"Your Kid Has Potential, But They Need Sleep": Teacher Perspectives on School-Based Sleep Promotion in Alberta, Canada

BACKGROUND

Insufficient sleep is a growing public health concern. Thirty percent of Canadian children and youth are not meeting national sleep recommendations. Inadequate sleep can negatively influence students' academics and physical and psychosocial health. Schools have been identified as ideal health promotion settings to influence children's health including their sleep behaviors. The objective of this study was to explore teachers' perspectives on sleep behaviors and their role in school-based sleep promotion.

METHODS

Nineteen elementary teachers were purposively sampled from the greater Edmonton area, Alberta, Canada. Interpretive description was used as the guiding method, and data were generated through one-on-one semi-structured interviews. Inductive descriptive thematic analysis was used to identify interview themes.

RESULTS

Three themes related to teachers' perspectives on sleep behaviors and school-based sleep promotion were identified: the importance of students' sleep, prioritizing sleep as part of teaching and learning, and a culture of healthy sleep habits.

CONCLUSIONS

This study found that teachers considered sleep to be essential for elementary students' academic success and wellbeing, and a whole school approach was necessary to support a healthy sleep culture in schools.

Process and experience of youth researchers within a Health Promoting Schools study in Nova Scotia, Canada

Youth Participatory Action Research (YPAR) is an approach to research that engages youth across the research process. The peer researcher method is a technique used in YPAR where youth are trained in research and ethics to interview their peers. The purpose of this study was to: (i) describe the process of engaging youth as peer researchers in a Health Promoting Schools (HPS) and student engagement project and (ii) understand the peer researchers' perspectives of their experience throughout the project. Youth from across Nova Scotia, Canada in grades 7-10 (ages 12-16) were recruited as peer researchers in the Summer, 2022. The project included three stages: (i) peer researcher training, (ii) practicing, recruiting and conducting interviews and (iii) data interpretation workshop. To understand the peer researcher's experience, quantitative data were collected from an evaluation questionnaire. Outputs were produced using descriptive statistics. Qualitative data were collected through a focus group and interviews and analyzed using inductive content analysis. A total of 11 youth were recruited and completed peer researcher training. Most youth provided positive feedback on the training with a satisfaction score of 8.7/10. Qualitative analysis indicated benefits to the peer researchers including opportunities to build interview and social skills and learn about other's perspectives. This study provides a detailed overview of how to use a peer researcher method in a YPAR project to involve youth in research related to HPS and student engagement. The research also highlights the benefits of engaging youth in YPAR. Future research will report on the findings from the peer interviews.

The health and educational impact of removing financial constraints for school sport

Financial barriers often restrict sport participation among children from low-income families. Schools are thought to offer equitable access to programming, including school sport participation. However, pay-to-play school sport models can inhibit participation among students from low-income households. Recognizing the potential benefits of school sport and realizing the financial barriers to participation, the purpose of this study was to understand the extent to which school sport promotes educational experiences and holistic well-being of Canadian youth from low-income families. A case study was conducted with stakeholders who were supported by funding from a non-profit organization to help cover the costs of school sport registration fees. Data were collected from in-depth interviews with low-income students and their parents, teacher-coaches and school administrators. Three overarching themes were representative of the experiences of school sport participation among low-income students: (1) healthy student-athletes, (2) developing student-athletes in school, for life, and (3) supporting student-athletes as a community. The participants perceived that school sport participation offered holistic health benefits, and developed skills and behaviours that support positive educational experiences and foster life skills. Further, our results highlighted the importance of the school community in supporting low-income students to participate in school sport teams and the need to reframe school sport to better support low-income families.

It takes a community: exploring APPLE Schools' impact within and beyond school walls in Canada

Childhood is a critical stage to develop healthy behaviours, and the school years are an important developmental period in which children are learning and growing. School-based health promotion interventions are increasingly using the comprehensive school health (CSH) approach that has been found effective at improving health behaviours, while adapting to the school and community context to create and sustain a healthy school culture. The interconnected environments of school, home and community are key to the CSH approach, however, there is minimal research that has been conducted to determine the impact at the community-level. This research used a qualitative multiple case study design to explore the influence of a school-based health promotion intervention, APPLE Schools, on the school and community environments from the perspectives of school staff in Alberta, Canada. Twenty-two participants participated in walking interviews in five schools. The walking interview approach combined interviewing and field observation and empowered participants to share their local expertise and knowledge within the context of school and community environments. Interviews were transcribed and analysed using an inductive thematic approach. Four themes were identified: APPLE schools look different, APPLE Schools build champions, APPLE Schools builds community partnerships and APPLE Schools honours community culture. Health promotion practice in schools was uniquely adapted based on strengths and needs of each school and was broadly influenced by the community outside of school walls. In sum, it was found that school-based health promotion reaches beyond school walls and can influence the broader community environment.

Implementation of Kenyan comprehensive school health program: improvement and association with students' academic attainment

There is growing evidence supporting the effectiveness of a comprehensive school health program. However, implementation in developing countries is a challenge. Furthermore, the available information on the association between a comprehensive school health program and students' academic attainment is limited. In Kenya, a project to verify the effects of a comprehensive school health program was carried out in Mbita sub-county, Homa Bay County from September 2012 to August 2017. This study aimed to clarify the improvement of school health during the project years and the association between school health and students' academic attainment. Primary schools in Mbita sub-county were selected as study sites. We assessed 44 schools' scores on a school health checklist developed from the Kenyan Comprehensive School Health Program, the students' mean score on the Kenya Certificate of Primary Education (KCPE), and absenteeism during the project years (2013-16). The mean school health checklist score (n = 44 schools) was 135.6 in 2013, 169.9 in 2014, 158.2 in 2015 and 181.3 in 2016. The difference of the mean score between 2013 and 2016 was significant. In addition, correlation analysis showed a significant association between mean KCPE score in the project years and school health checklist score (Pearson's coefficient was 0.43, p = 0.004). The results of this study suggest improvements of school health by the implementation of the Kenyan Comprehensive School Health Program and students' academic attainment.

Local School Wellness Policy as a Means to Advance Whole School, Whole Community, Whole Child: Assessing Alignment in Los Angeles County

BACKGROUND

District wellness policies provide an avenue to advance the Whole School, Whole Community, Whole Child (WSCC) model. The extent to which wellness policies currently align with WSCC is unclear; to-date, tools have been unavailable to examine this issue.

METHODS

We reviewed written health-focused policies among 37 school districts in Los Angeles County in 2017 utilizing a 54-item tool designed to examine the quality of policies in the 10 WSCC domains. Descriptive analyses explored overall and domain-specific comprehensiveness and strength; simple negative binomial regression models examined differences in the policy quality and structure by legislated status.

RESULTS

Approximately half of expected policies were present in wellness policies (mean comprehensiveness score = 52.65, ±18.09), < 20% were strong (mean strength score = 16.97, ±8.05). Content in WSCC domains addressed by legislative mandates was significantly more comprehensive and stronger, and more frequently located within the wellness policies, relative to content in non-legislated domains.

CONCLUSIONS

Opportunities exist for better alignment of wellness policies with WSCC. Education and health practitioners can utilize the tool developed for this study to identify priority areas where policy support is needed in their jurisdictions. Additional efforts are needed to help schools facilitate and document practice gains around WSCC-aligned policies.

Identifying Essential Components of School-Linked Mental Health Services for Refugee and Immigrant Children: A Comparative Case Study

BACKGROUND

Foreign-born children rarely use traditional school mental health services. Comprehensive programs that combine mental health services with academic, economic, and socioemotional supports reach more foreign-born children and improve wellbeing. However, little practical guidance exists regarding how to best combine these diverse services.

METHODS

To identify essential service components and their organization, we interviewed 92 parents, school staff, mental health providers, and community agency staff from 5 school-linked mental health programs designed specifically to serve immigrant and refugee youth.

RESULTS

Foreign-born parents did not distinguish between academic, behavioral, and emotional help for their children; these western categorizations of functioning were not meaningful to them. Consequently, programs needed to combine 4 components, organized in a pyramid: family engagement, assistance with basic needs, assistance with adaptation to a new culture, and emotional and behavioral supports. Family engagement was the foundation upon which all other services depended. Assistance with economic and cultural stressors directly promoted emotional wellbeing and helped parents trust clinical mental health interventions.

CONCLUSIONS

Specific strategies to implement the 4 essential components include home visits by program staff, a one-stop parent center located in the school to help with basic needs, working with cultural brokers, and informed consent procedures that clearly explain recommended care without requiring immigrant and refugee parents to internalize western conceptualizations of psychopathology. Future evaluations should assess the cost and effectiveness of these strategies. These data are essential to advocate payment for these nonclinical services by traditional funding mechanisms.

Noncomprehensive and Intermittent Obesity-Related School Programs and Policies May Not Work: Evidence from the COMPASS Study

BACKGROUND

The school environment has the potential to influence student body mass index (BMI) through programs and policies. Our objective was to examine the effect of modifying obesity-related school policies and programs on youths' BMI trajectories.

METHODS

Obesity-related school policies and programs related to physical activity and healthy eating were collected from 41 schools across Ontario at baseline (2012-2013) and year 2 (2013-2014) of the COMPASS study. Self-reported height and weight were collected from the 4951 grades 9 and 10 students who attended those schools for 3 years. Linear mixed effects regression models examined the effect of modifying obesity-related school policies and programs on youths' BMI trajectories.

RESULTS

Between Y₁ and Y₂ , 26 of the 41 schools implemented distinct new obesity-related programs or policies related to physical activity or healthy eating. Five of the interventions were associated with BMI trajectories of students attending those schools compared to students attending a pooled sample of control schools, predicting a higher BMI trajectory.

CONCLUSIONS

Isolated programs and policies may not successfully improve youths' BMI trajectories. Further research is required to test the implementation of policies and programs that follow a comprehensive school health (CSH) approach, targeting BMI and associated behaviors.

Support for healthy eating at schools according to the comprehensive school health framework: evaluation during the early years of the Ontario School Food and Beverage Policy implementation

INTRODUCTION

Provincial, national and international public health agencies recognize the importance of school nutrition policies that help create healthful environments aligned with healthy eating recommendations for youth. School-wide support for healthy living within the pillars of the comprehensive school health (CSH) framework (social and physical environments; teaching and learning; healthy school policy; and partnerships and services) has been positively associated with fostering improvements to student health behaviours. This study used the CSH framework to classify, compare and describe school support for healthy eating during the implementation of the Ontario School Food and Beverage Policy (P/PM 150).

METHODS

We collected data from consenting elementary and secondary schools in a populous region of Ontario in Time I (2012/13) and Time II (2014). Representatives from the schools completed the Healthy School Planner survey and a food environmental scan (FES), which underwent scoring and content analyses. Each school's support for healthy eating was classified as either "initiation," "action" or "maintenance" along the Healthy School Continuum in both time periods, and as "high/increased," "moderate" or "low/decreased" within individual CSH pillars from Time I to Time II.

RESULTS

Twenty-five school representatives (8 elementary, 17 secondary) participated. Most schools remained in the "action" category (n = 20) across both time periods, with varying levels of support in the CSH pillars. The physical environment was best supported (100% high/increased support) and the social environment was the least (68% low/decreased support). Only two schools achieved the highest rating (maintenance) in Time II. Supports aligned with P/PM 150 were reportedly influenced by administration buy-in, stakeholder support and relevancy to local context.

CONCLUSION

Further assistance is required to sustain comprehensive support for healthy eating in Ontario school food environments.

What Can Secondary School Students Teach Educators and School Nurses About Student Engagement in Health Promotion? A Scoping Review

Student engagement represents a critical component of a comprehensive school health (CSH) approach to health promotion. Nevertheless, questions remain about its implementation. This scoping review updates the field of student engagement in health promotion. Of the 1,388 located articles, 14 qualify for inclusion in this study. An analysis reveals four themes. CSH programs that incorporate student engagement promote a sense of belonging to a community, encourage meaningful involvement, give voice to student concerns, and advance supportive relationships. This study finds a lack of research regarding student engagement in health promotion but confirms that student participation in CSH initiatives contributes to a sense of ownership. Consequently, we can infer that student ownership of health promotion takes place through their meaningful engagement and can effect social change.

Facilitating health and education sector collaboration in support of comprehensive school health

Comprehensive school health (CSH) is embraced internationally as the most effective way of promoting the health of students and the school community. It is a framework for supporting improvements in students' educational outcomes while addressing their well-being in a planned, holistic way. While many successful CSH initiatives are brought about by passionate individuals at the grassroots level, these initiatives benefit greatly from effective cross-sector collaborations within and among governments to coordinate policy and funding from the health and education sectors. Governments represent just one group of professionals within the myriad of players involved in implementing CSH in Canada. To be effective contributors to the model, all levels of government need to work together to reduce duplication while at the same time minimizing gaps in the policies and practices that support school health promotion. Collaboration between the health and education sectors within and across governmental boundaries is proving to be an effective mechanism for achieving this. In its first five-year mandate, the Pan Canadian Joint Consortium for School Health has broken new ground in horizontal integration and, as a result, has identified a set of key factors necessary for successful cross-sector collaboration.