School Health Research Articles

Addressing access to greenspace and health inequalities in England: policy content analysis and systematic literature review

BackgroundCompelling evidence highlights a relationship between greenspace access and mental and physical health. Deprived areas often have limited greenspace, reducing opportunities for communities to benefit. This study systematically reviews evidence on access to greenspace and health inequalities in England, and analyses local authority greenspace strategies to assess how they address local health needs. MethodsA systematic literature review of 47 studies examined the relationship between access (presence, proximity) to greenspace and health inequalities in England. We searched four databases (MEDLINE, Embase, Web of Science, PyschINFO) for observational articles published between 1992–2021. Included studies were from England, reporting access measures, physical or mental health outcomes, and inequality dimensions such as age and deprivation. Due to methodological differences, we conducted a narrative synthesis and assessed article quality. Additionally, we analysed publicly available local authority greenspace strategies in England published between 2012–2024, sourced from OHID regional teams. A content analysis was performed extracting data on health policy and outcomes, demographics, inequalities, environmental change, monitoring and evaluation. FindingsThe systematic review found mixed evidence on the relationship between greenspace access and health inequalities. Higher greenspace coverage in deprived areas was linked to reduced mortality risk, while improved mental health was associated with increased access among men and those with lower education. Despite proximity to parks, residents in deprived areas reported poor greenspace access. The policy analysis revealed half of local authorities lack a greenspace strategy. Most recognise greenspace as important for physical health, and increasingly reference mental health, though few consider how green infrastructure improvements could address local inequalities. InterpretationThis study highlights the benefits of improved access to green space for physical and mental health, particularly for deprived populations. Local authorities can utilise green space strategies to address local health needs and national government should strategically incorporate greenspace access in planning policy to tackle health inequalities. FundingThis study was funded by the following NIHR Health Protection Research Units (HPRU) in partnership with UK Health Security Agency (UKHSA): the Environmental Change and Health HPRU at London School of Health and Tropical Medicine and University College London (HPRU ECH), (Grant number: NIHR200909). The funding source had no role in review design, the collection, analysis and interpretation of data, the writing of the article or the decision to submit it for publication.

Interventions and facilitators to increase HPV vaccination uptake among migrants: a systematic review

BackgroundSome migrants in the UK are under-immunised, including for the human papillomavirus (HPV) vaccine. We did a systematic review to understand factors influencing HPV vaccine uptake among migrants to generate transferable lessons for the UK. MethodsWe searched seven databases (2006–2023) without country or language restrictions. After screening titles, abstracts, and full-texts, we extracted data and mapped them onto the WHO-endorsed Behavioural and Social Driver of Vaccination Framework (BeSD). We performed thematic analysis for qualitative data, frequency counts for all data, and a qualitative synthesis. We assessed risk of bias using JBI's Critical Appraisal tools and ensured independent researcher triangulation throughout the review. FindingsWe included 102 studies (4% from the UK). Doctors’ recommendations and information from providers/peers were influential, depending on communication methods and ethnic/gender/cultural-linguistic concordance. Interventions such as school-based schemes and free-of-charge services led to increased uptake. UK studies highlighted culturally-rooted misconceptions and strong ‘father over mother’ power dynamics in African parents. The majority of studies (n=73) showed low-risk bias and only four studies indicated high-risk bias. InterpretationA multi-faceted strategy, including culturally appropriate messages involving fathers, strong doctor recommendations, and peer school health promoters, may increase HPV vaccine uptake among migrants in the UK. FundingNone.

Factors associated with the dietary patterns of Brazilian adolescents: analysis of the National Survey of School Health

ObjectivesTo identify the dietary patterns of Brazilian adolescents and to verify their associated factors. MethodsCross-sectional study with data from the 2019 National Survey of School Health. Students aged 13 to 17 participated in the survey, totaling a sample of 125,123 adolescents. The variables were divided into two groups: healthy and unhealthy diet. Principal component analysis was used to identify the dietary patterns. To evaluate the association, logistic regression was used, estimated by the Odds Ratio, with the respective 95 % confidence intervals. ResultsTwo main components were identified: first related to regular consumption of fruits, vegetables, and beans; the second related to non-regular consumption of sweet treats, soft drinks, and fast food. The highest likelihood of regularly consuming the first was observed among adolescents residing in the Central-West and Southeast regions, with higher maternal education, who abstained from alcohol, engaged in physical activity, were not sedentary, ate breakfast, had lunch or dinner with their parents, refrained from eating while engaging in other activities, and participated in school meal programs. The lowest likelihood of not regularly consuming the second was found among male adolescents aged 16 to 17, attending public schools, who abstained from alcohol, and were not sedentary. ConclusionsThis study identified two dietary patterns, both linked to socioeconomic factors and healthy lifestyle habits. Recognizing these patterns among adolescents enables health surveillance efforts aimed at reducing diseases and health problems.

Perception and acceptability towards HPV vaccination among mothers of adolescent girls employed in health care sector-a cross sectional study

BackgroundRaising awareness among parents of adolescent girls and addressing misconceptions is crucial to overcoming HPV vaccine hesitancy and ensuring the success of vaccination programs, ultimately reducing the burden of cervical cancer. ObjectiveTo assess perceptions of HPV infection and identify factors influencing the acceptability of the HPV vaccine among female healthcare staff with at least one adolescent daughter. MethodsFemale healthcare staff with at least one unmarried adolescent daughter were interviewed using a pre-tested semi-structured questionnaire after obtaining written informed consent. Participants without prior knowledge were provided information before questions on vaccine willingness were asked. Data analysis was conducted using SPSS, with categorical variables presented as proportions and Chi-square tests applied at a 5 % significance level. ResultsA total of 102 female staff members were interviewed. While 76 % had heard of cervical cancer, only 32.4 % were aware of HPV infection, and 14.7 % knew about its transmission. Awareness of HPV vaccination was primarily through healthcare providers, with only 36.2 % knowing of its availability. Factors such as age, education, occupation, and socioeconomic status significantly influenced perceptions of HPV infection and awareness of cervical cancer. Willingness for vaccination was strongly associated with occupation and socioeconomic status. ConclusionDespite gaps in understanding HPV and its connection to cervical cancer, there is high willingness to accept the vaccine. Enhancing mass awareness, especially among parents of adolescents through media and healthcare providers, is vital. Efforts should focus on integrating the HPV vaccine into Universal Immunization Programs, particularly within school health services.

Analysis Of The Relationship Between Self-Concept And Self-Esteem And The Behavior Of Female Students In Reproductive Health Maintenanceat The District Islamic Boarding School Batanghari Multicenter Study

Reproductive health is a serious problem throughout human life. Vaginal discharge is one of the reproductive health problems of adolescents, especially one that women often complain about. Survey results show that 65% of teenage girls in Indonesia experience vaginal discharge. Self-esteem is an important component in forming a person's self-concept, where self-concept is an important thing in determining a person's behavior, including maintaining reproductive health. This research aims to determine the relationship between self-concept and self-esteem and the behavior of female students in maintaining reproductive health in Islamic boarding schools in Batanghari Regency. This research is a correlative descriptive quantitative research with a cross-sectional, multi-centre research design involving 3 Islamic boarding schools in Batanghari Regency. Sampling used random sampling. The total sample was 98 respondents. The data analysis used includes univariate analysis (respondent characteristics, self-concept, self-esteem, student behavior), as well as bivariate analysis to measure the relationship between self-concept and self-esteem. The results of the research showed that 63.3% of respondents had poor female student behavior in maintaining reproductive health. There is a relationship between self-concept (p-value: 0.008), Self-Esteem (p-value: 0.006) and the behavior of female students in maintaining reproductive health. The research results showed that of the 56 respondents with a negative self-concept, 44 (74.6%) respondents had poor behavior among female students in maintaining reproductive health. Of the 39 respondents with positive self-concept, 18 (46.2%) respondents had good female behavior in maintaining reproductive health. Efforts are needed from Islamic boarding schools to conduct training and health promotion for female students in maintaining reproductive health regarding self-concept and self-esteem.

Exploring In-School Adolescent Smoking Behaviors: A Comparative Study of Rural and Urban Contexts in Anambra, Nigeria

The use of tobacco among adolescents is a big public health issue in low- and middle-income countries of the world including Nigeria. The aim of this study was to compare prevalence and determinants of tobacco use among in-school adolescents’ resident in urban and rural secondary schools in Anambra State. A cross-sectional analytical design was observed using multi stage random sampling to sample 360 students from some selected schools. A pretested, semi structured questionnaire adapted from the Global School Health Survey (GSHS) was used to collect data. The data was analyzed by descriptive and inferential statistics. Similar prevalence of tobacco use was found in both the urban (6.3%) and in the rural (6.5%) sites, without significance in either (p=1.000). Participation in protective factors including health education programs in which participants are educated on smoking dangers and sexually transmitted diseases (STDs) in particular was associated with non-smoking behavior significantly more in urban areas. On the other hand, being urban adolescents who reported tobacco use showed significantly association with risk factors such as poor school environment and bullying. Consequently, no difference in rates of tobacco use occur between urban and rural adolescents, despite differences in protective and risk factors. Recommendations aimed at strengthening health education, and improving school environments and reducing bullying are suggested to reduce adolescent smoking in these settings. Effective tobacco control of Nigerian adolescents requires targeting of public health interventions on the basis of the socio-cultural context.

A REALIZAÇÃO DO PROGRAMA SAÚDE NA ESCOLA COMO FERRAMENTA PARA PROMOÇÃO DE EDUCAÇÃO EM SAÚDE DURANTE A FORMAÇÃO EM MEDICINA DE FAMÍLIA E COMUNIDADE: UM RELATO DE EXPERIÊNCIA

Introduction: The School Health Program (PSE), announced by the Ministry of Health in 2007, aims to promote health in partnership with educational institutions to improve the quality of life of the population, specifically school-aged children. This involves collaboration between health and education professionals, providing appropriate knowledge to reduce vulnerabilities that may compromise the development and the future of children and adolescents. Objective: To report the experience of a family medicine resident, part of a family health team (eSF) in the Federal District (DF), primarily promoting sexual education for children and adolescents in two public schools within the team's area of coverage. Methodology: This is a descriptive and qualitative study, of the experience report type, conducted during the two years of residency in Family and Community Medicine, from 2023 to 2024, in the satellite city of Sobradinho, Federal District. Results: The students involved, aged between 9 and 12 years, showed great interest in the topics addressed regarding sexuality and hygiene habits, adopting a participatory attitude, engaging in the exchange of experiences, raising questions, and discussing the subjects covered in the meeting and topics detailed in the adolescent health booklet. Conclusion: The necessity of partnership between health teams and education professionals was evident to provide health promotion, especially focused on sexual education, aiming to reduce negative outcomes and minimize future social and health damages in the vulnerable population of the DF.

How to rank schools of public health? The PHAR project

Abstract Background Since the shattering and abrupt withdrawal of several Ivy League universities from ranking systems in 2022, the debate on rankings has been raging in the academic world and beyond. Despite this, rankings have undeniable advantages and continue to be used on a daily basis by a variety of stakeholders. As a previous work has demonstrated that there is no ranking specifically designed for schools of public health, the aim of this project was to create one. Methods To create the Public Health Academic Ranking (PHAR), the InCites Benchmarking and Analytics™ software and the Web Of Science™ Core Collection database were employed. Bibliometric data on 26 schools of public health, from each continent, were collected between August and September 2022. Eleven research indicators and scores, covering four criteria (productivity, quality, accessibility for readers, international collaboration), for the period 2017-2021, were used. For some schools whose affiliation was not mentioned directly in the software, a specific methodology was designed and tested, with unique research queries applied to the database. Results The five top schools of the PHAR were: the London School of Hygiene and Tropical Medicine, the Public Health Foundation of India (PHFI), the Harvard T.H. Chan School of Public Health, the Swiss School of Public Health (SSPH+), and the Johns Hopkins Bloomberg School of Public Health. Conclusions The PHAR provides an international bibliometric ranking of schools of public health. As this is a pilot project, the results should be taken with caution and future improvements should be developed. Key messages • The PHAR is the first university ranking system specifically designed for schools of public health and focuses on the research field of this discipline. • The PHAR makes it possible to rank schools of public health with an unusual structure (such as the PHFI and the SSPH+), which are generally overlooked by traditional rankings.

Promoting sexual health in schools: a systematic review of the European studies

Abstract Background Sexual ill-health causes a high health burden. There is, therefore, a need for more effective sexual health promotion interventions. Previous research has focused on preventive sexual health interventions and the limited evidence concerning school-based sexual health promotion interventions has not been synthesized. Hence, this study aimed to systematically review the current evidence on the effects of sexual health promotion interventions conducted in European schools. Methods A systematic review based on the JBI and PRISMA standards was performed, encompassing searches in seven databases to identify sexual health promotion interventions conducted in European schools between 2012 and 2022. Data coding was performed according to a predetermined protocol and a narrative synthesis of the included studies was performed, highlighting the collective results. Results The review included 17 records, reporting 16 individual studies conducted in 7 European countries. Of the 16 included studies, 13 had a quantitative research design, and three had a qualitative design. All qualitative studies described positive effects as experienced by the participants, and ten of the quantitative studies showed statistically significant positive effects on at least one of the outcomes of interest. Conclusions The findings indicate good evidence for the effectiveness of interventions with a health promotion approach, underscoring the importance of sexual health resources such as respect, communication skills, and attitudes. Most sexual health promotion intervention studies have focused on sexual health resource outcomes connected to attitudes and skills, whereas, e.g., sexual health literacy is less studied and can be recommended to be included in future research. Key messages • The synthesized evidence sheds light on the lack of evaluated interventions employing holistic and positive, resource-focused sexual health promotion interventions targeting European adolescents. • The included school-based sexual health promotion studies, although limited in number, show evidence of promising effects on sexual health outcomes among participants.

Estimated lifetime impact of a school-based intervention for mental health: A microsimulation study

Abstract Background The prevalence of childhood mental health problems is increasing. School-based interventions have the potential to reduce poor mental health and mental health inequalities. Our aim was to estimate the long-term costs and benefits of the Incredible Years Teacher® Classroom Management (IY-TCM) intervention in primary schools compared to no intervention. Methods LifeSim, an existing microsimulation model, was used to estimate the lifetime costs and benefits of IY-TCM by linking short-term changes in SDQ based on a previous trial in primary schools (Cluster RCT: 2075 children aged 4-9 years with a 30-month follow-up) to long-term health, social, economic and wellbeing outcomes. Benefits were measured in quality adjusted life years and wellbeing adjusted life years. We examined subgroup based on deprivation, conduct scores and parental depression. Results Microsimulation modelling estimated small gains in lifetime outcomes including reduced conduct disorder in adolescence and depression in adulthood. Estimates indicate IY-TCM could be cost-effective with a large amount of uncertainty (Net monetary benefit (NMB)=£21, Estimated CI = -£195, £240). IY-TCM was estimated to be more cost-effective for those with high deprivation (NMB = £231, Estimation CI - -£99, £231) and high conduct problem scores (NMB=£315, Estimated CI = £45, £483). Total net social benefit for a typical year size group was estimated to be £111m. Conclusions IY-TCM could be cost-effective compared to no intervention with a large estimated social benefit supporting wider implementation of IY-TCM, but results indicate a large amount of uncertainty. Greater benefits and higher certainty of cost-effectiveness for children with conduct problems and those living in a deprived area suggest IY-TCM has the potential to reduce mental health inequalities and may be more cost-effective for schools with higher deprivation and/or a high prevalence of conduct problems. Key messages • The Incredible Years Teacher Classroom Management intervention for mental health in primary schools could be considered cost-effective but there is a large amount of uncertainty. • Greater benefits for children with conduct problems and those living in a deprived area indicates the intervention has the potential to reduce mental health inequalities.

Honors Track in Global and Occupational Health: a students’ perspective from Humanitas University

Abstract Background To meet an increasing interest in global health, more opportunities for medical students should be created. Humanitas University (Milan, Italy) has debuted a new extracurricular activity called “Honors Track in Global and Occupational Health” (HT-GOH), to allow students critical insights into the field at the beginning of their career. Objectives HT-GOH is a two-year programme, led by expert professors in the field. The main aim is to circumvent limitations of global health education at individual institutions, achieved through a combined presence and online approach that allows for international collaboration with experts and attendance of online lectures and travel abroad for practical experiences. Complemented by monthly meetings, participation to workshops, seminars, conferences, and the discussion and literature review of crucial global health topics. Results The six participating students are actively promoting discussions, exchange of ideas, and literature findings on many global health issues. They audited courses in other universities and are building connections within the field. The active involvement of the students and their increasing interest in the global health debate can be seen by their participation in this abstract and the conference. The effectiveness of the programme is being evaluated through monthly feedback by students. Conclusions The programme allows for an initiation to research work, promoting collaboration between students and exploration of a variety of topics under the guidance of experts. The nature of a specific programme allows for a more individualized approach and greater development of skills unique to each student. This HT represent a valid approach to global health education, especially in settings in which this field is only taught in the context of a public health course. Key messages • A new programme at Humanitas University offering an innovative approach to the field of global health to interested students. • The students’ perspective towards an integrated approach to global health in medical schools.

Predictors of infectious disease-related behaviors among adolescents in Armenia

Abstract Background We explored the behaviors related to infectious diseases (ID) and its predictors among 15-17 years old adolescents in Armenia. Methods We surveyed adolescents from public and private high schools in Yerevan and one province in 2023. The instrument explored ID-related behaviors, health literacy (HL), interest in health, and socio-demographics. ID-related behaviors were measured with five Yes/No questions about sharing a toothbrush, covering their mouth when coughing or sneezing, and washing hands with soap and water - before eating, after using the bathroom, and when coming home. HL was assessed with ten questions on a scale from ‘Strongly disagree’ to ‘Strongly agree’. Summative scores were calculated for ID-related behaviors and HL. Multivariable regression analysis explored factors associated with ID-related behaviors. Results Overall, 366 students completed the survey, most of them being females (64.4%). The majority were interested in health issues (80.7%). Almost all respondents reported not sharing a toothbrush with other persons (97.9%) and usually covering their mouth when coughing or sneezing in public places (94.1%). Somewhat lower percentages reported washing hands with soap and water before eating (82.0%), after using the bathroom (89.2%), and when coming home (86.6%). The mean behavior score was 4.52 out of 5 (SD = 0.92) and the percent score was 90.4%. The average HL score was 17.41 out of 30 (SD = 4.47). In the regression analysis, being female vs. male, being interested in health vs. not, studying in private vs. public schools, and having higher HL were independent significant predictors for higher score of ID-related behaviors. Conclusions Armenian adolescents reported high levels of compliance with ID-related behaviors. Improving health literacy and fostering interest in health can help further enhance the performance of preventive behaviors. Interventions targeting public schools and male adolescents are particularly pertinent. Key messages • Being female, studying in private schools, having higher interest in health issues, and better health literacy independently positively influence infectious disease-related behaviors. • Promoting health literacy and fostering interest in health in high schools have the potential to further enhance infectious disease prevention behaviors among adolescents.

Postgraduate medical education in Public Health: the Italian scenario and a call to action

Abstract Introduction Public health training in Italy takes place within postgraduate medical training in Hygiene and Preventive Medicine. With 39 university schools of public health, spread across 17 of Italy’s 20 regions, the landscape is diverse. The government determines the number of available contracts annually. This study aims to provide an up-to-date analysis of the saturation of places in Public Health programmes, as well as an assessment of mobility trends between northern and southern Italy from 2017 to 2023. Methods Data on admissions, withdrawals and resignations were obtained from the Ministries of Universities and Health and from the archives of the ‘Associazione Liberi Specializzandi’ (ALS). Mobility was assessed as moving from the central-northern regions to the southern-islands of Italy, and vice versa, between registration with the Medical Council and specialisation programme enrollment. Results Between 2017 and 2023, a total of 2301 residents enrolled across Italy, out of 2953 available positions nationwide. During this period the number of available national places, increased from 180 to 576, impacting overall seat saturation. In 2017, 98.3% of positions were covered, compared to only 46.5% in 2023. Regarding the mobility trend, southern students attending northern schools increased from 8.3% in 2017 to 22.4% in 2023, while northern students attending southern schools decreased from 17.9% to 1%. However, the number of dropouts and withdrawals was higher in the North. Mobility students scored lower than non-mobility students nationally. Key messages • From 2017 to 2023, the number of residents enrolled increased, while the allocation rate decreased. There was a shift in mobility patterns, with more southern students moving north. • Addressing the identified inequalities and understanding the underlying factors driving mobility patterns is crucial for effective planning and allocation of resources.

Educational achievement and health during adolescence in second generation immigrants in Sweden

Abstract Background Over the last decades, immigration have increased markedly in Sweden. Educational achievement is essential for successful integration; however, second generation immigrants have been shown to lag behind. There is a complex intertwinement between educational attainment and health outcomes. Thus, schooling is crucial in terms of integration but also from a public health perspective. We aim to compare school performance and health in children of immigrant parents and children of parents born in Sweden. Methods In this population-based cohort study, 1723 children were followed from birth to age 20. Of these 246 (14.3%) had at least one parent born abroad. Logistic regression was performed controlling for gender, language spoken at home and sociodemographic data obtained at 3 months, 3-, 12- and 20 years. Outcome measures were school performance at age 12 (n = 984), grades from compulsory and upper secondary school (n = 1668) and register data on psychiatric diagnoses (n = 737). Self-response questionnaires on general health, long term health problems and psychiatric conditions were administered at age 20 (n = 731). Results There were no differences in reading (p = 0.676) or mathematics (p = 0.324) at age 12, eligibility to upper secondary school (p = 0.298) or university (p = 0.232) between second generation immigrants and children of native-born parents. No differences in frequency of psychiatric diagnoses (p = 0.112), presence of long-term health problems (p = 0.267) or self-reported health (p = 0.595) were shown. Conclusions The results indicate that young adults born in Sweden in the middle of the 1990’s with immigrant parents perform similarly in school compared to children of parents born in Sweden. They are not at increased risk for mental illness, long-term health conditions and report their general health equivalently to children of native-born. The comprehensive school system and child health programs used in Sweden are likely important factors to promote education and health. Key messages • In a birth-cohort of children followed into early adulthood, no difference in educational achievement or health was shown between second generation immigrants and children of parents born in Sweden. • International comparative studies are needed to highlight the importance of underlying structural and socio-cultural factors.

The Longlasting Program Keluarga Harapan as Conditional Cash Transfer in Indonesia: The Existing Problems and the Policy Recommendations

Program Keluarga Harapan (PKH) is a conditional cash transfer program in Indonesia that requires beneficiaries to meet certain requirements such as school attendance and health checks. Adopted from similar models in Latin America, PKH aims to reduce short-term poverty and invest in the health and education of future generations. Since its launch in 2007, PKH has operated in various regions with different poverty and infrastructure issues. PKH faces several challenges, including mistargeting of beneficiaries and burdensome bureaucracy for the poor. To address this, improvements to the targeting system and simplification of document procedures are recommended. The program has also contributed to reducing stunting through improved nutrition and health education, although health facilities need to be improved. In the education sector, PKH has succeeded in increasing school enrollment and attendance, but has not significantly reduced child labor. In terms of livelihoods, PKH encourages beneficiaries to shift to non-agricultural jobs, although often only casual labor. This study uses descriptive and explanatory designs to describe and explain the evolution of the PKH policy from 2007. Descriptive design is used to describe policy changes that occurred during the period, while explanatory design is used to explain the factors that influence policy changes and their impact on program effectiveness. The results found that there were problems with PKH facilitators including insufficient numbers, high workloads, and low salaries, which affected their effectiveness. To improve the performance of facilitators, new recruitment, regular training, and increased salaries and working conditions are recommended.

Facilitators and barriers to improving beverage consumption among primary school children in Belgium

Abstract Background School is seen as a relevant setting to intervene in children’s health behaviour, including their beverage consumption. A randomized controlled trial (DRINK) has been implemented to compare nutrition and sustainability-based interventions to reduce sugary beverages and to increase tap water consumptions among primary school children in French-speaking Belgium. The aim of this qualitative study was to describe the context before the intervention implementation and to identify the facilitators and barriers to implementing the project. Methods In 2021, the 48 schools included in the trial responded to a semi-structured interview prior to the intervention, and 30 were interviewed one year later. School characteristics (including socioeconomic index, SEI) and contextual components were summarised. The qualitative corpus was analysed using thematic content methods to identify emerging themes, then classified into obstacles and facilitators. Results Of the 48 schools, 70.8% were Walloon, 76.6% had a medium or high SEI, and 41.7% included less than 90 pupils. The majority had already implemented nutrition and sustainable development initiatives before the trial. While taps were available in classrooms and reusable bottles were used, the initiatives could be extended, e.g. to increasing the number of water points. The main facilitators were the interest to receive additional support by the schools already involved in other projects, and the flexibility of the intervention. The main barriers were related to lack of access to tap water; insufficient support for the implementation of the intervention; and poor availability of school staff to get involved in such a project. Conclusions Alongside the main trial findings, understanding the facilitators and barriers will enable the intervention to be further adapted and extended. Considering the school context and perceptions is essential to ensure effective and durable school health initiatives. Key messages • Largely involved in promoting nutrition and sustainability, the schools were keen to receive support to continue. • Strengthening access to water, communication and support for schools are essential.

Starting Right, an evidence-based assessment of children in municipalities healthcare centers

Abstract During the last century, children’s health has evolved significantly, with mental health issues becoming a prominent public health concern. Childhood health problems profoundly impact quality of life (QoL), development, school functioning, and social interactions, affecting society broadly. In Norway, child and school health services offer free comprehensive care within the municipal primary health care system, prioritizing health promotion and prevention to address social health inequalities. The Norwegian Starting RightTM project recruits’ children aged 6 months to16 years and their parents, emphasizing early intervention and support to reduce health inequalities and promote well-being. In the Starting RightTM project, online proxy- and child-reported questionnaires are used to support public health nurses (PHNs) in assessing children’s health and development in routine follow- up. Parents and children receive an SMS text message asking them to answer an online questionnaire before attending their regular appointments in child or school health services. Validated instruments measure the development (ASQ, ASQ-SE), mental health (SDQ) and health-related quality of life (HRQoL), (KIDSCREEN -27). By mapping children and adolescents’ health and through discussions with PHNs, parents and children may be more involved in children’s health and development and may increase their Health Literacy. The primary objective of the proposed project is to develop child and school health services and improve children’s health and HRQoL. The ongoing project is the first to systematically assess development, health and HRQoL in children and adolescents in Norway through ordinary services, and to do so longitudinally. At present, >2000 children have been included. The large sample size combined with a broad multi- and interdisciplinary approach is unique from a national perspective. The upcoming workshop will showcase findings from this innovative study.

It must not be dangerous to talk about it! Parents views of communication with schoolnurses on weight

Abstract Background The study aimed to describe parents’ experiences of communication with school nurses concerning the growth data and weight development of their children aged 8 and 10 years old in Sweden. Methods The design was descriptive and qualitative. 15 women and 3 men in south Sweden were included, with children who had performed health visits in the School Health Service (SHS). Data were collected through in - person semi structured interviews. Qualitative content analysis was used. Results The results illustrated the health visit’s purpose as unclear with need for improved dialogue and lacking feedback from the SHS. “To be able to get guidelines of what is the normal growth and what is a normal deviation and maybe a bit more about diet and lifestyle and movement.” The need for an improved channel for receiving information from SHS, and access to their child’s growth data. “Couldn’t they have a school nurse site or information page, where you get information about your child from the day they enroll in school until they leave.” Parents experienced a lack of a child-centered perspective, described the child’s context as not in focus, and desired collaboration. “I think that it is very important that children feel good in their bodies, and that is a really important task for health care.” Conclusions (a) Initiating a discussion regarding the preventive health work of school nurses and the main assignment of SHS. (b) Development of a child-centered perspective towards parents and children with focus on the child’s entire social context. (c) Implementation of evidence-based methods for communicating growth data and weight development between SHS and parents. Key messages • An increased dialogue between parents and SHS was requested, with a reachable way of communication via a digital platform. • A holistic view of the child, with positive professional attitudes seem essential to meet the needs of the child.

Unlocking adolescent dietary behaviours: the causal role of social contexts

Abstract Background Using a causal inference framework, our study aimed to extend previous work in providing a comprehensive understanding of the role various social contexts across different levels can play in predicting adolescent dietary behaviours. Methods Data came from the 2017/18 Health Behaviour in School-aged Children (HBSC) survey in Flanders (Belgium). The sample included representative data from 8,702 adolescents in 165 schools. Social factors at individual-level (family meals, family, peer, student and teacher support) and at contextual-level (school culture of student and teacher support and school-level socioeconomic status [SES]) were considered. Multilevel logistic regression analyses were performed. Results At individual-level, family meals and family and student support were positively associated with fruit and vegetable consumption, family meals with sweet consumption too. Student and teacher support showed positive associations solely with fruit consumption. At contextual-level, adolescents attending schools with a lower school-SES demonstrated lower vegetable consumption. Culture of teacher support was negatively associated with sweets but also vegetable consumption. For culture of student support no associations were found. Conclusions The study mainly provide cues for strengthening family social ties as dietary health promotion initiatives, with some evidence supporting the role of beneficial peer and school social factors. Mixed results for contextual school-level social factors warrant further research to identify additional school-related influences on adolescent dietary behaviours to advance current understandings. Key messages • Family meals and support promote healthy eating in adolescents, emphasising the health promoting role of family social ties in dietary habits. • Mixed findings on school-level social factors call for more research on school health policies.

Applying the FRAME for Systematic Adaptation of a State Health Curriculum to Enhance Physical Activity and Family Engagement.

A systematic adaptation of an evidence-based state health curriculum (Michigan Model for Health™, MMH) was created to enhance physical activity and family engagement materials but retain the core functional elements of the curriculum. The Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) was used to document the adaptation, which used materials from an evidence-informed physical activityprogram (Interrupting Prolonged sitting with ACTivity, InPACT). Acceptability, appropriateness, feasibility, and perceived value of the adaptation were assessed by key stakeholders, regional school health coordinators (HCs). A planned, fidelity-consistent adaptation was created in which InPACT resources were integrated into the MMH curriculum, with recommended integrations packaged in a supplemental guide. Training was modified as appropriate. The guide had high acceptability, appropriateness, and feasibility among HCs (n = 17), and 71% of HCs (n = 24) indicated that it had really strong value. Next steps involve implementing the adapted curriculum and evaluating its effects on family engagement, youth physical activity levels, and overall curriculum effectiveness.