School Health Promotion Research Articles

The need for health-promoting school attendance efforts in a Norwegian context

Abstract Issue/problem There has been an increase in mental health issues among young people in Norway in recent years, as in other European countries. This seems to result in more school anxiety and school absence across different school contexts. To meet this challenge, health promotion theory has been applied to develop practices facilitating mastering and empowerment in school. Description of the problem The objective of the project has been to develop health promoting principles and practices that support students to thrive and learn in school. Six primary schools, two lower secondary schools, one upper secondary school and five adult learning centres have participated in workshops and discussions for a period of a year. The questions that this project aims to answer are: 1) How can teachers facilitate health promotion in school? 2) How can health promoting practices support school attendance? Results The following principles for health promotion in schools were developed: 1) acknowledging by seeing the whole person, 2) trusting each individual, 3) respecting by creating tolerance for differences, 4) facilitating mastery and achievement, 5) facilitating participation by letting students develop ownership to solutions, 6) creating safety through clear and predictable frameworks, 7) facilitating motivation through engagement, 8) building relations by meeting students where they are, 9) promoting significant values. Lessons Based on the operationalisation of health promotion in this project, it is recommended that school employees promote and facilitate acknowledgement, trust, respect, mastery, participation, safety, motivation, relations, and values. The health promoting principles developed may easily be transferred to other educational contexts with similar challenges. Key messages • It is important to create an acknowledging and respectful learning environment to facilitate health promotion in schools. • To support school attendance, the environment needs to be supportive of student participation and empowerment.

Exploring the policy context of Whole School in eight EU countries: the Schools4Health project

Abstract Background Moving from the recognition of WHO principles of health promoting school (HPS) to concrete practices is challenging. The Schools4Health project is an EU initiative with the aim to introduce, strengthen, and sustain the adoption of a participatory whole-school approach to health and wellbeing. The aim of this work is to present an update about the policy environment around HPS approaches in eight EU countries. Methods Between September-November 2023, Schools4Health partners from Spain, Belgium, Hungary, Greece, Latvia, the Netherlands, Romania and Slovenia carried out a preliminary scoping exercise to investigate the policy conditions which can influence the national uptake of HPS approaches. A three-step methodology was developed: a. identification of core stakeholders b. Rapid Situation Analysis survey and c. national roundtable meetings, to assess stakeholders’ awareness of and engagement in health promotion programs in schools. Results In total, n = 192 responses from stakeholders from health, education, social and agricultural sectors were selected. Most experts were aware or partly aware of the HPS concept. While there is consensus that health promotion at school is essential, there is a lack of, or weak implementation of legislation and voluntary initiatives due to barriers such as limited time and financial resources, teachers burnout and insufficient interaction between education and health governmental bodies. Conclusions Effective advocacy can highlight the potential of HPS in addressing the urgent challenges related to wellbeing in youth, and the associated decline in educational performance across Europe. Policymakers, public authorities and the broader community should also be engaged. Key messages • Creating HPSs should not solely fall on schools and teaching staff. • Policymakers, public authorities and the broader community around schools have responsibility to ensure that policy measures and instruments embed the key considerations for HPS approach.

Visualizing patterns of factors influencing school health promotion implementation

Abstract Background The school setting offers a special opportunity for health-promotion (HP) interventions, as children spend 1/3 of their daily time there. Yet, implementing HP remains challenging due to the complexity of schools and unique contextual factors influencing implementation. While common influencing factors have been described, the aim of this study is to explore how influencing factors co-occur within and vary across schools, forming potential patterns of barriers and facilitators. Methods As part of a school HP program involving 258 institutions across Germany, nine schools were selected using maximum heterogeneity sampling for in-depth interviews on influencing factors by employing the Consolidated Framework for Implementation Research (CFIR). The interviews were transcribed verbatim and analyzed deductively using the CFIR as category system. Identified influencing factors were quantified [-5; +5] whether being a major barrier (-5) or a major facilitator (+5). To visualize potential patterns, a matrix heat map (MHM) displaying all influencing factors across all schools was created. Preliminary results Influencing factors in almost all CFIR categories were identified and all schools reported factors as barriers, such as parental engagement or (in)sufficient time. From the MHM, patterns of influencing factors, co-occurring within and differing across schools, emerged. For instance, some schools found the physical environment to be a barrier, while others considered it a facilitator, often in conjunction with financing as another facilitator. Conclusions Qualitative analysis and visualization of results with a MHM served as a way to navigate the complexity of the school setting and to highlight patterns of factors influencing implementation. Understanding these patterns can enhance tailoring implementation strategies, thereby improve implementation of school HP interventions and, ultimately, foster child health outcomes. Key messages • Influencing factors for school HP implementation manifest in varied patterns of barriers and facilitators across schools, which has implications for tailoring implementation strategies. • Using qualitative analysis guided by the CFIR and a MHM for visualization can aid in navigating the complexity of schools.

Health-promoting school. Mediation effects on health behaviors and the socio-economic level of pupils

Abstract Pupils health indicators and behaviors are marked by social and territorial inequalities which develop early (DREES, 2015, 2019). In order to combat these inequalities and improve the health behaviors and well-being of pupils, the “health-promoting school” approach is recognized as convincing. It is endorsed by the World Health Organization (Langford, 2015; WHO, 2021). The health policy currently implemented in French schools is convergent (MEN, 2018, 2021). In order to disseminate this policy, since 2019, the Alliance project has been implemented in 101 French schools (9 - 12 years old) and 97 municipalities in the AURA region. Each school and community are trained and supported to promote the development of professional practices and a health promotion project to improve the health behaviors of pupils. The question arises as to the extent to which the development of health-promoting teaching projects and practices participating in the strengthening of health protective factors - life skills and health literacy - of pupils would have a mediating effect from the point of view of socio-economic level and health behaviors of pupils? Each year, data are collected from pupils by questionnaire, mesuring their well-being, health habits, psychosocial competencies and their families’ socio-economic level. 11500 questionnaires collected during 3 years have been analyzed. Descriptive and bivariate analysis indicate sevreral improvements between years in their health habits like for example daily physical activities (6% for T0 and 16% for T2) or daily consumption of sweets (17% for T0 and 13% for T2). They confirm negative influence of risk factors as low socio-economic level on health habits. But mediation analysis show that psychosocial competencies, especially emotionnal and social competencies, mediate significatively this influence (mediation effect range from 5% to 21%). Key messages • The health indicators and behaviors of young people are marked very early on by social and territorial health inequalities. • Health-promoting school approach and particularly – life skills and health literacy – would have a mediation effect on health behaviors and the socio-economic level of students.

Implementation of organizational health literacy depending on school characteristics in Germany

Abstract Background Children and adolescents are important target groups for health promotion measures to sustain a healthy upbringing. Organizational health literacy in schools is a promising environmental intervention to strengthen health literacy in school children. This study examines the relationship between school characteristics and the implementation of organizational health literacy. Methods School principals in Germany were invited to complete a 20-minute online survey between November 2022 and July 2023. An 8-item self-report tool was used to measure organizational health literacy in schools (OHLS-Q-SF) that comprehends eight different areas within schools to become health literate. A hierarchical cluster analysis was carried out to identify groups according to the composition of the socioeconomic status of the student body. Descriptive statistics, Mann-Whitney-U tests, and Kruskal-Wallis tests were performed. Results 598 school principals (73.6% female, Ø 52.3 years old) who worked at primary schools (49.1%), secondary schools (37%), and special education schools (13.9%) completed the survey. Cluster analysis revealed two groups. The first one (36.8%) contains schools with mainly students with lower socioeconomic status, and the second group (63.2%) contains schools with more students from middle or higher socioeconomic status. The socioeconomic status of students within the schools showed no significant results for any area of organizational health literacy, whereas all eight areas are more likely implemented if the schools already participate in a school health promotion program or network (p < 0.001). Conclusions Participating in a school health promotion program was associated with higher levels of implementation in all areas of organizational health literacy in schools. This finding highlights the importance of those programs. Integrating organizational health literacy into those interventions can be a beneficial approach to sustaining health literate schools. Key messages • Participating in a school health promotion program or network might facilitate schools to become health literate organizations. • In Germany, the socioeconomic status of the students within the schools is not associated with the implementation of organizational health literacy.

Mental health of Finnish cis- and transgender youth before, during and after the COVID-19 pandemic

Abstract Background Transgender youth report more mental health problems than their cisgender peers, but little is known about their mental health during and after the COVID-19 pandemic. We studied symptoms of anxiety and depression among cis- and transgender youth before, during, and after the pandemic using large nationwide samples. Methods Data from the Finnish School Health Promotion survey from years 2019, 2021 and 2023 (461,249 students in total; mean age 15.7, SD 1.3) were used. Self-reports covered official gender, gender identity, symptoms of anxiety (Generalized Anxiety Disorder Scale-7 ≥10) and depression (Patient Health Questionnaire-2 ≥3). Categories of cisgender boy (officially boy; gender identity boy; N = 214,423), transfeminine youth (officially boy; gender identity girl, both, neither, or it varies; N = 5,069), cisgender girl (officially girl; gender identity girl; N = 224,753), and transmasculine youth (officially girl; gender identity boy, both, neither, or it varies; N = 14,508) were formed. Results In all timepoints, proportion of those with anxiety or depression was higher among transfeminine youth compared with cisgender boys and among transmasculine youth compared with cisgender girls. In all groups anxiety and depression increased significantly from 2019 to 2021 (ORs 1.4-1.8, p < 0.0001), with no significant differences in these changes between cis- and transgender groups. From 2021 to 2023, anxiety (OR 0.91, p = 0.015) and depression (OR 0.77, p < 0.0001) decreased among transmasculine youth but increased among cisgender girls (ORs 1.11 [p < 0.0001] and 1.07 [p < 0.0001], interactions p < 0.0001). Among transfeminine youth, generalized anxiety symptoms decreased from 2021 to 2023, whereas they remained at the level observed in 2021 among cisgender boys (interaction p = 0.0025). Conclusions In Spring 2023, we found still increasing mental health problems among cisgender girls, while among transgender youth the post-pandemic developments were more positive. Key messages • Post-pandemic, we found further increases in mental health symptoms in cisgender youth, while among transgender youth the development seemed more promising. • Transgender youth experience more anxiety and depression than their cisgender peers, thus gender diversity deserves still more attention in educational, social, and health care services.

Changes in anxiety among youth with and without disabilities before, during and after the pandemic

Abstract Background Disabled youth are a vulnerable group that have faced challenges during the pandemic. Research about mental health and its changes of disabled youth during and after the pandemic is limited. Thus, this study examined changes in anxiety symptoms among youth with disabilities compared to those without disabilities before, during, and after the pandemic. Methods We analyzed population-based cross-sectional data from the Finnish School Health Promotion study (SHP) of youths with an age range of 12-29 years obtained in before (2019; n = 155,166), during (2021; n = 160,796), and after (2023; n = 151,224) the pandemic. Disabled youth were identified based on the Child Functioning Module (CFM). Anxiety symptoms were measured using the Generalized Anxiety Disorder-7 (GAD-7). Logistic regression models were applied to investigate population-level changes in anxiety. Results Over the years, the prevalence of anxiety symptoms was higher among youth with disabilities (10.2%, CI95% 10.1-10.4) compared to youth without disabilities (40.1%, 39.9-40.4), females having more symptoms than males. Prevalence of anxiety increased significantly during the pandemic (Before: 31.7% 95%CI 31.2-32.3 & During: 41.8%, 41.4-42.3) and continued to increase slightly after (44.4%, 43.9-44.9) among disabled youth. The same trend was seen in non-disabled youth (Before: 7.5%, 7.4-7.7, During: 11.4%, 11.2-11.6 & After: 12.0%, 11.8-12.2). Conclusions The prevalence of anxiety among disabled youth increased during the pandemic and has continued to increase even afterward, highlighting the inequality among youth with disabilities. The results indicate that it is important for educators and stakeholders to target measures and resources to support the mental health of youth with disabilities during and after a crisis, improving their equality in schools and society. Key messages • Youth with disabilities experienced anxiety symptoms four times more often than non-disabled youth, and this difference has remained quite stable during the pandemic and afterwards. • Decision-makers should be aware of this weaker mental health condition of youth with disabilities while planning preventive actions and interventions.

Trends in the association between alcohol use and generalized anxiety in Finnish adolescents

Abstract Background During the past two decades, alcohol use has decreased among adolescents, but on the contrary, anxiety symptoms have increased (at least among females). These diverging trends set interesting opportunities to examine whether the strength of the well-known correlation/co-occurrence between alcohol use and anxiety has also changed. This study aims to examine changes in the co-occurrence and associations between heavy episodic drinking (HED) and generalized anxiety among adolescents in Finland from 2013 to 2023. Methods Data from the Finnish School Health Promotion Study between 2013-2023 covered 874 110 participants aged 13-20. Generalized anxiety was measured using Generalized Anxiety Disorder Scale (GAD-7) (range 0-21), and heavy episodic drinking was measured as reported heavy drunkenness once a month or more often versus less than once a month. Yearly prevalence estimates of co-occurrence were analyzed for those with moderate to severe anxiety symptoms (>10) and monthly or more frequent HED. Associations between anxiety and HED were analyzed using logistic regression and time-varying effect modelling. Interactions between time and anxiety predicting HED were also considered. Results The moderate to severe anxiety symptoms increased from 10.7% to 20.9% and HED decreased from 18.0% to 11.8% between 2013 and 2023. The proportion of those with both HED and moderate to severe anxiety increased from 2.9% in 2013 to 3.6% in 2023. The association between anxiety symptoms and HED was stable during the study period, with odds ratios ranging between 1.06 and 1.07. Conclusions During the past decade, diverging trends in generalized anxiety symptoms and heavy episodic drinking have not changed the association between them. The proportion of adolescents with these co-occurring health concerns has increased in females. This calls for continuous efforts to strengthen the integration of mental health and substance use prevention and services. Key messages • The association between generalized anxiety and heavy episodic drinking has not changed in adolescents in Finland between 2013 and 2023. • The proportion of those with both moderate to severe anxiety symptoms and heavy episodic drinking has increased in females and remained stable in males during the past decade (2.9% - 3.6%).

The Association between Organizational Factors of Health Promoting Schools and Teachers' Health Lifestyles: A Multilevel Analysis.

Schools are both learning environments for students and workplaces for faculty. Recognizing the role of organizational factors in staff health in school environments, the study aimed to explore which factors, including transformational leadership, teachers' perceived management support and HPS accreditation awards, were most associated with promoting a healthy lifestyle for teachers. A cross-sectional study was undertaken of 137 elementary schools in 2014, involving 433 directors and 2090 teachers. Data were collected using an anonymous structured questionnaire. Hierarchical linear modeling was used to analyze both teacher- and school-level factors associated with health-promoting lifestyles. There was a significant positive correlation between teachers' overall health-promoting lifestyle profile (HPLP-II) scores and both perceived management support (coefficient = .98, p < .001) and transformational leadership (coefficient = .38, p = .039). All 6 HPLP-II subscales also showed significant positive correlations with perceived management support (coefficients .12-.24, p < .001). Supporting a healthy working atmosphere and strong principal transformational leadership are keys to enhancing teachers' health-promoting lifestyles. Future research could explore how transformational leadership and management support influence teachers' health behaviors and identify effective strategies and interventions.

Interventions for Preventing Tobacco Uptake among Adolescents within School Setting in South-East Asia region: A Systematic Review

Abstract Background Tobacco users disproportionately reside in lower-and-middle income countries, with many people beginning consumption of tobacco in adolescence. Countries employ interventions in schools as a means of providing health education thereby creating mass awareness among them. However, research has mostly restricted to developed nations. Objective To examine the impact of interventions implemented in preventing tobacco uptake among adolescents in school setting in South-East Asia region. Method The protocol was registered prospectively on PROSPERO (CRD42022337341). Systematic search was conducted on 6 databases: PubMed, Embase, Scopus, CINAHL, ProQuest and Web of Science. Randomized Control Trials (RCT) and Cluster RCT conducted in school set-up in South-East Asia among adolescents below 18 years’ age were included. Articles between timeline 2002–2022 were considered. Results From a total of 963 articles, total of 13 studies were included. Four were RCT, while nine were Cluster RCT. Most of the studies were targeted at change in prevalence, followed change in knowledge and attitude towards tobacco and impact on susceptibility to use tobacco. Nine studies had interventions based on Health Promoting School Framework, three were Peer-led Interventions and one was Counsellor-centred Intervention. Risk of Bias assessment revealed eight studies had low risk of bias, two had some concerns while three were high risk studies. Conclusion Interventions that focus on building a holistic environment and go beyond the usual classroom environment have primarily been implemented and found to be effective in this region. There is a need for strong, high-quality RCT studies with standardised evaluation techniques to combat tobacco use among adolescents.

Teachers' and Principals' Familiarity with School Wellness Policy: A Health Promoting Schools Assessment.

The current study explored teacher and principal familiarity with school wellness polices in primary schools, including who serves on school wellness committees, and who should implement and enforce wellness policies in the school. An electronic survey guided by the Health Promoting Schools framework was administered from February to May 2020 to teachers and principals from one urban and one suburban school district in the Midwestern United States. There were 450 participants; response rates were 28% (urban), 33% (suburban), and 51% (school principals). Only 41.7% of the aggregate participant pool were familiar with their wellness policy. Participants were more familiar in the suburban compared to the urban district (χ2 = 68.2, p-value ≤ 0.001). Teachers/health teachers, nurses, and principals were most likely to be on wellness committees, and the most preferred wellness champions were teachers, nurses, and food service staff. Teachers and nurses are integral to school wellness and health education as part of multiple systems that can promote school health. The Health Promoting Schools framework is useful for guiding examinations to improve understanding of school wellness within school communities.

The Impact of School-Based Caries Prevention Programs on DMFT Scores and Oral Health Behaviors in School Children

Oral health promotion is recognized as one of the fundamental components of health-promoting schools. However, few studies have demonstrated the efficacy of supportive school environments for school children’s Oral health. This systematic review evaluates the impact of school-based caries prevention programs on DMFT scores and Oral health behaviours in school children. Objective: To evaluate the impact of school-based caries prevention programs on DMFT Scores and Oral Health Behaviors in school children. Methods: Databases like PubMed, Google Scholar, Cochrane Library, Springer, and Science Direct were searched from January 2009 to February 2024. Prisma guidelines were followed; 1, 950 studies were identified on the first search, titles, and abstracts of 500 papers were screened, 500 full-text papers were screened for eligibility, and 25 studies meeting the inclusion criteria were evaluated, relevant information was extracted, and a systematic review was conducted. Twenty-five studies were included in the systematic review. Results: These results indicate the significant role of SCPP among school-going children. Children with school-based caries prevention programs compared to those with no school-based caries prevention programs showed improved DMFT scores, reduced caries increment, healthy oral health behaviours, consistent Oral health hygienic habits, frequent use of flossing, fluoride toothpaste and mouth rinsing, and increased caries prevention knowledge. Conclusions: It was concluded that based on the pooled results, school-based caries prevention programs provide better, easily accessible, and sustainable caries prevention activities to school children to improve DMFT scores and Oral health behaviours.

Exploring the feasibility of using Participatory Action Research (PAR) as a mechanism for school culture change to improve mental health

ABSTRACT Adolescence is a key time to prevent or reduce poor mental health outcomes. Supportive school environments play an important role in this, and the concept of health-promoting schools have been supported globally. Participatory action research (PAR) combines theory, practice, action, and reflection by developing practical solutions to address concerns and issues within communities. Running four PAR groups across three secondary schools, we explored the feasibility of using the approach as a mechanism for bringing about culture change and improving mental health. We undertook interviews and focus groups with students (n = 24), school staff (n = 11), facilitators (n = 3), and parents/carers (n = 2). Findings are organised under five key headings: 1) Establishing PAR groups, and the PAR cycle; 2) PAR group impact; 3) Facilitators of PAR success; 4) Barriers to PAR success; 5) Future recommendations. This study demonstrated the feasibility of PAR as a tool to improve school culture. Students participating in PAR were engaged, passionate, and motivated to influence and transform school culture to improve mental health. Future research should aim to trial the PAR approach on a larger scale, to determine whether the barriers and facilitators of PAR success identified here are relevant and transferable to schools in other contexts, and to measure the impact of such initiatives on mental health outcomes.

Factors contributing to the development of health-promoting schools, applying Fullan’s triple change model – A qualitative study

Objective: Schools and the education system are powerful tools for cultivating healthy lifestyles. This research focuses on characterising the factors contributing to the development of health-promoting schools in Israel, and understanding how schools can offer a framework for improving students’ health. Fullan’s triple change model with its focus on three phases in the change process in schools – the initiation phase, the implementation phase and the institutionalisation phase – served as a framework for analysis. Design and setting: This qualitative-constructivist study involved the analysis of data collected from 26 elementary school principals in Israel, 15 of whom belonged to the health promotion school network (HPSN) and 11 who did not. In addition, 10 health promotion leaders from within the schools were interviewed. Methods: Data collection took place by means of semi-structured interviews. in which the questions asked referred to the three phases identified in Fullan’s process of change model. We analysed the data using thematic content analysis. Results: Each identified theme was associated with one of the phases proposed in Fullan’s model of change. The initiation phase included collaboration with key stakeholders, principals’ personal commitment, and dissemination of ideas through personal connections. The implementation phase included gaining access to appropriate tools and materials, action to deal with barriers to change, and the creation of a holistic health promotion environment. The institutionalisation phase included the development of administrative strategies such as adherence to routines, the inclusion of regular events in the school calendar, and the allocation of time frames for the activities undertaken. Conclusion: Fullan’s model proved useful in analysing efforts to develop health-promoting schools. The model signalled the importance of using a structured approach throughout the institutionalisation phase in a manner attuned to the unique nature of the school. Alongside identifying key factors that support assimilation, it is crucial to assess their integration into the school culture. The school principal’s role is critical throughout all the phases of the development process.

Trends in the Co-occurrence and Association Between Heavy Episodic Drinking and Generalized Anxiety Among Adolescents Between 2013 and 2023 in Finland

AbstractThe diverging trends of decreasing alcohol use and increasing anxiety symptoms among adolescents raise a question, has the strength of the well-known association between these issues also changed. This study examined changes in the co-occurrence and associations between heavy episodic drinking (HED) and generalized anxiety (GA) among Finnish adolescents between 2013 and 2023. From the repeated cross-sectional Finnish School Health Promotion Study (N = 874 110, age 13–20 years) we estimated self-reported GA symptoms and HED. The proportion of those with both HED and moderate to severe GA increased from 2.9% in 2013 to 3.6% in 2023, indicating a 21.5% relative difference. The association between GA symptoms and HED was stable during the study period (ORs 1.06–1.07). Although the association has been stable, there has been a rise in the proportion of adolescents experiencing both conditions concurrently over the past decade. This calls for strengthening the integration of mental health and substance use prevention and services.

The methodology of health education programs in schools—Qualitative study

ObjectiveTo assess strengths and weaknesses of the methodology of health education programs, carried out in the period 2010–2020, in schools in Serbia. DesignQualitative study, a thematic analysis approach. SiteRepresentatives of Public Health institutions, Serbian biggest nongovernmental organization, Youth organization, Ministry of education and municipality. ParticipantsNine professionals working in the field of Public Health and Health education. MethodFocus group gathered nine health and non-health professionals in 2022 year. Focus group was recorded, transcribed verbatim, coded and analyzed by three research team members. A coding template evolved through the analysis, providing the expansion of key concepts. Themes were, one by one, extracted, encoded, classified as the smallest units and interpretive, thematic analysis was applied. ResultsAlthough the Focus group in our study identified among other advantages, support of Health sector to Educational sector as crucial, it emphasized as well following weaknesses: Analyzed health education programs were implemented insufficiently as a separate process in schools, did not have the image of programs shared and integrated into community; Health education needs of schoolchildren, parents, and teachers should be examined prior the education implementation; Well-educated interdisciplinary educators have to be strengthened and supported; Parents participation is necessity; Standards and good practice guidelines are needed, and those developed through Health Promoting Schools program could be practiced. ConclusionIt is necessary to support cross-curricular competence, where health education should be integrated into all school subjects, and should go far beyond the school, grow into a culture of community life, which will interconnect all stakeholders in strong Public Health network.

Developing Self-Management in Type 1 Diabetes at Secondary Schools: Who Is Responsible? A Qualitative Study.

Occupational therapists have the proven capacity to improve outcomes for young adults who are self-managing Type 1 diabetes (T1D). There is insufficient understanding of adolescents' experiences of developing responsibility for diabetes self-management (DSM). To investigate adolescents' perceptions of sharing responsibility for T1D management at school. This study had a descriptive qualitative design and used semistructured interviews and thematic analysis. It is the second phase of a mixed-methods study with a sequential explanatory design that investigated mechanisms of responsibility-sharing at school. Secondary school in Australia. Purposive sample of adolescents (age 15-16 yr) with T1D (N = 11). Adolescents approached the complex occupation of school-based DSM primarily in partnership with their parents, with each adolescent having unique responsibilities while sharing others. Health care professionals and teachers reportedly had minimal involvement. Adolescents described owning most DSM tasks, with their perceptions of building independence limiting the sharing of this responsibility. A heightened sense of risk meant that adolescents were likely to communicate with others in cases of errant blood glucose readings. Current processes commonly resulted in reduced school participation. Adolescents valued working responsively and interdependently with their parents to manage T1D at school, which aligns with the occupational therapy model of co-occupation. Effective responsibility-sharing depends on clear, frequent, autonomy-supportive, team-based communications. Our results showed that patterns of communication for determining school-based DSM processes were fragmented and risk focused, with limited adolescent involvement, resulting in strategies that led to students at times being excluded from school activities. Plain-Language Summary: This is the first study to use an occupational lens to examine the way in which adolescents share their responsibility for diabetes care at school. Diabetes self-management in secondary schools occurs more often when adolescents work interdependently with their parents to manage their diabetes. Adolescent involvement in formal school processes and a clearer allocation of team roles and responsibilities would better support health-promoting habits and school participation.

COVID-19 school closures in Latin America: untangling approaches impacting student health and wellbeing

PurposeThis study compared approaches to school closures in four Latin American countries (Bolivia, Colombia, Ecuador, Peru), describing the impact on the health and educational wellbeing of school-age children and youth, and evaluating their approaches in regard to continuing education through the pandemic.Design/methodology/approachWe collected 75 publicly available documents including scientific and gray literature (government documents and news releases), that referred to school closures and their impact on children’s health and wellbeing. We did thematic analyses using open, axial, and selective coding and applied the latest Health Promoting Schools standards and indicators to the findings.FindingsResults showed that countries followed epidemiological reasons for prioritizing school closures while adopting some policies that abide by Health Promoting School principles. While they emphasized the need to reopen schools so that instruction could continue, school closures were among the longest in the world. The most significant impacts on wellbeing identified in the four countries were related to food security and mental health.Research limitations/implicationsThis study focused on a particular set of documents, and it may not capture the full spectrum of relevant information in different contexts or regions.Practical implicationsBy comparing school closures approaches among four Latin American countries, this study highlights the importance of context-specific interventions. In a post-pandemic era, lessons learned from these experiences should help foster more resilient and inclusive educational systems and explore the paths forward for following the new Health Promoting Schools framework in the region.Originality/valueCross-country qualitative analyses on this topic are rare. This study adds to the knowledge base by eliciting lessons for future health education research and policy efforts.

The school community's role in addressing vaping: Findings from qualitative research to inform pedagogy, practice and policy.

E-cigarettes are a significant concern in schools due to their rising use by adolescents. This research aimed to identify current and preferred intervention strategies to respond to vaping in the Western Australian school setting. Interviews and focus groups were held with 15 school professionals (leaders, teachers and nurses), parents (n = 12) and students aged 13-17 years (n = 32). Discussions were transcribed verbatim, anonymised and thematically analysed using a deductive approach aligned to the Health Promoting Schools Framework. Participants suggested that limited and varied attention has been directed towards policy in response to vaping in the school setting. Teaching and learning opportunities existed for students, parents and school professionals, albeit somewhat ad hoc in their approach. Additional training would benefit the whole-school community (students, parents and staff) to raise awareness of e-cigarette harms, increase knowledge and build skills in responding to student vaping. Clearly articulated policies are needed to guide school strategies and actions towards vaping. There needs to be a dedicated, developmentally appropriate, cross-subject vaping curriculum for students that incorporates mental health outcomes and social skills reinforcement; professional development for school staff; awareness of and access to school-based health services for help and information; visual cues to de-normalise vaping and parent and community involvement to support vape-free school environments. SO WHAT?: Comprehensive prevention activities are required to reduce the uptake of vaping among adolescents. Building students', school professionals' and parents' awareness of vaping and strategies to prevent use will contribute to de-normalising and reducing this practice among adolescents.

Implementation of the Health Promoting School Approach in Europe: A Cross-Sectional Study Among National Representatives.

Although principles of the health promoting school (HPS) approach are followed worldwide, differences between countries in the implementation are reported. The aim of the current study was (1) to examine the implementation of the HPS approach in European countries in terms of different implementation indicators, that is, percentage of schools implementing the HPS approach, implementation of core components, and positioning on so-called HPS-related spectra, (2) to explore patterns of consistency between the implementation indicators across countries, and (3) to examine perceived barriers and facilitators to the implementation of the HPS approach across countries. This study analyzed data from a survey that was part of the Schools for Health in Europe network's Monitoring Task 2020. The survey was completed by HPS representatives of 24 network member countries. Large variations exist in (the influencing factors for) the implementation of the HPS approach in European countries. Observed patterns show that countries with higher percentages of schools implementing the HPS approach also score higher on the implementation of the core components and, in terms of spectra, more toward implementing multiple HPS core components, add-in strategies, action-oriented research and national-level driven dissemination. In each country a unique mix of barriers and facilitators was observed. Countries committed to implementing the HPS approach in as many schools as possible also seem to pay attention to the quality of implementation. For a complete and accurate measurement of implementation, the use of multiple implementation indicators is desirable.