How elementary schools shape leisure-time physical activity among pupils in Israel: A cross-sectional quantitative study

BackgroundChildhood physical inactivity is rising globally and in Israel, posing a major public health challenge. Schools are pivotal settings for fostering lifelong physical activity habits. This study examined which pupil and school characteristics are associated with higher levels of leisure-time physical activity (LTPA).MethodsA cross-sectional survey was conducted among 1,398 pupils (ages 10-12) and 134 parents in 29 elementary schools across Israel, including 14 Health Promoting Schools (HPS). Data on LTPA, school sports activities, school climate, parental involvement, and health policies were collected via validated questionnaires. Statistical analyses included ANOVA, Pearson correlations, and ordinal logistic regression.ResultsParticipation in school sports activities (OR = 2.47, 95% CI: 2.14-2.86, p<.001) and a positive school climate (OR = 1.26, 95% CI: 1.10-1.44, p<.001) were significantly associated with higher LTPA. Boys reported higher LTPA levels than girls (p<.001). Socioeconomic status, school population group, and HPS affiliation showed no significant associations with LTPA.ConclusionsEmbedding structured sports activities and nurturing positive school climates are key to promoting LTPA among pupils. Formal HPS status alone is insufficient. Public health strategies should focus on creating inclusive, daily physical activity opportunities and gender-sensitive approaches within schools to foster sustainable health habits.Key messages• School climate and PA can promote lifelong healthy habits in children's lives.• Real change in pupils’ activity levels stems from action, not affiliation.

African American (AA) women have disproportionately high physical inactivity and obesity prevalence rates in comparison to their gender and racial counterparts. AA women experience unique barriers to leisure-time physical activity (LTPA); however, methods to overcome these barriers are less developed. Therefore, this study used semistructured interviews to explore strategies of young, active AA women that support LTPA maintenance and to identify their psychosocial and behavioral characteristics. The International Physical Activity Questionnaire-long was also administered to provide descriptors of participants’ LTPA. Ten women (age: M = 26.1, SD = 1.7 years) who met national guidelines for aerobic or muscle-strengthening LTPA at least 6 months (aerobic LTPA: M = 2,578.0, SD = 1,228.5 metabolic equivalent-minutes [MET-min]/week; muscle-strengthening physical activity: M = 4.0, SD = 1.9 days/week) completed the study. Four categories emerged from the interviews: (a) early-life contributors to LTPA participation, (b) characteristics of current LTPA, (c) initiating LTPA participation, and (d) maintaining LTPA participation. Findings revealed participants identified weightlifting as a preferred type of LTPA, identified various planning/preparation methods to overcome LTPA challenges, and relied on social media to initiate and maintain LTPA. This study identified several strategies used by young AA women to maintain regular LTPA and program preferences. These data are important in this understudied group as similar strategies may help inactive young AA women overcome LTPA challenges and promote long-term adherence. This could help prevent health and physical activity disparities in this population.

Background Around 35 years ago, the Health Promoting School (HPS) framework was introduced to promote student health behaviors. It is an integrated approach, including education, school health policy, health services, and a stimulating social and physical environment. Implementation of such whole school HPS programs often remains challenging due to the dynamic school system. In order to strengthen implementation and reduce heterogeneity in effects, the present study aimed to understand what works, for which schools and under which conditions. Methods In 2020, 535 schools filled out the HPS Implementation Questionnaire to determine the degree of HPS implementation, showing considerable variety. Based on their implementation scores, 21 ‘lower HPS’ and 22 ‘higher HPS’ schools (16 primary; 15 secondary; 12 secondary vocational) were recruited by Public Health Services for a visit in 2022 to examine differences. Data on implementation and 35 contextual factors (related to individuals, the school organization, HPS framework, and socio-political environment) were collected by observations, a semi-structured group interview, a questionnaire, document analysis, and field notes. Data were analyzed thematically in Nvivo, and will be followed up by Qualitative Comparative Analysis in R. Preliminary results Most evident conditions for degree of implementation were: 1) capacity (time), 2) employee attitude (mainly at primary schools), 3) program champion (mainly at secondary schools), 4) professional implementation support, 5) turbulence (e.g. merger), and 6) management support (mainly at secondary schools). Activity budgets and social support among employees were key factors as well, but did not explain differences in implementation. Conclusions In order to strengthen implementation of HPS programs, more efforts are needed to: 1) intensify support for schools in terms of time and professional advice, and 2) achieve a positive school climate among employees and management. Key messages • Implementation of HPS programs is challenging due to the dynamic nature of schools. • Offering support and achieving a positive school climate are crucial to strengthen HPS implementation in schools.

Background The Dutch Healthy School Program (‘Programma Gezonde School’; HSP) is a whole school approach including education, stimulating physical and social environment, health services, and school health policies. Implementation support is offered by Healthy School Advisers employed at 25 regional Public Health Services (PHSs). To strengthen this professional support, this study aimed to map conditions for the degree of support offered by PHSs and received by schools. Methods The data collection plan was developed together with a Community of Practice. In 2021 and 2022, two rounds of semi-structured group interviews were conducted in 8 PHSs (N = 1-4 employees and ±3.5 hours in total per PHS). Interviews focused on the degree of support (intensity, quality, context-focus, position in PHS and region) and 24 contextual factors regarding: 1) Healthy School Advisers, 2) PHS organization, 3) collaboration with partners, and 4) broader context. Additional data were collected from public websites, year reports, and the Dutch registry of implementing HSP. Data were analyzed thematically in Nvivo. Preliminary results There is large variation in all aspects of support between PHSs. Main conditions for this variation are related to the PHS organization: its policy, internal support, capacity, and (long-term) allocated budget. Other key conditions are related to collaboration with partners: coordination, division of responsibilities, and communication structure. Prerequisites for all PHSs were cohesive adviser teams, the HSP, and national school health promotion focus. Conclusions In order to strengthen professional support for whole school health promotion implementation, it is essential to: 1) establish strong positioning and (long-term) resources in the organization, 2) establish clear coordination between Healthy School Advisers and partners supporting schools, 3) maintain cohesion among adviser teams, and 4) maintain and intensify national (school) health promotion policy. Key messages • Degree of professional support for whole school health promotion varies substantially. • Positioning in the organization and clear coordination among professionals are key in strengthening support.

Evaluation of a health promoting schools program in a school board in Nova Scotia, Canada

Epidemic increase in chronic non-communicable diseases (CNCDs) is resulting in immense challenges in developing countries such as South Africa. Previously misunderstood to affect only high-income countries, 80% deaths due to CNCDs occur in developing countries. This review article traces the path of health promotion in the Eastern Cape and South Africa while considering health promotion developments globally. An example is the HealthPromoting school initiative in 180 schools in the Eastern Cape Province based on the World Health Organization’s Health-Promoting School Initiative. Alma Ata’s holistic ‘health for all’ ideals, the WHO’s ‘Right to health’ along with South Africa’s Bill of Rights have remained important paper based progress. However partial implementation of certain policies and lack of implementation of most broad based health promotion is a major challenge in South Africa which has to be addressed urgently to reverse the advancing CNCD epidemic. Keeping healthy population healthy and training them to prevent CNCDs to the maximum possible extent is feasible by strategically focusing on Health promoting schools in South Africa. Community participation, women’s organizations and youth participation are critical in implementing Health promoting schools in South Africa while being supported by the intersect oral cooperation of key stakeholders in the Department of Health, Department of Education and community engagement services of Universities.

The health promotion action means, described by the 1986 Ottawa Charter, highlights the creation of supportive environments for health(1). Following this line of reasoning, several strategies have been adopted for implementing health promotion policies, including the Health Promoting School. In 1995, the Pan American Health Organization / Regional Office for the Americas of the World Health Organization (PAHO/WHO) officially launched the Regional Health Promoting School Initiative. Since then, all the countries in Latin America and the Caribbean have strengthened school health promotion actions, rethinking school health activities(2). To become a Health Promoting School, the institution must take a comprehensive view of human beings – especially children and adolescents – in their familiar, community and social environment. It must provide a healthy environment, building constructive and harmonious relationships and hence being able to awaken skills and attitudes within participants, fostering autonomy, creativity and participation of students and also the whole school community(3). Never before has so much been said about health and health promotion as today, i.e., there is a need for promoting health at school as an element for changing reality. The school plays an important political role within this context for being a place where ideology can be constructed, destroyed or perpetuated through the transmission of values and beliefs, besides being an environment that favors the development of health education actions. Childhood is the defining moment for the construction and solidification of habits and attitudes, hence the importance of school as an environment that enhances the development of a targeted, systematized and permanent work. “Through the Health Promoting School Initiative, school health has a chance to move forward and expand its conception and practices with a comprehensive and interdisciplinary view of the human being within a broader community, environmental and political context”(4:6). The Health Promoting School seeks to develop knowledge, skills and dexterity for self care and prevention of risk behaviors. In addition, it creates education strategies to awaken – through a critical and reflexive analysis – values, behaviors, social conditions and lifestyles, and contributes to the improvement of health and human development, helping to construct citizenship and democracy, strengthening solidarity, community spirit and human rights(3). According to the Pan American Health Organization, health promotion at school has three main components: general health education, creation of a healthsupportive environment and provision of healthcare services(4). If we are to promote health, we can rely on school as a partner in this journey; and if we are to develop health education actions at school, we must rely on teachers’ support and commitment. The teacher’s role at school is complex and deserves attention because he is a (trans)formative agent(3,4). The realization of health promotion projects at school is supported by the teacher who represents an important and fundamental link, being a multiplier of ideas who should, therefore, be trained to approach the concept of health recommended in the International Conferences, the VIII National Healthcare Conference, Healthcare Public Policies and the National Curriculum Parameters (PCN) (1), not only through the handling of information but also educational strategies needed for an integrated construction of knowledge. This current issue of the Brazilian Journal in Health Promotion (Revista Brasileira em Promoção da Saúde – RBPS) features an article on the importance of the creation of a healthy environment at school, especially when it occurs in a region with low socioeconomic status. The article shows that the creation of a healthy environment since preschool years – besides being important – has an impact on children’s lives. Simple actions such as recreational activities at school, provided they are continuous, reflect on a remarkable learning. The RBPS believes that promoting the qualification of teachers and healthcare professionals, through its pages, will serve as a cornerstone of the Health Promoting School in Brazil and an example for other countries to share this idea. doi:10.5020/18061230.2013.p307

ABSTRACTBackgroundSchool‐based health promotion programs can improve children's health outcomes. This study examined levels of implementation of health promotion by Areas of Action in health‐promoting schools (HPS) and non‐HPS in Israel.MethodsA cross‐sectional survey was conducted among principals from 637 of 771 Israeli elementary and middle schools (52% Jewish, 48% Arab). The questionnaire assessed school activities according to Action Areas and domains of the Ottawa Charter.ResultsHPS recognition rates were 64% in secular Jewish schools and 69% in Arab schools. Among non‐HPS schools, 54% (n = 164) reported health promotion activities. HPSs had higher activity levels than non‐HPSs in the domains of policy (M = 7.79 vs. 5.45), environment (7.78 vs. 6.85), health education (2.01 vs. 1.67), and staff training and empowerment (1.71 vs. 0.97), all p < 0.001. Community involvement was also higher (90.8% vs. 58.6%, χ2 (1) = 62.92, p < 0.001. In Jewish schools, a higher socioeconomic status (SES) correlated with increased activity (B = 0.13, β = 0.107, t = 2.38, p < 0.05). Among Arab schools, SES was not significantly related to most domains, except for staff training and community involvement, where associations were negative.Implications for School Health Policy, Practice, and EquityA comprehensive, equity‐oriented policy is needed to ensure equal opportunities for health promotion, particularly in underserved communities.ConclusionsStrengthening the implementation of the Ottawa Charter principles alongside formal recognition of HPSs is fundamental to advancing effective school health promotion.

Purpose: This study aims to investigate effectiveness in foreign Health Promoting School through a systematic review. Methods: To perform a systematic literature survey, the researcher searched two database (PubMed and Springer Link) for literature relevant to 'health promoting schools' (published up to April 2013 from 2004). The key words used for the search were effectiveness, evaluation and promoting five evaluations in this review were selected in the peer reviewed. Results: 1. The areas of standardized assessments were dealing with school health policy, physical environment, psycho social environment, community participation, Literacy on health, personal hygienic skills, academic achievement, self report ed health status, and mental health. 2. There was evi-dence that the health promoting school has some positive influence on various domains of assessment. Conclusion: This systematic review provides evidence concerning the effectiveness of the health promoting school.

We read with interest Straker et al ’s editorial1 arguing how a focus on leisure-time physical activity is socially biased, and that designing jobs with the right amount and nature...

Background: Iran, with the second youngest population in the Eastern Mediterranean Region, faces a high demand on health and education. The Iranian youth are at risk for common behavioral problems that may affect their present and future health. The Health Promoting School Initiative is a well-known international approach that addresses these risks. The Health-Promoting School Program was launched as a national initiative in Iran in 2003. Objectives: This article is the result of an evaluation study that evaluated the intermediate outcomes of this initiative. Materials and Methods: The study was a before-after single community intervention with cluster sampling in which 32 clusters were randomly selected from 215 health-promoting schools in 6 socioeconomically representative provinces of Iran. The calculated sample size was 1260 students from the first grade (grade 9) of secondary school. Educational approach was a mix of active education, peer education and life skills training which targeted 6 prime messages on risk behaviors. Results: We observed improvement in the students’ knowledge on sound definition of health, the cause of HIV/AIDS and the route of transmission, different risks and the places with high potential to encounter a risk, consequences of smoking and violence. Attitudes of the participants towards risk and protective behaviors, with the exception of better understanding of laws, improved with little difference between male and female participants. Conclusions: The Health Promoting School Program model in Iran can significantly improve knowledge and attitude of students regarding the prime messages that address risk behaviors. There is a need to revise the material to maximize the outcomes.

Background. The Health Promoting Schools Initiative can provide a platform to explore integration of oral health promotion activities within the broader context of healthcare delivery. Objectives. To understand the contextualised delivery of oral health service provision within Health Promoting Schools, to conduct a situational analysis of existing services provided at these schools and to review current health and education policies. Methods. The explorative study design used a mixed methods approach. Twenty-three schools of a total sample of 154 were selected using multistage cluster sampling. Data collection comprised policy reviews, a self-administered questionnaire, a data capture sheet and an interview schedule. The study was approved by the Humanities and Social Sciences Research Ethics Committee of the University of KwaZulu-Natal (HSS/0509/013D). Results. Although policies included statements on oral health promotion, this was not translated into practice at school level. Barriers and challenges identified for successful implementation of an oral health promotion programme included lack of funds, human resources, knowledge and ownership, as well as high workloads and time constraints. Conclusion. Current delivery of oral health promotion services within the Health Promoting Schools Initiative will not reap the desired oral health outcomes owing to the inherent mismatch between policy planning and implementation. More research needs to be conducted to address opportunities and challenges facing educators and other oral healthcare providers working in the school environment.

PurposeThis study examines the relationship of principals’ systems thinking (PST) to student outcomes of academic achievement and school violence. The investigation relies on the contingency theory, according to which effective leadership is contingent on the nature of the situational influences to which managers are exposed. Specifically, the study investigates the influence of school structure – bureaucratic vs organic – on the relationship between PST and student outcomes of academic achievement and school violence after accounting for students’ socioeconomic backgrounds and principals' demographics.Design/methodology/approachA three-source survey design with self-reported and non-self-reported data was used, with a sample of 423 participants from 71 elementary schools in Israel. The sample included senior management team members and teachers. The data were aggregated at the school level of analysis.FindingsHierarchical regression analyses showed that organic school structure moderates the relationship between PST and student academic achievement, and bureaucratic school structure moderates the relationship between PST and school violence beyond the impact of students’ socioeconomic backgrounds.Originality/valueThis study provides important evidence for the benefits of aligning PST with school structure for improving student outcomes beyond the impact of students’ socioeconomic backgrounds. In addition, the study suggests principal system thinking leadership to achieve effective student outcomes that circumvent the effects of inequality on disadvantaged student groups.

Relying on the social cognitive theory, which postulates that human behaviour is due to social experiences and cognitive interpretation, the current study seeks to investigate the mediating role of collective teacher efficacy (CTE) in the relationship between principals’ systems thinking (PST) and school effectiveness in terms of academic emphasis and student academic achievement after accounting for students’ socioeconomic backgrounds. A three-source survey design with self-report and non-self-report data was used, from a sample of 423 participants from 71 elementary schools in Israel. The sample included school management team (SMT) members and teachers who were not SMT members. Data were aggregated at the school level of analysis. The results from structural equation modelling and bootstrapping analysis indicated that CTE partially mediates the relationship between PST and academic emphasis, irrespective of the students’ socioeconomic backgrounds. Theoretical and practical implications are discussed.

Purpose Evidence supports meaningful student engagement in Health-Promoting Schools (HPS) approaches as an essential condition for enhancing student well-being, yet little is known about this process. This study sought to interpret the process of student engagement in HPS through the perspectives of Youth Engagement Coordinators (YECs). Design/methodology/approach This qualitative exploratory study took place in Nova Scotia, Canada where HPS has been implemented since 2005. YECs (n = 6), recruited into positions to support student engagement in HPS, participated in the study. A transformative paradigm and generative co-design process guided the work. In a one-day co-design workshop, YECs collaborated with the research team to collect, analyze and interpret their data. YECs were engaged in a focus group, participatory mapping process and a theming exercise. Following the workshop, reflexive thematic analysis was conducted by the lead researcher through a reflection meeting with participating YECs. Findings Five themes were developed: Embodying a youth-engaged position – the necessary values and beliefs guiding YEC practice, discovering the layers of the school environment – understanding the history, ethos and culture of the setting; building trust within the school community – gaining acceptance through relations, role and reliability; creating a space for exploration on health – expanding the social and physical boundaries to learn and define health; and enacting principles of equity – acknowledging youth voice and disrupting power dynamics. Originality/value This research contributes to the continued development, implementation and evaluation of meaningful student engagement in HPS.