(This item is among the 5-10 highlights posted for ISHN members each week from the ISHN Member information service. Click on the web link to join this service and to support ISHN)
The importance of clean and safe toilets and latrines in schools in most often discussed in the context of countries with low resources or those recovering from disasters/conflict, but the same need for school "restrooms" exists in high resource contexts. An article in Issue #3, 2016 of Journal of Applied School Psychology reports on as small study that experimented with music in school toilets as a way to calm student noise and behavior. "This study investigated the effectiveness of Flushing Away Noise, an interdependent group contingency using an iPod equipped with a decibel meter application, for reducing noise in restrooms. Two Head Start classrooms in the Southeastern United States, referred for demonstrating high levels of student noise in the restroom, were included in the study. The authors used a multiple-baseline design across 4 groups to determine existence of a functional relation between implementation of the intervention and a decrease in noise level. After introducing the intervention, the authors observed substantial decreases in noise level in all groups. In addition, teachers indicated that they found the intervention socially acceptable." When we add other health needs such as adequate soap for handwashing, monitoring to prevent drug dealing and bullying and even gender-related considerations, the importance of including school toilets as as an important micro-environment within the school setting and our ecological model is underlined. Read more>>
(This item is among the 5-10 highlights posted for ISHN members each week from the ISHN Member information service. Click on the web link to join this service and to support ISHN)
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Several articles in Issue #5, 2015 of Youth & Society examine how school are organized, the norms and attitudes of teachers and their goals concerning student well-being have an impact on student health and social development. The first article notes that "There are few areas of school organization that reflect more dissatisfaction than how to structure the education of adolescents in the middle grades." A study from the Netherlands reported on how ethnic minority students in vocational high schools were often expelled from those schools to attend "rebound" schools. A third article reported that the number of middle and high schools in a community were predictive of higher levels of drug crime in New Mexico, USA. A fourth article made the argument for schools incorporating student well-being as an essential indicator of their effectiveness as a school. A Quebec study reported that ethnicity and teacher-perceived signs of disadvantage in kindergarten predicted that visible minority children were far less likely to have a positive relationship with their Grade Four teachers. Read More>> (An item from the ISHN Member information service)
(An item from the ISHN Member information service) The use of ecological analysis of the over-lapping and inter-acting influences of individual, family, neighbourhood, school and larger community on behaviour and health status is now well-accepted in health promotion research. The ISHN has a version of this thinking that we developed with several researchers. However, it is very difficult to sort out the relative impact of these various layers. Indeed, the more "proximal" and "distal" influences are likely to vary for different individuals, at different times in their lives and events. An article in Issue #11, 2015 of Public Health Nutrition describes the relative contributions of these layers of the Social Ecological Model (SEM) when examining childhood obesity. A randomized telephone survey conducted in 2009–2010 collected information on parental perceptions of their neighbourhoods, and household, parent and child demographic characteristics. Parents provided measured height and weight data for their children. Geocoded data were used to calculate proximity of a child’s residence to food and physical activity outlets. Multiple logistic regression models were estimated to determine the joint contribution of elements within each layer of the SEM as well as the relative contribution of each layer. Layers of the SEM representing parental perceptions of their neighbourhoods, parent demographics and neighbourhood characteristics made the strongest contributions to predicting whether a child was overweight or obese. Layers of the SEM representing food and physical activity environments made smaller, but still significant, contributions to predicting children’s weight status. Read more>>
(An item from the ISHN Member information service) A special issue (#5-6, 2015) of The Journal of Early Adolescence uses different measures to understand the early adolescents’ experience in schools. The introduction noted that "We are particularly interested in measures with direct application—providing actionable data to teachers, principals, parents, school counselors, or the students themselves, in ways that promote social-emotional and academic learning. In this introduction, we highlight the ways in which articles in this special issue offer rigorous, relevant, and feasible approaches to this measurement work". The next two articles examined the non-classroom settings within the school, hallways, cafeterias and school yards and measured items such as the density of student gatherings, verbal noise and staff perceptions, all of which were found to be significant. In the schoolyard, the researcher suggested a much greater focus on non-social students who were excluded from activities. My only question, a serious one, was whether the study included the bathrooms in the schools. Note: In the ISHN complex, ecological and systems-based model depicting the school environment, we do depict these various sub-settings within the school. Read more>>
(An item from the ISHN Member information service) An analysis of coordination the Dutch Healthy School Approach (HSA) is reported in the July 2015 Issue of BMC Public Health. "HSA targets demand-driven practices based on the epidemiological data, a prioritization of needs, an assessment of important/modifiable determinants, the drafting and implementation of a multi-year plan, and its evaluation. All this is done jointly with multiple stakeholders. At school level, implementation is assisted by a ‘HPS advisor’, who represents various public services and providers in individual contacts with schools. At local and regional levels, the public health services (PHSs) function as a coordinator between the education, health and other services stakeholders. Their coordinating role derives from a legal responsibility for the implementation of local public health policy and youth health care financed by the municipality". The study "reports on the longitudinal quantitative and qualitative data resulting from a two-year trajectory (2008–2011) based on the DIagnosis of Sustainable Collaboration (DISC) model. This trajectory aimed to support regional coordinators of comprehensive school health promotion (CSHP) in systematically developing change management and project management to establish intersectoral collaboration. Multilevel analyses of quantitative data on the determinants of collaborations according to the DISC model were done, with 90 respondents (response 57 %) at pretest and 69 respondents (52 %) at posttest. Quantitative data showed major improvements in change management and project management. There were also improvements in consensus development, commitment formation, formalization of the CSHP, and alignment of policies, although organizational problems within the collaboration increased. Content analyses of qualitative data identified five main management styles. Read more>>
(An item from the ISHN Member information service) An article in Volume 76, 2015 of Preventive Medicine reports on a review of studies using the Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to evaluate physical activity interventions aimed at youth. "A systematic search for controlled interventions conducted within the last ten years identified 50 studies that met the selection criteria. Based on Reach, Efficacy/Effectiveness, Adoption, Implementation and Maintenance criteria, most of these studies focused on statistically significant findings and internal validity rather than on issues of external validity. Due to this lack of information, it is difficult to determine whether or not reportedly successful interventions are feasible and sustainable in an uncontrolled, real-world setting. Areas requiring further research include costs associated with recruitment and implementation, adoption rate, and representativeness of participants and settings. This review adds data to support recommendations that interventions promoting physical activity in youth should include assessment of adoption and implementation issues". Read more>>
(An item from the ISHN Member information service) A traditional approach to evaluating the effectiveness of school health promotion programs was used in a small scale study reported in Issue #4, 2015 of Health Promotion Practice. The authors report that "SH interventions are evidence based and integrated into the curriculum, while embedded in complementary healthy school policies and environment. This study evaluates the effects of such an intervention on Dutch high schools. Methods. Two Dutch high schools and two controls were followed to evaluate the intervention’s effects on health behaviors, body mass index, and psychosocial problems after 1 year (N = 969) and 2 years (N = 605). Outcomes were measured via self-report surveys and analyzed with mixed methods regression analyses. To complement information on intervention effects, structured interviews were held with a representative sample of teachers per intervention school to map their respective whole school approach implementation success. Results. After 2 years, one intervention school showed significant improvements: Body mass index and excessive screen time use were reduced. In the other intervention school, priority targets did not improve. These findings reflected their respective success in intervention implementation, for example, differences in intervention integration and tailoring." The challenges associated with this type of study, beyond the short term measurement of behavioural effects, is that we are no informed about why implementation worked in one school but not the other. Read more>>
(An item from the ISHN Member information service) A number of experts were asked to refine the concept of integrated public health policy in order to move towards better ways of measuring and monitoring this idea that is central to the recent health sector attempts to promote health in all policies and the ISHN-ASCD-EI initiative on integrating health and social programs within education systems. The authors note "While expectations of integrated public health policy (IPHP) are high, assessment is hampered by the concept's ambiguity. This paper aims to clarify IPHP as first step in further measurement development. We invited 237 Dutch experts, 62 of whom generated statements on characteristics of IPHP. Next, 100 experts were invited, 24 of whom sorted the statements into piles according to their perceived similarity and rated the statements on relevance and measurability. The concept map consisted of 97 statements, grouped into 11 clusters and five themes. Core themes were ‘integration’, concerning ‘policy coherence’ and ‘organizing connections’, and ‘health’, concerning ‘positioning health’ and ‘addressing determinants’. Peripheral themes were ‘generic aspects’, ‘capacities’, and ‘goals and setting’, which respectively addressed general notions of integrated policy making, conditions for IPHP, and the variety in manifestations of IPHP. Measurability ratings were low compared to relevance." While this article is an important first step and knowing that it is always risky to comment based only on an abstract, this article raised a flag in that the issues of capacity and setting were relegated to a peripheral status. This dismissal of the real world capacities and powerful conditions based on context seems to run counter other complexity literature suggesting that working within complex environments will always require both capacity and a firm understanding of the circumstances. Read more>>
(An item from the ISHN Member information service) An article in Volume 36 of the Annual Review of Public Health describes some of the lessons we have collectively learned about complex interventions to improve health, especiually the ways that complex systems thinking is being used in clinical settings. "Complexity—resulting from interactions among many component parts—is a property of both the intervention and the context (or system) into which it is placed. Complexity increases the unpredictability of effects. Complexity invites new approaches to logic modeling, definitions of integrity and means of standardization, and evaluation. New metaphors and terminology are needed to capture the recognition that knowledge generation comes from the hands of practitioners/ implementers as much as it comes from those usually playing the role of intervention researcher. Failure to acknowledge this may blind us to the very mechanisms we seek to understand. Researchers in clinical settings are documenting health improvement gains made as a consequence of complex systems thinking. Improvement science in clinical settings has much to offer researchers in population health." This succinct summary, presented in the abstract, captures many of the lessons that need to be applied. Since ISHN sponsors a Wikipedia style web site that uses the slogan "where (research) evidence meets (professional) experience, and since many of the summaries in that web site attempt to explain these new ideas based on ecological, systems-based thinking, we highly recommend this article. Read more>>
(From the ISHN Member information service) An article in Issue #2, 2015 of Psychological Bulletin describes how any multiple intervention program such as school health promotion will need to determine how many health issues need to be addressed in their context, how many interventions will likely achieve an optimal affect and which issues being addressed are more relevant/proximal to the population being served. The " meta-analysis of 150 research reports summarizing the results of multiple behavior domain interventions examined theoretical predictions about the effects of the included number of recommendations on behavioral and clinical change in the domains of smoking, diet, and physical activity. The meta-analysis yielded 3 main conclusions. First, there is a curvilinear relation between the number of behavioral recommendations and improvements in behavioral and clinical measures, with a moderate number of recommendations producing the highest level of change. A moderate number of recommendations is likely to be associated with stronger effects because the intervention ensures the necessary level of motivation to implement the recommended changes, thereby increasing compliance with the goals set by the intervention, without making the intervention excessively demanding. Second, this curve was more pronounced when samples were likely to have low motivation to change, such as when interventions were delivered to nonpatient (vs. patient) populations, were implemented in nonclinic (vs. clinic) settings, used lay community (vs. expert) facilitators, and involved group (vs. individual) delivery formats. Finally, change in behavioral outcomes mediated the effects of number of recommended behaviors on clinical change. These findings provide important insights that can help guide the design of effective multiple behavior domain interventions". Read More>>
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