(From the ISHN Member information service)  An article in the February 2015 Issue of the International Journal of Obesity questions recent reports and reviewws that claim progress is being made in reducing childhood obesity rates. The authors report that "before concluding that the obesity epidemic is not increasing anymore, the validity of the presented data should be discussed more thoroughly. We had a closer look into the literature presented in recent reviews to address the major potential biases and distortions, and to develop insights about how to interpret the presented suggestions for a potential break in the obesity epidemic. Decreasing participation rates, the use of reported rather than measured data and small sample sizes, or lack of representativeness, did not seem to explain presented breaks in the obesity epidemic. Further, available evidence does not suggest that stabilization of obesity rates is seen in higher socioeconomic groups only, or that urbanization could explain a potential break in the obesity epidemic. However, follow-ups of short duration may, in part, explain the apparent break or decrease in the obesity epidemic. On the other hand, a single focus on body mass index (BMI) greater than or equal to25 or greater than or equal to30 kg m−2 is likely to mask a real increase in the obesity epidemic. And, in both children and adults, trends in waist circumferences were generally suggesting an increase, and were stronger than those reported for trends in BMI." 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>>

(From the ISHN Member information service) An article in Issue #1, 2014 of Child Development Perspectives reviews the research and broadens our understanding of why and how teachers respond to bullying. The analysis shows how teacher beliefs about bullying (being normative or not), their own sense of self-efficacy in delving into complex, private lives of their students and parents, their perceptions about emotional vs physical abuse/bullying and many other factors suggest that the issue and process is very complex. The article "provides a conceptual framework for examining the role of the teacher in the life of a child victimized by peers and for reviewing research. Central to this model is the teacher, who comes to the classroom with beliefs and experiences that affect teaching practices and relationships with students [3, 4]. A bidirectional arrow between the teacher and the victimized child depicts their unique dyadic relationship and the socialization processes that can occur within that relationship [5]. The intrapersonal characteristics of the child being victimized, in turn, shape how the teacher addresses the victimization. The teacher's ability to aid the victimized child also depends on interactions with the children engaging in the aggression, in part, driven by the characteristics of the aggressive children, their motivation for aggressing, and their modes of aggression. The actions of the teacher and children contribute to, and are influenced by, the larger classroom and school climate, including the quality of relationships among and between students and staff, norms for behavior, clarity and fairness of policies, organizational structure, and emphasis on academic success." Read more>>

(From the ISHN Member information service)  An article in the March 2015 issue of Journal of Adolescent Health reports that school-based health centresd can effectively promote sexual health among their clients. The researchers report that "Reproductive health indicators among students at four urban high schools in a single building with an SHC in 2009 were compared with students in a school without an SHC, using a quasi-experimental research design (N = 2,076 students, 1,365 from SHC and 711 from comparison school). The SHC provided comprehensive reproductive health education and services, including on-site provision of hormonal contraception. Students in the SHC were more likely to report receipt of health care provider counseling and classroom education about reproductive health and a willingness to use an SHC for reproductive health services. Use of hormonal contraception measured at various time points (first sex, last sex, and ever used) was greater among students in the SHC. Most 10th–12th graders using contraception in the SHC reported receiving contraception through the SHC. Comparing students in the nonintervention school to SHC nonusers to SHC users, we found stepwise increases in receipt of education and provider counseling, willingness to use the SHC, and contraceptive use. Read More>>

(From the ISHN Member information service) An article in the March 2015 issue of Pediatrics reports on progress being made in reducing childhood obesity in the US. The 2 national surveys that have provided the most valid and reliable data are the National Health and Nutrition Examination Survey (NHANES) and the Pediatric Nutrition Surveillance System (PedNSS). The authors report that" Inspection of prevalence rates over time show that after a consistent increase which began after 1980, the prevalence of obesity in 2- to 5-year-old children began to plateau between 2003 and 2004 (Fig 1). Data between 2003–2004 and 2009–2010 showed no statistically significant change in childhood obesity rates, whereas a decrease of 3.7% occurred between 2009–2010 and 2011–2012 in 2- to 5-year old children. No significant changes were observed in the prevalence of obesity among children and adolescents in other age groups. " These results are similar to an extensive analysis that ISHN did on Canadian efforts over the past two decades to reduce obesity levels among school-age children. The results in both countries suggest that a re-consideration of the current focus on calories and physical activity as primary intervention is warranted. Read More>>

(From the ISHN Member information service)   There are few studies that focus on teachers of health, personal and social development (HPSD)but, of the few, it can be said that there is remarkable number of new teachers assigned to teach HPSD who quickly seek a transfer to a different subject or leave the profession entirely. As part of a series of articles in Issue #1, 2015 of the Asia-Pacific Journal of Teacher Education one author focuses on the experiences of new teachers who are assigned out of the field in which they were trained. "The lived experiences of novice teachers in out-of-field positions influence future career decisions and impact on their journey towards being competent and experienced practitioners, conversely their “life-world” is often misunderstood. The purpose of this article is to investigate the lived experiences of these teachers, how principals’ understanding and leadership styles influence the lived experiences of these teachers. The article  argues that the strategies implemented by school leaders based on their understanding of novice out-of-field teachers’ lived experience greatly influence the development of these teachers. It draws on Gadamer’s theories to investigate the lived experiences and perceptions of four principals and four novice out-of-field teachers through the different lenses of these participants. It concludes with a discussion on the interrelationships between school leaders’ understanding and novice teachers’ lived experience. Participants’ interpretation of specific lived experiences connected to out-of-field teaching shapes meaning in their attempt to understand and to “belong,” for example, confidence issues, self-esteem concerns, and disconnectedness."  Since very few education faculties offer specialized training or courses in HPSD, it would appear that the majority of these teachers will be left alone in their "out of field"assignments. In a profession that experiences high rates of turnover for all new teachers, this is particularly significant. Read more>>

(From the ISHN Member information service)   One of the themes being discussed in the ISHN International Discussion Group on Integration of Health/Social Programs Within School Systems focuses on the political, normative and practical constraints on schools in doing this work. A special issue of Health Education (#1, 2015) illustrates these constraints as several articles discuss the nature and delivery of sexual education in several countries. The editorial introducing this special issue makes note of these powerful differences imposed by the national, state or local contexts. "The papers highlight contrasts, tensions, potentials and barriers embedded in the ways sexuality education is delivered to children and young people internationally. Examples are drawn from Russia, Wales, China and the USA; they identify historical and structural issues related to the implementation of comprehensive progressive approaches. Topics discussed include the importance of appropriate content, theoretical/conceptual frameworks, modes of delivery, timing, attitudes from key stakeholders and the need for comprehensive evaluation of innovative approaches to the delivery of sexual education." . These constraints are especially true for sex education but other, less sensitive issues can also be contentious.  These include compulsory vaccinations, the use of alcohol, gender equity, child abuse and neglect, and more. Even actions taken to promote huealthier school lunches can be politicized (eg the recent debates in the US) or cause controversy when letters are sent to parents asking them to prepare healthier lunches or that their child is overweight. 

(From the ISHN Member information service)  An article in Issue #1, 2015 of Public Health Reports discusses how governments can implement a Health in All Policies (HiAP) approach to inter-sectorial cooperation by using their legislative, regulatory leadership and funding levers. The article makes several practical suggestions on how governments can use the law to prescribe, authorize, structure and fund inter-sectorial cooperation. The article provide several state and local agency examples for each of these suggestions. Most of these cited legally required cooperative actions in the article are focused on responses to specific health issues rather than long-term inter-ministry or intra-ministry cooperation or long term approaches such as school health programs. However, the article can be used as a litmus test of government commitments to requiring and supporting their health ministries to work within other ministries and sectors who deliver their programs in settings such as schools, municipalities, workplaces etc. 
In this ISHN comment, we extract the suggestions from the article to determine if there is a commitment to the inter-sectorial approach that we call school health promotion. 
The article reviews the HiAP approach: "The U.S. Centers for Disease Control and Prevention, Institute of Medicine (IOM), European Union, and World Health Organization all recognize the potential of HiAP to address the social determinantsof health, and through them, upstream contributions to morbidity and mortality.Sometimes called “healthy public policy”14 or described as a component of “horizontal government,” “joint-up government,” or “whole-of-government,”15 HiAP is an approach that integrates
health considerations into non-health sectors; it recognizes that “corporate boardrooms, legislatures, and executive branches” make choices that profoundly affect health.11 Additional research is critical to determine whether HiAP leads to decisions that are more likely to consider health16 and, ultimately, improve it.Nonetheless, HiAP is a promising approach consistent with solving complex social problems through the “collective impact” of multiple sectors collaborating around a common agenda.19 These sectors include transportation, agriculture, housing, employment, planning, business, education, and energy, and in federal, state, and local government, they are often connected to agencies charged with regulating or facilitating their work."
The article goes onto suggest that legislation is a good way to implement HiAP. " But how do governments implement HiAP? Consistent with law’s contributions to improving the public’s health,law can be “an important tool for institutionalizing an infrastructure for HiAP and for requiring agencies to ensure that the policies they pursue serve . . . health.” Governments use law to integrate health into other sectors.They also use legal mechanisms to further cross-sector collaboration around health, which is a critical component of HiAP.
Since an effective HiAP strategy will require practical applications to inter-sectorial work, we suggest strongly that any introduction of an HiAP strategy will require the health sector to go to the venues or settings where the other sectors actually deliver their services and programs such as workplaces, municipalities, schools and other places. In other words, the health sector will need to return to a settings-based health promotion strategy if it expects ongoing cooperation from the other sectors. Otherwise the HiAP strategy runs the risk of being perceived as the health sector dumping its work onto the other sectors and they will resist, delay or simply not cooperate.    
The articles suggests that government levers can be used in several ways. Let's take a quick look at how many of these strategies are used to promote intersectorial cooperation through comprehensive, whole of government approaches to school health promotion.

1. Requiring collaboration: Law can create legally binding duties for departments to collaborate around health. This can be required at the national, state or local agency level.
   To our knowledge, there is no government that requires such cooperation by law for SH promotion. Many appoint officials and some even huave joint SH progrrams or committees, but this is not done in legislation. 
2. Authorizing collaboration. Even when law does not require cross-sector collaboration around health, it may permit it. This permission may be direct and explicit. Or, Law may also authorize collaboration around health implicitly, through broad grants of public health authority. -- Many governments authorize their health ministry staff and local health authorities to cooperate with school systems. But often the funding and staffing for this cooperation is not provided to the SH team. Usually funding for prevention and promotion work is delivered through other sections of the health ministry rather than the SH team or any other teams that have responsibility for working with the other sectors/settings. 
3. Establishing institutions for collaboration. Law can organize and implement collaboration by formalizing relationships through task forces, boards, commissions, or other institutions. -- To our knowledge, there is no government that has established an inter-ministry SH structure by law, although several exist by administrative decisions. These administrative structures often are changed when a new elected or appointed official decides to re-structure the huealth ministry to address new priorities, often focused on urgent health issues rather than ongoing relationships with other ministries. We have seen some structures on child or family health established by law but often they are not successful and often they are focused on urgent problems rather than long term solutions such as SH or on inter-ministry, inter-sectorial relationships. 
4. Prescribing a collaborative process. Governments can go beyond generally requiring or authorizing collaboration to prescribe specific collaborative processes. 
   Again, to our knowledge, there is no government that requires that a collaborative process within the health ministry, across ministries or among local agencies to promote health through schools. In many cases, there are committees, but their existence and use by the various ministries and agencies is always voluntary. Often such committees seldom meet. There are no requirements for ministries or agencies to cooperate in order to receive funding. There are few jointly appointed staff teams or coordinators. There are seldom any joint reporting requirements.
5. Assigning responsibility. The law can be used to assign responsibilities for cooperation and joint action. Often there are SH coordinators assigned within the health ministries or local health authorities. Sometimes these coordinators are assigned within the education system. However, often these coordinators are responsible for other duties. Often any funding that they have available to work with are focused on specific health issues or programs other than school health. 
6. Prioritizing a public health issue. Law can elevate a particular public health issue and focus the efforts of different agencies on that issue. 
   In our view, this suggestion  reflects a health sector bias, one that is most often focused on a disease or specific health problem. We recognize that this is how the health sector really works, but this tendency to ignore overall "health" to focus on the "absence of disease" will prevent any long-term cooperation with and within other sectors. If the health sector is unable to moderate this tendency and modulate its activities with other sectors to help them meet their respective goals and primary concerns, then all of the health checklists newly dressed up and prepared as part of a HiAP strategy will not be sustained. 
7. Coordinating government efforts. For a complex problem (or solution) such as homelessness (or healthy schools), requiring attention from several agencies, law can encourage agencies to work in concert and in consistent and complementary ways. -- The research on school health and other forms of health promotion and social development is now clearly recognizing the complexity involved in working within and across sectors. The authors note that " By requiring each participating agency to assign a representative responsible for homelessness (school health) with authority to bind the agency to the Council, use standard data, and contribute resources,the statute promotes consistent and complementary work. It also encourages working in concert by requiring the Council to survey available resources, provide and coordinate state services, improve information flow, establish a resource and information center, and develop monitoring guidelines." To our knowledge, there are few, if any SH councils in the world mandated by law in this manner. 
8. Providing for funding. Collaboration or executing collaborative recommendations may require funding. Law can create public finance infrastructure and provide and incentivize funding through appropriations, grants, or social impact bonds.
   In school health promotion, there are many, many bits and pieces of project funding, often offered to schools in short term competitions. But there are no funding incentives of the scale that would encourage federal departments, state ministries or even local health and education ministries to work together over the long term on school health promotion. 
9. Fostering informal relationships. Laws formalizing collaboration around any issue can improve relationships and create opportunities for future collaboration by requiring the participation of senior leaders within ministries (rather than program level staff), requiring a minimum number of meetings or reports. -- As noted above there are often such committees, but they are often have low level participation and few requirements about their joint work. 

This article on how HiAP strategies can be implemented through legislation is both useful and revealing. The many suggestions, illustrated by practical examples in the United states, are very applicable to school health promotion. The analysis also reveals a fundamental challengre to the successful implementation of HiAP in any jurisdiction. If it is used as a sledge hammer to require other sectors to work on then many urgent health problems of the day, rather than a way to re-establish long-term relationships and joint approaches that help those other sectors achieve their priorities (such as school health promotion) with other sectors, its shelf-life as a viable whole of government strategy. Read more>>