (McCuaig & Quennerstedt, 2018) and SOC-13. The data collection is ongoing (preliminary n = 200) and ends spring 2020. Statistical analyses were descriptive and included bivariate analyses.

Results

Preliminary results show that the most frequent health resources are social relations, positive energy and embodied identity for both men and women. A positive related correlation of the health resource habit of exercising were observed with a high sense of coherence.

Conclusion

The Salutogenic idea of having access to various health resources linked to a high sense of coherence is in line with the result of a positively related correlation direction and also with the health resource habit of exercising. The results of the study can contribute to knowledge about which health resources older adults develop in their participation in organised physical activity initiatives.

S07-5 Young peoplés perspectives on what makes a sports club health promoting

Background

In many European countries, about two-thirds of young people participate in sports clubs. However, these numbers peaks in early adolescence and then decrease. In addition, participation in sports clubs looks different in different groups. Participation in sports have the possibility to contribute to young peoplés health in a broad sense, both increasing their physical activity, but also their mental and social health. Sports clubs have also been acknowledged as health promoting settings by researchers and policymakers. Young people participate in sports for different reasons, most common are that it is fun, social, developing and healthy. On the other hand, young people drop out of sports because of coach and teammate relations, but also for organizational reasons like facilities or lack of coaches. A reason can also be too much focus on performance, although this can also be a motivating reason. A major task for sports clubs is to develop sports to maintain the participation of young people. Different perspectives can be used to develop sports clubs activities, among them the novel health-promoting sports clubs approach. Few studies have however explored young people's perspectives on health-promoting sports clubs. The aim of this study is therefore to explore young peoplés perspectives on what makes a sports club health-promoting.

Methods

This cross-sectional study conducted a brief survey in two schools in central Sweden with grade 9 pupils (15-16 years old). The sample consisted of 123 participants (54 % girls, 52 % sport clubs participants, 37 % former sports clubs participants). The questionnaire contained three open-ended questions about what characteristic of a sports clubs makes them feel well, not well and makes them want to stay in sports clubs. The data was analysed with content analysis in combination with statistical analyses.

Results

Early results shows that fun, social dimensions, coaches, but also organizing aspects like amount and ambition of practice are factors that young people think makes a sports club health-promoting.

Conclusions

Health-promoting perspective on sports clubs can from young peoplés perspective include many dimensions and develop sports clubs in this direction could lead to young people staying longer.

Development of the health promoting sports club-national audit tool

Background

Sports clubs have requested support from national governing authorities to invest in health promotion (HP), by developing policies, guidelines and dedicated funding. This article outlines the development of a national audit tool to review policies development and implementation to support HP in sports clubs.

Methods

A five-step process was undertaken by an international project team: (i) a rapid literature review to identify items assessing policies in physical activity, HP and sports, (ii) a thematic analysis to categorize items, (iii) a Delphi method to analyze item relevance, country specificity, reformulation, validation and organization, (iv) face validity through an online survey and in-depth interviews with expert representatives on physical activity and sports and (v) audit tool finalization though project team consensus.

Results

Eight sources were reviewed with 269 items identified. Items were coded into 25 categories with 3 broad themes: policies, actors and settings-based approach. The Delphi study extracted and refined 50 items and categorized them into 10 sections. After revisions from 22 surveys and 8 interviews, consensus was reached by the international project team on 41 items categorized into 11 sections: Role of ministry or department; Policies; Communication; Implementation and Dissemination; Evaluation and Measurement methods; Sub-national-level policies; Funding and Coordination; Participative approach; Actors and Stakeholders; National sporting events; Case studies and Implicated stakeholders.

Conclusion

To progress HP in the sports club context it is necessary to understand existing national-level policies. This national audit tool will aid in monitoring and assessing national policies for health promoting sports clubs.

Physical activity as a health resource: a cross-sectional survey applying a salutogenic approach to what older adults consider meaningful in organised physical activity initiatives

Objectives

Examine health resources that physically active older adults consider meaningful when participating in physical activity initiatives. Health resources are protective factors, including attitudes, knowledge, material factors or social support, that potentially enable people to understand and make sense of their lives or to cope with life stressors.

Design and main outcome measures

A cross-sectional quantitative study was conducted with two questionnaires used to serve as a compiled ‘ageing well’ survey: the Salutogenic Physical Activity Health Resources Questionnaire (SPAHRQ) and the short form of the Sense of Coherence questionnaire, SOC-13.

Results

The study included 372 participants ranging from 60 to 96 years of age (mean age: 74.4 ± 7 years; 60% women). Social relations, positive energy, the habit of exercising and embodied satisfaction were considered important by more than 70% of the participants. Social relations were the most meaningful health resource for both men and women (89%). Women rated positive energy as a significantly more important consequence of their participation in physical activity than men (W 88%, M 72%; p = .001). The three health resources that were considered less important were capability in and about physical activity, self-worth and identity as an exercising person. Those who were more physically active considered social relations, self-worth and the habit of exercising to a higher extent. Participants with higher sense of coherence consider the habit of exercising to a greater extent to be important.

Conclusions

Findings that social relations, positive energy, the habit of exercising and embodied satisfaction were considered important by more than 70% of the participants, can contribute to a wider understanding of health resources that older adults consider meaningful in their participation in organised physical activity initiatives.

Health Promotion in Sport, through Sport, as an Outcome of Sport, or Health-Promoting Sport-What Is the Difference?

What do we currently know about the relationship between health promotion and sport in research [...].

The health promoting sports club model: an intervention planning framework

Researchers and policymakers acknowledge sports clubs (SCs) as health promoting settings. Limited research links the health promoting sports club (HPSC) concept with evidence-driven strategies to provide SCs guidance to develop health promotion (HP) interventions. As implementation science insists on theoretically grounded interventions, the present work's objective was to provide SCs an evidence-driven intervention framework for planning, developing and implementing HP initiatives. Four iteratively sequenced steps were undertaken: (i) investigation of 'health promoting' indicators, (ii) adaptation of the HPSC concept to create the HPSC model, (iii) formulation of published evidence-driven guidelines into strategies and implementable intervention components (ICs) and (iv) merging the HPSC model with the ICs to create an intervention planning framework for SCs. First, researchers drafted five HPSC indicators. Second, they defined three SC levels (macro, meso and micro) and four health determinants (organizational, environmental, economic and social) to create an HPSC model. Third, researchers used published guidelines to develop 14 strategies with 55 ICs. Fourth, three workshops (one each with French master-level sport students, French sport and health professionals and Swedish sport and health professionals) had participants classify the ICs into the model. The HPSC model and intervention framework are starting points to plan, select and deliver interventions to increase SC HP. This planning framework is usable in several ways: (i) clubs can apply strategies to achieve specific goals, (ii) clubs can target specific levels with corresponding ICs and (iii) ICs can be used to address particular health determinants.

Experiences of stakeholder collaboration when promoting participation in physical activity among adolescents with autism spectrum disorder

PURPOSE

Various stakeholders contribute to the development of healthy physical activity habits in adolescents with autism spectrum disorder (ASD). Parents and stakeholders seek collaborative actions but little is still known about such efforts. The purpose of this study was thus to explore how professionals from different services experience stakeholder collaboration when promoting participation in physical activity for these adolescents.

METHOD

Five focus group discussions were held with 17 professionals from education, health care, community, and sports organizations, engaged in the promotion of physical activity in adolescents with ASD. The data were analyzed with qualitative content analysis.

RESULTS

The discussions revolved around a central theme: Collaboration is needed to promote physical literacy among adolescents with ASD. The professionals though experienced that this collaboration was hampered by the low priority given to physical activity issues within different organizations, by limited resources, lack of knowledge, and unclear roles.

CONCLUSIONS

Notwithstanding the professionals' different roles, all agreed that physical activity issues need to be prioritized and that each stakeholder needs to acknowledge the shared responsibility of collaboration. However, more clear routines for collaboration that include joined efforts but also highlight the organization-specific responsibilities might enhance the collaborative efforts.IMPLICATIONS FOR REHABILITATIONIn-depth understanding of both the adolescents' needs and the environments in which physical activity is promoted is required if participation in physical activity among adolescents with ASD is to be enhanced.Families and professionals within different organizations need to be supported to collaborate when mapping and meeting the adolescents' physical activity needs.Issues regarding developing physical activity habits need to be prioritized.Professionals, such as education, health, and community professionals who are important for the promotion of healthy physical activity habits need to be included in multi-stakeholder meetings.

The health promoting sports club model: An intervention planning framework

Background

Researchers and policymakers have acknowledged sports clubs (SCs) as health promoting settings. Limited research links the health promoting sports club (HPSC) concept with evidence-driven strategies to offer SCs guidance to develop health promotion interventions. As implementation science insists on theoretically grounded interventions, this work's objective was to provide SCs an evidence-driven intervention framework for planning health promotions.

Methods

A 4-step process was undertaken: 1) investigate indicators for SCs to be considered health promoting, 2) adapt the theoretical HPSC concept to create a HPSC model, 3) reformulate published evidence-driven guidelines into implementable intervention components (ICs) and 4) merge the model with the ICs to provide an intervention planning framework for SCs. During 3 workshops, researchers defined the model elements and ICs. Workshop participants classified ICs into the HSPC model. Each IC could be classified multiple times within the model.

Results

Researchers drafted 5 HPSC indicators: 1) an approach embracing all SC actions, 2) involve all SC levels in actions and decisions, 3) involve external partners, 4) promoting health is continuous and iterative and 5) base actions on needs. To create the HPSC model, elements were defined: 3 SC levels (club, management, coaches) and 4 health determinants (organizational, social, environmental, economic) per level based on the indicators. Published guidelines from literature reviews aided in developing 14 strategies with 55 ICs. Workshop classification of ICs into the model included: club (n = 79), management (n = 67) and coaches (n = 48).

Conclusions

The theoretical HPSC model and intervention planning framework act as starting points to develop and implement interventions to increase HP efforts by stakeholders in several ways: 1) SCs can apply strategies based on goals, 2) SCs can target specific levels with corresponding ICs or 3) ICs can target specific health determinants.

Key messages

A Health Promoting Sports Club model defines 4 health determinants at 3 levels (coach, management operational) of sports clubs to plan, develop and implement targeted health promotion activities. This HPSC intervention planning framework has 14 strategies with 55 intervention components targeting multiple sports club levels giving stakeholders a path to become a health promoting sports club.

Measuring Health Promotion in Sports Club Settings: A Modified Delphi Study

Settings-based approaches have become an increasing health promotion focus since the World Health Organization's 1986 Ottawa Charter. While schools, cities, and prisons have implemented this approach, its development within sports environments is recent. Sports are a popular leisure-time activity, requiring validated tools to measure health promotion activity. This study's aim was to develop a measurement tool based on international consensus that measures perceptions of health promotion within sports clubs. It is grounded in the settings-based approach and builds on theory from previous works expanding their context and knowledge. An online, three-round international Delphi study was conducted, inviting experts in sports and health fields to participate in designing the tool. Round 1 created a collaborative list of items; Round 2 validated items based on relevance, importance, and feasibility; and the final round classified items into one determinant category-social, cultural, environmental, or economic. Panelists (69 experts) from 13 countries participated, creating a final list of 62 items at 3 organizational levels; the sports club level included 23 items, the officials level retained 20 items, and the coaching level contained 19 items. This study provides several innovations: (1) applying the settings-based approach to health promotion within sports clubs, (2) defining each club level (sports club, official, coaching) and determinants (social, cultural, environmental, economic) within 3-levels, (3) creating a tool that measures perceptions of health-promotion activities per level and determinant, and (4) obtaining expert consensus on included items. These advancements allow further research on promoting health within sports clubs.

Measuring health promotion in a sports club setting: a modified Delphi study

Background

The settings-based approach has become an increasing focus in health promotion since the World Health Organization’s 1986 Ottawa Charter. Schools and cities have implemented this approach, but development within sports clubs is limited. Thus, an internationally validated measurement of health promotion within this setting is lacking.

Methods

A modified Delphi study was completed to develop an international evaluation tool grounded in the settings-based approach. Expert panelists from academia, sports and health sectors were invited to participate in 3 online rounds. Items were generated or selected based on 3 prior Delphi-based studies and 2 nationally validated scales. Round one created a collaborative list of items, round two validated items based on relevance, importance and feasibility and the final round classified items into one of four determinants: cultural, social, environmental or economic.

Results

Panelists (69) from 13 countries participated in creating a final list of 62 items at 3 organizational levels. The sports club level included; 5 cultural, 6 social, 6 environmental and 5 economic items. The management level included; 5 cultural, 5 social, 5 environmental and 3 economic items. The coaching level included; 5 cultural, 5 social, 4 environmental and 4 economic items.

Conclusions

This study provides three important innovations; 1- it is rooted in theory through the settings-based approach, 2- the measurement tool includes three levels within sports clubs, capturing a whole club dynamic and 3- all items included in the tool have been validated by an international panel of experts.

Key messages

This 62-item measurement tool allows the comparison of perceptions from participants, coaches and management regarding how health is promoted within their sports club. This information offers insight on the capacity of sports clubs to implement and monitor policies and practices on the promotion of health beyond sports performance within their organization.

Health Promotion Interventions in Sports Clubs: Can We Talk About a Setting-Based Approach? A Systematic Mapping Review

Many researchers and authorities have recognized the important role that sports clubs can play in public health. In spite of attempts to create a theoretical framework in the early 2000s, a thorough understanding of sports clubs as a setting for health promotion (HP) is lacking. Despite calls for more effective, sustainable, and theoretically grounded interventions, previous literature reviews have identified no controlled studies assessing HP interventions in sports clubs. This systematic mapping review details how the settings-based approach is applied through HP interventions in sports clubs and highlights facilitators and barriers for sports clubs to become health-promoting settings. In addition, the mapped facilitators and barriers have been used to reformulate previous guidelines of HP in sports clubs. Seven databases were searched for empirical research published between 1986 and 2017. Fifty-eight studies were included, principally coming from Australia and Europe, describing 33 unique interventions, which targeted mostly male participants in team sports. The settings-based approach was not yet applied in sports clubs, as more than half of the interventions implemented in sports club targeted only one level of the socio-ecological model, as well as focused only on study participants rather than the club overall. Based on empirical data, the analysis of facilitators and barriers helped develop revised guidelines for sports clubs to implement settings-based HP. This will be particularly useful when implementing HP initiatives to aid in the development of sports clubs working with a whole setting approach.

Does sports club participation contribute to physical activity among children and adolescents? A comparison across six European countries

Aims: Insufficient physical activity (PA) is one of the largest public health challenges of our time and requires a multisectoral public-health response. PA recommendations state that all children and adolescents should accumulate at least 60 minutes of moderate-to-vigorous PA (MVPA) daily and carry out vigorous PA (VPA) three times weekly. While participation in sports club activities is known to enhance the probability of reaching the recommended overall PA level, less is known about the contribution of sports club participation to VPA, and few cross-national comparisons have been carried out. The purpose of this paper is to study whether participation in sports club activities is associated with meeting the overall PA and VPA recommendations among children and adolescents across six European countries, namely Belgium (Flanders), Czech Republic, Finland, France, Ireland and Sweden. Methods: Analyses were carried out on existing self-reported national data sets using descriptive statistics and logistic regression. Results: Results indicate that approximately two-thirds of children and adolescents take part in sports club activities in the given countries. Sports club participants were more likely to meet the overall PA recommendations (OR 2.4-6.4) and VPA recommendation (OR 2.8-5.0) than non-participants. Conclusions: The extent to which overall PA and/or VPA is gained through sports club participation versus other settings needs to be further studied. Nonetheless, it can be argued that sports clubs have an important position in PA promotion for younger populations.

Leisure-time youth centres as health-promoting settings: Experiences from multicultural neighbourhoods in Sweden

AIMS

The aim of this paper is to advocate for the importance of meaningful leisure time for young people from a health-promotion perspective using experiences from two youth centres in multicultural neighbourhoods in Sweden.

METHODS

In this practice-based study, data were collected between 2012 and 2014 at two youth centres in multicultural, socially deprived suburbs in Sweden using surveys with 12- to 16-year-old adolescents ( n = 207), seven individual interviews with staff and three cooperation partners in the neighbourhoods, and six group interviews with adolescents (50% girls). Quantitative, qualitative and mixed methods were used for analysis.

RESULTS

As part of the youth centres' strategies, they are open and inclusive, foster supportive relationships, emphasise youth empowerment, and integrate family, school and community in their work. The youth centres are health-promoting settings with regard to four of the action areas in the Ottawa Charter: build healthy public policy, create supportive environments, strengthen community actions and develop personal skills.

CONCLUSIONS

There is a need for a variety and a combination of various structured and unstructured leisure-time activities because young people's background and life situation plays a role for their participation in leisure-time activities. We conclude that youth centres are well placed to be or to become health-promoting settings if the activities takes place in a structured environment.

Piecing the puzzle together: case studies of international research in health-promoting sports clubs

This paper seeks to review the current international health-promoting sports club (HPSC) research, drawing together findings based on case studies from various countries to illustrate the status of HPSCs. In addition, future challenges for HPSC research and implementation are considered. The review includes six case studies from five countries. In summary, there are two major research themes in this area, namely 'research into HPSC activity' and 'research into HPSC networks'. The first theme investigates the extent to which sports clubs and/or national sports organisations invest in health promotion (HP) - both in policy and practice. The latter theme is driven by an intention to widen the scope of HPSCs to reach novel internal actors, like parents, siblings, etc., and/or external non-sporting bodies, like communities, schools, etc. The future challenges for HPSC research require a better understanding of the motives, barriers and capacities of sports clubs and coaches. Sports organisations, clubs and coaches generally support the intent of the HPSC concept, but even with the best evidence- or theory-based HP programmes/guidelines/standards, nothing will happen in practice if the nature and capacities of sports clubs are not better acknowledged. Therefore, a call for embracing implementation science is finally made to enhance implementation.

How do minors succeed in buying beer in Sweden?

Aims

This study examines the compliance with the law against selling beer to under-aged persons in Sweden. It also analyses determinants of compliance and the importance of checking IDs. The paper also aims to reveal the strategies used by youths when purchasing beer.

Methods & Data

The study is the result of a close collaboration between the Swedish Youth Temperance movement (UNF) and researchers at Örebro University. UNF has been responsible for the purchase attempts, and the research team for the analyses. The data consists of 681 purchase attempts in seven cities in Sweden during 2003–2004.

Results

Almost half of the purchase attempts made by under-aged persons (14–17 years old) resulted in successfully buying beer. The study reveals that the genders of the check-out clerk and the buyer are significant with regard to both selling/buying beer and asking for ID. The proportion of sales was significantly higher to girls than boys, both in total and when they were asked for ID first.

Conclusions

The study shows that under-aged teenagers succeed in purchasing beer in Sweden despite the present legislation. Some succeed because of the tricks they use, and some because of the check-out clerk's negligence. The procedure used in the present study – letting under-aged persons attempt to purchase beer – resembles the situation for ordinary teenagers trying to buy beer under normal circumstances.

Prevalence and risk factors of electronic cigarette use among adolescents: Data from four Swedish municipalities

Aims

To assess the prevalence rates and risk factors of electronic cigarette (e-cigarette) use, with special focus on e-cigarettes containing nicotine, among grade 9 students (aged 15–16 years) in four different municipalities in Sweden.

Methods

A cross-sectional sample of 665 adolescents was collected in April 2014. The data was analysed using binary logistic regression analysis.

Results

The results show that 26% of adolescents in this study have smoked e-cigarettes (have ever used), while 19% have smoked e-cigarettes with nicotine or do not know whether or not they contained nicotine. The strongest risk factor for ever having used e-cigarettes (any type or with nicotine) was smoking conventional cigarettes. Having tried cigarettes and having tried snus, as well as using or having used alcohol and having smoked a water pipe were also statistically significant risk factors for ever use of any type of e-cigarettes but not for use of e-cigarettes with nicotine. There was no gender difference.

Conclusions

Our result show that the use of e-cigarettes tends to cluster with the use of other substances, such as other tobacco products and alcohol. As a relatively large share of the participating adolescents, more than a fourth, had smoked e-cigarettes, this rather new phenomenon requires monitoring as a part of the tobacco control.

Effects on alcohol use of a Swedish school-based prevention program for early adolescents: a longitudinal study

BACKGROUND

The aim of the study was to address the lack of evaluations of school-based substance use prevention programs and to conduct a quasi-experimental evaluation of the alcohol use part of the Triad intervention.

METHODS

Eleven Swedish intervention schools (285 pupils) and three control schools (159 pupils) participated in the evaluation. Baseline measurements were conducted in 2011 before the alcohol part in the prevention program was implemented in the intervention schools (school year 6, ages 12-13). We estimated an Intention-To-Treat (ITT) Difference-in-Difference (DD) model to analyze the effectiveness of the intervention on subsequent alcohol use measured in grades 7, 8 and 9.

RESULTS

The main results show no effect on the likelihood of drinking alcohol or drinking to intoxication.

CONCLUSIONS

The lack of positive effects highlights the need for policy-makers and public health officials need to carefully consider and evaluate prevention programs in order to ensure that they are worthwhile from school, health, and societal perspectives.

Gambling among adolescents with and without hearing loss

OBJECTIVES

This exploratory study investigates the prevalence of gambling, preferred types of gambling, and problem gambling in Swedish young people aged 15-18 years with and without hearing loss.

METHODS

A cross-sectional health survey was conducted in Örebro County, Sweden in 2014. A standardized questionnaire was distributed to 4888 students, and 4329 filled it. There were 318 (8 %) students with hearing loss. The response rate was 82 %. The 2-item Lie/Bet questionnaire (Johnson et al. in Psychol Rep 80:83-88, 1997) was used for measuring problem gambling.

RESULTS

More students with hearing loss had gambled during their lifetime (35 %) and in the past year (25 %) than their hearing counterparts (lifetime: 24 %; past-year: 19 %). More students with hearing loss compared to normal hearing students were identified as problem gamblers (7.7 % compared to 4.3 %).

CONCLUSION

More research is needed on gambling among people with hearing loss as well as other disabilities.

Evaluating the effectiveness of the SMART contract-signing strategy in reducing the growth of Swedish Adolescents' substance use and problem behaviors

Background

In 2013, around 40 % of the schools in Sweden had structured programs to prevent tobacco and alcohol debut in compulsory school. There has unfortunately been a lack of scientific evidence to support most of the prevention methods focusing on primary prevention in schools in Sweden. The aim and purpose of the present study is to evaluate the effectiveness of the Non-Governmental Organization SMART contract-signing strategy in reducing the growth of youth substance use and other problem behaviors amongst Swedish adolescents.

Methods

Students from five schools in a medium-sized Swedish municipality were surveyed in three waves from 7^th to 9^th grade of compulsory school. We used General Linear Model (GLM) repeated-measures ANOVA to test if the outcome measures smoking, use of snus and alcohol, drunkenness, delinquency, and bullying significantly changed different amounts over time in groups that had participated in the SMART program for long time, a short time, sporadically- or not at all. Groups were compared on demographic background variables, and outcome measures were assessed on all measurement occasions by a one-way ANOVA. The magnitude of group differences at the end of the study was estimated according to Cohen’s d.

Results

Number of years with a contract has an effect on the levels of self-reported youth problems in 9^th grade. We found small to medium-sized differences in measured outcomes between students who participated in the program for the longest period of time, 5 years, and who participated for the shortest time, 0–2 years.

Conclusion

Findings suggests that the SMART program has preventive effects on adolescent substance use.

How sports clubs include children and adolescents with disabilities in their activities. A systematic search of peer-reviewed articles

Young people with disabilities participate in sports to a lesser extent than other adolescents. That physical activity has positive effects on young people are understood. Sports clubs are identified as potential environments for physical activity. The reasons why young people with disabilities participate to a lower extent in organized sport is complex and barriers can be deriving from many different levels. However, barriers have been studied more than what can facilitate participation in organized sport. Therefor the aim of this study is to increase the understanding of how sports clubs include children and adolescents with disabilities in their activities. The results of this systematic search are presented using the three research questions: What are the characteristics of the sports clubs that include young people with disabilities?; How are the young people with disabilities included in sports clubs’ activities?; and finally Why are young people with disabilities included in the sports activities?. A vision must be to go from adapting physical activity for disabled persons to adapting physical activity for all people, because the diversity of people’s reasons for doing sports, their differing backgrounds and their uniqueness all demand it. This will result in more people doing sports for longer in life.

Academic practice-policy partnerships for health promotion research: experiences from three research programs

BACKGROUND

The development of knowledge for health promotion requires an effective mechanism for collaboration between academics, practitioners, and policymakers. The challenge is better to understand the dynamic and ever-changing context of the researcher-practitioner-policymaker-community relationship.

AIMS

The aims were to explore the factors that foster Academic Practice Policy (APP) partnerships, and to systematically and transparently to review three cases.

METHODS

Three partnerships were included: Power and Commitment-Alcohol and Drug Prevention by Non-Governmental Organizations in Sweden; Healthy City-Social Inclusion, Urban Governance, and Sustainable Welfare Development; and Empowering Families with Teenagers-Ideals and Reality in Karlskoga and Degerfors. The analysis includes searching for evidence for three hypotheses concerning contextual factors in multi-stakeholder collaboration, and the cumulative effects of partnership synergy.

RESULTS

APP partnerships emerge during different phases of research and development. Contextual factors are important; researchers need to be trusted by practitioners and politicians. During planning, it is important to involve the relevant partners. During the implementation phase, time is important. During data collection and capacity building, it is important to have shared objectives for and dialogues about research. Finally, dissemination needs to be integrated into any partnership. The links between process and outcomes in participatory research (PR) can be described by the theory of partnership synergy, which includes consideration of how PR can ensure culturally and logistically appropriate research, enhance recruitment capacity, and generate professional capacity and competence in stakeholder groups. Moreover, there are PR synergies over time.

CONCLUSIONS

The fundamentals of a genuine partnership are communication, collaboration, shared visions, and willingness of all stakeholders to learn from one another.

The youth sports club as a health-promoting setting: an integrative review of research

AIMS

The aims of this review is to compile and identify key issues in international research about youth sports clubs as health-promoting settings, and then discuss the results of the review in terms of a framework for the youth sports club as a health-promoting setting.

METHODS

The framework guiding this review of research is the health-promoting settings approach introduced by the World Health Organization (WHO). The method used is the integrated review. Inclusion criteria were, first, that the studies concerned sports clubs for young people, not professional clubs; second, that it be a question of voluntary participation in some sort of ongoing organized athletics outside of the regular school curricula; third, that the studies consider issues about youth sports clubs in terms of health-promoting settings as described by WHO. The final sample for the review consists of 44 publications.

RESULTS

The review shows that youth sports clubs have plentiful opportunities to be or become health-promoting settings; however this is not something that happens automatically. To do so, the club needs to include an emphasis on certain important elements in its strategies and daily practices. The youth sports club needs to be a supportive and healthy environment with activities designed for and adapted to the specific age-group or stage of development of the youth.

CONCLUSIONS

To become a health-promoting setting, a youth sports club needs to take a comprehensive approach to its activities, aims, and purposes.

A research strategy case study of alcohol and drug prevention by non-governmental organizations in Sweden 2003-2009

BACKGROUND

Alcohol and drug prevention is high on the public health agenda in many countries. An increasing trend is the call for evidence-based practice. In Sweden in 2002 an innovative project portfolio including an integrated research and competence-building strategy for non-governmental organisations (NGOs) was designed by the National Board of Health and Welfare (NBHW). This research strategy case study is based on this initiative.

METHODS

The embedded case study includes 135 projects in 69 organisations and 14 in-depth process or effect studies. The data in the case study has been compiled using multiple methods - administrative data; interviews and questionnaires to project leaders; focus group discussions and seminars; direct and participatory observations, interviews, and documentation of implementation; consultations with the NBHW and the NGOs; and a literature review. Annual reports have been submitted each year and three bi-national conferences Reflections on preventions have been held.

RESULTS

A broad range of organisations have been included in the NBHW project portfolio. A minority of the project were run by Alcohol or drug organisations, while a majority has children or adolescents as target groups. In order to develop a trustful partnership between practitioners, national agencies and researchers a series of measures were developed and implemented: meeting with project leaders, project dialogues and consultations, competence strengthening, support to documentation, in-depth studies and national conferences. A common element was that the projects were program-driven and not research-driven interventions. The role of researchers-as-technical advisors was suitable for the fostering of a trustful partnership for research and development. The independence of the NGOs was regarded as important for the momentum in the project implementation. The research strategy also includes elements of participatory research.

CONCLUSIONS

This research strategy case study shows that it is possible to integrate research into alcohol and drug prevention programs run by NGOs, and thereby contribute to a more evidence-based practice. A core element is developing a trustful partnership between the researchers and the organisations. Moreover, the funding agency must acknowledge the importance of knowledge development and allocating resources to research groups that is capable of cooperating with practitioners and NGOs.