School Health Research Articles

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.

Experts in promotion and prevention - The 100th Anniversary of Finnish public health nurse education

Abstract Issue/Problem Two key public health issues at present are mental health problems and obesity. Both typically begin before adulthood and once occurred, typically persist. Prevention would be important but also economically and humanely sensible. For this, competent experts in preventive work and health promotion are needed. Description of the problem Public health nurse education, originally known as health sister education, was initiated in Finland in 1924, by the Mannerheim League for Child Welfare. The six-month health sister education was targeted at nurses and began from the desire to focus not only on treating diseases but also on promoting health. In the 1940s, education was reformed and in the 1950s significantly expanded. In the 1970s, the professional title changed from ‘health sister’ to ‘public health nurse’. In 1987, the education was extended to 3 years, including the education of registered nurses. In 1992, the education was further extended to 3.5 years. By the beginning of the 21st century, education evolved into 4 years bachelor’s degree. Results In 2024, eighteen Universities of Applied Sciences provide public health nurse education in Finland. The 4-year Bachelor of Health Care in Public Health Nursing -degree (240 ECTS credits) also qualifies for a registered nurse. Nearly half of the education consists of clinical training. In addition, registered nurses can supplement their degrees by completing a one-year education (60 ECTS credits) that qualifies them as public health nurses. Lessons In Finland, approximately 700 new public health nurses graduate annually. They are trained to work independently as experts in preventive work, health promotion, and public health. Around 9,500 Finnish public health nurses work in settings such as maternity and child health clinics, school health services, occupational health care, and outpatient clinics. Key messages • Due to the overcrowding in many healthcare services providing treatment, educating experts in health promotion and disease prevention is crucial now and in the future. • By ensuring competent experts in health promotion and disease prevention, future healthcare services can continue to provide economically and humanely sensible and effective help for people.

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.

11.K. Scientific session: Roots of public health: school health literacy to enhance population health outcomes in Europe

Abstract This workshop will present empirical results from three representative studies on health literacy and digital health literacy conducted in primary and secondary schools in Wales and Germany: (1) Digital Health Literacy in Schools, (2), HLCA HL-Kids, (3) WHO HBSC Wales. While research on child and adolescent health literacy has gained traction in the past decade, only a few studies focus on health literacy in schools. While the European Commission and WHO, as well as most European governments, highlight the importance of schools to support children’s health literacy, schools remain neglected as a research context. With only little evidence available, it is difficult to derive strategies and programs to promote health literacy in schools. We aim to provide practical novel knowledge and contribute to closing the school health literacy gap that is prevalent in Europe. In turn, this will also contribute to European public health development and population health outcomes. Levels of health literacy in child and adolescent populations across European countries and age groups are alarmingly low, making low health literacy a severe risk factor for health outcomes. Low health literacy is associated with worse health conditions and unhealthy behaviours, and in turn, impacts school attainment and educational outcomes. Evidence suggests that health literacy acts as a determinant of health and itself is influenced by other social determinants of health, such as education, intertwining health and education. All studies conducted so far provide evidence that low health literacy follows a social gradient, with children from less affluent families being more likely to have lower health literacy, widening preexisting health inequities observed in almost all health domains within Europe. While effective interventions on the individual and system levels are needed to enhance health literacy, implementation and evaluation research concerning children’s health literacy is rare. Workshop objectives The aim of this workshop is to present findings from three representative studies on health literacy and digital health literacy in primary and secondary schools: (i) The 1st speaker will introduce a study on health literacy and health behaviours of children aged 8-11 (ii) The 2nd speaker will discuss the influence of living environments on health literacy in 4th-grader school kids (iii) The 3rd presentation will have its focus on navigating the infodemic through digital health literacy in adolescent students (iv) The 4th speaker will show links between digital health literacy and health behaviour in adolescent students The format of this workshop will be 4x10-minute presentations followed by a 20-minute panel discussion with the audience, reflecting the relevance of the results to public health research, practice, and policy. The chairs will provide a brief introduction to the concept and moderate the presentations and panel discussion. Key messages • Our results show that health literacy should be addressed as early as in primary schools and that the places, households, and environments children grow up are critical social determinants of health. • Digital health literacy has proven to be a valid learning topic in secondary schools and is linked to digital and media literacy, allowing us to define it as a targeted curriculum item.

7.K. Round table: Approaching new public health frontiers: health literacy on a global level

Abstract This workshop will introduce the newly established WHO Collaborating Centre for Health Literacy (WHO CC HL) at TU Munich (TUM) in Germany and reflect on its goals and discuss the potential impact on European public health research, policy, and practice. With the launch of the WHO CC HL, TUM, WHO, and their collaborators, among which are the EUPHA Health Literacy Section, the International Health Literacy Association, and the Global Health Literacy Research Network, jointly aim at systematically developing health literacy as part of the WHO Sustainable Development and Well-being agenda. Health literacy represents the skills and attitudes to find, understand, appraise, and apply health information and services. Low health literacy is prevalent among all population and age groups and it is linked to worse health outcomes and health inequalities. Across the social gradient, people from low socioeconomic backgrounds are more likely to have low health literacy, which is why the European Commission and WHO both highlighted the need to invest in health literacy and, in particular, in school health literacy. Two emerging fields of study include data generation and interventions. Both of which are highly critical to monitoring change and providing evidence-based data on population and system-level health literacy within and between countries. However, there are no health literacy monitoring systems in place on a global scale nor is there robust evaluation data on school-based interventions. These shortcomings will be addressed through the WHO CC HL at TUM. In this round table workshop with five key health literacy and public health experts, the main goal is to present the WHO CC HL and its roadmap for the next four years and critically discuss how the work can influence European and Global public health: Dr. Faten Ben Abdelaziz, WHO; Anastasia Kyoylu, WHO/Europe; Dr Kristine Sorensen, Global Health Literacy Academy; Dr. Charlotte Marchandise, EUPHA; Prof. Dr. Orkan Okan, WHO Collaborating Centre for Health Literacy at Technical University of Munich. First, the chair will provide a short introduction to the WHO CC HL and will, together with the co-chair, facilitate the following panel discussion. The panel members will share a short 2-to-3-minute statement from their point of view in relation to planned activities of the WHO CC HL and highlight synergies to public health and health literacy development. Following the short statement, the chairs will prepare individual questions for each panellist and engage them in a discussion, which shortly after will open towards the audience for them to participate actively with the panellists in a 30-minutes discussion. Key messages • The round table workshop will introduce the newly established WHO CC HL, highlight its goals and impact on public health, and highlight collaboration opportunities. • The key experts will reflect about the WHO CC HL from their unique standpoints and reveal new perspectives on the way forward and how the work can benefit from ongoing public health initiatives. Speakers/Panelists Faten Ben Abdelaziz WHO, Geneva, Switzerland Anastasia Koylyu WHO, Copenhagen, Denmark Kristine Sørensen Global Health Literacy Academy, Risskov, Denmark Charlotte Marchandise EUPHA Orkan Okan Technical University of Munich, Munich, Germany

Developing mental wellbeing promotion practices in Finnish primary schools: The CONSENSUS project

Abstract Issue/problem Schools constitute a key arena for promoting mental wellbeing among children and adolescents, and the Finnish welfare state has many beneficial structures in place for promoting mental wellbeing in schools. However, as mental health problems are prevalent, the need to advance this work is vital, ideally applying a holistic approach focusing on school-family interaction. Description of the problem The Finnish CONSENSUS project (2021-2025) focuses on the development of new practices and collaboration models in mental wellbeing promotion, targeting pupils in 13 primary schools in the Ostrobothnia region. The project answers question such as: What focal areas are prioritized by stakeholders in the development of mental wellbeing promotion in schools? How do participatory principles contribute to the development process and related outcomes? Results In 2024, a synthesis of previous project results (interviews, focus groups and longitudinal survey data collected among pupils, school personnel, school health care services and parents) was generated. The synthesis encompasses 20 possible priority areas to focus on in the development of mental well-being promotion actions, which are ranked by stakeholder representatives utilizing Delphi methods. Some pinpointed priority areas are implemented and evaluated in collaboration with self-selected schools during the academic year 2024-2025. Lessons Results highlight priorities in the development of mental wellbeing promotion in Finnish primary schools and describe focal areas being piloted, also illustrating opportunities and challenges when implementing participatory principles in action research projects. Key messages • Project results highlight prioritized areas in the development of mental wellbeing promotion in Finnish schools, as well as new initiatives currently being piloted. • The project approach emphasising participatory principles provides lessons for other initiatives focusing on mental wellbeing promotion development in schools.

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.

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.